Medicare Benefits Schedule - Item 10957

Attendance by an eligible allied health practitioner, as a member of a multidisciplinary case conference team, to participate in:

(a)   a community case conference; or

(b)   a multidisciplinary case conference in a residential aged care facility;

if the conference lasts for at least 20 minutes, but for less than 40 minutes (other than a service associated with a service to which another item in this Group applies)

Fee: $95.45 Benefit: 85% = $81.15

(See para MN.3.2 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $286.35

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These items provide MBS benefits for eligible allied health professionals to participate in a multidisciplinary case conference team in a community case conference with a patient’s GP or prescribed medical practitioner and other providers.

A prescribed medical practitioner is a medical practitioner other than a GP, specialist, or consultant physician. A multidisciplinary case conference means a process by which a multidisciplinary case conference team carries out all 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 for chronic disease management under the care of a GP/prescribed medical practitioner in either the community or for a resident of a residential aged care facility.

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

• 15–19 minutes (10955)
• 20–39 minutes (10957)
• 40 minutes or longer (10959)

Eligible Allied Health Professionals

For the purpose of these items, eligible health professionals must meet the eligibility requirements as set out in the Health Insurance (Section 3C General Medical Services – Allied Health Services) Determination 2024 and include the following:

• Aboriginal health worker
• Aboriginal and Torres Strait Islander health practitioner
• audiologist
• chiropractor
• diabetes educator
• dietitian
• exercise physiologist
• mental health worker which includes allied health professionals that meet the requirements of a mental health service which include Aboriginal and Torres Strait Islander health practitioners, Aboriginal and Torres Strait Islander health workers, mental health nurses, occupational therapists, psychologists and social workers
• nurse practitioner
• occupational therapist
• osteopath
• physiotherapist
• podiatrist
• psychologist
• speech pathologist

Organisation of a case conference

The case conference must be organised by the GP/prescribed medical practitioner. The multidisciplinary case conference team must include a GP/prescribed 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 GP/prescribed medical practitioner.

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

The allied health professional does not need all participants to be MBS-eligible to be able to claim payment for their participation. Members can include allied health professionals, home and community service providers and care organisers, including the following:

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

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

Participation in a case conference

A referral is not required for an allied health professional to access the multidisciplinary case conferencing items for chronic disease management. However, the allied health professional must be invited to participate in the case conference by the patient’s treating GP/prescribed medical practitioner.

The patient must agree to the allied 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 GP/prescribed medical practitioner. The GP/prescribed medical practitioner should ensure that the patient has agreed and that their agreement has been recorded appropriately.

Allied 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 allied health professional is not required to have a pre-existing relationship with the patient. However, the patient should agree to their participation 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 allied health services required and how they are allocated among professions within a patient’s entitlement.

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

Frequency limitations

These items cannot be claimed if the service has been performed in the last 3 months, unless in exceptional circumstances. An exceptional circumstance means there has been a significant change in the patient's clinical condition or care circumstances that necessitate the performance of the service.

Related Items: 10955 10957 10959