Medicare Benefits Schedule - Note AN.0.31

Item 319 or 91873 provides for an attendance, by a psychiatrist, to provide intensive psychotherapy where the patient’s clinical condition requires intensive treatment. Clinical appropriateness and indications for intensive psychotherapy are determined following a comprehensive assessment and formulation of a diagnosis and should be documented in the patient’s notes. It is also expected that other appropriate psychiatric treatment has been used for a suitable period and the patient has shown little or no response to such treatment. Such treatment would include, but not be limited to: shorter term psychotherapy; less frequent but long-term psychotherapy; pharmacological therapy; and cognitive behaviour therapy. 

Once a patient is identified as meeting the criteria of item 319 or 91873, eligibility continues under that item for the duration of that course of treatment (provided that attendances under items 296, 297, 299, 300, 302, 304, 306, 308, 319, 91827 to 91831, 91837 to 91839, 91873 and 92437 do not exceed 160 in a calendar year). If the patient requires more than 160 services in a calendar year for intensive psychotherapy, then such attendances would be covered by items 310, 312, 314, 316, 318, 91868 to 91872 or 91879 to 91881. 

Related Items: 296 297 299 300 302 304 306 308 310 312 314 316 318 319 91827 91831 91837 91839 91873 92437

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Professional attendance of more than 45 minutes in duration by a consultant physician in the practice of the consultant physician's speciality of psychiatry following referral of the patient to him or her by a referring practitioner-an attendance at consulting rooms if the patient:

(a) is a new patient for this consultant psychiatrist; or

(b) has not received a professional attendance from this consultant psychiatrist in the preceding 24 months;

other than attendance on a patient in relation to whom this item, or any of items 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 has applied in the preceding 24 months

Fee: $301.05 Benefit: 75% = $225.80 85% = $255.90

(See para AN.0.25, AN.0.30, AN.0.31, AN.0.32, AN.0.75, AN.0.76, AN.40.1 of explanatory notes to this Category)

Professional attendance of more than 45 minutes by a consultant physician in the practice of the consultant physician's speciality of psychiatry following referral of the patient to him or her by a referring practitioner-an attendance at hospital if the patient:

(a) is a new patient for this consultant psychiatrist; or

(b) has not received a professional attendance from this consultant psychiatrist in the preceding 24 months;

other than attendance on a patient in relation to whom this item, or any of items 296, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 has applied in the preceding 24 months (H)

Fee: $301.05 Benefit: 75% = $225.80

(See para AN.0.25, AN.0.30, AN.0.31, AN.0.32, AN.0.75, AN.0.76 of explanatory notes to this Category)

Professional attendance of more than 45 minutes by a consultant physician in the practice of the consultant physician's speciality of psychiatry following referral of the patient to him or her by a referring practitioner-an attendance at a place other than consulting rooms or a hospital if the patient:

(a) is a new patient for this consultant psychiatrist; or

(b) has not received a professional attendance from this consultant psychiatrist in the preceding 24 months;

other than attendance on a patient in relation to whom this item, or any of items 296, 297, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 has applied in the preceding 24 months

Fee: $359.90 Benefit: 85% = $305.95

(See para AN.0.25, AN.0.30, AN.0.31, AN.0.32, AN.0.75, AN.0.76 of explanatory notes to this Category)

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to him or her by a referring practitioner-an attendance of not more than 15 minutes in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 applies have not exceeded 50 attendances in a calendar year for the patient

Fee: $50.10 Benefit: 75% = $37.60 85% = $42.60

(See para AN.0.25, AN.0.30, AN.0.31, AN.0.32, AN.0.75, AN.0.76, AN.40.1 of explanatory notes to this Category)

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to him or her by a referring practitioner-an attendance of more than 15 minutes, but not more than 30 minutes, in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 applies have not exceeded 50 attendances in a calendar year for the patient

