Medicare Benefits Schedule - Item 81350

OSTEOPATHY HEALTH SERVICE provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible osteopath if:

(a)    either:

1. a medical practitioner has undertaken a health assessment and identified a need for follow-up allied health services; or

2. the person’s shared care plan identifies the need for follow-up allied health services; and

(b)    the person is referred to the eligible osteopath by a medical practitioner using a referral form that has been issued by the Department or a referral form that substantially complies with the form issued by the Department; and

(c)    the person is not an admitted patient of a hospital; and

(d)    the service is provided to the person individually and in person; and

(e)    the service is of at least 20 minutes duration; and

(f)    after the service, the eligible osteopath gives a written report to the referring medical practitioner mentioned in paragraph (b):

        (i) if the service is the only service under the referral - in relation to that service; or

        (ii) if the service is the first or the last service under the referral - in relation to the service; or

(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical                   practitioner would reasonably be expected to be informed of - in relation to those matters

 

- to a maximum of  five services (including services to which items 81300 to 81360, 93048, 93061, 93546 to 93558 and 93579 to 93593 inclusive apply) in a calendar year

Fee: $68.20 Benefit: 85% = $58.00

(See para MN.11.1 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $204.60

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Eligible Patients

A person who is of Aboriginal or Torres Strait Islander descent may be referred by their GP or medical practitioner for follow-up allied health services under items 81300, 81305, 81310, 81315, 81320, 81325, 81330, 81335, 81340, 81345, 81350, 81355, 81360, 93048 and 93061 when the GP or medical practitioner has undertaken a health assessment and identified a need for follow-up allied health services. 

These items are similar to the individual allied health items (items 10950, 10951, 10952, 10953, 10954, 10956, 10958, 10960, 10962, 10964, 10966, 10968, 10970, 93000 and 93013) and are available to patients who have a chronic or terminal medical condition and complex care needs managed under a GP Management Plan and Team Care Arrangements prepared by their GP. However, items 81300, 81305, 81310, 81315, 81320, 81325, 81330, 81335, 81340, 81345, 81350, 81355, 81360, 93048 and 93061 provide an alternative referral pathway for First Nations Australians to access allied health services. If a patient meets the eligibility criteria for individual allied health services under the Chronic Disease Management items and for follow-up allied health services, they can access both sets of services and are eligible for up to 10 allied health services under Medicare per calendar year. 

A practice nurse/Aboriginal and Torres Strait Islander health practitioner item (10987, 93048 and 93061) is also available for Indigenous Australians who have received a health check. This item enables Aboriginal or Torres Strait Islander people to receive follow-up services from a practice nurse or Aboriginal and Torres Strait Islander health practitioner on behalf of a GP or medical practitioner. More detail on this item is provided at explanatory note M.12.4 of the Medicare Benefits Schedule. 

Eligible Allied Health Services

The following allied health professionals are eligible to provide services under these items:

• Aboriginal and Torres Strait Islander health practitioners
• Aboriginal Health Workers
• Audiologists
• Chiropractors
• Diabetes Educators
• Dietitians
• Exercise Physiologists
• Mental Health Workers
• Occupational Therapists
• Osteopaths
• Physiotherapists
• Podiatrists
• Psychologists
• Speech Pathologists 

Publicly funded services

These items do not apply for services that are provided by any Commonwealth or state or territory government funded services or provided to an admitted patient of a hospital. However, where an exemption under subsection 19(2) of the Health Insurance Act 1973 has been granted to an Aboriginal Community Controlled Health Service or state/territory government health clinic, items 81300, 81305, 81310, 81315, 81320, 81325, 81330, 81335, 81340, 81345, 81350, 81355, 81360, 93048 and 93061 can be claimed for services provided by eligible allied health professionals salaried by, or contracted to, the service or health clinic. All requirements of the relevant item must be met, including registration of the allied health professional with Services Australia. Medicare services provided under a subsection 19(2) exemption must be bulk billed (i.e. the Medicare rebate is accepted as full payment for services). 

Number of services per year

Medicare benefits are available for up to 5 follow-up allied health services per eligible patient, per calendar year. The 5 allied health services can be made up of one type of service (e.g. 5 physiotherapy services) or a combination of different types of services (e.g. one dietetic, 2 podiatry and 2 physiotherapy services). 

The annual limit of 5 allied health services per patient under these items is in addition to the individual allied health services for patients with a chronic or terminal medical condition and complex care needs. 

Checking patient eligibility

If there is any doubt about a patient's eligibility, Services Australia will be able to confirm the number of allied health services already claimed by the patient during the calendar year. Allied health professionals can call Services Australia on 132 150 and patients can call Services Australia on 132 011 or alternatively, the Indigenous Access Line for Services Australia on 1800 556 955. 

Service length and type

Services provided by eligible allied health professionals under these items must meet the specific requirements set out in the item descriptors. These requirements include that:

• the service is of at least 20 minutes duration;
• the service is provided to the person individually (i.e. not as part of a group service) and for items 81300 to 81360 the service is provided in person (i.e. the allied health professional must personally attend the patient);
• the person is not an admitted patient of a hospital;
• the allied health professional must provide a written report to the GP; and
• if the patient has private health insurance, they cannot use their private health insurance general cover (also known as extras or ancillary cover) to 'top up' the Medicare rebate paid for these services. 

Private health insurance

Patients need to decide if they will use Medicare or their private health insurance general treatment cover (also known as ancillary or extras cover) cover to pay for these services. Patients cannot use their private health insurance general cover to 'top up' the Medicare rebate paid for the services. 

