Have you submitted a claim for a patient under a Medicare or DVA scheme and received a response code 160 "Maximum number of services for this item already paid"?

This response indicated the item claims has exceeded claimable limits due to care plan allocations or claiming periods. This typically occurs for allied health services where one or more professionals contribute to a patient care plan which has an annual cap. For example:

These limits apply in aggregate across all providers who may deliver services under those plans. Some claiming limits may also require a plan extension or review by the referring GP or specialist, whilst other plans may reset allocations by calendar year.
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Whilst you may track the number of sessions claims for your practice, should that same patient see other professionals in support of their plan, those services will be counted against annual limits.

You can confirm the number of claimed and remaining sessions by calling Medicare provider support, or if you are a Medical doctor, by logging into Medicare HPOS, select View Patient Care Plan History then Find Patient Record, confirm patient consent to view the record. On the patient record, you should then see a patient's care plan, including date of creation if they have it, plan type and number of sessions remaining. This includes a range of plan types including:

We recommend speaking to your patient, and let them know they've exceeded their allocated Medicare sessions for this calendar year. This means any additional sessions this year won't be eligible for Medicare claiming. If the plan allocation has been exhausted, speak to your patient about options for claiming under private health insurance or direct private billing.

If the plan requires an extension or review by the referring GP or specialist, you may need to send a report and request an extension to that referring provider. The patient may also be asked to attend a review session with that referring provider.