Medicare Benefits Schedule - Item 6007

Search Results for Item 6007

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Category 1 - PROFESSIONAL ATTENDANCES

6007

6007 - Additional Information

Item Start Date:
01-Nov-2006
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Jul-2022

Group
A26 - Neurosurgery Attendances To Which No Other Item Applies

Professional attendance by a specialist in the practice of neurosurgery following referral of the patient to the specialist-an attendance (other than a second or subsequent attendance in a single course of treatment) at consulting rooms or hospital

Fee: $139.05 Benefit: 75% = $104.30 85% = $118.20

(See para AN.0.64, AN.40.1 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $417.15


Associated Notes

Category 1 - PROFESSIONAL ATTENDANCES

AN.0.64

Neurosurgery Specialist Referred Consultation - (Items 6007 to 6015)

Referred consultations provided by specialist neurosurgeons will be covered under items 6007 to 6015.  These new items replace the use of specialist items 104 and 105 for referred consultations by neurosurgeons. 

The neurosurgical consultation structure comprises an initial consultation (item 6007) and four categories of subsequent consultations (items 6009-6015). These categories relate to the time AND level of complexity of the attendance i.e

(i) Level 1 - 6009

(ii) Level 2 - 6011

(iii) Level 3 - 6013

(iv) Level 4 - 6015 

The following provides further guidance for neurosurgeons in utilising the appropriate items in common clinical situations:

(i)   Initial consultation item 6007 will replace item 104. 

(ii) Subsequent consultation items 6009-6015 will replace item 105 

Item 6009 (subsequent consultation on a patient for 15 mins or less) covers a minor subsequent attendance which is straightforward in nature. Some examples of a minor attendance would include consulting with the patient for the purpose of issuing a repeat script for anticonvulsant medications or the routine review of a patient with a ventriculo-peritoneal shunt. 

Item 6011 (subsequent consultation on a patient for a duration of between 16 to 30 mins) would involve an detailed and comprehensive examination of the patient which is greater in complexity than would be provided under item 6009, arranging or evaluating any necessary investigations and include detailed relevant patient notes.  Where a management plan is formulated it is expected that this plan is discussed in detail with the patient and a written record included in the patient notes. Some examples of a detailed neurosurgical attendance would include:

· the reviewing of neuroimaging for the monitoring of a tumour or lesion and discussion of the results with the patient (e.g. meningiomaglioma, spinal cord tumour);

· consultation on a patient to review imaging for spinal cord/cauda equina/ nerve root compression from a disc prolapse and discussion of results; or

· consultation on a patient prior to insertion of a ventriculo-peritoneal shunt) 

Item 6013 (subsequent consultation on a patient with complex neurological conditions for the duration of between 31 to 45 mins) should involve a extensive and comprehensive examination of the patient greater in complexity than under item 6011, arranging or evaluating any necessary investigations and include detailed relevant patient notes.  Item 6013 would be expected to cover complications, adverse outcomes, or review of chronic conditions.  Where a management plan is formulated it is expected that this plan is discussed in detail with the patient and a written record be included in the patient notes. Some examples of an extensive neurosurgical attendance would include:

· an attendance on a patient prior to a craniotomy for cerebral tumour;

· surgery for spinal tumour;

· revision of spinal surgery;

· epilepsy surgery; or

· for the treatment of cerebral aneurysm.

Examination of such patients would include full cranial nerve examination or examination of upper and lower limb nervous system. 

Item 6015 (subsequent consultation on a patient with complex neurological conditions for a duration of more than 45 mins) should involve an exhaustive examination of the patient that is more comprehensive than 6013 and any ordering or evaluation of investigations and include detailed relevant patient notes.   It would be expected to cover complications, adverse outcomes, or review of chronic conditions. Where a management plan is formulated it is expected that this plan is thoroughly discussed with the patient and a written record be included in the patient notes. An exhaustive neurosurgical consultation includes:

· managing adverse neurological outcomes;

· detailed discussion when multiple modalities are available for treatment (e.g. clipping versus coiling for management of a cerebral aneurysm, surgical resection versus radiosurgery for cerebral tumour); or

· discussion where surgical intervention is likely to result in a neurological deficit but surgery is critical to patient's life or to stop progressive neurologic decline (e.g. cranial nerve dysfunction, motor dysfunction secondary to a cerebral or spinal cord lesion).

Examination of such patients would include exhaustive neurosurgical examination includings full neurological examination (cranial nerves and limbs) or detailed 'focused examination' (e.g.: brachial plexus examination) 

Complex neurosurgical problems referred to in items 6013 and 6015 include:

· deterioration in neurologic function following cranial or spinal surgery;

· presentation with new neurologic signs/symptoms; multifocal spinal and cranial disease (e.g. neurofibromatosis); or

· chronic pain states following spinal surgery (including discussion of other treatment options and referral to pain management) 

NOTE:     It is expected that informed financial consent be obtained from the patient where possible.

Related Items: 6007 6009 6011 6013 6015

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 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  -

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 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 early intervention for children with pervasive developmental disorder (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 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 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.

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: 104 105 110 116 119 132 133 135 137 141 143 289 291 293 296 300 302 304 306 308 342 344 346 348 350 352 410 411 412 413 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