Medicare Benefits Schedule - Item 91189

Phone attendance by a participating nurse practitioner lasting at least 6 minutes and less than 20 minutes if the attendance includes any of the following that are clinically relevant:

(a)     taking a short history;

(b)    arranging any necessary investigation;

(c)     implementing a management plan;

(d)    providing appropriate preventive health care

Fee: $31.80 Benefit: 85% = $27.05

(See para MN.0.1, MN.14.12, MN.14.15, MN.14.16 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $95.40

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It is a legislative requirement that nurse practitioner (using items from Group M18 Subgroup 5, 10) must only perform a telehealth service when they are the patient’s eligible telehealth practitioner.  

An eligible telehealth practitioner is defined as

• the nurse practitioner who performs the service has provided a face-to-face service to the patient in the last 12 months; or
• the nurse practitioner is located at a practice where the patient has received at least one MBS billed face-to-face service arranged by that practice in the 12 months preceding the telehealth attendances (including services performed by another medical or nurse practitioner located at the practice, an Approved Medical Deputising Service provider deputised by that practice, or by another health professional located at the practice, such as a practice nurse or Aboriginal and Torres Strait Islander health practitioner or Aboriginal and Torres Strait Islander health worker performing an on behalf of service for a medical practitioner);or
• there are exemptions to the eligible telehealth practitioner requirement.

The eligible telehealth practitioner requirement does not apply to:

• a person who is under the age of 12 months,
• a person who is experiencing homelessness,
• a person receiving treatment through Blood Borne Virus, Sexual or Reproductive Health telehealth,
• a person living in a natural disaster affected area,
• a person who receives the service from a nurse practitioner located at an Aboriginal Medical Service or an Aboriginal Community Controlled Health Service, or
• a person isolating because of a COVID-related State or Territory public health order, or in COVID-19 quarantine because of a State or Territory public health order.

A person who is experiencing homelessness means when a person does not have suitable accommodation alternatives, they are considered homeless if their current living arrangement:

(a)  is in a dwelling that is inadequate; or

(b)  has no tenure, or if their initial tenure is short and not extendable; or

(c)  does not allow them to have control of, and access to space for social relations.

A person receiving treatment through Blood Borne Virus, Sexual or Reproductive Health telehealth items means services must meet the general medically accepted interpretation as what is defined as these services. Note artificial reproductive technology and antenatal services cannot be claimed under this exemption.

A person living in a natural disaster affected area is defined as a State or Territory local government area which is currently declared as a natural disaster area by a State or Territory Government until that declaration is deemed to have expired.

It is a legislated requirement that providers document in patient clinical notes the exemption and the clinical reasoning.

A patient’s participation in a previous video or phone consultation does not constitute a face-to-face service for the purposes of ongoing telehealth eligibility.

Related Items: 91178 91179 91180 91189 91190 91191 91192 91193 91206

Services provided by participating nurse practitioners are covered by five MBS items 82200, 82205, 82210, 82215 and 82216. These also have phone equivalents 91193, 91189, 91190, 91191 and video equivalents 91192, 91178, 91179, 91180 and 91206.

These items provide for:

professional attendance for an obvious problem, straight forward in nature, with limited examination and management required (item 82200) 

professional attendance for a patient lasting no less than 6 minutes and no more than 20 minutes duration (item 82205) 

professional attendance for a patient lasting at least 20 minutes duration (item 82210);

professional attendance for a patient lasting at least 40 minutes duration (item 82215);

professional attendance for a patient lasting at least 60 minutes duration (item 82216).

Related Items: 82200 82205 82210 82215 82216 91178 91180 91189 91190 91191 91192 91193 91206

A participating nurse practitioner will be able to refer private patients to a specialist and consultant physician as clinical services dictate. 

This measure does not include referral by a nurse practitioner for allied or Aboriginal and Torres Strait Islander primary health care worker or practitioner health care. If a participating nurse practitioner refers a patient to an allied health practitioner or an Aboriginal and Torres Strait Islander primary health care worker or practitioner, no benefits would be payable for that service. 

A referral given by a participating nurse practitioner is valid until 12 months after the first service given in accordance with the referral. 

If the referral is lost, stolen or destroyed, the nurse practitioner would need to provide a replacement referral as soon as is practicable after the service is provided. 

A referral to a specialist must be in writing in the form of a letter or a note to the specialist and must be signed and dated by the referring nurse practitioner.  The referral must contain any information relevant to the patient and the specialist must have received the referral on or prior to providing a specialist consultation. 

There are exemptions from this requirement in an emergency if the specialist considers the patient's condition requires immediate attention without a referral.  In that situation, the specialist is taken to be the referring practitioner.

Related Items: 82200 82205 82210 82215 82216 91178 91179 91180 91189 91190 91191 91192 91193 91206

Pathology Services 

Determination of Necessity of Service

The participating nurse practitioner requesting a pathology service for a patient must determine that the pathology service is necessary. 

Request for Service

The service may only be provided in response to a request from the treating practitioner and the request must be in writing (or, if oral, confirmed in writing within fourteen days). 

Pathology Services approved for participating nurse practitioners

Nurse practitioners may request MBS pathology items in any Groups P1 to P8 or any of items 73826 to 73837 of the pathology services table. Requesting pathology services must be within the nurse practitioner's scope of practice. 

Further information

For further information about Medicare Benefits Schedule items, please refer to the Department of Health, Disability and Ageing's website at www.health.gov.au/mbsonline. 

Diagnostic Imaging Services 

Determination of Necessity of Service

The participating nurse practitioner requesting a diagnostic imaging service for a patient must determine that the diagnostic imaging service is necessary for the appropriate professional care of the patient.  

Request for Service

The service may only be provided in response to a request from the treating nurse practitioner, and the request must be in writing, signed and dated.  The legislation provides that a request must be in writing and contain sufficient information, in terms that are generally understood by the profession, to clearly identify the item/s of service requested.  This includes, where relevant, noting on the request the clinical indication(s) for the requested service.  The provision of additional relevant clinical information can often assist the service provider, and enhance the overall service provided to the patient. 

It is not necessary that a written request for a diagnostic imaging service be addressed to a particular provider or that, if the request is addressed to a particular provider, the service must be rendered by that provider. 

A single request may be used to order a number of diagnostic imaging services. However, all services provided under this request must be rendered within seven days after rendering the first service.

Further Information 

For further information on Medical Benefit Schedule items nurse practitioners can request for Diagnostic Imaging services please refer to note IN.0.6, which can be found here.

Related Items: 82200 82205 82210 82215 91178 91180 91189 91190 91191 91192 91193