Medicare eligibility requirements for telehealth services to support Indigenous health, including a case study.
Make sure you read the relevant Medicare Benefits Schedule (MBS) item descriptions and explanatory notes at MBS Online.
Telehealth is when eligible patients access specialist, consultant physician or consultant psychiatrist services via videoconferencing. There are two types of telehealth services:
- specialist-end where practitioners hold a consultation over video. There are 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 where health professionals provide face-to-face clinical support to the patient during a video consultation with a specialist. These health professionals could be:
- medical practitioners
- nurse practitioners
- practice nurses
- Aboriginal Health Workers
- Aboriginal and Torres Strait Islander Health Practitioners
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 a residential aged care facility (RACF) or
- living in a telehealth eligible area
Admitted hospital patients aren't eligible for MBS telehealth services.
Telehealth eligible areas
Only patients in eligible areas can access telehealth services. There must be at least 15km 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. Australian Standard Geographical Classification(ASGC) is a rating system for 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 to RA5, outside of major cities (RA1). There are exceptions to this.
Exceptions are applicable for patients of an eligible:
Referrals for telehealth specialist services
Practitioners must meet the same referral requirements when referring patients to telehealth consultations as they do for face-to-face consultations.
MBS requirements for claiming telehealth services
Specialists, consultant physicians or consultant psychiatrists should:
- determine if it's clinically appropriate to provide a video consultation to an eligible patient
- decide what clinically relevant support the patient needs
- provide videoconference consultations
The specialist and the patient must both see and hear each other during the videoconference consultation.
Where appropriate, you can provide videoconference consultations to patients in their home.
You can claim a telehealth MBS-derived fee item when you claim an existing attendance item number.
Stand-alone items apply for a short initial telehealth consultation that is 10 minutes or less.
When the same practitioner provides multiple video consultations for the same patient on the same day, you must include the times of each consultation on your claim. This doesn’t apply when the consultation continues an earlier video consultation.
Bulk billed patients can remotely assign their right to a Medicare benefit using an email agreement.
To claim telehealth items, patients must be in a telehealth eligible area or have an exception. Also, the practitioners and the patient must see and hear each other during the videoconference consultation.
Patient-end clinical support health professionals must be present with the patient during part or all of the videoconference consultation. This is so they can bill the correct time-tiered MBS item.
For billing purposes, patient-end clinical support health professionals include:
- medical practitioners, nurse practitioners and midwives using 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 using the medical practitioner's provider number
Regardless of how many health professionals provide support, you can only claim 1 telehealth MBS patient-end support service item.
You can claim patient-end items when you claim the associated eligible telehealth service.
This case study focuses on an Indigenous patient and provides examples of accepted telehealth items.
You’re a medical practitioner at a remote community health service. A 5-year-old Indigenous child presents with persistent ear discharge. Previous treatment hasn't fixed the condition.
The patient’s 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 treated with ear cleaning and Ciprofloxacin ear drops
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 means they can’t get to a regional city on a plane.
The patient’s parent agrees and you speak with the ENT specialist who decides a telehealth videoconference consultation is appropriate.
The ENT specialist:
- arranges a videoconference consultation with the patient and their parent at the community health service
- requests you provide 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.
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.
Claiming telehealth services
Checking patient eligibility
Before claiming, you need to check the patient’s eligibility. You can do this by using the MBS Online Items Checker in HPOS or by calling us.
Claiming telehealth video consultations
If the patient is eligible, the ENT specialist can claim:
- specialist initial attendance lasting 10 minutes or less for the first consultation - item 104
- specialist subsequent attendance for subsequent consultations - item 105
- telehealth specialist-end derived item - item 99
As the medical practitioner at the patient end, you can claim attendance services lasting 20 minutes or less - items 867 and 2126. You can also claim the additional bulk billing item 10991 which applies to the unreferred patient-end service - items 867 and 2126.
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