{
  "3": {
    "content": "HEADING: MBS Item 3 Summary for Billing Compliance\n\n- Item 3 pertains to **Level A Professional Attendance** by a general practitioner (GP) for straightforward problems.\n- The service must be provided in **consulting rooms** and cannot be claimed if another MBS item applies.\n- The attendance involves a **short patient history**, and if necessary, a **limited examination** and management.\n- The **scheduled fee** for Item 3 is **$20.55**, with a benefit of **100%**.\n- Ensure that the service provided is the **best description** of the attendance; if a more specific item exists, it should be claimed instead.\n- General attendance items require at least one of the following actions:\n  - **Taking a patient history**\n  - **Performing a clinical examination**\n  - **Arranging necessary investigations**\n  - **Implementing a management plan**\n  - **Providing preventive health care**\n- Maintain **appropriate and contemporaneous records** of the service provided.\n- The definition of a **professional attendance** includes evaluating the patient's condition, formulating management plans, and providing advice.\n- A **personal attendance** requires the patient to be present; services cannot be provided on behalf of the GP by another health practitioner.\n- Benefits are not payable if more than one medical practitioner attends to the same patient simultaneously.\n- For telehealth services, the definition of personal attendance is modified to a single health professional attending to a single person.\n- Regularly review and ensure compliance with the **MBS explanatory notes** to avoid audit issues.",
    "updated": "2026-07-04"
  },
  "23": {
    "content": "HEADING: MBS Item 23 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 23 refers to a **Level B professional attendance** by a general practitioner at consulting rooms, lasting **at least 6 minutes and less than 20 minutes**.\n- **Clinical Relevance**: The attendance must include clinically relevant activities such as:\n  - **Taking a patient history**\n  - **Performing a clinical examination**\n  - **Arranging necessary investigations**\n  - **Implementing a management plan**\n  - **Providing preventive health care**\n- **Documentation**: It is essential to maintain **appropriate and contemporaneous records** of the services provided during the consultation.\n- **Claiming Guidelines**: \n  - Item 23 should only be claimed when **no other MBS item applies** to the service provided.\n  - The item that **best describes the service** should be claimed; if a more specific item exists, it must be used instead.\n- **Professional Attendance Definition**: A professional attendance includes:\n  - Evaluating the patient's condition\n  - Formulating management plans\n  - Providing advice about the patient's condition and treatment\n  - Recording clinical details of the service provided\n- **Personal Attendance Requirement**: \n  - The patient must be present for the service to qualify as a personal attendance.\n  - Only time spent directly with the patient counts towards the attendance.\n  - Benefits are not payable if more than one medical practitioner attends the same patient simultaneously.\n- **Telehealth Considerations**: For telehealth services, the requirement is modified to a **single health professional attending a single person**.\n- **Audit Prevention**: \n  - Ensure that all claims are supported by **detailed documentation** of the consultation activities.\n  - Regularly review compliance with MBS guidelines to avoid discrepancies during audits.\n  - Train staff on the importance of accurate coding and documentation to minimize billing errors.",
    "updated": "2026-07-04"
  },
  "36": {
    "content": "HEADING: MBS Item 36 Summary for Billing Compliance\n\n- MBS Item 36 is for **Level C professional attendance** by a general practitioner (GP) in consulting rooms.\n- The consultation must last at least **20 minutes** and include clinically relevant activities such as:\n  - **Taking a detailed patient history**\n  - **Performing a clinical examination**\n  - **Arranging necessary investigations**\n  - **Implementing a management plan**\n  - **Providing appropriate preventive health care**\n- Ensure **appropriate documentation** is maintained for each attendance.\n- The **schedule fee** for Item 36 is **$87.10**, with a benefit of **100%** equating to the same amount.\n- This item should only be claimed when **no other MBS item** applies to the service provided.\n- It is crucial to select the item that **best describes the service** rendered; if a more specific item exists, it should be claimed instead.\n- Maintain **contemporaneous records** of the consultation, including details of the patient's condition and the services provided.\n- Understand that **professional attendance** includes evaluating the patient's condition, formulating management plans, and providing preventive health care.\n- **Personal attendance** requires the patient to be present; services cannot be provided on behalf of the GP by another health practitioner.\n- For telehealth consultations, ensure compliance with modified requirements for attendance by a single health professional on a single patient.\n- Regularly review and update knowledge on MBS guidelines to prevent audit issues and ensure compliance with billing practices.",
    "updated": "2026-07-04"
  },
  "44": {
    "content": "HEADING: MBS Item 44 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 44 pertains to a Level D professional attendance by a general practitioner at consulting rooms, lasting at least **40 minutes**.\n- **Clinical Relevance**: The attendance must include clinically relevant activities such as:\n  - **Taking an extensive patient history**\n  - **Performing a clinical examination**\n  - **Arranging necessary investigations**\n  - **Implementing a management plan**\n  - **Providing appropriate preventive health care**\n- **Documentation**: Ensure **appropriate documentation** is maintained for each attendance, detailing the services provided and the clinical rationale.\n- **Claiming Guidelines**: \n  - Item 44 should only be claimed when **no other MBS item** applies to the service provided.\n  - The item that best describes the service must be claimed; if a more specific item exists, it should be used instead.\n- **Professional Attendance Definition**: A professional attendance includes evaluating the patient\u2019s condition, formulating management plans, and providing preventive health care.\n- **Personal Attendance Requirement**: \n  - The patient must be present during the consultation.\n  - Only time spent directly with the patient counts towards the attendance.\n  - Benefits are not payable if multiple practitioners attend the same patient simultaneously.\n- **Telehealth Considerations**: For telehealth services, the definition of personal attendance is modified to a single health professional attending to a single patient.\n- **Audit Prevention**: \n  - Maintain **contemporaneous records** of the consultation.\n  - Ensure compliance with all relevant guidelines to avoid potential audits or claims rejection.\n  - Regularly review documentation practices to ensure alignment with MBS requirements.",
    "updated": "2026-07-04"
  },
  "10950": {
    "content": "HEADING: MBS Item 10950 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 10950 pertains to services provided by eligible Aboriginal and Torres Strait Islander health workers or practitioners for patients with chronic conditions and complex care needs.\n  \n- **Eligibility Criteria**:\n  - Patient must have a **chronic condition** managed by a medical practitioner (not a specialist).\n  - A **GP chronic condition management plan** must be prepared or reviewed within the last **18 months**.\n  - Alternatively, a **GP Management Plan** and **Team Care Arrangements** must be in place prior to **1 July 2025**.\n  - Services must be **recommended** in the patient\u2019s management plan.\n\n- **Service Requirements**:\n  - The service must last at least **20 minutes**.\n  - A maximum of **5 services** can be billed per calendar year, including any related services under this item or other specified items.\n\n- **Billing Details**:\n  - **Schedule Fee**: $74.55\n  - **Medicare Benefit**: 85% of the schedule fee, equating to **$63.40**.\n  - **Extended Medicare Safety Net Cap**: $223.65.\n\n- **Documentation**:\n  - Ensure that all services are **clinically relevant** and necessary for the patient's treatment.\n  - Maintain thorough records of the **chronic condition management plan** and any reviews conducted.\n  - Document the **duration** of the service provided to meet the minimum requirement.\n\n- **Audit Prevention**:\n  - Regularly review billing practices to ensure compliance with eligibility and service requirements.\n  - Verify that all claims are supported by appropriate documentation to defend against potential audits.\n  - Stay updated on any changes to MBS item descriptions or requirements to ensure ongoing compliance. \n\n- **Clinical Judgment**:\n  - Use clinical judgment to determine if a patient qualifies for the service based on their chronic condition.\n  - Ensure that the service provided is generally accepted as necessary within the medical profession.\n\n- **Patient Registration**:\n  - Patients registered with MyMedicare must access services through their registered practice to be eligible for billing under this item. \n\nBy adhering to these guidelines, GPs can ensure compliance with MBS Item 10950 and minimize the risk of audit discrepancies.",
    "updated": "2026-07-04"
  },
  "10990": {
    "content": "HEADING: MBS Item 10990 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 10990 pertains to unreferred medical services provided to patients who are not admitted to a hospital and are bulk-billed.\n- **Eligibility Criteria**:\n  - The service must be **unreferred**.\n  - The patient must **not** be an admitted hospital patient.\n  - The service must be **bulk-billed** in relation to this item and any other applicable MBS items.\n- **Fee and Benefit**:\n  - Schedule Fee: **$8.80**\n  - Benefit: **85%** of the fee, which is **$7.50**.\n- **Bulk Billing Incentives (BBIs)**:\n  - BBIs are additional payments for bulk-billing unreferred services.\n  - Admitted hospital patients are **not eligible** for BBIs.\n  - The appropriate BBI item depends on:\n    - The **geographic location** of the practice (Modified Monash area).\n    - The specific **medical service** provided.\n    - Patient registration status with **MyMedicare**.\n- **Claiming Guidelines**:\n  - BBIs can only be claimed when the service is **bulk-billed**.\n  - Only one BBI can be claimed per medical service.\n  - BBIs cannot be claimed with **diagnostic imaging** or **pathology services**.\n- **Practice Location**:\n  - The practice location associated with the Medicare provider number determines the applicable Modified Monash area.\n  - This applies regardless of where the service is provided (e.g., consulting rooms, residential aged care, telehealth).\n- **Audit Prevention**:\n  - Ensure all criteria for unreferred services are met before billing.\n  - Maintain accurate records of patient eligibility and service details.\n  - Regularly review compliance with bulk billing requirements to avoid discrepancies.\n  - Verify the correct application of BBIs based on the Modified Monash area and service type.\n- **Documentation**:\n  - Keep comprehensive documentation of services provided, including patient consent for bulk billing.\n  - Document any patient registration with MyMedicare if applicable.\n- **Updates**:\n  - Stay informed about updates to the MBS and any changes to item descriptions or claiming processes.",
    "updated": "2026-07-04"
  },
  "701": {
    "content": "HEADING: MBS Item 701 Summary for Billing Compliance\n\n- Item 701 pertains to **brief health assessments** conducted by a general practitioner (GP).\n- The assessment must last **not more than 30 minutes** and include:\n  - **Collection of relevant information**, including taking a patient history.\n  - A **basic physical examination**.\n  - **Initiation of interventions and referrals** as indicated.\n  - Provision of **preventive health care advice** and information to the patient.\n- The **scheduled fee** for Item 701 is **$71.00**, with a benefit of **100%**.\n- Ensure the assessment is conducted during a **personal attendance** by a single GP or prescribed medical practitioner (PMP) for a **single patient**.\n- Item 701 is applicable only to **specific patient cohorts**; refer to associated notes for eligibility criteria.\n- Health assessments must not include **screening services** as defined by the Health Insurance Act 1973.\n- Additional requirements may apply based on the **patient cohort**; consult relevant notes for details.\n- **Practice nurses** and other health workers may assist in the assessment under the **supervision** of the GP, ensuring compliance with accepted medical practice.\n- Maintain thorough documentation of the assessment process to support billing and prevent audits.\n- Regularly review and stay updated on any changes to the **Medicare Benefits Schedule** and associated regulations to ensure ongoing compliance.",
    "updated": "2026-07-04"
  },
  "703": {
