Medicare Benefits Schedule - Item 243

Attendance by a prescribed medical practitioner, as a member of a case conference team, to lead and coordinate a multidisciplinary case conference on a patient with cancer, to develop a multidisciplinary treatment plan, if the case conference lasts at least 10 minutes, with a multidisciplinary team of at least 3 other medical practitioners from different areas of medical practice (which may include general practice), and, in addition, allied health providers

Fee: $63.15 Benefit: 75% = $47.40 100% = $63.15

(See para AN.0.65, AN.7.1 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $189.45

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For the purposes of these items:

· private patients in public or private hospitals or the community with a malignancy of a solid organ or tissue or a systemic cancer such as a leukaemia or lymphoma are covered, with the exception of patients whose only cancer is a non-melanoma skin cancer;

· the billing general practitioner, specialist or consultant physician may be from any area of medical practice and must be a treating doctor of the patient discussed at the case conference.  A treating doctor should generally have treated or provided a formal diagnosis of the patient's cancer in the past 12 months or expect to do so within the next 12 months.  Attending non-treating clinicians, allied health providers or support staff are not eligible to bill the item.

· only one practitioner is eligible to claim item 871 for each patient case conference. This should be the doctor who assumes responsibility for leading and coordinating the case conference, ensures that records are kept and that the patient is informed of the outcome of the case conference. In most cases this will be the lead treating doctor. 

· each billing practitioner must ensure that their patient is informed that a charge will be incurred for the case conference for which a Medicare rebate will be payable;

· participants must be in communication with each other throughout the case conference, either face-to-face, or by telephone or video link;

· suitable allied health practitioners would generally be from one of the following disciplines: aboriginal health care worker; asthma educator; audiologist; dental therapist; dentist; diabetes educator; dietician; mental health worker; occupational therapist; optometrist; orthoptist; orthotist or prosthetist; pharmacist; physiotherapist; podiatrist; psychologist; registered nurse; social worker; or, speech pathologist;

· in general, it is expected that no more than two case conferences per patient per year will be billed by a practitioner; and

· cancer care case conferences are for the purpose of developing a cancer treatment plan in a multidisciplinary team meeting and should not be billed against case conference items for other purposes eg community or discharge case conferences.

Related Items: 243 244 871 872

Last reviewed: 1 November 2023

A prescribed medical practitioner is a medical practitioner:

(a) who is not a general practitioner (see GN.4.13), specialist or consultant physician, and

(b) who:

a. is registered under section 3GA of the Act and is practising during the period, and in the location in respect of which the medical practitioner is registered, and insofar as the circumstances specified for paragraph 19AA(3)(b) of the Act apply; or

b. is covered by an exemption under subsection 19AB(3) of the Act; or

c. first became a medical practitioner before 1 November 1996.

Related Items: 179 181 185 187 189 191 203 206 214 215 218 219 220 221 222 223 228 229 230 231 232 233 235 236 237 238 239 240 243 244 245 249 272 276 277 279 281 282 283 285 286 287 301 303 733 737 741 745 761 763 766 769 772 776 788 789 792 2197 2198 2200 90092 90093 90095 90096 90098 90183 90188 90202 90212 90215