Fee Navigator®

    Health Service Code 03.04K

    Comprehensive geriatric assessment, first full 90 minutes

    1. If the assessment is less than 90 minutes, then HSC 03.04A, 03.04AZ, 03.08A or 03.08AZ should be claimed.
    2. May only be claimed in an AHS regional facility or AHS/Contracted partner run geriatric program(s) or community clinic where a PCN multi-disciplinary team is contributing to the assessment.
    3. May only be claimed for patients aged 75 years or older.
    4. May only be claimed by general practitioners, internal medicine specialists or geriatric medicine specialists.
    5. May only be claimed once per patient per year.
    6. Each subsequent 15 minutes, or major portion thereof, may be claimed at the rate specified on the Price List, to a maximum of 7 calls.
    7. Assessment must include the following components:
      1. Medical includes but is not limited to a complete physical examination, a problem list, co morbidity conditions and disease severity, a medication review and nutritional status.
      2. Functional includes but is not limited to a review of basic activities of daily living, instrumental activities of daily living, activity/exercise status, gait, balance and assessment of senior falls.
      3. Cognitive/psychological includes but is not limited to review of mental status, administration of the Mini Mental State Examination (MMSE) and mood/depression testing through Geriatric Depression Scale (GDS).
      4. Social includes but is not limited to a review of informal support needs and assets, care resource eligibility and a financial assessment.
      5. Environmental includes but is not limited to a review of current living situation, home safety and transportation.
    8. Evidence that all components in note 7 were completed must be documented in the patient's records. This includes physician notes and copies of the MMSE and GDS.
    Category:V Visit
    Base rate:$319.80

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    CALLCOMGER1For Each Call Pay Base At100%
    CALLCOMGER2 - 7For Each Call Increase By$52.31

    Governing Rules:

    • 4.2.3

      Comprehensive Visit: An in-depth evaluation of a patient. This service includes the recording of a complete history and performing a complete physical examination appropriate to the physician's specialty, an appropriate record and advice to the patient. It may include the ordering of appropriate diagnostic tests and procedures as well as discussion with the patient. Advice to the patient must include discussion of a care plan related to the patient's condition(s). Patient care advice, including the discussed care plan, must be documented in the patient's record. The care plan does not have to be formally signed by the patient.