Medicare billing for immunisations

Information about billing Medicare Benefits Schedule (MBS) attendance items for immunisations.

Make sure you also read the relevant MBS item descriptions and explanatory notes at MBS Online.

When you can bill attendance items

When you immunise a patient, you may be able to bill an MBS attendance item. You can only do this if a funded mass immunisation program doesn’t cover the cost of administering it.

If you address an unrelated medical issue at the same time you administer a mass immunisation vaccine, you can bill for this. You can only bill for the time you spend managing the unrelated medical condition.

If a mass immunisation program doesn’t cover the vaccine you’re administering, you can bill for both:

  • time spent administering the vaccine
  • managing the unrelated medical condition.

MBS items only cover medical services. This means you can’t bill Medicare for the vaccine itself.

Learn more about Medicare benefits and vaccinations on explanatory note GN.12.32 at MBS Online.

About mass immunisation programs

Funded mass immunisation programs cover the costs of administering vaccines. They can be funded by either:

  • Commonwealth or state governments
  • a private organisation.

There are no Medicare benefits for administering vaccines covered by these programs.

COVID-19 vaccine suitability assessment service

There are MBS items to assess if a patient can get the COVID-19 vaccine.

The MBS COVID-19 vaccine suitability assessment service is free for patients and must be bulk billed.

You can bill this service to Medicare when you’ve assessed your patient and either:

  • given them the vaccine
  • not given them the vaccine for clinical reasons
  • they don’t consent to the vaccine.

To provide a COVID-19 vaccine suitability assessment, the vaccine must be available immediately after in the same location. The supervising GP must be present.

You can bill an MBS attendance item if you address an unrelated medical issue at the same time you do this assessment. Find out more about billing multiple MBS items.

View the fact sheet for more information.

Billing scenarios for immunisations

Scenario 1

A patient attends your practice for a COVID-19 vaccine suitability assessment. They also request an urgent review of their chronic disease management (CDM) plan, so they can get a new referral for physiotherapy.

You determine in this case that it’s clinically relevant to provide both:

  • a vaccine suitability assessment
  • a CDM review service.

You must bulk bill the COVID-19 vaccine suitability assessment service. You can also co-claim an MBS attendance item for the CDM review.

You can choose how to bill the patient for the attendance item.

Scenario 2

You see a patient to administer an influenza vaccine The National Immunisation Program (NIP) doesn’t cover them for the influenza vaccine.

After taking the patient’s history, you administer the vaccine.

You can bill an MBS attendance item for the time you spend on both the patient history and administering the vaccine.

You can charge your patient for the cost of the influenza vaccine. You can’t bill Medicare for the vaccine itself.

Scenario 3

You see a patient to administer an influenza vaccine. The NIP covers the cost of the vaccine, but not the administration cost.

After taking the patient’s history, you administer the vaccine.

You can bill the appropriate attendance item for the medical service you provided. You can’t charge the patient a separate amount for the cost of the influenza vaccine.

Scenario 4

You’re employed by a state or territory community health centre to administer vaccines. The service is not eligible for Medicare benefits as it’s a mass immunisation program.

You can’t bill an MBS item. You’re administering a vaccine under an arrangement with the state or territory.

Scenario 5

You see a patient to administer an influenza vaccine. Your patient’s employer is covering the cost of the vaccine and the administration.

You can’t bill an MBS item. We can't pay Medicare benefits if the employer of the patient pays for the medical expense.

Read more about the Medicare Benefits Schedule at MBS online.

Page last updated: 8 June 2021