Technical information
Description of non-hospital Medicare-subsidised services
This release provides information on non-hospital Medicare Benefits Schedule (MBS) service items up to 30 June 2019, which precedes the introduction of new MBS items in response to the COVID-19 pandemic.
In this report, non-hospital Medicare-subsidised services refers to services provided in non-inpatient settings. This excludes services delivered to patients admitted to hospital at the time of receiving the service or where the care was provided as part of an episode of hospital-substitute treatment where the patient received a benefit from a private health insurer. While services provided in-hospital are excluded, the data do include services provided in places like private outpatient clinics (which may or may not be located within the grounds of a hospital).
For detailed information on the reported services and MBS items, see the Australian Government Department of Health website: MBS Online.
| Reported service groups | Description | Broad Type Of Service (BTOS)/Group/subgroup/item included(a)(b) |
|---|---|---|
| GP attendances (total) |
GP attendances include Enhanced Primary Care, After-hours GP attendances, Practice Incentive Program (PIP) services, and Other GP services. These services are Medicare-subsidised patient/doctor encounters, such as visits and consultations, for which the patient has not been referred by another doctor. These services can be provided by a GP or other medical practitioner. Excludes services provided by practice nurses and Aboriginal and Torres Strait Islander health practitioners on a GP’s behalf. From 1 July 2018, new items were introduced to enable non-specialist practitioners to provide general attendance services. The terms non-specialist practitioner and other medical practitioner are used interchangeably in this report. For more information see 1 May 2019 Medicare Benefits Schedule book (Department of Health 2019a). GP subgroups affected by this change are footnoted (b). |
BTOS 101, 102(c), 103 (GP subtotals: Enhanced Primary Care, After-hours GP attendances, PIP services, and Other) |
See Notes section below for more information.
| Reported service groups | Description | BTOS/Group/subgroup/ item included(a)(b) |
|---|---|---|
| GP subtotal – Enhanced Primary Care |
In this report, GP Enhanced Primary Care refers to a range of services such as health assessments, medication management reviews, the creation and review of treatment plans, and coordination of care for people living with complex health conditions who require multidisciplinary, team-based care from a GP and at least two other providers. GP subtotal – Enhanced Primary Care includes Health Assessments, Chronic Disease Management Plans, Multidisciplinary Case Conferences, Domiciliary and Residential Medication Management Reviews, and Mental Health services (including preparation or review of mental health treatment plans, extended consultations related to a mental health issue but excluding focussed psychological strategies and family group therapy). These services are designed to provide a structured approach for GPs and non-specialist medical practitioners to care for people with chronic conditions and complex care needs, and to improve coordination of care for people who require multidisciplinary, team-based care. |
BTOS 102(c)(d) |
| GP Health Assessment | Health assessment of a patient's physical and psychological health and function and recommendation of preventive health care or education to improve that patient's health and physical, psychological and social function. Eligible patients include: people of Aboriginal and Torres Strait Islander descent, people who have an intellectual disability, refugees and humanitarian entrants, residents of residential aged care facilities, people aged 75 years or older, and people aged 40-49 years with a high risk of developing type 2 diabetes or at risk of developing another chronic disease. From 1 April 2019, Heart Health Assessments were added for people who have or are at risk of developing cardiovascular disease. | Group A14; Subgroup A7.5 |
| GP Chronic Disease Management Plan | Services relating to the preparation, coordination and review of a GP Management Plan or Team Care Arrangements, or the contribution to a Multidisciplinary Care Plan for patients with a chronic or terminal medical condition. A chronic medical condition is one that has been, or is likely to be, present for six months or longer. | Subgroup A15.1; Items 229, 230, 231, 232, 233 |
| GP Multidisciplinary Case Conference | Service where a medical practitioner (not including a specialist or consultant physician) organises and coordinates, or participates in, multidisciplinary case conferences for patients who have a chronic condition that has been (or is likely to be) present for 6 months or longer, or is terminal, and who has complex multidisciplinary care needs. Case conferences generally involve the patient’s usual GP, or non-specialist medical practitioner, and at least two other providers, such as allied health professionals, other medical practitioners, home and community service providers, and care organisers (e.g. “meals on wheels” providers). | Items 235, 236, 237, 238, 239, 240, 243, 244, 735, 739, 743, 747, 750, 758 |
| Medication Management Review (domiciliary) | Also known as Home Medicines Review. Available for people living in the community who are at risk of medication misadventure. Intended to maximise an individual patient's benefit from their medication regimen, and prevent medication-related problems through a team approach, involving the patient's GP, or non-specialist medical practitioner, and preferred community pharmacy or accredited pharmacist. These items are claimed by GPs or non-specialist medical practitioners. | Items 245, 900 |
| Medication Management Review (residential) |
A collaborative medication management service available to permanent residents of a residential aged care facility for whom quality use of medicines may be an issue or who are at risk of medication misadventure because of a significant change in their condition or medication regimen. These items are claimed by GPs or non-specialist medical practitioners. |
Items 249, 903 |
| GP Mental Health |
Early intervention, assessment and management of patients with mental disorders by GPs or other medical practitioners (who are not specialists or consultant physicians). These services include assessments, planning patient care and treatments, referring to other mental health professionals, ongoing management and review of the patient’s progress. This group comprises MBS items for the preparation and review of GP Mental Health Treatment Plans as well as extended consultations related to mental health issues, excluding GP Focussed Psychological Strategies and Family Group Therapy. Items 894, 896, 898, 2121, 2150 and 2196 are attendances by video conferencing to provide mental health and well-being support to people living in drought-affected communities. |
Subgroup A20.1; Items 272, 276, 277, 279, 281, 282, 894, 896, 898, 2121, 2150 and 2196 |
See Notes section below for more information.
