Medicare Benefits Schedule - Note AN.35.1

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Category 1 - PROFESSIONAL ATTENDANCES

AN.35.1

Flag fall amount for residential aged care facility attendance by a general practitioner

Medicare item 90001 provides a call-out fee for the initial attendance by a general practitioner at one RACF, on one occasion, applicable only to the first patient seen on the RACF visit. 

The Medicare benefit for the single call-out fee and the associated general consultation (either Level A to D) applies only for patients within a RACF who have a general consultation with a doctor in person.

If doctors do not bill the single call-out fee, the benefit will not be paid.

If a doctor has to return to the RACF facility twice or more on the same day and the attendances are not a continuation of an earlier episode of treatment, another call-out fee would apply per subsequent RACF visit.

When claiming the new attendance items there is no longer a requirement to transmit the number of patients seen. A doctor would claim each attendance item like any other consultation service.

MBS items 90001 is not to be used with existing derived fee services such as for afterhours, urgent afterhours, or telehealth services.  The bulk billing incentive only applies to the attendance item, not to the single call-out fee.

Related Items: 90001 90020 90035 90043 90051


Related Items

Category 1 - PROFESSIONAL ATTENDANCES

90001

90001 - Additional Information

Item Start Date:
01-Mar-2019
Description Start Date:
01-Mar-2019
Schedule Fee Start Date:
01-Mar-2019

A flag fall service to which item 90020, 90035, 90043 or 90051 applies. For the initial attendance at one residential aged care facility on one occasion, applicable to a maximum of one patient attended on.

Fee: $55.00 Benefit: 100% = $55.00

(See para AN.35.1 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

90020

90020 - Additional Information

Item Start Date:
01-Mar-2019
Description Start Date:
01-Mar-2019
Schedule Fee Start Date:
01-Mar-2019

Professional attendance (other than a service to which another item applies) at a residential aged care facility (other than a professional attendance at a self‑contained unit) or professional attendance at consulting rooms situated within such a complex if the patient is accommodated in a residential aged care facility (other than accommodation in a self‑contained unit) by a general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management—an attendance on one or more patients at one residential aged care facility on one occasion - each patient.

Fee: $17.20 Benefit: 100% = $17.20

(See para AN.0.9, AN.35.1 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

90035

90035 - Additional Information

Item Start Date:
01-Mar-2019
Description Start Date:
01-Mar-2019
Schedule Fee Start Date:
01-Mar-2019

Professional attendance by a general practitioner at a residential aged care facility to residents of the facility (other than a service to which another item in the table applies), lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation—an attendance on one or more patients at one residential aged care facility on one occasion—each patient

Fee: $37.60 Benefit: 100% = $37.60

(See para AN.0.9, AN.35.1 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

90043

90043 - Additional Information

Item Start Date:
01-Mar-2019
Description Start Date:
01-Mar-2019
Schedule Fee Start Date:
01-Mar-2019

Professional attendance by a general practitioner at a residential aged care facility to residents of the facility (other than a service to which another item in the table applies), lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation—an attendance on one or more patients at one residential aged care facility on one occasion—each patient

Fee: $72.80 Benefit: 100% = $72.80

(See para AN.0.9, AN.35.1 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

90051

90051 - Additional Information

Item Start Date:
01-Mar-2019
Description Start Date:
01-Mar-2019
Schedule Fee Start Date:
01-Mar-2019

Professional attendance by a general practitioner at a residential aged care facility to residents of the facility (other than a service to which another item in the table applies), lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation—an attendance on one or more patients at one residential aged care facility on one occasion—each patient

Fee: $107.15 Benefit: 100% = $107.15

(See para AN.0.9, AN.35.1 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