Reporting back to the GP/Medical Practitioner

Where an allied health professional provides a single service to the patient under a referral, the allied health professional must provide a written report back to the referring GP/ medical practitioner after that service. 

Where an allied health professional provides multiple services to the same patient under a referral, the allied health professional must provide a written report back to the referring GP/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. 

Allied health professionals are required to retain the report for 2 years.

Out-of-pocket expenses and Medicare safety net

Allied health professionals can determine their own fees for the professional service, except where the service is provided under a subsection 19(2) exemption. Charges in excess of the Medicare benefit for the allied health items are the responsibility of the patient. However, such out-of-pocket costs will count toward the Medicare safety net for that patient. Allied health services in excess of 5 in a calendar year will not attract a Medicare benefit and the safety net arrangements will not apply to costs incurred by the patient for such services. 

Referral Requirements

Referral form

For Medicare benefits to be payable, the patient must be referred to an eligible allied health professional by their GP or 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.

GPs and medical practitioners are encouraged to attach a copy of the relevant part of the patient's care plan to the referral form.

GPs and medical practitioner may use one referral form to refer patients for single or multiple services of the same service type (e.g. 5 dietetic services). If referring a patient for single or multiple services of different service types (e.g. 2 dietetic services and 3 podiatry services), a separate referral form will be needed for each service type. 

The patient will need to present the referral form to the allied health professional at the first consultation unless the GP/medical practitioner has previously provided it directly to the allied health professional. 

Allied health professionals are required to retain the referral form for 2 years from the date the service was rendered (for Services Australia auditing purposes). A copy of the referral form is not required to accompany Medicare claims, and allied health professionals do not need to attach a signed copy of the form to patients' itemised accounts/receipts or assignment of benefit forms. 

Completed forms do not have to be sent to the Department of Health and Aged Care. 

Referral validity

A referral is valid for the stated number of services. If all services are not used during the calendar year in which the patient was referred, the unused services can be used in the next calendar year. However, those services will be counted as part of the 5 rebates for allied health services available to the patient during that calendar year.

When patients have used all of their referred services, they will need to obtain a new referral from their GP/medical practitioner.

Allied health Professional Eligibility

These items can only be claimed for services provided by eligible allied health professionals who are registered with Services Australia. Allied health professionals already registered with Medicare do not need to register again to claim these items. 

Specific eligibility requirements for allied health professionals providing services under these items are: 

Aboriginal and Torres Strait Islander health practitioners must be registered with the Aboriginal and Torres Strait Islander Health Practice Board of Australia. Aboriginal and Torres Strait Islander health practitioners may use any of the titles authorised by the Aboriginal and Torres Strait Islander Health Practice Board: Aboriginal health practitioners; Aboriginal and Torres Strait Islander health practitioners; or Torres Strait Islander health practitioners. 

Aboriginal health workers in a State or Territory other than the Northern Territory must have been awarded either: 

• a Certificate III in Aboriginal and/or Torres Strait Islander Primary Health Care (or an equivalent or higher qualification) by a registered training organisation; or
• a Certificate III in Aboriginal and Torres Strait Islander Health (or an equivalent or higher qualification) by a registered training organisation before 1 July 2012. 

Note: Where individuals consider their qualification to be equivalent to or higher than the qualifications listed above, they will need to contact a registered training organisation in their state or territory to have the qualification assessed as such before they can register with Services Australia. In the Northern Territory, a practitioner must be registered with the Aboriginal and Torres Strait Islander Health Practice Board of Australia. 

Audiologists must be either a 'Full Member' of the Audiological Society of Australia Inc (ASA), who holds a 'Certificate of Clinical Practice' issued by the ASA; or an 'Ordinary Member - Audiologist' or 'Fellow Audiologist' of the Australian College of Audiology. 

Chiropractors must be registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided. Diabetes educators must be a Credentialled Diabetes Educator as credentialled by the Australian Diabetes Educators Association. 

Dietitians must be an 'Accredited Practising Dietitian' as recognised by the Dietitians Association of Australia. 

Exercise physiologists must be an 'Accredited Exercise Physiologist' as accredited by Exercise and Sports Science Australia. 

Mental health workers can include services provided by allied health professionals from the following:

• Aboriginal and Torres Strait Islander health practitioners; and
• Aboriginal health workers;
• mental health nurses;
• occupational therapists
• psychologists; and
• social workers.

Note. Psychologists, occupational therapists, Aboriginal and Torres Strait Islander health practitioners and Aboriginal health workers are eligible in separate categories for these items. 

Mental health nurses must be a credentialled mental health nurse, as certified by the Australian College of Mental Health Nurses. 

Social workers must be a 'Member' of the Australian Association of Social Workers (AASW); and be certified by AASW as meeting the standards for mental health set out in the document published by AASW titled 'Practice Standards for Mental Health Social Workers' as in force on 8 November 2008. 

Occupational therapists must be registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided.

Osteopaths must be registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided.

Physiotherapists must be registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided.

Podiatrists must be registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided.

Psychologists must be registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided.

Speech pathologists must be a 'Practising Member' of Speech Pathology Australia. 

Registering with Services Australia

Provider registration forms may be obtained from Services Australia on 132 150 or by visiting Services Australia website and then searching for "allied health application".

Further information

Further information about these items is available on the Department of Health and Aged Care. For providers, information is also available from Services Australia provider inquiry line on 132 150. The Indigenous Access Line for Services Australia on 1800 556 955 is also a useful source of information.

Related Items: 81300 81305 81310 81315 81320 81325 81330 81335 81340 81345 81350 81355 81360 93048 93061