Medicare Benefits Schedule - Note MN.9.1

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

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DIABETES EDUCATION SERVICE - ASSESSMENT FOR GROUP SERVICES

Diabetes education health service provided to a person by an eligible diabetes educator for the purposes of ASSESSING a 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 service is provided to a person who 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 shared care plan or a GP Management Plan or, if the person is a resident of an aged care facility, their medical practitioner has contributed to a multidisciplinary care plan; and  

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

(d)    the person is not an admitted patient of a hospital; and

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

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

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

(h)    in the case of a service in respect of which a private health insurance benefit is payable - the person who incurred the medical expenses in respect of the service has elected to claim the Medicare benefit in respect of the service, and not the private health insurance benefit.

Benefits are payable once only in a calendar year for this or any other Assessment for Group Services item (including services to which items 81100, 81110, 81120, 93284, 93286, 93606, 93607 and 93608 apply).

Fee: $87.50 Benefit: 85% = $74.40

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

DIABETES EDUCATION SERVICE - GROUP SERVICE

Diabetes education health service provided to a person by an eligible diabetes educator, 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, 81120, 93284, 93286, 93606, 93607 or 93608; and

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

(c)    the person is not an admitted patient of a hospital; and

(d)   the service is provided to a person involving the personal attendance by an eligible diabetes educator; and

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

(f)    after the last service in the group services program provided to the person under items 81105, 81115, 81125, 93285, 93613, 93614 or  93615 the eligible diabetes educator prepares, or contribute to, a written report to be provided to the referring medical practitioner; and

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

(h)  in the case of a service in respect of which a private health insurance benefit is payable - the person who incurred the medical expenses in respect of the service has elected to claim the Medicare benefit in respect of the service, and not the private health insurance benefit;

- to a maximum of eight  GROUP SERVICES (including services to which items 81105, 81115, 81125, 93285, 93613, 93614 and 93615 apply) in a calendar year.

Fee: $21.80 Benefit: 85% = $18.55

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

EXERCISE PHYSIOLOGY SERVICE - ASSESSMENT FOR GROUP  SERVICES

Exercise physiology health service provided to a person by an eligible exercise physiologist for the purposes of ASSESSING a 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 service is provided to a person who 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 shared care plan or a GP Management Plan or, if the person is a resident of an aged care facility, their  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 of Health, or a referral form that contains all the components of the form issued by the Department; and

(d)    the person is not an admitted patient of a hospital; and

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

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

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

(h)    in the case of a service in respect of which a private health insurance benefit is payable - the person who incurred the medical expenses in respect of the service has elected to claim the Medicare benefit in respect of the service, and not the private health insurance benefit.

Benefits are payable once only in a calendar year for this or any other Assessment for Group Services item (including services to which items 81100, 81110, 81120, 93284, 93286, 93606, 93607 and 93608 apply).

Fee: $87.50 Benefit: 85% = $74.40

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

EXERCISE PHYSIOLOGY SERVICE - GROUP SERVICE

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, 81120, 93284, 93286, 93606, 93607 or 93608; and

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

(c)    the person is not an admitted patient of a hospital; and

(d)   the service is provided to a person involving the personal attendance by an eligible exercise physiologist; and

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

(f)    after the last service in the group services program provided to the person under items 81105, 81115, 81125, 93285, 93613, 93614 or 93615, the eligible exercise physiologist prepares, or contribute to, a written report to be provided to the referring medical practitioner; and

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

(h)   in the case of a service in respect of which a private health insurance benefit is payable - the person who incurred the medical expenses in respect of the service has elected to claim the Medicare benefit in respect of the service, and not the private health insurance benefit;

- to a maximum of eight  GROUP SERVICES (including services to which items 81105, 81115, 81125, 93285, 93613, 93614 and 93615 apply) in a calendar year.

Fee: $21.80 Benefit: 85% = $18.55

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

DIETETICS SERVICE - ASSESSMENT FOR GROUP SERVICES

Dietetics health service provided to a person by an eligible dietitian for the purposes of ASSESSING a 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 service is provided to a person who 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 shared care plan or a GP Management Plan or, if the person is a resident of an aged care facility, their 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 of Health, or a referral form that contains all components of the form issued by the Department; and

(d)    the person is not an admitted patient of a hospital; and

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

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

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

(h)    in the case of a service in respect of which a private health insurance benefit is payable - the person who incurred the medical expenses in respect of the service has elected to claim the Medicare benefit in respect of the service, and not the private health insurance benefit.

Benefits are payable once only in a calendar year for this or any other Assessment for Group Services item (including services to which items 81100, 81110, 81120, 93284, 93286, 93606, 93607 and 93608 apply).

Fee: $87.50 Benefit: 85% = $74.40

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

DIETETICS SERVICE - GROUP SERVICE

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, 81120, 93284, 93286, 93606, 93607 or 93608; and

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

(c)    the person is not an admitted patient of a hospital; and

(d)   the service is provided to a person involving the personal attendance by an eligible dietitian; and

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

(f)    after the last service in the group services program provided to the person under items 81105, 81115, 81125, 93285, 93613, 93614 or 93615, the eligible dietitian prepares, or contribute to, a written report to be provided to the referring medical practitioner; and

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

(h)   in the case of a service in respect of which a private health insurance benefit is payable - the person who incurred the medical expenses in respect of the service has elected to claim the Medicare benefit in respect of the service, and not the private health insurance benefit;

- to a maximum of eight GROUP SERVICES (including services to which items 81105, 81115, 81125, 93285, 93613, 93614 and 93615 apply) in a calendar year.

Fee: $21.80 Benefit: 85% = $18.55

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