Medicare Benefits Schedule - Note AN.0.25

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Category 1 - PROFESSIONAL ATTENDANCES

AN.0.25

Attendance services for eligible disabilities

Intention and eligibility of this service under item 137 and telehealth equivalent item 92141

Items 137 or telehealth equivalent item 92141 are intended for diagnosis and treatment for patients under 25 years of age with an eligible disability by a specialist or consultant physician.

Definition of Eligible Disabilities is found at AR.29.1.

Referral pathways:

Early identification of, and intervention for, individuals with eligible disabilities is important in promoting positive longer-term outcomes. Symptoms can cause clinically significant impairment in social, occupational or other important areas of functioning.

Where indications of eligible disability concerns have been identified and brought to the attention of the patient’s GP to initially assess these concerns and the GP considers there are persisting indications that require more specialised assessment, they are encouraged to refer to a specialist or consultant physician for a comprehensive assessment.

Diagnostic Assessment:

The assessment and diagnosis of an eligible disability should be evaluated in the context of both a physical and developmental assessment. The specialist or consultant physician may require a number of separate attendances (through usual time-tiered or subsequent attendance items 104, 105, 110, 116, 119, 296, 297, 299, 300, 302, 304, 306, 308, 310, 312, 314, 316, 318, 319, 320, 324, 326, 328, 330, 332, 334, 336, 338, 341, 342, 343, 344, 345, 346, 347 or 349 or telehealth items 91822 to 91831, 91833, 91836 to 91839, 91868 to 91878 to 91882 to 91884, 92437 or 92455 to 92460) to complete a comprehensive accurate assessment and formulate a diagnosis, exclude other disorders or assess for co-occurring conditions.

Multi-disciplinary assistance with assessment and/or contribution to the treatment and management plan:

Depending on a range of factors, not limited to the patient’s age and nature of suspected disabilities, the specialist or consultant physician may require a multi-disciplinary approach to complete a comprehensive accurate assessment and formulate a diagnosis. 

Where the specialist or consultant physician determines the patient requires additional assessments to formulate a diagnosis, through the assistance of an Allied Health practitioner, they are able to refer the patient to an eligible Allied Health practitioner from standard attendance items 104, 105, 110, 116, 119, 296, 297, 299, 300, 302, 304, 306, 308, 310, 312, 314, 316, 318, 319, 320, 324, 326, 328, 330, 332, 334, 336, 338, 341, 342, 343, 344, 345, 346, 347 or 349 or telehealth items 91822 to 91831, 91833, 91836 to 91839, 91868 to 91878 to 91882 to 91884, 92437 or 92455 to 92460.

Whilst MBS items provide for a total of 8 Allied Health assessment services per patient per lifetime, an eligible Allied Health practitioner can only provide up to 4 services before the need for a review (the type of review can be specified in the referral to the eligible Allied Health practitioner) by the referring specialist or consultant physician, who must agree to the need for any additional Allied Health services prior to the delivery of the remaining 4 Allied Health assessment services.

Eligible Allied Health assessment practitioners include:

  • Psychologist (MBS item 82000, 93032, 93040)
  • Speech Pathologist (MBS item 82005, 93033, 93041)
  • Occupational Therapist (MBS item 82010, 93033, 93041)
  • Audiologist, Optometrist, Orthoptist, Physiotherapist (MBS item 82030, 93033, 93041)

Requirements of the referral to Allied Health practitioners

The specialist or consultant physician can refer to multiple eligible Allied Health practitioners concurrently, but a separate referral letter must be provided to each Allied Health practitioner. The referral should specify the intent of the assessment and if appropriate, specify the number of services to be provided. Where the number of sessions is not specified, each Allied Health practitioner can provide up to 4 assessment services without the need for review or agreement to provide further assessment services. 

Review requirements following delivery of 4 Allied Health assessment services

Where an eligible Allied Health practitioner has provided 4 assessment services (through items 82000, 82005, 82010, 82030, 93032, 93033, 93040 or 93041) and considers additional assessment services are required, they must ensure the referring specialist or consultant physician undertakes a review. If the type of review is not specified by the referring specialist or consultant physician an acceptable means of review includes: a case conference, phone call, written correspondence, secure online messaging exchange or attendance of the patient with the referring psychiatrist.

Inter-disciplinary Allied Health referral

Eligible Allied Health practitioners are also able to make inter-disciplinary referrals to other eligible Allied Health practitioners as clinically necessary to assist with the formulation of the diagnosis or contribute to the treatment and management plan. Inter-disciplinary referrals must be undertaken in consultation and agreement with the referring specialist or consultant physician.  Whilst they do not require the need for an attendance with the patient (face-to-face or telehealth) by the referring specialist or consultant physician, they do require an agreement from the referring specialist or consultant physician. This can be undertaken (but is not limited to) an exchange by phone, written communication or secure online messaging.

Contribution to the treatment and management plan through Allied Health referral

In addition to referring to Allied Health practitioners for assistance with formulating a diagnosis, once the specialist or consultant physician makes a diagnosis, the specialist or consultant physician may require the contribution of an eligible Allied Health practitioner to assist with the development of the treatment and management plan (before billing item 137 or 92141).

MBS items 82000, 82005, 82010, 82030, 93032[BJ1] , 93033, 93040 or 93041 provide a dual function for this purpose. It is important to note that the service limit of a total of 8 services per patient per lifetime apply regardless of whether the items are used for assistance with diagnosis or contribution to the treatment and management plan, and the referring specialist or consultant physician should be mindful of this when referring to eligible Allied Health practitioners.

Development of the treatment and management plan

Once the specialist or consultant physician has made a diagnosis of an eligible disability, to complete the item requirements of item 137 or 92141 they must develop a treatment and management plan which includes:

  • Written documentation of the patient’s confirmed diagnosis of an eligible disability, including any findings of assessments performed (which assisted with the formulation of the diagnosis or contributed to the treatment and management plan)
  • A risk assessment which means assessment of:

o the risk to the patient of a contributing co‑morbidity and

o environmental, physical, social and emotional risk factors that may apply to the patient or to another individual.

