Medicare Benefits Schedule

As a health practitioner, it is your responsibility to comply with Medicare obligations. It’s important to do the relevant training and understand the requirements and laws that apply. We provide lots of education and support to help you meet your obligations. Compliance and eligibility requirements apply to health practitioners who bill, claim, dispense and prescribe under the Medicare benefits schedule (MBS). There are 10 strategies you should adopt in your practice to identify, manage and prevent the risk of incorrect billing under Medicare.

MBS Online 

MBS Online contains the Medicare Benefits Schedule (MBS), a listing of the Medicare services subsidised by the Australian Government. Search MBS can be used to search details of specific item numbers.  

Telehealth Services 

Ongoing MBS telehealth arrangements remain in place and provide for a wide range of telephone and video services by qualified health practitioners to support safe and equitable telehealth services, informed by the MBS Review Taskforce Principles. 
 
MBS video and phone items are available to medical practitioners in general practice, specialists, consultant physicians, nurse practitioners, participating midwives, allied health providers and dental practitioners in the practice of oral and maxillofacial surgery. 
 
Patients in areas declared a natural disaster can access telehealth services from any to medical practitioners in general practice. Eligible regions are state or territory Local Government Areas (LGAs) identified as a natural disaster at the time of the service.  

Temporary exemptions from the established clinical relationship requirement for general practice video and phone services apply to patients with a confirmed COVID-19 diagnosis, and for patients who suspect they have COVID-19 and meet the PBS criteria for COVID-19 anti-viral therapy and require a referral for a PCR test to verify diagnosis. 

Bulk billing from 1 November 2023 

From 1 November 2023, 13 new higher bulk billing incentive items are being introduced for Commonwealth concession card holders and patients aged under 16 years of age. The new items are 75870, 75871, 75872, 75873, 75874, 75875 and 75876 (new general support service bulk billing items) and 75880, 75881, 75882, 75883, 75884 and 75885 (for patients enrolled in MyMedicare). 

These new items will support younger Australians and concessional patients to access general practice services, targeting investment in primary care to those who most need it. To find out more information, please visit the MBS Online website.

Assignment of benefit for bulk billing services 

Health professionals MUST obtain an ‘assignment of benefit’ from a patient for all bulk billed services. An assignment of benefit is a signature requirement when a patient assigns their Medicare benefit to the servicing provider as full payment of the service (bulk billing). 

Mixed billing for a single service

Under the Health Insurance Act 1973, a bulk billing facility for professional services is available to all persons in Australia who are eligible for a benefit under the Medicare program.  If a practitioner bulk bills for a service the practitioner undertakes to accept the relevant Medicare benefit as full payment for the service.  Additional charges for that service cannot be raised.  This includes but is not limited to: 

• any consumables that would be reasonably necessary to perform the service, including bandages and/or dressings;
• record keeping fees;
• a booking fee to be paid before each service, or;
• an annual administration or registration fee. 

To read the full explanatory notes, please visit the MBS Online website.

Factsheets and news

To view fact sheets that provide guidance and assist in the interpretation of areas of the MBS and to subscribe to MBS news updates, please visit MBS Online.  

Please visit our 'Training and Education’ page for further information and resources.