Medicare Benefits Schedule - Note AN.7.19

Eligibility

Items 251 to 257 are available to medical practitioners providing services in eligible areas.

Eligible area means an area that is a Modified Monash 2 area, Modified Monash 3 area, Modified Monash 4 area, Modified Monash 5 area, Modified Monash 6 area or Modified Monash 7 area.

Medical practitioners providing services in a Modified Monash 1 area should use the items in Group A19, Subgroup 1.

A locator map to identify a medical practice's Modified Monash Model Area location is available at the DoctorConnect website at http://www.doctorconnect.gov.au/internet/otd/publishing.nsf/Content/locator

Guidance Notes

Item numbers 251, 252, 253, 254, 255, 256 and 257 should be used in place of the usual attendance item where as part of a consultation, a sample for cervical screening is collected from a person between the ages of 24 years and 9 months and 74 years inclusive who has not had a cervical smear in the last four years. Cervical Screening in accordance with the National Cervical Screening Policy at P.16.11.

Self-collection of a sample for screening is only available for women between the ages of 30 and 74 years of age who are overdue for screening by two or more years (i.e. being 4 years since their last Pap test).  Self-collection should only be offered to an eligible person who refuses to have a sample collected by their requesting practitioner.

When providing this service, the medical practitioner must satisfy themselves that the person has not had a cervical screening test in the last four years by:

(a)   asking the person if they can remember having a cervical screening test in the last four years;

(b)   checking their own practice's medical records; and

(c)   checking the National Cancer Screening Register.

A person from the following groups are more likely than the general population to be unscreened or significantly under screened - low socio-economic status, culturally and linguistically diverse backgrounds, Indigenous communities, rural and remote areas and older people.

Vault smears are not eligible for items 251 to 257.

 In addition to attracting a Medicare rebate, the use of these items will initiate a Cervical Screening SIP through the PIP.

A PIP Cervical Screening SIP is available for taking a cervical screen from a person who has not been screened in the last for four years.  The SIP will be paid to the medical practitioner who provided the service if the service was provided in a medical practice participating in the PIP Cervical Screening Incentive. A further PIP Cervical Screening Incentive payment is paid to medical practices which reach target levels of cervical screening for their patients aged 24 years and 9 months of age to 74 years inclusive. More detailed information on the PIP Cervical Screening Incentive is available from the Department of Human Services PIP enquiry line on 1800 222 032 or from the Department of Human Services website.

Related Items: 251 252 253 254 255 256 257

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Professional attendance at consulting rooms of less than 5 minutes in duration by a medical practitioner in an eligible area at which a specimen for a cervical screening service is collected from the patient, if the patient is at least 24 years and 9 months of age but is less than 75 years of age and has not been provided with a cervical screening service or a cervical smear service in the last 4 years

Fee: $14.30 Benefit: 100% = $14.30

(See para AN.7.1, AN.7.19 of explanatory notes to this Category)

Professional attendance at consulting rooms of more than 5 minutes, but not more than 25 minutes in duration by a medical practitioner in an eligible area, at which a specimen for a cervical screening service is collected from the patient, if the patient is at least 24 years and 9 months of age but is less than 75 years of age and has not been provided with a cervical screening service or a cervical smear service in the last 4 years

Fee: $31.30 Benefit: 100% = $31.30

(See para AN.7.1, AN.7.19 of explanatory notes to this Category)

Professional attendance at a place other than consulting rooms of more than 5 minutes, but not more than 25 minutes in duration by a medical practitioner in an eligible area, at which a specimen for a cervical screening service is collected from the patient, if the patient is at least 24 years and 9 months of age but is less than 75 years of age and has not been provided with a cervical screening service or a cervical smear service in the last 4 years

The fee for item 252, plus $21.95 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 252 plus $1.70 per patient.
Ready Reckoner

(See para AN.7.1, AN.7.19 of explanatory notes to this Category)

Professional attendance at consulting rooms of more than 25 minutes, but not more than 45 minutes in duration by a medical practitioner in an eligible area, at which a specimen for a cervical screening service is collected from the patient, if the patient is at least 24 years and 9 months of age but is less than 75 years of age and has not been provided with a cervical screening service or a cervical smear service in the last 4 years

Fee: $60.65 Benefit: 100% = $60.65

(See para AN.7.1, AN.7.19 of explanatory notes to this Category)

Professional attendance at a place other than consulting rooms of more than 25 minutes, but not more than 45 minutes in duration by a medical practitioner in an eligible area, at which a specimen for a cervical screening service is collected from the patient, if the patient is at least 24 years and 9 months of age but is less than 75 years of age and has not been provided with a cervical screening service or a cervical smear service in the last 4 years

The fee for item 254, plus $21.95 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 254 plus $1.70 per patient.
Ready Reckoner

(See para AN.7.1, AN.7.19 of explanatory notes to this Category)

Professional attendance at consulting rooms of more than 45 minutes in duration by a medical practitioner in an eligible area, at which a specimen for a cervical screening service is collected from the patient, if the patient is at least 24 years and 9 months of age but is less than 75 years of age and has not been provided with a cervical screening service or a cervical smear service in the last 4 years

Fee: $89.30 Benefit: 100% = $89.30

(See para AN.7.1, AN.7.19 of explanatory notes to this Category)

Professional attendance at a place other than consulting rooms of more than 45 minutes in duration by a medical practitioner in an eligible area, at which a specimen for a cervical screening service is collected from the patient, if the patient is at least 24 years and 9 months of age but is less than 75 years of age and has not been provided with a cervical screening service or a cervical smear service in the last 4 years

The fee for item 256, plus $21.95 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 256 plus $1.70 per patient
Ready Reckoner

(See para AN.7.1, AN.7.19 of explanatory notes to this Category)