Medicare Benefits Schedule - Item 93284

Search Results for Item 93284

View Associated Notes

Category 8 - MISCELLANEOUS SERVICES

93284

93284 - Additional Information

Item Start Date:
22-May-2020
Description Updated:
01-Jan-2022
Schedule Fee Updated:
01-Nov-2023

Group
M18 - Allied health telehealth and phone services
Subgroup
25 - Allied health, group dietetics telehealth services

Telehealth attendance by an eligible dietitian to provide a dietetics health service to a person for assessing the person’s suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient’s needs and preparing the person for the group services if:

(a) the person has type 2 diabetes; and

(b) the person is being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a GP management plan or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and

(c) the person is referred to an eligible dietitian by the medical practitioner using a referral form that has been issued by the Department, or a referral form that contains all the components of the form issued by the Department; and

(d) the service is provided to the person individually; and

(e) the service is of at least 45 minutes duration; and

(f) after the service, the eligible dietitian gives a written report to the referring medical practitioner mentioned in paragraph (c);

payable once in a calendar year for this or any other assessment for group services item (including services to which this item, item 92386, or items 81100, 81110 and 81120 of the Allied Health  Determination apply)

Fee: $87.95 Benefit: 85% = $74.80

(See para MN.9.2, MN.9.3, MN.9.4, MN.9.6 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $263.85


Associated Notes

Category 8 - MISCELLANEOUS SERVICES

MN.9.2

Group Allied Health Services (Items 81100, 81110, 81120, 93284 and 93286) for People with Type 2 Diabetes - GP Referral Requirements

Patients must be referred by their GP or medical practitioner to an eligible allied health professional (diabetes educator, exercise physiologist or dietitian) who will undertake an individual assessment (under item 81100, 81110, 81120, 93284 or 93286) of the patient's suitability for a group services program.

 

Related Items: 81100 81110 81120 93284 93286

Category 8 - MISCELLANEOUS SERVICES

MN.9.3

Group Allied Health Services (Items 81100, 81105, 81110, 81115, 81120, 81125, 93284, 93285 and 93286) for People with Type 2 Diabetes - Eligible Allied Health Professionals

Items 81100, 81105, 81110, 81115, 81120, 81125, 93284, 93285 and 93286 only apply to services provided by eligible diabetes educators, exercise physiologists and dietitians who are registered with Services Australia. If providers are already registered with Services Australia to use items 10951, 10953, 10954, they do not need to register separately for these items. Eligibility criteria are as follows: 

Diabetes educator: must be a 'credentialed diabetes educator' as credentialed by the Australian Diabetes Educators Association. 

Exercise physiologist: must be an 'accredited exercise physiologist' as accredited by Exercise and Sports Science Australia. 

Dietitian: must be an 'accredited practising dietitian' as recognised by the Dietitians Association of Australia. 

Services Australia registration forms may be obtained from Services Australia on 132 150 or on the Services Australia website.

Related Items: 81100 81105 81110 81115 81120 81125 93284 93285 93286

Category 8 - MISCELLANEOUS SERVICES

MN.9.4

Assessment for Group Allied Health Services (Items 81100, 81110, 81120, 93284 and 93286) for People with Type 2 Diabetes

An assessment service is provided by a diabetes educator (item 81100), an exercise physiologist (item 81110) or a dietitian (items 81120, 93284 and 93286), on referral from a GP or medical practitioner. 

The purpose of this service is to undertake an individual assessment and determine the patient's suitability for a group services program. It involves taking a comprehensive patient history and identification of individual goals. This may also provide an opportunity to identify any patient who is likely to be unsuitable for group services.

Number of services per year

Patients are eligible for a maximum of one assessment for group services (either item 81100, 81110, 81120, 93284 or 93286) per calendar year. If more than one assessment service is provided in a calendar year, the subsequent service/s will not attract a Medicare rebate and the MBS Safety Net arrangements will not apply to costs incurred by the patient for the service/s. 

If there is any doubt about a patient's eligibility for these items, the allied health professional should contact Services Australia to confirm the number of assessment services already claimed by the patient in the calendar year. Allied health professionals can call Services Australia on 132 150 to check this information. 

Referral form

The GP or medical practitioner must refer the patient using the Referral form for group allied health services under Medicare for patients with type 2 diabetes or a form that contains all the components of this form. This includes:

  • identifying that the patient has type 2 diabetes and either:
    • has prepared a new GP Management Plan (MBS item 721) OR
    • has reviewed an existing GP Management Plan (MBS item 732) OR
    • for a resident of an aged care facility, the GP or medical practitioner has contributed to or reviewed a multidisciplinary care plan prepared by the facility (MBS item 731) [Note: Generally, residents of an aged care facility rely on the facility for assistance to manage their type 2 diabetes. Therefore, residents may not need to be referred for allied health group services as the self-management approach may not be appropriate.]
  • GP or medical practitioner details including provider number, name, address, signature and date of referral
  • Patient details including name and address
  • Allied Health Practitioner (or practice) the patient is referred to for assessment and the address 

The allied health professional undertaking the assessment service will need to complete Part B of this form providing information on:

  • Name of provider/s
  • Name of program
  • Number of sessions in the program
  • Venue (if known)
  • Name of allied health professional undertaking the assessment

The patient will then need to present this form/information to the provider/s of group services.

Length of service

This service must be of at least 45 minutes duration and provided to an individual patient. For items 81100, 81110 and 81120, the allied health professional must personally attend the patient. 

Reporting requirements

On completion of the assessment service, the allied health professional must provide a written report back to the referring GP outlining the assessment undertaken, whether the patient is suitable for group services and, if so, the nature of the group services to be delivered.

Related Items: 81100 81110 81120 93284 93286

Category 8 - MISCELLANEOUS SERVICES

MN.9.6

Group Allied Health Services (Items 81100, 81105, 81110, 81115, 81120, 81125, 93284, 93285 and 93286) for People with Type 2 Diabetes - Additional Requirements

Retention of Referral Form for Services Australia Audit Purposes

It is recommended that Allied health professionals retain a copy of the referral form for 2 years from the date the service was rendered (for Services Australia auditing purposes). 

Publicly funded services

Items 81100, 81105, 81110, 81115, 81120, 81125, 93284, 93285 and 93286 do not apply for services that are provided by any other Commonwealth or state-funded services or provided to an admitted patient of a hospital. However, where an exemption under subsection 19(2) of the Health Insurance Act 1973 has been granted to an Aboriginal Community Controlled Health Service or a state/territory government health clinic, these items can be claimed for services provided by eligible allied health professionals salaried by, or contracted to, service or health clinic. All requirements of the relevant item must be met, including registration of the allied health professional with Services Australia. These services must also be bulk billed. 

Private health insurance

Patients need to decide if they will use Medicare or their private health insurance general treatment cover (also known as ancillary or extras cover) to pay for these services. Patients cannot use their private health insurance general cover to 'top up' the Medicare rebate paid. 

Out-of-pocket expenses and Medicare Safety Net

Allied health professionals are free to determine their own fees for the professional service. Charges in excess of the Medicare benefit for the allied health items are the responsibility of the patient. However, such out-of-pocket costs will count toward the Medicare Safety Net for that patient.

Related Items: 81100 81105 81110 81115 81120 81125 93284 93285 93286


Legend

  • Assist - Addition/Deletion of (Assist.)
  • Amend - Amended Description
  • Anaes - Anaesthetic Values Amended
  • Emsn - EMSN Change
  • Fee - Fee Amended
  • Renum - Item Number Change (renumbered)
  • New - New Item
  • NewMin - New Item (previous Ministerial Determination)
  • Qfe - QFE Change