  • Treatment options which:

o Recommendations using a biopsychosocial model

o Identify major treatment goals and important milestones and objectives

o Recommendation and referral for treatment services provided by eligible Allied Health practitioners (where relevant) and who should provide this, specifying number of treatments recommended (to a maximum of 20 treatment services)

o  Indications for review or episodes requiring escalation of treatment strategies

  • Documenting the treatment and management plan and providing a copy to the referring medical practitioner and relevant Allied Health practitioner/s.

Referral for Allied Health treatment services

Once a treatment and management plan is in place (after item 137 or 92141 has been claimed) the specialist or consultant physician can refer the individual to eligible Allied Health practitioners for the provision of treatment services. Treatment services address the functional impairments identified through the comprehensive medical assessment which are outlined in the treatment and management plan. Treatment services focus on interventions to address developmental delays/disabilities or impairments.

Eligible Allied Health treatment practitioners include:

  • Psychologist (MBS items 82015, 93035, 93043)
  • Speech Pathologist (MBS items 82020, 93036, 93044)
  • Occupational Therapist (MBS items 82025, 93036, 93044)
  • Audiologist, Optometrist, Orthoptist, Physiotherapist (MBS items 82035, 93036, 93044)

A total of 20 Allied Health treatment services per patient per lifetime are available through the MBS, which may consist of any combination of items 82015, 82020, 82025 or 82035 or equivalent telehealth items. Whilst the specialist or consultant physician can refer to multiple eligible Allied Health practitioners concurrently, a separate referral letter must be provided to each Allied Health practitioner.

The referral must specify the goals of the treatment and if appropriate, specify the number of services to be provided. It is the responsibility of the referring psychiatrist to allocate the number of treatment services (up to a maximum of 10 services per course of treatment) in keeping with the individual’s treatment and management plan.

It is important to note, that a benefit will not be paid for the MBS Allied Health treatment services unless the pre-requisite items (137 or 92141) have been processed through the Medicare claiming system.

On the completion of a “course of treatment” (specified by the referring specialist or consultant physician, up to maximum of 10 services), the eligible Allied Health practitioner must provide a written report to the referring specialist or consultant physician, which must include information on the treatment provided, recommendations for future management of the individual’s disorder and any advice to caregivers (such as parents, carers, schoolteachers). This written report will inform the referring specialist or consultant physician’s decision to refer for further treatment services. Where subsequent courses of treatment after the initial 10 services are required (up to a maximum of 20 services per patient per lifetime) a new referral is required.

Related Items: 104 105 110 116 119 137 296 297 299 300 302 304 306 308 310 312 314 316 318 319 320 324 326 328 330 332 334 336 338 342 344 346 82000 82005 82010 82015 82020 82025 82030 82035 91822 91831 91833 91836 91839 92141 92437 92455 93032 93033 93035 93036 93040 93041 93043 93044


Related Items

Category 1 - PROFESSIONAL ATTENDANCES

104

104 - Additional Information

Item Start Date:
01-Nov-1990
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Nov-2023

Professional attendance at consulting rooms or hospital by a specialist in the practice of the specialist's specialty after referral of the patient to the specialist-each attendance, other than a second or subsequent attendance, in a single course of treatment, other than a service to which item 106, 109 or 16401 applies

Fee: $95.60 Benefit: 75% = $71.70 85% = $81.30

(See para AN.0.7, AN.0.25, AN.0.76, AN.2.1, AN.40.1, TN.1.4 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

105

105 - Additional Information

Item Start Date:
01-Nov-1990
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Nov-2023

Professional attendance by a specialist in the practice of the specialist's specialty following referral of the patient to the specialist-an attendance after the first in a single course of treatment, if that attendance is at consulting rooms or hospital, other than a service to which item 16404 applies

Fee: $48.05 Benefit: 75% = $36.05 85% = $40.85

(See para AN.0.7, AN.0.25, AN.0.70, AN.2.1, AN.3.1, AN.40.1, TN.1.4 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

137

137 - Additional Information

Item Start Date:
01-Jul-2011
Description Updated:
01-Mar-2023
Schedule Fee Updated:
01-Nov-2023

Professional attendance lasting at least 45 minutes by a specialist or consultant physician (not including a general practitioner), following referral of the patient to the specialist or consultant physician by a referring practitioner, for a patient aged under 25, if the specialist or consultant physician:

(a) undertakes, or has previously undertaken in prior attendances, a comprehensive assessment in relation to which a diagnosis of an eligible disability is made (if appropriate, using information provided by an eligible allied health provider); and

(b) develops a treatment and management plan, which must include:

(i) documentation of the confirmed diagnosis; and

(ii) findings of any assessments performed for the purposes of formulation of the diagnosis or contribution to the treatment and management plan; and

(iii) a risk assessment; and

(iv) treatment options (which may include biopsychosocial recommendations); and

(c) provides a copy of the treatment and management plan to:

(i) the referring practitioner; and

(ii) one or more allied health providers, if appropriate, for the treatment of the patient;

(other than attendance on a patient for whom payment has previously been made under this item or item 135, 139, 289, 92140, 92141, 92142 or 92434)

Applicable only once per lifetime

Fee: $294.85 Benefit: 75% = $221.15 85% = $250.65

(See para AN.0.25, AN.40.1, AR.29.1 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

91833

91833 - Additional Information

Item Start Date:
13-Mar-2020
Description Updated:
20-Apr-2020
Schedule Fee Updated:
01-Nov-2023

Phone attendance for a person by a specialist in the practice of the specialist’s specialty if:

(a)           the attendance follows referral of the patient to the specialist; and

(b)           the attendance was of more than 5 minutes in duration. 

Where the attendance is after the first attendance as part of a single course of treatment.

