Medicare Benefits Schedule - Note MN.3.1

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Category 8 - MISCELLANEOUS SERVICES

MN.3.1

Individual Allied Health Services (Items 10950 to 10970) for Chronic Disease Management - Eligible Patients

ELIGIBLE PATIENTS

Medicare benefits are available for certain services provided by eligible allied health professionals to people with chronic conditions and complex care needs who are being managed by a GP or medical practitioner using certain Chronic Disease Management (CDM) Medicare items or are enrolled in a Health Care Home.  The allied health services must be recommended in the patient's plan as part of the management of their chronic condition.

Chronic medical conditions and complex care needs

A chronic medical condition is one that has been or is likely to be present for at least six months, e.g. asthma, cancer, cardiovascular illness, diabetes mellitus, musculoskeletal conditions.and stroke.  A patient is considered to have complex care needs if they require ongoing care from a multidisciplinary team consisting of their GP or medical practitioner and at least two other health or care providers.

Prerequisite CDM services

Patients must have received the following MBS CDM services:

· GP Management Plan - MBS GP item 721 or medical practitioner item 229 (or GP review item 732 or medical practitioner review item 233 for a review of a GPMP); and

· Team Care Arrangements - MBS GP item 723 or medical practitioner item 230 (or GP review items 732 or medical practitioner review item 233 for a review of TCAs)

Alternatively, for patients who are permanent residents of an aged care facility, their GP or medical practitioner must have contributed to, or contributed to a review of, a multidisciplinary care plan prepared for them by the aged care facility (MBS GP item 731 or medical practitioner item 232).

Alternatively, for patients who are enrolled with a Health Care Home, a shared care plan must have been prepared by the medical practitioner who is leading the patient's care.

For more information on the CDM planning items, refer to the explanatory notes for these items.

Allied health membership of a TCAs team

The allied health professional providing the service may be a member of the TCAs team convened by the GP or medical practitioner to manage a patient's chronic condition and complex care needs.  However, the service may also be provided by an allied health professional who is not a member of the TCAs team, provided that the service has been identified as necessary by the patient's GP or medical practitioner and recommended in the patient's care plan/s.

Group services

In addition to individual services, patients who have type 2 diabetes may also access MBS items 81100 to 81125 which provide group allied health services.  Patients only need to have MBS GP items 721 or 723 or medical practitioner items 229 or 230 or a Health Care Home shared care plan in place to be eligible for the group services.

Related Items: 10950 10951 10952 10953 10954 10956 10958 10960 10962 10964 10966 10968 10970


Related Items

Category 8 - MISCELLANEOUS SERVICES

10950

10950 - Additional Information

Item Start Date:
01-Jul-2004
Description Start Date:
01-Oct-2017
Schedule Fee Start Date:
01-Nov-2012

ABORIGINAL AND TORRES STRAIT ISLANDER HEALTH SERVICE

Aboriginal or Torres Strait Islander health service provided to a person by an eligible Aboriginal health worker or eligible Aboriginal and Torres Strait Islander health practitioner if:

(a)    the service is provided to a person who has:

  1. a chronic condition; and
  2. complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a shared care plan or under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person's medical practitioner has contributed to a multidisciplinary care plan; and

(b)    the service is recommended in the person's Team Care Arrangements, multidisciplinary care plan or shared care plan as part of the management of the person's chronic condition and complex care needs; and

(c)    the person is referred to the eligible Aboriginal health worker or eligible Aboriginal and Torres Strait Islander health practitioner by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and

(d)    the person is not an admitted patient of a hospital; and

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

(f)    the service is of at least 20 minutes duration; and

(g)    after the service, the eligible Aboriginal health worker or eligible Aboriginal and Torres Strait Islander health practitioner gives a written report to the referring medical practitioner mentioned in paragraph (c):

    (i) if the service is the only service under the referral - in relation to that service; or

    (ii) if the service is the first or the last service under the referral - in relation to that service; or

    (iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of - in relation to those matters; and

(h)    for a service for which a private health insurance benefit is payable - the person who incurred the medical expenses for the service has elected to claim the Medicare benefit for the service, and not the private health insurance benefit;

- to a maximum of five services (including any services to which items 10950 to 10970 apply) in a calendar year

Fee: $62.25 Benefit: 85% = $52.95

(See para MN.3.1, MN.3.2, MN.3.3, MN.3.4, MN.3.5 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

