Medicare Benefits Schedule - Note MN.10.1

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Category 8 - MISCELLANEOUS SERVICES

MN.10.1

Assessment to assist with Diagnostic Formulation and Contribution to a Treatment and Management Plan by Eligible Allied Health Practitioner(s) for Complex Neurodevelopmental Disorder (such as Autism Spectrum Disorder) or Eligible Disability Services

These allied health items provide rebates for:

  • the assessment of patients for the purpose of assisting the referring eligible medical practitioner with the diagnosis (including a differential diagnosis) of a complex Neurodevelopmental Disorder (such as Autism Spectrum Disorder) or an eligible disability; or
  • to contribute to a treatment and management plan that is being developed by the referring eligible medical practitioner.

The list of eligible disabilities can be found at MN.10.3.

Number of services

  • A maximum of 8 services can be claimed per patient per lifetime, including services consisting of any combination of 82000, 82005, 82010, 82030, 93032, 93033, 93040 or 93041.
  • A course of assessment means up to 4 services.
  • Up to 4 of these services may be provided to the same patient on the same day.
  • Where a patient requires more than 4 services from the same eligible allied health provider, review and agreement is required by the referring medical practitioner before further Medicare eligible services can be claimed. 

Provision of assessment services and need for review and agreement by the referring eligible medical practitioner

  • An eligible allied health practitioner can provide up to 4 assessment services without the need for review and agreement by the referring eligible medical practitioner.
  • If an eligible allied health professional has provided 4 assessment services to a patient and proposes to provide more assessment services to that patient, review and agreement from the referring eligible medical practitioner must be obtained prior.
  • The referring eligible medical practitioner may specify the type of review that should be undertaken as part of the original referral. If it is not specified, an acceptable means of review includes: a case conference, phone call, written correspondence, secure online messaging exchange, or attendance with the referring eligible medical practitioner. 
  • The review and agreement by the referring eligible medical practitioner should be recorded by the eligible allied health practitioner in the patient notes.

Referral requirements

For an MBS rebate to be claimed for these services, a valid referral from an eligible medical practitioner (or subsequent interdisciplinary referral) is required. The eligible medical practitioner referral is only valid if the referring eligible medical practitioner used any of the following MBS items* for the suspected diagnosis of:

  • complex Neurodevelopmental Disorders referred by a:

- consultant psychiatrist using items 296 to 308, 310, 312, 314, 316, 318 or 319 to 352 of the general medical services table or items 91827, 91828, 91829, 91830, 91831, 91837, 91838, 91839, 92437, 92455, 92456, 92457, 92458, 92459 or 92460 of the COVID 19 Determination.

- consultant paediatrician using items 110 to 131 of the general medical services table or items 91824, 91825, 91826 or 91836 of the COVID 19 Determination.

  • eligible disability referred by a:

- specialist or consultant physician using items 104 to 131, 296 to 308, 310, 312, 314, 316, 318 or 319 to 352 of the general medical services table or items 91822 to 91839, 92437, 92455, 92456, 92457, 92458, 92459 or 92460 of the COVID 19 Determination.

- GP using items 3 to 47 of the general medical services table or item 91790, 91800, 91801, 91802, 91890, 91891 or 91894 of the COVID 19 Determination.

* Note that more information on the telehealth items that can be claimed for these services can be found in Note AN.40.1.

A separate referral from the eligible medical practitioner is required for each eligible allied health practitioner providing the service. The referral may be a letter, departmental form or note to an eligible allied health practitioner, signed and dated by the referring eligible medical practitioner. A Medicare claim must be submitted for the referring MBS service before a rebate for the subsequent referred allied health service can be paid.

Allied health practitioners should retain referrals for 24 months from the date the service was rendered for Medicare auditing purposes.

Interdisciplinary referrals

If an eligible allied health practitioner seeks to make an interdisciplinary referral of the patient to another eligible allied health professional, this must be undertaken in consultation and agreement with, but without the need for a physical attendance by, the original referring eligible medical practitioner (such as but not limited to, a phone call, written correspondence or secure online messaging exchange). This consultation and agreement should be documented in the patient notes by the eligible allied health practitioner and included in the interdisciplinary referral. The referral may be a letter or note to an eligible allied health practitioner, signed and dated by the referring eligible allied health practitioner. There is no specific form to refer patients for these services. The referral should include a copy of the original referral by the eligible medical practitioner.

Interdisciplinary referrals will only be valid where the referring eligible medical practitioner’s referral (whose original referral initiated the assessment and assisting with a diagnosis service/contribution to a treatment and management plan) remains valid.

