Medicare Benefits Schedule - Item 228

Professional attendance by a prescribed medical practitioner at consulting rooms or in a place other than a hospital or a residential aged care facility, for a health assessment of a patient who is of Aboriginal or Torres Strait Islander descent—applicable not more than once in a 9 month period and only if the following items are not applicable within the same 9 month period:
(a) item 715;
(b) item 92004 or 92011 of the Telehealth and Telephone Determination

Fee: $186.90 Benefit: 100% = $186.90

(See para AN.7.1, AN.7.13, AN.7.14, AN.7.15, AN.7.16 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $500.00

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Last reviewed: 1 November 2023

A prescribed medical practitioner is a medical practitioner:

(a) who is not a general practitioner (see GN.4.13), specialist or consultant physician, and

(b) who:

a. is registered under section 3GA of the Act and is practising during the period, and in the location in respect of which the medical practitioner is registered, and insofar as the circumstances specified for paragraph 19AA(3)(b) of the Act apply; or

b. is covered by an exemption under subsection 19AB(3) of the Act; or

c. first became a medical practitioner before 1 November 1996.

Related Items: 179 181 185 187 189 191 203 206 214 215 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 235 236 237 238 239 240 243 244 245 249 272 276 277 279 281 282 283 285 286 287 301 303 733 737 741 745 761 763 766 769 772 776 788 789 792 2197 2198 2200 90092 90093 90095 90096 90098 90183 90188 90202 90212 90215

Last reviewed: 1 November 2023

This health assessment is available to all people of Aboriginal and Torres Strait Islander descent and should be used for health assessments for the following age categories:

• An Aboriginal or Torres Strait Islander child who is less than 15 years.
• An Aboriginal or Torres Strait Islander person who is aged between 15 years and 54 years.
• An Aboriginal or Torres Strait Islander older person who is aged 55 years and over.

A health assessment means the assessment of a patient's health and physical, psychological and social function and consideration of whether preventive health care and education should be offered to the patient, to improve that patient's health and physical, psychological and social function.

MBS item 228 must include the following elements:

(a) information collection, including taking a patient history and undertaking examinations and investigations as required;

(b) making an overall assessment of the patient;

(c) recommending appropriate interventions;

(d) providing advice and information to the patient; and

(e) keeping a record of the health assessment, and offering the patient, and/or patient's carer, a written report about the health assessment with recommendations about matters covered by the health assessment; and

(f) offering the patient's carer (if any, and if the prescribed medical practitioner [see note AN.7.1] considers it appropriate and the patient agrees) a copy of the report or extracts of the report relevant to the carer.

If, after receiving this health assessment, a patient who is aged fifteen years and over but under the age of 55 years, is identified as having a high risk of developing type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool, the prescribed medical practitioner may refer that person to a subsidised lifestyle modification program, along with other possible strategies to improve the health status of the patient.

The Australian Type 2 Diabetes Risk Assessment Tool can be obtained from https://www.health.gov.au/resources/apps-and-tools/the-australian-type-2-diabetes-risk-assessment-tool-ausdrisk.

A health assessment may only be claimed by a prescribed medical practitioner.

A health assessment should generally be undertaken by the patient's 'usual doctor'.  For the purpose of the health assessment, "usual doctor" means the prescribed medical practitioner, or a medical practitioner working in the same medical practice, which has provided the majority of primary health care to the patient over the previous twelve months and/or will be providing the majority of care to the patient over the next twelve months.

The health assessment for Aboriginal and Torres Strait Islander People is not available to people who are in-patients of a hospital or care recipients in a residential aged care facility.

A health assessment should not take the form of a health screening service (see General Explanatory Note GN.13.33).

MBS health assessment item 228 must be provided by a prescribed medical practitioner personally attending upon a patient. Suitably qualified health professionals, such as practice nurses, Aboriginal health workers or Aboriginal and Torres Strait Islander health practitioners employed and/or otherwise engaged by a general practice or health service, may assist prescribed medical practitioners in performing this health assessment.  Such assistance must be provided in accordance with accepted medical practice and under the supervision of the prescribed medical practitioner.  This may include activities associated with:

• information collection; and
• providing patients with information about recommended interventions at the direction of the prescribed medical practitioner.

The prescribed medical practitioner should be satisfied that the assisting health professional has the necessary skills, expertise and training to collect the information required for the health assessment.

Prescribed medical practitioners should not conduct a separate consultation in conjunction with a health assessment unless it is clinically necessary (ie. the patient has an acute problem that needs to be managed separately from the assessment).

Item 228 does not apply for services that are provided by any other Commonwealth or State funded services.  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 State/Territory Government health clinic, item 228 can be claimed for services provided by prescribed medical practitioners salaried by or contracted to, the Service or health clinic.  All requirements of the item must be met.

Item 10990 or 10991 (bulk billing incentives) can be claimed in conjunction with any health assessment provided to an Aboriginal and Torres Strait Islander person, provided the conditions of items 10990 and 10991 are satisfied.

An eligible patient may only receive the Health Assessment for Aboriginal and Torres Strait Islander People using either item 228 or item 715 once in a 9-month period.

