Medicare Benefits Schedule - Item 82003

Attendance by an eligible allied health practitioner or eligible Aboriginal and Torres Strait Islander primary health care professional, as a member of a multidisciplinary case conference team, to participate in a community case conference if the conference lasts for at least 40 minutes (other than a service associated with a service to which another item in this Group applies)

Fee: $162.60 Benefit: 85% = $138.25

(See para MN.10.4 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $487.80

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These items provide MBS benefits for eligible allied health and Aboriginal and Torres Strait Islander primary health care professionals (health professionals) to participate in a multidisciplinary case conference team in a community case conference with a patient’s medical practitioner and other providers.

A multidisciplinary case conference means a process by which a multidisciplinary case conference team carries out all of the following activities:

• discussing a patient’s history;
• identifying the patient’s multidisciplinary care needs;
• identifying outcomes to be achieved by members of the multidisciplinary case conference team giving care and service to the patient;
• identifying tasks that need to be undertaken to achieve these outcomes, and allocating those tasks to members of the multidisciplinary case conference team;
• assessing whether previously identified outcomes (if any) have been achieved.

These items apply to non-hospital admitted patients who are under 25 years old and have either been diagnosed with, or are suspected of having:

• a complex neurodevelopmental condition (such as autism); or
• an eligible disability.

Eligible health professionals may claim reimbursement for participating in case conferences through three time-tiered items:

• 15–19 minutes (82001)
• 20–39 minutes (82002)
• over 40 minutes (82003)

There are no frequency restrictions for case conferencing items for patients with or suspected of having a complex neurodevelopmental condition or an eligible disability.

Eligible health professionals

For the purposes of these items, eligible health professional means:

• an eligible Aboriginal and Torres Strait Islander health practitioner
• an eligible Aboriginal and Torres Strait Islander health worker
• an eligible audiologist
• an eligible dietitian
• an eligible exercise physiologist
• an eligible mental health nurse
• an eligible mental health worker (health professionals that meet the requirements of a mental health service, namely, Aboriginal and Torres Strait Islander health practitioners, Aboriginal and Torres Strait Islander health workers, mental health nurses, occupational therapists, psychologists and social workers)
• an eligible occupational therapist
• an eligible optometrist
• an eligible orthoptist
• an eligible physiotherapist
• an eligible psychologist
• an eligible speech pathologist.

Eligible health professionals must meet the eligibility requirements as set out in the Health Insurance (Section 3C General Medical Services – Allied Health and other Primary Health Care Services) Determination 2024.

Eligible patients

These items apply to non-hospital admitted patients who are under 25 years old and have either been diagnosed with, or are suspected of having:

• a complex neurodevelopmental condition; or
• an eligible disability.

Organisation of a case conference

The case conference must be organised by the medical practitioner. The multidisciplinary case conference team must include a medical practitioner and at least 2 other members providing different kinds of care to the patient. The multidisciplinary case conference team requirements include:

• each member must provide a different kind of care or service to the patient; and
• each member must not be an unpaid carer of the patient; and
• one member may be another medical practitioner.

The patient and family members or carers can attend the case conference but will not count towards the minimum team member requirements.

Only eligible health professionals can claim payment for their participation.

Non-claiming attendees can include other health professionals, home and community service providers and care organisers, including the following:

• asthma educators
• dental therapists
• dentists
• diabetes educators
• education providers
• “meals on wheels” providers
• orthotists or prosthetists
• personal care workers
• pharmacists
• podiatrists
• probation officers
• registered nurses
• social workers.

In some instances, 2 eligible health professionals from the same profession may participate in the same case conference, where both provide different aspects of care to the patient. For example, the 2 providers from the same profession have different specialisations that are clinically relevant to the same patient and cannot be provided by one of the providers alone. In this instance, both providers will be able to claim the new items.

Participation in a case conference

A referral is not required for eligible health professionals to access the case conferencing items for complex neurodevelopmental condition and disability services. However, the health professional must be invited to participate in the case conference by the patient’s treating medical practitioner.

The patient must agree to the health professional participating in the case conference and be informed that Medicare will be accessed to fund the service. The patient may agree through discussion with their medical practitioner. The health professional should ensure that the patient has agreed and that their agreement has been recorded appropriately.

Health professionals claiming a case conferencing item should record the day, start and end times, the names of all participants and all matters discussed in the patient’s medical record.

The health professional is not required to have a pre-existing relationship with the patient. However, the patient must agree to the health professional participating in the case conference and be informed that Medicare will be accessed to fund the service.

The case conference may lead to an agreed care plan between all participating providers, including the number of individual health professional services required and how they are allocated among eligible health professionals within a patient’s entitlement.

The case conferencing items can be accessed in person, via video or telephone, using the same item number. There is no requirement that all participants use the same communication method.

Related Items: 82001 82002 82003