MBS Billings

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

Can’t find what you’re looking for? Useful Department of Health resources:

Common areas of interest

Mental Health

null
Review of Mental Health Care Plan (MHCP)

Item number: 2712
Fee: $74.60
Benefit: 75% = $55.95 100% = $74.60

See details

Professional attendance by a general practitioner to review a GP mental health treatment plan which he or she, or an associated general practitioner has prepared, or to review a Psychiatrist Assessment and Management Plan.

null
GP mental health consult ≥ 20 minutes

Item: 2713
Fee: $74.60
Benefit: 100% = $74.60

See details

Professional attendance by a general practitioner in relation to a mental disorder and of at least 20 minutes in duration, involving taking relevant history and identifying the presenting problem (to the extent not previously recorded), providing treatment and advice and, if appropriate, referral for other services or treatments, and documenting the outcomes of the consultation.

null
GP prepare a MHCP
GP with mental health training, prepare a MHCP, 20-39 minutes

Item: 2715
Fee: $94.75
Benefit: 75% = $71.10 100% = $94.75

GP with mental health training, prepare a MHCP, ≥ 40 minutes

Item: 2717
Fee: $139.55
Benefit: 75% = $104.70 100% = $139.55

GP without mental health training, prepare a mental health treatment
plan (MHCP), 20-39 minutes

Item: 2700
Fee: $74.60
Benefit: 75% = $55.95 100% = $74.60

GP without mental health training, prepare a MHCP, ≥ 40 minutes

Item: 2701
Fee: $109.85
Benefit: 75% = $82.40 100% = $109.85

null
Focused psychological strategies
Focused psychological strategies of 30 to 39 minutes

Item: 2721
Fee: $96.50
Benefit: 100% = $96.50

Focused psychological strategies ≥ 40 minutes

Item: 2725
Fee: $138.10
Benefit: 100% = $138.10

Women's Health

null
Urine pregnancy test

Item: 73806
Fee: $10.15
Benefit: 75% = $7.65 85% = $8.65

See details

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

null
Antenatal attendance
For routine antenatal attendances.

Item: 16500
Fee: $49.05
Benefit: 75% = $36.80 85% = $41.70

null
Management of a pregnancy >28/40

Item: 16591
Fee: $148.40
Benefit: 75% = $111.30 85% = $126.15

See details

Planning and management, by a practitioner, of pregnancy if: the pregnancy has progressed beyond 28 weeks gestation (including mental health assessment) by shared care GP who is not planning to perform the delivery.

This item can only be billed by a shared care GP and can’t be claimed for a patient where item 16590 (including delivery) is being claimed (usually by GP obs or private obs).

null
Non-directive pregnancy counselling

Item: 4001
Fee: $79.70
Benefit: 100% = $79.70

See details

Professional attendance of at least 20 minutes for someone who is currently pregnant; or has been pregnant in the past 12 months.

This service may only be provided by a GP who has completed appropriate non-directive pregnancy counselling training.

The service involves the GP undertaking a safe, confidential process that helps the patient explore concerns they have about a current pregnancy or a pregnancy that occurred in the preceding 12 months. This includes providing, on request, unbiased, evidence-based information about all options and services available to the patient.

null
Postnatal (4-8 weeks, including mental health assessment)

Item: 16407
Fee: $74.60
Benefit: 75% = $55.95 85% = $63.45

See details

Must be between 4 and 8 weeks after birth; consultation must last at least 20 minutes and include a mental health assessment (including screening for drug and alcohol use and domestic violence) of the patient; may be billed only once per pregnancy.

null
Long Acting Reversible Contraception (LARC) procedures
Administration of hormone implant by cannula (including Implanon)

Item: 14206
Fee: $37.05
Benefit: 75% = $27.80 85% = $31.50

Removal of Implanon

Item: 30062
Fee: $63.20
Benefit: 75% = $47.40 85% = $53.75

Insertion of IUD

Item 35503
Fee: $55.70
Benefit: 75% = $41.80 85% = $47.35

Bulk Billing Incentives

null
Concessions, medical services
Concession – medical services

Item: 10990
Fee: $7.65
Benefit: 85% = $6.55

Concession – medical services, rural or remote

Item: 10991
Fee: $11.60
Benefit: 85% = $9.90

The Department of Health has released a handy guide on these items.

null
Concession - pathology services
Concession – pathology services

Item 74990
Fee: $7.20
Benefit: 85% = $6.15

Concession – pathology services, rural or remote

Item: 74991
Fee: $10.90
Benefit: 85% = $9.30

The Department of Health has released a handy guide on these items.

Therapeutic procedures

null
Aftercare

TN.8.4
Aftercare (Post-operative Treatment), Definition

See details

Did you know, you can bill Medicare items for aftercare (post-operative treatment) even if someone else performed the procedure?

This includes all post-operative treatment rendered by medical specialists and consultant physicians, and includes all attendances until recovery from the operation, the final check or examination, regardless of whether the attendances are at the hospital, private rooms, or the patient’s home, such as routine aftercare including wound review, dressing removal/change, suture removal.

