Medicare Benefits Schedule - Item 81105

Search Results for Item 81105

View Associated Notes

Category 8 - MISCELLANEOUS SERVICES

81105

81105 - Additional Information

Item Start Date:
01-May-2007
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Group
M9 - Allied Health Group Services
Subgroup
1 - Diabetes education services

Diabetes education health service provided to a patient by an eligible diabetes educator, as a group service for the management of type 2 diabetes if:

(a)   the patient has been assessed as suitable for a type 2 diabetes group service under assessment item 81100, 81110 or 81120 or items 93284 or 93286 of the Telehealth and Telephone Determination; and

(b)  the service is provided to a patient who is part of a group of between 2 and 12 patients; and

(c)   the service is provided in person; and

(d)  the service is of at least 60 minutes duration; and

(e)   after the last service in the group services program provided to the patient under item 81105, 81115 or 81125 or item 93285 of the Telehealth and Telephone Determination, the eligible diabetes educator prepares, or contributes to, a written report to be provided to the referring medical practitioner; and

(f)   an attendance record for the group is maintained by the eligible diabetes educator;

to a maximum of 8 group services in a calendar year (including services in items 81105, 81115 and 81125 or item 93285 of the Telehealth and Telephone Determination)

Fee: $21.90 Benefit: 85% = $18.65

(See para MN.9.1, MN.9.3, MN.9.5, MN.9.6 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $65.70


Associated Notes

Category 8 - MISCELLANEOUS SERVICES

MN.9.1

Group Allied Health Services (Items 81100, 81105, 81110, 81115, 81120 and 81125) for People with Type 2 Diabetes - Eligible Patients

MBS items (81100, 81105, 81110, 81115, 81120 and 81125) are available for group allied health services for patients with type 2 diabetes. These items apply to services provided by eligible diabetes educators, exercise physiologists and dietitians, on referral from a GP or medical practitioner.

Services available under these items are in addition to the 5 individual allied health services available to patients each calendar year (refer to items 10950, 10951, 10952, 10953, 10954, 10956, 10958, 10960, 10962, 10964, 10966, 10968, 10970, 93000 and 93013).

To be eligible for these services, the patient must have in place one of the following:

  • a GP Management Plan (GPMP) (GP item 721 or medical practitioner item 229); OR
  • for a resident of a residential aged care facility, the GP or medical practitioner must have contributed to a multidisciplinary care plan, or contributed to a review of a multidisciplinary care plan prepared for them by the facility (GP item 731 or medical practitioner item 232). [Note: Generally, residents of an aged care facility rely on the facility for assistance to manage their type 2 diabetes. Therefore, the resident may not need to be referred for group allied health services under these items, as the self-management approach offered in group services may not be appropriate.].

Unlike the individual allied health services, there is no additional requirement for a Team Care Arrangement (GP item 723 or medical practitioner item 230) in order for the patient to be referred for group allied health services.

Once the patient has been referred by their GP or medical practitioner, a diabetes educator, exercise physiologist or dietitian will conduct an individual assessment (under items 81100, 81110, 81120, 93284 or 93286). A maximum of one assessment service is available per calendar year. After assessment, the patient may receive up to 8 group services per calendar year from an eligible diabetes educator, exercise physiologist and/or dietitian (under items 81105, 81115, 81125 or 93285). A collaborative approach, where diabetes educators, exercise physiologists and dietitians work together to develop group service programs in their local area, is encouraged.

Related Items: 81100 81105 81110 81115 81120 81125

Category 8 - MISCELLANEOUS SERVICES

MN.9.3

Group Allied Health Services (Items 81100, 81105, 81110, 81115, 81120, 81125, 93284, 93285 and 93286) for People with Type 2 Diabetes - Eligible Allied Health Professionals

Items 81100, 81105, 81110, 81115, 81120, 81125, 93284, 93285 and 93286 only apply to services provided by eligible diabetes educators, exercise physiologists and dietitians who are registered with Services Australia. If providers are already registered with Services Australia to use items 10951, 10953, 10954, they do not need to register separately for these items. Eligibility criteria are as follows: 

Diabetes educator: must be a 'credentialed diabetes educator' as credentialed by the Australian Diabetes Educators Association. 

Exercise physiologist: must be an 'accredited exercise physiologist' as accredited by Exercise and Sports Science Australia. 

Dietitian: must be an 'accredited practising dietitian' as recognised by the Dietitians Association of Australia. 

Services Australia registration forms may be obtained from Services Australia on 132 150 or on the Services Australia website.

Related Items: 81100 81105 81110 81115 81120 81125 93284 93285 93286

Category 8 - MISCELLANEOUS SERVICES

MN.9.5

Group Allied Health Services (Items 81105, 81115, 81125 and 93285) for People with Type 2 Diabetes - Service Requirements and Referral Forms

These services are provided in a group setting to assist with the management of type 2 diabetes. 

