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Category 1 - PROFESSIONAL ATTENDANCES
139 - Additional Information
Professional attendance lasting at least 45 minutes, at a place other than a hospital, by a general practitioner (not including a specialist or consultant physician), for a patient aged under 25, if the general practitioner:
(a) undertakes, or has previously undertaken in prior attendances, a comprehensive assessment in relation to which a diagnosis of an eligible disability is made (if appropriate, using information provided by an eligible allied health provider); and
(b) develops a treatment and management plan, which must include:
(i) documentation of the confirmed diagnosis; and
(ii) findings of any assessments performed for the purposes of formulation of the diagnosis or contribution to the treatment and management plan; and
(iii) a risk assessment; and
(iv) treatment options (which may include biopsychosocial recommendations); and
(c) provides a copy of the treatment and management plan to one or more allied health providers, if appropriate, for the treatment of the patient;
(other than attendance on a patient for whom payment has previously been made under this item or item 135, 137, 289, 92140, 92141, 92142 or 92434)
Applicable only once per lifetime
Fee: $148.05 Benefit: 100% = $148.05
Category 1 - PROFESSIONAL ATTENDANCES
Attendance services for eligible disabilities
Intention and eligibility of this service under item 139 and telehealth equivalent item 92142
Items 139 or telehealth equivalent item 92142 are intended for diagnosis and treatment for patients under 25 years of age with an eligible disability by a general practitioner.
Definition of Eligible Disabilities is found AR.29.1
The intention of this service is to provide access to treatment, through the development of a treatment and management plan by a general practitioner, for individuals under 25 years of age, diagnosed an eligible disability. 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, 82015, 82035, 93035, 93036, 93043 or 93044). This item is claimable once in a patient’s lifetime.
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.
The assessment and diagnosis of an eligible disability should be evaluated in the context of both a physical and developmental assessment. The GP may require a number of separate attendances (through usual time-tiered or subsequent attendance items 3 to 51 or 91790 to 91802) 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 GP may require a multi-disciplinary approach to complete a comprehensive accurate assessment and formulate a diagnosis.
Where the GP 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 (3 to 51 or 91790 to 91802).
Whilst Medicare rebates 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 GP, 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 (82010, 93033, 93041)
- Audiologist, Optometrist, Orthoptist, Physiotherapist (MBS item 82030, 93033, 93041)
Requirements of the referral to Allied Health practitioners
The GP 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, 93040, 93033 or 93041) and considers additional assessment services are required, they must ensure the referring GP undertakes a review. If the type of review is not specified by the GP, 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 GP. Whilst they do not require the need for an attendance with the patient (face-to-face or telehealth) by the referring GP, they do require an agreement from the referring GP. 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 GP makes a diagnosis, the GP may require the contribution of an eligible Allied Health practitioner to assist with the development of the Treatment and Management plan (before billing item 139 or 92142).
MBS items 82000, 82005, 82010, 82030, 93032, 93040, 93033 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 GP should be mindful of this when referring to eligible Allied Health practitioners.
Development of the Treatment and Management Plan
Once the GP has made a diagnosis of an eligible disability, to complete the item requirements of item 139 or 92142 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:
- 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:
- Recommendations using a biopsychosocial model
- Identify major treatment goals and important milestones and objectives
- 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)
- Indications for review or episodes requiring escalation of treatment strategies
- Documenting the Treatment and Management plan and providing a copy to relevant Allied Health practitioner/s.
Referral for Allied Health Treatment services
Once a treatment and management plan is in place (after item 139 or 92142 has been claimed) the GP 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 GP 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, the 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 (139 or 92142) have been processed through the Medicare claiming system.
On the completion of a “course of treatment” (specified by the referring GP, up to maximum of 10 services), the eligible Allied Health practitioner must provide a written report to the referring GP, 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, schoolteachers). This written report will inform the referring GPs 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.
Category 1 - PROFESSIONAL ATTENDANCES
Attendance services for eligible disabilities
Eligibility of this service under 137 or 92141 (specialists and consultant physicians), 139 or 92142 (general practitioners)
'Eligible disabilities' for the purpose of these services means any of the following conditions:
(a) sight impairment that results in vision of less than or equal to 6/18 vision or equivalent field loss in the better eye, with correction;
(b) hearing impairment that results in:
(i) a hearing loss of 40 decibels or greater in the better ear, across 4 frequencies; or
(ii) permanent conductive hearing loss and auditory neuropathy;
(d) cerebral palsy;
(e) Down syndrome;
(f) Fragile X syndrome;
(g) Prader‑Willi syndrome;
(h) Williams syndrome;
(i) Angelman syndrome;
(j) Kabuki syndrome;
(k) Smith‑Magenis syndrome;
(l) CHARGE syndrome;
(m) Cri du Chat syndrome;
(n) Cornelia de Lange syndrome;
(o) microcephaly, if a child has:
(i) a head circumference less than the third percentile for age and sex; and
(ii) a functional level at or below 2 standard deviations below the mean for age on a standard development test or an IQ score of less than 70 on a standardised test of intelligence*;
(p) Rett’s disorder;
(q) Fetal Alcohol Spectrum Disorder (FASD);
(r) Lesch‑Nyhan syndrome;
(s) 22q deletion syndrome.
*"standard developmental test" refers to tests such as the Bayley Scales of Infant Development or the Griffiths Mental Development Scales; "standardised test of intelligence" means the Wechsler Intelligence Scale for Children (WISC) or the Wechsler Preschool and Primary Scale of Intelligence (WPPSI). It is up to the clinical judgement of the diagnosing practitioner to determine which tests are appropriate to be used.
- 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