Reporting requirements for assessment services

After completion of the final assessment service by an eligible allied health practitioner, a written report must be provided to the referring eligible medical practitioner that outlines the assessment findings. Preparation of the report is not counted towards the service time under the item.

The written report must include information on:

  • the assessment/s provided;
  • the results of the assessment/s that may assist with diagnostic formulation or development of a treatment and management plan by the referring eligible medical practitioner; and
  • if applicable, advice on further assessments that could be undertaken by other eligible allied health practitioners to assist with the referring medical practitioners’ diagnostic formulation or development of a treatment and management plan by the referring eligible medical practitioner.

Related Items: 82000 82005 82010 82030 93032 93033 93035 93036 93040 93041 93043 93044


Related Items

Category 8 - MISCELLANEOUS SERVICES

82000

82000 - Additional Information

Item Start Date:
01-Mar-2024
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Psychology health service provided to a patient aged under 25 years by an eligible psychologist if:

(a)    the patient was referred by an eligible medical practitioner, or by an eligible allied health practitioner following referral by an eligible medical practitioner, to:

(i)   assist the eligible medical practitioner with diagnostic formulation where the patient has a suspected complex neurodevelopmental disorder or eligible disability; or

(ii)  contribute to the patient’s treatment and management plan developed by the referring eligible medical practitioner where a complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability is confirmed; and

(b)    the service is provided to the patient individually and in person; and

(c)    the service is at least 50 minutes duration

Up to 4 services to which this item or any of items 82005, 82010, 82030, 93032, 93033, 93040 or 93041 apply may be provided to the same patient on the same day

Fee: $109.80 Benefit: 85% = $93.35

(See para AN.0.25, MN.10.1, MN.10.3 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

82005

82005 - Additional Information

Item Start Date:
01-Mar-2024
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Speech pathology health service provided to a patient aged under 25 years by an eligible speech pathologist if:

(a)    the patient was referred by an eligible medical practitioner, or by an eligible allied health practitioner following referral by an eligible medical practitioner, to:

(i)   assist the eligible medical practitioner with diagnostic formulation where the patient has a suspected complex neurodevelopmental disorder or eligible disability; or

(ii)  contribute to the patient’s treatment and management plan developed by the referring eligible medical practitioner where a complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability is confirmed; and

(b)    the service is provided to the patient individually and in person; and

(c)    the service is at least 50 minutes duration

Up to 4 services to which this item or any of items 82000, 82010, 82030, 93032, 93033, 93040 or 93041 apply may be provided to the same patient on the same day

Fee: $96.80 Benefit: 85% = $82.30

(See para AN.0.25, MN.10.1, MN.10.3 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

82010

82010 - Additional Information

Item Start Date:
01-Mar-2024
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Occupational therapy health service provided to a patient aged under 25 years by an eligible occupational therapist if:

(a)    the patient was referred by an eligible medical practitioner, or by an eligible allied health practitioner following referral by an eligible medical practitioner, to:

(i)   assist the eligible medical practitioner with diagnostic formulation where the patient has a suspected complex neurodevelopmental disorder or eligible disability; or

(ii)  contribute to the patient’s treatment and management plan developed by the referring eligible medical practitioner where a complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability is confirmed; and

(b)    the service is provided to the patient individually and in person; and

(c)    the service is at least 50 minutes duration

Up to 4 services to which this item or any of items 82000, 82005, 82030, 93032, 93033, 93040 or 93041 apply may be provided to the same patient on the same day

Fee: $96.80 Benefit: 85% = $82.30

(See para AN.0.25, MN.10.1, MN.10.3 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

82030

82030 - Additional Information

Item Start Date:
01-Mar-2024
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Audiology, optometry, orthoptic or physiotherapy health service provided to a patient aged under 25 years by an eligible audiologist, optometrist, orthoptist or physiotherapist if:

(a)    the patient was referred by an eligible medical practitioner, or by an eligible allied health practitioner following referral by an eligible medical practitioner, to:

(i)   assist the eligible medical practitioner with diagnostic formulation where the patient has a suspected complex neurodevelopmental disorder or eligible disability; or

(ii)  contribute to the patient’s treatment and management plan developed by the referring eligible medical practitioner where a complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability is confirmed; and

(b)    the service is provided to the patient individually and in person; and

(c)    the service is at least 50 minutes duration

Up to 4 services to which this item or any of items 82000, 82005, 82010, 93032, 93033, 93040 or 93041 apply may be provided to the same patient on the same day

Fee: $96.80 Benefit: 85% = $82.30

(See para AN.0.25, MN.10.1, MN.10.3 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

93040

93040 - Additional Information

Item Start Date:
30-Mar-2020
Description Updated:
01-Mar-2023
Schedule Fee Updated:
01-Nov-2023