Number of services per year

Patients are eligible for up to 8 group allied health services in total (items 81105, 81115, 81125 and 93285 inclusive) per calendar year. Each separate group service must be provided to the patient by only one type of allied health professional (i.e. by a diabetes educator, or by an exercise physiologist or by a dietitian). However, the overall group services program provided for the patient could be comprised of one type of service only (e.g. 8 diabetes education services) or a combination of services (e.g. 3 diabetes education services, 3 dietitian services and 2 exercise physiology services). An eligible allied health professional with more than one Medicare provider number (e.g. for the provision of diabetes education and dietetics) may provide separate services under each of these provider numbers. 

Group allied health service providers are strongly encouraged to deliver multidisciplinary group services programs that allow patients to benefit from a range of interventions designed to assist in the management of their type 2 diabetes. 

Where a patient receives more than the limit of 8 group services in a calendar year, the additional service/s will not attract a Medicare benefit and the MBS Safety Net arrangements will not apply to costs incurred by the patient for the service/s. 

If there is any doubt about a patient's eligibility for group services, the allied health professional should contact Services Australia to confirm the number of group services already claimed by the patient in the calendar year. Allied health professionals can call Services Australia on 132 150 to check this information. 

Multiple services on the same day

Where clinically relevant, up to 2 group services may be provided consecutively on the same day by the same allied health professional. 

Referral form

The GP or medical practitioner must refer the patient using the referral form for group allied health services under Medicare for patients with type 2 diabetes or a form that contains all the components of this form. This includes:

  • identifying that the patient has type 2 diabetes and either: has prepared a new GP Management Plan (MBS item 721/229) OR
  • has reviewed an existing GP Management Plan (MBS item 732/233) OR
  • for a resident of an aged care facility, the GP or medical practitioner has contributed to or reviewed a multidisciplinary care plan prepared by the facility (MBS item 731/232) [Note: Generally, residents of an aged care facility rely on the facility for assistance to manage their type 2 diabetes. Therefore, residents may not need to be referred for allied health group services as the self-management approach may not be appropriate.]
  • GP or medical practitioner details including provider number, name, address, signature and date of referral
  • Patient details including name and address
  • Allied Health Practitioner (or practice) the patient is referred to for assessment and the address

The allied health professional undertaking the assessment service will need to complete Part B of this form providing information on:

  • Name of provider/s
  • Name of program
  • Number of sessions in the program
  • Venue (if known)
  • Name of allied health professional undertaking the assessment
  • The patient will then need to present this form/information to the provider/s of group services

 

Group size

The service must be provided to a person who is part of a group of between 2 and 12 persons. 

Length of service

Each group service must be of at least 60 minutes duration. 

Reporting requirements

On completion of the group services program, each allied health professional must provide, or contribute to, a written report back to the referring GP/medical practitioner in respect of each patient. The report should describe the group services provided for the patient and indicate the outcomes achieved. While each allied health professional is required to provide feedback to the GP/medical practitioner in relation to the group services they provide to the patient, allied health professionals involved in the provision of a multidisciplinary program are encouraged to combine feedback into a single report to the referring GP/medical practitioner.

Related Items: 81105 81115 81125 93285

Category 8 - MISCELLANEOUS SERVICES

MN.9.6

Group Allied Health Services (Items 81100, 81105, 81110, 81115, 81120, 81125, 93284, 93285 and 93286) for People with Type 2 Diabetes - Additional Requirements

Retention of Referral Form for Services Australia Audit Purposes

It is recommended that Allied health professionals retain a copy of the referral form for 2 years from the date the service was rendered (for Services Australia auditing purposes). 

Publicly funded services

Items 81100, 81105, 81110, 81115, 81120, 81125, 93284, 93285 and 93286 do not apply for services that are provided by any other Commonwealth or state-funded services or provided to an admitted patient of a hospital. 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 a state/territory government health clinic, these items can be claimed for services provided by eligible allied health professionals salaried by, or contracted to, service or health clinic. All requirements of the relevant item must be met, including registration of the allied health professional with Services Australia. These services must also be bulk billed. 

Private health insurance

Patients need to decide if they will use Medicare or their private health insurance general treatment cover (also known as ancillary or extras cover) to pay for these services. Patients cannot use their private health insurance general cover to 'top up' the Medicare rebate paid. 

Out-of-pocket expenses and Medicare Safety Net

Allied health professionals are free to determine their own fees for the professional service. Charges in excess of the Medicare benefit for the allied health items are the responsibility of the patient. However, such out-of-pocket costs will count toward the Medicare Safety Net for that patient.

Related Items: 81100 81105 81110 81115 81120 81125 93284 93285 93286


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