| Reported service groups | Description | BTOS/Group/subgroup/ item included(a)(b) |
|---|---|---|
| GP subtotal – After-hours GP attendances |
GP subtotal – After-hours GP attendances include urgent and non-urgent after-hours GP care. GP and non-specialist medical practitioner attendances provided on a public holiday, a Sunday, and during specified periods between Monday and Saturday. Note times vary depending on type of after-hours care, whether urgent or non-urgent, and for services provided at a place other than a consulting room. See After-hours GP (urgent) and After-hours GP (non-urgent) for more information. |
Group A11, A22, A23; Subgroup A7.10 (all items/groups below) |
| After-hours GP (urgent) |
After-hours GP attendance where the patient’s medical condition requires urgent assessment to prevent deterioration or potential deterioration in health and the assessment cannot be delayed until the next in-hours period. Eligibility requirements changed on 1 March 2018, which may affect comparability over time. Prior to this date, patients required urgent medical treatment (rather than assessment) to be eligible, and could book an urgent after-hours service two hours in advance (booking option no longer available). Urgent after-hours are described as follows:
|
Group A11 |
| After-hours GP (non-urgent) |
After-hours GP attendance for non-urgent assessment and treatment. These vary in time and complexity. Includes home visits and visits to residential aged care facilities. Non-urgent after-hours are described as follows:
From 1 July 2018, new after-hours attendances provided by a medical practitioner have been introduced, and are described as follows:
|
Groups A22, A23; Subgroup A7.10 |
See Notes section below for more information.
| Reported service groups | Description | BTOS/Group/subgroup/ item included(a)(b)(e) |
|---|---|---|
| GP subtotal – PIP |
GP subtotal PIP includes services provided as part of the Practice Incentive Program. This program aims to support general practice activities including continuous improvements, quality care, enhance capacity and improve access and health outcomes for patients. A practice must be accredited, or registered for accreditation to participate in PIP services. Includes cervical smear, diabetes mellitus annual cycle of care and asthma cycle of care PIP services. |
Group A18, A19; Subgroup A7.8 (all items/groups below) |
| Cervical smear PIP | A service claimed by a GP, or by non-specialist medical practitioners in eligible areas, where a cervical smear is taken from a person between the age of 24 years and 9 months and 74 years inclusive who has not had a cervical smear in the last four years. Eligibility requirements changed on 1 December 2017, which may affect comparability over time. Prior to this date, people aged between 20 and 69 years inclusive who have not had a cervical smear in the last four years could receive the service. | Subgroups A18.1, A19.1; Items 251, 252, 253, 254, 255, 256, 257 |
| Diabetes Mellitus Annual Cycle of Care PIP |
This service aims to encourage GPs and non-specialist medical practitioners to provide earlier diagnosis and effective management of people with established diabetes mellitus. The Annual Diabetes Cycle of Care must be completed over a period of 11 to 13 months, and includes (but is not limited to) measuring patients’ blood pressure, cholesterol and HbA1c, examining eyes and feet and reviewing diet, physical activity and medications. Services counted represent a completed cycle of care claimed by a GP, or non-specialist medical practitioners in eligible areas. The completion of the Diabetes Mellitus Annual Cycle of Care can be used as an indication of GP and non-specialist medical practitioner care for patients with diabetes, but do not reflect the quality of care, prevalence of diabetes, or all diabetes-related care provided in the GP setting. Patients may also use other forms of health care to manage their diabetes, such as standard and long GP consultations, Chronic Disease Management plans, and paediatric and specialist services. |
Subgroups A18.2, A19.2; Items 259, 260, 261, 262, 263, 264 |
| Asthma Cycle of Care PIP |
At a minimum the Asthma Cycle of Care includes at least 2 asthma related consultations within 12 months for a patient with moderate to severe asthma. This includes 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 of an asthma action plan and asthma self-management education. Services counted represent a completed cycle of care claimed by a GP, or by non-specialist medical practitioners in eligible areas. The completion of the Asthma Cycle of Care can be used as an indication of GP and non-specialist medical practitioner care for patients with asthma, but do not reflect the quality of care, prevalence of asthma, or all asthma-related care provided in the GP setting. Patients may also use other forms of health care to manage their asthma, such as standard and long GP consultations, Chronic Disease Management plans, and paediatric and specialist services. |
Subgroups A18.3, A19.3; Items 265, 266, 268, 269, 270, 271 |
See Notes section below for more information.
