Item: 700 - Annual Health Assessment 75 years and over - in consulting room

• As per the name, it is a once a year assessment for patients over 75 years
• Item numbers 700, 702, 704, or 706 must not have been claimed in last 12 months
• PN, AHW or other health professional may assist GP with information gathering component of this assessment

Item: 702 - Annual Health Assessment 75 years and over - not at consulting room, hospital or Residential Aged Care Facility

• As above but performed in the patient’s home
• Only part of the assessment needs to be done in the home for it to qualify as an item 702, the rest can be finalised by GP in the consulting room

Item: 704 - Aboriginal & Torres Strait Islander Annual Health Check 55 years and over – in consulting room

• A once a year health assessment for ATSI patients over the age of 55
• The patient’s Indigenous status and their age should be accepted on the basis of their self-identification
• Item numbers 700, 702, 704, or 706 must not have been claimed in last 12 months
• PN, AHW or other health professional may assist GP with information gathering component of this assessment

Item: 706 - Aboriginal & Torres Strait Islander Annual Health Check 55 years and over – not at consulting room, hospital or Residential Aged Care Facility

• As above but performed in the patient’s home
• Only part of the assessment needs to be done in the home for it to qualify as an item 706, the rest can be finalised by GP in the consulting room

Item: 708 - Aboriginal & Torres Strait Islander Child Health Check (0 - 14 years inclusive)

• This is an annual check but may be done as early as 9 months after previous claim for item 708
• Can be undertaken in or out of the surgery
• The patient’s Indigenous status and their age should be accepted on the basis of their self-identification, or is identified as such by their parent or carer
• Includes physical examination and assessment and comprehensive medical history
• PN, AHW or other health professional may assist GP with information gathering component of this assessment

Item: 709 - Healthy Kids Check by GP

• This is a once only health check for children who have received their four-year-old immunisation
• Parents / Guardians should receive a copy of “Get Set 4 Life - habits for healthy kids” guide
• This should be noted in the patient’s file

Item: 710 -  Aboriginal & Torres Strait Islander Adult Health Check (15 - 54 years inclusive)

• This health check can be done as early as 18 months after previous claim for item 710
• Can be undertaken in or out of the surgery
• The patient’s Indigenous status and their age should be accepted on the basis of their self-identification, or is identified as such by their parent or carer
• Includes physical examination and assessment and comprehensive medical history
• PN, AHW or other health professional may assist GP with information gathering component of this assessment

Item: 711 -  Healthy Kids Check by PN or Aboriginal Health Worker

• As for item 709

Item: 712 - Comprehensive Medical Assessment (CMA)

• Medical assessment for new and existing residents (criteria apply) of a Residential Aged Care Facility only
• Maximum of one CMA may be claimed in any 12 month period
• PN may assist GP with information gathering component of this assessment

Item: 713 - Type 2 Diabetes Risk Evaluation

• Used to address the health needs of the 40-49 year olds who are at ‘high risk’ of developing type 2 diabete
• ‘high risk’ score is determined by patient’s completion of the Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK)
• Medicare rebate payable only once every 3 years or after 3 years has elapsed since item 717 was claimed
• Eligible patients who have attended a diabetes risk evaluation with their GP under this item may be referred to a subsidised Lifestyle Modification Program
• PN, AHW or other health professional may assist GP in performing this evaluation

Item: 714 - Health Assessment for Refugee or Humanitarian Entrant – in consulting room

• An assessment provided to a patient within 12 months of them arriving in Australia or receiving residency under the Humanitarian Program
• Once only assessment where item numbers 700, 702, 712, or 716 must not have been claimed already
• Purpose is to introduce new refugees and other humanitarian entrants to the Australian primary health care system as soon as possible after entry to Australia
• Patients should be asked to provide proof of their visa status and date of arrival in Australia
• PN or other qualified health professional may assist GP with information gathering component of this assessment

Item: 716 - Health Assessment for Refugee or Humanitarian Entrant – not at consulting room, hospital or Residential Aged Care Facility

