View Associated Notes
Category 1 - PROFESSIONAL ATTENDANCES
110 - Additional Information
Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of the consultant physician's specialty (other than psychiatry) following referral of the patient to the consultant physician by a referring practitioner-initial attendance in a single course of treatment
Fee: $174.50 Benefit: 75% = $130.90 85% = $148.35
(See para AN.0.7, AN.0.25, AN.40.1 of explanatory notes to this Category)
Associated Notes
Category 1 - PROFESSIONAL ATTENDANCES
AN.0.7
Multiple Attendances on the Same Day
Payment of benefit may be made for each of several attendances on a patient on the same day by the same medical practitioner provided the subsequent attendances are not a continuation of the initial or earlier attendances. However, there should be a reasonable lapse of time between such attendances before they can be regarded as separate attendances.
Where two or more attendances are made on the one day by the same medical practitioner the time of each attendance should be stated on the account (eg 10.30 am and 3.15 pm) in order to assist in the assessment of benefits.
In some circumstances a subsequent attendance on the same day constitutes a continuation of an earlier attendance. For example, a preliminary eye examination may be concluded with the instillation of a mydriatic and then some time later an eye refraction is undertaken. These sessions are regarded as being one attendance for benefit purposes. Further examples of single attendances are skin sensitivity testing, and when a patient is issued a prescription for a vaccine and subsequently returns to the surgery for the injection.
Related Items: 104 105 110 116 119 132 133 91822 91823 91824 91825 91826 91833 91836 92422 92423
Category 1 - PROFESSIONAL ATTENDANCES
AN.0.25
Attendance services for eligible disabilities
Intention and eligibility of this service under item 137 and telehealth equivalent item 92141
Items 137 or telehealth equivalent item 92141 are intended for diagnosis and treatment for patients under 25 years of age with an eligible disability by a specialist or consultant physician.
Definition of Eligible Disabilities is found at AR.29.1.
Referral pathways:
Early identification of, and intervention for, individuals with eligible disabilities is important in promoting positive longer-term outcomes. Symptoms can cause clinically significant impairment in social, occupational or other important areas of functioning.
Where indications of eligible disability concerns have been identified and brought to the attention of the patient’s GP to initially assess these concerns and the GP considers there are persisting indications that require more specialised assessment, they are encouraged to refer to a specialist or consultant physician for a comprehensive assessment.
Diagnostic Assessment:
The assessment and diagnosis of an eligible disability should be evaluated in the context of both a physical and developmental assessment. The specialist or consultant physician may require a number of separate attendances (through usual time-tiered or subsequent attendance items 104, 105, 107, 108, 110, 116, 119, 122, 128, 131, 296, 297, 299, 300, 302, 304, 306, 308, 310, 312, 314, 316, 318, 319, 320, 324, 326, 328, 330, 332, 334, 336, 338, 341, 342, 343, 344, 345, 346, 347 or 349 or telehealth items 91822 to 91831, 91833, 91836 to 91839, 91868 to 91878 to 91882 to 91884, 92437 or 92455 to 92460) to complete a comprehensive accurate assessment and formulate a diagnosis, exclude other disorders or assess for co-occurring conditions.
Multi-disciplinary assistance with assessment and/or contribution to the treatment and management plan:
Depending on a range of factors, not limited to the patient’s age and nature of suspected disabilities, the specialist or consultant physician may require a multi-disciplinary approach to complete a comprehensive accurate assessment and formulate a diagnosis.
Where the specialist or consultant physician determines the patient requires additional assessments to formulate a diagnosis, through the assistance of an Allied Health practitioner, they are able to refer the patient to an eligible Allied Health practitioner from standard attendance items 104, 105, 107, 108, 110, 116, 119, 122, 128, 131, 296, 297, 299, 300, 302, 304, 306, 308, 310, 312, 314, 316, 318, 319, 320, 324, 326, 328, 330, 332, 334, 336, 338, 341, 342, 343, 344, 345, 346, 347 or 349 or telehealth items 91822 to 91831, 91833, 91836 to 91839, 91868 to 91878 to 91882 to 91884, 92437 or 92455 to 92460.
Whilst MBS items provide for a total of 8 Allied Health assessment services per patient per lifetime, an eligible Allied Health practitioner can only provide up to 4 services before the need for a review (the type of review can be specified in the referral to the eligible Allied Health practitioner) by the referring specialist or consultant physician, who must agree to the need for any additional Allied Health services prior to the delivery of the remaining 4 Allied Health assessment services.
