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Determinations/Health as made
This instrument continues patient access to certain general practitioner, specialist and allied health telehealth and phone services which were originally created specifically in response to the COVID-19 pandemic.
Administered by: Health
Registered 17 Dec 2021

Commonwealth Coat of Arms of Australia

 

Health Insurance (Section 3C General Medical Services – Telehealth and Telephone Attendances) Determination 2021

I, Travis Haslam, delegate of the Minister for Health and Aged Care, make the following determination.

Dated        16 December 2021

 

 

 

 

 

Travis Haslam

Acting First Assistant Secretary

Medical Benefits Division

Health Resourcing Group

Department of Health

 

 

 

 

 

  

  


Contents

Part 1—Preliminary                                                                                                    1

1  Name. ...................................................................................................................................... 1

2  Commencement........................................................................................................................ 1

3  Authority.................................................................................................................................. 1

4  Cessation.................................................................................................................................. 1

5  Definitions................................................................................................................................ 1

6  Treatment of relevant services.................................................................................................. 5

7  Application of items – general.................................................................................................. 6

Schedule 1 – GP and other medical practitioner services      8

Division 1.1 – Services and fees – Medical practitioner attendances via telehealth and phone  8

Schedule 2 –  Specialist, consultant physician and consultant psychiatrist services                                                                       41

Division 2.1 – Services and fees – specialist attendances via telehealth and phone        41

Division 2.2– Services and Fees – obstetric attendances                              57

Schedule 3 – Allied health services                                           60

Division 3.1 – Services and fees – Allied health telehealth and phone services   60

Schedule 4 – Nurse practitioner, midwife Aboriginal and Torres Strait Islander health practitioner and dental practitioner services   87

Division 4.1 ‑ Services and fees – Nurse practitioner telehealth and phone services      87

Division 4.2 ‑ Services and fees – midwifery telehealth and phone services 91

Division 4.3 ‑ Services and fees – dental practitioner services                     92

Schedule 5 – Temporary GP and medical practitioner telehealth and phone services                                                                       93

Division 5.1 – Services and fees – Medical practitioner attendances via telehealth and phone  93

 


Part 1—Preliminary

1  Name

       This instrument is the Health Insurance (Section 3C General Medical Services – Telehealth and Telephone Attendances) Determination 2021.

2  Commencement

(1 )   Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.

 

Commencement information

Column 1

Column 2

Column 3

Provisions

Commencement

Date/Details

1.  The whole of this instrument

1 January 2022.

 

Note:          This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.

(2)   Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.

3  Authority

This instrument is made under subsection 3C(1) of the Health Insurance Act 1973.

4  Cessation

Unless earlier revoked, Schedule 5 of this instrument ceases as if revoked on 30 June 2023 at 11.59pm.

5  Definitions

Note:     The following terms are defined in subsection 3(1) of the Act:

·        clinically relevant service

·        consultant physician

·        dental practitioner

·        general medical services table

·        hospital‑substitute treatment

·        hospital treatment

·        item

·        participating midwife

·        participating nurse practitioner

·       professional service

(1)   In this instrument:

Aboriginal and Torres Strait Islander health practitioner has the meaning given by Part 7 of the general medical services table.

Act means the Health Insurance Act 1973.

admitted patient means a patient who is receiving a service that is provided:

(a)  as part of an episode of hospital treatment; or

(b) as part of an episode of hospital‑substitute treatment in respect of which the person to whom the treatment is provided chooses to receive a benefit from a private health insurer.

Allied Health Determination means the Health Insurance (Allied Health Services) Determination 2014.

consultant psychiatrist means a consultant physician in the practice of the consultant physician’s specialty of psychiatry.

contribute to a multidisciplinary care plan has the meaning given by clause 2.16.3 of the general medical services table.

coordinating a review of team care arrangements has the meaning given by clause 2.16.5 of the general medical services table.

coordinating the development of team care arrangements has the meaning given by clause 2.16.4 of the general medical services table.

eating disorder treatment and management plan has the same meaning as in the general medical services table.

eligible Aboriginal health worker has the meaning given by section 4 of the Allied Health Determination.

eligible Aboriginal and Torres Strait Islander health practitioner has the meaning given by section 4 of the Allied Health Determination.

eligible allied health practitioner means:

(a)  an eligible Aboriginal health worker;

(b) an eligible Aboriginal and Torres Strait Islander health practitioner;

(c)  an eligible diabetes educator;

(d) an eligible audiologist;

(e)  an eligible dietitian;

(f)  an eligible mental health worker;

(g)  an eligible occupational therapist;

(h) an eligible exercise physiologist;

(i)  an eligible physiotherapist;

(j)  an eligible podiatrist;

(k) an eligible chiropractor;

(l)  an eligible osteopath;

(m)       an eligible psychologist; or

(n) an eligible speech pathologist.

eligible audiologist has the meaning given by section 4 of the Allied Health Determination.

eligible chiropractor has the meaning given by section 4 of the Allied Health Determination.

eligible clinical psychologist has the meaning given by section 4 of the Allied Health Determination.

eligible diabetes educator has the meaning given by section 4 of the Allied Health Determination.

eligible dietitian has the meaning given by section 4 of the Allied Health Determination.

eligible exercise physiologist has the meaning given by section 4 of the Allied Health Determination.

eligible mental health worker has the meaning given by section 4 of the Allied Health Determination.

eligible occupational therapist has the meaning given by section 4 of the Allied Health Determination.

eligible orthoptist has the meaning given by section 4 of the Allied Health Determination.

eligible osteopath has the meaning given by section 4 of the Allied Health Determination.

eligible physiotherapist has the meaning given by section 4 of the Allied Health Determination.

eligible psychologist has the meaning given by section 4 of the Allied Health Determination.

eligible podiatrist has the meaning given by section 4 of the Allied Health Determination.

eligible social worker has the meaning given by section 4 of the Allied Health Determination.

eligible speech pathologist has the meaning given by section 4 of the Allied Health Determination.

focussed psychological strategies has the meaning given by clause 2.20.1 of the general medical services table.

GP mental health treatment plan has the meaning given by section 4 of the Allied Health Determination.

multidisciplinary care plan:

(a)  for items 92026, 92027, 92070, 92071, 92057, 92058, 92101 and 92102—has the meaning given by clause 2.16.6 of the general medical services table; and

(b) for items 93201 and 93203—has the meaning given by clause 3.1.1 of the general medical services table.

non‑directive pregnancy support counselling means counselling provided to a person, who is currently pregnant or who has been pregnant in the preceding 12 months, by a health professional in which:

(a)  information and issues relating to pregnancy are discussed; but

(b)  the health professional does not impose his or her views or values about what the person should or should not do in relation to the pregnancy.

Other Medical Practitioner Determination means the Health Insurance (Section 3C General Medical Services ‑ Other Medical Practitioner) Determination 2018.

person who is experiencing homelessness means when a person does not have suitable accommodation alternatives they are considered homeless if their current living arrangement:

(a)  is in a dwelling that is inadequate; or

(b)  has no tenure, or if their initial tenure is short and not extendable; or

(c)  does not allow them to have control of, and access to space for social relations.

person who is in a COVID-19 Commonwealth declared hotspot means a patient who, at the time of accessing the service, is located in an area determined by the Commonwealth Chief Medical Officer to be a COVID-19 hotspot.

person who is in a flood affected area means a patient who, at the time of accessing the telehealth or telephone service, is located within a State or Territory local government area which is declared as a natural disaster area due to flood by a State or Territory Government.

phone attendance means a professional attendance by telephone where the health practitioner:

(a)  has the capacity to provide the full service through this means safely and in accordance with professional standards; and

(b) is satisfied that it is clinically appropriate to provide the service to the patient; and

(c)  maintains an audio link with the patient.

preparing a GP management plan, for items 92024 and 92068, has the meaning given by clause 2.16.7 of the general medical services table.

psychiatrist assessment and management plan means a psychiatrist assessment and management plan prepared by a consultant physician in the practice of the consultant physician’s specialty of psychiatry in accordance with item 92435 or item 291 of the general medical services table.

referring practitioner, in relation to a referral, means the person making the referral.

relevant provisions means all provisions of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under the National Health Act 1953, relating to medical services, professional services or items.

relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in a Schedule.

residential aged care facility has the meaning given in Part 7 of the general medical services table.

reviewing a GP management plan, for items 92028 and 92072, has the meaning given by clause 2.16.8 of the general medical services table.

Schedule means a Schedule to this instrument.

single course of treatment has the meaning given by clause 1.1.6 of the general medical services table.

telehealth attendance means a professional attendance by video conference where the rendering health practitioner:

(a)     has the capacity to provide the full service through this means safely and in accordance with relevant professional standards; and

(b)     is satisfied that it is clinically appropriate to provide the service to the patient; and

(c)     maintains a visual and audio link with the patient; and

(d)     is satisfied that the software and hardware used to deliver the service meets the applicable laws for security and privacy.

 

(2)   Unless the contrary intention appears, a reference in this instrument to a provision of the Act or the National Health Act 1953 or a legislative instrument made under the Act or under the National Health Act 1953 as applied, adopted or incorporated in relation to specifying a matter is a reference to those provisions as in force from time to time and any other reference to provisions of an Act or instrument is a reference to those provisions as in force from time to time.

(3)   In this instrument, a general practitioner includes a kind of medical practitioner specified in clause 1.1.3 of the general medical services table.

6  Treatment of relevant services

A health service provided in accordance with this Determination is to be treated, for the relevant provisions, as if:

                           (a)   it were both a professional service and a medical service; and

                             (b)                there were an item in the general medical services table that:

(i)    related to the service; and

                        (ii)        specified for the service a fee in relation to each State, being the fee                          specified in the item in the Schedule relating to the service.

Note: For this Determination, an internal Territory is deemed to form part of the State of New South Wales—see subsection 3C(7) of the Act.

7  Application of items – general

(1)   An item in a Schedule does not apply to a service mentioned in the item if the person is an admitted patient.

(2)   An item in Subgroup 3 or 10 of Group A40, Subgroups 1 to 4 of Group M18 or Subgroups 6 to 9 of Group M18 does not apply to a service provided to a patient who has already been provided, in the calendar year, with 10 services to which any of those items or the following items apply:

(a)  an item in Subgroup 2 of Group A20 of the general medical services table;

(b) items 283, 285, 286 or 287 of the Other Medical Practitioner Determination; or

(c)  items 80000 to 80015, 80100 to 80115, 80125 to 80140 or 80150 to 80165 of the Allied Health Determination; or

(d) items 941, 942, 2733, 2735, 93375, 93376, 93381, 93382, 93383, 93374, 93385 or 93386 of the Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Mental Health Services) Determination 2020.

(3)   Subject to subsection (4), an item in a Schedule only applies to a service that is an attendance by a single health professional on a single person.

Note: Health professionals who can provide services under this instrument include general         practitioners, medical practitioners, specialists and consultant physicians, allied health               professionals and participating nurses and midwives.

(4)   Subsection (3) does not apply to items 92455 to 92457.

(5)   An item in Schedule 1 applies to a service performed by the patient’s usual medical practitioner.

(6)   Subsection (5) does not apply to:

(a)   a service provided to:

(i)            a person who is under the age of 12 months; or

(ii)          a person who is experiencing homelessness; or

(iii)        a person who is in a COVID-19 Commonwealth declared hotspot; or

(iv)        a person who is in COVID-19 isolation because of a State or Territory public health order; or

(v)          a person who is in COVID-19 quarantine because of a State or Territory public health order; or

(vi)        a person who receives the service from a medical practitioner located at an Aboriginal Medical Service or an Aboriginal Community Controlled Health Service; or

(vii)      a person who is in a flood affected area; or

(b)   a service to which an item in Subgroup 3, 10, 15, 16, 19, 20, 21, 25, 26, 27, 28 or 29 of Group A40 applies.

(7)     For the purpose of subsection (5):

          patient’s usual medical practitioner means a medical practitioner (other than a specialist or consultant physician) who:

(a)  has provided at least one service to the patient in the past 12 months; or

(b)  is located at a medical practice at which at least one service to the patient was provided, or arranged by, in the past 12 months.

       For the purpose of this subsection, service means a personal attendance on the patient and excludes telehealth and phone attendances.

(8)     Subsection 2.31.7(2) of the general medical services table shall have effect as if a service to which an item in Subgroups 21 or 23 of Group A40 applies.

(9)     A service to which an item in Subgroup 17 of Group A40 or item 92434 applies must not be provided to a person if a service under any of the following items has previously been provided to the person:

(a)  an item in Subgroup 17 of Group A40; or

(b)  item 92434; or

(c)  items 135, 137, 139 or 289 of the general medical services table.

 


Schedule 1 – GP and other medical practitioner services

Division 1.1 – Services and fees – Medical practitioner attendances via telehealth and phone

1.1.01  Meaning of eligible area

(1)  For items 91794, 91806, 91807 and 91808, eligible area has the meaning given by section 4 of the Other Medical Practitioner Determination.

1.1.02  Application of items in Subgroups 3 and 10 of Group A40 – Focussed Psychological Strategies services

(1)  An item in Subgroup 3 or 10 of Group A40 only applies to a service which:

(a)   is clinically indicated under a GP mental health treatment plan or a psychiatrist assessment and management plan; and

(b)             is provided by a medical practitioner who meets any training and skills requirements, as determined by the General Practice Mental Health Standards Collaboration, for providing services to which Subgroup 2 of Group A20 of the general medical services table or items 283, 285, 286 or 287 of the Other Medical Practitioner Determination applies.

(2)  Paragraph 2.20.7(2)(a) of the general medical services table shall have effect as if items 91818, 91819, 91842 and 91843 were also specified in subparagraph 2.20.7(2)(a)(i).

1.1.03  Application of items in Subgroup 11 of Group A40

(1)  A health assessment (the current assessment) may be performed under an item in Subgroup 11 of Group A40 for a patient who:

                     (a)  has not been provided a health assessment under item 715 of the general medical services table or item 228 of the Other Medical Practitioner Determination within 9 months of the current assessment; and

                     (b)  has not been provided a health assessment under an item in Subgroup 11 of Group A40 within 9 months of the current assessment; and

                     (c)  identifies as being of Aboriginal or Torres Strait Islander descent.

(2)  A health assessment mentioned in an item in Subgroup 11 of Group A40 must not include a health screening service.

Note: health screening service is defined in subsection 19(5) of the Act.

(3)  A separate consultation must not be performed in conjunction with a health assessment, unless clinically necessary.

(4)  Practice nurses, Aboriginal health workers and Aboriginal and Torres Strait Islander health practitioners may assist practitioners in performing a health assessment, in accordance with accepted medical practice, and under the supervision of the practitioner.

(5)  For the purposes of subclause (4), assistance may include activities associated with:

                     (a)  information collection; and

                     (b)  at the direction of the practitioner—provision to patients of information on recommended interventions.

(6)  A health assessment must also include:

                     (a)  keeping a record of the health assessment; and

                     (b)  offering the patient a written report on the health assessment, with recommendations on matters covered by the health assessment (including a simple strategy for the good health of the patient).

 

1.1.04  Application of items 92024 to 92028

(1)  Item 92024 applies only to a service for a patient who suffers from at least one medical condition that has been (or is likely to be) present for at least 6 months or is terminal.

(2)  Items 92025 to 92028 apply only to a service for a patient who suffers from at least one medical condition that:

                     (a)  has been (or is likely to be) present for at least 6 months or is terminal; and

                     (b)  requires ongoing care from at least 3 persons who provide treatment or a service to the patient but who are not family carers of the patient, each of whom provides a different kind of treatment or service to the patient, and at least one of whom is a medical practitioner.

1.1.05  Application of items in relation to items 92024, 92025 and 92028

(1)  The following items do not apply to a service mentioned in the item that is provided by a general practitioner or medical practitioner, if the service is provided on the same day for the same patient for whom the practitioner provides a service mentioned in item 92024, 92025 or 92028:

                     (a)  any items specified in paragraphs 2.16.11(a), (b), (c), and (d) of the general medical services table;

                     (b)  any items in Division 1.2 or Division 1.10 of the Other Medical Practitioner Determination; and

                     (c)  items 91790, 91800, 91801, 91802, 91890, 91891, 91792, 91803, 91804, 91805, 91892, 91893, 91794, 91806, 91807, 91808, 92210 or 92211.

1.1.06  Limitation on items 92024 to 92028

(1)  This clause applies to the performances of services for a patient for whom exceptional circumstances do not exist.

(2)  Items 92024 to 92028 apply in the circumstances mentioned in table below.

 

Limitation on items 92024 to 92028

Item

Column 1

Item of

the table

Column 2

Circumstances

1

92024

(a) In the 3 months before performance of the service, being a service to which items 729, 731 or 732 of the general medical services table,  items 231, 232 or 233 of the Other Medical Practitioner Determination, items 92026, 92027 or 92028 of this instrument, or items 93469 or 93475 of the Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Chronic Disease Management Services for Care Recipients of a Residential Aged Care Facility) Determination 2020, applies (for reviewing a GP management plan) applies but had not been performed for the patient; and

(b) the service is not performed more than once in a 12 month period; and

(c) the service is not performed by a general practitioner:

(i) who is a recognised specialist in palliative medicine; and

(ii) who is treating a palliative patient that has been referred to the general practitioner; and

(iii) to which an item in Subgroup 3 or 4 of Group A24 applies because of the treatment of the palliative patient by the general practitioner

2

92025

(a) In the 3 months before performance of the service, being a service to which item 732 of the general medical services table, 233 of the Other Medical Practitioner Determination, 92028, item 93469 of this instrument, or 93475 of the Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Chronic Disease Management Services for Care Recipients of a Residential Aged Care Facility) Determination 2020, applies (for coordinating a review of team care arrangements, a multi‑disciplinary community care plan or a multi‑disciplinary discharge care plan) applies but had not been performed for the patient; and

(b) the service is performed not more than once in a 12 month period; and

(c) the service is not performed by a general practitioner:

(i) who is a recognised specialist in palliative medicine; and

(ii) who is treating a palliative patient that has been referred to the general practitioner; and

(iii) to which an item in Subgroup 3 or 4 of Group A24 applies because of the treatment of the palliative patient by the general practitioner

3

92026

(a) either:

(i) in the 3 months before performance of the service, being a service to which items 731 or 732 of the general medical services table, items 232 or 233 of the Other Medical Practitioner Determination, item 92027 or 92028 of this instrument, or items 93469 or 93475 of the Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Chronic Disease Management Services for Care Recipients of a Residential Aged Care Facility) Determination 2020, applies but had not been performed for the patient; or

(ii) in the 12 months before performance of the service, being a service that has not been performed for the patient:

(A) by the general practitioner who performs the service to which item 729 or 92026 would, but for this item, apply; and

(B) for which a payment has been made under item 721 or 723 of the general medical services table or 92024 or 92025; and

(b) the service is performed not more than once in a 3 month period

4

92027

(a) In the 3 months before performance of the service, being a service to which items 721, 723, 729 or 732 general medical services table, items 229, 230, 231 or 233 of the Other Medical Practitioner Determination, items 92024, 92025, 92026 or 92028 of this instrument, items 93469 or 93475 of the Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Chronic Disease Management Services for Care Recipients of a Residential Aged Care Facility) Determination 2020, applies but had not been performed for the patient; and

(b) the service is performed not more than once in a 3 month period

5

92028

(a) In the 3 months before performance of the service, being a service to which items 93469 or 93475 of the Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Chronic Disease Management Services for Care Recipients of a Residential Aged Care Facility) Determination 2020 applies but had not been performed for the patient; and

 (b) once in a 3 month period; and

 (c) on the same day; but

 (d) may not be performed by a general practitioner:

(i) who is a recognised specialist in palliative medicine; and

(ii) who is treating a palliative patient that has been referred to the general practitioner; and

(iii) to which an item in Subgroup 3 or 4 of Group A24 applies because of the treatment of the palliative patient by the general practitioner

 

(3)  In this clause exceptional circumstances, for a patient, means there has been a significant change in the patient’s clinical condition or care circumstances that necessitates the performance of the service for the patient.

