Changes to MBS telehealth items from 1 January 2022


Changes from 1 January 2022

From 1 January 2022, patient access to telehealth services will be supported by ongoing Medicare Benefits Schedule (MBS) arrangements.

It remains a legislative requirement that GPs and other medical practitioners (OMPs) working in general practice can only perform a telehealth service where they have an established clinical relationship with the patient, with limited exemptions. Patients who are subject to COVID-19 public health orders requiring isolation or quarantine will continue to have unrestricted access to MBS telehealth services, without needing to demonstrate an established clinical relationship with their telehealth provider.

The following changes to telehealth services will take effect from 1 January 2022:

  • A new extended telephone consultation item for attendances 20 minutes or longer for patients in rural and remote communities (Modified Monash Model areas 6 and 7) will be introduced.
  • The COVID-19 GP ‘hotspot’ telephone items for consultations longer than 20 minutes will cease.
  • Specific GP nicotine and smoking cessation services including telehealth will be extended to 31 December 2023. GP sexual and reproductive health services and non-directive pregnancy support counselling will be extended to 30 June 2023. These services do not require an established clinical relationship when provided by telehealth.
  • MBS telehealth items will now contribute to Standardised Whole Patient Equivalent (SWPE) calculations which determine the value of Practice Incentives Program (PIP) and Workforce Incentive Program – Practice Stream (WIP) payments.
  • Medicare compliance rules will be updated to include telephone and video services in the prescribed pattern of practice (the 80/20 rule), with a new ‘30/20’ rule for GP telephone services.
    • Any GP who provides more than a combined 80 services by face-to-face, video or telephone on 20 or more days in a 12-month period will be referred to the Professional Services Review (PSR).
    • In addition, any GP who provides more than 30 telephone consultations on 20 or more days in a 12-month period will be referred to the PSR.
  • Superseded pre-COVID telehealth and associated items will be removed from the MBS to avoid multiple different MBS items for the same service. This includes GP and OMP mental health consultations and general attendances by video. GP and OMP patient-end support items linked to pre-COVID medical specialist and consultant physician telehealth services will also be removed from 1 January 2022.

For more information on the changes, visit MBS Online.

Update: Deferral of changes to Medicare compliance rules

The changes to Medicare compliance rules outlined above (addition of telehealth services to the 80/20 rule and introduction of a 30/20 rule for phone services) have been deferred until at least 1 July 2022. This is in recognition of rapidly escalating COVID-19 cases across Australia, and the fact many patients will have their care managed via telehealth while case numbers remain high.


Level C MBS phone consultation items

In mid-January the federal government temporarily reinstated Level C MBS phone consultation items for attendances lasting longer than 20 minutes until 30 June 2022. These services are now available nationally.
The relevant item numbers are 92746 for GPs and 92747 for other medical practitioners. All Medicare-eligible patients can receive these services based on normal telehealth eligibility requirements and exemptions. Find out more on MBS Online.
 

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