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-Mar-2023
Schedule Fee Updated:
01-Nov-2023

Group
A29 - Attendance services for complex neurodevelopmental disorder or disability

Professional attendance lasting at least 45 minutes by a consultant physician in the practice of the consultant physician’s specialty of paediatrics, following referral of the patient to the consultant paediatrician by a referring practitioner, for a patient aged under 25, if the consultant paediatrician:

(a) undertakes, or has previously undertaken in prior attendances, a comprehensive assessment in relation to which a diagnosis of a complex neurodevelopmental disorder (such as autism spectrum disorder) is made (if appropriate, using information provided by an eligible allied health provider); and

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

(i) documentation of the confirmed diagnosis; and

(ii) findings of any assessments performed for the purposes of formulation of the diagnosis or contribution to the treatment and management plan; and

(iii) a risk assessment; and

(iv) treatment options (which may include biopsychosocial recommendations); and

(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, 289, 92140, 92141, 92142 or 92434)

Applicable only once per lifetime

Fee: $294.85 Benefit: 75% = $221.15 85% = $250.65

(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

Attendance services for complex neurodevelopmental disorders (such as autism spectrum disorder)

Intention of this service under item 135 and telehealth equivalent item 92140

Items 135 or telehealth equivalent item 92140 are intended for complex conditions, characterised by multi-domain cognitive and functional impairment. Patient eligibility is for neurodevelopmental disorders, which are assessed to be complex and mean that individuals require support across multiple domains.

The intention of this service is to provide access to treatment, through the development of a treatment and management plan by a paediatrician, for individuals diagnosed with a complex neurodevelopmental disorder (NDD). The development of the treatment and management plan, follows a comprehensive medical assessment, and provides the opportunity to refer to eligible Allied Health practitioners for up to a total of 20 MBS treatment services per patient’s lifetime (items 82015, 82020, 82025, 82035, 93035, 93036, 93043 or 93044). This item is claimable once in a patient’s lifetime.

Eligibility:

In the context of item 135 (or 92140), the diagnosis of a complex neurodevelopmental disorder requires evidence of requiring support and showing impairment across two or more neurodevelopmental domains. Complexity is characterised by multi-domain cognitive and functional disabilities, delay or clinically significant impairment.

Neurodevelopmental domains include:

  • Cognition
  • Language
  • Social-emotional development
  • Motor skills
  • Adaptive behaviour:  conceptual skills, practical skills, social skills or social communication skills

Age eligibility:

Whilst it is not expected that a paediatrician would routinely assess adult individuals (item 289 provides for assessments undertaken by a psychiatrist for patients aged over 18 years to under 25 years), item 135 provides an age ceiling which is consistent across all MBS items related to complex neurodevelopmental disorders and related Allied Health services. Where a paediatrician has been referred a patient (under 18 years of age) and the diagnostic formulation is not completed until after their 18th birthday, the higher age limit will allow the completion of the assessment by the paediatrician (as clinically appropriate).

Referral pathways:

Early identification of, and intervention for, individuals with complex NDD is important in promoting positive longer term outcomes. Symptoms can cause clinically significant impairment in social, occupational or other important areas of functioning.

Where neurodevelopmental concerns have been identified and brought to the attention of the patient’s GP to initially assess these concerns and the GP considers there are persisting indications that require more specialised assessment, they are encouraged to refer to either a consultant paediatrician or psychiatrist for a comprehensive assessment.

Diagnostic Assessment:

The assessment and diagnosis of a complex NDD should be evaluated in the context of both a physical and developmental assessment. The paediatrician may require a number of separate attendances (through usual time-tiered or subsequent attendance items 110, 116, 119, 122, 128, 131 or telehealth items 91824 to 91826) to complete a comprehensive accurate assessment and formulate a diagnosis, exclude other disorders or assess for co-occurring conditions.

Multi-disciplinary assistance with assessment and/or contribution to the treatment and management plan:

Depending on a range of factors, not limited to the patient’s age and nature of suspected complex NDD, the consultant physician may require a multi-disciplinary approach to complete a comprehensive accurate assessment and formulate a diagnosis. 