10951

10951 - Additional Information

Item Start Date:
01-Nov-2004
Description Start Date:
01-Oct-2017
Schedule Fee Start Date:
01-Nov-2012

DIABETES EDUCATION SERVICE

Diabetes education health service provided to a person by an eligible diabetes educator if:

(a)    the service is provided to a person who has:

  1. a chronic condition; and
  2. complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a shared care plan or under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person's medical practitioner has contributed to a multidisciplinary care plan; and

(b)    the service is recommended in the person's Team Care Arrangements, multidisciplinary care plan or shared care plan as part of the management of the person's chronic condition and complex care needs; and

(c)    the person is referred to the eligible diabetes educator by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and

(d)    the person is not an admitted patient of a hospital; and

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

(f)    the service is of at least 20 minutes duration; and

(g)    after the service, the eligible diabetes educator gives a written report to the referring medical practitioner mentioned in paragraph (c):

    (i) if the service is the only service under the referral - in relation to that service; or

    (ii) if the service is the first or the last service under the referral - in relation to that service; or

    (iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of - in relation to those matters; and

(h)    for a service for which a private health insurance benefit is payable - the person who incurred the medical expenses for the service has elected to claim the Medicare benefit for the service, and not the private health insurance benefit;

- to a maximum of five services (including any services to which items 10950 to 10970 apply) in a calendar year

Fee: $62.25 Benefit: 85% = $52.95

(See para MN.3.1, MN.3.2, MN.3.3, MN.3.4, MN.3.5 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

10952

10952 - Additional Information

Item Start Date:
01-Jul-2004
Description Start Date:
01-Oct-2017
Schedule Fee Start Date:
01-Nov-2012

AUDIOLOGY

Audiology health service provided to a person by an eligible audiologist if:

(a)    the service is provided to a person who has:

  1. a chronic condition; and
  2. complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a shared care plan or under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person's medical practitioner has contributed to a multidisciplinary care plan; and

(b)    the service is recommended in the person's Team Care Arrangements, multidisciplinary care plan or shared can plan as part of the management of the person's chronic condition and complex care needs; and

(c)    the person is referred to the eligible audiologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and

(d)    the person is not an admitted patient of a hospital; and

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

(f)    the service is of at least 20 minutes duration; and

(g)    after the service, the eligible audiologist gives a written report to the referring medical practitioner mentioned in paragraph (c):

    (i) if the service is the only service under the referral - in relation to that service; or

    (ii) if the service is the first or the last service under the referral - in relation to that service; or

    (iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of - in relation to those matters; and

(h)    for a service for which a private health insurance benefit is payable - the person who incurred the medical expenses for the service has elected to claim the Medicare benefit for the service, and not the private health insurance benefit;

- to a maximum of  five services (including any services to which items 10950 to 10970 apply) in a calendar year

Fee: $62.25 Benefit: 85% = $52.95

(See para MN.3.1, MN.3.2, MN.3.3, MN.3.4, MN.3.5 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

10953

10953 - Additional Information

Item Start Date:
01-Jan-2006
Description Start Date:
01-Oct-2017
Schedule Fee Start Date:
01-Nov-2012

EXERCISE PHYSIOLOGY

Exercise physiology service provided to a person by an eligible exercise physiologist if:

(a)    the service is provided to a person who has:

  1. a chronic condition; and
  2. complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a shared care plan or under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person's medical practitioner has contributed to a multidisciplinary care plan; and

(b)    the service is recommended in the person's Team Care Arrangements, multidisciplinary care plan or shared care plan as part of the management of the person's chronic condition and complex care needs; and

(c)    the person is referred to the eligible exercise physiologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and

(d)    the person is not an admitted patient of a hospital; and

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

(f)    the service is of at least 20 minutes duration; and

(g)    after the service, the eligible exercise physiologist gives a written report to the referring medical practitioner mentioned in paragraph (c):

    (i) if the service is the only service under the referral - in relation to that service; or

    (ii) if the service is the first or the last service under the referral - in relation to that service; or

    (iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of - in relation to those matters; and

(h)    for a service for which a private health insurance benefit is payable - the person who incurred the medical expenses for the service has elected to claim the Medicare benefit for the service, and not the private health insurance benefit;

- to a maximum of  five services (including any services to which items 10950 to 10970 apply) in a calendar year

Fee: $62.25 Benefit: 85% = $52.95

(See para MN.3.1, MN.3.2, MN.3.3, MN.3.4, MN.3.5 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

