Medicare Benefits Schedule - Item 224

Professional attendance by a prescribed medical practitioner to perform a brief health assessment, lasting not more than 30 minutes and including:
(a) collection of relevant information, including taking a patient history; and
(b) a basic physical examination; and
(c) initiating interventions and referrals as indicated; and
(d) providing the patient with preventive health care advice and information

Fee: $54.10 Benefit: 100% = $54.10

(See para AN.0.36, AN.0.37, AN.0.38, AN.0.39, AN.0.40, AN.0.41, AN.0.42, AN.0.69 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $162.30

• Previous - Item 223
• Next - Item 225

Publication date: 1 July 2024

SUMMARY

This note sets out common principles that apply when using MBS time-tiered health assessment items for general practitioners (GPs see GN.4.13) and prescribed medical practitioners (PMPs see AN.7.1).

Time-tiered health assessment items are only available to specific patient cohorts. Details of the requirements for a health assessment for each patient cohort are at:

• Type 2 diabetes risk evaluation (40-49 years) – see AN.0.37.
• Health assessment for people aged 45-49 years (inclusive) who are at risk of developing chronic disease – see AN.0.38.
• Health Assessment provided for people aged 75 years and older – see AN.0.39.
• Health Assessment provided as a comprehensive medical assessment for residents of residential aged care facilities – see AN.0.40.
• Health Assessment provided for people with an intellectual disability – see AN.0.41.
• Health Assessment provided for refugees and other humanitarian entrants – see AN.0.42.
• One-off health assessment for veterans – see AN.0.69.

USE OF THE ITEMS

Health assessment items are used to assess eligible patients’ health and physical, psychological and social function. This includes the medical practitioner’s consideration of whether preventive health care and education should be offered to the patient to improve their health or function.

The items apply only to a service provided in the course of a personal attendance by a single GP or PMP on a single patient.

While the requirements for health assessments vary according to patient cohort, in general they all require the GP or PMPs to undertake a range of activities, including:

• information collection, including taking a patient history and undertaking or arranging examinations and investigations as required
• making an overall assessment of the patient
• recommending appropriate interventions, and
• providing advice and information to the patient.

Additional item requirements apply to all health assessments conducted, tailored to meet the needs of each patient group being targeted under the items (see ‘Eligible Patients’). Information on additional item requirements is available in Notes: AN.0.37, AN.0.38, AN.0.39, AN.0.40, AN.0.41, AN.0.42, AN.0.69.

How do I choose which health assessment item to use?

The correct health assessment item will depend on:

• practitioner type – GP or PMP, and
• length of time spent with the patient (i.e. the personal attendance time).

Health Assessment service	GP	PMP
Brief health assessment lasting no more than 30 minutes	701	224
Standard health assessment lasting at least 30 minutes and less than 45 minutes	703	225
Long health assessment lasting at least 45 minutes and less than 60 minutes	705	226
Prolonged health assessment lasting more than 60 minutes	707	227

Are there specific requirements for any of the health assessment items?

Yes, additional item requirements apply to all health assessments conducted, tailored to meet the needs of each patient group being targeted under the items (see ‘Eligible Patients’). Information on additional item requirements is available in Notes: AN.0.37, AN.0.38, AN.0.39, AN.0.40, AN.0.41, AN.0.42, AN.0.69.

Is a health assessment a health screening service?

No. Clause 2.15.14 of the Health Insurance (General Medical Services Table) Regulations 2021 (the Regulations) specifies that a time-tiered health assessment must not include a screening service.

The Health Insurance Act 1973 defines a  health screening service as a medical examination or test that is not reasonably required for the management of the medical condition of the patient. A health screening service does not include a medical examination or a test on a symptomless patient by the that patient’s own medical practitioner in the course of normal medical practice, to ensure the patient receives any medical advice or treatment necessary to maintain their state of health.

Further information is available in Note GN.13.33.

Can another person assist the medical practitioner to undertake the health assessment?

Yes. Clause 2.15.14 of the Regulations states that practice nurses, Aboriginal health workers and Aboriginal Torres Strait Islander health practitioners may assist in accordance with accepted medical practice under the supervision of the medical practitioner.

Assistance provided must be in accordance with accepted medical practice and under the supervision of the GP or prescribed medical practitioner. This may include activities associated with:

• information collection, and
• providing patients with information about recommended interventions, at the direction of the medical practitioner.

The GP or prescribed medical practitioner should be satisfied that the assisting health professional has the necessary skills, expertise and training to collect the information required for the health assessment.

MBS items for Time-Tiered Health Assessments are for a complete service. For and on behalf of item 10997 may not be claimed in conjunction with these items.