| Reported service groups | Description | BTOS/Group/subgroup/ item included(a)(b) |
|---|---|---|
| GP subtotal – Other(d) | GP subtotal – Other includes: GP Short (Level A), GP Standard (Level B), GP Long (Level C), GP Prolonged (Level D), Other non-referred medical practitioner, GP Focussed Psychological Strategies and Family Group Therapy, GP Prolonged - Imminent danger of death, GP Acupuncture, GP Pregnancy support counselling and GP Telehealth (patient-end support) services. These are non-referred attendances by a GP or other medical practitioner. Does not include after-hours, Enhanced Primary Care and PIP GP attendances. | Groups A1, A2, A5, A6, A16(f), A27, A30, A35; Subgroups A7.1, A7.2, A7.3, A7.4, A7.11, A7.12, A20.2; Items 283, 285, 286, 287, 371 and 372. |
| GP Short (Level A) |
Professional attendance by a GP for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management. From 1 March 2019, includes telehealth consultations by GPs for patients in selected flood affected areas (item 2095). This item is different to items in GP Telehealth (patient-end support) where the medical practitioner provides clinical support to a patient who is participating in a video conferencing consultation with a specialist or consultant physician. Medicare benefits paid, and the resulting provider fees may be underestimated in 2018–19, as some expenditure relating to residential aged care item 90020 cannot be allocated. This expenditure is claimed under the new item 90001, introduced 1 March 2019 (included in ‘GP attendances (total)’ and ‘GP subtotal – Other’ only). |
Items 3, 4, 2095, 90020 |
| GP Standard (Level B) |
Professional attendance by a GP lasting less than 20 minutes, involving (where clinically relevant) taking patient history, performing a clinical examination, arranging any necessary investigation, implementing a management plan, and/or providing appropriate preventive health care. From 1 March 2019, includes telehealth consultations by GPs for patients in selected flood affected areas (item 2144). This item is different to items in GP Telehealth (patient-end support) where the medical practitioner provides clinical support to a patient who is participating in a video conferencing consultation with a specialist or consultant physician. Medicare benefits paid, and the resulting provider fees may be underestimated in 2018–19, as some expenditure relating to residential aged care item 90035 cannot be allocated. This expenditure is claimed under the new item 90001, introduced 1 March 2019 (included in ‘GP attendances (total)’ and ‘GP subtotal – Other’ only). |
Items 23, 24, 2144, 90035 |
| GP Long (Level C) |
Professional attendance by a GP lasting at least 20 minutes, involving (where clinically relevant) taking detailed patient history, performing a clinical examination, arranging any necessary investigation, implementing a management plan, and/or providing appropriate preventive health care. From 1 March 2019, includes telehealth consultations by GPs for patients in selected flood affected areas (item 2180). This item is different to items in GP Telehealth (patient-end support) where the medical practitioner provides clinical support to a patient who is participating in a video conferencing consultation with a specialist or consultant physician. Medicare benefits paid, and the resulting provider fees may be underestimated in 2018–19, as some expenditure relating to residential aged care item 90043 cannot be allocated. This expenditure is claimed under the new item 90001, introduced 1 March 2019 (included in ‘GP attendances (total)’ and ‘GP subtotal – Other’ only). |
Items 36, 37, 2180, 90043 |
| GP Prolonged (Level D) |
Professional attendance by a GP lasting at least 40 minutes, involving (where clinically relevant) taking extensive patient history, performing a clinical examination, arranging any necessary investigations, implementing a management plan, and/or providing appropriate preventive health care. From 1 March 2019, includes telehealth consultations by GPs for patients in selected flood affected areas (item 2193). This item is different to items in GP Telehealth (patient-end support) where the medical practitioner provides clinical support to a patient who is participating in a video conferencing consultation with a specialist or consultant physician. Medicare benefits paid, and the resulting provider fees may be underestimated in 2018–19, as some expenditure relating to residential aged care item 90051 cannot be allocated. This expenditure is claimed under the new item 90001, introduced 1 March 2019 (included in ‘GP attendances (total)’ and ‘GP subtotal – Other’ only). |
