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Make sure you read the relevant Medicare Benefits Schedule (MBS) item descriptions, factsheets and explanatory notes on MBS Online.
Health assessments
A health assessment looks at a patient’s health, physical, psychological and social function.
There are MBS items covering health assessments for specific target groups.
Health assessments aren’t available to hospital in-patients. They also aren’t available to aged care residents except for either:
- comprehensive medical assessments
- Aboriginal and Torres Strait Islander patients.
Patient eligibility
The decision to perform a health assessment on your patient will depend on both:
- your clinical judgement
- if your patient meets the criteria for 1 or more of the eligible target groups.
Patient consent
Before you do a health assessment, you must explain to your patient, their parent or carer about the:
- health assessment process
- benefits.
Your patient must consent to the health assessment and you must note this on their record.
The below table lists eligible target groups and the frequency for each type of health assessment.
| Patient eligibility for items 224-227 or 701-707 | How often |
|---|---|
|
A type 2 diabetes risk evaluation for people who are both:
|
Once every 3 years |
| People aged 45-49 years inclusive who are at risk of developing chronic disease | Once only |
| People aged 75 years and older | Once every 12 months |
| Permanent residents of residential aged care facilities | Once every 12 months |
| People with an intellectual disability | Once every 12 months |
| Refugees or other humanitarian entrants | Once only |
| Former serving members of the Australian Defence Force | Once only |
| Patient eligibility for item 177 or 699 | How often |
|---|---|
| Patient with or at risk of developing cardiovascular disease | Once every 12 months |
| Who is eligible for item 228 or 715 | How often |
|---|---|
|
Aboriginal or Torres Strait Islander people Read more about health assessments for Aboriginal and Torres Strait Islander people. |
Once every 9 months |
Who should undertake a health assessment
The patient’s usual medical practitioner should do the Health assessment. Non-vocationally recognised medical practitioners (Non-VR MPs) and general practitioners can also perform it.
You are the patient’s usual medical practitioner if you:
- or a medical practitioner in the same practice have provided the majority of health care to the patient over the last 12 months
- will provide the majority of health care to the patient over the next 12 months.
If a different medical practitioner performs a health assessment, they should send a copy to you with your patient’s consent.
MBS items
There are 4 time-based MBS health assessment services. When billing you should consider all of the following, the:
- time taken to complete the assessment
- complexity of your patient’s needs
- specific requirements for each target group.
The table below provides service descriptions, item numbers and the time required for each MBS item.
| Item numbers | Item name | Item description | Time Required |
|---|---|---|---|
| 224, 701 | Brief health assessment | A simple health assessment | 30 minutes or less |
| 225, 703 | Standard health assessment | An assessment for when the patient needs more than a brief assessment, but doesn’t have complex health issues | More than 30 but less than 45 minutes |
| 226, 705 | Long health assessment | An extensive assessment for when the patient has complex health issues | At least 45 but less than 60 minutes |
| 227, 707 | Prolonged health assessment | A complex assessment of a patient with significant, long-term health needs managed through a comprehensive preventative healthcare management plan | 60 or more minutes |
| 228, 715 | Health assessment | A health assessment for Aboriginal and Torres Strait Islander patients | No time requirements |
| 177, 699 | Health assessment | A health assessment for patients with cardiovascular disease or at risk of developing cardiovascular disease | At least 20 minutes |
Claiming limits
In some cases you can do a subsequent health assessment in the same 12-month period. You can do them if your patient is eligible for another health assessment under a different target group.
To help us assess your claim, please tell us which target groups the health assessment claim is for.
If you don’t specify the subsequent health assessment was for a different target group, we’ll reject your claim.
Heart health checks
You can bill a heart health check for your patient once every 12 months if your patient meets the criteria for these items.
Find out more about items 699 and 177 for these criteria on MBS Online.
You can’t bill a heart health check item for your patient if, in the last 12 months, they had another health assessment under:
- items 224-228
- items 701-715.
Record keeping
Make sure you:
- offer your patient a copy of the health assessment, including recommendations
- keep a copy of the health assessment for 2 years.
The Privacy Act 1988 covers information about medical records.
Find out more on the Department of Health and Aged Care website.