Prescribed Pattern of Services 80/20 rule

The 80/20 rule is a deeming provision to address consistent high volumes of rendered services by general practitioners and other medical practitioners.

Page last updated: 15 January 2016

What you need to know

The regulations specify that a general practitioner (GP) or other medical practitioner (OMP) is deemed to have practised inappropriately if they have rendered 80 or more professional attendances on each of 20 or more days in a 12 month period.

The 80/20 rule is based on the number of professional attendances per day, which may not be the same as the number of patients seen in a day. GP and OMP professional attendances include the following groups as listed in the Regulations:
    • A1 General practitioner attendances to which no other items applies
    • A2 Other non-referred attendances to which no other item applies
    • A5 Prolonged attendances to which no other item applies
    • A6 Group therapy
    • A7 Acupuncture
    • A9 Contact lenses - attendances
    • A11 Urgent attendances after hours
    • A13 Public health physician attendances to which no other item applies
    • A14 Health assessments
    • A15 GP management plans, team care arrangements and multidisciplinary care plans and case conferences
    • A16 No professional attendance items are currently listed in this Group
    • A17 Domiciliary and residential medication management reviews
    • A18 General practitioner attendances associated with Practice Incentive Program (PIP) payments
    • A19 Other non-referral attendances associated with PIP payments to which no other items applies
    • A20 Mental health care
    • A21 Medical practitioner (emergency physician) attendances to which no other item applies
    • A22 General practitioner after-hours attendances to which no other item applies
    • A23 Other non-referred after-hours attendances to which no other item applies
We routinely monitor Medicare claims of all GPs and OMPs to identify those who are approaching or have exceeded the 80/20 level of servicing.

If you are approaching this level you may be contacted and asked to review your daily attendances. We may also review your Medicare servicing and ask you to address concerns in addition to your level of servicing.

If you exceed the 80/20 level of servicing, you will be reviewed under the Practitioner Review Program. Once your breach is verified, a request will be made to the Director of Professional Services Review to review your provision of services.

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