Medicare Benefits Schedule - Note AN.0.26

Items 141 -147 apply only to services provided by a consultant physician or specialist in the specialty of Geriatric Medicine who has completed the additional requirements of the Royal Australasian College of Physicians for recognition in the subspecialty of geriatric medicine. 

Referral for Items 141-147 should be through the general practitioner for the comprehensive assessment and management of frail older patients, older than 65, with complex, often interacting medical, physical and psychosocial problems who are at significant risk of poor health outcomes.  In the event that a specialist of another discipline wishes to refer a patient for this item, the referral should take place through the GP. 

A comprehensive assessment of an older person should as a minimum cover:

· current active medical problems

· past medical history;

· medication review;

· immunisation status;

· advance care planning arrangements;

· current and previous physical function including personal, domestic and community activities of daily living;

· psychological function including cognition and mood; and

· social function including living arrangements, financial arrangements, community services, social support and carer issues. 

Note: Guidance on all aspects of conducting a comprehensive assessment on an older person is available on the Australian and New Zealand Society for Geriatric Medicine website at www.anzsgm.org. 

Some of the information collection component of the assessment may be rendered by a nurse or other assistant in accordance with accepted medical practice, acting under the supervision of the geriatrician. The remaining components of the assessment and development of the management plan must include a personal attendance by the geriatrician. 

A prioritised list of diagnoses/problems should be developed based on information provided by the history and examination, and any additional information provided by other means, including an interview of a person other than the patient. 

The management plan should be explained and if necessary provided in written form to the patient or where appropriate, their family or carer(s). 

A written report of the assessment including the management plan should be provided to the general practitioner within a maximum of 2 weeks of the assessment.  More prompt verbal communication may be appropriate. 

The Patient Assessment and Management plans must be kept for 2 years after the date of service.

Items 143 and 147 are available in instances where the GP initiates a review of the management plan provided under items 141 and 145, usually where the current plan is not achieving the anticipated outcome.  It is expected that when a management plan is reviewed, any modification necessary will be made. 

Items 143 and 147 can be claimed once in a 12 month period. However, if there has been a significant change in the patient's clinical condition or care circumstances necessitating another review, an additional item 143 or 147 can be claimed. In these circumstances, the patient's invoice or Medicare voucher should be annotated to briefly indicate the reason why the additional review was required (e.g. annotated as clinically indicated, exceptional circumstances, significant change etc).

Related Items: 141 143 145 147

• Previous - Note AN.0.25
• Next - Note AN.0.27

Professional attendance of more than 60 minutes in duration at consulting rooms or hospital by a consultant physician or specialist in the practice of the consultant physician's or specialist's specialty of geriatric medicine, if:

(a) the patient is at least 65 years old and referred by a medical practitioner practising in general practice (including a general practitioner, but not including a specialist or consultant physician) or a participating nurse practitioner; and

(b) the attendance is initiated by the referring practitioner for the provision of a comprehensive assessment and management plan; and

(c) during the attendance:

     (i) the medical, physical, psychological and social aspects of the patient's health are evaluated in detail using appropriately validated assessment tools if indicated (the assessment); and

     (ii) the patient's various health problems and care needs are identified and prioritised (the formulation); and

     (iii) a detailed management plan is prepared (the management plan) setting out:

          (A) the prioritised list of health problems and care needs; and

          (B) short and longer term management goals; and

          (C) recommended actions or intervention strategies to be undertaken by the patient's general practitioner or another relevant health care provider that are likely to improve or maintain health status and are readily available and acceptable to the patient and the patient's family and carers; and

    (iv) the management plan is explained and discussed with the patient and, if appropriate, the patient's family and any carers; and

    (v) the management plan is communicated in writing to the referring practitioner; and

(d) an attendance to which item 104, 105, 107, 108, 110, 116 or 119 applies has not been provided to the patient on the same day by the same practitioner; and

(e) an attendance to which this item or item 145 applies has not been provided to the patient by the same practitioner in the preceding 12 months

Fee: $505.70 Benefit: 75% = $379.30 85% = $429.85

(See para AN.0.26, AN.40.1 of explanatory notes to this Category)

