2019. 12. 11. 22:43ㆍmain
Updated May 2020: 32084, 32087, 32224
Version: 2020 Mar - CoVid Item numbers added
COVID Temporary Item Numbers
For Consultant Physicians and Specialists new items apply to video-conference consultation services and to telephone consultations.
For our GI and Liver patients, they apply to people considered more susceptible to the COVID-19 virus:
(i) at least 70 years old; or
(ii) at least 50 years old and is of Aboriginal or Torres Strait Islander descent; or
(iii) is pregnant; or
(iv) is a parent of a child under 12 months; or
(v) is already under treatment for chronic health conditions or is immune compromised.
Specific items that relate to Consultant Physicians include:
|
110 |
Initial attendance |
91824 |
Telehealth initial attendance |
|
116 |
Subsequent attendance |
91825 |
Telehealth subsequent attendance |
|
110 |
Initial attendance |
91834 |
Telephone initial attendance |
|
116 |
Subsequent attendance |
91835 |
Telephone subsequent attendance |
They apply from 13 March 2020. More details can be found at the following link.
DIAGNOSTIC PROCEDURES
Subgroup 7. Gastroenterology & Colorectal
Group D1. Miscellaneous Diagnostic Procedures And Investigations
|
11800 |
OESOPHAGEAL MOTILITY TEST, manometric Fee: $177.25 Benefit: 75% = $132.95 85% = $150.70 |
|
11801 |
CLINICAL ASSESSMENT OF GASTRO-OESOPHAGEAL REFLUX DISEASE that involves 48 hour catheter-free wireless ambulatory oesophageal pH monitoring including administration of the device and associated endoscopy procedure for placement, analysis and interpretation of the data and all attendances for providing the service, if (a) a cathetter-based ambulatory oesophageal pH-mnitoring: (i) has been attempted on the patient but failed due to clinical complications, or (ii) is not clinically appropriate for the patient due to anatomical reasons (nasopharyngeal anatomy) preventing the use of catheter-based pH monitoring; and (b) the services is performed by a specialist or consultant physician with endoscopic training that is recognised by The Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy. Not in association with another item in Category 2, sub-group 7 (Anaes.) Fee: $267.20 Benefit: 75% = $200.40 85% = $227.15 |
|
11810 |
CLINICAL ASSESSMENT of GASTRO-OESOPHAGEAL REFLUX DISEASE involving 24 hour pH monitoring, including analysis, interpretation and report and including any associated consultation Fee: $177.25 Benefit: 75% = $132.95 85% = $150.70 |
|
11820 |
Capsule endoscopy to investigate an episode of obscure gastrointestinal bleeding, using a capsule endoscopy device (including administration of the capsule, associated endoscopy procedure if required for placement, imaging, image reading and interpretation, and all attendances for providing the service on the day the capsule is administered) if: (a) the service is provided to a patient who: (i) has overt gastrointestinal bleeding; or (ii) has gastrointestinal bleeding that is recurrent or persistent, and iron deficiency anaemia that is not due to coeliac disease, and, if the patient also has menorrhagia, has had the menorrhagia considered and managed; and (b) an upper gastrointestinal endoscopy and a colonoscopy have been performed on the patient and have not identified the cause of the bleeding; and (c) the service has not been provided to the same patient on more than 2 occasions in the preceding 12 months; and (d) the service is performed by a specialist or consultant physician with endoscopic training that is recognised by the Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy; and (e) the service is not associated with a service to which item 30680, 30682, 30684 or 30686 applies
(See para DN.1.15 of explanatory notes to this Category) Fee: $1,249.00 Benefit: 75% = $936.75 85% = $1164.30 |
|
11823 |
Capsule endoscopy to conduct small bowel surveillance of a patient diagnosed with Peutz-Jeghers Syndrome, using a capsule endoscopy device approved by the Therapeutic Goods Administration (including administration of the capsule, imaging, image reading and interpretation, and all attendances for providing the service on the day the capsule is administered) if:
(a) the service is performed by a specialist or consultant physician with endoscopic training that is recognised by the Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy; and (b) the item is performed only once in any 2 year period; and (c) the service is not associated with balloon enteroscopy. (See para DN.1.15 of explanatory notes to this Category) Fee: $1,249.00 Benefit: 75% = $936.75 85% = $1164.30 |
|
11830 |
DIAGNOSIS of ABNORMALITIES of the PELVIC FLOOR involving anal manometry or measurement of anorectal sensation or measurement of the rectosphincteric reflex Fee: $189.80 Benefit: 75% = $142.35 85% = $161.35 |
|
11833 |
DIAGNOSIS of ABNORMALITIES of the PELVIC FLOOR and sphincter muscles involving electromyography or measurement of pudendal and spinal nerve motor latency Fee: $253.75 Benefit: 75% = $190.35 85% = $215.70 |
THERAPEUTIC PROCEDURES
SB TUBE
Cat 3 Therapeutics - T1 Miscellaneous Therapeutic Procedures - Subgroup 6. Gastroenterology
|
13506 |
GASTRO-OESOPHAGEAL balloon intubation, for control of bleeding from gastric oesophageal varices Fee: $187.45 Benefit: 75% = $140.60 85% = $159.35 |
GASTROSCOPY & RELATED
Cat 3 Therapeutics - T8 Surgical Operations - 1. General
N.B. 41816,41822 and 41825 : Rigid oesophagoscopy/ w. biopsy/ w. foreign body removal
#gastro #dilatation #PEG #peg
|
30473 |
Oesophagoscopy (not being a service to which item 41816 or 41822 applies), gastroscopy, duodenoscopy or panendoscopy (1 or more such procedures), with or without biopsy, not being a service associated with a service to which item 30478 or 30479 applies. (Anaes.)