 

 

Fee: $48.05 Benefit: 85% = $40.85

(See para AN.0.7, AN.0.25, AN.0.70, AN.3.1, AN.40.1 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

82000

82000 - Additional Information

Item Start Date:
01-Mar-2024
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Psychology health service provided to a patient aged under 25 years by an eligible psychologist if:

(a)    the patient was referred by an eligible medical practitioner, or by an eligible allied health practitioner following referral by an eligible medical practitioner, to:

(i)   assist the eligible medical practitioner with diagnostic formulation where the patient has a suspected complex neurodevelopmental disorder or eligible disability; or

(ii)  contribute to the patient’s treatment and management plan developed by the referring eligible medical practitioner where a complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability is confirmed; and

(b)    the service is provided to the patient individually and in person; and

(c)    the service is at least 50 minutes duration

Up to 4 services to which this item or any of items 82005, 82010, 82030, 93032, 93033, 93040 or 93041 apply may be provided to the same patient on the same day

Fee: $109.80 Benefit: 85% = $93.35

(See para AN.0.25, MN.10.1, MN.10.3 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

82005

82005 - Additional Information

Item Start Date:
01-Mar-2024
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Speech pathology health service provided to a patient aged under 25 years by an eligible speech pathologist if:

(a)    the patient was referred by an eligible medical practitioner, or by an eligible allied health practitioner following referral by an eligible medical practitioner, to:

(i)   assist the eligible medical practitioner with diagnostic formulation where the patient has a suspected complex neurodevelopmental disorder or eligible disability; or

(ii)  contribute to the patient’s treatment and management plan developed by the referring eligible medical practitioner where a complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability is confirmed; and

(b)    the service is provided to the patient individually and in person; and

(c)    the service is at least 50 minutes duration

Up to 4 services to which this item or any of items 82000, 82010, 82030, 93032, 93033, 93040 or 93041 apply may be provided to the same patient on the same day

Fee: $96.80 Benefit: 85% = $82.30

(See para AN.0.25, MN.10.1, MN.10.3 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

82010

82010 - Additional Information

Item Start Date:
01-Mar-2024
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Occupational therapy health service provided to a patient aged under 25 years by an eligible occupational therapist if:

(a)    the patient was referred by an eligible medical practitioner, or by an eligible allied health practitioner following referral by an eligible medical practitioner, to:

(i)   assist the eligible medical practitioner with diagnostic formulation where the patient has a suspected complex neurodevelopmental disorder or eligible disability; or

(ii)  contribute to the patient’s treatment and management plan developed by the referring eligible medical practitioner where a complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability is confirmed; and

(b)    the service is provided to the patient individually and in person; and

(c)    the service is at least 50 minutes duration

Up to 4 services to which this item or any of items 82000, 82005, 82030, 93032, 93033, 93040 or 93041 apply may be provided to the same patient on the same day

Fee: $96.80 Benefit: 85% = $82.30

(See para AN.0.25, MN.10.1, MN.10.3 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

82015

82015 - Additional Information

Item Start Date:
01-Mar-2024
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Psychology health service provided to a patient aged under 25 years for the treatment of a diagnosed complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability by an eligible psychologist, if:

(a)    the patient has a treatment and management plan in place and has been referred by an eligible medical practitioner for a course of treatment consistent with that treatment and management plan; and

(b)    the service is provided to the patient individually and in person; and

(c)    the service is at least 30 minutes duration; and

(d)    on the completion of the course of treatment, the eligible psychologist gives a written report to the referring eligible medical practitioner on assessments (if performed), treatment provided and recommendations on future management of the patient’s condition

Up to 4 services to which this item or any of items 82020, 82025, 82035, 93035, 93036, 93043 or 93044 apply may be provided to the same patient on the same day

Fee: $109.80 Benefit: 85% = $93.35

(See para AN.0.25, MN.10.2, MN.10.3 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

82020

82020 - Additional Information

Item Start Date:
01-Mar-2024
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Speech pathology health service provided to a patient aged under 25 years for the treatment of a diagnosed complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability by an eligible speech pathologist, if:

(a)    the patient has a treatment and management plan in place and has been referred by an eligible medical practitioner for a course of treatment consistent with that treatment and management plan; and

(b)    the service is provided to the patient individually and in person; and

(c)    the service is at least 30 minutes duration; and

(d)    on the completion of the course of treatment, the eligible speech pathologist gives a written report to the referring eligible medical practitioner on assessments (if performed), treatment provided and recommendations on future management of the patient’s condition

Up to 4 services to which this item or any of items 82015, 82025, 82035, 93035, 93036, 93043 or 93044 apply may be provided to the same patient on the same day

Fee: $96.80 Benefit: 85% = $82.30

(See para AN.0.25, MN.10.2, MN.10.3 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

82025

82025 - Additional Information

Item Start Date:
01-Mar-2024
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Occupational therapy health service provided to a patient aged under 25 years for the treatment of a diagnosed complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability by an eligible occupational therapist, if:

(a)    the patient has a treatment and management plan in place and has been referred by an eligible medical practitioner for a course of treatment consistent with that treatment and management plan; and

(b)    the service is provided to the patient individually and in person; and

(c)    the service is at least 30 minutes duration; and

(d)    on the completion of the course of treatment, the eligible occupational therapist gives a written report to the referring eligible medical practitioner on assessments (if performed), treatment provided and recommendations on future management of the patient’s condition

Up to 4 services to which this item or any of items 82015, 82020, 82035, 93035, 93036, 93043 or 93044 apply may be provided to the same patient on the same day

Fee: $96.80 Benefit: 85% = $82.30

(See para AN.0.25, MN.10.2, MN.10.3 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

82030

82030 - Additional Information

Item Start Date:
01-Mar-2024
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Audiology, optometry, orthoptic or physiotherapy health service provided to a patient aged under 25 years by an eligible audiologist, optometrist, orthoptist or physiotherapist if:

