Medicare Benefits Schedule - Note AN.7.29

Item 177 will support patients with cardiovascular disease, or patients at risk of developing cardiovascular disease, to access the heart health assessment through a doctor in general practice.

The item will fund a heart health assessment, lasting at least 20 minutes, by a medical practitioner working in general practice (177). The new item will provide patients with a comprehensive assessment of their cardiovascular health, identification of any physical or lifestyle-related risks to their cardiovascular health, and a comprehensive preventive health care plan to improve their cardiovascular health.

The heart health assessment item can be claimed once per patient in a 12 month period. The heart health assessment item cannot be claimed if a patient has had a health assessment service in the previous 12 months.

The intention of this item is to identify cardiovascular disease (CVD) in people not known to have CVD including:

(a) Aboriginal or Torres Strait Islander persons who are aged 30 years and above;

(b) Adults aged 45 years and above.

The absolute cardiovascular disease risk must be calculated as per the Australian Absolute Cardiovascular Disease Risk Calculator which can viewed at ‘http://www.cvdcheck.org.au/calculator/’.

Revision of the Australian Guidelines for the management of absolute cardiovascular disease risk (published in 2012) are currently underway (ACDPA | Absolute CVD risk guideline update), in the meantime resources on risk assessment for medical practitioners can be found at ACDPA | Resources. Medical practitioners can also refer to the RACGP’s 'National Guide to a Preventative Assessment for Aboriginal and Torres Strait Islander People' to complete this assessment.

Health assessments are not available to people who are in-patients of a hospital or care recipients in a residential aged care facility (with the exception of a comprehensive medical assessment provided to a permanent resident of a residential aged care facility).

Before a health assessment is commenced, the patient (and/or the patient's parent(s), carer or representative, as appropriate) must be given an explanation of the health assessment process and its likely benefits. The patient must be asked whether they consent to the health assessment being performed. In cases where the patient is not capable of giving consent, consent must be given by the patient's parent(s), carer or representative. Consent to the health assessment must be noted in the patient's records.

A health assessment may only be billed by a medical practitioner (not including a specialist or consultant physician).

A health assessment should generally be undertaken by the patient's 'usual doctor'. For the purpose of the health assessment items, 'usual doctor' means the medical practitioner, or a medical practitioner working in the same medical practice, which has provided the majority of primary health care to the patient over the previous twelve months and/or will be providing the majority of care to the patient over the next twelve months.

A health assessment should not take the form of a health screening service.

MBS health assessment items 177, 224, 225, 226 and 227 must be provided by a medical practitioner personally attending upon a patient. Suitably qualified health professionals, such as practice nurses or Aboriginal and Torres Strait Islander health practitioners, employed and/or otherwise engaged by a medical practice or health service, may assist medical practitioners in performing health assessments. Such assistance must be provided in accordance with accepted medical practice and under the supervision of the medical practitioner. This may include activities associated with:

·         information collection; and

·         providing patients with information about recommended interventions at the direction of the medical practitioner.

The medical practitioner should be satisfied that the assisting health professional has the necessary skills, expertise and training to collect the information required for the health assessment.

Medical practitioners should not conduct a separate consultation for another health-related issue in conjunction with a health assessment unless it is clinically necessary (ie. the patient has an acute problem that needs to be managed separately from the assessment). The only exception is the comprehensive medical assessment, where, if this health assessment is undertaken during the course of a consultation for another purpose, the health assessment item and the relevant item for the other consultation may both be claimed.

Items 177, 224, 225, 226 and 227 do not apply for services that are provided by any other Commonwealth or State funded services. However, where an exemption under subsection 19(2) of the Health Insurance Act 1973 has been granted to an Aboriginal Community Controlled Health Service or State/Territory Government health clinic, items 177, 224, 225, 226 and 227 can be claimed for services provided by medical practitioners salaried by or contracted to, the Service or health clinic. All other requirements of the items must be met.

Item 10990 or 10991 (bulk billing incentives) can be claimed in conjunction with any health assessment, provided the conditions of item 10990 and 10991 are satisfied.

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