Medicare Benefits Schedule - Note MN.10.2

These allied health items are available for patients that have been diagnosed with a complex Neurodevelopmental Disorder (such as Autism Spectrum Disorder) or an eligible disability. It is expected that eligible allied health practitioners will deliver treatment under these items that is consistent with the complex Neurodevelopmental Disorder or eligible disability treatment and management plan prepared by the referring eligible medical practitioner and is in keeping with commonly established interventions as practised by their profession and appropriate for the age and particular needs of the patient being treated.

It is anticipated that professional attendances at places other than consulting rooms will be provided where treatment in other environments is necessary to achieve therapeutic outcomes.

Number of services

• A maximum of 20 services can be claimed per patient per lifetime, including services consisting of any combination of 82015, 82020, 82025, 82035, 93035, 93036, 93043 or 93044.
• A course of treatment means up to 10 treatment services.
• Up to 4 of these services may be provided to the same patient on the same day.
• It is the responsibility of the referring eligible medical practitioner to allocate these services in keeping with the patient’s individual treatment needs and to refer the patient to the appropriate allied health professional(s) accordingly.

Referral Requirements

For a Medicare rebate to be paid, the eligible allied health practitioner providing the service must be in receipt of a current referral provided by an eligible medical practitioner. A separate referral from an eligible medical practitioner is required for each eligible allied health practitioner. The referral is only valid if the referring provider uses any of the following MBS items*:

• For a complex Neurodevelopmental Disorder referred by a:

  - consultant psychiatrist using item 289 of the general medical services table or item 92434 of the COVID 19 Determination.

  Note. If a patient has previously been provided with a service mentioned in item 289, a consultant physician specialising in the practice of the consultant physician’s field of psychiatry may only refer the patient for a service to which any of items 296 to 308, 310, 312, 314, 316, 318 or 319 to 352 of the general medical services table or items 91827, 91828, 91829, 91830, 91831, 91837, 91838, 91839, 92437, 92455, 92456, 92457, 92458, 92459 or 92460 of the COVID 19 Determination applies.

  - paediatrician using item 135 of the general medical services table or item 92140 of the COVID 19 Determination.

  Note. If a patient has previously been provided with a service mentioned in item 135 of the general medical services table or item 92140 of the COVID 19 Determination, a consultant physician specialising in the practice of the consultant physician’s field of paediatrics may only refer the patient for a service to which any of items 110 to 131 of the general medical services table or items 91824, 91825, 91826 or 91836 of the COVID 19 Determination applies.

  If a patient has previously been provided with a service mentioned in item 137 or 139 of the general medical services table or item 92141 or 92142 of the COVID 19 Determination, the medical practitioner cannot refer the patient for a service to which item 135 or 289 of the general medical services table or item 92140 or 92434 of the COVID 19 Determination applies.

• For an eligible disability referred by a:

  - specialist or consultant physician using item 137 of the general medical services table or item 92141 of the COVID 19 Determination.

  - GP using item 139 of the general medical services table or item 92142 of the COVID 19 Determination.

  Note. If a patient has previously been provided with a service mentioned in item 135 or 289 of the general medical services table or item 92140 or 92434 of the COVID 19 Determination, the medical practitioner cannot refer the patient for a service to which item 137 or 139 of the general medical services table or item 92141 or 92142 of the COVID 19 Determination applies.

* Note that more information on the telehealth items that can be claimed for these services can be found in Note AN.40.1.

The referral may be a letter or note to an eligible allied health practitioner, signed and dated by the referring eligible medical practitioner. Referring eligible medical practitioners are not required to use a specific form to refer patients for these services. A Medicare claim must be submitted for the referring service before a rebate for the subsequent referred allied health service can be paid.

The referred service consists of the number of allied health services stated on the patient’s referral. This enables the referring practitioner to consider a report from the allied health practitioners about the services provided to the patient, and the need for further treatment.

Within the maximum service allocation of 20 services for the treatment items, the eligible allied health practitioner/s can provide one or more courses of treatment. A new referral is required for each new course of treatment (up to 10 services). The amount of services in each course of treatment is determined by the referring eligible medical practitioner. The referring eligible medical practitioner should review the written report provided by the eligible allied health practitioner after completion of a course of treatment and prior to referring for a subsequent course of treatment.

