Medicare Benefits Schedule - Note MN.12.5

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Category 8 - MISCELLANEOUS SERVICES

MN.12.5

Telehealth Support Services by Health Professionals

These notes provide information on the telehealth MBS attendance items for health professionals to provide clinical support to their patients during video consultations with a specialist, consultant physicians and psychiatrists under items 10945 and 10946 in Group A10 which are available for participating optometrists and item 10983 in Group M12 for practice nurses, Aboriginal and Torres Strait Islander health practitioners or Aboriginal health workers for services provided for and on behalf of a medical practitioner.

From 1 January 2022, items 10945, 10946 and 10983 apply Australia wide.

Telehealth patient-end support services can only be claimed where:

  • a Medicare eligible specialist service is claimed;
  • the service is rendered in Australia; and
  • where this is necessary for the provision of the specialist service.

Clinical indications

The specialist, consultant physician or psychiatrist must be satisfied that it is clinically appropriate to provide a video consultation to a patient. The decision to provide clinically relevant support to the patient is the responsibility of the specialist, consultant physician or psychiatrist.

Telehealth specialist services can be provided to patients when there is no patient-end support service provided. 

Restrictions

The MBS telehealth attendance items are not payable for services to an admitted hospital patient (this includes hospital in the home patients). Benefits are not payable for telephone or email consultations. In order to fulfill the item descriptor there must be a visual and audio link between the patient and the remote practitioner. If the remote practitioner is unable to establish both a video and audio link with the patient, a MBS rebate for a telehealth attendance is not payable.

Record Keeping

Participating telehealth practitioners must keep contemporaneous notes of the consultation including documenting that the service was performed by video conference, the date, time and the people who participated.

Only clinical details recorded at the time of the attendance count towards the time of the consultation. It does not include information added at a later time, such as reports of investigations.

Multiple attendances on the same day

In some situations a patient may receive a telehealth consultation and a face to face consultation by the same or different practitioner on the same day.

Medicare benefits may be paid for more than one video consultation on a patient on the same day by the same practitioner, provided the second (and any following) video consultations are not a continuation of the initial or earlier video consultations. Practitioners will need to provide the times of each consultation on the patient's account or bulk billing voucher.

Aftercare Rule

Video consultations are subject to the same aftercare rules as face to face consultations.

Referrals

The referral procedure for a video consultation is the same as for conventional face-to-face consultations.

Technical requirements

In order to fulfill the item descriptor there must be a visual and audio link between the patient and the remote practitioner. If the remote practitioner is unable to establish both a video and audio link with the patient, a MBS rebate for a telehealth attendance is not payable.

Individual clinicians must be confident that the technology used is able to satisfy the item descriptor and that software and hardware used to deliver a video conference meets the applicable laws for security and privacy.

Duration of attendance

The practitioner attending at the patient end of the video consultation does not need to be present for the entire consultation, only as long as is clinically relevant - this can be established in consultation with the specialist. The MBS fee payable for the supporting practitioner will be determined by the total time spent assisting the patient. This time does not need to be continuous.

Aboriginal health workers

For the purpose of item 10983 an Aboriginal health worker means a person who:

a) holds a Certificate III in Aboriginal or Torres Strait Islander Health Worker Primary Health Care (Clinical) or other appropriate qualifications; or

b) is registered, and holds a current registration issued by a State or Territory regulatory authority, as an Aboriginal health worker; and

c) is employed by, or whose services are otherwise retained by a medical practitioner or their practice. This includes health service in relation to which a direction made under subsection 19(2) of the Act applies.

Aboriginal and Torres Strait Islander health practitioners

For the purpose of item 10983 an Aboriginal and Torres Strait Islander health practitioner means a person who has been registered as an Aboriginal and Torres Strait Islander health practitioner by the Aboriginal and Torres Strait Islander Health Practice Board of Australia and meets the Board's registration standards. The Aboriginal and Torres Strait Islander health practitioner must be employed or retained by a general practice, or by a health service that has an exemption to claim Medicare benefits under subsection 19(2) of the Health Insurance Act 1973.

An Aboriginal and Torres Strait Islander health practitioner may use any of the titles authorised by the Aboriginal and Torres Strait Islander Health Practice Board: Aboriginal health practitioner; Aboriginal and Torres Strait Islander health practitioner; or Torres Strait Islander health practitioner.

Practice Nurse

For the purpose of item 10983 a practice nurse means a registered or enrolled nurse who is employed by, or whose services are otherwise retained by a medical practitioner or their practice. This includes a health service in relation to which a direction made under subsection 19(2) of the Health Insurance Act 1973 applies.

Related Items: 10945 10946 10983


Related Items

Category 1 - PROFESSIONAL ATTENDANCES

10945

10945 - Additional Information

Item Start Date:
01-Sep-2015
Description Updated:
01-Jan-2022
Schedule Fee Updated:
01-Jul-2021

A professional attendance of less than 15 minutes (whether or not continuous) by an attending optometrist that requires the provision of clinical support to a patient who:

(a)    is participating in a video conferencing consultation with a specialist practising in his or her speciality of ophthalmology; and

(b)    is not an admitted patient

Fee: $34.80 Benefit: 85% = $29.60

(See para AN.0.22, MN.12.5 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

10946

10946 - Additional Information

Item Start Date:
01-Sep-2015
Description Updated:
01-Jan-2022
Schedule Fee Updated:
01-Jul-2021

A professional attendance of at least 15 minutes (whether or not continuous) by an attending optometrist that requires the provision of clinical support to a patient who:

(a)    is participating in a video conferencing consultation with a specialist practising in his or her speciality of ophthalmology; and

(b)    is not an admitted patient

Fee: $69.45 Benefit: 75% = $52.10 85% = $59.05

(See para AN.0.22, MN.12.5 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

10983

10983 - Additional Information

Item Start Date:
01-Jul-2011
Description Updated:
01-Jan-2022
Schedule Fee Updated:
01-Jul-2021

Attendance by a practice nurse, an Aboriginal health worker or an Aboriginal and Torres Strait Islander health practitioner on behalf of, and under the supervision of, a medical practitioner, to provide clinical support to a patient who:

(a)    is participating in a video conferencing consultation with a specialist, consultant physician or psychiatrist; and

(b)    is not an admitted patient

Fee: $33.70 Benefit: 100% = $33.70

(See para MN.12.5 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