1 November 2023 MBS changes


Indexation

  • From 1 November 2023, an additional indexation factor of 0.5% will be applied to:
    • most of the general medical services items;
    • most diagnostic imaging services (but excluding nuclear imaging services); and
    • pathology items in Group P12 (74990, 74991, 75861, 75962, 75863 and 75864).
  • This builds on the annual fee indexation of 3.6% applied to most MBS services on 1 July 2023.
  • The RACGP’s MBS online tool will be updated on 1 November with relevant new items and rebates.
 

Bulk billing incentive increases

  • From 1 November 2023, seven existing bulk billing incentive (BBI) items will be amended and 13 new BBI items will be added to the MBS.
  • There are no changes to patient eligibility for BBIs. Commonwealth concession card holders and patients aged under 16 years of age will be eligible for tripled BBIs when they receive an eligible service. Further information on Commonwealth concession cards is available at www.servicesaustralia.gov.au/concession-and-health-care-cards.
  • Tripled BBIs do not apply to all GP billable MBS items. Tripled BBIs can only be co-claimed with the following items:
    • MBS Levels B, C, D and E face-to-face general attendance consultations (and out-of-rooms, residential aged care facilities and after-hours equivalents)
    • MBS Level B telehealth general attendance consultations (video and phone)
    • Where a patient is registered for MyMedicare, tripled bulk billing incentives will also be billable for level C and D telehealth (video and phone) general attendance consultations and level E video consultations.
  • For all other MBS items, the existing, standard BBIs will remain billable.
  • For further information please see the Supporting Bulk Billing in General Practice factsheet and the DoHAC summary table of the new items
  • The RACGP has developed its own fact sheet to help members understand the new BBI item structure and the tie-in with MyMedicare. The fact sheet covers general eligibility for BBIs, tripled BBI item numbers by level of remoteness and eligible services, standard BBIs (pre-existing items), eligibility scenarios for the new tripled BBIs, and links to further information.
  • The new items for patients not registered with MyMedicare are listed in the table below:

 

MBS item number

Billable area

MBS benefit

75870

Metropolitan

$20.65

75871

Modified Monash area 2

$31.40

75872

Modified Monash area 2-7 (after hours)

$31.40

75873

Modified Monash area 3-4

$33.35

75874

Modified Monash area 5

$35.45

75875

Modified Monash area 6

$37.40

75876

Modified Monash area 7

$39.70


When billing items for patients linked to MyMedicare, the following MBS items should be used. These items can be claimed with Level C, D and E video general attendance items, and Level C and D telephone general attendance items, where the patient is registered with MyMedicare.

MBS item number

Billable area

MBS benefit

75880

Metropolitan

$20.65

75881

Modified Monash area 2

$31.40

75882

Modified Monash area 3-4

$33.35

75883

Modified Monash area 5

$35.45

75884

Modified Monash area 6

$37.40

75885

Modified Monash area 7

$39.70


Level E items

  • From 1 November new general attendance consultation items for consultations 60 minutes and over by GPs and medical practitioners (Level E items) will be available.
  • Like current general attendance items, Level E items will be available for face-to-face consultations, out-of-room consultations, consultations in residential aged care facilities and video consultations. Phone items are not available for Level E consultations.
  • Existing restrictions on same-day co-claiming of general attendance and chronic disease management MBS items and the standard caps for the Extended Medicare Safety Net will also apply to the Level E items.
  • As part of this change, existing Level D items will now have a maximum consultation length.
  • For a full list of general attendance items including new Level E items, please see the Department of Health and Aged Care’s General Attendance Items table.
  • For further information on Level E items please see the Level E long consultations fact sheet.
  • A list of new Level E items is available below with the new MBS benefits.
 

MBS item number

MBS item description

MBS benefit

General Practitioner items

123

Professional attendance by a general practitioner at consulting rooms (other than a service to which another item in this Schedule applies), lasting at least 60 minutes and including any of the following that are clinically relevant:(a) taking an extensive patient history;(b) performing a clinical examination;(c) arranging any necessary investigation;(d) implementing a management plan;(e) providing appropriate preventive health care; for one or more health-related issues, with appropriate documentation

$191.20

124

Professional attendance by a general practitioner (other than attendance at consulting rooms or a residential aged care facility or a service to which another item in this Schedule applies), lasting at least 60 minutes and including any of the following that are clinically relevant:(a) taking an extensive patient history;(b) performing a clinical examination;(c) arranging any necessary investigation;(d) implementing a management plan;(e) providing appropriate preventive health care; for one or more health-related issues, with appropriate documentation—an attendance on one or more patients at one place on one occasion—each patient

