Medicare Benefits Schedule - Note AN.1.1

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 91894 92210

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Phone attendance by a general practitioner lasting less than 6 minutes for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited management

Fee: $18.85 Benefit: 100% = $18.85

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

Phone attendance by a general practitioner lasting at least 6 minutes if the attendance includes any of the following that are clinically relevant:

(a) taking a short patient history;

(b) arranging any necessary investigation;

(c) implementing a management plan;

(d) providing appropriate preventative health care

Fee: $41.20 Benefit: 100% = $41.20

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

Phone attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician) lasting less than 6 minutes for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited management

Fee: $11.00 Benefit: 100% = $11.00

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

Phone attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician) lasting at least 6 minutes if the attendance includes any of the following that are clinically relevant:

(a) taking a short patient history;

(b) arranging any necessary investigation;

(c) implementing a management plan;

(d) providing appropriate preventative health care

Fee: $21.00 Benefit: 100% = $21.00

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

Phone attendance by a general practitioner lasting at least 20 minutes, if:

(a)     the attendance is performed from a practice location in Modified Monash areas 6 or 7; and

(b)    the attendance includes any of the following that are clinically relevant:

(i)        taking a detailed patient history;

(ii)       arranging any necessary investigation;

(iii)     implementing a management plan;

(iv)     providing appropriate preventative health care

Fee: $79.70 Benefit: 100% = $79.70

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

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: $167.55 Benefit: 100% = $167.55

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