Medicare Benefits Schedule - Note A18

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Category 1 - PROFESSIONAL ATTENDANCES

A18

Acupuncture (Item 173, 193, 195, 197 and 199)

A

The service of "acupuncture" must be performed by a medical practitioner and itemised under item 173, 193, 195, 197 or 199 to attract benefits. These items cover not only the performance of the acupuncture but include any consultation on the same occasion and any other attendance on the same day for the condition for which acupuncture was given.

 

Items 193, 195, 197 and 199 may only be performed by a general practitioner, (see Note 4 of 'Medicare Benefit Arrangements' for a definition) if the Medicare Australia CEO has received a written notice from the Royal Australian College of General Practitioners (RACGP) stating that the person meets the skills requirements for providing services to which the items apply.

 

Other items in Category 1 of the Schedule should not be itemised for professional attendances when the service "acupuncture" is provided.

 

For the purpose of payment of Medicare benefits "acupuncture" is interpreted as including treatment by means other than the use of acupuncture needles where the same effect is achieved without puncture, eg by application of ultrasound, laser beams, pressure or moxibustion, etc.

 

For more information on the content-based item structure used in this Group, see A.5 in the explanatory notes.

 

Related Items: 173 193 195 197 199


Related Items


LEVEL C

Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 20 minutes, including any of the following that are clinically relevant:

a)     taking a detailed patient history;

b)     performing a clinical examination;

c)     arranging any necessary investigation;

d)     implementing a management plan;

e)     providing appropriate preventive health care;

in relation to 1 or more health-related issues, with appropriate documentation.

Category 1 - PROFESSIONAL ATTENDANCES

197

197 - Additional Information

Item Start Date:
01-May-2003
Description Start Date:
01-May-2010
Schedule Fee Start Date:
01-Jul-2014

Professional attendance by a general practitioner who is a qualified medical acupuncturist, at a place other than a hospital, lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health-related issues, with appropriate documentation, at which acupuncture is performed by the qualified medical acupuncturist by the application of stimuli on or through the skin by any means, including any consultation on the same occasion and another attendance on the same day related to the condition for which the acupuncture is performed

Fee: $71.70 Benefit: 100% = $71.70

(See para A5, A18 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

173

173 - Additional Information

Item Start Date:
01-Dec-1991
Description Start Date:
01-May-2010
Schedule Fee Start Date:
01-Nov-1994


Professional attendance at which acupuncture is performed by a medical practitioner by application of stimuli on or through the surface of the skin by any means, including any consultation on the same occasion and another attendance on the same day related to the condition for which the acupuncture was performed

Fee: $21.65 Benefit: 75% = $16.25 100% = $21.65

(See para A18 of explanatory notes to this Category)


LEVEL B

Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting less than 20 minutes, including any of the following that are clinically relevant:

a)     taking a patient history;

b)     performing a clinical examination;

c)     arranging any necessary investigation;

d)     implementing a management plan;

e)     providing appropriate preventive health care;

in relation to 1 or more health-related issues, with appropriate documentation.

Category 1 - PROFESSIONAL ATTENDANCES

193

193 - Additional Information

Item Start Date:
01-Nov-1998
Description Start Date:
01-May-2010
Schedule Fee Start Date:
01-Jul-2014

Professional attendance by a general practitioner who is a qualified medical acupuncturist, at a place other than a hospital, lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health-related issues, with appropriate documentation, at which acupuncture is performed by the qualified medical acupuncturist by the application of stimuli on or through the skin by any means, including any consultation on the same occasion and another attendance on the same day related to the condition for which the acupuncture is performed

Fee: $37.05 Benefit: 100% = $37.05

(See para A5, A18 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

195

195 - Additional Information

Item Start Date:
01-Nov-1998
Description Start Date:
01-Jan-2013
Schedule Fee Start Date:
01-Jul-2014


Professional attendance by a general practitioner who is a qualified medical acupuncturist, on one or more patients at a hospital, lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health-related issues, with appropriate documentation, at which acupuncture is performed by the qualified medical acupuncturist by the application of stimuli on or through the skin by any means, including any consultation on the same occasion and another attendance on the same day related to the condition for which the acupuncture is performed

The fee for item 193, plus $25.95 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 193 plus $2.00 per patient.
Ready Reckoner

(See para A5, A18 of explanatory notes to this Category)


LEVEL D

Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 40 minutes, including any of the following that are clinically relevant:

a)     taking an extensive patient history;

b)     performing a clinical examination;

c)     arranging any necessary investigation;

d)     implementing a management plan;

e)     providing appropriate preventive health care;

in relation to 1 or more health-related issues, with appropriate documentation.

Category 1 - PROFESSIONAL ATTENDANCES

199

199 - Additional Information

Item Start Date:
01-May-2003
Description Start Date:
01-May-2010
Schedule Fee Start Date:
01-Jul-2014

Professional attendance by a general practitioner who is a qualified medical acupuncturist, at a place other than a hospital, lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health-related issues, with appropriate documentation, at which acupuncture is performed by the qualified medical acupuncturist by the application of stimuli on or through the skin by any means, including any consultation on the same occasion and another attendance on the same day related to the condition for which the acupuncture is performed

Fee: $105.55 Benefit: 100% = $105.55

(See para A5, A18 of explanatory notes to this Category)


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