AItem Number Medicare Benefit Item Description
Group A11 – After Hours
GP After Hours Between 11pm – 7am
(not more than 1 patient on the 1 occasion)599 $144.30 At Consulting rooms
-patient requires urgent treatment; GP needs to specifically open rooms. -patient requires urgent treatment.
GP Transitional Hours
597 $122.45 At a place other than, or in consult rooms -patients condition requires urgent treatment
– Mon to Fri – 7am-8am and 6pm – 11am-Sat – 7am-8am and 12pm – 1pm; Sun and public holiday – 7am – 11am
Group 22 – After Hours Attendances to which no other item applies
Public holiday, Sunday, before 8am or after 1pm on Saturday or before 8am or after 8pm any other day5000 $27.35 Level A consult in rooms5003 Level A consult elsewhere (excluding hospital and aged care)5010 Level A consult in aged care facility5020 $46.25 Level B consult in rooms5023 Level B consult elsewhere (excluding hospital and aged care)5028 Level B consult in aged care facility5040 $79.15 Level C consult in rooms5043 Level C consult elsewhere (excluding hospital and aged care)5049 Level C consult in aged care facility5060 $110.1
0Level D consult in rooms
5063 Level D consult elsewhere (excluding hospital and aged care)5067 Level D in aged care facility
Asthma Cycle of Care
(note: benefits are payable for only one service including – 2546, 2547, 2552, 2553, 2558, 2559, 2664, 2666, 2668, 2673, 2675, 2677 – in a 12mo period
Asthma cycle of care must include:- = or > 2 asthma related consults within 12mo for patient with mod/severe asthma(at least one of
which is a consult which was planned at a previous consultation)- Severity – symptoms on most days or use of preventor or bronchodilator at least 3x per week or
hospital attendance or admission following acute exacerbation- Documented diagnosis and assessment of level of asthma control and severity of asthma
- Review of patient use of and access to asthma related medication and devices.- Written asthma action plan
- Provision of asthma self management education- Once every 12months
2546 $34.90 Level B Consult for Asthma cycle of care – in rooms2547 Level B consult for asthma cycle of care – not in rooms2552 $67.65 Level C consult for asthma cycle of care – in rooms2553 Level C consult for asthma cycle of care – not in rooms2558 $99.55 Level D consult for asthma cycle of care – in rooms2559 Level D consult for asthma cycle of care – not in rooms
11610 $61.30 Ankle Brachial indices (using Doppler)16500 $38.55 Antenatal Attendance16591 $116.70 Antenatal – beyond 20wk – planning and management (only once)11306 $21.10 Audiometry
BItem Number Medicare Benefit Item description
30003 $34.90 Burns Dressing30006 $44.75 Burns Dressing - extensive30071 $42.75 Biopsy
(after care is 2 days)10990 Bulk Billing Incentive:
<16yo; pensioner; health care card holders
CItem Number Medicare Benefit Item Description
2501 $34.30 Cervical Smear – Level B2504 $65.20 Cervical Smear – Level C2507 Cervical Smear – Level D
30192 $32.35 Cryotherapy – 10 or more premalignant lesions
Chronic Disease ManagementSee entries under – GP management plan; team care arrangements; multidisciplinary care plans and case
conferencesA patient who has at least one medical condition that is likely to be present >6mo or terminal.