    "content": "HEADING: MBS Item 703 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 703 covers a **standard health assessment** performed by a general practitioner (GP) lasting **more than 30 minutes but less than 45 minutes**.\n- **Key Components**: The assessment must include:\n  - **Detailed information collection**, including taking a patient history.\n  - An **extensive physical examination**.\n  - **Initiating interventions and referrals** as indicated.\n  - Providing a **preventive health care strategy** for the patient.\n- **Fee Structure**: \n  - Schedule Fee: **$165.05**.\n  - Benefit: **100% = $165.05**.\n  - Extended Medicare Safety Net Cap: **$495.15**.\n- **Eligible Patient Cohorts**: Health assessments are available for specific patient groups, including:\n  - Individuals aged **45-49 years** at risk of chronic disease.\n  - Patients aged **75 years and older**.\n  - Residents of **residential aged care facilities**.\n  - Individuals with an **intellectual disability**.\n  - **Refugees and humanitarian entrants**.\n  - **Veterans** for one-off assessments.\n- **Audit Prevention**: \n  - Ensure that the assessment meets the **time requirement** (30-45 minutes).\n  - Confirm that the patient falls within the **eligible cohorts** for Item 703.\n  - Document all components of the assessment thoroughly, including history, examination findings, and any interventions or referrals made.\n  - Avoid billing for health assessments that include **screening services**, as these are not covered under this item.\n- **Assistance in Assessments**: Other healthcare professionals, such as practice nurses or Aboriginal and Torres Strait Islander health workers, may assist under the **supervision of the GP**, provided it aligns with accepted medical practice.\n- **Documentation**: Maintain comprehensive records of the assessment process to support billing and compliance with MBS requirements.",
    "updated": "2026-07-04"
  },
  "705": {
    "content": "HEADING: MBS Item 705 Overview\n\n- **Item 705** pertains to a **long health assessment** conducted by a general practitioner (GP).\n- The assessment must last **at least 45 minutes but less than 60 minutes**.\n- Key components of the assessment include:\n  - **Comprehensive information collection**, including taking a patient history.\n  - **Extensive examination** of the patient's medical condition and physical function.\n  - **Initiation of interventions and referrals** as indicated.\n  - Provision of a **basic preventive health care management plan** for the patient.\n\nHEADING: Billing Compliance Guidelines\n\n- The **schedule fee** for Item 705 is **$227.75**, with a benefit of **100%**.\n- Ensure that the service is provided during a **personal attendance** by a single GP or prescribed medical practitioner (PMP).\n- Confirm that the patient falls within the **eligible cohorts** for health assessments, as outlined in associated notes (AN.0.36 to AN.0.42).\n- Document all components of the assessment thoroughly to support the billing claim and prevent audit issues.\n\nHEADING: Audit Prevention Strategies\n\n- Maintain accurate **time records** to substantiate the duration of the assessment (45-59 minutes).\n- Ensure that the assessment does not include any **screening services**, as defined by the Health Insurance Act 1973.\n- Utilize **practice nurses or health workers** only under the supervision of the GP, ensuring their involvement aligns with accepted medical practice.\n- Regularly review and update knowledge on **additional item requirements** specific to each patient cohort to ensure compliance.\n\nHEADING: Additional Considerations\n\n- Be aware of the **Extended Medicare Safety Net Cap** of **$500.00** for eligible patients.\n- Familiarize yourself with the **specific requirements** for different patient groups, such as those aged 45-49 at risk of chronic disease or residents of aged care facilities.\n- Ensure that all health assessments are tailored to meet the **individual needs** of the patient while adhering to MBS guidelines.",
    "updated": "2026-07-04"
  },
  "707": {
    "content": "HEADING: MBS Item 707 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 707 pertains to a **prolonged health assessment** conducted by a general practitioner (GP) lasting at least **60 minutes**.\n- **Fee Structure**: The scheduled fee for Item 707 is **$321.75**, with a benefit of **100%** coverage.\n- **Eligibility**: This item is applicable only to specific patient cohorts, including:\n  - Individuals aged **45-49 years** at risk of chronic disease.\n  - Patients aged **75 years and older**.\n  - Residents of **residential aged care facilities**.\n  - Individuals with an **intellectual disability**.\n  - **Refugees** and humanitarian entrants.\n  - **Veterans** for one-off health assessments.\n- **Assessment Components**: The assessment must include:\n  - **Comprehensive information collection**, including patient history.\n  - An **extensive examination** of the patient's medical, physical, psychological, and social condition.\n  - **Initiation of interventions** or referrals as necessary.\n  - Development of a **comprehensive preventive health care management plan**.\n- **Audit Prevention**: To ensure compliance and prevent audits:\n  - Document all components of the assessment thoroughly, including time spent and activities performed.\n  - Ensure that the assessment is conducted in a **personal attendance** setting by a single GP or prescribed medical practitioner (PMP).\n  - Avoid including any **screening services** as defined by the Health Insurance Act 1973.\n  - Utilize appropriate **assistance** from practice nurses or health workers under supervision, ensuring compliance with accepted medical practices.\n- **Additional Notes**: Refer to explanatory notes AN.0.36 to AN.0.42 for specific requirements related to each patient cohort and additional compliance guidelines.",
    "updated": "2026-07-04"
  },
  "8": {
    "content": "HEADING: MBS Item 8 Overview\n\n- MBS Item 8 is currently **not available** in the Medicare Benefits Schedule.\n- Ensure that you are referencing the **correct item number** when billing.\n- Regularly check for updates or changes to the MBS to avoid using outdated information.\n\nHEADING: Billing Compliance Considerations\n\n- Always verify the **eligibility criteria** for any MBS item before billing.\n- Maintain accurate and detailed **clinical documentation** to support the services provided.\n- Ensure that the service rendered aligns with the **description** of the MBS item being billed.\n- Be aware of the **fee schedule** associated with MBS items to ensure correct billing amounts.\n- Implement a system for **regular audits** of billing practices to identify and rectify potential discrepancies.\n- Train staff on the importance of **compliance** with MBS guidelines to minimize the risk of audits and penalties.\n\nHEADING: Audit Prevention Strategies\n\n- Keep up-to-date with any **amendments** or changes to MBS items, including Item 8.\n- Document all patient interactions and services provided in a clear and concise manner.\n- Review billing practices periodically to ensure adherence to **Medicare guidelines**.\n- Establish a protocol for addressing any **billing errors** promptly to mitigate potential issues.\n- Engage in continuous education regarding **Medicare compliance** for all staff involved in billing processes.",
    "updated": "2026-07-04"
  },
  "2023": {
    "content": "HEADING: MBS Item 2023 Summary for Billing Compliance\n\n- MBS Item 2023 is currently **not available** in the Medicare Benefits Schedule.\n- Ensure to **verify** the item number before billing to avoid errors.\n- Regularly check the **MBS Online** for updates or changes to item listings.\n- Maintain accurate records of **services provided** to support billing claims.\n- Familiarize yourself with **alternative item numbers** that may apply to similar services.\n- Implement a system for **tracking changes** in the MBS to stay compliant.\n- Conduct regular **audits** of billing practices to identify potential discrepancies.\n- Ensure that all claims are supported by **clinical documentation** that justifies the service.\n- Stay informed about **Medicare compliance guidelines** to minimize audit risks.",
    "updated": "2026-07-04"
  },
  "75870": {
    "content": "HEADING: MBS Item 75870 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 75870 pertains to professional attendance by a general practitioner providing a general practice support service to a patient who is not an admitted hospital patient.\n- **Bulk Billing Requirement**: The service must be **bulk-billed** for both this item and the associated general practice support service item.\n- **Eligible Patients**: Only patients who are **not admitted** to a hospital can be billed under this item.\n- **Co-Claiming**: This item can be claimed alongside face-to-face level B, C, D, and E general attendance items, as well as level B video and phone general attendance items.\n- **Fee Structure**: The schedule fee for this item is **$26.35**, with a benefit of **85%** equating to **$22.40**.\n- **Audit Prevention**: Ensure that the service is documented clearly as a **general practice support service** and confirm that the patient is not admitted to a hospital to avoid audit discrepancies.\n- **Unreferred Services Definition**: An unreferred service is defined as a medical service provided to a patient who has not been referred to the practitioner for that service.\n- **Bulk Billing Incentives (BBIs)**: BBIs can be claimed when bulk billing unreferred services, with specific items applicable based on the **Modified Monash area** of the practice.\n- **Practice Location**: The practice location associated with the Medicare provider number is critical for determining eligibility for BBIs and must be accurately recorded.\n- **Claiming Restrictions**: BBIs must be claimed in conjunction with an eligible MBS item; ensure compliance with co-claiming restrictions to prevent billing errors.",
    "updated": "2026-07-04"
  },
  "75871": {
    "content": "HEADING: MBS Item 75871 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 75871 pertains to professional attendance by a general practitioner providing a general practice support service.\n- **Eligibility Criteria**:\n  - The service must be provided to a **non-admitted patient** of a hospital.\n  - The service must be **bulk-billed** for both this item and the associated general practice support service item.\n  - The attendance must occur at a practice location in a **Modified Monash 2 area**.\n  - This item cannot be claimed in conjunction with specific other MBS items listed in the description.\n  \n- **Claiming Conditions**:\n  - Can be claimed with face-to-face level B, C, D, and E general attendance items.\n  - Can also be claimed with level B video and phone general attendance items.\n  \n- **Fee Structure**:\n  - Schedule Fee: **$40.10**\n  - Benefit: **85%** of the fee, equating to **$34.10**.\n  \n- **Bulk Billing Incentives (BBIs)**:\n  - BBIs are additional payments for bulk-billed unreferred services.\n  - Admitted hospital patients are **not eligible** for BBIs.\n  - The appropriate BBI item depends on the **geographic location** of the practice and the specific medical service provided.\n  \n- **Practice Location**:\n  - The practice location is determined by the **Medicare provider number** associated with the medical practitioner.\n  - The location is crucial for determining eligibility for BBIs based on the Modified Monash area classification.\n  \n- **Audit Prevention Tips**:\n  - Ensure that the patient is **not referred** to avoid non-compliance with the unreferred service definition.\n  - Verify that the service is **bulk-billed** and meets all criteria before submission.\n  - Maintain accurate records of the **practice location** and ensure it aligns with the provider number used for billing.\n  - Regularly review the list of **ineligible items** to prevent incorrect claims.\n  \n- **Documentation**:\n  - Keep thorough documentation of the service provided, including patient details and the nature of the attendance, to support claims and facilitate audits.",
    "updated": "2026-07-04"
  },
  "75872": {
    "content": "HEADING: MBS Item 75872 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 75872 pertains to professional attendance services provided by a general practitioner (GP) in specific geographic areas, under certain conditions.\n- **Eligibility Criteria**:\n  - The service must be an **unreferred service**.\n  - The patient must **not be an admitted patient** of a hospital.\n  - The service must be provided **outside consulting rooms**.\n  - The service must be delivered in a **Modified Monash area** (2 to 7).\n  - The service must be **bulk-billed**.\n- **Fee Structure**:\n  - Schedule Fee: **$40.10**\n  - Benefit: **85%** of the fee, equating to **$34.10**.\n- **Bulk Billing Incentives (BBIs)**:\n  - BBIs are available for bulk-billed unreferred services.\n  - The specific BBI item depends on the **geographic location** of the practice and the **specific medical service** provided.\n  - Ensure to check the **Modified Monash area** for correct BBI application.\n- **Claiming Requirements**:\n  - Claims must be submitted with the appropriate **MBS item numbers** for services provided.\n  - Ensure that the service is not provided in **consulting rooms** to qualify for the item.\n  - Verify that the service is provided by a GP whose practice location is outside the specified Modified Monash areas.\n- **Audit Prevention Tips**:\n  - Maintain accurate records of patient eligibility and service details to support claims.\n  - Regularly review compliance with the **MBS guidelines** to avoid discrepancies.\n  - Ensure that all staff involved in billing are trained on the specific requirements for MBS Item 75872.\n- **Documentation**:\n  - Keep detailed notes on the nature of the service provided, including the location and patient status.\n  - Document any relevant patient interactions that support the claim for an unreferred service.\n\nBy adhering to these guidelines, GPs can ensure compliance with MBS Item 75872 and minimize the risk of audit issues.",
    "updated": "2026-07-04"
  },
  "75873": {
