Medicare Benefits Schedule - Note MN.3.2

Search Results for Note MN.3.2

View Related Items

Category 8 - MISCELLANEOUS SERVICES

MN.3.2

Multidisciplinary Case Conferencing for Chronic Disease Management (Items 10955, 10957, 10959)

These items provide MBS benefits for eligible allied health professionals to participate in a multidisciplinary case conference team in a community case conference with a patient’s GP or prescribed medical practitioner and other providers.

A prescribed medical practitioner is a medical practitioner other than a GP, specialist, or consultant physician. A multidisciplinary case conference means a process by which a multidisciplinary case conference team carries out all the following activities:

  • discussing a patient’s history;
  • identifying the patient’s multidisciplinary care needs;
  • identifying outcomes to be achieved by members of the multidisciplinary case conference team giving care and service to the patient;
  • identifying tasks that need to be undertaken to achieve these outcomes, and allocating those tasks to members of the multidisciplinary case conference team;
  • assessing whether previously identified outcomes (if any) have been achieved.

These items apply to non-hospital admitted patients for chronic disease management under the care of a GP/prescribed medical practitioner in either the community or for a resident of a residential aged care facility.

Eligible allied health professionals may claim reimbursement for participating in case conferences through the following time-tiered items:

  • 15–19 minutes (10955)
  • 20–39 minutes (10957)
  • 40 minutes or longer (10959)

Eligible Allied Health Professionals

For the purpose of these items, eligible health professionals must meet the eligibility requirements as set out in the Health Insurance (Section 3C General Medical Services – Allied Health Services) Determination 2024 and include the following:

  • Aboriginal health worker
  • Aboriginal and Torres Strait Islander health practitioner
  • audiologist
  • chiropractor
  • diabetes educator
  • dietitian
  • exercise physiologist
  • mental health worker which includes allied health professionals that meet the requirements of a mental health service which include Aboriginal and Torres Strait Islander health practitioners, Aboriginal and Torres Strait Islander health workers, mental health nurses, occupational therapists, psychologists and social workers
  • occupational therapist
  • osteopath
  • physiotherapist
  • podiatrist
  • psychologist
  • speech pathologist


Organisation of a case conference

The case conference must be organised by the GP/prescribed medical practitioner. The multidisciplinary case conference team must include a GP/prescribed medical practitioner and at least 2 other members providing different kinds of care to the patient. The multidisciplinary case conference team requirements include:

  • each member must provide a different kind of care or service to the patient; and
  • each member must not be an unpaid carer of the patient; and
  • one member may be another GP/prescribed medical practitioner.

The patient and family members or carers can attend the case conference but will not count towards the minimum team member requirements. 

The allied health professional does not need all participants to be MBS-eligible to be able to claim payment for their participation. Members can include allied health professionals, home and community service providers and care organisers, including the following:

  • asthma educators;
  • dental therapists;
  • dentists;
  • optometrists;
  • orthoptists;
  • orthotists or prosthetists;
  • pharmacists;
  • podiatrists;
  • registered nurses;
  • education providers;
  • “meals on wheels” providers;
  • personal care workers; and
  • probation officers.

In some instances, 2 allied health professionals from the same profession may participate in the same case conference, where both provide different aspects of care to the patient. For instance, the 2 allied health professionals from the same profession have different specialisations that are clinically relevant to the same patient and cannot be provided by one of them alone. In this instance, both allied health professionals will be able to claim the items.

Participation in a case conference

A referral is not required for an allied health professional to access the multidisciplinary case conferencing items for chronic disease management. However, the allied health professional must be invited to participate in the case conference by the patient’s treating GP/prescribed medical practitioner.

The patient must agree to the allied health professional participating in the case conference and be informed that Medicare will be accessed to fund the service. The patient may agree through discussion with their GP/prescribed medical practitioner. The GP/prescribed medical practitioner should ensure that the patient has agreed and that their agreement has been recorded appropriately.

Allied health professionals claiming a case conferencing item should record the day, start, and end times, the names of all participants and all matters discussed in the patient’s medical record.

The allied health professional is not required to have a pre-existing relationship with the patient. However, the patient should agree to their participation in the case conference and be informed that Medicare will be accessed to fund the service.

The case conference may lead to an agreed care plan between all participating providers, including the number of individual allied health services required and how they are allocated among professions within a patient’s entitlement.