Eligible allied health practitioners should retain the referral for 24 months from the date the service was rendered for Medicare auditing purposes.

Reporting requirements

On completion of a course of treatment (and any subsequent courses of treatment), the eligible allied health practitioner must provide a written report to the referring eligible medical practitioner which includes information on:

• treatment provided;
• recommendations on future management of the patient’s disorder or disability; and
• if applicable, any advice provided to third parties (for example: parents, schools, places of employment).

The writing of the report is not counted towards the service time under the item.

Related Items: 82015 82020 82025 82035 93035 93036 93043 93044

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Psychology health service provided to a patient aged under 25 years for the treatment of a diagnosed complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability by an eligible psychologist, if:

(a)    the patient has a treatment and management plan in place and has been referred by an eligible medical practitioner for a course of treatment consistent with that treatment and management plan; and

(b)    the service is provided to the patient individually and in person; and

(c)    the service is at least 30 minutes duration; and

(d)    on the completion of the course of treatment, the eligible psychologist gives a written report to the referring eligible medical practitioner on assessments (if performed), treatment provided and recommendations on future management of the patient’s condition

Up to 4 services to which this item or any of items 82020, 82025, 82035, 93035, 93036, 93043 or 93044 apply may be provided to the same patient on the same day

Fee: $109.80 Benefit: 85% = $93.35

(See para AN.0.25, MN.10.2, MN.10.3 of explanatory notes to this Category)

Speech pathology health service provided to a patient aged under 25 years for the treatment of a diagnosed complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability by an eligible speech pathologist, if:

(a)    the patient has a treatment and management plan in place and has been referred by an eligible medical practitioner for a course of treatment consistent with that treatment and management plan; and

(b)    the service is provided to the patient individually and in person; and

(c)    the service is at least 30 minutes duration; and

(d)    on the completion of the course of treatment, the eligible speech pathologist gives a written report to the referring eligible medical practitioner on assessments (if performed), treatment provided and recommendations on future management of the patient’s condition

Up to 4 services to which this item or any of items 82015, 82025, 82035, 93035, 93036, 93043 or 93044 apply may be provided to the same patient on the same day

Fee: $96.80 Benefit: 85% = $82.30

(See para AN.0.25, MN.10.2, MN.10.3 of explanatory notes to this Category)

Occupational therapy health service provided to a patient aged under 25 years for the treatment of a diagnosed complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability by an eligible occupational therapist, if:

(a)    the patient has a treatment and management plan in place and has been referred by an eligible medical practitioner for a course of treatment consistent with that treatment and management plan; and

(b)    the service is provided to the patient individually and in person; and

(c)    the service is at least 30 minutes duration; and

(d)    on the completion of the course of treatment, the eligible occupational therapist gives a written report to the referring eligible medical practitioner on assessments (if performed), treatment provided and recommendations on future management of the patient’s condition

Up to 4 services to which this item or any of items 82015, 82020, 82035, 93035, 93036, 93043 or 93044 apply may be provided to the same patient on the same day

Fee: $96.80 Benefit: 85% = $82.30

(See para AN.0.25, MN.10.2, MN.10.3 of explanatory notes to this Category)

Audiology, optometry, orthoptic or physiotherapy health service provided to a patient aged under 25 years for the treatment of a diagnosed complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability by an eligible audiologist, optometrist, orthoptist or physiotherapist, if:

(a)    the patient has a treatment and management plan in place and has been referred by an eligible medical practitioner for a course of treatment consistent with that treatment and management plan; and

(b)    the service is provided to the patient individually and in person; and

(c)    the service is at least 30 minutes duration; and

(d)    on the completion of the course of treatment, the eligible audiologist, optometrist, orthoptist or physiotherapist gives a written report to the referring eligible medical practitioner on assessments (if performed), treatment provided and recommendations on future management of the patient’s condition

Up to 4 services to which this item or any of items 82015, 82020, 82025, 93035, 93036, 93043 or 93044 apply may be provided to the same patient on the same day

Fee: $96.80 Benefit: 85% = $82.30

(See para AN.0.25, MN.10.2, MN.10.3 of explanatory notes to this Category)

