Medicare Benefits Schedule - Note AN.0.7

Payment of benefit may be made for each of several attendances on a patient on the same day by the same medical practitioner provided the subsequent attendances are not a continuation of the initial or earlier attendances. However, there should be a reasonable lapse of time between such attendances before they can be regarded as separate attendances. 

Where two or more attendances are made on the one day by the same medical practitioner the time of each attendance should be stated on the account (eg 10.30 am and 3.15 pm) in order to assist in the assessment of benefits. 

In some circumstances a subsequent attendance on the same day constitutes a continuation of an earlier attendance. For example, a preliminary eye examination may be concluded with the instillation of a mydriatic and then some time later an eye refraction is undertaken. These sessions are regarded as being one attendance for benefit purposes. Further examples of single attendances are skin sensitivity testing, and when a patient is issued a prescription for a vaccine and subsequently returns to the surgery for the injection.

Related Items: 104 105 110 116 119 132 133 91822 91823 91824 91825 91826 91833 91836 92422 92423

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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)

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)

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)

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

Fee: $168.60 Benefit: 85% = $143.35

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

Telehealth 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 not a minor attendance after the first as part of a single course of treatment.

Fee: $84.35 Benefit: 85% = $71.70

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

Telehealth 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.0.70, AN.3.1, AN.40.1 of explanatory notes to this Category)

Telehealth attendance by a consultant physician in the practice of the consultant physician’s specialty (other than psychiatry) of at least 45 minutes in duration for an initial assessment of a patient with at least 2 morbidities (which may include complex congenital, developmental and behavioural disorders) following referral of the patient to the consultant physician by a referring practitioner, if:

(a) an assessment is undertaken that covers:

     (i) a comprehensive history, including psychosocial history and medication review; and

     (ii) comprehensive multi or detailed single organ system assessment; and

     (iii) the formulation of differential diagnoses; and

(b) a consultant physician treatment and management plan of significant complexity is prepared and provided to the referring practitioner, which involves:

    (i) an opinion on diagnosis and risk assessment; and

    (ii) treatment options and decisions; and

    (iii) medication recommendations; and

(c) an attendance on the patient to which item 110, 116, 119 of the general medical services table or item 91824, 91825, 91826 or 91836 applies did not take place on the same day by the same consultant physician; and

(d) this item, or item 132 of the general medical services table, has not applied to an attendance on the patient in the preceding 12 months by the same consultant physician

Fee: $294.85 Benefit: 85% = $250.65

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

Telehealth attendance by a consultant physician in the practice of the consultant physician’s specialty (other than psychiatry) of at least 20 minutes in duration after the first attendance in a single course of treatment for a review of a patient with at least 2 morbidities (which may include complex congenital, developmental and behavioural disorders) if:

(a) a review is undertaken that covers:

    (i) review of initial presenting problems and results of diagnostic investigations; and

    (ii) review of responses to treatment and medication plans initiated at time of initial consultation; and

    (iii) comprehensive multi or detailed single organ system assessment; and

    (iv) review of original and differential diagnoses; and

(b) the modified consultant physician treatment and management plan is provided to the referring practitioner, which involves, if appropriate:

     (i) a revised opinion on the diagnosis and risk assessment; and

     (ii) treatment options and decisions; and

     (iii) revised medication recommendations; and

(c) an attendance on the patient to which item 110, 116, 119 of the general medical services table or 91824, 91825, 91826 or 91836 applies did not take place on the same day by the same consultant physician; and

(d) item 132 of the general medical services table or item 92422 applied to an attendance claimed in the preceding 12 months; and

(e) the attendance under this item is claimed by the same consultant physician who claimed item 132 of the general medical services table or 92422; and

(f) this item, or item 133 of the general medical services table has not applied more than twice in any 12 month period

Fee: $147.65 Benefit: 85% = $125.55

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

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)

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)

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)

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)

Professional attendance by a consultant physician in the practice of the consultant physician's specialty (other than psychiatry) of at least 45 minutes in duration for an initial assessment of a patient with at least 2 morbidities (which may include complex congenital, developmental and behavioural disorders) following referral of the patient to the consultant physician by a referring practitioner, if:

(a) an assessment is undertaken that covers:

      (i) a comprehensive history, including psychosocial history and medication review; and

      (ii) comprehensive multi or detailed single organ system assessment; and

      (iii) the formulation of differential diagnoses; and

(b) a consultant physician treatment and management plan of significant complexity is prepared and provided to the referring practitioner, which involves:

      (i) an opinion on diagnosis and risk assessment; and

      (ii) treatment options and decisions; and

      (iii) medication recommendations; and

(c) an attendance on the patient to which item 110, 116 or 119 applies did not take place on the same day by the same consultant physician; and

(d) this item has not applied to an attendance on the patient in the preceding 12 months by the same consultant physician

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

(See para AN.0.7, AN.0.23, AN.40.1 of explanatory notes to this Category)

Professional attendance by a consultant physician in the practice of the consultant physician's specialty (other than psychiatry) of at least 20 minutes in duration after the first attendance in a single course of treatment for a review of a patient with at least 2 morbidities (which may include complex congenital, developmental and behavioural disorders) if:

(a) a review is undertaken that covers:

      (i) review of initial presenting problems and results of diagnostic investigations; and

      (ii) review of responses to treatment and medication plans initiated at time of initial consultation; and

      (iii) comprehensive multi or detailed single organ system assessment; and

      (iv) review of original and differential diagnoses; and

(b) the modified consultant physician treatment and management plan is provided to the referring practitioner, which involves, if appropriate:

     (i) a revised opinion on the diagnosis and risk assessment; and

     (ii) treatment options and decisions; and

     (iii) revised medication recommendations; and

(c) an attendance on the patient to which item 110, 116 or 119 applies did not take place on the same day by the same consultant physician; and

(d) item 132 applied to an attendance claimed in the preceding 12 months; and

(e) the attendance under this item is claimed by the same consultant physician who claimed item 132 or a locum tenens; and

(f) this item has not applied more than twice in any 12 month period

Fee: $147.65 Benefit: 75% = $110.75 85% = $125.55

(See para AN.0.7, AN.0.23, AN.40.1 of explanatory notes to this Category)

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)

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 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.0.70, AN.3.1, AN.40.1 of explanatory notes to this Category)