Team includes medical practitioner & at least 2 other members, each of whom provides a different service
Case conferences - Multidisciplinary- Not a service where 731 applies
735 $66.60 Community Case Conference - Organised and coordinated by GP- 15-20min duration
739 $114.1 Community Case Conference - Organised and coordinated by GP- 20-40min duration
743 $190.20 Community case conference - Organised and coordinated by GP- >40min duration
747 $48.95 Community Case conference – participation by GP- 15-20min
750 $83.90 Community Case Conference – participation by GP- 20-40min
758 $139.40 Community Case Conference – participation by GP- >40min
DItem Number Medicare Benefit Item Description
Diabetes Cycle of care (established DM)The following must be completed over a period of at least 11mo and up to 13mo:-
- 2x in 12mo – Wt, BMI, BP, feet exam- Once in 12mo – HbA1c, lipids, microalbuminuria
- Every 2years – ophthalmology review- Self care, education, r/v diet, r/v activity levels, smoking and review medication
2517 $34.90 Level B consult in rooms - <20min2518 Level B consult else where - <20min2521 $67.65 Level C consult in rooms - >20min2522 Level C consult elsewhere >20min2525 $99.55 Level D consult in rooms >40min2526 Level D elsewhere >40min
DislocationsNot requiring a general anaesthetic
Closed reductions only)47003 Clavicle47015 Shoulder47018 Elbow47036 Interphalangeal Joint47042 MCPJ47069 Toe
EItem Description Medicare Benefit Item Description
11700 $30.05 ECG – 12 Lead
ExcisionsAfter care period is usually 10/7
30186 (<10)30185 (>10)
$38.85 Plantar Wart – excisionDefinitive removal excluding ablative methods alone
31205 $78.05 Lesion <10mm rest of body – tumour, cyst, ulcer or scar (not wart or seb k)
31210 $100.70 Lesion 10-20mm rest of body – tumour, cyst, ulcer or scar(not wart or seb k)
31215 $117.40 Lesion >20mm rest of body – tumour, cyst, ulcer or scar(not wart or seb k)
31220 $175.45 Tumour, cyst ulcer or scar4-10 lesions removed by surgical excision
(not wart or sebk)31230 $137.45 Lesion - nose, eyelid, lip, ear, digit, genitals
Removal by surgical excision (not shave excision)31235 $117.40 Lesion <10mm – face neck, lower leg
Removal by surgical excision (not shave excision)31240 $137.45 Lesion >10mm – face, neck, lower leg
Removal by surgical excision (not shave excision)31255 $181.05 BCC, SCC, KA <10mm – Nose, eyelid, lip, ear, digit, genitalia
Removal by surgical excision (not shave excision)(31256 – removal of residual lesion)
(31258 – removal of recurrent lesion)31260 $258.10 BCC, SCC, KA >10mm – Nose, eyelid, lip, ear, digit, genitalia
Removal by surgical excision (not shave excision)(31261 – removal or residual lesion)
(31263 – removal of recurrent lesion)31265 $150.90 BCC, SCC, KA <10mm – face, neck, lower leg
Removal by surgical excision (not shave excision)(31266 – removal of residual lesion)
(31268 – removal of recurrent lesion)31270 $211.85 BCC, SCC, KA 10-20mm – face, neck, lower leg
Removal by surgical excision (not shave excision)(31271 – removal of residual lesion)
(31273 – removal of recurrent lesion)31275 $244.75 BCC, SCC, KA >20mm – face, neck, lower leg
Removal by surgical excision (not shave excision)(31276 – removal of residual lesion)
(31278 – removal of recurrent lesion)31280 $127.50 BCC, SCC, KA <10mm – rest of body
Removal by surgical excision (not shave excision)(31281 – removal of residual lesion)
(31283 – removal of recurrent lesion)31285 $174.20 BCC, SCC, KA 10-20mm – rest of body
Removal by surgical excision (not shave excision)
(31286 – removal of residual lesion)(31288 – removal of recurrent lesion)
31290 $201.10 BCC, SCC, KA >20mm – rest of bodyRemoval by surgical excision (not shave excision)
(31291 – removal of residual lesion)(31293 – removal of recurrent lesion)
