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Read the relevant item descriptions, fact sheets and explanatory notes on the MBS Online website.
MBS items are available for assessing, diagnosing and treating patients with a Complex Neurodevelopmental Disorder, such as Autism Spectrum Disorder or an eligible disability.
Billing requirements
To be eligible to claim or bill these Medicare Benefits Schedule (MBS) items you must provide:
- all services to the eligible patient personally
- the service to a single patient on a single occasion.
The patient must be present for all services provided.
Allied health professionals must provide allied health assessment and treatment items as non-admitted or outpatient services.
Allied health services don’t attract Medicare benefits until we’ve paid the prerequisite medical practitioner item.
Billing referral pathways
The item numbers for assessment, diagnosis and treatment cover:
- assessment and diagnosis
- making a treatment and management plan
- 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.
These services can be performed and billed through telehealth. Read about Telehealth MBS items.
Assessment and diagnosis
There are different item numbers medical practitioners and allied health professionals should use when making assessments and diagnosing patients.
Medical practitioners
The following table shows the item numbers medical practitioners should use to refer to allied health assessment MBS services for a Complex Neurodevelopmental Disorder.
| Medical practitioner | Item numbers |
|---|---|
| Consultant paediatricians | 110, 116, 119, 122, 128, 131 or telehealth items 91824 to 91826, 91836 |
| Consultant psychiatrists | 296, 297, 299, 300, 302, 304, 306, 308, 310, 312, 314, 316, 318 to 341, 343, 345, 347 and 349 or telehealth and phone items 91827 to 91831, 91837 to 91839, 91868 to 91884, 92437 |
The following table shows the item numbers needed to refer to allied health assessment MBS services for an eligible disability.
| Medical practitioner | Item numbers |
|---|---|
| Specialist or consultant physicians | 104, 105, 107, 108, 110, 116, 119, 122, 128, 131 or 296, 297, 299, 300, 302, 304, 306, 308, 310, 312, 314, 316, 318 to 341or telehealth and phone items 91822 to 91839, 91868 to 91884, 92437 |
| General practitioners | 3 to 47 or telehealth items 91790, 91800 to 91802, 91890, 91891 |
If you need help from an allied health professional to diagnose the patient you must write a referral for up to 4 services.
Allied health professionals
The following table shows the item numbers allied health professionals should use to assess and diagnose patients.
| Allied health professional | Item numbers |
|---|---|
| Psychologists | 82000, 93032, 93040 |
| Speech pathologists | 82005, 93033, 93041 |
| Occupational therapists | 82010, 93033, 93041 |
| Audiologists, optometrists, orthoptists and physiotherapists | 82030, 93033, 93041 |
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.
Making a treatment and management plan
For medical practitioners to complete a treatment and management plan for an eligible disability:
- specialists and consultant physicians can bill item 137 or 92141.
- general practitioners can bill item 139 or 92142.
To complete a treatment and management plan for a Complex Neurodevelopmental Disorder:
- consultant paediatricians can bill item 135 or 92140.
- consultant psychiatrists can bill item 289 or 92434.
Only one treatment and management plan item is payable per eligible patient’s lifetime.
You must write a referral if the treatment and management plan allocates allied health treatment services. A maximum of 10 services can be allocated in each course of treatment.
Up to 20 allied health treatment services are payable per eligible patient’s lifetime.
Treatment services
The following table shows the item numbers allied health professionals should use to provide treatment services.
| Allied health professional | Item numbers |
|---|---|
| Psychologists | 82015, 93035, 93043 |
| Speech pathologists | 82020, 93036, 93044 |
| Occupational therapists | 82025, 93036, 93044 |
| Audiologists, optometrists, orthoptists and physiotherapists | 82035, 93036, 93044 |
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.
Review and follow-up
To review a plan or provide additional referrals, medical practitioners should use the item numbers relevant for a Complex Neurodevelopmental Disorder or an eligible disability.
Medical practitioners should use the following item numbers to review a plan or provide referrals for a Complex Neurodevelopmental Disorder.
| Medical practitioners | Item numbers |
|---|---|
| Consultant paediatricians | 110, 116, 119, 122, 128, 131 or telehealth items 91824 to 91826 and 91836 |
| Consultant psychiatrists | 296, 297, 299, 300, 302, 304, 306, 308, 310, 312, 314, 316, 318 to 341, 343, 345, 347 and 349 or telehealth and phone items 91827 to 91831, 91837 to 91839, 91868 to 91884, 92437 |
Medical practitioners should use the following item numbers to review a plan or provide referrals for an eligible disability.
| Medical practitioners | Item numbers |
|---|---|
| Specialist or consultant physicians | 104, 105, 107, 108, 110 ,116, 119, 122, 128, 131 or 296, 297, 299, 300, 302, 304, 306, 308, 310, 312, 314, 316, 318 to 341, 343, 345, 347 and 349 or telehealth and phone items 91822 to 91839, 91868 to 91884, 92437. |
| General practitioners | 3 to 47 or telehealth items 91790, 91800 to 91802, 91890 and 91891. |
Further information for medical practitioners
Treatment and management plans under MBS items 135, 137, 139 and 289 and telehealth items 92140, 92141, 92142 or 92434 must include:
- an assessment and diagnosis of a patient’s condition
- treatment options and decisions
- recommendations for medicine if required.
They must also include 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.
If you’ve allocated treatment services to allied health professionals, you must give them a copy of the completed treatment and management plan 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 health professional.
Further information for allied health practitioners
A maximum limit of 4 allied health services per day applies for the eligible patient.
Written reports
Reports to the referring medical practitioner should include:
- assessments carried out
- treatment provided
- recommendations on future management for the patient’s disability
- advice given to third parties, for example, parents and schools.