Items 44, 47, 2193, 90051 |
| Other Non-referred Medical Practitioner attendances |
Non-referred professional attendance by a medical practitioner who is not a vocationally registered GP. These services are broadly similar to the other GP services included in this report. Includes services provided to patients in the community and residential aged care facilities. From 1 March 2019, includes telehealth consultations by medical practitioners for patients in selected flood affected areas (items 899, 901, 905 and 906). These items are different to items in GP Telehealth (patient-end support) where the medical practitioner provides clinical support to a patient who is participating in a video conferencing consultation with a specialist of consultant physician. From 1 July 2018, for Group A2 and Subgroups A7.2, A35.3 and A35.4, changes in provider eligibility in selected geographic areas may impact comparability over time. |
Groups A2, A16(f); Subgroups A7.2, A35.3, A35.4; Items 899, 901, 905, 906, 90002 |
| GP Focussed Psychological Strategies and Family Group Therapy |
Includes Focussed Psychological Strategies for patients with assessed mental disorders, and family group therapy. The provision of Focussed Psychological Strategies to a patient must be made either in the context of a GP Mental Health Treatment Plan, shared care plan or a psychiatrist assessment and management plan. Family group therapy services can be provided by medical practitioners, including specialists and consultant physicians other than consultant psychiatrists. Prior to 1 July 2018, Focussed Psychological Strategy services could be provided by eligible medical practitioners who practiced in a general practice (other than a specialist or a consultant physician). From 1 July 2018, these items were not restricted to being provided in a general practice. |
Group A6; Subgroups A20.2, A7.4; Items(d) 283, 285, 286, 287, 371, 372 |
| GP Prolonged - Imminent danger of death |
Prolonged attendance for a patient in imminent danger of death. Services range from at least 1 hour to 5 hours or more. From 1 July 2018, new items were introduced to enable non-specialist medical practitioners to provide general attendance services. |
Group A5; Subgroup A7.3 |
| GP Acupuncture | Professional attendance at which acupuncture is performed by a medical practitioner who is a qualified medical acupuncturist by application of stimuli on or through the surface of the skin by any means. For the purpose of payment of Medicare benefits "acupuncture" is interpreted as including treatment by means other than the use of acupuncture needles where the same effect is achieved without puncture, e.g. by application of ultrasound, laser beams, pressure or moxibustion, etc. | Items 173, 193, 195, 197, 199 |
| GP Pregnancy Support Counselling |
Non-directive pregnancy support counselling services provided to a person who is pregnant or who has been pregnant in the 12 months preceding the first service, by a medical practitioner (including a GP, but not including a specialist or consultant physician). From 1 July 2018, new items were introduced to enable non-specialist medical practitioners to provide general attendance services. |
Group A27; Subgroup A7.11 |
| GP Telehealth (patient-end support) |
Provision of clinical support by a medical practitioner to a patient (in a telehealth eligible area) who is participating in a video conferencing consultation with a specialist or consultant physician. Does not include telephone or email consultations. From 1 July 2018, new items were introduced to enable non-specialist medical practitioners to provide general attendance services. |
Subgroups A30.1, A30.2; Items 812, 827, 829, 867, 868, 869, 873, 876, 881, 885, 891, 892 |
See Notes section below for more information.
