Education guide - Claiming bulk bill incentive items
Information about basic eligibility for claiming bulk bill incentive payments.
Make sure you read the relevant Medicare Benefits Schedule (MBS) item descriptions and explanatory notes at MBS Online.
Medical practitioner eligibility for claiming bulk bill incentive items
All medical practitioners, vocationally registered or not, can claim bulk bill incentive items on eligible unreferred services.
Specialists and consultant physicians are also eligible if they:
- hold both medical practitioner and specialist Medicare recognition for their qualifications
- provide services to patients in their capacity as medical practitioners.
Medical practitioners can only claim bulk bill incentive items if they've met the conditions in the item descriptor. In general, if a health professional provides a bulk billed service, they can claim additional MBS items if:
- the service is an unreferred service
- the service is for a person under the age of 16 or a Commonwealth concession card holder
- the person isn't an admitted patient in a hospital
- both the service and associated additional item are bulk billed.
If a Medicare benefit isn’t payable for a service, it’s also not payable for the associated bulk billed incentive item.
The table below gives some explanations for terms on this page.
|Unreferred service||When a medical practitioner, or someone acting on their behalf, provides a medical, diagnostic imaging or pathology service that wasn’t referred by a person with referring rights.|
|Commonwealth concession cardholder||
A person who holds one of the following cards issued by Centrelink or the Department of Veterans’ Affairs (DVA):
DVA Gold or White Cards aren’t recognised Commonwealth concession cards. DVA Gold or White card holders must hold a concession card listed above to be treated under Medicare arrangements.
Bulk bill incentive items
All bulk bill incentive items below are for unreferred services.
Medical service items:
Diagnostic imaging service items:
Pathology service items:
For items 10991, 10992, 64991 and 74991, additional conditions apply to the location where the medical practitioner provided the service.
Bulk bill incentive items aren’t payable with COVID-19 vaccine suitability assessment services.
Refer to MBS Online for details.
Checking a patient’s concessional eligibility
A patient is eligible for a concession if they hold a valid Commonwealth concession card at the date of service.
You can check if a patient’s eligible for a concession in real time either:
- through Health Professionals Online Services (HPOS)
- by calling us and using Interactive Voice Response (IVR) self-service.
We base a patient’s concessional eligibility on the information that we know at the time you check.
You can also check if a patient’s eligible for a concession by:
- viewing the patient's concession card
- confirming the patient is the person named on the concession card
- making sure the concession card is valid and current.
Read more about:
- the Schedule at MBS Online
- education services for health professionals
- health assessment resources
- our website disclaimer.
Contact us for Medicare provider enquiries.
Provide your feedback on our education resources.
Page last updated: 12 March 2021
This information was printed 27 November 2021 from https://www.servicesaustralia.gov.au/organisations/health-professionals/topics/education-guide-claiming-bulk-bill-incentive-items/33011. It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.servicesaustralia.gov.au/individuals/site-notices when using this material.