New items from March 2021
From March 2021, 16 new MBS items will be available to enable GPs and suitably qualified health professionals to assess patients for their suitability to receive a COVID-19 vaccine. The MBS COVID-19 vaccine suitability assessment service is free to Medicare eligible patients and the MBS items must be bulk billed for all patients.
Bulk billing incentives (double for dose one, single for dose two) are incorporated into the value of the items, meaning the new items cannot be co-claimed with bulk billing incentive items 10990, 10991 or 10992. An accredited general practice that has completed two vaccine suitability assessment services for the same patient in a clinically appropriate timeframe is also eligible for a $10 payment under the Practice Incentives Program (payable only once per patient).
Detailed information on the new items is available on MBS Online. This fact sheet includes scenarios which offer examples of how the MBS items can be billed, what to do when patients present with multiple clinical matters, and guidance on issues such as co-claiming.
In situations where a COVID-19 vaccine suitability assessment service is provided and the patient elects to be vaccinated, but the vaccination cannot be delivered due to unforeseen circumstances, the patient may return to the medical practice at a later date to receive their vaccination. A further vaccine suitability assessment service would also need to be provided, to ensure that the patient can still receive the vaccine safely. Circumstances that may lead to this kind of delay include unanticipated staff absences leading to reduced capacity to vaccinate all patients on the day of service.
For the most up to date rebates for MBS COVID-19 vaccine items, please refer to the RACGP's MBS online tool.
On 14 June 2021, a new MBS vaccine flag fall item was introduced. GPs administering COVID-19 vaccines to people at home or in a disability or residential aged care facility will be paid an additional fee for each visit they make. Item 90005 pays $57.25 per visit, regardless of how many patients are vaccinated. The flag fall item must be bulk billed and can be claimed in addition to existing MBS items to assess a patient’s suitability to receive a COVID-19 vaccine. Visit MBS Online for more information
On 18 June 2021, the Minister for Health announced a new Medicare item for GPs to counsel patients and build confidence in the COVID-19 vaccine (item 10660). The item is equivalent to a Level B consultation with a rebate of $39.10, can be claimed once per patient and must be bulk billed.
The item can only be claimed where a GP attends to a patient in person for more than 10 minutes, and must be provided in conjunction with a relevant MBS COVID-19 vaccine suitability assessment item. It cannot be billed with other MBS items.
On 29 June 2021, the Minister announced the vaccine counselling item, which previously only applied to patients aged over 50, will be expanded to all patients irrespective of age.
A separate item for other medical practitioners working in a general practice setting is also available (item 10661).
Visit MBS Online for more information.
In October 2021 the federal government announced that individuals who are severely immunocompromised should receive a third dose of the COVID-19 vaccine. Assessment of suitability for these third doses are eligible for MBS reimbursement with the same rules as suitability assessments for second doses. The same second dose MBS items are used, including when a medical practitioner performs a suitability assessment for a patient and determines they are not suitable for a third vaccine dose.
Flag fall and in-depth patient assessments may also be claimed if all other eligibility requirements are met (in-depth patient assessments can only be claimed once per patient). The additional Practice Incentives Program (PIP) payment for administering COVID-19 vaccines is not claimable for a third dose. It remains payable only when the first and second vaccine doses are administered at the same general practice.
On 28 October 2021, the federal government announced funding arrangements for the wider vaccine booster program, which will commence on 8 November 2021. MBS rebates for boosters will stay at the existing level for administering a second dose, with no PIP payment included.
Funding for paediatric vaccine administration is as per adult populations. Eligible practices are able to claim the $10 Practice Incentive Payment if the child receives both vaccines at the same practice.
Additional funding announced for administration of third and booster doses
Following National Cabinet on Wednesday 22 December 2021, Prime Minister Scott Morrison announced that general practices will receive an additional $10 per COVID-19 booster dose administered.
As per MBS online:
- Commencing 23 December 2021, a new temporary Medicare Benefits Schedule (MBS) item has been made available to support medical practitioners providing vaccine suitability assessment services to patients who require booster vaccinations.
- MBS item 93666 provides an incentive payment of $10 per eligible vaccine suitability assessment service to patients receiving a COVID-19 third dose or booster vaccination.
- The incentive will be paid in conjunction with COVID-19 vaccine suitability assessment services provided to patients receiving a third dose or booster dose of a COVID-19 vaccine.
- The item will not be paid for patients receiving a second dose service.
- The MBS item is available until 30 June 2022.
Read the MBS Factsheet: COVID-19 Booster Incentive Payment
Two new MBS items will be introduced which allow qualified health professionals to provide vaccine suitability assessment services outside of a medical practice without on-site supervision by a medical practitioner. Item 93660 is for Modified Monash Model (MMM) 1 areas and item 93661 is for MMM 2-7 areas. These new items are intended to target the provision of COVID-19 vaccines to vulnerable people who may have difficulty travelling to a medical practice. Like all MBS COVID-19 vaccine items, the items must be bulk billed.
The medical practitioner retains responsibility for the health, safety and clinical outcomes of the patient. They must be satisfied that the relevant health professional is appropriately qualified and trained to provide the service.