Changes to MBS items

Additional MBS items are now available for:

• telehealth and telephone attendances
• pathology testing
• 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
• complex neurodevelopmental disorder and eligible disability
• chronic disease management
• mental health treatment and planning
• eating disorder treatment and management
• team care arrangements
• 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’s some exemptions to this rule if patients are:

• in isolation or quarantine due to COVID-19
• confirmed as COVID-19 positive, either through laboratory testing or an approved COVID-19 rapid antigen test in the last 7 days
• 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
• experiencing acute respiratory symptoms and meets the PBS criteria for COVID-19 antiviral therapy until 31 December 2023.

Read more about Patients Usual Medical Practitioner from the Department of Health and Aged Care.

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’s 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’s barriers due to privacy or limited service availability.

Coronavirus (COVID-19) vaccines support services

GPs and qualified health professionals can use items 93644-93661 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’re given 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 ended

From 1 February 2023, Medicare benefits are no longer available for a COVID-19 vaccine booster incentive service.

Find out more about simplified COVID-19 Vaccinations on the MBS online 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 (93644-93656)
• you can only claim items once per patient per lifetime.

Co-claiming

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

• bulk-billing incentive items 10990, 10991, 10992, 75855, 75856, 75857, 75858, 75870, 75871, 75872, 75873, 75874, 75875, 75876, 75880, 75881, 75882, 75883, 75884, and 75885
• Aboriginal and Torres Strait Islander health practitioner immunisation item 10988.

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

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

Attendance items for COVID-19 antiviral treatment

Temporary 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.

MBS pathology items for coronavirus (COVID-19) and other respiratory pathogens

There’s certain temporary 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.

If you perform COVID-19 pathology testing, use items:

• 69506
• 69511.

If you perform combined testing of COVID-19 and other respiratory pathogens, use items:

• 69507-69510
• 69512-69515.

Pathology items 69506-69515 are exempt from patient episode coning and limited to one per day.

Find out more about MBS pathology items for coronavirus (COVID-19) and other respiratory pathogens on the MBS online website.

Assignment of benefit and signature requirements for telehealth services

You need your patient’s agreement to bulk bill the items before we can pay you the Medicare benefit, or the agreement of a responsible person for the patient. For example, a responsible person could be a child’s parent.

You can obtain a patient’s agreement in writing or by email for telehealth services. You’ll need to complete an approved assignment of benefit form. You must give the patient a copy of the completed approved form.

Read more about how you can get a patient’s agreement for a telehealth service by email.

Verbal assignment of benefit for telehealth services

If you can’t get patient agreement in writing or by email for telehealth services, you can get verbal agreement from your patient during the telehealth consultation.

You must complete the form approved for the purposes of s 20A of the Health Insurance Act 1973 electronically. You can use these approved forms:

• Bulk bill voucher- electronically transmitted claims form (DB4E)
• Assignment of benefit Medicare bulk bill Webclaim (DB020).

Explain to the patient how you’ll fill in the Patient signature field in the approved form and confirm that the patient agrees. If the patient agrees, you need to type patient verbally agreed in the Patient signature field. You must send the completed form electronically to your patient.

If the patient doesn’t agree to assign their benefits, you can send them a private bill for the service.

You should keep a copy of all correspondence, claims and forms for at least 2 years. This is for auditing purposes if you are subject to a compliance review.

Getting verbal agreement is a temporary measure.

These requirements are not applicable to patients accessing health care funded by the Department of Veteran’s Affairs.

Read more about assignment of benefit signature requirements.