FREQUENTLY USED DESKTOP GUIDE TO ITEM NUMBERS for Allied Health Services July 2014
FREQUENTLY USED DESKTOP GUIDE TO ITEM NUMBERS ELIGIBILITY CRITERIA FOR ALLIED HEALTH PROFESSIONALS... 3 ALLIED HEALTH SERVICES FOR CHRONIC CONDITIONS REQUIRING TEAM CARE... 4 ALLIED HEALTH GROUP SERVICES FOR PATIENTS WITH TYPE 2 DIABETES... 5 FOLLOW-UP ALLIED HEALTH SERVICES FOR ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLE.. 6 BETTER START FOR CHILDREN WITH DISABILITY INITIATIVE... 7 Page 2 of 9
FREQUENTLY USED DESKTOP GUIDE TO ITEM NUMBERS For a comprehensive explanation of each MBS number please refer to the Medicare Benefits Schedule online at www.health.gov.au/mbsonline Eligibility Criteria for Allied Health Professionals providing chronic disease allied health (individual & group) Medicare services Profession Aboriginal and Torres Strait Islander Health Practitioner / Aboriginal Health Workers Audiologists Description Aboriginal and Torres Strait Islander Health Practitioners must be registered with the Aboriginal and Torres Strait Islander Health Practice Board of Australia. Aboriginal Health Workers practising in the Northern Territory (NT) must be registered under the Health Practitioners Act (NT); in other States and the Australian Capital Territory they must have been awarded a Certificate III in Aboriginal and Torres Strait Islander Primary Health Care (or an equivalent or higher qualification) OR a Certificate III in Aboriginal and Torres Strait Islander Health (or an equivalent or higher qualification, prior to 1 July 2012). Must be either a Full Member of the Audiological Society of Australia Inc (ASA) and the holder of a Certificate of Clinical Practice issued by the ASA; or an Ordinary Member Audiologist or a Fellow Audiologist of the Australian College of Audiology (ACAud). Chiropractors Must be registered with the Chiropractors Board of Australia. Diabetes Educators Must be a Credentialled Diabetes Educator (CDE) as credentialled by the Australian Diabetes Educators Association (ADEA). Dietitians Must be an Accredited Practising Dietitian as recognised by the Dietitians Association of Australia (DAA). Exercise Physiologists Workers Nurse Must be an Accredited Exercise Physiologist as accredited by Exercise and Sports Science Australia (ESSA). Mental health can include services provided by members of the five following professional groups: psychologists; mental health nurses; occupational therapists; social workers; and Aboriginal and Torres Strait Islander health practitioners / Aboriginal health workers. Psychologists, occupational therapists Aboriginal and Torres Strait Islander health practitioners and Aboriginal health workers are eligible in separate categories for these items. Must be a credentialed mental health nurse, as certified by the Australian College of Nurses. Occupational Therapists Must be registered with the Occupational Therapy Board of Australia. Osteopaths Must be registered with the Osteopathy Board of Australia. Physiotherapists Must be registered with the Physiotherapy Board of Australia. Podiatrists Podiatrists must be registered with the Podiatry Board of Australia. Psychologists Psychologists must hold General Registration with the Board of Australia. Speech Pathologists In Queensland must be registered with the Speech Pathologist Board of Queensland. In all other states and territories, they must be a Practising Member of Speech Pathology Australia. Page 3 of 9
ALLIED HEALTH SERVICES FOR CHRONIC CONDITIONS REQUIRING TEAM CARE Assessment and Provision of services GP must have completed a GP Management Plan (721) AND Team Care Arrangement (723) or contributed to a Multidisciplinary Care Plan in a Residential Aged Care Facility (731) Patient must have a chronic or terminal medical condition and complex care needs requiring care from a multidisciplinary team consisting of their GP and at least two other health or care providers. 715 Patients that have identified as Aboriginal and Torres Strait Islander and have undertaken the 715 Health Assessment can be referred for Allied Health follow-up if required. The assessment covers all age groups; however, it may vary depending on the age of the person. Refer to MBS primary care items 81300 to 81360 Allied Health Service Fee / Benefit Description / Recommended Frequency 10950 Aboriginal and Torres Strait Islander Health Service 10951 Diabetes Education Allied Health Provider must be Medicare registered. 10952 Audiology Maximum of 5 allied health services per patient each calendar year. 10953 10954 10958 10960 10962 Exercise Physiology Dietetics Occupational Therapy Physiotherapy Podiatry Can be 5 sessions with one provider or a combination e.g. 3 dietitian and 2 diabetes education sessions. GP refers to allied health professional using Referral Form for Chronic Disease Alled Health (Individual) Services under Medicare or a referral form containing all components. One for each provider. Services must be of at least 20min duration and provided to an individual not a group. 10964 10966 Chiropractic Osteopathy Allied health professionals must report back to the referring GP after first and last visit. 10970 Speech Pathology 10956 10968 For mental health conditions use Better Access Care items - 10 sessions For chronic physical conditions use GPMP and TCA - 5 sessions Better access and GPMP can be used for the same patient where eligible. Page 4 of 9
ALLIED HEALTH GROUP SERVICES FOR PATIENTS WITH TYPE 2 DIABETES For a comprehensive explanation of each MBS number please refer to the Medicare Benefits Schedule online at www.health.gov.au/mbsonline Assessment and Provision of Services GP must have completed a GP Management Plan (721), or reviewed an existing GPMP (732), or contributed to, or reviewed, a Multidisciplinary Care Plan in a Residential Aged Care Facility (731) Fee / Benefit Description / Recommended Frequency 81100 81110 81120 $79.85 / $67.90 $79.85 / $67.90 $79.85 / $67.90 Assessment for group services for Diabetes Education Assessment for group services for Exercise Physiology Assessment for group services for Dietitics One assessment session only by either Diabetes Educator, Exercise Physiologist or Dietitian, per calendar year. Must be at least 45 mins duration. Refer using Medicare Allied Health Group Services for Type 2 Diabetes Form or current referral method used in a practice. 81105 81115 $19.90 / $16.95 $19.90 / $16.95 Group service for Diabetes Education Group service for Exercise Physiology 8 group services per calendar year, can be 8 sessions with one provider or a combination e.g. 3 diabetes education, 3 dietitian and 2 exercise physiology sessions. Group services must be at least 60 minutes duration. 81125 $19.90 / $16.95 Group service for Dietitics Medicare Allied Health Group Services for Type 2 Diabetes Referral Form or a referral form containing all components. Each allied health provider to provide a written report to GP. If more than one, these can be combined into a single report. Page 5 of 9
