MBS Billings

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Helpful information and brief summaries of useful Medicare Benefits Schedule (MBS) item numbers for GP registrars.

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This page is thanks to the GPRA Advisory Council.


Please note: GPRA provides general information on Medicare Item Numbers. Under the Health Insurance Act 1973 you are legally responsible for services billed to Medicare under your Medicare provider number or in your name. As such you are responsible for ensuring that item numbers are correctly used in patient billings. Please refer to the MBS for the definition of each item number and its associated notes. Please contact the AskMBS Email Advice Service for specific advice on matters relating to the interpretation of MBS items.


12 lead Electrocardiography and report

Item number: 11700
Fee: $31.75

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Can be billed/added to consult numbers such as 23 and 36 when an ECG is done and interpreted by the billing doctor.

If the ECG is recorded for the purpose of interpretation by another medical practitioner then item 11702 applies, or if you are interpreting an ECG trace recorded by another medical practitioner in a separate consultation then item 11701 is used.

Urine pregnancy test

Item number: 73806
Fee: $10.15

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This can be billed/added to consult numbers such as 23 and 36 if a hCG urine test is done during the consult.

Measurement of spirometry

Item number 11505
Fee: $41.10

Item number 11506
Fee: $20.55

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Item number 11505

Measurement of spirometry, that:

(a) involves a permanently recorded tracing, performed before and after inhalation of a bronchodilator; and

(b) is performed to confirm diagnosis of:

(i) asthma; or

(ii) chronic obstructive pulmonary disease (COPD); or

(iii) another cause of airflow limitation;

each occasion at which *3 or more recordings* are made

Applicable only once in any 12 month period

Fee: $41.10 Benefit: 75% = $30.85 85% = $34.95

Item number 11506

Measurement of spirometry, that:

(a) involves a permanently recorded tracing, performed before and after inhalation of a bronchodilator; and

(b) is performed to:

(i) confirm diagnosis of chronic obstructive pulmonary disease (COPD); or

(ii) assess acute exacerbations of asthma; or

(iii) monitor asthma and COPD; or

(iv) assess other causes of obstructive lung disease or the presence of restrictive lung disease;

each occasion at which recordings are made

Fee: $20.55 Benefit: 75% = $15.45 85% = $17.50 

Professional attendance

Item number: 3
Fee: $17.20

Item number: 23
Fee: $37.60

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Item number: 3
Professional attendance at consulting rooms (other than a service to which another item applies) by a general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management-each attendance.

LEVEL A
A Level A item will be used for obvious and straightforward cases and this should be reflected in the practitioner's records. In this context, the practitioner should undertake the necessary examination of the affected part if required, and note the action taken.

Item number: 23
Professional attendance by a general practitioner at consulting rooms (other than a service to which another item in the table applies), lasting less than 20 minutes and including any of the following that are clinically relevant:
a) taking a patient history;
b) performing a clinical examination;
c) arranging any necessary investigation;
d) implementing a management plan;
e) providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation.

LEVEL B
A Level B item will be used for a consultation lasting less than 20 minutes for cases that are not obvious or straightforward in relation to one or more health-related issues. The medical practitioner may undertake all or some of the tasks set out in the item descriptor as clinically relevant, and this should be reflected in the practitioner's record. In the item descriptor singular also means plural and vice versa.

As described, for a brief consult where no other action is taken, then a level A consult is warranted. Keep in mind, it is the doctor's time only that is taken into the decision for what level is attributed, not the nursing+doctor's time. For example,billing an Item 3 for a brief consult with the only action being a flu vaccination administered by the nursing staff.

Ingrown toenails

Item number:47915
Fee: $169.50

Item number: 47916
Fee: $85.15

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47915
INGROWING NAIL OF TOE, wedge resection for, with removal of segment of nail, ungual fold and portion of the nail bed
Fee: $169.50
Benefit: 75% = $127.15 85% = $144.10

47916
INGROWING NAIL OF TOE, partial resection of nail, with destruction of nail matrix by phenolisation, electrocautery, laser, sodium hydroxide or acid but not including excision of nail bed
Fee: $85.15
Benefit: 75% = $63.90 85% = $72.40

New MBS items for Heart Health Check

From 1 April 2019, two new interim items (699 and 177) were introduced for GPs and medical practitioners (other than a specialist of consultant physicians) to conduct a heart health check that lasts at least 20 minutes, in consulting rooms. Eligible patients will now be able to receive a Medicare rebate for having a specific heart health check conducted by a GP. Read the DoH factsheet on these items.

