Medicare Benefits Schedule - Item 90267

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Category 1 - PROFESSIONAL ATTENDANCES

90267

90267 - Additional Information

Item Start Date:
01-Nov-2019
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Jul-2020

Group
A36 - Eating Disorder Services
Subgroup
3 - Review of eating disorder treatment and management plans

Professional attendance of at least 20 minutes in duration at consulting rooms by a consultant physician in the practice of the consultant physician’s specialty of paediatrics for an eligible patient, if:

(a) the consultant paediatrician reviews the treatment efficacy of services provided under the eating disorder treatment and management plan, including a discussion with the patient regarding whether the eating disorders psychological treatment and dietetic services are meeting the patient’s needs; and

(b) the patient has been referred by a referring practitioner; and

(c) during the attendance, the consultant paediatrician reviews the eating disorder treatment and management plan, including a:

(i) review of initial presenting problems and results of diagnostic investigations; and

(ii) review of responses to treatment and medication plans initiated at time of initial consultation; and

(iii) comprehensive multi or detailed single organ system assessment; and

(iv) review of original and differential diagnoses; and

(d) within 2 weeks after the attendance, the consultant paediatrician:

(i) prepares a written diagnosis of the patient; and

(ii) revises the eating disorder treatment and management; and

(iii) gives the referring practitioner a copy of the diagnosis and the revised management plan; and

(iv) if clinically appropriate, explains the diagnosis and the revised management plan, and gives a copy, to:

(A) the patient; and

(B) is the patient’s carer (if any), if the patient agrees.

Fee: $138.30 Benefit: 85% = $117.60

(See para AN.36.1, AN.36.3, AN.40.1 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $414.90


Associated Notes

Category 1 - PROFESSIONAL ATTENDANCES

AN.36.1

Eating Disorders General Explanatory Notes

Eating Disorders General Explanatory Notes (items 90250-90257, 90260-90269 and 90271-90282)


This note provides a general overview of the full range of 1 November 2019 eating disorders Items and supporting information more specifically on the Category 1 – Professional Attendances: Group A36 – Eating Disorders Services (90250-90257, 90260-90269 and 90271-90282).

It includes an overview of the items, model of care, patient eligibility, and inks to other guidance and resources.

Overview

All 1 November 2019 Eating Disorders new items:

The Eating Disorders items define services for which Medicare rebates are payable where service providers undertake assessment and management of patients with a diagnosis of anorexia nervosa and patients with other specified eating disorder diagnoses who meet the eligibility criteria (see – patient eligibility). It is expected that there will be a multidisciplinary approach to patient management through these items.

The items mean eligible patients are able to receive a Medicare rebate for development of an eating disorders treatment plan by a medical practitioner in general practice (Group A36, subgroup 1), psychiatry or paediatrics (Group A36, subgroup 2). Patients with an eating disorders treatment and management plan (EDP) will be eligible for comprehensive treatment and management services for a 12 month period, including:

  • Up to 20 dietetic services under items 10954, 82350 and 82351.
  • Up to 40 eating disorder psychological treatment services (EDPT service).  
  • Review and ongoing management services to ensure that the patient accesses the appropriate level of intervention (Group A36, subgroup 3).

An EDPT service includes mental health treatment services which are provided by an allied health professional or a medical practitioner in general practice with appropriate mental health training. These treatment services include:

  • Medicare mental health treatment services currently provided to patients under the ‘Better Access to Psychiatrists, Psychologists and General Practitioners through the MBS (‘Better Access’) initiative.
    • This includes medical practitioner items 2721, 2723, 2725, 2727, 283, 285, 286, 287, 371, 372; and
    • This includes allied health items in Groups M6 and M7 of Category 8; and
  • new items for EDPT services provided by suitably trained medical practitioners in general practice (items 90271, 90272, 90273, 90274, 90275, 90276, 90277, 90278, 90279, 90280, 90281, 90282)
  • new items for EDPT services provided by eligible clinical psychologists (items 82352-82359), eligible psychologists (items 82360-82367), eligible occupational therapists (items 82368-82375) and eligible social workers (items 82376-82383)
     

For the purpose of the 40 EDPT count; eating disorder psychological treatment service includes a service under provided under the following items: 90271, 90272, 90273, 90274, 90275, 90276, 90277, 90278, 90279, 90280, 90281, 90282, 2721, 2723, 2725, 2727, 283, 285, 286, 287, 371, 372 and items in Groups M6, M7 and M16 (excluding items 82350 and 82351).

For any particular patient, an eating disorder treatment and management plan expires at the end of a 12 month period following provision of that service. After that period, a patient will require a new EDP to continue accessing EDPT services.

Patient Eligibility

The eating disorder items are available to eligible patients in the community. These items do not apply to services provided to admitted (in-hospital) patients.

