Medicare Benefits Schedule

Quick Guide


Welcome to the Medicare Benefit Schedule (MBS) Toolkit.  This page is designed to provide information on the Medicare Benefit Schedule (MBS), and provide updates to general practice teams, which is a listing of Medicare services subsided by the Australian Government.

Latest MBS Updates

Bulk Billing in General Practice from 1 November 2023

From 1 November 2023, thirteen new higher bulk billing incentive items have been introduced for Commonwealth concession card holders and patients aged under 16 years of age. The new items are 75870, 75871, 75872, 75873, 75874, 75875 and 75876 (new general support service bulk billing items) and 75880, 75881, 75882, 75883, 75884 and 75885 (for patients enrolled in MyMedicare).

These new items will support younger Australians and concessional patients to access general practice services, targeting investment in primary care to those who most need it.



Further information and resources on changes to bulk billing incentives are available at MBS Online:

November 2023 Updates

From 1 November 2023 there have been other changes to the MBS with significant importance for general practice. Information on these changes, including factsheets and guides can be found on MBS Online and in the following links.

MBS items linked to MyMedicare Registration

With the introduction of MyMedicare there are changes to some existing telephone item numbers and the introduction of two new items.
  • New phone items 91900 (Level C) and 91910 (Level D) will be introduced for longer general practice attendances with a GP, where the patient is registered under MyMedicare.
  • Existing phone item 91894 will be deleted. This item currently provides patients in rural and remote areas with access to longer general practice phone consultation items. Patients in these areas will continue to have access to longer general practice phone services where they are registered under MyMedicare.

Other information

  • MBS Note AN.0.74 provides a useful table containing information on general attendance items and the time basis for each level.
  • The RACGP provides a comprehensive summary of the MBS changes from 1 November 2023.

January 2024 Updates

From 1 January 2024 there will be several changes to the Medicare Benefits Schedule (MBS). These changes include indexation of the Extended Medicare Safety Net, the introduction of a new co-dependent pathology item, the cessation of 23 items and minor administrative policy changes.

Information on these changes, including factsheets and guides can be found on MBS January 2024 News and the MBS January 2024 Downloads.
 

MBS Information

Medicare

Medicare is Australia’s universal health care system that provides subsidised health care services to the Australia population. It was established in 1984 under the Health Insurance Act 1973 and is a universal system with the goal of providing Australians with affordable, accessible, and high-quality health care.

Resources and Information:

For further information on Medicare, please refer to Services Australia.

Medicare Benefits Schedule (MBS)

The Medicare Benefits Schedule (MBS) is a listing of the Medicare services subsidised by the Australian government. The Schedule is part of the wider Medicare Benefits Scheme managed by the Department of Health and Aged Care and administered by Services Australia.
 
MBS Online contains the full list of services under the Medicare Benefits Schedule. Each MBS item has a description and explanatory statement that explains how the item should be used.
 
MBS can be accessed through MBS Online that contains the latest MBS information and is updated as changes to the MBS occur. To access MBS Online, please refer to MBS Online

Resources and Information:

What is covered by MBS?

The MBS provides benefits for:
  • consultation fees for medical practitioners, including but not limited to, general practitioners and specialists.
  • tests and examinations by general practitioners needed to diagnose illnesses, including X-rays and pathology tests.
  • eye tests performed by optometrists.
  • most surgical and other therapeutic procedures performed by general and other medical practitioners.
  • specified items for allied health services.

What are the Medicare benefits and schedule fee?

Medicare benefits are based on fees determined for each medical service. The fee is referred to in these notes as the "Schedule fee". The fee for any item listed in the MBS is that which is regarded as being reasonable on average for that service having regard to usual and reasonable variations in the time involved in performing the service on different occasions and to reasonable ranges of complexity and technical difficulty encountered.
 
The Schedule fee and Medicare benefit levels for the medical services contained in the MBS are located within the item descriptions on MBS Online. 

Resources and Information:

What is Medicare Safety Nets?

Medicare safety nets give you extra support if you have high out-of-pocket medical costs. Once you incur a certain amount of out-of-pocket costs for out-of-hospital medical services, Medicare gives you a higher amount back for the rest of the year.

Information on Medicare Safety Nets can be found on Department of Health and Aged Care.

What is Reciprocal Health Care Agreements?

Agreements with 11 countries that covers the cost of medically necessary care when Australians visit certain countries and visitors from these countries visit Australia.

Resources and Information: Information on Reciprocal Health Care Agreements can be found on Services Australia.
 

AskMBS

AskMBS Email Advice Service for Providers:

AskMBS responds to enquiries from providers of services listed on the MBS seeking advice on interpretation of MBS (including outpatient services), explanatory notes and associated legislation. This advice is primarily to assist health professionals, practice managers and others to understand and comply with MBS billing requirements.
 
If you are seeking advice in relation to Medicare billing, claiming, payments or obtaining a provider number, please contact Services Australia on the Provider Enquiry Line - 13 21 50.
 
If you have a query relating exclusively to interpretation of the Schedule, you can email askmbs@health.gov.au
 
AskMBS also have an Advisories page summarising responses to frequently asked questions on specific subject areas.

MBS Factsheets for use in General Practice

Frequently used MBS Item Numbers

Care Plans and Health Assessments

Miscellaneous

MBS Claiming

Medicare Online (Webclaims) and Medicare Easyclaims

To submit a claim, you can use:

For eLearning and Infographics, please visit the Services Australia Health Professionals Online Services (HPOS).

Checking MBS claiming history:

There are some item numbers that have restrictions on claiming due to timeframes or numbers of claims. To ensure a patient is eligible to claim for an item number with such restrictions you can check a patients MBS claiming history for eligibility includes:

  • MBS items online check in HPOS – learn how to use this service here
  • My Health Record
  • MBS Online Provider Enquiry Line

My Health Record Medicare overview guides:

My Health Record is a secure online summary of key patient health information. Healthcare providers can access the system to view and add information.

Note: These steps assume that your software is connected to the My Health Record system, the patient has a My Health Record and their individual healthcare identifier (IHI) has been validated in your system.

Residential and Aged Care Facilities MBS Information

Residential and Aged Care Facilities items and information

The Residential Aged Care facility (RACF) items are only for Medicare-eligible GP and other medical practitioners providing primary care services in RACFs.

Resources: The full item descriptor and information on other changes to the RACF MBS can be found at the MBS Online website.
 

Telehealth Information

Ongoing Telehealth information

Ongoing MBS telehealth arrangements remain in place and provide for a wide range of telephone and video services by qualified health practitioners and support safe and equitable telehealth services which are informed by the MBS Review Taskforce Principles. 

Resources:

COVID-19 MBS Information

COVID-19 MBS items and information

As part of the coronavirus (COVID-19) response, there’s changes to the MBS items.

Resources: For further information, visit the MBS Telehealth Services web page or refer to HealthPathways WA - COVID-19 MBS Items (for login details, email healthpathways@wapha.org.au)
 
Practice Assist acknowledges and pays respect to the Traditional Owners and Elders of this country and recognises the significant importance of their cultural heritage, values and beliefs and how these contribute to the positive health and wellbeing of the whole community.

Disclaimer
While the Australian Government Department of Health has contributed to the funding of this website, the information on this website does not necessarily reflect the views of the Australian Government and is not advice that is provided, or information that is endorsed, by the Australian Government. The Australian Government is not responsible in negligence or otherwise for any injury, loss or damage however arising from the use of or reliance on the information provided on this website.