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

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.

• 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

,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.

• 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

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.

• 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.

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.
 

Subject to the passage of legislation from 1 November 2024, major changes to the MBS framework for chronic disease management in primary care will come into effect.

These changes are a result of a review by the MBS Review Taskforce, which was informed by the General Practice and Primary Care Clinical Committee. The revised framework will support patients through improved continuity of care and improved arrangements for the transfer of information between members of their care team.

Transition arrangements will be in place for two years to ensure current patients don’t lose access to services.

See the latest information on the MBS Factsheet released 23 August 2024 - Upcoming Changes to Chronic Disease Management MBS Items – Overview

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

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 Department of Health and Aged Care.

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

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

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 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)

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

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

Resources:

• Changes to MBS items (As part of the COVID-19 Response)