Medicare Benefits Schedule - Note MN.9.5

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Category 8 - MISCELLANEOUS SERVICES

MN.9.5

Group Allied Health Services (Items 81105, 81115 and 81125) for People with Type 2 Diabetes - Service Requirements and Referral Forms

These services are provided in a group setting to assist with the management of type 2 diabetes. 

Number of services per year

Patients are eligible for up to eight group allied health services in total (items 81105, 81115 and 81125 inclusive) per calendar year.  Each separate group service must be provided to the patient by only one type of allied health professional (i.e. by a diabetes educator, or by an exercise physiologist or by a dietitian).  However, the overall group services program provided for the patient could be comprised of one type of service only (e.g. eight diabetes education services) or a combination of services (e.g. three diabetes education services, three dietitian services and two exercise physiology services).  An eligible allied health professional with more than one Medicare provider number (e.g. for the provision of diabetes education and dietetics) may provide separate services under each of these provider numbers. 

Group allied health service providers are strongly encouraged to deliver multidisciplinary group services programs that allow patients to benefit from a range of interventions designed to assist in the management of their type 2 diabetes. 

Where a patient receives more than the limit of eight group 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 there is any doubt about a patient's eligibility for group services, the allied health professional should contact the Department of Human Services to confirm the number of group services already claimed by the patient in the calendar year.  Allied health professionals can call the Department of Human Services on 132 150 to check this information. 

Multiple services on the same day

Where clinically relevant, up to two group services may be provided consecutively on the same day by the same allied health professional. 

Referral form

The allied health professional/s undertaking the group services will need to receive the Referral form for group allied health services under Medicare for patients with type 2 diabetes issued by the Department of Health or the Health Care Home shared care plan or a form that contains all the components of this form, with Part B completed by the provider who has undertaken the assessment service.  The form issued by the department is available at http://www.health.gov.au/mbsprimarycareitems (click on the link for group allied health services). 

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. 

Group size

The service must be provided to a person who is part of a group of between two and 12 persons. 

Length of service

Each group service must be of at least 60 minutes duration. 

Reporting requirements

On completion of the group services program, each allied health professional must provide, or contribute to, a written report back to the referring GP in respect of each patient.  The report should describe the group services provided for the patient and indicate the outcomes achieved.  While each allied health professional is required to provide feedback to the GP in relation to the group services that they provide to the patient, allied health professionals involved in the provision of a multidisciplinary program are encouraged to combine feedback into a single report to the referring GP.

Related Items: 81105 81115 81125


Related Items

Category 8 - MISCELLANEOUS SERVICES

81105 Fee

81105 - Additional Information

Item Start Date:
01-May-2007
Description Start Date:
01-Nov-2010
Schedule Fee Start Date:
01-Jul-2019

DIABETES EDUCATION SERVICE - GROUP SERVICE


Diabetes education health service provided to a person by an eligible diabetes educator, as a GROUP SERVICE for the management of type 2 diabetes if:

(a)    the person has been assessed as suitable for a type 2 diabetes group service under assessment item 81100, 81110 or 81120; and

(b)   the service is provided to a person who is part of a group of between 2 and 12 patients inclusive; and

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

(d)   the service is provided to a person involving the personal attendance by an eligible diabetes educator; and

(e)   the service is of at least 60 minutes duration; and

(f)    after the last service in the group services program provided to the person under items 81105, 81115 or 81125, the eligible diabetes educator prepares, or contribute to, a written report to be provided to the referring medical practitioner; and

(g)   an attendance record for the group is maintained by the eligible diabetes educator; and

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


- to a maximum of eight  GROUP SERVICES (including services to which items 81105, 81115 and 81125 apply) in a calendar year.

Fee: $20.20 Benefit: 85% = $17.20

(See para MN.9.1, MN.9.2, MN.9.3, MN.9.5, MN.9.6, MN.9.7 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

81115 Fee

81115 - Additional Information

Item Start Date:
01-May-2007
Description Start Date:
01-Nov-2010
Schedule Fee Start Date:
01-Jul-2019

EXERCISE PHYSIOLOGY SERVICE - GROUP SERVICE


Exercise physiology health service provided to a person by an eligible exercise physiologist, as a GROUP SERVICE for the management of type 2 diabetes if:

(a)    the person has been assessed as suitable for a type 2 diabetes group service under assessment item 81100, 81110 or 81120; and

(b)   the service is provided to a person who is part of a group of between 2 and 12 patients inclusive; and

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

(d)   the service is provided to a person involving the personal attendance by an eligible exercise physiologist; and

(e)   the service is of at least 60 minutes duration; and

(f)    after the last service in the group services program provided to the person under items 81105, 81115 or 81125, the eligible exercise physiologist prepares, or contribute to, a written report to be provided to the referring medical practitioner; and

(g)   an attendance record for the group is maintained by the eligible exercise physiologist; and

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


- to a maximum of eight  GROUP SERVICES (including services to which items 81105, 81115 and 81125 apply) in a calendar year.

Fee: $20.20 Benefit: 85% = $17.20

(See para MN.9.1, MN.9.2, MN.9.3, MN.9.5, MN.9.6, MN.9.7 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

81125 Fee

81125 - Additional Information

Item Start Date:
01-May-2007
Description Start Date:
01-Nov-2010
Schedule Fee Start Date:
01-Jul-2019

DIETETICS SERVICE - GROUP SERVICE


Dietetics health service provided to a person by an eligible dietitian, as a GROUP SERVICE for the management of type 2 diabetes if:

(a)    the person has been assessed as suitable for a type 2 diabetes group service under assessment item 81100, 81110 or 81120; and

(b)   the service is provided to a person who is part of a group of between 2 and 12 patients inclusive; and

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

(d)   the service is provided to a person involving the personal attendance by an eligible dietitian; and

(e)   the service is of at least 60 minutes duration; and

(f)    after the last service in the group services program provided to the person under items 81105, 81115 or 81125, the eligible dietitian prepares, or contribute to, a written report to be provided to the referring medical practitioner; and

(g)   an attendance record for the group is maintained by the eligible dietitian; and

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


- to a maximum of eight GROUP SERVICES (including services to which items 81105, 81115 and 81125 apply) in a calendar year.

Fee: $20.20 Benefit: 85% = $17.20

(See para MN.9.1, MN.9.2, MN.9.3, MN.9.5, MN.9.6, MN.9.7 of explanatory notes to this Category)


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