1.1.07  Meaning of item descriptors for items 92055 to 92059

 

(1)  For items 92055 to 92059, the following terms have the same meaning as in Division 2.16 of the general medical services table as if the reference to a general practitioner were a reference to a medical practitioner:

(a)  preparation of a GP management plan;

(b)  coordinate the development of team care arrangements;

(c)  multidisciplinary care plan;

(d)  contribute to a multidisciplinary care plan;

(e)  coordinating a review of team care arrangements; and

(f)  reviewing a GP management plan.

 

(2)  For items 92059 associated medical practitioner means a medical practitioner who, if not engaged in the same general practice as the medical practitioner mentioned in the item, performs the service mentioned in the item at the request of the patient (or the patient’s guardian).

1.1.08  Application of items 92055 to 92059

             

(1)  Items 92055, 92056 or 92059 do not apply to a service mentioned in those items that is provided by a medical practitioner, if the service is provided on the same day for the same patient for whom the practitioner provides a service mentioned in the following items:

(a)     any items specified in paragraphs 2.16.11(a), (b), (c), and (d) of the general medical services table;

(b)     any items in Division 1.2 or Division 1.10 of the Other Medical Practitioner Determination; and

(c)     items 91790, 91800, 91801, 91802, 91890, 91891, 91792, 91803, 91804, 91805, 91892, 91893, 91794, 91806, 91807, 91808, 92210 or 92211.

(2)  Item 92055 applies only to a service for a patient who suffers from at least one medical condition that has been (or is likely to be) present for at least 6 months or is terminal.

(3)  Items 92056 to 92059 apply only to a service for a patient who suffers from at least one medical condition that:

(a)     has been (or is likely to be) present for at least 6 months or is terminal; and

(b)     requires ongoing care from at least 3 persons who provide treatment or a service to the patient but who are not family carers of the patient, each of whom provides a different kind of treatment or service to the patient, and at least one of whom is a medical practitioner.       

1.1.09  Limitation on 92055 to 92059

(1)  This clause applies to the performances of services for a patient for whom exceptional circumstances do not exist.

(2)  Items 92055 to 92059 apply in the circumstances mentioned in table below.

(3)  In this clause, exceptional circumstances, for a patient, means there has been a significant change in the patient’s clinical condition or care circumstances that necessitates the performance of the service for the patient.

 

Limitation on items 92055 to 92059

Item

Column 1

Item of

the table

Column 2

Circumstances

1

92055

(a) In the 3 months before performance of the service, being a service to which item 729, 731 or 732 of the general medical services table, item  231, 232 or 233 of the Other Medical Practitioner Determination, item 93469 or 93475 of the Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Chronic Disease Management Services for Care Recipients of a Residential Aged Care Facility) Determination 2020 or item 92026, 92027, 92028, 92057, 92058 or 92059 of this instrument, applies (for reviewing a GP management plan) but had not been performed for the patient; and

(b) a service to which item 721 of the general medical services table or 229 of the Other Medical Practitioner Determination or items 92024, 92055 of this instrument, applies has not been performed in the past 12 months; and

(c) the service is not performed more than once in a 12 month period; and

(d) the service is not performed by a person:

(i) who is a recognised specialist in palliative medicine; and

(ii) who is treating a palliative patient that has been referred to the medical practitioner; and

(iii) to which an item in Subgroup 3 or 4 of Group A24 of the Other Medical Practitioner Determination applies because of the treatment of the palliative patient by the medical practitioner

2

92056

(a) In the 3 months before performance of the service, being a service to which item 732 of the general medical services table, item 233 of the Other Medical Practitioner Determination, items 93469 or 93475 of the Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Chronic Disease Management Services for Care Recipients of a Residential Aged Care Facility) Determination 2020, or items 92028 or 92059, applies (for coordinating a review of team care arrangements, a multi‑disciplinary community care plan or a multi‑disciplinary discharge care plan) but had not been performed for the patient; and

(b) a service to which item 723 of the general medical services table, item 230 of the Other Medical Practitioner Determination, or items 92025 or 92026 of this instrument, applies is performed not more than once in a 12 months; and

(c) the service is performed not more than once in a 12 month period; and

(d) the service is not performed by a person:

(i) who is a recognised specialist in palliative medicine; and

(ii) who is treating a palliative patient that has been referred to the medical practitioner; and

(iii) to which an item in Subgroup 3 or 4 of Group A24 of the Other Medical Practitioner Determination applies because of the treatment of the palliative patient by the general practitioner

3

92057

(a) either:

(i) in the 3 months before performance of the service, being a service to which item 731 or 732 of the general medical services table, or item 232 or 233 of the Other Medical Practitioner Determination, item 93469 or 93475 of the Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Chronic Disease Management Services for Care Recipients of a Residential Aged Care Facility) Determination 2020, or items 92027, 92028, 92058, 92059 of this instrument, applies but had not been performed for the patient; or

(ii) in the 12 months before performance of the service, being a service that has not been performed for the patient:

(A) by the medical practitioner who performs the service to which item 729 of the general medical services table, or item 231 of the Other Medical Practitioner Determination, or item 92026 or 92057 of this instrument, would, but for this item, apply; and

(B) for which a payment has been made under item 721 or 723 of the general medical services table or item 229 or 230 of the Other Medical Practitioner Determination or items 92024, 92025 of this instrument; and

(b) a service to which item 729 of the general medical services table, item 231 of the Other Medical Practitioner Determination, or items 92026, 92057, 92070 or 92101, applies is performed not more than once in a 3 month period; and

(c) the service is performed not more than once in a 3 month period.

4

92058

(a) In the 3 months before performance of the service, being a service to which items 721, 723, 729 or 732 of the general medical services table, or items 229, 230, 231 or 233 of the Other Medical Practitioner Determination, items 93469 or 93475 of the Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Chronic Disease Management Services for Care Recipients of a Residential Aged Care Facility) Determination 2020, or items 92024, 92025, 92026, 92028, 92055, 92056, 92057 or 92059, applies but had not been performed for the patient; and

(b) a service to which item 731 of the general medical services table or item 92027 applies is performed not more than once in a 3 month period; and

(c) the service is performed not more than once in a 3 month period.

5

92059

Each service may be performed if a service to which item 732 of the general medical services table, item 93469 or 93475 of the Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Chronic Disease Management Services for Care Recipients of a Residential Aged Care Facility) Determination 2020 or item 92028 of this instrument has not been claimed in the past three months;

(a) once in a 3 month period; and

(b) on the same day; but

(c) may not be performed by a person:

(i) who is a recognised specialist in palliative medicine; and

(ii) who is treating a palliative patient that has been referred to the general practitioner; and

(iii) to which an item in Subgroup 3 or 4 of Group A24 of the Other Medical Practitioner Determination applies because of the treatment of the palliative patient by the general practitioner

1.1.10 Application of items in Subgroup 15 of Group A40

(1)  A service to which an item in subgroups 15 of Group A40 applies:

(a)  must not be provided by a general practitioner or medical practitioner who has a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination; and

(b)  may be used to address any pregnancy related issue.

(2)  An item in Subgroup 15 of Group A40 does not apply if a patient has already been provided, for the same pregnancy, with 3 services to which any of the following items apply:

(a)  an item in Subgroup 15 of Group A40; or

(b)  item 792 of the Other Medical Practitioner Determination, item 4001 of the general medical services table, item 81000, 81005 or 81010 of the Allied Health Determination or item 93026 or 93029.

1.1.11  Application of items in Subgroup 17 of Group A40

(1)  In an item in Subgroup 17 of Group A40:

eligible allied health provider has the meaning given in Part 7 of the general medical service table.

risk assessment has the meaning given in clause 2.6.2 of the general medical service table.

eligible disability has the meaning given in clause 2.6.1 of the general medical services table.

1.1.12 Application of items in Subgroup 19 and 20 of Group A40

(1)  Subject to subclause (2), for an item in Subgroup 19 or 20 of Group A40:    

associated focussed psychological strategies has the meaning given in clause 2.20.1 of the general medical services table.

associated general practitioner has the meaning given in clause 2.20.5 of the general medical services table.

mental disorder has the meaning given in clause 2.20.1 of the general medical services table.

preparation of a GP mental health treatment plan has the meaning given in clause 2.20.3 of the general medical services table.  

(2)  In items 92118 to 92133:

associated medical practitioner means a medical practitioner (not including a specialist or consultant physician) who, if not engaged in the same general practice as the medical practitioner mentioned in items 92118 to 92133, performs the service mentioned in the item at the request of the patient (or the patient’s guardian).

preparation of a GP mental health treatment plan has the meaning given in clause 2.20.3 of the general medical services table, as if the reference to the term “general practitioner” were a reference to the term “medical practitioner”.

review of a GP mental health treatment plan has the meaning given in clause 2.20.4 of the general medical services table, as if the reference to the term “general practitioner” were a reference to the term “medical practitioner”.

(3)  For the purpose of Subgroups 19 and 20 in Group A40, the preparation of a GP mental health treatment plan includes the preparation of a written plan by a general practitioner for the patient that includes referral and treatment options, including, subject to the applicable limitations:

                     (a)  psychological therapies provided to the patient by a clinical psychologist (items 91166, 91167, 91181 and 91182 and items in Group M6 of the Allied Health Determination); and

                     (b)  focussed psychological strategies services provided to the patient by a general practitioner mentioned in paragraph 2.20.7(1)(b) of the general medical services table to provide those services (items 2721 to 2727); and

                     (c)  focussed psychological strategies services provided to the patient by an allied mental health professional (items 91169 to 91176 and 91183 to 91188 and items 80100 to 80171 of the Allied Health Determination; and

(d) items 91818, 91819, 91842 and 91843.   

(4)  Items in Subgroups 19 and 20 of Group A40 apply only to a patient with a mental disorder.  

(5)  Items 92112, 92113, 92114, 92116, 92117, 92118, 92119, 92120, 92122, 92123, 92126 or 92132 apply only to a patient in the community.            

(6)  Unless exceptional circumstances exist, items 92112, 92113, 92116, 92117, 92118, 92119, 92122 or 92123 cannot be claimed:

                     (a)  with a service to which the following items apply:

                              (i)  items 735 to 758 or 2713 of the general medical services table; or

                             (ii)  items 92115, 92121, 92127 or 92133; or

                            (iii)  items 235 to 240 or 279 of the Other Medical Practitioner Determination; or

                     (b)  more than once in a 12 month period from the provision of any of the items for a particular patient.

(7)  Items 92114, 92126, 92120 and 92132 apply only if one of the following services has been provided to the patient:

                     (a)  the preparation of a GP mental health treatment plan under:

                              (i)  items 2700, 2701, 2715 or 2717 of the general medical services table; or

                             (ii)  items 272, 276, 281, 282 of the Other Medical Practitioner Determination; or

                            (iii)  items 92112, 92113, 92116, 92117, 92124, 92125, 92128, 92129, 92118, 92119, 92122, 92123, 92130, 92131, 92134 or 92135; or

                     (b)  a psychiatrist assessment and management plan.

(8)  Items 92114, 92126, 92120 and 92132 do not apply:

                     (a)  to a service to which the following items apply:

                              (i)  items 735 to 758 of the general medical services table; or

                             (ii)  items 92133 or 92121; or

                            (iii)  items 92115, 92127, 92121 and 92133; or

(iv) items 235 to 240 or 279 of the Other Medical Practitioners Determination.

                     (b)  unless exceptional circumstances exist for the provision of the service:

                              (i)  more than once in a 3 month period; or

                             (ii)  within 4 weeks following the preparation of a GP mental health treatment plan under:

                                    (A)       items 2700, 2701, 2715 or 2717 of the general medical          services table; or

                                    (B)       items 272, 276, 281 or 282 of the Other Medical Practitioner             Determination; or

                                    (C)       items 92112, 92113, 92116, 92117, 92124, 92125, 92128,    92129, 92118, 92119, 92122 or 92123; or

                            (iii)  within 3 months following the provision of a service under item 2712 of the general medical services table, item 277 of the Other Medical Practitioner Determination or items 92114, 92126, 92120 or 92132.

(9)  Items 92115, 92127, 92121 and 92133 do not apply in association with a service to which the following items apply:

                     (a)  items 2700, 2701, 2712, 2715, 2717 of the general medical service table; or

                     (b)  items 272, 276, 277, 281, 282 of the Other Medical Practitioner Determination; or

                     (c)  items 92112, 92113, 92114, 92116, 92117, 92132, 92118, 92119, 92120, 92122 or 92123.

(10) Items 92116, 92117, 92122, 92123, 92148, 92149, 92152 and 92153 apply only if the general practitioner or medical practitioner providing the service has successfully completed mental health skills training accredited by the General Practice Mental Health Standards Collaboration.

Note:          The General Practice Mental Health Standards Collaboration operates under the auspices of the Royal Australian College of General Practitioners.

(11) In this clause:

exceptional circumstances means a significant change in:

                     (a)  the patient’s clinical condition; or

                     (b)  the patient’s care circumstances.

1.1.13 Limitations on eating disorder services

(1)  Items in Subgroups 21, 22, 25 and 26 of Group A40 do not apply if performed in association with a service to which items 279 of the Other Medical Practitioner Determination, 2713 of the general medical services table or items 92115, 92121, 92127 or 92133 applies.

1.1.14 Application of items in Subgroup 21 of Group A40

(1)  For any particular patient:

                     (a)  items in Subgroup 21 of Group A40 do not apply in association with a service to which items 735 to 758 of the general medical services table apply; and

                     (b)  items in Subgroups 21 of Group A40 do not apply in association with a service to which items 235 to 244 of the Other Medical Practitioner Determination apply.

1.1.15 Application of items in Subgroups 25 and 26 of Group A40

(1)  In items 92170, 92171, 92176 and 92177:

      associated medical practitioner working in general practice means a medical practitioner (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).

1.1.16 Eligible patients for eating disorders items

(1)  For an item in Subgroup 27 or 28 of Group A40, a patient is an eligible patient if the patient meets the requirements for a patient specified in clause 2.31.2 of the general medical services table.

1.1.17 Application of items in Subgroups 27 and 28 of Group A40

(1)  For an item in Subgroup 27 or 28 of Group A40, the service must involve the provision of any of the following mental health care management strategies:

                     (a)  family based treatment (including whole family, parent based therapy, parent only or separated therapy)

                     (b)  adolescent focused therapy;

                     (c)  cognitive behavioural therapy;

                     (d)  cognitive behavioural therapy‑anorexia nervosa;

                     (e)  cognitive behavioural therapy for bulimia nervosa and binge‑eating disorder;

                      (f)  specialist supportive clinical management;

                     (g)  maudsley model of anorexia treatment in adults;

                     (h)  interpersonal therapy for bulimia nervosa and binge‑eating disorder;

                      (i)  dialectical behavioural therapy for bulimia nervosa and binge‑eating disorder;

                      (j)  focal psychodynamic therapy.

(2)  An item in Subgroup 27 or 28 of Group A40 applies to a service which is provided by a medical practitioner:

                     (a)  whose name is entered in the register maintained by the Chief Executive Medicare under section 33 of the Human Services (Medicare) Regulations 2017; and

                     (b)  who is identified in the register as a medical practitioner who can provide services to which Subgroup 2 of Group A20 of the general medical services table applies, items 283, 285, 286 and 287 of the Other Medical Practitioner Determination or items 91820, 91821, 91844 and 91845 applies; and

                     (c)  who meets any training and skills requirements, as determined by the General Practice Mental Health Standards Collaboration for providing services to which Subgroup 2 of Group A20 of the general medical services table applies or items 283, 285, 286 and 287 of the Other Medical Practitioner Determination or items 91820, 91821, 91844 and 91845 applies.

(3)  An item in Subgroup 27 or 28 of Group A40 does not apply to a service providing a treatment to a patient under an eating disorder treatment and management plan if:

                     (a)  the service is provided more than 12 months after the plan is prepared; or

                     (b)  the patient has already been provided with 40 services under the plan; or

                     (c)  the service is provided after the patient has already been provided with 10 services under the plan but before a recommendation by a reviewing practitioner is given that additional services should be provided under the plan; or

                     (d)  the service is provided after the patient has already been provided with 20 services under the plan but before recommendations that additional services should be provided under the plan are given by each of the following:

                              (i)  a medical practitioner (other than a specialist or consultant physician);

                             (ii)  a consultant physician practising in the specialty of psychiatry or paediatrics; or

                     (e)  the service is provided after the patient has already been provided with 30 services under the plan but before a recommendation is given by a reviewing practitioner that additional services should be provided.

(4)  A reviewing practitioner may recommend that additional services be provided under a plan only if:

                     (a)  the recommendation is made as part of a service to which an item in Subgroup 3 of Group A36 of the general medical services table or Subgroups 25 or 26 of Group A40 apply; and

                     (b)  the service is provided:

                              (i)  for the purposes of paragraph (3)(c)—after the patient has been provided with 10 services under the plan; and

                             (ii)  for the purposes of paragraph (3)(d)—after the patient has been provided with 20 services under the plan; and

                            (iii)  for the purposes of paragraph (3)(e)—after the patient has been provided with 30 services under the plan; and

                     (c)  the practitioner records the recommendation in the patient’s records.

(5)  For the purposes of this clause, in counting the services providing treatments under a plan, only count the services to which any of the following apply:

                     (a)  items 283, 285, 286 and 287;

                     (b)  items 2721, 2723, 2725 and 2727;

                     (c)  items in Groups M6, M7 and M16 other than items 82350 and 82351;

                     (d)  items 90271, 90272, 90273, 90274, 90275, 90276, 90277, 90278, 90279, 90280, 90281 and 90282;

                     (e)  items 91166, 91167, 91169, 91170, 91172, 91173, 91175, 91176, 91181 to 91188, 91818, 91819, 91820, 91821, 91842, 91843, 91844, 91845, 92182, 92184, 92186, 92188, 92194, 92196, 92198, 92200, 93076, 93079, 93084. 93087, 93092, 93095, 93100, 93103, 93110, 93113, 93118, 93121, 93126, 93129, 93134 and 93137.

 

1.1.18 Application of items in Subgroup 29 of Group A40

(1)  In an item in Subgroup 29 of Group A40:

                   patient’s medical condition requires urgent assessment has the meaning given in subclause 2.14.1(1) of the general medical services table.

                   responsible person, for a patient:

(a) includes a spouse, parent, carer or guardian of the patient; but

(b) does not include:

(i) the attending medical practitioner; or

(ii) an employee of the attending medical practitioner; or

(iii) a person contracted by, or an employee or member of, the general practice of which the attending medical practitioner is a contractor, employee or member; or

(iv) a call centre; or

(v) a reception service.

(2)  Items in Subgroup 29 apply to a service only if the practitioner keeps a record of the assessment of the patient.