(See para TN.8.17 of explanatory notes to this Category) Fee: $179.95 Benefit: 75% = $135.00 85% = $153.00 |
|
30475 |
Endoscopic dilatation of stricture of upper gastrointestinal tract (including the use of imaging intensification where clinically indicated) (Anaes.) (See para TN.8.17, TN.8.133 of explanatory notes to this Category) Fee: $354.55 Benefit: 75% = $265.95 85% = $301.40 |
|
30478 |
Oesophagoscopy(other than a service to which item 41816, 41822 or 41825 applies), gastroscopy, duodenoscopy, panendoscopy or push enteroscopy, one or more such procedures, if: (a) the procedures are performed using one or more of the following endoscopic procedures: (i) polypectomy, (ii) sclerosing or adrenalin injections, (iii) banding (iv) endoscopic clips, (v) haemostatic powders, (vi) diathermy, (vii) argon plasma coagulation; and
(b) the procedures are for the treatment of one or more of the following: (i) upper gastrointestinal tract bleeding, (ii) polyps, (iii) removal of foreign body, (iv) oesophageal or gastric varices; (v) peptic ulcers, (vi) neoplasia, (vii) benign vascular lesions, (viii) strictures of the gastrointestinal tract; (ix) tumorous overgrowth through or over oesophageal stents; other than a service associated with a service to which item 30473 or 30479 applies(Anaes.)(See para TN.8.17 of explanatory notes to this Category) Fee:$249.50Benefit:75% = $187.1585% = $212.10 |
|
30479 |
Endoscopy with laser therapy, for the treatment of one or more of the following: (a) neoplasia; (b) benign vascular lesions; (c) strictures of the gastrointestinal tract; (d) tumorous overgrowth through or over oesophageal stents; (e) peptic ulcers; (f) angiodysplasia; (g) gastric antral vascular ectasia; (h) post-polypectomy bleeding;
other than a service associated with a service to which item 30473 or 30478 applies (Anaes.) (See para TN.8.17 of explanatory notes to this Category) Fee:$483.70Benefit:75% = $362.8085% = $411.15 |
|
30481 |
PERCUTANEOUS GASTROSTOMY (initialprocedure): (a) including any associated imaging services; and (b) excluding the insertion of a device for the purpose of facilitating weight loss (Anaes.) (See para TN.8.17 of explanatory notes to this Category) Fee:$362.70Benefit:75% = $272.0585% = $308.30 |
|
30482 |
PERCUTANEOUS GASTROSTOMY (repeat procedure): (a) including any associated imaging services; and (b) excluding the insertion of a device for the purpose of facilitating weight loss (Anaes.) Fee:$257.90Benefit:75% = $193.4585% = $219.25 |
|
30483 |
GASTROSTOMY BUTTON, CAECOSTOMY ANTEGRADE ENEMA DEVICE (CHAIT etc.) or STOMAL INDWELLING DEVICE: (a) non-endoscopic insertion of; or (b) non-endoscopic replacement of; on a person 10 years of age or over, excluding the insertion of a device for the purpose of facilitating weight loss (Anaes.) Fee:$179.90Benefit:75% = $134.9585% = $152.95 |
NASOGASTRIC
Cat 3 Therapeutics - T8 Surgical Operations - 1. General
#NG #ng #ngtube
|
31456 |
GASTROSCOPY and insertion of nasogastric or nasoenteral feeding tube, where blind insertion of the feeding tube has failed or is inappropriate due to the patient's medical condition (Anaes.) Fee: $249.50 Benefit: 75% = $187.15 |
|
31458 |
GASTROSCOPY and insertion of nasogastric or nasoenteral feeding tube, where blind insertion of the feeding tube has failed or is inappropriate due to the patient's medical condition, and where the use of imaging intensification is clinically indicated (Anaes.) Fee: $299.35 Benefit: 75% = $224.55 |
|
31460 |
PERCUTANEOUS GASTROSTOMY TUBE, jejunal extension to, including any associated imaging services (Anaes.) (Assist.) Fee: $362.70 Benefit: 75% = $272.05 |
ERCP
Cat 3 Therapeutics - T8 Surgical Operations - 1. General
|
30484 |
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (Anaes.) (See para TN.8.17 of explanatory notes to this Category) Fee:$370.75Benefit:75% = $278.1085% = $315.15 |
|
30485 |
ENDOSCOPIC SPHINCTEROTOMY with or without extraction of stones from common bile duct (Anaes.) (See para TN.8.17 of explanatory notes to this Category) Fee:$572.30Benefit:75% = $429.2585% = $487.60 |
|
30488 |
SMALL BOWEL INTUBATION as an independent procedure (Anaes.) Fee:$91.45Benefit:75% = $68.6085% = $77.75 |
|
30490 |
OESOPHAGEAL PROSTHESIS, insertion of, including endoscopy and dilatation (Anaes.) (See para TN.8.17 of explanatory notes to this Category) Fee:$534.80Benefit:75% = $401.1085% = $454.60 |
|
30491 |
BILE DUCT, ENDOSCOPIC STENTING OF (including endoscopy and dilatation) (Anaes.) (See para TN.8.17 of explanatory notes to this Category) Fee: $564.25 Benefit: 75% = $423.20 85% = $479.65 |
|
30492 |
BILE DUCT, PERCUTANEOUS STENTING OF (including dilatation when performed), using interventional imaging techniques - but not including imaging (Anaes.) Fee: $799.90 Benefit: 75% = $599.95 |
|
30494 |
ENDOSCOPIC BILIARY DILATATION (Anaes.) (See para TN.8.17 of explanatory notes to this Category) Fee: $427.25 Benefit: 75% = $320.45 |
SMALL BOWEL ENTERO. & BARRETT'S
Cat 3 Therapeutics- T8 Surgical Operations - 1. General
|
30680 |
Balloon enteroscopy, examination of the small bowel (oral approach), with or without biopsy, WITHOUT intraprocedural therapy, for diagnosis of patients with obscure gastrointestinal bleeding, not in association with another item in this subgroup (with the exception of item 30682 or 30686)
The patient to whom the service is provided must: (i) have recurrent or persistent bleeding; and (ii) be anaemic or have active bleeding; and (iii) have had an upper gastrointestinal endoscopy and a colonoscopy performed which did not identify the cause of the bleeding. (Anaes.) (See para TN.8.17 of explanatory notes to this Category) Fee: $1,188.70 Benefit: 75% = $891.55 85% = $1104.00 |
|
30682 |
Balloon enteroscopy, examination of the small bowel (anal approach), with or without biopsy, WITHOUT intraprocedural therapy, for diagnosis of patients with obscure gastrointestinal bleeding, not in association with another item in this subgroup (with the exception of item 30680 or 30684)
The patient to whom the service is provided must: (i) have recurrent or persistent bleeding; and (ii) be anaemic or have active bleeding; and (iii) have had an upper gastrointestinal endoscopy and a colonoscopy performed which did not identify the cause of the bleeding. (Anaes.) (See para TN.8.17 of explanatory notes to this Category) Fee: $1,188.70 Benefit: 75% = $891.55 85% = $1104.00 |
|
30684 |
Balloon enteroscopy, examination of the small bowel (oral approach), with or without biopsy, WITH 1 or more of the following procedures (snare polypectomy, removal of foreign body, diathermy, heater probe, laser coagulation or argon plasma coagulation), for diagnosis and management of patients with obscure gastrointestinal bleeding, not in association with another item in this subgroup (with the exception of item 30682 or 30686)
