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.

Make sure you read the relevant Medicare Benefits Schedule (MBS) item descriptions and explanatory notes at MBS Online.

Better Start for Children with Disability initiative

MBS items are available for diagnosing and treating children with an eligible disability.

The initiative links to the Helping Children with Autism program (HCWA). Children with both an eligible disability and autism or other pervasive developmental disorder can access either the Better Start initiative or the HCWA. They can’t access both. When creating a treatment and management plan you should consider both conditions.

Age criteria for MBS services under the initiative

The child must be under 13 years of age to have:

  • allied health MBS items for assistance in diagnosing the child or contributing to a treatment plan
  • a treatment and management plan prepared by a specialist, consultant physician or general practitioner.

The child must be under 15 years of age to have allied health MBS items for treatment services.

Eligible disabilities

Eligible disabilities include:

  • sight impairment resulting in vision of less than or equal to 6/18 vision or equivalent field loss in the better eye, with correction
  • hearing impairment with either
    • a hearing loss of 40 decibels or greater in the better ear, across 4 frequencies
    • 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 a child has
    • a head circumference less than the third percentile for age and sex
    • a functional level at or below 2 standard deviations below the mean for age on a standard development test or an IQ score of less than 70 on a standardised test of intelligence
  • Rett’s disorder.

When diagnosing children with microcephaly:

  • a standard developmental test refers to either
    • a Bayley Scales of Infant Development
    • the Griffiths Mental Development Scales standard development test
  • a standardised test of intelligence refers to
    • the Wechsler Intelligence Scale for Children
    • the Wechsler Preschool and Primary Scale of Intelligence.

It is the diagnosing practitioner’s clinical judgement whether other tests are appropriate.

Billing and referral requirements

To be eligible for Medicare benefits:

  • you, as the medical practitioner or allied health professional, must provide all services to the eligible child personally
  • you must provide the service to a single child on a single occasion
  • the child must be present for all services provided. Where appropriate, specialist or consultant physicians can use telehealth video consultations. Telephone attendances don’t attract Medicare benefits.

Allied health services don’t attract Medicare benefits until we have paid the prerequisite medical practitioner item.

Allied health professionals must provide allied health assessment and treatment items as non-admitted or outpatient services.

Referrals

There is no specific referral form for allied health services. A signed and dated referral letter or note that includes the required number of services is acceptable.

Patients need a separate referral for each allied health professional they are referred to. They also need a separate referral for assessment and diagnosis services and treatment services.

Referrals for allied health treatment services can include up to 10 services per course of treatment.

From 1 July 2018 you must retain referrals and management plan documents for 2 years.

Overview of the initiative

The item numbers for the initiative are designed to be used in 3 stages:

  1. assessment and diagnosis
  2. making a treatment and management plan
  3. treatment services.

At the end of each stage, the responsible health professional should provide a written document. This could be a referral, a treatment plan or a report.

The table below shows the stages and the documents you need to provide at each stage.

Stage Health professional MBS items, referrrals and reporting
Assessment and diagnosis Medical practitioners

To assess and diagnose patients:

  • specialists can use items 104-109
  • consultant physicians can use items 110-131 and 296-370 (excluding item 359)
  • general practitioners can use items 3-51 and items 179-212.

If you need help from an allied health professional to diagnose the patient you must write a referral.

Up to 4 allied health assessment services are payable per eligible child’s lifetime.

Allied health professionals

To assess and diagnose patients:

  • psychologists should use item 82000
  • speech pathologists should use item 82005
  • occupational therapists should use item 82010
  • audiologists, optometrists, orthoptists or physiotherapists should use item 82030.

Each assessment service must be a minimum of 50 minutes

The allied health professional must submit a report to the referring practitioner after the assessment.

Treatment and management plan Medical practitioners

To complete a treatment and management plan:

  • specialists and consultant physicians can use item 137
  • general practitioners can use item 139.

Only 1 treatment and management plan item is payable per eligible child’s lifetime.

If the treatment and management plan allocates allied health treatment services you must write a referral. A maximum of 10 services can be allocated in each course of treatment.

Up to 20 allied health treatment services are payable per eligible child’s lifetime.

Treatment services Allied health professionals

To provide treatment services:

  • psychologists should use item 82015
  • speech pathologists should use item 82020
  • occupational therapists should use item 82025
  • audiologists, optometrists, orthoptists or physiotherapists should use item 82035.

Each treatment service must be a minimum of 30 minutes.

The allied health professional must submit a report to the referring practitioner after each course of treatment.

Further information for medical practitioners

Treatment and management plan

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
  • 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 along with the referral. If you’re a specialist or consultant physician, you should also give a copy of the treatment and management plan to the initial referring provider.

Review and follow up

You should use the following MBS items to review the plan or provide additional referrals:

  • 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.

Further information for allied health practitioners

A maximum limit of 4 allied health services per day applies for the eligible child.

Written reports

Reports to the referring medical practitioner should include:

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

More information

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Page last updated: 23 October 2018