Medicare Benefits Schedule - Item 90005

Search Results for Item 90005

View Associated Notes

Category 1 - PROFESSIONAL ATTENDANCES

90005

90005 - Additional Information

Item Start Date:
14-Jun-2021
Description Updated:
01-Feb-2023
Schedule Fee Updated:
01-Nov-2023

Group
A35 - Services For Patients in Residential Aged Care Facilities
Subgroup
1 - Flag Fall Amount For Residential Aged Care Facilities

A flag fall service to which item 93644, 93645, 93646, 93647, 93653, 93654, 93655, 93656, 93660 or 93661 applies. For the first patient attended during one attendance by a general practitioner or by a medical practitioner (other than a general practitioner) at:

 (a) one residential aged care facility, or at consulting rooms situated within such a complex, on one occasion; or
 (b) one residential disability setting facility, or at consulting rooms situated within such a complex, on one occasion; or
 (c) a person’s place of residence (other than a residential aged care facility) on one occasion.

Fee: $144.70 Benefit: 85% = $123.00

(See para AN.44.1 of explanatory notes to this Category)


Associated Notes

Category 1 - PROFESSIONAL ATTENDANCES

AN.44.1

MBS COVID-19 Vaccine Support Services

MBS COVID-19 Vaccine Support Services

Item descriptions

Attendance items to assess a patient’s suitability for a COVID-19 vaccine (items 93644, 93645, 93646, 93647, 93653, 93654, 93655, 93656)

Vaccine suitability assessments undertaken by a suitably qualified health professional on behalf of a medical practitioner in a location other than consulting rooms (items 93660 and 93661).

Attendance items for in-depth patient assessment services co-claimed with a vaccine suitability assessment service and provided where additional assessment and advice is required, including in relation to the patient’s individual risks and benefits associated with receiving a COVID-19 vaccine (items 10660 and 10661).

Flag-fall item co-claimed with a vaccine suitability assessment service provided as an initial attendance at a residential aged care facility (RACF), residential disability facility setting or a patient’s place of residence, on one occasion (item 90005).

All MBS COVID-19 Vaccine Support items must be bulk-billed.

The items can only be billed to Medicare if a dose of a COVID-19 vaccine is available to be given immediately to the patient who is to be assessed. Medical practices that do not have access to supplies of a COVID-19 vaccine for immediate delivery to patients cannot use any of the COVID-19 vaccine items.

In this explanatory note:

Other Medical Practitioner (OMP) includes specialist medical practitioners and consultant physicians working in a general practice setting in their capacity as medical practitioners who are not vocationally registered general practitioners (GPs); and

Suitably qualified health professional refers to a person, including a registered nurse, who is registered in a health profession regulated under the Health Practitioner Regulation National Law. More information is available at the AHPRA website at: www.ahpra.gov.au.

Application of the items

The attendance items for assessing patient suitability for a COVID-19 vaccine may be claimed as follows:

MBS Items 93644, 93645, 93646 and 93647 apply to a professional attendance that: 

  • is provided in a business hours period for the purpose of assessing a patient’s suitability to receive a COVID-19 vaccine; and
  • is bulk billed.
     

MBS Items 93653, 93654, 93655 and 93656 apply to a professional attendance that:

  • is provided in an after-hours period hours for the purpose of assessing a patient’s suitability to receive a COVID-19 vaccine; and
  • is bulk billed.
     

MBS item 93660 and 93661 applies to a service provided by a suitably qualified health professional on behalf of the GP/OMP out of the consulting rooms and must be bulk billed.

MBS Items 93644, 93645, 93646, 93647, 93653, 93654, 93655, 93656, 93660 and 93661 can be used to assess vaccine suitability for a patient eligible for any vaccine dose, whether that is part of a primary course or a booster.

MBS items 10660 and 10661 apply to a professional attendance that can only be claimed once per patient during their lifetime. The service is bulk billed and must be personally performed by the medical practitioner.

MBS item 90005 applies only to the first service provided during a single attendance at a RACF, residential disability facility setting or a patient’s place of residence. The item is bulk-billed.

Business hours and after-hours services

MBS Items 93644, 93645, 93646, and 93647 apply to a professional attendance that is provided:

  • after 8am or before 8pm on a weekday;
  • after 8am or before 1.00pm on a Saturday.

