Medicare Benefits Schedule

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 Bulk-billing incentive items GP tables - PDF Version (*the above MBS Bulk Billing Incentive Item Numbers table link the incentive number to the item numbers they apply to)
• Bulk Billing in General Practice from 1 November 2023

Other MBS Changes

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

• Introduction of new Level E consultation items lasting 60 minutes or more
• Other Medical Practitioner and General Practitioner Medicare Benefits Schedule (MBS) items administrative changes
• Introduction of 6 minute minimum time for MBS Level B GP consultations

MBS Changes 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.

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:

• About Medicare
• What Medicare covers
• Recognition for Medicare benefits
• Eligibility to access Medicare benefits
• Medicare compliance
• Medicare safety nets
• Your guide to Medicare for Indigenous health services
• Medicare provider numbers and PBS prescriber numbers
• Claim a benefit
• Medicare Benefits Schedule (MBS) data collection
• Health Professionals Online Services (HPOS) eLearning

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

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:

• MBS Online
• Collection of files containing historical information on the MBS
• Medicare Benefits Schedule (MBS) Review
• Medicare Benefits Schedule (MBS) eLearning

Source:

• Medicare Australia
• Medicare Benefits Schedule Online
• Department of Health and Aged Care

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.

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:

• Schedule fees and Medicare benefits

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.

Source:

• Medicare Australia
• Medicare Benefits Schedule Online
• Department of Health and Aged Care

• MBS Items frequently used in General Practice (Fact Sheet)
• MBS Items for Skin Excisions and Biopsies (Fact Sheet)
• MBS Items for use in the Treatment Room (Cheat Sheet)
• MBS Items in Aboriginal and Torres Strait Islander Health Care (Fact Sheet
• MBS Items for Practice Nurses (Fact Sheet)
• MBS Items for Heart Health Check (Fact Sheet)
• MBS Telehealth Services

• MBS Items for Chronic Disease Management (Fact Sheet)
• MBS Items for GP Mental Health Treatment Plan (Fact Sheet)
• MBS Items for Health Assessments​​ (Fact Sheet)
• MBS Items for Health Assessments​​ of people 75 and over (Fact Sheet)

• MBS Items for 3GA Programs and MDRAP (Fact Sheet
• Reciprocal Health Care Arrangements (Fact Sheet)
• MBS Items for Advanced Care Planning (Fact Sheet)
• Factsheet for Additional 10 MBS Mental Health Sessions

To submit a claim, you can use:

• Medicare Online
• Medicare Easyclaim

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:

• BP Premier - Accessing the Medicare overview (PDF, 1006.18 KB)
• Medical Director - Accessing the Medicare overview (PDF, 1.16 MB)
• Genie - Accessing the Medicare overview (PDF, 489.74 KB)
• Zedmed - Accessing the Medicare overview (PDF, 991.41 KB)

The RACF items are only for Medicare-eligible GP and other medical practitioners providing primary care services in RACFs.

Resources:

• New arrangements for GP Residential Aged Care Facility (RACF) services
• Temporary COVID-19 Allied Health Support Services and GP/OMP Services for Aged Care Residents
• Extending Mental Health Support for Aged Care Residents during COVID-19
• RACGP Aged Care Clinical Guide (Silver Book)
• Family and Carer Participation under the Better Access Initiative
• Medicare Benefits Schedule Better Access initiative – mental health support for aged care residents during the COVID-19 pandemic

The full item descriptor and information on other changes to the Residential Aged Care facility (RACF) MBS can be found at the MBS Online website.

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:

• Medicare Compliance and Telehealth Services
• Verbal assignment of benefit arrangements for telehealth services
• MBS Telehealth Services
• Telehealth MBS eligibility for COVID-19 positive patients
• Telehealth available through a patient’s regular GP/practice: Frequently asked questions
• Continuing MBS Telehealth Services (Fact Sheet)

Source:

• Medicare Australia
• Medicare Benefits Schedule Online
• Department of Health and Aged Care

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

Resources:

• Changes to MBS items
• MBS COVID-19 Management Support Service
• COVID-19 Temporary MBS Telehealth Services
• Assessment for a COVID-19 oral anti-viral medication
• Telehealth MBS eligibility for COVID-19 positive patients
• SARS-CoV-2 (COVID-19) and other respiratory pathogens pathology items
• Temporary COVID-19 Allied Health Support Services and GP/OMP Services for Aged Care Residents
• Telehealth available through a patient’s regular GP/practice: Frequently asked questions

Source:

• Medicare Australia
• Medicare Benefits Schedule Online
• Department of Health and Aged Care
• Royal Australian College of General Practitioners

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).