Eligible Allied Health assessment practitioners include:
- Psychologist (MBS item 82000, 93032, 93040)
- Speech Pathologist (MBS item 82005, 93033, 93041)
- Occupational Therapist (MBS item 82010, 93033, 93041)
- Audiologist, Optometrist, Orthoptist, Physiotherapist (MBS item 82030, 93033, 93041)
Requirements of the referral to Allied Health practitioners
The specialist or consultant physician can refer to multiple eligible Allied Health practitioners concurrently, but a separate referral letter must be provided to each Allied Health practitioner. The referral should specify the intent of the assessment and if appropriate, specify the number of services to be provided. Where the number of sessions is not specified, each Allied Health practitioner can provide up to 4 assessment services without the need for review or agreement to provide further assessment services.
Review requirements following delivery of 4 Allied Health assessment services
Where an eligible Allied Health practitioner has provided 4 assessment services (through items 82000, 82005, 82010, 82030, 93032, 93033, 93040 or 93041) and considers additional assessment services are required, they must ensure the referring specialist or consultant physician undertakes a review. If the type of review is not specified by the referring specialist or consultant physician an acceptable means of review includes: a case conference, phone call, written correspondence, secure online messaging exchange or attendance of the patient with the referring psychiatrist.
Inter-disciplinary Allied Health referral
Eligible Allied Health practitioners are also able to make inter-disciplinary referrals to other eligible Allied Health practitioners as clinically necessary to assist with the formulation of the diagnosis or contribute to the treatment and management plan. Inter-disciplinary referrals must be undertaken in consultation and agreement with the referring specialist or consultant physician. Whilst they do not require the need for an attendance with the patient (face-to-face or telehealth) by the referring specialist or consultant physician, they do require an agreement from the referring specialist or consultant physician. This can be undertaken (but is not limited to) an exchange by phone, written communication or secure online messaging.
Contribution to the treatment and management plan through Allied Health referral
In addition to referring to Allied Health practitioners for assistance with formulating a diagnosis, once the specialist or consultant physician makes a diagnosis, the specialist or consultant physician may require the contribution of an eligible Allied Health practitioner to assist with the development of the treatment and management plan (before billing item 137 or 92141).
MBS items 82000, 82005, 82010, 82030, 93032[BJ1] , 93033, 93040 or 93041 provide a dual function for this purpose. It is important to note that the service limit of a total of 8 services per patient per lifetime apply regardless of whether the items are used for assistance with diagnosis or contribution to the treatment and management plan, and the referring specialist or consultant physician should be mindful of this when referring to eligible Allied Health practitioners.
Development of the treatment and management plan
Once the specialist or consultant physician has made a diagnosis of an eligible disability, to complete the item requirements of item 137 or 92141 they must develop a treatment and management plan which includes:
- Written documentation of the patient’s confirmed diagnosis of an eligible disability, including any findings of assessments performed (which assisted with the formulation of the diagnosis or contributed to the treatment and management plan)
- A risk assessment which means assessment of:
o the risk to the patient of a contributing co‑morbidity and
o environmental, physical, social and emotional risk factors that may apply to the patient or to another individual.
- Treatment options which:
o Recommendations using a biopsychosocial model
o Identify major treatment goals and important milestones and objectives
o Recommendation and referral for treatment services provided by eligible Allied Health practitioners (where relevant) and who should provide this, specifying number of treatments recommended (to a maximum of 20 treatment services)
o Indications for review or episodes requiring escalation of treatment strategies
- Documenting the treatment and management plan and providing a copy to the referring medical practitioner and relevant Allied Health practitioner/s.
Referral for Allied Health treatment services
Once a treatment and management plan is in place (after item 137 or 92141 has been claimed) the specialist or consultant physician can refer the individual to eligible Allied Health practitioners for the provision of treatment services. Treatment services address the functional impairments identified through the comprehensive medical assessment which are outlined in the treatment and management plan. Treatment services focus on interventions to address developmental delays/disabilities or impairments.
Eligible Allied Health treatment practitioners include:
- Psychologist (MBS items 82015, 93035, 93043)
- Speech Pathologist (MBS items 82020, 93036, 93044)
- Occupational Therapist (MBS items 82025, 93036, 93044)
- Audiologist, Optometrist, Orthoptist, Physiotherapist (MBS items 82035, 93036, 93044)
A total of 20 Allied Health treatment services per patient per lifetime are available through the MBS, which may consist of any combination of items 82015, 82020, 82025 or 82035 or equivalent telehealth items. Whilst the specialist or consultant physician can refer to multiple eligible Allied Health practitioners concurrently, a separate referral letter must be provided to each Allied Health practitioner.
