View Associated Notes
Category 3 - THERAPEUTIC PROCEDURES
14219 - Additional Information
Professional attendance on a patient by a psychiatrist, who has undertaken training in Repetitive Transcranial Magnetic Stimulation (rTMS), for treatment mapping for rTMS, if the patient:
(a) is at least 18 years old; and
(b) is diagnosed with a major depressive episode; and
(c) has failed to receive satisfactory improvement for the major depressive episode despite the adequate trialling of at least 2 different classes of antidepressant medications, unless contraindicated, and all of the following apply:
(i) the patient’s adherence to antidepressant treatment has been formally assessed;
(ii) the trialling of each antidepressant medication has been at the recommended therapeutic dose for a minimum of 3 weeks;
(iii) where clinically appropriate, the treatment has been titrated to the maximum tolerated therapeutic dose; and
(d) has undertaken psychological therapy, if clinically appropriate; and
(e) has previously received an initial service under item 14217 and the patient:
(i) has relapsed after a remission following the initial service; and
(ii) has had a satisfactory clinical response to the service under item 14217 (which has been assessed by a validated major depressive disorder tool at least 4 months after receiving that service)
Fee: $197.20 Benefit: 75% = $147.90 85% = $167.65
(See para TN.1.28 of explanatory notes to this Category)
Category 3 - THERAPEUTIC PROCEDURES
Repetitive Transcranial Magnetic Stimulation items 14216, 14217, 14219 and 14220
TN.1.28 Repetitive Transcranial Magnetic Stimulation (rTMS) therapy items (14216, 14217, 14219 and 14220)
Items for Initial course of repetitive transcranial magnetic stimulation (rTMS):
· Item 14216 - prescription and treatment mapping of an initial course of treatment provided by a psychiatrist with appropriate training in rTMS.
· Item 14217 - delivery of an initial course of rTMS treatment of up to 35 sessions provided by, or on behalf of, a psychiatrist with appropriate training in rTMS.
Items for retreatment course of rTMS:
· Item 14219 - prescription and mapping of a retreatment course of rTMS treatment by a psychiatrist with appropriate training in rTMS.
· Item 14220 - delivery of a retreatment course of rTMS treatment of up to 15 sessions provided by, or on behalf of, a psychiatrist with appropriate training in rTMS.
Referral for item 14216 should be through a GP or a psychiatrist. Where there is an existing therapeutic relationship between the patient and the rTMS-trained psychiatrist, no additional referral is required.
Practitioners should have regard to the relevant diagnostic criteria set out in the International Statistical Classification of Diseases and Related Health Problems – 11th Revision (ICD-11) and the Diagnostic and Statistical Manual of the American Psychiatric Association – Fifth Edition (DSM-5). Major Depressive Disorder is defined as an episode of depression that lasts at least two weeks with marked impairment.
Eligibility for item 14216 requires trialling of each antidepressant medication at the recommended therapeutic dose for a minimum of 3 weeks. While this is the minimum period required, practitioners should have regard to the RANZCP’s clinical guidance, noting trialling of each antidepressant medication at the recommended therapeutic dose for a minimum of 4 weeks (with no response) and 6-8 weeks (where there has been a partial response).
Practice should further be guided by the RANZCP Professional Practice Guidelines for the administration of repetitive transcranial magnetic stimulation.
Where can rTMS services be provided?
While clinical advice indicates that the majority of rTMS services will not require hospital treatment and can be provided on an outpatient basis or in consultation rooms, there will be circumstances where some patients may require hospital treatment. Medicare rebates will apply in both circumstances for eligible patients.
Where rTMS treatment is to be provided as part of hospital treatment (i.e. as an inpatient), the psychiatrist will need to provide written certification that hospital treatment is required for the patient in order for hospital accommodation and other private health insurance benefits to be paid. This is an important requirement under the Private Health Insurance (Benefit Requirements) Rules 2011 (the Rules).
The rTMS MBS items have a ‘Type C’ private health insurance procedure classification. Type C procedures are those not normally requiring hospital treatment under the Rules. However, the Rules allow for hospital accommodation and other private health insurance benefits to be paid for Type C procedures if certification is provided.
The medical practitioner (psychiatrist) providing the professional service must certify in writing that, because of the medical condition of the patient or because of the special circumstances specified, it would be contrary to accepted medical practice to provide the procedure to the patient except as hospital treatment in a hospital.
To assist psychiatrists, the Department has published further guidance on the type of information required in a Type C certification on the MBS online website found at MBSonline.
Provider Eligibility and Training Requirements
Providers who can bill these items
These MBS services may only be provided by a psychiatrist, or health care professional on behalf of a psychiatrist, who has undertaken rTMS training.
Prescription and mapping services (items 14216 and 14219) must be personally performed by the psychiatrist trained in rTMS.
Treatment services (14217 and 14220) can be performed by a psychiatrist trained in rTMS, or a health care professional on behalf of the psychiatrist.
Requirements of the health care professional providing rTMS on behalf of the psychiatrist:
A health care professional may include a nurse practitioner, practice nurse or an allied health professional who is trained in the provision of rTMS treatment.
The health care professional performing rTMS treatment services “on behalf of” the psychiatrist should either:
· Be employed by the psychiatrist, or
· Supervised by the psychiatrist, in accordance with accepted medical practice.
It is the responsibility of the prescribing psychiatrist trained in rTMS to ensure that the health professional providing the treatment on behalf of the psychiatrist is appropriately and formally trained in rTMS. Records must be kept to demonstrate that all health care professionals providing rTMS services are appropriately trained.
In line with good practice, the psychiatrist should be available to provide advice as required during treatment and this supervision could be provided from a physician distance (this could be by phone). When rTMS services are provided on behalf the psychiatrist, the psychiatrist continues to remain responsible for planning and monitoring treatment outcomes.
The training requirements for psychiatrists have been endorsed through the Royal Australian and New Zealand College of Psychiatrists (RANZCP). RANZCP-endorsed training courses can be found on the RANZCP website here.
All providers will be subject to ongoing Continuing Professional Development (CPD) requirements set by the RANZCP.
Co-claiming with other items
The following services may be claimed on the same day:
· Prescription and mapping of an initial course of treatment (14216) and the first service in the delivery of treatment (14217).
· Prescription and mapping of a course of retreatment (14219) and the first service in the delivery of retreatment (14220).
MBS item 14217 can be claimed more than once on the same day if deemed clinically appropriate and in line with RANZCP Professional Practice Guidelines.
MBS item 14220 can be claimed more than once on the same day if deemed clinically appropriate and in line with RANZCP Professional Practice Guidelines.
Further information about the MBS items and provision of rTMS services is available on the MBS Online website at MBS Online under ‘Fact Sheets’. The information on the website may be updated from time to time in response to questions or feedback from providers, patients and other stakeholders.
- 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