Medicare Benefits Schedule - Note MN.9.5

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Category 8 - MISCELLANEOUS SERVICES

MN.9.5

Group Allied Health Services (Items 81105, 81115, 81125 and 93285) for People with Type 2 Diabetes - Service Requirements and Referral Forms

These services are provided in a group setting to assist with the management of type 2 diabetes. 

Number of services per year

Patients are eligible for up to 8 group allied health services in total (items 81105, 81115, 81125 and 93285 inclusive) per calendar year. Each separate group service must be provided to the patient by only one type of allied health professional (i.e. by a diabetes educator, or by an exercise physiologist or by a dietitian). However, the overall group services program provided for the patient could be comprised of one type of service only (e.g. 8 diabetes education services) or a combination of services (e.g. 3 diabetes education services, 3 dietitian services and 2 exercise physiology services). An eligible allied health professional with more than one Medicare provider number (e.g. for the provision of diabetes education and dietetics) may provide separate services under each of these provider numbers. 

Group allied health service providers are strongly encouraged to deliver multidisciplinary group services programs that allow patients to benefit from a range of interventions designed to assist in the management of their type 2 diabetes. 

Where a patient receives more than the limit of 8 group services in a calendar year, the additional service/s will not attract a Medicare benefit and the MBS Safety Net arrangements will not apply to costs incurred by the patient for the service/s. 

If there is any doubt about a patient's eligibility for group services, the allied health professional should contact Services Australia to confirm the number of group services already claimed by the patient in the calendar year. Allied health professionals can call Services Australia on 132 150 to check this information. 

Multiple services on the same day

Where clinically relevant, up to 2 group services may be provided consecutively on the same day by the same allied health professional. 

Referral form

The GP or medical practitioner must refer the patient using the referral form for group allied health services under Medicare for patients with type 2 diabetes or a form that contains all the components of this form. This includes:

  • identifying that the patient has type 2 diabetes and either: has prepared a new GP Management Plan (MBS item 721/229) OR
  • has reviewed an existing GP Management Plan (MBS item 732/233) OR
  • for a resident of an aged care facility, the GP or medical practitioner has contributed to or reviewed a multidisciplinary care plan prepared by the facility (MBS item 731/232) [Note: Generally, residents of an aged care facility rely on the facility for assistance to manage their type 2 diabetes. Therefore, residents may not need to be referred for allied health group services as the self-management approach may not be appropriate.]
  • GP or medical practitioner details including provider number, name, address, signature and date of referral
  • Patient details including name and address
  • Allied Health Practitioner (or practice) the patient is referred to for assessment and the address

The allied health professional undertaking the assessment service will need to complete Part B of this form providing information on:

  • Name of provider/s
  • Name of program
  • Number of sessions in the program
  • Venue (if known)
  • Name of allied health professional undertaking the assessment
  • The patient will then need to present this form/information to the provider/s of group services

 

Group size

The service must be provided to a person who is part of a group of between 2 and 12 persons. 

Length of service

Each group service must be of at least 60 minutes duration. 

Reporting requirements

On completion of the group services program, each allied health professional must provide, or contribute to, a written report back to the referring GP/medical practitioner in respect of each patient. The report should describe the group services provided for the patient and indicate the outcomes achieved. While each allied health professional is required to provide feedback to the GP/medical practitioner in relation to the group services they provide to the patient, allied health professionals involved in the provision of a multidisciplinary program are encouraged to combine feedback into a single report to the referring GP/medical practitioner.

Related Items: 81105 81115 81125 93285


Related Items

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

93285

93285 - Additional Information

Item Start Date:
22-May-2020
Description Updated:
22-May-2020
Schedule Fee Updated:
01-Nov-2023

Telehealth attendance by an eligible dietitian to provide a dietetics health service, 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 items 81100, 81110 or 81120 of the Allied Health Determination or items 93284 or 93286; 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 of at least 60 minutes duration; and

(d)    after the last service in the group services program provided to the person under this item or items 81105, 81115 or 81125 of the Allied Health Determination, the eligible dietitian prepares, or contributes to, a written report to be provided to the referring medical practitioner; and

(e)    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 this item or items 81105, 81115 and 81125 of the Allied Health Determination apply)

Fee: $21.90 Benefit: 85% = $18.65

(See para MN.9.3, MN.9.5, 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

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