10954

10954 - Additional Information

Item Start Date:
01-Jul-2004
Description Start Date:
01-Oct-2017
Schedule Fee Start Date:
01-Nov-2012

DIETETICS SERVICES

Dietetics health service provided to a person by an eligible dietician if:

(a)    the service is provided to a person who has:

  1. a chronic condition; and
  2. complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a shared care plan or under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person's medical practitioner has contributed to a multidisciplinary care plan; and

(b)    the service is recommended in the person's Team Care Arrangements, multidisciplinary care plan or shared care plan as part of the management of the person's chronic condition and complex care needs; and

(c)    the person is referred to the eligible dietician by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and

(d)    the person is not an admitted patient of a hospital; and

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

(f)    the service is of at least 20 minutes duration; and

(g)    after the service, the eligible dietician gives a written report to the referring medical practitioner mentioned in   paragraph (c):

    (i) if the service is the only service under the referral - in relation to that service; or

    (ii) if the service is the first or the last service under the referral - in relation to that service; or

    (iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of - in relation to those matters; and

(h)    for a service for which a private health insurance benefit is payable - the person who incurred the medical expenses for the service has elected to claim the Medicare benefit for the service, and not the private health insurance benefit;

- to a maximum of  five services (including any services to which items 10950 to 10970 apply) in a calendar year

Fee: $62.25 Benefit: 85% = $52.95

(See para MN.3.1, MN.3.2, MN.3.3, MN.3.4, MN.3.5 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

10956

10956 - Additional Information

Item Start Date:
01-Jul-2004
Description Start Date:
01-Oct-2017
Schedule Fee Start Date:
01-Nov-2012

MENTAL HEALTH SERVICE

Mental health service provided to a person by an eligible mental health worker if:

(a)    the service is provided to a person who has:

  1. a chronic condition; and
  2. complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a shared care plan or under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person's medical practitioner has contributed to a multidisciplinary care plan; and

(b)    the service is recommended in the person's Team Care Arrangements, multidisciplinary care plan or shared care plan as part of the management of the person's chronic condition and complex care needs; and

(c)    the person is referred to the eligible mental health worker by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and

(d)    the person is not an admitted patient of a hospital; and

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

(f)    the service is of at least 20 minutes duration; and

(g)    after the service, the eligible mental health worker gives a written report to the referring medical practitioner mentioned in paragraph (c):

    (i) if the service is the only service under the referral - in relation to that service; or

    (ii) if the service is the first or the last service under the referral - in relation to that service; or

    (iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of - in relation to those matters; and

(h)    for a service for which a private health insurance benefit is payable - the person who incurred the medical expenses for the service has elected to claim the Medicare benefit for the service, and not the private health insurance benefit;

- to a maximum of  five services (including any services to which items 10950 to 10970 apply) in a calendar year

Fee: $62.25 Benefit: 85% = $52.95

(See para MN.3.1, MN.3.2, MN.3.3, MN.3.4, MN.3.5 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

10958

10958 - Additional Information

Item Start Date:
01-Jul-2004
Description Start Date:
01-Oct-2017
Schedule Fee Start Date:
01-Nov-2012

OCCUPATIONAL THERAPY

Occupational therapy health service provided to a person by an eligible occupational therapist if:

(a)    the service is provided to a person who has:

  1. a chronic condition; and
  2. complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a shared care plan or under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person's medical practitioner has contributed to a multidisciplinary care plan; and

(b)    the service is recommended in the person's Team Care Arrangements, multidisciplinary care plan or shared care plan as part of the management of the person's chronic condition and complex care needs; and

(c)    the person is referred to the eligible occupational therapist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and

(d)    the person is not an admitted patient of a hospital; and

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

(f)    the service is of at least 20 minutes duration; and

(g)    after the service, the eligible occupational therapist gives a written report to the referring medical practitioner mentioned in paragraph (c):

    (i) if the service is the only service under the referral - in relation to that service; or

    (ii) if the service is the first or the last service under the referral - in relation to that service; or

    (iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of - in relation to those matters; and

(h)    for a service for which a private health insurance benefit is payable - the person who incurred the medical expenses for the service has elected to claim the Medicare benefit for the service, and not the private health insurance benefit;

- to a maximum of  five services (including any services to which items 10950 to 10970 apply) in a calendar year

Fee: $62.25 Benefit: 85% = $52.95

(See para MN.3.1, MN.3.2, MN.3.3, MN.3.4, MN.3.5 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

