Medicare Benefits Schedule

The Understanding Medicare: Provider Handbook (the handbook) has now been published. It is hosted on the Health website, as well as linked on the Health Professionals Education website, the Australian Medical Council resources website, MBS Online and the Services Australia website.
 
The handbook is a plain English resource that introduces the basic concepts of the Medicare program and aims to:

• build a foundational knowledge from the beginning of a health professional’s journey with Medicare and the MBS;
• serve as a reminder or knowledge check for existing Provider cohorts of their responsibilities when claiming with Medicare; and
• support administrative staff and third parties involved in Medicare claiming with their understanding of Medicare and the MBS.

The implementation of changes to chronic disease management items has been deferred from 1 November 2024 until 1 July 2025 to support all practices and providers, including GPs and allied health providers, to be ready for the changes to these important services. For more information on the deferral see Upcoming changes to MBS Chronic Disease Management Arrangements | Australian Government Department of Health and Aged Care.

Subject to the passage of legislation, from 1 July 2025 a revised framework for MBS items for chronic disease management in primary care will come into effect. These arrangements simplify and streamline the current MBS arrangements, including:

• Replacing the current GP management plan and team care arrangements items with a single GP chronic condition management plan,
• Patients will be eligible for the plan whether their condition is managed by their GP or prescribed medical practitioner, or multidisciplinary care is required,
• Where multidisciplinary care is required, patients will be able to access the same range of services currently available through GP management plans and team care arrangements, and
• GPs and prescribed medical practitioners will refer patients with a GP chronic condition management plan to allied health services directly. The requirement to consult with at least two collaborating providers, as described under the current team care arrangements will be removed.

• 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

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

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

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 the Department of Health and Aged Care website. 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 the Department of Health and Aged Care website.

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:

• Reciprocal Health Care Agreements
• About Reciprocal Health Care Agreements

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.

• Health Professionals Online Services (HPOS) eLearning
• Understanding Medicare: Provider Handbook

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

 

MBS Items frequently used in General Practice MBS Items frequently used in General Practice (Fact Sheet)

​MBS Items for Skin Excisions and Biopsies Amendment to existing skin excision and skin flap items Billing skin lesion treatment and biopsy items under Medicare

​MBS Items for use in the Treatment Room MBS Items for use in the Treatment Room (Cheat Sheet)

MBS Items in Aboriginal and Torres Strait Islander Health Care Frequently claimed MBS Items for Aboriginal Community Controlled Health Services and other Primary Health Care Provider Aboriginal and Torres Strait islander Health Practitioner and Aboriginal Health Worker MBS Items Medicare Benefits Schedule – Item 715 Completing an Aboriginal and Torres Strait Islander Health Assessment GP Led Primary Care Planning for Indigenous Patients

MBS Items for Practice Nurses Practice Nurse MBS Items Practice Nurse Items

MBS Items for Nurse Practitioner  Nurse practitioner MBS changes from 1 July 2024

MBS Items for Heart Health Check Heart Health Assessment Items

MBS Telehealth Services MBS Telehealth Services – from 1 November 2023 Verbal Assignment of Benefit Arrangements for Telehealth Services

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MBS Items for Chronic Disease Management MBS Items for Chronic Disease Management (Fact Sheet) Chronic Disease GP Management Plans and Team Care Arrangements Chronic Disease Management Items (Items 721 to 732)

MBS Items for GP Mental Health Treatment Plan Better Access to Mental Health Care (Fact Sheet for General Practitioners)

MBS Items for Health Assessments MBS Health Assessment Items 701, 703, 705, 707 and 715 Medicare Health Assessment: MBS Items 701-707 and 715 Health Assessments and Your Record Keeping Responsibilities Heart Health Assessment Items Medicare Benefits Schedule – Item 715 Completing an Aboriginal and Torres Strait Islander Health Assessment GP Led Primary Care Planning for Indigenous Patients

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MBS Items for Advanced Care Planning  Advance Care Planning in General Practice MBS items to support planned palliative care in general practice and residential aged care (Fact Sheet)

 

MBS Items for 3GA Programs and MDRAP MBS Items for 3GA Programs and MDRAP (Fact Sheet) Section 19AA and 3GA Programs (Fact Sheet)

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:

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.

• 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)

Resources and information to improve access to primary health for Aboriginal and Torres Strait Islander people.

Resources:

• Health Check Templates - including templates that span the life course
• Aboriginal and Torres Strait Islander Health Checks – Adolescents and Young People (12 – 24 years)
• Annual Health Check for Aboriginal and Torres Strait Islander People – Resources Collection
• Item Number 715 Health Check to Improve Indigenous Health
• Item Number 715 Health Check Brochure *PHN Central Queensland, Wide Bay, Sunshine Coast
• Aboriginal and Torres Strait Islander Health Assessments and follow-up services
• Aboriginal and Torres Strait Islander Health Practitioner and Aboriginal Health Worker MBS Items

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

Resources:

• MBS Attendance Items in RACFs (Fact Sheet)
• New arrangements for GP Residential Aged Care Facility (RACF) services
• RACGP Aged Care Clinical Guide (Silver Book)
• Family and Carer Participation under the Better Access Initiative

The full item descriptor and information on other changes to the 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:

• About Telehealth
• Medicare Compliance and Telehealth Services
• Verbal assignment of benefit arrangements for telehealth services
• Telehealth MBS eligibility for COVID-19 positive patients
• RACGP Telehealth Guides
• MBS Telehealth Services – from 1 January 2024