Medicare Benefits Schedule - Note AN.7.21

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Medical Practitioner Completion of the Asthma Cycle of Care (Items 265 to 271)


Items 265 to 271 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 3.

A locator map to identify a medical practice's Modified Monash Model Area location is available at the DoctorConnect website at

Guidance Notes

Item numbers 265, 266, 268, 269, 270 and 271 should be used in place of the usual attendance item when a consultation completes the minimum requirements of the Asthma Cycle of Care. The Practice Incentives Program (PIP) Asthma Incentive is for patients with moderate to severe asthma who in the opinion of the medical practitioner could benefit from review, eg those whose asthma management could be improved.

At a minimum the Asthma Cycle of Care must include:

  • At least 2 asthma related consultations within 12 months for a patient with moderate to severe asthma (at least 1 of which (the review consultation) is a consultation that was planned at a previous consultation);
  • Documented diagnosis and assessment of level of asthma control and severity of asthma;
  • Review of the patient's use of and access to asthma-related medication and devices;
  • Provision to the patient of a written asthma action plan (if the patient is unable to use a written asthma action plan - discussion with the patient about an alternative method of providing an asthma action plan, and documentation of the discussion in the patient's medical records);
  • Provision of asthma self-management education to the patient, and
  • Review of the written or documented asthma action plan.

The Asthma Cycle of Care should be provided to a patient by one medical practitioner or in exceptional circumstances by another medical practitioner within the same practice. In most cases, this will be the patient's usual medical practitioner. Completion of the Asthma Cycle of Care does not preclude referral to a specialist, but a specialist consultation cannot be counted as one of the two visits.

The patient's medical record should include documentation of each of these requirements and the clinical content of the patient-held written asthma action plan.

These items will only be payable for the completion of one Asthma Cycle of Care for each eligible patient per 12 month period, unless a further Asthma Cycle of Care is clinically indicated by exceptional circumstances.

If a subsequent Asthma Cycle of Care is indicated and the incentive item is to be claimed more than once per 12 month period for a patient, then the patient's invoice or Medicare voucher should be annotated to indicate that the Asthma Cycle of Care was required to be provided within 12 months of another Asthma Cycle of Care.

The minimum requirements of the Asthma Cycle of Care may be carried out in two (2) visits or if necessary as many visits as clinically required. The National Asthma Council's website provides a guide for completion of the Asthma Cycle of Care.

The visit that completes the Asthma Cycle of Care should be billed using the appropriate item listed in Group A7 Subgroup 8.

All visits should be billed under the normal attendance items with the exception of the visit that completes all of the minimum requirements of the Asthma Cycle of Care.

In addition to attracting a Medicare rebate, recording a completion of an Asthma Cycle of Care through the use of these items, will initiate an Asthma Service Incentive Payment (SIP) through the PIP.

A PIP Asthma SIP is available for completing the minimum requirements of the Asthma Cycle of Care for individual patients as specified above. 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 Asthma Incentive. More detailed information on the PIP Asthma Incentive is available from the Department of Human Services PIP enquiry line on 1800222032 or from the Department of Human Services website.

For more detailed information regarding asthma diagnosis, assessment and best practice management refer to the National Asthma Council's website.

Assessment of Severity

Generally, patients who meet the following criteria can be assumed to have been assessed as having moderate to severe asthma:

  • Symptoms on most days, OR
  • Use of preventer medication, OR
  • Bronchodilator use at least 3 times per week, OR
  • Hospital attendance or admission following an acute exacerbation of asthma.

Where the general rule does not apply to a particular patient, the classification of severity described by the current edition of the National Asthma Council's Asthma Management Handbook can be used. Visit the National Asthma Council's website for more details.


  • 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