Medicare Benefits Schedule - Item 223

Professional attendance for the purpose of Group therapy lasting at least one hour given under the direct continuous supervision of a prescribed medical practitioner, involving members of a family and persons with close personal relationships with that family—each Group of 4 or more patients

Fee: $137.35 Benefit: 75% = $103.05 100% = $137.35

(See para AN.7.1, AN.7.4 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $412.05

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Last reviewed: 1 November 2023

A prescribed medical practitioner is a medical practitioner:

(a) who is not a general practitioner (see GN.4.13), specialist or consultant physician, and

(b) who:

a. is registered under section 3GA of the Act and is practising during the period, and in the location in respect of which the medical practitioner is registered, and insofar as the circumstances specified for paragraph 19AA(3)(b) of the Act apply; or

b. is covered by an exemption under subsection 19AB(3) of the Act; or

c. first became a medical practitioner before 1 November 1996.

Related Items: 179 181 185 187 189 191 203 206 214 215 218 219 220 221 222 223 228 229 230 231 232 233 235 236 237 238 239 240 243 244 245 249 272 276 277 279 281 282 283 285 286 287 301 303 733 737 741 745 761 763 766 769 772 776 788 789 792 2197 2198 2200 90092 90093 90095 90096 90098 90183 90188 90202 90212 90215

Last reviewed: 1 November 2023

These items refer to family group therapy supervised by prescribed medical practitioners (see note AN.7.1). To be used, these items require that a formal intervention with a specific therapeutic outcome, such as improved family function and/or communication, is undertaken. Other types of group attendances do not attract benefits. It should be noted that only one fee applies in respect of each group of patients.

Telephone consultations, letters of advice by prescribed medical practitioners, the issue of repeat prescriptions when the patient is not in attendance, post mortem examinations, the issue of death certificates, cremation certificates, counselling of relatives (note ‑ items 348, 350 and 352 are not counselling services), group attendances (other than group attendances covered by items 170, 171, 172, 221, 222, 223, 342, 344 and 346) such as group counselling, health education, weight reduction or fitness classes do not qualify for benefit.

Although Medicare benefits are not payable for the issue of a death certificate, an attendance on a patient at which it is determined that life is extinct can be claimed under the appropriate attendance item. The outcome of the attendance may be that a death certificate is issued, however, Medicare benefits are only payable for the attendance component of the service.

Related Items: 221 222 223