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Pharmaceutical Benefits Scheme (PBS) prescription—patient category, entitlement code AA

Identifying and definitional attributes

Metadata item type:Help on this termData Element
Short name:Help on this termPatient category
Synonymous names:Help on this termPatient entitlement status; Beneficiary status
METeOR identifier:Help on this term600978
Registration status:Help on this termCommonwealth Department of Health, Standard 17/12/2015
Definition:Help on this term

The level of patient entitlement applicable for the prescribed Pharmaceutical Benefits Scheme (PBS) item being processed, as represented by a code.

Data Element Concept:Pharmaceutical Benefits Scheme (PBS) prescription—patient category

Value domain attributes

Representational attributes

Representation class:Help on this termCode
Data type:Help on this termString
Format:Help on this termAA
Maximum character length:Help on this term2
Permissible values:Help on this term
ValueMeaning
GEGeneral consumer
COConcession card holder
PEPensioner
RERepatriation (Department of Veterans' Affairs - DVA)
DBPrescriber Bag
OCStoma
OPParaplegic and quadriplegic

Collection and usage attributes

Guide for use:Help on this term

CODE GE   General consumer

General consumers must hold a Medicare card, and pay the full patient contribution for PBS prescription items unless they reach the applicable general Safety Net threshold in a given calendar year.

Under the Reciprocal Health Care Agreements, visitors from participating countries are treated as general consumers. To receive a pharmaceutical benefit, visitors must present either an interim Medicare card (blue), a Reciprocal Health Care Medicare card (pale green) or their passport.

CODE CO   Concession card holder

The first level of reduced patient contribution for PBS items.

Concessional consumers must hold a Medicare card and at least one of the following cards from either Centrelink, the Department of Veterans' Affairs (DVA) or the Department of Human Services (DHS).

  • Pensioner Concession card (Centrelink or DVA)
  • Commonwealth Seniors Health card (Centrelink or DVA)
  • Health Care card
  • Safety Net concession card (general consumers who reach or exceed the applicable general Safety Net threshold in a given calendar year pay the same patient contribution as concession card holders for the remainder of that calendar year).

CODE PE   Pensioner

The second level of reduced patient contribution for PBS items.

This code is only applicable to concession card holders (see Code 'CO' above) who reach or exceed the concessional Safety Net threshold in a given calendar year.

PBS items for consumers in this category are supplied free of charge for the remainder of the calendar year, with the consumer continuing to pay any applicable special patient contributions, brand premiums or therapeutic group premiums.

Safety Net consumers must hold a Safety Net Entitlement card ('SN' prefix on the number) issued by the Department of Human Services (DHS).

CODE RE   Repatriation (Department of Veterans' Affairs)

Veterans' Affairs claims.

Repatriation consumers must hold one of the following cards from the Department of Veterans' Affairs (DVA).

  • Repatriation Health Card For All Conditions (gold) - concessional patients under the Repatriation Pharmaceutical Benefits Scheme (RPBS)
  • Repatriation Health Card For Specific Conditions (white) – only regarded as concessional patients for RPBS prescriptions unless they hold a separate entitlement from Centrelink, otherwise they are general patients
  • Repatriation Pharmaceutical Benefits Card (orange) - concessional patients under the RPBS
  • Safety Net Concession Card or Safety Net Entitlement Card - issued by the Department of Human Services.

CODE DB   Prescriber Bag

Also known as Doctor's Bag, particularly in the context of historical data.

Items supplied on Prescriber Bag order forms. Consumers currently pay no contribution.

CODE OC   Stoma

This code applies to those patients who are likely to claim benefits related to the provision of stoma-related aids and appliances.

Assistance in relation to stoma-related products is provided via the Stoma Appliance Scheme (SAS). The SAS provides assistance to Medicare-eligible Australian residents who have a temporary or permanent artificial body opening, whether created surgically or otherwise, which facilitates the removal of urine and products of the gastrointestinal tract where the person does not have normal gastrointestinal tract or bladder functions.

To receive subsidised stoma-related products a patient must be a member of a stoma association in Australia and hold an SAS entitlement card issued by Medicare through one of the associations.

CODE OP   Paraplegic and quadriplegic

This code applies to those patients who claim PBS benefits related to the provision of paraplegic- or quadriplegic-related products.

Assistance in relation to paraplegic- or quadriplegic-related products is provided via the provisions of the National Health (Paraplegic and Quadriplegic Program) Special Arrangement 2010. The program provides assistance to Medicare-eligible Australian residents who have paraplegia or quadriplegia.

To receive subsidised paraplegic- or quadriplegic-related products a patient must be a member of an authorised paraplegic or quadriplegic association in Australia and hold an entitlement card issued by Medicare through one of the associations.

Collection methods:Help on this term

The payment type code is determined by the pharmacist at the time of supply and is indicated on the prescription form. For electronically submitted claims, the payment type code information is supplied from the pharmacy computer system. For manually entered claims, the payment type code is keyed by the operator.

Source and reference attributes

Submitting organisation:Help on this term

Department of Health

Reference documents:Help on this term

Department of Health 2015. Stoma Appliance Scheme web page. Department of Health, Canberra. Viewed 17 September 2015,
http://www.health.gov.au/internet/main/publishing.nsf/
Content/Stoma+Appliance+Scheme-3

Office of Parliamentary Counsel, ComLaw website 2015. National Health (Paraplegic and Quadriplegic Program) Special Arrangement 2010 (PB 118 of 2010) (Cwth). Office of Parliamentary Counsel, Canberra. Viewed 17 September 2015,
https://www.comlaw.gov.au/Details/F2015C00562

Department of Human Services 2015. Pharmaceutical Benefits Scheme (PBS) Safety Net. Department of Human Services, Canberra. Viewed 22 September 2015,
http://www.humanservices.gov.au/customer/services/medicare/pbs-safety-net

Data element attributes

Collection and usage attributes

Guide for use:Help on this term

This data item represents the patient's entitlement category as at the date of supply of the PBS item to the patient or PBS consumer.

Source and reference attributes

Submitting organisation:Help on this term

Department of Health

Relational attributes

Related metadata references:Help on this term

See also Pharmaceutical Benefits Scheme (PBS) prescription—patient entitlement status (derived), Commonwealth government assistance scheme code AX Commonwealth Department of Health, Standard 17/12/2015

See also Pharmaceutical Benefits Scheme (PBS) prescription—patient payment category, code X Commonwealth Department of Health, Standard 17/12/2015

Implementation in Data Set Specifications:Help on this term

Pharmaceutical Benefits Scheme (PBS) state/territory data extract 2013-14 Commonwealth Department of Health, Standard 17/12/2015

DSS specific attributes +
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