Medicare Benefits Schedule - Note AN.46.1

Search Results for Note AN.46.1

View Related Items

Category 1 - PROFESSIONAL ATTENDANCES

AN.46.1

Attendance items to assess a patient’s suitability for oral anti-viral medications by telephone, including provision of a relevant prescription if clinically appropriate (items 93716 and 93717).

General Practice COVID-19 Treatment Review (Items 93716 and 93717)

Item descriptions

Attendance items to assess a patient’s suitability for oral anti-viral medications by telephone, including provision of a relevant prescription if clinically appropriate (items 93716 and 93717).  These items are temporary, commencing from 19 July 2022 and ceasing at 11.59pm on 31 October 2022.

Item 93716 is to be used by General Practitioners (GP).  Item 93717 is to be used by Other Medical Practitioners (OMPs). Refer to Eligible Providers section below for more detail.

Application of the items

Items 93716 and 93717 provide rebates for longer telephone consultations when assessing patients with COVID-19 for suitability for oral anti-viral medications.

Oral anti-viral medications for COVID-19 require a comprehensive patient history for safe prescribing. These items are available where a treating practitioner requires 20 minutes (25 minutes for OMPs) or longer to take a detailed history and assess a patient’s suitability for prescription of COVID-19 oral anti-viral medication, where virtual consultation supports infection control if the patient has confirmed COVID-19.

Patients with COVID-19 can access general telehealth consultations from any GP under normal Medicare Benefits Schedule (MBS) telehealth eligibility requirements, supporting timely access to care. No face-to-face service to the patient in the 12 months preceding the telehealth attendance is required (unlike other GP telehealth items).

Timeliness of assessment for COVID-19 oral anti-virals is critical, as treatment must be initiated within 5 days of symptom onset. The temporary items recognise the additional time required to assess patients, particularly when the consultation is not undertaken by the patient’s usual treating practitioner. Prescription of antiviral medication is not a requirement to claim the item number, as some patients may ultimately be determined to be ineligible.

In conducting this consultation, treating practitioners should note that these items can only be claimed for patients that meet the criteria outlined under Patient Eligibility (see below).

The treating practitioner must:

  • confirm a patient’s positive COVID-19 diagnosis;
  • confirm that the patient has reported their positive diagnosis to meet relevant state and territory reporting requirements, or assist the patient to report their diagnosis if required; and
  • include a record of a patient’s positive pathology result for COVID-19 test, or their logging of their positive result from self-test with relevant authorities.

Further information is available on the application of these items here.

Information on clinical criteria for prescribing medicines is published for the Pharmaceutical Benefits Scheme online, at www.pbs.gov.au.  

Management of a patient’s other health concerns in conjunction with assessment for antiviral eligibility is appropriate in the same consultation and contributes to the time taken in the consultation. The MBS rules for multiple attendances on the same day apply to these services

Eligible providers

Items 93716 - relate to attendances rendered by General Practitioners who are:

  • listed on the Vocational Register of General Practitioners maintained by the Department of Human Services; or
  • holders of the Fellowship of the Royal Australian College of General Practitioners (FRACGP) who participate in, and meet the requirements of the RACGP for continuing medical education and quality assurance as defined in the RACGP Quality Assurance and Continuing Medical Education program; or
  • holders of the Fellowship of the Australian College of Rural and Remote Medicine (FACRRM) who participate in, and meet the requirements of the Australian College of Rural and Remote Medicine (ACRRM) for continuing medical education and quality assurance as defined in ACRRM's Professional Development Program; or
  • undertaking an approved placement in general practice as part of a training program for general practice leading to the award of the FRACGP or training recognised by the RACGP as being of an equivalent standard; or
  • undertaking an approved placement in general practice as part of a training program for general practice leading to the award of the FACRRM or training recognised by ACRRM as being of an equivalent standard. 

Items 93716 and 93717 only apply to a service performed by a treating practitioner (other than a specialist or consultant physician) who:

  1. is located at a medical practice with capacity for in person face-to-face assessment where appropriate; or
  2. has a formal agreement with a medical practice to provide personal attendance services.

Item 93717 relates to attendances rendered by an Other Medical Practitioner who is not a general practitioner, and who:

  1. is registered under section 3GA of the Act, to the extent that the person is practising during the period in respect of which, and in the location in respect of which, they are registered, and insofar as the circumstances specified for paragraph 19AA(3)(b) of the Act apply; or
  2. is covered by an exemption under subsection 19AB(3) of the Act; or
  3. first obtained registration as a medical practitioner before 1 November 1996.

