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MBS Primary Care Items

Information about MBS items changing on 1 May 2010

Information on 1 May 2010 Changes to Primary Care Items as a result of the MBS Review.

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Note: Explanatory notes will be available at www.health.gov.au/MBSonline in April 2010

Professional Attendances

Professional attendances by medical practitioners cover consultations during which the practitioner: evaluates the patient's health-related issue or issues, using certain health screening services if applicable; formulates a management plan in relation to one or more health-related issues for the patient; provides advice to the patient and/or relatives (if authorised by the patient); provides appropriate preventive health care; and records the clinical detail of the service(s) provided to the patient. (See the General Explanatory Notes for more information on health screening services.)

Attendances by General Practitioners (Items 3 to 51, 193, 195, 197, 199, 597, 599, 2497-2559 and 5000-5067)

Items 3 to 51 and 193, 195, 197, 199, 597, 599, 2497-2559 and 5000-5067 relate specifically to attendances rendered by medical practitioners who are either:

• listed on the Vocational Register of General Practitioners maintained by Medicare Australia;
• holders of the Fellowship of the Royal Australian College of General Practitioners (FRACGP) who participate in, and meet the requirements of the RACGP for continuing medical education and quality assurance as defined in the RACGP Quality Assurance and Continuing Medical Education program; or
• holders of the Fellowship of the Australian College of Rural and Remote Medicine (FACRRM) who participate in, and meet the requirements of the Australian College of Rural and Remote Medicine (ACRRM) for continuing medical education and quality assurance as defined in ACRRM’s Professional Development Program;
• undertaking an approved placement in general practice as part of a training program for general practice leading to the award of the FRACGP or training recognised by the RACGP as being of an equivalent standard; or
• undertaking an approved placement in general practice as part of a training program for general practice leading to the award of the FACRRM or training recognised by ACRRM as being of an equivalent standard.

Only general practitioners are eligible to itemise the Group A1, items 597 and 599 of Group A11 and Group A22 content-based items. (See the General Explanatory Notes for further details of eligibility and registration.)
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To assist general practitioners in selecting the appropriate item number for Medicare benefit purposes the following notes in respect of the various levels are given.

Level A

A Level A item will be used for obvious and straightforward cases and this should be reflected in the practitioner’s records. In this context, the practitioner should undertake the necessary examination of the affected part if required, and note the action taken.

Level B

A Level B item will be used for a consultation lasting less than 20 minutes for cases that are not obvious or straightforward in relation to one or more health-related issues. The medical practitioner may undertake all or some of the tasks set out in the item descriptor as clinically relevant, and this should be reflected in the practitioner's record. In the item descriptor singular also means plural and vice versa.

Level C

A Level C item will be used for a consultation lasting at least 20 minutes for cases in relation to one or more health-related issues. The medical practitioner may undertake all or some of the tasks set out in the item descriptor as clinically relevant, and this should be reflected in the practitioner's record. In the item descriptor singular also means plural and vice versa.

Level D

A Level D item will be used for a consultation lasting at least 40 minutes for cases in relation to one or more health-related issues. The medical practitioner may undertake all or some of the tasks set out in the item descriptor as clinically relevant, and this should be reflected in the practitioner's record. In the item descriptor singular also means plural and vice versa.

Counselling or Advice to Patients or Relatives
For items 23 to 51 and 5020 to 5067 'implementation of a management plan' includes counselling services.

Items 3 to 51 and 5000 to 5067 include advice to patients and/or relatives during the course of an attendance. The advising of relatives at a later time does not extend the time of attendance.

Items 5906 to 5912 include advice to patients and/or relatives during the course of an attendance. The advising of relatives at a later time does not extend the time of attendance.

Recording Clinical Notes
In relation to the time taken in recording appropriate details of the service, only clinical details recorded at the time of the attendance count towards the time of consultation. It does not include information added at a later time, such as reports of investigations.
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Other Services at the Time of Attendance
Where, during the course of a single attendance by a general practitioner, both a consultation and another medical service are rendered, Medicare benefits are generally payable for both the consultation and the other service. Exceptions are in respect of medical services which form part of the normal consultative process, or services which include a component for the associated consultation (see the General Explanatory Notes for further information on the interpretation of the Schedule).

Professional Attendances at an Institution (Items 4, 24, 37, 47, 58, 59, 60, 65, 5003, 5023, 5043, 5063, 5220, 5223, 5227, 5228)

For the purposes of these items an "institution" means a place (not being a hospital or residential aged care facility) at which residential accommodation or day care or both such accommodation and such care is made available to:

1. disadvantaged children;
2. juvenile offenders;
3. aged persons;
4. chronically ill psychiatric patients;
5. homeless persons;
6. unemployed persons;
7. persons suffering from alcoholism;
8. persons addicted to drugs; or
9. physically or intellectually disabled persons.

Attendances at a Hospital (Items 4, 24, 37, 47, 58, 59, 60, 65)

These items refer to attendances on patients admitted to a hospital. Where medical practitioners have made arrangements with a local hospital to routinely use out-patient facilities to see their private patients, items for services provided in consulting rooms would apply.

After Hours Attendances (Items 448, 449, 597, 598, 599, 600, 5000, 5003, 5010, 5020, 5023, 5028, 5040, 5043, 5049, 5060, 5063, 5067, 5220, 5223, 5227, 5228, 5260, 5263 and 5265)

After hours attendance items may be claimed as follows:

Items 448, 449, 597, 598, 599, 600 apply only to a professional attendance that is provided:

1. on a public holiday;
2. on a Sunday;
3. before 8am, or after 12 noon on a Saturday;
4. before 8am, or after 6pm on any day other than a Saturday, Sunday or public holiday.

Items 5000, 5020, 5040, 5060, 5200, 5203, 5207 and 5208 apply only to a professional attendance that is provided:

1. on a public holiday;
2. on a Sunday;
3. before 8am, or after 1 pm on a Saturday;
4. before 8am, or after 8pm on any day other than a Saturday, Sunday or public holiday.

Items 5003, 5010, 5023, 5028, 5043, 5049, 5063, 5067, 5220, 5223, 5227, 5228, 5260, 5263, 5265 and 5267 apply to a professional attendance that is provided:

1. on a public holiday;
2. on a Sunday;
3. before 8am, or after 12 noon on a Saturday;
4. before 8am, or after 6pm on any day other than a Saturday, Sunday or public holiday.