    "content": "HEADING: MBS Item 75873 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 75873 pertains to **professional attendance** by a general practitioner providing a **general practice support service**.\n- **Eligibility Criteria**:\n  - The service must be provided to a **non-admitted patient**.\n  - The service must be **bulk-billed**.\n  - The attendance must occur at a practice location in either a **Modified Monash 3** or **Modified Monash 4** area.\n  - The service cannot be associated with specific items listed (e.g., 10990, 75855, etc.).\n- **Claiming Conditions**:\n  - This item can be claimed alongside **face-to-face level B, C, D, and E** general attendance items.\n  - It can also be claimed with **level B video and phone** general attendance items.\n- **Fee Structure**:\n  - The **schedule fee** for this item is **$42.60**.\n  - The **Medicare benefit** is **85%**, equating to **$36.25**.\n- **Bulk Billing Incentives (BBIs)**:\n  - BBIs can be claimed when bulk billing **unreferred services**.\n  - Ensure the correct BBI item is used based on the **geographic location** of the practice and the specific medical service provided.\n- **Audit Prevention Tips**:\n  - Verify that the patient is **not admitted** to a hospital before claiming this item.\n  - Ensure that the service is **bulk-billed** and that all criteria are met to avoid potential audits.\n  - Maintain accurate records of the **Modified Monash area** for compliance with claiming requirements.\n  - Regularly review the list of **excluded items** to ensure compliance with billing practices.\n- **Documentation**:\n  - Keep detailed notes of the **attendance service** provided, including the nature of the support service and patient details.\n  - Document the **location** of the service to confirm eligibility for the Modified Monash area requirements.",
    "updated": "2026-07-04"
  },
  "75874": {
    "content": "HEADING: MBS Item 75874 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 75874 pertains to **professional attendance** by a general practitioner providing a **general practice support service**.\n- **Eligibility Criteria**:\n  - The service must be provided to a **non-admitted patient** of a hospital.\n  - The service must be **bulk-billed** for both this item and the associated general practice support service item.\n  - The service must be provided at a practice location in a **Modified Monash 5 area**.\n  - Exclusions apply for services associated with specific items (e.g., 10990, 10991, etc.).\n  \n- **Claiming Guidelines**:\n  - This item can be claimed alongside **face-to-face level B, C, D, and E** general attendance items, as well as **level B video and phone** general attendance items.\n  \n- **Fee Structure**:\n  - Schedule Fee: **$45.30**\n  - Benefit: **85%** = **$38.55** (Refer to explanatory notes for further details).\n  \n- **Bulk Billing Incentives (BBIs)**:\n  - BBIs are available for bulk-billed unreferred services.\n  - Ensure to check the **geographic location** of the practice using the **Health Workforce Locator**.\n  - The specific BBI item to co-claim depends on the **Modified Monash area** and the medical service provided.\n  \n- **Audit Prevention Tips**:\n  - Confirm that the patient is **not admitted** to a hospital before billing.\n  - Ensure that the service is **bulk-billed** and meets all eligibility criteria.\n  - Maintain accurate records of the **practice location** and ensure it aligns with the **Medicare provider number**.\n  - Regularly review the **Modified Monash area** classification to ensure compliance with billing requirements.\n  \n- **Documentation**:\n  - Keep detailed notes of the **attendance service** provided, including the nature of the support service.\n  - Document patient interactions clearly to support the bulk billing claim and any associated BBIs.",
    "updated": "2026-07-04"
  },
  "75875": {
    "content": "HEADING: MBS Item 75875 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 75875 pertains to **professional attendance** by a general practitioner providing a **general practice support service**.\n- **Eligibility Criteria**:\n  - The service must be provided to a **patient who is not an admitted patient** of a hospital.\n  - The service must be **bulk-billed** for both this item and the associated general practice support service item.\n  - The attendance must occur at a practice location in a **Modified Monash 6 area**.\n  - This item cannot be claimed in conjunction with specific other MBS items listed in the description.\n  \n- **Claiming Conditions**:\n  - Item 75875 can be claimed alongside **face-to-face level B, C, D, and E general attendance items**, as well as **level B video and phone general attendance items**.\n  \n- **Fee Structure**:\n  - The **schedule fee** for this item is **$47.80**.\n  - The **Medicare benefit** for this item is **85%**, equating to **$40.65**.\n\n- **Bulk Billing Incentives (BBIs)**:\n  - BBIs are available for bulk-billed unreferred services.\n  - Ensure to check the **geographic location** of the practice using the **Health Workforce Locator** to determine the appropriate BBI item.\n  - The specific BBI item depends on the **Modified Monash area** and the type of medical service provided.\n\n- **Audit Prevention Tips**:\n  - Confirm that the patient is **not referred** to avoid non-compliance with the unreferred service definition.\n  - Ensure that the service is **bulk-billed** and that all associated items are correctly claimed.\n  - Maintain accurate records of the **practice location** and ensure it aligns with the Medicare provider number used for billing.\n  - Regularly review compliance with the **Modified Monash area** requirements to ensure correct billing practices.\n\n- **Documentation**:\n  - Keep thorough documentation of the service provided, including patient details and the nature of the attendance to support claims and prevent audits.\n  \nBy adhering to these guidelines, compliance with MBS Item 75875 can be maintained, reducing the risk of audit issues.",
    "updated": "2026-07-04"
  },
  "75876": {
    "content": "HEADING: MBS Item 75876 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 75876 pertains to professional attendance by a general practitioner providing a general practice support service.\n- **Eligibility Criteria**:\n  - The service must be provided to a **non-admitted patient**.\n  - The service must be **bulk-billed** for both this item and the associated general practice support service item.\n  - The attendance must occur at a practice location in a **Modified Monash 7 area**.\n  - This item cannot be claimed in conjunction with specific other MBS items listed in the description.\n  \n- **Claiming Guidelines**:\n  - Item 75876 can be claimed alongside face-to-face level B, C, D, and E general attendance items, as well as level B video and phone general attendance items.\n  - Ensure that the service is classified as an **unreferred service** as defined by the Health Insurance Regulations.\n\n- **Fee and Benefit**:\n  - The schedule fee for this item is **$50.75**.\n  - The benefit payable is **85%**, amounting to **$43.15**.\n\n- **Bulk Billing Incentives (BBIs)**:\n  - BBIs are applicable when bulk billing unreferred services.\n  - The specific BBI item to co-claim depends on the **geographic location** of the practice and the specific medical service provided.\n  - Ensure that the patient is not an admitted hospital patient to qualify for BBIs.\n\n- **Audit Prevention Tips**:\n  - Maintain accurate records of patient eligibility and service details to support claims.\n  - Regularly verify the **Modified Monash area** classification of your practice location.\n  - Ensure compliance with the bulk billing requirements to avoid potential audit issues.\n  - Review the list of excluded items to prevent incorrect claims.\n\n- **Documentation**:\n  - Keep thorough documentation of the services provided, including patient consent for bulk billing.\n  - Document the nature of the attendance service and ensure it aligns with the definitions provided in the MBS.\n\nBy adhering to these guidelines, compliance with MBS Item 75876 can be maintained, reducing the risk of audit discrepancies.",
    "updated": "2026-07-04"
  },
  "75880": {
    "content": "HEADING: MBS Item 75880 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 75880 pertains to professional attendance by a general practitioner for patients enrolled in MyMedicare, provided the service is bulk-billed.\n- **Eligibility Criteria**:\n  - The patient must be **enrolled in MyMedicare** at the practice providing the service.\n  - The patient must **not be an admitted patient** of a hospital.\n  - The service must be **bulk-billed** for both this item and the applicable MyMedicare service item.\n- **Claiming Restrictions**: This item cannot be claimed in conjunction with specific attendance services (items 10990, 10991, 10992, 75855-75858, 75870-75876, 75881-75885).\n- **Co-Claiming**: Item 75880 can be claimed alongside level C, D, and E video general attendance items, as well as level C and D phone general attendance items, provided the patient is registered with MyMedicare.\n- **Fee Structure**:\n  - Schedule Fee: **$26.35**\n  - Benefit: **85%** = **$22.40**\n- **Bulk Billing Incentives (BBIs)**: \n  - BBIs are available for unreferred services that are bulk-billed.\n  - Admitted hospital patients are **not eligible** for BBIs.\n  - The appropriate BBI item depends on the **geographic location** of the practice and the specific medical service provided.\n- **Practice Location**: The practice location associated with the Medicare provider number is crucial for determining eligibility for BBIs.\n- **Audit Prevention Tips**:\n  - Ensure that all eligibility criteria are met before billing Item 75880.\n  - Maintain accurate records of patient enrollment in MyMedicare.\n  - Verify that the service is bulk-billed and not associated with excluded items.\n  - Regularly review billing practices to ensure compliance with the latest MBS updates and guidelines.",
    "updated": "2026-07-04"
  },
  "75881": {
    "content": "HEADING: MBS Item 75881 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 75881 pertains to professional attendance by a general practitioner for patients enrolled in MyMedicare, provided the service is bulk-billed and meets specific criteria.\n\n- **Eligibility Criteria**:\n  - The patient must be **enrolled in MyMedicare** at the practice providing the service.\n  - The patient must **not be an admitted patient** of a hospital.\n  - The service must be **bulk-billed** for both this item and the applicable MyMedicare service item.\n  - The service must be provided from a practice location in a **Modified Monash 2 area**.\n\n- **Exclusions**: This item cannot be claimed in conjunction with services related to specific MBS items (e.g., 10990, 10991, 75855-75885).\n\n- **Claiming Guidelines**:\n  - Item 75881 can be claimed alongside **level C, D, and E video general attendance items**, and **level C and D phone general attendance items**, provided the patient is registered with MyMedicare.\n  - Ensure that the service is **not associated** with any excluded items to avoid audit issues.\n\n- **Fee Structure**:\n  - The schedule fee for Item 75881 is **$40.10**.\n  - The benefit payable is **85%**, amounting to **$34.10**.\n\n- **Bulk Billing Incentives (BBIs)**:\n  - BBIs can be claimed when bulk billing unreferred services.\n  - Verify the **geographic location** of the practice to determine the appropriate BBI item.\n  - Ensure that the service is classified as an **unreferred service** as defined by regulations.\n\n- **Documentation and Record Keeping**:\n  - Maintain accurate records of patient enrollment in MyMedicare.\n  - Document the service details to support the claim and ensure compliance with MBS requirements.\n  - Regularly review billing practices to align with the latest MBS updates and guidelines.\n\n- **Audit Prevention**:\n  - Regularly train staff on MBS item requirements and billing compliance.\n  - Conduct internal audits to ensure adherence to claiming guidelines and identify potential discrepancies before external audits occur.",
    "updated": "2026-07-04"
  },
  "75882": {
    "content": "HEADING: MBS Item 75882 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 75882 pertains to professional attendance by a general practitioner for patients enrolled in MyMedicare, provided the service is bulk-billed.\n- **Eligibility Criteria**:\n  - The patient must be **enrolled in MyMedicare** at the practice where the service is provided.\n  - The patient must **not be an admitted patient** of a hospital.\n  - The service must be **bulk-billed** for both this item and the applicable MyMedicare service item.\n  - The service must be provided from a practice location in either a **Modified Monash 3 or 4 area**.\n- **Exclusions**: This item cannot be claimed in conjunction with specific services outlined in items 10990, 10991, 10992, 75855-75858, 75870-75881, and 75883-75885.\n- **Claiming Conditions**:\n  - This item can be claimed alongside **level C, D, and E video attendance items**, and **level C and D phone attendance items**, provided the patient is registered with MyMedicare.\n- **Fee Structure**:\n  - Schedule Fee: **$42.60**\n  - Benefit: **85%** of the fee, equating to **$36.25**.\n- **Bulk Billing Incentives (BBIs)**:\n  - BBIs can be claimed when bulk billing unreferred services.\n  - Ensure to check the **geographic location** of the practice using the Modified Monash area for appropriate BBI claims.\n- **Audit Prevention Tips**:\n  - Confirm patient enrollment in MyMedicare before billing.\n  - Ensure the service is bulk-billed and meets all eligibility criteria.\n  - Maintain accurate records of the service provided, including the location and patient status.\n  - Regularly review compliance with the latest MBS updates and guidelines to avoid billing errors.",
    "updated": "2026-07-04"
  },
  "75883": {