• See item 714
• Once only assessment where item numbers 700, 702, 712, or 714 must not have been claimed already
• Fee for more than one patient is derived by using payment for item 714, plus $23.50 divided by the number of patients seen, up to a maximum of 6 patients. For 7 or more patients - the fee for item 714 plus $1.75 per patient

Item: 717 - 45 Year Old Health check (45 – 49 years inclusive)

• Health check targeted at people between 45 and 49 years of age (inclusive) who are at risk of developing a chronic disease
• A once only health check
• PN, AHW or other health professional may assist GP in performing this health check

Item: 718 - Intellectual Disability Health Assessment – in consulting room

• Does not apply to in-patients of a hospital or Residential Aged Care Facility
• A person is deemed to have an intellectual disability if they have significantly sub-average general intellectual functioning (two standard deviations below the average intelligence quotient (IQ)) and would benefit from assistance with daily living activities
• An annual health assessment
• PN, AHW or other health professional may assist GP with information gathering component of this assessment

Item: 719 - Intellectual Disability Health Assessment – not at consulting room, hospital or Residential Aged Care Facility

• As for item 718
• Only part of the assessment needs to be done in the home for it to qualify as an item 719, the rest can be finalised by GP in the consulting room

NOTES:

• All the above item numbers should generally be undertaken by the patient’s usual doctor.
• If not undertaken by patient’s usual doctor, a copy should be forwarded to that doctor or practice, with the patient’s consent.
• Consent for the assessment must be noted on the patient record.
• These item numbers are available to all GPs whether or not they are vocationally registered.
• Item 10990 or 10991 (bulk billing incentives) can be claimed in conjunction with the above items provided the conditions of item 10990 and 10991 are satisfied.

Item: 721 - Preparation of a GP Management Plan (GPMP) by a GP (including on discharge for private patients)

• Patient must have a chronic condition that has been in place for 6 months or will be in place for 6 months, or they must have a terminal illness
• PN, AHW or other health professional may assist the GP in preparing the GPMP but must include a personal attendance by GP
• Can be claimed once every two years but not within 12 months of prior claim for same item or 3 months of a claim for items 725,727, 729 or 731 except in exceptional circumstances

Item: 723 - Coordination of Team Care Arrangements (TCA) by a GP (including on discharge for private patients)

• As for item 721 AND in addition must have complex care needs necessitating ongoing multidisciplinary care involving at least two other health or care providers
• PN, AHW or other health professional may assist the GP in preparing the GPMP but must include a personal attendance by GP - also requires collaboration with other providers
• Can be claimed once every two years but not within 12 months of prior claim for same item or 3 months of a claim for items 725,727, 729 or 731 except in exceptional circumstances

Item: 725 - Review of a GP Management Plan by a GP

• Must have an item 721 in place
• PN, AHW or other health professional may assist the GP in preparing the GPMP review but must include a personal attendance by GP
• Recommended frequency of this service is once every 6 months
• Rebate will not be paid within 3 months of a previous 721 or 725, except in exceptional circumstances

Item: 727 - Coordination of a review of Team Care Arrangements by a GP

• Must have an item 723 in place
• PN, AHW or other health professional may assist the GP in preparing the TCA review but must include a personal attendance by GP - also requires collaboration with other providers
• Recommended frequency of this service is once every 6 months
• Rebate will not be paid within 3 months of a previous 723 or 727, except in exceptional circumstances

Item: 729 - Contribution to a care plan or a review of a care plan prepared by another provider

• Not for residents of an Aged Care Facility
• Must be two other providers contributing to care plan
• Recommended frequency is once every 6 months but rebate will not be paid within 12 months of items 721 or 723 or within 3 months of an item 725, 727, 729 other than in exceptional circumstances

Item: 731 - Contribution by GP to Care Plan for a patient in a Residential Aged Care Facility prepared by that facility

• Only for residents of an Aged Care Facility
• Must be two other providers contributing to care plan
• rebate will not be paid within 3 months of items 721, 723, 725, 727, 729 or 731
• contribution must be at the request of the Aged Care Facility
• resident becomes eligible to access rebates for allied health and dental care items

Notes:

