What is your take on item 11607? Can a GP bill this number?

Question: What is your take on item 11607? Can a GP bill this number?

Answer: Yes, a GP can use the item 11607. Medicare mentions ‘medical practitioner’ in the description of this number, rather than a specialist.

When a 24-hour ambulatory blood pressure monitor (ABPM) can be billed.

1. Who qualifies
   • The patient’s blood pressure in the clinic is in the “high but not extreme” range:
     • Systolic (top number): between 140 and 180 mmHg, or
     • Diastolic (bottom number): between 90 and 110 mmHg.
   • The patient has not yet started blood pressure tablets.
2. How the test must be done
   • It runs for at least 24 hours, including times when the patient is resting.
   • The machine must use modern digital analysis (not just a simple cuff and logbook).
   • A doctor must interpret the results, write the report, and give the patient a treatment plan.
3. What it cannot be combined with
   • It cannot be done at the same time as a 24-hour heart rhythm (ECG) monitor.
   • It cannot be billed together with a list of other specific Medicare item numbers (mostly health assessments, care plans, and certain cardiac tests).
   • It can be billed with 23 if this consultation is unrelated to the blood pressure problem or blood pressure monitoring.

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In short:
If a patient has moderately high blood pressure, hasn’t started treatment, and you use proper ABPM equipment for at least 24 hours, including rest, with a doctor interpreting and giving a plan, then this item can be billed—unless it’s being done alongside certain other Medicare services.

Treatment Plan Guidelines

To meet Medicare requirements, the doctor must prepare a written plan that includes:

1. Diagnosis – state the patient’s blood pressure diagnosis.
2. Goals – set realistic management goals that the patient agrees with.
3. Interventions – lifestyle advice (diet, exercise, reducing alcohol, smoking cessation).
4. Possible treatment – note any medication that may be needed.
5. Review date – specify when the plan will be reviewed.

When preparing the plan, the doctor must:

• Explain the process to the patient (and carer if relevant).
• Record the plan and the patient’s agreement.
• Offer a copy to the patient (and carer if relevant).
• Keep a copy in the medical record.

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Additional Claiming Guidelines

• Equipment: Both the in-clinic and the ambulatory monitor must be ARTG-listed and regularly recalibrated.
• Consultations: A separate consultation can only be billed if another unrelated problem needs immediate attention.
  • If this happens, the invoice or Medicare voucher should clearly note that the extra consultation was “clinically required.”

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 In short:
To bill item 11607 for 24-hour ABPM, the patient must meet the blood pressure criteria, not yet be on tablets, the test must be done with approved equipment, and the doctor must provide a proper written treatment plan with goals, interventions, and a review date. A separate consult can only be billed if another urgent issue arises at the same visit.

Please always refer to the MBS schedule book for the interpretation of Medicare items.