The case conferencing items can be accessed in person, via videoconference or telephone, using the same item number. There is no requirement that all participants use the same communication method.

Related Items: 10950 10951 10952 10953 10954 10956 10958 10960 10962 10964 10966 10968 10970 93000 93013


Related Items

Category 8 - MISCELLANEOUS SERVICES

93000

93000 - Additional Information

Item Start Date:
30-Mar-2020
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Telehealth attendance by an eligible allied health practitioner if:

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

(i) a chronic condition; and

(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) 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 or multidisciplinary 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 allied 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 service is provided to the person individually; and

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

(f) after the service, the eligible allied 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 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;

to a maximum of 5 services (including any services to which this item, item 93013 or any item in Subgroup 1 of Group M3 of the Allied Health Determination applies) in a calendar year

Fee: $68.55 Benefit: 85% = $58.30

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

Category 8 - MISCELLANEOUS SERVICES

93013

93013 - Additional Information

Item Start Date:
30-Mar-2020
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Phone attendance by an eligible allied health practitioner if:

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

(i) a chronic condition; and

(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) 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 or multidisciplinary 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 allied 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 service is provided to the person individually; and

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

(f) after the service, the eligible allied 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 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;

to a maximum of 5 services (including any services to which this item, item 93000 or any item in Subgroup 1 of Group M3 of the Allied Health Determination applies) in a calendar year

Fee: $68.55 Benefit: 85% = $58.30

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

Category 8 - MISCELLANEOUS SERVICES

10950

10950 - Additional Information

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

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

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

(i) a chronic condition; and

(ii) complex care needs being managed by a medical practitioner (other than a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the patient is a resident of an aged care facility, the patient’s medical practitioner has contributed to a multidisciplinary care plan; and

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

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

to a maximum of 5 services (including any services to which this item or any other item in this Subgroup or item 93000 or 93013 in the Telehealth and Telephone Determination applies) in a calendar year

Fee: $68.55 Benefit: 85% = $58.30

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

Category 8 - MISCELLANEOUS SERVICES

10951

10951 - Additional Information

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

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

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

(i) a chronic condition; and

(ii) complex care needs being managed by a medical practitioner (other than a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the patient is a resident of an aged care facility, the patient’s medical practitioner has contributed to a multidisciplinary care plan; and

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

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

to a maximum of 5 services (including any services to which this item or any other item in this Subgroup or item 93000 or 93013 in the Telehealth and Telephone Determination applies) in a calendar year

Fee: $68.55 Benefit: 85% = $58.30

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

Category 8 - MISCELLANEOUS SERVICES

10952

10952 - Additional Information

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

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

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

(i) a chronic condition; and

(ii) complex care needs being managed by a medical practitioner (other than a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the patient is a resident of an aged care facility, the patient’s medical practitioner has contributed to a multidisciplinary care plan; and

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

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

to a maximum of 5 services (including any services to which this item or any other item in this Subgroup or item 93000 or 93013 in the Telehealth and Telephone Determination applies) in a calendar year

Fee: $68.55 Benefit: 85% = $58.30

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

Category 8 - MISCELLANEOUS SERVICES

10953

10953 - Additional Information

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

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

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

(i) a chronic condition; and

(ii) complex care needs being managed by a medical practitioner (other than a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the patient is a resident of an aged care facility, the patient’s medical practitioner has contributed to a multidisciplinary care plan; and

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

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

to a maximum of 5 services (including any services to which this item or any other item in this Subgroup or items 93000 or 93013 in the Telehealth and Telephone Determination applies) in a calendar year

Fee: $68.55 Benefit: 85% = $58.30

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

Category 8 - MISCELLANEOUS SERVICES

10954

10954 - Additional Information

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

Dietetics health service provided to a patient by an eligible dietitian if:

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

(i) a chronic condition; and

(ii) complex care needs being managed by a medical practitioner (other than a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the patient is a resident of an aged care facility, the patient’s medical practitioner has contributed to a multidisciplinary care plan; and

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

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

to a maximum of 5 services (including any services to which this item or any other item in this Subgroup or item 93000 or 93013 in the Telehealth and Telephone Determination applies) in a calendar year