Professional attendance of more than 30 minutes in duration at consulting rooms or hospital by a consultant physician or specialist in the practice of the consultant physician's or specialist's specialty of geriatric medicine to review a management plan previously prepared by that consultant physician or specialist under item 141 or 145, if:

(a) the review is initiated by the referring medical practitioner practising in general practice or a participating nurse practitioner; and

(b) during the attendance:

     (i) the patient's health status is reassessed; and

     (ii) a management plan prepared under item 141 or 145 is reviewed and revised; and

     (iii) the revised management plan is explained to the patient and (if appropriate) the patient's family and any carers and communicated in writing to the referring practitioner; and

(c) an attendance to which item 104, 105, 107, 108, 110, 116 or 119 applies was not provided to the patient on the same day by the same practitioner; and

(d) an attendance to which item 141 or 145 applies has been provided to the patient by the same practitioner in the preceding 12 months; and

(e) an attendance to which this item or item 147 applies has not been provided to the patient in the preceding 12 months, unless there has been a significant change in the patient's clinical condition or care circumstances that requires a further review

Fee: $316.15 Benefit: 75% = $237.15 85% = $268.75

(See para AN.0.26, AN.40.1 of explanatory notes to this Category)

Professional attendance of more than 60 minutes in duration at a place other than consulting rooms or hospital by a consultant physician or specialist in the practice of the consultant physician's or specialist's specialty of geriatric medicine, if:

(a) the patient is at least 65 years old and referred by a medical practitioner practising in general practice (including a general practitioner, but not including a specialist or consultant physician) or a participating nurse practitioner; and

(b) the attendance is initiated by the referring practitioner for the provision of a comprehensive assessment and management plan; and

(c) during the attendance:

    (i) the medical, physical, psychological and social aspects of the patient's health are evaluated in detail utilising appropriately validated              assessment tools if indicated (the assessment); and

    (ii) the patient's various health problems and care needs are identified and prioritised (the formulation); and

    (iii) a detailed management plan is prepared (the management plan) setting out:

          (A) the prioritised list of health problems and care needs; and

          (B) short and longer term management goals; and

          (C) recommended actions or intervention strategies, to be undertaken by the patient's general practitioner or another relevant health                   care provider that are likely to improve or maintain health status and are readily available and acceptable to the patient, the                         patient's family and any carers; and

    (iv) the management plan is explained and discussed with the patient and, if appropriate, the patient's family and any carers; and

    (v) the management plan is communicated in writing to the referring practitioner; and

(d) an attendance to which item 104, 105, 107, 108, 110, 116 or 119 applies has not been provided to the patient on the same day by the same practitioner; and

(e) an attendance to which this item or item 141 applies has not been provided to the patient by the same practitioner in the preceding 12 months

Fee: $613.15 Benefit: 85% = $521.20

(See para AN.0.26 of explanatory notes to this Category)

Professional attendance of more than 30 minutes in duration at a place other than consulting rooms or hospital by a consultant physician or specialist in the practice of the consultant physician's or specialist's specialty of geriatric medicine to review a management plan previously prepared by that consultant physician or specialist under items 141 or 145, if:

(a) the review is initiated by the referring medical practitioner practising in general practice or a participating nurse practitioner; and

(b) during the attendance:

     (i) the patient's health status is reassessed; and

     (ii) a management plan that was prepared under item 141 or 145 is reviewed and revised; and

     (iii) the revised management plan is explained to the patient and (if appropriate) the patient's family and any carers and communicated in writing to the referring practitioner; and

(c) an attendance to which item 104, 105, 107, 108, 110, 116 or 119 applies has not been provided to the patient on the same day by the same practitioner; and

(d) an attendance to which item 141 or 145 applies has been provided to the patient by the same practitioner in the preceding 12 months; and

(e) an attendance to which this item or 143 applies has not been provided by the same practitioner in the preceding 12 months, unless there has been a significant change in the patient's clinical condition or care circumstances that requires a further review

Fee: $383.30 Benefit: 85% = $325.85

(See para AN.0.26 of explanatory notes to this Category)