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GPs', LMOs' and Specialists' fee schedules

Chronic Pain Honorarium

Where an anaesthetist specialises in pain management, the Australian Society of Anaesthetists (ASA) may recommend that the anaesthetist have access to the Chronic Pain Honorarium.
The Chronic Pain Honorarium rules outline:

  • the Honorarium is not subject to referral or prior approval
  • an eligible anaesthetist may receive one payment per patient within a 12 month period, and
  • the Honorarium is payable only where pain has existed for a minimum of eight weeks.

In exceptional circumstances, more than one honorarium may be approved by DVA for a genuine new episode of pain within a 12 month period. Prior approval is required for the extra payment and must be indicated by the anaesthetist on his/her account. Appropriate documentation supporting such an occurrence must accompany the request.

Chronic Pain Honorarium fees

Chronic Pain Honorarium fee items are reviewed annually on 1 November.
The latest fees are available in the Medical Software Vendor File and Fee schedules for Medical Services

Clinical notes fees

Fees effective 1 July 2014

Fees for the provision of clinical notes (when requested by DVA)
DVA Item No. Description GPs
CN01 For notes which give a statement of attendance of diagnosis only or a brief record of one or two visits $29.90
CN02 For a statement of attendances and transcriptions of notes which may include specialist reports and diagnosis, results of X-rays, pathology tests etc $61.85
CN03 For notes which, in addition to the information supplied as in (2), include a summing up of the case over a period of time and/or with opinions helpful to the Department $93.35
CN04 In exceptional cases, a higher fee (up to a maximum of*) when a practitioner is required to spend considerable time in research into records of the case and in recording opinion $162.00

Please note: When claiming payment for the provision of clinical notes requested by DVA, you must quote the relevant DVA item number shown above.

Compensation consultation fees

Fees effective 1 July 2014

Listed below is the schedule of fees for medico-legal services provided by GPs for compensation purposes to use when determining payment of fees for compensation purposes. The fee structure for consultations is based on the Medical Benefits Schedule. Note that GST should be claimed on all services provided for medico-legal purposes. Amount of GST charged should be clearly specified on your tax invoice.

Send all reports, together with a tax invoice specifying the item numbers as shown below, to the Compensation Section of your State's DVA Office. Do not use a voucher or your invoice will be sent to the Medicare Australia and payment may be refused.

Surgery consultations
DVA Item No. Description GPs
DCC01 Less than 20 minutes $37.10
DCC02 20 to 40 minutes $71.80
DCC03 More than 40 minutes $105.10

 

Home or hospital visits
DVA Item No. Description GPs
DCC04 Less than 40 minutes $97.70
DCC05 More than 40 minutes $131.60

 

DVA Medical Report forms, Medical Impairment Assessment forms, Diagnostic Reports, and Ability to Work forms
Cost per page (inclusive of GST)
Consultation not required
$14.70

 

Clinical Notes
DVA Item No. Description GPs
DCN01 A brief record of an individual’s treatment. $29.95
DCN02 A brief record of an individual’s treatment, together with copies of specialist reports and/or test results. $6.90
DCN03 A more comprehensive record of an individual’s treatment, together with copies of specialist reports and/or test results. $93.40
DCN04 A detailed record of an individual’s treatment, together with copies of specialist reports and/or test results. $162.00

 

Completion of claim forms
DCN01 plus relevant consultation fee e.g. Consultation less than 20 minutes plus DCN01 $37.10 + $29.95 (Clinical notes fee)

Coordinated Veterans’ Care Program Fees

Fees effective 1 July 2014

Fees for the provision of Coordinated Veterans’ Care Program (CVC Program) items (LMOs and GPs only).

The CVC Program pays LMOs/GPs to enrol eligible Gold Card holders in the program and to provide quarterly periods of care to enrolled participants. The LMO/GP is responsible for the overall leadership of care which must be coordinated by a practice nurse, an Aboriginal health worker employed by the practice or a community nurse provided by a DVA contracted community nursing provider. Where none of those are available, the LMO/GP may perform the coordination role.

The CVC Programme items are DVA only items and do not appear in the MBS Schedule. Payments are 100% of the listed fee.

