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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
3	Brief Consult, Level A	$16.30		160	1-2 hours total time per patient on a single occasion	$213.10
4	Brief Home Visit or Consult at an institution (other than a RACF)	Formula		161	2-3 hours total time per patient on a single occasion	$355.15
23	Standard Consult Level B, less than 20 min	$35.60		162	3-4 hours total time per patient on a single occasion	$497.05
24	Standard Home Visit or Consult at an institution (other than a RACF)	Formula		163	4-5 hours total time per patient on a single occasion	$639.35
36	Long Consult Level C, 20-40 min	$69.00		164	5 hours total time per patient on a single occasion	$710.40
37	Long Home Visit or Consult at an institution (other than a RACF)	Formula		Miscellaneous Diagnostic Tests and Procedures
44	Prolonged Consult Level D, more than 40 min	$101.55		11506	Spirometry with printout before and after bronchodilator	85%=$17.15
47	Prolonged 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				11701	Twelve-lead electrocardiography, report only	85%=$13.00
5000	Brief Consult, Level A at consulting rooms	$27.90		11702	Twelve-lead electrocardiography, tracing only	85%=$13.00
5003	Brief Consult Level A (other than at consulting room, hospital or RACF)	Formula		13757	Therapeutic Venesection (polycthaemia/haemochromatosis or porphyria cutanea tarda)	85%=$60.90
5020	Standard Consult Level B, less than 20 min at consulting rooms	$47.15		14203	Hormone or Living Tissue Implantation by incision and suture	85%=$42.70
5023	Standard Consult level B (other than at consulting room, hospital or RACF)	Formula		14206	Hormone or Living Tissue Implantation by cannula	85%=$29.75
5040	Long Consult Level C,20-40 min at consulting rooms	$80.75		73805	Microscopy of urine, whether stained or not, or catalase test	85%=$3.95
5043	Long Consult, level C 20-40 min (other than at consulting rooms, hospital or RACF)	Formula		73806	Pregnancy Test by 1 or more immunochemical methods	85%=$8.70
5060	Prolonged Consult Level D, more than 40 min at consulting rooms	$113.30		73811	Mantoux test	85%=$9.65
5063	Prolonged 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				30006	Dressing of Extensive Burns, without Anaesthesia (not involving grafting)	85%=$38.85
597	Urgent Attendance - after hours (other than between 11pm and 7am)	$124.90		30026	Repair Skin Lac (not Face/Neck)<7cm, superficial	85%=$43.60
599	Urgent attendance - unsociable hours (11pm-7am)	$147.20		30029	Repair Skin Lac (not Face/Neck)<7cm, deep tissue	85%=$75.10
Consultation Items for Non-VR GPs				30032	Repair Skin Lac of Face/Neck<7cm, superficial	85%=$68.85
52	Brief Consult, less than 5 min at consulting room	$11.00		30035	Repair Skin Lac of Face/Neck<7cm, deep tissue	85%=$98.05
53	Standard Consult, 5-25 min at consulting room	$21.00		30038	Repair Skin Lac (not Face/Neck)>7cm, superficial	85%=$75.10
54	Long Consult, 25-45 min at consulting room	$38.00		30041	Repair Skin Lac (not Face/Neck)>7cm, deep tissue	85%=$120.15
57	Prolonged Consult, more than 45 min at consulting room	$61.00		30045	Repair Skin Lac of Face/Neck >7cm, superficial	85%=$98.05
58	Brief Home Visit or Consult at an institution (other than a RACF)	Formula		30048	Repair Skin Lac of Face/Neck>7cm, deep tissue	85%=$124.95
59	Standard Home Visit or Consult at an institution (other than a RACF)	Formula		30061	Superficial foreign body removal (including from cornea or sclera), as an independent procedure	85%=$19.60
60	Long Home Visit or Consult at an institution (other than a RACF)	Formula		30064	Subcutaneous foreign body removal (incision and Exploration) including closure of wound if performed as an independent procedure	85%=$91.70
65	Prolonged Home Visit or Consult at an institution (other than a RACF)	Formula		30071	Biopsy of Skin or Muc Membranes, as an independent procedure	85%=$43.60
After-hours Consultation Items No-VR GPs				30192	Premalignant skin lesions (including solar keratoses), treatment of, by ablative technique (10 or more lesions)	85%=$33.00
5200	Brief Consult, less than 5 min	$21.00		30219	Haematoma, Furuncle, Small Abscess or Similar Lesion not requiring admission to a hospital - incision with drainage of (excluding aftercare)	85%=$22.85
5203	Standard Consult, 5-25 min	$31.00		Bulk- Billed Services
5207	Long Consult, 25-45min	$48.00		10990	Additional payment for each bulk billed medical service provided to Commonwealth concession cardholders and children under 16 yrs	85%=$5.90