Additional advice on the use of other health professionals’ time when undertaking health assessments can be found in the AskMBS Advisory – General Practice 1 (health.gov.au).

A Practice nurse means a registered or an enrolled nurse who is employed by, or whose services are otherwise retained by, a general practice or eligible health service.

An Aboriginal and Torres Strait Islander health practitioner means a person who:

• is registered under a law of a State or Territory as an Aboriginal and Torres Strait Islander health practitioner, and
• is employed by, or whose services are otherwise retained by, a GP or prescribed medical practitioner in a general practice, or an eligible health service.

An Aboriginal health worker means a person who:

• holds a Certificate III in Aboriginal or Torres Strait Islander Health Worker Primary Health Care (Clinical) or other appropriate qualification, and
• is engaged by a GP or prescribed medical practitioner in a general practice or an eligible health service.

Can I include additional time required for communications (e.g. with an interpreter) in the time taken for the health assessment?

Yes, a wide range of factors may affect the time needed to communicate effectively with a patient during a consultation. These include, but are not limited to, situations where a language barrier exists between the medical practitioner and patient (including when an interpreter is required), or when a patient has hearing problems, difficulty with speech, an intellectual disability, and/or dementia.

When claiming for time-tiered MBS items, the total consultation time includes the time required to communicate effectively with the patient. Where more time than usual is required to communicate effectively with a particular patient, it is considered reasonable to claim a longer attendance item than might otherwise be expected for the service.

In such situations, medical practitioners should make a brief record in the patient’s notes including details about why the additional time was required. For example, stating ‘consultation extended due to use of interpreter’ and, if relevant, citing the Translating and Interpreting Service (TIS) job number.

My patient is eligible for more than one category of health assessment. Which health assessment should I do?

Patients can receive each health assessment they are eligible for. For example, a 42 year old patient with an intellectual disability who is also found to be at high risk of developing type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool can receive:

• a health assessment for a person with an intellectual disability annually, and
• a type 2 diabetes risk evaluation every 3 years until they are 49 (inclusive).

Where the patient is eligible for more than one health assessment there is no minimum interval of time between the provision of the different health assessments. Where patients are eligible for more than one health assessment  practitioner should ensure they identify which target group the health assessment relates to when submitting claims to Services Australia. Additional information on claiming limits is available on the Services Australia - Health assessments and your record keeping responsibilities webpage.

ELIGIBLE PATIENTS

Any patient who is eligible to receive Medicare benefits and meets the criteria for one or more of the following target groups may receive a health assessment service, at the stated frequencies:

Target Group	Frequency of Service	Associated Note
A type 2 diabetes risk evaluation for people aged 40-49 years (inclusive) with a high risk of developing type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool	Once every three years to an eligible patient	AN.0.37
A health assessment for people aged 45-49 years (inclusive) who are at risk of developing chronic disease	Once only to an eligible patient	AN.0.38
A health assessment for people aged 75 years and older	Provided annually to an eligible patient	AN.0.39
A comprehensive medical assessment for permanent residents of residential aged care facilities	Provided annually to an eligible patient	AN.0.40
A health assessment for people with an intellectual disability	Provided annually to an eligible patient	AN.0.41
A health assessment for refugees and other humanitarian entrants	Once only to an eligible patient	AN.0.42
A health assessment for former serving members of the Australian Defence Force	Once only to an eligible patient	AN.0.69

Residential aged care facility-specific items are only available to Medicare-eligible patients that are residents of a residential aged care facility and who are currently not in-patients of a hospital.

All other health assessment items are not available to people who are in-patients of a hospital or care recipients in a residential aged care facility.

ELIGIBLE PRACTITIONERS

Health assessment items are available for different practitioner types:

• general practitioner items can be claimed by GPs only (see GN.4.13).
• prescribed medical practitioner items can be claimed by prescribed medical practitioners only (see AN.7.1).

Note: Clause 2.15.14 of the Regulations specifies patients must access health assessment services through their usual GP or prescribed medical practitioner, if reasonably practicable.

The patient’s usual GP or prescribed medical practitioner means the practitioner:

• who has provided the majority of services to the patient in the past 12 months, or
• who is likely to provide the majority of services to the patient in the following 12 months, or
• is located at a medical practice that:
  • has provided the majority of services to the patient in the past 12 months, or
  • is likely to provide the majority of services to the patient in the next 12 months.

CO-CLAIMING RESTRICTIONS

Clause 2.15.14 of the Regulations specifies a separate consultation must not be performed in conjunction with a health assessment, unless clinically necessary.

