Medicare Benefits Schedule - Item 132

Professional attendance by a consultant physician in the practice of the consultant physician's specialty (other than psychiatry) lasting at least 45 minutes for an initial assessment of a patient with at least 2 morbidities (which may include complex congenital, developmental and behavioural disorders) following referral of the patient to the consultant physician by a referring practitioner, if:

(a) an assessment is undertaken that covers:

      (i) a comprehensive history, including psychosocial history and medication review; and

      (ii) comprehensive multi or detailed single organ system assessment; and

      (iii) the formulation of differential diagnoses; and

(b) a consultant physician treatment and management plan of significant complexity is prepared and provided to the referring practitioner, which involves:

      (i) an opinion on diagnosis and risk assessment; and

      (ii) treatment options and decisions; and

      (iii) medication recommendations; and

(c) an attendance on the patient to which item 110, 116, 119, 91824, 91825, 91826, 91836 or 92440 applies did not take place on the same day by the same consultant physician; and

(d) a service to which this item or item 92422 applies has not been provided to the patient by the same consultant physician in the preceding 12 months

 

Fee: $312.45 Benefit: 75% = $234.35 85% = $265.60

(See para AN.0.23, AN.0.24, AN.36.2, AN.40.1 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $500.00

• Previous - Item 131
• Next - Item 133

Patients with at least two morbidities which can include complex congenital, development and behavioural disorders are eligible for these services when referred by their referring practitioner. 

Item 132 should include the development of options for discussion with the patient, and family members, if present, including the exploration of treatment modalities and the development of a comprehensive consultant physician treatment and management plan, with discussion of recommendations for services by other health providers as appropriate. 

Item 133 is available in instances where a review of the consultant physician treatment and management plan provided under item 132 is required, up to a maximum of two claims for this item in a 12 month period. Should further reviews of the consultant physician treatment and management plan be required, the appropriate item for such service/s is 116. 

Where a patient with a GP health assessment or GP Chronic Condition Management Plan (CCMP) (or a GP management Plan or Team Care Arrangement put in place prior to 1 November 2024) is referred to a consultant physician for further assessment, it is intended that the consultant physician treatment and management plan should augment the CCMP for that patient. 

Preparation of the consultant physician treatment and management plan should be in consultation with the patient. If appropriate, a written copy of the consultant physician treatment and management plan should be provided to the patient. A written copy of the consultant physician treatment and management plan should be provided to the referring medical practitioner, usually within two weeks of the consultant physician consultation. In more serious cases, more prompt provision of the plan and verbal communication with the referring medical practitioner may be appropriate. A guide to the content of such consultant physician treatment and management plans which are to be provided under this item is included within this Schedule.

(Note: This information is provided as a guide only and each case should be addressed according to a patient's individual needs.) 

REFERRED PATIENT CONSULTANT PHYSICIAN TREATMENT AND MANAGEMENT PLAN 

- The following content outline is indicative of what would normally be sent back to the referring practitioner.

- The consultant physician treatment and management plan should address the specific questions and issues raised by the referring practitioner. 

History

The consultant physician treatment and management plan should encompass a comprehensive patient history which addresses all aspects of the patient's health, including psychosocial history, past clinically relevant medical history, any relevant pathology results if performed and a review of medication and interactions.  There should be a particular focus on the presenting symptoms and current difficulties, including precipitating and ongoing conditions. The results of relevant assessments by other health professionals, including GPs and/or specialists, including relevant care plans or health assessments performed by GPs under the Enhanced Primary Care and Chronic Condition Management should also be noted. 

Examination

A comprehensive medical examination means a full multi-system or detailed single organ system assessment. The clinically relevant findings of the examination should be recorded in the management plan. 

Diagnosis

This should be based on information obtained from the history and medical examination of the patient. The list of diagnoses and/or problems should form the basis of any actions to be taken as a result of the comprehensive assessment. In some cases, the diagnosis may differ from that stated by the referring practitioner, and an explanation of why the diagnosis differs should be included.  The report should also provide a risk assessment, management options and decisions. 

Management plan

Treatment options/Treatment plan

The consultant physician treatment and management plan should include a planned follow-up of issues and/or conditions, including an outline of the recommended intervention activities and treatment options. Consideration should also be given to recommendations for allied health professional services, where appropriate. 

Medication recommendations

Provide recommendations for immediate management, including the alternatives or options. This should include doses, expected response times, adverse effects and interactions, and a warning of any contra-indicated therapies. 