The patient to whom the service is provided must: (i) have recurrent or persistent bleeding; and (ii) be anaemic or have active bleeding; and (iii) have had an upper gastrointestinal endoscopy and a colonoscopy performed which did not identify the cause of the bleeding. (Anaes.) (See para TN.8.17 of explanatory notes to this Category) Fee: $1,462.90 Benefit: 75% = $1097.20 85% = $1378.20 |
|
30686 |
Balloon enteroscopy, examination of the small bowel (anal approach), with or without biopsy, WITH 1 or more of the following procedures (snare polypectomy, removal of foreign body, diathermy, heater probe, laser coagulation or argon plasma coagulation), for diagnosis and management of patients with obscure gastrointestinal bleeding, not in association with another item in this subgroup (with the exception of item 30680 or 30684)
The patient to whom the service is provided must: (i) have recurrent or persistent bleeding; and (ii) be anaemic or have active bleeding; and (iii) have had an upper gastrointestinal endoscopy and a colonoscopy performed which did not identify the cause of the bleeding. (Anaes.) (See para TN.8.17 of explanatory notes to this Category) Fee: $1,462.90 Benefit: 75% = $1097.20 85% = $1378.20 |
|
30687 |
ENDOSCOPY with RADIOFREQUENCY ABLATION of mucosal metaplasia for the treatment of Barrett's Oesophagus in a single course of treatment, following diagnosis of high grade dysplasia confirmed by histological examination (Anaes.) (See para TN.8.17, TN.8.20 of explanatory notes to this Category) Fee: $483.70 Benefit: 75% = $362.80 85% = $411.15 |
Endoscopic US
Cat 3 Therapeutics- T8 Surgical Operations - 1. General
|
30688 |
Endoscopic ultrasound (endoscopy with ultrasound imaging), with or without biopsy, for the staging of 1 or more of oesophageal, gastric or pancreatic cancer, not in association with another item in this Subgroup (other than item 30484, 30485, 30491 or 30494) and other than a service associated with the routine monitoring of chronic pancreatitis. (Anaes.) (See para TN.8.21, TN.8.17 of explanatory notes to this Category) Fee: $370.75 Benefit: 75% = $278.10 85% = $315.15 |
|
30690 |
Endoscopic ultrasound (endoscopy with ultrasound imaging), with or without biopsy, with fine needle aspiration, including aspiration of the locoregional lymph nodes if performed, for the staging of 1 or more of oesophageal, gastric or pancreatic cancer, not in association with another item in this Subgroup (other than item 30484, 30485, 30491 or 30494) and other than a service associated with the routine monitoring of chronic pancreatitis. (Anaes.) (See para TN.8.21, TN.8.17 of explanatory notes to this Category) Fee: $572.30 Benefit: 75% = $429.25 85% = $487.60 |
|
30692 |
Endoscopic ultrasound (endoscopy with ultrasound imaging), with or without biopsy, for the diagnosis of 1 or more of pancreatic, biliary or gastric submucosal tumours, not in association with another item in this Subgroup (other than item 30484, 30485, 30491 or 30494) and other than a service associated with the routine monitoring of chronic pancreatitis. (Anaes.) (See para TN.8.21, TN.8.17 of explanatory notes to this Category) Fee: $370.75 Benefit: 75% = $278.10 85% = $315.15 |
|
30694 |
Endoscopic ultrasound (endoscopy with ultrasound imaging), with or without biopsy, with fine needle aspiration, for the diagnosis of 1 or more of pancreatic, biliary or gastric submucosal tumours, not in association with another item in this Subgroup (other than item 30484, 30485, 30491 or 30494) and other than a service associated with the routine monitoring of chronic pancreatitis. (Anaes.) (See para TN.8.21, TN.8.17 of explanatory notes to this Category) Fee: $572.30 Benefit: 75% = $429.25 85% = $487.60 |
|
30696 |
ENDOSCOPIC ULTRASOUND GUIDED FINE NEEDLE ASPIRATION BIOPSY(S) (endoscopy with ultrasound imaging) to obtain one or more specimens from either: (a) mediastinal mass(es) or (b) locoregional nodes to stage non-small cell lung carcinoma
not being a service associated with another item in this subgroup or to which items 30710 and 55054 apply (Anaes.) (See para TN.8.21 of explanatory notes to this Category) Fee: $572.30 Benefit: 75% = $429.25 85% = $487.60 |
|
30710 |
ENDOBRONCHIAL ULTRASOUND GUIDED BIOPSY(S) (bronchoscopy with ultrasound imaging, with or without associated fluoroscopic imaging) to obtain one or more specimens by either:
(a) transbronchial biopsy(s) of peripheral lung lesions; or (b) fine needle aspiration(s) of a mediastinal mass(es); or (c) fine needle aspiration(s) of locoregional nodes to stage non-small cell lung carcinoma
not being a service associated with another item in this subgroup or to which items 30696, 41892, 41898, and 60500 to 60509 applies (Anaes.) (See para TN.8.21 of explanatory notes to this Category) Fee: $572.30 Benefit: 75% = $429.25 85% = $487.60 |
COLONOSCOPY
Cat 3 Therapeutics - T8. Surgical Operations - 2. Colorectal
|
New 32222 |
Endoscopic examination of the colon to the caecum by colonoscopy, for a patient: (a) following a positive faecal occult blood test; or (b) who has symptoms consistent with pathology of the colonic mucosa; or (c) with anaemia or iron deficiency; or (d) for whom diagnostic imaging has shown an abnormality of the colon; or (e) who is undergoing the first examination following surgery for colorectal cancer; or (f) who is undergoing pre‑operative evaluation; or (g) for whom a repeat colonoscopy is required due to inadequate bowel preparation for the patient’s previous colonoscopy; or (h) for the management of inflammatory bowel disease
Applicable only once on a day under a single episode of anaesthesia or other sedation (Anaes.) (See para TN.8.152, TN.8.17, TN.8.2 of explanatory notes to this Category) Fee: $339.70 Benefit: 75% = $254.80 85% = $288.75 |
|
New 32223 |
Endoscopic examination of the colon to the caecum by colonoscopy, for a patient: (a) who has had a colonoscopy that revealed 1 to 4 adenomas, each of which were less than 10mm in diameter, had no villous features and had no high grade dysplasia; or (b) with a moderate risk of colorectal cancer due to family history; or (c) with a history of colorectal cancer, who has had an initial post‑operative colonoscopy that did not reveal any adenomas or colorectal cancer Applicable only once in any 5 year period (Anaes.) (See para TN.8.152, TN.8.2, TN.8.17 of explanatory notes to this Category) Fee: $339.70 Benefit: 75% = $254.80 85% = $288.75 |
|
May 20 32224 |