Patient eligibility

Items 93716 and 93717 are available to people who have at least one symptom of COVID-19 (with symptom onset less than or equal to 5 days ago), and have received a positive COVID-19 test result, confirmed by either:

  1. laboratory testing (PCR); or
  2. a COVID-19 rapid antigen self test (RAT) which has been approved for supply in Australia by the Therapeutic Goods Administration.

Billing

Normal arrangements of billing apply including payments of bulk billing incentives for eligible services.

Co-claiming

MBS items 93716 and 93717 are not payable in association with any other attendance service on the same occasion by the same treating practitioner.

Record keeping requirements

Record-keeping requirements for services claimed must be consistent with Medicare rules requiring practitioners to maintain adequate and contemporaneous records of the rendering or initiating of services.

Providers are required to record the date of the positive COVID-19 test result and the date of symptom onset in the patient’s clinical record.

Restrictions

Items 93716 and 93717 are not available for patients admitted into hospital.

Items 93716 and 93717 cannot be claimed in association with any other attendance service on the same occasion by the same treating practitioner.

REGULATORY REQUIREMENTS

In conducting items 93716 and 93717 a treating practitioner must, with the patient’s consent conduct an assessment and discussion with the patient lasting at least 20 minutes (25 minutes for an OMP) which includes any of the following that are clinically relevant:

  • taking a detailed patient history;
  • arranging any necessary investigation;
  • implementing a management plan, including follow up arrangements;
  • providing any necessary treatment, including prescribing a COVID-19 oral antiviral treatment if appropriate; and
  • providing appropriate preventive health care for one or more related issues.

The treating practitioner must also meet the below regulatory requirements:

  1. adhere to section 7 of the Determination*; and
  2. not apply the item to a service if the patient seeking treatment is an admitted patient; and
  3. not apply the item if the service is performed in association with any other attendance on the same occasion by the same medical practitioner.

7.  Application of COVID‑19 Treatment Items

1. An item in a Schedule of this Determination only applies to a service mentioned in the item if the patient’s COVID-19 infection has been confirmed by either:

a. laboratory testing; or

b. COVID 19 rapid antigen self test which has been approved for supply in Australia by the Therapeutic Goods Administration, where:

i. the treating practitioner makes a record in the patient’s notes that the relevant state and territory reporting requirements have been met, if applicable, and either:

A. confirms the patient has reported the positive test result to the relevant state or territory public health unit where reporting requirements are in place from time to time; or

B. assists the patient to report the positive result to the relevant state or territory public health unit where reporting  requirements are in place from time to time.

2. An item in a Schedule of this Determination only applies to a service performed by a medical practitioner (other than a specialist or        consultant physician) who:  

a. is located at a medical practice with capacity for in person assessment where appropriate; or

b. has a formal agreement with a medical practice to provide personal attendance services.

Related Items: 93716 93717


Related Items

Category 1 - PROFESSIONAL ATTENDANCES

93716

93716 - Additional Information

Item Start Date:
19-Jul-2022
Description Updated:
19-Jul-2022
Schedule Fee Updated:
19-Jul-2022

Phone attendance by a general practitioner lasting at least 20 minutes for the assessment and management of a person with COVID‑19 infection of recent onset, for the purposes of determining the patient’s eligibility for receiving a COVID-19 oral antiviral treatment, where the service includes any of the following that are clinically relevant:

(a) taking a detailed patient history;
(b) arranging any necessary investigation;
(c) implementing a management plan, including follow up arrangements;
(d) providing any necessary treatment, including prescribing a COVID-19 oral antiviral treatment;
(e) providing appropriate preventive health care for one or more related issues;

with appropriate documentation

Fee: $90.50 Benefit: 85% = $76.95

(See para AN.46.1 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

93717

93717 - Additional Information

Item Start Date:
19-Jul-2022
Description Updated:
19-Jul-2022
Schedule Fee Updated:
19-Jul-2022

Phone attendance by a medical practitioner (other than a general practitioner) lasting at least 25 minutes for the assessment and management of a person with COVID‑19 infection of recent onset, for the purposes of determining the patient’s eligibility for receiving a COVID-19 oral antiviral treatment, where the service includes any of the following that are clinically relevant:

(a) taking a detailed patient history;
(b) arranging any necessary investigation;
(c) implementing a management plan, including follow up arrangements;
(d) providing any necessary treatment, including prescribing a COVID-19 oral antiviral treatment;
(e)providing appropriate preventive health care for one or more related issues;

with appropriate documentation

Fee: $44.70 Benefit: 85% = $38.00

(See para AN.46.1 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