Medicare Benefits Schedule - Note AN.7.2

Eligibility

Items 179 to 212 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 A2.

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

To assist medical practitioners in selecting the appropriate item number for Medicare benefit purposes the following notes in respect of the various levels are given.

Professional consultation of not more than 5 minutes duration

The item will be used for obvious and straightforward cases and this should be reflected in the practitioner's records.  In this context, the practitioner should undertake the necessary examination of the affected part if required, and note the action taken.

Professional consultation of more than 5 minutes but not more than 25 minutes

The item will be used for a consultation lasting more than 5 minutes but less than 25 minutes for cases that are not obvious or straightforward in relation to one or more health related issues.  This should be reflected in the practitioner's record.  In the item descriptor singular also means plural and vice versa.

Professional consultation of more than 25 minutes but not more than 45 minutes

The item will be used for a consultation lasting more than 25 minutes but less than 45 minutes for cases in relation to one or more complex health related issues.  This should be reflected in the practitioner's record.  In the item descriptor singular also means plural and vice versa.

Professional consultation of more than 45 minutes

The item will be used for a consultation lasting at least 40 minutes for cases in relation to one or more very complex health related issues.  This should be reflected in the practitioner's record. In the item descriptor singular also means plural and vice versa.

Creating and Updating a My Health Record

The time spent by a medical practitioner on the following activities may be counted towards the total consultation time:

• Reviewing a patient's clinical history, in the patient's file and/or the My Health Record, and preparing or updating a Shared Health Summary where it involves the exercise of clinical judgement about what aspects of the clinical history are relevant to inform ongoing management of the patient's care by other providers; or
• Preparing an Event Summary for the episode of care.

Preparing or updating a Shared Health Summary and preparing an Event Summary are clinically relevant activities.  When either of these activities are undertaken with any form of patient history taking and/or the other clinically relevant activities that can form part of a consultation, the item that can be billed is the one with the time period that matches the total consultation time.

MBS rebates are not available for creating or updating a Shared Health Summary as a stand-alone service.

Recording Clinical Notes

In relation to the time taken in recording appropriate details of the service, only clinical details recorded at the time of the attendance count towards the time of consultation.  It does not include information added at a later time, such as reports of investigations.

Other Services at the Time of Attendance

Where, during the course of a single attendance by a medical practitioner, both a consultation and another medical service are rendered, Medicare benefits are generally payable for both the consultation and the other service. Exceptions are in respect of medical services which form part of the normal consultative process, or services which include a component for the associated consultation (see the General Explanatory Notes for further information on the interpretation of the Schedule).

Related Items: 179 181 185 187 189 191 203 206

• Previous - Note AN.7.1
• Next - Note AN.7.3

Professional attendance at consulting rooms of not more than 5 minutes in duration (other than a service to which any other item applies)—each attendance, by a medical practitioner in an eligible area.

Fee: $14.55 Benefit: 100% = $14.55

(See para AN.7.1, AN.7.2 of explanatory notes to this Category)

Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a service to which any other item in the table applies), not more than 5 minutes in duration—an attendance on one or more patients at one place on one occasion—each patient, by a medical practitioner in an eligible area

The fee for item 179, plus $22.30 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 179 plus $1.75 per patient.
Ready Reckoner

(See para AN.7.1, AN.7.2 of explanatory notes to this Category)

Professional attendance at consulting rooms of more than 5 minutes in duration but not more than 25 minutes (other than a service to which any other item applies)—each attendance, by a medical practitioner in an eligible area

Fee: $31.80 Benefit: 100% = $31.80

(See para AN.7.1, AN.7.2 of explanatory notes to this Category)

Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a service to which any other item in the table applies) of more than 5 minutes in duration but not more than 25 minutes—an attendance on one or more patients at one place on one occasion—each patient, by a medical practitioner in an eligible area

The fee for item 185, plus $22.30 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 185 plus $1.75 per patient.
Ready Reckoner

(See para AN.7.1, AN.7.2 of explanatory notes to this Category)

Professional attendance at consulting rooms of more than 25 minutes in duration but not more than 45 minutes (other than a service to which any other item applies)—each attendance, by a medical practitioner in an eligible area

Fee: $61.55 Benefit: 100% = $61.55

(See para AN.7.1, AN.7.2 of explanatory notes to this Category)

Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a service to which any other item in the table applies) of more than 25 minutes in duration but not more than 45 minutes—an attendance on one or more patients at one place on one occasion—each patient, by a medical practitioner in an eligible area

The fee for item 189, plus $22.30 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 189 plus $1.75 per patient.
Ready Reckoner

(See para AN.7.1, AN.7.2 of explanatory notes to this Category)

Professional attendance at consulting rooms of more than 45 minutes in duration (other than a service to which any other item applies)—each attendance, by a medical practitioner in an eligible area

Fee: $90.65 Benefit: 100% = $90.65

(See para AN.7.1, AN.7.2 of explanatory notes to this Category)

Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a service to which any other item in the table applies) of more than 45 minutes in duration—an attendance on one or more patients at one place on one occasion—each patient, by a medical practitioner in an eligible area

The fee for item 203, plus $22.30 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 203 plus $1.75 per patient.
Ready Reckoner

(See para AN.7.1, AN.7.2 of explanatory notes to this Category)