Medicare Benefits Schedule - Note AN.0.69

Publication date: 1 July 2024

SUMMARY

Time tiered health assessment items may be used to undertake a one-off Veterans’ Health Assessment for former serving members of the Australian Defence Force (ADF), including former members of permanent and reserve forces.

Annual Veterans’ Health Checks are available for certain DVA Veteran Card holders. These health checks are not provided through the MBS. More information on the Annual Veterans’ health checks is available from the Department of Veterans’ Affairs.

Note: The requirements below must be met in addition to common principles for time tiered health assessment items, contained in AN.0.36.

USE OF ITEMS

The specific requirements of the Veterans’ Health Assessment are set out in Clause 2.15.10 of the Health Insurance (General Medical Services Table) Regulations 2021 (the Regulations).

The Regulations require that a Veterans Health Assessment must include:

• an assessment of a patient's physical and psychological health and social function, and
• whether health care, education or other assistance should be offered to the patient to improve the patient's physical or psychological health or social function.

The Regulations also state that the health assessment must include taking a history of the patient that includes the following:

• an assessment of the patient's service with the Australian Defence Force, including service type, years of service, field of work, number of deployments and reason for discharge
• the patient's social history, including relationship status, number of children (if any) and current occupation
• the patient's current medical conditions, and
• whether the patient suffers from hearing loss or tinnitus
• the patient's use of medication, including medication prescribed by another doctor and medication obtained without a prescription
• the patient's smoking, if applicable
• the patient's alcohol use, if applicable
• the patient's substance use, if applicable
• the patient's level of physical activity
• whether the patient has bodily pain
• whether the patient has difficulty getting to sleep or staying asleep
• whether the patient has psychological distress
• whether the patient has post-traumatic stress disorder
• whether the patient is at risk of harm to self or others
• whether the patient has anger problems
• the patient's sexual health, and
• any other health concerns the patient has.

Note: The Regulations do not preclude a medical practitioner’s consideration of the patient’s broader immunisation status, such as for immunisations listed under the National Immunisation Program schedule or for COVID-19, or broader health factors, such as a patient’s occupational exposure to biological or chemical substances that may be potentially harmful.

A Veterans Health Check must also include:

• measuring the patient’s height
• weighing the patient and ascertaining, or asking the patient, whether the patient’s weight has changed in the last 12 months
• measuring the patient’s waist circumference
• taking the patient’s blood pressure
• using information gained in the course of taking the patient's history to assess whether any further assessment of the patient's health is necessary either by:
  • making the further assessment, or
  • or referring the patient to another medical practitioner who can make the further assessment,
• documenting a strategy for improving the patient's health, and
• offering to give the patient a written report of the assessment that makes recommendations for treating the patient including preventive health measures. 

The Veterans Health Assessment may be performed using the ADF Post-discharge GP Health Assessment Tool found on the Department of Veterans' Affairs website at: https://www.dva.gov.au/about-us/dva-forms/veteran-health-check-assessment-tool.

ELIGIBLE PATIENTS

Patients eligible for a Veterans’ Health Assessments are former members of the Permanent Forces or a former member of the Reserves. 

A Veterans’ Health Assessment cannot be claimed more than once by an eligible patient.

ELIGIBLE PRACTITIONERS

A Veterans’ Health Assessment can be undertaken by a general practitioner (see GN.4.13) or a prescribed medical practitioner (see AN.7.1).

Patients must access a Veterans’ Health Assessment through their usual GP or prescribed medical practitioner. In relation to a patient, means a general practitioner, or a prescribed medical practitioner, employed by a medical practice:

• that has provided at least 50% of the primary health care required by the patient in the last 12 months, or
• that the patient anticipates will provide at least 50% of the patient’s primary health care requirements in the next 12 months.

Note: the usual doctor requirements for the Veterans’ Health Assessment are different to those applying to health assessments generally.

Information on the definition of usual GP or prescribed medical practitioner for health assessment items is available in AN.0.36.

CO-CLAIMING RESTRICTIONS

A separate consultation must not be performed in conjunction with a Veterans’ Health Assessment service, unless clinically necessary.

To co-claim a health assessment item and another item, both items must be clinically necessary and distinct services.

RECORD KEEPING AND REPORTING REQUIREMENTS

The Regulations require that the doctor must keep a record of the assessment.

The department undertakes regular post payment auditing to ensure that MBS items are claimed appropriately. Practitioners should ensure they keep adequate and contemporaneous records. For information on what constitutes adequate and contemporaneous records see GN.15.39.

Clause 4.3 of the Health Insurance Act 1973 specifies that, where an item specifies the creation of a document (however described) and a document it created, the document must be retained for the period of 2 years.

