Medicare Benefits Schedule - Note AR.29.1

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Category 1 - PROFESSIONAL ATTENDANCES

AR.29.1

Attendance services for eligible disabilities

Eligibility of this service under 137 or 92141 (specialists and consultant physicians), 139 or 92142 (general practitioners)

'Eligible disabilities' for the purpose of these services means any of the following conditions: 

(a)  sight impairment that results in vision of less than or equal to 6/18 vision or equivalent field loss in the better eye, with correction;

(b)  hearing impairment that results in:

(i)  a hearing loss of 40 decibels or greater in the better ear, across 4 frequencies; or

(ii)  permanent conductive hearing loss and auditory neuropathy;

(c)  deafblindness;

(d)  cerebral palsy;

(e)  Down syndrome;

(f)  Fragile X syndrome;

(g)  Prader‑Willi syndrome;

(h)  Williams syndrome;

(i)  Angelman syndrome;

(j)  Kabuki syndrome;

(k)  Smith‑Magenis syndrome;

(l)  CHARGE syndrome;

(m)  Cri du Chat syndrome;

(n)  Cornelia de Lange syndrome;

(o)  microcephaly, if a child has:

(i)  a head circumference less than the third percentile for age and sex; and

(ii)  a functional level at or below 2 standard deviations below the mean for age on a standard development test or an IQ score of less than 70 on a standardised test of intelligence*;

(p)  Rett’s disorder;

(q)  Fetal Alcohol Spectrum Disorder (FASD);

(r)  Lesch‑Nyhan syndrome;

(s)  22q deletion syndrome.

 

*"standard developmental test" refers to tests such as the Bayley Scales of Infant Development or the Griffiths Mental Development Scales; "standardised test of intelligence" means the Wechsler Intelligence Scale for Children (WISC) or the Wechsler Preschool and Primary Scale of Intelligence (WPPSI).  It is up to the clinical judgement of the diagnosing practitioner to determine which tests are appropriate to be used. 

Related Items: 137 139 92141 92142


Related Items

Category 1 - PROFESSIONAL ATTENDANCES

137

137 - Additional Information

Item Start Date:
01-Jul-2011
Description Updated:
01-Mar-2023
Schedule Fee Updated:
01-Nov-2023

Professional attendance lasting at least 45 minutes by a specialist or consultant physician (not including a general practitioner), following referral of the patient to the specialist or consultant physician by a referring practitioner, for a patient aged under 25, if the specialist or consultant physician:

(a) undertakes, or has previously undertaken in prior attendances, a comprehensive assessment in relation to which a diagnosis of an eligible disability is made (if appropriate, using information provided by an eligible allied health provider); and

(b) develops a treatment and management plan, which must include:

(i) documentation of the confirmed diagnosis; and

(ii) findings of any assessments performed for the purposes of formulation of the diagnosis or contribution to the treatment and management plan; and

(iii) a risk assessment; and

(iv) treatment options (which may include biopsychosocial recommendations); and

(c) provides a copy of the treatment and management plan to:

(i) the referring practitioner; and

(ii) one or more allied health providers, if appropriate, for the treatment of the patient;

(other than attendance on a patient for whom payment has previously been made under this item or item 135, 139, 289, 92140, 92141, 92142 or 92434)

Applicable only once per lifetime

Fee: $294.85 Benefit: 75% = $221.15 85% = $250.65

(See para AN.0.25, AN.40.1, AR.29.1 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

139

139 - Additional Information

Item Start Date:
01-Jul-2011
Description Updated:
01-Mar-2023
Schedule Fee Updated:
01-Nov-2023

Professional attendance lasting at least 45 minutes, at a place other than a hospital, by a general practitioner (not including a specialist or consultant physician), for a patient aged under 25, if the general practitioner:

(a) undertakes, or has previously undertaken in prior attendances, a comprehensive assessment in relation to which a diagnosis of an eligible disability is made (if appropriate, using information provided by an eligible allied health provider); and

(b) develops a treatment and management plan, which must include:

(i) documentation of the confirmed diagnosis; and

(ii) findings of any assessments performed for the purposes of formulation of the diagnosis or contribution to the treatment and management plan; and

(iii) a risk assessment; and

(iv) treatment options (which may include biopsychosocial recommendations); and

(c) provides a copy of the treatment and management plan to one or more allied health providers, if appropriate, for the treatment of the patient;

(other than attendance on a patient for whom payment has previously been made under this item or item 135, 137, 289, 92140, 92141, 92142 or 92434)

Applicable only once per lifetime

Fee: $148.05 Benefit: 100% = $148.05

(See para AN.0.73, AR.29.1 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

92141

92141 - Additional Information

Item Start Date:
30-Mar-2020
Description Updated:
01-Mar-2023
Schedule Fee Updated:
01-Nov-2023

Telehealth attendance lasting at least 45 minutes by a specialist or consultant physician (not including a general practitioner), following referral of the patient to the specialist or consultant physician by a referring practitioner, for a patient aged under 25, if the specialist or consultant physician:

(a) undertakes, or has previously undertaken in prior attendances, a comprehensive assessment in relation to which a diagnosis of an eligible disability is made (if appropriate, using information provided by an eligible allied health provider); and

(b) develops a treatment and management plan, which must include:

(i) documentation of the confirmed diagnosis; and

(ii) findings of any assessments performed for the purposes of formulation of the diagnosis or contribution to the treatment and management plan; and

(iii) a risk assessment; and

(iv) treatment options (which may include biopsychosocial recommendations); and

(c) provides a copy of the treatment and management plan to:

(i) the referring practitioner; and

(ii) one or more allied health providers, if appropriate, for the treatment of the patient;

(other than attendance on a patient for whom payment has previously been made under this item or item 135, 137, 139, 289, 92140, 92142 or 92434)

Applicable only once per lifetime

Fee: $294.85 Benefit: 85% = $250.65

(See para AN.0.25, AR.29.1 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

92142

92142 - Additional Information

Item Start Date:
30-Mar-2020
Description Updated:
01-Mar-2023
Schedule Fee Updated:
01-Nov-2023

Telehealth attendance lasting at least 45 minutes by a general practitioner (not including a specialist or consultant physician), for a patient aged under 25, if the general practitioner:

(a) undertakes, or has previously undertaken in prior attendances, a comprehensive assessment in relation to which a diagnosis of an eligible disability is made (if appropriate, using information provided by an eligible allied health provider); and

(b) develops a treatment and management plan, which must include:

(i) documentation of the confirmed diagnosis; and

(ii) findings of any assessments performed for the purposes of formulation of the diagnosis or contribution to the treatment and management plan; and

(iii) a risk assessment; and

(iv) treatment options (which may include biopsychosocial recommendations); and

(c) provides a copy of the treatment and management plan to one or more allied health providers, if appropriate, for the treatment of the patient;

(other than attendance on a patient for whom payment has previously been made under this item or item 135, 137, 139, 289, 92140, 92141 or 92434)

Applicable only once per lifetime

Fee: $148.05 Benefit: 100% = $148.05

(See para AN.0.73, AR.29.1 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