Psychology health service provided by phone attendance to a patient aged under 25 years by an eligible psychologist if:

(a) the patient was referred by an eligible medical practitioner, or by an eligible allied health practitioner following referral by an eligible medical practitioner, to:

(i) assist the eligible medical practitioner with diagnostic formulation where the patient has a suspected complex neurodevelopmental disorder or eligible disability; or

(ii) contribute to the patient’s treatment and management plan developed by the referring eligible medical practitioner where a complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability is confirmed; and

(b) the service is provided to the patient individually; and

(c) the service is at least 50 minutes duration

Up to 4 services to which this item or any of items 82000, 82005, 82010, 82030, 93032, 93033 or 93041 apply may be provided to the same patient on the same day

Further information on the requirements for this item are available in the explanatory notes to this Category

Fee: $109.80 Benefit: 85% = $93.35

(See para AN.0.25, MN.10.1, MN.10.3 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

93041

93041 - Additional Information

Item Start Date:
30-Mar-2020
Description Updated:
01-Mar-2023
Schedule Fee Updated:
01-Nov-2023

Speech pathology, occupational therapy, audiology, optometry, orthoptic or physiotherapy health service provided by phone attendance to a patient aged under 25 years by an eligible speech pathologist, occupational therapist, audiologist, optometrist, orthoptist or physiotherapist if:

(a) the patient was referred by an eligible medical practitioner, or by an eligible allied health practitioner following referral by an eligible medical practitioner, to:

(i) assist the eligible medical practitioner with diagnostic formulation where the patient has a suspected complex neurodevelopmental disorder or eligible disability; or

(ii) contribute to the patient’s treatment and management plan developed by the referring eligible medical practitioner where a complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability is confirmed; and

(b) the service is provided to the patient individually; and

(c) the service is at least 50 minutes duration

Up to 4 services to which this item or any of items 82000, 82005, 82010, 82030, 93032, 93033 or 93040 apply may be provided to the same patient on the same day

Further information on the requirements for this item are available in the explanatory notes to this Category

Fee: $96.80 Benefit: 85% = $82.30

(See para AN.0.25, MN.10.1, MN.10.3 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

93043

93043 - Additional Information

Item Start Date:
30-Mar-2020
Description Updated:
01-Mar-2023
Schedule Fee Updated:
01-Nov-2023

Psychology health service provided by phone attendance to a patient aged under 25 years for the treatment of a diagnosed complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability by an eligible psychologist, if:

(a) the patient has a treatment and management plan in place and has been referred by an eligible medical practitioner for a course of treatment consistent with that treatment and management plan; and

(b) the service is provided to the patient individually; and

(c) the service is at least 30 minutes duration; and

(d) on the completion of the course of treatment, the eligible psychologist gives a written report to the referring eligible medical practitioner on assessments (if performed), treatment provided and recommendations on future management of the patient’s condition

Up to 4 services to which this item or any of items 82015, 82020, 82025, 82035, 93035, 93036 or 93044 apply may be provided to the same patient on the same day

Further information on the requirements for this item are available in the explanatory notes to this Category

Fee: $109.80 Benefit: 85% = $93.35

(See para AN.0.25, MN.10.1, MN.10.2, MN.10.3 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

93044

93044 - Additional Information

Item Start Date:
30-Mar-2020
Description Updated:
01-Mar-2023
Schedule Fee Updated:
01-Nov-2023

Speech pathology, occupational therapy, audiology, optometry, orthoptic or physiotherapy health service provided by phone attendance to a patient aged under 25 years for the treatment of a diagnosed complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability by an eligible speech pathologist, occupational therapist, audiologist, optometrist, orthoptist or physiotherapist, if:

(a) the patient has a treatment and management plan in place and has been referred by an eligible medical practitioner for a course of treatment consistent with that treatment and management plan; and

(b) the service is provided to the patient individually; and

(c) the service is at least 30 minutes duration; and

(d) on the completion of the course of treatment, the eligible speech pathologist, occupational therapist, audiologist, optometrist, orthoptist or physiotherapist gives a written report to the referring eligible medical practitioner on assessments (if performed), treatment provided and recommendations on future management of the patient’s condition

Up to 4 services to which this item or any of items 82015, 82020, 82025, 82035, 93035, 93036 or 93043 apply may be provided to the same patient on the same day

Further information on the requirements for this item are available in the explanatory notes to this Category

Fee: $96.80 Benefit: 85% = $82.30

(See para AN.0.25, MN.10.1, MN.10.2, MN.10.3 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