RECORD KEEPING AND REPORTING REQUIREMENTS

The department undertakes regular post payment auditing to ensure that MBS items are claimed appropriately. Practitioners should ensure they keep adequate and contemporaneous records. For information on what constitutes adequate and contemporaneous records see GN.15.39.

Clause 4.3 of the Health Insurance Act 1973 specifies that, where an item specifies the creation of a document (however described) and a document it created, the document must be retained for the period of 2 years. 

RELEVANT LEGISLATION

Details about the legislative requirements of the MBS items can be found on the Federal Register of Legislation at www.legislation.gov.au. Health assessment items are set out in the following regulatory instrument:

• Health Insurance (General Medical Services Table) Regulations 2021.

Related Items: 224 225 226 227 701 703 705 707

Publication date: 1 July 2024

SUMMARY

Time-tiered health assessment items may be used to undertake a Type 2 Diabetes Risk Evaluation for Medicare eligible patients aged 40-49 years (inclusive) with a high risk of developing type 2 diabetes.

Note: The requirements below must be met in addition to common principles for time-tiered health assessment items, contained in AN.0.36.

USE OF THE ITEMS

The specific requirements of the Type 2 Diabetes Risk Evaluation are set out in clause 2.15.4 of the Health Insurance (General Medical Services Table) Regulations 2021 (the Regulations).

The Regulations require that a Type 2 Diabetes Risk Evaluation must include:

• a review of the risk factors underlying a patient’s high-risk score as identified by the Australian Type 2 Diabetes Risk Assessment Tool, and
• initiating interventions, if appropriate, to address risk factors or to exclude diabetes.

 The Regulations also state that the evaluation must include:

• assessing the patient’s high-risk score as determined by the Australian Type 2 Diabetes Risk Assessment Tool
• updating the patient’s history and performing physical examinations and clinical investigations
• making an overall assessment of the patient’s risk factors and the results of examinations and investigations
• initiating interventions, if appropriate, including referrals and follow‑up services relating to the management of any risk factors identified, and
• giving the patient advice and information, including strategies to achieve lifestyle and behaviour changes if appropriate.

For the purposes of a Type 2 Diabetes Risk Evaluation, risk factors include:

• lifestyle risk factors (e.g. smoking, physical inactivity or poor nutrition)
• biomedical risk factors (e.g. high blood pressure, impaired glucose metabolism or excess weight), and
• a family history of a chronic disease.

ELIGIBLE PATIENTS

Patients eligible for a Type 2 Diabetes Risk Evaluation are:

• aged between 40-49 years (inclusive), and
• have a high risk of developing type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool.

The Australian Type 2 Diabetes Risk Assessment Tool must have been completed by the patient no more than 3 months prior to the Type 2 Diabetes Risk Evaluation.

A Type 2 Diabetes Risk Evaluation cannot be claimed more than once every 3 years by an eligible patient.

ELIGIBLE PRACTITIONERS

Type 2 Diabetes Risk Evaluations can be undertaken by a general practitioner (see GN.4.13) or a prescribed medical practitioner (see AN.7.1).

CO-CLAIMING RESTRICTIONS 

A separate consultation must not be performed in conjunction with a Type 2 Diabetes Risk Evaluation, unless clinically necessary.

To co-claim a Type 2 Diabetes Risk Evaluation item and another item, both items must be clinically necessary and distinct services.

RECORD KEEPING AND REPORTING REQUIREMENTS

The department undertakes regular post payment auditing to ensure that MBS items are claimed appropriately. Practitioners should ensure they keep adequate and contemporaneous records. For information on what constitutes adequate and contemporaneous records see GN.15.39.

Clause 4.3 of the Health Insurance Act 1973 specifies that, where an item specifies the creation of a document (however described) and where a document is created, the document must be retained for the period of 2 years.

RELEVANT LEGISLATION

Details about the legislative requirements of the MBS items can be found on the Federal Register of Legislation at www.legislation.gov.au. Health assessment items are set out in the following regulatory instrument:

• Health Insurance (General Medical Services Table) Regulations 2021.

Related Items: 224 225 226 227 701 703 705 707

Publication date: 1 July 2024 

SUMMARY

Time-tiered health assessment items may be used to undertake a health assessment for people aged 45-49 years (inclusive) who are at risk of developing chronic disease.

Note: The requirements below must be met in addition to common principles for time tiered health assessment items, contained in AN.0.36.

USE OF ITEMS

The specific requirements of the Type 2 Diabetes Risk Evaluation are set out in clause 2.15.5 of the Health Insurance (General Medical Service Table) Regulations 2021 (the Regulations).