(a)    the patient was referred by an eligible medical practitioner, or by an eligible allied health practitioner following referral by an eligible medical practitioner, to:

(i)   assist the eligible medical practitioner with diagnostic formulation where the patient has a suspected complex neurodevelopmental disorder or eligible disability; or

(ii)  contribute to the patient’s treatment and management plan developed by the referring eligible medical practitioner where a complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability is confirmed; and

(b)    the service is provided to the patient individually and in person; and

(c)    the service is at least 50 minutes duration

Up to 4 services to which this item or any of items 82000, 82005, 82010, 93032, 93033, 93040 or 93041 apply may be provided to the same patient on the same day

Fee: $96.80 Benefit: 85% = $82.30

(See para AN.0.25, MN.10.1, MN.10.3 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

82035

82035 - Additional Information

Item Start Date:
01-Mar-2024
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Audiology, optometry, orthoptic or physiotherapy health service provided to a patient aged under 25 years for the treatment of a diagnosed complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability by an eligible audiologist, optometrist, orthoptist or physiotherapist, if:

(a)    the patient has a treatment and management plan in place and has been referred by an eligible medical practitioner for a course of treatment consistent with that treatment and management plan; and

(b)    the service is provided to the patient individually and in person; and

(c)    the service is at least 30 minutes duration; and

(d)    on the completion of the course of treatment, the eligible audiologist, optometrist, orthoptist or physiotherapist gives a written report to the referring eligible medical practitioner on assessments (if performed), treatment provided and recommendations on future management of the patient’s condition

Up to 4 services to which this item or any of items 82015, 82020, 82025, 93035, 93036, 93043 or 93044 apply may be provided to the same patient on the same day

Fee: $96.80 Benefit: 85% = $82.30

(See para AN.0.25, MN.10.2, MN.10.3 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

296

296 - Additional Information

Item Start Date:
01-Nov-2006
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Professional attendance of more than 45 minutes in duration by a consultant physician in the practice of the consultant physician's speciality of psychiatry following referral of the patient to him or her by a referring practitioner-an attendance at consulting rooms if the patient:

(a) is a new patient for this consultant psychiatrist; or

(b) has not received a professional attendance from this consultant psychiatrist in the preceding 24 months;

other than attendance on a patient in relation to whom this item, or any of items 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 has applied in the preceding 24 months

Fee: $290.85 Benefit: 75% = $218.15 85% = $247.25

(See para AN.0.25, AN.0.30, AN.0.31, AN.0.32, AN.0.75, AN.0.76, AN.40.1 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

297

297 - Additional Information

Item Start Date:
01-Nov-2006
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Professional attendance of more than 45 minutes by a consultant physician in the practice of the consultant physician's speciality of psychiatry following referral of the patient to him or her by a referring practitioner-an attendance at hospital if the patient:

(a) is a new patient for this consultant psychiatrist; or

(b) has not received a professional attendance from this consultant psychiatrist in the preceding 24 months;

other than attendance on a patient in relation to whom this item, or any of items 296, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 has applied in the preceding 24 months (H)

Fee: $290.85 Benefit: 75% = $218.15

(See para AN.0.25, AN.0.30, AN.0.31, AN.0.32, AN.0.75, AN.0.76 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

299

299 - Additional Information

Item Start Date:
01-Nov-2006
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Professional attendance of more than 45 minutes by a consultant physician in the practice of the consultant physician's speciality of psychiatry following referral of the patient to him or her by a referring practitioner-an attendance at a place other than consulting rooms or a hospital if the patient:

(a) is a new patient for this consultant psychiatrist; or

(b) has not received a professional attendance from this consultant psychiatrist in the preceding 24 months;

other than attendance on a patient in relation to whom this item, or any of items 296, 297, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 has applied in the preceding 24 months

Fee: $347.75 Benefit: 85% = $295.60

(See para AN.0.25, AN.0.30, AN.0.31, AN.0.32, AN.0.75, AN.0.76 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

300

300 - Additional Information

Item Start Date:
01-Nov-1996
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to him or her by a referring practitioner-an attendance of not more than 15 minutes in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 applies have not exceeded 50 attendances in a calendar year for the patient

Fee: $48.40 Benefit: 75% = $36.30 85% = $41.15

(See para AN.0.25, AN.0.30, AN.0.31, AN.0.32, AN.0.75, AN.0.76, AN.40.1 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

302

302 - Additional Information

Item Start Date:
01-Nov-1996
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to him or her by a referring practitioner-an attendance of more than 15 minutes, but not more than 30 minutes, in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 applies have not exceeded 50 attendances in a calendar year for the patient

Fee: $96.60 Benefit: 75% = $72.45 85% = $82.15

(See para AN.0.25, AN.0.30, AN.0.31, AN.0.32, AN.0.75, AN.0.76, AN.40.1 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

304

304 - Additional Information

Item Start Date:
01-Nov-1996
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to him or her by a referring practitioner-an attendance of more than 30 minutes, but not more than 45 minutes, in duration at consulting rooms), if that attendance and another attendance to which any of items 296, 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 applies have not exceeded 50 attendances in a calendar year for the patient

Fee: $148.70 Benefit: 75% = $111.55 85% = $126.40

(See para AN.0.25, AN.0.30, AN.0.31, AN.0.32, AN.0.75, AN.0.76, AN.40.1 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

306

306 - Additional Information

Item Start Date:
01-Nov-1996
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to him or her by a referring practitioner-an attendance of more than 45 minutes, but not more than 75 minutes, in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 applies have not exceeded 50 attendances in a calendar year for the patient

Fee: $205.20 Benefit: 75% = $153.90 85% = $174.45

(See para AN.0.25, AN.0.30, AN.0.31, AN.0.32, AN.0.75, AN.0.76, AN.40.1 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

308

308 - Additional Information

Item Start Date:
01-Nov-1996
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to him or her by a referring practitioner-an attendance of more than 75 minutes in duration at consulting rooms), if that attendance and another attendance to which any of items 296, 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 applies have not exceeded 50 attendances in a calendar year for the patient

