Medicare Benefits Schedule - Item 92721

Telehealth attendance for the provision of services related to blood borne viruses, sexual or reproductive health by a general practitioner of more than 20 minutes in duration but not more than 40 minutes if the attendance includes any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) arranging any necessary investigation;

(c) implementing a management plan;

(d) providing appropriate preventive health care

Note: Consultations related to assisted reproductive technology and antenatal care are outside the scope of these items and cannot be rendered under these items.

Fee: $82.90 Benefit: 100% = $82.90

(See para AN.1.1, AN.40.5 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $248.70

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It is a legislative requirement that 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 receiving treatment through Mental Health telehealth items, a person receiving treatment through Blood Borne Virus, Sexual or Reproductive Health telehealth items, a person living in a natural disaster affected area, a person receiving an urgent after-hours service (in unsociable hours), a person who receives the service from a medical practitioner located at an Aboriginal Medical Service or an Aboriginal Community Controlled Health Service, or a person isolating because of a COVID-related State or Territory public health order, or in COVID-19 quarantine because of a State or Territory public health order.

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 receiving treatment through Mental Health telehealth items means services must be claimed as specific GP or prescribed medical practitioner mental health and eating disorder telehealth items. 

person receiving treatment through Blood Borne Virus, Sexual or Reproductive Health telehealth items means services must be claimed as specific GP or prescribed medical practitioner telehealth items (see also AN.40.5) 

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: 92210 92211 92715 92716 92717 92718 92719 92720 92721 92722 92723 92724 92725 92726 92731 92732 92733 92734 92735 92736 92737 92738 92739 92740 92741 92742

The video and phone items for the provision of services related to blood borne viruses, sexual or reproductive health provides for Medicare benefits to be paid for these health care services without the requirement for the patient to have an established clinical relationship with the physician. This does not exclude practitioners who have an established clinical relationship with the patient from using these items.

These items are intended to support patient access to medical services where there may be barriers due to privacy or limited service provision, and are not intended to replace routine services that a patient’s usual practitioner might provide.

The practitioner must keep adequate and contemporary notes to support the service provided.

There are 24 MBS items for the provision of video or phone services related to blood borne viruses, sexual or reproductive health.

Video consultation

Item 92715 – services provided by a General Practitioner (level A)

Item 92716 – services provided by an Other Medical Practitioner - urban

Item 92717 – services provided by an Other Medical Practitioner – rural

Item 92718 – services provided by a General Practitioner (level B)

Item 92719 – services provided by an Other Medical Practitioner - urban

Item 92720 – services provided by an Other Medical Practitioner – rural

Item 92721 – services provided by a General Practitioner (level C)

Item 92722 – services provided by an Other Medical Practitioner - urban

Item 92723 – services provided by an Other Medical Practitioner – rural

Item 92724 – services provided by a General Practitioner (level D)

Item 92725 – services provided by an Other Medical Practitioner – urban

Item 92726 – services provided by an Other Medical Practitioner – rural

Phone consultation

Item 92731 – services provided by a General Practitioner (level A)

Item 92732 – services provided by an Other Medical Practitioner - urban

Item 92733 – services provided by an Other Medical Practitioner – rural

Item 92734 – services provided by a General Practitioner (level B)

Item 92735 – services provided by an Other Medical Practitioner - urban

Item 92736 – services provided by an Other Medical Practitioner – rural

Item 92737 – services provided by a General Practitioner (level C)

Item 92738 – services provided by an Other Medical Practitioner - urban

Item 92739 – services provided by an Other Medical Practitioner – rural

Item 92740– services provided by a General Practitioner (level D)

Item 92741– services provided by an Other Medical Practitioner – urban

Item 92742 – services provided by an Other Medical Practitioner - rural

To be eligible for use of this item, practitioners must be located at a medical practice or have a formal agreement with a medical practice that provides onsite face to face services to patients.

Consultations related to assisted reproductive technology and antenatal care are outside the scope of these items and cannot be rendered under these items.

Related Items: 92715 92716 92717 92718 92719 92720 92721 92722 92723 92724 92725 92726 92731 92732 92733 92734 92735 92736 92737 92738 92739 92740 92741 92742