The Regulations specify GPs (see GN.4.13) and prescribed medical practitioners (PMP, see AN.7.1) can provide this health assessment to patients, where in the clinical judgement of the attending medical practitioner, a specific risk factor for chronic disease has been identified.

Specific risk factors the medical practitioner can consider when providing this health assessment include, but are not limited to:

• lifestyle risk factors (such as smoking, physical inactivity, poor nutrition or alcohol misuse)
• biomedical risk factors (such as high cholesterol, high blood pressure, impaired glucose metabolism or excess weight)
• a family history of a chronic disease.

The regulation states the health assessment must include:

• information collection, including taking a patient's history and performing examinations and investigations, as required
• making an overall assessment of the patient
  initiating interventions or referrals, as appropriate, and
  giving health advice and information to the patient.

The Regulations state that a chronic disease is one that “has been, or is likely to be, present for at least 6 months, including, but not limited to: asthma, cancer, cardiovascular illness, diabetes mellitus, a mental health condition, arthritis or a musculoskeletal condition.” It is important to note that this definition of a chronic disease is specific to this health assessment cohort. It does not apply more broadly across the MBS.

ELIGIBLE PATIENTS

Eligible patients for a health assessment for people who are at risk of developing a chronic disease are:

• aged between 45-49 years (inclusive), and
• are at risk of developing a chronic disease, in the clinical judgement of the attending medical practitioner based on the identification of a specific risk factor.

A health assessment for a patient at risk of developing a chronic disease cannot be claimed more than once per eligible patient.

ELIGIBLE PRACTITIONERS

A health assessment for patients at risk of developing a chronic disease can be undertaken by a general practitioner (see GN.4.13) or a prescribed medical practitioner (see AN.7.1).

CO-CLAIMING RESTRICTIONS

Clause 2.15.14 of the Regulations specifies a separate consultation must not be performed in conjunction with a health assessment for patients at risk of developing a chronic disease, unless clinically necessary.

To co-claim the health assessment item for patients at risk of developing a chronic disease and another item, both items must be clinically necessary and distinct services.

RECORD KEEPING AND REPORTING REQUIREMENTS

The department undertakes regular post payment auditing to ensure that MBS items are claimed appropriately. Practitioners should ensure they keep adequate and contemporaneous records. For information on what constitutes adequate and contemporaneous records see GN.15.39.

Clause 4.3 of the Health Insurance Act 1973 specifies that, where an item specifies the creation of a document (however described) and a document is created, the document must be retained for the period of 2 years. 

RELEVANT LEGISLATION

Details about the legislative requirements of the MBS items can be found on the Federal Register of Legislation at www.legislation.gov.au. Health assessment items are set out in the following regulatory instrument:

• Health Insurance (General Medical Services Table) Regulations 2021.

Related Items: 224 225 226 227 701 703 705 707

Publication date: 1 July 2024

SUMMARY

Time-tiered health assessment items may be used to undertake an Older Person’s health assessment for Medicare eligible patients aged 75 years and older every 12 months.

Note: The requirements below must be met in addition to common principles for time-tiered health assessment items, contained in AN.0.36.

USE OF THE ITEMS

The specific requirements of the Older Person’s health Assessment are set out in clause 2.15.6 of the Health Insurance (General Medical Services Table) Regulations 2021 (the Regulations).

The regulations state that an Older Person’s health assessment is the assessment of:

• a patient’s health and physical, psychological and social function, and
• whether preventive health care and education should be offered to the patient, to improve the patient’s health and physical, psychological and social function.

The Regulations also state that the health assessment must include:

• personal attendance by a general practitioner or prescribed medical practitioner
• measurement of the patient's blood pressure, pulse rate and rhythm
• an assessment of the patient's medication
• an assessment of the patient's continence
• an assessment of the patient's immunisation status for influenza, tetanus and pneumococcus
• an assessment of the patient's physical function, including the patient's activities of daily living, and whether or not the patient has had a fall in the last 3 months
• an assessment of the patient's psychological function, including the patient's cognition and mood, and
• an assessment of the patient's social function, including:
  • the availability and adequacy of paid and unpaid help, and
  • whether the patient is responsible for caring for another person.

Note: The Regulations do not preclude a medical practitioner’s consideration of the patient’s broader immunisation status, such as for immunisations listed under the National Immunisation Program schedule or for COVID-19.

ELIGIBLE PATIENTS

Patients eligible for an Older Person’s health assessment are:

• aged 75 years and older and not an in-patient of a hospital or a care recipient in a residential aged care facility.

For comprehensive medical assessments for residents of residential aged care facilities see AN.0.40.

An Older Person’s health assessment cannot be claimed more than once every 12 months by an eligible patient.