Fee: $68.55 Benefit: 85% = $58.30

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

Category 8 - MISCELLANEOUS SERVICES

10956

10956 - Additional Information

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

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

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

(i) a chronic condition; and

(ii) complex care needs being managed by a medical practitioner (other than a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the patient is a resident of an aged care facility, the patient’s medical practitioner has contributed to a multidisciplinary care plan; and

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

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

to a maximum of 5 services (including any services to which this item or any other item in this Subgroup or item 93000 or 93013 in the Telehealth and Telephone Determination applies) in a calendar year

Fee: $68.55 Benefit: 85% = $58.30

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

Category 8 - MISCELLANEOUS SERVICES

10958

10958 - 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 by an eligible occupational therapist if:

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

(i) a chronic condition; and

(ii) complex care needs being managed by a medical practitioner (other than a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the patient is a resident of an aged care facility, the patient’s medical practitioner has contributed to a multidisciplinary care plan; and

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

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

to a maximum of 5 services (including any services to which this item or any other item in this Subgroup or item 93000 or 93013 in the Telehealth and Telephone Determination applies) in a calendar year

Fee: $68.55 Benefit: 85% = $58.30

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

Category 8 - MISCELLANEOUS SERVICES

10960

10960 - Additional Information

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

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

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

(i) a chronic condition; and

(ii) complex care needs being managed by a medical practitioner (other than a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the patient is a resident of an aged care facility, the patient’s medical practitioner has contributed to a multidisciplinary care plan; and

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

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

to a maximum of 5 services (including any services to which this item or any other item in this Subgroup or item 93000 or 93013 in the Telehealth and Telephone Determination applies) in a calendar year

Fee: $68.55 Benefit: 85% = $58.30

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

Category 8 - MISCELLANEOUS SERVICES

10962

10962 - Additional Information

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

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

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

(i) a chronic condition; and

(ii) complex care needs being managed by a medical practitioner (other than a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the patient is a resident of an aged care facility, the patient’s medical practitioner has contributed to a multidisciplinary care plan; and

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

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

to a maximum of 5 services (including any services to which this item or any other item in this Subgroup or item 93000 or 93013 in the Telehealth and Telephone Determination applies) in a calendar year

Fee: $68.55 Benefit: 85% = $58.30

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

Category 8 - MISCELLANEOUS SERVICES

10964

10964 - Additional Information

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

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

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

(i) a chronic condition; and
(ii) complex care needs being managed by a medical practitioner (other than a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the patient is a resident of an aged care facility, the patient’s medical practitioner has contributed to a multidisciplinary care plan; and

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

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

to a maximum of 5 services (including any services to which this item or any other item in this Subgroup or item 93000 or 93013 in the Telehealth and Telephone Determination applies) in a calendar year

Fee: $68.55 Benefit: 85% = $58.30

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

Category 8 - MISCELLANEOUS SERVICES

10966

10966 - Additional Information

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

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

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

(i) a chronic condition; and

(ii) complex care needs being managed by a medical practitioner (other than a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the patient is a resident of an aged care facility, the patient’s medical practitioner has contributed to a multidisciplinary care plan; and

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

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

to a maximum of 5 services (including any services to which this item or any other item in this Subgroup or item 93000 or 93013 in the Telehealth and Telephone Determination applies) in a calendar year

Fee: $68.55 Benefit: 85% = $58.30

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

Category 8 - MISCELLANEOUS SERVICES

10968

10968 - 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 by an eligible psychologist if:

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

(i) a chronic condition; and

(ii) complex care needs being managed by a medical practitioner (other than a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the patient is a resident of an aged care facility, the patient’s medical practitioner has contributed to a multidisciplinary care plan; and

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

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

to a maximum of 5 services (including any services to which this item or any other item in this Subgroup or item 93000 or 93013 in the Telehealth and Telephone Determination applies) in a calendar year

Fee: $68.55 Benefit: 85% = $58.30

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

Category 8 - MISCELLANEOUS SERVICES

10970

10970 - 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 by an eligible speech pathologist if:

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

(i) a chronic condition; and

(ii) complex care needs being managed by a medical practitioner (other than a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the patient is a resident of an aged care facility, the patient’s medical practitioner has contributed to a multidisciplinary care plan; and

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

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

to a maximum of 5 services (including any services to which this item or any other item in this Subgroup or item 93000 or 93013 in the Telehealth and Telephone Determination applies) in a calendar year

Fee: $68.55 Benefit: 85% = $58.30

(See para MN.3.1, MN.3.2 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