Health Assessment items

Contents

- Overview
- Patient Cohorts and Individual Requirements
- Billing
- Links

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Overview

Eligibility

There are a number of patient cohorts eligible for Health Assessments.

These include patients aged 75 years and older, patients residing in a residential care facility, patients with an intellectual disability, refugees and other humanitarian entrants, veterans, patient aged between 40-49 years at high risk of developing diabetes, and patients aged 45-49 years at risk of developing chronic disease.

Each cohort group has different regulations around the frequency of which a health assessment item number can be billed, as laid out below.

Patient Cohort	Frequency of Assessment
Patients aged 75 years and over	Annually
Residents of an aged care facility (RACF)	Annually
Patients with an intellectual disability	Annually
Patients 40-49 years old deemed to be at high risk of developing Type 2 diabetes	Every 3 years
Patients 45-49 years at risk of chronic disease	Once per lifetime
Refugees or other humanitarian entrants	Once per lifetime
Veterans	Once per lifetime

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Patient Cohorts and Individual Requirements

Patients aged 75 years and over

Patients must be aged 75 years or older and living in the community.

Health Assessment must be completed in person and should include assessment of:

• Physical health with measurement of blood pressure, pulse rate and rhythm
• Medication taken and compliance and understanding of these
• Continence
• Immunisation status
• Physical function including falls and ability to complete activities of daily living
• Psychological function including cognition and mood
• Social function and the need for or utilisation of services

 

Residents of an aged care facility (RACF)

Patients who are residing within a residential care facility.

Health Assessment must be completed in person and should include:

• A detailed medical history
• A comprehensive medical examination including physical examination and recording of observations
• Developing a list of pertinent diagnoses and medical issues and how these are to be addressed
• Arrangement of investigations and referrals as appropriate
• A written summary of the above

 

Patients with an intellectual disability

Patient must be living in the community with an intellectual disability.

Health Assessment must be completed in person and should include:

• Assessment of the patient’s physical, psychological and social function
• The need for any medical intervention or preventive health activities
• Assessment of dental, aural and ocular health, with referral for audiometry and/or optometry review if not performed in the last 5 years
• Assessment of nutritional status
• Assessment of bladder and bowel function
• Assessment of medications taken including both prescribed and over the counter, interactions or side effects from same, compliance and the need for monitoring
• Checking of immunisation status
• Checking exercise and physical activity levels
• Ensuring the current support provided is adequate
• Considering and advising on the need for population screening activities such as mammograms, cervical and bowel screening
• Checking for dysphagia and gastroesophageal disease where appropriate
• Assessing risk factors for osteoporosis and managing this as requires
• Screening for thyroid disease at least every 2 years
• Assessing for and managing any comorbid physical or mental health diagnoses
• Considering the management of sexual and reproductive health where appropriate
• Ensuring there are no signs of physical, psychological or sexual abuse

 

Patients 40-49 years old deemed to be at high risk of developing Type 2 diabetes

Patients aged between 40 and 49 years old who have returned a high risk score on the Australian Type 2 Diabetes Risk Assessment Tool in the preceding 3 months.

The Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK) | Australian Government Department of Health and Aged Care

A Type 2 Diabetes Risk Evaluation must include;

• Assessment of the patient’s AUSDRISK high risk score and a review of their risk factors
• Initiation of appropriate intervention to exclude a current diabetes diagnosis and manage identified risk factors
• Physical examination
• Arrangement of appropriate clinical investigations
• Initiation of interventions including referrals and follow up as required
• Education including strategies to reduce their risk

 

Patients 45-49 years at risk of chronic disease

Patients aged between 45 and 49 years of age, in whom the practitioner has identified risk factors for chronic disease. This could include lifestyle risk factors such as smoking, poor nutrition or substance abuse, biomedical risk factors such as high cholesterol, high blood pressure or obesity and family history of a chronic disease.

The Health Assessment in to be performed in person and should include:

• Assessment of modifiable and non modifiable risk factors such as lifestyle factors, biomedical markers and family history
• Physical examination including in room observations
• Ordering relevant investigations
• Initiating appropriate interventions or referrals
• Educating the patient about their risk and providing advice about managing this

 

Refugee or Humanitarian Entrant

Must be a refugee or humanitarian entrant with medicare eligibility and must have held a relevant visa for less than 12 months, or have entered Australia less than 12 months before the assessment is performed. Relevant visas include subclass 070, 200, 201, 202, 203, 204, 786, 790 and 866.

The health assessment should be conducted in person, with awareness of and management of possible communication barriers (eg with the use of an interpreter in the case of a language barrier) and must include:

• Assessment of the patient’s physical and psychological health and social function
• The patient’s medical history
• Physical examination of the patient including observations
• Arranging investigations, referrals or interventions where required
• Development of a management plan addressing any health care needs, health problems and medical conditions identified during the health assessment
• Preventive health care and patient education

 

Veterans

Former members of the permanent forces or reserves are eligible for a one off medicare funded Veterans Health Assessment.

The Medicare funded one off Veterans Health Assessment must include:

• Assessment of the patient’s physical and psychological health and social function as outlined below
• Information about the patient’s service within the defence force, including service type, years of service, field of work, number of deployments and reason for discharge
• Social history including current occupation, relationship status and number of dependents
• Physical health assessment including measurement of height, weight (noting any change in the last 12 months), waist measurement and blood pressure
• Assessment of any mental health concerns including anger management issues, insomnia, psychological distress, a diagnosis of PTSD and any risk of harm to self or others
• A list of current medical conditions and medications, including over the counter or those prescribed elsewhere
• The presence of hearing loss or tinnitus
• Smoking, alcohol and substance use if applicable
• Current level of physical activity
• The presence of any pain
• Sexual health concerns
• Referrals for any further investigations or assessments as required
• Relevant patient education and a plan to manage any identified areas of concern

 

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Billing

Health assessments are time based, and therefore the item number chosen depends on the duration of the consultation.

The item number is different whether completed by a vocationally-registered (VR) general practitioner (GP) or non-VR GP.

A practice nurse, Aboriginal and Torres Strait Islander health practitioner or Aboriginal health worker can provide assistance in the completion of a health assessment, and their time is also included in this.

Duration of Health Assessment (HA)	VR GP	Non-VR GP
Brief HA lasting less than 30 minutes	701	224
Standard HA lasting 30-45 minutes	703	225
Long HA lasting 45-60 minutes	705	226
Prolonged HA lasting more than 60 minutes	707	227

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Links

Item 705 | Medicare Benefits Schedule

Medicare Benefits Schedule - Note AN.0.36

The Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK) | Australian Government Department of Health and Aged Care 

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