Australian Association of Consultant Physicians

What is Telehealth

Telehealth is a consultation with a patient that is carried out by an eligible provider using different forms of communications technology.

This allows you to provide your specialist services to patients that would otherwise miss out due to difficulty getting to you, or because of their location.

On 1 July 2011, Medicare and DVA rebates and financial incentives were made available for telehealth. The new telehealth rebates are available for patients in most areas who access a consultant physician and paediatrician (CPP) via a videoconference. The new items are for consultations between a patient and a CPP where the patient is accompanied by a health professional who provides clinical support to the patient or assists where an examination may be required.

What constitutes a telehealth video consultation?

A telehealth video consultation under these arrangements involves a patient (accompanied by a health professional providing clinical support) and a consultant physician, paediatrician or medical specialist participating in a consultation via both an audio and video link.

To bill an MBS item for a specialist video consultation (items 99, 112, 149, 288, 389, 2820, 3015, 6016, 13210, 16399, or 17609) all of the following conditions must be met:

  • an associated item that relates to the consultant physician, paediatrician or medical specialist's service must be billed;
  • the service must be rendered in Australia;
  • the service must be provided via video conferencing (where both video and audio communication between the patient and specialist occurs);
  • the patient must be an eligible patient.

How do the telehealth items work?

As an example, a GP refers a patient to a consultant physician or paediatrician, who decides the consultation may be done by videoconference. When the video consultation occurs, the consultant physician or paediatrician, who is remotely located from the patient, bills the relevant attendance item, e.g. 110, and also bills the associated telehealth item 112.

Note the "derived fee" for item 112 is 50% of the Medicare fee for item 110. That is, item 110 has a Medicare fee of $145.20, so the "derived fee" for item 112 in this case would be $72.60. The "derived fee" is capped to a maximum of $100, so if associated with an item 132 (Medicare fee of $253.90) the "derived fee" would be $100, not 50% of $253.90.

In addition, this service also triggers a telehealth incentive payment and, if it is the first telehealth service billed by the specialist provider, a one-off "on board incentive" payment is also generated. If the service is bulk billed, a bulk bill incentive payment will also be made.

Which health professionals can participate in a telehealth video consultation?

There are telehealth items for consultant physicians, paediatricians and medical specialists as well as items for a range of health professionals who provide "patient end" services (that is, provide clinical support to the patient while the patient is participating in a videoconference consultation with a CPP or specialist – see "Who are patient end practitioners").

A list of the new telehealth items is available here; a table mapping the new telehealth items to the existing attendance items is available here.

The new telehealth items are "derived items"; that is, the telehealth item is charged in addition to the base item. For example, if a consultant physician or paediatrician undertakes an video consultation for which an item 110 is charged, then an item 112 is also charged in recognition of the additional time and complexity associated with undertaking a consultation via videoconference.
For consultant physicians and paediatricians, the new telehealth item 112 is associated with existing attendance items 110, 116, 119, 132 and 133.

For geriatric medicine items 141 and 143, there is a new telehealth item 149. For medical specialists, new item 99 is associated with specialist attendance items 104 and 105. For consultant occupational physicians, new item 389 is associated with existing attendance items 385 and 386.

How do you participate in telehealth?

There is no need to formally lodge any application for participation in the telehealth initiative as the first use of one of the new telehealth Medicare item numbers identifies to Medicare Australia that a consultant physician or paediatrician is participating in the telehealth arrangements.

Who are "Patient-End Practitioners"?

"Patient-end practitioners" are GPs, other medical practitioners, participating nurse practitioners, participating midwives, Aboriginal health workers and practice nurses to provide face-to-face clinical services to the patient during the specialist video consultation. There are 23 new MBS items be available for "patient-end" services.