93032

93032 - Additional Information

Item Start Date:
30-Mar-2020
Description Updated:
01-Mar-2023
Schedule Fee Updated:
01-Nov-2023

Psychology health service provided by telehealth attendance to a patient aged under 25 years by an eligible psychologist if:

(a) the patient was referred by an eligible medical practitioner, or by an eligible allied health practitioner following referral by an eligible medical practitioner, to:

(i) assist the eligible medical practitioner with diagnostic formulation where the patient has a suspected complex neurodevelopmental disorder or eligible disability; or

(ii) contribute to the patient’s treatment and management plan developed by the referring eligible medical practitioner where a complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability is confirmed; and

(b) the service is provided to the patient individually; and

(c) the service is at least 50 minutes duration

Up to 4 services to which this item or any of items 82000, 82005, 82010, 82030, 93033, 93040 or 93041 apply may be provided to the same patient on the same day

Further information on the requirements for this item are available in the explanatory notes to this Category

Fee: $109.80 Benefit: 85% = $93.35

(See para AN.0.25, MN.10.1, MN.10.3 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

93033

93033 - Additional Information

Item Start Date:
30-Mar-2020
Description Updated:
01-Mar-2023
Schedule Fee Updated:
01-Nov-2023

Speech pathology, occupational therapy, audiology, optometry, orthoptic or physiotherapy health service provided by telehealth attendance to a patient aged under 25 years by an eligible speech pathologist, occupational therapist, audiologist, optometrist, orthoptist or physiotherapist if:

(a) the patient was referred by an eligible medical practitioner, or by an eligible allied health practitioner following referral by an eligible medical practitioner, to:

(i) assist the eligible medical practitioner with diagnostic formulation where the patient has a suspected complex neurodevelopmental disorder or eligible disability; or

(ii) contribute to the patient’s treatment and management plan developed by the referring eligible medical practitioner where a complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability is confirmed; and

(b) the service is provided to the patient individually; and

(c) the service is at least 50 minutes duration

Up to 4 services to which this item or any of items 82000, 82005, 82010, 82030, 93032, 93040 or 93041 apply may be provided to the same patient on the same day

Further information on the requirements for this item are available in the explanatory notes to this Category

Fee: $96.80 Benefit: 85% = $82.30

(See para AN.0.25, MN.10.1, MN.10.3 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

93035

93035 - Additional Information

Item Start Date:
30-Mar-2020
Description Updated:
01-Mar-2023
Schedule Fee Updated:
01-Nov-2023

Psychology health service provided by telehealth attendance to a patient aged under 25 years for the treatment of a diagnosed complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability by an eligible psychologist, if:

(a) the patient has a treatment and management plan in place and has been referred by an eligible medical practitioner for a course of treatment consistent with that treatment and management plan; and

(b) the service is provided to the patient individually; and

(c) the service is at least 30 minutes duration; and

(d) on the completion of the course of treatment, the eligible psychologist gives a written report to the referring eligible medical practitioner on assessments (if performed), treatment provided and recommendations on future management of the patient’s condition

Up to 4 services to which this item or any of items 82015, 82020, 82025, 82035, 93036, 93043 or 93044 apply may be provided to the same patient on the same day

Further information on the requirements for this item are available in the explanatory notes to this Category

Fee: $109.80 Benefit: 85% = $93.35

(See para AN.0.25, MN.10.1, MN.10.2, MN.10.3 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

93036

93036 - Additional Information

Item Start Date:
30-Mar-2020
Description Updated:
01-Mar-2023
Schedule Fee Updated:
01-Nov-2023

Speech pathology, occupational therapy, audiology, optometry, orthoptic or physiotherapy health service provided by telehealth attendance to a patient aged under 25 years for the treatment of a diagnosed complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability by an eligible speech pathologist, occupational therapist, audiologist, optometrist, orthoptist or physiotherapist, if:

(a) the patient has a treatment and management plan in place and has been referred by an eligible medical practitioner for a course of treatment consistent with that treatment and management plan; and

(b) the service is provided to the patient individually; and

(c) the service is at least 30 minutes duration; and

(d) on the completion of the course of treatment, the eligible speech pathologist, occupational therapist, audiologist, optometrist, orthoptist or physiotherapist gives a written report to the referring eligible medical practitioner on assessments (if performed), treatment provided and recommendations on future management of the patient’s condition

Up to 4 services to which this item or any of items 82015, 82020, 82025, 82035, 93035, 93043 or 93044 apply may be provided to the same patient on the same day

Further information on the requirements for this item are available in the explanatory notes to this Category

Fee: $96.80 Benefit: 85% = $82.30

(See para AN.0.25, MN.10.1, MN.10.2, MN.10.3 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