Summary of useful links
The RACGP has compiled links to information about the Medicare Benefits Schedule (MBS) and Medicare compliance so you can easily access these from one central location.
This page includes Department of Health and Aged Care, Services Australia and RACGP resources. Links are grouped under key themes, which are in alphabetical order. We’ve also included short descriptions of each resource to help you find what you need.
Resources on this page include MBS explanatory notes, education guides, fact sheets, eLearning programs and infographics. We encourage you to bookmark this page for easy reference. If you identify that any links on this page aren’t working or are no longer available, please let us know by emailing firstname.lastname@example.org.
MBS Note AN.0.19 – After-hours attendances
- Outlines claiming requirements for the following MBS items: 585, 588, 591, 594, 599, 600, 5000, 5003, 5010, 5020, 5023, 5028, 5040, 5043, 5049, 5060, 5063, 5067, 5200, 5203, 5207, 5208, 5220, 5223, 5227, 5228, 5260, 5263, 5265 and 5267.
MBS Note AN.0.9 – Attendances by GPs
MBS Note AN.35.1 – Flag fall amount for RACF attendance by a GP
- Outlines claiming requirements for the following MBS items: 3-4, 23-24, 36-37, 44, 47, 193, 195, 197, 199, 585, 594, 599, 2497-2559, 5000-5067 and 90020-90051.
RACF MBS attendance items
- Outlines claiming requirements for MBS item 90001.
- A list of MBS items for services provided in residential aged care facilities.
MBS Online news
MBS Online fact sheets
- A collection of news updates on changes to the MBS.
MBS Review Advisory Committee (MRAC)
- A collection of fact sheets on changes to the MBS.
- The MBS Review Advisory Committee supports the MBS Continuous Review to ensure the MBS is contemporary, sustainable, evidence-based, and supports universal access to high-value care for all Australians.
About Medicare compliance
When Medicare compliance applies
- This page provides an overview of what Medicare compliance is and why it’s important, the costs and impacts of non-compliance, who is involved in Medicare compliance, and how to report suspected non-compliance.
How to comply with Medicare obligations
- This page provides an overview of who must comply with Medicare obligations, and programs and payments covered by Medicare compliance.
eLearning module – Introduction to compliance within Medicare
- This page contains links to education and support to help you meet your compliance obligations.
Medicare compliance activities
- This module provides an overview of the Medicare compliance program, compliance activities to protect the integrity of Medicare, and resources to help you voluntarily comply and meet your obligations.
Voluntary acknowledgement of incorrect payments
- An overview of compliance activities undertaken by the Department of Health and Aged Care.
Online Compliance Platform (OCP)
- If you think you’ve incorrectly claimed a Medicare or practice incentive payment, you must let the Department of Health and Aged Care know as soon as you can.
- You can do this by submitting a voluntary acknowledgement of incorrect payments form.
Non-compliance debts and penalties
- This page contains information about the OCP, including links to FAQs and supporting resources.
- The OCP is a secure digital portal for health providers. If you are contacted by the Department of Health and Aged Care about certain Medicare compliance activities, they may also invite you to use the OCP. You can use it to self-review your Medicare claims, identify any potential errors and respond to the Department online.
Shared Debt Recovery Scheme
- You must repay any incorrect payments made to you under Medicare.
- You might also have to pay additional penalties. How you work with the Department of Health and Aged Care can decrease or increase any penalty amount.
Reporting incorrect billing, claiming, or suspected fraud
- Under the Shared Debt Recovery Scheme, a debt can be split between the practitioner and the person who manages their billing and claiming.
- Information on how to submit a tip-off in relation to billing by a healthcare professional.
MBS audit process
Application to review a compliance audit decision
- A fact sheet describing the Medicare audit process.
- Use this form to request a review of decision of a compliance audit under subsection 129AAJ(1) of the Health Insurance Act 1973.
Practitioner Review Program
Practitioner Review Program
What you need to know
- An overview of the Practitioner Review Program (PRP), including what constitutes inappropriate practice and how reviews are conducted.
- Information about the purpose of the PRP, how inappropriate practice is identified, how a PRP case is conducted, and participating in the PRP process.
The six-month review
- Information about the PRP interview process.
Referral to the delegate without a six-month review
- Information about the PRP six-month period of review, which may be offered if some or all identified concerns remain after the interview.
- Information about the PRP where practitioners are referred to a delegate of the Chief Executive Medicare after an interview without a six-month period of review.
Frequently asked questions
- Information about the PRP and the review by a delegate of the Chief Executive Medicare.
Preparing a written submission for the Practitioner Review Program
- Frequently asked questions about the PRP.
A guide for those who employ or engage practitioners
- As part of the PRP, you may be given an opportunity to provide a written submission or additional information relating to concerns about your claiming or prescribing.