Social measures

Identify issues which may have triggered or are contributing to the problem in the family, workplace or other social environment which need to be addressed, including suggestions for addressing them. 

Other non medication measures

This may include other options such as life style changes including exercise and diet, any rehabilitation recommendations and discussion of any relevant referrals to other health providers. 

Indications for review

It is anticipated that the majority of patients will be able to be managed effectively by the referring practitioner using the consultant physician treatment and management plan. If there are particular concerns about the indications or possible need for further review, these should be noted in the consultant physician treatment and management plan. 

Longer term management

Provide a longer term consultant physician treatment and management plan, listing alternative measures that might be taken in the future if the clinical situation changes. This might be articulated as anticipated response times, adverse effects and interactions with the consultant physician treatment and management plan options recommended under the consultant physician treatment and management plan. 

Services Australia (SA), in consultation with the Department of Health, Disability and Ageing, has developed an Health Practitioner Guideline to substantiate that a valid referral existed (specialist or consultant physician) which is located on the Department of Health, Disability and Ageing's website.

Related Items: 132 133 92423

Intention of this service under item 135 and video equivalent item 92140

Items 135 or video equivalent item 92140 are intended for complex conditions, characterised by multi-domain cognitive and functional impairment. Patient eligibility is for neurodevelopmental disorders (NDD), which are assessed to be complex and mean that individuals require support across multiple domains.

The intention of this service is to provide access to treatment, through the development of a treatment and management plan by a paediatrician, for individuals diagnosed with a complex NDD. The development of the treatment and management plan follows a comprehensive medical assessment, and provides the opportunity to refer to eligible allied health practitioners for up to a total of 20 MBS treatment services per patient’s lifetime (items 82015, 82020, 82025, 82035, 93035, 93036, 93043 or 93044). This item is claimable once in a patient’s lifetime.

Eligibility:

In the context of item 135 (or 92140), the diagnosis of a complex NDD requires evidence of requiring support and showing impairment across two or more neurodevelopmental domains. Complexity is characterised by multi-domain cognitive and functional disabilities, delay or clinically significant impairment.

Neurodevelopmental domains include:

• Cognition
• Language
• Social-emotional development
• Motor skills
• Adaptive behaviour:  conceptual skills, practical skills, social skills or social communication skills

Age eligibility:

Whilst it is not expected that a paediatrician would routinely assess adult individuals (item 289 provides for assessments undertaken by a psychiatrist for patients aged over 18 years to under 25 years), item 135 provides an age ceiling which is consistent across all MBS items related to complex NDD and related allied health services. Where a paediatrician has been referred a patient (under 18 years of age) and the diagnostic formulation is not completed until after their 18th birthday, the higher age limit will allow the completion of the assessment by the paediatrician (as clinically appropriate).

Referral pathways:

Early identification of, and intervention for, individuals with complex NDD is important in promoting positive longer-term outcomes. Symptoms can cause clinically significant impairment in social, occupational or other important areas of functioning.

Where neurodevelopmental 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 either a consultant paediatrician or psychiatrist for a comprehensive assessment.

Diagnostic Assessment:

The assessment and diagnosis of a complex NDD should be evaluated in the context of both a physical and developmental assessment. The paediatrician may require a number of separate attendances (through usual time-tiered or subsequent attendance items 110, 116, 119, 122, 128, 131 or video items 91824 to 91826) 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 complex NDD, the consultant physician may require a multi-disciplinary approach to complete a comprehensive accurate assessment and formulate a diagnosis. 

Where the paediatrician 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 provider from standard attendance items (110 to 131 or telehealth (video or phone) items equivalent items).

Whilst Medicare benefits 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 professional) by the referring paediatrician, 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, dietitian, exercise physiologist, optometrist, orthoptist, physiotherapist (MBS item 82030, 93033, 93041)

Requirements of the referral to allied health practitioners

The paediatrician 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 four (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 paediatrician undertakes a review. If the type of review is not specified by the referring paediatrician 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 paediatrician.

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 paediatrician. Whilst they do not require the need for an attendance with the patient (face-to-face/video/phone) by the referring paediatrician, they do require an agreement from the referring paediatrician. 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 a paediatrician makes a complex NDD diagnosis, the paediatrician may require the contribution of an eligible allied health practitioner to assist with the development of the Treatment and Management plan (before billing item 135 or 92140).

MBS items 82000, 82005, 82010, 82030, 93032, 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 paediatrician should be mindful of this when referring to eligible allied health practitioners.