10960

10960 - Additional Information

Item Start Date:
01-Jul-2004
Description Start Date:
01-Oct-2017
Schedule Fee Start Date:
01-Nov-2012

PHYSIOTHERAPY

Physiotherapy health service provided to a person by an eligible physiotherapist if:

(a)    the service is provided to a person who has:

  1. a chronic condition; and
  2. complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a shared care plan or under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person's medical practitioner has contributed to a multidisciplinary care plan; and

(b)    the service is recommended in the person's Team Care Arrangements, multidisciplinary care plan or shared care plan as part of the management of the person's chronic condition and  complex care needs; and

(c)    the person is referred to the eligible physiotherapist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and

(d)    the person is not an admitted patient of a hospital; and

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

(f)    the service is of at least 20 minutes duration; and

(g)    after the service, the eligible physiotherapist gives a written report to the referring medical practitioner mentioned in paragraph (c):

    (i) if the service is the only service under the referral - in relation to that service; or

    (ii) if the service is the first or the last service under the referral - in relation to that service; or

    (iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of - in relation to those matters; and

(h)    for a service for which a private health insurance benefit is payable - the person who incurred the medical expenses for the service has elected to claim the Medicare benefit for the service, and not the private health insurance benefit;

- to a maximum of  five services (including any services to which items 10950 to 10970 apply) in a calendar year

Fee: $62.25 Benefit: 85% = $52.95

(See para MN.3.1, MN.3.2, MN.3.3, MN.3.4, MN.3.5 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

10962

10962 - Additional Information

Item Start Date:
01-Jul-2004
Description Start Date:
01-Oct-2017
Schedule Fee Start Date:
01-Nov-2012

PODIATRY

Podiatry health service provided to a person by an eligible podiatrist if:

(a)    the service is provided to a person who has:

  1. a chronic condition; and
  2. complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a shared care plan or under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person's medical practitioner has contributed to a multidisciplinary care plan; and

(b)    the service is recommended in the person's Team Care Arrangements, multidisciplinary care plan or shared care plan as part of the management of the person's chronic condition and complex care needs; and

(c)    the person is referred to the eligible podiatrist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and

(d)    the person is not an admitted patient of a hospital; and

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

(f)    the service is of at least 20 minutes duration; and

(g)    after the service, the eligible podiatrist gives a written report to the referring medical practitioner mentioned in paragraph (c):

    (i) if the service is the only service under the referral - in relation to that service; or

    (ii) if the service is the first or the last service under the referral - in relation to that service; or

    (iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of - in relation to those matters; and

(h)    for a service for which a private health insurance benefit is payable - the person who incurred the medical expenses for the service has elected to claim the Medicare benefit for the service, and not the private health insurance benefit;

- to a maximum of  five services (including any services to which items 10950 to 10970 apply) in a calendar year

Fee: $62.25 Benefit: 85% = $52.95

(See para MN.3.1, MN.3.2, MN.3.3, MN.3.4, MN.3.5 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

10964

10964 - Additional Information

Item Start Date:
01-Jul-2004
Description Start Date:
01-Oct-2017
Schedule Fee Start Date:
01-Nov-2012

CHIROPRACTIC SERVICE

Chiropractic health service provided to a person by an eligible chiropractor if:

(a)    the service is provided to a person who has:

  1. a chronic condition; and
  2. complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a shared care plan or under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person's medical practitioner has contributed to a multidisciplinary care plan; and

(b)    the service is recommended in the person's Team Care Arrangements, multidisciplinary care plan or shared care plan as part of the management of the person's chronic condition and complex care needs; and

(c)    the person is referred to the eligible chiropractor by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and

(d)    the person is not an admitted patient of a hospital; and

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

(f)    the service is of at least 20 minutes duration; and

(g)    after the service, the eligible chiropractor gives a written report to the referring medical practitioner mentioned in paragraph (c):

    (i) if the service is the only service under the referral - in relation to that service; or

    (ii) if the service is the first or the last service under the referral - in relation to that service; or

    (iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of - in relation to those matters; and

(h)    for a service for which a private health insurance benefit is payable - the person who incurred the medical expenses for the service has elected to claim the Medicare benefit for the service, and not the private health insurance benefit;

- to a maximum of  five services (including any services to which items 10950 to 10970 apply) in a calendar year

Fee: $62.25 Benefit: 85% = $52.95

(See para MN.3.1, MN.3.2, MN.3.3, MN.3.4, MN.3.5 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

