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Category 8 - MISCELLANEOUS SERVICES
82315 - Additional Information
Audiology health service, consisting of an AIR AND BONE CONDUCTION AND SPEECH DISCRIMINATION AUDIOGRAM performed on a person by an eligible audiologist if:
(a) the service is performed pursuant to a written request made by an eligible practitioner to assist the eligible practitioner in the diagnosis and/or treatment and/or management of ear disease or a related disorder in the person; and
(b) the eligible practitioner is:
(i) a specialist in the specialty of otolaryngology head and neck surgery; or
(ii) a specialist or consultant physician in the specialty of neurology; and
(c) the service is not performed for the purpose of a hearing screening; and
(d) the person is not an admitted patient of a hospital; and
(e) the service is performed on the person individually and in person; and
(f) after the service, the eligible audiologist provides a copy of the results of the service performed, together with relevant comments in writing that the eligible audiologist has on those results, to the eligible practitioner who requested the service; and
(g) a service to which item 11315 applies has not been performed on the person on the same day.
Fee: $40.95 Benefit: 85% = $34.85
Category 8 - MISCELLANEOUS SERVICES
Conditions for Audiology Services - (Items 82309 to 82318)
A service specified in Items 82309 to 82318 shall be taken to be a service for the purposes of payment of benefits if, and only if, it is rendered:
(a) in conditions that allow the establishment of determinate thresholds;
(b) in a sound attenuated environment with background noise conditions that comply with Australian Standard
AS/NZS 1269.3-2005; and
(c) using calibrated equipment that complies with Australian Standard AS IEC 60645.1-22002, ASIEC60645.2-2002 and AS IEC 60645.3-2002.
Category 8 - MISCELLANEOUS SERVICES
Provision of Diagnostic Audiology Services by Audiologists - (Items 82300 to 82332)
The diagnostic audiology services available through MBS items 82300 to 82332 enable an eligible audiologist to perform diagnostic tests upon written request from an Ear, Nose and Throat (ENT) specialist (a specialist in the specialty of otolaryngology head and neck surgery); or for some services, a written request from a neurologist (a specialist or consultant physician in the specialty of neurology).
These diagnostic audiology services assist ENT specialists and neurologists in their medical diagnosis and/or treatment and/or management of ear disease or related disorders. The new diagnostic audiology items supplement the existing Otolaryngology items for services delivered by, or on behalf of medical practitioners (MBS items 11300 to 11339, excluding 11304).
Medicare benefits are payable only under the following circumstances:
· For items 82300 and 82306, the written request must be made by an eligible practitioner who is a specialist in the specialty of otolaryngology head and neck surgery;
· For items 82309 to 82332, the written request must be made by an eligible practitioner who is a specialist in the specialty of otolaryngology head and neck surgery or a specialist or consultant physician in the specialty of neurology.
The written request must be in writing and must contain:
(a) the date of the request; and
(b) the name of the eligible practitioner who requested the service and either the address of his or her place of practice or the provider number in respect of his or her place of practice; and
(c) a description of the service which provides sufficient information to identify the service as relating to a particular item (but need not specify the item number).
Written requests should, where possible, note the clinical indication/s for the requested service/s.
A request may be for the performance of more than one diagnostic audiology service making up a single audiological assessment, but cannot be for more than one audiological assessment. This means that for Medicare benefits to be payable, any re-evaluation of the patient should be made at the discretion of the ENT specialist or neurologist through a separate request.
Audiologists do not have the discretion to self-determine diagnostic tests under items 82300 to 82332. If a written request is incomplete or requires clarification, the audiologist should contact the requesting ENT specialist or neurologist for further information. If an audiologist considers that additional tests may be necessary, the audiologist should contact the requesting ENTspecialist or neurologist to discuss the need and if the requesting practitioner determines that additional tests are necessary, an amended or separate written request must be arranged.
It is recommended that audiologists retain the written request for 24 months from the date the service was rendered (for Medicare auditing purposes). A copy of the written request is not required to accompany Medicare claims or be attached to patients' itemised accounts/receipts or assignment of benefit forms.
Eligibility requirements for audiologists
The diagnostic audiology items (82300 to 82332) can only be claimed by audiologists who are registered with the Department of Human Services. To be eligible to register with the Department of Human Services to provide these services, audiologists must meet the following requirements:
Audiologists must be either:
· a 'Full Member' of the Audiological Society of Australia Inc (ASA), who holds a 'Certificate of Clinical Practice' issued by the ASA; or
· an 'Ordinary Member - Audiologist' or 'Fellow Audiologist' of the Australian College of Audiology (ACAud).
Registering with the Department of Human Services
Provider registration forms may be obtained from Medicare on 132 150 or at www.humanservices.gov.au.
Changes to provider details
Audiologists must notify the Department of Human Services in writing of all changes to mailing details to ensure that they continue to receive information about Medicare services.
Where an audiologist provides diagnostic audiology service/s to the patient under a written request, they must provide a copy of the results of the service/s performed together with relevant written comments on those results to the requesting ENT specialist or neurologist. It is recommended that these be provided within 7 days of the date the service was performed.
Out-of-pocket expenses and Medicare Safety Net
Audiologists can determine their own fees for the professional service. Charges in excess of the Medicare benefit are the responsibility of the patient. However, out-of-pocket costs will count toward the Medicare Safety Net for that patient.
Publicly funded services
Items 82300 to 82332 do not apply for services that are provided by any Commonwealth or state funded services or provided to an admitted patient of a hospital. 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 82300 to 82332 can be claimed for services provided by audiologists salaried by, or contracted to, the service or health clinic. All requirements of the relevant item must be met, including registration of the audiologist with the Department of Human Services. Medicare services provided under a subsection 19(2) exemption must be bulk billed (i.e. the Medicare rebate is accepted as full payment for services).
Private health insurance
Patients need to decide if they will use Medicare or their private health insurance ancillary cover to pay for these services. Patients cannot use their private health insurance ancillary cover to 'top up' the Medicare rebate paid for the services.
- 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