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Related Items: 10950 10951 10952 10953 10954 10956 10958 10960 10962 10964 10966 10968 10970 93000 93013

• Previous - Note MN.1.8
• Next - Note MN.3.2

Related Items: 81300 81305 81310 81315 81320 81325 81330 81335 81340 81345 81350 81355 81360 93048 93061

• Previous - Note MN.10.4
• Next - Note MN.12.1

Related Items: 30175

• Previous - Note TN.8.275
• Next - Note TN.8.277

Physiotherapy health service provided to a patient by an eligible physiotherapist if:

(a) the service is provided to a patient who has:

(i) a chronic condition; and

(ii) complex care needs being managed by a medical practitioner (other than a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements 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

(b) the service is recommended in the patient’s Team Care Arrangements or multidisciplinary care plan as part of the management of the patient’s chronic condition and complex care needs; and

(c) the service is of at least 20 minutes duration;

to a maximum of 5 services (including any services to which this item or any other item in this Subgroup or item 93000 or 93013 in the Telehealth and Telephone Determination applies) in a calendar year

Fee: $70.95 Benefit: 85% = $60.35

(See para MN.3.1 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $212.85

• Previous - Item 10959
• Next - Item 10962

Radical abdominoplasty, with repair of rectus diastasis, excision of skin and subcutaneous tissue, and transposition of umbilicus, not being a laparoscopic procedure, if:
(a) the patient has an abdominal wall defect as a consequence of pregnancy; and
(b) the patient:

(i) has a diastasis of at least 3cm measured by diagnostic imaging prior to this service; and
(ii) has either or both of the following:

(A) at least moderately severe pain or discomfort at the site of the diastasis in the abdominal wall during functional use and the pain or discomfort has been documented in the patient’s records by the practitioner providing the service;
(B) low back pain or urinary symptoms likely due to rectus diastasis and the pain or symptoms have been documented in the patient’s records by the practitioner providing the service; and

(iii) has failed to respond to non-surgical conservative treatment, that must have included physiotherapy; and
(iv) has not been pregnant in the last 12 months; and

(c) the service is not a service associated with a service to which item 30166, 30169, 30176, 30177, 30179, 30651, 30655, 45530, 45531, 45564, 45565, 45567, 46060, 46062, 46064, 46066, 46068, 46070, 46072, 46080, 46082, 46084, 46086, 46088 or 46090 applies
Applicable once per lifetime (H)

Multiple Operation Rule

Fee: $1,105.15 Benefit: 75% = $828.90

(See para TN.8.8, TN.8.97, TN.8.276 of explanatory notes to this Category)

• Previous - Item 30169
• Next - Item 30176

Physiotherapy health service provided to a patient who is of Aboriginal or Torres Strait Islander descent by an eligible physiotherapist if the service is of at least 20 minutes duration and:

(a) a medical practitioner has undertaken a health assessment and identified a need for follow-up allied health services; or

(b) the patient has:

(i) a chronic condition;

(ii) complex care needs being managed by a medical practitioner (other than a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements 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

(iii) the service is recommended in the patient’s Team Care Arrangements or multidisciplinary care plan as part of the management of the patient’s chronic condition and complex care needs;

to a maximum of 10 services (including any services to which this item or any other item in this Group or Subgroup 1 of Group M3 or item 93000, 93013, 93048 or 93061 of the Telehealth and Telephone Determination applies) in a calendar year

Fee: $70.95 Benefit: 85% = $60.35

(See para MN.11.1 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $212.85

• Previous - Item 81330
• Next - Item 81340

Audiology, optometry, orthoptic or physiotherapy health service provided to a patient aged under 25 years by an eligible audiologist, optometrist, orthoptist or physiotherapist if:

(a)    the patient was referred by an eligible medical practitioner, or by an eligible allied health practitioner following referral by an eligible medical practitioner, to:

(i)   assist the eligible medical practitioner with diagnostic formulation where the patient has a suspected complex neurodevelopmental disorder or eligible disability; or

(ii)  contribute to the patient’s treatment and management plan developed by the referring eligible medical practitioner where a complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability is confirmed; and

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

(c)    the service is at least 50 minutes duration

Up to 4 services to which this item or any of items 82000, 82005, 82010, 93032, 93033, 93040 or 93041 apply may be provided to the same patient on the same day

Fee: $100.20 Benefit: 85% = $85.20

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

Extended Medicare Safety Net Cap: $300.60

• Previous - Item 82025
• Next - Item 82035

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: $100.20 Benefit: 85% = $85.20

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

Extended Medicare Safety Net Cap: $300.60

• Previous - Item 82030
• Next - Item 82100

Speech pathology, occupational therapy, audiology, optometry, orthoptic or physiotherapy health service provided by telehealth attendance to a patient aged under 25 years by an eligible speech pathologist, occupational therapist, audiologist, optometrist, orthoptist or physiotherapist if:

(a) the patient was referred by an eligible medical practitioner, or by an eligible allied health practitioner following referral by an eligible medical practitioner, to:

(i) assist the eligible medical practitioner with diagnostic formulation where the patient has a suspected complex neurodevelopmental disorder or eligible disability; or

(ii) contribute to the patient’s treatment and management plan developed by the referring eligible medical practitioner where a complex neurodevelopmental disorder (such as autism spectrum disorder) or eligible disability is confirmed; and

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

(c) the service is at least 50 minutes duration

Up to 4 services to which this item or any of items 82000, 82005, 82010, 82030, 93032, 93040 or 93041 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: $100.20 Benefit: 85% = $85.20

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

Extended Medicare Safety Net Cap: $300.60

• Previous - Item 93032
• Next - Item 93035

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: $100.20 Benefit: 85% = $85.20

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

Extended Medicare Safety Net Cap: $300.60

• Previous - Item 93035
• Next - Item 93040