Medicare Benefits Schedule - Item 239

Attendance by a prescribed medical practitioner, as a member of a multidisciplinary case conference team, to participate in:
(a) a community case conference; or
(b) a multidisciplinary case conference in a residential aged care facility; or
(c) a multidisciplinary discharge case conference;
if the conference lasts for at least 20 minutes but less than 40 minutes, other than a service associated with a service to any of items 229 to 233 and 721 to 732 apply

Fee: $78.40 Benefit: 75% = $58.80 100% = $78.40

(See para AN.7.1, AN.7.27 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $235.20

• Previous - Item 238
• Next - Item 240

Last reviewed: 1 November 2023

A prescribed medical practitioner is a medical practitioner:

(a) who is not a general practitioner (see GN.4.13), specialist or consultant physician, and

(b) who:

a. is registered under section 3GA of the Act and is practising during the period, and in the location in respect of which the medical practitioner is registered, and insofar as the circumstances specified for paragraph 19AA(3)(b) of the Act apply; or

b. is covered by an exemption under subsection 19AB(3) of the Act; or

c. first became a medical practitioner before 1 November 1996.

Related Items: 179 181 185 187 189 191 203 206 214 215 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 235 236 237 238 239 240 243 244 245 249 272 276 277 279 281 282 283 285 286 287 301 303 733 737 741 745 761 763 766 769 772 776 788 789 792 2197 2198 2200 90092 90093 90095 90096 90098 90183 90188 90202 90212 90215

Last reviewed: 1 November 2023

Items 235 to 244 provide rebates for prescribed medical practitioners (see note AN.7.1) to organise and coordinate, or participate in, multidisciplinary case conferences for patients in the community or patients being discharged into the community from hospital or people living in residential aged care facilities. This group of items include two items for prescribed medical practitioners participating in cancer care case conferences.

REGULATORY REQUIREMENTS

To organise and coordinate case conference items 235, 236 and 237, the prescribed medical practitioner must:

(a) explain to the patient the nature of a multidisciplinary case conference, and ask the patient for their agreement to the conference taking place; and

(b) record the patient's agreement to the conference; and

(c) record the day on which the conference was held, and the times at which the conference started and ended; and

(d) record the names of the participants; and

(e) offer the patient and the patient's carer (if any, and if the prescribed medical practitioner considers it appropriate and the patient agrees) a summary of the conference and provide this summary to other team members; and

(f) discuss the outcomes of the conference with the patient and the patient's carer (if any, and if the prescribed medical practitioner considers it appropriate and the patient agrees); and

(g) record all matters discussed and identified by the case conferencing team and put a copy of that record in the patient's medical records.

To participate in multidisciplinary case conference items 238, 239 and 240, the prescribed medical practitioner must:

(a) explain to the patient the nature of a multidisciplinary case conference, and ask the patient whether they agree to the prescribed medical practitioner's participation in the conference; and

(b) record the patient's agreement to the prescribed medical practitioner's participation; and

(c) record the day on which the conference was held, and the times at which the conference started and ended; and

(d) record the names of the participants; and

(e) record all matters discussed and identified by the case conferencing team and put a copy of that record in the patient's medical records.

Cancer care case conference items 243 and 244

For the purposes of these items:

• private patients in public or private hospitals or the community with a malignancy of a solid organ or tissue or a systemic cancer such as a leukaemia or lymphoma are covered, with the exception of patients whose only cancer is a non-melanoma skin cancer;

• the billing prescribed medical practitioner must be a treating doctor of the patient discussed at the case conference.  A treating doctor should generally have treated or provided a formal diagnosis of the patient's cancer in the past 12 months or expect to do so within the next 12 months.  Attending non-treating clinicians, allied health providers or support staff are not eligible to bill the item;

• only one prescribed medical practitioner is eligible to claim item 243 for each patient case conference. This should be the prescribed medical practitioner who assumes responsibility for leading and coordinating the case conference, ensures that records are kept and that the patient is informed of the outcome of the case conference. In most cases this will be the lead treating prescribed medical practitioner;

• each billing prescribed medical practitioner must ensure that their patient is informed that a charge will be incurred for the case conference for which a Medicare rebate will be payable;

• participants must be in communication with each other throughout the case conference, either face-to-face, or by telephone or video link;

• suitable allied health practitioners would generally be from one of the following disciplines: aboriginal health care worker; asthma educator; audiologist; dental therapist; dentist; diabetes educator; dietitian; mental health worker; occupational therapist; optometrist; orthoptist; orthotist or prosthetist; pharmacist; physiotherapist; podiatrist; psychologist; registered nurse; social worker; or speech pathologist;

• in general, it is expected that no more than two case conferences per patient per year will be billed by a prescribed medical practitioner; and

• cancer care case conferences are for the purpose of developing a cancer treatment plan in a multidisciplinary team meeting and should not be billed against case conference items for other purposes (eg. community or discharge case conferences).

ADDITIONAL INFORMATION

Usual medical practitioner

Items 235 to 244 should generally be undertaken by the patient's usual medical practitioner. This is a prescribed medical practitioner, or a medical practitioner working in the same medical practice that has provided the majority of services to the patient over the previous 12 months and/or will be providing the majority of services to the patient over the coming 12 months.

Multidisciplinary case conference team members

Examples of persons who, for the purposes of care planning and case conferencing may be included in a multidisciplinary care team are allied health professionals such as, but not limited to: Aboriginal health care workers; asthma educators; audiologists; dental therapists; dentists; diabetes educators; dietitians; mental health workers; occupational therapists; optometrists; orthoptists; orthotists or prosthetists; pharmacists; physiotherapists; podiatrists; psychologists; registered nurses; social workers; speech pathologists.

A team may also include home and community service providers, or care organisers, such as: education providers; "meals on wheels" providers; personal care workers (workers who are paid to provide care services); probation officers.

The patient's informal or family carer may be included as a formal member of the team in addition to the minimum of three health or care providers.  The patient and the informal or family carer do not count towards the minimum of three.

Discharge case conference

Organisation and coordination of a multidisciplinary discharge case conference (items 235, 236 and 237) may be provided for private in-patients being discharged into the community from hospital.

Further sources of information

Further information is also available for providers from Services Australia provider inquiry line on 132 150.

Related Items: 235 236 237 238 239 240 243 244