Aboriginal and Torres Strait Islander health assessments and follow-up services

Information on Indigenous health assessments and follow-up services for Aboriginal and Torres Strait Islander patients.

We recommend you also read the relevant Medicare Benefits Schedule (MBS) item descriptions, factsheets and explanatory notes on MBS Online.

Health assessment - MBS items

These items are for patients of Aboriginal and Torres Strait Islander descent. You can claim them once every 9 months.

Patients in the community are eligible for items 228 and 715.

Residents in Aged Care Facilities are eligible for items 93470 and 93479.

In-patients of hospitals aren’t eligible.

These items provide a comprehensive health check for all ages. They also help evaluate a patient’s health, including their physical, psychological and social wellbeing.

They help to support good health or improve health and prevent or reduce chronic disease risk factors.

Item requirements

To provide items 228, 715, 93470 and 93479 you must be an eligible practitioner working in general practice. You must also personally attend the patient. You can’t be a specialist or consultant physician.

When you provide the items, you must do all of the following:

  • take a patient history
  • do an examination and investigate as required
  • make an overall assessment
  • recommend appropriate interventions
  • advise and inform the patient
  • keep a health assessment record.

Specific requirements for patient life stages

The explanatory notes on MBS Online outline specific requirements for items 228 and 715 at different patient life stages.

These life stages include the following:

  • child - 0 to less than 15
  • adult - 15 to under 55
  • older person - 55 and over.

Written report

You should offer the patient a written report, including any recommendations on the health assessment. If the patient agrees, you may provide relevant extracts to the patient’s carer.

Completing a health assessment and follow-up services

This flowchart shows the process for completing an Aboriginal and Torres Strait Islander health assessment and follow-up services.

You undertake the health assessment. If required you can seek help from any of the following:

  • a practice nurse
  • an Aboriginal health worker
  • an Aboriginal and Torres Strait Islander health practitioner.

Once the health assessment is complete, you can claim the appropriate MBS item.

You can claim an attendance item for your follow-up consultation with the patient.

Any of the following health professionals can provide follow-ups on your behalf:

  • a practice nurse
  • an Aboriginal and Torres Strait Islander health practitioner.

They can provide this up to 10 times per calendar year. Once they provide the follow-up, you can claim the 10987 attendance item.

If allied health follow-up is needed, you can refer your patient for up to 5 services per calendar year. The form used to do this depends on the type of service you’re referring the patient to.

You can find out more about referred allied health follow-up services on MBS Online.

Considerations when doing health assessments

Generally, the patient’s usual doctor does the health assessment.

When doing a health assessment:

  • you must explain what’s involved in the health assessment to patients, parents or carers
  • patients must give their consent for the health assessment and for collection of their personal information
  • you must record the patient’s consent.

Health assessments are not the same as a health screening service.

Suitably qualified practice nurses, Aboriginal health workers and Aboriginal and Torres Strait Islander health practitioners can also do health assessments under your supervision. If they do, you must be satisfied that they have the required skills, expertise and training to both:

  • collect information
  • provide information on recommended interventions to patients, parents or carers.

Follow-up services on behalf of eligible health professionals

After completing a health assessment, you can claim item 10987 for follow-up services. Practice nurses and Aboriginal and Torres Strait Islander health practitioners provide these services on your behalf and under your supervision.

Supervision of the practice nurse or Aboriginal and Torres Strait Islander health practitioner at a distance is acceptable. The time spent for this service doesn’t count towards the time taken for your attendance with the patient.

Follow-up services give patients preventative health care and education between consultations. These can include:

  • examinations and interventions indicated in the health assessment
  • education on medication compliance and related monitoring
  • checks on clinical progress and service access
  • education, monitoring and counselling activities on lifestyle advice
  • taking a medical history
  • preventative advice for chronic conditions and related follow-up.

In-patients of hospitals aren’t eligible.

Patients can have up to 10 follow-up services per calendar year. For bulk bill claims, incentive items 10990 or 10991 also apply when claimed with item 10987.