 

 

 

Group A40 – Telehealth and phone attendance services

 

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 1 – General practice telehealth services

91790

 

Telehealth attendance by a general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited management

21.05

91800

 

Telehealth attendance by a general practitioner lasting less than 20 minutes if the attendance includes any of the following that are clinically relevant:

(a)   taking a short patient history;

(b)   arranging any necessary investigation;

(c)   implementing a management plan;

(d)   providing appropriate preventative health care

46.00

91801

Telehealth attendance by a general practitioner lasting at least 20 minutes if the attendance includes any of the following that are clinically relevant:

(a)   taking a detailed patient history;

(b)   arranging any necessary investigation;

(c)   implementing a management plan;

(d)   providing appropriate preventative health care

89.10

91802

Telehealth attendance by a general practitioner lasting at least 40 minutes if the attendance includes any of the following that are clinically relevant:

(a)   taking an extensive patient history;

(b)   arranging any necessary investigation;

(c)   implementing a management plan;

(d)   providing appropriate preventative health care

131.15

91792

Telehealth attendance by a medical practitioner (not including a general practitioner) of not more than 5 minutes

12.90

91803

Telehealth attendance by a medical practitioner (not including a general practitioner) of more than 5 minutes in duration but not more than 25 minutes if the attendance includes any of the following that are clinically relevant:

(a)   taking a short patient history;

(b)   arranging any necessary investigation;

(c)   implementing a management plan;

(d)   providing appropriate preventative health care

24.70

91804

Telehealth attendance by a medical practitioner (not including a general practitioner) of more than 25 minutes in duration but not more than 45 minutes if the attendance includes any of the following that are clinically relevant:

(a)   taking a detailed patient history;

(b)   arranging any necessary investigation;

(c)   implementing a management plan;

(d)   providing appropriate preventative health care

44.70

91805

Telehealth attendance by a medical practitioner (not including a general practitioner) of at least 45 minutes in duration if the attendance includes any of the following that are clinically relevant:

(a)   taking an extensive patient history;

(b)   arranging any necessary investigation;

(c)   implementing a management plan;

(d)   providing appropriate preventative health care

71.75

91794

Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), in an eligible area, of not more than 5 minutes

16.80

91806

Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), in an eligible area, of more than 5 minutes in duration but not more than 25 minutes if the attendance includes any of the following that are clinically relevant:

(a)   taking a short patient history;

(b)   arranging any necessary investigation;

(c)   implementing a management plan;

(d)   providing appropriate preventative health care

36.80

91807

Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), in an eligible area, of more than 25 minutes in duration but not more than 45 minutes if the attendance includes any of the following that are clinically relevant:

(a)   taking a detailed patient history;

(b)   arranging any necessary investigation;

(c)   implementing a management plan;

(d)   providing appropriate preventative health care

71.25

91808

Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), in an eligible area, of at least 45 minutes in duration if the attendance includes any of the following that are clinically relevant:

(a)   taking an extensive patient history;

(b)   arranging any necessary investigation;

(c)   implementing a management plan;

(d)   providing appropriate preventative health care

104.90

Subgroup 2 – General practice phone services

91890

Phone attendance by a general practitioner lasting less than 6 minutes for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited management

21.05

91891

Phone attendance by a general practitioner lasting at least 6 minutes if the attendance includes any of the following that are clinically relevant:

(a)   taking a short patient history;

(b)   arranging any necessary investigation;

(c)   implementing a management plan;

(d)   providing appropriate preventative health care

46.00

91892

Phone attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician) lasting less than 6 minutes for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited management

12.90

91893

Phone attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician) lasting at least 6 minutes if the attendance includes any of the following that are clinically relevant:

(a)   taking a short patient history;

(b)   arranging any necessary investigation;

(c)   implementing a management plan;

(d)   providing appropriate preventative health care

24.70

91894

Phone attendance by a general practitioner lasting at least 20 minutes, if:

(a)     the attendance is performed from a practice location in Modified Monash areas 6 or 7; and

(b)     the attendance includes any of the following that are clinically relevant:

(i)         taking a detailed patient history;

(ii)        arranging any necessary investigation;

(iii)      implementing a management plan;

(iv)      providing appropriate preventative health care

89.10

91895

Phone attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), of more than 25 minutes in duration but not more than 45 minutes, if:

(a)     the attendance is performed from a practice location in Modified Monash areas 6 or 7; and

(b)     the attendance includes any of the following that are clinically relevant:

(i)         taking a detailed patient history;

(ii)        arranging any necessary investigation;

(iii)      implementing a management plan;

(iv)      providing appropriate preventative health care

71.25

Subgroup 3 – Focussed Psychological Strategies telehealth services

91818

Telehealth attendance by a general practitioner, for the purpose of providing focussed psychological strategies for assessed mental disorders if:

(a)   the practitioner is registered with the Chief Executive Medicare as meeting the credentialing requirements for provision of this service; and

(b)   the service lasts at least 30 minutes, but less than 40 minutes.

113.50

91819

Telehealth attendance by a general practitioner, for the purpose of providing focussed psychological strategies for assessed mental disorders if:

(a)   the practitioner is registered with the Chief Executive Medicare as meeting the credentialing requirements for provision of this service; and

(b)   the service lasts at least 40 minutes

162.45

91820

Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), for the purpose of providing focussed psychological strategies for assessed mental disorders if:

(a)   the practitioner is registered with the Chief Executive Medicare as meeting the credentialing requirements for provision of this service; and

(b)   the service lasts at least 30 minutes, but less than 40 minutes

90.80

91821

Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), for the purpose of providing focussed psychological strategies for assessed mental disorders if:

(a)   the practitioner is registered with the Chief Executive Medicare as meeting the credentialing requirements for provision of this service; and

(b)   the service lasts at least 40 minutes

130.00

Subgroup 10 – Focussed Psychological Strategies phone services

91842

Phone attendance by a general practitioner, for the purpose of providing focussed psychological strategies for assessed mental disorders if:

(a)   the practitioner is registered with the Chief Executive Medicare as meeting the credentialing requirements for provision of this service; and

(b)   the service lasts at least 30 minutes, but less than 40 minutes

113.50

91843

Phone attendance by a general practitioner, for the purpose of providing focussed psychological strategies for assessed mental disorders if:

(a)   the practitioner is registered with the Chief Executive Medicare as meeting the credentialing requirements for provision of this service; and

(b)   the service lasts at least 40 minutes

162.45

91844

Phone attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), for the purpose of providing focussed psychological strategies for assessed mental disorders if:

(a)     the practitioner is registered with the Chief Executive Medicare as meeting the credentialing requirements for provision of this service; and

(b)     the service lasts at least 30 minutes, but less than 40 minutes

90.80

91845

Phone attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), for the purpose of providing focussed psychological strategies for assessed mental disorders if:

(a)   the practitioner is registered with the Chief Executive Medicare as meeting the credentialing requirements for provision of this service; and

(b)   the service lasts at least 40 minutes

130.00

Subgroup 11— Health Assessments for Aboriginal and Torres Strait Islander People ‑ Telehealth Service

92004

Telehealth attendance by a general practitioner for a health assessment of a patient. Only if items 93470 or 93479 of the Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Chronic Disease Management Services for Care Recipients of a Residential Aged Care Facility) Determination 2020 is also not applicable within that same 9 month period

259.80

92011

Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician) for a health assessment. Only if items 93470 or 93479 of the Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Chronic Disease Management Services for Care Recipients of a Residential Aged Care Facility) Determination 2020 is also not applicable within that same 9 month period

207.85

Subgroup 13 —GP management plans, team care arrangements and multidisciplinary care plans via telehealth attendance 

92024

Telehealth attendance by a general practitioner, for preparation of a GP management plan for a patient (other than a service associated with a service to which any of items 735 to 758 of the general medical services table or items 235 to 240 of the Other Medical Practitioner Determination apply)

176.55

 

92025

Telehealth attendance by a general practitioner, to coordinate the development of team care arrangements for a patient (other than a service associated with a service to which any of items 735 to 758 of the general medical services table or items 235 to 240 of the Other Medical Practitioner Determination apply)

139.90

 

92026

Contribution by a general practitioner by telehealth, to a multidisciplinary care plan prepared by another provider or a review of a multidisciplinary care plan prepared by another provider (other than a service associated with a service to which any of items 735 to 758 of the general medical services table or items 235 to 240 of the Other Medical Practitioner Determination apply)

86.15

 

92027

Contribution by a general practitioner by telehealth to:

(a) a multidisciplinary care plan for a patient in a residential aged care facility, prepared by that facility, or to a review of such a plan prepared by such a facility; or

(b) a multidisciplinary care plan prepared for a patient by another provider before the patient is discharged from a hospital, or to a review of such a plan prepared by another provider.

(other than a service associated with a service to which items 735 to 758 of the general medical services table or items 235 to 240 of the Other Medical Practitioner Determination apply)

86.15

 

92028

Telehealth attendance by a general practitioner to review or coordinate a review of:

(a) a GP management plan prepared by a general practitioner (or an associated general practitioner) to which items 721 of the general medical services table, item 229 of the Other Medical Practitioner Determination, or item 92024, 92055, 92068 or 92099 applies;

(b) team care arrangements which have been coordinated by the general practitioner (or an associated general practitioner) to which item 723 of the general medical services table, item 230 of the Other Medical Practitioner Determination, or item 92025 or 92069 applies

88.15

 

92055

Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), for preparation of a GP management plan for a patient (other than a service associated with a service to which any of items 735 to 758 of the general medical services table or items 235 to 240 in the Other Medical Practitioner Determination apply)

141.25

 

92056

Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), to coordinate the development of team care arrangements for a patient (other than a service associated with a service to which any of items 735 to 758 of the general medical services table or items 235 to 240 of the Other Medical Practitioner Determination apply)

111.90

 

92057

Contribution by a medical practitioner (not including a general practitioner, specialist or consultant physician) by telehealth to a multidisciplinary care plan prepared by another provider or a review of a multidisciplinary care plan prepared by another provider (other than a service associated with a service to which any of items 735 to 758 of the general medical services table or items 235 to 240 of the Other Medical Practitioner Determination apply)

68.90

 

92058

Contribution by a medical practitioner (not including a general practitioner, specialist or consultant physician) by telehealth to:

(a) a multidisciplinary care plan for a patient in a residential aged care facility, prepared by that facility, or to a review of such a plan prepared by such a facility; or

(b) a multidisciplinary care plan prepared for a patient by another provider before the patient is discharged from a hospital, or to a review of such a plan prepared by another provider

(other than a service associated with a service to which items 735 to 758 of the general medical services table or items 235 to 240 of the Other Medical Practitioner Determination apply)

68.90

 

92059

Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician) to review or coordinate a review of:

(a) a GP management plan prepared by a medical practitioner (or an associated medical practitioner) to which item 721 or item 229 of the general medical services table or item 92024, 92055, 92068 or 92099 applies; or

(b) team care arrangements which have been coordinated by the medical practitioner (or an associated medical practitioner) to which item 723 of the general medical services table or item 230 of the Other Medical Practitioner Determination or item 92025, 92056, 92069 or 92100 applies

70.50

 

Subgroup 15 ‑ GP Pregnancy Support Counselling ‑ Telehealth Service

 

92136

Telehealth attendance of at least 20 minutes in duration by a general practitioner who is registered with the Chief Executive Medicare as meeting the credentialing requirements for provision of this service for the purpose of providing non‑directive pregnancy support counselling to a person who:

(a) is currently pregnant; or

(b) has been pregnant in the 12 months preceding the provision of the first service to which this item or item 4001 of the general medical services table, or item 792 of the Other Medical Practitioner Determination, or item 81000, 81005 or 81010 of the Allied Health Determination, or item 92137, 92138, 92139, 93026 or 93029 applies in relation to that pregnancy

93.75

 

92137

Telehealth attendance of at least 20 minutes in duration by a medical practitioner (not including a general practitioner, specialist or consultant physician) who is registered with the Chief Executive Medicare as meeting the credentialing requirements for provision of this service for the purpose of providing non‑directive pregnancy support counselling to a person who:

(a) is currently pregnant; or

(b) has been pregnant in the 12 months preceding the provision of the first service to which this item or item 4001 of the general medical services table, or item 792 of the Other Medical Practitioner Determination, or item 81000, 81005 or 81010 of the Allied Health Determination, or item 92136, 92138, 92139, 93026 or 93029 applies in relation to that pregnancy

75.00

 

Subgroup 16 ‑ GP Pregnancy Support Counselling ‑ Phone Service

 

92138

Phone attendance of at least 20 minutes in duration by a general practitioner who is registered with the Chief Executive Medicare as meeting the credentialing requirements for provision of this service for the purpose of providing non‑directive pregnancy support counselling to a person who:

(a) is currently pregnant; or

(b) has been pregnant in the 12 months preceding the provision of the first service to which this item or item 4001 of the general medical services table, or item 792 of the Other Medical Practitioner Determination, or item 81000, 81005 or 81010 of the Allied Health Determination, or item 92136, 92137, 92139, 93026 or 93029 applies in relation to that pregnancy

93.75

 

92139

Phone attendance of at least 20 minutes in duration by a medical practitioner (not including a general practitioner, specialist or consultant physician) who is registered with the Chief Executive Medicare as meeting the credentialing requirements for provision of this service for the purpose of providing non‑directive pregnancy support counselling to a person who:

(a) is currently pregnant; or

(b) has been pregnant in the 12 months preceding the provision of the first service to which this item or item 4001 of the general medical services table, or item 792 of the Other Medical Practitioner Determination, or item 81000, 81005 or 81010 of the Allied Health Determination or item 92136, 92137, 92138, 93026 or 93029 applies in relation to that pregnancy

75.00

 

Subgroup 17 ‑ GP, Specialist and Consultant Physician Autism Service ‑ Telehealth Service

 

92142

Telehealth attendance of at least 45 minutes in duration by a general practitioner for assessment, diagnosis and preparation of a treatment and management plan for a patient under 13 years with an eligible disability if the general practitioner does all of the following:

(a) undertakes a comprehensive assessment and makes a diagnosis (if appropriate, using information provided by an eligible allied health provider);

(b) develops a treatment and management plan, which must include the following:

(i) an assessment and diagnosis of the patient’s condition;

(ii) a risk assessment;

(iii) treatment options and decisions;

(iv) if necessary—medication recommendations;

(c) provides a copy of the treatment and management plan to one or more allied health providers, if appropriate, for the treatment of the patient

164.60

 

Subgroup 19— GP Mental Health Treatment Plan ‑ Telehealth Service

 

92112

Telehealth attendance, by a general practitioner who has not undertaken mental health skills training (and not including a specialist or consultant physician), of at least 20 minutes but less than 40 minutes in duration for the preparation of a GP mental health treatment plan for a patient

87.75

 

92113

Telehealth attendance, by a general practitioner who has not undertaken mental health skills training (and not including a specialist or consultant physician), of at least 40 minutes in duration for the preparation of a GP mental health treatment plan for a patient

129.20

 

92114

Telehealth attendance by a general practitioner to review a GP mental health treatment plan which the general practitioner, or an associated general practitioner has prepared, or to review a psychiatrist assessment and management plan

87.75

 

92115

Telehealth attendance by a general practitioner in relation to a mental disorder and of at least 20 minutes in duration, involving taking relevant history and identifying the presenting problem (to the extent not previously recorded), providing treatment and advice and, if appropriate, referral for other services or treatments, and documenting the outcomes of the consultation

87.75

 

92116

Telehealth attendance, by a general practitioner who has undertaken mental health skills training, of at least 20 minutes but less than 40 minutes in duration for the preparation of a GP mental health treatment plan for a patient

111.45

 

92117

Telehealth attendance, by a general practitioner who has undertaken mental health skills training, of at least 40 minutes in duration for the preparation of a GP mental health treatment plan for a patient

164.15

 

92118

Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), who has not undertaken mental health skills training, of at least 20 minutes but less than 40 minutes in duration for the preparation of a GP mental health treatment plan for a patient

70.20

 

92119

Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), who has not undertaken mental health skills training, of at least 40 minutes in duration for the preparation of a GP mental health treatment plan for a patient

103.40

 

92120

Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician) to review a GP mental health treatment plan which he or she, or an associated medical practitioner has prepared, or to review a psychiatrist assessment and management plan

70.20

 

92121

Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician) in relation to a mental disorder and of at least 20 minutes in duration, involving taking relevant history and identifying the presenting problem (to the extent not previously recorded), providing treatment and advice and, if appropriate, referral for other services or treatments, and documenting the outcomes of the consultation

70.20

 

92122

Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), who has undertaken mental health skills training, of at least 20 minutes but less than 40 minutes in duration for the preparation of a GP mental health treatment plan for a patient

89.15

 

92123

Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), who has undertaken mental health skills training, of at least 40 minutes in duration for the preparation of a GP mental health treatment plan for a patient

131.35

 

Subgroup 20 — GP Mental Health Treatment Plan ‑ Phone Service

 

92126

Phone attendance by a general practitioner to review a GP mental health treatment plan which the general practitioner, or an associated general practitioner has prepared, or to review a psychiatrist assessment and management plan

87.75

92127

Phone attendance by a general practitioner in relation to a mental disorder and of at least 20 minutes in duration, involving taking relevant history and identifying the presenting problem (to the extent not previously recorded), providing treatment and advice and, if appropriate, referral for other services or treatments, and documenting the outcomes of the consultation

87.75

92132

Phone attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician) to review a GP mental health treatment plan which he or she, or an associated medical practitioner has prepared, or to review a psychiatrist assessment and management plan

70.20

92133

Phone attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician) in relation to a mental disorder and of at least 20 minutes in duration, involving taking relevant history and identifying the presenting problem (to the extent not previously recorded), providing treatment and advice and, if appropriate, referral for other services or treatments, and documenting the outcomes of the consultation

70.20

Subgroup 21 GP Eating Disorder Treatment and Management Plan – Telehealth Service

92146

Telehealth attendance by a general practitioner who has not undertaken mental health skills training, of at least 20 minutes but less than 40 minutes in duration for the preparation of a written eating disorder treatment and management plan for an eligible patient, if:

(a)   the plan includes an opinion on diagnosis of the patient’s eating disorder; and

(b)   the plan includes treatment options and recommendations to manage the patient’s condition for the following 12 months; and

(c)   the plan includes an outline of the referral options to allied health professionals for mental health and dietetic services, and specialists, as appropriate; and

(d)   the general practitioner offers the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees):

(i) a copy of the plan; and

(ii) suitable education about the eating disorder

87.75

92147

 

Telehealth attendance by a general practitioner who has not undertaken mental health skills training, of at least 40 minutes in duration for the preparation of a written eating disorder treatment and management plan for an eligible patient, if:

(a)   the plan includes an opinion on diagnosis of the patient’s eating disorder; and

(b)   the plan includes treatment options and recommendations to manage the patient’s condition for the following 12 months; and

(c)   the plan includes an outline of the referral options to allied health professionals for mental health and dietetic services, and specialists, as appropriate; and

(d)   the general practitioner offers the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees):

(i) a copy of the plan; and

(ii) suitable education about the eating disorder

129.20

92148

Telehealth attendance by a general practitioner who has undertaken mental health skills training, of at least 20 minutes but less than 40 minutes in duration for the preparation of a written eating disorder treatment and management plan for an eligible patient, if:

(a)   the plan includes an opinion on diagnosis of the patient’s eating disorder; and

(b)   the plan includes treatment options and recommendations to manage the patient’s condition for the following 12 months; and