CO-CLAIMING RESTRICTIONS

A separate consultation must not be performed in conjunction with an Older Person’s health assessment service, unless clinically necessary.

To co-claim a health assessment item and another item, both items must be clinically necessary and distinct services.

RECORD KEEPING AND REPORTING REQUIREMENTS

The Regulations state that an Older Person’s health assessment must include:

• keeping a record of the health assessment
• offering the patient a written report on the health assessment, with recommendations about matters covered by the health assessment, and
• offering the patient's carer (if any, and if the practitioner considers it appropriate and the patient agrees) a copy of the report or extracts of the report relevant to the carer.

The department undertakes regular post payment auditing to ensure that MBS items are claimed appropriately. Practitioners should ensure they keep adequate and contemporaneous records. For information on what constitutes adequate and contemporaneous records see GN.15.39.

Clause 4.3 of the Health Insurance Act 1973 specifies that, where an item specifies the creation of a document (however described) and a document it created, the document must be retained for the period of 2 years.

RELEVANT LEGISLATION

Details about the legislative requirements of the MBS items can be found on the Federal Register of Legislation at www.legislation.gov.au. Health assessment items are set out in the following regulatory instrument:

• Health Insurance (General Medical Services Table) Regulations 2021.

Related Items: 224 225 226 227 701 703 705 707

Publication date: 1 July 2024

SUMMARY

Time-tiered health assessment items may be used to undertake a Comprehensive Medical Assessment for a care recipient of a residential aged care facility (RACF).

Note: The requirements below must be met in addition to common principles for time-tiered health assessment items, contained in AN.0.36.

USE OF THE ITEMS

The specific requirements of the Comprehensive Medical Assessment for care recipients in a RACF are set out in clause 2.15.7 of the Health Insurance (General Medical Service Table) Regulations 2021 (the Regulations).

The regulations require that a Comprehensive Medical Assessment for care a recipient in a RACF must include an assessment of the resident's health, physical and psychological function.

It must also include:

• a personal attendance by a general practitioner or prescribed medical practitioner
• taking a detailed patient history of the resident
• conducting a comprehensive medical examination of the resident
• developing a list of diagnoses and medical problems based on the medical history and examination, and
• making a written summary of the Comprehensive Medical Assessment.

ELIGIBLE PATIENTS

Patients eligible for a Comprehensive Medical Assessment are care recipients in a residential aged care facility. The Regulations define a care recipient as a person to whom residential care (as defined in section 41-3 of the Aged Care Act 1997) is provided.

A Comprehensive Medical Assessment may be provided on admission to a residential aged care facility, if a Comprehensive Medical Assessment has not already been provided to the patient in another residential aged care facility in the last 12 months.

A Comprehensive Medical Assessment may be claimed by eligible patients:

• on admission to a residential aged care facility, if a Comprehensive Medical Assessment has not already been provided in another residential aged care facility in the last 12 months, and
• at 12 month intervals after that assessment.

ELIGIBLE PRACTITIONERS

A Comprehensive Medical Assessment can be undertaken by a general practitioner (see GN.4.13) or a prescribed medical practitioner (see AN.7.1).

CO-CLAIMING RESTRICTIONS

A Comprehensive Medical Assessment may be performed in conjunction with a consultation for another purpose, but must be claimed separately.

To co-claim a Comprehensive Medical Assessment item and another item, both items must be clinically necessary and distinct services.

RECORD KEEPING AND REPORTING REQUIREMENTS

The Regulations state that a Comprehensive Medical Assessment must include:

• making a written summary of the Comprehensive Medical Assessment
• giving a copy of the summary to the residential aged care facility, and
• offering the resident a copy of the summary.

The department undertakes regular post payment auditing to ensure that MBS items are claimed appropriately. Practitioners should ensure they keep adequate and contemporaneous records. For information on what constitutes adequate and contemporaneous records see GN.15.39.

Clause 4.3 of the Health Insurance Act 1973 specifies that, where an item specifies the creation of a document (however described) and a document it created, the document must be retained for the period of 2 years. 

RELEVANT LEGISLATION

Details about the legislative requirements of the MBS items can be found on the Federal Register of Legislation at www.legislation.gov.au. Health assessment items are set out in the following regulatory instrument:

• Health Insurance (General Medical Services Table) Regulations 2021.

Related Items: 224 225 226 227 701 703 705 707

Publication date: 1 July 2024

SUMMARY

Time-tiered health assessment items may be used to undertake a health assessment for a person with an intellectual disability.

Note: The requirements below must be met in addition to common principles for time-tiered health assessment items, contained in AN.0.36.

