Enhanced Primary Care Program (EPC)

Consultant Physician Items 132 and 133, Development and Review of a Treatment and Management Plan

Questions and Answers for GPs

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Q: What are the consultant physician items?

A: Two Medicare Benefits Schedule items (132 and 133) were introduced on 1 November 2007 to provide for a professional attendance by a consultant physician (not in the specialty of psychiatry), for the assessment and review of a patient with at least two morbidities. The morbidities can include complex congenital, developmental and behavioural disorders.

Item 132
• An initial attendance of at least 45 minutes duration to undertake a comprehensive assessment of a patient with at least two morbidities, and the development of a treatment and management plan.
• The schedule fee for this item is $243.80.

Item 133
• A subsequent attendance of at least 20 minutes duration to review the initial diagnoses, problems and responses to treatment, and to revise the treatment and management plan(if necessary).
• The schedule fee for this item is $122.05.

Q: Who can claim these items?

A: All consultant physicians, in a specialty other than psychiatry, can claim these items providing all requirements of the item are met. It is expected that the majority of these services will be provided by consultant physicians in the non-procedural/cognitive specialties, such as internal and general medicine, geriatrics, paediatrics, renal medicine, rheumatology and haematology.

Q: Who is eligible for treatment under items 132 and 133?

A: Items 132 and 133 provide for the assessment and management of patients with at least two morbidities, for example, diabetes and other related problems such as kidney disease or neuropathies. This includes but is not limited to, patients being managed by their general practitioner (GP) with a GP Management Plan (GPMP) or Team Care Arrangements (TCA). It is expected that the consultant physician treatment and management plan will augment the GPMP or TCA.

Q: Does the patient need to be referred to be eligible for treatment under items 132 and 133?

A: Yes, the patient must be referred by a medical practitioner. The patient may be referred specifically for the purposes of items 132 and 133 or for other purposes. The need to develop a treatment and management plan is based on the consultant physician’s clinical judgement.

A new referral is not required for a review service (item 133), however item 132 must have been claimed by the patient in the preceding 12 months. The consultant physician or referring practitioner can initiate the review of the patient. If the consultant physician has particular concerns about the indications or possible need for further reviews, these should be noted in the consultant physician treatment and management plan.

Q: Can a consultant physician refer a patient for allied health services?

A: To be eligible for Medicare benefits for allied health treatment of chronic disease, the patient must be managed by their GP using a GP Management Plan and TCA, and referred to eligible allied health services by their GP.
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A consultant physician can refer a patient to an allied health professional, but the allied health service will not be eligible for a Medicare rebate on the basis of this referral.

A consultant physician can identify the need for allied health services in the preparation of the treatment and management plan. The GP would then need to review the TCA to incorporate that recommendation and make a referral that meets the Medicare requirements for allied health services.

Q: What should a referral to a consultant physician include?

A: To ensure the appropriate treatment of the patient, it is important that the referral contains adequate information to inform the treating specialist or consultant physician of the purpose of referral. The referral from the medical practitioner to the consultant physician should include the patient’s history, relevant pathology results, details of medications and interactions, with particular focus on presenting symptoms and current difficulties. Assessments by other health professionals, including GPs and specialists, relevant care plans and health assessments should also be noted.

Q. What information is the consultant physician expected to provide to the referring medical practitioner?

A. The consultant physician is expected to provide the patient’s referring medical practitioner with the results of a comprehensive medical examination of the patient and a treatment and management plan, including a risk assessment, management decisions and options, usually within two weeks from the time of the consultation. In more serious cases, more prompt provision of the plan and verbal communication with the referring medical practitioner may be appropriate.

Q: What information should be included in a consultant physician treatment and management plan?

A: A treatment and management plan must be developed by the consultant physician that includes the following:

• an opinion on diagnosis and a risk assessment
• treatment options and decisions
• medication recommendations.

Q: What happens to care plans already developed by the GP?

A: As a general principle, the creation of multiple care plans should be avoided. Where a patient is already being managed by their GP with a GP Management Plan (GPMP) or Team Care Arrangements (TCA) and is referred to a consultant physician for further assessment, the consultant physician treatment and management plan should augment the GPMP or TCA for that patient. The GP may choose to review the GPMP or TCA to incorporate the consultant physician’s treatment and management plan.

Further information

More detailed information regarding the claiming requirement of items can be obtained by calling the Medicare Provider Hotline on 132 150 (for practitioners) or 131 011 (for patients).

The item descriptors and explanatory notes can be downloaded from the MBS online website at: www.mbsonline.gov.au