EPC Decision Tool

This resource is designed to assist General Practice in the use of MBS items for Enhanced Primary Care. It is not meant to be a complete list.

Also check out the companion pages, EPC useful guides and Chronic Disease Management

Prices current as of the 1st of November 2009.

Acknowledgements

The Ballarat and District Division of General Practice received funding from the Australian Government to develop this resource.

Item 700: 75+ health assessment (in practice)

Overview	Health assessment by the patient's usual GP ⁵ for people aged 75 years and over, and where the assessment is occurring in the GP's practice.
Rebate	$179.15
Might also be eligible for	Bulk billing incentive 10991 ($8.55) ³ GP Management Plan 721 and review 725 ⁴ Team Care Arrangement 723 and review 727 725 ⁴ Contribution to Multidisciplinary Care Plan 729 Home Medicine Review 900 GP Mental Health Care Plan 2710
Templates	Medical Director users can select a patient, go to Assessments, then select Health Assessments MedTech32 users can select Module > Clinical > Extended Primary Care > Health Assessment (patient record must be open)
More	DoHA's checklists and questions and answers

Item 702: 75+ health assessment (not in practice)

Overview	Health assessment by the patient's usual GP ⁵ for people aged 75 years and over, and where the assessment is not occurring in the GP's practice.
Rebate	$253.30
Might also be eligible for	Bulk billing incentive 10991 ($8.55) ³ GP Management Plan 721 and review 725 725 ⁴ Team Care Arrangement 723 and review 727 725 ⁴ Contribution to Multidisciplinary Care Plan 729 Home Medicine Review 900 GP Mental Health Care Plan 2710
Templates	Medical Director users can select a patient, go to Assessments, then select Health Assessments MedTech32 users can select Module > Clinical > Extended Primary Care > Health Assessment (patient record must be open)
More	DoHA's checklists and questions and answers

Item 704: ATSI health assessment (in practice)

Overview	Health assessment by the patient's usual GP ⁵ for people aged 55 years and over, and of Aboriginal or Torres Straight Islander descent, in the GP's practice
Rebate	$179.15
Might also be eligible for	Bulk billing incentive 10991 ($8.55) ³ GP Management Plan 721 and review 725 725 ⁴ Team Care Arrangement 723 and review 727 725 ⁴ Contribution to Multidisciplinary Care Plan 729 Home Medicine Review 900 GP Mental Health Care Plan 2710
Templates	Medical Director users can select a patient, go to Assessments, then select Health Assessments MedTech32 users can select Module > Clinical > Extended Primary Care > Health Assessment (patient record must be open)
More	MBS Online's explanatory notes on this item

Item 706: ATSI health assessment (not in practice)

Overview	Health assessment by the patient's usual GP ⁵ for people aged 55 years and over, and of Aboriginal or Torres Straight Islander descent, not in the GP's practice
Rebate	$253.30
Might also be eligible for	Bulk billing incentive 10991 ($8.55) ³ GP Management Plan 721 and review 725 725 ⁴ Team Care Arrangement 723 and review 727 725 ⁴ Contribution to Multidisciplinary Care Plan 729 Home Medicine Review 900 GP Mental Health Care Plan 2710
Templates	Medical Director users can select a patient, go to Assessments, then select Health Assessments MedTech32 users can select Module > Clinical > Extended Primary Care > Health Assessment (patient record must be open)
More	MBS Online's explanatory notes on this item

Item 709: Healthy kids check (in practice)

Overview	A one-off check by the patient's usual GP ⁵ to ensure every four year old child in Australia has a basic health check to promote healthy lifestyles and introduce early intervention strategies.
Rebate	$47.10
Might also be eligible for	Item 709 can not be claimed in conjunction with another GP attendance item on the same day except where this is clinically required. In these exception cases, the claim for the attendance item should be annotated to indicate that the attendance was not related to the Healthy Kids Check.
Eligibility	Children 3.5 to 5 years who have not previously had a health assessment, and is receiving pre-school immunisation
Templates	Medical Director four year old health assessment template (thanks to NEVDGP)
More	Item 709 check list You'll need a Health Kids Resource Kit for each child. Call DoHA's National Mailing and Marketing department on 02 6269 1060 to order kits. List of local psychologists, you can search for those who specialise in children MBS Online's explanatory notes on this item DoHA's page on item 709

Item 712: Comprehensive medical assessment (CMA)

Overview	Comprehensive medical assessment (CMA) undertaken on a resident in an Aged Care Facility by the patient's usual GP ⁵.
Rebate	$200.70
Might also be eligible for	Bulk billing incentive 10991 ($8.55) ³ Contribution to Multidisplinary Care Plan for resident in Aged Care Facility 731 PN or AHW providing chronic disease support and monitoring, item 10997 ($11.35) only if a 731 has already been claimed RMMR 903
Templates	The Pink Peril - CMA resident information form for ACFs to give to practices CMA template, print (PDF) or Word version (meets ACFI requirements) Medical Director EPC referral forms for Allied Health Worker and Dental Practitioner MedTech EPC referral forms for Allied Health Worker and Dental Practitioner Referral form for Allied Health Group Services under Medicare for patients with type 2 diabetes 712 CMA assessment for Medical Director
More	CMA Fact Sheet, checklist and flowchart. More (including the CMA service delivery model, referring from GP to Practice Nurse) can be found on the EPC Useful Guides page. Don't want to do a CMA, but want to inform ACF of resident's care needs? Use this medical directive letter.