FOLLOW-UP ALLIED HEALTH SERVICES FOR ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLES WHO HAVE HAD A HEALTH ASSESSMENT For a comprehensive explanation of each MBS number please refer to the Medicare Benefits Schedule online at www.health.gov.au/mbsonline Assessment and Provision of services These items provide an alternative pathway for Aboriginal or Torres Strait Islander peoples to access allied health services, and they can be accessed in addition to the individual allied health services for patients with a chronic medical condition and complex care needs (10950 to 10970) 715 Patients that have identified as Aboriginal and Torres Strait Islander and have undertaken the 715 Health Assessment can be referred for Allied Health follow-up if required. The assessment covers all age groups; however, it may vary depending on the age of the person. Fee / Benefit Description / Recommended Frequency 81300 Aboriginal and Torres Strait Islander Health Service 81305 Diabetes Education 81310 Audiology 81315 Exercise Physiology Allied Health Provider must be Medicare registered. 81320 81325 Dietetics Maximum of 5 allied health services per patient each calendar year (in addition to the 5 services eligible from TCA 10950-10970). 81330 Occupational Therapy Services must be of at least 20min duration. 81335 Physiotherapy Medicare Referral Form can be used. One for each provider. 81340 81345 Podiatry Chiropractic Allied health professionals must report back to the referring GP after the first and last services. 81350 Osteopathy 81355 81360 Speech Pathology Page 6 of 9
CHILDREN WITH AUTISM, PERVASIVE DEVELOPMENTAL DISORDER OR AN ELIGIBLE DISABILITY For a comprehensive explanation of each MBS number please refer to the Medicare Benefits Schedule online at www.health.gov.au/mbsonline Assessment and Provision of services Services are provided for children with autism or any other pervasive developmental disorder (PDD) through the Helping Children with Autism program and through the Better Start for Children with Disability program for children with an eligible disability. Children with both autism/pdd and an eligible disability can access either program, but not both. Service Fee / Benefit Description / Access 82000 $99.75 / $84.80 Child with autism/pdd must be aged under 13 years and referred by an eligible consultant psychiatrist or paediatrician. 82005 Speech Pathology A child with an eligible disability must be aged under 13 years and referred by a specialist, consultant physician or GP. Assessment/ diagnosis Services 82010 Occupational Therapy A separate referral is required for each provider. Services must be of at least 50min duration. A child may receive up to 4 services on the same day. 82030 Audiology Optometry Orthoptic or Physiotherapy These items are limited to a maximum of 4 services per patient, consisting of any combination of these item numbers. A written report is required to the referring medical practitioner after assessment and diagnosis and development of the treatment plan. 82015 82020 $99.75 / $84.80 Speech Pathology A Child with autism/pdd must be aged under 15 years, and a treatment and management plan be put in place before their 13 th birthday, and have been referred by an eligible consultant psychiatrist or paediatrician. Treatment Services 82025 82035 Occupational Therapy Audiology Optometry Orthoptic or Physiotherapy A child with an eligible disability must be aged under 15 years, and a treatment and management plan be put in place before their 13 th birthday, and have been referred by a specialist, consultant physician, or GP. A separate referral is required for each provider. Services must be of at least 30min duration. Page 7 of 9
A child may receive up to 4 Medicare eligible services from an allied health professional on the same day. These items are limited to a maximum of 20 services per patient, consisting of any combination of these item numbers. Each referral is for a course of treatment as stated on the referral, up to a maximum of 10 services. Each provider can provide 1 or more courses of treatment up to the maximum of 20 services. A written report is required to the referring medical practitioner at the completion of each course of treatment. Acknowledgement and thanks to Northern Sydney Medicare Local November 2013 Page 8 of 9
PREGNANCY SUPPORT COUNSELLING For a comprehensive explanation of each MBS number please refer to the Medicare Benefits Schedule online at www.health.gov.au/mbsonline Assessment and Provision of services Non-directive pregnancy support counselling services are provided to women who are concerned about a current pregnancy, or a pregnancy that occurred in the preceding 12 months. More information can be found here www.health.gov.au/internet/main/publishing.nsf/content/health-pcdpregnancy-support Fee / Benefit Description / Access 81000 $73.15 / $62.20 Allied Health Provider must be Medicare registered and have completed appropriate non-directive pregnancy counselling training. Allied Health Provider must not have a direct financial interest in a health service that has as its primary purpose the provision. 81005 $73.15 / $62.20 Social Worker Patients must be referred by a GP. No specific form required, can use letter or note signed and dated by GP. Maximum of 3 services per patient per pregnancy, partners can attend. Patient can be referred to more than one Allied Health Provider; however a new referral is required. 81010 $73.15 / $62.20 Nurse Services must be at least 30 min duration. Page 9 of 9