What does the Medicare item number 699 represent?

Medicare Item 699 represents a Heart Health Check in Australia, which is a dedicated, 20-minute-plus cardiovascular disease (CVD) risk assessment performed by a general practitioner (GP) at consulting rooms.

Key Details of Item 699

• Purpose: To evaluate a patient's risk of developing cardiovascular disease (such as heart attacks or strokes) and to put an ongoing management plan in place.
• Eligible Patients: Available to eligible patients aged 30 and older who do not already have established cardiovascular disease.
• Time Requirement: Must last at least 20 minutes of personal attendance by the GP.
• What is Included:
  • Collecting a medical history (checking smoking status, alcohol intake, diabetes status, cholesterol status, and blood glucose).
  • Performing a physical examination, which includes recording blood pressure.
  • Calculating absolute cardiovascular risk.
  • Initiating interventions, referrals, and a tailored treatment/management plan.
  • Providing preventative health and lifestyle advice.
• Claim Frequency: Can be claimed once every 12 months per eligible patient (subject to exclusions regarding other standard health assessments).
• Rebate: Features a scheduled fee (currently $87.10 with a 100% Medicare benefit).

You can view the full schedule details on the Australian Government Medicare Benefits Schedule or read more about the initiative through the Heart Foundation Heart Health Check Toolkit.

Medicare Item 699 (the Heart Health Check) is available to all Medicare-eligible patients in Australia aged 30 years and over who do not already have diagnosed cardiovascular disease.

Age and Specific Group Guidelines

• Aged 45 to 79 years: General routine assessment for adults.
• Aged 35 to 79 years: For patients with diabetes.
• Aged 30 to 79 years: For First Nations (Aboriginal and Torres Strait Islander) people.

Key Rules

• Can be claimed once every 12 months per patient.
• Cannot be claimed if the patient has had another general health assessment (such as items 701–707) billed within the past 12 months.
• Performed by a general practitioner (GP) in a consulting room for at least 20 minutes.

You can check more detailed guidelines on the MBS Online Factsheet or review the Heart Foundation Heart Health Check page.

You cannot co-claim Medicare Benefits Schedule (MBS Online) item 699 (Heart Health Check) and item 23 (standard general attendance) on the same day unless they represent entirely separate, unrelated clinical visits held at different times.

Co-Claiming Rules

• Same-Day Restrictions: You cannot stack a time-tiered general attendance consultation (like item 23) on top of a health assessment item (like item 699) for the same continuous patient encounter.
• Separate Consultations: Services Australia permits separate same-day billing only if the visits are distinct, clinically unrelated, and timed reasonably apart rather than being a continuation of the same service.
• Exclusions: Item 699 itself requires a minimum of 20 minutes dedicated to cardiovascular risk assessment, which often overlaps with the clinical scope and time spent if a level B consult is appended improperly.

Yes, Medicare pays for outpatient visits and treatments with a cardiologist under Medicare Part B once you meet your annual deductible.

Coverage Details

• Outpatient Visits: Medicare Part B covers 80% of the Medicare-approved amount for doctor consultations, diagnostic tests (like echocardiograms or stress tests), and procedures after you pay your deductible.
• Inpatient Care: If you are admitted to a hospital by a cardiologist, Medicare Part A covers your inpatient hospital care and services.
• Referral Rules: Under Original Medicare, you do not need a referral from a primary care doctor to see a cardiologist. If you have a Medicare Advantage plan, check your specific rules, as referrals or in-network doctors may be required.

Cost Factors

• Provider Acceptance: Make sure your cardiologist accepts Medicare. Participating providers accept Medicare's approved amount as full payment, while non-participating providers may charge up to 15% more. Opt-out providers do not take Medicare at all.
• Supplemental Insurance: A Medigap or secondary insurance policy can help cover your 20% coinsurance and deductible costs.

A Medicare menopause health assessment (under Australia's MBS Item 695 or Item 19000) must last at least 20 minutes and be conducted by a general practitioner (GP) or prescribed medical practitioner.

Key Requirements

• Patient Eligibility: Patients must be experiencing symptoms of perimenopause, menopause, early menopause, or premature ovarian insufficiency.
• Time and Format: The consultation must take at least 20 minutes and generally be conducted face-to-face (not via telehealth for Item 695).
• Clinical History: Collect a patient history to determine menopausal status (pre-, peri-, or post-menopausal), evaluate general wellbeing, and identify any contraindications for management.
• Physical Examination: Perform a basic physical check, including recording blood pressure, height, and weight.
• Investigations and Referrals: Initiate clinical tests or referrals as needed, specifically considering cervical screening, mammography, and bone densitometry.
• Management Options: Discuss non-pharmacological and pharmacological strategies, including their risks and benefits.
• Management Plan: Implement a patient-centered symptom management plan.
• Preventive Advice: Provide lifestyle and preventive guidance regarding physical activity, smoking cessation, alcohol use, nutrition, and weight management.