Medicare Benefits Schedule - Item 92210

Telehealth attendance by a general practitioner on not more than one patient on one occasion—each attendance in unsociable hours if:

(a) the attendance is requested by the patient or a responsible person in the same unbroken after‑hours period; and

(b) the patient’s medical condition requires urgent assessment.

Fee: $174.30 Benefit: 100% = $174.30

(See para AN.1.1 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $500.00

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It is a legislative requirement that medical practitioners working in general practice must only perform a telehealth or telephone service where they have an established clinical relationship with the patient.

An established clinical relationship is defined as:

• the medical practitioner who performs the service has provided a face-to-face service to the patient in the last 12 months; or
• the medical practitioner who performs the service is located at a medical practice, and the patient has a face-to-face service arranged by that practice in the last 12 months. This can be a service performed by another doctor located at the practice, or a service performed by another health professional located at the practice (such as a practice nurse or Aboriginal and Torres Strait Islander health worker); or
• the medical practitioner who performs the service is a participant in the Approved Medical Deputising Service (AMDS) program, and the Approved Medical Deputising Service provider (AMDS provider) that employs the medical practitioner has a formal agreement with a medical practice that has provided at least one face-to-face service to the patient in the last 12 months.

This 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 Mental Health telehealth items, a person receiving treatment through Blood Borne Virus, Sexual or Reproductive Health telehealth items, a person living in a natural disaster affected area, a person receiving an urgent after-hours service (in unsociable hours), a person who receives the service from a medical 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.

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.

person receiving treatment through Mental Health telehealth items means services must be claimed as specific GP or prescribed medical practitioner mental health and eating disorder telehealth items. 

person receiving treatment through Blood Borne Virus, Sexual or Reproductive Health telehealth items means services must be claimed as specific GP or prescribed medical practitioner telehealth items (see also AN.40.5) 

people 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.

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