Medicare Benefits Schedule - Item 135

Search Results for Item 135

View Associated Notes

Category 1 - PROFESSIONAL ATTENDANCES

135

135 - Additional Information

Item Start Date:
01-Jul-2008
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Jul-2022

Group
A29 - Early Intervention Services For Children With Autism, Pervasive Developmental Disorder Or Disability

Professional attendance of at least 45 minutes in duration at consulting rooms or hospital, by a consultant physician in the practice of the consultant physician's specialty of paediatrics, following referral of the patient to the consultant by a referring practitioner, for assessment, diagnosis and preparation of a treatment and management plan for a patient aged under 13 years with autism or another pervasive developmental disorder, if the consultant paediatrician does all of the following:

(a) undertakes a comprehensive assessment and makes a diagnosis (if appropriate, using information provided by an eligible allied health provider);

(b) develops a treatment and management plan, which must include the following:

     (i) an assessment and diagnosis of the patient's condition;

     (ii) a risk assessment;

     (iii) treatment options and decisions;

     (iv) if necessary-medical recommendations;

(c) provides a copy of the treatment and management plan to:

     (i) the referring practitioner; and

     (ii) one or more allied health providers, if appropriate, for the treatment of the patient; (other than attendance on a patient for whom payment has previously been made under this item or item 137, 139 or 289)

Fee: $283.20 Benefit: 75% = $212.40 85% = $240.75

(See para AN.0.24, AN.40.1 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $500.00


Associated Notes

Category 1 - PROFESSIONAL ATTENDANCES

AN.0.24

Referred patient assessment, diagnosis and treatment and management plan for autism or any other pervasive developmental disorder (items 135 and 289)

These items are for consultant paediatricians (item 135) or psychiatrists (item 289), on referral from a medical practitioner, to provide early diagnosis and treatment of autism or any other pervasive development disorder (PDD) for children aged under 13 years. The items are for assessment, diagnosis and the creation of a treatment and management plan, and are claimable only once per patient per lifetime.

When item 135 or item 289 is in place, a consultant paediatrician or psychiatrist can refer a child with autism or other PDD to eligible allied health professionals for treatment services.

A child can access either the allied health services for autism/other PDD (using item 135 or 289) or for disability (using item 137 or 139), but not both.

If a child sees a consultant paediatrician or psychiatrist other than the one who put the treatment and management plan in place, the consultant paediatrician or psychiatrist who is seen subsequently can refer the child for any remaining allied health treatment services that are available to the child.

Children with an existing treatment and management plan created under item 135 or 289 can be reviewed under attendance items for consultant psychiatrists and paediatricians.

Where the patient presents with another morbidity in addition to autism or other PDD,item 132 can also be used for development of a treatment and management plan. However, the use of this item will not provide access to Medicare rebateable allied health services for treatment of autism or any other PDD.

Items 135 or 289 also provide a referral pathway for access to services provided through Childhood Autism Advisors by the Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA). For further information on assistance available through FaHCSIA, phone 1800 778 581 or emailASD.Support@fahcsia.gov.au. TTY users - phone 1800 555 677 then ask for the 1800 toll-free number you wish to contact.

Referral requirements

Items 135 (paediatrician) or 289 ( psychiatrist) are for diagnosis and treatment of autism or any other PDD where clinically appropriate, including referral to allied health treatment services.

A course of treatment for the allied health treatment services consists of the number of allied health services stated on the child's referral, up to a maximum of 10 services. This enables the referring practitioner to consider a report from the allied health professional(s) about the services provided to the child, and the need for further treatment.

Within the maximum service allocation of twenty treatment services, the allied health professional(s) can provide one or more courses of treatment. Patients will require a separate referral for each allied health professional they are referred to and they will also need new referrals for each new course of treatment.

In addition to referrals to allied health treatment services, a consultant paediatrician or psychiatrist can refer a child to an eligible allied health provider to assist with diagnosis of the child or for the purpose of contributing to the child's pervasive developmental disorder (PDD). Referrals for these allied health assessment services can be made by a consultant paediatrician or psychiatrist as an outcome of the service provided under one of items 110-131 or 296-370 inclusive.

Referrals are only valid when prerequisite MBS services have been provided. If the referring service has not yet been claimed, the Department of Human Services (DHS) will not be aware of the child's eligibility and Medicare benefits cannot be paid. Providers can call DHS on 132 150 to confirm whether a relevant MBS service has been claimed and/or the number of allied health services already claimed by the child.

Referring medical practitioners are not required to use a specific form to refer patients for the allied health services that are available through the Helping Children with Autism program. The referral may be a letter or note to an eligible allied health professional signed and dated by the referring practitioner.

