Medicare Benefits Schedule - Item 92210

Telehealth attendance by a general practitioner on not more than one patient on one occasion—each attendance in unsociable hours if:

(a) the attendance is requested by the patient or a responsible person in the same unbroken after‑hours period; and

(b) the patient’s medical condition requires urgent assessment.

Fee: $168.40 Benefit: 100% = $168.40

(See para AN.1.1 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $500.00

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It is a legislative requirement that GPs and other medical practitioners working in general practice must only perform a telehealth or telephone service where they have an established clinical relationship with the patient.

An established clinical relationship is defined as:

·         the medical practitioner who performs the service has provided a face-to-face service to the patient in the last 12 months; or

·         the medical practitioner who performs the service is located at a medical practice, and the patient has a face-to-face service arranged by that practice in the last 12 months. This can be a service performed by another doctor located at the practice, or a service performed by another health professional located at the practice (such as a practice nurse or Aboriginal and Torres Strait Islander health worker); or

·         the medical practitioner who performs the service is a participant in the Approved Medical Deputising Service (AMDS) program, and the Approved Medical Deputising Service provider (AMDS provider) that employs the medical practitioner has a formal agreement with a medical practice that has provided at least one face-to-face service to the patient in the last 12 months.

This requirement does not apply to a person who is under the age of 12 months, a person who is experiencing homelessness, a person who has tested positive for COVID-19, or person who is experiencing acute respiratory symptoms and who meets the PBS criteria for COVID-19 antiviral therapy (until 31 December 2023), or people living in a natural disaster affected area, a person receiving an urgent after-hours service (in unsociable hours), or a person who receives the service from a medical practitioner located at an Aboriginal Medical Service or an Aboriginal Community Controlled Health Service.

person who is experiencing homelessness means when a person does not have suitable accommodation alternatives they are considered homeless if their current living arrangement:

(a)  is in a dwelling that is inadequate; or

(b)  has no tenure, or if their initial tenure is short and not extendable; or

(c)  does not allow them to have control of, and access to space for social relations.

person who has tested positive for COVID-19 means a patient who has received a positive COVID-19 test result within the last 7 days, confirmed by either:

(a)  Laboratory testing (PCR); or

(b)  A COVID-19 rapid antigen self test (RAT) which has been approved for supply in Australia by the Therapeutic Goods Administration.

person who meets the PBS criteria for COVID-19 antiviral therapy means a person who is:

(a)  70 years of age or older;

(b)  50 years of age or older with at least two additional risk factors;

(c)  of First Nations descent, who is 30 years of age or older and with at least one additional risk factor; or

(d)  18 years of age or older and who is moderately to severely immunocompromised

people living in a natural disaster affected area is defined as a State or Territory local government area which is currently declared as a natural disaster area by a State or Territory Government until that declaration is deemed to have expired.

Related Items: 91890 91891 91892 91893 92210