| Reported service | Description | BTOS/Group/subgroup/ item included(a)(b)(g) |
|---|---|---|
| GP attendances relating to residential aged care facilities | Professional attendance by a GP, non-specialist practitioner or other medical practitioner at a residential aged care facility or consulting room situated within such a complex where the patient is accommodated in the residential aged care facility (Group A35). Refer to the following service groups for more information GP Chronic Disease Management Plan (item 232 and 731), Medication Management Review (residential) (item 249 and 903) GP after-hours (non-urgent) (items 772, 776, 788, 789, 5010, 5028, 5049, 5067, 5260, 5263, 5265 and 5267) and GP Telehealth (patient-end support) (items 829, 869, 881, 892, 2125, 2138, 2179 and 2220). | Group A35; Items 232, 249, 731, 772, 776, 788, 789, 829, 869, 881, 892, 903, 2125, 2138, 2179, 2220, 5010, 5028, 5049, 5067, 5260, 5263, 5265, 5267 |
See Notes section below for more information.
| Reported service groups | Description | BTOS/Group/subgroup/item included(a) |
|---|---|---|
| Diagnostic Imaging services (total) | Medicare-subsidised diagnostic imaging procedures such as X-rays, computerised tomography scans, ultrasound scans, magnetic resonance imaging scans and nuclear medicine scans. | BTOS 600 |
See Notes section below for more information.
| Reported service groups | Description | BTOS/Group/subgroup/item included(a) |
|---|---|---|
| Allied Health attendances (total) | Allied Health attendances (total) includes Medicare-subsidised primary health services provided by a broad range of health professionals who are not doctors, nurses or dentists, comprising all services provided in the Optometry, Mental Health Care, Physical Heath Care, and ‘Other’ allied health subtotals. With the exception of optometry, these services are generally only available to patients with chronic, mental, developmental, and/or complex health conditions with a referral from a GP or specialist medical practitioner. | BTOS 150(h), 900 (Allied health subtotals: Optometry, Mental Health Care, Physical Health Care and Other) |
See Notes section below for more information.
| Reported service groups | Description | BTOS/Group/subgroup/item included(a) |
|---|---|---|
| Allied Health subtotal – Optometry | Optometry services provided by eligible optometrists for the assessment of vision and diagnosis and treatment of other eye conditions. In general, asymptomatic patients aged less than 65 years are eligible for a Medicare-subsidised comprehensive optometry service every 3 years, while asymptomatic patients aged 65 or over are eligible ever year. Some patients may be eligible for more frequent Medicare-subsidised services (e.g. patients with progressive disorders or significant changes in visual function). Prior to 1 January 2015, all asymptomatic patients, regardless of age, were eligible for a comprehensive service every 2 years. From 1 September 2015, includes patient-end telehealth support services, where optometrists can provide clinical support to their patient during video consultations with ophthalmologists. Does not include the purchase of glasses or contact lenses; cosmetic surgery; tests for fitness to undertake sporting, leisure or vocational activities; or attendances on behalf of teaching institutions on patients of supervised students of optometry. | BTOS 900 |
See Notes section below for more information.
| Reported service groups | Description | BTOS/Group/subgroup/ item included(a) |
|---|---|---|
| Allied Health subtotal – Mental Health Care | Allied Health subtotal – Mental Health Care includes assessment, treatment and management of patients with mental disorders by clinical psychologists, other psychologists and other allied mental health workers. Does not include psychiatry services. Note: From 1 November 2017, patients living in telehealth eligible areas (regional, rural and remote Australia) were able to claim telehealth psychological services. | Groups M6, M7; Items 10956, 10968, 81325, 81355, 82000, 82015 |
| Clinical Psychologist(i) |
Psychological therapy services provided by eligible clinical psychologists. Includes individual attendances, group therapy, and telehealth video consultations. Note: Clinical psychologists may also claim services included in the ‘Other Psychologists’ and ‘Other Allied Mental Health’categories. Items 80001, 80011 and 80021 refer to psychological therapy services via videoconferencing to people located in telehealth eligible areas. |
Group M6 |
| Other Psychologist(i) |
Focussed Psychological Strategies and enhanced primary care services provided by any eligible psychologist, including clinical and other psychologists (i.e. fully registered psychologists in the relevant jurisdiction regardless of any specialist clinical training). Includes individual attendances, group therapy, and telehealth video consultations. Items 80101, 80111 and 80121 refer to telehealth services provided to people located in eligible areas. |
Items 10968, 80100, 80101, 80105, 80110, 80111, 80115, 80120, 80121, 81355, 82000, 82015 |
| Other Allied Mental Health(i) |
Mental health services provided by other allied health professionals such as occupational therapists, mental health nurses, Aboriginal health workers and some social workers. Psychologists (clinical or other) may also provide some of these services, however they cannot be readily separated from the other mental health workers included in the group. These services cover Focussed Psychological Strategies – allied mental health (occupational therapist and social worker items) and enhanced primary care – allied health (mental health worker item). Includes individual attendances, group therapy, and telehealth video consultations. Items 80126, 80136, 80146, 80151, 80161 and 80171 refer to telehealth services provided to people located in eligible areas. |
Items 10956, 80125, 80126, 80130, 80135, 80136, 80140, 80145, 80146, 80150, 80151, 80155, 80160, 80161, 80165, 80170, 80171, 81325 |
See Notes section below for more information.