5208	Prolonged Consult, more than 45 min	$71.00		10991	Additional payment for each bulk-billed medical service provided to Commonwealth concession cardholders and children under 16 yrs,	85%=$8.90
5220	Brief Home Visit or Consult (other than at consulting rooms, hospital or RACF)	Formula		64990	Radiology bulk billing incentive (e.g. scans).	85%=$5.90
5223	Standard Home Visit or Consult (other than at consulting rooms, hospital or RACF)	Formula		64991	Radiology bulk billing incentive (e.g. scans).	85%=$8.90
5227	Long Home Visit or Consult at an institution (other than a hospital or RACF)	Formula		74990	Pathology bulk billing incentive	85%=$5.90
5228	Prolonged Home Visit or Consult at an institution (other than at consulting rooms, hospital or RACF)	Formula		74991	Pathology 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)
598	Non-VR urgent attendance - after hours (other than between 11pm and 7am)	$104.75		721	Prepare GP Management Plan	$138.75
600	Non-VR urgent attendance - unsociable hours (between 11pm and 7am)	$124.25		723	Coordinate Team Care arrangements	$109.95
Health Assessments				729	Contribution to a Multidisciplinary Care Plan or a Review of a Multidisciplinary Care Plan prepared by another provider	$67.70
701	Brief Health Assessment, less than 30 min	$57.10		731	Participation in review, prepared by residential aged care facility	$67.70
703	Standard Health Assessment, 30-45 min	$132.70		732	Review of GP Management Plan or Coordinate a Review of Team Care Arrangements	$69.35
705	Long Heath Assessment, 45-60 min	$183.05		739	Organise and coordinate CC 20-40 min	$116.40
707	Prolonged Health Assessment, more than 60 min	$258.65		743	Organise and coordinate discharge CC more than 40 min	$194.00
715	Aboriginal and Torres Strait Islander peoples Health Assessment	$204.20		747	Member 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)				750	Particpate in CC Team 20-40 min	$85.60
81300	Aboriginal Health Worker Service	85%=$51.95		758	Member of CC Team, more than 40 min	$142.60
81305	Diabetes 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
81310	Audiology Service	85%=$51.95		10950	Aboriginal Health Worker Service	85%=$51.95
81315	Exercise Physiology Service	85%=$51.95		10951	Diabetes Education Service	85%=$51.95
81320	Dietetics Service	85%=$51.95		10952	Audiology Service	85%=$51.95
81325	Mental Health Service	85%=$51.95		10953	Exercise Physiology Service	85%=$51.95
81330	Occupational Therapy Service	85%=$51.95		10954	Dietetics Service	85%=$51.95
81335	Physiotherapy Service	85%=$51.95		10956	Mental Health Service	85%=$51.95
81340	Podiatry Service	85%=$51.95		10958	Occupational Therapy Service	85%=$51.95
81345	Chiropractic Service	85%=$51.95		10960	Physiotherapy Service	85%=$51.95
81350	Osteopathy Service	85%=$51.95		10962	Podiatry Service	85%=$51.95
81355	Psychology Service	85%=$51.95		10964	Chiropractic Service	85%=$51.95
81360	Speech Pathology Service	85%=$51.95		10966	Osteopathy Service	85%=$51.95
Practice Nurse & Aboriginal Health Worker Items				10968	Psychology Service	85%=$51.95
10986	Healthy Kids check provided by a Practice Nurse or Aboriginal Health Worker (registered AHW only)	$57.10		10970	Speech Pathology Service	85%=$51.95
10987	Follow 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
10998	Cervical smear, regional, rural, remote (practice nurse only)	$11.80			Items 85011-87777
10999	Cervical 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
10993	Immunisation (practice nurse only)	$11.80		Antenatal Consults
10996	Wound management (practice nurse only)	$11.80		16400	Antenatal attendance (midwife, practice nurse or registered AHW RRMA 3-7)	85%= $22.75
10997	Monitoring 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		16500	Antenatal attendance	85%= $39.35
Practice Incentive Items				16502	Complicated Antenatal attendance (each attendance that is not a routine)	85%= $39.35
2501	Cervical smear, between 20-69 yrs & more than 4 yrs since last cervical smear (Level B)	$35.60		55703	Pregnancy ultrasound (uncertain dates less than 12 weeks)	85%= $29.75
2504	Cervical smear, between 20-69 yrs & more than 4 yrs since last cervical smear (Level C)	$69.00		55709	Pregnancy ultrasound (dating is 17 to 22 weeks)	85%= $32.30
2507	Cervical smear, between 20-69 yrs & more than 4 yrs since last cervical smear (Level D)	$101.55		Medication Management Review
2517	Annual cycle of care for diabetes (Level B)	$35.60		900	Home medicines review	$148.90
2521	Annual 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