31300 $261.65 Malignant Melanoma <10mm – nose, eyelid, lip, ear, digit, genitalia
(includes other locally aggressive tumours)(needs to be definitive excision)
31305 Malignant Melanoma >10mm – as for 3130031310 Malignant melanoma <10mm – face, neck, lower limb
(includes other locally aggressive tumours)(needs to be definitive excision)
31315 Malignant Melanoma 10-20mm – as for 3131031320 Malignant Melanoma >20mm – as for 3131031325 Malignant melanoma <10mm – rest of body
(includes other locally aggressive tumours)(needs to be definitive excision)
31330 Malignant Melanoma 10-20mm – as for 3132531335 Malignant Melanoma >20mm – as for 31325
41647 $89.00 Ear Toilet- Using operating microscope and microinspection of TM
41656 $100.50 Epistaxis – post nasal haemorrhageArrest with post nasal packing
41677 $73.60 Epistaxis – arrest with cauterisation or packing or both(if done by cryotherapy – see 41680)
30071 $42.75 Excisional biopsy(After care is 2 days)
30195 $51.95 Benign neoplasm of skin-not wart, seb K, cyst or skin tag
-electrosurgical destruction, curettage, shave excision30196 $103.30 Malignant neoplasm of skin
- Proven by histology- Removal by serial excision, cryotherapy or diathermy
FItem Number Medicare Benefit Item Description
Family group therapy-professional attendance for group therapy of >1hour duration given under direct continuous supervision of a medical practitioner involving members of a family and persons with close personal relationships with
that family170 $110.90 2 patients171 $116.80 3 patients172 $142.15 4+ patients
Foreign Bodies41500 $66.30 Removal FB from ear
Not with syringe41659 $63.45 Removal FB from nose
Other than by simple probing30061 $19.25 Removal FB – superficial
- Incl cornea or sclera30064 $89.90 Removal FB – superficial – requiring incision and exploration
Including wound closure30067G $182.90 Removal FB in muscle tendon or other deep tissue(assist)42644 Removal of FB from cornea or sclera
Imbedded FBSubepithelial or intraepithelial and completely removed using needle
or surgical instrument and magnification
Fractures+/-Closed reduction
47300 Distal phalanx of finger/thumb47307 Distal phalanx of finger/thumb
Intraarticular fracture47312 Middle phalanx of finger47315 Middle phalanx of finger
Intra-articular fracture47324 Proximal fracture of finger/thumb47327 Proximal fracture of finger/thumb
Intra-articular fracture47336 Metacarpal fracture47339 Metacarpal fracture
Intra-articular47348 Carpus fracture (not scaphoid)47354 Scaphoid – treatment of fracture47360 Radius or ulna – distal
Cast immobilisation(47363 – with reduction)
47369 Radius – distal (colles, smiths,Bartons)Cast immobilisation
(47372 – with reduction)47378 Radius or ulna – shaft
Cast immobilisation47387 Radius and ulna – shaft (assist)
Cast immobilisation47405 Radius – fracture of head or neck
Closed reduction47423 Humerus – proximal
No reduction required47444 Humerus – shaft
No reduction required47462 Fracture of clavicle – Tx of fracture47471 Ribs – fracture of one or more rib
Each attendance47561 Tibial – shaft
Cast immobilisation47576 Fibular fracture47594 Ankle fracture47633 Fracture of 1 metatarsal
No reduction required47642 Fracture of 2 metatarsals
No reduction required47651 Fracture of 3 metatarsals
No reduction required47735 Nasal bone fracture
No reduction requiredEach attendance
GItem Number Medicare Benefit Item Description
GP Management Plans
721 $136.05 GP Management Plan- Not being a service to which items 735-758 apply- Condition likely to be present >6mo or terminal
- Only billed once every 12mo- Not within 3mo of claim for 729, 731 or 732 except if
significant change in patients condition or care circumstances that need a new plan
- Not for patient in RACF732 $68.00 GP Management Plan – Review
