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Make sure you read the relevant Medicare Benefits Schedule (MBS) item descriptions, factsheets and explanatory notes on MBS Online.
A health assessment looks at a patient’s health, physical, psychological and social function.
There are MBS items covering health assessments for specific target groups.
Health assessments aren’t available to hospital in-patients. They also aren’t available to aged care residents except for either:
- comprehensive medical assessments
- Aboriginal and Torres Strait Islander patients.
The decision to perform a health assessment on your patient will depend on:
- your clinical judgement
- if your patient meets the criteria for 1 or more of the eligible target groups.
Before you do a health assessment, you must explain to your patient, their parent or carer about the:
- health assessment process
Your patient must consent to the health assessment and you must note this on their record.
The below table lists eligible target groups and the frequency for each type of health assessment.
|Patient eligibility for items 224-227 or 701-707||How often|
|A type 2 diabetes risk evaluation for people aged 40-49 years inclusive with a high risk of
developing type 2 diabetes, as determined by the Australian Type 2 Diabetes Risk Assessment Tool
|Once every 3 years|
|People aged 45-49 years inclusive who are at risk of developing chronic disease||Once only|
|People aged 75 years and older||Once every 12 months|
|Permanent residents of residential aged care facilities||Once every 12 months|
|People with an intellectual disability||Once every 12 months|
|Refugees or other humanitarian entrants||Once only|
|Former serving members of the Australian Defence Force||Once only|
|Patient eligibility for item 177 or 699||How often|
|Patient with or at risk of developing cardiovascular disease||Once every 12 months|
|Who is eligible for item 228 or 715||How often|
Aboriginal or Torres Strait Islander people
Read more about health assessments for Aboriginal and Torres Strait Islander people.
|Once every 9 months|
Who should undertake a health assessment
The patient’s usual medical practitioner should do the Health assessment. Non-vocationally recognised medical practitioners (Non-VR MPs) and general practitioners can perform it.
You are the patient’s usual medical practitioner if you:
- or a medical practitioner in the same practice have provided the majority of health care to the patient over the last 12 months
- will provide the majority of health care to the patient over the next 12 months.
If a different medical practitioner performs a health assessment, they should send a copy to you with your patient’s consent.
There are 4 time-based MBS health assessment services. When billing please consider the:
- time taken to complete the assessment
- complexity of your patient’s needs
- specific requirements for each target group.
The table below provides service descriptions, item numbers and the time required for each MBS item.
|Item numbers||Item name||Item description||Time Required|
|224, 701||Brief health assessment||A simple health assessment||30 minutes or less|
|225, 703||Standard health assessment||An assessment for when the patient needs more than a brief assessment, but doesn’t have complex health issues||More than 30 but less than 45 minutes|
|226, 705||Long health assessment||An extensive assessment for when the patient has complex health issues||More than 45 but less than 60 minutes|
|227, 707||Prolonged health assessment||A complex assessment of a patient with significant, long-term health needs managed through a comprehensive preventative healthcare management plan||60 or more minutes|
|228, 715||Health assessment||A health assessment for Aboriginal and Torres Strait Islander patients||No time requirements|
|177, 699||Health assessment||A health assessment for patients with cardiovascular disease or at risk of developing cardiovascular disease||No time requirements|
In some cases you can do a subsequent health assessment in the same 12-month period. You can do them if your patient is eligible for another health assessment under a different target group.
To help us assess your claim, please tell us which target groups the health assessment claim is for.
If you don’t specify the subsequent health assessment was for a different target group, we’ll reject your claim.
Heart health checks
You can bill a heart health check for your patient once every 12 months if your patient meets the criteria for these items. The MBS Online general explanatory notes for items 699 and 177 provide more information about these criteria.
You can’t bill a heart health check item for your patient if in the last 12 months they had another health assessment under:
- items 224-228
- items 701-715.
Make sure you:
- offer your patient a copy of the health assessment, including recommendations
- keep a copy of the health assessment for 2 years.
The Privacy Act 1988 covers information about medical records.
For more information go to the Department of Health and Aged Care website.
Read more about:
- the Schedule at MBS Online
- Education services for health professionals
- health assessment resources on the Department of Health and Aged Care website
- Health Professional Education Resources Gateway
- our website disclaimer.
Contact us for MBS item interpretation.
Provide your feedback on our education resources.