Medicare items CDM, Assessments and auxiliary (follow up notes)

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Medicare items CDM, Assessments and auxiliary

(It is not the whole guide on CDM items but a follow up / reminder to GPs who had CDM training recently)

Item Brief description How this item is utilised
721

($144.25)

General Practitioner Management Plan (GPMP) Patient must have chronic condition

Plan has to be recorded

Patient’s consent has to be recorded

Copy has to be offered to the patient

Can be billed every 12 – 24 months

723

(114.30)

Team Care Arrangement (TCA) Patient must have chronic condition

Plan has to be recorded

Patient’s consent has to be recorded

Copy has to be offered to the patient

+

There has to be 2 collaborating providers agreeing to be part of TCA

Completion of GPMP + TCA gives right to issue AHP EPC referral to see approved  allied health practitioners 5 times in calendar year with Medicare Rebate

Can be billed every 12 – 24 months

732

($72.05)

Review of General Practitioner Management Plan (GPMP) OR/ AND Team Care Arrangement (TCA) Review of the above items.

Can be billed as 732+732 on the same day – Not Duplicate Service

Can be billed every 3 – 6 months

900

($154.80)

Home Medicine Review or Domiciliary Medicine Review Best HMR system: https://www.hmrreferrals.com.au/

Can be billed every 12- 24 months

701

($59.35)

Health Assessment

0 <30 min

Important: the only Medicare item that allows combining GP and a Nurse time.

AusDrisk (every 3 years)

45- 49 years old check up (once in a lifetime)

75+ Annual Assessment (every year)

Intellectual disability assessment (every 12 months)

4 years old check up – removed

Refugee assessment (once in a lifetime)

703

($137.90)

Health Assessment

30 min < 45 min

705

($190.30)

Health Assessment

45 min < 60 min

707

($268.80)

Health Assessment

> 60 min

11506

($17.50)

Spirometry 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
11610

($54.20)

ABI Doppler MEASUREMENT OF ANKLE: BRACHIAL INDICES AND 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.
4001

($76.60)

Nondirective support counselling Professional attendance for the purpose of providing non-directive pregnancy support counselling to a person who is currently pregnant or who has been pregnant in the preceding 12 months, by a medical practitioner registered with Medicare Australia as meeting the credentialing requirements for provision of this service, and lasting at least 20 minutes. The service may be used to address any pregnancy related issues for which non-directive counselling is appropriate.

(In order to bill this items – GPs must complete online training first)

10997

($12.00)

CDM Follow up item billed on behalf of the GP by a nurse Service provided to a person with a chronic disease by a practice nurse or an Aboriginal and Torres Strait Islander health practitioner if:

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

(b) the person is not an admitted patient of a hospital; and

(c) the person has a GP Management Plan, Team Care Arrangements or Multidisciplinary Care Plan in place; and

(d) the service is consistent with the GP Management Plan, Team Care Arrangements or Multidisciplinary Care Plan

to a maximum of 5 services per patient in a calendar year

2717

($134.10)

Mental Health Plan >40 minutes Consist of two parts:

Assessment

An assessment of a patient must include:

·           recording the patient’s agreement for the GP Mental Health Treatment Plan service;

·           taking relevant history (biological, psychological, social) including the presenting complaint;

·           conducting a mental state examination;

·           assessing associated risk and any co-morbidity;

·           making a diagnosis and/or formulation; and

·           administering an outcome measurement tool, except where it is considered clinically inappropriate.

AND

In addition to assessment of the patient, preparation of a GP Mental Health Treatment Plan must include:

·           discussing the assessment with the patient, including the mental health formulation and diagnosis or provisional diagnosis;

·           identifying and discussing referral and treatment options with the patient, including appropriate support services;

·           agreeing goals with the patient – what should be achieved by the treatment – and any actions the patient will take;

·           provision of psycho-education;

·           a plan for crisis intervention and/or for relapse prevention, if appropriate at this stage;

·           making arrangements for required referrals, treatment, appropriate support services, review and follow-up; and

·           documenting this (results of assessment, patient needs, goals and actions, referrals and required treatment/services, and review date) in the patient’s GP Mental Health Treatment Plan.

2715

($91.05)

Mental Health Plan

20 to 40 minutes

2712

($71.70)

Review of Mental Health Plan No time limit.

Can be billed every 3 – 6 months

2713

($71.70)

Mental Health Consultation Has to be 20 min long

Has to be dedicated to a mental health issue

A GP Mental Health Treatment Consultation must include:

·           taking relevant history and identifying the patient’s presenting problem(s) (if not previously documented);

·           providing treatment, advice and/or referral for other services or treatment; and

·           documenting the outcomes of the consultation in the patient’s medical records and other relevant mental health plan (where applicable).

715

($212.25)

ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLES HEALTH ASSESSMENT At consulting rooms or in another place

NOT hospital or Residential Aged Care Facility

Health assessment of a patient who is of Aboriginal or Torres Strait Islander

Once in a 9 month period.

2517 or 2521 Diabetes Service Incentive Payment

Level B or C respectively

COMPLETION OF A CYCLE OF CARE FOR PATIENTS WITH ESTABLISHED DIABETES MELLITUS

The minimum requirements of care to complete an annual Diabetes Cycle of Care for patients with established diabetes mellitus must be completed over a period of at least 11 months and up to 13 months, and must include:

–     Assess diabetes control by measuring HbA1c      At least once every  year

–     Ensure that a comprehensive eye examination is carried out*     At least once every two years

–     Measure weight and height and calculate BMI**      At least twice every cycle of care

–     Measure blood pressure      At least twice every cycle of care

–     Examine feet***      At least twice every cycle of care

–     Measure total cholesterol, triglycerides and HDL cholesterol     At least once every year

–     Test for microalbuminuria      At least once  every year

Test for estimated Glomerular Filtration Rate (eGFR)                 At least once every year

–     Provide self-care education      Patient education regarding diabetes management

–     Review diet      Reinforce information about appropriate dietary                      choices

–     Review levels of physical activity      Reinforce information about appropriate levels of                      physical activity

–     Check smoking status      Encourage cessation of smoking (if relevant)

–     Review of medication      Medication review

Download as PDF Medicare items CDM Assessments and auxiliary

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