- Not being a service to which items 735-758 apply- Not claimed in last 3mo
- No claim in last 3mo for 729, 731, 732 except if significant change in condition or patient care
General Practitioner AttendancesNo other item applies
1 $120.30 Urgent attendance after hours – elsewhere2 $120.30 Urgent attendance after hours – in rooms3 $16.00 Level A – in rooms
Straightforward problem (short hx, limited exam, management)20 Level A – at aged care facility23 $34.90 Level B – in rooms
Involving taking selective history, exam and management for one or more problems or professional attendance of <20min involving
components of a service to which items for level C/D apply35 Level B – aged care facility36 $67.65 Level C – in rooms
Involves detailed history, exam of multiple systems, arranging any necessary investigation and implementing management plan for
one or more problems and lasting at least 20min or attendance of <40min for Level D items
43 Level C – aged care facility44 $99.55 Level D – in rooms
Involves exhaustive history, comprehensive exam of multiple systems, arranging investigations, implementing management plan in relation to 1 or more complex problems and lasting >40min OR a
professional attendance of >40min for implementation of management plan
51 Level D – aged care facility
HItem Number Medicare Benefit Item Description
Health AssessmentsBrief = <30min = item 701 - $56.00
Standard = 30-45min = item 703 - $130.10Long = 45-60min = item 705 - $179.45
Prolonged =>60min = item 707 – 253.60
(note – patient has not had payment made under this item or item 702, 704, 706 in last 12mo)75yo+ - health assessment
4yo health checkComprehensive medical assessment (CMA)
Permanent RACF residentNil CMA in last 12mo
Type 2 Diabetes risk evaluation40-49yo + high risk of type 2 DM
No risk evaluation in last 3 years under 717 or 713www.health.gov.au/preventionoftype2diabetes
45yo health check45-49yo at risk of chronic disease
Only payable onceRisk factors include – smoking, physical inactivity, poor nutrition,
alcohol use, high cholesterol, hypertension, impaired glucose tolerance, obesity, family hx of chronic disease
Refugee Health assessment-not being health assessment in patient with previous claim under
items 700, 702, 712, 714 or 716-within 12mo of arrival or receiving residency
-only payable oncePatient with intellectual disability
Must include:- dental check, aural exam, audiometry every 5yrs, ocular health, nutritional status, bowel and bladder function,
medications, osteoporosis risk factors (diet, exercise, vitD, FHx), seizure control, thyroid dis, signs of abuse, immunisations, ADL
support, dysphasia and GORD(consider breast screen, papsmear, testicular exam, lipid level,
prostate assessment)10986 4yo health check – by nurse
715 55yo+ with ATSI decent715 0-14yo with ATSI decent
No payment for this item in last 9moConsider FBC and audiometry
715 15-55yo with ATSI decentNo payment for this item in last 9mo
Include assessment for hearing loss, dipstick urine and ELFT
32147 $36.30 Haemorrhoid - Incision of perianal thrombosisB100 Holter monitor (BP only)
IItem Number Medicare Benefit Item Description
10993 $11.35 Immunisation by nurse14206 $34.25 Implanon/Zoladex implant30062 $58.45 Implanon removal30061 $18.90 IUD removal30219 $26.30 Incision and drainage – abscess
Includes haematoma, furuncleExcluding aftercare
MItem Number Medicare Benefit Item description
729
(or RACF – 731)
$66.35 Multidisciplinary Care Plans- Contribution of GP to multidisciplinary care plan prepared by
another or review of care plan prepared by another.- Not being a service to which items 734-779 apply
- Condition likely to be present for >6mo or terminal. - No claim within 12mo by same GP for 721 or 723.
