Medicare Cheat Sheet - Frequently Used MBS Items

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Medicare Australia
Indigenous Hotline
FREQUENTLY USED MBS ITEMS
1800 556 955
Updated: 01 November 2014
To access MBS item numbers online: http://www.mbsonline.gov.au
MBS Benefit
Item Name – Short Description
Item No
CONSULTATIONS GROUP A1 - Vocationally Registered
GROUP A2 - Non-Vocationally Registered
3
CONSULT BRIEF
$ 16.95
LEVEL A Straightforward cases e.g. Immunisation
GROUP A1
LEVEL B,C & D
Professional attendance by GP involving, where clinically relevant:
a) Taking a history*;
b) Undertaking clinical examination;
c) Arranging any necessary investigation;
d) Implementing a management plan;
e) Providing appropriate preventive health care;
in relation to one or more health related issues, with appropriate documentation
*Level B: taking a selective history; Level C: taking a detailed history; Level D: taking an extensive history.
23
CONSULT STANDARD
LEVEL B less than 20 minutes (see description above)
VR GROUP A1
$ 37.05
36
CONSULT LONG
LEVEL C at least 20 minutes (see description above)
VR GROUP A1
$ 71.70
44
CONSULT PROLONGED
LEVEL D at least 40 minutes (see description above)
VR GROUP A1
$ 105.55
52
53
54
57
CONSULT BRIEF
CONSULT STANDARD
CONSULT LONG
CONSULT PROLONGED
<5MINS
5-25MINS
25-45MINS
>45MINS
Non-VR
Non-VR
Non-VR
Non-VR
GROUP A2
GROUP A2
GROUP A2
GROUP A2
$ 11.00
$ 21.00
$ 38.00
$ 61.00
EMERGENCY IMMINENT DANGER The patient must be in imminent danger of death. One or more medical practitioners
can claim these items for simultaneous attendance on one patient. The time spent by the practitioner does not have to be continuous.
160
161
162
163
164
CRITICAL CONDITION, prolonged attendance in treatment of
CRITICAL CONDITION, prolonged attendance in treatment of
CRITICAL CONDITION, prolonged attendance in treatment of
CRITICAL CONDITION, prolonged attendance in treatment of
CRITICAL CONDITION, prolonged attendance in treatment of
1-2HR
2-3HR
3-4HR
4-5HR
>5HR
$ 221.50
$ 369.15
$ 516.65
$ 664.55
$ 738.40
HOME VISITS These items are for consultations at a place other than consulting rooms, including when RMPs visit remote NT
community aged care facilities. For after-hours home visits, refer to the separate cheat sheet “After-Hours”.
ITEM
4
24
37
47
No of
PATIENTS
ONE
TWO
THREE
FOUR
FIVE
SIX
SEVEN+
GROUP A1 – Vocationally Registered
HOME VISIT BRIEF
LEVEL A, see above
HOME VISIT STANDARD
LEVEL B, see above
HOME VISIT LONG
LEVEL C, see above
HOME VISIT PROLONGED
LEVEL D, see above
ITEM 4
$ 42.90
$ 29.90
$ 25.60
$ 23.45
$ 22.15
$ 21.25
$ 18.95
TABLE 1 – GROUP A1 – HOME VISITS
ITEM 24
ITEM 37
ITEM 47
$ 63.00
$ 97.65
$ 131.50
$ 50.00
$ 84.65
$ 118.50
$ 45.70
$ 80.35
$ 114.20
$ 43.55
$ 78.20
$ 112.05
$ 42.25
$ 76.90
$ 110.75
$ 41.35
$ 76.00
$ 109.85
$ 39.05
$ 73.70
$ 107.55
See Table 1
See Table 1
See Table 1
See Table 1
ITEM 58
$ 24.00
$ 16.25
$ 13.65
$ 12.35
$ 11.60
$ 11.10
$ 9.20
ITEM
58
59
60
65
GROUP A2 – Non-VR
See Table 2
<5MINS
See Table 2
5-25MINS
See Table 2
25-45MINS
See Table 2
>45MINS
TABLE 2 – GROUP A2 – HOME VISITS
ITEM 59
ITEM 60
ITEM 65
$ 33.50
$ 51.00
$ 73.00
$ 24.75
$ 43.25
$ 65.25
$ 21.85
$ 40.65
$ 62.65
$ 20.35
$ 39.35
$ 61.35
$ 19.50
$ 38.60
$ 60.60
$ 18.90
$ 38.10
$ 60.10
$ 16.70
$ 36.20
$ 58.20
ATTENDANCE AFTER-HOURS Medicare generally classifies clinic hours as 8am-6pm Monday to Friday, and 8am-12noon
Saturday. For item numbers and details of after-hours attendances, refer to the separate cheat sheet “After-Hours”.