Item 713: Diabetes Risk Assessment for patients aged 40-49

Overview	Provision of a type 2 diabetes risk evaluation for a patient who is 40 to 49 years of age (inclusive) with a high risk of developing type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK)
Rebate	$62.80
Might also be eligible for	Bulk billing incentive 10991 ($8.55) ³
Templates	NEVDGP's LMP referral for Medical Director (suitable for referral of all patients over 40 to both a Lifestyle Modification Program (LMP) or Life! program) DoHA's printable GP referral form (suitable for referral of patients 40-49 years of age to a LMP) Risk Assessment Tool and Item 713 Template for Medical Director, available here (developed by Monash Division)
More	Cannot bill within 3 years of a 717. About item 713 and lifestyle modification programs GP Checklist for Item 713 Type 2 Diabetes Risk Assessment (fees, patient eligibility, components of evaluation, follow-up) MBS explanatory notes on this item Waiting room poster Guide for patients at high risk of diabetes More information on diabetes prevention is available at bddgp.org.au/diabetes-prevention

Item 717: 45 year old health check

Overview	Attendance by a GP at a place other than a hospital to undertake a health check for a patient between the age of 45 and 49 (inclusive) at risk of developing a chronic disease.
Rebate	$106.95
Might also be eligible for	Bulk billing incentive 10991 ($8.55) ³ GP Management Plan 721 and review 725 Team Care Arrangement 723 and review 727 Contribution to Multidisciplinary Care Plan 729 Home Medicine Review 900 GP Mental Health Care Plan 2710
Referral	Template for Medical Director Template for MedTech32 Template for Best Practice Template for Microsoft Word 45 year old health check patient request letter 1, patient request letter 2 and recall letter. These are suitable for Medical Director, but can also be used in Microsoft Word.
More	Item 717 to be billed only once. Cannot bill within 3 years of a 713. Following a 717, patients at high risk of developing type 2 diabetes may be eligible for an LMP. Indigenous people are encouraged to use item 710. MBS Online's explanatory notes on this item. RACGP - Organisational issues for consideration, including: Identifying eligible patients Patients readiness to change Referrals 45+ health check Fact Sheet, waiting room poster, tips and patient fact sheet. Other resources: RACGP's 717 page, LifeScripts, Green Book, Red Book and SNAP
Optionals	Baseline ECG Lung function test, e.g. Piko test or spirometry

Items 718/719: Health Assessment for People with Intellectual Disabilty

Overview	Attendance by a general practitioner for a patient with an intellectual disability. Claim item 718 if the attendance is in the practice, otherwise item 719.
Rebate	$213.50 for 718, $237.50 for 719
Might also be eligible for
Forms	Referral form for disability services to complete. Pro forma for practices in PDF or Medical Director format.
More	DoHA's explanatory notes on this item Patient brochure and Q&A

Item 721: GP Management Plan (GPMP)

Overview	Preparation of a GP Management Plan by the patient's usual GP ⁵
Rebate	$133.65
Might also be eligible for	Bulk billing incentive 10991 ($8.55) ³ Team Care Arrangement 723 and review 727 PN or AHW providing chronic disease support and monitoring, item 10997 ($11.35) Home Medicine Review 900 GP Mental Health Care Plan 2710
Management Plans	Sample management plans for Medical Director: arthritis, breast cancer, COPD, diabetes, IHD, parkinsons and prostate cancer. Sample management plans for MedTech32: arthritis, breast cancer, COPD, diabetes, IHD, parkinsons and prostate cancer. Sample GPMP & TCA for dementia for Medical Director
More	DoHA's CDM resources Patient fact sheet Recommended freqency is every two years, with a minimum claiming period of twelve months except in exceptional circumstances ¹.

Item 723: Team Care Arrangement (TCA)

Overview	Coordination of a Team Care Arrangment by the patient's usual GP ⁵.
Rebate	$105.90
Might also be eligible for	Bulk billing incentive 10991 ($8.55) ³ PN or AHW providing chronic disease support and monitoring, item 10997 ($11.35) Referral form for Allied Health Group Services under Medicare for patients with type 2 diabetes
Referral	Templates for Medical Director Templates for MedTech32 Medical Director EPC referral forms for Allied Health Worker MedTech EPC referral forms for Allied Health Worker PDF (print) EPC referral forms for Allied Health Worker PDF (print) EPC referral froms for Dental Care
More	Recommended freqency is every two years, with a minimum claiming period of twelve months except in exceptional circumstances ¹. DoHA's CDM resources

Item 725: GP Management Plan (GPMP) review

Overview	Review of the GP Management Plan by the patient's usual GP ⁵.
Rebate	$66.80
Might also be eligible for	Bulk billing incentive 10991 ($8.55) ³ Team care arrangment 723 ² PN or AHW providing chronic disease support and monitoring, item 10997 ($11.35)
Referral	Not currently available
More	DoHA's CDM resources Recommended frequency is once every six months, with a minimum claiming period of three months except in exceptional circumstances ¹.