UP01

Initial Payment – LMO/GP with Practice Nurse Coordinator $424.15

UP01
Item Description Business Rules
The payment is to an LMO/GP, with a Practice Nurse coordinator, for enrolling a person in the CVC Program and having done all things necessary for the enrolment as described in the Guide for General Practice or Notes for CVC Program Providers and summarised as follows:
  • The LMO/GP has made any required changes to the Practice   before enrolling the participant in the Program.
  • The participant has been  assessed by the LMO/GP as meeting the eligibility criteria for participation in the Program.
  • The LMO/GP has explained the Program and the person has provided informed consent to being enrolled in the Program and to the sharing of health and medical information.
  • A care coordinator employed by the general practice has been appointed: either a Practice Nurse or an Aboriginal Health Worker.
  • A comprehensive needs assessment of the participant has been carried out by the care coordinator or the LMO/GP.
  • A care plan (GP Management Plan – GPMP) has been prepared and agreed with the participant and a patient friendly copy provided to the participant and any carer/ family as agreed.
  • This item will be claimed on enrolment of a participant in the CVC Program
  • Only one claim of either UP01 or UP02 will be paid per participant regardless of a change in LMO/GP or in Practice Nurse arrangements.
  • Where a person ceases to be a participant and later re-enters the Program, the initial incentive payment (UP01 or UP02)will not be payable.
  • The date of service is the date of enrolment in the Program which is the date that all steps necessary for enrolment in the Program have been completed.

UP02

Initial Payment – LMO/GP without a Practice Nurse Coordinator $265.05

Note: Prompt claiming of UP02 is very important, as the Community Nurse CVC claims (UP05 or UP06) will reject if a GP Initial Incentive payment has not been made.

UP02
Item Description Business Rules
The payment is to an LMO/GP, without a Practice Nurse coordinator,  for enrolling a person in the CVC Program and having done all steps necessary for the enrolment as described in the Guide for General Practice or Notes for CVC Program Providers and summarised as follows:
  • The LMO/GP has made any required changes to the Practice before enrolling the participant in the program.
  • The participant has been assessed by the LMO/GP as meeting the eligibility criteria for participation in the program.
  • The LMO/GP has explained the program and the person has provided informed consent to being enrolled in the program and to the sharing of health and medical information.
  • A care coordinator has been arranged through referral to a DVA contracted community nursing provider or, the LMO/GP has determined that the care coordination role will be performed by the LMO/GP
  • A comprehensive needs assessment of the participant has been carried out by the LMO/GP.
  • A care plan (GP Management Plan – GPMP) has been prepared and agreed with the participant and a patient friendly copy provided to the participant and any carer/ family as agreed.
  • This item will be claimed on enrolment of a participant in the CVC Program.
  • Only one claim of either UP01 or UP02 will be paid per participant regardless of a change in LMO/GP or in Practice Nurse.
  • Where a person ceases to be a participant and later re-enters the program, the initial incentive payment (Up01 or UP02) will not be applicable.
  • The date of service is the date of enrolment in the program which is the date that all steps necessary for enrolment in the program have been completed.

UP03

Quarterly Payment –LMO/GP with Practice Nurse Coordinator $442.65

UP03
Item Description Business Rules
This item enables an LMO/ GP with a Practice Nurse coordinator (including an Aboriginal Health Worker) to claim a fee for the ongoing leadership and coordination of the clinical care of a participant in the CVC Program in quarterly periods of care. This item covers a period of care as opposed to items that are for individual fee for service visits. The payment is for having done all things necessary for the quarterly period of care as described in the Guide for General Practice or Notes for CVC Program Providers and summarised as follows:
  • The LMO/GP has ensured that the General Practice Nurse has coordinated treatment services under the care plan including:
     
    • Assist with making appointments with other health professionals.
    • Remind the participant of appointments and any documents they must take or restrictions beforehand e.g. fasting.
    • Monitor the participant’s condition and address any concerns.
    • Coach and assist in self management.
    • Provide regular feedback to the LMO/GP.
       