Endoscopic examination of the colon to the caecum by colonoscopy, for a patient with a moderate risk of colorectal cancer due to: (a) a history of adenomas, including an adenoma that: (i) was greater than or equal to 10mm in diameter; or (ii) had villous features; or (iii) had high grade dysplasia; or (iv) was an advanced serrated adenoma; or (b) having had a previous colonoscopy that revealed 5 to 9 adenomas, each of which was less than 10mm in diameter, had no villous features and had no high grade dysplasia Applicable only once in any 3 year period (Anaes.) (See para TN.8.152, TN.8.2, TN.8.17 of explanatory notes to this Category) Fee: $339.70 Benefit: 75% = $254.80 85% = $288.75 |
|
New 32225 |
Endoscopic examination of the colon to the caecum by colonoscopy, for a patient with a high risk of colorectal cancer due to having had a previous colonoscopy that: (a) revealed 10 or more adenomas; or (b) included a piecemeal, or possibly incomplete, excision of a large, sessile polyp Applicable not more than 4 times in any 12 month period (Anaes.) (See para TN.8.152, TN.8.2, TN.8.17 of explanatory notes to this Category) Fee: $339.70 Benefit: 75% = $254.80 85% = $288.75 |
|
New 32226 |
Endoscopic examination of the colon to the caecum by colonoscopy, for a patient with a high risk of colorectal cancer due to: (a) a known or suspected familial condition, such as familial adenomatous polyposis, Lynch syndrome or serrated polyposis syndrome; or (b) a genetic mutation associated with hereditary colorectal cancer Applicable only once in any 12 month period (Anaes.) (See para TN.8.152, TN.8.2, TN.8.17 of explanatory notes to this Category) Fee: $339.70 Benefit: 75% = $254.80 85% = $288.75 |
|
May 20 32227 |
Endoscopic examination of the colon to the caecum by colonoscopy: (a) for the treatment of bleeding, including one or more of the following: (i) radiation proctitis; (ii) angioectasia; (iii) post‑polypectomy bleeding; or (b) for the treatment of colonic strictures with balloon dilatation Applicable only once on a day under a single episode of anaesthesia or other sedation (Anaes.) (See para TN.8.152, TN.8.17, TN.8.2 of explanatory notes to this Category) Fee: $476.70 Benefit: 75% = $357.55 85% = $405.20 |
|
New 32228 |
Endoscopic examination of the colon to the caecum by colonoscopy, other that a service to which item 32222, 32223, 32224, 32225, or 32226 applies. Applicable only once (Anaes.) (See para TN.8.17, TN.8.2, TN.8.152 of explanatory notes to this Category) Fee: $339.70 Benefit: 75% = $254.80 85% = $288.75 |
|
New 32229 |
Removal of one or more polyps during colonoscopy, in association with a service to which item 32222, 32223, 32224, 32225, 32226, or 32228 applies (Anaes.) (See para TN.8.152, TN.8.17, TN.8.2 of explanatory notes to this Category) Fee: $274.00 Benefit: 75% = $205.50 85% = $232.90 |
|
32023 |
Endoscopic insertion of stent or stents for large bowel obstruction, stricture or stenosis, including colonoscopy and any image intensification, where the obstruction is due to: a) a pre-diagnosed colorectal cancer, or cancer of an organ adjacent to the bowel; or b) an unknown diagnosis (Anaes.) (See para TN.8.17 of explanatory notes to this Category) Fee: $564.25 Benefit: 75% = $423.20 |
|
32072 |
SIGMOIDOSCOPIC EXAMINATION (with rigid sigmoidoscope), with or without biopsy Fee: $48.60 Benefit: 75% = $36.45 85% = $41.35 |
|
32075 |
SIGMOIDOSCOPIC EXAMINATION (with rigid sigmoidoscope), UNDER GENERAL ANAESTHESIA, with or without biopsy, not being a service associated with a service to which another item in this Group applies (Anaes.) Fee: $76.25 Benefit: 75% = $57.20 85% = $64.85 |
|
May 20 32084 |
Sigmoidoscopy or fibreoptic colonoscopy up to the hepatic flexure, with or without biopsy, other than a service associated with a service to which any of items 32222 to 32228 applies. (Anaes.) (See para TN.8.17, TN.8.134 of explanatory notes to this Category) Fee: $113.15 Benefit: 75% = $84.90 85% = $96.20 |
|
May 20 32087 |
Endoscopic examination of the colon up to the hepatic flexure by sigmoidoscopy or colonoscopy for the removal of 1 or more polyps other than a service associated with a service to which any of items 32222 to 32228 applies(Anaes.) (See para TN.8.17, TN.8.134 of explanatory notes to this Category) Fee: $208.00 Benefit: 75% = $156.00 85% = $176.80 |
|
32094 |
ENDOSCOPIC DILATATION OF COLORECTAL STRICTURES including colonoscopy (Anaes.) (See para TN.8.17 of explanatory notes to this Category) Fee: $560.70 Benefit: 75% = $420.55 |
|
32095 |
ENDOSCOPIC EXAMINATION of SMALL BOWEL with flexible endoscope passed by stoma, with or without biopsies (Anaes.) (See para TN.8.17 of explanatory notes to this Category) Fee: $129.85 Benefit: 75% = $97.40 85% = $110.40 |
|
32096 |
RECTAL BIOPSY, full thickness, under general anaesthesia, or under epidural or spinal (intrathecal) nerve block where undertaken in a hospital (Anaes.) (Assist.) Fee: $261.05 Benefit: 75% = $195.80 |
|
32099 |
RECTAL TUMOUR of 5 centimetres or less in diameter, per anal submucosal excision of (Anaes.) (Assist.) Fee: $338.55 Benefit: 75% = $253.95 |
|
32102 |
RECTAL TUMOUR of greater than 5 centimetres in diameter, indicated by pathological examination, per anal submucosal excision of (Anaes.) (Assist.) Fee: $644.85 Benefit: 75% = $483.65 |
|
32103 |
RECTAL TUMOUR, of less than 4 cm in diameter, per anal excision of, using rectoscopy incorporating either 3 dimensional or 2 dimensional optic viewing systems, if removal is unable to be performed during colonoscopy or by local excision, other than a service associated with a service to which item 32024, 32025, 32104 or 32106 applies (Anaes.) (Assist.) (See para TN.8.31, TN.8.17 of explanatory notes to this Category) Fee: $784.65 Benefit: 75% = $588.50 |
|
32104 |
RECTAL TUMOUR, of 4 cm or greater in diameter, per anal excision of, using rectoscopy incorporating either 3 dimensional or 2 dimensional optic viewing systems, if removal is unable to be performed during colonoscopy or by local excision, other than a service associated with a service to which item 32024, 32025, 32103 or 32106 applies (Anaes.) (Assist.) (See para TN.8.31, TN.8.17 of explanatory notes to this Category) Fee: $1,015.65 Benefit: 75% = $761.75 |
|
32105 |
ANORECTAL CARCINOMA per anal full thickness excision of (Anaes.) (Assist.) Fee: $491.70 Benefit: 75% = $368.80 85% = $417.95 |
|
32171 |
ANORECTAL EXAMINATION, with or without biopsy, under general anaesthetic, not being a service associated with a service to which another item in this Group applies (Anaes.) Fee: $90.20 Benefit: 75% = $67.65 |
Liver Biopsy
1. General - T8. Surgical Operations
|
30409 |
LIVER BIOPSY, percutaneous (Anaes.) Fee: $177.25 Benefit: 75% = $132.95 85% = $150.70 |
|
30411 |
LIVER BIOPSY by wedge excision when performed in conjunction with another intraabdominal procedure (Anaes.) Fee: $90.20 Benefit: 75% = $67.65 |
|
30412 |
