MBS Billings

Confused about MBS billings?

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.


Women's health

Urine pregnancy test

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

Read the details

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


Antenatal Care

Item: 16500
Fee: $47.90
Benefit: 75% = $35.95 / 85% = $40.75

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For routine antenatal attendances.


Management of a pregnancy >28/40

Item: 16591
Fee: $144.95
Benefit: 75% = $108.75 / 85% = $123.25

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Planning and management, by a practitioner, of a 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).


Non-directive pregnancy counselling

Item: 4001
Fee: $77.85
Benefit: 100%

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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.


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

Item number: 16407
Fee: $72.85
Benefit: 75% = $54.65 / 85% = $61.95

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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.


Long Acting Reversible Contraception (LARC) procedures

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Administration of hormone implant by cannula (including Implanon)
Item: 14206
Fee: $36.15
Benefit: 75% = $27.15 / 85% = $30.75

Removal of Implanon
Item: 30062
Fee: $61.70
Benefit: 75% = $46.30 / 85% = $52.45

Insertion of IUD
Item 35503
Fee: $54.40
Benefit: 75% = $40.80 / 85% = $46.25


Bulk Billing Incentives

Concessions, medical services

Concession - medical services
Item: 10990
Fee: $15.00
Benefit: 85% = $12.00

Concession - medical services, rural or remote
Item: 10991
Fee: $22.70
Benefit: 85% = $19.30

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

Read the details

Item 10990 is for an un-referred service to a person who is under the age of 16 or a person who is a Commonwealth concession card holder; and the person is not an admitted patient of a hospital. This item can be billed in addition to other MBS items.

The same criteria applies to item 10991, except the service must be provided at, or from, a practice location in a regional, rural or remote area (MMM 2 to 7 areas under the Modified Monash Model classification system). A locator map that can be used to identify a medical practice's MMM classification is available on the Department of Health website.

Item 10990 or 10991 cannot be claimed in conjunction with each other.

Item 10990 and item 10991 can only be used in conjunction with items in the General Medical Services Table of the MBS.

Please note, other Associated Notes apply, please check the MBS item page for more information.


Concession - pathology services

Concession - pathology services
Item 74990
Fee: $14.10
Benefit: 85% = $12.00

Concession - pathology services, rural or remote
Item: 74991
Fee: $21.30
Benefit: 85% = $18.15

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

Read the details

Item 74990 is an unreferred pathology tests by GP to a person who is under the age of 16 or a person who is a Commonwealth concession card holder; and the person is not an admitted patient of a hospital. This item can be billed in addition to other MBS items

The same criteria applies to item 74991, except the service must be provided at, or from, a practice location in a regional, rural or remote area (MMM 2 to 7 areas under the Modified Monash Model classification system). A locator map that can be used to identify a medical practice's MMM classification is available on the Department of Health website.

Item 74990 or 74991 cannot be claimed in conjunction with each other.

Item 74990 and 74991 can only be used in conjunction with items in the Pathology Services Table of the MBS.

Please note, other Associated Notes apply, please check the MBS item page for more information.

Therapeutic procedures

Aftercare

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

Read the 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).


Catheterisation of the bladder

Item number: 36800
Fee: $28.05
Benefit: 75% = $21.05 / 85% = $23.85

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


Ingrown toenails

Item number:47915
Fee: $172.20
Benefit: 75% = $129.15 / 85% = $146.40

Item number: 47916
Fee: $86.50
Benefit: 75% = $64.90 / 85% = $73.55

Read the 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.


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.


Diagnostic procedures and investigations

12 lead Electrocardiography and report

Item number: 11700
Fee: $31.75
Benefit: 75% = $23.85 / 85% = $27.00

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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.


Measurement of spirometry

Item number 11505
Fee: $41.75
Benefit: 75% = $31.35 / 85% = $35.50

Item number 11506
Fee: $20.90
Benefit: 75% = $15.70 / 85% = $17.80

Read the details

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


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: $53.05
Benefit: 75% = $39.80 / 85% = $45.10

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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)


Consultations

Professional attendance

Item number: 3
Fee: $17.50
Benefit: 100%

Item number: 23
Fee: $38.20
Benefit: 100%

Read the 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.


After hours attendances

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: $49.80-
Benefit: 100%

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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:


Aboriginal and Torres Strait Islander health check

Item number: 715
Fee: $215.65
Benefit: 100%

Read the details

An annual health check for Aboriginal and Torres Strait Islander people of all ages.


Health Assessments

New MBS items for Heart Health Check

Two new 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 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: $73.95
Benefit: 100%

Item number: 177
Fee: $59.15
Benefit: 100%

Read the 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.


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