Medicare Benefits Schedule - Note MN.9.2

Patients must be referred by their GP or medical practitioner to an eligible allied health professional (diabetes educator, exercise physiologist or dietitian) who will undertake an individual assessment (under item 81100, 81110, 81120, 93284 or 93286) of the patient's suitability for a group services program.

Related Items: 81100 81110 81120 93284 93286

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Diabetes education health service provided to a patient by an eligible diabetes educator for assessing the patient’s suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient’s needs and preparing the patient for the group services if:

(a)   the patient has type 2 diabetes; and

(b)  the patient is being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a GP Management Plan or, if the patient is a resident of an aged care facility, the patient’s medical practitioner has contributed to a multidisciplinary care plan; and

(c)   the patient is referred to an eligible diabetes educator by the medical practitioner using a referral form that has been issued by the Department, or a referral form that contains all the components of the form issued by the Department; and

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

(e)   the service is of at least 45 minutes duration; and

(f)   after the service, the eligible diabetes educator gives a written report to the referring medical practitioner mentioned in paragraph (c);

payable once in a calendar year for this or any other assessment for group services item (including services in items 81100, 81110 and 81120 or items 93284 or 93286 of the Telehealth and Telephone Determination)

Fee: $87.95 Benefit: 85% = $74.80

(See para MN.9.1, MN.9.2, MN.9.3, MN.9.4, MN.9.6 of explanatory notes to this Category)

Telehealth attendance by an eligible dietitian to provide a dietetics health service to a person for assessing the person’s suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient’s needs and preparing the person for the group services if:

(a) the person has type 2 diabetes; and

(b) the person is being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a GP management plan or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and

(c) the person is referred to an eligible dietitian by the medical practitioner using a referral form that has been issued by the Department, or a referral form that contains all the components of the form issued by the Department; and

(d) the service is provided to the person individually; and

(e) the service is of at least 45 minutes duration; and

(f) after the service, the eligible dietitian gives a written report to the referring medical practitioner mentioned in paragraph (c);

payable once in a calendar year for this or any other assessment for group services item (including services to which this item, item 92386, or items 81100, 81110 and 81120 of the Allied Health  Determination apply)

Fee: $87.95 Benefit: 85% = $74.80

(See para MN.9.2, MN.9.3, MN.9.4, MN.9.6 of explanatory notes to this Category)

Exercise physiology health service provided to a person by an eligible exercise physiologist for assessing the person’s suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient’s needs and preparing the person for the group services if:

(a)   the person has type 2 diabetes; and

(b)  the person is being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a GP Management Plan or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and

(c)   the person is referred to an eligible exercise physiologist by the medical practitioner using a referral form that has been issued by the Department, or a referral form that contains all the components of the form issued by the Department; and

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

(e)   the service is of at least 45 minutes duration; and

(f)   after the service, the eligible exercise physiologist gives a written report to the referring medical practitioner mentioned in paragraph (c);

payable once in a calendar year for this or any other assessment for group services item (including services in items 81100, 81110 and 81120 or items 93284 or 93286 of the Telehealth and Telephone Determination)

Fee: $87.95 Benefit: 85% = $74.80

(See para MN.9.1, MN.9.2, MN.9.3, MN.9.4, MN.9.6 of explanatory notes to this Category)

Phone attendance by an eligible dietitian to provide a dietetics health service to a person for assessing the person’s suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient’s needs and preparing the person for the group services if:

(a) the person has type 2 diabetes; and

(b) the person is being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a GP management plan or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and

(c) the person is referred to an eligible dietitian by the medical practitioner using a referral form that has been issued by the Department, or a referral form that contains all the components of the form issued by the Department; and

(d) the service is provided to the person individually; and

(e) the service is of at least 45 minutes duration; and

(f) after the service, the eligible dietitian gives a written report to the referring medical practitioner mentioned in paragraph (c);

payable once in a calendar year for this or any other assessment for group services item (including services to which this item, item 92384, or in items 81100, 81110 and 81120 of the Allied Health Determination apply)

Fee: $87.95 Benefit: 85% = $74.80

(See para MN.9.2, MN.9.3, MN.9.4, MN.9.6 of explanatory notes to this Category)

Dietetics health service provided to a person by an eligible dietitian for assessing the person’s suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient’s needs and preparing the person for the group services if:

(a)   the person has type 2 diabetes; and

(b)  the person is being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a GP Management Plan or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and

(c)   the person is referred to an eligible dietitian by the medical practitioner using a referral form that has been issued by the Department, or a referral form that contains all the components of the form issued by the Department; and

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

(e)   the service is of at least 45 minutes duration; and

(f)   after the service, the eligible dietitian gives a written report to the referring medical practitioner mentioned in paragraph (c);

payable once in a calendar year for this or any other assessment for group services item (including services in items 81100, 81110 and 81120 or items 93284 or 93286 of the Telehealth and Telephone Determination)

Fee: $87.95 Benefit: 85% = $74.80

(See para MN.9.1, MN.9.2, MN.9.3, MN.9.4, MN.9.6 of explanatory notes to this Category)