Urgent After Hours Attendances (Items 597- 600)
Items 597, 598, 599 and 600 can be used for urgent services provided in consulting rooms, or at a place other than consulting rooms, in an after hours period.

Urgent After Hours Attendances (Items 597 and 598) allow for urgent attendances (other than an attendance between 11pm and 7am) in an after hours period.

Urgent After Hours Attendances during Unsociable Hours (Items 599 and 600) allow for urgent attendances between 11pm and 7am in an after hours period.

The attendance for all these items must be requested by the patient or a responsible person in, or not more than 2 hours before the start of the same unbroken urgent after hours period. The patient's condition must require urgent medical treatment and if the attendance is undertaken at consulting rooms, it is necessary for the practitioner to return to, and specially open the consulting rooms for the attendance.
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If more than one patient is seen on the one occasion, the standard after-hours attendance items should be used in respect of the second and subsequent patients attended on the same occasion.

Medical practitioners who routinely provide services to patients in the after-hours periods at consulting rooms, or who provide the services (as a contractor, employee, member or otherwise) for a general practice or clinic that routinely provides services to patients in after-hours periods at consulting rooms will not be able to bill urgent after hours items 597, 598, 599 and 600.

Non-Urgent After Hours Attendances (5000 – 5063 and 5220 - 5267)
Non-Urgent After Hours Attendances in Consulting Rooms (Items 5000, 5020, 5040, 5060, 5200, 5203, 5207 and 5208) are to be used for non-urgent consultations at consulting rooms initiated either on a public holiday, on a Sunday, or before 8am and after 1pm on a Saturday, or before 8am and after 8pm on any other day.

Non-Urgent After Hours Attendances at a Place Other than Consulting Rooms (Other than a Hospital or Residential Aged Care Facility) (items 5003, 5023, 5043, 5063, 5220, 5223, 5227 and 5228) and Non-Urgent After Hours Attendances in a Residential Aged Care Facility (Items 5010, 5028, 5049, 5067, 5260, 5263, 5265 and 5267) are to be used for non-urgent attendances on 1 or more patients on 1 occasion on a public holiday, on a Sunday, or before 8am and after 12 noon on a Saturday, or before 8am and after 6pm on any other day.

Attendance Period	Applicable Time			Items
	Monday to Friday*	Saturday*	Sunday and/or public holiday
Urgent after-hours attendance	Between 7am - 8am and 6pm - 11pm	Between 7am - 8am and 12 noon - 11pm	Between 7am - 11pm	597, 598
Urgent after-hours in unsociable hours	Between 11pm - 7am	Between 11pm - 7am	Between 11pm - 7am	599, 600
Non-urgent After hours In consulting rooms	Before 8am or after 8pm	Before 8am or after 1pm	24 hours	5000, 5020 5040, 5060 5200, 5203, 5207, 5208
Non-urgent After hours at a place other than consulting rooms	Before 8am or after 6pm	Before 8am or after 12 noon	24 hours	5003, 5010, 5023, 5028 5043, 5049, 5063, 5067 5220 - 5267

* with the exception of public holidays which fall on a Saturday

Acupuncture (Items 173, 193, 195, 197 and 199)

The service of "acupuncture" must be performed by a medical practitioner and itemised under item 173, 193, 195, 197 or 199 to attract benefits. These items cover not only the performance of the acupuncture but include any consultation on the same occasion and any other attendance on the same day for the condition for which acupuncture was given. Items 193, 195, 197 and 199 may only be performed by a general practitioner, (see Note 4 of ‘Medicare Benefit Arrangements’ for a definition) if:

1. the person maintains accreditation as a Medical Acupuncturist with the Joint Consultative Committee on Medical Acupuncture (JCCMA); and
2. the Medicare Australia CEO has received a written notice from the Royal Australian College of General Practitioners (RACGP) stating that the person meets the skills requirements for providing services to which the items apply.

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Item 173 does not require a medical practitioner to have accreditation with the JCCMA or written notice to Medicare Australia from the RACGP.

Other items in Category 1 of the Schedule should not be itemised for professional attendances when the service "acupuncture" is provided.

For the purpose of payment of Medicare benefits "acupuncture" is interpreted as including treatment by means other than the use of acupuncture needles where the same effect is achieved without puncture, eg by application of ultrasound, laser beams, pressure or moxibustion, etc.

For more information on the content-based item structure used in this Group, see A.5 in the explanatory notes.

Health Assessment (Items 701, 703, 705, 707)

There are four time-based health assessment items, consisting of brief, standard, long and prolonged consultations.

Brief Health Assessment (MBS Item 701)

A brief health assessment is used to undertake simple health assessments. The health assessment should take not more than 30 minutes to complete.

Standard Health Assessment (MBS Item 703)

A standard health assessment is used for straightforward assessments where the patient does not present with complex health issues but may require more attention than can be provided in a brief assessment. The assessment lasts more than 30 minutes but takes less than 45 minutes.

Long Health Assessment (MBS Item 705)

A long health assessment is used for an extensive assessment, where the patient has a range of health issues that require more in-depth consideration, and longer-term strategies for managing the patient’s health may be necessary. The assessment lasts at least 45 minutes but less than 60 minutes.

Prolonged Health Assessment (MBS Item 707)

A prolonged health assessment is used for a complex assessment of a patient with significant, long-term health needs that need to be
managed through a comprehensive preventive health care plan. The assessment takes 60 minutes or more to complete.

Medical practitioners may select one of the MBS health assessment items to provide a health assessment service to a member of any of the target groups listed in the table below. The health assessment item that is selected will depend on the time taken to complete the health assessment service. This is determined by the complexity of the patient’s presentation and the specific requirements that have been established for each target group eligible for health assessments.

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MBS Items 701, 703, 705 and 707 may be used to undertake a health assessment for the following target groups:

Target Group	Frequency of Service
A Healthy Kids Check for children aged at least 3 years and less than 5 years of age, who have received or who are receiving their 4 year old immunisation	Once only to an eligible patient
A type 2 diabetes risk evaluation for people aged 40-49 years (inclusive) with a high risk of developing type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool	Once every three years to an eligible patient
A health assessment for people aged 45-49 years (inclusive) who are at risk of developing chronic disease	Once only to an eligible patient
A health assessment for people aged 75 years and older	Provided annually to an eligible patient
A comprehensive medical assessment for permanent residents of residential aged care facilities	Provided annually to an eligible patient
A health assessment for people with an intellectual disability	Provided annually to an eligible patient
A health assessment for refugees and other humanitarian entrants	Once only to an eligible patient

A health assessment means the assessment of a patient's health and physical, psychological and social function and consideration of whether preventive health care and education should be offered to the patient, to improve that patient's health and physical, psychological and social function.