LIVER BIOPSY by core needle, when performed in conjunction with another intra-abdominal procedure (Anaes.) Fee: $53.20 Benefit: 75% = $39.90 85% = $45.25 |
CONSULTATION
Group A3. Specialist Attendances To Which No Other Item Applies
|
Amend 99 |
Professional attendance on a patient by a specialist practising in the specialist's specialty if: (a) the attendance is by video conference; and (b) the attendance is for a service: (i) provided with item 104 lasting more than 10 minutes; or (ii) provided with item 105; and (c) the patient is not an admitted patient; and (d) the patient: (i) is located both: (A) within a telehealth eligible area; and (B) at the time of the attendance-at least 15 kms by road from the specialist; or (ii) is a care recipient in a residential care service; or (iii) is a patient of: (A) an Aboriginal Medical Service; or (B) an Aboriginal Community Controlled Health Service; for which a direction made under subsection 19(2) of the Act applies (See para AN.0.68 of explanatory notes to this Category) Derived Fee: 50% of the fee for item 104 or 105. Benefit: 85% of the derived fee Extended Medicare Safety Net Cap: 300% of the Derived fee for this item, or $500.00, whichever is the lesser amount |
|
Amend 104 |
Professional attendance at consulting rooms or hospital by a specialist in the practice of the specialist's specialty after referral of the patient to the specialist-each attendance, other than a second or subsequent attendance, in a single course of treatment, other than a service to which item 106, 109 or 16401 applies (See para TN.1.4 of explanatory notes to this Category) Fee: $88.25 Benefit: 75% = $66.20 85% = $75.05 Extended Medicare Safety Net Cap: $264.75 |
|
Amend 105 |
Professional attendance by a specialist in the practice of the specialist's specialty following referral of the patient to the specialist-an attendance after the first in a single course of treatment, if that attendance is at consulting rooms or hospital, other than a service to which item 16404 applies (See para TN.1.4, AN.0.70 of explanatory notes to this Category) Fee: $44.35 Benefit: 75% = $33.30 85% = $37.70 Extended Medicare Safety Net Cap: $133.05 |
|
Amend 106 |
Professional attendance by a specialist in the practice of the specialist's specialty of ophthalmology and following referral of the patient to the specialist-an attendance (other than a second or subsequent attendance in a single course of treatment) at which the only service provided is refraction testing for the issue of a prescription for spectacles or contact lenses, if that attendance is at consulting rooms or hospital (other than a service to which any of items 104, 109 and 10801 to 10816 applies) Fee: $73.20 Benefit: 75% = $54.90 85% = $62.25 Extended Medicare Safety Net Cap: $219.60 |
|
Amend 107 |
Professional attendance by a specialist in the practice of the specialist's specialty following referral of the patient to the specialist-an attendance (other than a second or subsequent attendance in a single course of treatment), if that attendance is at a place other than consulting rooms or hospital Fee: $129.45 Benefit: 75% = $97.10 85% = $110.05 Extended Medicare Safety Net Cap: $388.35 |
|
Amend 108 |
Professional attendance by a specialist in the practice of the specialist's specialty following referral of the patient to the specialist-each attendance after the first in a single course of treatment, if that attendance is at a place other than consulting rooms or hospital Fee: $81.95 Benefit: 75% = $61.50 85% = $69.70 Extended Medicare Safety Net Cap: $245.85 |
|
Amend 109 |
Professional attendance by a specialist in the practice of the specialist's specialty of ophthalmology following referral of the patient to the specialist-an attendance (other than a second or subsequent attendance in a single course of treatment) at which a comprehensive eye examination, including pupil dilation, is performed on: (a) a patient aged 9 years or younger; or (b) a patient aged 14 years or younger with developmental delay; (other than a service to which any of items 104, 106 and 10801 to 10816 applies) Fee: $198.85 Benefit: 75% = $149.15 85% = $169.05 Extended Medicare Safety Net Cap: $500.00 |
|
Amend 111 |
Professional attendance at consulting rooms or in hospital by a specialist in the practice of the specialist's specialty following referral of the patient to the specialist by a referring practitioner-an attendance after the first attendance in a single course of treatment, if: (a) during the attendance, the specialist determines the need to perform an operation on the patient that had not otherwise been scheduled; and (b) the specialist subsequently performs the operation on the patient, on the same day; and (c) the operation is a service to which an item in Group T8 applies; and (d) the amount specified in the item in Group T8 as the fee for a service to which that item applies is $304.80 or more For any particular patient, once only on the same day Fee: $44.35 Benefit: 75% = $33.30 85% = $37.70 Extended Medicare Safety Net Cap: $133.05 |
|
Amend 113 |
Initial professional attendance of 10 minutes or less in duration on a patient by a specialist in the practice of the specialist's speciality if: (a) the attendance is by video conference; and (b) the patient is not an admitted patient; and (c) the patient: (i) is located both: (A) within a telehealth eligible area; and (B) at the time of the attendance-at least 15 kms by road from the specialist; or (ii) is a care recipient in a residential care service; or (iii) is a patient of: (A) an Aboriginal Medical Service; or (B) an Aboriginal Community Controlled Health Service; for which a direction made under subsection 19(2) of the Act applies; and (d) no other initial consultation has taken place for a single course of treatment (See para AN.0.68 of explanatory notes to this Category) Fee: $66.20 Benefit: 85% = $56.30 Extended Medicare Safety Net Cap: $198.60 |
|
115 |
Professional attendance at consulting rooms or in hospital by a specialist or consultant physician in the practice of the medical practitioner’s specialty after referral of the patient to the specialist or consultant physician by a referring practitioner—an attendance after the first attendance in a single course of treatment, if: (a) the specialist or consultant physician performs a scheduled operation on that patient on the same day; and (b) the operation is one to which an item in Group T8 applies; and (c) the amount specified in the item in Group T8 as the fee for a service to which the item applies is $304.80 or more; and (d) the attendance is unrelated to the scheduled operation; and (e) it is considered a clinical risk to defer the attendance to a later date. For any particular patient, once only on the same day.
