Medicare Benefits Schedule - Item 177

Search Results for Item 177

View Associated Notes

Category 1 - PROFESSIONAL ATTENDANCES

177

177 - Additional Information

Item Start Date:
01-Apr-2019
Description Updated:
01-Jul-2024
Schedule Fee Updated:
01-Jul-2024

Group
A7 - Acupuncture and Non-Specialist Practitioner Items
Subgroup
5 - Prescribed medical practitioner health assessments

Professional attendance on a patient who is 30 years of age or over for a heart health assessment by a prescribed medical practitioner at consulting rooms lasting at least 20 minutes and including:

(a) collection of relevant information, including taking a patient history; and

(b) a basic physical examination, which must include recording blood pressure and cholesterol; and

(c) initiating interventions and referrals as indicated; and

(d) implementing a management plan; and

(e) providing the patient with preventative health care advice and information.

Fee: $66.35 Benefit: 100% = $66.35

(See para AN.14.2 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $199.05


Associated Notes

Category 1 - PROFESSIONAL ATTENDANCES

AN.14.2

Heart health assessment provided by general practitioners and prescribed medical practitioners

Item 699 and 177 may be used to undertake a heart health assessment, lasting at least 20 minutes, by a general practitioner (GPs see GN.4.13) or prescribed medical practitioner (PMPs see AN.7.1) to support patients with cardiovascular disease, or patients at risk of developing cardiovascular disease (CVD). Unless indicated otherwise, the term medical practitioner in this note includes both a general practitioner providing a service under item 699 or a prescribed medical practitioner providing a service under item 177.

The items provide patients with a comprehensive assessment of their cardiovascular health, identification of any physical or lifestyle-related risks to their cardiovascular health, and a comprehensive preventive health care plan to improve their cardiovascular health. The assessment may include auscultation of the patient’s heart, where clinically relevant.

The heart health assessment item can be claimed once per patient in a 12-month period. The heart health assessment items cannot be claimed if a patient has had a health assessment service, excluding an Aboriginal and Torres Strait Islander Peoples Health Assessment (item 715, 228, 92004, 92011), in the previous 12 months.

This item is available to all Medicare eligible patients aged 30 years and over who would benefit from an assessment of this type. The intention of this item is to identify CVD in people not known to have CVD.

The absolute cardiovascular disease risk is calculated as per the Australian Absolute Cardiovascular Disease Risk Calculator which can viewed at ‘http://www.cvdcheck.org.au/calculator/’.

Revision of the Australian Guidelines for the management of absolute cardiovascular disease risk (published in 2012) are currently underway (ACDPA | Absolute CVD risk guideline update), in the meantime resources on risk assessment can be found at ACDPA | Resources. Medical practitioners can also refer to the RACGP’s 'National Guide to a Preventative Assessment for Aboriginal and Torres Strait Islander People' to complete this assessment.

Heart health assessments are not available to people who are in-patients of a hospital or care recipients in a residential aged care facility.

Before a health assessment is commenced, the patient (and/or the patient's parent(s), carer or representative, as appropriate) must be given an explanation of the health assessment process and its likely benefits. The patient must be asked whether they consent to the health assessment being performed. In cases where the patient is not capable of giving consent, consent must be given by the patient's parent(s), carer or representative. Consent to the health assessment must be noted in the patient's records.

The heart health assessment may only be provided by a general practitioner (699) or prescribed medical practitioner (177).

A health assessment should generally be undertaken by the patient's 'usual doctor'. For the purpose of the heart health assessment items, 'usual doctor' means the general practitioner, or a prescribed medical practitioner working in the medical practice, which has provided the majority of primary health care to the patient over the previous 12 months and/or will be providing the majority of care to the patient over the next 12 months.

A health assessment should not take the form of a health screening service.

A copy of the heart health assessment must be retained for a period of two years after the date of service.

MBS heart health assessment items must be provided by a medical practitioner personally attending upon a patient. Suitably qualified health professionals, such as practice nurses or Aboriginal and Torres Strait Islander health practitioners, employed and/or otherwise engaged by a general practice or health service, may assist medical practitioners in performing health assessments. Such assistance must be provided in accordance with accepted medical practice and under the supervision of the medical practitioner. This may include activities associated with:

  • information collection; and
  • providing patients with information about recommended interventions at the direction of the medical practitioner.

The medical practitioner should be satisfied that the assisting health professional has the necessary skills, expertise and training to collect the information required for the heart health assessment.

Medical practitioners should not conduct a separate consultation for another health-related issue in conjunction with a health assessment unless it is clinically necessary (ie. the patient has an acute problem that needs to be managed separately from the assessment).

Heart health assessment items do 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, heart health assessment items can be claimed for services provided by medical practitioners salaried by or contracted to, the Service or health clinic. All other requirements of the items must be met.

Medicare bulk billing incentive items can be claimed in conjunction with any heart health assessment for eligible patients, provided the conditions of item are met.

Related Items: 177 699


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