Fee: $238.15 Benefit: 75% = $178.65 85% = $202.45

(See para AN.0.25, AN.0.30, AN.0.31, AN.0.32, AN.0.75, AN.0.76, AN.40.1 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

310

310 - Additional Information

Item Start Date:
01-Nov-1996
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner-an attendance of not more than 15 minutes in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 applies exceed 50 attendances in a calendar year for the patient

Fee: $24.10 Benefit: 75% = $18.10 85% = $20.50

(See para AN.0.25, AN.0.31, AN.0.32, AN.0.76 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

312

312 - Additional Information

Item Start Date:
01-Nov-1996
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner-an attendance of more than 15 minutes, but not more than 30 minutes, in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 applies exceed 50 attendances in a calendar year for the patient

Fee: $48.40 Benefit: 75% = $36.30 85% = $41.15

(See para AN.0.25, AN.0.31, AN.0.32, AN.0.76 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

314

314 - Additional Information

Item Start Date:
01-Nov-1996
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner-an attendance of more than 30 minutes, but not more than 45 minutes, in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 applies exceed 50 attendances in a calendar year for the patient

Fee: $74.55 Benefit: 75% = $55.95 85% = $63.40

(See para AN.0.25, AN.0.31, AN.0.32, AN.0.76 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

316

316 - Additional Information

Item Start Date:
01-Nov-1996
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner-an attendance of more than 45 minutes, but not more than 75 minutes, in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 applies exceed 50 attendances in a calendar year for the patient

Fee: $102.70 Benefit: 75% = $77.05 85% = $87.30

(See para AN.0.25, AN.0.31, AN.0.32, AN.0.76 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

318

318 - Additional Information

Item Start Date:
01-Nov-1996
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner-an attendance of more than 75 minutes in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 applies exceed 50 attendances in a calendar year for the patient

Fee: $119.10 Benefit: 75% = $89.35 85% = $101.25

(See para AN.0.25, AN.0.31, AN.0.32, AN.0.76 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

319

319 - Additional Information

Item Start Date:
01-May-1997
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—an attendance lasting more than 45 minutes at consulting rooms, if:

(a) the formulation of the patient’s clinical presentation indicates intensive psychotherapy is a clinically appropriate and indicated treatment; and

(b) that attendance and another attendance to which any of items 296, 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839, 91873 and 92437 applies have not exceeded 160 attendances in a calendar year for the patient



Fee: $205.20 Benefit: 75% = $153.90 85% = $174.45

(See para AN.0.25, AN.0.31, AN.0.32, AN.0.76 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

320

320 - Additional Information

Item Start Date:
01-Nov-1996
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Nov-2023

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner-an attendance of not more than 15 minutes in duration at hospital

Fee: $48.40 Benefit: 75% = $36.30 85% = $41.15

(See para AN.0.25, AN.0.32, AN.0.76 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

324

324 - Additional Information

Item Start Date:
01-Nov-1996
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Nov-2023

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner-an attendance of more than 30 minutes, but not more than 45 minutes, in duration at hospital

Fee: $148.70 Benefit: 75% = $111.55 85% = $126.40

(See para AN.0.25, AN.0.32, AN.0.76 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

326

326 - Additional Information

Item Start Date:
01-Nov-1996
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Nov-2023

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner-an attendance of more than 45 minutes, but not more than 75 minutes, in duration at hospital

Fee: $205.20 Benefit: 75% = $153.90 85% = $174.45

(See para AN.0.25, AN.0.32, AN.0.76 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

328

328 - Additional Information

Item Start Date:
01-Nov-1996
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Nov-2023

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner-an attendance of more than 75 minutes in duration at hospital

Fee: $238.15 Benefit: 75% = $178.65 85% = $202.45

(See para AN.0.25, AN.0.32, AN.0.76 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

330

330 - Additional Information

Item Start Date:
01-Nov-1996
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Nov-2023

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner-an attendance of not more than 15 minutes in duration if that attendance is at a place other than consulting rooms or hospital

Fee: $88.90 Benefit: 75% = $66.70 85% = $75.60

(See para AN.0.25, AN.0.76 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

332

332 - Additional Information

Item Start Date:
01-Nov-1996
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Nov-2023

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner-an attendance of more than 15 minutes, but not more than 30 minutes, in duration if that attendance is at a place other than consulting rooms or hospital

Fee: $139.20 Benefit: 75% = $104.40 85% = $118.35

(See para AN.0.25, AN.0.76 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

334

334 - Additional Information

Item Start Date:
01-Nov-1996
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Nov-2023

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner-an attendance of more than 30 minutes, but not more than 45 minutes, in duration if that attendance is at a place other than consulting rooms or hospital

Fee: $202.85 Benefit: 75% = $152.15 85% = $172.45

(See para AN.0.25, AN.0.76 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

336

336 - Additional Information

Item Start Date:
01-Nov-1996
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Nov-2023

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner-an attendance of more than 45 minutes, but not more than 75 minutes, in duration if that attendance is at a place other than consulting rooms or hospital

Fee: $245.45 Benefit: 75% = $184.10 85% = $208.65

(See para AN.0.25, AN.0.76 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

338

338 - Additional Information

Item Start Date:
01-Nov-1996
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Nov-2023

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner-an attendance of more than 75 minutes in duration if that attendance is at a place other than consulting rooms or hospital

Fee: $278.80 Benefit: 75% = $209.10 85% = $237.00

(See para AN.0.25, AN.0.76 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

342

342 - Additional Information

Item Start Date:
01-Nov-1996
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Nov-2023

Group psychotherapy (including any associated consultations with a patient taking place on the same occasion and relating to the condition for which group therapy is conducted) of not less than 1 hour in duration given under the continuous direct supervision of a consultant physician in the practice of the consultant physician's specialty of psychiatry, involving a group of 2 to 9 unrelated patients or a family group of more than 3 patients, each of whom is referred to the consultant physician by a referring practitioner-each patient

