Medicare Benefits Schedule - Note MN.3.2

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Category 8 - MISCELLANEOUS SERVICES

MN.3.2

Individual Allied Health Services (Items 10950 to 10970) for Chronic Disease Management - Referral Requirements

Referral form

For Medicare benefits to be payable, the patient must be referred to an eligible allied health professional by their GP or medical practitioner using a referral form that has been issued by the Australian Government Department of Health or a form that contains all the components of this form.

The form issued by the department is available at www.health.gov.au/mbsprimarycareitems (click on the link for allied health individual services).

GPs and medical practitioners are encouraged to attach a copy of the relevant part of the patient's care plan to the referral form.

GPs and medical practitioners may use one referral form to refer patients for single or multiple services of the same service type (e.g. five chiropractic services).  If referring a patient for single or multiple services of different service types (e.g.  two dietetic services and three podiatry services), a separate referral form will be needed for each service type.

The patient will need to present the referral form to the allied health professional at the first consultation, unless the GP or medical practitioner has previously provided it directly to the allied health professional.

It is required that allied health professionals retain the referral form for 2 years from the date the service was rendered (for the Department of Human Services auditing purposes).

A copy of the referral form is not required to accompany Medicare claims, and allied health professionals do not need to attach a signed copy of the form to patients' itemised accounts/receipts or assignment of benefit forms.

Completed forms do not have to be sent to the Department of Health.

Health Care Home shared care plan

A Health Care Home shared care plan means a written plan that is prepared for a patient enrolled at a Health Care Home trial site; is prepared by a medical practitioner (including a general practitioner but not including a specialist or consultant physician) who is leading the patient's care at the Health Care Home trial site; and includes:  an outline of the patient's agreed current and long-term goals; the person or people responsible for each activity; arrangements to review the plan by a day mentioned in the plan; and if authorised by the patient, arrangements for the transfer of information between the medical practitioner and other health care providers supporting patient care about the patient's condition or conditions and treatment. A Health Care Home Shared care plan must be kept for 2 years after the date it was created.

Referral validity

Medicare benefits are available for up to five allied health services per patient per calendar year.  Where a patient receives more than the limit of five services in a calendar year, the additional service/s will not attract a Medicare benefit and the MBS Safety Net arrangements will not apply to costs incurred by the patient for the service/s.

If a patient has not used all of their allied health services under a referral in a calendar year, it is not necessary to obtain a new referral for the "unused" services.  However, any "unused" services received from 1 January in the following year under that referral will count as part of the total of five services for which the patient is eligible in that calendar year.

When patients have used all of their referred services, or require a referral for a different type of allied health service recommended in their CDM plan/s or Health Care Home shared care plan, they will need to obtain a new referral from their GP or medical practitioner.  GPs and medical practitioners may choose to use this visit to undertake a review of the patient's CDM plan/s or, where appropriate, to manage the process using a GP/medical practitioner consultation item.

It is not necessary to have a new CDM plan/s prepared each calendar year in order to access a new referral/s for eligible allied health services.  Patients continue to be eligible for rebates for allied health services while they are being managed under the prerequisite CDM items or Health Care Home shared care plan as long as the need for eligible services continues to be recommended in their plan.  However, regular reviews using MBS GP item 732 or medical practitioner item 233 are encouraged.

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-Jul-2019

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: $63.25 Benefit: 85% = $53.80

(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-Jul-2019

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: $63.25 Benefit: 85% = $53.80

(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-Jul-2019

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: $63.25 Benefit: 85% = $53.80

(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-Jul-2019

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: $63.25 Benefit: 85% = $53.80

(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-Jul-2019

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: $63.25 Benefit: 85% = $53.80

(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-Jul-2019

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: $63.25 Benefit: 85% = $53.80

(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-Jul-2019

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: $63.25 Benefit: 85% = $53.80

(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-Jul-2019

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: $63.25 Benefit: 85% = $53.80

(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-Jul-2019

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: $63.25 Benefit: 85% = $53.80

(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-Jul-2019

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: $63.25 Benefit: 85% = $53.80

(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-Jul-2019

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: $63.25 Benefit: 85% = $53.80

(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-Jul-2019

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: $63.25 Benefit: 85% = $53.80

(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-Jul-2019

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: $63.25 Benefit: 85% = $53.80

(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