The referral must specify the goals of the treatment and if appropriate, specify the number of services to be provided. It is the responsibility of the referring psychiatrist to allocate the number of treatment services (up to a maximum of 10 services per course of treatment) in keeping with the individual’s treatment and management plan.
It is important to note, that a benefit will not be paid for the MBS Allied Health treatment services unless the pre-requisite items (137 or 92141) have been processed through the Medicare claiming system.
On the completion of a “course of treatment” (specified by the referring specialist or consultant physician, up to maximum of 10 services), the eligible Allied Health practitioner must provide a written report to the referring specialist or consultant physician, which must include information on the treatment provided, recommendations for future management of the individual’s disorder and any advice to caregivers (such as parents, carers, schoolteachers). This written report will inform the referring specialist or consultant physician’s decision to refer for further treatment services. Where subsequent courses of treatment after the initial 10 services are required (up to a maximum of 20 services per patient per lifetime) a new referral is required.
Related Items: 104 105 107 108 110 116 119 122 128 131 137 296 297 299 300 302 304 306 308 310 312 314 316 318 319 320 324 326 328 330 332 334 336 338 342 344 346 82000 82005 82010 82015 82020 82025 82030 82035 91822 91831 91833 91836 91839 92141 92437 92455 93032 93033 93035 93036 93040 93041 93043 93044
Category 1 - PROFESSIONAL ATTENDANCES
AN.40.1
Specialist and Consultant Physician MBS Telehealth and Telephone attendance items
From 1 January 2022, a number of telehealth items were permanently added to the MBS.
The intent of these ongoing telehealth items is to allow practitioners to provide MBS attendances remotely (by videoconference or telephone) where it is safe and clinically appropriate to do so in accordance with relevant professional standards.
Providing telehealth services by videoconference is the preferred substitution for a face-to-face consultation. However, providers can provide a consultation via telephone where it is clinically relevant (and the service is covered by a relevant telephone item).
A list of the ongoing telehealth items and the equivalent face‑to‑face items can be found at Table 1.
Table 1 – Ongoing telehealth items and equivalent face to face services (out of hospital patients)
Service | Face-to-face items |
Video items | Telephone items |
Specialist Services | |||
Specialist. Initial attendance | 104 | 91822 | - |
Specialist. Subsequent attendance | 105 | 91823 | 91833 |
Consultant Physician Services | - | ||
Consultant physician. Initial attendance | 110 | 91824 | - |
Consultant physician. Subsequent attendance | 116 | 91825 | - |
Consultant physician. Minor attendance | 119 | 91826 | 91836 |
Consultant physician. Initial assessment, patient with at least 2 morbidities, prepare a treatment and management plan, at least 45 minutes | 132 | 92422 | - |
Consultant physician, Subsequent assessment, patient with at least 2 morbidities, review a treatment and management plan, at least 20 minutes | 133 | 92423 | - |
Specialist and Consultant Physician Services | |||
Specialist or consultant physician, develop a treatment and management plan, patient aged under 25, with an eligible disability | 137 | 92141 | - |
Geriatrician Services | |||
Geriatrician, prepare an assessment and management plan, patient at least 65 years, more than 60 minutes | 141 | 92623 | - |
Geriatrician, review a management plan, more than 30 minutes | 143 | 92624 |
- |
Consultant Psychiatrist services | |||
Consultant psychiatrist, develop a treatment and management plan, patient aged under 25, with a complex neurodevelopmental disorder (such as autism spectrum disorder), at least 45 minutes | 289 | 92434 | - |
Consultant psychiatrist, prepare a management plan, more than 45 minutes | 291 | 92435 | - |
Consultant psychiatrist, review management plan, 30 to 45 minutes | 293 | 92436 | - |
Consultant psychiatrist, attendance, new patient (or has not received attendance in preceding 24 mths), more than 45 minutes | 296 | 92437 | - |
Consultant psychiatrist. Consultation, not more than 15 minutes | 300 | 91827 | 91837 |
Consultant psychiatrist. Consultation, 15 to 30 minutes | 302 | 91828 | 91838 |
Consultant psychiatrist. Consultation, 30 to 45 minutes | 304 | 91829 | 91839 |
Consultant psychiatrist. Consultation, 45 to 75 minutes | 306 | 91830 | - |
Consultant psychiatrist. Consultation, more than 75 minutes | 308 | 91831 | - |