| Reported service groups | Description | BTOS/Group/subgroup/item included(a) |
|---|---|---|
| Allied Health subtotal – Physical Health Care | Allied Health subtotal – Physical Health Care includes physiotherapy, exercise physiology, chiropractic and osteopathy services provided to a person who has a chronic condition and complex care needs, and/or is of Aboriginal or Torres Strait Islander descent who has had a health check and identified as needing a follow-up allied health service. | Items 10953, 10960, 10964, 10966, 81110, 81115, 81315, 81335, 81345, 81350 |
| Physiotherapy(j) | Physiotherapy service involving the non-surgical treatment of musculoskeletal and related pain and movement issues. Provided by an eligible physiotherapist to a person who has a chronic condition and complex care needs, and/or is of Aboriginal or Torres Strait Islander descent who have had a health check and identified as needing a follow-up allied health service. | Items 10960, 81335 |
| Exercise Physiology | Exercise physiology service involving exercise-based interventions for a broad range of health conditions. Provided by an eligible exercise physiologist to a person who has a chronic condition and complex care needs, and/or is of Aboriginal or Torres Strait Islander descent who have had a health check and identified as needing a follow-up allied health service. Includes individual and group services. | Items 10953, 81110, 81115, 81315 |
| Chiropractic Services | Chiropractic service involving the non-surgical treatment of musculoskeletal and related pain and movement issues. Provided by an eligible chiropractor to a person who has a chronic condition and complex care needs, and/or is of Aboriginal or Torres Strait Islander descent who have had a health check and identified as needing a follow-up allied health service. | Items 10964, 81345 |
| Osteopathy | Osteopathy service involving the non-surgical treatment of musculoskeletal and related pain and movement issues. Provided by an eligible osteopath to a person who has a chronic condition and complex care needs, and/or is of Aboriginal or Torres Strait Islander descent who have had a health check and identified as needing a follow-up allied health service. | Items 10966, 81350 |
See Notes section below for information on footnotes.
| Reported service groups | Description | BTOS/Group/subgroup/ item included(a) |
|---|---|---|
| Allied Health subtotal – Other | Allied Health subtotal – Other includes podiatry, dietetics, occupational therapy, speech pathology, diabetes education, audiology and other allied health services provided to a person who has a chronic, developmental, and/or complex health condition and/or is of Aboriginal or Torres Strait Islander descent who have had a health check and identified as needing a follow-up allied health service. | Items 10950, 10951, 10952, 10954, 10958, 10962, 10970, 81000, 81005, 81010, 81100, 81105, 81120, 81125, 81300, 81305, 81310, 81320, 81330, 81340, 81360, 82005, 82010, 82020, 82025, 82030, 82035, 82300, 82306, 82309, 82312, 82315, 82318, 82324, 82327, 82332 |
| Podiatry | Podiatry service involving diagnosis and treatment of disorders of the foot, ankle and lower extremity. Provided by an eligible podiatrist to a person who has a chronic condition and complex care needs, and/or is of Aboriginal or Torres Strait Islander descent who have had a health check and identified as needing a follow-up allied health service. | Items 10962, 81340 |
| Dietetics | Dietetics service provided by an eligible dietitian to help patients appropriately manage their diet and nutrition. Eligible patients include people who have a chronic condition and complex care needs, and/or are of Aboriginal or Torres Strait Islander descent who have had a health check and identified as needing a follow-up allied health service. Includes individual and group services. | Items 10954, 81120, 81125, 81320 |
| Occupational Therapy(k) | Occupational therapy service involving the assessment and intervention to develop, recover, or maintain meaningful activities, or occupations. Provided by an eligible occupational therapist to a person who has a chronic condition and complex care needs; and/or is of Aboriginal or Torres Strait Islander descent who have had a health check and identified as needing a follow-up allied health service; or is a child aged under 15 years for the diagnosis or treatment of a pervasive developmental disorder (PDD) or an eligible disability. | Items 10958, 81330, 82010, 82025 |
| Speech Pathology | Speech pathology service involving the diagnosis and treatment of communication disorders of eligible patients with a referral, including people with chronic and complex conditions; people of Aboriginal or Torres Strait Islander descent who have had a health check and identified as needing a follow-up allied health service; children aged under 13 years; or for the treatment of a PDD for children aged under 15 years. | Items 10970, 81360, 82005, 82020 |
