1 January 2024 will bring an end to some temporary MBS items and extensions to others as well as increases to the Medicare Safety net.
Smoking cessation items
Smoking cessation items (93680, 93683, 93690, 93693, 93700 and 93703) are not being extended beyond 31 December 2023. Smoking cessation services can continue to be provided to patients through general consultation items and telehealth equivalents.
COVID-19 response measures
A range of COVID-19 health measures are being extended. This will include MBS item 93716 to prescribe COVID-19 antiviral medication via telephone. The exemption from the established clinical relationship requirement for telehealth consultations will also continue for this item.
Exemptions to the established clinical relationship requirement will also continue to apply to:
- people with a confirmed COVID-19 diagnosis (via PCR test or RAT) in the last seven days
- people who meet the PBS criteria for COVID‑19 antiviral therapy, are experiencing acute respiratory symptoms, and are seeking a request to a private pathologist for a COVID-19 PCR test.
These exemptions have been extended until 30 June 2024.
Established clinical relationship requirement – new exemption for selected urgent care clinics
A new exemption to the established clinical relationship requirement will be introduced for specified telehealth services provided at an eligible urgent care clinic under the Commonwealth Urgent Care Clinic Program. Services provided to a patient under telehealth items 91790, 91800, 91801, 91802, 91920, 92115 or 91853 at the Kimberly Medical Group located in Broome, Western Australia or My Clinic Plus located in Devonport, Tasmania will not be required to be provided by a patient’s usual medical practitioner, if:
- the service is provided under the Commonwealth Urgent Care Clinic Program by a GP engaged to provide services at an eligible urgent care clinic
- the service is provided during the hours of operation of the eligible urgent care clinic under the Commonwealth Urgent Care Clinic Program
- at the time the service is provided, a GP or participating nurse practitioner is not in attendance at the eligible urgent care clinic to provide the service in person.
Pregnancy support and sexual and reproductive health services
Pregnancy support telehealth items (92136 and 92138) have been extended into 2024 along with blood borne viruses, sexual or reproductive health service telehealth items (92715, 92718, 92721, 92724, 92731, 92734, 92737 and 92740).
Expansion of telehealth services to hospital outpatients
The definition of ‘admitted patient’ will be amended in the relevant legislation, and a new definition of ‘outpatient hospital service’ will be inserted to allow patients to receive relevant video and phone services in outpatient hospital settings. These amendments will allow patients to access relevant telehealth services provided at an outpatient hospital setting from 85% of the schedule fee.
An outpatient hospital service means a service provided, or arranged, with the direct involvement of a hospital where:
- the service is provided by a practitioner located at the hospital
- the patient is not located at the hospital and has previously been an admitted patient of the hospital
- the service is not covered by private health insurance.
Increases to Medicare Safety Net Arrangements
January 1 will bring an increase to Medicare Safety Net threshold amounts.
The Original Medicare Safety Net (OMSN) will increase from $531.70 to $560.40 (this amount is the same for concessional and non-concessional individuals and families). The Extended Medicare Safety Net (EMSN) will increase from $770.30 to $811.80 for concessional individuals and families and from $2,414.00 to $2,544.30 for non-concessional individuals and families.
Once patient gap expenses reach the OMSN threshold, Medicare will begin reimbursing 100% of the schedule fee instead of 85%, increasing the affordability of care for patients receiving out-of-hospital services. This will mostly impact patient affordability of non-GP services as most GP services already reimburse 100% of the schedule fee.
Once patient out-of-pocket expenses reach the EMSN threshold, Medicare will cover up to 80% of any further out-of-pocket expenses for out-of-hospital medical services subsidised under the MBS.
Where an MBS item has an EMSN benefit cap, patients may receive less than 80% of further out-of-pocket expenses if the out-of-pocket cost exceeds the EMSN benefits cap. EMSN benefit caps vary by individual MBS items and can be found in the MBS item descriptor.
For more information on the January MBS changes please visit the MBS Online website. As always, the RACGP’s MBS online tool will be updated with the latest item numbers and rebates when the changes come into effect on 1 January.