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

<Up>

- 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

<Up>

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

<Up>

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

<Up>

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

-