Aboriginal and Torres Strait Islander health practitioners can provide another service for the patient on the same day. For example immunisation or wound management. You can claim for all Aboriginal and Torres Strait Islander health practitioner services provided.

If you decide you need to see the patient, you can also claim a Medicare attendance item.

Patient eligibility for referred allied health services

You can refer for up to 5 allied health follow-up services per calendar year.

The 5 services can include:

  • 5 of the same service type, for example physiotherapy
  • a mix of different service types, for example 1 dietetic, 2 podiatry and 2 physiotherapy services.

In-patients of hospitals aren’t eligible for follow-up allied health items.

Patients in the community are eligible for items 81300 to 81360.

Residents in Aged Care Facilities are eligible for:

  • initial items 93546 to 93558
  • subsequent items 93579-93591.

You can refer your Residential Aged Care patient for 5 additional physical therapy items 93571-93573 in the same calendar year.

The additional services include exercise physiology, occupational therapy and physiotherapy.

Referral requirements

For the patient to access follow-up allied health services, you must:

  1. identify which allied health services are appropriate for the patient
  2. refer patients to the relevant allied health professional
  3. use the referral form issued by the Department of Health or a form that contains all the components of this form.

When referring to a single service or the same service 5 times, use 1 referral form.

When different service types, use a separate referral form for each type.

A health assessment referral form and proformas are available on the Department of Health website.

Reporting requirements

Allied health professionals must provide a written report for you, including details about all:

  • investigations, tests and assessments performed on the patient
  • treatment provided, and
  • future management needed for the patient’s condition or problem.

Where allied health professionals provide multiple follow-up services, they must provide a report either:

  • after the first and last service
  • more often if clinically necessary.

Where they provide only a single service, they need to provide a report after that service.

Checking patient eligibility

You can check a patient’s eligibility by using the MBS Items Online Checker in HPOS to:

  • view and check patient eligibility based on their MBS history
  • check your own eligibility for claiming MBS items
  • check claiming conditions for MBS items.

If you can’t do this online, you can call us on the Medicare provider enquiries line.

Closing the Gap (CTG) on Indigenous health

The CTG PBS Co-payment Measure supports Aboriginal and Torres Strait Islanders to access low cost or free PBS medicines.

You can register patients if you’re either:

  • a PBS prescriber
  • an Aboriginal or Torres Strait Islander Health Practitioner registered with both the Australian Health Practitioner Regulation Agency (AHPRA) and Medicare.

Your Health Professional Online Service (HPOS) delegate can also register a patient once you assess them as eligible.

Read more about Closing the Gap PBS Co-payment for health professionals.

Practice Incentives Program (PIP) Indigenous Health Incentive (IHI)

The PIP IHI supports general practices and Aboriginal and Torres Strait Islander health services to better manage chronic disease for Aboriginal and Torres Strait Islander patients.

Practices must be approved for the PIP, and meet the eligibility criteria in the PIP IHI Guidelines.

Read more about the PIP IHI.

Case Study

A 55 year old patient presents with moderately severe impetigo requiring antibiotic treatment. As their usual medical practitioner, you’re concerned about improving their general health. You make the clinical decision to do a health assessment while the patient is at the practice.

This table shows the health assessment actions for the medical practitioner and patient.

Health assessment stage Eligible health professional actions Patient
Before

Before the health assessment:

  • discuss the patient’s health and potential benefits of a health assessment to identify and prevent or reduce chronic disease risk factors
  • explain what’s involved in the health assessment
  • ask if they mind having the practice nurse help with collecting information for the health assessment.
gives consent
During

During the health assessment:

  • do the assessment considering physical, psychological and social factors
  • conduct an examination.
 
After

After the health assessment:

  • discuss health issues identified in the health assessment with the patient
  • agree on a strategy to improve their health and reduce the risk of future disease.

As part of this strategy you:

  • can refer the patient for 5 follow-up allied health services:
  • ask them back for follow-up services with the practice nurse to encourage medication compliance, education and lifestyle advice.
  • offer a written report on the health assessment with recommendations on matters covered.
agrees to this

More information

Read more about:

Contact us at MBS item interpretation.

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Page last updated: 23 February 2022