(c)   the plan includes an outline of the referral options to allied health professionals for mental health and dietetic services, and specialists, as appropriate; and

(d)   the general practitioner offers the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees):

(i) a copy of the plan; and

(ii) suitable education about the eating disorder

111.45

92149

Telehealth attendance by a general practitioner who has undertaken mental health skills training, of at least 40 minutes in duration for the preparation of a written eating disorder treatment and management plan for an eligible patient, if:

(a)   the plan includes an opinion on diagnosis of the patient’s eating disorder; and

(b)   the plan includes treatment options and recommendations to manage the patient’s condition for the following 12 months; and

(c)   the plan includes an outline of the referral options to allied health professionals for mental health and dietetic services, and specialists, as appropriate; and

(d)   the general practitioner offers the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees):

(i) a copy of the plan; and

(ii) suitable education about the eating disorder

164.15

92150

Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician) who has not undertaken mental health skills training, of at least 20 minutes but less than 40 minutes in duration for the preparation of a written eating disorder treatment and management plan for an eligible patient, if:

(a)   the plan includes an opinion on diagnosis of the patient’s eating disorder; and

(b)   the plan includes treatment options and recommendations to manage the patient’s condition for the following 12 months; and

(c)   the plan includes an outline of the referral options to allied health professionals for mental health and dietetic services, and specialists, as appropriate; and

(d)   the medical practitioner offers the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees):

(i) a copy of the plan; and

(ii) suitable education about the eating disorder

70.20

92151

Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician) who has not undertaken mental health skills training, of at least 40 minutes in duration for the preparation of a written eating disorder treatment and management plan for an eligible patient, if:

(a)   the plan includes an opinion on diagnosis of the patient’s eating disorder; and

(b)   the plan includes treatment options and recommendations to manage the patient’s condition for the following 12 months; and

(c)   the plan includes an outline of the referral options to allied health professionals for mental health and dietetic services, and specialists, as appropriate; and

(d)   the medical practitioner offers the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees):

(i) a copy of the plan; and

(ii) suitable education about the eating disorder

103.40

92152

Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician) who has undertaken mental health skills training, of at least 20 minutes but less than 40 minutes in duration for the preparation of a written eating disorder treatment and management plan for an eligible patient, if:

(a)   the plan includes an opinion on diagnosis of the patient’s eating disorder; and

(b)   the plan includes treatment options and recommendations to manage the patient’s condition for the following 12 months; and

(c)   the plan includes an outline of the referral options to allied health professionals for mental health and dietetic services, and specialists, as appropriate; and

(d)   the medical practitioner offers the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees):

(i) a copy of the plan; and

(ii) suitable education about the eating disorder

89.15

92153

Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician) who has undertaken mental health skills training, of at least 40 minutes in duration for the preparation of a written eating disorder treatment and management plan for an eligible patient, if:

(a)   the plan includes an opinion on diagnosis of the patient’s eating disorder; and

(b)   the plan includes treatment options and recommendations to manage the patient’s condition for the following 12 months; and

(c)   the plan includes an outline of the referral options to allied health professionals for mental health and dietetic services, and specialists, as appropriate; and

(d)   the medical practitioner offers the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees):

(i) a copy of the plan; and

(ii) suitable education about the eating disorder

131.35

Subgroup 25 Review of an Eating Disorder Plan ‑ Telehealth Service

92170

Telehealth attendance by a general practitioner to review an eligible patient’s eating disorder treatment and management plan prepared by the general practitioner, an associated medical practitioner working in general practice, or a consultant physician practising in the specialty of psychiatry or paediatrics, if:

(a)   the general practitioner reviews the treatment efficacy of services provided under the eating disorder treatment and management plan, including a discussion with the patient regarding whether the eating disorders psychological treatment and dietetic services are meeting the patient’s needs; and

(b)   modifications are made to the eating disorder treatment and management plan, recorded in writing, including:

(i)    recommendations to continue with treatment options detailed in the plan; or

(ii)   recommendations to alter the treatment options detailed in the plan, with the new arrangements documented in the plan; and

(c)  initiates referrals for a review by a consultant physician practising in the specialty of psychiatry or paediatrics, where appropriate; and

(d)   the general practitioner offers the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees):

(i) a copy of the plan; and

(ii) suitable education about the eating disorder

87.75

92171

Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician) to review an eligible patient’s eating disorder treatment and management plan prepared by the medical practitioner, an associated medical practitioner working in general practice, or a consultant physician practising in the specialty of psychiatry or paediatrics, if:

(a)   the medical practitioner reviews the treatment efficacy of services provided under the eating disorder treatment and management plan, including a discussion with the patient regarding whether the eating disorders psychological treatment and dietetic services are meeting the patient’s needs; and

(b)   modifications are made to the eating disorder treatment and management plan, recorded in writing, including:

(i)    recommendations to continue with treatment options detailed in the plan; or

(ii)   recommendations to alter the treatment options detailed in the plan, with the new arrangements documented in the plan; and

(c)  initiates referrals for a review by a consultant physician practising in the specialty of psychiatry or paediatrics, where appropriate; and

(d)   the medical practitioner offers the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees):

(i) a copy of the plan; and

(ii) suitable education about the eating disorder

70.20

Subgroup 26—Review of an Eating Disorder Plan – Phone Service

92176

Phone attendance by a general practitioner to review an eligible patient’s eating disorder treatment and management plan prepared by the general practitioner, an associated medical practitioner working in general practice, or a consultant physician practising in the specialty of psychiatry or paediatrics, if:

(a)   the general practitioner reviews the treatment efficacy of services provided under the eating disorder treatment and management plan, including a discussion with the patient regarding whether the eating disorders psychological treatment and dietetic services are meeting the patient’s needs; and

(b)   modifications are made to the eating disorder treatment and management plan, recorded in writing, including:

(i)    recommendations to continue with treatment options detailed in the plan; or

(ii)   recommendations to alter the treatment options detailed in the plan, with the new arrangements documented in the plan; and

(c)  initiates referrals for a review by a consultant physician practising in the specialty of psychiatry or paediatrics, where appropriate; and

(e)   the general practitioner offers the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees):

(i) a copy of the plan; and

(ii) suitable education about the eating disorder

87.75

92177

Phone attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician) to review an eligible patient’s eating disorder treatment and management plan prepared by the medical practitioner, an associated medical practitioner working in general practice, or a consultant physician practising in the specialty of psychiatry or paediatrics, if:

(a)   the medical practitioner reviews the treatment efficacy of services provided under the eating disorder treatment and management plan, including a discussion with the patient regarding whether the eating disorders psychological treatment and dietetic services are meeting the patient’s needs; and

(b)   modifications are made to the eating disorder treatment and management plan, recorded in writing, including:

(i)    recommendations to continue with treatment options detailed in the plan; or

(ii)   recommendations to alter the treatment options detailed in the plan, with the new arrangements documented in the plan; and

(c)  initiates referrals for a review by a consultant physician practising in the specialty of psychiatry or paediatrics, where appropriate; and

(e)   the medical practitioner offers the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees):

(i) a copy of the plan; and

(ii) suitable education about the eating disorder

70.20

Subgroup 27— Eating Disorder Psychological Treatment Services – Telehealth Service

92182

Telehealth attendance by a general practitioner, for providing eating disorder psychological treatment services by a general practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 30 minutes but less than 40 minutes in duration, for an eligible patient if treatment is clinically indicated under an eating disorder treatment and management plan

113.50

92184

Telehealth attendance by a general practitioner, for providing eating disorder psychological treatment services by a general practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 40 minutes in duration, for an eligible patient if treatment is clinically indicated under an eating disorder treatment and management plan

162.45

92186

Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), for providing eating disorder psychological treatment services by a medical practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 30 minutes but less than 40 minutes in duration, for an eligible patient if treatment is clinically indicated under an eating disorder treatment and management plan

90.80

92188

Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), for providing eating disorder psychological treatment services by a medical practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 40 minutes in duration, for an eligible patient if treatment is clinically indicated under an eating disorder treatment and management plan

130.00

Subgroup 28—Eating Disorder Psychological Treatment Strategies – Phone Service

92194

Phone attendance by a general practitioner, for providing eating disorder psychological treatment services by a general practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 30 minutes but less than 40 minutes in duration, for an eligible patient if treatment is clinically indicated under an eating disorder treatment and management plan

113.50

92196

Phone attendance by a general practitioner, for providing eating disorder psychological treatment services by a general practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 40 minutes in duration, for an eligible patient if treatment is clinically indicated under an eating disorder treatment and management plan

162.45

92198

Phone attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), for providing eating disorder psychological treatment services by a medical practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 30 minutes but less than 40 minutes in duration, for an eligible patient if treatment is clinically indicated under an eating disorder treatment and management plan

90.80

92200

Phone attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), for providing eating disorder psychological treatment services by a medical practitioner registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service, and lasting at least 40 minutes in duration, for an eligible patient if treatment is clinically indicated under an eating disorder treatment and management plan

130.00

Subgroup 29 ‑ GP and Other Medical Practitioner ‑ Urgent After Hours Service in Unsociable Hours ‑ Telehealth Service

92210

Telehealth attendance by a general practitioner on not more than one patient on one occasion—each attendance in unsociable hours if:

(a) the attendance is requested by the patient or a responsible person in the same unbroken after‑hours period; and

(b) the patient’s medical condition requires urgent assessment

187.25

92211

Telehealth attendance by a medical practitioner (other than a general practitioner) on not more than one patient on one occasion—each attendance in unsociable hours if:

(a) the attendance is requested by the patient or a responsible person in the same unbroken after‑hours period; and

(b) the patient’s medical condition requires urgent assessment

149.70

 

Schedule 2 –  Specialist, consultant physician and consultant psychiatrist services

 

Division 2.1 – Services and fees – specialist attendances via telehealth and phone

2.1.1 Application of specialist, consultant physician and consultant psychiatrist telehealth and phone services

(1)   Clause 1.2.2 of the general medical services table shall have effect as if all items in Division 2.1 (other than item in Subgroups 33, 34 and 37) were specified in the clause.

2.1.2 Application of item 92434

(1)  In items 92434:

eligible allied health provider has the meaning given in Part 7 of the general medical services table.

risk assessment has the meaning given in clause 2.11.4 of the general medical services table.

2.1.3 Application of items in Subgroup 23 of Group A40

(1)  Item 92163 does not apply if performed in association with a service to which items 110, 116, 119, 132 or 133 of the general medical services table or items 91824, 91825, 91826, 91836, 92422 or 92423 applies.

2.1.4  Application of items in Subgroups 33 and 34 of Group A40

(1)  Clause 2.13.1 of the general medical services table shall have effect as if items 92513 to 92516 and 92521 to 92522 were specified in the clause.

 

 

Group A40 – Telehealth and phone attendance services

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 4 – Specialist attendances telehealth services

91822

 

Telehealth attendance for a person by a specialist in the practice of the specialist’s specialty if:

(a)       the attendance follows referral of the patient to the specialist; and

(b)       the attendance was of more than 5 minutes in duration.

Where the attendance was other than a second or subsequent attendance as part of a single course of treatment

90.35

91823

 

 

Telehealth attendance for a person by a specialist in the practice of the specialist’s specialty if:

(a)       the attendance follows referral of the patient to the specialist; and

(b)       the attendance was of more than 5 minutes in duration.

Where the attendance is after the first attendance as part of a single course of treatment

45.40

Subgroup 5 – Consultant physician telehealth services

91824

 

Telehealth attendance for a person by a consultant physician in the practice of the consultant physician’s specialty (other than psychiatry) if:

(a)       the attendance follows referral of the patient to the specialist; and

(b)       the attendance was of more than 5 minutes in duration;

Where the attendance was other than a second or subsequent attendance as part of a single course of treatment

159.35

91825

 

Telehealth attendance for a person by a consultant physician in the practice of the consultant physician’s specialty (other than psychiatry) if:

(a)       the attendance follows referral of the patient to the specialist; and

(b)       the attendance was of more than 5 minutes in duration;

Where the attendance is not a minor attendance after the first as part of a single course of treatment

79.75

91826

 

Telehealth attendance for a person by a consultant physician in the practice of the consultant physician’s specialty (other than psychiatry) if:

(a)       the attendance follows referral of the patient to the specialist; and

(b)       the attendance was of more than 5 minutes in duration;

Where the attendance is a minor attendance after the first as part of a single course of treatment

45.40

92422

 

Telehealth attendance by a consultant physician in the practice of the consultant physician’s specialty (other than psychiatry) of at least 45 minutes in duration for an initial assessment of a patient with at least 2 morbidities (which may include complex congenital, developmental and behavioural disorders) following referral of the patient to the consultant physician by a referring practitioner, if:

(a) an assessment is undertaken that covers:

(i) a comprehensive history, including psychosocial history and medication review; and

(ii) comprehensive multi or detailed single organ system assessment; and

(iii) the formulation of differential diagnoses; and

(b) a consultant physician treatment and management plan of significant complexity is prepared and provided to the referring practitioner, which involves:

(i) an opinion on diagnosis and risk assessment; and

(ii) treatment options and decisions; and

(iii) medication recommendations; and

(c)  an attendance on the patient to which item 110, 116 or 119 of the general medical services table or item 91824, 91825, 91826 or 91836 applies did not take place on the same day by the same consultant physician; and

(d) this item, or item 132 of the general medical services table, has not applied to an attendance on the patient in the preceding 12 months by the same consultant physician

278.75

92423

 

Telehealth attendance by a consultant physician in the practice of the consultant physician’s specialty (other than psychiatry) of at least 20 minutes in duration after the first attendance in a single course of treatment for a review of a patient with at least 2 morbidities (which may include complex congenital, developmental and behavioural disorders) if:

(a) a review is undertaken that covers:

(i) review of initial presenting problems and results of diagnostic investigations; and

(ii) review of responses to treatment and medication plans initiated at time of initial consultation; and

(iii) comprehensive multi or detailed single organ system assessment; and

(iv) review of original and differential diagnoses; and

(b) the modified consultant physician treatment and management plan is provided to the referring practitioner, which involves, if appropriate:

(i) a revised opinion on the diagnosis and risk assessment; and

(ii) treatment options and decisions; and

(iii) revised medication recommendations; and

(c) an attendance on the patient to which item 110, 116 or 119 of the general medical services table or item 91824, 91825, 91826 or 91836 applies did not take place on the same day by the same consultant physician; and

(d) item 132 of the general medical services table or item 92422 applied to an attendance claimed in the preceding 12 months; and

(e) the attendance under this item is claimed by the same consultant physician who claimed item 132 of the general medical services table or item 92422; and

(f) this item, or item 133 of the general medical services table has not applied more than twice in any 12 month period

139.55

Subgroup 6 – Consultant psychiatrist telehealth services

91827

 

Telehealth attendance for a person by a consultant psychiatrist; if:

(a)   the attendance follows a referral of the patient to the consultant psychiatrist by a referring practitioner; and

(b)   the attendance was not more than 15 minutes duration

45.75

91828

 

Telehealth attendance for a person by a consultant psychiatrist; if:

(a)   the attendance follows a referral of the patient to the consultant psychiatrist by a referring practitioner; and

(b)   the attendance was at least 15 minutes, but not more than 30 minutes in duration

91.30

91829

 

Telehealth attendance for a person by a consultant psychiatrist; if:

(a)   the attendance follows a referral of the patient to the consultant psychiatrist by a referring practitioner; and

(b)   the attendance was at least 30 minutes, but not more than 45 minutes in duration

140.55

91830

 

Telehealth attendance for a person by a consultant psychiatrist; if:

(a)   the attendance follows a referral of the patient to the consultant psychiatrist by a referring practitioner; and

(b)   the attendance was at least 45 minutes, but not more than 75 minutes in duration

194.00

91831

 

Telehealth attendance for a person by a consultant psychiatrist; if:

(a)   the attendance follows a referral of the patient to the consultant psychiatrist by a referring practitioner; and

(b)   the attendance was at least 75 minutes in duration

225.10

92434

 

Telehealth attendance of at least 45 minutes in duration, by a consultant physician in the practice of the consultant physician’s specialty of psychiatry, following referral of the patient to the consultant physician by a referring practitioner, for assessment, diagnosis and preparation of a treatment and management plan for a patient under 13 years with autism or another pervasive developmental disorder, if the consultant physician does all of the following:

(a) undertakes a comprehensive assessment and makes a diagnosis (if appropriate, using information provided by an eligible allied health provider);

(b) develops a treatment and management plan which must include the following:

(i) an assessment and diagnosis of the patient’s condition;

(ii) a risk assessment;

(iii) treatment options and decisions;

(iv) if necessary—medication recommendations;

(c) provides a copy of the treatment and management plan to the referring practitioner;

(d) provides a copy of the treatment and management plan to one or more allied health providers, if appropriate, for the treatment of the patient;

(other than attendance on a patient for whom payment has previously been made under this item, or item 135, 137, 139 or 289 of the general medical services table, or item 92140, 92141, 92142 or 92145)

278.75

92435

 

Telehealth attendance of more than 45 minutes by a consultant physician in the practice of the consultant physician’s specialty of psychiatry, if:

(a) the attendance follows referral of the patient to the consultant for an assessment or management by a medical practitioner in general practice (not including a specialist or consultant physician) or a participating nurse practitioner; and

(b) during the attendance, the consultant:

(i) uses an outcome tool (if clinically appropriate); and

(ii) carries out a mental state examination; and

(iii) makes a psychiatric diagnosis; and

(c) the consultant decides that it is clinically appropriate for the patient to be managed by the referring practitioner without ongoing treatment by the consultant; and

(d) within 2 weeks after the attendance, the consultant:

(i) prepares a written diagnosis of the patient; and

(ii) prepares a written management plan for the patient that:

(A) covers the next 12 months; and

(B) is appropriate to the patient’s diagnosis; and

(C) comprehensively evaluates the patient’s biological, psychological and social issues; and

(D) addresses the patient’s diagnostic psychiatric issues; and

(E) makes management recommendations addressing the patient’s biological, psychological and social issues; and

(iii) gives the referring practitioner a copy of the diagnosis and the management plan; and

(iv) if clinically appropriate, explains the diagnosis and management plan, and a gives a copy, to:

(A) the patient; and

(B) the patient’s carer (if any), if the patient agrees; and

(e) in the preceding 12 months, a service to which this item or item 291 of the general medical services table applies has not been provided

478.05

92436

 

Telehealth attendance of more than 30 minutes but not more than 45 minutes in duration by a consultant physician in the practice of the consultant physician’s specialty of psychiatry, if:

(a) the patient is being managed by a medical practitioner or a participating nurse practitioner in accordance with a management plan prepared by the consultant in accordance with item 291 or 92435; and

(b) the attendance follows referral of the patient to the consultant for review of the management plan by the medical practitioner or a participating nurse practitioner managing the patient; and

(c) during the attendance, the consultant:

(i) uses an outcome tool (if clinically appropriate); and

(ii) carries out a mental state examination; and

(iii) makes a psychiatric diagnosis; and

(iv) reviews the management plan; and

(d) within 2 weeks after the attendance, the consultant:

(i) prepares a written diagnosis of the patient; and

(ii) revises the management plan; and

(iii) gives the referring practitioner a copy of the diagnosis and the revised management plan; and

(iv) if clinically appropriate, explains the diagnosis and the revised management plan, and gives a copy, to:

(A) the patient; and

(B) the patient’s carer (if any), if the patient agrees; and

(e)  in the preceding 12 months, a service to which item 291 of the general medical services table or item 92435 applies has been provided; and