Professional Services Review
Guide to the PSR process
- A guide to practitioner reviews for persons who employ or otherwise engage practitioners.
Professional Services Review website
- This guide outlines in detail the stages in the PSR process for those who are referred to the PSR.
PSR monthly case outcome reports
- The PSR agency administers the PSR Scheme to investigate Medicare-referred cases of possible inappropriate practice relating to Medicare, the CDBS and the PBS.
- Throughout the year, the PSR publishes monthly reports of case outcomes.
- All matters referred to the PSR are treated on their merits and with consideration of individual circumstances.
- These summaries of outcomes, reported in the interests of transparency, are not indicative of a likely outcome in any particular case.
Prescribed pattern of services – The 80/20 and 30/20 rules
80/20 and 30/20 rules
30/20 telephone rule
- A collection of information for practitioners about the prescribed pattern of services (the 80/20 and 30/20 rules).
What you need to know
- Information on the prescribed pattern of service 30/20 telephone rule, including relevant telephone attendance services. The rule was introduced on 1 October 2022.
How are breaches detected and what happens next?
- Information about inappropriate practice and prescribed pattern of services (the 80/20 and 30/20 rules) and which professional attendance services apply.
- Information about how a breach of the prescribed pattern of services (the 80/20 and 30/20 rules) is detected and the next steps when an 80/20 or 30/20 breach is found.
- Information on legislative requirements and considerations when there is a breach of the prescribed pattern of services (the 80/20 and 30/20 rules).
The Department of Health and Aged Care’s role in identifying potential inappropriate practice
- Information on the definition of inappropriate practice and how it applies to practitioners and corporate entities.
Common compliance issues associated with findings of inappropriate practice
- Information on the Department’s role in identifying and intervening with practitioners and corporate entities where potential inappropriate is found.
What can I do to avoid practising inappropriately?
- Information on the common compliance issues associated with inappropriate practice based on Professional Services Review outcomes.
- Information on how to avoid practicing inappropriately, your responsibilities and sources of information to meet Medicare requirements.
MBS Note TN.8.125 – Removal of skin lesions – Necessary excision diameter
MBS Note TN.8.22 – Removal of skin lesions
- Outlines claiming requirements for MBS items 31356 to 31383.
MBS Note TN.8.23 – Removal of skin lesions from face
- Outlines claiming requirements for MBS items 31356 to 31383.
MBS Note TN.8.6 – Repair of wound
- Outlines claiming requirements for MBS items 31245, 31361-31364, 31372, 31373, 31379 and 31380.
Education guide – Billing skin lesion treatment and biopsy items under Medicare
- Outlines claiming requirements for MBS items 30023 to 30049.
Consultation items and the treatment of skin lesions
- A guide to billing skin biopsy, skin lesion treatment and skin flap MBS items.
Skin lesion excision and local flap repair
- This module provides guidance on the appropriate billing of MBS attendance items for assessment and/or treatment of skin lesions.
- It outlines instances where an attendance item can be claimed in addition to an MBS procedural item for the treatment of skin lesions.
Treatment of skin lesions other than excision
- This module provides guidance on the appropriate billing of skin lesion excisions.
- It also contains information on performing local skin flap repair, seeking confirmation of clinically suspected melanoma, and follow-up excision where melanoma is confirmed.
Treatment of skin lesions – Case studies and knowledge checks
- This module includes extracts from MBS explanatory notes to help you understand the requirements for the treatment of skin lesions, other than by excision.
Determining lesion size
Malignant melanoma skin lesions
Non-malignant skin lesions
Malignant skin lesions
Mohs micrographic surgery
Removal of tumours, cysts, ulcers or scars
Skin lesion excision and flap repair item restrictions
Types of skin defects
Suspected melanoma skin lesions
- This module provides case studies and knowledge checks relating to:
- plantar warts, solar keratoses, multiple warts and solar skin disease
- the appropriate billing of skin lesion excisions
- situations where an attendance item only can be claimed.
MBS Note AN.36.1 – General explanatory notes
MBS Note AN.36.2 – Eating disorder treatment and management plans
- Outlines claiming requirements for MBS items 90250-90257, 90260-90267, 90271-90278, 92182, 92184, 92186, 92188, 92194, 92196, 92198 and 92200.
MBS Note AN.36.4 – Eating disorder psychological treatment services
- Outlines claiming requirements for MBS items 90250-90257 and 90260-90263.
Education guide – Eating disorder treatment and management plans
- Outlines claiming requirements for MBS items 90271-90278, 92182, 92184, 92186, 92188, 92194, 92196, 92198 and 92200.
eLearning program – Eating disorder treatment and management plans
- Information for medical practitioners about eating disorder treatment and management plans.
