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Related Items: 10950 10951 10952 10953 10954 10956 10958 10960 10962 10964 10966 10968 10970 93000 93013

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Exercise physiology health service provided to a patient by an eligible exercise physiologist if:

(a) the patient has a chronic condition and complex care needs being managed by a medical practitioner (other than a specialist or consultant physician) under:

(i) a GP chronic condition management plan that has been prepared or reviewed in the last 18 months; or

(ii) until the end of 30 June 2027—a GP Management Plan and Team Care Arrangements prepared prior to 1 July 2025; or

(iii) a multidisciplinary care plan; and

(b) the service is recommended in the patient’s plan or arrangements as part of the management of the patient’s chronic condition and complex care needs; and

(c) the service is of at least 20 minutes duration;

to a maximum of 5 services (including any services to which this item or any other item in this Subgroup or item 93000 or 93013 in the Telehealth Attendance Determination applies) in a calendar year

Fee: $72.65 Benefit: 85% = $61.80

(See para AN.15.3, AN.15.5, AN.15.6, MN.3.1 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $217.95

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Exercise physiology health service provided to a person by an eligible exercise physiologist 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 patient is being managed by a medical practitioner (other than a specialist or consultant physician) under:

(i) a GP chronic condition management plan that has been prepared or reviewed in the last 18 months; or

(ii) until the end of 30 June 2027—a GP Management Plan prepared prior to 1 July 2025; or

(iii) a multidisciplinary care plan; and

(c) the patient is referred to an eligible exercise physiologist by the medical practitioner; and

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

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

(f) after the service, the eligible exercise physiologist 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 in items 81100, 81110 and 81120 or items 93284 or 93286 of the Telehealth Attendance Determination)

Fee: $93.25 Benefit: 85% = $79.30

(See para AN.15.3, AN.15.5, AN.15.6, MN.9.1, MN.9.2 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $279.75

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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 Attendance 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 Attendance 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 Attendance Determination)

Fee: $23.20 Benefit: 85% = $19.75

(See para AN.15.3, AN.15.5, AN.15.6 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $69.60

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