Development of the Treatment and Management Plan

Once the paediatrician has made a diagnosis of a complex NDD, to complete the item requirements of item 135 or 92140 they must develop a treatment and management plan which includes:

Written documentation of the patient’s confirmed diagnosis of a complex NDD, 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:
  • the risk to the patient of a contributing co‑morbidity and
  • environmental, physical, social and emotional risk factors that may apply to the patient or to another individual.
• Treatment options which include:
  • Recommendations using a biopsychosocial model
  • Identifying major treatment goals and important milestones and objectives
  • Recommendation/s 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)
  • 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 (under item 135 or 92140) the paediatrician 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, dietitian, exercise physiologist, 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 video or phone items. Whilst the paediatrician can refer to multiple eligible allied health practitioners concurrently, a separate referral letter must be provided to each allied health practitioner.

The referral should specify the goals of the treatment and if appropriate, specify the number of services to be provided. It is the responsibility of the referring paediatrician 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 (135 or 92140) have been processed through the Medicare claiming system.

On the completion of a “course of treatment” (specified by the referring paediatrician, up to maximum of 10 services), the eligible allied health practitioner must provide a written report to the referring paediatrician, which should include information on the treatment provided, recommendations on future management of the individual’s disorder and any advice to caregivers (such as parents, carers, school teachers). This written report will inform the referring paediatrician’s decision to refer for further treatment services. Where subsequent courses of treatment are required after the initial 10 services (up to a maximum of 20 services per patient per lifetime) a new referral is required.

Inconclusive assessment:

Where a patient does not meet the diagnostic threshold of a complex NDD and where ongoing medical management is required, patients can be managed through subsequent attendance items (such as 116 or 91825) or where at least two separate diagnoses are made through item 132 or 92422.

Examples include where:

• Neurodevelopmental assessment is incomplete or inconclusive
• Neurodevelopmental impairment is present in fewer than two domains
• Neurodevelopmental impairment is present in two or more domains, but individuals do not require sufficient support to meet criteria
• Comprehensive, age-appropriate neurodevelopmental assessment is impossible or unavailable (e.g. in infants or young children- particularly those under 6 years of age)

These individuals may be considered “at risk of a complex NDD” and require follow-up and reassessment in the future.

Related Items: 110 111 115 116 117 119 120 122 123 124 128 131 132 135 82000 82005 82010 82015 82020 82025 82030 82035 91824 91825 91826 92140 92422 93032 93033 93035 93036 93040 93041 93043 93044

Eating Disorders Treatment and Management Plans Explanatory Notes (items 90250-90257, 92146-92153, 90260-90261, and 92162-92163)

This note provides information on Eating Disorders Treatment and Management Plan (EDTMP) items and should be read in conjunction with the Eating Disorders General Explanatory Notes

Eating Disorder Treatment and Management Plan (EDTMP) items overview

The EDTMP items define services for which Medicare benefits are payable where practitioners undertake the development of a treatment and management plan for patients with a diagnosis of anorexia nervosa, bulimia nervosa, binge-eating disorder and other specified feeding or eating disorder diagnoses who meet the eligibility criteria.

The EDTMP items trigger eligibility for items which provide delivery of eating disorders psychological treatment services (up to a total of 40 psychological services in a 12-month period) and dietetic services (up to a total of 20 in a 12-month period).

For any particular patient, an eating disorder treatment and management plan expires at the end of a 12-month period following provision of that service. Eating Disorders treatment services are not available to the patient if the EDTMP has expired.

Preparation of the EDTMP must include:

• discussing the patient’s medical and psychological health status with the patient and if appropriate their family/carer;
• identifying and discussing referral and treatment options with the patient and their family/carer where appropriate, including identification of appropriate support services;
• agreeing goals with the patient and their family/carer where appropriate - what should be achieved by the treatment - and any actions the patient will take;
• planning for the provision of appropriate patient and family/carer education;
• a plan for crisis intervention and/or for relapse prevention, if appropriate at this stage;
• making arrangements for required referrals, treatment, appropriate support services, review and follow-up;
• documenting the results of assessment, patient needs, goals and actions, referrals and required treatment/services, and review date in the patient's plan;
• discussing and organising the appropriate reviews throughout the patient’s treatment; and
• discussing the need for the patient to be reviewed to access a higher intensity of eating disorder psychological treatment services in a 12-month period.
   