  • Where the participant lives within a reasonable time and distance from the practice, the LMO/GP has ensured that at least one home visit was undertaken by the Practice Nurse within the first month of the participant being enrolled in the program and one home visit per year was undertaken.
  • The LMO/GP has ensured that the nurse coordinator has liaised with other care providers and provided regular feedback to the LMO/GP, who has oversighted the overall provision of care to the participant during the quarterly period.
  • The LMO/GP has ensured that the care plan has been regularly reviewed, updated and renewed where necessary.
  • Only one of either UP 03 or UP04 can be claimed in any quarterly period and only 4 of these items in any 12 month period.
  • The previous quarterly period of care must have expired before the commencement of the new quarterly period.
  • A claim will be rejected for a care period commencing after a participant’s date of death.
  • The date of service is the first day of the quarterly period of care.
  • The claim cannot be made until the quarterly period of care has expired.

UP04

Quarterly Payment –LMO/GP without Practice Nurse Coordinator $198.80

UP04
Item Description Business Rules
This item enables an LMO/ GP without a Practice Nurse coordinator (i.e. a Community Nurse from a DVA contracted community nursing provider or the LMO/GP is performing the care coordinator role) to claim a fee for the ongoing  leadership and coordination of the clinical care of a participant in the CVC Program in quarterly periods of care. This item covers a period of care as opposed to  items that are for individual fee for service visits. The payment is for having done all things necessary for the quarterly period of care as described in the Guide for General Practice or Notes for CVC Program Providers and summarised as follows:
  • The LMO/GP has ensured that a Community Nurse or the LMO/GP has coordinated treatment services under the care plan.
  • Where the LMO/GP has coordinated and the participant lives within a reasonable time and distance from the practice, at least one home visit was undertaken within the first month of the participant being enrolled in the programme and one home visit per year has been undertaken.
  • The LMO/GP has obtained regular feedback from the community nurse coordinator and has supervised the overall provision of care to the participant for the quarterly period of care.
  • The LMO/GP has ensured that the care plan has been regularly reviewed, updated and renewed where necessary.
  • Only one of either UP 03 or UP04 can be claimed in any quarterly period and only 4 of these items in any 12 month period.
  • The previous quarterly period of care must have expired before the commencement of the new quarterly period.
  • A claim will be rejected for a care period commencing after a participant’s date of death.
  • The date of service is the first day of the quarterly period of care.
  • The claim cannot be made until the quarterly period of care has expired.

Payments to an LMO/GP with a Practice Nurse or Aboriginal Health Worker coordinator are higher. Where a Community Nurse is the care coordinator, the DVA contracted community nursing provider is paid according to the Classification System and Schedule of Item numbers and Fees – Community Nursing Services. Please refer to the Community Nursing page.

Derived Fees Ready Reckoner for Local Medical Officers

The Derived fees ready reckoner for Local Medical Officers is available in the Medical Software Vendor File and Fee schedules for Medical Services

Diagnostic Imaging Fees

The latest diagnostic imaging fees are available in the Medical Software Vendor File and Fee schedules for Medical Services

Dose Administration Aid (DAA) Service Fees

Fees for GPs and LMOs effective 1 November 2012

Description, item number and LMO fee
Description Item No. LMO Fee (115% MBS)1
Home Medicines Review2 MBS 900 $174.55
  • VAPAC authorisation
  • Prescribe six months DAA
MBS Consult3  
  • VAPAC authorisation
  • Refers to community pharmacist for Veteran’s Six Month Review (VSMR)
MBS Consult4  
Assess and review VSMR CP42 $50.00

1 Only GPs registered as Local Medical Officers (LMOs) with Medicare Australia receive the higher fee (115% MBS).
2 Home Medicines Review (HMR) - also known as a Domiciliary Medication Management Review - can be claimed once in a 12-month period except where there is significant change in the patient’s condition – new diagnosis, discharge from hospital.
HMR is no longer a pre-requisite to commencing the DAA Service. However, DVA recommends strongly that an HMR is conducted within the first six-month cycle where no other HMR has been performed within the preceding 12 months.
3-4 The relevant consultation item from the Medicare Benefits Schedule will need to be claimed.