(f)  in the preceding 12 months, a service to which this item, or item 293 of the general medical services table applies has not been provided

298.85

92437

 

Telehealth attendance of more than 45 minutes in duration by a consultant physician in the practice of the consultant physician’s speciality of psychiatry following referral of the patient to the consultant physician by a referring practitioner:

(a) if the patient:

(i) is a new patient for this consultant physician; or

(ii) has not received an attendance from this consultant physician in the preceding 24 months; and

(b) the patient has not received an attendance under this item, or item 91827 to 91831, 91837 to 91839, 92455 to 92457, or item 296, 297, 299 or 300 to 346 of the general medical services table, in the preceding 24 months

274.95

92455

 

Telehealth attendance for group psychotherapy (including any associated consultations with a patient taking place on the same occasion and relating to the condition for which group therapy is conducted):

(a) of not less than 1 hour in duration; and

(b) given under the continuous direct supervision of a consultant physician in the practice of the consultant physician’s specialty of psychiatry; and

(c) involving a group of 2 to 9 unrelated patients or a family group of more than 3 patients, each of whom is referred to the consultant physician by a referring practitioner;

—each patient

52.05

92456

 

Telehealth attendance for group psychotherapy (including any associated consultations with a patient taking place on the same occasion and relating to the condition for which group therapy is conducted):

(a) of not less than 1 hour in duration; and

(b) given under the continuous direct supervision of a consultant physician in the practice of the consultant physician’s specialty of psychiatry; and

(c) involving a family group of 3 patients, each of whom is referred to the consultant physician by a referring practitioner;

—each patient

69.10

92457

 

Telehealth attendance for group psychotherapy (including any associated consultations with a patient taking place on the same occasion and relating to the condition for which group therapy is conducted):

(a) of not less than 1 hour in duration; and

(b) given under the continuous direct supervision of a consultant physician in the practice of the consultant physician’s specialty of psychiatry; and

(c) involving a family group of 2 patients, each of whom is referred to the consultant physician by a referring practitioner;

—each patient

102.20

92458

 

Telehealth attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry, following referral of the patient to the consultant physician by a referring practitioner, involving an interview of a person other than the patient of not less than 20 minutes, but less than 45 minutes, in duration, in the course of initial diagnostic evaluation of a patient

133.85

92459

 

Telehealth attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry, following referral of the patient to the consultant physician by a referring practitioner, involving an interview of a person other than the patient of not less than 45 minutes in duration, in the course of initial diagnostic evaluation of a patient

184.80

92460

 

Telehealth attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry, following referral of the patient to the consultant physician by a referring practitioner, involving an interview of a person other than the patient of not less than 20 minutes in duration, in the course of continuing management of a patient—if that attendance and another attendance to which this item or item 352 of the general medical services table applies have not exceeded 4 in a calendar year for the patient

133.85

Subgroup 7 – Specialist attendances phone services

91833

 

 

Phone attendance for a person by a specialist in the practice of the specialist’s specialty if:

(a)       the attendance follows referral of the patient to the specialist; and

(b)       the attendance was of more than 5 minutes in duration;

Where the attendance is after the first attendance as part of a single course of treatment

45.40

Subgroup 8 – Consultant physician phone services

91836

 

Phone attendance for a person by a consultant physician in the practice of the consultant physician’s specialty (other than psychiatry) if:

(a)       the attendance follows referral of the patient to the specialist; and

(b)       the attendance was of more than 5 minutes in duration;

Where the attendance is a minor attendance after the first as part of a single course of treatment

45.40

Subgroup 9 – Consultant psychiatrist phone services

91837

 

Phone attendance for a person by a consultant psychiatrist; if:

(a)   the attendance follows a referral of the patient to the consultant psychiatrist by a referring practitioner; and

(b)   the attendance was not more than 15 minutes duration;

Where the attendance is after the first attendance as part of a single course of treatment

45.75

91838

 

Phone attendance for a person by a consultant psychiatrist; if:

(a)   the attendance follows a referral of the patient to the consultant psychiatrist by a referring practitioner and

(b)   the attendance was at least 15 minutes, but not more than 30 minutes in duration;

Where the attendance is after the first attendance as part of a single course of treatment

91.30

91839

 

Phone attendance for a person by a consultant psychiatrist; if:

(a)   the attendance follows a referral of the patient to the consultant psychiatrist by a referring practitioner; and

(b)   the attendance was at least 30 minutes, but not more than 45 minutes in duration

Where the attendance is after the first attendance as part of a single course of treatment

140.55

Subgroup 17 ‑ GP, Specialist and Consultant Physician Autism Service ‑ Telehealth Service

92140

Telehealth attendance of at least 45 minutes in duration by a consultant physician in the practice of the consultant physician’s specialty of paediatrics, following referral of the patient to the consultant by a referring practitioner, for assessment, diagnosis and preparation of a treatment and management plan for a patient aged under 13 years with autism or another pervasive developmental disorder, if the consultant paediatrician does all of the following:

(a) undertakes a comprehensive assessment and makes a diagnosis (if appropriate, using information provided by an eligible allied health provider);

(b) develops a treatment and management plan, which must include the following:

(i) an assessment and diagnosis of the patient’s condition;

(ii) a risk assessment;

(iii) treatment options and decisions;

(iv) if necessary—medical recommendations;

(c) provides a copy of the treatment and management plan to the referring practitioner and one or more allied health providers, if appropriate, for the treatment of the patient

278.75

92141

Telehealth attendance of at least 45 minutes in duration by a specialist or consultant physician  following referral of the patient to the specialist or consultant physician by a referring practitioner, for assessment, diagnosis and preparation of a treatment and management plan for a patient under 13 years with an eligible disability if the specialist or consultant physician does all of the following:

(a) undertakes a comprehensive assessment and makes a diagnosis (if appropriate, using information provided by an eligible allied health provider);

(b) develops a treatment and management plan, which must include the following:

(i) an assessment and diagnosis of the patient’s condition;

(ii) a risk assessment;

(iii) treatment options and decisions;

(iv) if necessary—medication recommendations;

(c) provides a copy of the treatment and management plan to one or more allied health providers, if appropriate, for the treatment of the patient

(other than attendance on a patient for whom payment has previously been made under this item or item 137, 139 or 289)

278.75

Subgroup 23 Consultant Physician and Psychiatrist ‑ Eating Disorder Treatment and Management Plan – Telehealth Service

92162

Telehealth attendance of at least 45 minutes in duration by a consultant physician in the practice of the consultant physician’s specialty of psychiatry for the preparation of an eating disorder treatment and management plan for an eligible patient, if:

(a)  the patient has been referred by a referring practitioner; and

(b)  during the attendance, the consultant psychiatrist:

(i) uses an outcome tool (if clinically appropriate); and

(ii) carries out a mental state examination; and

(iii) makes a psychiatric diagnosis; and

(c)  within 2 weeks after the attendance, the consultant psychiatrist:

(i)  prepares a written diagnosis of the patient; and

(ii) prepares a written management plan for the patient that:

(A) covers the next 12 months; and

(B) is appropriate to the patient’s diagnosis; and

(C) comprehensively evaluates the patient’s biological, psychological and social issues; and

(D) addresses the patient’s diagnostic psychiatric issues; and

(E) makes management recommendations addressing the patient’s biological, psychological and social issues; and

(iii) gives the referring practitioner a copy of the diagnosis and the management plan; and

(iv) if clinically appropriate, explains the diagnosis and  management plan, and a gives a copy, to:

(A) the patient; and

(B) the patient’s carer (if any), if the patient agrees

478.05

92163

Telehealth attendance of at least 45 minutes in duration by a consultant physician in the practice of the consultant physician’s specialty of paediatrics for the preparation of an eating disorder treatment and management plan for an eligible patient, if:

(a)   the patient has been referred by a referring practitioner; and

(b)   during the attendance, the consultant paediatrician undertakes an assessment that covers:

(i)   a comprehensive history, including psychosocial history and medication review; and

(ii)  comprehensive multi or detailed single organ system assessment; and

(iii)  the formulation of diagnoses; and

(c)  within 2 weeks after the attendance, the consultant paediatrician:

(i)  prepares a written diagnosis of the patient; and

(ii) prepares a written management plan for the patient that involves:

(A) an opinion on diagnosis and risk assessment; and

(B) treatment options and decisions; and

(C) medication recommendations; and

(iii) gives the referring practitioner a copy of the diagnosis and the management plan; and

(iv) if clinically appropriate, explains the diagnosis and  management plan, and a gives a copy, to:

(A) the patient; and

(B) the patient’s carer (if any), if the patient agrees

278.75

Subgroup 25 Review of an Eating Disorder Plan ‑ Telehealth Service

92172

Telehealth attendance of at least 30 minutes in duration by a consultant physician in the practice of the consultant physician’s specialty of psychiatry for an eligible patient, if:

(a)  the consultant psychiatrist reviews the treatment efficacy of services provided under the eating disorder treatment and management plan, including a discussion with the patient regarding whether the eating disorders psychological treatment and dietetic services are meeting the patient’s needs; and

(b)  the patient has been referred by a referring practitioner; and

(c)  during the attendance, the consultant psychiatrist:

(i) uses an outcome tool (if clinically appropriate); and

(ii) carries out a mental state examination; and

(iii) makes a psychiatric diagnosis; and

(iv) reviews the eating disorder treatment and management plan; and

(d)  within 2 weeks after the attendance, the consultant psychiatrist:

(i)  prepares a written diagnosis of the patient; and

(ii)  revises the eating disorder treatment and management; and

(iii) gives the referring practitioner a copy of the diagnosis and the revised management plan; and

(iv) if clinically appropriate, explains the diagnosis and the revised management plan, and gives a copy, to:

(A) the patient; and

(B) the patient’s carer (if any), if the patient agrees

298.85

92173

Telehealth attendance of at least 30 minutes in duration by a consultant physician in the practice of the consultant physician’s specialty of paediatrics for an eligible patient, if:

(a)  the consultant paediatrician reviews the treatment efficacy of services provided under the eating disorder treatment and management plan, including a discussion with the patient regarding whether the eating disorders psychological treatment and dietetic services are meeting the patient’s needs; and

(b)  the patient has been referred by a referring practitioner; and

(c)  during the attendance, the consultant paediatrician:

(i) uses an outcome tool (if clinically appropriate); and

(ii) carries out a mental state examination; and

(iii) makes a psychiatric diagnosis; and

(iv) reviews the eating disorder treatment and management plan; and

(d)  within 2 weeks after the attendance, the consultant paediatrician:

(i)  prepares a written diagnosis of the patient; and

(ii)  revises the eating disorder treatment and management; and

(iii) gives the referring practitioner a copy of the diagnosis and the revised management plan; and

(iv) if clinically appropriate, explains the diagnosis and the revised management plan, and gives a copy, to:

(A) the patient; and

(B) the patient’s carer (if any), if the patient agrees

139.55

Subgroup 31—Geriatric Medicine – Telehealth Services

92623

 

Telehealth attendance of more than 60 minutes in duration by a consultant physician or specialist in the practice of the consultant physician’s or specialist’s specialty of geriatric medicine, if:

(a) the patient is at least 65 years old and referred by a medical practitioner practising in general practice (not including a specialist or consultant physician) or a participating nurse practitioner; and

(b) the attendance is initiated by the referring practitioner for the provision of a comprehensive assessment and management plan; and

(c) during the attendance:

(i) all relevant aspects of the patient’s health are evaluated in detail using appropriately validated assessment tools if indicated (the assessment); and

(ii) the patient’s various health problems and care needs are identified and prioritised (the formulation); and

(iii) a detailed management plan is prepared (the management plan) setting out:

(A) the prioritised list of health problems and care needs; and

(B) short and longer term management goals; and

(C) recommended actions or intervention strategies to be undertaken by the patient’s general practitioner or another relevant health care provider that are likely to improve or maintain health status and are readily available and acceptable to the patient and the patient’s family and carers; and

(iv) the management plan is explained and discussed with the patient and, if appropriate, the patient’s family and any carers; and

(v) the management plan is communicated in writing to the referring practitioner; and

(d) an attendance to which item 104, 105, 107, 108, 110, 116 or 119 of the general medical services table or item 91822, 91823, 91833, 91824, 91825, 91826 or 91836 applies has not been provided to the patient on the same day by the same practitioner; and

(e)  an attendance to which this item or item 145 of the general medical services table applies has not been provided to the patient by the same practitioner in the preceding 12 months

478.05

92624

 

Telehealth attendance of more than 30 minutes in duration by a consultant physician or specialist in the practice of the consultant physician’s or specialist’s specialty of geriatric medicine to review a management plan previously prepared by that consultant physician or specialist under item 141, 92623 or 145, if:

(a) the review is initiated by the referring medical practitioner practising in general practice or a participating nurse practitioner; and

(b) during the attendance:

(i) the patient’s health status is reassessed; and

(ii) a management plan prepared under item 141, 92623 or 145 is reviewed and revised; and

(iii) the revised management plan is explained to the patient and (if appropriate) the patient’s family and any carers and communicated in writing to the referring practitioner; and

(c)  an attendance to which item 104, 105, 107, 108, 110, 116 or 119 of the general medical services table or item 91822, 91823, 91833, 91824, 91825, 91826 or 91836 applies was not provided to the patient on the same day by the same practitioner; and

(d) an attendance to which item 141 or 145 of the general medical services table, or item 92623 applies has been provided to the patient by the same practitioner in the preceding 12 months; and

(e)  an attendance to which this item, or item 147 of the general medical services table applies has not been provided to the patient in the preceding 12 months, unless there has been a significant change in the patient’s clinical condition or care circumstances that requires a further review

298.85

Subgroup 33— Public health physician – Telehealth Services 

92513

 

Telehealth attendance by a public health physician in the practice of the public health physician’s specialty of public health medicine—attendance for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited management

20.65

92514

 

Telehealth attendance by a public health physician in the practice of the public health physician’s specialty of public health medicine, lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) arranging any necessary investigation;

(c) implementing a management plan;

(d) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation

45.15

92515

 

Telehealth attendance by a public health physician in the practice of the public health physician’s specialty of public health medicine, lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) arranging any necessary investigation;

(c) implementing a management plan;

(d) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation

87.35

92516

Telehealth attendance by a public health physician in the practice of the public health physician’s specialty of public health medicine, lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) arranging any necessary investigation;

(c) implementing a management plan;

(d) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation

128.60

Subgroup 34— Public health physician – Phone Services 

92521

 

Phone attendance by a public health physician in the practice of the public health physician’s specialty of public health medicine—attendance for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited management;

Where the attendance is not the first attendance for that particular clinical indication

20.65

92522

 

Phone attendance by a public health physician in the practice of the public health physician’s specialty of public health medicine, lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) arranging any necessary investigation;

(c) implementing a management plan;

(d) providing appropriate preventive health care;

for one or more health‑related issues, where the attendance is not the first attendance for those particular health‑related issues, with appropriate documentation

45.15

Subgroup 35— Neurosurgery attendances – Telehealth Services 

92610

 

Telehealth attendance by a specialist in the practice of neurosurgery following referral of the patient to the specialist (other than a second or subsequent attendance in a single course of treatment)

136.85

92611

 

Telehealth attendance by a specialist in the practice of neurosurgery following referral of the patient to the specialist—a minor attendance after the first in a single course of treatment

45.40

92612

 

Telehealth attendance by a specialist in the practice of neurosurgery following referral of the patient to the specialist—an attendance after the first in a single course of treatment, involving arranging any necessary investigations in relation to one or more complex problems and of more than 15 minutes in duration but not more than 30 minutes in duration

90.35

92613

 

Telehealth attendance by a specialist in the practice of neurosurgery following referral of the patient to the specialist—an attendance after the first in a single course of treatment, involving arranging any necessary investigations in relation to one or more complex problems and of more than 30 minutes in duration but not more than 45 minutes in duration

125.15

92614

 

Telehealth attendance by a specialist in the practice of neurosurgery following referral of the patient to the specialist—an attendance after the first in a single course of treatment, involving arranging any necessary investigations in relation to one or more complex problems and of more than 45 minutes in duration

159.35

Subgroup 36—Neurosurgery attendances – Phone Services

92618

 

Phone attendance by a specialist in the practice of neurosurgery following referral of the patient to the specialist—a minor attendance after the first in a single course of treatment

45.40

Subgroup 37 —Specialist, anaesthesia telehealth services

92701

 

Telehealth attendance by a medical practitioner in the practice of anaesthesia for a consultation on a patient undergoing advanced surgery or who has complex medical problems, involving a selective history and the formulation of a written patient management plan documented in the patient notes, and lasting more than 15 minutes (other than a service associated with a service to which any of items 2801 to 3000 of the general medical services table apply)

90.35

 


 

Division 2.2– Services and Fees – obstetric attendances

2.2.1 Application of Obstetric telehealth and phone services

             (1)  For an item in Subgroups 1 or 2 of Group T4:

                     (a)  practice midwife has the same meaning as in clause 5.5.2 of the general medical services table;

                     (b)  nurse has the same meaning as in clause 5.5.1 of the general medical services table.

             (2)  For items 91850 and 91855:

                     (a)  the items apply to an antenatal service provided to a patient by a practice midwife, nurse or Aboriginal and Torres Strait Islander health practitioner only if:

                              (i)  the practice midwife, nurse or Aboriginal and Torres Strait Islander health practitioner has the appropriate training and skills to perform an antenatal service; and

                             (ii)  the medical practitioner under whose supervision the antenatal service is provided retains responsibility for clinical outcomes and for the health and safety of the patient; and

                            (iii)  the practice midwife, nurse or Aboriginal and Torres Strait Islander health practitioner complies with relevant legislative or regulatory requirements regarding the provision of the antenatal service in the State or Territory where the service is provided;

                     (b)  the items do not apply in conjunction with another antenatal attendance item for the same patient, on the same day by the same practitioner;

                     (c)  the items do not apply in conjunction with items 10981, 10982, 10990, 10991 or 10992; and

                     (d)  for any particular patient, item 91850 and 91855 and item 16400 in the general medical services table apply not more than 10 times in a 9 month period.

(3)   Clause 1.2.2 of the general medical services table shall have effect as if all items in Division 2.2 of this determination (other than items 91850, 91853, 91855 or 91857), were specified in the clause.

 

Group T4—Obstetrics

Item

Description

Fee ($)

Subgroup 1 – Obstetric telehealth services

91850

Antenatal telehealth service provided by a practice midwife, nurse or an Aboriginal and Torres Strait Islander health practitioner, to a maximum of 10 services per pregnancy, if:

(a)   the service is provided on behalf of, and under the supervision of, a medical practitioner; and

(b)   the service is not performed in conjunction with another antenatal attendance item in Group T4 for the same patient on the same day by the same practitioner

28.35

91851

Postnatal telehealth attendance by an obstetrician or general practitioner (other than a service to which any other item applies) if:

(a)   is between 4 and 8 weeks after the birth; and

(b)   lasts at least 20 minutes in duration; and

(c)   includes a mental health assessment (including screening for drug and alcohol use and domestic violence) of the patient; and

(d)   is for a pregnancy in relation to which a service to which item 82140 applies is not provided. 

