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

Changes to MBS Chronic Disease Management Framework from 1 July 2025

From 1 July 2025, major changes to the MBS framework for chronic disease management in primary care will come into effect. These changes implement the recommendations of the MBS Review Taskforce.
 

What are the changes:

o    The changes taking effect on 1 July 2025 apply to new plans for patients with a chronic condition and new referrals written under existing GPMPs and TCAs, or new GPCCMPs.
o    For patients that have a GPMP and/or TCA in place prior 1 July 2025 there is no immediate action required.
       –  Patients can continue to access allied health and other services under their existing plans until 30 June 2027.
       –  Referrals written prior to 1 July 2025 will continue to be valid until all services under that referral have been provided.
o    Patients that require a review of their GPMP and/or TCA after 1 July 2025 can be transitioned to the new GPCCMP at that time.
o    From 1 July 2027 patients will require a GPCCMP to continue to access allied health and other services.
 
Name of Item  GP item number  Prescribed medical practitioner item number 
Prepare a GP chronic condition management plan – face to face  965  392 
Prepare a GP chronic condition management plan - video  92029  92060 
Review a GP chronic condition management plan – face to face  967  393 
Review a GP chronic condition management plan – video  92030  92061 
 

Where can I find more information:

o    Upcoming changes to the MBS Chronic Disease Management Framework
o    Upcoming changes to MBS Chronic Disease Management Arrangements
o    Chronic Disease Management plan - Health professionals
 

Other MBS information:

o    Full item descriptors and information about other changes to MBS items can be found on the MBS Online website
o    You can subscribe to future MBS updates by via Subscribe to the MBS on the MBS Online website. 
o    Health care providers seeking advice on the interpretation of MBS items, explanatory notes and associated legislation can use the department’s email advice service by emailing askMBS@health.gov.au

The new Understanding Medicare: Provider Handbook has now been published - 25 November 2024

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.

Updates to MBS Telehealth Services and MBS Nurse Practitioner item numbers

Updates to both MBS ongoing Telehealth Service item numbers and descriptor and Nurse Practitioner MBS item numbers have been released. 

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:

About 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 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.

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:

AskMBS

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 education

MBS Factsheets for use in General Practice

Frequently used MBS Item Numbers

Care Plans and Health Assessments

MBS Items for Advance Care Planning and Palliative Care

Miscellaneous

 
MBS Items for 3GA Programs and MDRAP

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:
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.