USE OF THE ITEMS

The specific requirements of a health assessment for a person with an intellectual disability are set out in clause 2.15.8 of the Health Insurance (General Medical Services Table) Regulations 2021 (the Regulations).

The Regulations specify that a Health assessment for a person with an intellectual disability is an assessment of:

• the patient’s physical, psychological and social function, and
• whether any medical intervention and preventive health care is required.

They also state that the health assessment must include the following matters, to the extent that they are relevant to the patient:

• checking dental health (including dentition)
• conducting an aural examination (including arranging a formal audiometry if an audiometry has not been conducted within the last 5 years)
• assessing ocular health (arrange review by an ophthalmologist or optometrist if a comprehensive eye examination has not been conducted within the last 5 years)
• assessing nutritional status (including weight and height measurements) and a review of growth and development
• assessing bowel and bladder function (particularly for incontinence or chronic constipation)
• assessing medications including:
  • ­non-prescription medicines taken by the patient, prescriptions from other doctors, medications prescribed but not taken, interactions, side effects and review of indications
  • advice to carers on the common side effects and interactions, and
  • ­consideration of the need for a formal medication review
• checking immunisation status (including influenza, tetanus, hepatitis A and B, measles, mumps, rubella and pneumococcal vaccinations)
• checking exercise opportunities (with the aim of moderate exercise for at least 30 minutes each day)
• checking whether the support provided for activities of daily living adequately and appropriately meets the patient’s needs, and considering formal review if required
• considering the need for breast examination, mammography, papanicolaou smears, testicular examination, lipid measurement and prostate assessment as for the general population
• checking for dysphagia and gastroesophageal disease (especially for patients with cerebral palsy) and arranging for investigation or treatment as required
• assessing risk factors for osteoporosis (including diet, exercise, Vitamin D deficiency, hormonal status, family history, medication and fracture history) and arranging for investigation or treatment as required
• for a patient diagnosed with epilepsy—reviewing seizure control (including anticonvulsant drugs) and considering referral to a neurologist at appropriate intervals
• screening for thyroid disease at least every 2 years (or yearly for patients with Down syndrome)
• for a patient without a definitive aetiological diagnosis—considering referral to a genetic clinic every 5 years
• assessing or reviewing treatment for comorbid mental health issues
• considering timing of puberty and management of sexual development, sexual activity and reproductive health, and
• considering whether there are any signs of physical, psychological or sexual abuse.

Note: The Regulations do not preclude a medical practitioner’s consideration of the patient’s broader immunisation status, such as for immunisations listed under the National Immunisation Program schedule or for COVID-19.

Practitioners may also wish to utilise publicly available guidelines such as the Royal Australian College of General Practitioner’s Guidelines for preventative activities in general practice as a guideline to conduct patient assessments to current clinical standards.

Eligible health practitioners may wish to consider the use of relevant assessment tools in the delivery of this service, such as the Adult Comprehensive Health Assessment Program (CHAP). However, it remains the responsibility of the treating practitioner to ensure all requirements of the items are met.

ELIGIBLE PATIENTS

Patients are eligible for this assessment if they are a person living with an intellectual disability.

A health assessment for a person with an intellectual disability cannot be claimed more than once every 12 months by an eligible patient.

ELIGIBLE PRACTITIONERS

Health assessment for a person with an intellectual disability can be undertaken by a general practitioner (see GN.4.13) or a prescribed medical practitioner (see AN.7.1).

CO-CLAIMING RESTRICTIONS

To co-claim a health assessment for a person with an intellectual disability item and another item, both items must be clinically necessary and distinct services.

RECORD KEEPING AND REPORTING REQUIREMENTS

A health assessment for a person with an intellectual disability must include:

• keeping a record of the health assessment;
• offering the patient a written report on the health assessment;
• offering the patient’s carer (if any, and if the general practitioner or the prescribed medical practitioner considers it appropriate, and the patient agrees) a copy of the report or extracts of the report; and
• offering relevant disability professionals (if the general practitioner or the prescribed medical practitioner considers it appropriate and the patient or, if appropriate, the patient’s carer, agrees) a copy of the report or extracts of the report.

The department undertakes regular post payment auditing to ensure that MBS items are claimed appropriately. Practitioners should ensure they keep adequate and contemporaneous records. For information on what constitutes adequate and contemporaneous records see GN.15.39.

Clause 4.3 of the Health Insurance Act 1973 specifies that, where an item specifies the creation of a document (however described) and a document it created, the document must be retained for the period of 2 years.

