Education Guide – 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.
Billing attendance items for immunisations
When administering an immunisation, you may be able to bill an MBS attendance item. You can do this if the administration service isn't covered under a funded mass immunisation.
A funded mass immunisation program covers costs of administering vaccines. There are no Medicare benefits for administrating vaccines covered by a funded mass immunisation.
Mass immunisations can be funded by either:
- Commonwealth or state government
- an international or private organisation, such as a patient’s employer.
You can bill a MBS attendance item if addressing an unrelated medical issue at the same time as administering a mass immunisation vaccine. You can only bill for the time spent managing the unrelated medical condition.
If administering the vaccine isn’t covered by a mass immunisation program, 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.
Billing scenarios for immunisations
You see a patient to administer an influenza vaccination. Your patient isn’t covered for the influenza vaccine under the National Immunisation Program (NIP).
After taking a short patient history, you administer the vaccine.
You can bill a MBS attendance item for your time for both the patient history and administering the vaccine.
You can charge your patient a separate amount for the cost of the vaccine. You can’t bill Medicare for the vaccine itself.
You see a patient to administer an influenza vaccination. Your patient is covered for the vaccine under the NIP. The NIP covers the cost of the vaccine, but not the cost for administering it.
After taking a short patient history, you administer the vaccine to the patient. You can bill the appropriate attendance item for the medical service provided. You can’t charge the patient a separate amount for the cost of the vaccine.
You’re employed by a state or territory community health centre to administer vaccines and provide no additional medical services. 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.
You see a patient to administer an influenza vaccination. 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.
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Page last updated: 22 January 2019
This information was printed 30 May 2020 from https://www.servicesaustralia.gov.au/topics/education-guide-medicare-billing-immunisations/45691. 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.