Item number: 699
Fee: $85.60

Item number: 177
Fee: $68.50

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Item number: 699
Professional attendance for a heart health assessment by a general practitioner at consulting
rooms lasting at least 20 minutes and must include:

(a) collection of relevant information, including taking a patient history that is aimed
at identifying cardiovascular disease risk factors, including diabetes status, alcohol
intake, smoking status, cholesterol status (if not performed within the last 12
months) and blood glucose;
(b) a physical examination, which must include recording of blood pressure;
(c) initiating interventions and referrals to address the identified risk factors;
(d) implementing a management plan for appropriate treatment of identified risk
factors;
(e) providing the patient with preventative health care advice and information,
including modifiable lifestyle factors;

with appropriate documentation.

Fee: $85.60 MBS benefit: 85% = $72.80 

Item number: 177
Professional attendance for a heart health assessment by a medical practitioner (other than a
specialist or consultant physician) at consulting rooms lasting at least 20 minutes and must
include:

(a) collection of relevant information, including taking a patient history that is aimed
at identifying cardiovascular disease risk factors, including diabetes status, alcohol
intake, smoking status, cholesterol status (if not performed within the last 12
months) and blood glucose;
(b) a physical examination, which must include recording of blood pressure;
(c) initiating interventions and referrals to address the identified risk factors;
(d) implementing a management plan for appropriate treatment of identified risk
factors;
(e) providing the patient with preventative health care advice and information,
including modifiable lifestyle factors;

with appropriate documentation.

Fee: $68.50 MBS benefit: 85% = $58.20  

Diagnostic biopsy of skin

Diagnostic biopsy of skin, as an independent procedure, if the biopsy specimen is sent for pathological examination.

Item number: 30071
Fee: $52.50

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A Diagnostic biopsy of skin, as an independent procedure, if the biopsy specimen is sent for pathological examination.

Including punch and shave biopsy of a suspicious skin lesion billed at the time of the procedure, can be billed for each biopsy done on the same or that day (ie if 3x punch biopsies done bill 30071,30071,30071)

Includes-multiple billing rule

Where you are paid 100% of the first billed number,50%second and 25% of third (& subsequent procedures ie $52.50+$26.25+$13.13=$91.86 for x3 biopsies)

After hours attendances have different item numbers

While item 23 is used for standard consultations (Level B, less than 20 minutes) in consulting rooms, there is a different item number for after hours:

Item number: 5020
Fee: $49-

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Level B (less than 20min attendance) that is provided in consulting rooms (i.e. at the practice):

  • on a public holiday;
  • on a Sunday;
  • before 8am, or after 1pm on a Saturday;
  • before 8am, or after 8pm on any day other than a Saturday, Sunday or public holiday.

Similarly, there are after hour item numbers for the other in practice consultations:

Skin lesions

Item number/s: 31356 to 31376
Fee/s: Varying

DoH factsheet: Determining lesion size for MBS item selection

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The excision of warts and seborrheic keratoses attracts benefits on an attendance basis with the exceptions outlined in T8.13 of the explanatory notes to this category. Excision of pre-malignant lesions including solar keratoses where clinically indicated are covered by items 31357, 31360, 31362, 31364, 31366, 31368 and 31370.

The excision of suspicious pigmented lesions for diagnostic purposes attract benefits under items 31357, 31360, 31362, 31364, 31366, 31368 and 31370.

Malignant tumours are covered by items 31356, 31358, 31359, 31361, 31363, 31365, 31367, 31369 and 31371 to 31376.

Items 31357, 31360, 31362, 31364, 31366, 31368, 31370 require that the specimen be sent for histological examination.

Items 31356, 31358, 31359, 31361, 31363, 31365, 31367, 31369, 31371-31376 also require that a specimen has been sent for histological confirmation of malignancy, and any subsequent specimens are sent for histological examination. Confirmation of malignancy must be received before itemisation of accounts for Medicare benefits purposes.

Where histological results are available at the time of issuing accounts, the histological diagnosis will decide the appropriate itemisation. If the histological report shows the lesion to be benign, items 31357, 31360, 31362, 31364, 31366, 31368 or 31370 should be used.

It will be necessary for practitioners to retain copies of histological reports.

Information from DoH website.

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