Medicare Benefits Schedule - Item 705

Search Results for Item 705

View Associated Notes

Health Assessments

The category of people eligible for health assessments are :

a)     People aged 40 to 49 years (inclusive) with a high risk of developing type 2 diabetes as determined by the Australian     Type 2 Diabetes Risk Assessment Tool

b)     People between the age of 45 and 49 (inclusive) who are at risk of developing a chronic disease

c)     People aged 75 years and older

d)     Permanent residents of a Residential Aged Care Facility

e)     People who have an intellectual disability

f)     Humanitarian entrants who are resident in Australia with access to Medicare services, including Refugees and Special     Humanitarian Program and Protection Program entrants

g)     Former serving members of the Australian Defence Force including former members of permanent and reserve forces

Category 1 - PROFESSIONAL ATTENDANCES

705

705 - Additional Information

Item Start Date:
01-May-2010
Description Start Date:
01-Jul-2018
Schedule Fee Start Date:
01-Jul-2019

Group
A14 - Health Assessments
Subheading
1 - Health Assessments

Professional attendance by a general practitioner  to perform a long health assessment, lasting at least 45 minutes but less than 60 minutes, including:

(a) comprehensive information collection, including taking a patient history; and

(b) an extensive examination of the patient's medical condition and physical function; and

(c) initiating interventions and referrals as indicated; and

(d) providing a basic preventive health care management plan for the patient

Fee: $193.35 Benefit: 100% = $193.35

(See para AN.0.36, AN.0.37, AN.0.38, AN.0.39, AN.0.40, AN.0.41, AN.0.42, AN.0.69 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $500.00


Associated Notes

Category 1 - PROFESSIONAL ATTENDANCES

AN.0.36

Health Assessments (Items 701, 703, 705, 707)

There are four time-based health assessment items, consisting of brief, standard, long and prolonged consultations.

Brief Health Assessment (MBS Item 701)

A brief health assessment is used to undertake simple health assessments. The health assessment should take no more than 30 minutes to complete.

Standard Health Assessment (MBS Item 703)

A standard health assessment is used for straightforward assessments where the patient does not present with complex health issues but may require more attention than can be provided in a brief assessment. The assessment lasts more than 30 minutes but takes less than 45 minutes.

Long Health Assessment (MBS Item 705)

A long health assessment is used for an extensive assessment, where the patient has a range of health issues that require more in-depth consideration, and longer-term strategies for managing the patient's health may be necessary. The assessment lasts at least 45 minutes but less than 60 minutes.

Prolonged Health Assessment (MBS Item 707)

A prolonged health assessment is used for a complex assessment of a patient with significant, long-term health needs that need to be managed through a comprehensive preventive health care plan. The assessment takes 60 minutes or more to complete.

General practitioners may select one of the MBS health assessment items to provide a health assessment service to a member of any of the target groups listed in the table below. The health assessment item that is selected will depend on the time taken to complete the health assessment service. This is determined by the complexity of the patient's presentation and the specific requirements that have been established for each target group eligible for health assessments.

MBS Items 701, 703, 705 and 707 may be used to undertake a health assessment for the following target groups:

Target Group Frequency of Service
A type 2 diabetes risk evaluation for people aged 40-49 years (inclusive) with a high risk of
developing type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool
Once every three years to an eligible patient
A health assessment for people aged 45-49 years (inclusive) who are at risk of developing chronic disease Once only to an eligible patient
A health assessment for people aged 75 years and older Provided annually to an eligible patient
A comprehensive medical assessment for permanent residents of residential aged care facilities Provided annually to an eligible patient
A health assessment for people with an intellectual disability Provided annually to an eligible patient
A health assessment for refugees and other humanitarian entrants Once only to an eligible patient
A health assessment for former serving members of the Australian Defence Force Once only to an eligible patient

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.

Health assessments are not available to people who are in-patients of a hospital or care recipients in a residential aged care facility (with the exception of a comprehensive medical assessment provided to a permanent resident of a residential aged care facility).

Before a health assessment is commenced, the patient (and/or his or her parent(s), carer or representative, as appropriate) must be given an explanation of the health assessment process and its likely benefits. The patient must be asked whether he or she consents to the health assessment being performed. In cases where the patient is not capable of giving consent, consent must be given by his or her parent(s), carer or representative. Consent to the health assessment must be noted in the patient's records.

