OATSIH Publications
Frequently Claimed MBS Items for Aboriginal Community Controlled Health Services and Other Primary Health Care Providers
Benefits are based on the 1 November 2012 Medicare Benefits Schedule
HTML/Text version of the Frequently Claimed MBS Items
Consultation Items for VR GPs
| No. | Item | Benefit |
|---|---|---|
| 3 | Brief Consult, Level A | $16.60 |
| 4 | Brief Home Visit or Consult at an institution (other than a RACF) | Formula |
| 23 | Standard Consult Level B, less than 20 min | $36.30 |
| 24 | Standard Home Visit or Consult at an institution (other than a RACF) | Formula |
| 36 | Long Consult Level C, 20-40 min | $70.30 |
| 37 | Long Home Visit or Consult at an institution (other than a RACF) | Formula |
| 44 | Prolonged Consult Level D, more than 40 min | $103.50 |
| 47 | Prolonged Home Visit or Consult at an institution (other than a RACF) | Formula |
After—hours Consultation Items for VR GPs
| No. | Item | Benefit |
|---|---|---|
| 5000 | Brief Consult, Level A at consulting rooms | $28.45 |
| 5003 | Brief Home Visit or Consult at an institution (other than a hospital or RACF) | Formula |
| 5020 | Standard Consult Level B, less than 20 min | $ |
| 5023 | Standard Home visit or Consult at an institution(other than a hospital or RACF) | Formula |
| 5040 | Long Consult Level C,20-40 min at consulting rooms | $82.30 |
| 5043 | Long Home visit or Consult at an institution(other than a hospital or RACF) | Formula |
| 5060 | Prolonged Consult Level D, more than 40 min | $115.45 |
| 5063 | Prolonged Home Visit or Consult at an institution (other than a hospital or RACF) | Formula |
Urgent After—hours Consultation Items VR GPs
Top of page| No. | Item | Benefit |
|---|---|---|
| 597 | Urgent Attendance - after hours (other than between 11pm and 7am) | $127.25 |
| 599 | Urgent attendance - unsociable hours (11pm-7am) | $150.00 |
Consultation items for Non—VR GPs
| No. | Item | Benefit |
|---|---|---|
| 52 | Brief Consult, less than 5 min at consulting room | $11.00 |
| 53 | Standard Consult, 5-25 min at consulting room | $21.00 |
| 54 | Long Consult, 25-45 min at consulting room | $38.00 |
| 57 | Prolonged Consult, more than 45 min at consulting room | $61.00 |
| 58 | Brief Home Visit or Consult at an institution (other than a RACF) | Formula |
| 59 | Standard Home Visit or Consult at an institution (other than a RACF) | Formula |
| 60 | Long Home Visit or Consult at an institution (other than a RACF) | Formula |
| 65 | Prolonged Home Visit or Consult at an institution (other than a RACF) | Formula |
After-hours Consultation Items Non—VR GPs
| No. | Item | Benefit |
|---|---|---|
| 5200 | Brief Consult, less than 5 min | $21.00 |
| 5203 | Standard Consult, 5-25 min | $31.00 |
| 5207 | Long Consult, 25-45min | $48.00 |
| 5208 | Prolonged Consult, more than 45 min | $71.00 |
| 5220 | Brief Home Visit or Consult (other than at consulting rooms, hospital or RACF) | Formula |
| 5223 | Standard Home Visit or Consult (other than at consulting rooms, hospital or RACF) | Formula |
| 5227 | Long Home Visit or Consult at an institution (other than a hospital or RACF) | Formula |
| 5228 | Prolonged Home Visit or Consult at an institution (other than at consulting rooms, hospital or RACF) | Formula |
Urgent After—hours Consultation Items Non—VR GPs
Top of page| No. | Item | Benefit |
|---|---|---|
| 598 | Non-VR urgent attendance - after hours (other than between 11pm and 7am) | $104.75 |
| 600 | Non-VR urgent attendance - unsociable hours (between 11pm and 7am) | $124.25 |
Prolonged Consults for Management of Life Threatening Conditions
| No. | Item | Benefit |
|---|---|---|
| 160 | 1-2 hours total time per patient on a single occasion | $217.15 |
| 161 | 2-3 hours total time per patient on a single occasion | $361.90 |
| 162 | 3-4 hours total time per patient on a single occasion | $506.50 |
| 163 | 4-5 hours total time per patient on a single occasion | $651.50 |
| 164 | 5 hours or more total time per patient on a single occasion | $723.90 |
Miscellaneous Diagnostic Tests and Procedures
Top of page| No. | Item | Benefit |
|---|---|---|
| 11506 | Spirometry with printout before and after bronchodilator | 85% = $17.50 |
| 11700 | Twelve-lead electrocardiography, tracing and report | 85% = $26.60 |
