Attachment E – Current urgent after-hours item descriptors and explanatory notes

 

GROUP A11 - URGENT ATTENDANCE AFTER-HOURS

 

SUBGROUP 1 - URGENT ATTENDANCE - AFTER-HOURS

597

 

Professional attendance by a GP on not more than 1 patient on the 1 occasion – each attendance (other than an attendance between 11pm and 7am) in an after-hours period if:

a) the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken urgent after-hours period;

b) the patient’s condition requires urgent medical treatment; and

c) if the attendance is undertaken at consulting rooms, it is necessary for the practitioner to return to, and specially open, the consulting rooms for the attendance.

(See para A5 and A10 of explanatory notes to this Category)

Fee: $129.80 Benefit: 75% = $97.35 100% = $129.80

Extended Medicare Safety Net Cap: $389.40

598

 

Professional attendance by a medical practitioner (other than a GP) on not more than 1 patient on the 1 occasion – each attendance (other than an attendance between 11pm and 7am) in an after-hours period if:

a) the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken urgent after-hours period;

b) the patient’s condition requires urgent medical treatment; and

c) if the attendance is undertaken at consulting rooms, it is necessary for the practitioner to return to, and specially open, the consulting rooms for the attendance.

Fee: $104.75 Benefit: 75% = $78.60 100% = $104.75

Extended Medicare Safety Net Cap: $314.25

 

SUBGROUP 2 - URGENT ATTENDANCE UNSOCIABLE AFTER-HOURS

599

 

Professional attendance, by a GP on not more than 1 patient on the 1 occasion – each attendance between 11pm and 7am, if:

a) the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken after-hours period; and

b) the patient’s condition requires urgent medical treatment; and

c) if the attendance is undertaken at consulting rooms, it is necessary for the practitioner to return to and specially open, the consulting rooms for the attendance.

(See para A5 and A10 of explanatory notes to this Category)

Fee: $153.00 Benefit: 75% = $114.75 100% = $153.00

Extended Medicare Safety Net Cap: $459.00

600

 

Professional attendance, by a medical practitioner, (other than a GP) on not more than 1 patient on the 1 occasion – each attendance between 11pm and 7am, if:

a) the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken after-hours period; and

b) the patient’s condition requires urgent medical treatment; and

c) if the attendance is undertaken at consulting rooms, it is necessary for the practitioner to return to and specially open, the consulting rooms for the attendance.

(See para A10 of explanatory notes to this Category)

Fee: $124.25 Benefit: 75% = $93.20 100% = $124.25

Extended Medicare Safety Net Cap: $372.75


Explanatory notes:

A10 - Urgent After-hours Attendances (Items 597- 600)

Items 597, 598, 599 and 600 can be used for urgent services provided in consulting rooms, or at a place other than consulting rooms, in an after-hours period. 

Urgent After-hours Attendances (Items 597 and 598) allow for urgent attendances (other than an attendance between 11pm and 7am) in an after-hours period. 

Urgent After-hours Attendances during Unsociable Hours (Items 599 and 600) allow for urgent attendances between 11pm and 7am in an after-hours period. 

The attendance for all these items must be requested by the patient or a responsible person in, or not more than 2 hours before the start of the same unbroken urgent after-hours period. The patient's condition must require urgent medical treatment and if the attendance is undertaken at consulting rooms, it is necessary for the practitioner to return to, and specially open the consulting rooms for the attendance.

If more than one patient is seen on the one occasion, the standard after-hours attendance items should be used in respect of the second and subsequent patients attended on the same occasion.

Medical practitioners who routinely provide services to patients in the after-hours periods at consulting rooms, or who provide the services (as a contractor, employee, member or otherwise) for a general practice or clinic that routinely provides services to patients in after-hours periods at consulting rooms will not be able to bill urgent after-hours items 597, 598, 599 and 600.

A routine service means a regular or habitual provision of services to patients. This does not include ad hoc services provided after-hours in consulting rooms by a medical practitioner (excluding consultant physicians and specialists) working in a general practice or a clinic while participating in an on-call roster

After-hours attendance items may be claimed as follows:

Items 597, 598, 599, 600 apply only to a professional attendance that is provided:

 

on a public holiday;

on a Sunday;

before 8am, or after 12 noon on a Saturday;

before 8am, or after 6pm on any day other than a Saturday, Sunday or public holiday