A health assessment must include the following elements:

  1. information collection, including taking a patient history and undertaking or arranging examinations and investigations as required;
  2. making an overall assessment of the patient;
  3. recommending appropriate interventions;
  4. providing advice and information to the patient;
  5. keeping a record of the health assessment, and offering the patient a written report about the health assessment, with recommendations about matters covered by the health assessment; and
  6. offering the patient's carer (if any, and if the general practitioner considers it appropriate and the patient agrees) a copy of the report or extracts of the report relevant to the carer.

A health assessment may only be claimed by a general practitioner.

A health assessment should generally be undertaken by the patient's 'usual doctor'. For the purpose of the health assessment items, 'usual doctor' means the general practitioner, or a general practitioner working in the 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.

A health assessment should not take the form of a health screening service.

A copy of the Health Assessment must be retained for a period of 2 years after the date of service.

MBS health assessment items 701, 703, 705, 707 must be provided by a general practitioner personally attending upon a patient. Suitably qualified health professionals, such as practice nurses or Aboriginal and Torres Strait Islander health practitioners, employed and/or otherwise engaged by a general practice or health service, may assist general practitioners in performing health assessments. Such assistance must be provided in accordance with accepted medical practice and under the supervision of the general practitioner. This may include activities associated with:

- information collection; and

- providing patients with information about recommended interventions at the direction of the general practitioner.

The general 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.

General practitioners should not conduct a separate consultation for another health-related issue 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). The only exception is the comprehensive medical assessment, where, if this health assessment is undertaken during the course of a consultation for another purpose, the health assessment item and the relevant item for the other consultation may both be claimed.

Items 701, 703, 705 and 707 do 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, items 701, 703, 705 and 707 can be claimed for services provided by general practitioners salaried by or contracted to, the Service or health clinic. All other requirements of the items must be met.

Item 10990 or 10991 (bulk billing incentives) can be claimed in conjunction with any health assessment, provided the conditions of item 10990 and 10991 are satisfied.

Related Items: 701 703 705 707

Category 1 - PROFESSIONAL ATTENDANCES

AN.0.37

Health Assessment provided as a type 2 diabetes risk evaluation for people aged 40-49 years with a high risk of developing type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool

Items 701, 703, 705 and 707 may be used to undertake a type 2 diabetes risk evaluation for people aged 40-49 years (inclusive) with a high risk of developing type 2 diabetes, as determined by the Australian Type 2 Diabetes Risk Assessment Tool. 

The aim of this health assessment is to review the factors underlying the 'high risk' score identified by the Australian Type 2 Diabetes Risk Assessment Tool to instigate early interventions, such as lifestyle modification programs, to assist with the prevention of type 2 diabetes. 

The Australian Type 2 Diabetes Risk Assessment Tool has been developed to provide a basis for both health professionals and health consumers to assess the risk of type 2 diabetes.  It consists of a short list of questions which, when completed, provides a guide to a patient's current level of risk of developing type 2 diabetes.  The item scores and risk rating calculations in the tool have been developed using demographic, lifestyle, anthropometric and biomedical data from the 2000 Australian Diabetes, Obesity and Lifestyle baseline survey and the AusDiab 2005 follow-up study. 

The Australian Type 2 Diabetes Risk Assessment Tool can be obtained from the Department's prevention of diabetes web page

Clinical risk factors that the general practitioner must consider when providing this health assessment include:

(a) lifestyle, such as smoking, physical inactivity and poor nutrition;

(b) biomedical risk factors, such as high blood pressure, impaired glucose metabolism and excess weight;

(c) any relevant recent diagnostic test results; and

(d) a family history of chronic disease. 