    "content": "HEADING: MBS Item 75883 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 75883 pertains to professional attendance by a general practitioner for patients enrolled in MyMedicare, provided the service is bulk-billed and not associated with certain other specified items.\n\n- **Eligibility Criteria**:\n  - The patient must be **enrolled in MyMedicare** at the practice where the service is provided.\n  - The patient must **not be an admitted patient** of a hospital.\n  - The service must be **bulk-billed** for both this item and the applicable MyMedicare service item.\n  - The service must be provided from a practice location in a **Modified Monash 5 area**.\n\n- **Claiming Conditions**:\n  - This item can be claimed in conjunction with **level C, D, and E video general attendance items**, as well as **level C and D phone general attendance items**, provided the patient is registered with MyMedicare.\n\n- **Fee Structure**:\n  - The schedule fee for this item is **$45.30**.\n  - The benefit payable is **85%**, amounting to **$38.55**.\n\n- **Audit Prevention Tips**:\n  - Ensure that the patient\u2019s **MyMedicare enrollment** is verified before claiming this item.\n  - Confirm that the service is **bulk-billed** and that the correct item numbers are used in conjunction with this claim.\n  - Maintain accurate records of the **practice location** to ensure compliance with the Modified Monash area requirements.\n  - Regularly review the list of **excluded items** to avoid incorrect claims associated with this item.\n\n- **Additional Notes**:\n  - Bulk billing incentives (BBIs) may apply when bulk billing unreferred services, but admitted hospital patients are **not eligible**.\n  - Familiarize yourself with the **geographic location** of the practice as it affects the claiming of BBIs.\n\n- **Compliance Reminder**:\n  - Regularly update knowledge on MBS changes and ensure all staff involved in billing are trained on the specific requirements for MBS Item 75883 to minimize the risk of audit discrepancies.",
    "updated": "2026-07-04"
  },
  "75884": {
    "content": "HEADING: MBS Item 75884 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 75884 pertains to professional attendance by a general practitioner for patients enrolled in MyMedicare, provided in a Modified Monash 6 area.\n- **Eligibility Criteria**:\n  - The patient must be **enrolled in MyMedicare** at the practice where the service is provided.\n  - The patient must **not be an admitted patient** of a hospital.\n  - The service must be **bulk-billed** for both this item and the applicable MyMedicare service item.\n  - The service must be provided at a practice location classified as **Modified Monash 6**.\n- **Exclusions**: This item cannot be claimed in conjunction with services related to specific MBS items (10990, 10991, 10992, 75855-75883, 75885).\n- **Claiming Guidelines**:\n  - This item can be claimed alongside **level C, D, and E video general attendance items**, and **level C and D phone general attendance items**, provided the patient is registered with MyMedicare.\n- **Fee Structure**:\n  - Schedule Fee: **$47.80**\n  - Benefit: **85%** = **$40.65**\n- **Bulk Billing Incentives (BBIs)**:\n  - BBIs can be claimed when bulk billing unreferred services.\n  - Ensure the correct BBI item is used based on the **geographic location** of the practice and the specific medical service provided.\n- **Audit Prevention Tips**:\n  - Verify patient enrollment in MyMedicare before claiming.\n  - Ensure services are provided in compliance with the **Modified Monash classification**.\n  - Maintain accurate records of services provided and ensure they align with the criteria for claiming Item 75884.\n  - Regularly review and update knowledge on MBS items and associated claiming rules to prevent errors.",
    "updated": "2026-07-04"
  },
  "75885": {
    "content": "HEADING: MBS Item 75885 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 75885 pertains to professional attendance by a general practitioner for patients enrolled in MyMedicare, provided in a Modified Monash 7 area.\n- **Eligibility Criteria**:\n  - The patient must be **enrolled in MyMedicare** at the practice where the service is provided.\n  - The patient must **not be an admitted patient** of a hospital.\n  - The service must be **bulk-billed** for both this item and the applicable MyMedicare service item.\n  - The attendance must occur at a practice location in a **Modified Monash 7 area**.\n- **Claiming Restrictions**: This item cannot be claimed in conjunction with specific items (e.g., 10990, 10991, etc.) that are not related to bulk-billed services.\n- **Fee Structure**: \n  - Schedule Fee: **$50.75**\n  - Benefit: **85%** = **$43.15**\n- **Co-Claiming**: This item can be claimed alongside level C, D, and E video general attendance items, and level C and D phone general attendance items, provided the patient is registered with MyMedicare.\n- **Audit Prevention Tips**:\n  - Ensure that all eligibility criteria are met before billing.\n  - Maintain accurate records of patient enrollment in MyMedicare.\n  - Verify that the service is provided in a **Modified Monash 7 area**.\n  - Confirm that the service is **bulk-billed** and properly documented.\n  - Regularly review claiming practices to ensure compliance with MBS guidelines and avoid potential audits.",
    "updated": "2026-07-04"
  },
  "20": {
    "content": "HEADING: MBS Item 20 Overview\n\n- MBS Item 20 pertains to **consultation services** provided by General Practitioners (GPs).\n- It is essential to ensure that the **consultation meets the criteria** outlined in the MBS for appropriate billing.\n- The item is typically used for **standard consultations** that do not involve complex procedures or extended timeframes.\n\nHEADING: Billing Compliance Guidelines\n\n- Ensure that the **consultation duration** aligns with the requirements for Item 20; typically, this is a **short consultation**.\n- Document all **clinical details** of the consultation in the patient's medical record to support the billing claim.\n- Verify that the **reason for the consultation** is clearly stated and justifies the use of Item 20.\n- Be aware of the **patient's eligibility** for Medicare benefits and confirm that they are enrolled.\n- Maintain accurate records of **previous consultations** to avoid duplicate billing for the same service.\n- Regularly review the **MBS updates** to stay informed about any changes to Item 20 or related billing practices.\n\nHEADING: Audit Prevention Strategies\n\n- Conduct regular **internal audits** of billing practices to ensure compliance with MBS Item 20.\n- Train staff on the importance of **accurate documentation** and the implications of incorrect billing.\n- Implement a system for **tracking consultations** to ensure that all billed services are supported by appropriate documentation.\n- Establish a protocol for **reviewing claims** before submission to identify potential discrepancies or errors.\n- Encourage open communication among staff regarding **billing practices** and any uncertainties related to MBS Item 20.\n\nHEADING: Conclusion\n\n- Adhering to these guidelines will help ensure compliance with MBS Item 20 and reduce the risk of audits or penalties.\n- Continuous education and monitoring are key to maintaining high standards in billing practices for Australian General Practice.",
    "updated": "2026-07-04"
  },
  "40": {
    "content": "HEADING: MBS Item 40 Overview\n\n- MBS Item 40 pertains to **consultation services** provided by General Practitioners (GPs).\n- It is essential to ensure that the **consultation** meets the criteria outlined in the MBS for appropriate billing.\n- The item is applicable for **face-to-face consultations** with patients.\n\nHEADING: Billing Compliance Guidelines\n\n- Ensure that the **consultation duration** aligns with the requirements for Item 40.\n- Document the **clinical details** of the consultation thoroughly, including the patient's presenting issues and any management plans discussed.\n- Verify that the **patient's medical history** is reviewed and documented as part of the consultation process.\n- Maintain accurate records of any **referrals** or follow-up actions recommended during the consultation.\n- Ensure that the **patient's consent** is obtained and documented, particularly for any procedures or treatments discussed.\n\nHEADING: Audit Prevention Strategies\n\n- Regularly review billing practices to ensure compliance with the **MBS guidelines** for Item 40.\n- Conduct internal audits of patient records to confirm that documentation supports the billing of Item 40.\n- Provide ongoing training for staff on the importance of **accurate documentation** and compliance with MBS requirements.\n- Implement a system for **tracking consultations** to ensure that all relevant information is captured and billed correctly.\n- Stay updated on any changes to the MBS that may affect Item 40 billing practices. \n\nHEADING: Key Considerations\n\n- Be aware of the **timeframes** and specific conditions under which Item 40 can be billed.\n- Ensure that all consultations billed under Item 40 are for **medically necessary** services.\n- Familiarize yourself with any **exclusions** or limitations associated with Item 40 to avoid billing errors.",
    "updated": "2026-07-04"
  },
  "123": {
    "content": "HEADING: MBS Item 123 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 123 pertains to a professional attendance by a general practitioner at consulting rooms, lasting at least **60 minutes**.\n- **Clinical Relevance**: The attendance must include clinically relevant activities such as:\n  - **Taking an extensive patient history**\n  - **Performing a clinical examination**\n  - **Arranging necessary investigations**\n  - **Implementing a management plan**\n  - **Providing appropriate preventive health care**\n- **Documentation**: Maintain **appropriate and contemporaneous records** of the services provided, including details of the patient history, examination findings, and management plans.\n- **Claiming Guidelines**: \n  - This item should only be claimed when **no other MBS item** applies.\n  - Ensure that the service provided is accurately reflected by the item claimed; use more specific items when available.\n- **Professional Attendance Definition**: A professional attendance includes evaluating the patient's condition, formulating management plans, and providing preventive health care.\n- **Personal Attendance Requirement**: \n  - The patient must be present during the consultation.\n  - Only time spent directly with the patient counts towards the attendance.\n  - Benefits are not payable if multiple practitioners attend the same patient simultaneously.\n- **Telehealth Considerations**: For telehealth services, the requirement is modified to a single health professional attending a single person.\n- **Audit Prevention**: \n  - Ensure compliance with all documentation and claiming guidelines to prevent audits.\n  - Regularly review and update practice protocols to align with MBS requirements.\n- **Fee and Benefit**: The schedule fee for Item 123 is **$207.90**, with a benefit of **100%** payable. \n\nBy adhering to these guidelines, general practitioners can ensure compliance with MBS Item 123 and minimize the risk of audit issues.",
    "updated": "2026-07-04"
  },
  "52": {
    "content": "HEADING: MBS Item 52 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 52 covers professional attendance at consulting rooms for a duration of **not more than 5 minutes**. This item is applicable for medical practitioners who are **not general practitioners** or for **Group A1 disqualified general practitioners**.\n\n- **Fee and Benefit**: The schedule fee for Item 52 is **$11.00**, with a benefit of **100%**, meaning the patient is reimbursed the full amount.\n\n- **Claiming Conditions**: This item should only be claimed when **no other MBS item** applies. It is essential to ensure that the service provided does not fall under a more specific item.\n\n- **Documentation Requirements**: Maintain **appropriate and contemporaneous records** of the service provided, including:\n  - Patient history taken\n  - Clinical examination performed\n  - Any investigations arranged\n  - Management plan implemented\n  - Preventive health care provided\n\n- **Professional Attendance Definition**: Ensure that the service qualifies as a **professional attendance**, which includes evaluating the patient's condition, formulating management plans, and providing advice.\n\n- **Personal Attendance Definition**: Confirm that the service meets the criteria for **personal attendance**, meaning:\n  - The patient must be present during the consultation.\n  - Only time spent directly with the patient counts towards the attendance.\n  - Services cannot be provided on behalf of the medical practitioner by another health professional.\n\n- **Audit Prevention**: To prevent audits, ensure:\n  - Accurate use of Item 52 only when applicable.\n  - Comprehensive documentation that supports the claim.\n  - Regular training for staff on MBS compliance and updates.\n\n- **Extended Medicare Safety Net**: Be aware that Item 52 is subject to the **Extended Medicare Safety Net Cap** of **$33.00**.\n\n- **Consultation Duration**: Ensure that the consultation does not exceed **5 minutes**, as this is a strict requirement for claiming Item 52.\n\n- **Telehealth Considerations**: If claiming for telehealth services, ensure compliance with additional requirements specific to telehealth consultations. \n\nBy adhering to these guidelines, compliance with MBS Item 52 can be maintained, reducing the risk of audit and ensuring proper billing practices.",
    "updated": "2026-07-04"
  },
  "5": {