(See para AN.3.1 of explanatory notes to this Category) Fee: $44.35 Benefit: 75% = $33.30 85% = $37.70 Extended Medicare Safety Net Cap: $133.05 |
Group A4. Consultant Physician Attendances To Which No Other Item Applies
|
Amend 110 |
Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of the consultant physician's specialty (other than psychiatry) following referral of the patient to the consultant physician by a referring practitioner-initial attendance in a single course of treatment Fee: $155.60 Benefit: 75% = $116.70 85% = $132.30 Extended Medicare Safety Net Cap: $466.80 |
|
Amend 112 |
Professional attendance on a patient by a consultant physician practising in the consultant physician's specialty if: (a) the attendance is by video conference; and (b) the attendance is for a service: (i) provided with item 110 lasting more than 10 minutes; or (ii) provided with item 116, 119, 132 or 133; and (c) the patient is not an admitted patient; and (d) the patient: (i) is located both: (A) within a telehealth eligible area; and (B) at the time of the attendance-at least 15 kms by road from the physician; or (ii) is a care recipient in a residential care service; or (iii) is a patient of: (A) an Aboriginal Medical Service; or (B) an Aboriginal Community Controlled Health Service; for which a direction made under subsection 19(2) of the Act applies (See para AN.0.68 of explanatory notes to this Category) Derived Fee: 50% of the fee for the associated item. Benefit: 85% of derived fee. Extended Medicare Safety Net Cap: 300% of the Derived fee for this item, or $500.00, whichever is the lesser amount |
|
Amend 114 |
Initial professional attendance of 10 minutes or less in duration on a patient by a consultant physician practising in the consultant physician's specialty if: (a) the attendance is by video conference; and (b) the patient is not an admitted patient; and (c) the patient: (i) is located both: (A) within a telehealth eligible area; and (B) at the time of the attendance-at least 15 kms by road from the physician; or (ii) is a care recipient in a residential care service; or (iii) is a patient of: (A) an Aboriginal Medical Service; or (B) an Aboriginal Community Controlled Health Service; for which a direction made under subsection 19(2) of the Act applies; and (d) no other initial consultation has taken place for a single course of treatment
(See para AN.0.68 of explanatory notes to this Category) Fee: $116.75 Benefit: 85% = $99.25 Extended Medicare Safety Net Cap: $350.25 |
|
Amend 116 |
Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of the consultant physician's specialty (other than psychiatry) following referral of the patient to the consultant physician by a referring practitioner-each attendance (other than a service to which item 119 applies) after the first in a single course of treatment (See para AN.0.70 of explanatory notes to this Category) Fee: $77.90 Benefit: 75% = $58.45 85% = $66.25 Extended Medicare Safety Net Cap: $233.70 |
|
Amend 117 |
Professional attendance at consulting rooms or in hospital, by a consultant physician in the practice of the consultant physician's specialty (other than psychiatry) following referral of the patient to the consultant physician by a referring practitioner-an attendance after the first attendance in a single course of treatment, if: (a) the attendance is not a minor attendance; and (b) during the attendance, the consultant physician determines the need to perform an operation on the patient that had not otherwise been scheduled; and (c) the consultant physician subsequently performs the operation on the patient, on the same day; and (d) the operation is a service to which an item in Group T8 applies; and (e) the amount specified in the item in Group T8 as the fee for a service to which that item applies is $304.80 or more For any particular patient, once only on the same day Fee: $77.90 Benefit: 75% = $58.45 85% = $66.25 Extended Medicare Safety Net Cap: $233.70 |
|
Amend 119 |
Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of the consultant physician's specialty (other than psychiatry) following referral of the patient to the consultant physician by a referring practitioner-each minor attendance after the first in a single course of treatment (See para AN.0.21, AN.0.70 of explanatory notes to this Category) Fee: $44.35 Benefit: 75% = $33.30 85% = $37.70 Extended Medicare Safety Net Cap: $133.05 |
|
Amend 120 |
Professional attendance at consulting rooms or in hospital by a consultant physician in the practice of the consultant physician's specialty (other than psychiatry) following referral of the patient to the consultant physician by a referring practitioner-an attendance after the first attendance in a single course of treatment, if: (a) the attendance is a minor attendance; and (b) during the attendance, the consultant physician determines the need to perform an operation on the patient that had not otherwise been scheduled; and (c) the consultant physician subsequently performs the operation on the patient, on the same day; and (d) the operation is a service to which an item in Group T8 applies; and (e) the amount specified in the item in Group T8 as the fee for a service to which that item applies is $304.80 or more For any particular patient, once only on the same day (See para AN.0.21 of explanatory notes to this Category) Fee: $44.35 Benefit: 75% = $33.30 85% = $37.70 Extended Medicare Safety Net Cap: $133.05 |
|
Amend 122 |
Professional attendance at a place other than consulting rooms or hospital, by a consultant physician in the practice of the consultant physician's specialty (other than psychiatry) following referral of the patient to the consultant physician by a referring practitioner-initial attendance in a single course of treatment Fee: $188.80 Benefit: 75% = $141.60 85% = $160.50 Extended Medicare Safety Net Cap: $500.00 |
|
Amend 128 |
Professional attendance at a place other than consulting rooms or hospital, by a consultant physician in the practice of the consultant physician's specialty (other than psychiatry) following referral of the patient to the consultant physician by a referring practitioner-each attendance (other than a service to which item 131 applies) after the first in a single course of treatment Fee: $114.20 Benefit: 75% = $85.65 85% = $97.10 Extended Medicare Safety Net Cap: $342.60 |
|
Amend 131 |
Professional attendance at a place other than consulting rooms or hospital, by a consultant physician in the practice of the consultant physician's specialty (other than psychiatry) following referral of the patient to the consultant physician by a referring practitioner-each minor attendance after the first in a single course of treatment (See para AN.0.21 of explanatory notes to this Category) Fee: $82.25 Benefit: 75% = $61.70 85% = $69.95 Extended Medicare Safety Net Cap: $246.75 |
|
Amend 132 |
Professional 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 applies did not take place on the same day by the same consultant physician; and (d) this item has not applied to an attendance on the patient in the preceding 12 months by the same consultant physician (See para AN.0.23 of explanatory notes to this Category) Fee: $272.15 Benefit: 75% = $204.15 85% = $231.35 Extended Medicare Safety Net Cap: $500.00 |
|
Amend 133 |
Professional 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 applies did not take place on the same day by the same consultant physician; and (d) item 132 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 or a locum tenens; and (f) this item has not applied more than twice in any 12 month period (See para AN.0.23 of explanatory notes to this Category) Fee: $136.25 Benefit: 75% = $102.20 85% = $115.85 Extended Medicare Safety Net Cap: $408.75 |
Group A5. Prolonged Attendances To Which No Other Item Applies
PROLONGED PROFESSIONAL ATTENDANCE
Professional attendance (not being a service to which another item in this Category applies) on a patient in imminent danger of death. The time period relates to the total time spent with a single patient, even if the time spent by the practitioner is not continuous. Attendance on one patient at risk of imminent death may be provided by one or more general practitioners, specialists or consultant physicians on the one occasion.