The health assessment must include the following:

(a) evaluating a patient's high risk score, as determined by the Australian Type 2 Diabetes Risk Assessment Tool which has been completed by the patient within a period of 3 months prior to undertaking the health assessment;

(b) updating the patient's history and undertaking physical examinations and clinical investigations in accordance with relevant guidelines;

(c) making an overall assessment of the patient's risk factors and of the results of relevant examinations and investigations;

(d) initiating interventions, if appropriate, including referral to a lifestyle modification program and follow-up relating to the management of any risk factors identified (further information is available at the Department's prevention of diabetes web page.); and

(e) providing the patient with advice and information (such as the Lifescript resources produced by the Department of Health), including strategies to achieve lifestyle and behaviour changes if appropriate (further information is available at the Department's Lifescript web page). 

The completion of the Australian Type 2 Diabetes Risk Assessment Tool is mandatory for patient access to this health assessment.  The tool can be completed either by the patient or with the assistance of a health professional or practice staff.  Patients with a 'high' score result are eligible for the health assessment, and subsequent referral to the subsidised lifestyle modification programs if appropriate (further information is available at the Department's prevention of diabetes web page). 

A health assessment for a type 2 diabetes risk evaluation for people aged 40-49 years with a high risk of developing type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool may only be claimed once every three years by an eligible patient.

Related Items: 701 703 705 707

Category 1 - PROFESSIONAL ATTENDANCES

AN.0.38

Health Assessment provided for people aged 45-49 years who are at risk of developing chronic disease

Items 701, 703, 705 and 707 may be used to undertake a health assessment for people aged 45-49 years (inclusive) who are at risk of developing chronic disease.

For the purposes of this health assessment, a patient is at risk of developing a chronic disease if, in the clinical judgement of the attending general practitioner, a specific risk factor for chronic disease is identified.

Risk factors that the general practitioner can consider include, but are not limited to:

(a) lifestyle risk factors, such as smoking, physical inactivity, poor nutrition or alcohol use;

(b) biomedical risk factors, such as high cholesterol, high blood pressure, impaired glucose metabolism or excess weight; or

(c) family history of a chronic disease. 

A chronic disease or condition is one that has been or is likely to be present for at least six months, including but not limited to asthma, cancer, cardiovascular illness, diabetes mellitus, mental health conditions, arthritis and musculoskeletal conditions. 

If, after receiving this health assessment, a patient is identifed as having a high risk of type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool, the general practitioner may refer that person to a subsidised lifestyle modification program, along with other possible strategies to improve the health status of the patient (further information is available at http://www.health.gov.au/preventionoftype2diabetes). 

The Australian Type 2 Diabetes Risk Assessment Tool can be obtained from http://www.health.gov.au/preventionoftype2diabetes 

A health assessment for people aged 45-49 years who are at risk of developing chronic disease may only be claimed once by an eligible patient.

Related Items: 701 703 705 707

Category 1 - PROFESSIONAL ATTENDANCES

AN.0.39

Health Assessment provided for people aged 75 years and older

Items 701, 703, 705 and 707 may be used to undertake a health assessment for people aged 75 years and older. 

A health assessment for people aged 75 years and older is an assessment of a patient's health and physical, psychological and social function for the purpose of initiating preventive health care and/or medical interventions as appropriate. 

This health assessment must include:

(a) measurement of the patient's blood pressure, pulse rate and rhythm;

(b) an assessment of the patient's medication;

(c) an assessment of the patient's continence;

(d) an assessment of the patient's immunisation status for influenza, tetanus and pneumococcus;

(e) 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 3 months;

(f) an assessment of the patient's psychological function, including the patient's cognition and mood; and

(g) an assessment of the patient's social function, including the availability and adequacy of paid and unpaid help, and whether the patient is responsible for caring for another person.

(h) A health assessment for people aged 75 years and older may be claimed once every twelve months by an eligible patient.

Related Items: 701 703 705 707

Category 1 - PROFESSIONAL ATTENDANCES

AN.0.40

Health Assessment provided as a comprehensive medical assessment for residents of residential aged care facilities

Items 701, 703, 705 and 707 may be used to undertake a comprehensive medical assessment of a resident of a residential aged care facility

This health assessment requires assessment of the resident's health and physical and psychological function, and must include:

(a) making a written summary of the comprehensive medical assessment;

(b) developing a list of diagnoses and medical problems based on the medical history and examination;

(c) providing a copy of the summary to the residential aged care facility; and

(d) offering the resident a copy of the summary. 