Where the paediatrician determines the patient requires additional assessments to formulate a diagnosis, through the assistance of an Allied Health practitioner, they are able to refer the patient to an eligible Allied Health provider from standard attendance items (110 to 131 or telehealth items 91824 to 91826 and 91834 to 91836).

Whilst Medicare rebates provide for a total of 8 Allied Health assessment services per patient per lifetime, an eligible Allied Health practitioner can only provide up to 4 services before the need for a review (the type of review can be specified in the referral to the eligible Allied Health professional) by the referring paediatrician, who must agree to the need for any additional Allied Health services prior to the delivery of the remaining 4 Allied Health assessment services.

Eligible Allied Health Assessment practitioners include:

  • Psychologist (MBS item 82000, 93032, 93040)
  • Speech Pathologist (MBS item 82005, 93033, 93041)
  • Occupational Therapist (82010, 93033, 93041)
  • Audiologist, Optometrist, Orthoptist, Physiotherapist (MBS item 82030, 93033, 93041)

Requirements of the referral to Allied Health practitioners

The paediatrician can refer to multiple eligible Allied Health practitioners concurrently, but a separate referral letter must be provided to each Allied Health practitioner. The referral should specify the intent of the assessment and if appropriate, specify the number of services to be provided. Where the number of sessions is not specified, each Allied Health practitioner can provide up to 4 assessment services without the need for review or agreement to provide further assessment services.  

Review requirements following delivery of 4 Allied Health Assessment services

Where an eligible Allied Health practitioner has provided 4 assessment services (through items 82000, 82005, 82010, 82030, 93032, 93033, 93040 or 93041) and considers additional assessment services are required, they must ensure the referring paediatrician undertakes a review. If the type of review is not specified by the referring paediatrician an acceptable means of review includes: a case conference, phone call, written correspondence, secure online messaging exchange or attendance of the patient with the referring paediatrician.

Inter-disciplinary Allied Health referral

Eligible Allied Health practitioners are also able to make inter-disciplinary referrals to other eligible Allied Health practitioners as clinically necessary to assist with the formulation of the diagnosis or contribute to the treatment and management plan. Inter-disciplinary referrals must be undertaken in consultation and agreement with the referring paediatrician. Whilst they do not require the need for an attendance with the patient (face-to-face or telehealth) by the referring paediatrician, they do require an agreement from the referring paediatrician. This can be undertaken (but is not limited to) an exchange by phone, written communication or secure online messaging.

Contribution to the Treatment and Management Plan through Allied Health referral

In addition to referring to Allied Health practitioners for assistance with formulating a diagnosis, once a paediatrician makes a complex neurodevelopmental disorder diagnosis, the paediatrician may require the contribution of an eligible Allied Health practitioner to assist with the development of the Treatment and Management plan (before billing item 135 or 92140).

MBS items 82000, 82005, 82010, 82030, 93032, 93033, 93040 or 93041 provide a dual function for this purpose. It is important to note that the service limit of a total of 8 services per patient per lifetime apply regardless of whether the items are used for assistance with diagnosis or contribution to the treatment and management plan, and the referring paediatrician should be mindful of this when referring to eligible Allied Health practitioners.

Development of the Treatment and Management Plan

Once the paediatrician has made a diagnosis of a complex neurodevelopmental disorder, to complete the item requirements of item 135 or 92140 they must develop a treatment and management plan which includes:

Written documentation of the patient’s confirmed diagnosis of a complex neurodevelopmental disorder, including any findings of assessments performed (which assisted with the formulation of the diagnosis or contributed to the treatment and management plan)

  • A risk assessment which means assessment of:
    • the risk to the patient of a contributing co‑morbidity and
    • environmental, physical, social and emotional risk factors that may apply to the patient or to another individual.
  • Treatment options which include:
    • Recommendations using a biopsychosocial model
    • Identify major treatment goals and important milestones and objectives
    • Recommendation and referral for treatment services provided by eligible Allied Health practitioners (where relevant) and who should provide this, specifying number of treatments recommended (to a maximum of 20 treatment services)
    • Indications for review or episodes requiring escalation of treatment strategies
  • Documenting the Treatment and Management plan and providing a copy to the referring medical practitioner and relevant Allied Health practitioner/s.