Applicable once for a pregnancy

74.60

91852

Postnatal telehealth attendance (other than a service to which any other item applies) if:

(a)   the attendance is rendered by:

(i)            a practice midwife (on behalf of and under the supervision of the medical practitioner who attended the birth); or

(ii)           an obstetrician; or

(iii)          a general practitioner; and

(b)   is between 1 week and 4 weeks after the birth; and

(c)   lasts at least 20 minutes; and

(d)   is for a patient who was privately admitted for the birth; and

(e)   is for a pregnancy in relation to which a service to which item 82130, 82135 or 82140 of the Health Insurance (Midwife and Nurse Practitioner) Determination 2015 or item 91214, 91215, 91221 or 91222 is not provided.

Applicable once for a pregnancy

55.55

91853

Antenatal telehealth attendance

49.05

Subgroup 2 – Obstetric phone services

91855

Antenatal phone service provided by a practice midwife, nurse or an Aboriginal and Torres Strait Islander health practitioner, to a maximum of 10 services per pregnancy, if:

(a)   the service is provided on behalf of, and under the supervision of, a medical practitioner; and

(b)   the service is not performed in conjunction with another antenatal attendance item in Group T4 for the same patient on the same day by the same practitioner

28.35

91856

Postnatal phone attendance by an obstetrician or general practitioner (other than a service to which any other item applies) if:

(a)   is between 4 and 8 weeks after the birth; and

(b)   lasts at least 20 minutes in duration; and

(c)   includes a mental health assessment (including screening for drug and alcohol use and domestic violence) of the patient; and

(d)   is for a pregnancy in relation to which a service to which item 82140 applies is not provided.

Applicable once for a pregnancy

74.60

91857

Postnatal phone attendance (other than a service to which any other item applies) if:

(a)   the attendance is rendered by:

(i)            a practice midwife (on behalf of and under the supervision of the medical practitioner who attended the birth); or

(ii)           an obstetrician; or

(iii)          a general practitioner; and

(b)   is between 1 week and 4 weeks after the birth; and

(c)   lasts at least 20 minutes; and

(d)   is for a patient who was privately admitted for the birth; and

(e)   is for a pregnancy in relation to which a service to which item 82130, 82135 or 82140 of the Health Insurance (Midwife and Nurse Practitioner) Determination 2015 or item 91214, 91215, 91221 or 91222 is not provided.

Applicable once for a pregnancy

55.55

91858

Antenatal phone attendance

49.05

 

Schedule 3 – Allied health services

 

Division 3.1 – Services and fees – Allied health telehealth and phone services

3.1.1 Application of allied health attendances via telehealth and phone ‑ general

(1)  An item in Schedule 3 applies only if a private health insurance benefit has not been claimed for the service.

3.1.2  Referrals by psychiatrists and paediatricians for pervasive developmental disorder services

(1)         This section applies to items in Subgroups 15 and 16 of Group M18.

(2)         For items 93032, 93033, 93040 and 93041 the referral by a consultant physician specialising in the practice of his or her field of psychiatry must be a referral for a service to which any of items 296 to 352 of the general medical services or to which any of items 91827, 91828, 91829, 91830, 91831, 91837, 91838, 91839, 92437, 92455, 92456, 92457, 92458, 92459 or 92460 applies.

(3)         For items 93032, 93033, 93040 and 93041 the referral by a consultant physician specialising in the practice of his or her field of paediatrics must be a referral for a service to which any of items 110 to 131 of the general medical services table or to which any of items 91824, 91825, 91826 or 91836 applies.

(4)         For items 93035, 93036, 93043 and 93044 the referral by a consultant physician specialising in the practice of his or her field of psychiatry must be a referral for a service to which item 289 of the general medical services table or to which item 92434 applies.

(5)  If a child has previously been provided with a service mentioned in item 289 of the general medical services table or item 92434, a consultant physician specialising in the practice of his or her field of psychiatry may only refer the child for a service to which any of items 296 to 352 of the general medical services table or to which any of items 91827, 91828, 91829, 91830, 91831, 91837, 91838, 91839, 92437, 92455, 92456, 92457, 92458, 92459 or 92460 applies.

(6)         For items 93035, 93036, 93043 and 93044 the referral by a consultant physician specialising in the practice of his or her field of paediatrics must be a referral for a service to which item 135 of the general medical services table or to which item 92140 applies.

(7)  If a child has previously been provided with a service mentioned in item 135 of the general medical services table or item 92140, a consultant physician specialising in the practice of his or her field of paediatrics may only refer the child for a service to which any of items 110 to 131 of the general medical services table or to which any of items 91824, 91825, 91826 or 91836 applies.

(8)  If a child has previously been provided with a service mentioned in item 137 or 139 of the general medical services table or item 92141, 92142, or 92145, the medical practitioner cannot refer the child for a service to which item 135 or 289 of the general medical services table or to which item 92140 or 92434 applies.

3.1.3 Referrals by specialists, consultant physicians and general practitioners for disability services

(1)  This section applies to items in Subgroups 15 and 16 of Group M18.

(2)  For items 93032, 93033, 93040 and 93041 the referral by a specialist or consultant physician specialising in the practice of his or her field of speciality must be a referral for a service to which any of items 104 to 131 or 296 to 352 of the general medical services table or items 91822 to 91839, 92437, 92455, 92456, 92457 92458, 92459 or 92460 apply.

(3)  For items 93032, 93033, 93040 and 93041, the referral by a general practitioner must be a referral for a service to which any of items 3 to 51 of the general medical services table or to which any of items 91790, 91800, 91801, 91802, 91890, 91891, 91892 or 91893 applies.

(4)  For items 93035, 93036, 93043 and 93044 the referral by a specialist or consultant physician specialising in the practice of his or her field of speciality must be a referral for a service to which item 137 of the general medical services table or to which item 92141 applies.

(5)  For items 93035, 93036, 93043 and 93044 the referral by a general practitioner must be a referral for a service to which item 139 of the general medical services table or item 92142 or 92145 applies.

(6)  If a child has previously been provided with a service mentioned in item 135 or 289 of the general medical services table or item 92140, or 92434 the medical practitioner cannot refer the child for a service to which item 137 or 139 of the general medical services table or item 92141, 92142 or 92145 applies.

3.1.4  Pervasive developmental disorder and disability services course of assessment—reporting requirements

(1)  This section applies to items 93032, 93033, 93040 and 93041.

(2)  At the completion of a course of assessment, the allied health professional must provide a written report to the referring medical practitioner.

3.1.5  Referrals by specialists, consultant physicians and general practitioners for psychological therapy and focussed psychological strategies therapy health services

(1)  For items 91166 to 91176 and 91181 to 91188:

(a)  the referral by a consultant physician specialising in the practice of his or her field of psychiatry must be a referral for a service to which any of items 91827, 91828, 91829, 91830, 91831, 91837, 91838, 91839, 92436, 92437, 92458, 92459 or 92460, or items 293 to 352 of the general medical services table applies;

(b)  the referral by a consultant physician specialising in the practice of his or her field of paediatrics must be a referral for a service to which any of items 110 to 133 of the general medical services table or to which any of items 91824, 91825, 91826, 91836, 92422 or 92423 applies;

(c)  the referral by a specialist in the practice of his or her field of psychiatry or paediatrics must be a referral for a service to which any of items 104 to 109 of the general medical services table or items 91822, 91823, or 91833 applies.

3.1.6 Eligible patient for eating disorders items

(1)  For an item in Subgroups 19, 20, 21 or 22 of Group M18, a patient is an eligible patient if the patient meets the requirements for a patient specified in clause 2.31.2 of the general medical services table.

3.1.7  Limitations on allied health eating disorders items

(1)  For an item in Subgroups 20 and 22 of Group M18, the service must involve the provision of any of the following mental health care management strategies:

(a)  family based treatment (including whole family, parent based therapy, parent only or separated therapy);

(b)  adolescent focused therapy;

(c)  cognitive behavioural therapy;

(d)  cognitive behavioural therapy‑anorexia nervosa;

(e)  cognitive behavioural therapy for bulimia nervosa and binge‑eating disorder;

(f)  specialist supportive clinical management;

(g)  maudsley model of anorexia treatment in adults;

(h)  interpersonal therapy for bulimia nervosa and binge‑eating disorder;

(i)   dialectical behavioural therapy for bulimia nervosa and binge‑eating disorder;

(j)   focal psychodynamic therapy.

(2)  An item in Subgroup 20 or 22 of Group M18 does not apply to a service providing a treatment to a patient under an eating disorder treatment and management plan if:

(a)  the service is provided more than 12 months after the plan is prepared; or

(b)  the patient has already been provided with 40 services under the plan; or

(c)  the service is provided after the patient has already been provided with 10 services under the plan but before a recommendation by a reviewing practitioner is given that additional services should be provided under the plan; or

(d)  the service is provided after the patient has already been provided with 20 services under the plan but before recommendations that additional services should be provided under the plan are given by each of the following:

(i)    a medical practitioner (other than a specialist or consultant physician);

(ii)   a consultant physician practising in the specialty of psychiatry or paediatrics; or

(e)  the service is provided after the patient has already been provided with 30 services under the plan but before a recommendation is given by a reviewing practitioner that additional services should be provided.

(3)  A reviewing practitioner may recommend that additional services be provided under a plan only if:

(a)  the recommendation is made as part of a service to which an item in Subgroup 3 of Group A36 of the general medical services table or Subgroups 25 or 26 of Group A40 apply; and

(b)  the service is provided:

(i)    for the purposes of paragraph (2)(c)—after the patient has been provided with 10 services under the plan; and

(ii)   for the purposes of paragraph (2)(d)—after the patient has been provided with 20 services under the plan; and

(iii)  for the purposes of paragraph (2)(e)—after the patient has been provided with 30 services under the plan; and

(c)  the practitioner records the recommendation in the patient’s records.

(4)  For any particular patient, items in Subgroups 19 and 21 of Group M18 do not apply to a service if the patient has had 20 eating disorder dietetic treatment services in a 12 month period commencing from the provision of an eating disorder treatment and management plan.

(5)  For the purposes of this clause, in counting the services providing treatments under a plan, only count the services to which any of the following apply:

(a)  items 283, 285, 286 and 287;

(b)  items 2721, 2723, 2725 and 2727;

(c)  items in Groups M6, M7 and M16 other than items 82350 and 82351;

(d)  items 90271, 90272, 90273, 90274, 90275, 90276, 90277, 90278, 90279, 90280, 90281 and 90282;

(e)  items 91166, 91167, 91169, 91170, 91172, 91173, 91175, 91176, 91181 to 91188, 91818, 91819, 91820, 91821, 91842, 91843, 91844, 91845, 92182, 92184, 92186, 92188, 92194, 92196, 92198, 92200, 93076, 93079, 93084. 93087, 93092, 93095, 93100, 93103, 93110, 93113, 93118, 93121, 93126, 93129, 93134 and 93137.

(6)  For any particular patient, items in Subgroups 19 to 22 of Group M18 do not apply unless the patient has been referred by:

(a)  a general practitioner or medical practitioner who issued the referral as part of a service to which an item in Subgroup 1 of Group 36 of the general medical services table or item 92146, 92147, 92148, 92149, 92150, 92151, 92152. 92153, 92154, 92155, 92156, 92157, 92158, 92159, 92160 or 92161 applies; or

(b)  a consultant physician in the specialty of psychiatry or paediatrics who issued the referral as part of a service to which an item in Subgroup 2 of Group 36 of the general medical services table or item 92162 or 92163 applies; or

(c)  a medical practitioner who issued the referral as part of a service to which an item in Subgroup 3 of Group 36 of the general medical services table or item 92170 to 92173, 92176 or 92177 applies.

3.1.8  Reporting requirements for allied health eating disorder items

(1)  For an item in Subgroups 19 to 22 of Group M18, the relevant allied health professional must provide the referring medical practitioner with a written report on assessments carried out, treatment provided and recommendations for future management of the patient’s condition at required intervals.

(2)  A report under subsection (1) is to be provided:

                            (a)  after the first service;

                            (b)  as clinically required following subsequent services; and

                            (c)  after the final service.

 

 

Group M18 – Allied health telehealth and phone services

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 1 – Psychological therapies telehealth services

91166

 

Psychological therapy health service provided by telehealth attendance by an eligible clinical psychologist if:

(a) the person is referred by:

(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

(iii)   a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

(b) the service is provided to the person individually; and

(c) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

(d) on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

(e)   the service is at least 30 minutes but less than 50 minutes duration

103.80

91167

Psychological therapy health service provided by telehealth attendance by an eligible clinical psychologist if:

(a) the person is referred by:

(i)  a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

(ii)   a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

(iii)  a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

(b) the service is provided to the person individually; and

(c) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

(d) on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

(e) the service is at least 50 minutes duration

152.40

Subgroup 2 – Psychologist focussed psychological strategies telehealth services

91169

Focussed psychological strategies health service provided by telehealth attendance by an eligible psychologist if:

(a)  the person is referred by:

(i)  a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

(b)  the service is provided to the person individually; and

(c)  at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

(d)  on the completion of the course of treatment, the eligible psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

(e)  the service is at least 20 minutes but less than 50 minutes duration

73.55

91170

Focussed psychological strategies health service provided by telehealth attendance by an eligible psychologist if:

(a)  the person is referred by:

(i)  a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

(b)  the service is provided to the person individually; and

(c)  at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

(d) on the completion of the course of treatment, the eligible psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

(e)  the service is at least 50 minutes duration

103.80

Subgroup 3 – Occupational therapist focussed psychological strategies telehealth services

91172

Focussed psychological strategies health service provided by telehealth attendance by an eligible occupational therapist if:

(a) the person is referred by:

(i)  a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

(b)  the service is provided to the person individually; and

(c)  at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

(d) on the completion of the course of treatment, the eligible occupational therapist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

(e)  the service is at least 20 minutes but less than 50 minutes duration

64.80

91173

Focussed psychological strategies health service provided by telehealth attendance by an eligible occupational therapist if:

(a) the person is referred by:

(i)  a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

(b)  the service is provided to the person individually; and

(c)  at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

(d)  on the completion of the course of treatment, the eligible occupational therapist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

(e)  the service is at least 50 minutes in duration

91.50

Subgroup 4 – Social worker focussed psychological strategies telehealth services

91175

Focussed psychological strategies health service provided by telehealth attendance by an eligible social worker if:

(a)  the person is referred by:

(i)  a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

(ii)   a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

(iii)   a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

(b)  the service is provided to the person individually; and

(c)  at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

(d) on the completion of the course of treatment, the eligible social worker gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

(e)  the service is at least 20 minutes but less than 50 minutes duration

64.80

91176

Focussed psychological strategies health service provided by telehealth attendance by an eligible social worker if:

(a)  the person is referred by:

(i)  a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

(ii)   a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

(iii)   a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

(b)  the service is provided to the person individually; and

(c)  at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

(d) on the completion of the course of treatment, the eligible social worker gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

(e)  the service is at least 50 minutes duration

91.50

Subgroup 6 – Psychological therapies phone services

91181

Psychological therapy health service provided by phone attendance by an eligible clinical psychologist if:

(a)   the person is referred by:

(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

(iii)   a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

(b)   the service is provided to the person individually; and

(c)   at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

(d)   on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

(e) the service is at least 30 minutes but less than 50 minutes duration

103.80

91182

Psychological therapy health service provided by phone attendance by an eligible clinical psychologist if:

(a)   the person is referred by:

(i)  a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

(ii)   a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

(iii)  a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

(b)   the service is provided to the person individually; and

(c)   at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

(d)   on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

(e)     the service is at least 50 minutes duration

152.40

Subgroup 7 – Psychologist focussed psychological strategies phone service

91183

Focussed psychological strategies health service provided by phone attendance by an eligible psychologist if:

(a)   the person is referred by:

(i)  a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

(b)   the service is provided to the person individually; and

(c)   at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

(d)   on the completion of the course of treatment, the eligible psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

(e)     the service is at least 20 minutes but less than 50 minutes duration

73.55

91184

Focussed psychological strategies health service provided by phone attendance by an eligible psychologist if:

(a)   the person is referred by:

(i)  a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

(b)   the service is provided to the person individually; and

(c)   at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

(d)   on the completion of the course of treatment, the eligible psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

(e)     the service is at least 50 minutes duration

103.80

Subgroup 8 – Occupational therapist focussed psychological strategies phone services

91185

Focussed psychological strategies health service provided by phone attendance by an eligible occupational therapist if:

(a)   the person is referred by:

(i)  a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

(b)   the service is provided to the person individually; and

(c)   at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

(d)   on the completion of the course of treatment, the eligible occupational therapist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

(e)     the service is at least 20 minutes but less than 50 minutes duration

64.80

91186

Focussed psychological strategies health service provided by phone attendance by an eligible occupational therapist if:

(a)   the person is referred by:

(i)  a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

(b)   the service is provided to the person individually; and

(c)   at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

(d)   on the completion of the course of treatment, the eligible occupational therapist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

(e)     the service is at least 50 minutes in duration

91.50

Subgroup 9 – Social worker focussed psychological strategies phone services

91187

Focussed psychological strategies health service provided by phone attendance by an eligible social worker if:

(a)   the person is referred by:

(i)  a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

(ii)   a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

(iii)   a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

(b)   the service is provided to the person individually; and

(c)   at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

(d)   on the completion of the course of treatment, the eligible social worker gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

(e)     the service is at least 20 minutes but less than 50 minutes duration

64.80

91188

Focussed psychological strategies health service provided by phone attendance by an eligible social worker if:

(a)   the person is referred by:

(i)  a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

(ii)  a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

(b)   the service is provided to the person individually; and

(c)   at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

(d)   on the completion of the course of treatment, the eligible social worker gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

(e)     the service is at least 50 minutes duration

91.50

Subgroup 11 – General allied health telehealth services

93000

Telehealth attendance by an eligible allied health practitioner if:

    (a)   the service is provided to a person who has:

(i)        a chronic condition; and

(ii)       complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and

  (b)     the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and

  (c)     the person is referred to the eligible allied health practitioner by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and

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

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

(f)     after the service, the eligible allied health practitioner gives a written report to the referring medical practitioner mentioned in paragraph (c):

(i)         if the service is the only service under the referral—in relation to that service; or

           (ii)      if the service is the first or last service under the referral—in relation to that service; or

          (iii)     if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of —in relation to those matters;

to a maximum of 5 services (including any services to which this item, item 93013 or any item in Part 1 of the Schedule to the Allied Health Determination applies) in a calendar year

64.80

Subgroup 12 – General allied health phone services

93013

Phone attendance by an eligible allied health practitioner if:

    (a)   the service is provided to a person who has:

(i)        a chronic condition; and

(ii)       complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and

  (b)     the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and

  (c)     the person is referred to the eligible allied health practitioner by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and

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

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

(f)     after the service, the eligible allied health practitioner gives a written report to the referring medical practitioner mentioned in paragraph (c):

(i)         if the service is the only service under the referral—in relation to that service; or

           (ii)      if the service is the first or last service under the referral—in relation to that service; or

          (iii)     if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of —in relation to those matters;

to a maximum of 5 services (including any services to which this item, item 93000 or any item in Part 1 of the Schedule to the Allied Health Determination applies) in a calendar year

64.80

Subgroup 13 – Pregnancy support counselling telehealth services

93026

Non directive pregnancy support counselling health service provided to a person who is currently pregnant or who has been pregnant in the preceding 12 months by an eligible psychologist, eligible social worker or eligible mental health nurse as a telehealth attendance if:

(a) the person is concerned about a current pregnancy or a pregnancy that occurred in the 12 months preceding the provision of the first service; and

(b) the person is referred by a medical practitioner who is not a specialist or consultant physician; and

(c) the service is provided to the person individually; and

(d) the eligible psychologist, eligible social worker or eligible mental health nurse does not have a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination; and

(e) the service is at least 30 minutes duration;

to a maximum of 3 services (including services to which items 81000, 81005, 81010 in the Allied Health Determination, item 4001 of the general medical services table and item 93029, 92136 and 92138 apply) for each pregnancy.