Consultant psychiatrist, group psychotherapy, at least 1 hour, involving group of 2 to 9 unrelated patients or a family group of more than 3 patients, each referred to consultant psychiatrist |
342 | 92455 | - |
Consultant psychiatrist, group psychotherapy, at least 1 hour, involving family group of 3 patients, each referred to consultant psychiatrist |
344 | 92456 | - |
Consultant psychiatrist, group psychotherapy, at least 1 hour, involving family group of 2 patients, each referred to consultant psychiatrist |
346 | 92457 | |
Consultant psychiatrist, interview of a person other than patient, in the course of initial diagnostic evaluation of patient, 20 to 45 minutes | 348 | 92458 | - |
Consultant psychiatrist, interview of a person other than patient, in the course of initial diagnostic evaluation of patient, 45 minutes or more | 350 | 92459 | - |
Consultant psychiatrist, interview of a person other than patient, in the course of continuing management of patient, not less than 20 minutes, not exceeding 4 attendances per calendar year | 352 | 92460 | - |
Consultant psychiatrist, prepare an eating disorder treatment and management plan, more than 45 minutes | 90260 | 92162 | |
Consultant psychiatrist, to review an eating disorder plan, more than 30 minutes | 90266 | 92172 | |
Paediatrician Services (also refer to consultant physician services) | |||
Paediatrician, develop a treatment and management plan, patient aged under 25, with a complex neurodevelopmental disorder (such as autism spectrum disorder), at least 45 minutes | 135 | 92140 | |
Paediatrician, prepare an eating disorder treatment and management plan, more than 45 minutes | 90261 | 92163 | |
Paediatrician, to review an eating disorder plan, more than 20 minutes | 90267 | 92173 | |
Public Health Physician Services | |||
Public health physician, level A attendance | 410 | 92513 | 92521 |
Public health physician, level B attendance, less than 20 minutes | 411 | 92514 | 92522 |
Public health physician, level C attendance, at least 20 minutes | 412 | 92515 | - |
Public health physician, level D attendance, at least 40 minutes | 413 | 92516 | - |
Neurosurgery attendances | |||
Neurosurgeon, initial attendance | 6007 | 92610 | - |
Neurosurgeon, minor attendance | 6009 | 92611 | 92618 |
Neurosurgeon, subsequent attendance, 15 to 30 minutes | 6011 | 92612 | - |
Neurosurgeon, subsequent attendance, 30 to 45 minutes | 6013 | 92613 | - |
Neurosurgeon, subsequent attendance, more than 45 minutes | 6015 | 92614 | - |
Anaesthetist attendance | |||
Anaesthetist, professional attendance, advanced or complex | 17615 | 92701 | - |
Further information on the telehealth changes can be found at www.mbsonline.gov.au by searching under the Facts Sheets tab – July 2022.
Eligible providers
All MBS items for referred attendances require a valid referral. However, if the specialist, consultant physician, consultant psychiatrist, paediatrician or geriatrician has previously seen the patient under a referral that is still valid, there is no need to obtain a specific referral for the purposes of claiming the video and telephone items.
Restrictions
All MBS telehealth and telephone attendance items are stand-alone items and are to be billed instead of a face‑to-face MBS item.
Billing Requirements
Bulk billing of specialist (and Allied Health) telehealth services is at the discretion of the provider, so long as informed financial consent is obtained prior to the provision of the service.
Further information on the assignment of benefit for bulk billed MBS telehealth services can be found in the ‘Provider Frequently Asked Questions’ at www.mbsonline.gov.au.
Relevant definitions and requirements
Specialist telehealth services (91822, 91823 and 91833) can be billed by all specialities that can currently bill items 104 and 105 or equivalent MBS items. This also includes sports and exercise medicine and occupational and environmental health medicine specialists.
Consultant physician telehealth services (91824, 91825, 91826 and 91836) can be billed by all specialities that can currently bill items 110, 116 and 119 or equivalent MBS items. This also includes pain and palliative medicine, sexual health medicine and addiction medicine.
Consultant physician telehealth services to prepare and review a management plan (92422 and 92423) can be billed by all physicians that can currently bill items 132 and 133 or equivalent MBS items. This also includes sexual health medicine, addiction medicine and paediatricians.
The specialist and consultant physician service for diagnosis and treatment for patients with an eligible disability (92141) can be billed by specialists and consultant physicians that are able to item 137.
