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-2021

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: $278.75 Benefit: 75% = $209.10 85% = $236.95

(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

Specialist and Consultant Physician MBS Telehealth and Telephone attendance items

MBS telehealth and telephone attendance items by specialist, consultant physician, consultant psychiatrist, neurosurgery, public health medicine, geriatrician, paediatrician and anaesthetist.

The intent of these items is to allow practitioners to provide certain MBS attendances remotely (by videoconference or telephone). This can only be done where it is safe, in accordance with relevant professional standards and clinically appropriate to do so.  

MBS telehealth services by videoconference is the preferred substitution for a face-to-face consultation. However, providers will also be able to offer audio-only services via telephone if video is not available, for which there are separate items.

 

 Service 
Equivalent face to face Items 

Telehealth items  -video-conference 

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  

 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 MBS telehealth and telephone items.

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

·   The remote attendance items are to be billed instead of the usual face to face MBS items.

·   Services do not apply to admitted patients.

Billing Requirements (for specialist, consultant physician, consultant psychiatrist, neurosurgery, public health medicine, geriatrician, paediatrician and anaesthetist)

The bulk billing of MBS specialist 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 (for specialist, consultant physician, consultant psychiatrist, neurosurgery, public health medicine, geriatrician, paediatrician and anaesthetist)

For the purposes of these items, an admitted patient means a patient who is receiving a service that is provided:

a.       as part of an episode of hospital treatment; or

b.       as part of an episode of hospital substitute treatment in respect of which the person to whom the treatment is provided choses to receive a benefit from a private health insurer.

Note: “hospital treatment” and “hospital-substitute treatment” have the meaning given by subsection 3(1) of the Health Insurance Act 1973.

Specialist and Consultant Physician services

Eligible providers

Specialist telehealth services (91822, 91823, and 91833) can be billed by all specialities that can currently bill MBS 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 MBS 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 MBS items 132 and 133 or equivalent MBS items. This also includes sexual health medicine, addiction medicine and paediatricians.

Specialists and consultant physician services for early intervention for children with pervasive developmental disorder (92141), can be billed by specialists and consultant physicians that are able to MBS item 137.

Single course of treatment

The same conditions for a single course of treatment apply across all modalities (ie  face to face, telehealth 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 MBS item 104 has been billed), MBS items 91823 (telehealth) 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 MBS item 17615.

Single course of treatment

The same conditions for a single course of treatment apply across all modalities (ie face to face, telehealth or telephone). Once an initial consultation has been billed, all subsequent services related to the same condition are considered as part of the same single course of treatment. For example if a patient has seen a psychiatrist in a face to face consultation (where MBS item 296 has been billed) then MBS item 91827-91831 (telehealth) or 91837 – 91839 (telephone) should be billed if the patient sees the psychiatrist remotely for the same condition.

Service limits

At present, service limits do not apply to psychiatry attendances provided by telehealth (video or telephone). This will continue to be the case from 1 January 2022. A future review of psychiatry attendances will be undertaken to determine if the service limits that apply to face to face psychiatry services will apply to telehealth services.

Interview item (92460)

This item 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 any of items 352, 92460 in the same calendar year.

Management Plan items (92435, 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 MBS items (291 and 293). Please refer to MBS Explanatory Note AN.0.30 for further information.

Group psychotherapy items (92455, 92456, 92457)

The MBS remote attendance group psychotherapy items have the same requirements as the existing face-to-face MBS 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 (for specialist, consultant physician, consultant psychiatrist, neurosurgery, public health medicine, geriatrician, paediatrician and anaesthetist)

The services can be provided by telehealth, or in circumstances when video conferencing is unavailable, 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 practitioner:

a.       has the capacity to provide the full service through this means safely and in accordance with relevant professional standards; and

b.       is satisfied that it is clinically appropriate to provide the service to the patient; and

c.       maintains a visual and audio link with the patient; and

d.       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:

a.       has the capacity to provide the full service through this means safely and in accordance with professional standards; and

b.       is satisfied that it is clinically appropriate to provide the service to the patient; and

c.       maintains an audio link with the patient.

There are no geographic restrictions on the telehealth and 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.

Creating and Updating a My Health Record

The time spent by a medical practitioner on the following activities may be counted towards the total consultation time:

·   Reviewing a patient's clinical history, in the patient's file and/or the My Health Record, and preparing or updating a Shared Health Summary where it involves the exercise of clinical judgement about what aspects of the clinical history are relevant to inform ongoing management of the patient's care by other providers; or

·   Preparing an Event Summary for the episode of care.

Preparing or updating a Shared Health Summary and preparing an Event Summary are clinically relevant activities.  When either of these activities are undertaken with any form of patient history taking and/or the other clinically relevant activities that can form part of a consultation, the item that can be billed is the one with the time period that matches the total consultation time. 

MBS rebates are not available for creating or updating a Shared Health Summary as a standalone service.  

 

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 91832 91833 91834 91835 91836 91840 91841 92143 92144 92166 92167 92178 92179 92422 92423 92431 92432 92474 92475 92476 92477 92495 92496 92497 92498 92499 92500 92523 92524 92617 92619 92620 92621 92628 92629 92712


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