Referral for Allied Health Treatment services

Once a treatment and management plan is in place (under item 135 or 92140) the paediatrician can refer the individual to eligible Allied Health practitioners for the provision of treatment services. Treatment services address the functional impairments identified through the comprehensive medical assessment which are outlined in the treatment and management plan. Treatment services focus on interventions to address developmental delays/disabilities or impairments.

Eligible Allied Health treatment practitioners include:

  • Psychologist (MBS items 82015, 93035, 93043)
  • Speech Pathologist (MBS items 82020, 93036, 93044)
  • Occupational Therapist (MBS items 82025, 93036, 93044)
  • Audiologist, Optometrist, Orthoptist, Physiotherapist (MBS items 82035, 93036, 93044)

A total of 20 Allied Health Treatment services per patient per lifetime are available through the MBS, which may consist of any combination of items 82015, 82020, 82025 or 82035 or equivalent telehealth items. Whilst the paediatrician can refer to multiple eligible Allied Health practitioners concurrently, a separate referral letter must be provided to each Allied Health practitioner.

The referral should specify the goals of the treatment and if appropriate, specify the number of services to be provided. It is the responsibility of the referring paediatrician to allocate the number of treatment services (up to a maximum of 10 services per course of treatment) in keeping with the individual’s treatment and management plan.

It is important to note, that a benefit will not be paid for the MBS Allied Health Treatment services unless the pre-requisite items (135 or 92140) have been processed through the Medicare claiming system.

On the completion of a “course of treatment” (specified by the referring paediatrician, up to maximum of 10 services), the eligible Allied Health practitioner must provide a written report to the referring paediatrician, which should include information on the treatment provided, recommendations on future management of the individual’s disorder and any advice to caregivers (such as parents, carers, school teachers). This written report will inform the referring paediatrician’s decision to refer for further treatment services. Where subsequent courses of treatment are required after the initial 10 services (up to a maximum of 20 services per patient per lifetime) a new referral is required.

Inconclusive assessment:

Where a patient does not meet the diagnostic threshold of a complex neurodevelopmental disorder and where ongoing medical management is required, patients can be managed through subsequent attendance items (such as 116 or 91825) or where at least two separate diagnoses are made through item 132 or 92422.

Examples include where:

  • Neurodevelopment assessment is incomplete or inconclusive
  • Neurodevelopmental impairment is present in fewer than two domains
  • Neurodevelopmental impairment is present in two or more domains, but individuals do not require sufficient support to meet criteria
  • Comprehensive, age-appropriate neurodevelopmental assessment is impossible or unavailable (e.g. in infants or young children- particularly those under 6 years of age)

These individuals may be considered “at risk of a complex neurodevelopmental” and require follow-up and reassessment in the future.

Related Items: 135 92140

Category 1 - PROFESSIONAL ATTENDANCES

AN.40.1

Specialist and Consultant Physician MBS Telehealth and Telephone attendance items

From 1 January 2022, a number of 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.

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, develop a treatment and management plan, patient aged under 25, with an eligible 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, develop a treatment and management plan, patient aged under 25, with a complex neurodevelopmental disorder (such as autism spectrum 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, develop a treatment and management plan, patient aged under 25, with a complex neurodevelopmental disorder (such as autism spectrum disorder), at least 45 minutes  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 www.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 diagnosis and treatment for patients with an eligible disability (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 and Aged Care 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 at: www.cyber.gov.au

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: 104 105 110 116 119 132 133 135 137 141 143 289 291 293 296 300 302 304 306 308 342 344 346 410 411 412 413 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