The referring practitioner is responsible for determining that a patient is eligible for an EDP and therefore EDPT and dietetic services.

‘Eligible patient’ defines the group of patients who can access the new eating disorder services. There are two cohorts of eligible patients.

  1. Patients with a clinical diagnosis of anorexia nervosa; or
  2. Patients who meet the eligibility criteria (below), and have a clinical diagnosis of any of the following conditions:
    1. bulimia nervosa;
    2. binge-eating disorder;
    3. other specified feeding or eating disorder.

The eligibility criteria, for a patient, is:

  1. a person who has been assessed as having an Eating Disorder Examination Questionnaire score of 3 or more; and
  2. the condition is characterised by rapid weight loss, or frequent binge eating or inappropriate compensatory behaviour as manifested by 3 or more occurrences per week; and
  3. a person who has at least two of the following indicators:
    1. clinically underweight with a body weight less than 85% of expected weight where weight loss is directly attributable to the eating disorder;
    2. current or high risk of medical complications due to eating disorder behaviours and symptoms;
    3. serious comorbid medical or psychological conditions significantly impacting on medical or psychological health status with impacts on function;
    4. the person has been admitted to a hospital for an eating disorder in the previous 12 months;
    5. inadequate treatment response to evidence based eating disorder treatment over the past six months despite active and consistent participation.

Practitioners should have regard to the relevant diagnostic criteria set out in the Diagnostic and Statistical Manual of the American Psychiatric Association – Fifth Edition (DSM-5)

Practitioners can access the Eating Disorder Examination Questionnaire at https://www.credo-oxford.com/pdfs/EDE_17.0D.pdf

The Eating Disorders Items Stepped Model of Care

The eating disorder items incorporate a ‘stepped model’ for best practice care for eligible patients with eating disorders that comprise:

  • assessment and treatment planning
  • provision of and/or referral for appropriate evidence based eating disorder specific treatment services by allied mental health professionals and provision of services by dietitians
  • review and ongoing management items to ensure that the patient accesses the appropriate level of intervention.

The Stepped Model

‘STEP 1’ – PLANNING (trigger eating disorders pathway) 90250-90257 and 90260-90263

An eligible patient receives an eating disorder plan (EDP) developed by a medical practitioner in general practice (items 90250-90257), psychiatry (items 90260-90262) or paediatrics (items 90261-90263).

 ‘STEP 2’ – COMMENCE INITIAL COURSE OF TREATMENT (psychological & dietetic services)

Once an eligible patient has an EDP in place, the 12 month period commences, and the patient is eligible for an initial course of treatment up to 20 dietetic services and 10 eating disorder psychological treatment (EDPT) services. A patient will be eligible for an additional 30 EDPT services in the 12 month period, subject to reviews from medical practitioners to determine appropriate intensity of treatment.

 ‘STEP 3” – CONTINUE ON INITIAL COURSE OF TREATMENT 90264-90269 (managing practitioner review and progress up to 20 EDPT services)

It is expected that the managing practitioner will be reviewing the patient on a regular, ongoing and as required basis. However, a patient must have a review of the EDP (90264-90269), to assess the patient’s progress against the EDP or update the EDP, before they can access more than 10 EDPT services. This is known as the ‘first review’. The first review should be provided by the patient’s managing practitioner, where possible.

‘STEP 4’ FORMAL SPECIALIST AND PRACTITIONER REVIEW 90266-90269 (continue beyond 20 EDPT services)

A patient must have two additional reviews before they can access more than 20 EDPT services. One review (the ‘second review’) must be performed by a medical practitioner in general practice (who is expected to be the managing practitioner), and the other (the ‘third review’) must be performed by a paediatrician (90267 or 90269) or psychiatrist (90266 or 90268). Should both recommend the patient requires more intensive treatment, the patient would be able to access an additional 10 EDPT services in the 12 month period. These reviews are required to determine that the patient has not responded to treatment at the lower intensity levels.

The patient’s managing practitioner should be provided with a copy of the specialist review.

The specialist review by the psychiatrist or paediatrician can occur at any point before 20 EDPT services. The practitioner should refer the patient for specialist review as early in the treatment process as appropriate. If the practitioner is of the opinion that the patient should receive more than 20 EDPT services, the referral should occur at the first practitioner review (after the first course of treatment) if it has not been initiated earlier.

Practitioners should be aware that the specialist review can be provided via telehealth (90268 and 90269). Where appropriate, provision has been made for practitioner participation on the patient-end of the telehealth consultation.

It is expected that the managing practitioner will be reviewing the patient on a regular, ongoing and as required basis. However, a patient must have a review of the EDP (90264-90269), to assess the patient’s progress against the EDP or update the EDP, before they can access the next course of treatment.

