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

COVID-19 MBS telehealth and telephone attendance items by specialist, consultant physician, consultant psychiatrist, neurosurgery, public health medicine, geriatrician, paediatrician and anaesthetist.

The intent of these temporary items is to allow practitioners to provide certain MBS attendances remotely (by videoconference or telephone), in response to the COVID-19 pandemic. This can only be done where it is safe, in accordance with relevant professional standards and clinically appropriate to do so.  

COVID-19 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.

COVID-19 – TEMPORARY MBS TELEHEALTH ITEMS

SPECIALIST, CONSULTANT PHYSICIAN, PSYCHIATRIST, PAEDIATRICIAN, GERIATRICIAN, PUBLIC HEALTH PHYSICIAN, NEUROSURGEON AND ANAESTHETIST ATTENDANCES

As of 20 April 2020 bulk billing of specialist services is at the discretion of the provider, so long as informed financial consent is obtained prior to the provision of the service.

Service	Existing Items face to face	Telehealth items  -video-conference	Telephone items – for when video-conferencing is not available
Specialist Services (from 13 March 2020)
Specialist. Initial attendance	104	91822	91832
Specialist. Subsequent attendance	105	91823	91833
Consultant Physician Services (from 13 March 2020)
Consultant physician. Initial attendance	110	91824	91834
Consultant physician. Subsequent attendance	116	91825	91835
Consultant physician. Minor attendance	119	91826	91836
(from 6 April 2020)
Consultant physician. Initial assessment, patient with at least 2 morbidities, prepare a treatment and management plan, at least 45 minutes	132	92422	92431
Consultant physician, Subsequent assessment, patient with at least 2 morbidities, review a treatment and management plan, at least 20 minutes	133	92423	92432
Specialist and Consultant Physician Services (from 30 March 2020)
Specialist or consultant physician early intervention services for children with autism, pervasive developmental disorder or disability	137	92141	92144
Geriatrician Services (from 6 April 2020)
Geriatrician, prepare an assessment and management plan, patient at least 65 years, more than 60 minutes	141	92623	92628
Geriatrician,  review a management plan, more than 30 minutes	143	92624	92629
Consultant Psychiatrist services
(from 6 April 2020)
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	92474
Consultant psychiatrist, prepare a management plan, more than 45 minutes	291	92435	92475
Consultant psychiatrist, review management plan, 30 to 45 minutes	293	92436	92476
Consultant psychiatrist, attendance, new patient (or has not received attendance in preceding 24 mths), more than 45 minutes	296	92437	92477
(from 13 March 2020)
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	91840
Consultant psychiatrist. Consultation, more than 75 minutes	308	91831	91841
(from 20 April 2020)
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	92495
Consultant psychiatrist, group psychotherapy, at least 1 hour, involving family group of 3 patients, each referred to consultant psychiatrist	344	92456	92496
Consultant psychiatrist, group psychotherapy, at least 1 hour, involving family group of 2 patients, each referred to consultant psychiatrist	346	92457	92497
Consultant psychiatrist, interview of a person other than patient, in the course of initial diagnostic evaluation of patient, 20 to 45 minutes	348	92458	92498
(from 6 April 2020)
Consultant psychiatrist, interview of a person other than patient, in the course of initial diagnostic evaluation of patient,  45 minutes or more	350	92459	92499
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	92500
(from 30 March 2020)
Consultant psychiatrist, prepare an eating disorder treatment and management plan, more than 45 minutes	90260	92162	92166
Consultant psychiatrist, to review an eating disorder plan, more than 30 minutes	90266	92172	92178
Paediatrician Services (also refer to consultant physician services) (from 30 March 2020)
Paediatrician early intervention services for children with autism, pervasive developmental disorder or disability	135	92140	92143
Paediatrician, prepare an eating disorder treatment and management plan, more than 45 minutes	90261	92163	92167
Paediatrician, to review an eating disorder plan, more than 20 minutes	90267	92173	92179
Public Health Physician Services (from 20 April 2020)
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	92523
Public health physician, level D attendance, at least 40 minutes	413	92516	92524
Neurosurgery attendances (from 20 April 2020)
Neurosurgeon, initial attendance	6007	92610	92617
Neurosurgeon, minor attendance	6009	92611	92618
Neurosurgeon, subsequent attendance, 15 to 30 minutes	6011	92612	92619
Neurosurgeon, subsequent attendance, 30 to 45 minutes	6013	92613	92620
Neurosurgeon, subsequent attendance, more than 45 minutes	6015	92614	92621
Anaesthetist attendance (from 22 May 2020)
Anaesthetist, professional attendance, advanced or complex	17615	92701	92712

 

Further information related to COVID-19 telehealth and telephone services rendered by specialists, consultant physicians, consultant psychiatrists, paediatricians, geriatricians and anaesthetists can be found in the Temporary Telehealth Bulk-Billed Items for COVID-19 fact sheets and frequently asked questions.

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 COVID-19 telehealth and telephone items.

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

• Telephone attendance items only apply if the practitioner or the patient do not have the capacity to undertake the attendance by telehealth (videoconference).
• The new temporary 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)

As of 20 April 2020, bulk billing of COVID-19 specialist (and allied health) 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 temporary COVID-19 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:

1. as part of an episode of hospital treatment; or
2. 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, 91832, 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, 91834, 91835 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, 92423, 92431 and 92432) 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 and 92144), 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 services (92701, 92712) can be billed by practitioners that can currently bill MBS item 17615.

Consultant Psychiatrist services

Videoconference services are the preferred approach for substituting a face-to-face consultation. However, in response to the COVID-19 pandemic, providers will also be able to offer audio-only services via telephone if video is not available. There are separate items available for audio-only services.

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 – 91841 (telephone) should be billed if the patient sees the psychiatrist remotely for the same condition.

Service limits

The service limits that apply to standard psychiatry services generally do not currently apply to the COVID-19 remote attendance items for psychiatry (except for items 92460 and 92500). Patients who have received more than 50 attendances under existing items are eligible to receive services under the telehealth and telephone psychiatry items, provided they meet the item descriptor requirements.

In addition, patients who have received more than 50 attendances under MBS item 319 are eligible to receive services under the COVID-19 telehealth and telephone psychiatry items, provided they meet the item descriptor requirements.

Interview items (92460 and 92500)

These items provide 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 92500, 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 or 92500 once more in the calendar year if a patient has received three MBS services under any of items 352, 92460 or 92500 in the same calendar year.

Management Plan items (92435, 92436, 92475, and 92476)

The new 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, 92495, 92496 and 92497)

The new 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 general 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.

Note: A phone attendance can only be performed in instances where the attendance could not be performed by telehealth (i.e. videoconference).

There are no geographic restrictions on the COVID-19 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 92422 92423 92431 92432