Health assessments are not available to people who are in-patients of a hospital or care recipients in a residential aged care facility (with the exception of a comprehensive medical assessment provided to a permanent resident of a residential aged care facility).

Before a health assessment is commenced, the patient (and/or his or her parent(s), carer or representative, as appropriate) must be given an explanation of the health assessment process and its likely benefits. The patient must be asked whether he or she consents to the health assessment being performed. In cases where the patient is not capable of giving consent, consent must be given by his or her parent(s), carer or representative. Consent to the health assessment must be noted in the patient’s records.
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A health assessment must include the following elements:

1. information collection, including taking a patient history and undertaking or arranging examinations and investigations as required;
2. making an overall assessment of the patient;
3. recommending appropriate interventions;
4. providing advice and information to the patient;
5. keeping a record of the health assessment, and offering the patient a written report about the health assessment, with recommendations about matters covered by the health assessment; and
6. offering the patient’s carer (if any, and if the medical practitioner considers it appropriate and the patient agrees) a copy of the report or extracts of the report relevant to the carer.

A health assessment may only be claimed by a medical practitioner (including a general practitioner but not including a specialist or consultant physician).

A health assessment should generally be undertaken by the patient’s ‘usual doctor’. For the purpose of the health assessment items, ‘usual doctor’ means the medical practitioner, or a medical practitioner working in the medical practice, which has provided the majority of primary health care to the patient over the previous twelve months and/or will be providing the majority of care to the patient over the next twelve months.

A health assessment should not take the form of a health screening service (see General Explanatory Notes G.13.1).

Practice nurses and registered Aboriginal health workers may assist medical practitioners in performing the health assessment, in accordance with accepted medical practice and under the supervision of the medical practitioner. This may include activities associated with:

1. information collection; and
2. providing patients with information about recommended interventions at the direction of the medical practitioner.

All other components of the health assessment must include a personal attendance by a medical practitioner.

Medical practitioners should not conduct a separate consultation for another health-related issue in conjunction with a health assessment unless it is clinically necessary (ie. the patient has an acute problem that needs to be managed separately from the assessment). The only exceptions are:

1. a health assessment provided as a Healthy Kids Check, where a consultation associated with the four year old immunisation can be conducted on the same occasion; and
2. the comprehensive medical assessment, where, if this health assessment is undertaken during the course of a consultation for another purpose, the health assessment item and the relevant item for the other consultation may both be claimed.

Items 701, 703, 705 and 707 do not apply for services that are provided by any other Commonwealth or State funded services. 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 State/Territory Government health clinic, items 701, 703, 705 and 707 can be claimed for services provided by medical practitioners salaried by or contracted to, the Service or health clinic. All other requirements of the items must be met.

Item 10990 or 10991 (bulk billing incentives) can be claimed in conjunction with any health assessment, provided the conditions of item 10990 and 10991 are satisfied.

Health Assessment provided as a Healthy Kids Check

Items 701, 703, 705 and 707 may be used to provide a Health Kids Check for children aged at least 3 years and less than 5 years of age, who have received or who are receiving their 4 year old immunisation.
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The Healthy Kids Check is an assessment of a patient’s physical health, general well-being and development, with the purpose of initiating medical interventions as appropriate.

The Healthy Kids Check must include the following basic physical examinations and assessments:

1. Height and weight (plot and interpret growth curve/calculate BMI)
2. Eyesight
3. Hearing
4. Oral health (teeth and gums)
5. Toileting
6. Allergies

The medical practitioner is required to note if a copy of the Department's publication ‘Get Set 4 Life – habits for healthy kids’ has been provided to the patient’s parent(s)/guardian.

The medical practitioner is also required to note that the four year-old immunisation has been given (including evidence provided).

The Healthy Kids Check can also be undertaken on behalf of a medical practitioner by a practice nurse or a registered Aboriginal health worker under MBS item 10986.

Items 10993 (immunisation by Practice Nurse) and 10988 (immunisation by registered Aboriginal health worker) can be claimed in conjunction with the Healthy Kids Check health assessment, provided the conditions of items 10993 and 10988 are satisfied.

A health assessment for a Healthy Kids Check may only be claimed once by an eligible patient and only if the patient has not already claimed item 10986 (the Healthy Kids Check provided by a practice nurse or registered Aboriginal health worker).

Health Assessment provided as a type 2 diabetes risk evaluation for people aged 40-49 years with a high risk of developing type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool

Items 701, 703, 705 and 707 may be used to undertake a type 2 diabetes risk evaluation for people aged 40-49 years (inclusive) with a high risk of developing type 2 diabetes, as determined by the Australian Type 2 Diabetes Risk Assessment Tool.

The aim of this health assessment is to review the factors underlying the ‘high risk’ score identified by the Australian Type 2 Diabetes Risk Assessment Tool to instigate early interventions, such as lifestyle modification programs, to assist with the prevention of type 2 diabetes.

The Australian Type 2 Diabetes Risk Assessment Tool has been developed to provide a basis for both health professionals and health consumers to assess the risk of type 2 diabetes. It consists of a short list of questions which, when completed, provides a guide to a patient’s current level of risk of developing type 2 diabetes. The item scores and risk rating calculations in the tool have been developed using demographic, lifestyle, anthropometric and biomedical data from the 2000 Australian Diabetes, Obesity and Lifestyle baseline survey and the AusDiab 2005 follow-up study.
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The Australian Type 2 Diabetes Risk Assessment Tool can be obtained from http://www.health.gov.au/preventionoftype2diabetes

Clinical risk factors that the medical practitioner must consider when providing this health assessment include:

1. lifestyle, such as smoking, physical inactivity and poor nutrition;
2. biomedical risk factors, such as high blood pressure, impaired glucose metabolism and excess weight;
3. any relevant recent diagnostic test results; and
4. a family history of chronic disease.

The health assessment must include the following:

1. evaluating a patient’s high risk score, as determined by the Australian Type 2 Diabetes Risk Assessment Tool which has been completed by the patient within a period of 3 months prior to undertaking the health assessment;
2. updating the patient’s history and undertaking physical examinations and clinical investigations in accordance with relevant guidelines;
3. making an overall assessment of the patient’s risk factors and of the results of relevant examinations and investigations;
4. initiating interventions, if appropriate, including referral to a lifestyle modification program and follow-up relating to the management of any risk factors identified (further information is available at http://www.health.gov.au/preventionoftype2diabetes); and
5. providing the patient with advice and information (such as the Lifescript resources produced by the Department of Health and Ageing), including strategies to achieve lifestyle and behaviour changes if appropriate (further information is available at http://www.health.gov.au/lifescripts).

