MEDICAL BENEFITS SCHEDULE ENHANCED PRIMARY CARE CHRONIC DISEASE by jf8fmfif9d

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									                                                                              MEDICAL BENEFITS SCHEDULE ENHANCED PRIMARY CARE
                                                                                 CHRONIC DISEASE MANAGEMENT ITEM NUMBERS
                                                                                           FOR GENERAL PRACTICE

             MBS GROUP                 ITEM          SERVICE DESCRIPTOR                                                         BRIEF GP GUIDE & WEB ADDRESS                                              100%        Time Line
                                        NO.                                                                                                                                                              REBATE      Red=If clinically
                                                                                                                                                                                                                        indicated
Aged Care                                     Comprehensive Medical Assessment –         GP conducts assessment of RACF resident and records plan for care in resident’s RACF Care Plan                             0,12 months
* P/N can collect and record info      712    CMA*                                       http://www9.health.gov.au/mbs/se arch.cfm?q=712                                                                $ 196.20
                                                                                         GP contributes to a RACF Care Plan for resident’s care and records involvement on the Care Plan                $ 63.75     0,3,6,9,12,15,
* P/N can provide monitoring &                Contribution to a Care Plan or Review      Reviews a Care Plan and records OR Contributes to a residents discharge care planning by a hospital                        18,21,24 mnths
                                       731
support between GP reviews                    of a Care Plan*^                           http://www9.health.gov.au/mbs/search.cfm?q=731
                                                                                         ^ GP can’t claim 731 and 10997 on same day.
                                       734                                               Resident’s GP organizes and coordinates a Case Conference in a RACF which involves at least 2 other            $ 87.55
#                                             Organise and Co-ordinate
    Claim re length of Conference      736                                               health care providers                                                                                          $ 131.35
                                              a Case Conference#
                                       738                                               http://www9.health.gov.au/mbs/search.cfm?q=734                                                                 $ 175.10
                                       775                                               GP participates in a Case Conference re a resident, in a RACF                                                  $ 62.50
                                       778    Participate in a Case conference#          http://www9.health.gov.au/mbs/search.cfm?q=775                                                                 $ 100.05
                                       779                                                                                                                                                              $ 137.55
General Practice Care Plans                                                              GP plans and records the management of a GP patient with a chronic or terminal medical condition                           12, 24mnths
* P/N can measure, monitor, collect    721    GP Management Plan – GPMP*                 If a GPMP in place, GP can refer type 2 diabetes patients to specific allied health providers for group        $ 130.65
and record info                                                                          education sessions which can be in addition to the allied health services provided in a TCA
                                                                                         http://www9.health.gov.au/mbs/search.cfm?q=721
                                                                                         GP reviews the original GPMP                                                                                   $ 65.30     3,6,9 months
                                       725    Review of a GP Management Plan
                                                                                         http://www9.health.gov.au/mbs/search.cfm?q=725
                                                                                         GP coordinates involvement of at least 2 other health care providers in a written plan to manage a GP          $ 103.50    12, 24mnths
                                              Team Care Arrangement – TCA*
                                                                                         patients’ chronic or terminal medical condition with complex needs requiring multidisciplinary care
                                                                                         If a GPMP and TCA in place, GP can include private allied health providers for free individual allied health
                                       723
                                                                                         services such as physio as part of the TCA
                                                                                         If a GPMP and TCA in place GP can refer patient to dentist or prosthesis’
                                                                                         http://www9.health.gov.au/mbs/search.cfm?q=723
                                                                                         GP coordinates a review of a TCA in collaboration with the other providers                                     $   65.30   3,6,9 months
                                       727    Coordination of a review of a TCA
                                                                                         http://www9.health.gov.au/mbs/search.cfm?q=727
                                              Contribution to a Multidisciplinary Care   GP contributes to another provider’s care plan or reviews another provider’s care plan                         $   63.75   3,6,9,12,15,18,
                                       729
                                              Plan                                       http://www9.health.gov.au/mbs/search.cfm?q=729                                                                             21 mths
SIP                                    2517   Completion of ACC for Diabetes             Minimum requirements of care needed to be assessed to complete a cycle of care for patients with               $ 33.55+    1 Annually