MBS Items 93653, 93654, 93655 and 93656 apply to a professional attendance that is provided:

  • on a public holiday;
  • on a Sunday;
  • before 8am, or after 1pm on a Saturday;
  • before 8am, or after 8pm on any day other than a Saturday, Sunday or public holiday.
     

Geographic requirements

MBS Items 93644, 93646, 93653, 93655 and 93660 apply to a professional attendance delivered in a Modified Monash 1 (metropolitan) location.

MBS Items 93645, 93647, 93654, 93656 and 93661 apply to a professional attendance delivered in a Modified Monash 2-7 (non-metropolitan) location.

A locator map to identify a medical practice's Modified Monash location is available at the Health Workforce Locator website at: www.health.gov.au/resources/apps-and-tools/health-workforce-locator/health-workforce-locator.

Eligible practitioners

MBS items 93644, 93645, 93653, 93654 and 10660 relate to attendances rendered by medical practitioners who are:

  • listed on the Vocational Register of General Practitioners maintained by Services Australia; or
  • holders of the Fellowship of the Royal Australian College of General Practitioners (FRACGP) who participate in, and meet the requirements of the RACGP for continuing medical education and quality assurance as defined in the RACGP Quality Assurance and Continuing Medical Education program; or
  • holders of the Fellowship of the Australian College of Rural and Remote Medicine (FACRRM) who participate in, and meet the requirements of the ACRRM for continuing medical education and quality assurance as defined in ACRRM's Professional Development Program; or
  • undertaking an approved placement in general practice as part of a training program for general practice leading to the award of the FRACGP or training recognised by the RACGP as being of an equivalent standard; or
  • undertaking an approved placement in general practice as part of a training program for general practice leading to the award of the FACRRM or training recognised by ACRRM as being of an equivalent standard.

MBS items 93646, 93647, 93655, 93656 and 10661 relate to attendances rendered by a medical practitioner who is not a general practitioner.

Activities associated with the claiming of MBS items 93644, 93645, 93646, 93647, 93653, 93654, 93655 or 93656 can be undertaken by a GP, OMP or a suitably qualified health professional on the GP/OMP’s behalf working within their scope of practice.

Services rendered under MBS items 93644, 93645, 93646, 93647, 93653, 93654, 93655 or 93656 will only attract a Medicare rebate where the service is billed in the name of the supervising GP or OMP, who must be present at the location at which the vaccine suitability assessment service is undertaken and must accept full responsibility for the service.

Services rendered under MBS items 93660 and 93661 may only be claimed by a medical practitioner, who retains clinical responsibility for the service, however, the GP/OMP is not required to be physically present at the location at which the vaccine suitability assessment service is provided. The medical practitioner retains full responsibility for the clinical outcome of the service at all times.

 

Eligible patients

Services utilising MBS items 93644, 93645, 93646, 93647, 93653, 93654, 93655, 93656, 93660, 93661, 10660, and 10661 can be provided to any patient who is eligible for Medicare.

Administration of a COVID-19 vaccine

If, following a vaccine suitability assessment service, a patient is offered and agrees to receive a COVID-19 vaccination, the vaccine will be administered (with no other MBS item claimable for that administration). The GP, OMP or suitably qualified health professional responsible for administering the vaccine must be appropriately qualified and trained to provide immunisation to the patient.

Co-administration of a COVID-19 vaccine and an influenza vaccine

ATAGI has advised that a COVID-19 vaccination and an influenza vaccination can be administered at the same time. These services may be provided during the same attendance.

A vaccine suitability assessment MBS item would be billed for the COVID-19 vaccination. Influenza vaccine services are typically administered with standard MBS attendance items.

Note: There are no MBS items for administering an influenza vaccine for and on behalf of a medical practitioner.

While a medical practitioner is under no obligation to bulk-bill a patient receiving an influenza vaccination, a patient who also receives a COVID-19 booster vaccination as part of the same occasion of care must be bulk-billed for the MBS COVID-19 vaccine suitability assessment component of the overall service. Patients should be informed of any potential out of pocket costs before any service is provided, preferably when they book their appointment.

Medical practitioners administering influenza vaccinations should be aware of the requirements of the National Immunisation Program including eligibility criteria for Government funded vaccines.

Billing the COVID-19 vaccine suitability assessment items

The MBS COVID-19 vaccine suitability assessment items can only be billed to Medicare by a GP or OMP.