    "content": "HEADING: MBS Item 5 Overview\n\n- MBS Item 5 pertains to **consultation services** provided by General Practitioners (GPs).\n- It is essential to ensure that the **consultation** meets the criteria outlined in the MBS for appropriate billing.\n- The item is typically used for **face-to-face consultations** with patients.\n\nHEADING: Key Compliance Considerations\n\n- Ensure that the **consultation duration** aligns with the requirements for Item 5 billing.\n- Document the **clinical details** of the consultation thoroughly, including:\n  - Reason for the visit\n  - Relevant medical history\n  - Examination findings\n  - Management plan\n- Maintain accurate **patient records** to support the billing of Item 5.\n- Verify that the **patient's eligibility** for Medicare benefits is confirmed prior to billing.\n- Be aware of any **exclusions** or **limitations** associated with Item 5 to avoid billing errors.\n\nHEADING: Audit Prevention Strategies\n\n- Regularly review billing practices to ensure compliance with MBS guidelines.\n- Conduct internal audits of patient records and billing to identify potential discrepancies.\n- Provide ongoing **training** for staff on MBS Item 5 requirements and documentation standards.\n- Implement a system for **tracking** consultations to ensure all eligible services are billed correctly.\n- Stay updated on any changes to the MBS that may affect Item 5 billing practices.",
    "updated": "2026-07-04"
  },
  "53": {
    "content": "HEADING: MBS Item 53 Summary for Billing Compliance\n\n- MBS Item 53 applies to **professional attendance** at consulting rooms lasting **more than 5 minutes but not more than 25 minutes**.\n- This item is specifically for **medical practitioners who are not general practitioners** or **disqualified general practitioners**.\n- The **schedule fee** for Item 53 is **$21.00**, with a **100% benefit** available.\n- Ensure that Item 53 is claimed **only when no other MBS item applies** to the service provided.\n- The service must include at least one of the following:\n  - **Taking a patient history**\n  - **Performing a clinical examination**\n  - **Arranging necessary investigations**\n  - **Implementing a management plan**\n  - **Providing appropriate preventive health care**\n- Maintain **appropriate and contemporaneous records** of the service provided to support the claim.\n- Claims should reflect the **best description of the service**; use more specific items when applicable (e.g., skin biopsy under MBS item 30071).\n- Understand the distinction between **professional attendance** (services provided directly to the patient) and **personal attendance** (single practitioner with a single patient).\n- For telehealth services, ensure compliance with modified requirements for **personal attendance**.\n- Regularly review and update knowledge on **MBS guidelines** and **explanatory notes** to avoid billing errors and ensure compliance.",
    "updated": "2026-07-04"
  },
  "25": {
    "content": "HEADING: MBS Item 25 Overview\n\n- MBS Item 25 pertains to **consultation services** provided by General Practitioners (GPs).\n- It is essential to ensure that the **consultation** meets the criteria outlined in the MBS for appropriate billing.\n\nHEADING: Key Compliance Points\n\n- Ensure that the **consultation duration** aligns with the requirements for Item 25, typically involving a **standard consultation**.\n- Document the **reason for the consultation** clearly in the patient's medical record to justify the billing.\n- Confirm that the **patient's medical history** and any relevant examinations are recorded to support the service provided.\n- Maintain accurate **time records** of the consultation to validate the billing period.\n- Be aware of the **specific exclusions** and **limitations** associated with Item 25 to avoid billing errors.\n\nHEADING: Audit Prevention Strategies\n\n- Regularly review and update **clinical documentation** practices to ensure compliance with MBS requirements.\n- Implement a **checklist** for consultations to ensure all necessary components are documented before billing.\n- Conduct **internal audits** periodically to identify and rectify any discrepancies in billing practices.\n- Provide ongoing **training** for staff on MBS Item 25 requirements and updates to ensure adherence to compliance standards.\n- Establish a protocol for addressing any **billing queries** or audits from Medicare to ensure timely and accurate responses.",
    "updated": "2026-07-04"
  },
  "54": {
    "content": "HEADING: MBS Item 54 Summary for Billing Compliance\n\n- MBS Item 54 pertains to **professional attendance** at consulting rooms lasting **more than 25 minutes but not more than 45 minutes**.\n- This item is applicable for **medical practitioners who are not general practitioners** or **disqualified general practitioners** as defined in the General Medical Services Table (GMST).\n- The **schedule fee** for Item 54 is **$38.00**, with a benefit of **100%** equating to **$38.00**.\n- Ensure that Item 54 is claimed **only when no other MBS item applies** to the service provided.\n- The service must include at least one of the following:\n  - **Taking a patient history**\n  - **Performing a clinical examination**\n  - **Arranging necessary investigations**\n  - **Implementing a management plan**\n  - **Providing appropriate preventive health care**\n- Maintain **appropriate and contemporaneous records** of the service provided, including clinical details.\n- Understand that **general attendance items** are claimed for services that do not fit more specific MBS items; always select the item that best describes the service.\n- Be aware that **personal attendance** requires the patient to be present, and only time spent directly with the patient counts towards the attendance.\n- Benefits are not payable if **more than one medical practitioner** provides an attendance on the same patient at the same time.\n- For telehealth services, the definition of personal attendance is modified to include **a single health professional** attending to a **single person**.\n- Regularly review the **explanatory notes** associated with Item 54 for updates and compliance requirements.",
    "updated": "2026-07-04"
  },
  "45": {
    "content": "HEADING: MBS Item 45 Overview\n\n- MBS Item 45 pertains to **consultation services** provided by General Practitioners (GPs).\n- It is essential to ensure that the **consultation duration** meets the minimum time requirements specified for billing.\n- The item is applicable for **face-to-face consultations** with patients, emphasizing the need for direct interaction.\n- Documentation must include a **clear clinical rationale** for the consultation, detailing the patient's condition and the services provided.\n- Ensure that the **patient's medical history** and any relevant investigations are reviewed and documented during the consultation.\n- Billing should reflect the **complexity of the consultation**, including any additional services or procedures performed.\n- Maintain accurate **patient records** to support the billing claim, as these may be reviewed during audits.\n- Be aware of the **timeframes** for billing, ensuring claims are submitted within the specified period post-consultation.\n- Regularly review and update knowledge on any **changes to MBS guidelines** or item descriptors to ensure compliance.\n- Implement a system for **internal audits** to regularly check compliance with MBS Item 45 billing practices.",
    "updated": "2026-07-04"
  },
  "57": {
    "content": "HEADING: MBS Item 57 Summary for Billing Compliance\n\n- MBS Item 57 is applicable for **professional attendance** at consulting rooms lasting **more than 45 minutes but not more than 60 minutes**.\n- This item is specifically for **medical practitioners who are not general practitioners** or **Group A1 disqualified general practitioners**.\n- The **schedule fee** for Item 57 is **$61.00**, with a benefit of **100%** equating to **$61.00**.\n- Ensure that Item 57 is claimed **only when no other MBS item applies** to the service provided.\n- It is crucial to select the **most appropriate MBS item** that accurately reflects the service rendered; if a more specific item exists, it should be claimed instead.\n- General attendance items require that the medical practitioner performs at least one of the following:\n  - **Taking a patient history**\n  - **Performing a clinical examination**\n  - **Arranging necessary investigations**\n  - **Implementing a management plan**\n  - **Providing appropriate preventive health care**\n- Maintain **appropriate and contemporaneous records** of the service provided, including clinical details.\n- Understand the distinction between **professional attendance** and **personal attendance**:\n  - Professional attendance includes evaluating the patient\u2019s condition, formulating management plans, and providing advice.\n  - Personal attendance requires the patient to be present, and only time spent directly with the patient counts towards the attendance.\n- Be aware that benefits are not payable if **more than one medical practitioner** provides an attendance on the same patient at the same time.\n- For telehealth services, the definition of personal attendance is modified to include a **single health professional** attending to a **single person**.\n- Regularly review the **explanatory notes** associated with MBS Item 57 for updates and compliance requirements.",
    "updated": "2026-07-04"
  },
  "151": {
    "content": "HEADING: MBS Item 151 Summary for Billing Compliance\n\n- MBS Item 151 applies to **professional attendance** at consulting rooms lasting more than **60 minutes**.\n- This item is specifically for **medical practitioners who are not general practitioners** or **disqualified general practitioners** under Group A1.\n- The **schedule fee** for Item 151 is **$98.40**, with a **100% benefit** of **$98.40**.\n- Ensure that the service provided does not fall under any other MBS item; Item 151 is to be claimed only when **no other item applies**.\n- The service must include at least one of the following:\n  - **Taking a patient history**\n  - **Performing a clinical examination**\n  - **Arranging necessary investigations**\n  - **Implementing a management plan**\n  - **Providing appropriate preventive health care**\n- Maintain **appropriate and contemporaneous records** of the service provided to support the claim.\n- Claims should reflect the **best description** of the service; if a more specific item exists, that item should be claimed instead.\n- Understand the distinction between **professional** and **personal attendances**:\n  - Professional attendance includes evaluating, formulating management plans, and providing advice.\n  - Personal attendance requires the patient to be present, and only time spent directly with the patient counts.\n- For telehealth services, ensure compliance with modified requirements for personal attendance.\n- Regularly review and stay updated on **explanatory notes** and guidelines related to MBS Item 151 to ensure compliance and prevent audits.",
    "updated": "2026-07-04"
  },
  "5000": {
    "content": "HEADING: MBS Item 5000 Summary for Billing Compliance\n\n- Item 5000 is designated for **professional attendance** by a general practitioner (GP) for an **obvious problem** requiring a **short patient history** and possibly a **limited examination** and management.\n- The **schedule fee** for Item 5000 is **$34.70**, with a benefit of **100%** equating to **$34.70**.\n- This item applies to **after-hours attendances** where no other MBS item is applicable.\n- Ensure that the service provided meets the criteria of a **general attendance item**; if a more specific item exists, it should be claimed instead.\n- Documentation must include **appropriate and contemporaneous records** of the patient's history, examination, and management plan.\n- The service must involve at least one of the following actions:\n  - Taking a **patient history**\n  - Performing a **clinical examination**\n  - Arranging necessary **investigations**\n  - Implementing a **management plan**\n  - Providing **preventive health care**\n- Claims for Item 5000 should only be made if the attendance is a **personal attendance** by a single medical practitioner on a single patient.\n- Benefits are not payable if more than one medical practitioner provides an attendance on the same patient at the same time.\n- For telehealth services, ensure compliance with modified requirements for **personal attendance**.\n- Regularly review and stay updated on the **explanatory notes** associated with Item 5000 to ensure compliance with billing practices.\n- Maintain awareness of the **Extended Medicare Safety Net Cap** of **$104.10** for additional patient benefits.",
    "updated": "2026-07-04"
  },
  "5020": {
    "content": "HEADING: MBS Item 5020 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 5020 pertains to **Level B professional attendance** by a general practitioner (GP) in consulting rooms, lasting **at least 6 minutes and less than 20 minutes**.\n- **Clinical Relevance**: The attendance must include clinically relevant activities such as:\n  - **Taking a patient history**\n  - **Performing a clinical examination**\n  - **Arranging necessary investigations**\n  - **Implementing a management plan**\n  - **Providing preventive health care**\n- **Documentation**: It is essential to maintain **appropriate and contemporaneous records** of the services provided during the attendance.\n- **Claiming Guidelines**: \n  - This item should only be claimed when **no other MBS item applies**.\n  - The item that best describes the service provided should be claimed; if a more specific item exists, it should be used instead.\n- **Professional Attendance Definition**: A professional attendance includes evaluating the patient\u2019s condition, formulating management plans, and providing advice about treatment.\n- **Personal Attendance Requirement**: \n  - The patient must be present during the consultation.\n  - Only time spent directly with the patient counts towards the attendance.\n  - Services cannot be provided on behalf of the GP by another health practitioner.\n- **Telehealth Considerations**: For telehealth services, the requirement is modified to a single health professional attending to a single person.\n- **Fee and Benefits**: The schedule fee for Item 5020 is **$58.65**, with a benefit of **100%** of the fee.\n- **Audit Prevention**: \n  - Ensure all claims are supported by **detailed documentation** of the services rendered.\n  - Regularly review compliance with MBS guidelines to avoid discrepancies in billing.\n  - Be aware of the **Extended Medicare Safety Net Cap** of **$175.95** for additional context on billing limits.",