RELEVANT LEGISLATION

Details about the legislative requirements of the MBS items can be found on the Federal Register of Legislation at www.legislation.gov.au. Health assessment items are set out in the following regulatory instrument:

• Health Insurance (General Medical Services Table) Regulations 2021.

Related Items: 224 225 226 227 701 703 705 707

• Previous - Note AN.0.66
• Next - Note AN.0.70

Professional attendance by a general practitioner  to perform a brief health assessment, lasting not more than 30 minutes and including:

(a) collection of relevant information, including taking a patient history; and

(b) a basic physical examination; and

(c) initiating interventions and referrals as indicated; and

(d) providing the patient with preventive health care advice and information

Fee: $67.60 Benefit: 100% = $67.60

(See para AN.0.36, AN.0.37, AN.0.38, AN.0.39, AN.0.40, AN.0.41, AN.0.42, AN.0.69 of explanatory notes to this Category)

Professional attendance by a general practitioner to perform a standard health assessment, lasting more than 30 minutes but less than 45 minutes, including:

(a) detailed information collection, including taking a patient history; and

(b) an extensive physical examination; and

(c) initiating interventions and referrals as indicated; and

(d) providing a preventive health care strategy for the patient

Fee: $157.10 Benefit: 100% = $157.10

(See para AN.0.36, AN.0.37, AN.0.38, AN.0.39, AN.0.40, AN.0.41, AN.0.42, AN.0.69 of explanatory notes to this Category)

Professional attendance by a general practitioner  to perform a long health assessment, lasting at least 45 minutes but less than 60 minutes, including:

(a) comprehensive information collection, including taking a patient history; and

(b) an extensive examination of the patient's medical condition and physical function; and

(c) initiating interventions and referrals as indicated; and

(d) providing a basic preventive health care management plan for the patient

Fee: $216.80 Benefit: 100% = $216.80

(See para AN.0.36, AN.0.37, AN.0.38, AN.0.39, AN.0.40, AN.0.41, AN.0.42, AN.0.69 of explanatory notes to this Category)

Professional attendance by a general practitioner to perform a prolonged health assessment (lasting at least 60 minutes) including:

(a) comprehensive information collection, including taking a patient history; and

(b) an extensive examination of the patient's medical condition, and physical, psychological and social function; and

(c) initiating interventions or referrals as indicated; and

(d) providing a comprehensive preventive health care management plan for the patient

Fee: $306.25 Benefit: 100% = $306.25

(See para AN.0.36, AN.0.37, AN.0.38, AN.0.39, AN.0.40, AN.0.41, AN.0.42, AN.0.69 of explanatory notes to this Category)

Professional attendance by a prescribed medical practitioner to perform a brief health assessment, lasting not more than 30 minutes and including:
(a) collection of relevant information, including taking a patient history; and
(b) a basic physical examination; and
(c) initiating interventions and referrals as indicated; and
(d) providing the patient with preventive health care advice and information

Fee: $54.10 Benefit: 100% = $54.10

(See para AN.0.36, AN.0.37, AN.0.38, AN.0.39, AN.0.40, AN.0.41, AN.0.42, AN.0.69 of explanatory notes to this Category)

Professional attendance by a prescribed medical practitioner to perform a standard health assessment, lasting more than 30 minutes but less than 45 minutes, including:
(a) detailed information collection, including taking a patient history; and
(b) an extensive physical examination; and
(c) initiating interventions and referrals as indicated; and
(d) providing a preventive health care strategy for the patient

Fee: $125.70 Benefit: 100% = $125.70

(See para AN.0.36, AN.0.37, AN.0.38, AN.0.39, AN.0.40, AN.0.41, AN.0.42, AN.0.69 of explanatory notes to this Category)

Professional attendance by a prescribed medical practitioner to perform a long health assessment, lasting at least 45 minutes but less than 60 minutes, including:
(a) comprehensive information collection, including taking a patient history; and
(b) an extensive examination of the patient’s medical condition and physical function; and
(c) initiating interventions and referrals as indicated; and
(d) providing a basic preventive health care management plan for the patient

Fee: $173.40 Benefit: 100% = $173.40

(See para AN.0.36, AN.0.37, AN.0.38, AN.0.39, AN.0.40, AN.0.41, AN.0.42, AN.0.69 of explanatory notes to this Category)

Professional attendance by a prescribed medical practitioner to perform a prolonged health assessment, lasting at least 60 minutes, including:
(a) comprehensive information collection, including taking a patient history; and
(b) an extensive examination of the patient’s medical condition, and physical, psychological and social function; and
(c) initiating interventions and referrals as indicated; and
(d) providing a comprehensive preventive health care management plan for the patient

Fee: $245.00 Benefit: 100% = $245.00

(See para AN.0.36, AN.0.37, AN.0.38, AN.0.39, AN.0.40, AN.0.41, AN.0.42, AN.0.69 of explanatory notes to this Category)