Medicare Benefits Schedule - Note AN.0.39

Publication date: 1 July 2024

SUMMARY

Time-tiered health assessment items may be used to undertake an Older Person’s health assessment for Medicare eligible patients aged 75 years and older every 12 months.

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 THE ITEMS

The specific requirements of the Older Person’s health Assessment are set out in clause 2.15.6 of the Health Insurance (General Medical Services Table) Regulations 2021 (the Regulations).

The regulations state that an Older Person’s health assessment is the assessment of:

• a patient’s health and physical, psychological and social function, and
• whether preventive health care and education should be offered to the patient, to improve the patient’s health and physical, psychological and social function.

The Regulations also state that the health assessment must include:

• personal attendance by a general practitioner or prescribed medical practitioner
• measurement of the patient's blood pressure, pulse rate and rhythm
• an assessment of the patient's medication
• an assessment of the patient's continence
• an assessment of the patient's immunisation status for influenza, tetanus and pneumococcus
• an assessment of the patient's physical function, including the patient's activities of daily living, and whether or not the patient has had a fall in the last 3 months
• an assessment of the patient's psychological function, including the patient's cognition and mood, and
• an assessment of the patient's social function, including:
  • the availability and adequacy of paid and unpaid help, and
  • whether the patient is responsible for caring for another person.

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.

ELIGIBLE PATIENTS

Patients eligible for an Older Person’s health assessment are:

• aged 75 years and older and not an in-patient of a hospital or a care recipient in a residential aged care facility.

For comprehensive medical assessments for residents of residential aged care facilities see AN.0.40.

An Older Person’s health assessment cannot be claimed more than once every 12 months by an eligible patient.

CO-CLAIMING RESTRICTIONS

A separate consultation must not be performed in conjunction with an Older Person’s 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 state that an Older Person’s health assessment must include:

• keeping a record of the health assessment
• offering the patient a written report on the health assessment, with recommendations about matters covered by the health assessment, and
• offering the patient's carer (if any, and if the practitioner considers it appropriate and the patient agrees) a copy of the report or extracts of the report relevant to the carer.

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.0.38
• Next - Note AN.0.40

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)