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

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

Health assessment - MBS items

Patients of Aboriginal and Torres Strait Islander descent are eligible for health assessment items:

• 228 - Other Medical Practitioner (OMP)
• 715 - General Practitioner (GP).

You can claim them once every 9 months.

Patients aren’t eligible if they’re:

• in-patients of hospitals
• care recipients in residential aged care facilities.

These items:

• provide a comprehensive health check for all ages
• evaluate a patient’s health, including their physical, psychological and social wellbeing
• support good health or improve health and prevent or reduce chronic disease risk factors.

Item requirements

To provide items 228 and 715 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.

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.

When you’re doing a health assessment, 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.

You can refer your patient for up to 5 services per calendar year if they need allied health follow-up.

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 collection of their personal information
• you must record the patient’s consent.

Health assessments aren’t the same as a health screening service.

Others can do health assessments under your supervision if they’re any of the following:

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

You must be satisfied 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 for 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 can provide these services for you under your supervision.

You can supervise these practitioners remotely. This supervision time doesn’t count towards the time you attend with your patient.

You can provide patients follow-up services for preventative health care and education between consultations. These can include:

• examinations and interventions written 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.

You can also claim one of the following incentive items for bulk bill claims when claiming item 10987:

• 10990 and 10991
• 75855 - 75858.

Aboriginal and Torres Strait Islander health practitioners can also 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 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.

Referral requirements

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

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

You can use one referral form if you’re referring to a:

• single service
• the same service 5 times.

You’ll need to use a separate referral form for different service types.

A referral form for follow-up allied health services is available on the Department of Health and Aged Care 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
• 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 patients
• Torres Strait Islander patients.

Practices must be:

• approved for the PIP
• 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.