General Practitioners not participating in the LMO Scheme

General practitioners not participating in the LMO Scheme will receive a fee of 100% of the MBS plus 60 cents for services listed on the LMO Fee Schedule. Items not listed on the LMO Fee Schedule will be paid the fee listed on the appropriate DVA fee schedule.

Kilometre Allowance

Kilometre allowance for each kilometre after the first 10 kilometres in accordance with provisions in Section 7 of the LMO notes is 76 cents per kilometre (effective 1 November 2012).

Medication Review Fees

Medication review items are reviewed annually on 1 July.

Medication Review Fees
DVA Item No. Description Fee
CP20 Medication review undertaken in rooms $106.20
CP21 Medication review undertaken at the patient's home or institution $139.35

Pathology Fee Schedule

The Pathology Fee Schedule is available in the Medical Software Vendor File and Fee schedules for Medical Services
Psychiatrist fees

Attachment B to the Guidelines For Psychiatric Compensation Claims 

Effective 1 November 2013

Medical Services covered by this Schedule

The fees listed overleaf apply to medical services conducted at the request of Rehabilitation and Compensation Sections. They do not apply to:

  • treatment services under a Gold or White Card or
  • services requested by Income Support Sections.

Payment will be made for medical services which are requested by an officer of this Department. The Department will NOT pay for medical reports which are requested by other parties, including veterans or former members of the ADF, their advocates, solicitors or dependants.

Invoicing Procedure

A Tax Invoice must be lodged, attached to the completed form.

Note – All fees for reports and consultations provided as part of this investigation incur Goods and Services Tax (GST) if the provider is GST registered.
To enable payment to be made promptly, the tax invoice should be attached to the medical report form. An invoice cannot be paid until the related report is received.
Note – GST has been included in all of the rates listed overleaf.
The report and the invoice should be addressed to the contact officer who requested the report.
Do not use Treatment Service Vouchers for these accounts. 
Categories of the Medical Services which may be requested and the relevant fees are listed.
The fees outlined represent an amount for the consultation (where required) and report-writing time. 

Type of service provided and fee
Type of Service Provided Fee
(GST Inclusive)
Providing Clinical Notes (brief photocopies only) $51.70
Standard report without consultation $193.90
Extended report without consultation $290.90
For a report that involves one standard consultation (up to one hour) that addresses all parts of the Diagnostic Guidelines for Psychiatric Assessment, comments on laboratory and other investigations, and may or may not include an interview with a family member or other third party: $805.00
For a report that involves two standard consultations or one consultation of up to two hours' duration,  that addresses all parts of the Diagnostic Guidelines for Psychiatric Assessment, comments on laboratory and other investigations, and includes  interview with a family member or other third party: $1,155.20
For a report that involves three consultations or one consultation of up to three hours' duration, that addresses all parts of the Diagnostic Guidelines for Psychiatric Assessment, comments on laboratory and other investigations, and includes  an interview with a family member or other third party: $1,507.60
Administration and documentation of a clinical instrument (such as CAPS) attracts an additional fee. $135.20
For an assessment of all specified emotional and behavioural conditions including completion of a Departmental Emotional Behavioural Impairment Worksheet. The fee includes all consultations with the veteran and family members or other third parties in which the sole or major objective was to obtain data to assess the impairment. $452.50

In some circumstances, the Department may be willing to negotiate a different fee, however, prior written approval must be obtained.

Relative Value Guide Fee Schedule

The Relative Value Guide (RVG) Fee Schedule is available in the Medical Software Vendor File and Fee schedules for Medical Services

Rural Enhancement Initiative

The Rural Enhancement Initiative (REI) loading of 10% continues to apply to relevant consult items for services at hospitals designated under the REI. The REI is not payable on items listed on the RMFS or RVG.

Veterans Access Payment (VAP)

Fees effective 1 July 2014

  • $7.05 (items 64990, and 74990); or
  • $7.20 (item 10990) or
  • $10.65 (items 64991 and 74991) or.
  • $10.85 (items 10991 and 10992)

The VAP is assessed according to the MBS rules for the equivalent Medicare Bulk Billing Incentive items, and is not payable on inpatient items.  The VAP cannot be claimed against items listed on the RMFS and RVG.

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