$220 for one patient (see Ready Reckoner for fees for multiple patients)

90054

Professional attendance by a general practitioner, on care recipients in a residential aged care facility, other than a service to which another item applies, lasting at least 60 minutes and including any of the following that are clinically relevant:(a) taking an extensive patient history;(b) performing a clinical examination;(c) arranging any necessary investigation;(d) implementing a management plan;(e) providing appropriate preventive health care; for one or more health-related issues, with appropriate documentation—an attendance on one or more patients at one residential aged care facility on one occasion—each patient (subject to clause 2.30.1)

$191.20

91920

Telehealth attendance by a general practitioner, lasting at least 60 minutes and including any of the following that are clinically relevant:(a) taking an extensive patient history;(b) arranging any necessary investigation;(c) implementing a management plan;(d) providing appropriate preventive health care; for one or more health-related issues, with appropriate documentation NOTE: It is a legislative requirement that this service must be performed by the patient’s usual medical practitioner (please see Note AN.1.1 for the definition of ‘patient’s usual medical practitioner’ as some exemptions do apply).

$191.20

5071

Professional attendance by a general practitioner at consulting rooms (other than a service to which another item in this Schedule applies), lasting at least 60 minutes and including any of the following that are clinically relevant:(a) taking an extensive patient history;(b) performing a clinical examination;(c) arranging any necessary investigation;(d) implementing a management plan;(e) providing appropriate preventive health care; for one or more health-related issues, with appropriate documentation

$220.25

5076

Professional attendance by a general practitioner (other than attendance at consulting rooms, a hospital or a residential aged care facility or a service to which another item in this Schedule applies), lasting at least 60 minutes and including any of the following that are clinically relevant:(a) taking an extensive patient history;(b) performing a clinical examination;(c) arranging any necessary investigation;(d) implementing a management plan;(e) providing appropriate preventive health care; for one or more health-related issues, with appropriate documentation—an attendance on one or more patients on one occasion—each patient

$248.85 for one patient (see Ready Reckoner for fees for multiple patients)

5077 Professional attendance by a general practitioner, on care recipients in a residential aged care facility, other than a service to which another item in this Schedule applies, lasting at least 60 minutes and including any of the following that are clinically relevant:(a) taking an extensive patient history;(b) performing a clinical examination;(c) arranging any necessary investigation;(d) implementing a management plan;(e) providing appropriate preventive health care;for one or more health-related issues, with appropriate documentation—an attendance on one or more patients at one residential aged care facility on one occasion—each patient $271.70 for one patient (see Ready Reckoner for fees for multiple patients)


Other MBS changes

  • Existing level D items will be amended to include a maximum attendance time.
  • A minimum service time of six minutes will be introduced for level B GP consultation items 23, 24, 5020, 5023, 5028 and 90035 applying to a consultation service lasting at least six minutes and less than 20 minutes.
  • Further information regarding the introduction of a 6-minute minimum time for Level B consultations can be found in the recently published fact sheet.
  • New phone items 91900 (Level C) and 91910 (Level D) will be introduced for longer general practice attendances with a GP, where the patient is registered under MyMedicare with the billing practice.
  • Amendments to telehealth item 91800, to introduce appropriate minimum and maximum consultation times.
  • Existing phone item 91894 will be deleted. This item currently provides patients in rural and remote areas with access to longer general practice phone consultation items. Patients in these areas will continue to have access to longer general practice phone services where they are registered under MyMedicare.
  • From 1 November 2023, the current age restrictions relating to prescribed dental patients with cleft and craniofacial conditions will be removed. This may enable adult patients to receive MBS rebated services through dental service providers who were previously ineligible.
  • Information about all other 1 November MBS changes can be viewed in the MBS November 2023 news.
 

Administrative changes to Other Medical Practitioner MBS items

  • For administrative reasons the Department will change references to a medical practitioner who is not a general practitioner, specialist, or consultant physician from ‘other medical practitioner’ to ‘prescribed medical practitioner’.
  • These changes are administrative in nature and will help streamline the MBS regulatory framework. There are no policy changes resulting from these changes.
  • There are no changes to item numbers, eligibility or requirements resulting from these changes. Providers may notice minor drafting amendments to a number of items and regulatory clauses; however, these changes are administrative in nature only.
  • For further information please see the Administrative changes to OMP and GP MBS items factsheet.

Advertising

Advertising