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Frequently Claimed MBS Items for Aboriginal Community Controlled Health Services and Other Primary Health Care Providers

Benefits are based on the 1 November 2011 Medicare Benefits Schedule

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No.

Item

Benefit

No.

Item

Benefit

Consultation Items for VR GPs

Prolonged Consults for Management of Life Threatening Conditions

3Brief Consult, Level A
$16.30
1601-2 hours total time per patient on a single occasion
$213.10
4Brief Home Visit or Consult at an institution (other than a RACF)
Formula
1612-3 hours total time per patient on a single occasion
$355.15
23Standard Consult Level B, less than 20 min
$35.60
1623-4 hours total time per patient on a single occasion
$497.05
24Standard Home Visit or Consult at an institution (other than a RACF)
Formula
1634-5 hours total time per patient on a single occasion
$639.35
36Long Consult Level C, 20-40 min
$69.00
1645 hours total time per patient on a single occasion
$710.40
37Long Home Visit or Consult at an institution (other than a RACF)
Formula

Miscellaneous Diagnostic Tests and Procedures

44Prolonged Consult Level D, more than 40 min
$101.55
11506 Spirometry with printout before and after bronchodilator
85%=$17.15
47Prolonged Home Visit or Consult at an institution (other than a RACF)
Formula
11700 Twelve-lead electrocardiography, tracing and report
85%=$26.10

After-hours Consultation Items VR GPs

11701Twelve-lead electrocardiography, report only
85%=$13.00
5000Brief Consult, Level A at consulting rooms
$27.90
11702Twelve-lead electrocardiography, tracing only
85%=$13.00
5003Brief Consult Level A (other than at consulting room, hospital or RACF)
Formula
13757Therapeutic Venesection (polycthaemia/haemochromatosis or porphyria cutanea tarda)
85%=$60.90
5020Standard Consult Level B, less than 20 min at consulting rooms
$47.15
14203Hormone or Living Tissue Implantation by incision and suture
85%=$42.70
5023Standard Consult level B (other than at consulting room, hospital or RACF)
Formula
14206Hormone or Living Tissue Implantation by cannula
85%=$29.75
5040Long Consult Level C,20-40 min at consulting rooms
$80.75
73805Microscopy of urine, whether stained or not, or catalase test
85%=$3.95
5043Long Consult, level C 20-40 min (other than at consulting rooms, hospital or RACF)
Formula
73806Pregnancy Test by 1 or more immunochemical methods
85%=$8.70
5060Prolonged Consult Level D, more than 40 min at consulting rooms
$113.30
73811Mantoux test
85%=$9.65
5063Prolonged Consult Level D, more than 40 min
(other than at consulting rooms, hospital or RACF)
Formula
30003 Dressing of Localised Burns (not involving grafting)
85%=$30.30

Urgent After-hours Consultation Items VR GPs

30006Dressing of Extensive Burns, without Anaesthesia
(not involving grafting)
85%=$38.85
597Urgent Attendance - after hours (other than between 11pm and 7am)
$124.90
30026Repair Skin Lac (not Face/Neck)<7cm, superficial
85%=$43.60
599Urgent attendance - unsociable hours (11pm-7am)
$147.20
30029Repair Skin Lac (not Face/Neck)<7cm, deep tissue
85%=$75.10

Consultation Items for Non-VR GPs

30032Repair Skin Lac of Face/Neck<7cm, superficial
85%=$68.85
52Brief Consult, less than 5 min at consulting room
$11.00
30035Repair Skin Lac of Face/Neck<7cm, deep tissue
85%=$98.05
53Standard Consult, 5-25 min at consulting room
$21.00
30038Repair Skin Lac (not Face/Neck)>7cm, superficial
85%=$75.10
54Long Consult, 25-45 min at consulting room
$38.00
30041Repair Skin Lac (not Face/Neck)>7cm, deep tissue
85%=$120.15
57Prolonged Consult, more than 45 min at consulting room
$61.00
30045Repair Skin Lac of Face/Neck >7cm, superficial
85%=$98.05
58Brief Home Visit or Consult at an institution (other than a RACF)
Formula
30048Repair Skin Lac of Face/Neck>7cm, deep tissue
85%=$124.95
59Standard Home Visit or Consult at an institution (other than a RACF)
Formula
30061Superficial foreign body removal (including from cornea or sclera), as an independent procedure
85%=$19.60
60Long Home Visit or Consult at an institution (other than a RACF)
Formula
30064Subcutaneous foreign body removal (incision and Exploration) including closure of wound if performed as an independent procedure
85%=$91.70
65Prolonged Home Visit or Consult at an institution (other than a RACF)
Formula
30071Biopsy of Skin or Muc Membranes, as an independent procedure
85%=$43.60

After-hours Consultation Items No-VR GPs

30192Premalignant skin lesions (including solar keratoses), treatment of, by ablative technique (10 or more lesions)
85%=$33.00
5200Brief Consult, less than 5 min
$21.00
30219Haematoma, Furuncle, Small Abscess or Similar Lesion not requiring admission to a hospital - incision with drainage of (excluding aftercare)
85%=$22.85
5203Standard Consult, 5-25 min
$31.00

Bulk- Billed Services

5207Long Consult, 25-45min
$48.00
10990Additional payment for each bulk billed medical service provided to Commonwealth concession cardholders and children under 16 yrs
85%=$5.90
5208Prolonged Consult, more than 45 min
$71.00
10991Additional payment for each bulk-billed medical service provided to Commonwealth concession cardholders and children under 16 yrs,
85%=$8.90
5220Brief Home Visit or Consult (other than at consulting rooms, hospital or RACF)
Formula
64990
Radiology bulk billing incentive (e.g. scans).
85%=$5.90
5223Standard Home Visit or Consult (other than at consulting rooms, hospital or RACF)
Formula
64991Radiology bulk billing incentive (e.g. scans).
85%=$8.90
5227Long Home Visit or Consult at an institution (other than a hospital or RACF)
Formula
74990Pathology bulk billing incentive
85%=$5.90
5228Prolonged Home Visit or Consult at an institution (other than at consulting rooms, hospital or RACF)
Formula
74991Pathology bulk billing incentive
85%=$8.90

