Medicare Benefits Schedule - Item 91873

Telehealth attendance lasting at least 45 minutes by a consultant physician in the practice of the consultant physician’s specialty of psychiatry, following referral of the patient to the psychiatrist by a referring practitioner, where the formulation of the patient’s clinical presentation indicates intensive psychotherapy is a clinically appropriate and indicated treatment, if that attendance and another attendance to which any of items 296, 297, 299 or any of items 300, 302, 304, 306, 308, 319, 92437, 91827, 91828, 91829, 91830, 91831, 91837, 91838, 91839, 91868, 91869, 91870, 91871, 91872 or 91879 to 91881 applies has not exceeded 160 attendances in a calendar year for the patient

Fee: $205.20 Benefit: 85% = $174.45

(See para AN.0.31 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $500.00

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Item 319 or 91873 provides for an attendance, by a psychiatrist, to provide intensive psychotherapy where the patient’s clinical condition requires intensive treatment. Clinical appropriateness and indications for intensive psychotherapy are determined following a comprehensive assessment and formulation of a diagnosis and should be documented in the patient’s notes. It is also expected that other appropriate psychiatric treatment has been used for a suitable period and the patient has shown little or no response to such treatment. Such treatment would include, but not be limited to: shorter term psychotherapy; less frequent but long-term psychotherapy; pharmacological therapy; and cognitive behaviour therapy. 

Once a patient is identified as meeting the criteria of item 319 or 91873, eligibility continues under that item for the duration of that course of treatment (provided that attendances under items 296, 297, 299, 300, 302, 304, 306, 308, 319, 91827 to 91831, 91837 to 91839, 91873 and 92437 do not exceed 160 in a calendar year). If the patient requires more than 160 services in a calendar year for intensive psychotherapy, then such attendances would be covered by items 310, 312, 314, 316, 318, 91868 to 91872 or 91879 to 91881. 

Related Items: 296 297 299 300 302 304 306 308 310 312 314 316 318 319 91827 91831 91837 91839 91873 92437