The service may be used to address any pregnancy related issues for which non directive counselling is appropriate

76.10

Subgroup 14 – Pregnancy support counselling phone services

93029

Non directive pregnancy support counselling health service provided to a person, who is currently pregnant or who has been pregnant in the preceding 12 months by an eligible psychologist, eligible social worker or eligible mental health nurse as a phone attendance if:

(a)    the person is concerned about a current pregnancy or a pregnancy that occurred in the 12 months preceding the provision of the first service; and

(b)    the person is referred by a medical practitioner who is not a specialist or consultant physician; and

(c)     the service is provided to the person individually; and

(d)    the eligible psychologist, eligible social worker or eligible mental health nurse does not have a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination; and

(e)     the service is at least 30 minutes duration;

to a maximum of 3 services (including services to which items 81000, 81005, 81010 in the Allied Health Determination, item 4001 of the general medical services table and item 93026, 92136 and 92138 apply) for each pregnancy.

The service may be used to address any pregnancy related issues for which non directive counselling is appropriate

76.10

Subgroup 15 – Autism, pervasive developmental disorder and disability telehealth services

93032

Psychology health service provided by telehealth attendance to a child aged under 13 years by an eligible psychologist if:

(a)     the child was referred to the eligible psychologist by an eligible practitioner:

            (i)   to assist with the diagnosis of the child by the practitioner; or

           (ii)   to contribute to the child’s PDD or disability treatment and management plan, developed by the practitioner; and

    (b)   the eligible practitioner is:

(i)       for a child with PDD, a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics; or

(ii)      for a child with disability, a specialist or consultant physician practising in his or her specialty, or a general practitioner; and

    (c)   the eligible psychologist attending the child is registered with the Department of Human Services as meeting the credentialing requirements for the provision of that service; and

    (d)   the service is provided to the child individually; and

    (e)   the service is at least 50 minutes duration;

to a maximum of 4 services (including services to which this item, items 93033, 93040 and 93041 or items 82000, 82005, 82010 and 82030 in the Allied Health Determination apply).

Up to 4 services may be provided to the same child on the same day

103.80

93033

Speech pathology, occupational therapy, audiology, optometry, orthoptic or physiotherapy health service provided by telehealth attendance to a child aged under 13 years by an eligible speech pathologist, occupational therapist, audiologist, optometrist, orthoptist or physiotherapist if:

(a)     the child was referred to the eligible speech pathologist, occupational therapist, audiologist, optometrist, orthoptist or physiotherapist by an eligible practitioner:

            (i)   to assist with the diagnosis of the child by the practitioner; or

           (ii)   to contribute to the child’s PDD or disability treatment and management plan, developed by the practitioner; and

    (b)   the eligible practitioner is:

(i)       for a child with PDD, a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics; or

(ii)      for a child with disability, a specialist or consultant physician practising in his or her specialty, or a general practitioner; and

    (c)   the eligible speech pathologist, occupational therapist, audiologist, optometrist, orthoptist or physiotherapist attending the child is registered with the Department of Human Services as meeting the credentialing requirements for the provision of that service; and

    (d)   the service is provided to the child individually; and

    (e)   the service is at least 50 minutes duration;

to a maximum of 4 services (including services to which this item, items 93032, 93040 or 93041, or items 82000, 82005, 82010 and 82030 in the Allied Health Determination apply).

Up to 4 services may be provided to the same child on the same day

91.50

93035

Psychology health service provided by telehealth attendance to a child aged under 15 years for treatment of a pervasive developmental disorder (PDD) or eligible disability by an eligible psychologist, if:

    (a)   the child has been diagnosed with a PDD or an eligible disability; and

    (b)   the child, while aged under 13 years, received a PDD or disability treatment and management plan as prepared by the eligible practitioner; and

    (c)   the child was referred by an eligible practitioner for services consistent with the child’s PDD or disability treatment and management plan; and

    (d)   the eligible practitioner is:

(i)       for a child with PDD, a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics;

(ii)      for a child with disability, a specialist or consultant physician practising in his or her field of specialty, or a general practitioner; and

    (e)   the eligible psychologist attending the child is registered with the Department of Human Services as meeting the credentialing requirements for the provision of those services; and

   (f)    on the completion of the course of treatment, the eligible psychologist gives a written report to the referring eligible practitioner on assessments carried out, treatment provided and recommendations on future management of the child’s condition; and

    (g)   the eligible practitioner is:

(i)        for a child with PDD, a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics;

(ii)       for a child with disability, a specialist or consultant physician practising in his or her specialty, or a general practitioner; and

    (h)   the service is provided to the child individually; and

     (i)   the service is at least 30 minutes duration;

to a maximum of 20 services (including services to which this item, items 93036, 93043 and 93044, or items 82015, 82020, 82025 and 82035 in the Allied Health Determination apply).

Up to 4 services may be provided to the same child on the same day

103.80

93036

Speech pathology, occupational therapy, audiology, optometry, orthoptic or physiotherapy health service provided by telehealth attendance to a child aged under 15 years for treatment of a pervasive developmental disorder (PDD) or eligible disability by an eligible speech pathologist, occupational therapist, audiologist, optometrist, orthoptist or physiotherapist if:

    (a)   the child has been diagnosed with a PDD or an eligible disability; and

    (b)   the child, while aged under 13 years, received a PDD or disability treatment and management plan as prepared by the eligible practitioner; and

    (c)   the child was referred by an eligible practitioner for services consistent with the child’s PDD or disability treatment and management plan; and

    (d)   the eligible practitioner is:

(i)       for a child with PDD, a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics;

(ii)      for a child with disability, a specialist or consultant physician practising in his or her specialty, or a general practitioner; and

    (e)   the eligible speech pathologist, occupational therapist, audiologist, optometrist, orthoptist or physiotherapist attending the child is registered with the Department of Human Services as meeting the credentialing requirements for the provision of those services; and

     (f)   on the completion of the course of treatment, the eligible speech pathologist gives a written report to the referring eligible practitioner on assessments carried out, treatment provided and recommendations on future management of the child’s condition; and

    (g)   the service is provided to the child individually; and

     (i)   the service is at least 30 minutes duration;

to a maximum of 20 services (including services to which this item, item 93035, 93043 and 93044, or items 82015, 82020 82025 and 82035 in the Allied Health Determination apply)

91.50

Subgroup 16 – Autism, pervasive developmental disorder and disability phone services

93040

Psychology health service provided by phone attendance to a child aged under 13 years by an eligible psychologist if:

(a)     the child was referred to the eligible psychologist by an eligible practitioner:

            (i)   to assist with the diagnosis of the child by the practitioner; or

           (ii)   to contribute to the child’s PDD or disability treatment and management plan, developed by the practitioner; and

    (b)   the eligible practitioner is:

(i)       for a child with PDD, a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics; or

(ii)      for a child with disability, a specialist or consultant physician practising in his or her specialty, or a general practitioner; and

    (c)   the eligible psychologist attending the child is registered with the Department of Human Services as meeting the credentialing requirements for the provision of that service; and

    (d)   the service is provided to the child individually; and

    (e)   the service is at least 50 minutes duration;

to a maximum of 4 services (including services to which this item, items 93032, 93033 and 93041, or items 82005, 82010 and 82030 in the Allied Health Determination apply).

Up to 4 services may be provided to the same child on the same day

103.80

93041

Speech pathology, occupational therapy, audiology, optometry, orthoptic or physiotherapy health service provided by phone attendance to a child aged under 13 years by an eligible speech pathologist, occupational therapist, audiologist, optometrist, orthoptist or physiotherapist if:

(a)     the child was referred to the eligible speech pathologist, occupational therapist, audiologist, optometrist, orthoptist or physiotherapist by an eligible practitioner:

            (i)   to assist with the diagnosis of the child by the practitioner; or

           (ii)   to contribute to the child’s PDD or disability treatment and management plan, developed by the practitioner; and

    (b)   the eligible practitioner is:

(i)       for a child with PDD, a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics; or

(ii)      for a child with disability, a specialist or consultant physician practising in his or her specialty, or a general practitioner; and

    (c)   the eligible speech pathologist, occupational therapist, audiologist, optometrist, orthoptist or physiotherapist attending the child is registered with the Department of Human Services as meeting the credentialing requirements for the provision of that service; and

    (d)   the service is provided to the child individually; and

    (e)   the service is at least 50 minutes duration;

to a maximum of 4 services (including services to which this item, items 93032, 93033 and 93040 or items 82005, 82010 and 82030 in the Allied Health Determination apply).

Up to 4 services may be provided to the same child on the same day

91.50

93043

Psychology health service provided by phone attendance to a child aged under 15 years for treatment of a pervasive developmental disorder (PDD) or eligible disability by an eligible psychologist, if:

    (a)   the child has been diagnosed with a PDD or an eligible disability; and

    (b)   the child, while aged under 13 years, received a PDD or disability treatment and management plan as prepared by the eligible practitioner; and

    (c)   the child was referred by an eligible practitioner for services consistent with the child’s PDD or disability treatment and management plan; and

    (d)   the eligible practitioner is:

(i)       for a child with PDD, a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics;

(ii)      for a child with disability, a specialist or consultant physician practising in his or her field of specialty, or a general practitioner; and

    (e)   the eligible psychologist attending the child is registered with the Department of Human Services as meeting the credentialing requirements for the provision of those services; and

   (f)    on the completion of the course of treatment, the eligible psychologist gives a written report to the referring eligible practitioner on assessments carried out, treatment provided and recommendations on future management of the child’s condition; and

    (g)   the eligible practitioner is:

(i)        for a child with PDD, a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics;

(ii)       for a child with disability, a specialist or consultant physician practising in his or her specialty, or a general practitioner; and

    (h)   the service is provided to the child individually; and

     (i)   the service is at least 30 minutes duration;

to a maximum of 20 services (including services to which this item, items 93032, 93035, 93036 and 93044 or items 82020, 82025 and 82035 in the Allied Health Determination apply)

103.80

93044

Speech pathology, occupational therapy, audiology, optometry, orthoptic or physiotherapy health service provided by phone attendance to a child aged under 15 years for treatment of a pervasive developmental disorder (PDD) or eligible disability by an eligible speech pathologist, occupational therapist, audiologist, optometrist, orthoptist or physiotherapist if:

    (a)   the child has been diagnosed with a PDD or an eligible disability; and

    (b)   the child, while aged under 13 years, received a PDD or disability treatment and management plan as prepared by the eligible practitioner; and

    (c)   the child was referred by an eligible practitioner for services consistent with the child’s PDD or disability treatment and management plan; and

    (d)   the eligible practitioner is:

(i)       for a child with PDD, a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics;

(ii)      for a child with disability, a specialist or consultant physician practising in his or her specialty, or a general practitioner; and

    (e)   the eligible speech pathologist, occupational therapist, audiologist, optometrist, orthoptist or physiotherapist attending the child is registered with the Department of Human Services as meeting the credentialing requirements for the provision of those services; and

     (f)   on the completion of the course of treatment, the eligible speech pathologist gives a written report to the referring eligible practitioner on assessments carried out, treatment provided and recommendations on future management of the child’s condition; and

    (g)   the service is provided to the child individually; and

     (i)   the service is at least 30 minutes duration;

to a maximum of 20 services (including services to which this item, items 93035, 93036 and 93043 or items 82015, 82025 and 82035 in the Allied Health Determination apply).

91.50

Subgroup 17 – Telehealth attendance to person of Aboriginal and Torres Strait Islander descent

93048

Telehealth attendance provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible allied health practitioner if:

    (a)   a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and

    (b)   the person is referred to the eligible allied health practitioner by a medical practitioner using a referral form issued by the Department or a referral form that contains all the components of the form issued by the Department; and

    (c)   the service is provided to the person individually; and

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

    (e)   after the service, the eligible allied health practitioner gives a written report to the referring medical practitioner mentioned in paragraph (b):

(i)        if the service is the only service under the referral—in relation to that service; or

(ii)       if the service is the first or the last service under the referral—in relation to that service; or

(iii)      if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters;

to a maximum of 5 services (including any services to which this item or 93061 or any item in Part 6 of Schedule 2 to the Allied Health Determination applies) in a calendar year

64.80

Subgroup 18 – Phone attendance to person of Aboriginal and Torres Strait Islander descent

93061

Phone attendance provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible allied health practitioner if:

    (a)   a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health services; and

    (b)   the person is referred to the eligible allied health practitioner by a medical practitioner using a referral form issued by the Department or a referral form that contains all the components of the form issued by the Department; and

    (c)   the service is provided to the person individually; and

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

    (e)   after the service, the eligible allied health practitioner gives a written report to the referring medical practitioner mentioned in paragraph (b):

(i)        if the service is the only service under the referral—in relation to that service; or

(ii)       if the service is the first or the last service under the referral—in relation to that service; or

(iii)      if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters;

to a maximum of 5 services (including any services to which this item or item 93060 or any item in Part 6 of Schedule 2 to the Allied Health Determination applies) in a calendar year

64.80

Subgroup 19 – Eating disorder dietetics telehealth services

93074

Dietetics health service provided by telehealth attendance to an eligible patient by an eligible dietitian:

(a) the service is recommended in the patient’s eating disorder treatment and management plan; and

(b) the service is provided to the patient individually; and

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

64.80

Subgroup 20 – Eating disorder psychological treatment telehealth services

93076

Eating disorder psychological treatment service provided by telehealth attendance to an eligible patient by an eligible clinical psychologist if:

(a) the service is recommended in the patient’s eating disorder treatment and management plan; and

(b) the service is provided to the patient individually; and

(c) the service is at least 30 minutes but less than 50 minutes in duration

103.80

93079

Eating disorder psychological treatment service provided by telehealth attendance to an eligible patient by an eligible clinical psychologist if:

(a) the service is recommended in the patient’s eating disorder treatment and management plan; and

(b) the service is provided to the patient individually; and

(c) the service is at least 50 minutes in duration

152.40

93084

Eating disorder psychological treatment service provided by telehealth attendance to an eligible patient by an eligible psychologist if:

(a) the service is recommended in the patient’s eating disorder treatment and management plan; and

(b) the service is provided to the patient individually; and

(c) the service is at least 20 minutes but less than 50 minutes in duration

73.55

93087

Eating disorder psychological treatment service provided by telehealth attendance to an eligible patient by an eligible psychologist if:

(a) the service is recommended in the patient’s eating disorder treatment and management plan; and

(b) the service is provided to the patient individually; and

(c) the service is at least 50 minutes in duration

103.80

93092

Eating disorder psychological treatment service provided by telehealth attendance to an eligible patient by an eligible occupational therapist if:

(a) the service is recommended in the patient’s eating disorder treatment and management plan; and

(b) the service is provided to the patient individually person; and

(c) the service is at least 20 minutes but less than 50 minutes in duration

64.80

93095

Eating disorder psychological treatment service provided by telehealth attendance to an eligible patient by an eligible occupational therapist if:

(a) the service is recommended in the patient’s eating disorder treatment and management plan; and

(b) the service is provided to the patient individually; and

(c) the service is at least 50 minutes in duration

91.50

93100

Eating disorder psychological treatment service provided by telehealth attendance to an eligible patient by an eligible social worker if:

(a) the service is recommended in the patient’s eating disorder treatment and management plan; and

(b) the service is provided to the patient individually; and

(c) the service is at least 20 minutes but less than 50 minutes in duration

64.80

93103

Eating disorder psychological treatment service provided by telehealth attendance to an eligible patient by an eligible social worker if:

(a) the service is recommended in the patient’s eating disorder treatment and management plan; and

(b) the service is provided to the patient individually; and

(c) the service is at least 50 minutes in duration

91.50

Subgroup 21 – Eating disorder dietetics phone services

93108

Dietetics health service provided by phone attendance to an eligible patient by an eligible dietitian:

(a) the service is recommended in the patient’s eating disorder treatment and management plan; and

(b) the service is provided to the patient individually; and

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

64.80

Subgroup 22 – Eating disorder psychological treatment phone services

93110

Eating disorder psychological treatment service provided by phone attendance to an eligible patient by an eligible clinical psychologist if:

(a) the service is recommended in the patient’s eating disorder treatment and management plan; and

(b) the service is provided to the patient individually; and

(c) the service is at least 30 minutes but less than 50 minutes in duration

103.80

93113

Eating disorder psychological treatment service provided by phone attendance to an eligible patient by an eligible clinical psychologist if:

(a) the service is recommended in the patient’s eating disorder treatment and management plan; and

(b) the service is provided to the patient individually; and

(c) the service is at least 50 minutes in duration

152.40

93118

Eating disorder psychological treatment service provided by phone attendance to an eligible patient by an eligible psychologist if:

(a) the service is recommended in the patient’s eating disorder treatment and management plan; and

(b) the service is provided to the patient individually; and

(c) the service is at least 20 minutes but less than 50 minutes in duration

73.55

93121

Eating disorder psychological treatment service provided by phone attendance to an eligible patient by an eligible psychologist if:

(a) the service is recommended in the patient’s eating disorder treatment and management plan; and

(b) the service is provided to the patient individually; and

(c) the service is at least 50 minutes in duration

103.80

93126

Eating disorder psychological treatment service provided by phone attendance to an eligible patient by an eligible occupational therapist if:

(a) the service is recommended in the patient’s eating disorder treatment and management plan; and

(b) the service is provided to the patient individually person; and

(c) the service is at least 20 minutes but less than 50 minutes in duration

64.80

93129

Eating disorder psychological treatment service provided by phone attendance to an eligible patient by an eligible occupational therapist if:

(a) the service is recommended in the patient’s eating disorder treatment and management plan; and

(b) the service is provided to the patient individually; and

(c) the service is at least 50 minutes in duration

91.50

93134

Eating disorder psychological treatment service provided by phone attendance to an eligible patient by an eligible social worker if:

(a) the service is recommended in the patient’s eating disorder treatment and management plan; and

(b) the service is provided to the patient individually; and

(c) the service is at least 20 minutes but less than 50 minutes in duration

64.80

93137

Eating disorder psychological treatment service provided by phone attendance to an eligible patient by an eligible social worker if:

(a) the service is recommended in the patient’s eating disorder treatment and management plan; and

(b) the service is provided to the patient individually; and

(c) the service is at least 50 minutes in duration           

91.50

Subgroup 25 – Allied health, group dietetics telehealth services

93284

Telehealth attendance by an eligible dietitian to provide a dietetics health service to a person for assessing the person’s suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient’s needs and preparing the person for the group services if:

(a)     the person has type 2 diabetes; and

(b)     the person is being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a GP management plan or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and

(c)     the person is referred to an eligible dietitian by the medical practitioner using a referral form that has been issued by the Department, or a referral form that contains all the components of the form issued by the Department; and

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

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

(f)     after the service, the eligible dietitian gives a written report to the referring medical practitioner mentioned in paragraph (c);

payable once in a calendar year for this or any other assessment for group services item (including services to which this item, item 92386, or items 81100, 81110 and 81120 of the Allied Health  Determination apply)

