Education guide - Telehealth - supporting Indigenous health

Medicare eligibility requirements for telehealth services to support Indigenous health, including a case study.

We recommend you also read the relevant Medicare Benefits Schedule (MBS) item descriptors and explanatory notes available at the MBS Online website.

About telehealth

Telehealth is the use of video conference facilities to help eligible patients access specialist, consultant physician or consultant psychiatrist services, including:

  • specialist-end video consultations and a range of MBS attendance items with a derived fee added to the base item fee. There are stand-alone items for short consultations
  • patient-end clinical support services provided face-to-face to the patient during the specialist video consultation by health professionals including:
    • medical practitioners
    • nurse practitioners
    • midwives
    • Aboriginal health workers
    • Aboriginal and Torres Strait Islander health practitioners
    • practice nurses

Telehealth patient eligibility

You can refer patients for a telehealth specialist video conference consultation if they’re:

  • patients of an eligible Aboriginal Medical Service (AMS)
  • patients of an eligible Aboriginal Community Controlled Health Service (ACCHS)
  • residents of an aged care facility, or
  • living in a telehealth eligible area

Admitted hospital patients aren't eligible for MBS telehealth services.

Telehealth eligible areas

Telehealth services are restricted to patients in eligible areas, if they’re at least 15km away driving distance between the patient and specialist.

Check telehealth eligible areas at DoctorConnect on the Department of Health website. To do this:

  • select 'Search the map' from the menu
  • 'ASGC Remoteness Areas layer' is already displayed in 'Choose your Layer'. ASGC stands for Australian Standard Geographical Classification and is used to rate Remoteness Areas (RAs)
  • enter the address of the patient's location during the consultation
  • select 'Search'

Remoteness Area (RA) categories

  • RA1 - Major Cities of Australia
  • RA2 - Inner Regional Australia
  • RA3 - Outer Regional Australia
  • RA4 - Remote Australia
  • RA5 - Very Remote Australia

Telehealth eligible areas are RA2-RA5, outside of major cities (RA1). There are exceptions to this.

Exceptions to telehealth eligible area requirements

Exceptions are applicable for patients of an eligible:

  • AMS
  • ACCHS
  • aged care facility

MBS requirements for claiming telehealth services

Referrals for telehealth specialist services

Treating medical practitioners must meet the same referral requirements when referring eligible patients to specialists, consultant physicians or consultant psychiatrists as for face-to-face consultations.

Specialist-end

Requirements Claiming details

Specialists, consultant physicians or consultant psychiatrists

  • determine:
    • if it's clinically appropriate to provide a video consultation to an eligible patient
    • clinically relevant support for the patient
    • where appropriate can provide video conference consultations to eligible patients in their home
  • provide video conference consultations to patients where it's been determined no patient-end support service is required
  • you and your patient must both see and hear each other during the video conference consultation
  • telehealth MBS derived fee item numbers are available when claimed with an existing attendance item number
  • stand-alone items apply for a short 10 minutes or less initial telehealth consultation
  • where the same specialist, consultant physician or consultant psychiatrist provides multiple video consultations for the same patient on the same day which aren't a continuation of the earlier video consultation, you must provide times for each consultation on the account or in the claim
  • bulk billed patients can remotely assign their right to a Medicare benefit using an 'email agreement'

Patient-end

Requirements Claiming details

Patients

  • must be in a telehealth eligible area, at least 15km by road from the specialist, consultant physician or consultant psychiatrist. This doesn't apply to any patients of an eligible:
    • AMS
    • ACCHS
    • aged care facility
  • and their specialist, consultant physician or consultant psychiatrist must see and hear each other during the video conference consultation

Patient-end clinical support health professionals

  • must be present with the patient, where needed, during part or all of the video conference consultation to bill the correct time-tiered MBS item
  • for billing purposes, patient-end clinical support health professionals include:
    • medical practitioners, nurse practitioners and midwives use their provider number
    • practice nurses, Aboriginal and Torres Strait Islander health practitioners and Aboriginal health workers providing clinical support services on behalf of (and under the supervision of) medical practitioners use the medical practitioner's provider number
  • only 1 telehealth MBS patient-end support service item is payable regardless of how many health professionals provided support to the patient
  • patient-end items are payable when the associated eligible telehealth MBS specialist service is claimed

Case study

This case study focuses on an Indigenous patient and provides examples of accepted telehealth items. We recommend you also read the relevant Medicare Benefits Schedule (MBS) item descriptors and explanatory notes on the MBS Online website.

You’re a GP at a remote community health service. A 5 year old Indigenous child presents with a persistent ear discharge. Previous treatment hasn't fixed the condition. You discuss the patient’s condition with their parent and refer them to an ear nose and throat (ENT) specialist. The patient’s current condition complicates air travel for a specialist visit in a regional city.

Medical history

Includes:

  • previous episodes of recurrent otitis media with perforation, treated with antibiotics and ear cleaning
  • previous audiological examinations, which showed mild temporary hearing loss
  • chronic suppurative otitis media (CSOM) treated with ear cleaning and Ciprofloxacin ear drops

The patient’s parent agrees and you speak with the ENT specialist who decides a telehealth videoconference consultation is appropriate.

Telehealth services

The ENT specialist:

  • arranges a videoconference consultation with the patient and their parent at the community health service
  • requests you provide the patient-end clinical support during the videoconference to perform any required examinations
  • tells the patient’s parent that they’d like to bulk bill Medicare

The patient’s parent agrees and assigns the right to a Medicare benefit to the ENT specialist.

Claiming MBS telehealth services

Initial telehealth video consultation

Health professionals Item numbers Short item description
ENT specialist 104 specialist initial attendance lasting >10 mins
  99 telehealth specialist-end derived item
medical practitioner (patient-end) 2126 telehealth attendance at consulting rooms < 20 mins

Additional bulk billing item 10991 also applies to the unreferred patient-end service, MBS item 2126.

Following the initial consultation you discuss the patient’s ongoing care with the ENT specialist. The ENT specialist schedules a follow up videoconference consultation to review progress.

Follow-up telehealth video consultation

Health professionals Item numbers Short item description
ENT specialist 105 specialist subsequent attendance
  99 telehealth specialist-end derived item
medical practitioner (patient-end) 2126 telehealth attendance at consulting rooms < 20 mins

Additional bulk billing item 10991 also applies to the unreferred patient-end service, MBS item 2126.

More information

Online:

Contact us at MBS item interpretation.

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Page last updated: 13 October 2016

This information was printed Sunday 4 December 2016 from humanservices.gov.au/health-professionals/enablers/education-guide-telehealth-supporting-indigenous-health 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.