| 11701 | Twelve-lead electrocardiography, report only | 85% = $13.25 |
| 11702 | Twelve-lead electrocardiography, tracing only | 85% = $13.25 |
| 13757 | Therapeutic Venesection (polycthaemia/haemochromatosis or porphyria cutanea tarda) | 85% = $62.05 |
| 11506 | Spirometry with printout before and after bronchodilator | 85% = $17.50 |
| 11700 | Twelve-lead electrocardiography, tracing and report | 85% = $26.60 |
| 11701 | Twelve-lead electrocardiography, report only | 85% = $13.25 |
| 11702 | Twelve-lead electrocardiography, tracing only | 85% = $13.25 |
| 13757 | Therapeutic Venesection (polycthaemia/haemochromatosis or porphyria cutanea tarda) | 85% = $62.05 |
| 14203 | Hormone or Living Tissue Implantation by incision and suture | 85% = $43.50 |
| 14206 | Hormone or Living Tissue Implantation by cannula | 85% = $30.30 |
| 73805 | Microscopy of urine, whether stained or not, or catalase test | 85% = $3.95 |
| 73806 | Pregnancy Test by 1 or more immunochemical methods | 85% = $8.70 |
| 73811 | Mantoux test | 85% = $9.65 |
| 30003 | Dressing of Localised Burns (not involving grafting) | 85% = $30.90 |
| 30006 | Dressing of Extensive Burns, without Anaesthesia (not involving grafting) | 85% = $39.55 |
| 30026 | Repair Skin Lac (not Face/Neck)<7cm, superficial | 85% = $44.40 |
| 30029 | Repair Skin Lac (not Face/Neck)<7cm, deep tissue | 85% = $76.50 |
| 30032 | Repair Skin Lac of Face/Neck<7cm, superficial | 85% = $70.15 |
| 30035 | Repair Skin Lac of Face/Neck<7cm, deep tissue | 85% = $99.95 |
| 30038 | Repair Skin Lac (not Face/Neck)>7cm, superficial | 85% = $76.50 |
| 30041 | Repair Skin Lac (not Face/Neck)>7cm, deep tissue | 85% = $122.40 |
| 30045 | Repair Skin Lac of Face/Neck >7cm, superficial | 85% = $99.95 |
| 30048 | Repair Skin Lac of Face/Neck>7cm, deep tissue | 85% = $127.30 |
| 30061 | Superficial foreign body removal (including from cornea or sclera), as an independent procedure | 85% = $20.00 |
| 30064 | Subcutaneous foreign body removal (incision and exploration) | 85% = $93.45 |
| 30071 | Biopsy of Skin or Muc Membranes, as an independent procedure | 85% = $44.40 |
| 30192 | Premalignant skin lesions (including solar keratoses), treatment of, by ablative technique (10 or more lesions) | 85% = $33.65 |
| 30219 | Haematoma, Furuncle, Small Abscess or Similar Lesion - incision with drainage | 85% = $23.25 |
Bulk—Billed Services
Top of page| No. | Item | Benefit |
|---|---|---|
| 10990 | Additional payment for each bulk billed medical service provided to Commonwealth concession cardholders and children under 16 yrs | 85% = $6.00 |
| 10991 | Additional payment for each bulk-billed medical service provided to Commonwealth concession cardholders and children under 16 yrs- specified areas only | 85%= $9.10 |
| 64990 | Radiology bulk billing incentive (e.g. scans). | 85% = $6.00 |
| 64991 | Radiology bulk billing incentive (e.g. scans). | 85% = $9.10 |
| 74990 | Pathology bulk billing incentive | 85% = $6.00 |
| 74991 | Pathology bulk billing incentive | 85% = $9.10 |
Health Assessments
| No. | Item | Benefit |
|---|---|---|
| 701 | Brief Health Assessment, less than 30 min | $58.20 |
| 703 | Standard Health Assessment, 30-45 min | $135.20 |
| 705 | Long Heath Assessment, 45-60 min | $186.55 |
| 707 | Prolonged Health Assessment, more than 60 min | $263.55 |
| 715 | Aboriginal and Torres Strait Islander peoples Health Assessment | $208.10 |
Follow—up Allied Health Items for people of Aboriginal and Torres Strait Islander descent (linked to Health Assessments)
Top of page| No. | Item | Benefit |
|---|---|---|
| 81300 | Aboriginal and Torres Strait Islander Health Service | 85% = $52.95 |
| 81305 | Diabetes Education Service | 85% = $52.95 |
| 81310 | Audiology Service | 85% = $52.95 |
| 81315 | Exercise Physiology Service | 85% = $52.95 |
| 81320 | Dietetics Service | 85% = $52.95 |
| 81325 | Mental Health Service | 85% = $52.95 |
| 81330 | Occupational Therapy Service | 85% = $52.95 |
| 81335 | Physiotherapy Service | 85% = $52.95 |
| 81340 | Podiatry Service | 85% = $52.95 |
| 81345 | Chiropractic Service | 85% = $52.95 |
| 81350 | Osteopathy Service | 85% = $52.95 |
| 81355 | Psychology Service | 85% = $52.95 |
| 81360 | Speech Pathology Service | 85% = $52.95 |
Practice Nurse & Aboriginal and Torres Strait Islander Health Practitioner Items