A residential aged care facility is a facility in which residential care services, as defined in the Aged Care Act 1997, are provided.  This includes facilities that were formerly known as nursing homes and hostels.  A person is a resident of a residential aged care facility if the person has been admitted as a permanent resident of that facility. 

This health assessment is available to new residents on admission into a residential aged care facility. It is recommended that new residents should receive the health assessment as soon as possible after admission, preferably within six weeks following admission into a residential aged care facility. 

A health assessment for the purpose of a comprehensive medical assessment of a resident of a residential aged care facility may be claimed by an eligible patient:

(a) on admission to a residential aged care facility, provided that a comprehensive medical assessment has not already been provided in another residential aged care facility within the previous 12 months; and

(b) at 12 month intervals thereafter.

Related Items: 701 703 705 707

Category 1 - PROFESSIONAL ATTENDANCES

AN.0.41

Health Assessment provided for people with an intellectual disability

Items 701, 703, 705 and 707 may be used to undertake a health assessment for people with an intellectual disability. 

A person is considered to have an intellectual disability if they have significantly sub-average general intellectual functioning (two standard deviations below the average intelligence quotient [IQ]) and would benefit from assistance with daily living activities.  Where general practitioners wish to confirm intellectual disability and a patient's need for assistance with activities of daily living, they may seek verification from a paediatrician registered to practice in Australia or from a government-provided or funded disability service that has assessed the patient's intellectual function. 

The health assessment provides a structured clinical framework for general practitioners to comprehensively assess the physical, psychological and social function of patients with an intellectual disability and to identify any medical intervention and preventive health care required.   The health assessment must include the following items as relevant to the patient or his or her representative:

(a) Check dental health (including dentition);

(b) Conduct aural examination (arrange formal audiometry if audiometry has not been conducted within 5 years);

(c) Assess ocular health (arrange review by an ophthalmologist or optometrist if a comprehensive eye examination has not been conducted within 5 years);

(d) Assess nutritional status (including weight and height measurements) and a review of growth and development;

(e) Assess bowel and bladder function (particularly for incontinence or chronic constipation);

(f) Assess medications (including non-prescription medicines taken by the patient, prescriptions from other doctors, medications prescribed but not taken, interactions, side effects and review of indications);

-       Advise carers of the common side effects and interactions.

-       Consider the need for a formal medication review.

(g) Check immunisation status, including influenza, tetanus, hepatitis A and B, Measles, Mumps and Rubella (MMR) and pneumococcal vaccinations;

(h) Check exercise opportunities (with the aim of moderate exercise for at least 30 minutes per day);

(i) Check whether the support provided for activities of daily living adequately and appropriately meets the patient's needs, and consider formal review if required;

(j) Consider the need for breast examination, mammography, cervical screening, testicular examination, lipid measurement and prostate assessment as for the general population;

(k) Check for dysphagia and gastro-oesophageal disease (especially for patients with cerebral palsy), and arrange for investigation or treatment as required;

(l) Assess risk factors for osteoporosis (including diet, exercise, Vitamin D deficiency, hormonal status, family history, medication fracture history) and arrange for investigation or treatment as required;

(m) For patients diagnosed with epilepsy, review of seizure control (including anticonvulsant drugs) and consider referral to a neurologist at appropriate intervals;

(n) Check for thyroid disease at least every two years (or yearly for patients with Down syndrome);

(o) For patients without a definitive aetiological diagnosis, consider referral to a genetic clinic every 5 years;

(p) Assess or review treatment for co-morbid mental health issues;

(q) Consider timing of puberty and management of sexual development, sexual activity and reproductive health; and

(r) Consider whether there are any signs of physical, psychological or sexual abuse. 

A health assessment for people with an intellectual disability may be claimed once every twelve months by an eligible patient.

Related Items: 701 703 705 707

Category 1 - PROFESSIONAL ATTENDANCES

AN.0.42

Health Assessment provided for refugees and other humanitarian entrants

Items 701, 703, 705 and 707 may be used to undertake a health assessment for refugees and other humanitarian entrants. 

The purpose of this health assessment is to introduce new refugees and other humanitarian entrants to the Australian primary health care system, as soon as possible after their arrival in Australia (within twelve months of arrival). 