Fee: $55.05 Benefit: 75% = $41.30 85% = $46.80

(See para AN.0.5, AN.0.25, AN.0.76, AN.40.1 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

344

344 - Additional Information

Item Start Date:
01-Nov-1996
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Nov-2023

Group psychotherapy (including any associated consultations with a patient taking place on the same occasion and relating to the condition for which group therapy is conducted) of not less than 1 hour in duration given under the continuous direct supervision of a consultant physician in the practice of the consultant physician's specialty of psychiatry, involving a family group of 3 patients, each of whom is referred to the consultant physician by a referring practitioner-each patient

Fee: $73.10 Benefit: 75% = $54.85 85% = $62.15

(See para AN.0.5, AN.0.25, AN.0.76, AN.40.1 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

346

346 - Additional Information

Item Start Date:
01-Nov-1996
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Nov-2023

Group psychotherapy (including any associated consultations with a patient taking place on the same occasion and relating to the condition for which group therapy is conducted) of not less than 1 hour in duration given under the continuous direct supervision of a consultant physician in the practice of the consultant physician's specialty of psychiatry, involving a family group of 2 patients, each of whom is referred to the consultant physician by a referring practitioner-each patient

Fee: $108.15 Benefit: 75% = $81.15 85% = $91.95

(See para AN.0.5, AN.0.25, AN.0.76, AN.0.77, AN.40.1 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

91836

91836 - Additional Information

Item Start Date:
13-Mar-2020
Description Updated:
20-Apr-2020
Schedule Fee Updated:
01-Nov-2023

Phone attendance for a person by a consultant physician in the practice of the consultant physician’s specialty (other than psychiatry) if:

(a)           the attendance follows referral of the patient to the specialist; and

(b)           the attendance was of more than 5 minutes in duration.

Where the attendance is a minor attendance after the first as part of a single course of treatment.

 

 

Fee: $48.05 Benefit: 85% = $40.85

(See para AN.0.7, AN.0.25, AN.0.70, AN.3.1, AN.40.1 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

92141

92141 - Additional Information

Item Start Date:
30-Mar-2020
Description Updated:
01-Mar-2023
Schedule Fee Updated:
01-Nov-2023

Telehealth attendance lasting at least 45 minutes by a specialist or consultant physician (not including a general practitioner), following referral of the patient to the specialist or consultant physician by a referring practitioner, for a patient aged under 25, if the specialist or consultant physician:

(a) undertakes, or has previously undertaken in prior attendances, a comprehensive assessment in relation to which a diagnosis of an eligible disability is made (if appropriate, using information provided by an eligible allied health provider); and

(b) develops a treatment and management plan, which must include:

(i) documentation of the confirmed diagnosis; and

(ii) findings of any assessments performed for the purposes of formulation of the diagnosis or contribution to the treatment and management plan; and

(iii) a risk assessment; and

(iv) treatment options (which may include biopsychosocial recommendations); and

(c) provides a copy of the treatment and management plan to:

(i) the referring practitioner; and

(ii) one or more allied health providers, if appropriate, for the treatment of the patient;

(other than attendance on a patient for whom payment has previously been made under this item or item 135, 137, 139, 289, 92140, 92142 or 92434)

Applicable only once per lifetime

Fee: $294.85 Benefit: 85% = $250.65

(See para AN.0.25, AR.29.1 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

93040

93040 - Additional Information

Item Start Date:
30-Mar-2020
Description Updated:
01-Mar-2023
Schedule Fee Updated:
01-Nov-2023

Psychology health service provided by phone attendance to a patient aged under 25 years by an eligible psychologist if:

(a) the patient was referred by an eligible medical practitioner, or by an eligible allied health practitioner following referral by an eligible medical practitioner, to:

(i) assist the eligible medical practitioner with diagnostic formulation where the patient has a suspected complex neurodevelopmental disorder or eligible disability; or

(ii) contribute to the patient’s treatment and management plan developed by the referring eligible medical practitioner where a complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability is confirmed; and

(b) the service is provided to the patient individually; and

(c) the service is at least 50 minutes duration

Up to 4 services to which this item or any of items 82000, 82005, 82010, 82030, 93032, 93033 or 93041 apply may be provided to the same patient on the same day

Further information on the requirements for this item are available in the explanatory notes to this Category

Fee: $109.80 Benefit: 85% = $93.35

(See para AN.0.25, MN.10.1, MN.10.3 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

93041

93041 - Additional Information

Item Start Date:
30-Mar-2020
Description Updated:
01-Mar-2023
Schedule Fee Updated:
01-Nov-2023

Speech pathology, occupational therapy, audiology, optometry, orthoptic or physiotherapy health service provided by phone attendance to a patient aged under 25 years by an eligible speech pathologist, occupational therapist, audiologist, optometrist, orthoptist or physiotherapist if:

(a) the patient was referred by an eligible medical practitioner, or by an eligible allied health practitioner following referral by an eligible medical practitioner, to:

(i) assist the eligible medical practitioner with diagnostic formulation where the patient has a suspected complex neurodevelopmental disorder or eligible disability; or

(ii) contribute to the patient’s treatment and management plan developed by the referring eligible medical practitioner where a complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability is confirmed; and

(b) the service is provided to the patient individually; and

(c) the service is at least 50 minutes duration

Up to 4 services to which this item or any of items 82000, 82005, 82010, 82030, 93032, 93033 or 93040 apply may be provided to the same patient on the same day

Further information on the requirements for this item are available in the explanatory notes to this Category

Fee: $96.80 Benefit: 85% = $82.30

(See para AN.0.25, MN.10.1, MN.10.3 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

93043

93043 - Additional Information

Item Start Date:
30-Mar-2020
Description Updated:
01-Mar-2023
Schedule Fee Updated:
01-Nov-2023

