Medicare Benefits Schedule - Item 82216

Professional attendance by a participating nurse practitioner lasting at least 60 minutes and including any of the following:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health related issues, with appropriate documentation

Fee: $134.35 Benefit: 85% = $114.20

(See para MN.14.12, MN.14.15 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $403.05

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Services provided by participating nurse practitioners are covered by five MBS items 82200, 82205, 82210, 82215 and 82216. These also have phone equivalents 91193, 91189, 91190, 91191 and video equivalents 91192, 91178, 91179, 91180 and 91206.

These items provide for:

professional attendance for an obvious problem, straight forward in nature, with limited examination and management required (item 82200) 

professional attendance for a patient lasting no less than 6 minutes and no more than 20 minutes duration (item 82205) 

professional attendance for a patient lasting at least 20 minutes duration (item 82210);

professional attendance for a patient lasting at least 40 minutes duration (item 82215);

professional attendance for a patient lasting at least 60 minutes duration (item 82216).

Related Items: 82200 82205 82210 82215 82216 91178 91180 91189 91190 91191 91192 91193 91206

A participating nurse practitioner will be able to refer private patients to a specialist and consultant physician as clinical services dictate. 

This measure does not include referral by a nurse practitioner for allied or Aboriginal and Torres Strait Islander primary health care worker or practitioner health care. If a participating nurse practitioner refers a patient to an allied health practitioner or an Aboriginal and Torres Strait Islander primary health care worker or practitioner, no benefits would be payable for that service. 

A referral given by a participating nurse practitioner is valid until 12 months after the first service given in accordance with the referral. 

If the referral is lost, stolen or destroyed, the nurse practitioner would need to provide a replacement referral as soon as is practicable after the service is provided. 

A referral to a specialist must be in writing in the form of a letter or a note to the specialist and must be signed and dated by the referring nurse practitioner.  The referral must contain any information relevant to the patient and the specialist must have received the referral on or prior to providing a specialist consultation. 

There are exemptions from this requirement in an emergency if the specialist considers the patient's condition requires immediate attention without a referral.  In that situation, the specialist is taken to be the referring practitioner.

Related Items: 82200 82205 82210 82215 82216 91178 91179 91180 91189 91190 91191 91192 91193 91206