RELEVANT LEGISLATION

Details about the legislative requirements of the MBS items can be found on the Federal Register of Legislation at www.legislation.gov.au. Health assessment items are set out in the following regulatory instrument:

• Health Insurance (General Medical Services Table) Regulations 2021.

 

Related Items: 224 225 226 227 701 703 705 707

Publication date: 1 July 2024

SUMMARY

Time-tiered health assessment items may be used to undertake a health assessment provided for a refugee or other humanitarian entrant.

Note: The requirements below must be met in addition to common principles for time-tiered health assessment items, contained in AN.0.36.

USE OF THE ITEMS

The specific requirements of the health assessment for a refugee or other humanitarian entrant are set out in clause 2.15.9 of the Health Insurance (General Medical Services Table) Regulations 2021 (the Regulations).

The Regulations require that a health assessment provided for a refugee or other humanitarian entrant is an assessment of:

• the patient’s health and physical, psychological and social function, and
• whether preventive health care and education should be offered to the patient to improve their health and physical, psychological or social function.

The Regulations also state that the health assessment must include:

• a personal attendance by a GP or prescribed medical practitioner
• taking the patient’s history
• examining the patient
• performing or arranging any required investigations
• assessing the patient, using the information gained from the above points
• developing a management plan addressing the patient’s health care needs, health problems and relevant conditions, and
• making or arranging any necessary interventions and referrals.

A wide range of factors may affect the time needed to communicate effectively with a patient during a consultation. These include, but are not limited to, situations where a language barrier exists between the medical practitioner and patient (including when an interpreter is required), or when a patient has hearing problems, difficulty with speech, an intellectual disability, and/or dementia.

When claiming for time-tiered MBS items, the total consultation time includes the time required to communicate effectively with the patient. Where more time than usual is required to communicate effectively with a particular patient, it is considered reasonable to claim a longer attendance item than might otherwise be expected for the service.

In such situations, medical practitioners and other providers should make a brief record in the patient’s notes including details about why the additional time was required. For example, stating ‘consultation extended due to use of interpreter’ and, if relevant, citing the Translating and Interpreting Service (TIS) job number.

ELIGIBLE PATIENTS

Patients are eligible for this assessment if they are:

• a refugee or humanitarian entrant, with eligibility for Medicare, and
• either:
  • ­hold a relevant visa that the person has held for less than 12 months at the time of the assessment, or
  • ­first entered Australia less than 12 months before the assessment is performed.

A relevant visa means any of the following visas granted under the Migration Act 1958:

• Subclass 070 Bridging (Removal Pending) visa
• Subclass 200 (Refugee) visa
• Subclass 201 (In-country Special Humanitarian) visa
• Subclass 202 (Global Special Humanitarian) visa
• Subclass 203 (Emergency Rescue) visa
• Subclass 204 (Woman at Risk) visa
• Subclass 786 (Temporary (Humanitarian Concern)) visa
• Subclass 790 (Safe Haven Enterprise) visa
• Subclass 866 (Protection) visa

A health assessment provided for a refugee or other humanitarian entrant may only be claimed once by an eligible patient.

ELIGIBLE PRACTITIONERS

A health assessment provided for a refugee or other humanitarian entrant can be undertaken by a general practitioner (see GN.4.13) or a prescribed medical practitioner (see AN.7.1).

CO-CLAIMING RESTRICTIONS

To co-claim a health assessment provided for a refugee or other humanitarian entrant item and another item, both items must be clinically necessary and distinct services. 

RECORD KEEPING AND REPORTING REQUIREMENTS

A health assessment provided for a refugee or other humanitarian entrant must include:

• keeping a record of the health assessment; and
• offering the patient a written report on the health assessment.

The department undertakes regular post payment auditing to ensure that MBS items are claimed appropriately. Practitioners should ensure they keep adequate and contemporaneous records. For information on what constitutes adequate and contemporaneous records see GN.15.39.

Clause 4.3 of the Health Insurance Act 1973 specifies that, where an item specifies the creation of a document (however described) and a document it created, the document must be retained for the period of 2 years. 

RELEVANT LEGISLATION

Details about the legislative requirements of the MBS items can be found on the Federal Register of Legislation at www.legislation.gov.au. Health assessment items are set out in the following regulatory instrument:

• Health Insurance (General Medical Services Table) Regulations 2021

Related Items: 224 225 226 227 701 703 705 707

Publication date: 1 July 2024

SUMMARY

Time tiered health assessment items may be used to undertake a one-off Veterans’ Health Assessment for former serving members of the Australian Defence Force (ADF), including former members of permanent and reserve forces.

Annual Veterans’ Health Checks are available for certain DVA Veteran Card holders. These health checks are not provided through the MBS. More information on the Annual Veterans’ health checks is available from the Department of Veterans’ Affairs.