• In general, a separate consultation item should not be undertaken in conjunction with a GPMP or TCA unless it is clinically indicated that a problem must be treated immediately.
• All the above item numbers should generally be undertaken by the patient’s usual doctor.
• If not undertaken by patient’s usual doctor, a copy should be forwarded to that doctor or practice, with the patient’s consent.
• Consent must be noted on the patient record.
• Patients need to be aware of any likely out-of-pocket costs.
• These item numbers are available to all GPs whether or not they are vocationally registered.
• “Exceptional circumstances’ apply where there has been a significant change in the patient’s clinical condition or care circumstances that requires a new GPMP, TCA or new review, rather than, for example, amending the existing GPMP or TCA.
• Item 10990 or 10991 (bulk billing incentives) can be claimed in conjunction with the above items provided the conditions of item 10990 and 10991 are satisfied.

Items: 734, 736, 738 - Organise and coordinate a case conference in a Residential Aged Care Facility

Items: 775, 778, 779 - Participate in a case conference in a Residential Aged Care Facility

• Patient must suffer from at least one medical condition that has been (or is likely to be) present for at least 6 months, or is terminal
• Item number and fee dependent upon length of case conference
• Must include two other providers, one of whom can be the Aged Care Facility

Items: 740, 742, 744 - Organise and coordinate a community case conference

Items: 759, 762, 765 - Participate in a community case conference

• Patient must suffer from at least one medical condition that has been (or is likely to be) present for at least 6 months, or is terminal
• Item number and fee dependent upon length of case conference
• Cannot be an in-patient of a hospital or care recipient in a residential aged care facility

Items: 746, 749, 757 - Organise and coordinate a discharge case conference

Items: 768,771, 773 - Participate in a discharge case conference

• Patient must suffer from at least one medical condition that has been (or is likely to be) present for at least 6 months, or is terminal AND is an in-patient of a hospital
• Item number and fee dependent upon length of case conference
• Cannot be a care recipient in a residential aged care facility
  

Item: 900 - Domiciliary Medication Management Review (DMMR)

• For patients living in a community setting
• Rebate payable one in a 12 month period, except where there has been a significant change in the patient’s condition or medication regimen requiring a new DMMR
• Criteria apply

Item: 903 - Residential Medication Management Review (RMMR)

• For permanent residents of a residential aged care facility
• Payable for new residents on admission to an aged care facility and for existing residents on an as required basis although maximum of one RMMR in any 12 month period except in exceptional circumstances

Notes:

• The above item numbers should generally be undertaken by the patient’s usual doctor.
• Consent must be noted on the patient record.
• PN’s role in these item numbers can be to assist with information gathering for the referral and to track the process from referral through to claiming the item number.

Items: 2517, 2521, 2525 - Diabetes Annual Cycle of Care – surgery consultation

Items: 2620, 2622, 2624 - Diabetes Annual Cycle of Care – surgery consultation - other non-referred

Items: 2518, 2522, 2526 - Diabetes Annual Cycle of Care – out of surgery consultation

Items: 2631, 2633, 2635 - Diabetes Annual Cycle of Care – out of surgery consultation - other non-referred

Notes:

• Rebates for item numbers listed above equate to Level B, C, and D consultation items
• Item number triggers the service incentive payment (SIP) of $40.00 and in some cases an outcomes payment of $20.00 through the Practice Incentives Program (PIP)
• Rebate for out of surgery consultations varies depending on the number of patients seen
• Paid once every 11 - 13 months
• All visits should be billed under normal attendance items with the exception of the visit that completes all the requirements of the Diabetes Cycle of Care

Items: 2546, 2552, 2558 - Asthma Annual Cycle of Care – surgery consultation

Items: 2664, 2666, 2668 - Asthma Annual Cycle of Care – surgery consultation - other non-referred

Items: 2547, 2553, 2559 - Asthma Annual Cycle of Care – out of surgery consultation

Items: 2673, 2675, 2677 - Asthma Annual Cycle of Care – out of surgery consultation - other non-referred

• At least 2 asthma related consultations within 12 months where at least one of which (the review consultation) is planned at a previous consultation
• Documented diagnosis and assessment of level of asthma control and severity of asthma
• Review of the patient’s use of and access to asthma-related medication and devices
• Provision to the patient of a written asthma action plan (documented plan if patient unable to use written one)
• Provision of asthma self-management education to the patient
• Review of the written or documented asthma action plan