Related Items: 228

Last reviewed: 1 November 2023

An Aboriginal and Torres Strait Islander child health assessment must include:

a.     a personal attendance by a prescribed medical practitioner (see note AN.7.1);

b.    taking the patient's medical history, including the following:

i.      mother's pregnancy history;

ii.     birth and neo-natal history:

iii.    breastfeeding history;

iv.    weaning, food access and dietary history;

v.     physical activity;

vi.    previous presentations, hospital admissions and medication usage;

vii.   relevant family medical history;

viii.  immunisation status;

ix.    vision and hearing (including neonatal hearing screening);

x.     development (including achievement of age appropriate milestones);

xi.    family relationships, social circumstances and whether the person is cared for by another person;

xii.   exposure to environmental factors (including tobacco smoke);

xiii.  environmental and living conditions;

xiv. educational progress;

xv.  stressful life events;

xvi. mood (including incidence of depression and risk of self-harm);

xvii. substance use;

xviii. sexual and reproductive health; and

xix. dental hygiene (including access to dental services).

c.     examination of the patient, including the following:

i.      measurement of height and weight to calculate body mass index and position on the growth curve;

ii.     newborn baby check (if not previously completed);

iii.    vision (including red reflex in a newborn);

iv.    ear examination (including otoscopy);

v.     oral examination (including gums and dentition);

vi.    trachoma check, if indicated;

vii.   skin examination, if indicated;

viii.  respiratory examination, if indicated;

ix.    cardiac auscultation, if indicated;

x.     development assessment, if indicated, to determine whether age appropriate milestones have been achieved;

xi.    assessment of parent and child interaction, if indicated; and

xii.   other examinations in accordance with national or regional guidelines or specific regional needs, or as indicated by a previous child health assessment.

d.      undertaking or arranging any required investigation, considering the need for the following tests, in particular:

i.      haemoglobin testing for those at a high risk of anaemia; and

ii.     audiometry, if required, especially for those of school age

e.      assessing the patient using the information gained in the child health check; and

f.       making or arranging any necessary interventions and referrals, and documenting a simple strategy for the good health of the patient.

Related Items: 228

Last reviewed: 1 November 2023

An Aboriginal and Torres Strait Islander adult health assessment must include:

a.     a personal attendance by a prescribed medical practitioner (see note AN.7.1);

b.     taking the patient's medical history, including the following:

i.      current health problems and risk factors;

ii.     relevant family medical history;

iii.    medication usage (including medication obtained without prescription or from other doctors);

iv.    immunisation status, by reference to the appropriate current age and sex immunisation schedule;

v.     sexual and reproductive health;

vi.    physical activity, nutrition and alcohol, tobacco or other substance use;

vii.   hearing loss;

viii.  mood(including incidence of depression and risk of self-harm);

ix.    family relationships and whether the patient is a carer, or is cared for by another person; and

x.     vision

c.      examination of the patient, including the following:

i.      measurement of the patient's blood pressure, pulse rate and rhythm;

ii.     measurement of height and weight to calculate body mass index and, if indicated, measurement of waist circumference for central obesity;

iii.    oral examination (including gums and dentition);

iv.    ear and hearing examination (including otoscopy and, if indicated, a whisper test); and

v.     urinalysis (by dipstick) for proteinurea;

vi.    eye examination;

d.     undertaking or arranging any required investigation, considering the need for the following tests, in particular, (in accordance with national or regional guidelines or specific regional needs):

i.      fasting blood sugar and lipids (by laboratory based test on venous sample) or, if necessary, random blood glucose levels;

ii.     cervical screening;

iii.    examination for sexually transmitted infection (by urine or endocervical swab for chlamydia and gonorrhoea, especially for those aged from 15 to 35years); and

iv.    mammography, if eligible (by scheduling appointments with visiting services or facilitating direct referral).

e.     assessing the patient using the information gained in the adult health assessment; and

f.      making or arranging any necessary interventions and referrals, and documenting a simple strategy for the good health of the patient.

An Aboriginal and Torres Strait Islander Older Person's health assessment must also include:

a.     keeping a record of the health assessment; and

b.    offering the patient a written report on the health assessment, with recommendations on matters covered by the health assessment.

Related Items: 228

Last reviewed: 1 November 2023

An Aboriginal and Torres Strait Islander Older Person's health assessment must include:

a.     a personal attendance by the prescribed medical practitioner (see note AN.7.1);

b.    measurement of the patient's blood pressure, pulse rate and rhythm;

c.     an assessment of the patient's medication;

d.    an assessment of the patient's continence;

e.     an assessment of the patient's immunisation status for influenza, tetanus and pneumococcus;

f.     an assessment of the patient's physical function, including the patient's activities of daily living and whether or not the patient has had a fall in the last 3months;

g.    an assessment of the patient's psychological function, including the patient's cognition and mood;

h.     an assessment of the patient's social function, including:

i.      the availability and adequacy of paid, and unpaid, help;

ii.     whether the patient is responsible for caring for another person;

i.      an eye examination

An Aboriginal and Torres Strait Islander Older Person's health assessment must also include:

a.     keeping a record of the health assessment; and

b.    offering the patient a written report on the health assessment, with

c.     recommendations on matters covered by the health assessment; and

d.    offering the patient's carer (if any, and if the prescribed medical practitioner considers it appropriate and the patient agrees) a copy of the report or extracts of the report relevant to the carer.

Related Items: 228