Psychology health service provided by phone attendance to a patient aged under 25 years for the treatment of a diagnosed complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability by an eligible psychologist, if:

(a) the patient has a treatment and management plan in place and has been referred by an eligible medical practitioner for a course of treatment consistent with that treatment and management plan; and

(b) the service is provided to the patient individually; and

(c) the service is at least 30 minutes duration; and

(d) on the completion of the course of treatment, the eligible psychologist gives a written report to the referring eligible medical practitioner on assessments (if performed), treatment provided and recommendations on future management of the patient’s condition

Up to 4 services to which this item or any of items 82015, 82020, 82025, 82035, 93035, 93036 or 93044 apply may be provided to the same patient on the same day

Further information on the requirements for this item are available in the explanatory notes to this Category

Fee: $109.80 Benefit: 85% = $93.35

(See para AN.0.25, MN.10.1, MN.10.2, MN.10.3 of explanatory notes to this Category)

Speech pathology, occupational therapy, audiology, optometry, orthoptic or physiotherapy health service provided by phone attendance to a patient aged under 25 years for the treatment of a diagnosed complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability by an eligible speech pathologist, occupational therapist, audiologist, optometrist, orthoptist or physiotherapist, if:

(a) the patient has a treatment and management plan in place and has been referred by an eligible medical practitioner for a course of treatment consistent with that treatment and management plan; and

(b) the service is provided to the patient individually; and

(c) the service is at least 30 minutes duration; and

(d) on the completion of the course of treatment, the eligible speech pathologist, occupational therapist, audiologist, optometrist, orthoptist or physiotherapist gives a written report to the referring eligible medical practitioner on assessments (if performed), treatment provided and recommendations on future management of the patient’s condition

Up to 4 services to which this item or any of items 82015, 82020, 82025, 82035, 93035, 93036 or 93043 apply may be provided to the same patient on the same day

Further information on the requirements for this item are available in the explanatory notes to this Category

Fee: $96.80 Benefit: 85% = $82.30

(See para AN.0.25, MN.10.1, MN.10.2, MN.10.3 of explanatory notes to this Category)

Psychology health service provided by telehealth attendance to a patient aged under 25 years for the treatment of a diagnosed complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability by an eligible psychologist, if:

(a) the patient has a treatment and management plan in place and has been referred by an eligible medical practitioner for a course of treatment consistent with that treatment and management plan; and

(b) the service is provided to the patient individually; and

(c) the service is at least 30 minutes duration; and

(d) on the completion of the course of treatment, the eligible psychologist gives a written report to the referring eligible medical practitioner on assessments (if performed), treatment provided and recommendations on future management of the patient’s condition

Up to 4 services to which this item or any of items 82015, 82020, 82025, 82035, 93036, 93043 or 93044 apply may be provided to the same patient on the same day

Further information on the requirements for this item are available in the explanatory notes to this Category

Fee: $109.80 Benefit: 85% = $93.35

(See para AN.0.25, MN.10.1, MN.10.2, MN.10.3 of explanatory notes to this Category)

Speech pathology, occupational therapy, audiology, optometry, orthoptic or physiotherapy health service provided by telehealth attendance to a patient aged under 25 years for the treatment of a diagnosed complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability by an eligible speech pathologist, occupational therapist, audiologist, optometrist, orthoptist or physiotherapist, if:

(a) the patient has a treatment and management plan in place and has been referred by an eligible medical practitioner for a course of treatment consistent with that treatment and management plan; and

(b) the service is provided to the patient individually; and

(c) the service is at least 30 minutes duration; and

(d) on the completion of the course of treatment, the eligible speech pathologist, occupational therapist, audiologist, optometrist, orthoptist or physiotherapist gives a written report to the referring eligible medical practitioner on assessments (if performed), treatment provided and recommendations on future management of the patient’s condition

Up to 4 services to which this item or any of items 82015, 82020, 82025, 82035, 93035, 93043 or 93044 apply may be provided to the same patient on the same day

Further information on the requirements for this item are available in the explanatory notes to this Category

Fee: $96.80 Benefit: 85% = $82.30

(See para AN.0.25, MN.10.1, MN.10.2, MN.10.3 of explanatory notes to this Category)