Changes to MBS Items

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

Additional MBS items are now available for:

  • telehealth and telephone attendances
  • pathology testing
  • mental health support
  • chronic disease management
  • coronavirus (COVID-19) vaccine attendances.

MBS telehealth and telephone items

You can use these MBS items if you provide phone and video services to patients for:

  • general attendances
  • specialist attendances
  • allied health
  • health assessments
  • chronic disease management and team care arrangements
  • early interventions for children with autism, pervasive developmental disorder or disability
  • mental health treatment and planning
  • eating disorder treatment and management
  • focused psychological strategies
  • oral and maxillofacial surgical attendances
  • pregnancy support counselling
  • antenatal and postnatal attendances
  • nurse practitioner attendances
  • participating midwives attendances.

If you’re a GP or a medical practitioner, you can only use these items for patients:

  • you have an existing relationship with
  • who have visited your practice for a face-to-face service in the last 12 months.

There are some exemptions to this rule if patients are:

  • in isolation or quarantine due to COVID-19
  • experiencing homelessness
  • under 12 months of age
  • treated at an Aboriginal Medical Service or an Aboriginal Community Controlled Health Service
  • in a natural disaster area
  • needing mental health support
  • requiring urgent after hours service in unsociable hours
  • undergoing eating disorder support or pregnancy counselling.

Health professionals can:

  • bulk bill patients at their discretion
  • use these items with existing bulk bill incentive items.

Blood borne viruses, sexual and reproductive health services

GPs and medical practitioners can use temporary items 92715-92742 for telehealth services for:

  • blood borne viruses
  • sexual and reproductive health.

You can’t use these items for the following consultations:

  • Assisted Reproductive Technology (ART)
  • antenatal care.

These services are:

  • exempt from the existing relationship rule
  • intended to help patients use medical services where there are barriers due to privacy or limited service availability.

Find out more about these MBS items on the MBS online website.

Nicotine and smoking cessation counselling services

GPs and medical practitioners can use temporary items 93680-93705 for face-to-face and telehealth attendances services.

This includes nicotine and smoking cessation counselling, care and advice.

These items are:

  • exempt from the existing relationship rule
  • intended to help patients use medical services where there are barriers due to privacy or limited service availability.

Coronavirus (COVID-19) vaccines support services

GPs and qualified health professionals can use items 93624-93661 to assess a patient’s suitability to get a COVID-19 vaccine.

This service is free to patients and the MBS items must be bulk billed. You must provide patients a face-to-face assessment before they get the first, second and subsequent doses of the vaccine.

You can bulk bill this service to Medicare when your patient:

  • is assessed and gets the vaccine
  • has been assessed but doesn’t get the vaccine for clinical reasons
  • has been assessed but doesn’t consent to the vaccine.

Except for items 93660 and 93661, if you provide a COVID-19 vaccine suitability assessment:

  • you must provide the vaccine immediately after
  • the supervising GP must be present at the same location.

If you’re a qualified health professional, you can use vaccine suitability assessment items 93660 and 93661 if:

  • it’s not at the general practice or hospital
  • you provide it on behalf of a medical practitioner who’s not at the same service location.

Flag fall arrangements

Use the flag fall service item number 90005 if you assess your patient’s suitability for a vaccine at a:

  • residential aged care facility
  • residential disability setting facility
  • person’s place of residence
  • place other than at the practice location, not including a hospital.

You can only claim the flag fall service item for your first appointment at each location.

COVID-19 vaccine booster incentive

GPs and medical practitioners can use item 93666 as an incentive when providing vaccine suitability assessment services to patients having a booster dose.

The item must be:

  • bulk-billed
  • provided with items for second or subsequent dose COVID-19 vaccine suitability assessment (93644-93656)
  • for a booster dose only.

A booster dose is a dose of a COVID-19 vaccine that isn’t a primary dose. This varies according to the patient.

Find out more about up-to-date COVID-19 vaccinations statuses on the Department of Health website.