The completion of the Australian Type 2 Diabetes Risk Assessment Tool is mandatory for patient access to this health assessment. The tool can be completed either by the patient or with the assistance of a health professional or practice staff. Patients with a ‘high’ score result are eligible for the health assessment, and subsequent referral to the subsidised lifestyle modification programs if appropriate (further information is available at http://www.health.gov.au/preventionoftype2diabetes).

A health assessment for a type 2 diabetes risk evaluation for people aged 40-49 years with a high risk of developing type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool may only be claimed once every three years by an eligible patient.

Health Assessment provided for people aged 45-49 years who are at risk of developing chronic disease

Items 701, 703, 705 and 707 may be used to undertake a health assessment for people aged 45-49 years (inclusive) who are at risk of developing chronic disease.

For the purposes of this health assessment, a patient is at risk of developing a chronic disease if, in the clinical judgement of the attending medical practitioner, a specific risk factor for chronic disease is identified.

Risk factors that the medical practitioner can consider include, but are not limited to:

1. lifestyle risk factors, such as smoking, physical inactivity, poor nutrition or alcohol use;
2. biomedical risk factors, such as high cholesterol, high blood pressure, impaired glucose metabolism or excess weight; or
3. family history of a chronic disease.

A chronic disease or condition is one that has been or is likely to be present for at least six months, including but not limited to asthma, cancer, cardiovascular illness, diabetes mellitus, mental health conditions, arthritis and musculoskeletal conditions.
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If, after receiving this health assessment, a patient is identified as having a high risk of type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool, the medical practitioner may refer that person to a subsidised lifestyle modification program, along with other possible strategies to improve the health status of the patient (further information is available at http://www.health.gov.au/preventionoftype2diabetes).

The Australian Type 2 Diabetes Risk Assessment Tool can be obtained from http://www.health.gov.au/preventionoftype2diabetes

A health assessment for people aged 45-49 years who are at risk of developing chronic disease may only be claimed once by an eligible patient.

Health Assessment provided for people aged 75 years and older

Items 701, 703, 705 and 707 may be used to undertake a health assessment for people aged 75 years and older.

A health assessment for people aged 75 years and older is an assessment of a patient’s health and physical, psychological and social function for the purpose of initiating preventive health care and/or medical interventions as appropriate.

This health assessment must include:

1. measurement of the patient’s blood pressure, pulse rate and rhythm;
2. an assessment of the patient’s medication;
3. an assessment of the patient’s continence;
4. an assessment of the patient’s immunisation status for influenza, tetanus and pneumococcus;
5. an assessment of the patient’s physical function, including the patient’s activities of daily living, and whether or not the patient has had a fall in the last 3 months;
6. an assessment of the patient’s psychological function, including the patient’s cognition and mood; and
7. an assessment of the patient’s social function, including the availability and adequacy of paid and unpaid help, and whether the patient is responsible for caring for another person.

A health assessment for people aged 75 years and older may be claimed once every twelve months by an eligible patient.

Health Assessment provided as a comprehensive medical assessment for residents of residential aged care facilities

Items 701, 703, 705 and 707 may be used to undertake a comprehensive medical assessment of a resident of a residential aged care facility.
This health assessment requires assessment of the resident’s health and physical and psychological function, and must include:

1. making a written summary of the comprehensive medical assessment;
2. developing a list of diagnoses and medical problems based on the medical history and examination;
3. providing a copy of the summary to the residential aged care facility; and
4. offering the resident a copy of the summary.

A residential aged care facility is a facility in which residential care services, as defined in the Aged Care Act 1997, are provided. This includes facilities that were formerly known as nursing homes and hostels. A person is a resident of a residential aged care facility if the person has been admitted as a permanent resident of that facility.
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This health assessment is available to new residents on admission into a residential aged care facility. It is recommended that new residents should receive the health assessment as soon as possible after admission, preferably within six weeks following admission into a residential aged care facility.

A health assessment for the purpose of a comprehensive medical assessment of a resident of a residential aged care facility may be claimed by an eligible patient:

1. on admission to a residential aged care facility, provided that a comprehensive medical assessment has not already been provided in another residential aged care facility within the previous 12 months; and
2. at 12 month intervals thereafter.

Health Assessment provided for people with an intellectual disability

Items 701, 703, 705 and 707 may be used to undertake a health assessment for people with an intellectual disability.

A person is considered to have an intellectual disability if they have significantly sub-average general intellectual functioning (two standard deviations below the average intelligence quotient [IQ]) and would benefit from assistance with daily living activities. Where medical practitioners wish to confirm intellectual disability and a patient’s need for assistance with activities of daily living, they may seek verification from a paediatrician registered to practice in Australia or from a government-provided or funded disability service that has assessed the patient’s intellectual function.

The health assessment provides a structured clinical framework for medical practitioners to comprehensively assess the physical, psychological and social function of patients with an intellectual disability and to identify any medical intervention and preventive health care required. The health assessment must include the following items as relevant to the patient or his or her representative:

1. Check dental health (including dentition);
2. Conduct aural examination (arrange formal audiometry if audiometry has not been conducted within 5 years);
3. Assess ocular health (arrange review by an ophthalmologist or optometrist if a comprehensive eye examination has not been conducted within 5 years);
4. Assess nutritional status (including weight and height measurements) and a review of growth and development;
5. Assess bowel and bladder function (particularly for incontinence or chronic constipation);
6. Assess medications (including non-prescription medicines taken by the patient, prescriptions from other doctors, medications prescribed but not taken, interactions, side effects and review of indications);
   • Advise carers of the common side effects and interactions.
   • Consider the need for a formal medication review.
7. Check immunisation status, including influenza, tetanus, hepatitis A and B, Measles, Mumps and Rubella (MMR) and pneumococcal vaccinations;
8. Check exercise opportunities (with the aim of moderate exercise for at least 30 minutes per day);
9. Check whether the support provided for activities of daily living adequately and appropriately meets the patient’s needs, and consider formal review if required;
10. Consider the need for breast examination, mammography, Papanicolaou smears, testicular examination, lipid measurement and prostate assessment as for the general population;
11. Check for dysphagia and gastro-oesophageal disease (especially for patients with cerebral palsy), and arrange for investigation or treatment as required;
12. Assess risk factors for osteoporosis (including diet, exercise, Vitamin D deficiency, hormonal status, family history, medication fracture history) and arrange for investigation or treatment as required;
13. For patients diagnosed with epilepsy, review of seizure control (including anticonvulsant drugs) and consider referral to a neurologist at appropriate intervals;
14. Check for thyroid disease at least every two years (or yearly for patients with Down syndrome);
15. For patients without a definitive aetiological diagnosis, consider referral to a genetic clinic every 5 years;
16. Assess or review treatment for co-morbid mental health issues;
17. Consider timing of puberty and management of sexual development, sexual activity and reproductive health; and
18. Consider whether there are any signs of physical, psychological or sexual abuse.