Allied health assistance with diagnosis/assessment and treatment

Helping Children with Autism Program - Allied Health Items

MBS items for allied health assessment
and treatment of autism/PDD
Allied health provider
Assistance with diagnosis / contribution to a treatment plan*
82000 Psychologist
82005 Speech pathologist
82010 Occupational therapist
82030 Audiologist, optometrist, orthoptist, physiotherapist
 
Treatment services**
82015 Psychologist
82020 Speech pathologist
82025 Occupational therapist
82035 Audiologist, optometrist, orthoptist, physiotherapist

* Prerequisite MBS items: 110-131 (paediatrician) or items 296-370 (psychiatrist).
** Prerequisite MBS items: 135 (paediatrician) or 289 (psychiatrist).

Assessment services

Assessment services are available for an allied health provider to assist the referring practitioner with diagnosis or for contributing to a child's treatment and management plan. These services can be accessed by children aged under 13 years.

Medicare rebates are available for up to four allied health services in total per eligible child. 

An allied health professional can provide these services when:

  • the child has previously been provided with any MBS service covering items 110-131 inclusive by a consultant paediatrician; or
  • the child has previously been provided with any MBS service covering items 296-370 (excluding item 359) inclusive by a consultant psychiatrist.

The four allied health assessment services may consist of any combination of items 82000, 82005, 82010 and 82030. 

It is the responsibility of the referring practitioner to allocate these services in keeping with the child's individual treatment needs and to refer the child to appropriate allied health professional(s) accordingly.

Treatment services

Treatment services can be accessed when a child with autism or other PDD is aged under 15 years and has had a treatment and management plan put in place for them before their 13th birthday.

Medicare rebates are available for up to twenty allied health treatment services in total per eligible child. 

An eligible allied health professional can provide these services when:

  • the child has previously been provided with a treatment plan (item 135) by a consultant paediatrician; or
  • the child has previously been provided with a treatment plan (item 289) by a consultant psychiatrist.

The twenty treatment services may consist of any combination of items 82015, 82020, 82025 or 82035.

It is the responsibility of the referring practitioner to allocate these services in keeping with the child's individual treatment needs and to refer the child to appropriate allied health professional(s) accordingly.

Existing patients or patients with an existing diagnosis

Where a specific plan has not been created previously for the treatment and management of autism or any other PDD, a new plan can be developed by the treating practitioner under item 135 or 289 where it is clinically appropriate to treat the patient under such a plan. 

Children with an existing treatment and management plan created under item 135 or 289 can be reviewed under attendance items for consultant psychiatrists and paediatricians.

Related Items: 135 289

Category 1 - PROFESSIONAL ATTENDANCES

AN.40.1

COVID-19 Specialist and Consultant Physician MBS Telehealth and Telephone attendance items

From 1 January 2022, a number of the temporary COVID-19 telehealth items were permanently added to the MBS.

The intent of these ongoing telehealth items is to allow practitioners to provide MBS attendances remotely (by videoconference or telephone) where it is safe and clinically appropriate to do so in accordance with relevant professional standards.  

Providing telehealth services by videoconference is the preferred substitution for a face-to-face consultation. However, providers can provide a consultation via telephone where it is clinically relevant (and the service is covered by a relevant telephone item).

A list of the ongoing telehealth items and the equivalent face‑to‑face items can be found at Table 1.

Note: On 16 January 2022, the Australian Government announced that a range of temporary specialist telehealth that were due to cease on 31 December 2021, would be temporarily reinstated until 30 June 2022.  These items have now ceased.

 

Table 1 – Ongoing telehealth items and equivalent face to face services (out of hospital patients)

 Service 

Face-to-face items

Video items  Telephone items
Specialist Services      
Specialist. Initial attendance  104  91822  -
Specialist. Subsequent attendance 105  91823  91833
       
Consultant Physician Services       -
Consultant physician. Initial attendance  110  91824   -
Consultant physician. Subsequent attendance  116  91825 -
Consultant physician. Minor attendance  119  91826  91836
Consultant physician. Initial assessment, patient with at least 2 morbidities, prepare a treatment and management plan, at least 45 minutes  132  92422  -
Consultant physician, Subsequent assessment, patient with at least 2 morbidities, review a treatment and management plan, at least 20 minutes    133  92423  -
Specialist and Consultant Physician Services      
Specialist or consultant physician early intervention services for children with autism, pervasive developmental disorder or disability  137  92141  -
Geriatrician Services      
Geriatrician, prepare an assessment and management plan, patient at least 65 years, more than 60 minutes  141  92623  -
Geriatrician,  review a management plan, more than 30 minutes  143  92624
 