Single course of treatment
The same conditions for a single course of treatment apply across all modalities (i.e. face‑to-face, video or telephone). Once an initial consultation is billed, all subsequent services related to the same condition are considered to be part of a single course of treatment. For example, if a patient has seen a specialist in a face‑to‑face consultation (where item 104 has been billed), item 91823 (video) or 91833 (telephone) should be billed if the patient sees the specialist remotely for the same condition.
Anaesthetist services
The Anaesthetist telehealth service (92701) can be billed by practitioners that can currently bill item 17615.
Service limits
At present, the service limits that apply to standard psychiatry services do not currently apply to the video and telephone attendance items for psychiatry (except for item 92460). Patients who have received more than 50 attendances under existing items are eligible to receive services under the video and telephone psychiatry items as long as they meet the item descriptor requirements.
In addition, patients who have received more than 50 attendances under item 319 are eligible to receive services under the video and telephone psychiatry items as long as they meet the item descriptor requirements.
The Department of Health and Aged Care will work with the Royal Australian and New Zealand College of Psychiatrists (RANZCP) and the Medicare Review Advisory Committee (MRAC) to review the current service limits, and ensure a consistent approach across all of the psychiatry attendance items, including services provided by face‑to‑face, video and telephone.
Interview item (92460)
Item 92460 provides for an interview with a person other than the patient. A maximum of 4 services in a calendar year can be billed under item 92460, or the equivalent face‑to‑face item (item 352), in the continuing management of a patient. That is, a consultant psychiatrist can bill for a service under item 92460 once more in the calendar year if a patient has received three MBS services under items 352 or 92460 in the same calendar year.
Management Plan items (92435 and 92436)
The MBS remote attendance preparation and review of GP management plan items have the same diagnosis, assessment and record-keeping requirements as the existing face-to-face items (291 and 293). Refer to MBS Explanatory Note AN.0.30 for further information.
Group psychotherapy items (92455, 92456 and 92457)
The MBS remote attendance group psychotherapy items have the same requirements as the existing face-to-face items (342, 344 and 346). It is the responsibility of the practitioner rendering the service to maintain privacy and confidentiality for all participants throughout the service. Practitioners should refer to the relevant professional practice standards and guidelines for technology-based consultations.
Technical Requirements
The services can be provided by telehealth and by phone. It is the responsibility of the practitioner rendering the service to maintain privacy and confidentiality for all participants throughout the service.
Telehealth attendance means a professional attendance by video conference where the medical practitioner:
- has the capacity to provide the full service through this means safely and in accordance with relevant professional standards; and
- is satisfied that it is clinically appropriate to provide the service to the patient; and
- maintains a visual and audio link with the patient; and
- is satisfied that the software and hardware used to deliver the service meets the applicable laws for security and privacy.
Note – only the time where a visual and audio link is maintained between the patient and the provider can be counted in meeting the relevant item descriptor.
No specific equipment is required to provide Medicare-compliant telehealth services. Practitioners must ensure that their chosen telecommunications solution meets their clinical requirements and satisfies privacy laws. Information on how to select a web conferencing solution is available at: www.cyber.gov.au
Phone attendance means a professional attendance by telephone where the health practitioner:
- has the capacity to provide the full service through this means safely and in accordance with professional standards; and
- is satisfied that it is clinically appropriate to provide the service to the patient; and
- maintains an audio link with the patient.
There are no longer geographic restrictions on the MBS video or telephone services provided by specialists, consultant physicians, consultant psychiatrists, paediatricians, geriatricians and anaesthetists.
Recording Clinical Notes (for specialist, consultant physician, consultant psychiatrist, neurosurgery, public health medicine, geriatrician, paediatrician and anaesthetist)
In relation to the time taken in recording appropriate details of the service, only clinical details recorded at the time of the attendance count towards the time of consultation. It does not include information added later, such as reports of investigations, or when either the visual or audio link between the patient and the practitioner is lost.
Clinicians should record the date, time and duration of the consultation, and retain these records.
Related Items: 104 105 110 116 119 132 133 135 137 141 143 289 291 293 296 300 302 304 306 308 342 344 346 410 411 412 413 6007 6009 6011 6013 6015 90260 90261 90266 90267 91822 91823 91824 91825 91826 91833 91836 92422 92423
Legend
- Assist - Addition/Deletion of (Assist.)
- Amend - Amended Description
- Anaes - Anaesthetic Values Amended
- Emsn - EMSN Change
- Fee - Fee Amended
- Renum - Item Number Change (renumbered)
- New - New Item
- NewMin - New Item (previous Ministerial Determination)
- Qfe - QFE Change