| Diabetes Education | Diabetes education service to assist in managing diabetes by enhancing patient’s knowledge about diabetes and self-management. Provided by an eligible diabetes educator to a person who has a chronic condition and complex care needs, and/or is of Aboriginal or Torres Strait Islander descent who have had a health check and identified as needing a follow-up allied health service. Includes individual and group services. | Items 10951, 81100, 81105, 81305 |
| Audiology(j) | Audiology service involving the diagnosis, treatment, and monitoring of disorders of the auditory and vestibular systems. Provided by an eligible audiologist to a person who has a chronic condition and complex care needs; and/or is of Aboriginal or Torres Strait Islander descent who have had a health check and identified as needing a follow-up allied health service; or for the diagnosis and/or treatment and/or management of ear disease or a related disorder; or for the detection of permanent congenital hearing impairment of an infant or child. | Items 10952, 81310, 82300, 82306, 82309, 82312, 82315, 82318, 82324, 82327, 82332 |
| Other Allied Health | Medicare-subsidised allied health services not included in the above six sub-groups. Includes Aboriginal or Torres Strait Islander health services by an eligible Aboriginal health worker or eligible Aboriginal and Torres Strait Islander health practitioner; non-directive pregnancy support counselling services provided by an eligible psychologist, social worker or mental health nurse; and audiology, optometry, orthoptic or physiotherapy health services provided to a child aged under 13 years with a PDD or eligible disability. To protect confidentiality, these items were combined. | Items 10950, 81000, 81005, 81010, 81300, 82030, 82035 |
See Notes section below for more information.
| Reported services | Description | BTOS/Group/subgroup/ item included(a) |
|---|---|---|
| Specialist attendances (total) | Specialist attendances include psychiatry services and early intervention services for children, as well as other specialist attendances not reported separately in this report. Specialist attendances are Medicare-subsidised referred patient/doctor encounters, such as visits, consultations, and attendances by video conference, involving medical practitioners who have been recognised as specialists or consultant physicians for Medicare benefits purposes. | BTOS 200 (Psychiatry, Early Intervention and other services (not reported separately)) |
| Psychiatry | Medicare-subsidised services provided by a psychiatrist, including patient attendances (or consultations), group psychotherapy, tele-psychiatry, case conferences and electroconvulsive therapy. Electroconvulsive therapy may be provided by either a psychiatrist or another medical practitioner together with an anaesthetist. | Group A8(l); Items 855, 857, 858, 861, 864, 866, 14224 |
| Early Intervention Services for Children | Professional attendance of at least 45 minutes, by a consultant paediatrician, consultant physician or specialist of another discipline, or GP, for assessment, diagnosis and preparation of a treatment and management plan for a child aged under 13 years with autism, another PDD or another eligible disability. This may include referral to Medicare-subsidised allied health treatment services available through the Helping Children with Autism program. | Group A29 |
See Notes section below for more information.
| Reported service groups | Description |
BTOS/Group/subgroup/ item included(a) |
|---|---|---|
| Nursing and Aboriginal Health Workers (total) | Includes services provided by Practice Nurses, Aboriginal Health Workers, Midwives and Nurse Practitioners. | Groups M2(f), M12, M13, M14 (Practice Nurse/Aboriginal Health Worker, Midwifery and Nurse Practitioner items) |
| Practice Nurse/Aboriginal Health Worker |
Service by a practice nurse, Aboriginal health worker or Aboriginal and Torres Strait Islander health practitioner provided on behalf of, and under the supervision of, a medical practitioner. This group includes telehealth patient-end support services. These services do not require a referral. |
Groups M2(f), M12 |
| Midwifery | Antenatal, intrapartum and postnatal care provided by participating midwives who have a collaborative arrangement with an authorised medical practitioner in place that must provide for consultation, referral or transfer of care as clinical needs dictate, to ensure safe, high quality maternity care. This group includes telehealth patient-end support services. | Group M13 |
| Nurse practitioners | Services provided by nurse practitioners who have a collaborative arrangement with an authorised medical practitioner so they can assist if clinically relevant. Includes, but is not limited to, clinical examinations, implementing management plans, and telehealth patient-end support services. | Group M14 |
See Notes section below for more information.