 -
Consultant Psychiatrist services      
Consultant psychiatrist, prepare a treatment and management plan, patient under 13 years with autism or another pervasive developmental disorder, at least 45 minutes  289  92434  -
Consultant psychiatrist, prepare a management plan, more than 45 minutes   291  92435  -
Consultant psychiatrist, review management plan, 30 to 45 minutes  293  92436  -
Consultant psychiatrist, attendance, new patient (or has not received attendance in preceding 24 mths), more than 45 minutes  296  92437  -
Consultant psychiatrist. Consultation, not more than 15 minutes  300  91827  91837
Consultant psychiatrist. Consultation, 15 to 30 minutes  302  91828  91838
Consultant psychiatrist. Consultation, 30 to 45 minutes  304  91829  91839
 Consultant psychiatrist. Consultation, 45 to 75 minutes  306  91830  -
Consultant psychiatrist. Consultation, more than 75 minutes  308  91831  -
Consultant psychiatrist, group psychotherapy, at least
1 hour, involving group of 2 to 9 unrelated patients or a family group of more than 3 patients, each referred to consultant psychiatrist
 342  92455  -
Consultant psychiatrist, group psychotherapy, at least
1 hour, involving family group of 3 patients, each referred to consultant psychiatrist
 344  92456  -
Consultant psychiatrist, group psychotherapy, at least
1 hour, involving family group of 2 patients, each referred to consultant psychiatrist
 346  92457  
Consultant psychiatrist, interview of a person other than patient, in the course of initial diagnostic evaluation of patient, 20 to 45 minutes  348 92458  -
Consultant psychiatrist, interview of a person other than patient, in the course of initial diagnostic evaluation of patient,  45 minutes or more  350  92459  -
Consultant psychiatrist, interview of a person other than patient, in the course of continuing management of patient, not less than 20 minutes, not exceeding 4 attendances per calendar year    352  92460  -
Consultant psychiatrist, prepare an eating disorder treatment and management plan, more than 45 minutes  90260  92162  
Consultant psychiatrist, to review an eating disorder plan, more than 30 minutes  90266  92172  
Paediatrician Services (also refer to consultant physician services)      
Paediatrician early intervention services for children with autism, pervasive developmental disorder or disability  135  92140  
Paediatrician, prepare an eating disorder treatment and management plan, more than 45 minutes  90261  92163  
Paediatrician, to review an eating disorder plan, more than 20 minutes  90267  92173  
Public Health Physician Services      
Public health physician, level A attendance   410  92513  92521
Public health physician, level B attendance, less than 20 minutes  411  92514  92522
Public health physician, level C attendance, at least 20 minutes  412  92515  -
Public health physician, level D attendance, at least 40 minutes  413  92516  -
Neurosurgery attendances      
Neurosurgeon, initial attendance  6007  92610  -
Neurosurgeon, minor attendance  6009  92611  92618
Neurosurgeon, subsequent attendance, 15 to 30 minutes  6011  92612  -
Neurosurgeon, subsequent attendance, 30 to 45 minutes  6013  92613  -
Neurosurgeon, subsequent attendance, more than 45 minutes  6015  92614  -
Anaesthetist attendance       
Anaesthetist, professional attendance, advanced or complex 17615 92701  -

Further information on the telehealth changes can be found at www.MBSonline.gov.au by searching under the  Facts Sheets tab – July 2022.

Eligible providers

All MBS items for referred attendances require a valid referral. However, if the specialist, consultant physician, consultant psychiatrist, paediatrician or geriatrician has previously seen the patient under a referral that is still valid, there is no need to obtain a specific referral for the purposes of claiming the video and telephone items.

Restrictions

All MBS telehealth and telephone attendance items are stand-alone items and are to be billed instead of a face‑to-face MBS item.

Billing Requirements

Bulk billing of specialist (and allied health) telehealth services is at the discretion of the provider, so long as informed financial consent is obtained prior to the provision of the service.

Further information on the assignment of benefit for bulk billed MBS telehealth services can be found in the ‘Provider Frequently Asked Questions’ at MBSonline.gov.au.

Relevant definitions and requirements

Specialist telehealth services (91822, 91823 and 91833) can be billed by all specialities that can currently bill items 104 and 105 or equivalent MBS items. This also includes sports and exercise medicine and occupational and environmental health medicine specialists.

Consultant physician telehealth services (91824, 91825, 91826 and 91836) can be billed by all specialities that can currently bill items 110, 116 and 119 or equivalent MBS items. This also includes pain and palliative medicine, sexual health medicine and addiction medicine.

