Medicare Benefits Schedule - Note MN.9.6

Retention of Referral Form for Services Australia Audit Purposes

It is recommended that Allied health professionals retain a copy of the referral form for 2 years from the date the service was rendered (for Services Australia auditing purposes). 

Publicly funded services

Items 81100, 81105, 81110, 81115, 81120, 81125, 93284, 93285 and 93286 do not apply for services that are provided by any other Commonwealth or state-funded services or provided to an admitted patient of a hospital. However, where an exemption under subsection 19(2) of the Health Insurance Act 1973 has been granted to an Aboriginal Community Controlled Health Service or a state/territory government health clinic, these items can be claimed for services provided by eligible allied health professionals salaried by, or contracted to, service or health clinic. All requirements of the relevant item must be met, including registration of the allied health professional with Services Australia. These services must also be bulk billed. 

Private health insurance

Patients need to decide if they will use Medicare or their private health insurance general treatment cover (also known as ancillary or extras cover) to pay for these services. Patients cannot use their private health insurance general cover to 'top up' the Medicare rebate paid. 

Out-of-pocket expenses and Medicare Safety Net

Allied health professionals are free to determine their own fees for the professional service. Charges in excess of the Medicare benefit for the allied health items are the responsibility of the patient. However, such out-of-pocket costs will count toward the Medicare Safety Net for that patient.

Related Items: 81100 81105 81110 81115 81120 81125 93284 93285 93286

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Telehealth attendance by an eligible dietitian to provide a dietetics health service to a person for assessing the 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 person 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 GP management plan or, if the person is a resident of an aged care facility, the person’s 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, or a referral form that contains all the components of the form issued by the Department; and

(d) the service is provided to the person individually; and

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

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

payable once in a calendar year for this or any other assessment for group services item (including services to which this item, item 92386, or items 81100, 81110 and 81120 of the Allied Health  Determination apply)

Fee: $87.50 Benefit: 85% = $74.40

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

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: $21.80 Benefit: 85% = $18.55

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

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)

Phone attendance by an eligible dietitian to provide a dietetics health service to a person for assessing the 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 person 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 GP management plan or, if the person is a resident of an aged care facility, the person’s 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, or a referral form that contains all the components of the form issued by the Department; and

(d) the service is provided to the person individually; and

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

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

payable once in a calendar year for this or any other assessment for group services item (including services to which this item, item 92384, or in items 81100, 81110 and 81120 of the Allied Health Determination apply)

Fee: $87.50 Benefit: 85% = $74.40

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