Medicare Benefits Schedule - Note MN.3.5

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Category 8 - MISCELLANEOUS SERVICES

MN.3.5

Individual Allied Health Services for Chronic Disease Management - Case Conferencing (Items 10955, 10957, 10959)

The allied health items provide MBS rebates for eligible allied health practitioners to participate in a multidisciplinary case conference team in a community case conference with a patient’s medical practitioner and other providers.

A multidisciplinary case conference means a process by which a multidisciplinary case conference team carries out all of the following activities:

  • discussing a patient’s history;
  • identifying the patient’s multidisciplinary care needs;
  • identifying outcomes to be achieved by members of the multidisciplinary case conference team giving care and service to the patient;
  • identifying tasks that need to be undertaken to achieve these outcomes, and allocating those tasks to members of the multidisciplinary case conference team;
  • assessing whether previously identified outcomes (if any) have been achieved.

 These items apply to non-hospital admitted patients for:

  • chronic disease management under the care of a GP/medical practitioner in either community or for a care recipient in a residential aged care facility.

 Eligible allied health practitioners may claim reimbursement for participating in case conferences through the following time-tiered items:

  • 15–20 minutes (10955)
  • 20–40 minutes (10957)
  • At least 40 minutes (10959)

Eligible allied health practitioners

For the purposes of these items, eligible allied health practitioner means an eligible:

  • Aboriginal health worker;
  • Aboriginal and Torres Strait Islander health practitioner;
  • diabetes educator;
  • audiologist;
  • dietitian;
  • mental health worker;
  • occupational therapist;
  • exercise physiologist;
  • physiotherapist;
  • podiatrist;
  • chiropractor;
  • osteopath;
  • psychologist; or
  • speech pathologist.

Eligible patients

These items only apply to patients who, are not an admitted patient of a hospital and have at least one medical condition that has been (or is likely to be) present for at least six months; or is terminal.

Frequency limitations

These items cannot be claimed if the service has been performed in the last 3 months, unless in exceptional circumstances. An exceptional circumstance means there has been a significant change in the patient’s clinical condition or care circumstances that necessitate the performance of the service.

 Organisation of a case conference

The case conference must be organised by the medical practitioner. The multidisciplinary case conference team must include a medical practitioner and at least 2 other members providing different kinds of care to the patient. The multidisciplinary case conference team requirements include:

  • each member must provide a different kind of care or service to the patient; and
  • each member must not be an unpaid carer of the patient; and
  • one member may be another medical practitioner.

The patient and family members or carers can attend the case conference but will not count towards the minimum team member requirements. 

The eligible allied health practitioner does not need all participants to be MBS-eligible to be able to claim payment for their participation. Members can include allied health professionals, home and community service providers and care organisers, including the following:

  • Aboriginal and Torres Strait Islander health practitioners;
  • asthma educators;
  • audiologists;
  • dental therapists;
  • dentists;
  • diabetes educators;
  • dieticians;
  • mental health workers;
  • occupational therapists;
  • optometrists;
  • orthoptists;
  • orthotists or prosthetists;
  • pharmacists;
  • physiotherapists;
  • podiatrists;
  • psychologists;
  • registered nurses;
  • social workers;
  • speech pathologists;
  • education providers;
  • “meals on wheels” providers;
  • personal care workers;
  • probation officers.

In some instances, 2 eligible allied health practitioners from the same profession may participate in the same case conference, where both provide different aspects of care to the patient. For instance, the 2 providers from the same profession have different specialisations that are clinically relevant to the same patient and cannot be provided by one of the providers alone. In this instance, both providers will be able to claim the items.

Participation in a case conference

A referral is not required for eligible allied health practitioners to access the allied health case conferencing items for chronic disease management. However, the allied health practitioner must be invited to participate in the case conference by the patient’s treating medical practitioner.

The patient must agree to the allied health practitioner participating in the case conference and be informed that Medicare will be accessed to fund the service. The patient may agree through discussion with their medical practitioner. The allied health practitioner should ensure that the patient has agreed and that their agreement has been recorded appropriately.

Allied health practitioners claiming a case conferencing item should record the day, start and end times, the names of all participants and all matters discussed in the patient’s medical record.

The allied health practitioner is not required to have a pre-existing relationship with the patient. However, the patient should agree to the allied health practitioner participating in the case conference and be informed that Medicare will be accessed to fund the service.

The case conference may lead to an agreed care plan between all participating providers, including the number of allied health practitioner services required and how they are allocated among eligible allied health practitioners within a patient’s entitlement.

The case conferencing items can be accessed in person, via videoconference or telephone, using the same item number. There is no requirement that all participants use the same communication method.

Related Items: 10955 10957 10959


Related Items

Category 8 - MISCELLANEOUS SERVICES

10955

10955 - Additional Information

Item Start Date:
01-Nov-2021
Description Updated:
01-Nov-2021
Schedule Fee Updated:
01-Nov-2023

Attendance by an eligible allied health practitioner, as a member of a multidisciplinary case conference team, to participate in:

(a)   a community case conference; or

(b)   a multidisciplinary case conference in a residential aged care facility;

if the conference lasts for at least 15 minutes, but for less than 20 minutes (other than a service associated with a service to which another item in this Group applies)

Fee: $53.75 Benefit: 85% = $45.70

(See para MN.3.5 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

10957

10957 - Additional Information

Item Start Date:
01-Nov-2021
Description Updated:
01-Nov-2021
Schedule Fee Updated:
01-Nov-2023

Attendance by an eligible allied health practitioner, as a member of a multidisciplinary case conference team, to participate in:

(a)   a community case conference; or

(b)   a multidisciplinary case conference in a residential aged care facility;

if the conference lasts for at least 20 minutes, but for less than 40 minutes (other than a service associated with a service to which another item in this Group applies)

Fee: $92.20 Benefit: 85% = $78.40

(See para MN.3.5 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

10959

10959 - Additional Information

Item Start Date:
01-Nov-2021
Description Updated:
01-Nov-2021
Schedule Fee Updated:
01-Nov-2023

Attendance by an eligible allied health practitioner, as a member of a multidisciplinary case conference team, to participate in:

(a)   a community case conference; or

(b)   a multidisciplinary case conference in a residential aged care facility;

if the conference lasts for at least 40 minutes (other than a service associated with a service to which another item in this Group applies)

Fee: $153.45 Benefit: 85% = $130.45

(See para MN.3.5 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