Consultant physician telehealth services to prepare and review a management plan (92422 and 92423) can be billed by all physicians that can currently bill items 132 and 133 or equivalent MBS items. This also includes sexual health medicine, addiction medicine and paediatricians.

The specialist and consultant physician service for early intervention for children with pervasive developmental disorder (92141) can be billed by specialists and consultant physicians that are able to item 137.

Single course of treatment

The same conditions for a single course of treatment apply across all modalities (i.e. face‑to-face, video or telephone). Once an initial consultation is billed, all subsequent services related to the same condition are considered to be part of a single course of treatment. For example, if a patient has seen a specialist in a face‑to‑face consultation (where item 104 has been billed), item 91823 (video) or 91833 (telephone) should be billed if the patient sees the specialist remotely for the same condition.

Anaesthetist services

The Anaesthetist telehealth service (92701) can be billed by practitioners that can currently bill item 17615.

Service limits

At present, the service limits that apply to standard psychiatry services do not currently apply to the video and telephone attendance items for psychiatry (except for item 92460). Patients who have received more than 50 attendances under existing items are eligible to receive services under the video and telephone psychiatry items as long as they meet the item descriptor requirements.

In addition, patients who have received more than 50 attendances under item 319 are eligible to receive services under the video and telephone psychiatry items as long as they meet the item descriptor requirements.

The Department of Health will work with the Royal Australian and New Zealand College of Psychiatrists (RANZCP) and the Medicare Review Advisory Committee (MRAC) to review the current service limits, and ensure a consistent approach across all of the psychiatry attendance items, including services provided by face‑to‑face, video and telephone.

Interview item (92460)

Item 92460 provides for an interview with a person other than the patient. A maximum of 4 services in a calendar year can be billed under item 92460, or the equivalent face‑to‑face item (item 352), in the continuing management of a patient. That is, a consultant psychiatrist can bill for a service under item 92460 once more in the calendar year if a patient has received three MBS services under items 352 or 92460 in the same calendar year.

Management Plan items (92435 and 92436)

The MBS remote attendance preparation and review of GP management plan items have the same diagnosis, assessment and record-keeping requirements as the existing face-to-face items (291 and 293). Refer to MBS Explanatory Note AN.0.30 for further information.

Group psychotherapy items (92455, 92456 and 92457)

The MBS remote attendance group psychotherapy items have the same requirements as the existing face-to-face  items (342, 344 and 346). It is the responsibility of the practitioner rendering the service to maintain privacy and confidentiality for all participants throughout the service. Practitioners should refer to the relevant professional practice standards and guidelines for technology-based consultations.

Technical Requirements

The services can be provided by telehealth and by phone. It is the responsibility of the practitioner rendering the service to maintain privacy and confidentiality for all participants throughout the service. 

Telehealth attendance means a professional attendance by video conference where the medical practitioner:

  1. has the capacity to provide the full service through this means safely and in accordance with relevant professional standards; and
  2. is satisfied that it is clinically appropriate to provide the service to the patient; and
  3. maintains a visual and audio link with the patient; and
  4. is satisfied that the software and hardware used to deliver the service meets the applicable laws for security and privacy.

Note – only the time where a visual and audio link is maintained between the patient and the provider can be counted in meeting the relevant item descriptor.

No specific equipment is required to provide Medicare-compliant telehealth services. Practitioners must ensure that their chosen telecommunications solution meets their clinical requirements and satisfies privacy laws. Information on how to select a web conferencing solution is available on the Australian Cyber Security Centre website.

Phone attendance means a professional attendance by telephone where the health practitioner:

  1. has the capacity to provide the full service through this means safely and in accordance with professional standards; and
  2. is satisfied that it is clinically appropriate to provide the service to the patient; and
  3. maintains an audio link with the patient.

There are no longer geographic restrictions on the MBS video or telephone services provided by specialists, consultant physicians, consultant psychiatrists, paediatricians, geriatricians and anaesthetists.

Recording Clinical Notes (for specialist, consultant physician, consultant psychiatrist, neurosurgery, public health medicine, geriatrician, paediatrician and anaesthetist)

In relation to the time taken in recording appropriate details of the service, only clinical details recorded at the time of the attendance count towards the time of consultation.  It does not include information added later, such as reports of investigations, or when either the visual or audio link between the patient and the practitioner is lost. 

Clinicians should record the date, time and duration of the consultation, and retain these records.

Related Items: 104 105 110 116 119 132 133 135 137 141 143 289 291 293 296 300 302 304 306 308 342 344 346 348 350 352 410 411 412 413 6007 6009 6011 6013 6015 90260 90261 90266 90267 91822 91823 91824 91825 91826 91833 91836 92422 92423


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