|
160 |
Professional attendance by a general practitioner, specialist or consultant physician for a period of not less than 1 hour but less than 2 hours (other than a service to which another item applies) on a patient in imminent danger of death (See para AN.0.27 of explanatory notes to this Category) Fee: $225.05 Benefit: 75% = $168.80 100% = $225.05 Extended Medicare Safety Net Cap: $500.00 |
|
161 |
Professional attendance by a general practitioner, specialist or consultant physician for a period of not less than 2 hours but less than 3 hours (other than a service to which another item applies) on a patient in imminent danger of death (See para AN.0.27 of explanatory notes to this Category) Fee: $375.05 Benefit: 75% = $281.30 100% = $375.05 Extended Medicare Safety Net Cap: $500.00 |
|
162 |
Professional attendance by a general practitioner, specialist or consultant physician for a period of not less than 3 hours but less than 4 hours (other than a service to which another item applies) on a patient in imminent danger of death (See para AN.0.27 of explanatory notes to this Category) Fee: $524.90 Benefit: 75% = $393.70 100% = $524.90 Extended Medicare Safety Net Cap: $500.00 |
|
163 |
Professional attendance by a general practitioner, specialist or consultant physician for a period of not less than 4 hours but less than 5 hours (other than a service to which another item applies) on a patient in imminent danger of death (See para AN.0.27 of explanatory notes to this Category) Fee: $675.20 Benefit: 75% = $506.40 100% = $675.20 Extended Medicare Safety Net Cap: $500.00 |
|
164 |
Professional attendance by a general practitioner, specialist or consultant physician for a period of 5 hours or more (other than a service to which another item applies) on a patient in imminent danger of death (See para AN.0.27 of explanatory notes to this Category) Fee: $750.20 Benefit: 75% = $562.65 100% = $750.20 Extended Medicare Safety Net Cap: $500.00 |
Telehealth
Group A30. Medical Practitioner (Including A General Practitioner, Specialist Or Consultant Physician) Telehealth Attendances
Subgroup 1. Telehealth Attendance At Consulting Rooms, Home Visits Or Other Institutions
|
2100 |
Professional attendance at consulting rooms of at least 5 minutes in duration (whether or not continuous) by a medical practitioner providing clinical support to a patient who: (a) is participating in a video conferencing consultation with a specialist or consultant physician; and (b) is not an admitted patient; and (c) either: (i) is located both: (A) within a telehealth eligible area; and (B) at the time of the attendance-at least 15 kms by road from the specialist or physician mentioned in paragraph (a); or (ii) is a patient of: (A) an Aboriginal Medical Service; or (B) an Aboriginal Community Controlled Health Service: for which a direction made under subsection 19(2) of the Act applies (See para AN.0.67 of explanatory notes to this Category) Fee: $23.25 Benefit: 100% = $23.25 Extended Medicare Safety Net Cap: $69.75 |
|
2122 |
Professional attendance not in consulting rooms of at least 5 minutes in duration (whether or not continuous) by a medical practitioner providing clinical support to a patient who: (a) is participating in a video conferencing consultation with a specialist or consultant physician; and (b) is not an admitted patient; and (c) is not a care recipient in a residential care service; and (d) is located both: (i) within a telehealth eligible area; and (ii) at the time of the attendance-at least 15 kms by road from the specialist or physician mentioned in paragraph (a); for an attendance on one or more patients at one place on one occasion-each patient (See para AN.0.67 of explanatory notes to this Category) Derived Fee: The fee for item 2100 plus $26.35 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 2100 plus $2.05 per patient. Extended Medicare Safety Net Cap: 300% of the Derived fee for this item, or $500.00, whichever is the lesser amount |
|
2126 |
Professional attendance at consulting rooms of less than 20 minutes in duration (whether or not continuous) by a medical practitioner providing clinical support to a patient who: (a) is participating in a video conferencing consultation with a specialist or consultant physician; and (b) is not an admitted patient; and (c) either: (i) is located both: (A) within a telehealth eligible area; and (B) at the time of the attendance-at least 15 kms by road from the specialist or physician mentioned in paragraph (a); or (ii) is a patient of: (A) an Aboriginal Medical Service; or (B) an Aboriginal Community Controlled Health Service; for which a direction made under subsection 19(2) of the Act applies (See para AN.0.67 of explanatory notes to this Category) Fee: $50.75 Benefit: 100% = $50.75 Extended Medicare Safety Net Cap: $152.25 |
|
2137 |
Professional attendance not in consulting rooms of less than 20 minutes in duration (whether or not continuous) by a medical practitioner providing clinical support to a patient who: (a) is participating in a video conferencing consultation with a specialist or consultant physician; and (b) is not an admitted patient; and (c) is not a care recipient in a residential care service; and (d) is located both: (i) within a telehealth eligible area; and (ii) at the time of the attendance-at least 15 kms by road from the specialist or physician mentioned in paragraph (a); for an attendance on one or more patients at one place on one occasion-each patient (See para AN.0.67 of explanatory notes to this Category) Derived Fee: The fee for item 2126 plus $26.35 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 2126 plus $2.05 per patient. Extended Medicare Safety Net Cap: 300% of the Derived fee for this item, or $500.00, whichever is the lesser amount |
|
2143 |
Professional attendance at consulting rooms of at least 20 minutes in duration (whether or not continuous) by a medical practitioner who provides clinical support to a patient who: (a) is participating in a video conferencing consultation with a specialist or consultant physician; and (b) is not an admitted patient; and (c) either: (i) is located both: (A) within a telehealth eligible area; and (B) at the time of the attendance-at least 15 kms by road from the specialist or physician mentioned in paragraph (a); or (ii) is a patient of: (A) an Aboriginal Medical Service; or (B) an Aboriginal Community Controlled Health Service: for which a direction made under subsection 19(2) of the Act applies (See para AN.0.67 of explanatory notes to this Category) Fee: $98.40 Benefit: 100% = $98.40 Extended Medicare Safety Net Cap: $295.20 |
|
2147 |
Professional attendance not in consulting rooms of at least 20 minutes in duration (whether or not continuous) by a medical practitioner providing clinical support to a patient who: (a) is participating in a video conferencing consultation with a specialist or consultant physician; and (b) is not an admitted patient; and (c) is not a care recipient in a residential care service; and (d) is located both: (i) within a telehealth eligible area; and (ii) at the time of the attendance-at least 15 kms by road from the specialist or physician mentioned in paragraph (a); for an attendance on one or more patients at one place on one occasion-each patient (See para AN.0.67 of explanatory notes to this Category) Derived Fee: The fee for item 2143 plus $26.35 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 2143 plus $2.05 per patient. Extended Medicare Safety Net Cap: 300% of the Derived fee for this item, or $500.00, whichever is the lesser amount |
|
2195 |