No additional MBS attendance item can be used to bill Medicare for the time spent administering a vaccine following a suitability assessment service.

Co-claiming the COVID-19 vaccine suitability assessment items with other general attendance items

Patients presenting with multiple clinical matters requiring attention should be encouraged to book a separate consultation, and preferably with their usual medical practice. There may be some circumstances where deferral of treatment is not feasible or in the patient’s best interests; these include clinical matters where treatment cannot be deferred or opportunistic treatment for other conditions.

Standard MBS multiple same-day attendance rules apply to the COVID-19 vaccination suitability assessment services. Co-claiming is only permitted where another Medicare service is provided that is unrelated to the vaccine suitability assessment item. Payment of benefit may be made for more than one attendance on a patient on the same day by the same GP or OMP, provided the subsequent attendances are not a continuation of the initial or earlier attendances. Examples of other Medicare services include but are not restricted to: a standard consultation for a different presenting problem; provision of a time-tiered health assessment service; or review of a chronic disease management plan.

Before an additional service is provided to the patient the medical practice must obtain and record the patient’s informed financial consent to ensure that they (the patient) understand that there is no cost associated with the vaccine suitability assessment and/or the administration of the vaccine.  

Patients must also be informed if any other service that they receive on the same occasion will be bulk-billed or will attract an out of pocket cost.

Note: where a GP or OMP completes a vaccine suitability assessment, but the patient is found to be unsuitable on clinical grounds or declines to receive the vaccination, the service may be billed using the appropriate vaccine suitability assessment item. If the patient returns at a later date, it would be appropriate for another vaccine suitability assessment to be undertaken and a claim made for the relevant Medicare item.

Co-claiming restrictions

The table below lists the restrictions on co-claiming the MBS vaccine support services.

MBS Item(s) Must be co-claimed May be co-claimed Cannot be co-claimed
93644, 93645, 93646, 93647, 93653, 93654, 93655, 93656   90005, 10660, 10661 10990, 10991, 10992, 75855, 75856, 75857, 75858, 10988
93660, 93661   90005 10990, 10991, 10992, 75855, 75856, 75857, 75858, 10988, 10660, 10661
90005 93644, 93645, 93646, 93647, 93653, 93654, 93655, 93656, 93660, 93661 10660, 10661 10990, 10991, 10992, 75855, 75856, 75857, 75858
10660 93644, 93645, 93653, 93654 90005 10990, 10991, 10992, 75855, 75856, 75857, 75858, 93660, 93661
10661 93646, 93647, 93655, 93656 90005 10990, 10991, 10992, 75855, 75856, 75857, 75858, 93660, 93661

 

Record keeping and reporting requirements

Medical practices participating in the vaccine program need to comply with the record keeping requirements to substantiate a Medicare service.

For the purposes of Medicare, a patient or clinical record should be created or updated at the time a service is provided, or as soon as practicable afterwards.  The record needs to:

  • clearly identify the name of the patient;
  • contain a separate entry for each attendance by the patient for the vaccination suitability assessment service and the date(s) on which the service was provided;
  • record the patient’s consent to receive the vaccine;
  • provide clinical information adequate to explain the service;
  • be sufficiently comprehensible that another practitioner, relying on the record, can effectively undertake the patient’s ongoing care as it relates to COVID-19 vaccinations.

Where a patient receives a service using either MBS item 10660 or 10661 in association with a vaccine suitability assessment service, the reason for the service also needs to be recorded.

Medical practices participating in the Australian Government’s COVID-19 vaccination program will be required to update the vaccination status of a patient who has received the vaccine on the Australian Immunisation Register (AIR) portal in line with the Australian Immunisation Register requirements.

Restrictions

MBS items 93644, 93645, 93646, 93647, 93653, 93654, 93655, 93656, 93660 and 93661 apply only to a professional attendance where:

  • the GP, OMP or suitably qualified health professional administering a COVID-19 vaccine is appropriately qualified and trained to provide immunisation to a patient; and
  • a dose of COVID-19 vaccine is immediately available for administration to the patient at the practice location.

A service using the items cannot be provided as part of an episode of hospital treatment or hospital-substitute treatment.

Related Items: 10660 10661 90005 93644 93645 93646 93647 93653 93654 93655 93656 93660 93661


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