Medicare Benefits Schedule - Note AN.7.5

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Category 1 - PROFESSIONAL ATTENDANCES

AN.7.5

Medical Practitioner Health Assessments (Items 224 to 227)

There are four time-based health assessment items, consisting of brief, standard, long and prolonged consultations.

Brief Health Assessment (MBS Item 224)

A brief health assessment is used to undertake simple health assessments. The health assessment should take no more than 30 minutes to complete.

Standard Health Assessment (MBS Item 225)

A standard health assessment is used for straightforward assessments where the patient does not present with complex health issues but may require more attention than can be provided in a brief assessment. The assessment lasts more than 30 minutes but takes less than 45 minutes.

Long Health Assessment (MBS Item 226)

A long health assessment is used for an extensive assessment, where the patient has a range of health issues that require more in-depth consideration, and longer-term strategies for managing the patient's health may be necessary. The assessment lasts at least 45 minutes but less than 60 minutes.

Prolonged Health Assessment (MBS Item 227)

A prolonged health assessment is used for a complex assessment of a patient with significant, long-term health needs that need to be managed through a comprehensive preventive health care plan. The assessment takes 60 minutes or more to complete.

Medical practitioners may select one of the MBS health assessment items to provide a health assessment service to a member of any of the target groups listed in the table below. The health assessment item that is selected will depend on the time taken to complete the health assessment service. This is determined by the complexity of the patient's presentation and the specific requirements that have been established for each target group eligible for health assessments.

MBS Items 224, 225, 226 and 227 may be used to undertake a health assessment for the following target groups:

Target Group Frequency of Service
A type 2 diabetes risk evaluation for people aged 40-49 years (inclusive) with a high risk of developing type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool Once every three years to an eligible patient
A health assessment for people aged 45-49 years (inclusive) who are at risk of developing chronic disease Once only to an eligible patient
A health assessment for people aged 75 years and older Provided annually to an eligible patient
A comprehensive medical assessment for permanent residents of residential aged care facilities Provided annually to an eligible patient
A health assessment for people with an intellectual disability Provided annually to an eligible patient
A health assessment for refugees and other humanitarian entrants Once only to an eligible patient
A health assessment for former serving members of the Australian Defence Force Once only to an eligible patient

Frequency of service

The frequency with which patients in different population groups may receive a health assessment is described in the table above. Patients may not have more services than they are eligible for under the frequency provisions that apply to specific types of health assessment.

Important Note: patients may receive services using MBS items 224 to 227 and 701 to 707. However, once a patient has received a service using an MBS item from either group of MBS health assessment items, the patient may not receive another MBS health assessment until the appropriate time period has expired. In the case of health assessment services that are provided only once in a patient's lifetime, the patient would not be eligible for another health assessment.

The only exception is patients who are eligible for more than one type of health assessment (that is, the patient belongs to more than one eligible patient category). However, the frequency of service restrictions also apply to these services.

If a medical practitioner is not sure if a patient is eligible for an MBS health assessment service, they may telephone the Department of Human Services on 132011, with the patient present, to check eligibility.

Guidance Notes

A health assessment means the assessment of a patient's health and physical, psychological and social function and consideration of whether preventive health care and education should be offered to the patient, to improve that patient's health and physical, psychological and social function.

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 his or her 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 he or she consents to the health assessment being performed. In cases where the patient is not capable of giving consent, consent must be given by his or her parent(s), carer or representative. Consent to the health assessment must be noted in the patient's records.

A health assessment must include the following elements:

a.     information collection, including taking a patient history and undertaking or arranging examinations and investigations as required;

b.    making an overall assessment of the patient;

c.     recommending appropriate interventions;

d.    providing advice and information to the patient;

e.     keeping a record of the health assessment, and offering the patient a written report about the health assessment, with recommendations about matters covered by the health assessment; and

f.     offering the patient's carer (if any, and if the medical practitioner considers it appropriate and the patient agrees) a copy of the report or extracts of the report relevant to the carer.

Restrictions on billing the health assessment items

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 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 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 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.

Related Items: 224 225 226 227


Related Items

Category 1 - PROFESSIONAL ATTENDANCES

224

224 - Additional Information

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

Professional attendance by a medical 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: $48.25 Benefit: 100% = $48.25

(See para AN.7.1, AN.7.5, AN.7.6, AN.7.7, AN.7.8, AN.7.9, AN.7.10, AN.7.11, AN.7.12 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

225

225 - Additional Information

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

Professional attendance by a medical 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: $112.10 Benefit: 100% = $112.10

(See para AN.7.1, AN.7.5, AN.7.6, AN.7.7, AN.7.8, AN.7.9, AN.7.10, AN.7.11, AN.7.12 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

226

226 - Additional Information

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

Professional attendance by a medical 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: $154.70 Benefit: 100% = $154.70

(See para AN.7.1, AN.7.5, AN.7.6, AN.7.7, AN.7.8, AN.7.9, AN.7.10, AN.7.11, AN.7.12 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

227

227 - Additional Information

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

Professional attendance by a medical 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: $218.50 Benefit: 100% = $218.50

(See para AN.7.1, AN.7.5, AN.7.6, AN.7.7, AN.7.8, AN.7.9, AN.7.10, AN.7.11, AN.7.12 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