Medicare Benefits Schedule - Note AN.0.65

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Category 1 - PROFESSIONAL ATTENDANCES

AN.0.65

Cancer Care Case Conference - (Items 871 and 872)

For the purposes of these items:

· private patients in public or private hospitals or the community with a malignancy of a solid organ or tissue or a systemic cancer such as a leukaemia or lymphoma are covered, with the exception of patients whose only cancer is a non-melanoma skin cancer;

· the billing general practitioner, specialist or consultant physician may be from any area of medical practice and must be a treating doctor of the patient discussed at the case conference.  A treating doctor should generally have treated or provided a formal diagnosis of the patient's cancer in the past 12 months or expect to do so within the next 12 months.  Attending non-treating clinicians, allied health providers or support staff are not eligible to bill the item.

· only one practitioner is eligible to claim item 871 for each patient case conference. This should be the doctor who assumes responsibility for leading and coordinating the case conference, ensures that records are kept and that the patient is informed of the outcome of the case conference. In most cases this will be the lead treating doctor. 

· each billing practitioner must ensure that his or her patient is informed that a charge will be incurred for the case conference for which a Medicare rebate will be payable;

· participants must be in communication with each other throughout the case conference, either face-to-face, or by telephone or video link;

· suitable allied health practitioners would generally be from one of the following disciplines: aboriginal health care worker; asthma educator; audiologist; dental therapist; dentist; diabetes educator; dietician; mental health worker; occupational therapist; optometrist; orthoptist; orthotist or prosthetist; pharmacist; physiotherapist; podiatrist; psychologist; registered nurse; social worker; or, speech pathologist;

· in general, it is expected that no more than two case conferences per patient per year will be billed by a practitioner; and

· cancer care case conferences are for the purpose of developing a cancer treatment plan in a multidisciplinary team meeting and should not be billed against case conference items for other purposes eg community or discharge case conferences.

Related Items: 871 872


Related Items


Case Conferences

MULTIDISCIPLINARY CASE CONFERENCE - MEDICAL PRACTITIONER (OTHER THAN A SPECIALIST OR CONSULTANT PHYSICIAN)


These services are for patients who:

    (a)     have at least one medical condition that:

         i.      has been (or is likely to be) present for at least six months; or

         ii.      is terminal; and

    (b)     require ongoing care from a multidisciplinary case conference team which includes:

         i.     a medical practitioner; and

         ii.     at least two other members, each of whom provides a different kind of care or service to the patient and is not a family carer of the patient, and one of whom may be another medical practitioner.


For the purposes of items 735-758, a multidisciplinary case conference is a process by which a multidisciplinary case conference team:

    (a)     discusses a patient’s history; and

    (b)     identifies the patient’s multidisciplinary care needs; and

    (c)     identifies outcomes to be achieved by members of the case conference team giving care and service to the patient; and

    (d)     identifies tasks that need to be undertaken to achieve these outcomes, and allocates those tasks to members of the case conference team; and

    (e)     assesses whether previously identified outcomes (if any) have been achieved.


Participation in a multidisciplinary case conference must be at the request of the person who organises and coordinates the conference.

Category 1 - PROFESSIONAL ATTENDANCES

871

871 - Additional Information

Item Start Date:
01-Nov-2006
Description Start Date:
01-Jul-2018
Schedule Fee Start Date:
01-Jul-2019

Attendance by a general practitioner, specialist or consultant physician as a member of a case conference team, to lead and coordinate a multidisciplinary case conference on a patient with cancer to develop a multidisciplinary treatment plan, if the case conference is of at least 10 minutes, with a multidisciplinary team of at least 3 other medical practitioners from different areas of medical practice (which may include general practice), and, in addition, allied health providers

Fee: $82.80 Benefit: 75% = $62.10 85% = $70.40

(See para AN.0.65 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

872

872 - Additional Information

Item Start Date:
01-Nov-2006
Description Start Date:
01-Jul-2018
Schedule Fee Start Date:
01-Jul-2019

Attendance by a general practitioner, specialist or consultant physician as a member of a case conference team, to participate in a multidisciplinary case conference on a patient with cancer to develop a multidisciplinary treatment plan, if the case conference is of at least 10 minutes, with a multidisciplinary team of at least 4 medical practitioners from different areas of medical practice (which may include general practice), and, in addition, allied health providers

Fee: $38.55 Benefit: 75% = $28.95 85% = $32.80

(See para AN.0.65 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