Top of page| No | Item | Benefit |
|---|---|---|
| 10986 | Healthy Kids check provided by a Practice Nurse or Aboriginal and Torres Strait Islander Health Practitioner | $58.20 |
| 10987 | Follow up for a patient who has received an Aboriginal & Torres Strait Islander peoples health assessment (Max 10 services per calendar year) | $24.00 |
| 10997 | Monitoring and support for a person with a Chronic Disease Care Plan (Max 5 services per calendar year, practice nurse or Aboriginal and Torres Strait Islander Health Practitioner) | $12.00 |
| 10988 | Immunisation (Aboriginal and Torres Strait Islander Health Practitioner) | $12.00 |
| 10989 | Wound Management (Aboriginal and Torres Strait Islander Health Practitioner) | $12.00 |
Practice Incentive Items
| No. | Item | Benefit |
|---|---|---|
| 2501 | Cervical smear, between 20-69 yrs & more than 4 yrs since last cervical smear (Level B) | $36.30 |
| 2504 | Cervical smear, between 20-69 yrs & more than 4 yrs since last cervical smear (Level C) | $70.30 |
| 2507 | Cervical smear, between 20-69 yrs & more than 4 yrs since last cervical smear (Level D) | $103.50 |
| 2517 | Annual cycle of care for diabetes (Level B) | $36.30 |
| 2521 | Annual cycle of care for diabetes (Level C) | $70.30 |
| 2525 | Annual cycle of care for diabetes (Level D) | $103.50 |
| 2546 | Completion of asthma cycle of care (Level B) | $36.30 |
| 2552 | Completion of asthma cycle of care (Level C) | $70.30 |
| 2558 | Completion of asthma cycle of care (Level D) | $103.50 |
Chronic Disease Management (CDM) Items (formerly referred to as ‘EPC’ plans) and Case Conferences (CC)
Top of page| No. | Item | Benefit |
|---|---|---|
| 721 | Prepare GP Management Plan | $141.40 |
| 723 | Coordinate Team Care arrangements | $112.05 |
| 729 | Contribution to a Multidisciplinary Care Plan or a Review of a Multidisciplinary Care Plan prepared by another provider | $69.00 |
| 731 | Participation in review, prepared by residential aged care facility | $69.00 |
| 732 | Review of GP Management Plan or Coordinate a Review of Team Care Arrangements | $70.65 |
| 739 | Organise and coordinate CC 20-40 min | $118.60 |
| 743 | Organise and coordinate discharge CC more than 40 min | $197.70 |
| 747 | Member of CC Team 15-20 min | $50.90 |
| 750 | Particpate in CC Team 20-40 min | $87.25 |
| 758 | Member of CC Team, more than 40 min | $145.30 |
Individual Allied Health Items for people with a chronic condition and complex care needs (linked to CDM items 721 & 723)
| No. | Item | Benefit |
|---|---|---|
| 10950 | Aboriginal and Torres Strait Islander Health Service | 85% = $52.95 |
| 10951 | Diabetes Education Service | 85% = $52.95 |
| 10952 | Audiology Service | 85% = $52.95 |
| 10953 | Exercise Physiology Service | 85% = $52.95 |
| 10954 | Dietetics Service | 85% = $52.95 |
| 10956 | Mental Health Service | 85% = $52.95 |
| 10958 | Occupational Therapy Service | 85% = $52.95 |
| 10960 | Physiotherapy Service | 85% = $52.95 |
| 10962 | Podiatry Service | 85% = $52.95 |
| 10964 | Chiropractic Service | 85% = $52.95 |
| 10966 | Osteopathy Service | 85% = $52.95 |
| 10968 | Psychology Service | 85% = $52.95 |
| 10970 | Speech Pathology Service | 85% = $52.95 |
Antenatal Consults
Top of page| No. | Item | Benefit |
|---|---|---|
| 16400 | Antenatal attendance (midwife, practice nurse or registered AHW RRMA 3-7) | 85% = $23.20 |
| 16500 | Antenatal attendance | 85% = $40.10 |
| 16502 | Complicated Antenatal attendance (each attendance that is not a routine) | 85% = $40.10 |
| 55703 | Pregnancy ultrasound (uncertain dates less than 12 weeks) | 85% = $29.75 |
| 55709 | Pregnancy ultrasound (dating is 17 to 22 weeks) | 85% = $32.30 |
Medication Management Review
| No | Item | Benefit |
|---|---|---|
| 900 | Home medicines review | $151.75 |
Please Note: This table does not provide a comprehensive list of MBS items and should be read in conjunction with the item and explanatory notes set out in the Medicare Benefits Schedule book and supplement. The full list of MBS items is available at MBS Online
For Medicare Claiming enquiries, please phone the Medicare Australia Indigenous Access line on 1800 556 955For feedback or additional copies, please email OATSIH 19.2 enquiries mailbox or phone (02) 6289 4465
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