MEDICARE INCENTIVES An additional rebate can be claimed for bulk billed services in Rural and Remote areas, where the
service is provided to a Commonwealth Concession Card holder or to a child under the age of 16 years.
10991
64991
74991
GENERAL MEDICAL SERVICES TABLE (GMST) – Claimed in conjunction with each service
DIAGNOSTIC IMAGING SERVICES TABLE (DIST) – Claimed in conjunction with each service
PATHOLOGY SERVICES TABLE (PST) – Claimed in conjunction with items in Group 9
$ 9.25
$ 9.10
$ 9.10
Note: Aged care facilities in remote communities in the Northern Territory are not recognised as such by the Department of Health and
Aging. Therefore, if a doctor attends a client in a remote community aged care facility, the item to claim is a home visit at a place other
than a consulting room.
Department of Health is a Smoke Free Workplace
Item Name – Short
Item No
ANTENATAL
 16500
 16591
16518
16519
16522
ANTENATAL ATTENDANCE
ANTENATAL ATTENDANCE pregnancy >20 wks – only one per pregnancy
LABOUR MANAGEMENT INCOMPLETE- THEN TRANSFER
LABOUR AND DELIVERY
MANAGEMENT OF COMPLICATED LABOUR & DELIVERY
MBS Benefit
$ 40.10
$ 121.30
$ 383.10
$ 617.75
$ 1,553.15
SIMPLE PROCEDURES For other commonly claimed items, refer to cheat sheets “Lesions” and “Fractures & Dislocations”
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
11506
11700
14206
30062
30023
30026
30029
30032
30035
30038
30041
30045
30052
30061
30064
30067
30071
30219
36800
41500
41659
42644
SPIROMETRY-BEFORE & AFTER BRONCHODILATOR
ECG TRACING & REPORT
IMPLANON INSERTION (hormone or living tissue implantation by cannula)
IMPLANON REMOVAL includes suturing
DEEP OR CONTAMINATED WOUND SUTURE REG BLOCK
SUTURE < 7CM SUPERFICIAL NOT FACE
SUTURE < 7CM DEEP NOT FACE
SUTURE < 7CM SUPERFICIAL FACE
SUTURE < 7CM DEEP FACE
SUTURE > 7CM SUPERFICIAL NOT FACE
SUTURE > 7CM DEEP NOT FACE
SUTURE > 7CM DEEP FACE
SUTURE EYELID/NOSE/EAR
FOREIGN BODY SUPERFICIAL–REMOVAL OF (INC CORNEA/SCLERA)
FOREIGN BODY SUBCUTANEOUS - REMOVAL OF
FOREIGN BODY DEEP – REMOVAL OF
BIOPSY SKIN
HAEMATOMA, FURUNCLE,ABSCESS, LESION–INCISION WITH DRAINAGE OF
URINARY CATHETER
FOREIGN BODY EAR – REMOVAL OF by means other than simple syringing
FOREIGN BODY NOSE – REMOVAL OF
by means other than simple probing
FOREIGN BODY CORNEA/SCLERA – REMOVAL OF IMBEDDED
PATHOLOGY Medicare incentive 74991 if applicable
# 73802 HB OR FBC
Medicare incentive 74991 if applicable
# 73806 PREGNANCY TEST
Medicare incentive 74991 if applicable
Medicare incentive 74991 if applicable
# 73840 HbA1c (QAAMS project participants only)
Medicare incentive 74991 if applicable
# 73844 Urinary ACR (QAAMS project participants only)
$ 17.50
$ 26.60
$ 30.30
$ 51.65
$ 277.15
$ 44.40
$ 76.50
$ 70.15
$ 99.95
$ 76.50
$ 122.40
$ 99.95
$ 215.90
$ 20.00
$ 93.45
$ 190.10
$ 44.40
$ 23.25
$ 23.50