Certain items exclude aftercare, which means you can bill Medicare items for aftercare even if you performed the procedure.

For example, 30219 – HAEMATOMA, FURUNCLE, SMALL ABSCESS OR SIMILAR LESION not requiring admission to a hospital – INCISION WITH DRAINAGE OF (excluding aftercare).

null
Catheterisation of the bladder

Item number: 36800
Fee: $28.70
Benefit: 75% = $21.55 85% = $24.40

See details

This can be billed/added to consult if catheterisation of the bladder is required, where no other procedure is performed.

null
Ingrown toenails

Item: 47915
Fee: $176.35
Benefit: 75% = $132.30 85% = $149.90

Item: 47916
Fee: $88.60
Benefit: 75% = $66.45 85% = $75.35

See details

47915
INGROWING NAIL OF TOE, wedge resection for, with removal of segment of nail, ungual fold and portion of the nail bed.

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.

null
Skin lesions

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

DoH factsheet: Determining lesion size for MBS item selection

See details

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.

Diagnostic procedures and investigations

null
Measurement of spirometry

Item: 11505
Fee: $42.80
Benefit: 75% = $32.10 85% = $36.40

Item: 11506
Fee: $21.40
Benefit: 75% = $16.05 85% = $18.20

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

Item: 30071
Fee: $54.35
Benefit: 75% = $40.80 85% = $46.20

See details

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 (i.e. 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 the third (and subsequent procedures i.e. $52.50+$26.25+$13.13=$91.86 for x3 biopsies).

Consultations

null
Professional attendance

Item 3
Straightforward presentation
Fee: $17.90
Benefit: 100% = $17.90

Item 23
Attendance < 20 minutes
Fee: $39.10
Benefit: 100% = $39.10

Item 36
Attendance 20-39 minutes
Fee: $75.75
Benefit: 100% = $75.75

Item 44
Attendance ≥ 40 minutes
Fee: $111.50
Benefit: 100% = $111.50

See details

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.

null
After hours attendances
The item number can change based off:
  • where the consultation is taking place (in a consultation room or elsewhere);
  • what time the consultation is taking place (unsociable hours or other hours);
  • whether the consultation is on a weekday, weekend, or public holiday;
See details

Attendance Period

Monday – Friday

Saturday*

Sunday and/or public holiday

Items

Urgent after-hours attendance

Between 7-8 am and 6-11 pm

Between 7-8 am and 12noon-11 pm

Between 7 am – 11 pm

585, 588, 591, 594

Urgent after-hours in unsociable hours

Between 11pm-7am

Between 11pm-7am

Between 11pm-7am

599, 600

Non-urgent after-hours in consulting rooms

Before 8am or after 8pm

Before 8am or after 1pm

24 hours

5000, 5020, 5040, 5060, 5200, 5203, 5207, 5208

Non-urgent after-hours at a place other than consulting rooms (except hospital or residential aged care facility)

Before 8am or after 8pm

Before 8am or after 1pm

24 hours

5003, 5023, 5043, 5063, 5220, 5223, 5227, 5228

Non-urgent after-hours in a residential aged care facility

Before 8am or after 8pm

Before 8am or after 1pm

24 hours

5010, 5028, 5049, 5067, 5260, 5263, 5265, 5267

null
After hours attendances in consulting rooms
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: 5020
Fee: $51.00
Benefit: 100% = $51.00

See details

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:

Consultation

In-hours item number

After-hours item number

Level A – Brief

3

5000

Level B – Standard <20mins

23

5020

Level C – Long >20mins <40mins

36

5040

Level D – Prolonged >40mins

44

5060

null
Urgent Attendance after-hours
Urgent after-hours attendances

(Items 585, 588, 591, and 594) allow for urgent attendances (other than an attendance between 11pm and 7am) in an after-hours period.

Urgent after-hours attendances during unsociable hours

(Items 599 and 600) allow for urgent attendances between 11pm and 7am in an after-hours period.

See details

Items 585, 588, 591, 594, 599, 600 apply only to a professional attendance that is provided:

  • on a public holiday;
  • on a Sunday;
  • before 8am, or after 12 noon on a Saturday;
  • before 8am, or after 6pm on any day other than a Saturday, Sunday or public holiday.
null
Aboriginal and Torres Strait Islander health check
An annual health check for Aboriginal and Torres Strait Islander people of all ages.

Item: 715
Fee: $220.85
Benefit: 100% = $220.85

Health Assessments

null
MBS items for Heart Health Check

Two interim items (699 and 177) were introduced in April 2019 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 can receive a Medicare rebate for having a specific heart health check conducted by a GP. Read the DoH factsheet on these items.

Item: 699
Fee: $75.75
Benefit: 100% = $75.75

Item: 177
Fee: $60.60
Benefit: 100% = $60.60

See details

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.

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.

This page has been compiled with help from 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.