Fee: $100.00 Benefit: 75% = $75.00 85% = $85.00

(See para AN.0.25, AN.0.30, AN.0.31, AN.0.32, AN.0.75, AN.0.76, AN.40.1 of explanatory notes to this Category)

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to him or her by a referring practitioner-an attendance of more than 30 minutes, but not more than 45 minutes, in duration at consulting rooms), if that attendance and another attendance to which any of items 296, 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 applies have not exceeded 50 attendances in a calendar year for the patient

Fee: $153.90 Benefit: 75% = $115.45 85% = $130.85

(See para AN.0.25, AN.0.30, AN.0.31, AN.0.32, AN.0.75, AN.0.76, AN.40.1 of explanatory notes to this Category)

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to him or her by a referring practitioner-an attendance of more than 45 minutes, but not more than 75 minutes, in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 applies have not exceeded 50 attendances in a calendar year for the patient

Fee: $212.40 Benefit: 75% = $159.30 85% = $180.55

(See para AN.0.25, AN.0.30, AN.0.31, AN.0.32, AN.0.75, AN.0.76, AN.40.1 of explanatory notes to this Category)

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to him or her by a referring practitioner-an attendance of more than 75 minutes in duration at consulting rooms), if that attendance and another attendance to which any of items 296, 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 applies have not exceeded 50 attendances in a calendar year for the patient

Fee: $246.50 Benefit: 75% = $184.90 85% = $209.55

(See para AN.0.25, AN.0.30, AN.0.31, AN.0.32, AN.0.75, AN.0.76, AN.40.1 of explanatory notes to this Category)

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner-an attendance of not more than 15 minutes in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 applies exceed 50 attendances in a calendar year for the patient

Fee: $24.95 Benefit: 75% = $18.75 85% = $21.25

(See para AN.0.25, AN.0.31, AN.0.32, AN.0.76 of explanatory notes to this Category)

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner-an attendance of more than 15 minutes, but not more than 30 minutes, in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 applies exceed 50 attendances in a calendar year for the patient

Fee: $50.10 Benefit: 75% = $37.60 85% = $42.60

(See para AN.0.25, AN.0.31, AN.0.32, AN.0.76 of explanatory notes to this Category)

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner-an attendance of more than 30 minutes, but not more than 45 minutes, in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 applies exceed 50 attendances in a calendar year for the patient

Fee: $77.15 Benefit: 75% = $57.90 85% = $65.60

(See para AN.0.25, AN.0.31, AN.0.32, AN.0.76 of explanatory notes to this Category)

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner-an attendance of more than 45 minutes, but not more than 75 minutes, in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 applies exceed 50 attendances in a calendar year for the patient

Fee: $106.30 Benefit: 75% = $79.75 85% = $90.40

(See para AN.0.25, AN.0.31, AN.0.32, AN.0.76 of explanatory notes to this Category)

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner-an attendance of more than 75 minutes in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 applies exceed 50 attendances in a calendar year for the patient

Fee: $123.25 Benefit: 75% = $92.45 85% = $104.80

(See para AN.0.25, AN.0.31, AN.0.32, AN.0.76 of explanatory notes to this Category)

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—an attendance lasting more than 45 minutes at consulting rooms, if:

(a) the formulation of the patient’s clinical presentation indicates intensive psychotherapy is a clinically appropriate and indicated treatment; and

(b) that attendance and another attendance to which any of items 296, 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839, 91873 and 92437 applies have not exceeded 160 attendances in a calendar year for the patient

Fee: $212.40 Benefit: 75% = $159.30 85% = $180.55

(See para AN.0.25, AN.0.31, AN.0.32, AN.0.76 of explanatory notes to this Category)

Telehealth attendance for a person by a consultant psychiatrist; if:

(a)     the attendance follows a referral of the patient to the consultant psychiatrist by a referring practitioner; and

(b)     the attendance was not more than 15 minutes in duration;

if that attendance and another attendance to which item 296, 297, 299 or any of items 300, 302, 304, 306, 308, 91828 to 91831, 91837 to 91839 and 92437 applies have not exceeded 50 attendances in a calendar year