A health assessment for people with an intellectual disability may be claimed once every twelve months by an eligible patient.

Health Assessment provided for refugees and other humanitarian entrants

Items 701, 703, 705 and 707 may be used to undertake a health assessment for refugees and other humanitarian entrants.
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The purpose of this health assessment is to introduce new refugees and other humanitarian entrants to the Australian primary health care system, as soon as possible after their arrival in Australia (within twelve months of arrival).

In addition to general requirements for health assessments, the assessment must include development of a management plan addressing the patient’s health care needs, health problems and relevant conditions.

The health assessment applies to humanitarian entrants who are resident in Australia with access to Medicare services. This includes Refugees, Special Humanitarian Program and Protection Program entrants with the following visas:

Offshore Refugee Category including

1. 200 Refugee


2. 201 In Country Special Humanitarian


3. 203 Emergency rescue


4. 204 Women at Risk

Offshore – Special Humanitarian Program

5. 202 Global Special Humanitarian

Offshore – Temporary Humanitarian Visas (THV) including:

6. 447 Secondary Movement Offshore Entry Temporary


7. 451 Secondary Movement Relocation Temporary


8. 786 Temporary Humanitarian Concern

Onshore Protection Program including:

9. 866 Permanent Protection Visa (PPV)


10. 785 Temporary Protection Visa (TPV)

Patients should be asked to provide proof of their visa status and date of arrival in Australia. Alternatively, medical practitioners may telephone Medicare Australia on 132011, with the patient present, to check eligibility.

The medical practitioner and patient can use the service of a translator by accessing the Commonwealth Government’s Translating and Interpreting Service (TIS) and the Doctors Priority Line. To be eligible for the fee-free TIS and Doctors Priority Line, the medical examiner must be in a private practice and provide a Medicare service to patients who do not speak English and are permanent residents.

A health assessment for refugees and other humanitarian entrants may only be claimed once by an eligible patient

Health Assessment for Aboriginal and Torres Strait Islander People (MBS Item 715)

This health assessment is available to all people of Aboriginal and Torres Strait Islander descent and should be used for health assessments for the following age categories:

• An Aboriginal or Torres Strait Islander child who is less than 15 years.
• An Aboriginal or Torres Strait Islander person who is aged between 15 years and 54 years.
• An Aboriginal or Torres Strait Islander older person who is aged 55 years and over.

A health assessment means the assessment of a patient's health and physical, psychological and social function and consideration of whether preventive health care and education should be offered to the patient, to improve that patient's health and physical, psychological and social function.

MBS item 715 must include the following elements:

1. information collection, including taking a patient history and undertaking examinations and investigations as required;
2. making an overall assessment of the patient;
3. recommending appropriate interventions;
4. providing advice and information to the patient;
5. keeping a record of the health assessment, and offering the patient, and/or patient’s carer, a written report about the health assessment with recommendations about matters covered by the health assessment; and
6. offering the patient’s carer (if any, and if the medical practitioner considers it appropriate and the patient agrees) a copy of the report or extracts of the report relevant to the carer.

If, after receiving this health assessment, a patient, who is aged fifteen years and over but under the age of 55 years, is identified as having a high risk of developing type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool, the medical practitioner may refer that person to a subsidised lifestyle modification program, along with other possible strategies to improve the health status of the patient.
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The Australian Type 2 Diabetes Risk Assessment Tool can be obtained from http://www.health.gov.au/preventionoftype2diabetes

A health assessment may only be claimed by a medical practitioner (including a general practitioner but not including a specialist or consultant physician).

A health assessment should generally be undertaken by the patient’s ‘usual doctor’. For the purpose of the health assessment, “usual doctor” means the medical practitioner, or a medical practitioner working in the medical practice, which has provided the majority of primary health care to the patient over the previous twelve months and/or will be providing the majority of care to the patient over the next twelve months.

The Health Assessment for Aboriginal and Torres Strait Islander People is not available to people who are in-patients of a hospital or care recipients in a residential aged care facility.

A health assessment should not take the form of a health screening service (see General Explanatory Notes G.13.1).

Practice nurses and registered Aboriginal health workers may assist medical practitioners in performing the health assessment, in accordance with accepted medical practice and under the supervision of the medical practitioner. This may include activities associated with:

1. information collection; and
2. providing patients with information about recommended interventions at the direction of the medical practitioner.

All other components of the health assessment must include a personal attendance by a medical practitioner.

Medical practitioners should not conduct a separate consultation in conjunction with a health assessment unless it is clinically necessary (ie. the patient has an acute problem that needs to be managed separately from the assessment).

Item 715 does not apply for services that are provided by any other Commonwealth or State funded services. 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 State/Territory Government health clinic, item 715 can be claimed for services provided by medical practitioners salaried by or contracted to, the Service or health clinic. All requirements of the item must be met.

Item 10990 or 10991 (bulk billing incentives) can be claimed in conjunction with any health assessment provided to an Aboriginal and Torres Strait Islander person, provided the conditions of item 10990 and 10991 are satisfied.
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The Aboriginal and Torres Strait Islander Persons Health Assessment may be provided once every 9 months.

A health Assessment for an Aboriginal and Torres Strait Islander child (less than 15 years of age)

This health assessment involves all of the following:

1. a personal attendance by a medical practitioner;


2. taking the patient’s medical history, including the following:

1. mother’s pregnancy history;
2. birth and neo-natal history;


3. breastfeeding history;


4. weaning, food access and dietary history;


5. physical activity;


6. previous presentations, hospital admissions and medication usage;


7. relevant family medical history;


8. immunisation status;


9. vision and hearing (including neonatal hearing screening);


10. development (including achievement of age appropriate milestones);


11. family relationships, social circumstances and whether the person is cared for by another person;


12. exposure to environmental factors (including tobacco smoke);


13. environmental and living conditions;


14. educational progress;


15. stressful life events;


16. mood (including incidence of depression and risk of self‑harm);


17. substance use;


18. sexual and reproductive health; and


19. dental hygiene (including access to dental services).

