Medicare Benefits Schedule - Item 412

LEVEL C

Professional attendance by a public health physician in the practice of his or her specialty of public health medicine at consulting rooms lasting at least 20 minutes, including any of the following that are clinically relevant:

a)    taking a detailed patient history;

b)    performing a clinical examination;

c)    arranging any necessary investigation;

d)    implementing a management plan;

e)    providing appropriate preventive health care;

in relation to 1 or more health-related issues, with appropriate documentation.

Fee: $87.35 Benefit: 75% = $65.55 85% = $74.25

(See para AN.0.50, AN.40.1 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $262.05

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Attendances by public health physicians will attract Medicare benefits under the new items only where the attendance relates to one or more of the following: - 

(i)    management of a patient's vaccination requirements for accepted immunisation programs; or

(ii)   prevention or management of sexually transmitted disease; or

(iii)  prevention or management of disease due to environmental hazards or poisons; or

(iv)  prevention or management of exotic diseases; or

(v)   prevention or management of infection during outbreaks of infectious disease. 

For more information on the content-based item structure used in this Group, see A.5 in the explanatory notes.

Related Items: 410 411 412 413 414 415 416 417

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