Medicare Benefits Schedule - Note MN.9.1

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Category 8 - MISCELLANEOUS SERVICES

MN.9.1

Group Allied Health Services (Items 81100, 81105, 81110, 81115, 81120 and 81125) for People with Type 2 Diabetes - Eligible Patients

MBS items (81100, 81105, 81110, 81115, 81120 and 81125) are available for group allied health services for patients with type 2 diabetes. These items apply to services provided by eligible diabetes educators, exercise physiologists and dietitians, on referral from a GP or medical practitioner.

Services available under these items are in addition to the 5 individual allied health services available to patients each calendar year (refer to items 10950, 10951, 10952, 10953, 10954, 10956, 10958, 10960, 10962, 10964, 10966, 10968, 10970, 93000 and 93013).

To be eligible for these services, the patient must have in place one of the following:

  • a GP Management Plan (GPMP) (GP item 721 or medical practitioner item 229); OR
  • for a resident of a residential aged care facility, the GP or medical practitioner must have contributed to a multidisciplinary care plan, or contributed to a review of a multidisciplinary care plan prepared for them by the facility (GP item 731 or medical practitioner item 232). [Note: Generally, residents of an aged care facility rely on the facility for assistance to manage their type 2 diabetes. Therefore, the resident may not need to be referred for group allied health services under these items, as the self-management approach offered in group services may not be appropriate.].

Unlike the individual allied health services, there is no additional requirement for a Team Care Arrangement (GP item 723 or medical practitioner item 230) in order for the patient to be referred for group allied health services.

Once the patient has been referred by their GP or medical practitioner, a diabetes educator, exercise physiologist or dietitian will conduct an individual assessment (under items 81100, 81110, 81120, 93284 or 93286). A maximum of one assessment service is available per calendar year. After assessment, the patient may receive up to 8 group services per calendar year from an eligible diabetes educator, exercise physiologist and/or dietitian (under items 81105, 81115, 81125 or 93285). A collaborative approach, where diabetes educators, exercise physiologists and dietitians work together to develop group service programs in their local area, is encouraged.

Related Items: 81100 81105 81110 81115 81120 81125


Related Items

Category 8 - MISCELLANEOUS SERVICES

81100

81100 - Additional Information

Item Start Date:
01-May-2007
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Diabetes education health service provided to a patient by an eligible diabetes educator for assessing the patient’s suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient’s needs and preparing the patient for the group services if:

(a)   the patient has type 2 diabetes; and

(b)  the patient is being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a GP Management Plan or, if the patient is a resident of an aged care facility, the patient’s medical practitioner has contributed to a multidisciplinary care plan; and

(c)   the patient is referred to an eligible diabetes educator by the medical practitioner using a referral form that has been issued by the Department, or a referral form that contains all the components of the form issued by the Department; and

(d)  the service is provided to the patient individually and in person; and

(e)   the service is of at least 45 minutes duration; and

(f)   after the service, the eligible diabetes educator gives a written report to the referring medical practitioner mentioned in paragraph (c);

payable once in a calendar year for this or any other assessment for group services item (including services in items 81100, 81110 and 81120 or items 93284 or 93286 of the Telehealth and Telephone Determination)

Fee: $87.95 Benefit: 85% = $74.80

(See para MN.9.1, MN.9.2, MN.9.3, MN.9.4, MN.9.6 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

81105

81105 - Additional Information

Item Start Date:
01-May-2007
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Diabetes education health service provided to a patient by an eligible diabetes educator, as a group service for the management of type 2 diabetes if:

(a)   the patient has been assessed as suitable for a type 2 diabetes group service under assessment item 81100, 81110 or 81120 or items 93284 or 93286 of the Telehealth and Telephone Determination; and

(b)  the service is provided to a patient who is part of a group of between 2 and 12 patients; and

(c)   the service is provided in person; and

(d)  the service is of at least 60 minutes duration; and

(e)   after the last service in the group services program provided to the patient under item 81105, 81115 or 81125 or item 93285 of the Telehealth and Telephone Determination, the eligible diabetes educator prepares, or contributes to, a written report to be provided to the referring medical practitioner; and

(f)   an attendance record for the group is maintained by the eligible diabetes educator;

to a maximum of 8 group services in a calendar year (including services in items 81105, 81115 and 81125 or item 93285 of the Telehealth and Telephone Determination)

Fee: $21.90 Benefit: 85% = $18.65

(See para MN.9.1, MN.9.3, MN.9.5, MN.9.6 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

81110

81110 - Additional Information

Item Start Date:
01-May-2007
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Exercise physiology health service provided to a person by an eligible exercise physiologist for assessing the person’s suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient’s needs and preparing the person for the group services if:

