Medicare Benefits Schedule - Note AN.0.36

Publication date: 1 July 2024

SUMMARY

This note sets out common principles that apply when using MBS time-tiered health assessment items for general practitioners (GPs see GN.4.13) and prescribed medical practitioners (PMPs see AN.7.1).

Time-tiered health assessment items are only available to specific patient cohorts. Details of the requirements for a health assessment for each patient cohort are at:

• Type 2 diabetes risk evaluation (40-49 years) – see AN.0.37.
• Health assessment for people aged 45-49 years (inclusive) who are at risk of developing chronic disease – see AN.0.38.
• Health Assessment provided for people aged 75 years and older – see AN.0.39.
• Health Assessment provided as a comprehensive medical assessment for residents of residential aged care facilities – see AN.0.40.
• Health Assessment provided for people with an intellectual disability – see AN.0.41.
• Health Assessment provided for refugees and other humanitarian entrants – see AN.0.42.
• One-off health assessment for veterans – see AN.0.69.

USE OF THE ITEMS

Health assessment items are used to assess eligible patients’ health and physical, psychological and social function. This includes the medical practitioner’s consideration of whether preventive health care and education should be offered to the patient to improve their health or function.

The items apply only to a service provided in the course of a personal attendance by a single GP or PMP on a single patient.

While the requirements for health assessments vary according to patient cohort, in general they all require the GP or PMPs to undertake a range of activities, including:

• information collection, including taking a patient history and undertaking or arranging examinations and investigations as required
• making an overall assessment of the patient
• recommending appropriate interventions, and
• providing advice and information to the patient.

Additional item requirements apply to all health assessments conducted, tailored to meet the needs of each patient group being targeted under the items (see ‘Eligible Patients’). Information on additional item requirements is available in Notes: AN.0.37, AN.0.38, AN.0.39, AN.0.40, AN.0.41, AN.0.42, AN.0.69.

How do I choose which health assessment item to use?

The correct health assessment item will depend on:

• practitioner type – GP or PMP, and
• length of time spent with the patient (i.e. the personal attendance time).

Health Assessment service	GP	PMP
Brief health assessment lasting no more than 30 minutes	701	224
Standard health assessment lasting at least 30 minutes and less than 45 minutes	703	225
Long health assessment lasting at least 45 minutes and less than 60 minutes	705	226
Prolonged health assessment lasting more than 60 minutes	707	227

Are there specific requirements for any of the health assessment items?

Yes, additional item requirements apply to all health assessments conducted, tailored to meet the needs of each patient group being targeted under the items (see ‘Eligible Patients’). Information on additional item requirements is available in Notes: AN.0.37, AN.0.38, AN.0.39, AN.0.40, AN.0.41, AN.0.42, AN.0.69.

Is a health assessment a health screening service?

No. Clause 2.15.14 of the Health Insurance (General Medical Services Table) Regulations 2021 (the Regulations) specifies that a time-tiered health assessment must not include a screening service.

The Health Insurance Act 1973 defines a  health screening service as a medical examination or test that is not reasonably required for the management of the medical condition of the patient. A health screening service does not include a medical examination or a test on a symptomless patient by the that patient’s own medical practitioner in the course of normal medical practice, to ensure the patient receives any medical advice or treatment necessary to maintain their state of health.

Further information is available in Note GN.13.33.

Can another person assist the medical practitioner to undertake the health assessment?

Yes. Clause 2.15.14 of the Regulations states that practice nurses, Aboriginal health workers and Aboriginal Torres Strait Islander health practitioners may assist in accordance with accepted medical practice under the supervision of the medical practitioner.

Assistance provided must be in accordance with accepted medical practice and under the supervision of the GP or prescribed medical practitioner. This may include activities associated with:

• information collection, and
• providing patients with information about recommended interventions, at the direction of the medical practitioner.

The GP or prescribed medical practitioner should be satisfied that the assisting health professional has the necessary skills, expertise and training to collect the information required for the health assessment.

MBS items for Time-Tiered Health Assessments are for a complete service. For and on behalf of item 10997 may not be claimed in conjunction with these items.

Additional advice on the use of other health professionals’ time when undertaking health assessments can be found in the AskMBS Advisory – General Practice 1 (health.gov.au).

A Practice nurse means a registered or an enrolled nurse who is employed by, or whose services are otherwise retained by, a general practice or eligible health service.