‘STEP 5’ ACCESS TO MAXIMUM INTENSITY OF TREATMENT 90266-90269 (continue beyond 30 EDPT services)

To access more than 30 EDPT treatment services in the 12 month period, patients are required to have an additional review (the ‘fourth review’) to ensure the highest intensity of treatment is appropriate. Subject to this review, a patient could access the maximum of 40 EDPT treatment services in a 12 month period. The fourth review should be provided by the patient’s managing practitioner, where possible. 

An Integrated Team Approach

A patient’s family and/or carers should be involved in the treatment planning and discussions where appropriate. The family can be involved in care options throughout the diagnosis and assessment, and are usually the support unit that help to bridge the gap between initial diagnosis and eating disorder specific treatment.

The National Standards for the safe treatment of eating disorders specify a multi-disciplinary treatment approach that provides coordinated psychological, physical, behavioural, nutritional and functional care to address all aspects of eating disorders. People with eating disorders require integrated inter-professional treatment that is able to work within a framework of shared goals, care plans and client and family information. Frequent communication is required between treatment providers to prevent deterioration in physical and mental health (RANZCP Clinical Guidelines: Hay et al., 2014). Consider regular case conferencing to ensure that the contributing team members are able to work within a shared care plan and with client and carers to achieve best outcomes.

Clinical guidelines and other resources

It is expected that the consultants providing services under these items should have the appropriate skills, knowledge and experience to provide eating disorders treatment. However, there are a number of resources which may be of assistance to practitioners in supporting and developing eating disorders treatment plans, these include:

Note: This information is provided as a guide only and each case should be addressed according to a patient's individual needs. An electronic version of the Guidelines is available on the RANZCP website at www.ranzcp.org

National Eating Disorders Collaboration Eating Disorders: a professional resources for general practitioners available at www.nedc.com.au

Eating Disorders Training

It is expected that practitioners who are providing services under these items have appropriate training, skills and experience in treatment of patients with eating disorders and meet the national workforce core competencies for the safe and effective identification of and response to eating disorders more information available at National Eating Disorders Collaboration

Training Services

Practitioners should contact their professional organisation to identify education and training which may assist to practitioners to gain the skills and knowledge to provide services under these items.

The following organisations provide training which may assist practitioners to meet the workforce competency standards:

  • The Australia and New Zealand Academy of eating disorders (ANZAED) - National
  • InsideOut Institute - National
  • The Victorian Centre of Excellence in Eating Disorders (CEED) - VIC
  • Queensland Eating Disorder Service (QuEDS) - QLD
  • Statewide Eating Disorder Service (SEDS) - SA
  • WA Eating Disorders Outreach & Consultation Service (WAEDOCS) – WA

This list is not exhaustive, but has been included to provide examples on the types of training available which may assist practitioners to upskill in this area.

 

Related Items: 90250 90251 90252 90253 90254 90255 90256 90257 90260 90261 90262 90263 90264 90265 90266 90267 90268 90269 90271 90272 90273 90274 90275 90276 90277 90278 90279 90280 90281 90282

Category 1 - PROFESSIONAL ATTENDANCES

AN.36.3

Eating Disorders Treatment and Management Plan Reviews

Eating Disorders Treatment and Management Plan Reviews (items 90264-90269)

This note provides information on Eating Disorders Treatment and Management Plan (EDP) review items and should be read in conjunction with the AN.36.1 Eating Disorders General Explanatory Notes and the AN.36.2 Eating Disorders Treatment and Management Plans Explanatory Notes

Eating Disorder Treatment Plan review (EDR) items overview

The EDR items define services for which Medicare rebates are payable where practitioners undertake to review the efficacy of the patient’s eating disorder treatment and management plan (EDP). This includes modifying the patient’s plan, where appropriate, to improve patient outcomes. The review services can be provided by medical practitioners working in general practice, psychiatry and paediatrics.

An EDR may be provided by the managing practitioner who prepared the patient's initial plan (or another practitioner in the same practice or in another practice where the patient has changed practices) and should include a systematic review of the patient's progress against the initial EDP (whether it was prepared by a GP, psychiatrist or paediatrician) and by completing the activities that must be included in a review (see below).

When to render an EDR review item

It is expected that the managing practitioner will be reviewing the patient on a regular, ongoing and as required basis. However, a patient must have a review of the EDP to assess the patient’s progress against the EDP or update the EDP, as the patient is approaching the end of each course of treatment before they can access the next course of treatment.

The eating disorder items incorporate a ‘stepped model’ for best practice care for eligible patients with eating disorders. Under the Eating Disorders Items Stepped Model of Care a course of treatment is defined as 10 eating disorder psychological treatment (EDPT) services. It is required that a patient must have a review after each course of treatment (see AN.36.1 Eating Disorders General Explanatory Notes). 