The health assessment applies to humanitarian entrants who are resident in Australia with access to Medicare services.  This includes Refugees, Special Humanitarian Program and Protection Program entrants with the following visas: 

Offshore Refugee Category including: 

(a) 200 Refugee

(b) 201 In Country Special Humanitarian

(c) 203 Emergency rescue

(d) 204 Women at Risk

(e) Offshore - Special Humanitarian Program

(f) 202 Global Special Humanitarian 

Offshore - Temporary Humanitarian Visas (THV) including: 

(g) Subclass 695 (Return Pending)

(h) Subclass 070 (Removal Pending Bridging) 

Onshore Protection Program including: 

(i) 866 Permanent Protection Visa (PPV)

(j) 785 Temporary Protection Visa (TPV) 

Patients should be asked to provide proof of their visa status and date of arrival in Australia.  Alternatively, general practitioners may telephone the Department of Human Services on 132011, with the patient present, to check eligibility. 

The general practitioner and patient can use the service of a translator by accessing the Commonwealth Government's Translating and Interpreting Service (TIS) and the Doctors Priority Line.  To be eligible for the fee-free TIS and Doctors Priority Line, the medical examiner must be in a private practice and provide a Medicare service to patients who do not speak English and are permanent residents. 

A health assessment for refugees and other humanitarian entrants may only be claimed once by an eligible patient.

Related Items: 701 703 705 707

Category 1 - PROFESSIONAL ATTENDANCES

AN.0.69

Australian Defence Force Post-discharge GP Health Assessment

Items 701, 703, 705 and 707 may be used to undertake a health assessment for a former serving member of the Australian Defence Force, including a former member of permanent and reserve forces.

A health assessment for a former serving member of the Australian Defence Force is an assessment of:

  1. a patient's physical and psychological health and social function; and
  2. whether health care, education and other assistance should be offered to the patient to improve their physical, psychological health or social function.

This health assessment must include:

  1. a personal attendance by a general practitioner; and
  2. taking the patient's history, including the following:
    1. the patient's service with the Australian Defence Force, including service type, years of service, field of work, number of deployments and reason for discharge;
    2. the patient's social history, including relationship status, number of children (if any) and current occupation;
    3. the patient's current medical conditions;
    4. whether the patient suffers from hearing loss or tinnitus;
    5. the patient's use of medication, including medication prescribed by another doctor and medication obtained without a prescription;
    6. the patient's smoking, if applicable;
    7. the patient's alcohol use, if applicable;
    8. the patient's substance use, if applicable;
    9. the patient's level of physical activity;
    10. whether the patient has bodily pain;
    11. whether the patient has difficulty getting to sleep or staying asleep;
    12. whether the patient has psychological distress;
    13. whether the patient has posttraumatic stress disorder;
    14. whether the patient is at risk of harm to self or others;
    15. whether the patient has anger problems;
    16. the patient's sexual health;
    17. any other health concerns the patient has.

The assessment must also include the following:

  1. measuring the patient's height;
  2. weighing the patient and ascertaining, or asking the patient, whether the patient's weight has changed in the last 12 months;
  3. measuring the patient's waist circumference;
  4. taking the patient's blood pressure;
  5. using information gained in the course of taking the patient's history to assess whether any further assessment of the patient's health is necessary;
  6. either making the further assessment or referring the patient to another medical practitioner who can make the further assessment;
  7. documenting a strategy for improving the patient's health;
  8. offering to give the patient a written report of the assessment that makes recommendations for treating the patient including preventive health measures;
  9. keeping a record of the assessment.

A general practitioner may use the 'ADF Post-discharge GP Health Assessment Tool' as a screening tool for the health assessment. This assessment tool can be viewed on the At Ease portal of the Department of Veterans' Affairs' website at: http://at-ease.dva.gov.au. Other assessment tools mentioned in the Department of Veteran's Affairs Mental Health Advice Book may be relevant and can also be viewed on the At Ease portal.

This health assessment may only be claimed once by an eligible patient.

The health assessment must not be performed in conjunction with a separate consultation in relation to the patient unless the consultation is clinically necessary.

The health assessment must be performed by the patient's usual doctor.

Related Items: 701 703 705 707


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