Medicare Benefits Schedule - Note MN.9.4

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Category 8 - MISCELLANEOUS SERVICES

MN.9.4

Assessment for Group Allied Health Services (Items 81100, 81110 and 81120) for People with Type 2 Diabetes

An assessment service is provided by a diabetes educator (item 81100), an exercise physiologist (item 81110) or a dietitian (item 81120), on referral from a GP. 

The purpose of this service is to undertake an individual assessment and determine the patient's suitability for a group services program.  It involves taking a comprehensive patient history and identification of individual goals.  This may also provide an opportunity to identify any patient who is likely to be unsuitable for group services. 

Number of services per year

Patients are eligible for a maximum of one assessment for group services (item 81100 or 81110 or 81120) per calendar year.  If more than one assessment service is provided in a calendar year, the subsequent service/s will not attract a Medicare rebate and the MBS Safety Net arrangements will not apply to costs incurred by the patient for the service/s. 

If there is any doubt about a patient's eligibility for items 81100, 81110 or 81120, the allied health professional should contact the Department of Human Services to confirm the number of assessment services already claimed by the patient in the calendar year.  Allied health professionals can call the Department of Human Services on 132 150 to check this information. 

Referral form

The GP must refer the patient using the Referral form for group allied health services under Medicare for patients with type 2 diabetes or a Health Care Home shared care plan or a form that contains all the components of this form.  The form issued by the department is available at http://www.health.gov.au/mbsprimarycareitems (click on the link for group allied health services). 

The allied health professional undertaking the assessment service will need to complete Part B of this form, and the patient will then need to present this form to the provider/s of group services.  

Health Care Home shared care plan

A Health Care Home shared care plan means a written plan that is prepared for a patient enrolled at a Health Care Home trial site; is prepared by a medical practitioner (including a general practitioner but not including a specialist or consultant physician) who is leading the patient's care at the Health Care Home trial site; and includes:  an outline of the patient's agreed current and long-term goals; the person or people responsible for each activity; arrangements to review the plan by a day mentioned in the plan; and if authorised by the patient, arrangements for the transfer of information between the medical practitioner and other health care providers supporting patient care about the patient's condition or conditions and treatment. 

Length of service

This service must be of at least 45 minutes duration and provided to an individual patient.  The allied health professional must personally attend the patient. 

Reporting requirements

On completion of the assessment service, the allied health professional must provide a written report back to the referring GP outlining the assessment undertaken, whether the patient is suitable for group services and, if so, the nature of the group services to be delivered.

Related Items: 81100 81110 81120


Related Items

Category 8 - MISCELLANEOUS SERVICES

81100

81100 - Additional Information

Item Start Date:
01-May-2007
Description Start Date:
01-Oct-2017
Schedule Fee Start Date:
01-Jul-2019

DIABETES EDUCATION SERVICE - ASSESSMENT FOR GROUP SERVICES

 

Diabetes education health service provided to a person by an eligible diabetes educator for the purposes of ASSESSING a 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 service is provided to a person who 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 shared care plan or a GP Management Plan [ie item 721 or 732], or if the person is a resident of an aged care facility, their medical practitioner has contributed to a multidisciplinary care plan [ie item 731]; and  

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

(d)    the person is not an admitted patient of a hospital; and

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

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

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

(h)    in the case of a service in respect of which a private health insurance benefit is payable - the person who incurred the medical expenses in respect of the service has elected to claim the Medicare benefit in respect of the service, and not the private health insurance benefit.

 

Benefits are payable once only in a calendar year for this or any other Assessment for Group Services item (including services to which items 81100, 81110 and 81120 apply).

Fee: $81.15 Benefit: 85% = $69.00

(See para MN.9.1, MN.9.2, MN.9.3, MN.9.4, MN.9.6, MN.9.7 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

81110

81110 - Additional Information

Item Start Date:
01-May-2007
Description Start Date:
01-Oct-2017
Schedule Fee Start Date:
01-Jul-2019

EXERCISE PHYSIOLOGY SERVICE - ASSESSMENT FOR GROUP  SERVICES

 

Exercise physiology health service provided to a person by an eligible exercise physiologist for the purposes of ASSESSING a 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 service is provided to a person who 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 shared care plan or a GP Management Plan [ie item 721 or 732, or if the person is a resident of an aged care facility, their  medical practitioner has contributed to a multidisciplinary care plan [ie item 731]; 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 of Health, or a referral form that contains all the components of the form issued by the Department; and

(d)    the person is not an admitted patient of a hospital; and

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

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

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

(h)    in the case of a service in respect of which a private health insurance benefit is payable - the person who incurred the medical expenses in respect of the service has elected to claim the Medicare benefit in respect of the service, and not the private health insurance benefit.

 

Benefits are payable once only in a calendar year for this or any other Assessment for Group Services item (including services to which items 81100, 81110 and 81120 apply).

Fee: $81.15 Benefit: 85% = $69.00

(See para MN.9.1, MN.9.2, MN.9.3, MN.9.4, MN.9.6, MN.9.7 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

81120

81120 - Additional Information

Item Start Date:
01-May-2007
Description Start Date:
01-Oct-2017
Schedule Fee Start Date:
01-Jul-2019

DIETETICS SERVICE - ASSESSMENT FOR GROUP SERVICES

 

Dietetics health service provided to a person by an eligible dietitian for the purposes of ASSESSING a 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 service is provided to a person who 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 shared care plan or a GP Management Plan [ie item 721 or 732], or if the person is a resident of an aged care facility, their medical practitioner has contributed to a multidisciplinary care plan [ie item 731]; 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 of Health, or a referral form that contains all components of the form issued by the Department; and

(d)    the person is not an admitted patient of a hospital; and

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

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

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

(h)    in the case of a service in respect of which a private health insurance benefit is payable - the person who incurred the medical expenses in respect of the service has elected to claim the Medicare benefit in respect of the service, and not the private health insurance benefit.

 

Benefits are payable once only in a calendar year for this or any other Assessment for Group Services item (including services to which items 81100, 81110 and item 81120 apply).

Fee: $81.15 Benefit: 85% = $69.00

(See para MN.9.1, MN.9.2, MN.9.3, MN.9.4, MN.9.6, MN.9.7 of explanatory notes to this Category)


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  • 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