$ 70.15
$ 65.95
$ 61.35
$ 3.90
$ 8.65
$ 14.45
$ 17.30
CHRONIC DISEASE MANAGEMENT
 701 - 707
Health Assessments – based on RMP time taken (includes time taken by RMP, RAN or ATSIHP)
701 <30mins $59.35 703 30<45mins $137.90 705 45<60mins $190.30 707 60+mins $268.80

715 ABORIGINAL & TORRES STRAIT ISLANDER PEOPLES HEALTH ASSESSMENT
$ 212.25
721
CHRONIC DISEASE MANAGEMENT PLAN (CDMP) preparation by GP ONLY
$ 144.25
723
CHRONIC DISEASE MANAGEMENT PLAN (CDMP) preparation of TEAM CARE ARRANGEMENTS
$ 114.30
732
REVIEW of a CHRONIC DISEASE MANAGEMENT PLAN (CDMP)
$ 72.05
Item 732 can be claimed twice on the same day – once as a review for item 721, and once as a review for item 723. It must be noted on the claim that they
were two different services, and the time each item 732 was commenced also noted (explanatory note A.36 MBS)
 735 ORGANISE CASE CONF 15-20 minutes, not discharge
$ 70.65
 739 ORGANISE CASE CONF 20-40 minutes, not discharge
$ 120.95
 743 ORGANISE CASE CONF > 40 minutes, not discharge
$ 201.65
TELEHEALTH Refer to Telehealth cheat sheet for telehealth attendances at a place other than consulting rooms




2100
2126
2143
2195
Attendance at health centre
Attendance at health centre
Attendance at health centre
Attendance at health centre
Level A
Level B
Level C
Level D
At least 5 minutes
Less than 20 minutes
20-39 minutes
40 or more minutes
$ 22.90
$ 49.95
$ 96.85
$ 142.50
MENTAL HEALTH
 2713 ATTENDANCE in relation to a mental disorder, lasting at least 20 minutes
Note that items 2702 and 2710 were discontinued 01 November 2011
 2700 GP Mental Health Treatment Plan (for GPs without mental health skills training), at least 20 minutes
 2701 GP Mental Health Treatment Plan (for GPs without mental health skills training), at least 40 minutes
 2715 GP Mental Health Treatment Plan (for GPs with mental health skills training), at least 20 minutes
 2717 GP Mental Health Treatment Plan (for GPs with mental health skills training), at least 40 minutes
 2712 REVIEW of a GP Mental Health Treatment Plan (applicable to items 2700, 2701, 2715, 2717)
$ 71.70
$ 71.70
$ 105.55
$ 91.05
$ 134.10
$ 71.70
# A consultation can also be claimed with item numbers marked #
 A consultation can also be claimed with item numbers marked  if it is clinically indicated that a problem must be treated immediately (to be noted on the claim)
 A consultation can also be claimed with items marked  if they are not for related conditions (to be noted on the claim)
 A consultation can also be claimed with items marked  if not at the same time (times to be noted on the claim)
Department of Health – Primary Health Medicare Trainers
Top End
8922 8467 / 8922 7611
Central Australia
8951 7754 / 8951 7129
Department of Health is a Smoke Free Workplace
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