In-depth patient assessment

Use items 10660 and 10661 when providing additional assessment and advice on your patient’s risk and benefits for the COVID-19 vaccine.

Billing requirements:

  • the GP or medical practitioner must attend in person for more than 10 minutes
  • it must be bulk-billed
  • it must be provided with a COVID-19 vaccine suitability assessment service (93624-93656)
  • you can only claim items once per patient per lifetime.

Co-claiming

The vaccine support items can’t be co-claimed with:

You can co-claim COVID-19 vaccine suitability assessment items with normal attendance items.

For example, item number 23 where the patient both:

  • attends for an unrelated condition
  • is eligible for the vaccine.

The relevant incentive item is still payable for the other attendance.

Make a note on the account or include service text for electronic claims. Suitable text may include:

  • times of each attendance
  • ‘Unrelated to COVID-19 assessment’ on the attendance item.

This helps us assess the claim.

Patients shouldn’t need more than one vaccine suitability assessment on the same day.

You can provide another service on the same day if:

  • there are exceptional circumstances
  • you record the exceptional circumstance in the patient’s notes.

Find out more about these MBS items on the MBS online website.

COVID-19 management support service

You can provide COVID-19 management support services if you’re a GP or medical practitioner working in general practice.

Item 93715 is:

  • for the assessment and management of a person with COVID-19 infection of recent onset and confirmed by laboratory testing or an approved COVID-19 rapid antigen test
  • to be co-claimed with an eligible attendance item
  • only payable when you provide a face-to-face attendance
  • not payable for admitted patients.

Find out more about the MBS COVID-19 Management Support Service on the MBS online website.

Items 93716-93717 are for long phone attendances when you assess if patients need COVID-19 antiviral treatment.

Find out more about the COVID-19 oral anti-viral medication on the MBS online website.

MRI mRNA COVID-19 vaccine related myocarditis

You can use item 63399:

  • for cardiac magnetic resonance imaging (MRI) to diagnose myocarditis associated with mRNA COVID-19 vaccination
  • when myocarditis cannot be definitively diagnosed using conventional imaging and other diagnostic tests.

Find out more about this MBS item on the MBS Online website.

Additional mental health support

Patients can access up to 10 additional mental health treatment sessions. Medicare covers these sessions.

Your patient is eligible for the sessions if all of the following apply:

  • they have a current mental health treatment plan
  • they’ve had a review with their GP
  • they’ve used all of their previous Medicare covered sessions.

Make sure you use the MBS items when providing extra sessions for your patients. Find out more about the MBS additional mental health items on the MBS online website.

These items are temporary.

Support for patients in residential aged care

Patients in residential aged cared facilities can get MBS mental health and multidisciplinary care items during the coronavirus (COVID-19) response.

These items are temporary.

They apply to residents who benefit from referral to allied health services under Mental Health Treatment Plans.

If you travel to residential aged care facilities to provide these services, you can also use flag fall service items:

You can only use them for your first appointment at each facility.

Find out more about MBS items for aged care residents on the MBS online website.

MBS pathology items for coronavirus (COVID-19)

There are certain MBS pathology items you can use if you perform pathology tests for COVID-19.

You must bulk bill them if you perform these tests out-of-hospital.

You can privately bill for private patients admitted to hospital, but the total charge cannot exceed the Medicare schedule fee.

Use items 69479 or 69480 if you perform COVID-19 pathology testing.

Assignment of benefit requirements

You need your patient’s agreement to bulk bill the items, before we can pay you the Medicare benefit.

You can get their agreement either:

  • in writing
  • by email
  • verbally during the consultation.

If you get verbal agreement from your patient, you must write:

  • ‘unable to sign’ in the Patient signature field
  • why the patient is unable to sign in the Provider field, for example COVID-19.

You must keep a record of the agreement.

Getting verbal consent is a temporary policy measure. This finishes on 31 December 2022.

Page last updated: 21 July 2022