Urgent After-hours Consultation Items Non-VR GPs

Chronic Disease Management (CDM) Items (formerly referred to as "EPC" Plans) and Case Conferences (CC)

598Non-VR urgent attendance - after hours (other than between 11pm and 7am)
$104.75
721Prepare GP Management Plan
$138.75
600Non-VR urgent attendance - unsociable hours (between 11pm and 7am)
$124.25
723Coordinate Team Care arrangements
$109.95

Health Assessments

729Contribution to a Multidisciplinary Care Plan or a Review of a Multidisciplinary Care Plan prepared by another provider
$67.70
701Brief Health Assessment, less than 30 min
$57.10
731Participation in review, prepared by residential aged care facility
$67.70
703Standard Health Assessment, 30-45 min
$132.70
732Review of GP Management Plan or Coordinate a Review of Team Care Arrangements
$69.35
705Long Heath Assessment, 45-60 min
$183.05
739Organise and coordinate CC 20-40 min
$116.40
707Prolonged Health Assessment, more than 60 min
$258.65
743Organise and coordinate discharge CC more than 40 min
$194.00
715Aboriginal and Torres Strait Islander peoples Health Assessment
$204.20
747Member of CC Team 15-20 min
$49.95

Follow-up Allied Health Items for people of Aboriginal and Torres Straight Islander decent (linked to Health Assessments)

750Particpate in CC Team 20-40 min
$85.60
81300Aboriginal Health Worker Service
85%=$51.95
758Member of CC Team, more than 40 min
$142.60
81305Diabetes Education Service
85%=$51.95

Individual Allied Health Items for people with a chronic condition and complex care needs (linked to CDM items 721 & 723

81310Audiology Service
85%=$51.95
10950Aboriginal Health Worker Service
85%=$51.95
81315Exercise Physiology Service
85%=$51.95
10951Diabetes Education Service
85%=$51.95
81320Dietetics Service
85%=$51.95
10952Audiology Service
85%=$51.95
81325Mental Health Service
85%=$51.95
10953Exercise Physiology Service
85%=$51.95
81330Occupational Therapy Service
85%=$51.95
10954Dietetics Service
85%=$51.95
81335Physiotherapy Service
85%=$51.95
10956Mental Health Service
85%=$51.95
81340Podiatry Service
85%=$51.95
10958Occupational Therapy Service
85%=$51.95
81345Chiropractic Service
85%=$51.95
10960Physiotherapy Service
85%=$51.95
81350Osteopathy Service
85%=$51.95
10962Podiatry Service
85%=$51.95
81355Psychology Service
85%=$51.95
10964Chiropractic Service
85%=$51.95
81360Speech Pathology Service
85%=$51.95
10966Osteopathy Service
85%=$51.95

Practice Nurse & Aboriginal Health Worker Items

10968Psychology Service
85%=$51.95
10986Healthy Kids check provided by a Practice Nurse or Aboriginal Health Worker (registered AHW only)
$57.10
10970Speech Pathology Service
85%=$51.95
10987Follow up for a patient who has received an Aboriginal & Torres Strait Islander peoples health assessment (Max 10 services per calendar year)
$23.55

Dental Care (CDM) Items on referral from a GP

10998Cervical smear, regional, rural, remote (practice nurse only)
$11.80
Items 85011-87777
10999Cervical smear, between 20-69 yrs & more than 4 yrs since last cervical smear (practice nurse only)
$11.80
For patients with chronic conditions and complex care needs
10993Immunisation (practice nurse only)
$11.80

Antenatal Consults

10996Wound management (practice nurse only)
$11.80
16400Antenatal attendance (midwife, practice nurse or registered AHW
RRMA 3-7)
85%= $22.75
10997Monitoring and support for a person with a Chronic Disease Care Plan (Max 5 services per calendar year, practice nurse or registered AHW only)
$11.80
16500Antenatal attendance
85%= $39.35

Practice Incentive Items

16502Complicated Antenatal attendance (each attendance that is not a routine)
85%= $39.35
2501Cervical smear, between 20-69 yrs & more than 4 yrs since last cervical smear (Level B)
$35.60
55703Pregnancy ultrasound (uncertain dates less than 12 weeks)
85%= $29.75
2504Cervical smear, between 20-69 yrs & more than 4 yrs since last cervical smear (Level C)
$69.00
55709Pregnancy ultrasound (dating is 17 to 22 weeks)
85%= $32.30
2507Cervical smear, between 20-69 yrs & more than 4 yrs since last cervical smear (Level D)
$101.55

Medication Management Review

2517Annual cycle of care for diabetes (Level B)
$35.60
900Home medicines review
$148.90
2521Annual cycle of care for diabetes (Level C)
$69.00

2525 Annual cycle of care for diabetes (Level D) $101.55
2546 Completion of asthma cycle of care (Level B) $35.60
2552 Completion of asthma cycle of care (Level C) $69.00
2558 Completion of asthma cycle of care (Level D) $101.55

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: www.mbsonline.gov.au

For Medicare Claiming enquiries, please phone the Medicare Australia Indigenous Access line on 1800 556 955
For feedback or additional copies, please email OATSIH19.2enquiries@health.gov.au or phone (02) 6289 4465

For more information on the Medicare Benefits Schedule view the following link: MBS Online

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