    "updated": "2026-07-04"
  },
  "5040": {
    "content": "HEADING: MBS Item 5040 Summary for Billing Compliance\n\n- Item 5040 pertains to **after-hours professional attendance** by a general practitioner (GP) at consulting rooms.\n- The attendance must last at least **20 minutes** and include clinically relevant activities such as:\n  - Taking a **detailed patient history**\n  - Performing a **clinical examination**\n  - Arranging necessary **investigations**\n  - Implementing a **management plan**\n  - Providing appropriate **preventive health care**\n- Each attendance must be **appropriately documented** to support the claim.\n- The **schedule fee** for Item 5040 is **$100.55**, with a benefit of **100%**.\n- Claims should only be made for Item 5040 when **no other MBS item** applies to the service provided.\n- It is essential to ensure that the service claimed is the one that **best describes** the attendance.\n- Maintain **contemporaneous records** of the consultation, including details of the services provided.\n- Understand that **professional attendances** include evaluating the patient's condition, formulating management plans, and providing advice.\n- Ensure that the patient is present during the attendance; benefits are not payable if multiple practitioners attend the same patient simultaneously.\n- For telehealth services, the definition of attendance is modified to a **single health professional** attending a **single person**.\n- Regularly review and adhere to the **explanatory notes** associated with Item 5040 to ensure compliance and prevent audits.",
    "updated": "2026-07-04"
  },
  "5060": {
    "content": "HEADING: MBS Item 5060 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 5060 pertains to Level D professional attendance by a general practitioner (GP) at consulting rooms, lasting at least **40 minutes**.\n- **Clinical Relevance**: The attendance must include clinically relevant activities such as:\n  - **Taking an extensive patient history**\n  - **Performing a clinical examination**\n  - **Arranging necessary investigations**\n  - **Implementing a management plan**\n  - **Providing appropriate preventive health care**\n- **Documentation Requirement**: Each attendance must be supported by **appropriate documentation** of the services provided.\n- **Fee Structure**: The schedule fee for Item 5060 is **$140.95**, with a benefit of **100%** payable.\n- **Claiming Guidelines**: \n  - Item 5060 should only be claimed when **no other MBS item** applies to the service provided.\n  - If a more specific MBS item exists that accurately reflects the service, that item should be claimed instead.\n- **Record Keeping**: Maintain **contemporaneous records** of the attendance, including details of the patient\u2019s condition, management plan, and any advice given.\n- **Professional Attendance Definition**: Ensure that the service provided meets the definition of a **professional attendance**, which includes evaluating the patient's condition and formulating a management plan.\n- **Personal Attendance Requirement**: Confirm that the service is a **personal attendance**, meaning the patient must be present during the consultation, and only time spent directly with the patient counts towards the attendance.\n- **Audit Prevention**: \n  - Regularly review documentation practices to ensure compliance with MBS requirements.\n  - Conduct internal audits to verify that claims are made in accordance with the guidelines and that appropriate records are maintained.\n- **Telehealth Considerations**: For telehealth services, ensure compliance with modified requirements for personal attendance, confirming that the service is provided by a single health professional to a single patient.",
    "updated": "2026-07-04"
  },
  "5071": {
    "content": "HEADING: MBS Item 5071 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 5071 pertains to professional attendance by a general practitioner (GP) at consulting rooms, lasting at least **60 minutes** and addressing one or more health-related issues.\n\n- **Clinical Relevance**: The attendance must include clinically relevant activities such as:\n  - **Taking an extensive patient history**\n  - **Performing a clinical examination**\n  - **Arranging necessary investigations**\n  - **Implementing a management plan**\n  - **Providing appropriate preventive health care**\n\n- **Fee Structure**: \n  - **Schedule Fee**: $239.45\n  - **Medicare Benefit**: 100% of the fee, equating to $239.45\n\n- **Extended Medicare Safety Net Cap**: $500.00\n\n- **Claiming Guidelines**:\n  - Item 5071 should only be claimed when **no other MBS item** applies to the service provided.\n  - Ensure that the service claimed is the one that **best describes** the attendance.\n\n- **Documentation Requirements**:\n  - Maintain **appropriate and contemporaneous records** of the attendance.\n  - Document all clinically relevant activities performed during the consultation.\n\n- **Professional vs. Personal Attendance**:\n  - A professional attendance includes evaluating the patient's condition, formulating management plans, and providing preventive care.\n  - Personal attendance requires the patient to be present, and only time spent directly with the patient counts towards the attendance.\n\n- **Audit Prevention**:\n  - Ensure compliance with the **time requirement** of at least 60 minutes.\n  - Verify that all claimed activities are **clinically relevant** and documented.\n  - Avoid claiming this item if a more specific MBS item is applicable to the service provided.\n\n- **Telehealth Considerations**: For telehealth services, ensure compliance with modified requirements for personal attendance, confirming that the service is provided by a single health professional to a single patient.\n\n- **Reference Notes**: Familiarize yourself with explanatory notes AN.0.9, AN.0.19, AN.0.74, MN.1.3 to MN.1.8 for additional guidance on the use of this item.",
    "updated": "2026-07-04"
  },
  "10991": {
    "content": "HEADING: MBS Item 10991 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 10991 pertains to a medical service that is bulk-billed and applies to unreferred services provided to patients who are not admitted to a hospital.\n- **Eligibility Criteria**:\n  - The service must be **unreferred**.\n  - The patient must not be an **admitted patient** of a hospital.\n  - The service must be **bulk-billed**.\n  - The service must be provided at a practice location in a **Modified Monash 2 area**.\n- **Exclusions**:\n  - Services associated with other items in the same group.\n  - General practice support services.\n  - MyMedicare services.\n- **Fee Structure**:\n  - Schedule Fee: **$13.35**.\n  - Benefit: **85%** of the fee, equating to **$11.35**.\n- **Bulk Billing Incentives (BBIs)**:\n  - BBIs are additional payments for bulk-billed unreferred services.\n  - Admitted hospital patients are **not eligible** for BBIs.\n  - The specific BBI item depends on the **geographic location** of the practice and the specific medical service provided.\n- **Claiming Guidelines**:\n  - BBIs can only be claimed when the service is **bulk-billed**.\n  - Only one BBI can be claimed per medical service.\n  - Ensure that the practice location is correctly associated with the **Medicare provider number**.\n- **Audit Prevention Tips**:\n  - Verify that the service meets all eligibility criteria before billing.\n  - Maintain accurate records of patient status (unreferred and not admitted).\n  - Ensure compliance with the Modified Monash area requirements.\n  - Regularly review billing practices to ensure adherence to MBS guidelines and avoid potential audits.",
    "updated": "2026-07-04"
  },
  "75855": {
    "content": "HEADING: Summary of MBS Item 75855 for Billing Compliance\n\n- **Item Description**: MBS Item 75855 pertains to unreferred medical services provided by a general practitioner to patients who are not admitted to a hospital and are bulk-billed.\n  \n- **Eligibility Criteria**:\n  - The service must be **unreferred**.\n  - The patient must not be an **admitted hospital patient**.\n  - The service must be **bulk-billed**.\n  - The service must be provided at a practice location in a **Modified Monash 3 or 4 area**.\n  \n- **Exclusions**:\n  - Services associated with other items in the same group.\n  - General practice support services.\n  - MyMedicare services.\n  \n- **Fee Structure**:\n  - Schedule Fee: **$14.10**\n  - Benefit: **85%** of the fee, equating to **$12.00**.\n  \n- **Bulk Billing Incentives (BBIs)**:\n  - BBIs can be claimed when bulk billing unreferred services.\n  - Admitted hospital patients are **not eligible** for BBIs.\n  \n- **Claiming Guidelines**:\n  - Ensure the service is **bulk-billed** to the patient.\n  - Verify the **geographic location** of the practice using the Modified Monash area.\n  - Use the appropriate BBI item based on the service provided and the patient's registration status with MyMedicare.\n  \n- **Audit Prevention Tips**:\n  - Maintain accurate records of patient eligibility and service details.\n  - Regularly review compliance with the **Modified Monash area** requirements.\n  - Ensure that only one BBI is claimed per eligible medical service.\n  - Familiarize staff with the definitions of **unreferred services** to avoid misclassification.\n  \n- **Documentation**:\n  - Keep comprehensive documentation of all services provided under this item to support claims during audits.\n  - Document the patient's registration status with MyMedicare if applicable.",
    "updated": "2026-07-04"
  },
  "75856": {
    "content": "HEADING: MBS Item 75856 Summary for Billing Compliance\n\n- Item 75856 is classified under **Category 8 - MISCELLANEOUS SERVICES**.\n- The service must be an **unreferred service**, meaning the patient has not been referred to the practitioner for the service.\n- The service must be provided to a person who is **not an admitted patient** of a hospital.\n- The service must be **bulk-billed** in relation to the fees for this item and any other applicable item in the MBS.\n- The service must be provided at, or from, a practice location in a **Modified Monash 5 area**.\n- Exclusions apply for services associated with other items in the same group, general practice support services, or MyMedicare services.\n- The **schedule fee** for this item is **$15.10**, with a benefit of **85%** equating to **$12.85**.\n- Bulk billing incentives (BBIs) can be claimed when bulk billing unreferred services, but admitted hospital patients are **not eligible**.\n- The appropriate BBI item depends on the **geographic location** of the practice and the specific medical service provided.\n- Ensure to check the **Modified Monash area** using the Health Workforce Locator to determine the correct BBI.\n- Only one BBI can be claimed per medical service, and BBIs must be claimed in conjunction with an eligible MBS item.\n- Maintain accurate records to support the bulk billing claim, including patient eligibility and service details.\n- Regularly review compliance with MBS guidelines to prevent audit issues and ensure adherence to billing regulations.",
    "updated": "2026-07-04"
  },
  "75857": {
    "content": "HEADING: MBS Item 75857 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 75857 pertains to a medical service that is an **unreferred service** provided to a patient who is not an admitted hospital patient.\n- **Bulk Billing Requirement**: The service must be **bulk-billed** in relation to the fees for this item and any other applicable item in the MBS.\n- **Location Specification**: The service must be provided at or from a practice location in a **Modified Monash 6 area**.\n- **Exclusions**: This item does not apply to services associated with:\n  - Other items in the same group\n  - General practice support services\n  - MyMedicare services\n- **Fee Structure**: The schedule fee for this item is **$15.85**, with a benefit of **85%** equating to **$13.50**.\n- **Audit Prevention**: Ensure that:\n  - The service is correctly classified as an **unreferred service**.\n  - The patient is not an admitted hospital patient.\n  - The service is provided in the correct **Modified Monash area**.\n  - Bulk billing is properly documented and claimed.\n- **Claiming Bulk Billing Incentives (BBIs)**: BBIs can be claimed when bulk billing unreferred services, with specific items depending on:\n  - Geographic location of the practice\n  - The specific medical service provided\n  - Patient registration status with MyMedicare\n- **Co-Claiming Restrictions**: BBIs must be claimed alongside an eligible MBS item, and only one BBI can be claimed per medical service.\n- **Documentation**: Maintain thorough records of services provided, including patient details, service type, and billing practices to support compliance and prevent audits.",
    "updated": "2026-07-04"
  },
  "75858": {