Preparing a Medical practitioner in general practice Eating Disorder Treatment & Management Plan (items 90250-90257 and 92146-92153)

Who can provide the service

Items in subgroup 1 of Group A36 can be rendered by a medical practitioner in general practice. This includes:

• Medical practitioners who can render a general practitioner service in Group A1 of the MBS (see note AN.0.9 for the types of medical practitioners). These medical practitioners can render a ‘general practitioner’ service for items in subgroup 1 of Group A36.
• Medical practitioners who are not general practitioners, specialists or consultant physicians. These medical practitioners can render a ‘medical practitioner’ service for items in subgroup 1 of Group A36.

What is Involved - Assess and Plan

It is expected that the practitioner developing the EDTMP has either performed or reviewed the assessments and examinations required to make a judgement that the patient meets the eligibility criteria for accessing these items.

Items 90250-90257 and their equivalent telehealth items (92146-92153) provide services for development of the eating disorder treatment and management plan. Where a comprehensive physical examination is performed, either on the same occasion or different occasion, the appropriate item could be claimed provided the time taken performing the assessment is not included in the time for producing the plan, or time producing the EDTMP is not included in the time for assessment.

It is emphasised that it is best practice for the practitioner to perform a comprehensive physical assessment to facilitate ongoing patient management and monitoring of medical and nutritional status.

Patient Assessment

An assessment of a patient with an eating disorders includes:

• taking relevant history (biological, psychological, social, including family/carer support);
• eating disorder diagnostic assessment;
• medical review including physical examination and relevant tests;
• conducting an assessment of mental state, including identification of comorbid psychiatric conditions;
• an assessment of eating disorder behaviours;
• an assessment of associated risk and any medical co-morbidity, including as assessment on how this impacts on the patients functioning and activities of daily living;
• an assessment of family and/or carer support; and
• administering an outcome measurement tool, except where it is considered clinically inappropriate.

Risk assessment for a patient with an eating disorder should include identification of:

• medical instability and risk of hospitalisation;
• level of psychological distress and suicide risk;
• level of malnourishment;
• identification of psychiatric comorbidity;
• level of disability;
• duration of illness;
• response to earlier evidence-based eating disorders treatment;
• level of family/carer support.

It should be noted that the patient's EDTMP should be treated as a living document for updating as required. In particular, the plan can be updated at any time to incorporate relevant information, such as feedback or advice from other health professionals on the diagnosis or treatment of the patient.

Preparing a Consultant Psychiatrist Eating Disorder Treatment & Management Plan (90260-90261 and 92162-92163)

Who can provide the service

Items in subgroup 2 of Group 36 can be rendered by consultant psychiatrists (items 90260 and 90261, and their respective telehealth items 92162 and 92163).

What is Involved – Assess and Plan

Items 90260-90261 and their equivalent telehealth items (92162 and 92163) provide access to specialist assessment and treatment planning. It is expected that items will be a single attendance. However, there may be particular circumstances where a patient has been referred by a GP for an assessment and management plan, but it is not possible for the consultant to determine in the initial consultation whether the patient is suitable for management under such a plan. In these cases, where clinically appropriate, other appropriate consultation items may be used. In those circumstances where the consultant undertakes a consultation (in accordance with the item requirements) prior to the consultation for providing the referring practitioner with an assessment and management plan. It is expected that such occurrences would be unusual for the purpose of diagnosis under item 90260.

Patient Assessment

In order to facilitate ongoing patient focussed management, an assessment of the patient must include:

• administering an outcome measurement tool during the assessment and review stages of treatment, where clinically appropriate. The choice of outcome tool to be used is at the clinical discretion of the practitioner;
• conducting a mental state examination;
• taking relevant history (biological, psychological, behavioural, nutritional, social);
• assessing associated risk and any co-morbidity; and
• making a psychiatric diagnosis for conditions meeting the eligibility criteria.

Risk assessment for a patient with an eating disorder should include identification of:

• medical instability and risk of hospitalisation;
• level of psychological distress and suicide risk;
• level of malnourishment;
• identification of psychiatric comorbidity;
• level of disability;
• duration of illness;
• response to earlier evidence-based eating disorders treatment;
• level of family/carer support.
   

Where a consultant psychiatrist provides an EDTMP service, the service must also include:

• administering an outcome measurement tool, where clinically appropriate. The choice of outcome tool to be used is at the clinical discretion of the practitioner. Practitioners using such tools should be familiar with their appropriate clinical use, and if not, should seek appropriate education and training; and
• conducting a mental state examination.

