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Medicare Australia

ESSA members wishing to provide Medicare funded services must be a financial AEP and have a current provider number issued by Medicare Australia. Applications for a provider number can be downloaded from the Medicare website. You are required to supply a copy of your EP accreditation certificate on application.

Medicare Australia provides the following initiatives that attract a Medicare rebate when the service has been provided by an accredited exercise physiologist.

 

Area Item Number** Description MBS Benefit (85%)
Aboriginal Health Services 81315 Exercise physiology health service $52.95
CDM 10953 TCA – Exercise physiology $52.95
Type 2 diabetes 81110 Exercise Physiology – assessment for group services $67.90
Type 2 diabetes 81115 Exercise Physiology – group services $16.95

** Each item number is described by a series of requirements that must be met by AEPs who provide these services. Before providing any services ensure you are familiar with the related items descriptors. Item descriptors can be viewed at MBSOnline by typing the item number into the ‘search the MBS’ field or clicking the hyperlink above. AEPs are regularly audited by Medicare Australia to monitor service compliance. Failure to follow these item descriptors may result in a loss of provider eligibility or repayment of collected patient fees.

Allied Health Items for People of Aboriginal and Torres Strait Islander Descent

Allied health items are available to encourage people of Aboriginal and Torres Strait Islander descent who have had a health assessment to receive follow up allied health services to improve their health on referral from their regular GP. Further information is available on the Department of Health and Ageing website.

Chronic Disease Management Item

Medicare rebates are available for allied health services to be provided to patients with chronic conditions and complex care needs on referral from their regular GP. This program was previously known as the ‘Enhanced Primary Care (EPC)’ program

Detailed information including: eligibility criteria for allied health professionals, the MBS item descriptors, the MBS explanatory notes, factsheets and referral forms are available on the Department of Health and Ageing website.

Type 2 Diabetes Group Items

Under this initiative Medicare rebates are available to people with type 2 diabetes when accessing services provided by the following allied health professionals: Credentialled Diabetes Educators (CDEs), Accredited Exercise Physiologists (AEPs) and Accredited Practicing Dietitians (APDs) on referral from their regular GP. Patients are able to access to access an initial assessment to determine their suitability for participating in up to eight (8) group intervention services per year. These services may be delivered by exercise physiologists as part of a multidisciplinary team, or a sole providers.

Detailed information including: eligibility criteria for allied health professionals, the MBS item descriptors, the MBS explanatory notes, factsheets and referral forms are available on the Department of Health and Ageing website.

Other important information

On the 1st March each year ESSA notifies Medicare Australia of our unfinancial members to maintain correctness of their registered provider listing. Medicare Australia conducts compliance audits of providers each year. View details on their website.

Medicare Australia’s provider enquiry telephone number is 132 150

 

Other Resources

Medicare Benefit Schedule for Allied Health Services (pdf)
Medicare group services information pack (pdf)
This pack contains the practical information allied health professionals will   need to know about the new items.
GP PowerPoint resource (ppt)
This is a complete PowerPoint presentation for allied health professionals to   use when promoting their group services to GPs.
Medicare Group Services Types 2 Diabetes (pdf)
This provides some background to current literature on Type 2 diabetes and group intervention.Medicare Online EducationA range of online education services are available to help health professionals   understand their obligations when working with the Medicare Benefits Schedule (MBS)

Medicare Service Checklist. (TBC)

This checklist assist EPs in maintaining contemporaneous patient records according to Medicare Australia requirements