10966

10966 - Additional Information

Item Start Date:
01-Jul-2004
Description Start Date:
01-Oct-2017
Schedule Fee Start Date:
01-Nov-2012

OSTEOPATHY

Osteopathy health service provided to a person by an eligible osteopath if:

(a)    the service is provided to a person who has:

  1. a chronic condition; and
  2. complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a shared care plan or under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person's medical practitioner has contributed to a multidisciplinary care plan; and

(b)    the service is recommended in the person's Team Care Arrangements, multidisciplinary care plan or shared care plan as part of the management of the person's chronic condition and complex care needs; and

(c)    the person is referred to the eligible osteopath by the medical practitioner using a referral form that has been issued by the Department  or a referral form that contains all the components of the form issued by the Department; and

(d)    the person is not an admitted patient of a hospital; and

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

(f)    the service is of at least 20 minutes duration; and

(g)    after the service, the eligible osteopath gives a written report to the referring medical practitioner mentioned in paragraph (c):

    (i) if the service is the only service under the referral - in relation to that service; or

    (ii) if the service is the first or the last service under the referral - in relation to that service; or

    (iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of - in relation to those matters; and

(h)    for a service for which a private health insurance benefit is payable - the person who incurred the medical expenses for the service has elected to claim the Medicare benefit for the service, and not the private health insurance benefit;

- to a maximum of  five services (including any services to which items 10950 to 10970 apply) in a calendar year

Fee: $62.25 Benefit: 85% = $52.95

(See para MN.3.1, MN.3.2, MN.3.3, MN.3.4, MN.3.5 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

10968

10968 - Additional Information

Item Start Date:
01-Jul-2004
Description Start Date:
01-Oct-2017
Schedule Fee Start Date:
01-Nov-2012

PSYCHOLOGY

Psychology health service provided to a person by an eligible psychologist if:

(a)    the service is provided to a person who has:

  1. a chronic condition; and
  2. complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a shared care plan or under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person's medical practitioner has contributed to a multidisciplinary care plan; and

(b)    the service is recommended in the person's Team Care Arrangements, multidisciplinary care plan or shared care plan as part of the management of the person's chronic condition and complex care needs; and

(c)    the person is referred to the eligible psychologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and

(d)    the person is not an admitted patient of a hospital; and

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

(f)    the service is of at least 20 minutes duration; and

(g)    after the service, the eligible psychologist gives a written report to the referring medical practitioner mentioned in paragraph (c):

    (i) if the service is the only service under the referral - in relation to that service; or

    (ii) if the service is the first or the last service under the referral - in relation to that service; or

    (iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of - in relation to those matters; and

(h)    for a service for which a private health insurance benefit is payable - the person who incurred the medical expenses for the service has elected to claim the Medicare benefit for the service, and not the private health insurance benefit;

- to a maximum of  five services (including any services to which items 10950 to 10970 apply) in a calendar year

Fee: $62.25 Benefit: 85% = $52.95

(See para MN.3.1, MN.3.2, MN.3.3, MN.3.4, MN.3.5 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

10970

10970 - Additional Information

Item Start Date:
01-Jul-2004
Description Start Date:
01-Oct-2017
Schedule Fee Start Date:
01-Nov-2012

SPEECH PATHOLOGY

Speech pathology health service provided to a person by an eligible speech pathologist if:

(a)    the service is provided to a person who has:

  1. a chronic condition; and
  2. complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a shared care plan or under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person's medical practitioner has contributed to a multidisciplinary care plan; and

(b)    the service is recommended in the person's Team Care Arrangements, multidisciplinary care plan or shared care plan as part of the management of the person's chronic condition and complex care needs; and

(c)    the person is referred to the eligible speech pathologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and

(d)    the person is not an admitted patient of a hospital; and

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

(f)    the service is of at least 20 minutes duration; and

(g)    after the service, the eligible speech pathologist gives a written report to the referring medical practitioner mentioned in paragraph (c):

    (i) if the service is the only service under the referral - in relation to that service; or

    (ii) if the service is the first or the last service under the referral - in relation to that service; or

    (iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of - in relation to those matters; and

(h)    for a service for which a private health insurance benefit is payable - the person who incurred the medical expenses for the service has elected to claim the Medicare benefit for the service, and not the private health insurance benefit;

- to a maximum of  five services (including any services to which items 10950 to 10970 apply) in a calendar year

Fee: $62.25 Benefit: 85% = $52.95

(See para MN.3.1, MN.3.2, MN.3.3, MN.3.4, MN.3.5 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