- No claim within 30 – 729, 731 or 732 except if significant changes
- In consultation with two other collaborating medical providers
GP Mental Health treatment plans
2702(2710 if GP undertaken PIP training)
$128.20(2702)163.35(2710)
Preparation of a GP Mental Health treatment plan- Only one per 12mo
- Where 2713, 734 to 779 do not apply- Not within 3mo of claim for 2712 except if sign change
2712 $108.90 Review of GP Mental health plan- r/v of plan to which 2702/2710 applies or review psychiatrist
management plan to which 291 applies- every 3 months unless significant change- where 2713 or 734 to 779 do not apply
- not within 4 weeks of claim for 2702/27102713 $71.85 Consult in relation to mental health disorder
- involving history and providing treatment, advice &/or referral on patient in relation to mental health disorder
- lasting at least 20min- where items 2702, 2710 and 2712 do not apply
10990 Miscellaneous Charge Bulk billing incentive for patients who are <16yo, pensioner, health
care card holder
Medication management review- patient must be at risk of medication misadventure due to co-morbidities, age, or social
circumstances, complexity of treatment regimen (eg >12doses/day) or due to lack of knowledge or skill to use medicines to their best effect)
900 $146.00 Domiciliary Medication management review- patient living in community
- in liason with pharmacist- payable every 12mo except if significant change
- benefit not payable until all components have been rendered- (also known as home medicine review)
903 Domicilliary Medication management review – in RACF
NItem Number Medicare Benefit Item description
Nails of digits46531 $69.65 Ingrowing nail of finger or thumb
- Partial resection – but not including excision of nail bed47916 $69.65 Ingrowing nail of toe
-partial resection but not including excision of nail bed47904 Removal of nail of toe
10997 Nurse monitoring and support of a client with a chronic condition(5x per calendar year; for patient with GP Mx plan)
PItem Number Medicare Benefit Item Description
Prolonged attendances to which no other item appliesProfessional attendance (where no other item applies on a patient in imminent danger of death requiring
continuous attendance to the exclusion of all other patients160 $208.90 Duration 1-2hr161 $348.20 Duration 2-3hr
Papsmears-unscreened or significantly underscreened patient (ie>4yrs)
-20 – 69 years old-non inconjunction with 10994, 10995, 10998 or 10999
2501 $34.90 Level B Consult + papsmear2504 $67.65 Level C consult + papsmear2507 $99.55 Level D consult + papsmear
Pregnancy4001 $72.25 Pregnancy support counselling
- Need to meet medicare credentialling- Provision of non directive pregnancy support counselling to a
woman who is concerned about her pregnancy or a pregnancy that occurred in last 12mo
- Lasting >20min- May address any pregnancy related issues for which non
directive counselling is appropriate. - Maximum 3 sessions per patient per pregnancy
73806 $8.70 Pregnancy Test16591 Pregnancy over 20wks
Can only be claimed once per pregnancy
Focused Psychological Strategies- must have done higher level mental health training
- up to 12 planned sessions per year (comprising 2 groups of 6 sessions)- these 12 sessions are part of the 12 total psych sessions under GPMHCP
2721 $87.50 Surgery ConsultDuration 30-40min
2725 $125.20 Surgery Consult – extended attendance>40min
SItem Number Medicare Benefit Item Description
11506 $19.75 Spirometry- done before and after bronchodilator
Suturing
30026 $42.75 Body, superficial <7cm30029 $73.60 Body, deep superficial <7cm30032 $67.45 Face/neck – superficial <7cm30035 $96.15 Face/neck – deep <7cm30038 $73.60 Body superficial >7cm30041 $117.80 Body deep >7cm30045 $96.15 Face/neck superficial >7cm30048 $122.45 Face/neck deep >7cm
TItem Number Medicare Benefit Item description
723 $107.80 Team Care Arrangements- Not being a service to which items 735-758 apply- Condition likely to be present >6mo or terminal
- Nil claim in last 12mo- Nil claim in last 3mo for 732 except if significant change to
condition or care circumstances- Must involve 2 other health providers
- Not for RACF patients732 $66.80 Team Care Arrangement – Review
- Not being a service to which items 734-779 apply- No claim within 3mo
- No claim for 723 within 3mo except if significant change- Note- each service to which a 732 applies may be claimed in a
3mo period (unless significant change) & 732 can be claimed more than once in the same day – eg for TCA and GPMP
WItem number Medicare Benefit Item Description
10996 11.35 Wound management30185 (<10)30186(>10)
Warts – palmar or plantarDefinitive removal (excluding ablative methods)
Other Notes:
Level A consult = straight forward problem
Level B consult = selective history exam and management to 1 or more problems OR attendance less than or equal to 20min involving components of a Level C consult
Level C consult = detailed history, multisystem exam, investigation and management. At least 20min OR attendance less than or equal to 40min involving components to which a Level D consult applies.
Level D consult = exhaustive history, comprehensive exam, investigation and management of one or more complex problems and longer than 40min OR attendance of at least 40min for implementation of management plan.
All figures in this document are either the amount listed on the MBS or, where more than one amount is given, the 85% benefit has been used.
While every effort has been made to ensure that all information in this document is correct, misinformation may occur. If you find an error please let me know on [email protected]