Note: The requirements below must be met in addition to common principles for time tiered health assessment items, contained in AN.0.36.

USE OF ITEMS

The specific requirements of the Veterans’ Health Assessment are set out in Clause 2.15.10 of the Health Insurance (General Medical Services Table) Regulations 2021 (the Regulations).

The Regulations require that a Veterans Health Assessment must include:

• an assessment of a patient's physical and psychological health and social function, and
• whether health care, education or other assistance should be offered to the patient to improve the patient's physical or psychological health or social function.

The Regulations also state that the health assessment must include taking a history of the patient that includes the following:

• an assessment of the patient's service with the Australian Defence Force, including service type, years of service, field of work, number of deployments and reason for discharge
• the patient's social history, including relationship status, number of children (if any) and current occupation
• the patient's current medical conditions, and
• whether the patient suffers from hearing loss or tinnitus
• the patient's use of medication, including medication prescribed by another doctor and medication obtained without a prescription
• the patient's smoking, if applicable
• the patient's alcohol use, if applicable
• the patient's substance use, if applicable
• the patient's level of physical activity
• whether the patient has bodily pain
• whether the patient has difficulty getting to sleep or staying asleep
• whether the patient has psychological distress
• whether the patient has post-traumatic stress disorder
• whether the patient is at risk of harm to self or others
• whether the patient has anger problems
• the patient's sexual health, and
• any other health concerns the patient has.

Note: The Regulations do not preclude a medical practitioner’s consideration of the patient’s broader immunisation status, such as for immunisations listed under the National Immunisation Program schedule or for COVID-19, or broader health factors, such as a patient’s occupational exposure to biological or chemical substances that may be potentially harmful.

A Veterans Health Check must also include:

• measuring the patient’s height
• weighing the patient and ascertaining, or asking the patient, whether the patient’s weight has changed in the last 12 months
• measuring the patient’s waist circumference
• taking the patient’s blood pressure
• using information gained in the course of taking the patient's history to assess whether any further assessment of the patient's health is necessary either by:
  • making the further assessment, or
  • or referring the patient to another medical practitioner who can make the further assessment,
• documenting a strategy for improving the patient's health, and
• offering to give the patient a written report of the assessment that makes recommendations for treating the patient including preventive health measures. 

The Veterans Health Assessment may be performed using the ADF Post-discharge GP Health Assessment Tool found on the Department of Veterans' Affairs website at: https://www.dva.gov.au/about-us/dva-forms/veteran-health-check-assessment-tool.

ELIGIBLE PATIENTS

Patients eligible for a Veterans’ Health Assessments are former members of the Permanent Forces or a former member of the Reserves. 

A Veterans’ Health Assessment cannot be claimed more than once by an eligible patient.

ELIGIBLE PRACTITIONERS

A Veterans’ Health Assessment can be undertaken by a general practitioner (see GN.4.13) or a prescribed medical practitioner (see AN.7.1).

Patients must access a Veterans’ Health Assessment through their usual GP or prescribed medical practitioner. In relation to a patient, means a general practitioner, or a prescribed medical practitioner, employed by a medical practice:

• that has provided at least 50% of the primary health care required by the patient in the last 12 months, or
• that the patient anticipates will provide at least 50% of the patient’s primary health care requirements in the next 12 months.

Note: the usual doctor requirements for the Veterans’ Health Assessment are different to those applying to health assessments generally.

Information on the definition of usual GP or prescribed medical practitioner for health assessment items is available in AN.0.36.

CO-CLAIMING RESTRICTIONS

A separate consultation must not be performed in conjunction with a Veterans’ Health Assessment service, unless clinically necessary.

To co-claim a health assessment item and another item, both items must be clinically necessary and distinct services.

RECORD KEEPING AND REPORTING REQUIREMENTS

The Regulations require that the doctor must keep a record of the assessment.

The department undertakes regular post payment auditing to ensure that MBS items are claimed appropriately. Practitioners should ensure they keep adequate and contemporaneous records. For information on what constitutes adequate and contemporaneous records see GN.15.39.

Clause 4.3 of the Health Insurance Act 1973 specifies that, where an item specifies the creation of a document (however described) and a document it created, the document must be retained for the period of 2 years.

RELEVANT LEGISLATION

Details about the legislative requirements of the MBS items can be found on the Federal Register of Legislation at www.legislation.gov.au. Health assessment items are set out in the following regulatory instrument:

• Health Insurance (General Medical Services Table) Regulations 2021.

Related Items: 224 225 226 227 701 703 705 707