Medicare Benefits Schedule - Note MN.0.1

It is a legislative requirement that nurse practitioner (using items from Group M18 Subgroup 5, 10) must only perform a telehealth service when they are the patient’s eligible telehealth practitioner.  

An eligible telehealth practitioner is defined as

• the nurse practitioner who performs the service has provided a face-to-face service to the patient in the last 12 months; or
• the nurse practitioner is located at a practice where the patient has received at least one MBS billed face-to-face service arranged by that practice in the 12 months preceding the telehealth attendances (including services performed by another medical or nurse practitioner located at the practice, an Approved Medical Deputising Service provider deputised by that practice, or by another health professional located at the practice, such as a practice nurse or Aboriginal and Torres Strait Islander health practitioner or Aboriginal and Torres Strait Islander health worker performing an on behalf of service for a medical practitioner);or
• there are exemptions to the eligible telehealth practitioner requirement.

The eligible telehealth practitioner requirement does not apply to:

• a person who is under the age of 12 months,
• a person who is experiencing homelessness,
• a person receiving treatment through Blood Borne Virus, Sexual or Reproductive Health telehealth,
• a person living in a natural disaster affected area,
• a person who receives the service from a nurse practitioner located at an Aboriginal Medical Service or an Aboriginal Community Controlled Health Service, or
• a person isolating because of a COVID-related State or Territory public health order, or in COVID-19 quarantine because of a State or Territory public health order.

A person who is experiencing homelessness means when a person does not have suitable accommodation alternatives, they are considered homeless if their current living arrangement:

(a)  is in a dwelling that is inadequate; or

(b)  has no tenure, or if their initial tenure is short and not extendable; or

(c)  does not allow them to have control of, and access to space for social relations.

A person receiving treatment through Blood Borne Virus, Sexual or Reproductive Health telehealth items means services must meet the general medically accepted interpretation as what is defined as these services. Note artificial reproductive technology and antenatal services cannot be claimed under this exemption.

A person living in a natural disaster affected area is defined as a State or Territory local government area which is currently declared as a natural disaster area by a State or Territory Government until that declaration is deemed to have expired.

It is a legislated requirement that providers document in patient clinical notes the exemption and the clinical reasoning.

A patient’s participation in a previous video or phone consultation does not constitute a face-to-face service for the purposes of ongoing telehealth eligibility.

Related Items: 91178 91179 91180 91189 91190 91191 91192 91193 91206

• Next - Note MN.1.1

Phone attendance by a participating nurse practitioner lasting at least 6 minutes and less than 20 minutes if the attendance includes any of the following that are clinically relevant:

(a)     taking a short history;

(b)    arranging any necessary investigation;

(c)     implementing a management plan;

(d)    providing appropriate preventive health care

Fee: $31.80 Benefit: 85% = $27.05

(See para MN.0.1, MN.14.12, MN.14.15, MN.14.16 of explanatory notes to this Category)

Phone attendance by a participating nurse practitioner lasting at least 20 minutes if the attendance includes any of the following that are clinically relevant:

(a)     taking a detailed history;

(b)    arranging any necessary investigation;

(c)     implementing a management plan;

(d)    providing appropriate preventive health care.

Fee: $60.25 Benefit: 85% = $51.25

(See para MN.0.1, MN.14.12, MN.14.15, MN.14.16 of explanatory notes to this Category)

Phone attendance by a participating nurse practitioner lasting at least 40 minutes if the attendance includes any of the following that are clinically relevant:

(a)     taking an extensive history;

(b)    arranging any necessary investigation;

(c)     implementing a management plan;

(d)    providing appropriate preventive health care.

Fee: $88.90 Benefit: 85% = $75.60

(See para MN.0.1, MN.14.12, MN.14.15, MN.14.16 of explanatory notes to this Category)

Phone attendance by a participating nurse practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited management.

Fee: $14.55 Benefit: 85% = $12.40

(See para MN.0.1, MN.14.12, MN.14.15, MN.14.16 of explanatory notes to this Category)

Video attendance by a participating nurse practitioner lasting at least 6 minutes and less than 20 minutes if  the attendance includes any of the following that are clinically relevant:

(a) taking a short history;

(b) arranging any necessary investigation;

(c) implementing a management plan;

(d) providing appropriate preventive health care

Fee: $31.80 Benefit: 85% = $27.05

(See para AN.1.1, MN.0.1, MN.14.12, MN.14.15, MN.14.16 of explanatory notes to this Category)

Video attendance by a participating nurse practitioner lasting at least 20 minutes if the attendance includes any of the following that are clinically relevant:

(a)     taking a detailed history;

(b)     arranging any necessary investigation;

(c)     implementing a management plan;

(d)     providing appropriate preventive health care

Fee: $60.25 Benefit: 85% = $51.25

(See para AN.1.1, MN.0.1, MN.14.15 of explanatory notes to this Category)

Video attendance by a participating nurse practitioner lasting at least 40 minutes if  the attendance includes any of the following that are clinically relevant:

(a)     taking an extensive history;

(b)    arranging any necessary investigation;

(c)     implementing a management plan;

(d)    providing appropriate preventive health care

Fee: $88.90 Benefit: 85% = $75.60

(See para AN.1.1, MN.0.1, MN.14.12, MN.14.15, MN.14.16 of explanatory notes to this Category)

Video attendance by a participating nurse practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited management

Fee: $14.55 Benefit: 85% = $12.40

(See para MN.0.1, MN.14.12, MN.14.15, MN.14.16 of explanatory notes to this Category)

Video attendance by a participating nurse practitioner lasting at least 60 minutes and including any of the following that are clinically relevant:

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