Consultation with the patient’s managing practitioner

A written copy of the EDTMP should be provided to the patient’s managing practitioner, within a maximum of two weeks of the assessment. It should be noted that two weeks is the outer limit and in more serious cases more prompt provision of the plan and verbal communication with the managing practitioner may be appropriate.

Additional Claiming Information (general conditions and limitations)

Patients seeking benefits for items 90250-90257 and 90260-90261 will not be eligible if the patient has had a claim within the last 12-months.

Items 90250-90257 cannot be claimed with Items 2713, 279, 735, 758, 235 and 244. Items 90261 cannot be claimed with Items 110, 116, 119, 132, 133.

Consultant psychiatrist and paediatrician EDTMP items 90260-90261 do not apply if the patient does not have a referral within the period of validity.

Before proceeding with the EDTMP the medical practitioner must ensure that:

(a) the steps involved in providing the service are explained to the patient and (if appropriate and with the patient's permission) to the patient's carer; and

(b) the patient's agreement to proceed is recorded.

The medical practitioner must offer the patient a copy of the EDTMP and add the document to the patient's records. This should include, subject to the patient's agreement, offering a copy to their carer, where appropriate. The medical practitioner may, with the permission of the patient, provide a copy of the EDTMP, or relevant parts of the plan, to other providers involved in the patient's treatment.

The medical practitioner EDTMP cover the service of developing an EDTMP. A separate consultation item can be performed with the EDTMP if the patient is treated for an unrelated condition to their eating disorder. Where a separate consultation is performed, it should be annotated separately on the patient’s account that a separate consultation was clinically required/indicated.

All consultations conducted as part of the EDTMP must be rendered by the medical practitioner and include a personal attendance with the patient. A specialist mental health nurse, other allied health practitioner, Aboriginal and Torres Strait Islander health practitioner or Aboriginal and Torres Strait Islander health worker with appropriate mental health qualifications and training may provide general assistance to the medical practitioner in provision of this care.

Additional Claiming Information (interaction with Chronic Condition Management and Better Access)

It is preferable that wherever possible patients have only one plan for primary care management of their disorder. As a general principle the creation of multiple plans should be avoided, unless the patient clearly requires an additional plan for the management of a separate medical condition.

The Chronic Condition Management (CCM) items (items 231, 232, 392, 393, 729, 731, 965, 967, 92026, 92027, 92029, 92030, 92057, 92058, 92060 and 92061) continue to be available for patients with chronic medical conditions, including patients with complex needs. 

Where a patient has a separate chronic medical condition, it may be appropriate to manage the patient's medical condition through a CCM Plan, and to manage their eating disorder through an EDTMP. In this case, both items can be used. Where the patient receives dietetic services under the CCM arrangements (item 10954), these services will count towards the patients maximum of 20 dietetic services in a 12-month period. 

Where a patient has other psychiatric comorbidities, these conditions should be managed under the EDTMP. Once a patient has a claim for an EDTMP, the patient should not be able to have a claim for the development or review of a Mental Health Treatment plan by a GP (items 2700, 2701, 2715 and 2717) or medical practitioner in general practice (items 272, 276, 281 and 282) within 12-months of their EDTMP unless there are exceptional circumstances.

For the purpose of the 40 eating disorder psychological treatment count; eating disorder psychological treatment service includes a service provided under the following items: 90271-90278, 92182, 92184, 92186, 92188, 92194, 92196, 92198, 92200, 2721, 2723, 2725, 2727, 283, 285, 286, 287 and items in Groups M6, M7 and M16 (excluding item 82350). 

Related Items: 110 116 119 132 133 231 232 235 244 272 276 281 282 283 285 286 287 392 393 729 731 735 758 965 967 2700 2701 2715 2717 2721 2723 2725 2727 82350 90250 90251 90252 90253 90254 90255 90256 90257 90260 90261 90271 90272 90273 90274 90275 90276 90277 90278 92026 92027 92029 92030 92057 92058 92060 92061 92146 92147 92148 92149 92150 92151 92152 92153 92162 92163 92182 92184 92186 92188 92194 92196 92198 92200

A number of telehealth (video and phone) items are permanently available.