    "content": "HEADING: MBS Item 75858 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 75858 pertains to a medical service that is an **unreferred service** provided to a patient who is not an admitted hospital patient.\n- **Bulk Billing Requirement**: The service must be **bulk-billed** in relation to the fees for this item and any other applicable MBS items.\n- **Location Specification**: The service must be provided at or from a practice location in a **Modified Monash 7 area**.\n- **Exclusions**: This item cannot be claimed if the service is associated with:\n  - Another item in the same group.\n  - A general practice support service.\n  - A MyMedicare service.\n- **Fee Structure**: The schedule fee for this item is **$16.95**, with a benefit of **85%** equating to **$14.45**.\n- **Audit Prevention**: Ensure that:\n  - The service is correctly classified as an **unreferred service**.\n  - The patient is not an admitted hospital patient.\n  - The service is provided in the correct **Modified Monash area**.\n  - Bulk billing is applied correctly to avoid discrepancies.\n- **Co-Claiming Guidelines**: \n  - Bulk billing incentives (BBIs) can be claimed when bulk billing an unreferred service.\n  - Only one BBI can be claimed per medical service.\n  - Ensure that BBIs are claimed in conjunction with an eligible MBS item.\n- **Documentation**: Maintain accurate records of:\n  - Patient eligibility.\n  - Service details and location.\n  - Bulk billing consent to support claims and prevent audits.\n- **MyMedicare Considerations**: Be aware of the implications of patient registration with MyMedicare, as it may affect the eligibility for certain BBIs.",
    "updated": "2026-07-04"
  },
  "16500": {
    "content": "HEADING: MBS Item 16500 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 16500 pertains to antenatal attendance for pregnant patients, allowing GPs to bill for routine antenatal care.\n- **Fee Structure**: \n  - Schedule Fee: **$56.45**\n  - Benefit: \n    - 75% = **$42.35**\n    - 85% = **$48.00**\n- **Eligibility**: \n  - Applicable for antenatal care during the pregnancy.\n  - Services must be clinically relevant and safe to provide.\n- **Associated Services**: \n  - Additional services during the antenatal period may include Items 16501, 16502, 16505, and others listed in the explanatory notes.\n  - Initial consultation for pregnancy diagnosis and first specialist referral are also covered.\n- **Telehealth Provision**: \n  - Telehealth services (video and phone) can be billed under Item 16500 if clinically appropriate.\n  - Video consultations are preferred; phone consultations are acceptable when video is not available.\n- **Documentation Requirements**: \n  - Maintain thorough documentation of all antenatal consultations, including any telehealth services.\n  - Record patient consent for telehealth services and any mental health assessments offered.\n- **Mental Health Assessments**: \n  - For postnatal attendances (Items 91851 and 91856), mental health assessments must be offered and documented.\n  - If a patient declines the assessment, this decision should be noted in the clinical records.\n- **Audit Prevention**: \n  - Ensure all claims are supported by appropriate clinical documentation.\n  - Verify that services billed under Item 16500 are not duplicated with other MBS items.\n  - Regularly review billing practices to align with MBS guidelines and updates.\n- **Referral Requirements**: \n  - Valid referrals are necessary for certain services; ensure compliance with referral protocols.\n  - If a patient has an existing valid referral, a new referral is not required for subsequent claims.",
    "updated": "2026-07-04"
  },
  "16590": {
    "content": "HEADING: MBS Item 16590 Summary for Billing Compliance\n\n- **Item Description**: Item 16590 covers the planning and management of a pregnancy that has progressed beyond **28 weeks gestation** for privately admitted patients.\n- **Practitioner Responsibility**: The practitioner must intend to take **primary responsibility** for the management of the pregnancy and any complications, and be available for the birth.\n- **Mental Health Assessment Requirement**: A **mental health assessment** must be included, which encompasses screening for **drug and alcohol use** and **domestic violence**.\n- **Eligibility Criteria**: \n  - The patient must intend to be **privately admitted** for the birth.\n  - The practitioner must have **maternity privileges** at a hospital or birth centre.\n  - The service must not overlap with Item 16591 for the same pregnancy.\n- **Claim Limitations**: This item can only be claimed **once per pregnancy**.\n- **Fee Structure**: \n  - Schedule Fee: **$446.15**\n  - Benefit: 75% = **$334.65**, 85% = **$379.25**\n- **Extended Medicare Safety Net Cap**: The cap for this item is **$277.20**.\n- **Documentation Requirements**: \n  - Results of the mental health assessment must be **documented** in the patient\u2019s medical record.\n  - If a patient declines the mental health assessment, this decision must also be **recorded** in the clinical notes.\n- **Guideline Compliance**: Mental health assessments should align with the **NHMRC endorsed guidelines** for perinatal mental health care.\n- **Audit Prevention**: Ensure all eligibility criteria are met, document all assessments and patient decisions thoroughly, and avoid claiming this item more than once per pregnancy to prevent audit issues.",
    "updated": "2026-07-04"
  },
  "28": {
    "content": "HEADING: Summary of MBS Item 28 for Billing Compliance\n\n- MBS Item 28 pertains to **specific services** provided by General Practitioners (GPs).\n- Ensure that the **service rendered** aligns with the description and requirements outlined in the MBS.\n- Verify that the **patient's clinical need** justifies the use of this item to avoid potential audit issues.\n- Maintain accurate and detailed **clinical documentation** to support the billing of Item 28.\n- Confirm that the **service is not duplicated** with other MBS items billed for the same consultation.\n- Be aware of any **recent amendments** or updates to the item description or billing criteria.\n- Ensure compliance with **Medicare guidelines** to minimize the risk of non-compliance findings during audits.\n- Regularly review and update **practice policies** regarding the billing of MBS items to reflect current regulations.\n- Train staff on the importance of **correct item usage** and documentation practices to support compliance efforts.",
    "updated": "2026-07-04"
  },
  "16591": {
    "content": "HEADING: MBS Item 16591 Summary for Billing Compliance\n\n- **Item Description**: Item 16591 pertains to the **planning and management of a pregnancy** that has progressed beyond **28 weeks gestation**.\n- **Mental Health Assessment Requirement**: The service must include a **mental health assessment**, which encompasses screening for **drug and alcohol use** and **domestic violence**.\n- **Claiming Restrictions**: This item can only be claimed **once per pregnancy** and should not be claimed if a service to which **item 16590** applies is provided for the same pregnancy.\n- **Eligibility for Benefits**: \n  - **Schedule Fee**: $170.75\n  - **Medicare Benefit**: \n    - 75% = $128.10\n    - 85% = $145.15\n- **Extended Medicare Safety Net Cap**: The cap for this item is **$138.40**.\n- **Documentation Requirements**: \n  - Results of the **mental health assessment** must be documented in the **patient\u2019s medical record**.\n  - If a patient declines the mental health assessment, this decision must also be recorded in the **clinical notes**.\n- **Guideline Compliance**: Mental health assessments should align with the **NHMRC endorsed guideline**: Mental Health Care in the Perinatal Period.\n- **Audit Prevention**: Ensure all documentation is complete and accurate to prevent audits. Maintain clear records of assessments and patient decisions regarding mental health evaluations.",
    "updated": "2026-07-04"
  },
  "14206": {
    "content": "HEADING: MBS Item 14206 Summary for Billing Compliance\n\n- Item 14206 pertains to **hormone or living tissue implantation** performed by cannula.\n- The **schedule fee** for this item is **$103.00** with a benefit of **75%** ($77.25) and **85%** ($87.55).\n- This item is classified under **Category 3 - Therapeutic Procedures** and falls within **Group T1 - Miscellaneous Therapeutic Procedures**.\n- Ensure that the service is performed in accordance with **clinical practice guidelines** from RANZCOG and RACGP, particularly regarding **pain relief**.\n- When bulk billing, practitioners must accept the **Medicare benefit as full payment** and cannot charge additional fees for consumables or administrative costs.\n- If a patient is bulk billed for the service, all associated MBS items must also be bulk billed to comply with regulations.\n- The **loading item 35501** can be claimed in conjunction with item 14206 when performing a **long-acting reversible contraceptive (LARC)** insertion or removal, provided all conditions for bulk billing are met.\n- Claim the loading item **immediately after** the relevant LARC item to ensure compliance.\n- Be aware of **claiming restrictions**: Medicare benefits are not payable for any other MBS items in connection with item 14206, particularly in relation to assisted reproductive technology (ART) services.\n- Maintain thorough documentation of the clinical circumstances and services rendered to support the appropriateness of the claimed items.\n- Regularly review billing practices to ensure alignment with **Medicare guidelines** and to prevent potential audits or compliance issues.",
    "updated": "2026-07-04"
  },
  "30062": {
    "content": "HEADING: MBS Item 30062 Summary for Billing Compliance\n\n- Item 30062 pertains to the **removal of an Etonogestrel subcutaneous implant**.\n- The **schedule fee** for this item is **$107.90**.\n- The **Medicare benefit** is **75%** of the schedule fee ($80.95) or **85%** ($91.75).\n- This item falls under **Category 3 - Therapeutic Procedures** and is classified as a **surgical operation**.\n- Ensure compliance with the **Multiple Operation Rule** when billing for this item.\n- For patients receiving a **long-acting reversible contraceptive (LARC)**, consider using **loading item 35501** to support bulk billing.\n- To claim loading item 35501, the following conditions must be met:\n  - All item requirements for LARC services must be fulfilled.\n  - The patient must be **bulk billed** for each MBS item claimed during the LARC appointment.\n  - The relevant LARC item(s) must be claimed alongside the loading item.\n- Loading item 35501 applies only when one or more of the following services are performed:\n  - Hormonal implant implantation (MBS item 14206)\n  - Hormonal implant removal (MBS item 30062)\n  - IUD insertion (MBS item 35503)\n  - IUD removal under general anaesthetic (MBS item 35506)\n- If anaesthetic is not required for IUD removal, it can be billed under an appropriate MBS attendance item, and loading item 35501 will not apply.\n- Both removal and insertion items can be claimed if performed on the same day in the same appointment.\n- It is the **practitioner\u2019s responsibility** to determine the appropriate MBS item(s) to bill based on clinical circumstances.\n- Adhere to **clinical practice guidelines** from RANZCOG and RACGP regarding pain relief and patient care.\n- When bulk billing, practitioners must accept the Medicare benefit as **full payment** for the service, with no additional charges allowed for consumables or administrative fees.\n- If a clinician opts to privately charge for any part of the service, loading item 35501 cannot be claimed.\n- Claim loading item 35501 immediately after the associated LARC item, ensuring proper sequence in billing.",
    "updated": "2026-07-04"
  },
  "35503": {
    "content": "HEADING: MBS Item 35503 Summary for Billing Compliance\n\n- **Item Description**: Item 35503 covers the introduction of an **intra-uterine device (IUD)** for purposes such as **abnormal uterine bleeding**, **contraception**, or **endometrial protection** during **oestrogen replacement therapy**.\n  \n- **Claiming Conditions**: This item should not be associated with any other service in the same group, except for specific items like **30062**, **35501**, **35506**, or **35620**.\n\n- **Fee Structure**: \n  - Schedule Fee: **$221.55**\n  - Medicare Benefit: \n    - 75% = **$166.20**\n    - 85% = **$188.35**\n\n- **Bulk Billing Requirements**: \n  - If bulk billing is chosen, the practitioner must accept the Medicare benefit as **full payment** and cannot charge additional fees for consumables or other associated costs.\n  - All related services must also be bulk billed.\n\n- **Loading Item 35501**: \n  - This item supports bulk billing for long-acting reversible contraceptives (LARCs) and must be claimed alongside relevant LARC items.\n  - To claim this loading item, all associated services must be bulk billed.\n\n- **Claiming Process**: \n  - The loading item (35501) should be claimed immediately after the associated LARC item (e.g., 35503 for IUD insertion).\n  - If multiple LARC items are claimed, the loading item should follow each relevant service.\n\n- **Clinical Guidelines**: \n  - Providers should adhere to clinical practice guidelines from the **Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG)** and the **Royal Australian College of General Practitioners (RACGP)** regarding pain relief and patient care.\n\n- **Audit Prevention**: \n  - Ensure all item requirements are met and document clinical justification for the services rendered.\n  - Regularly review billing practices to ensure compliance with MBS guidelines and avoid potential audits or penalties. \n\n- **Professional Responsibility**: \n  - Practitioners must ensure their billing practices align with peer standards and clinical circumstances, maintaining ethical and compliant service delivery.",
    "updated": "2026-07-04"
  },
  "73806": {