Fee: $50.10 Benefit: 85% = $42.60

(See para AN.0.30, AN.0.31, AN.0.75 of explanatory notes to this Category)

Telehealth attendance for a person by a consultant psychiatrist; if:

(a)     the attendance follows a referral of the patient to the consultant psychiatrist by a referring practitioner; and

(b)     the attendance was at least 75 minutes in duration;

if that attendance and another attendance to which item 296, 297, 299 or any of items 300, 302, 304, 306 to 308, 91827 to 91830, 91837 to 91839 and 92437 applies have not exceeded 50 attendances in a calendar year.

Fee: $246.50 Benefit: 85% = $209.55

(See para AN.0.25, AN.0.30, AN.0.31, AN.0.75 of explanatory notes to this Category)

Telehealth attendance lasting at least 45 minutes by a consultant physician in the practice of the consultant physician’s specialty of psychiatry, following referral of the patient to the psychiatrist by a referring practitioner, where the formulation of the patient’s clinical presentation indicates intensive psychotherapy is a clinically appropriate and indicated treatment, if that attendance and another attendance to which any of items 296, 297, 299 or any of items 300, 302, 304, 306, 308, 319, 92437, 91827, 91828, 91829, 91830, 91831, 91837, 91838, 91839, 91868, 91869, 91870, 91871, 91872 or 91879 to 91881 applies has not exceeded 160 attendances in a calendar year for the patient

Fee: $212.40 Benefit: 85% = $180.55

(See para AN.0.31 of explanatory notes to this Category)

Telehealth attendance of more than 45 minutes in duration by a consultant physician in the practice of the consultant physician’s speciality of psychiatry following referral of the patient to the consultant physician by a referring practitioner:

(a) if the patient:

    (i) is a new patient for this consultant physician; or

    (ii) has not received an attendance from this consultant physician in the preceding 24 months; and

(b)  the patient has not received an attendance under this item, or item 91827 to 91831, 91837 to 91839, 92455 to 92457, 91868 to 91873, 91879 to 91881 or item 296, 297, 299, 300, 302, 304, 306 to 308, 310, 312, 314, 316, 318, 319, 320, 322, 324, 326, 328, 330, 332, 334, 336, 338, 342, 344 or 346 of the general medical services table, in the preceding 24 months

Fee: $301.05 Benefit: 85% = $255.90

(See para AN.0.25, AN.0.30, AN.0.31, AN.0.75, AN.0.76 of explanatory notes to this Category)

Phone attendance for a person by a consultant psychiatrist; if:

(a)   the attendance follows a referral of the patient to the consultant psychiatrist by a referring practitioner; and

(b)   the attendance was not more than 15 minutes duration;

Where the attendance is after the first attendance as part of a single course of treatment, if that attendance and another attendance to which item 296, 297, 299 or any of items 300, 302, 304, 306 to 308, 91827 to 91831, 91838, 91839 and 92437 applies have not exceeded 50 attendances in a calendar year

Fee: $50.10 Benefit: 85% = $42.60

(See para AN.0.30, AN.0.31, AN.0.75 of explanatory notes to this Category)

 Phone attendance for a person by a consultant psychiatrist; if:

(a)   the attendance follows a referral of the patient to the consultant psychiatrist by a referring practitioner; and

(b)   the attendance was at least 30 minutes, but not more than 45 minutes in duration

Where the attendance is after the first attendance as part of a single course of treatment, if that attendance and another attendance to which item 296, 297, 299 or any of items 300, 302, 304, 306 to 308, 91827 to 91831, 91837, 91838 and 92437 applies have not exceeded 50 attendances in a calendar year

Fee: $153.90 Benefit: 85% = $130.85

(See para AN.0.25, AN.0.30, AN.0.31, AN.0.75 of explanatory notes to this Category)