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 by video/videoconference is the preferred substitute for a face-to-face consultation. However, providers can provide a phone consultation via telephone where it is clinically relevant (and the service is covered by a relevant phone 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	Phone items
Specialist Services
Specialist. Initial attendance	104	91822	-
Specialist. Subsequent attendance	105	91823	91833
Gynaecologist Specialist Services
Specialist gynaecologist long consult initial attendance	125	127	-
Specialist gynaecologist long consult subsequent attendance	126	129	-
Consultant Physician Services			-
Consultant physician. Initial attendance	110	91824	-
Consultant physician. Subsequent attendance	116	91825	92440
Consultant physician. Subsequent 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	92443
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	92448
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	92444
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	92441
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	92442
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	92445
Neurosurgeon, subsequent attendance, 30 to 45 minutes	6013	92613	92446
Neurosurgeon, subsequent attendance, more than 45 minutes	6015	92614	92447
Anaesthetist attendance
Anaesthetist, professional attendance, advanced or complex	17615	92701	-
Consultant occupational physician
Consultant occupational physician, initial attendance	385	92748	-
Consultant occupational physician, subsequent attendance	386	92749	92750
Pain medicine services
Pain medicine specialist or consultant, initial attendance	2801	92751	-
Pain medicine specialist or consultant, subsequent attendance	2806	92752	-
Pain medicine specialist or consultant, subsequent minor attendance	2814	92753	92754
Palliative medicine
Palliative medicine specialist or consultant physician, initial attendance	3005	92755	-
Palliative medicine specialist or consultant physician, subsequent attendance	3010	92756	-
Palliative medicine specialist or consultant physician, subsequent minor attendance	3014	92757	92758
Addiction medicine services
Addiction medicine specialist, initial attendance	6018	92759	-
Addiction medicine specialist, subsequent attendance	6019	92760	-
Addiction medicine specialist, subsequent minor attendance	119	-	92761
Addiction medicine specialist, initial attendance, patient with at least 2 morbidities not less than 45 minutes	6023	92762	-
Addiction medicine specialist, subsequent attendance with review of patient with at least 2 morbidities, not less than 20 minutes	6024	92763	-
Sexual health medicine services
Sexual health medicine specialist, initial attendance	6051	92764	-
Sexual health medicine specialist, subsequent attendance	6052	92765	-
Sexual health medicine specialist, subsequent minor attendance	119	-	92766
Sexual health medicine specialist, initial attendance, patient with at least 2 morbidities not less than 45 minutes	6057	92767	-
Sexual health medicine specialist, subsequent attendance with review of patient with at least 2 morbidities, not less than 20 minutes	6058	92768	-

Further information can be found on the MBS Telehealth Services factsheet page on MBS Online.

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 phone items.

Restrictions

All MBS telehealth (video and phone) 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 occupational and environmental health medicine specialists.

Consultant physician video services (91824, 91825 and 91826) and phone services (92440 and 91836) can be billed by all specialities that can currently bill items 110, 116 and 119 or equivalent MBS items. 

Consultant physician video services to prepare and review a management plan (92422 and 92423) and phone services (92443) can be billed by all physicians that can currently bill items 132 and 133 or equivalent MBS items. 

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 phone). 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 (phone) should be billed if the patient sees the specialist remotely for the same condition.

Anaesthetist services

The Anaesthetist video 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 phone 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 phone 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 phone psychiatry items as long as they meet the item descriptor requirements.

The Department of Health, Disability and Ageing 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 phone.

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 (video and phone). It is the responsibility of the practitioner rendering the service to maintain privacy and confidentiality for all participants throughout the service. 

Video attendance means a professional attendance by video conference where the medical practitioner:

1. has the capacity to provide the full service through this means safely and in accordance with relevant professional standards; and
2. is satisfied that it is clinically appropriate to provide the service to the patient; and
3. maintains a visual and audio link with the patient; and
4. 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:

1. has the capacity to provide the full service through this means safely and in accordance with professional standards; and
2. is satisfied that it is clinically appropriate to provide the service to the patient; and
3. maintains an audio link with the patient.

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: 104 105 110 116 119 125 126 127 129 132 133 135 137 141 143 289 291 293 296 300 302 304 306 308 342 344 346 385 386 410 411 412 413 2801 2806 2814 3005 3010 3014 6007 6009 6011 6013 6015 6018 6019 6023 6024 6051 6052 6057 6058 90260 90261 90266 90267 91822 91823 91824 91825 91826 91833 91836 92422 92423 92440 92441 92442 92443 92444 92445 92446 92447 92448 92748 92749 92750 92751 92752 92753 92754 92755 92756 92757 92758 92759 92760 92761 92762 92763 92764 92765 92766 92767 92768