83.10

93285

Telehealth attendance by an eligible dietitian to provide a dietetics health service, as a group service for the management of type 2 diabetes if:

(a)     the person has been assessed as suitable for a type 2 diabetes group service under assessment items 81100, 81110 or 81120 of the Allied Health Determination or items 93284 or 93286; and

(b)     the service is provided to a person who is part of a group of between 2 and 12 patients; and

(c)     the service is of at least 60 minutes duration; and

(d)     after the last service in the group services program provided to the person under this item or items 81105, 81115 or 81125 of the Allied Health Determination, the eligible dietitian prepares, or contributes to, a written report to be provided to the referring medical practitioner; and

(e)     an attendance record for the group is maintained by the eligible dietitian;

to a maximum of 8 group services in a calendar year (including services to which this item or items 81105, 81115 and 81125 of the Allied Health Determination apply)

20.70

Subgroup 26 – Allied health, group dietetics phone services

93286

Phone attendance by an eligible dietitian to provide a dietetics health service to a person for assessing the person’s suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient’s needs and preparing the person for the group services if:

(a)     the person has type 2 diabetes; and

(b)     the person is being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a GP management plan or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and

(c)     the person is referred to an eligible dietitian by the medical practitioner using a referral form that has been issued by the Department, or a referral form that contains all the components of the form issued by the Department; and

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

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

(f)     after the service, the eligible dietitian gives a written report to the referring medical practitioner mentioned in paragraph (c);

payable once in a calendar year for this or any other assessment for group services item (including services to which this item, item 92384, or in items 81100, 81110 and 81120 of the Allied Health Determination apply)

83.10


Schedule 4 – Nurse practitioner, midwife Aboriginal and Torres Strait Islander health practitioner and dental practitioner services

 

Division 4.1 ‑ Services and fees – Nurse practitioner telehealth and phone services

4.1.1  Application of items in Subgroups 11, 12, 25 and 26 of Group M18

(1)  In items 93201, 93203, 93284, and 93286:

                            GP management plan means a plan under:

                             (a)  item 721 or 732 of the general medical services table (for coordination of a review of a GP management plan under item 721); or

                             (b)  item 229 or 233 of the Other Medical Practitioner Determination (for coordination of a review of a GP management plan under item 229); or

                             (c)  item 92024, 92028, 92055, 92059, 92068, 92072, 92099 or 92103 (for coordination of a review of a GP management plan under item 92024,  92055, 92068 or 92099);

                            multidisciplinary care plan means a plan under:

                             (a)  item 729 or 731 of the general medical services table; or

                             (b)  item 231 or 232 of the Other Medical Practitioner Determination; or

                             (c)  item 92026, 92027, 92057, 92058, 92070, 92071, 92101 or 92102;

                            person with a chronic disease means a person who has a care plan under:

                             (a)  item 721, 723, 729, 731 or 732 of the general medical services table; or

                             (b)  item 229, 230, 231, 232 or 233 of the Other Medical Practitioner Determination; or

                             (c)  item 92024 to 92028, 92055 to 92059, 92068 to 92072 or 92099 to 92103.

(2)  A person cannot receive a service under item 93200 or 93202 if, in the same calendar year, the person has received 10 services to which any of the following items apply:

                     (a)  item 10987 of the general medical services table; or

                     (b)  item 93200 or 93202.

(3)  A person cannot receive a service under item 93201 or 93203 if, in the same calendar year, the person has received 5 services to which any of the following items apply:

                     (a)  item 10997 of the general medical services table; or

                     (b)  item 93201 or 93203.

 

Group M18— Allied health telehealth services  

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 5 – Nurse practitioner telehealth services

91192

Telehealth attendance by a participating nurse practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited management

10.00

91178

Telehealth attendance by a participating nurse practitioner lasting less than 20 minutes if  the attendance includes any of the following that are clinically relevant:

(a)   taking a short history;

(b)   arranging any necessary investigation;

(c)   implementing a management plan;

(d)   providing appropriate preventive health care

21.80

91179

Telehealth attendance by a participating nurse practitioner lasting at least 20 minutes if the attendance includes any of the following that are clinically relevant:

(a)   taking a detailed history;

(b)   arranging any necessary investigation;

(c)   implementing a management plan;

(d)   providing appropriate preventive health care

41.35

91180

Telehealth attendance by a participating nurse practitioner lasting at least 40 minutes if  the attendance includes any of the following that are clinically relevant:

(a)   taking an extensive history;

(b)   arranging any necessary investigation;

(c)   implementing a management plan;

(d)   providing appropriate preventive health care

60.95

Subgroup 10 – Nurse practitioner phone services

91193

Phone attendance by a participating nurse practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited management

10.00

91189

Phone attendance by a participating nurse practitioner lasting less than 20 minutes if the attendance includes any of the following that are clinically relevant:

(a)   taking a short history;

(b)   arranging any necessary investigation;

(c)   implementing a management plan;

providing appropriate preventive health care

21.80

91190

Phone attendance by a participating nurse practitioner lasting at least 20 minutes if the attendance includes any of the following that are clinically relevant:

(a)   taking a detailed history;

(b)   arranging any necessary investigation;

(c)   implementing a management plan;

(d)   providing appropriate preventive health care

41.35

91191

Phone attendance by a participating nurse practitioner lasting at least 40 minutes if the attendance includes any of the following that are clinically relevant:

(a)   taking an extensive history;

(b)   arranging any necessary investigation;

(c)   implementing a management plan;

(d)   providing appropriate preventive health care

60.95

Subgroup 23—Follow up service provided by a practice nurse or Aboriginal and Torres Strait Islander health practitioner – Telehealth Services

93200

 

Follow‑up telehealth attendance provided by a practice nurse or an Aboriginal and Torres Strait Islander health practitioner, on behalf of a medical practitioner, for an Indigenous person who has received a health check if:

(a) the service is provided on behalf of and under the supervision of a medical practitioner; and

(b) the service is consistent with the needs identified through the health assessment

29.35

93201

 

Telehealth attendance provided by a practice nurse or an Aboriginal and Torres Strait Islander health practitioner to a person with a chronic disease if:

(a) the service is provided on behalf of and under the supervision of a medical practitioner; and

(b) the person has a GP management plan, team care arrangements or multidisciplinary care plan in place and the service is consistent with the plan or arrangements

14.70

Subgroup 24—Follow up service provided by a practice nurse or Aboriginal and Torres Strait Islander health practitioner – Phone Services

93202

 

Follow‑up phone attendance provided by a practice nurse or an Aboriginal and Torres Strait Islander health practitioner, on behalf of a medical practitioner, for an Indigenous person who has received a health check if:

(a) the service is provided on behalf of and under the supervision of a medical practitioner; and

(b) the service is consistent with the needs identified through the health assessment

29.35

93203

 

Phone attendance provided by a practice nurse or an Aboriginal and Torres Strait Islander health practitioner to a person with a chronic disease if:

(a) the service is provided on behalf of and under the supervision of a medical practitioner; and

(b) the person has a GP management plan, team care arrangements or multidisciplinary care plan in place and the service is consistent with the plan or arrangements

14.70


 

Division 4.2 ‑ Services and fees – midwifery telehealth and phone services

 

Group M19 – Midwifery telehealth and phone services

 

Item

Description

Fee ($)

Subgroup 1 – Midwifery telehealth services

91211

Short antenatal telehealth attendance by a participating midwife, lasting up to 40 minutes

33.60

91212

Long antenatal telehealth attendance by a participating midwife, lasting at least 40 minutes

55.55

91214

Short postnatal telehealth attendance by a participating midwife, lasting up to 40 minutes

55.55

91215

Long postnatal telehealth attendance by a participating midwife, lasting at least 40 minutes

81.70

Subgroup 2 – Midwifery phone services

91218

Short antenatal phone attendance by a participating midwife, lasting up to 40 minutes

33.60

91219

Long antenatal phone attendance by a participating midwife, lasting at least 40 minutes

55.55

91221

Short postnatal phone attendance by a participating midwife, lasting up to 40 minutes

55.55

91222

Long postnatal phone attendance by a participating midwife, lasting at least 40 minutes

81.70


 

Division 4.3 ‑ Services and fees – dental practitioner services

4.3.1 – Application of dental practitioner services

          Items 54001 to 54004 apply only to a service provided in the course of dental practice by a dental practitioner approved by the Minister before 1 November 2004 for the definition of professional service in subsection 3(1) of the Act.

Group O1—Consultations

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 1—dental practitioner telehealth services

54001

Telehealth attendance (other than a second or subsequent attendance in a single course of treatment) by an approved dental practitioner in the practice of oral and maxillofacial surgery, if the patient is referred to the approved dental practitioner

89.00

54002

Telehealth attendance by an approved dental practitioner in the practice of oral and maxillofacial surgery, each attendance after the first in a single course of treatment, if the patient is referred to the approved dental practitioner

44.75

Subgroup 2—dental practitioner phone services

54004

Phone attendance by an approved dental practitioner in the practice of oral and maxillofacial surgery, each attendance after the first in a single course of treatment, if the patient is referred to the approved dental practitioner

44.75

 


 

Schedule 5 – Temporary GP and medical practitioner telehealth and phone services

 

Division 5.1 – Services and fees – Medical practitioner attendances via telehealth and phone

5.1.1  Application of items in Subgroups 39 and 40 of Group A40

(1)  For items 92717, 92720, 92723, 92726, 92733, 92736, 92739 and 92742 eligible area has the meaning given by section 4 of the Other Medical Practitioner Determination.

(2)  An item in Subgroup 39 or 40 of Group A40 does not apply to a service described in the item if the service is provided to a patient for the purpose of, or in relation to, assisted reproductive technology or antenatal care.

(3)  An item in Subgroup 39 or 40 of Group A40 only applies to a service performed by a medical practitioner (other than a specialist or consultant physician) who:

                     (a)  is located at a medical practice; or

                     (b)  has a formal agreement with a medical practice to provide personal attendance services.

 

Group A40 – Telehealth and phone attendance services

 

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 39 – GP Blood Borne Viruses, Sexual or Reproductive Health Consultation – Telehealth Service

92715

Telehealth attendance for the provision of services related to blood borne viruses, sexual or reproductive health by a general practitioner of not more than 5 minutes if the attendance includes any of the following that are clinically relevant:

(a)    taking a short patient history;

(b)    arranging any necessary investigation;

(c)    implementing a management plan;

(d)    providing appropriate preventive health care

21.05

92716

Telehealth attendance for the provision of services related to blood borne viruses, sexual or reproductive health by a medical practitioner (not including a general practitioner, specialist or consultant physician) of not more than 5 minutes if the attendance includes any of the following that are clinically relevant:

(a)    taking a short patient history;

(b)    arranging any necessary investigation;

(c)    implementing a management plan;

(d)    providing appropriate preventive health care

12.90

92717

Telehealth attendance for the provision of services related to blood borne viruses, sexual or reproductive health by a medical practitioner (not including a general practitioner, specialist or consultant physician), in an eligible area, of not more than 5 minutes if the attendance includes any of the following that are clinically relevant:

(a)    taking a short patient history;

(b)    arranging any necessary investigation;

(c)    implementing a management plan;

(d)    providing appropriate preventive health care

16.80

92718

Telehealth attendance for the provision of services related to blood borne viruses, sexual or reproductive health by a general practitioner of more than 5 minutes in duration but not more than 20 minutes if the attendance includes any of the following that are clinically relevant:

(a)    taking a patient history;

(b)    arranging any necessary investigation;

(c)    implementing a management plan;

(d)    providing appropriate preventive health care

46.00

92719

Telehealth attendance for the provision of services related to blood borne viruses, sexual or reproductive health by a medical practitioner (not including a general practitioner, specialist or consultant physician) of more than 5 minutes in duration but not more than 20 minutes if the attendance includes any of the following that are clinically relevant:

(a)    taking a patient history;

(b)    arranging any necessary investigation;

(c)    implementing a management plan;

(d)    providing appropriate preventive health care

24.70

92720

Telehealth attendance for the provision of services related to blood borne viruses, sexual or reproductive health by a medical practitioner (not including a general practitioner, specialist or consultant physician), in an eligible area, of more than 5 minutes in duration but not more than 20 minutes if the attendance includes any of the following that are clinically relevant:

(a)    taking a patient history;

(b)    arranging any necessary investigation;

(c)    implementing a management plan;

(d)    providing appropriate preventive health care

36.80

92721

Telehealth attendance for the provision of services related to blood borne viruses, sexual or reproductive health by a general practitioner of more than 20 minutes in duration but not more than 40 minutes if the attendance includes any of the following that are clinically relevant:

(a)    taking a detailed patient history;

(b)    arranging any necessary investigation;

(c)    implementing a management plan;

(d)    providing appropriate preventive health care

89.10

92722

Telehealth attendance for the provision of services related to blood borne viruses, sexual or reproductive health by a medical practitioner (not including a general practitioner, specialist or consultant physician) of more than 20 minutes in duration but not more than 40 minutes if the attendance includes any of the following that are clinically relevant:

(a)    taking a detailed patient history;

(b)    arranging any necessary investigation;

(c)    implementing a management plan;

(d)    providing appropriate preventive health care

44.70

92723

Telehealth attendance for the provision of services related to blood borne viruses, sexual or reproductive health by a medical practitioner (not including a general practitioner, specialist or consultant physician), in an eligible area, of more than 20 minutes in duration but not more than 40 minutes if the attendance includes any of the following that are clinically relevant:

(a)    taking a detailed patient history;

(b)    arranging any necessary investigation;

(c)    implementing a management plan;

(d)    providing appropriate preventive health care

71.25

92724

Telehealth attendance for the provision of services related to blood borne viruses, sexual or reproductive health by a general practitioner lasting at least 40 minutes in duration if the attendance includes any of the following that are clinically relevant:

(a)    taking a detailed patient history;

(b)    arranging any necessary investigation;

(c)    implementing a management plan;

(d)    providing appropriate preventive health care

131.15

92725

Telehealth attendance for the provision of services related to blood borne viruses, sexual or reproductive health by a medical practitioner (not including a general practitioner, specialist or consultant physician) lasting at least 40 minutes in duration if the attendance includes any of the following that are clinically relevant:

(a)    taking an extensive patient history;

(b)    arranging any necessary investigation;

(c)    implementing a management plan;

(d)    providing appropriate preventive health care

71.75

92726

Telehealth attendance for the provision of services related to blood borne viruses, sexual or reproductive health by a medical practitioner (not including a general practitioner, specialist or consultant physician), in an eligible area, lasting at least 40 minutes in duration if the attendance includes any of the following that are clinically relevant:

(a)    taking an extensive patient history;

(b)    arranging any necessary investigation;

(c)    implementing a management plan;

(d)    providing appropriate preventive health care

104.90

Subgroup 40 – GP Blood Borne Viruses, Sexual or Reproductive Health Consultation – Phone Service

92731

Phone attendance for the provision of services related to blood borne viruses, sexual or reproductive health by a general practitioner of not more than 5 minutes if the attendance includes any of the following that are clinically relevant:

(a)    taking a short patient history;

(b)    arranging any necessary investigation;

(c)    implementing a management plan;

(d)    providing appropriate preventive health care

21.05

92732

Phone attendance for the provision of services related to blood borne viruses, sexual or reproductive health by a medical practitioner (not including a general practitioner, specialist or consultant physician) of not more than 5 minutes if the attendance includes any of the following that are clinically relevant:

(a)    taking a short patient history;

(b)    arranging any necessary investigation;

(c)    implementing a management plan;

(d)    providing appropriate preventive health care

12.90

92733

Phone attendance for the provision of services related to blood borne viruses, sexual or reproductive health by a medical practitioner (not including a general practitioner, specialist or consultant physician), in an eligible area, of not more than 5 minutes if the attendance includes any of the following that are clinically relevant:

(a)    taking a short patient history;

(b)    arranging any necessary investigation;

(c)    implementing a management plan;

(d)    providing appropriate preventive health care

16.70

92734

Phone attendance for the provision of services related to blood borne viruses, sexual or reproductive health by a general practitioner of more than 5 minutes in duration but not more than 20 minutes if the attendance includes any of the following that are clinically relevant:

(a)    taking a patient history;

(b)    arranging any necessary investigation;

(c)    implementing a management plan;

(d)    providing appropriate preventive health care

46.00

92735

Phone attendance for the provision of services related to blood borne viruses, sexual or reproductive health by a medical practitioner (not including a general practitioner, specialist or consultant physician) of more than 5 minutes in duration but not more than 20 minutes if the attendance includes any of the following that are clinically relevant:

(a)    taking a patient history;

(b)    arranging any necessary investigation;

(c)    implementing a management plan;

(d)    providing appropriate preventive health care

24.70

92736

Phone attendance for the provision of services related to blood borne viruses, sexual or reproductive health by a medical practitioner (not including a general practitioner, specialist or consultant physician), in an eligible area, of more than 5 minutes in duration but not more than 20 minutes if the attendance includes any of the following that are clinically relevant:

(a)    taking a patient history;

(b)    arranging any necessary investigation;

(c)    implementing a management plan;

(d)    providing appropriate preventive health care

36.45

92737

Phone attendance for the provision of services related to blood borne viruses, sexual or reproductive health by a general practitioner of more than 20 minutes in duration but not more than 40 minutes if the attendance includes any of the following that are clinically relevant:

(a)    taking a detailed patient history;

(b)    arranging any necessary investigation;

(c)    implementing a management plan;

(d)    providing appropriate preventive health care

89.10

92738

Phone attendance for the provision of services related to blood borne viruses, sexual or reproductive health by a medical practitioner (not including a general practitioner, specialist or consultant physician) of more than 20 minutes in duration but not more than 40 minutes if the attendance includes any of the following that are clinically relevant:

(a)    taking a detailed patient history;

(b)    arranging any necessary investigation;

(c)    implementing a management plan;

(d)    providing appropriate preventive health care

44.70

92739

Phone attendance for the provision of services related to blood borne viruses, sexual or reproductive health by a medical practitioner (not including a general practitioner, specialist or consultant physician), in an eligible area, of more than 20 minutes in duration but not more than 40 minutes if the attendance includes any of the following that are clinically relevant:

(a)    taking a detailed patient history;

(b)    arranging any necessary investigation;

(c)    implementing a management plan;

(d)    providing appropriate preventive health care

70.60

92740

Phone attendance for the provision of services related to blood borne viruses, sexual or reproductive health by a general practitioner lasting at least 40 minutes in duration if the attendance includes any of the following that are clinically relevant:

(a)    taking an extensive patient history;

(b)    arranging any necessary investigation;

(c)    implementing a management plan;

(d)    providing appropriate preventive health care

131.15

92741

Phone attendance for the provision of services related to blood borne viruses, sexual or reproductive health by a medical practitioner (not including a general practitioner, specialist or consultant physician) lasting at least 40 minutes in duration if the attendance includes any of the following that are clinically relevant:

(a)    taking an extensive patient history;

(b)    arranging any necessary investigation;

(c)    implementing a management plan;

(d)    providing appropriate preventive health care

71.75

92742

Phone attendance for the provision of services related to blood borne viruses, sexual or reproductive health by a medical practitioner (not including a general practitioner, specialist or consultant physician), in an eligible area, lasting at least 40 minutes in duration if the attendance includes any of the following that are clinically relevant:

(a)    taking an extensive patient history;

(b)    arranging any necessary investigation;

(c)    implementing a management plan;

(d)    providing appropriate preventive health care

104.90