Professional attendance at consulting rooms of at least 40 minutes in duration (whether or not continuous) by a medical practitioner providing clinical support to a patient who: (a) is participating in a video conferencing consultation with a specialist or consultant physician; and (b) is not an admitted patient; and (c) either: (i) is located both: (A) within a telehealth eligible area; and (B) at the time of the attendance-at least 15 kms by road from the specialist or physician mentioned in paragraph (a); or (ii) is a patient of: (A) an Aboriginal Medical Service; or (B) an Aboriginal Community Controlled Health Service; for which a direction made under subsection 19(2) of the Act applies (See para AN.0.67 of explanatory notes to this Category) Fee: $144.80 Benefit: 100% = $144.80 Extended Medicare Safety Net Cap: $434.40 |
|
2199 |
Professional attendance not in consulting rooms of at least 40 minutes in duration (whether or not continuous) by a medical practitioner providing clinical support to a patient who: (a) is participating in a video conferencing consultation with a specialist or consultant physician; and (b) is not an admitted patient; and (c) is not a care recipient in a residential care service; and (d) is located both: (i) within a telehealth eligible area; and (ii) at the time of the attendance-at least 15 kms by road from the specialist or physician mentioned in paragraph (a); for an attendance on one or more patients at one place on one occasion-each patient (See para AN.0.67 of explanatory notes to this Category) Derived Fee: The fee for item 2195 plus $26.35 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 2195 plus $2.05 per patient. Extended Medicare Safety Net Cap: 300% of the Derived fee for this item, or $500.00, whichever is the lesser amount |
Group A30. Medical Practitioner (Including A General Practitioner, Specialist Or Consultant Physician) Telehealth Attendances
|
2125 |
Professional attendance of at least 5 minutes in duration (whether or not continuous) by a general practitioner, specialist or consultant physician providing clinical support to a patient who: (a) is participating in a video conferencing consultation with a specialist or consultant physician; and (b) is a care recipient in a residential care service; and (c) is not a resident of a self-contained unit; for an attendance on one or more patients at one place on one occasion-each patient (See para AN.0.67 of explanatory notes to this Category) Derived Fee: The fee for item 2100 plus $47.45 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 2100 plus $3.35 per patient. Extended Medicare Safety Net Cap: 300% of the Derived fee for this item, or $500.00, whichever is the lesser amount |
|
2138 |
Professional attendance of less than 20 minutes in duration (whether or not continuous) by a general practitioner, specialist or consultant physician providing clinical support to a patient who: (a) is participating in a video conferencing consultation with a specialist or consultant physician; and (b) is a care recipient in a residential care service; and (c) is not a resident of a self-contained unit; for an attendance on one or more patients at one place on one occasion-each patient (See para AN.0.67 of explanatory notes to this Category) Derived Fee: The fee for item 2126 plus $47.45 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 2126 plus $3.35 per patient. Extended Medicare Safety Net Cap: 300% of the Derived fee for this item, or $500.00, whichever is the lesser amount |
|
2179 |
Professional attendance of at least 20 minutes in duration (whether or not continuous) by a general practitioner, specialist or consultant physician providing clinical support to a patient who: (a) is participating in a video conferencing consultation with a specialist or consultant physician; and (b) is a care recipient in a residential care service; and (c) is not a resident of a self-contained unit; for an attendance on one or more patients at one place on one occasion-each patient (See para AN.0.67 of explanatory notes to this Category) Derived Fee: The fee for item 2143 plus $47.45 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 2143 plus $3.35 per patient. Extended Medicare Safety Net Cap: 300% of the Derived fee for this item, or $500.00, whichever is the lesser amount |
|
2220 |
Professional attendance of at least 40 minutes in duration (whether or not continuous) by a general practitioner, specialist or consultant physician providing clinical support to a patient who: (a) is participating in a video conferencing consultation with a specialist or consultant physician; and (b) is a care recipient in a residential care service; and (c) is not a resident of a self-contained unit; for an attendance on one or more patients at one place on one occasion-each patient (See para AN.0.67 of explanatory notes to this Category) Derived Fee: The fee for item 2195 plus $47.45 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 2195 plus $3.35 per patient. Extended Medicare Safety Net Cap: 300% of the Derived fee for this item, or $500.00, whichever is the lesser amount |
Rural Tele
Group A30. Medical Practitioner (Including A General Practitioner, Specialist Or Consultant Physician) Telehealth Attendances
Subgroup 6. Other Non-Referred Video Conferencing Consultation Attendance for Patients in Rural and Remote Areas
|
New 2471 |
Professional attendance by video conference of not more than 5 minutes in duration (other than a service to which another item applies) by a medical practitioner (who is not a general practitioner), only if: (a) the patient is not an admitted patient; and (b) the patient is located within a Modified Monash 6 area or a Modified Monash 7 area; and (c) at the time of the attendance, the patient and the medical practitioner are at least 15 km by road from each other; and (d) the patient has received 3 face‑to‑face professional attendances from that practitioner in the preceding 12 months.
Fee: $11.00 Benefit: 100% = $11.00 Extended Medicare Safety Net Cap: $33.00 |
|
New 2472 |
Professional attendance by video conference of more than 5 minutes in duration but not more than 25 minutes (other than a service to which another item applies) by a medical practitioner (who is not a general practitioner), only if: (a) the patient is not an admitted patient; and (b) the patient is located within a Modified Monash 6 area or a Modified Monash 7 area; and (c) at the time of the attendance, the patient and the medical practitioner are at least 15 km by road from each other; and (d) the patient has received 3 face‑to‑face professional attendances from that practitioner in the preceding 12 months. Fee: $21.00 Benefit: 100% = $21.00 Extended Medicare Safety Net Cap: $63.00 |
|
New 2475 |
Professional attendance by video conference of more than 25 minutes in duration but not more than 45 minutes (other than a service to which another item applies) by a medical practitioner (who is not a general practitioner), only if: (a) the patient is not an admitted patient; and (b) the patient is located within a Modified Monash 6 area or a Modified Monash 7 area; and (c) at the time of the attendance, the patient and the medical practitioner are at least 15 km by road from each other; and (d) the patient has received 3 face‑to‑face professional attendances from that practitioner in the preceding 12 months. Fee: $38.00 Benefit: 100% = $38.00 Extended Medicare Safety Net Cap: $114.00 |
|
New 2478 |
Professional attendance by video conference of more than 45 minutes in duration (other than a service to which another item applies) by a medical practitioner (who is not a general practitioner), only if: (a) the patient is not an admitted patient; and (b) the patient is located within a Modified Monash 6 area or a Modified Monash 7 area; and (c) at the time of the attendance, the patient and the medical practitioner are at least 15 km by road from each other; and (d) the patient has received 3 face‑to‑face professional attendances from that practitioner in the preceding 12 months. Fee: $61.00 Benefit: 100% = $61.00 Extended Medicare Safety Net Cap: $183.00 |
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