Item 727: Team Care Arrangement (TCA) review

Overview	Review of the Team Care Arrangement by the patient's usual GP ⁵.
Rebate	$66.80
Might also be eligible for	Bulk billing incentive 10991 ($8.55) ³ GPMP 721 ² PN or AHW providing chronic disease support and monitoring, item 10997 ($11.35)
Referral	Not currently available
More	DoHA's CDM resources Recommended frequency is once every six months, with a minimum claiming period of three months except in exceptional circumstances ¹.

Item 729: Contribution or review of multi-disciplinary care plan

Overview	Contribution to, or review of, a multi-disciplinary care plan established by another health provider.
Rebate	$65.20
Might also be eligible for	Bulk billing incentive 10991 ($8.55) ³ PN or AHW providing chronic disease support and monitoring, item 10997 ($11.35) Referral form for Allied Health Group Services under Medicare for patients with type 2 diabetes
Referral	Tempate for item 729 not currently available Medical Director EPC referral forms for Allied Health Worker MedTech EPC referral forms for Allied Health Worker
More	MBS Online's explanatory notes on this item Recommended frequency is once every six months, with a minimum claiming period of three months except in exceptional circumstances ¹.

Item 731: Contribution or review of multi-disciplinary care plan (in RACF)

Overview	Contribution to, or review of, a multi-disciplinary care plan prepared by a residential aged care facility or another health provider for a resident in an aged care facility.
Rebate	$65.20
Might also be eligible for	Bulk billing incentive 10991 ($8.55) ³ PN or AHW providing chronic disease support and monitoring, item 10997 ($11.35) Referral form for Allied Health Group Services under Medicare for patients with type 2 diabetes
Referral	Referral form for Microsoft Word Medical Director EPC referral forms for Allied Health Worker MedTech EPC referral forms for Allied Health Worker
More	MBS Online's explanatory notes on this item Recommended frequency is once every six months, with a minimum claiming period of three months except in exceptional circumstances ¹.

Item 900: Home Medication Review (HMR or DMMR)

Overview	Home Medication Review (HMR or DMMR), a review of the patient's medications occurring in the patient's home by the patient's preferred pharmacist.
Rebate	$143.30
Might also be eligible for	Bulk billing incentive 10991 ($8.55) ³ GPMP and review TCA and review
Referral	Referral form for Medical Director Referral form for MedTech32 Referral and review for print (PDF)
For GPs and pharmacists	HMR fact sheet and flowchart.
For patients	Pamphlet Patient information sheet 1 Patient information sheet 2 Recommended frequency every twelve months, minimum claiming period can be less than twelve months except in exceptional circumstances ¹.

Item 903: Residential Medication Management Review (RMMR)

Overview	Residential Medication Management Review (RMMR), a review of the patients' medications occurring in an aged care facility by a pharmacist. RMMRs can be undertaken in two ways; collaborative RMMR initiated by a GP, and/or annual RMMR initiated by a pharmacist GPs can only claim for a collaborative RMMR (item 903) where they have sent a signed referral to the pharmacist. GPs cannot claim for an annual pharmacist RMMR.
Rebate	$98.20
Might also be eligible for	Bulk billing incentive 10991 ($8.55) ³ CMA 712 (ideally RMMR is done as part of CMA) Contribution or review of multi-disciplinary care plan (in RACF) 731
Referral	Referral form for Medical Director Referral form for MedTech32 Sample PDF referral form for print Referral forms for Word: to a GP and from a GP
For GPs and pharmacists	RMMR checklist and flowchart. RMMR info for GPs and RACFs, and some RMMR questions and answers. Recommended frequency every twelve months, minimum claiming period can be less than twelve months except in exceptional circumstances ¹.

References

Chronic Disease and Cancer Management, Using MBS Items: for General Practice. Ballarat & District Division of General Practice, 2007
Department of Health and Ageing (DoHA)
Royal Australian College of General Practitioners (RACGP)
MBS Online

Disclaimer

The information on this web site is restricted to a group of MBS items, and is not intended to represent all available MBS items. While efforts have been made to keep this MBS information up to date, the Ballarat & District Division of General Practice does not guarantee total accuracy or legislative compliance. It is the responsibility of the claimant to ensure that all Medicare claims comply with Medicare Australia's requirements.

Footnotes

¹ Exceptional cirumstances - significant change in the patient's clinical conditions or care circumstances. Medicare voucher annotated with;

clinically indicated
discharged
exceptional circumstances
significant change

² If not already claimed

³ Only claimed at 85% of the full bulk billing amount

⁴ Items 721, 723, 725 and 727 can only be claimed after 700, 702, 704 and 706, not before, and only if the patient meets the eligibility requirements

⁵ The patient's usual GP is the GP, or a GP working in the same medical practice, that has provided the majority of care to the patient over the previous 12 months and/or will be providing the majority of care to the patient over the next 12 months

Ballarat & District Division of General Practice