Infographic – Eating disorder treatment and management plans
- This module provides information for medical practitioners and allied health professionals about eating disorder treatment and management plans.
- You’ll learn about eligible conditions and eligibility criteria, and referrals for psychological and dietetic treatment services.
Infographic – Eligibility for treatment services under an eating disorder plan
- A flowchart outlining review and referral pathways for patients with eating disorder plans.
- A flowchart outlining patient eligibility for treatment services under an eating disorder plan.
MBS Note AN.0.9 – Attendances by GPs
Inclusion of communication time when claiming time-tiered MBS items
- Outlines claiming requirements for MBS items 3-4, 23-24, 36-37, 44, 47, 193, 195, 197, 199, 585, 594, 599, 2497-2559, 5000-5067 and 90020-90051.
- This fact sheet provides information on how to account for time taken to communicate with patients (eg those who require an interpreter) when claiming time-tiered MBS items.
MBS Note AN.0.36 – Health assessments
MBS Note AN.14.2 – Heart health assessment
- Outlines claiming requirements for MBS items 701, 703, 705 and 707.
MBS Note AN.0.43 – Health assessment for Aboriginal and Torres Strait Islander people
- Outlines claiming requirements for MBS item 699.
MBS health assessment items 701, 703, 705, 707 and 715
- Outlines claiming requirements for MBS item 715.
Education guide – Health assessments and your record keeping responsibilities
- Information about health assessment items including components of a health assessment, patient consent, what is meant by the patient’s ‘usual doctor’, assistance provided by other health professionals, and claiming restrictions.
Education guide – Aboriginal and Torres Strait Islander health assessments and follow-up services
- A guide to record keeping requirements when billing MBS health assessment items.
How to access Medicare bulk bill reports in HPOS
- Information on Indigenous health assessments and follow-up services for Aboriginal and Torres Strait Islander patients.
Accessing Medicare Easyclaim reports using HPOS
- This resource shows you how to access bulk bill payment and processing reports in HPOS. You will be able to view claims that have been successfully submitted and paid, and any claims processed with errors.
- A guide to using HPOS to generate bulk bill processing and payment reports for Medicare Easyclaim.
Accessing Medicare for health practitioners and industry
What Medicare covers
- Health practitioners must meet certain requirements to bill MBS items under Medicare or prescribe subsidised medicines.
- This page provides information on what is and isn’t covered under Medicare, and support available through other programs.
Subscribe to receive MBS updates
- MBS Online (www.mbsonline.gov.au) is the central hub for information about MBS items. You can search for item numbers and view descriptors and explanatory notes.
- The website also contains news on major changes to the MBS and fact sheets with further information.
AskMBS email advice service
- Subscribe here to receive MBS Online update emails.
- This fact sheet provides an overview of the AskMBS email advice service. This advice assists health professionals, practice managers and others to understand and comply with MBS billing requirements.
AskMBS Advisory #1 – General practice services
AskMBS Advisory #2 – General practice services
- This collection of AskMBS advisories will help health professionals, practice managers and others to understand and comply with MBS billing requirements.
Services Australia eLearning programs – Medicare for health professionals
- Advice for health providers and other users of the MBS on the interpretation and application of MBS items, explanatory notes and associated legislation, to assist them in billing Medicare correctly.
The Australian healthcare system
- A collection of modules that provide an introduction to Medicare.
The Medicare program
- This module will provide you with an understanding of the Australian healthcare system and what Medicare covers.
Provider and prescriber number eligibility
- This module will provide you with an understanding of patient eligibility, the importance of a Medicare card, and how to read the details on a Medicare card.
Introduction to the MBS
- This module provides an overview of health professional eligibility and how to apply for a provider or prescriber number from Medicare.
Referrals and requests
- Item numbers, descriptors, explanatory notes – what do these terms mean? How will knowing about them help you in your everyday work? Find the answers to these questions and more in this module.
Medicare billing and claiming basics
- This module explains the difference between referrals and requests, and outlines what constitutes a valid referral for MBS item billing purposes.
- This module explains generic aspects of patient billing and the different claiming and payment options.
Education guide – Medicare reason codes and reducing claim rejections
- This module provides an overview of MBS primary care items and focuses on selecting appropriate attendance items based on characteristics of the attendance.
Bulk bill payments to health professionals
- This guide provides an overview of Medicare reason codes used when services are rejected in claims lodged for Medicare benefits.
- Information to help you with Medicare bulk billing. Topics covered include assignment of benefit, additional charges and bulk billing, bulk billing and private billing together, and claiming bulk bill payments.
Strategies to minimise risk
- There are 10 strategies you should adopt in your practice to identify, manage and prevent the risk of incorrect billing under Medicare.
- The five steps in the toolkit make up a continuous improvement cycle for your practice’s Medicare billing assurance approach.