An Aboriginal and Torres Strait Islander health practitioner means a person who:

• is registered under a law of a State or Territory as an Aboriginal and Torres Strait Islander health practitioner, and
• is employed by, or whose services are otherwise retained by, a GP or prescribed medical practitioner in a general practice, or an eligible health service.

An Aboriginal health worker means a person who:

• holds a Certificate III in Aboriginal or Torres Strait Islander Health Worker Primary Health Care (Clinical) or other appropriate qualification, and
• is engaged by a GP or prescribed medical practitioner in a general practice or an eligible health service.

Can I include additional time required for communications (e.g. with an interpreter) in the time taken for the health assessment?

Yes, a wide range of factors may affect the time needed to communicate effectively with a patient during a consultation. These include, but are not limited to, situations where a language barrier exists between the medical practitioner and patient (including when an interpreter is required), or when a patient has hearing problems, difficulty with speech, an intellectual disability, and/or dementia.

When claiming for time-tiered MBS items, the total consultation time includes the time required to communicate effectively with the patient. Where more time than usual is required to communicate effectively with a particular patient, it is considered reasonable to claim a longer attendance item than might otherwise be expected for the service.

In such situations, medical practitioners should make a brief record in the patient’s notes including details about why the additional time was required. For example, stating ‘consultation extended due to use of interpreter’ and, if relevant, citing the Translating and Interpreting Service (TIS) job number.

My patient is eligible for more than one category of health assessment. Which health assessment should I do?

Patients can receive each health assessment they are eligible for. For example, a 42 year old patient with an intellectual disability who is also found to be at high risk of developing type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool can receive:

• a health assessment for a person with an intellectual disability annually, and
• a type 2 diabetes risk evaluation every 3 years until they are 49 (inclusive).

Where the patient is eligible for more than one health assessment there is no minimum interval of time between the provision of the different health assessments. Where patients are eligible for more than one health assessment  practitioner should ensure they identify which target group the health assessment relates to when submitting claims to Services Australia. Additional information on claiming limits is available on the Services Australia - Health assessments and your record keeping responsibilities webpage.

ELIGIBLE PATIENTS

Any patient who is eligible to receive Medicare benefits and meets the criteria for one or more of the following target groups may receive a health assessment service, at the stated frequencies:

Target Group	Frequency of Service	Associated Note
A type 2 diabetes risk evaluation for people aged 40-49 years (inclusive) with a high risk of developing type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool	Once every three years to an eligible patient	AN.0.37
A health assessment for people aged 45-49 years (inclusive) who are at risk of developing chronic disease	Once only to an eligible patient	AN.0.38
A health assessment for people aged 75 years and older	Provided annually to an eligible patient	AN.0.39
A comprehensive medical assessment for permanent residents of residential aged care facilities	Provided annually to an eligible patient	AN.0.40
A health assessment for people with an intellectual disability	Provided annually to an eligible patient	AN.0.41
A health assessment for refugees and other humanitarian entrants	Once only to an eligible patient	AN.0.42
A health assessment for former serving members of the Australian Defence Force	Once only to an eligible patient	AN.0.69

Residential aged care facility-specific items are only available to Medicare-eligible patients that are residents of a residential aged care facility and who are currently not in-patients of a hospital.

All other health assessment items are not available to people who are in-patients of a hospital or care recipients in a residential aged care facility.

ELIGIBLE PRACTITIONERS

Health assessment items are available for different practitioner types:

• general practitioner items can be claimed by GPs only (see GN.4.13).
• prescribed medical practitioner items can be claimed by prescribed medical practitioners only (see AN.7.1).

Note: Clause 2.15.14 of the Regulations specifies patients must access health assessment services through their usual GP or prescribed medical practitioner, if reasonably practicable.

The patient’s usual GP or prescribed medical practitioner means the practitioner:

• who has provided the majority of services to the patient in the past 12 months, or
• who is likely to provide the majority of services to the patient in the following 12 months, or
• is located at a medical practice that:
  • has provided the majority of services to the patient in the past 12 months, or
  • is likely to provide the majority of services to the patient in the next 12 months.

CO-CLAIMING RESTRICTIONS

Clause 2.15.14 of the Regulations specifies a separate consultation must not be performed in conjunction with a health assessment, unless clinically necessary.

RECORD KEEPING AND REPORTING REQUIREMENTS

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.0.35
• Next - Note AN.0.37

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)