Reviewing an Eating Disorders Treatment Plan

The EDR must include:

  • recording the patient's agreement for this service;
  • referral to a psychiatrist or paediatrician for review under items 90266-90269, if this has not been initiated at an earlier stage;
  • a review of the patient's progress against the goals outlined in the EDP, including discussion with the patient/and or their family/carer as to whether the EDPT services are meeting their needs;
  • modification of the documented EDP if required;
  • checking, reinforcing and expanding education;
  • a plan for crisis intervention and/or for relapse prevention, if appropriate and if not previously provided; and
  • reviewing reports back from the allied mental health professional on the patient’s response to treatment and documenting a recommendation on whether patient should continue with another course of EDPT services with that health professional or another health professional.
     

Where a consultant psychiatrist or paediatrician provides an EDR, the consultant physician must give the referring practitioner a copy of the diagnosis and the revised EDP within 2 weeks after the attendance. Where a consultant psychiatrist provides an EDR service, the review must also include:

  • administering an outcome measurement tool, where clinically appropriate. The choice of outcome tool to be used is at the clinical discretion of the practitioner. Practitioners using such tools should be familiar with their appropriate clinical use, and if not, should seek appropriate education and training; and
  • conducting a mental state examination.

Note: It is expected there will be other consultations between the patient and the managing practitioner as part of ongoing patient and medical management, including the ordering and reviewing of the required testing for monitoring the patients’ medical and nutritional status. All other ongoing patient reviews should be claimed under the appropriate item.

Checking patient eligibility for services

Note: The 12 month period commences from the date of the EDP.

To provide an EDR service in items 90264-90269, the patient must have had an EDP 90250-90257 or 90260-90263 in the previous 12 months.

If the EDP service has not yet been claimed, the Department of Human Services will not be aware of the patient's eligibility. In this case the practitioner should, with the patient's permission, contact the referring practitioner to ensure the relevant service has been provided to the patient.

Support:

If there is any doubt about whether a patient has had a claim for an eating disorder service, health professionals can access the Health Professionals Online System (HPOS). HPOS is a fast and secure way for health professionals and administrators to check if a patient is eligible for a Medicare benefit for a specific item on the date of the proposed service. However, this system will only return advice that the service/item is payable or not payable.

Patients can also access their own claiming history with a My Health Record or by establishing a Medicare online account through myGov or the Express Plus Medicare mobile app.

Alternatively, health professionals can call the Department of Human Services on 132 150 to check this information, while patients can seek clarification by calling 132 011.

 Additional Claiming Information (general conditions and limitations)

Items 90264- 90265 cannot be claimed with item 2713 and 279.

Consultant psychiatrist and paediatrician EDP items 90266- 90269 do not apply if the patient does not have a referral within the period of validity.

Before proceeding with the EDR service the medical practitioner must ensure that:

(a) the steps involved in providing the service are explained to the patient and (if appropriate and with the patient's permission) to the patient's carer; and

(b) the patient's agreement to proceed is recorded.

 The medical practitioner must offer the patient a copy of the reviewed EDP and add the document to the patient's records. This should include, subject to the patient's agreement, offering a copy to their carer, where appropriate. The medical practitioner may, with the permission of the patient, provide a copy of the revised EDP, or relevant parts of the plan, to other providers involved in the patient's treatment.

The medical practitioner EDR items cover the service of reviewing an EDP. A separate consultation item can be performed with the EDP if the patient is treated for an unrelated condition to their eating disorder. Where a separate consultation is performed, it should be annotated separately on the patient’s account that a separate consultation was clinically required/indicated.

All consultations conducted as part of the EDP or review must be rendered by the medical practitioner and include a personal attendance with the patient. A specialist mental health nurse, other allied health practitioner, Aboriginal and Torres Strait Islander health practitioner or Aboriginal Health Worker with appropriate mental health qualifications and training may provide general assistance to the medical practitioner in provision of this care.

Additional Claiming Information (interaction with Better Access)

Items 90264-90265 for an EDR, performed by a medical practitioner working in general practice, should not be performed in association with a GP mental health consultation review service (item 2712 and 277).

 

 

Related Items: 90264 90265 90266 90267 90268 90269

Category 1 - PROFESSIONAL ATTENDANCES

AN.40.1

COVID-19 Specialist and Consultant Physician MBS Telehealth and Telephone attendance items

COVID-19 MBS telehealth and telephone attendance items by specialist, consultant physician, consultant psychiatrist, neurosurgery, public health medicine, geriatrician, paediatrician and anaesthetist (ceases on 30 September 2020 unless revoked earlier).

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


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