Saturday, 30 August, 2014


Medicare Benefits Schedule - Note A25

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Category 1 - PROFESSIONAL ATTENDANCES
A25  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.

 

Medical 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 Healthy Kids Check for children aged at least 3 years and less than 5 years of age, who have received or who are receiving their 4 year old immunisation

Once only to an eligible patient

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:

(a)                information collection, including taking a patient history and undertaking or arranging examinations and investigations as required;

(b)                making an overall assessment of the patient;

(c)                 recommending appropriate interventions;

(d)                providing advice and information to the patient;

(e)                 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

(f)                 offering the patient's carer (if any, and if the medical 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 medical practitioner (including a general practitioner but not including a specialist or consultant physician).

 

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 medical practitioner, or a medical 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.

 

MBS health assessment items 701, 703, 705, 707 must be provided by a medical 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 medical practitioners in performing health assessments.  Such assistance must be provided in accordance with accepted medical practice and under the supervision of the medical practitioner.  This may include activities associated with:

 

-  information collection; and

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

 

The medical 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.

 

Medical 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 exceptions are:

(a)                a health assessment provided as a Healthy Kids Check, where a consultation associated with the four year old immunisation can be conducted on the same occasion; and

(b)                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 medical 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
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Related Items


HEALTH ASSESSMENTS

The category of people eligible for health assessments are :

a)     Healthy Kids Check for children who have received or are receiving their four year old immunisation

b)     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

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

d)     People aged 75 years and older

e)     Permanent residents of a Residential Aged Care Facility

f)     People who have an intellectual disability

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

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

Category 1 - PROFESSIONAL ATTENDANCES
701  More information  

HEALTH ASSESSMENT - BRIEF

Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) to perform a brief health assessment, lasting not more than 30 minutes and, including:

a)    Collection of relevant information, including taking a patient history;

b)    A basic physical examination;

c)    Initiating interventions and referrals as indicated; and

d)    Providing the patient with preventive health care advice and information.


Fee: $59.35 Benefit: 100% = $59.35
(See para A25, A26, A27, A28, A29, A30, A31, A32, A59 of explanatory notes to this Category)
Category 1 - PROFESSIONAL ATTENDANCES
703  More information  

HEALTH ASSESSMENT - STANDARD

Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) to perform a standard health assessment, lasting more than 30 minutes but less than 45 minutes, including:

a)    Detailed information collection, including taking a patient history;

b)    An extensive physical examination;

c)    Initiating interventions and referrals as indicated; and

d)    Providing a preventive health care strategy for the patient.


Fee: $137.90 Benefit: 100% = $137.90
(See para A25, A26, A27, A28, A29, A30, A31, A32, A59 of explanatory notes to this Category)
Category 1 - PROFESSIONAL ATTENDANCES
705  More information  

HEALTH ASSESSMENT - LONG

Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) 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;

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

c)    Initiating interventions and referrals as indicated; and

d)    Providing a basic preventive health care management plan for the patient.


Fee: $190.30 Benefit: 100% = $190.30
(See para A25, A26, A27, A28, A29, A30, A31, A32, A59 of explanatory notes to this Category)
Category 1 - PROFESSIONAL ATTENDANCES
707  More information  

HEALTH ASSESSMENT - PROLONGED

Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) to perform a prolonged health assessment, lasting at least 60 minutes, including:

a)    Comprehensive information collection, including taking a patient history;

b)    An extensive examination of the patient's medical condition, and physical, psychological and social function.

c)    Initiating interventions and referrals as indicated; and

d)    Providing a comprehensive preventive health care management plan for the patient.


Fee: $268.80 Benefit: 100% = $268.80
(See para A25, A26, A27, A28, A29, A30, A31, A32, A59 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