(a)   the person has type 2 diabetes; and

(b)  the person is being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a GP Management Plan or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and

(c)   the person is referred to an eligible exercise physiologist by the medical practitioner using a referral form that has been issued by the Department, or a referral form that contains all the components of the form issued by the Department; and

(d)  the service is provided to the person individually and in person; and

(e)   the service is of at least 45 minutes duration; and

(f)   after the service, the eligible exercise physiologist gives a written report to the referring medical practitioner mentioned in paragraph (c);

payable once in a calendar year for this or any other assessment for group services item (including services in items 81100, 81110 and 81120 or items 93284 or 93286 of the Telehealth and Telephone Determination)

Fee: $87.95 Benefit: 85% = $74.80

(See para MN.9.1, MN.9.2, MN.9.3, MN.9.4, MN.9.6 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

81115

81115 - Additional Information

Item Start Date:
01-May-2007
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Exercise physiology health service provided to a person by an eligible exercise physiologist, as a group service for the management of type 2 diabetes if:

(a)   the person has been assessed as suitable for a type 2 diabetes group service under assessment item 81100, 81110 or 81120 or items 93284 or 93286 of the Telehealth and Telephone Determination; and

(b)  the service is provided to a person who is part of a group of between 2 and 12 patients; and

(c)   the service is provided in person; and

(d)  the service is of at least 60 minutes duration; and

(e)   after the last service in the group services program provided to the person under item 81105, 81115 or 81125 or item 93285 of the Telehealth and Telephone Determination, the eligible exercise physiologist prepares, or contributes to, a written report to be provided to the referring medical practitioner; and

(f)   an attendance record for the group is maintained by the eligible exercise physiologist;

to a maximum of 8 group services in a calendar year (including services in items 81105, 81115 and 81125 or item 93285 of the Telehealth and Telephone Determination)

Fee: $21.90 Benefit: 85% = $18.65

(See para MN.9.1, MN.9.3, MN.9.5, MN.9.6 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

81120

81120 - Additional Information

Item Start Date:
01-May-2007
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Dietetics health service provided to a person by an eligible dietitian for assessing the person’s suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient’s needs and preparing the person for the group services if:

(a)   the person has type 2 diabetes; and

(b)  the person is being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a GP Management Plan or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and

(c)   the person is referred to an eligible dietitian by the medical practitioner using a referral form that has been issued by the Department, or a referral form that contains all the components of the form issued by the Department; and

(d)  the service is provided to the person individually and in person; and

(e)   the service is of at least 45 minutes duration; and

(f)   after the service, the eligible dietitian gives a written report to the referring medical practitioner mentioned in paragraph (c);

payable once in a calendar year for this or any other assessment for group services item (including services in items 81100, 81110 and 81120 or items 93284 or 93286 of the Telehealth and Telephone Determination)

Fee: $87.95 Benefit: 85% = $74.80

(See para MN.9.1, MN.9.2, MN.9.3, MN.9.4, MN.9.6 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

81125

81125 - Additional Information

Item Start Date:
01-May-2007
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Dietetics health service provided to a person by an eligible dietitian, as a group service for the management of type 2 diabetes if:

(a)   the person has been assessed as suitable for a type 2 diabetes group service under assessment item 81100, 81110 or 81120 or items 93284 or 93286 of the Telehealth and Telephone Determination; and

(b)  the service is provided to a person who is part of a group of between 2 and 12 patients; and

(c)   the service is provided in person; and

(d)  the service is of at least 60 minutes duration; and

(e)   after the last service in the group services program provided to the person under item 81105, 81115 or 81125 or item 93285 of the Telehealth and Telephone Determination, the eligible dietitian prepares, or contributes to, a written report to be provided to the referring medical practitioner; and

(f)   an attendance record for the group is maintained by the eligible dietitian;

to a maximum of 8 group services in a calendar year (including services to which items 81105, 81115 and 81125 or item 93285 of the Telehealth and Telephone Determination apply)

Fee: $21.90 Benefit: 85% = $18.65

(See para MN.9.1, MN.9.3, MN.9.5, MN.9.6 of explanatory notes to this Category)


Legend

  • Assist - Addition/Deletion of (Assist.)
  • Amend - Amended Description
  • Anaes - Anaesthetic Values Amended
  • Emsn - EMSN Change
  • Fee - Fee Amended
  • Renum - Item Number Change (renumbered)
  • New - New Item
  • NewMin - New Item (previous Ministerial Determination)
  • Qfe - QFE Change