3. examination of the patient, including the following:
   
   
   1. measurement of height and weight to calculate body mass index and position on the growth curve;
   
   
   2. newborn baby check (if not previously completed);
   
   
   3. vision (including red reflex in a newborn);
   
   
   4. ear examination (including otoscopy);
   
   
   5. oral examination (including gums and dentition);
   
   
   6. trachoma check, if indicated;
   
   
   7. skin examination, if indicated;
   
   
   8. respiratory examination, if indicated;
   
   
   9. cardiac auscultation, if indicated;
   
   
   10. development assessment, if indicated, to determine whether age appropriate milestones have been achieved;
   
   
   11. assessment of parent and child interaction, if indicated; and
   
   
   12. other examinations in accordance with national or regional guidelines or specific regional needs, or as indicated by a previous child health assessment.


4. undertaking or arranging any required investigation, considering the need for the following tests, in particular:


1. haemoglobin testing for those at a high risk of anaemia; and


2. audiometry, if required, especially for those of school age.


5. assessing the patient using the information gained in the child health check; and


6. making or arranging any necessary interventions and referrals, and documenting a simple strategy for the good health of the patient.

A health assessment for an Aboriginal and Torres Strait Islander adult (aged between 15 years and 54 years)

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This health assessment involves all of the following:

1. a personal attendance by a medical practitioner;


2. taking the patient’s medical history, including the following:

1. current health problems and risk factors;


2. relevant family medical history;


3. medication usage (including medication obtained without prescription or from other doctors);


4. immunisation status, by reference to the appropriate current age and sex immunisation schedule;


5. sexual and reproductive health;


6. physical activity, nutrition and alcohol, tobacco or other substance use;


7. hearing loss;


8. mood (including incidence of depression and risk of self‑harm); and


9. family relationships and whether the patient is a carer, or is cared for by another person.

3. examination of the patient, including the following:
   
   
   1. measurement of the patient’s blood pressure, pulse rate and rhythm;
   
   
   2. measurement of height and weight to calculate body mass index and, if indicated, measurement of waist circumference for central obesity;
   
   
   3. oral examination (including gums and dentition);
   
   
   4. ear and hearing examination (including otoscopy and, if indicated, a whisper test); and
   
   
   5. urinalysis (by dipstick) for proteinurea.


4. undertaking or arranging any required investigation, considering the need for the following tests, in particular, (in accordance with national or regional guidelines or specific regional needs):
   
   1. fasting blood sugar and lipids (by laboratory based test on venous sample) or, if necessary, random blood glucose levels;
   
   
   2. pap smear;
   
   
   3. examination for sexually transmitted infection (by urine or endocervical swab for chlamydia and gonorrhoea, especially for those aged from 15 to 35 years); and
   
   
   4. mammography, if eligible (by scheduling appointments with visiting services or facilitating direct referral).

5. assessing the patient using the information gained in the adult health check; and


6. making or arranging any necessary interventions and referrals, and documenting a simple strategy for the good health of the patient.

A health assessment for an Aboriginal and Torres Strait Islander older person (aged 55 years and over)

This health assessment involves all of the following:

1. a personal attendance by the medical practitioner;
2. measurement of the patient’s blood pressure, pulse rate and rhythm;
3. an assessment of the patient’s medication;
4. an assessment of the patient’s continence;
5. an assessment of the patient’s immunisation status for influenza, tetanus and pneumococcus;
6. an assessment of the patient’s physical functions, including the patient’s activities of daily living and whether or not the patient has had a fall in the last 3 months;
7. an assessment of the patient’s psychological function, including the patient’s cognition and mood;
8. an assessment of the patient’s social function, including:
   1. the availability and adequacy of paid, and unpaid, help; and
   2. whether the patient is responsible for caring for another person.

Public Health Medicine - (Items 410 to 417)

Attendances by public health physicians will attract Medicare benefits under the new items only where the attendance relates to one or more of the following: -

1. management of a patient's vaccination requirements for accepted immunisation programs; or
2. prevention or management of sexually transmitted disease; or
3. prevention or management of disease due to environmental hazards or poisons; or
4. prevention or management of exotic diseases; or
5. prevention or management of infection during outbreaks of infectious disease.

For more information on the content-based item structure used in this Group, see A.5 in the explanatory notes.

Healthy Kids check provided by a practice nurse or registered Aboriginal Health Worker (Item 10986)

A health assessment means the assessment of a patient's health and physical, psychological and social function and consideration of whether preventive health care and education should be offered to the patient, to improve that patient's health and physical, psychological and social function.

A health assessment must include the following elements:

1. information collection, including taking a patient history and undertaking examinations and investigations as required;
2. making an overall assessment of the patient;
3. recommending appropriate interventions;
4. providing advice and information to the patient;
5. keeping a record of the health assessment, and offering the patient a written report about the health assessment, with recommendations about matters covered by the health assessment; and
6. offering the patient’s carer (if any, and if the medical practitioner considers it appropriate and the patient agrees) a copy of the report or extracts of the report relevant to the carer.

MBS Item 10986 may be provided by a practice nurse or registered Aboriginal health worker, but may only be claimed by a medical practitioner (including a general practitioner but not including a specialist or consultant physician).
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A health assessment should not take the form of a health screening service (see General Explanatory Notes G.13.1).

The practice nurse or registered Aboriginal health worker is required to note if a copy of the Department's publication ‘Get Set 4 Life – habits for healthy kids’ has been provided to the patient’s parents/guardian.

The practice nurse or registered Aboriginal health worker is also required to note that the four year-old immunisation has been given (including evidence provided).

The practice nurse is a registered or enrolled nurse who is employed by, or whose services are otherwise retained by a general practice. A registered Aboriginal health worker means a person in the Northern Territory who is registered as an Aboriginal health worker under the Health Practitioners Act 2004 (NT), who is employed or retained by a general practice, or by a health service that has an exemption to claim Medicare benefits under sub-section 19(2) of the Health Insurance Act 1973.

Should the practice nurse or registered Aboriginal health worker identify any health concerns that require medical intervention, the patient must be reviewed by the patient’s ‘usual doctor’ who will arrange referrals and follow-up as clinically required.

