Education guide – Medicare items for Better Start for Children with Disability initiative

Information about services available in the Medicare Benefits Schedule (MBS) for the Better Start for Children with Disability initiative.

We recommend you also read the relevant MBS item descriptors and explanatory notes available on the MBS Online website.

Better Start for Children with Disability initiative

MBS items are available for the early diagnosis and treatment of children with an eligible disability.

The initiative is delivered in a similar way as the Helping Children with Autism program. Children under 13 years with both an eligible disability and autism or other pervasive developmental disorder can access either the:

  • Helping Children with Autism program, or
  • Better Start for Children with Disability initiative

Eligible disabilities

Eligible disabilities include:

  • sight impairment where, with correction, vision is less than or equal to 6/18 vision or equivalent field loss in the better eye
  • hearing impairment with:
    • a hearing loss of 40 decibels or greater in the better ear, across 4 frequencies, or
    • permanent conductive hearing loss and auditory neuropathy
  • deafblindness
  • cerebral palsy
  • Down syndrome
  • Fragile X syndrome
  • Prader-Willi syndrome
  • Williams syndrome
  • Angelman syndrome
  • Kabuki syndrome
  • Smith-Magenis syndrome
  • CHARGE syndrome
  • Cri du Chat syndrome
  • Cornelia de Lange syndrome
  • microcephaly, if the child has:
    • a head circumference less than the third percentile for age and sex, and
    • a functional level at or below 2  standard deviations below the mean for age on a Bayley Scales of Infant Development or the Griffiths Mental Development Scales standard development test, or
    • an IQ score of less than 70 on a ‘standardised test of intelligence’ as determined by the Wechsler Intelligence Scale for Children or the Wechsler Preschool and Primary Scale of Intelligence. It is the diagnosing practitioner’s clinical judgement if other tests are appropriate to be used
    • Rett’s disorder

MBS items, referrals and reporting

A range of MBS items are available for diagnosis and assessment, and for treatment, of children with an eligible disability.

For Medicare benefits to be paid:

  • all services provided to eligible children with a disability must be personally performed by you as the medical practitioner or allied health professional
  • the service must be provided to a single child on a single occasion
  • the child must be present for any service provided however, where appropriate, telehealth video consultations may be used for specialist or consultant physician services. Telephone attendances don’t attract Medicare benefits
  • allied health assessment and treatment items must be provided as non-admitted or outpatient services

Age criteria for MBS services under the initiative

MBS items for assessment, diagnosis and the creation of a treatment and management plan are available for a child under 13 years. MBS items for allied health treatment are available for a child up to 15 years. The child must have had a treatment and management plan prepared for them before their 13th birthday.

Overview of MBS items, referrals and reporting

You should use the following MBS items to assess and diagnose:

  • items 104-109 if you are a specialist
  • items 110-131 or 296-370, excluding 359, if you are a consultant physician
  • items 3-51 if you are a general practitioner

You may require help with diagnosis from an allied health professional as a result of the service provided under one of the above items. A referral for up to 4 allied health assessment services is available throughout each eligible child’s life.

You should use the following MBS items to complete a treatment or management plan:

  • item 137 if you are a specialist or consultant physician
  • item 139 if you are a general practitioner

Up to 20 allied health treatment services are available, under referral, for children with an eligible disability. The child must have a treatment and management plan in place as per the items above.

Only 1 treatment and management plan is payable throughout each eligible child’s life.

Allied health professionals use the following MBS items for assessment services:

  • item 82000 if you are a psychologist
  • item 82005 if you are a speech pathologist
  • item 82010 if you are an occupational therapist
  • item 82030 if you are an audiologist, optometrist, orthoptist or physiotherapist

Each assessment service must be a minimum of 50 minutes in duration and a report is required once the assessment has finished.

A maximum of 4 assessment services is payable throughout each eligible child’s life.

Allied health professionals use the following MBS items for treatment services:

  • item 82015 if you are a psychologist
  • item 82020 if you are a speech pathologist
  • item 82025 if you are an occupational therapist
  • item 82035 if you are an audiologist, optometrist, orthoptist or physiotherapist

Each treatment service must be a minimum of 30 minutes in duration and a report is required once the course of treatment has finished.

A maximum of 20 allied health treatment services is payable throughout each eligible child’s life.

Treatment and management plan requirements

Plans under MBS item 137 or 139 must include:

  • an assessment and diagnosis of a patient’s condition
  • a risk assessment covering:
    • risk of contributing co-morbidity
    • environmental, physical, social and emotional risk factors that may apply to the patient or to another individual
  • treatment options and decisions, and
  • recommendations for medicine if required

If you’ve allocated treatment services to allied health professionals, you must give them a copy of the completed treatment and management plan.

Claiming and item eligibility

The prerequisite medical practitioner MBS items must be claimed, processed and a Medicare benefit paid before allied health assessment or treatment items can be paid.

Referral and reporting requirements

A separate referral is required for each allied health professional the patient is referred to for assessment and diagnosis, or treatment services. For Medicare auditing purposes, allied health professionals must keep a copy of the referral for 2 years from the date the service was provided.

It’s important to remember the following when completing assessment and diagnoses services and treatment services:

  • when a referral is required, a signed and dated referral letter or note that includes the required number of services is acceptable. Where appropriate, a copy of the treatment and management plan should be given to the relevant allied health provider
  • once an assessment service or course of treatment has finished, the allied health professional must provide a written report to the referring medical practitioner. Reports will help inform the medical practitioner whether any further assessment or treatment services are needed. A new referral is required for any more treatment

When completing assessment and diagnoses services, medical practitioners can refer for up to 4 allied health assessment services for help with diagnosis.

When completing treatment services, medical practitioners can refer up to 20 allied health treatment services, with up to 10 services per course of treatment.

Reports to the referring medical practitioner or allied health professional should include:

  • assessments carried out
  • treatment provided
  • recommendations on future management for the child’s disability, and
  • advice given to third parties, for example, parents and schools

More information

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Page last updated: 15 September 2016

This information was printed Wednesday 7 December 2016 from humanservices.gov.au/health-professionals/enablers/education-guide-medicare-items-better-start-children-disability-initiative It may not include all of the relevant information on this topic. Please consider any relevant site notices at humanservices.gov.au/siteinformation when using this material.