Medicare Benefits Schedule - Note AN.7.9

Last reviewed: 1 November 2023

Items 224, 225, 226 and 227 may be used to undertake a comprehensive medical assessment of a resident of a residential aged care facility.

This health assessment requires assessment of the resident's health and physical and psychological function, and must include:

(a) making a written summary of the comprehensive medical assessment;

(b) developing a list of diagnoses and medical problems based on the medical history and examination;

(c) providing a copy of the summary to the residential aged care facility; and

(d) offering the resident a copy of the summary.

A residential aged care facility is a facility in which residential care services, as defined in the Aged Care Act 1997, are provided.  This includes facilities that were formerly known as nursing homes and hostels.  A person is a resident of a residential aged care facility if the person has been admitted as a permanent resident of that facility.

This health assessment is available to new residents on admission into a residential aged care facility. It is recommended that new residents should receive the health assessment as soon as possible after admission, preferably within six weeks following admission into a residential aged care facility.

A health assessment for the purpose of a comprehensive medical assessment of a resident of a residential aged care facility may be claimed by an eligible patient:

(a) on admission to a residential aged care facility, provided that a comprehensive medical assessment has not already been provided in another residential aged care facility within the previous 12 months; and

(b) at 12-month intervals thereafter.

Related Items: 224 225 226 227

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Professional attendance by a prescribed 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: $52.25 Benefit: 100% = $52.25

(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)

Professional attendance by a prescribed 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: $121.45 Benefit: 100% = $121.45

(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)

Professional attendance by a prescribed 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: $167.55 Benefit: 100% = $167.55

(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)

Professional attendance by a prescribed 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 and referrals as indicated; and
(d) providing a comprehensive preventive health care management plan for the patient

Fee: $236.70 Benefit: 100% = $236.70

(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)