In all cases, the medical practitioner under whose supervision the health Check is being provided retains responsibility for the health, safety and clinical outcomes of the patient. The medical practitioner must be satisfied that the practice nurse or registered Aboriginal health worker is appropriately qualified and trained to provide the service.
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General practices and Aboriginal Community Controlled Health Services and State/Territory health clinics that are exempt under subsection 19(2) of the Health Insurance Act 1973 that utilise nurses and registered Aboriginal health workers to provide the Healthy Kids Check must also have a written clinical risk management strategy.

Where the medical practitioner and practice nurse or registered Aboriginal health worker are at the same location, the medical practitioner is not required to be present while the Healthy Kids Check is undertaken. The medical practitioner must decide whether he or she needs to see the patient.

Items 10993 (immunisation by Practice Nurse) and 10988 (immunisation by registered Aboriginal Health Worker) can be claimed in conjunction with the Healthy Kids Check health assessment, provided the conditions of item 10993 and 10988 are satisfied.

The Healthy Kids Check must include the following basic physical examinations and assessments:

1. Height and weight (plot and interpret growth curve/calculate BMI)
2. Eyesight
3. Hearing
4. Oral health (teeth and gums)
5. Toileting
6. Allergies

Item 10986 does not apply for services that are provided by any other Commonwealth or State funded services. 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 State/Territory Government health clinic, item 10986 can be claimed for services provided by nurses or registered Aboriginal health workers salaried by or contracted to, the Service or health clinic. All other requirements of the item must be met.

The Healthy Kids Check provided by a practice nurse or registered Aboriginal Health Worker (item 10986) may only be claimed once by an eligible patient and only if the patient has not already claimed a Healthy Kids Check service under items 701, 703, 705 or 707.

Chronic Disease Management Items (Items 721 to 732)

Description	Item No	Minimum claiming period*
Preparation of a GP Management Plan (GPMP)	721	12 months*
Coordination of Team Care Arrangements (TCAs)	723	12 months*
Contribution to a Multidisciplinary Care Plan, or to a review of a multidisciplinary care plan, for a patient who is not a care recipient in a residential aged care facility	729	3 months*
Contribution to a multidisciplinary care plan, or to a review of a multidisciplinary care plan, for a resident in an aged care facility	731	3 months*
Review of a GP Management Plan or Coordination of a Review of Team Care Arrangements	732	3 months*

* CDM services may be provided more frequently in the exceptional circumstances defined below.

Regulatory Requirements

Items 721, 723, 729, 731 and 732 provide rebates for GPs to manage chronic or terminal medical conditions by preparing, coordinating, reviewing or contributing to Chronic Disease Management (CDM) plans. They apply for a patient who suffers from at least one medical condition that has been present (or is likely to be present) for at least six months or is terminal.

Patient eligibility

In addition to the eligibility requirements listed in the individual CDM Item Descriptors, the General Medical Services Table (GMST) mandates the following eligibility criteria:
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CDM items 721, 723 and 732
These are:

• available to:
  1. patients in the community; and
  2. private in-patients of a hospital (including private in-patients who are residents of aged care facilities) being discharged from hospital.
• not available to:
  1. i. public in-patients of a hospital; or
  2. ii. care recipients in a residential aged care facility.

CDM item 729
This is:

• available to:
  1. patients in the community
  2. both private and public in-patients being discharged from hospital.
• not available to care recipients in a residential aged care facility.

CDM item 731
This item is available to care recipients in a residential aged care facility only.

Item 721

A comprehensive written plan must be prepared describing:

1. the patient’s health care needs, health problems and relevant conditions;
2. management goals with which the patient agrees;
3. actions to be taken by the patient;
4. treatment and services the patient is likely to need;
5. arrangements for providing this treatment and these services;
6. arrangements to review the plan by a date specified in the plan.

In preparing the plan, the provider must:

1. explain to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees) the steps involved in preparing the plan; and
2. record the plan; and
3. record the patient’s agreement to the preparation of the plan; and
4. offer a copy of the plan to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and
5. add a copy of the plan to the patient’s medical records.

Item 723
When coordinating the development of Team Care Arrangements (TCAs), the medical practitioner must:

1. consult with at least two collaborating providers, each of whom will provide a different kind of treatment or service to the patient, and one of whom may be another medical practitioner, when making arrangements for the multidisciplinary care of the patient; and
2. prepare a document that describes:
   1. treatment and service goals for the patient;
   2. treatment and services that collaborating providers will provide to the patient; and
   3. actions to be taken by the patient;
   4. arrangements to review (i), (ii) and (iii) by a date specified in the document; and
3. explain the steps involved in the development of the arrangements to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees);
4. discuss with the patient the collaborating providers who will contribute to the development of the Team Care Arrangements and provide treatment and services to the patient under those arrangements; and
5. record the patient’s agreement to the development of Team Care Arrangements;
6. give copies of the relevant parts of the document to the collaborating providers;
7. offer a copy of the document to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and
8. add a copy of the document to the patient’s medical records.

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One of the minimum two service providers collaborating with the GP can be another medical practitioner. The patient’s informal or family carer can be included in the collaborative process but does not count towards the minimum of three collaborating providers.

Item 729

A multidisciplinary care plan means a written plan that:

1. is prepared for a patient by:
   1. a medical practitioner in consultation with two other collaborating providers, each of whom provides a different kind of treatment or service to the patient, and one of whom may be another medical practitioner; or
   2. a collaborating provider (other than a medical practitioner) in consultation with at least two other collaborating providers, each of whom provides a different kind of treatment or services to the patient; and
2. describes, at least, treatment and services to be provided to the patient by the collaborating providers.

When contributing to a multidisciplinary care plan or to a review of the care plan, the medical practitioner must:

1. prepare part of the plan or amendments to the plan and add a copy to the patient’s medical records; or
2. give advice to a person who prepares or reviews the plan and record in writing, on the patient’s medical records, any advice provided to such a person.

Item 731

A multidisciplinary care plan in a Residential Aged Care Facility (RACF) means a written plan that:

1. is prepared for a patient by a collaborating provider (other than a medical practitioner, e.g. a RACF), in consultation with at least two other collaborating providers, each of whom provides a different kind of treatment or services to the patient; and
2. describes, at least, treatment and services to be provided to the patient by the collaborating providers.

When contributing to a multidisciplinary care plan or to a review of the care plan, the medical practitioner must:

1. prepare part of the plan or amendments to the plan and add a copy to the patient’s medical records; or
2. give advice to a person who prepares or reviews the plan and record in writing, on the patient’s medical records, any advice provided to such a person.