Psychology health service provided by phone attendance to a patient aged under 25 years for the treatment of a diagnosed complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability by an eligible psychologist, if:

(a) the patient has a treatment and management plan in place and has been referred by an eligible medical practitioner for a course of treatment consistent with that treatment and management plan; and

(b) the service is provided to the patient individually; and

(c) the service is at least 30 minutes duration; and

(d) on the completion of the course of treatment, the eligible psychologist gives a written report to the referring eligible medical practitioner on assessments (if performed), treatment provided and recommendations on future management of the patient’s condition

Up to 4 services to which this item or any of items 82015, 82020, 82025, 82035, 93035, 93036 or 93044 apply may be provided to the same patient on the same day

Further information on the requirements for this item are available in the explanatory notes to this Category

Fee: $109.80 Benefit: 85% = $93.35

(See para AN.0.25, MN.10.1, MN.10.2, MN.10.3 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

93044

93044 - Additional Information

Item Start Date:
30-Mar-2020
Description Updated:
01-Mar-2023
Schedule Fee Updated:
01-Nov-2023

Speech pathology, occupational therapy, audiology, optometry, orthoptic or physiotherapy health service provided by phone attendance to a patient aged under 25 years for the treatment of a diagnosed complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability by an eligible speech pathologist, occupational therapist, audiologist, optometrist, orthoptist or physiotherapist, if:

(a) the patient has a treatment and management plan in place and has been referred by an eligible medical practitioner for a course of treatment consistent with that treatment and management plan; and

(b) the service is provided to the patient individually; and

(c) the service is at least 30 minutes duration; and

(d) on the completion of the course of treatment, the eligible speech pathologist, occupational therapist, audiologist, optometrist, orthoptist or physiotherapist gives a written report to the referring eligible medical practitioner on assessments (if performed), treatment provided and recommendations on future management of the patient’s condition

Up to 4 services to which this item or any of items 82015, 82020, 82025, 82035, 93035, 93036 or 93043 apply may be provided to the same patient on the same day

Further information on the requirements for this item are available in the explanatory notes to this Category

Fee: $96.80 Benefit: 85% = $82.30

(See para AN.0.25, MN.10.1, MN.10.2, MN.10.3 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

91831

91831 - Additional Information

Item Start Date:
13-Mar-2020
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Telehealth attendance for a person by a consultant psychiatrist; if:

(a)     the attendance follows a referral of the patient to the consultant psychiatrist by a referring practitioner; and

(b)     the attendance was at least 75 minutes in duration;

if that attendance and another attendance to which item 296, 297, 299 or any of items 300, 302, 304, 306 to 308, 91827 to 91830, 91837 to 91839 and 92437 applies have not exceeded 50 attendances in a calendar year.

Fee: $238.15 Benefit: 85% = $202.45

(See para AN.0.25, AN.0.30, AN.0.31, AN.0.75 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

92437

92437 - Additional Information

Item Start Date:
06-Apr-2020
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Telehealth attendance of more than 45 minutes in duration by a consultant physician in the practice of the consultant physician’s speciality of psychiatry following referral of the patient to the consultant physician by a referring practitioner:

(a) if the patient:

    (i) is a new patient for this consultant physician; or

    (ii) has not received an attendance from this consultant physician in the preceding 24 months; and

(b)  the patient has not received an attendance under this item, or item 91827 to 91831, 91837 to 91839, 92455 to 92457, 91868 to 91873, 91879 to 91881 or item 296, 297, 299, 300, 302, 304, 306 to 308, 310, 312, 314, 316, 318, 319, 320, 322, 324, 326, 328, 330, 332, 334, 336, 338, 342, 344 or 346 of the general medical services table, in the preceding 24 months

Fee: $290.85 Benefit: 85% = $247.25

(See para AN.0.25, AN.0.30, AN.0.31, AN.0.75, AN.0.76 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

92455

92455 - Additional Information

Item Start Date:
20-Apr-2020
Description Updated:
20-Apr-2020
Schedule Fee Updated:
01-Nov-2023

Telehealth attendance for group psychotherapy (including any associated consultations with a patient taking place on the same occasion and relating to the condition for which group therapy is conducted):

(a) of not less than 1 hour in duration; and

(b) given under the continuous direct supervision of a consultant physician in the practice of the consultant physician’s specialty of psychiatry; and

(c) involving a group of 2 to 9 unrelated patients or a family group of more than 3 patients, each of whom is referred to the consultant physician by a referring practitioner;

—each patient

Fee: $55.05 Benefit: 85% = $46.80

(See para AN.0.25 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

110

110 - Additional Information

Item Start Date:
01-Mar-1987
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Nov-2023

Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of the consultant physician's specialty (other than psychiatry) following referral of the patient to the consultant physician by a referring practitioner-initial attendance in a single course of treatment

Fee: $168.60 Benefit: 75% = $126.45 85% = $143.35

(See para AN.0.7, AN.0.25, AN.40.1 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

116

116 - Additional Information

Item Start Date:
01-Mar-1987
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Nov-2023

Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of the consultant physician's specialty (other than psychiatry) following referral of the patient to the consultant physician by a referring practitioner-each attendance (other than a service to which item 119 applies) after the first in a single course of treatment

Fee: $84.35 Benefit: 75% = $63.30 85% = $71.70

(See para AN.0.7, AN.0.25, AN.0.70, AN.3.1, AN.40.1 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

119

119 - Additional Information

Item Start Date:
22-Dec-1987
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Nov-2023

Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of the consultant physician's specialty (other than psychiatry) following referral of the patient to the consultant physician by a referring practitioner-each minor attendance after the first in a single course of treatment

Fee: $48.05 Benefit: 75% = $36.05 85% = $40.85

(See para AN.0.7, AN.0.21, AN.0.25, AN.0.70, AN.3.1, AN.40.1 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

91822

91822 - Additional Information

Item Start Date:
13-Mar-2020
Description Updated:
20-Apr-2020
Schedule Fee Updated:
01-Nov-2023

Telehealth attendance for a person by a specialist in the practice of the specialist’s specialty if:

(a)           the attendance follows referral of the patient to the specialist; and

(b)           the attendance was of more than 5 minutes in duration.

