Medicare Benefits Schedule - Item 10997

Service provided to a person with a chronic disease by a practice nurse or an Aboriginal and Torres Strait Islander health practitioner if:

(a) the service is provided on behalf of and under the supervision of a medical practitioner; and

(b) the person is not an admitted patient of a hospital; and

(c) the person has a GP Management Plan, Team Care Arrangements or Multidisciplinary Care Plan in place; and

(d) the service is consistent with the GP Management Plan, Team Care Arrangements or Multidisciplinary Care Plan

to a maximum of 5 services per patient in a calendar year

Fee: $13.20 Benefit: 100% = $13.20

(See para MN.12.4 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $39.60

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Item 10997 may be claimed by a medical practitioner, where a monitoring and support service for a person with a chronic disease care plan is provided by a practice nurse or Aboriginal and Torres Strait Islander health practitioner on behalf of that medical practitioner. 

All GPs whether vocationally registered or not are eligible to claim this item.  The term 'GP' is used in these notes as a generic reference to medical practitioners able to claim this item.

Item 10997 does not apply for services that are provided by any other Commonwealth or State funded services.  However, where an exemption under subsection 19(2) of the Health Insurance Act 1973 has been granted to an Aboriginal Community Controlled Health Service or State/Territory Government health clinic, item 10997 can be claimed for services provided by practice nurses or Aboriginal and Torres Strait Islander health practitioners salaried by or contracted to, the Service or health clinic.  All requirements of the item must be met.

Item 10997 will assist patients who require access to ongoing care, routine treatment and ongoing monitoring and support between the more structured reviews of the care plan by the patient's usual GP.

Item 10997 may be used to provide:

• checks on clinical progress;

• monitoring medication compliance;

• self management advice, and;

• collection of information to support GP/medical practitioner reviews of  Care Plans.

The services provided by the practice nurse or Aboriginal and Torres Strait Islander health practitioner should be consistent with the scope of the GP Management Plan, Team Care Arrangements, or Multidisciplinary Care Plan.

Item 10997 may be claimed up to a maximum of 5 times per patient per calendar year.

Item 10997 may only be accessed by a patient with a GP Management Plan, Team Care Arrangements or Multidisciplinary Care Plan (GP items 721, 723, 729, 731, 732 or medical practitioner items 229, 230, 231, 232, 233).

Patients whose condition is unstable/deteriorating should be referred to their GP or medical practitioner for further treatment.

A practice nurse means a registered or enrolled nurse or Nurse Practitioner who is employed by, or whose services are otherwise retained by a general practice.

An Aboriginal and Torres Strait Islander health practitioner means a person who has been registered as an Aboriginal and Torres Strait Islander health practitioner by the Aboriginal and Torres Strait Islander Health Practice Board of Australia and meets the Board's registration standards. The Aboriginal and Torres Strait Islander health practitioner must be employed or retained by a general practice, or by a health service that has an exemption to claim Medicare benefits under subsection 19(2) of the Health Insurance Act 1973.

An Aboriginal and Torres Strait Islander health practitioner may use any of the titles authorised by the Aboriginal and Torres Strait Islander Health Practice Board: Aboriginal health practitioner; Aboriginal and Torres Strait Islander health practitioner; or Torres Strait Islander health practitioner.

In all cases, the GP or medical practitioner under whose supervision the chronic disease monitoring and support is being provided retains responsibility for the health, safety and clinical outcomes of the patient.  The GP or medical practitioner must be satisfied that the practice nurse is appropriately qualified and trained to provide chronic disease support and monitoring.  GPs and medical practitioners are advised to consult their insurer concerning indemnity coverage for services performed on their behalf.

General practices where nurses or Aboriginal and Torres Strait Islander health practitioner provide chronic disease support and monitoring, should also have a written clinical risk management strategy covering issues like clinical roles, patient follow up and patient consent.

Continuing professional development is recommended for all nurses and Aboriginal and Torres Strait Islander health practitioners providing chronic disease monitoring and support.

Supervision by the GP or medical practitioner at a distance is recognised as an acceptable form of supervision. This means that the claiming GP or medical practitioner does not have to be physically present at the time the service is provided. However, the GP/medical practitioner should be able to be contacted if required.

Where the GP/medical practitioner and the practice nurse/ Aboriginal and Torres Strait Islander health practitioner are at the same location, the GP/medical practitioner is not required to be present while the chronic disease monitoring and support is undertaken. It is up to the GP/medical practitioner to decide whether they need to see the patient.  Where the GP/medical practitioner has a consultation with the patient, then the GP/medical practitioner is entitled to claim a Medicare item for the time and complexity of their personal attendance on the patient.  The time the patient spends receiving a service from the practice nurse or Aboriginal and Torres Strait Islander health practitioner is itemised separately under item 10997 and should not be counted as part of the Medicare item claimed for time spent with the GP/medical practitioner.  Where the practice nurse or Aboriginal and Torres Strait Islander health practitioner provides another service (eg immunisation) on the same day, the GP/medical practitioner is able to claim for both practice nurse/ Aboriginal and Torres Strait Islander health practitioner items.

Item 10990 or 10991 (bulk billing incentives) can be claimed in conjunction with item 10997 provided the conditions of item 10990 or 10991 are satisfied (see explanatory note M.1).

Related Items: 10997