Item 731 can also be used for contribution to A Multidisciplinary Care Plan prepared for a resident by another provider before the resident is discharged from a hospital or an approved day-hospital facility, OR to a review of such a plan prepared by another provider (not being a service associated with a service to which items 735 to 758 apply).

Item 732

An “associated medical practitioner” is a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) who, if not engaged in the same general practice as the medical practitioner mentioned in that item, performs the service mentioned in the item at the request of the patient (or the patient’s guardian).
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When reviewing a GP Management Plan, the medical practitioner must:

1. explain to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees) the steps involved in the review;
2. record the patient’s agreement to the review of the plan;
3. review all the matters set out in the relevant plan;
4. make any required amendments to the patient’s plan;
5. offer a copy of the amended document to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees);
6. add a copy of the amended document to the patient’s records; and
7. provide for further review of the amended plan by a date specified in the plan.

When coordinating a review of Team Care Arrangements, a multidisciplinary community care plan or a multidisciplinary discharge care plan, the practitioner must:

1. explain the steps involved in the review to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees);
2. record the patient’s agreement to the review of the TCAs or plan;
3. consult with at least two health or care providers (each of whom provides a service or treatment to the patient that is different from each other and different from the service or treatment provided by the medical practitioner who is coordinating the TCAs or plan) to review all the matters set out in the relevant plan;
4. make any required amendments to the patient’s plan;
5. offer a copy of the amended document to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees);
6. provide for further review of the amended plan by a date specified in the plan;
7. give copies of the relevant parts of the amended plan to the collaborating providers; and
8. add a copy of the amended document to the patient’s records.

Item 732 can also be used to Coordinate a review of a Multidisiciplinary Community Care Plan to Discharge Care Plan to which former item 722 applies, where these services were coordinated or prepared by that medical practitioner (or an associated medical practitioner), and not being a service associated with a service to which items 735-758 apply.
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Claiming of benefits
Each service to which item 732 applies (i.e. Review of a GP Management Plan and Review of Team Care Arrangements) may be claimed once in a three-month period, except where there are exceptional circumstances arising from a significant change in the patient’s clinical condition or care circumstances that necessitates earlier performance of the service for the patient.

Where a service is provided in exceptional circumstances, the patient's invoice or Medicare voucher should be annotated to indicate the reason why the service was required earlier than the minimum time interval for the relevant item. Payment can then be made.

Item 732 can be claimed twice on the same day providing an item 732 for reviewing a GP Management Plan and another 732 for reviewing Team Care Arrangements (TCAs) are both delivered on the same day as per the MBS item descriptors and explanatory notes.

Exceptional circumstances

Exceptional circumstances exist for a patient if there has been a significant change in the patient’s clinical condition or care requirements that necessitates the performance of the service for the patient.

Usual medical practitioner

Items 721-732 should generally be undertaken by the patient’s usual medical practitioner.

The patient’s “usual GP” means the GP, or a GP working in the medical practice, who has provided the majority of care to the patient over the previous twelve months and/or will be providing the majority of GP services to the patient over the next twelve months. The term “usual GP” would not generally apply to a practice that provides only one specific CDM service.

Prolonged Attendance in Treatment of a Critical Condition (Items 160 164)

The conditions to be met before services covered by items 160-164 attract benefits are:-

1. the patient must be in imminent danger of death;
2. if the personal attendance is not continuous, the occasion on which the service is provided is taken to be the total time of the attendance; and
3. if personal attendance on a single patient is provided by 1 or more medical practitioners concurrently, each practitioner may claim an attendance fee.

After-hours services provided in areas eligible for the higher bulk billing payment - (Item 10985 and 10992)

Item 10985 and 10992 can only be claimed where all of the conditions set out in paragraphs (a) to (g) of item 10985 or 10992 have been met:

• Item 10985 must be claimed in conjunction with one of the items 597, 598, 599 and 600. These items are for services provided after hours outside of consulting rooms.
• Item 10992 must be claimed in conjunction with one of the items 5003, 5010, 5023, 5028, 5043, 5049, 5063, 5067, 5220, 5223, 5227, 5228, 5260, 5263 5265, or 5267. These items are for services provided after-hours outside of consulting rooms or hospital.
• Item 10985 and 10992 can only be used where the service is provided in one of the eligible areas listed in item 10985 or 10992 by a medical practitioner whose practice location (ie the location associated with the medical practitioner’s provider number) is not in one of these areas.
• Medical practitioners whose practice location is inside one of these listed locations should claim item 10985 or 10991 for eligible services.

Item 10985 and 10992 cannot be claimed in conjunction with item 10990 or 10991.
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Where a Medicare benefit is not payable for a particular service the payment for item 10985 and 10992 will not be paid for that service.

All GPs, whether vocationally registered or not, are eligible to claim the additional bulk billing payment.

Commonwealth concession card holder means a person listed on a Pensioner Concession Card, Health Care Card or Commonwealth Seniors Health Card issued by either Centrelink or the Department of Veterans’ Affairs. Gold or White Cards issued by the Department of Veterans’ Affairs do not attract the additional bulk billing payment. However, if a Gold or White Card holder also holds a recognised Commonwealth concession card and chooses to be treated under the Medicare arrangements, then that patient is an eligible concession card holder.

Unreferred service means a medical service provided to a patient by, or on behalf of, a medical practitioner, being a service that has not been referred to that practitioner by another medical practitioner or person with referring rights.

Medicare Australia will undertake regular post payment auditing to ensure that the additional bulk billing payment is being claimed correctly. Centrelink data will be used to verify concessional status and Medicare records will be used to confirm patient age.

Additional Information

Advice on the items and further guidance are available at: www.health.gov.au/mbsprimarycareitems

A practice nurse, Aboriginal health worker or other health professional may assist a GP with items 721, 723, and 732 (e.g. in patient assessment, identification of patient needs and making arrangements for services). However, the GP must review and confirm all assessments and arrangements, and see the patient.

Patients being managed under the chronic disease management items may be eligible for:

• allied health services (items 10950 to 10970); and/or
• allied health group services (items 81100 to 81125); and/or
• dental services (items 85011-87777).

More information on eligibility requirements can be found at note A.34 (dental services), M.3.1 (allied health individual services) and M.9.1 (allied health group services).

Further information is also available for providers from the Medicare Australia provider inquiry line on 132 150.
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