                                              Mellitus                                   established diabetes mellitus, refer to                                                                        BB+SIP+
                                                                                         http://www9.health.gov.au/mbs/search.cfm?q=2517                                                                PIP
                                       2546   Asthma Cycle of Care                       Level 'B' Professional attendance involving taking a selective history, examination of the patient with the    $ 33.55     1 Annually
                                                                                         implementation of a management plan in relation to one or more problems, OR a professional attendance of
                                                                                         less than 20 minutes duration AND which completes the minimum requirements of the Asthma Cycle of Care
                                                                                         http://www9.health.gov.au/mbs/search.cfm?q=2546                                                                $ 63.75
                                       2552                                              Level ‘C’ as above 40 minutes duration
                                              Domiciliary or Home Medicine               GP arranges for a GP patient’s medicine to be reviewed in their own home                                       $ 140.20    0,12,24 mths
Medicine Reviews                       900
                                              Management Review – HMMR                   http://www9.health.gov.au/mbs/search.cfm?q=900
                                              Residential Medicine Management            GP arranges for a resident of a RACF to have their medicines reviewed in the RACF                              $ 96.00     0,12,24 mths
                                       903
                                              review – RMMR                              http://www9.health.gov.au/mbs/search.cfm?q=903
                                              Health Assessment of a patient who is      GP assesses the patient in the GP setting                                                                      $ 175.10    1 Annually
Health Checks and Assessments          700
                                              at least 75 years old*                     http://www9.health.gov.au/mbs/search.cfm?q=700
                                              Health Assessment of a patient who is      GP assesses the patient in their home, not RACF                                                                            1 Annually
                                       702                                                                                                                                                              $ 247.60
                                              at least 75 yrs*                           http://www9.health.gov.au/mbs/search.cfm?q=702
P/N can measure, monitor, collect      704    Health Assessment of an ATSI patient       GP assesses the ATSI patient in the GP setting                                                                 $ 175.10    1 Annually
and record info with all these items          who is at least 55 years old.              http://www9.health.gov.au/mbs/search.cfm?q=704
                                       706    Health Assessment of an ATSI patient       GP assesses the ATSI patient e.g. in their home                                                                $ 247.60    1 Annually
                                              who is at least 55 years old*              http://www9.health.gov.au/mbs/search.cfm?q=706
                                       708    ATSI Child Health Check*                   GP assesses an ATSI patient who is less than 15 years of age                                                   $ 175.10    9 mths
Version 5 - October, 2008                                                                      Program Funded by Department of Health & Ageing                                                                                           1
             MBS GROUP                ITEM           SERVICE DESCRIPTOR                                                      BRIEF GP GUIDE & WEB ADDRESS                                              100%       Time Line
                                       NO.                                                                                                                                                            REBATE     Red=If clinically
                                                                                                                                                                                                                    indicated
                                                                                      http://www9.health.gov.au/mbs/search.cfm?q=708
                                                                                      GP undertakes a health check for a patient who is receiving or has received their four year old immunization              1 only
                                              Healthy Kids Check – 4 year old
                                       709                                            http://www9.health.gov.au/mbs/search.cfm?q=709                                                                 $ 46.05
                                              Health Assessment of an ATSI patient    GP assesses patient in the GP setting (not adult health check)                                                            18 mths
                                       710
                                              who is 15 to 55 years of age*           http://www9.health.gov.au/mbs/search.cfm?q=710                                                                 $ 208.70
                                                                                      Practice nurse undertakes a health check for a patient who is receiving or has received their four year old    $ 46.05    1 only
                                       711    Healthy Kids Check – 4 year old         immunization
                                                                                      http://www9.health.gov.au/mbs/search.cfm?q=711
                                                                                      GP reviews patients aged 40 – 49 who are at a high risk of developing type 2 diabetes and instigates early     $ 61.40    1 Annually
                                       713    Diabetes Risk Evaluation                interventions to assist in the prevention of type 2 diabetes
                                                                                      http://www9.health.gov.au/mbs/search.cfm?q=713
                                       714    Health Assessment for Refugee and       GP assesses patient in the GP setting within 12 months of arrival
                                                                                      http://www9.health.gov.au/mbs/search.cfm?q=714                                                                 $ 208.70   1 only