 Where the attendance was other than a second or subsequent attendance as part of a single course of treatment.

 

 


 

Fee: $95.60 Benefit: 85% = $81.30

(See para AN.0.7, AN.0.25, AN.40.1 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

91839

91839 - Additional Information

Item Start Date:
13-Mar-2020
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

 Phone attendance for a person by a consultant psychiatrist; if:

(a)   the attendance follows a referral of the patient to the consultant psychiatrist by a referring practitioner; and

(b)   the attendance was at least 30 minutes, but not more than 45 minutes in duration

Where the attendance is after the first attendance as part of a single course of treatment, if that attendance and another attendance to which item 296, 297, 299 or any of items 300, 302, 304, 306 to 308, 91827 to 91831, 91837, 91838 and 92437 applies have not exceeded 50 attendances in a calendar year

Fee: $148.70 Benefit: 85% = $126.40

(See para AN.0.25, AN.0.30, AN.0.31, AN.0.75 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

93032

93032 - Additional Information

Item Start Date:
30-Mar-2020
Description Updated:
01-Mar-2023
Schedule Fee Updated:
01-Nov-2023

Psychology health service provided by telehealth attendance to a patient aged under 25 years by an eligible psychologist if:

(a) the patient was referred by an eligible medical practitioner, or by an eligible allied health practitioner following referral by an eligible medical practitioner, to:

(i) assist the eligible medical practitioner with diagnostic formulation where the patient has a suspected complex neurodevelopmental disorder or eligible disability; or

(ii) contribute to the patient’s treatment and management plan developed by the referring eligible medical practitioner where a complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability is confirmed; and

(b) the service is provided to the patient individually; and

(c) the service is at least 50 minutes duration

Up to 4 services to which this item or any of items 82000, 82005, 82010, 82030, 93033, 93040 or 93041 apply may be provided to the same patient on the same day

Further information on the requirements for this item are available in the explanatory notes to this Category

Fee: $109.80 Benefit: 85% = $93.35

(See para AN.0.25, MN.10.1, MN.10.3 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

93033

93033 - Additional Information

Item Start Date:
30-Mar-2020
Description Updated:
01-Mar-2023
Schedule Fee Updated:
01-Nov-2023

Speech pathology, occupational therapy, audiology, optometry, orthoptic or physiotherapy health service provided by telehealth attendance to a patient aged under 25 years by an eligible speech pathologist, occupational therapist, audiologist, optometrist, orthoptist or physiotherapist if:

(a) the patient was referred by an eligible medical practitioner, or by an eligible allied health practitioner following referral by an eligible medical practitioner, to:

(i) assist the eligible medical practitioner with diagnostic formulation where the patient has a suspected complex neurodevelopmental disorder or eligible disability; or

(ii) contribute to the patient’s treatment and management plan developed by the referring eligible medical practitioner where a complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability is confirmed; and

(b) the service is provided to the patient individually; and

(c) the service is at least 50 minutes duration

Up to 4 services to which this item or any of items 82000, 82005, 82010, 82030, 93032, 93040 or 93041 apply may be provided to the same patient on the same day

Further information on the requirements for this item are available in the explanatory notes to this Category

Fee: $96.80 Benefit: 85% = $82.30

(See para AN.0.25, MN.10.1, MN.10.3 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

93035

93035 - Additional Information

Item Start Date:
30-Mar-2020
Description Updated:
01-Mar-2023
Schedule Fee Updated:
01-Nov-2023

Psychology health service provided by telehealth attendance to a patient aged under 25 years for the treatment of a diagnosed complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability by an eligible psychologist, if:

(a) the patient has a treatment and management plan in place and has been referred by an eligible medical practitioner for a course of treatment consistent with that treatment and management plan; and

(b) the service is provided to the patient individually; and

(c) the service is at least 30 minutes duration; and

(d) on the completion of the course of treatment, the eligible psychologist gives a written report to the referring eligible medical practitioner on assessments (if performed), treatment provided and recommendations on future management of the patient’s condition

Up to 4 services to which this item or any of items 82015, 82020, 82025, 82035, 93036, 93043 or 93044 apply may be provided to the same patient on the same day

Further information on the requirements for this item are available in the explanatory notes to this Category

Fee: $109.80 Benefit: 85% = $93.35

(See para AN.0.25, MN.10.1, MN.10.2, MN.10.3 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

93036

93036 - Additional Information

Item Start Date:
30-Mar-2020
Description Updated:
01-Mar-2023
Schedule Fee Updated:
01-Nov-2023

Speech pathology, occupational therapy, audiology, optometry, orthoptic or physiotherapy health service provided by telehealth attendance to a patient aged under 25 years for the treatment of a diagnosed complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability by an eligible speech pathologist, occupational therapist, audiologist, optometrist, orthoptist or physiotherapist, if:

(a) the patient has a treatment and management plan in place and has been referred by an eligible medical practitioner for a course of treatment consistent with that treatment and management plan; and

(b) the service is provided to the patient individually; and

(c) the service is at least 30 minutes duration; and

(d) on the completion of the course of treatment, the eligible speech pathologist, occupational therapist, audiologist, optometrist, orthoptist or physiotherapist gives a written report to the referring eligible medical practitioner on assessments (if performed), treatment provided and recommendations on future management of the patient’s condition

Up to 4 services to which this item or any of items 82015, 82020, 82025, 82035, 93035, 93043 or 93044 apply may be provided to the same patient on the same day

Further information on the requirements for this item are available in the explanatory notes to this Category

Fee: $96.80 Benefit: 85% = $82.30

(See para AN.0.25, MN.10.1, MN.10.2, MN.10.3 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