Medicare

Last updated 20.09.12

 

Index

 

Medicare Benefits Schedule (MBS) items

-  Online search: http://www.mbsonline.gov.au/

 

-  Levels

-  GP Consultations

-  Acupuncture

-  Procedures

-  Obstetrics

 

 

 

Levels of GP Attendances

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-  GP attendance based on time spent w pt

-  May be in relation to 1+ health concerns (unless Level A)

-  In item descriptors singular = plural, plural = singular

-  Level A

-  Used for obvious and straightforward cases & should be reflected in notes

-  GP should undertake necessary exam of the affected part if required, & note the action taken

-  Item 3, 173

-  Level B

-  Used for a consultation lasting <20 min for cases that are not obvious or straightforward

-  GP may undertake all or some of the tasks in item descriptor as clinically relevant, should be reflected in notes

-  Level C

-  Used for a consultation lasting at 20-40min

-  GP may undertake all or some of the tasks in item descriptor as clinically relevant, should be reflected in notes

-  Level D

-  Used for a consultation lasting 40 min+

-  GP may undertake all or some of the tasks in item descriptor as clinically relevant, should be reflected in notes

 

 

 

GP Consultations

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General Info

-  GP consults based on time as per Levels

-  Items 3, 23, 36 or 44 to attract MBS

 

-  597: $127.25

-  Attendance by GP

-  599: $150

-  Attendance by GP, single patient, single occasion

-  4: item 3 + $25.45/# patients up to 6 patients, pts >6 = item 3 + $1.95

-  Attendance by GP (not in culsulting rooms or aged care), short R/V

-  24: item 23 + $25.45/# patients up to 6 patients, pts >6 = item 3 + $1.95

-  Attendance by GP (not in culsulting rooms or aged care) <20min

 

Consultations

-  In Hours

-  Level A: 3

-  Level B: 23

-  Level C: 36

-  Level D: 44

-  After Hours

-  2000-2300hrs: 597

-  0700-0800hrs: 597

-  2300-0700hrs: 599

-  Level A: 5000

-  Level B: 5020

-  Level C: 5040

-  Level D: 5060

-  Home visit/Hospital

-  Level B: 24

-  Level C: 37

-  Aged Care

-  Level A: 5010

-  Level B: 5028

-  Level C: 5049

-  Level D: 5067

 

Item 3

-  Level A

-  Fee: $15.70

-  Item 5000

-  After hrs

-  Fee: $26.85

 

Item 23

-  Level B

-  Fee: $34.30

-  Item 5020

-  After hrs

-  Fee: $45.45

 

Item 36

-  Level C

-  Fee: $66.45

-  Item 5028

-  After hrs

-  Fee: $77.75

 

Item 44

-  Level D

-  Fee: $97.80

-  Item 5060

-  After hrs

-  Fee: $109.15

 

 

Acupuncture

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General Info

-  Items 173, 193, 195, 197 or 199 to attract MBS

-  Acupuncutre must be perfomed by medical practitioner

-  For item 173 any medical practitioner

-  For items 193, 195, 197 & 199 GP must be accredited w JCCMA (Joint Consultative Committee on Medical Acupuncture) & RACGP must inform Medicare

-  Items include acupuncture + consultation

-  Acupuncture = application of stimuli on or through the surface of the skin by any means: laser, ultrasound, needle..

-  Consultation = same occasion or same day if for same condition as for acupuncture

 

Item 173

-  Level A: obvious & straightforward

-  Attendance at which acupuncture is performed by a medical practitioner

-  Fee: $21.65

-  Benefit

-  75% = $16.25

-  100% = $21.65

 

Item 193

-  Level B: < 20min

-  Consultation by a GP, who is a qualified medical acupuncturist at a place other than a hospital at which acupuncture is performed

-  Fee: $34.30

-  Benefit 100% = $21.65

 

Item 195

-  Level B: < 20min

-  Consultation by a GP, who is a qualified medical acupuncturist at a hospital on one or more patients on one occasion at which acupuncture is performed

-  Fee: $34.30

-  + $24.05/# pts (up to 6 pts)

-  OR + $1.80 per pt if 7+ pts

-  Therefore

-  1 pt = $58.35

-  2 pts = $46.30 (? each)

-  7 pts = $36.10 (? each)

 

Item 197

-  Level C: >20min (<40min)

-  Consultation by a GP, who is a qualified medical acupuncturist at a place other than a hospital at which acupuncture is performed

-  Fee: $66.45

-  Benefit 100% = $66.45

 

Item 199

-  Level D: 40min +

-  Consultation by a GP, who is a qualified medical acupuncturist at a place other than a hospital at which acupuncture is performed

-  Fee: $97.80

-  Benefit 100% = $97.80

 

 

Procedures

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Miscellaneous

-  Punch Bx: 30071

-  Hormone Implant (Including Implanon): 14206

-  Implanon Removal: 30062

-  Burn Dressing: 30003

-  ECG: 11700

-  Pregnancy test: 73806

-  Bladder catheterization: 36800

 

Fractures

-  Distal radius &/or ulna: 47360

-  Shaft of radius &/or ulna: 47378

-  Clavicle: 47462

-  Colles: 47369

-  Rib: 47471

-  Ankle: 47594

-  Metatarsal: 47633

 

Foreign Bodies

-  Superficial (incl eye): 30061

-  Subcutaneous with incision: 30064

 

Lacerations

-  Face/Neck

-  Small superficial: 30032

-  Small deep: 30035

-  Large superficial: 30045

-  Large deep: 30048

-  Body

-  Small superficial: 30026

-  Small deep: 30029

-  Large superficial: 30038

-  Large deep: 30041

 

Caesarean Section

-  16519 = + post op care 7/7, where pts care has been t/f by another Dr, & attending Dr has not performed antenatal care

-  Fee: $766.55

 

Labour & Delivery (Inc Caesarean)

-  16522 = Or delivery alone + during antenatal care 1+ of

-  Multiple pregnancy

-  ..

-  Fee: $1,539.90

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