Notes:

• Rebates for item numbers listed above equate to Level B, C, and D consultation items
• Item number triggers the service incentive payment (SIP) of $100.00 through the Practice Incentives Program (PIP)
• Rebate for out of surgery consultations varies depending on the number of patients seen
• Payable once in a 12 month period, unless it is clinically indicated that another cycle of care be undertaken
• All visits should be billed under normal attendance items with the exception of the visit that completes all the requirements of the Asthma Cycle of Care

Item: 2710 - Preparation of a GP Mental Health Care Plan

• Once a GP Mental Health Care Plan has been completed and claimed on Medicare, patient is eligible to be referred for up to 12 Medicare rebateable allied mental health services per calendar year and will also be eligible for 12 separate group therapy sessions
• A new plan should not be prepared unless clinically required and generally not within 12 months of a previous plan
• Ongoing care is through item 2712, 2713, or standard consultation items

Item: 2712 - GP Mental Health Care Plan Review

• Should occur between 4 weeks and 6 months after completion of item 2710
• If required, a second review can occur 3 months after first review
• Can be used to follow up where a psychiatrist has prepared a referred assessment and management plan (item 291)
• Rebate will not be paid within 3 months of a previous claim for item 2712 or within 4 weeks of a claim for item 2710 other than in exceptional circumstances

Item: 2713 - GP Mental Health Consultation

• Independent of items 2710 and 2712 and must be at least 20 minutes duration

Notes:

• These item numbers are for GPs only and are included to enhance PN knowledge
• Mental Health Nurses may assist GPs to undertake items 2710 and 2712
• Dementia, delirium, tobacco use disorder and mental retardation are not regarded as mental disorders for the purposes of the GP Mental Health Care items
• Item 10990 or 10991 (bulk billing incentives) can be claimed in conjunction with the above items provided the conditions of item 10990 and 10991 are satisfied.

Item: 81010 - Non-directive Pregnancy Support Counselling Service by a Mental Health Nurse

• Provided to women who are concerned about a current pregnancy, or a pregnancy that occurrin the preceding 12 months
• Based on the understanding that, in many situations, people can resolve their own problems without being provided with a solution by the counsellor. The counsellor’s role is to encourage the patient to express their feelings but not suggest what decision the patient should make. By listening and reflecting back what the person reveals to them, the counsellor helps the patient to explore and understand their feelings. With this understanding, the patient is able to make the decision which is best for them
• Medicare benefits are payable for up to three non-directive pregnancy support counselling services per patient, per pregnancy.

Item: 10987 - Follow up service provided by a practice nurse or registered Aboriginal Health Worker, on behalf of a GP, for an Indigenous person who has received a health check

• Service must be consistent with the needs identified through the health check items 704, 706, 708, or 710
• May undertake up to 5 services per patient in a calendar year
• May be used to provide: examinations / interventions as indicated by the Health Check; education regarding medication compliance and associated monitoring; checks on clinical progress and service access; education, monitoring and counselling activities and lifestyle advice; taking a medical history; and prevention advice for chronic conditions, and associated follow up

Item: 10988 - Immunisation services provided by a registered Aboriginal Health Worker

• Can be claimed only once per patient visit regardless of how many vaccinations are being administered
• Covers all vaccines in the Australian Immunisation Handbook 8th edition.

Item: 10989 - Wound management services provided by a registered Aboriginal Health Worker

• Can be claimed only once per patient visit regardless of how many wounds are being treated
• Where AHW provides ongoing wound management, the GP is not required to see the patient during each subsequent visit

Item: 10993 - Immunisation services provided to a person by a practice nurse

• Can be claimed only once per patient visit regardless of how many vaccinations are being administered
• Covers all vaccines in the Australian Immunisation Handbook 8th edition.