- Encourage health professionals in your practice to complete the following questionnaire before undertaking a Medicare billing assurance review of your practice. You can track perceptions and attitudes and identity trends to focus on.
Record keeping tips
- Encourage health professionals in your practice to complete this questionnaire after undertaking a Medicare billing assurance review. You can use the responses to track perceptions and attitudes in your practice and identity areas to focus on.
Medicare billing assurance template
- These 10 simple tips will help you establish and maintain an effective administrative record keeping system.
Medicare billing assurance charter
- This template is intended to assist practices to develop a customised Medicare billing assurance manual. It contains examples of policy statements and operational guidance.
Medicare billing assurance manual template
- This Medicare billing assurance charter sets out the principles that support billing activities under Medicare.
- This template helps practices develop a Medicare billing assurance manual. The manual can be customised to suit the particular requirements of each practice. It contains examples of policy statements and operational guidance which can create a Medicare billing assurance approach.
MBS Note AN.0.56 – GP Mental Health Treatment items
MBS Note AN.0.57 – Provision of Focussed Psychological Strategies
- Outlines claiming requirements for MBS items 2700, 2701, 2712, 2713, 2715 and 2717, and is also applicable for video and phone equivalent MBS items 92112, 92113, 92114, 92115, 92116, 92117, 92126 and 92127.
MBS Note AN.20.1 – Provision of Focussed Psychological Strategies to a person other than the patient
- Outlines claiming requirements for MBS items 2721, 2723, 2725, 2727, 91818, 91819, 91842 and 91843.
Better Access initiative – Department of Health and Aged Care website
- Outlines claiming requirements for MBS items 2739, 2741, 2743, 2745, 91859, 91861, 91864 and 91865.
Better Access initiative – Services Australia website
- The Better Access initiative gives Medicare rebates to help people access mental health professionals and care, regardless of where they live. Find out how the initiative works, who is eligible and how people can access supports.
Frequently asked questions – GP Mental Health Treatment Medicare items
- Information about services eligible health professionals can provide to patients under the Better Access initiative.
Frequently asked questions on MBS mental health items – General Practice Mental Health Standards Collaboration (GPMHSC) website
- Frequently asked questions about GP Mental Health Treatment Medicare items.
eLearning program – Access to mental health services for eligible medical practitioners
- Find out more about MBS item numbers used for the provision of primary mental healthcare. This page includes common questions and answers obtained from various sources, such as the Australian Psychological Society (APS) and the Department of Health and Aged Care.
Infographic – Better Access mental health treatment referred allied health services
- This module provides information about the Better Access to Psychiatrists, Psychologists and General Practitioners (Better Access) initiative in the MBS.
- A flowchart outlining pathways for patients accessing allied health services under the Better Access initiative.
Medicare Benefits Schedule online tool
Updates on major changes to the MBS affecting GPs
- This tool allows RACGP members to enter fees for services they provide. The tool will calculate the patient out-of-pocket amount based on the Medicare rebate. Users can also create custom lists of items they use in their practice. You will need to log in to the RACGP website to access this resource.
Statement on Medicare interpretation and compliance
- This page provides updates on major changes to the MBS affecting GPs, such as the introduction of new item numbers.
On-demand webinar – Improving your understanding of the MBS
- This statement outlines the RACGP’s position on Medicare interpretation and compliance processes. You will need to log in to the RACGP website to view this page.
Q&A – Improving your understanding of the MBS
- This webinar provides an overview of how to improve your understanding of the MBS. The session covers:
- resources available to support MBS use and interpretation
- how to ensure your use of the MBS is compliant
- understanding your billing profile – how to find information about your billing profile from common practice software systems
- RACGP resources to assist with MBS use (eg MBS online tool).
Q&A – Demystifying Medicare
- This document provides written responses to questions asked by attendees at the above webinar.
On-demand webinar – Unpacking the Medicare compliance process
- This document provides written responses to questions asked by attendees at the Demystifying Medicare session held at the RACGP’s 2023 Practice Owners National Conference. This session was presented by Dr Robert Menz and Brett McPherson.
- This webinar is a joint presentation between the Department of Health and Aged Care and the Professional Services Review on the Medicare compliance process. It aims to alleviate some of the fear and misconceptions that exist around compliance.
The RACGP provides a support program for members who are experiencing stress or similar difficulties due to compliance measures.
GP Support Program
Self-care and mental health resources
MBS Note GN.7.17 – Billing procedures
Bulk billing and private billing together
- Where a practitioner provides a number of services (excluding operations) on the one occasion, they can choose to bulk bill some or all of those services and privately charge a fee for the other services, in excess of the Medicare rebate.
- This note contains more information on the rules pertaining to split billing.
- Information on the Services Australia website about split billing.