Helping Children with Autism

Helping Children with Autism – Medicare Allied Health Professional Items for Pervasive Developmental Disorders (PDD)

Overview of the allied health professional Medicare items for PDDs

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From 1 July 2008, six items are available on the Medicare Benefits Schedule (MBS) as part of the Australian Government’s $190 million Helping Children with Autism package. These items allow allied health professionals to provide services for children aged under 13 years (for diagnosis) and under 15 years (for treatment) with autism or any other pervasive developmental disorder (PDD). The MBS items have been developed in close consultation with allied health professional organisations.

These items apply to services provided by eligible psychologists, speech pathologists and occupational therapists. The items cover two specific types of services that allow allied health professionals to:

• Collaborate with the referring practitioner (consultant psychiatrist or paediatrician) in the diagnosis of the child and/or development of the child’s treatment plan; and
• Provide treatment to the patient for their particular condition, consistent with the treatment and management plan prepared by the referring practitioner.

The Allied Health Medicare items

There are three allied health PDD items for collaboration with diagnosis and/or contribution to the practitioner’s treatment plan, and three allied health PDD items for treatment services.

Medicare item numbers for the diagnosis and contribution to a practitioner’s PDD treatment and management plan

• Psychology: MBS item 82000
• Speech Pathology: MBS item 82005
• Occupational Therapy: MBS item 82010.

Description:
Professional attendance provided to a child aged under 13 years where:

• the child is referred by an eligible practitioner for the purpose of collaborating with the practitioner for the diagnosis of the child; and/or
• the child is referred by an eligible practitioner for the purpose of contributing to the child’s pervasive developmental disorder (PDD) treatment plan, developed by the practitioner;
• the eligible practitioner is a consultant physician in the practice of his or her field of psychiatry or paediatrics;
• the allied health provider attending the child is registered with Medicare Australia as meeting the credentialing requirements for the provision of these services;
• the child is not an admitted patient of an hospital;
• the service is provided to the child individually and in person;
• the service lasts at least 50 minutes in duration.

These items are limited to a maximum of four services in total per child consisting of any combination of 82000, 82005 and 82010, provided by any combination of allied health professionals.

Medicare item numbers for treatment of pervasive developmental disorders (PDD)

• Psychology: MBS item 82015
• Speech Pathology: MBS item 82020
• Occupational Therapy: MBS item 82025

Description:
Professional attendance provided for treatment of autism and any other pervasive developmental disorder (PDD) for a child aged under 15 years where:

A PDD treatment plan has been prepared for the child by an eligible practitioner;

• the child has been referred by an eligible practitioner for services that are consistent with the PDD treatment plan;
• the eligible practitioner is a consultant physician in the practice of his or her field of psychiatry or paediatrics;
• the allied health provider attending the child is registered with Medicare Australia as meeting credentialing requirements for the provision of these services;
• the child is not an admitted patient of an hospital;
• the service is provided to the child individually and in person;
• the service lasts at least 30 minutes in duration.

These items are limited to a maximum of twenty services, in total, per child consisting of any combination of 82015, 82020 and 82025, provided by any combination of allied health professionals. A course of treatment will consist of the number of services stated on the child’s referral (up to a maximum of 10).

Who can access autism and other PDD services?

Children aged under 13 years of age (for diagnosis), where the child is referred by an eligible psychiatrist or paediatrician and under 15 years of age while receiving treatment, and where their condition is being managed by a psychiatrist or paediatrician under a PDD treatment and management plan can access these services.

What is considered autism or PDD for the purposes of the items?

The conditions classified as PDD for the purposes of these services are informed by the “American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorder”, Fourth Edition (DSM-IV-TR).

More information:

Further information on the PDD items is available at http://www.health.gov.au/internet/main/publishing.nsf/Content/mental-autism. Paper copies of information on the PDD items can be obtained by calling (02 6289 4297).

More information on other elements of the Helping children with autism package can be obtained from the Department of Families, Housing, Community Services and Indigenous Affairs website at http://www.facs.gov.au/internet/facsinternet.nsf/disabilities/services-help_child_autism.htm

Registering with Medicare Australia:

Provider registration forms can be obtained from Medicare Australia on 132 150 or at www.medicareaustralia.gov.au

Page last modified: 30 June, 2008

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