Item: 10994 - Service provided by a practice nurse, being the taking of a cervical smear and preventive check

• Cannot be claimed with GP cervical smear incentive items 2497 - 2509 and 2598 - 2616 or with items 10995, 10998 or 10999
• Must be at least one preventative check taken
• Preventative checks include: checks for sexually transmitted infections (including Chlamydia); taking of a sexual and reproductive history; advice on contraception; breast awareness education; advice on post natal issues; continence advice and education; Smoking, Nutrition, Alcohol and Physical Activity behavioural risk factor assessment; blood pressure measurement

Item: 10995 - Service provided by a practice nurse, being the taking of a cervical smear from a woman between the ages of 20 & 69 inclusive who has not had a cervical smear in the last 4 years, and preventative check

• Cannot be claimed with GP cervical smear incentive items 2497 - 2509 and 2598 - 2616 or with items 10994, 10998 or 10999
• As for item10994

Item: 10996 - Treatment of a person’s wound (other than normal aftercare) provided by a practice nurse

• Can be claimed only once per patient visit regardless of how many wounds are being treated
• Where PN provides ongoing wound management, the GP is not required to see the patient during each subsequent visit

Item: 10997 - Service provided to a person with a chronic disease by a practice nurse or registered Aboriginal Health Worker

• Patient must have a GP Management Plan or TCA in place
• May undertake up to 5 services per patient in a calendar year
• May be used to provide checks on clinical progress; monitoring medication compliance; self management advice; and, collection of information to support GP reviews of care plans
• Services provided should be consistent with the scope of the GPMP, TCA or review items

Item: 10998 - Service provided by a practice nurse, being the taking of a cervical smear

• Cannot be claimed with GP cervical smear incentive items 2497 - 2509 and 2598 - 2616 or with items 10994, 10995 or 10999

Item: 10999 - Service provided by a practice nurse, being the taking of a cervical smear from a woman between the ages of 20 & 69 inclusive who has not had a cervical smear in the last 4 years

• Cannot be claimed with GP cervical smear incentive items 2497 - 2509 and 2598 - 2616 or with items 10994, 10995 or 10998

Notes:

• Provided on behalf of, and under the supervision of, a medical practitioner
• Not for patient who is an admitted patient of a hospital
• Item 10990 or 10991 (bulk billing incentives) can be claimed in conjunction with the above items provided the conditions of item 10990 and 10991 are satisfied
• Practice nurse means a registered nurse or an enrolled nurse who is employed by, or whose services are otherwise retained by, a general practice
• Supervision by the GP at a distance is recognised as an acceptable form of supervision i.e. GP does not need to be physically present but should be contactable if required
• All GPs whether vocationally registered or not are eligible to claim these items

Item: 16400 - Antenatal service provided by a midwife, nurse or a registered Aboriginal Health Worker

• Service is provided on behalf of, and under the supervision of, a medical practitioner
• Provided at, or from, a practice location in a regional, rural or remote area RRMA 3-7
• Not performed in conjunction with another antenatal attendance item (same patient, same practitioner on the same day)
• Not provided for an admitted patient of a hospital
• Undertake to a maximum of 10 service per pregnancy

Item: 11506 - Spirometry – before and after inhalation of bronchodilator

• Measurement of respiratory function involving a permanently recorded tracing performed before and after inhalation of bronchodilator - each occasion at which 1 or more such tests are performed

Item: 11610 - Measurement Ankle Brachial Indices & arterial waveform analysis

• Measurement of posterior tibial and dorsalis pedis (or toe) and brachial arterial pressures bilaterally using Doppler or plethysmographic techniques, the calculation of ankle (or toe) brachial systolic pressure indices and assessment of arterial waveforms for the evaluation of lower extremity arterial disease, examination, hard copy trace and report

Item: 11700 - ECG – 12 lead, tracing and report

• Medicare benefits are precluded under this item unless a full 12-lead ECG is performed. Examinations involving less than twelve leads are regarded as part of the accompanying consultation. A 12-lead ECG refers to the recordings produced of 12 views of the heart by various combinations of placement of electrodes

Item: 16400 - Antenatal service provided by nurse, midwife, or AHW , or behalf of and under the supervision of medical practitioner in RRMA 3-7 (regional, rural and remote)

Item: 73805 - Urine Catalase Test

• Microscopy of urine, whether stained or not, or catalase test

Item: 73806 - Pregnancy Test

• Pregnancy test by 1 or more immunochemical methods