Sources: AHPA 2017a; Department of Health 2019a
Notes:
(a) Medicare codes are based on the 1 May 2019 Medical Benefits Schedule book (Department of Health 2019a). Broad Type of Service (BTOS) groups similar Medicare services. For information on BTOS groups, see Department of Health’s Annual Medicare Statistics. MBS items can also be grouped into a hierarchy of Group – Subgroup – Item. MBS Groups start with a letter followed by two numbers, e.g. Group A15. All items within a nominated group are included, unless stated. An MBS Subgroup is represented by a Group code followed by a full stop and a number, e.g. Subgroup A15.1. This indicates all items within the subgroup have been included, unless stated. Where a Group or Subgroup is followed by numbers in brackets (e.g. A15.2 (735–779)), only the MBS items in the brackets are included.
(b) From 1 July 2018, new MBS items were introduced to enable non-specialist practitioners to provide general attendance services. The new MBS item group established differential (tiered) rebates on GP items for non-vocationally recognised general practitioners (non-VR GPs) that integrated an incentive for doctors to become fully qualified and to work in regional, rural and remote areas. New MBS items have been created under Group A7 – Acupuncture and non-specialist practitioner items. These items replicate the General Practice items under Schedule A of the MBS, and set the relevant item fee at 80% of the equivalent VR item. For GP subtotal PIP and subgroups (Cervical smear PIP, Diabetes Cycle of Care PIP or Asthma Cycle of Care PIP), new items were introduced to enable non-specialist practitioners to provide services in eligible areas. Note, the terms non-specialist practitioner and other medical practitioner are used interchangeably in this report. For more information see 1 May 2019 Medicare Benefits Schedule book (Department of Health 2019a).
(c) In 2017–18, item 6087 (Health Care Home MBS item) was excluded to protect confidentiality. In 2018–19, item 6087 is included but not reported separately.
(d) Items 283, 285, 286, 287, 371 and 372 (GP Focussed Psychological Strategies MBS items) are included in both GP subtotal – Other and GP subtotal – Enhanced Primary Care for 2018–19 results. These new items contribute to GP Focussed Psychological Strategies and Family Group Therapy which is a service group of GP subtotal – Other. These new items are also categorised as GP subtotal – Enhanced Primary Care items under BTOS groups.
(e) Completion of cervical screening, Diabetes Cycle of Care or Asthma Cycle of Care through the use of relevant MBS items initiated the relevant Service Incentive Payment (SIP) through the PIP until 31 July 2019. From 1 August 2019, claims made against these items by GPs or non-specialist medical practitioners will no longer receive an incentive payment. This change does not affect data presented in this report, but will be reflected in future reporting for the period 2019–20 onwards.
(f) Items discontinued, however, some services were processed during 2013–14 to 2017–18.
(g) These items refer to GP attendances within residential aged care facilities. People who live in residential aged care facilities may access other GP services, including visiting a GP at their practice outside of the facility. In particular this group does not include MBS items 244, 225, 226, 227, 701, 703, 705 or 707 (health assessments) or items 235, 236, 237, 238, 239, 240, 243, 244, 735, 739, 743, 747, 750 or 758 (case conferences), which can also be provided to permanent residents of residential aged care facilities. In MBS claims data, it is not possible to distinguish between patients who are permanent residents and those who are receiving respite care in residential aged care facilities.
(h) Excludes items in groups N1, N2, N3 (Medicare Chronic Disease Dental Scheme), which ceased 1 December 2012.
(i) Clinical psychologist refers to Clinical psychologist psychological therapy services. Other psychologist includes other psychology services that can be provided by clinical psychologists or other psychologists. Psychologists (clinical or other) also provide some Other Allied Mental Health services.
(j) Does not include Other Allied Health MBS items 82030 and 82035.
(k) Does not include the Other Allied Mental Health MBS items 80140, 80145 and 80146 (Mental health services provided by occupational therapists).
(l) Does not include items 297, 320, 322, 324, 326 and 328 as these items refer to attendances in hospitals. However, a small number of services for these items were processed as non-hospital in 2014–15 and 2015–16, which may be due to administrative error (see Technical Note for more information). These small number of services have been included in the report for 2014–15 and 2015–16.
References
AHPA 2017a. What is allied health?. Melbourne: AHPA. Viewed 14 July 2020.
Department of Health 2019a. Medicare Benefits Schedule book, operating from 01 May 2019. Canberra: Department of Health. Viewed 14 July 2020.