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Menopause and Perimenopause Health Assessment

Professional attendance on a patient for the assessment and management of menopause or perimenopause by a general practitioner lasting at least 20 minutes and including, but not limited to:

a) collecting relevant information, including taking a patient history to determine pre-, peri- or post-menopausal status, patient wellbeing and contraindications for management; and

b) undertaking a basic physical examination, including recording blood pressure, and review of height and weight; and

c) initiating investigations and referrals as clinically indicated, with consideration given to the need for cervical screening, mammography and bone densitometry; and

d) discussing management options including non-pharmacological and pharmacological strategies including risks and benefits;

e) implementing a management plan which includes patient centred symptoms management; and

f) providing the patient with preventative health care advice and information as clinically indicated, including advice on physical activity, smoking cessation, alcohol consumption, nutritional intake and weight management.

Fee: $101.90 Benefit: 100% = $101.90

(See para AN.14.3 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $305.70

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Professional attendance on a patient who is 30 years of age or over for a heart health assessment by a general practitioner at consulting rooms lasting at least 20 minutes and including:

1. collection of relevant information, including taking a patient history; and

2. a basic physical examination, which must include recording blood pressure and cholesterol; and

3. initiating interventions and referrals as indicated; and

4. implementing a management plan; and

5. providing the patient with preventative health care advice and information.

Fee: $84.90 Benefit: 100% = $84.90

(See para AN.14.2 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $254.70

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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: $69.20 Benefit: 100% = $69.20

(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)

Extended Medicare Safety Net Cap: $207.60

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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: $160.85 Benefit: 100% = $160.85

(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)

Extended Medicare Safety Net Cap: $482.55

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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: $222.00 Benefit: 100% = $222.00

(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)

Extended Medicare Safety Net Cap: $500.00

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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: $313.60 Benefit: 100% = $313.60

(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)

Extended Medicare Safety Net Cap: $500.00

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Professional attendance by a general practitioner, at consulting rooms or in a place other than a hospital or a residential aged care facility:

(a) for a health assessment of a patient who is of Aboriginal or Torres Strait Islander descent; and

(b) that includes the following:

(i) recognising the patient’s health priorities;

(ii) taking the patient’s medical history;

(iii) undertaking any relevant physical examinations;

(iv) undertaking or arranging any required investigations;

(v) assessing the patient using the information gained in the health assessment;

(vi) initiating any necessary interventions and referrals;

(vii) developing and documenting a plan to manage the patient’s health, including for follow‑up, based on the health assessment and the patient’s priorities;

(viii) offering the patient (or the patient’s carer (if any) if the practitioner considers it appropriate and the patient agrees) a written report of the health assessment, with recommendations on matters covered by the health assessment and a strategy for the patient’s good health;

(ix) if the offer referred to in subparagraph (viii) is accepted—giving the report to the patient or the patient’s carer (as applicable);

(x) adding a record of the health assessment to the patient’s medical records

Applicable only if a service to which this item or item 228, 92004 or 92011 applies has not been provided to the patient in the preceding 9 months

Note:    For items 92004 and 92011, see the Telehealth Attendance Determination.

Fee: $247.65 Benefit: 100% = $247.65

(See para AN.0.43 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $500.00

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