View Associated Notes
Category 8 - MISCELLANEOUS SERVICES
81305 - Additional Information
Diabetes education health service provided to a patient who is of Aboriginal or Torres Strait Islander descent by an eligible diabetes educator if the service is of at least 20 minutes duration and:
(a) a medical practitioner has undertaken a health assessment and identified a need for follow-up allied health services; or
(b) the patient has:
(i) a chronic condition;
(ii) complex care needs being managed by a medical practitioner (other than a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the patient is a resident of an aged care facility, the patient’s medical practitioner has contributed to a multidisciplinary care plan; and
(iii) the service is recommended in the patient’s Team Care Arrangements or multidisciplinary care plan as part of the management of the patient’s chronic condition and complex care needs;
to a maximum of 10 services (including any services to which this item or any other item in this Group or Subgroup 1 of Group M3 or item 93000, 93013, 93048 or 93061 of the Telehealth and Telephone Determination applies) in a calendar year
Fee: $70.95 Benefit: 85% = $60.35
(See para MN.11.1 of explanatory notes to this Category)
Associated Notes
Category 8 - MISCELLANEOUS SERVICES
MN.11.1
Individual Allied Health Services for people of Aboriginal or Torres Strait Islander descent following a health assessment or a Chronic Disease Management plan (items 81300 to 81360, 93048 and 93061)
Eligible Patients
A patient who is of Aboriginal or Torres Strait Islander descent may be referred for individual allied health services under items 81300 to 81360, 93048 and 93061 (MBS Group M11 and equivalent telehealth services) when the GP or prescribed medical practitioner:
- has undertaken a health assessment and identified a need for follow-up allied health services; or
- is managing the patients complex care needs under a GP Management Plan and Team Care Arrangements or, if the patient is a resident of a residential aged care facility, the patient’s GP/prescribed medical practitioner has contributed to a multidisciplinary care plan.
A prescribed medical practitioner is a medical practitioner other than a GP, specialist, or consultant physician.
Number of Services Per Calendar Year
Medicare benefits are available for up to 10 individual allied health services per eligible patient, per calendar year. The 10 services can be made up of one type of service (e.g. 10 physiotherapy services) or a combination of different types of services (e.g. one dietetic service, 2 podiatry services, 2 Aboriginal and Torres Strait Islander health practitioner services, and 5 physiotherapy services).
The annual total limit of 10 individual allied health services per patient can include a combination of the following items:
- up to 5 services under a GP Management Plan and Team Care Arrangement (10950, 10951, 10952, 10953, 10954, 10956, 10958, 10960, 10962, 10964, 10966, 10968, 10970, 93000 and 93013 - MBS Group M3 and equivalent telehealth services) using a referral form for Chronic Disease Management (see MN 3.1).
- up to 10 services under MBS Group M11 and equivalent telehealth services (81300 to 81360, 93048 and 93061).
Referral Requirements
A referral is required for patients of Aboriginal or Torres Strait Islander descent to access up to 10 individual allied health services following a health assessment, or where the patient is being managed under a GP Management Plan and Team Care Arrangements or a multidisciplinary care plan.
Referral form
For Medicare benefits to be payable, the patient must be referred to an eligible allied health professional by their GP or prescribed medical practitioner using a referral form that has been issued by the Australian Government Department of Health and Aged Care or a form that contains all the components of this form.
The form issued by the department is available on the Department of Health and Aged Care website. This referral form is to be used for a referral to health service/s under M11 (or equivalent telehealth service). GPs and prescribed medical practitioners are encouraged to attach relevant information to the referral form.
GPs and prescribed medical practitioners may use one referral form to refer patients for single or multiple services of the same service type (e.g. 10 dietetic services). If referring a patient for single or multiple services of different service types (e.g. 2 dietetic services and 8 podiatry services), a separate referral form will be needed for each service type.
Providers should retain referrals for their services for 24 months from the date the service was rendered for Medicare auditing purposes.
Referral validity
If a patient has not used all their services under a referral in a calendar year, it is not necessary to obtain a new referral for the ‘unused’ services. The ‘unused’ services will roll over into the following calendar year and will count towards the total of 10 services for which the patient is eligible in that calendar year.
When patients have used all their eligible referred services, they will need to obtain a new referral from their GP/prescribed medical practitioner (noting that a new referral will not enable the patient to access more than 10 services in that calendar year).
Eligible Allied Health Professionals
To provide services under these items, allied health professionals must meet the eligibility requirements as set out in the Health Insurance (Section 3C General Medical Services – Allied Health Services) Determination 2024.
The following allied health professionals are eligible to provide services under these items:
- Aboriginal and Torres Strait Islander health practitioners (81300)
- Aboriginal health workers (81300)
- audiologists (81310)
- chiropractors (81345)
- diabetes educators (81305)
- dietitians (81320)
- exercise physiologists (81315)
- mental health workers (81325) which include 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
- occupational therapists (81330)
- osteopaths (81350)
- physiotherapists (81335)
- podiatrists (81340)
- psychologists (81355)
- speech pathologists (81360)
The telehealth items for these services can be claimed under 93048 and 93061.
Reporting back to the GP/ Prescribed Medical Practitioner
Where an allied health professional provides a single service to the patient under a referral, they must provide a written report back to the referring GP/ prescribed medical practitioner after that service.
Where an allied health professional provides multiple services to the same patient under a referral, they must provide a written report back to the referring GP/ prescribed medical practitioner after the first and last service, or more often if clinically necessary. Written reports should include:
- any investigations, tests, and/or assessments carried out on the patient;
- any treatment provided; and
- future management of the patient's condition or problem.
The report/s to the referring practitioner must be kept by the allied health professional who provided the service for 2 years from the date of the service.
Related Items: 81300 81305 81310 81315 81320 81325 81330 81335 81340 81345 81350 81355 81360 93048 93061
Legend
- 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