COVID-19 Claiming Guide for Primary Care updated 14 September 2022 v2
Notification to GP
Chart Review if indicated $34.00 ($56.10^)
Enrolled with GP?
Becomes unwell / Requests consult?
Self Management
Yes
Positive test reported
Stays on selfmanagement until auto discharge
No
Meets criteria* for assessment?
No Clinical Escalation - Clinical care provided during acute episode $125.00 (206.25^)
No
Yes
Allocated to provider by Care Coordination Hub
Initial Clinical Assessment Standard $187.50 or ($309.39^) High needs $243.75 (402.19^)
Requires hospitalisation (claim under clinical escalation)
No
Active Management required?
Legend Funded activities shown in blue shaded boxes above Criteria* Pharmac’s access criteria for COVID-19 antiviral medicine Symptomatic household contacts of positive case are eligible for therapeutics if they meet the criteria. Out of hours ^ ^ denotes After Hours rate (8pm to 8am Monday through Thursday, weekend and public holidays from 5pm Friday through 8am Monday and any public holiday
Yes
One-off Clinical assessment post discharge from hospital $125.00 (206.25^)
Able to self manage
COVID Care case regular review as clinically determined Standard N $34.00 ($56.10^) Higher needs N $44.20 ($72.93^)
Additional service components available to use as clinically indicated In person consult In home $250.00/hour (412.50/hour^) plus travel time @ $0.62/km In practice/clinic $250.00/hour (412.50/hour^) Follow-up Check One-off follow-up check $62.50 (within 6 weeks from positive COVID test Antiviral Medicine - Pharmacist support Clinical Escalation may be claimed when queries are raised with a GP by pharmacies about antiviral medicine prescriptions