Medicare Benefits Schedule - Note AN.0.41

Items 701, 703, 705 and 707 may be used to undertake a health assessment for people with an intellectual disability. 

A person is considered to have an intellectual disability if they have significantly sub-average general intellectual functioning (two standard deviations below the average intelligence quotient [IQ]) and would benefit from assistance with daily living activities.  Where general practitioners wish to confirm intellectual disability and a patient's need for assistance with activities of daily living, they may seek verification from a paediatrician registered to practice in Australia or from a government-provided or funded disability service that has assessed the patient's intellectual function. 

The health assessment provides a structured clinical framework for general practitioners to comprehensively assess the physical, psychological and social function of patients with an intellectual disability and to identify any medical intervention and preventive health care required.   The health assessment must include the following items as relevant to the patient or the patient's representative:

(a) Check dental health (including dentition);

(b) Conduct aural examination (arrange formal audiometry if audiometry has not been conducted within 5 years);

(c) Assess ocular health (arrange review by an ophthalmologist or optometrist if a comprehensive eye examination has not been conducted within 5 years);

(d) Assess nutritional status (including weight and height measurements) and a review of growth and development;

(e) Assess bowel and bladder function (particularly for incontinence or chronic constipation);

(f) Assess medications (including non-prescription medicines taken by the patient, prescriptions from other doctors, medications prescribed but not taken, interactions, side effects and review of indications);

-       Advise carers of the common side effects and interactions.

-       Consider the need for a formal medication review.

(g) Check immunisation status, including influenza, tetanus, hepatitis A and B, Measles, Mumps and Rubella (MMR) and pneumococcal vaccinations;

(h) Check exercise opportunities (with the aim of moderate exercise for at least 30 minutes per day);

(i) Check whether the support provided for activities of daily living adequately and appropriately meets the patient's needs, and consider formal review if required;

(j) Consider the need for breast examination, mammography, cervical screening, testicular examination, lipid measurement and prostate assessment as for the general population;

(k) Check for dysphagia and gastro-oesophageal disease (especially for patients with cerebral palsy), and arrange for investigation or treatment as required;

(l) Assess risk factors for osteoporosis (including diet, exercise, Vitamin D deficiency, hormonal status, family history, medication fracture history) and arrange for investigation or treatment as required;

(m) For patients diagnosed with epilepsy, review of seizure control (including anticonvulsant drugs) and consider referral to a neurologist at appropriate intervals;

(n) Check for thyroid disease at least every two years (or yearly for patients with Down syndrome);

(o) For patients without a definitive aetiological diagnosis, consider referral to a genetic clinic every 5 years;

(p) Assess or review treatment for co-morbid mental health issues;

(q) Consider timing of puberty and management of sexual development, sexual activity and reproductive health; and

(r) Consider whether there are any signs of physical, psychological or sexual abuse. 

A health assessment for people with an intellectual disability may be claimed once every twelve months by an eligible patient.

Related Items: 701 703 705 707

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Professional attendance by a general practitioner  to perform a brief health assessment, lasting not more than 30 minutes and including:

(a) collection of relevant information, including taking a patient history; and

(b) a basic physical examination; and

(c) initiating interventions and referrals as indicated; and

(d) providing the patient with preventive health care advice and information

Fee: $65.30 Benefit: 100% = $65.30

(See para AN.0.36, AN.0.37, AN.0.38, AN.0.39, AN.0.40, AN.0.41, AN.0.42, AN.0.69 of explanatory notes to this Category)

Professional attendance by a general practitioner 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; and

(b) an extensive physical examination; and

(c) initiating interventions and referrals as indicated; and

(d) providing a preventive health care strategy for the patient

Fee: $151.80 Benefit: 100% = $151.80

(See para AN.0.36, AN.0.37, AN.0.38, AN.0.39, AN.0.40, AN.0.41, AN.0.42, AN.0.69 of explanatory notes to this Category)

Professional attendance by a general practitioner  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; and

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

(c) initiating interventions and referrals as indicated; and

(d) providing a basic preventive health care management plan for the patient

Fee: $209.45 Benefit: 100% = $209.45

(See para AN.0.36, AN.0.37, AN.0.38, AN.0.39, AN.0.40, AN.0.41, AN.0.42, AN.0.69 of explanatory notes to this Category)

Professional attendance by a general practitioner to perform a prolonged health assessment (lasting at least 60 minutes) including:

(a) comprehensive information collection, including taking a patient history; and

(b) an extensive examination of the patient's medical condition, and physical, psychological and social function; and

(c) initiating interventions or referrals as indicated; and

(d) providing a comprehensive preventive health care management plan for the patient

Fee: $295.90 Benefit: 100% = $295.90

(See para AN.0.36, AN.0.37, AN.0.38, AN.0.39, AN.0.40, AN.0.41, AN.0.42, AN.0.69 of explanatory notes to this Category)