                                              other Humanitarian Entrants*
                                       716    Health Assessment for Refugee and       GP assesses patient (s) out of GP clinic within 12 months of arrival                                           Up to      1 only
                                              other Humanitarian Entrants*            http://www9.health.gov.au/mbs/search.cfm?q=716                                                                 $ 226.95
                                                                                      GP checks health of patient 45-49 years who is at risk of developing chronic disease                           $ 104.55   1 only
                                       717    45 year old Health Check
                                                                                      http://www9.health.gov.au/mbs/search.cfm?q=717
                                       718    Health Check of a person with an        GP conducts annual health assessment of GP patient with an intellectual disability                             $ 208.70   1 Annually
                                              Intellectual Disability*                http://www9.health.gov.au/mbs/search.cfm?q=718
                                              Health Check of a person with an        GP conducts annual health assessment of GP patient with an intellectual disability e.g. in patient’s home      $ 232.15   1 Annually
                                       719
                                              Intellectual Disability*                http://www9.health.gov.au/mbs/search.cfm?q=719
Mental Health                                                                         GP assesses and plans treatment                                                                                $ 156.85   1 Annually
* P Nurse can measure, monitor,       2710    GP Mental Health Care Plan*             If a MH Care Plan in place GP can refer patients for allied health group therapy
collect and record info                                                               http://www9.health.gov.au/mbs/search.cfm?q=2710
                                                                                      GP reviews the treatment plan                                                                                  $ 104.55   3,6,9 mths
                                      2712    Review of a GP MH Care Plan*
                                                                                      http://www9.health.gov.au/mbs/search.cfm?q=2712
                                      2713    GP MH Care Consultation                 GP provides extended MH consultation other than 2710 or 2712 service                                           $ 69.00
                                                                                      http://www9.health.gov.au/mbs/search.cfm?q=2713
                                      2721    Focused Psychological Strategies -      Lvl 2 GP provides up to 12 planned sessions comprising 2 groups of up to 6 sessions and a further 6            $ 182.10
                                      2727    FPS                                     sessions may be approved                                                                                       to
                                                                                      http://www9.health.gov.au/mbs/search.cfm?q=2721                                                                $ 117.55
                                                                                      Credentialed Div 1 Practice Nurse administers TGA vaccines on GP instructions. Excludes mass
Practice Nurse                        10993   Immunisation+                           immunisations                                                                                                  $ 11.10
                                                                                      http://www9.health.gov.au/mbs/search.cfm?q=10993
Ensure practice medical indemnity             Cervical Smear and Preventative         Credentialed Div 1 Practice Nurse provides service on behalf of GP to female patients of any age and           $ 22.20
                                      10994
insurance covers procedures.                  Check+                                  http://www9.health.gov.au/mbs/search.cfm?q=10994 preventative health checks
+
  If GP also provides service in      10995   Cervical Smear and Preventative         Credentialed Div 1 Practice Nurse provides service for a woman between 20 and 69 years of age who has          $ 22.20
addition to nurse, OK to claim GP &           Check+                                  not had service in last 4 years and preventative health check
nurse items                                                                           http://www9.health.gov.au/mbs/search.cfm?q=10995
                                                                                      Credentialed Div 1 or Div 2 attends to GP patient’s wound after GP has assessed                                $ 11.10
                                      10996   Wound Management+                       http://www9.health.gov.au/mbs/search.cfm?q=10996
^GP can’t claim 721, 723, 725, 727,           Services Provided by a Practice Nurse   Practice Nurse or Aboriginal Health Worker attends patients on behalf of and under supervision of GP where     $ 11.10
729 or 731 on same day                10997   or an Aboriginal Health Worker on       GPMP and/ or TCA are in place - Max. of 5 services per patient per calendar year
                                              behalf of GP^                           http://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=10997
                                      10998   Cervical Smear+                         Credentialed Practice Nurse provides smear service only to a woman who is not in a hospital facility           $ 11.10
                                                                                      http://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=10998
                                                                                      Credentialed Practice Nurse provides smear service only to a woman between 20 and 69 years of age who          $ 11.10
                                      10999   Cervical Smear+                         has not had service in last 4 years
                                                                                      http://www9.health.gov.au/mbs/search.cfm?q=10999
    •    SOME CLAIM FREQUENCY PERIODS ARE SUBJECT TO EXCEPTIONAL CIRCUMSTANCES - CHECK MBS RULES BEFORE CLAIMING
    •    ACCESS MBS ON LINE AND SEARCH FOR ITEMS BY NUMBERS OR DESCRIPTION AT: http://www9.health.gov.au/mbs/search.cfm
    •    CALL THE MEDICARE PROVIDER LIAISON LINE ON: 13 21 50 OR CONTACT YOUR LOCAL DIVISION FOR ASSISTANCE WITH MBS ITEMS



Version 5 - October, 2008                                                                   Program Funded by Department of Health & Ageing                                                                                          2

								
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