    "content": "HEADING: MBS Item 73806 Summary for Billing Compliance\n\n- Item 73806 pertains to **pathology services** specifically for a **pregnancy test** using one or more **immunochemical methods**.\n- The **schedule fee** for this item is **$10.15**.\n- The **Medicare benefit** is structured as follows:\n  - **75% benefit**: $7.65\n  - **85% benefit**: $8.65\n- Ensure that the test is performed in accordance with the **clinical guidelines** for pregnancy testing.\n- Document the **clinical indication** for the test in the patient's medical record to support the necessity of the service.\n- Verify that the test is conducted by an **accredited pathology laboratory** to meet compliance standards.\n- Maintain accurate records of the **date of service**, **patient details**, and **test results** to facilitate audits.\n- Be aware of the **item start date** (01-Dec-1991) and the last update to the description (01-Jul-1994) to ensure adherence to current billing practices.\n- Regularly review any updates to the **Medicare Benefits Schedule** to stay informed about changes that may affect billing for this item.",
    "updated": "2026-07-04"
  },
  "30": {
    "content": "HEADING: MBS Item 30 Overview\n\n- MBS Item 30 pertains to **consultation services** provided by General Practitioners (GPs).\n- It is essential to ensure that the **consultation** meets the criteria outlined in the MBS for appropriate billing.\n\nHEADING: Key Compliance Points\n\n- Ensure that the **consultation duration** aligns with the requirements for Item 30, as this affects the eligibility for billing.\n- Document all **clinical details** of the consultation, including patient history, examination findings, and management plans, to support the billing claim.\n- Verify that the **patient's medical necessity** for the consultation is clearly established and documented.\n- Maintain accurate **records** of any referrals or follow-up actions taken during the consultation to substantiate the service provided.\n- Be aware of any **exclusions** or specific conditions that may apply to Item 30 to avoid billing errors.\n\nHEADING: Audit Prevention Strategies\n\n- Regularly review and update **clinical documentation** practices to ensure compliance with MBS requirements.\n- Conduct periodic **internal audits** of billing practices to identify and rectify any discrepancies or potential issues.\n- Provide ongoing **training** for staff on MBS billing guidelines and documentation standards to enhance compliance.\n- Implement a system for **tracking** consultations and associated documentation to ensure all claims are supported by adequate evidence.\n- Stay informed about any changes or updates to the MBS that may impact billing for Item 30 to ensure ongoing compliance.",
    "updated": "2026-07-04"
  },
  "60": {
    "content": "HEADING: MBS Item 60 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 60 pertains to professional attendances by medical practitioners (not GPs) or disqualified GPs, conducted outside consulting rooms or residential aged care facilities, lasting more than 25 minutes but not exceeding 45 minutes.\n\n- **Eligibility**: This item is applicable for attendances on **one or more patients** at a single location on one occasion.\n\n- **Fee Structure**: \n  - Base fee of **$35.50**.\n  - Additional **$15.50** divided by the number of patients seen (up to a maximum of six patients).\n  - For **seven or more patients**, the fee is **$35.50** plus **$0.70** per patient.\n\n- **Documentation Requirements**: \n  - Maintain **appropriate and contemporaneous records** of the service provided.\n  - Ensure documentation includes patient history, clinical examination, investigations arranged, management plans, and preventive health care provided.\n\n- **Claiming Guidelines**: \n  - Only claim Item 60 if **no other MBS item** applies to the service provided.\n  - The item that **best describes** the service should be claimed.\n  - Ensure that the service meets the criteria for a general attendance item.\n\n- **Professional Attendance Definition**: \n  - Involves evaluating the patient's condition, formulating management plans, providing advice, and recording clinical details.\n\n- **Audit Prevention Tips**: \n  - Verify that the service provided aligns with the requirements of Item 60.\n  - Avoid claiming this item if a more specific MBS item is applicable.\n  - Ensure that all patient interactions are documented accurately to support claims.\n\n- **Extended Medicare Safety Net Cap**: \n  - The cap is set at **300% of the derived fee** for this item or **$500**, whichever is lower.\n\n- **Compliance with Time-Tiered Items**: \n  - Familiarize with the principles of using time-tiered professional attendance items to ensure correct billing practices.\n\n- **Additional Considerations**: \n  - Be aware of any specific requirements for telehealth consultations if applicable.\n  - Regularly review updates to the MBS and associated notes to remain compliant with billing practices.",
    "updated": "2026-07-04"
  },
  "91790": {
    "content": "HEADING: MBS Item 91790 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 91790 covers video attendance by a general practitioner for an obvious problem requiring a short patient history and limited management.\n- **Eligibility**: The service must be performed by the patient\u2019s **eligible telehealth practitioner**. Ensure compliance with legislative requirements regarding practitioner eligibility.\n- **Fee Structure**: The schedule fee is **$20.55**, with a benefit of **100%** equating to **$20.55**.\n- **Extended Medicare Safety Net Cap**: The cap for this item is **$61.65**.\n- **Documentation Requirements**: Maintain **appropriate and contemporaneous records** of the service provided, including:\n  - Patient history taken\n  - Clinical examination performed\n  - Any investigations arranged\n  - Management plan implemented\n  - Preventive health care provided\n- **Claiming Principles**: \n  - Only claim this item if no other MBS item accurately reflects the service provided.\n  - Ensure that the service is a **professional attendance**, which includes evaluating the patient\u2019s condition and formulating a management plan.\n- **Personal Attendance Definition**: The service must be provided during a **personal attendance** by a single medical practitioner to a single patient. This means:\n  - The patient must be present during the consultation.\n  - Time spent with the patient is the only time counted towards the attendance.\n  - Services cannot be provided on behalf of the practitioner by another health professional.\n- **Audit Prevention**: \n  - Ensure that all claims are substantiated with clear documentation.\n  - Regularly review compliance with eligibility criteria for telehealth practitioners.\n  - Avoid claiming this item if a more specific MBS item applies to the service provided.\n- **Consultation Duration**: This item is intended for **short consultations**; ensure that the nature of the problem is straightforward and does not require extensive management.",
    "updated": "2026-07-04"
  },
  "91800": {
    "content": "HEADING: MBS Item 91800 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 91800 covers video attendance by a general practitioner lasting at least **6 minutes but less than 20 minutes**.\n- **Clinical Relevance**: The attendance must include at least one of the following:\n  - **Taking a short patient history**\n  - **Arranging necessary investigations**\n  - **Implementing a management plan**\n  - **Providing appropriate preventative health care**\n- **Legislative Requirement**: The service must be performed by the **patient\u2019s eligible telehealth practitioner**. Ensure compliance with definitions and exemptions as outlined in Note AN.1.1.\n- **Fee Structure**: The schedule fee for this item is **$45.05**, with a benefit of **100%** payable.\n- **Extended Medicare Safety Net Cap**: The cap for this item is **$135.15**.\n- **Documentation**: Maintain **appropriate and contemporaneous records** of the service provided, including:\n  - Patient history taken\n  - Investigations arranged\n  - Management plans implemented\n  - Preventative health care provided\n- **Claiming Principles**: \n  - Only claim this item if no other MBS item applies that better describes the service.\n  - Ensure that the service provided meets the requirements of a general attendance item.\n- **Professional Attendance Definition**: Understand that a professional attendance includes evaluating the patient\u2019s condition, formulating management plans, and providing advice.\n- **Personal Attendance Definition**: Ensure that the service is provided during a **personal attendance** by a single medical practitioner to a single patient on a single occasion.\n- **Audit Prevention**: Regularly review billing practices to ensure compliance with MBS guidelines and maintain accurate records to support claims.",
    "updated": "2026-07-04"
  },
  "91801": {
    "content": "HEADING: MBS Item 91801 Compliance Summary\n\n- **Item Description**: MBS Item 91801 covers video attendance by a general practitioner lasting at least **20 minutes** that includes clinically relevant activities such as taking a detailed patient history, arranging investigations, implementing management plans, or providing preventative health care.\n\n- **Eligibility**: The service must be performed by the **patient\u2019s eligible telehealth practitioner**. Ensure that the practitioner meets the legislative requirements as outlined in Note AN.1.1.\n\n- **Fee Structure**: The schedule fee for Item 91801 is **$87.10**, with a benefit of **100%** equating to the same amount. \n\n- **Extended Medicare Safety Net**: The cap for this item under the Extended Medicare Safety Net is **$261.30**.\n\n- **Documentation Requirements**: Maintain **appropriate and contemporaneous records** of the service provided, including details of the patient\u2019s condition, management plans, and any advice given.\n\n- **Claiming Principles**: Only claim this item if no other specific MBS item applies. The item that best describes the service provided should be claimed. \n\n- **Professional Attendance Definition**: Ensure that the service provided includes evaluating the patient\u2019s condition, formulating management plans, and providing preventive health care, as these are key components of a **professional attendance**.\n\n- **Personal Attendance Clarification**: For telehealth services, the definition of personal attendance is modified to mean a service provided by a **single health professional** to a **single person**. \n\n- **Audit Prevention**: To prevent audits, ensure compliance with all requirements, including time spent, eligibility of the practitioner, and the nature of the service provided. Regularly review documentation practices to ensure they meet Medicare standards.\n\n- **Consultation Duration**: Confirm that the consultation lasts at least **20 minutes** and includes the necessary clinically relevant activities to qualify for billing under this item.\n\n- **Training and Awareness**: Regularly train staff on the requirements and updates related to MBS Item 91801 to ensure ongoing compliance and understanding of billing practices.",
    "updated": "2026-07-04"
  },
  "91890": {
    "content": "HEADING: MBS Item 91890 Summary for Billing Compliance\n\n- Item 91890 pertains to **telehealth attendance services** specifically for phone consultations by a general practitioner.\n- The service must last **less than 6 minutes** and address an **obvious problem** that requires a **short patient history** and potentially **limited management**.\n- It is a **legislative requirement** that this service is performed by the patient\u2019s **eligible telehealth practitioner**.\n- The **schedule fee** for this item is **$20.55**, with a benefit of **100%** equating to the same amount.\n- Ensure compliance with the **Extended Medicare Safety Net Cap** of **$61.65**.\n- Claims should only be made if no other **specific MBS item** applies to the service provided.\n- Maintain **appropriate and contemporaneous records** of the consultation, including patient history and any management plans discussed.\n- The service must be a **professional attendance**, meaning it involves evaluating the patient\u2019s condition, formulating management plans, and providing advice.\n- Ensure that the service is provided as a **single attendance** by one medical practitioner to one patient at a time.\n- Be aware that benefits are not payable if more than one medical practitioner attends to the same patient simultaneously.\n- Review the relevant **explanatory notes** (AN.0.9, AN.0.73, etc.) for additional guidance on compliance and billing practices.\n- Regularly update knowledge on any changes to the MBS or telehealth regulations to prevent audit issues.",
    "updated": "2026-07-04"
  },
  "6": {
    "content": "HEADING: MBS Item 6 Summary for Billing Compliance\n\n- MBS Item 6 is currently **not available** in the Medicare Benefits Schedule.\n- Ensure to **verify** the item number before billing to avoid errors.\n- Regularly check the **MBS Online** for updates or changes to item availability.\n- Maintain accurate **documentation** of services provided, even if the item is not billable.\n- Be aware of potential **audit triggers** related to billing for unavailable items.\n- Ensure that all claims submitted are for **eligible services** as per the current MBS guidelines.\n- Keep records of any **communication** with Medicare regarding item status or billing inquiries.\n- Implement a system for **tracking changes** in the MBS to stay compliant with billing practices.",
    "updated": "2026-07-04"
  },
  "91891": {
    "content": "HEADING: MBS Item 91891 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 91891 covers telehealth phone attendance by a general practitioner lasting at least **6 minutes**.\n- **Clinical Relevance**: The attendance must include at least one of the following:\n  - **Taking a short patient history**\n  - **Arranging necessary investigations**\n  - **Implementing a management plan**\n  - **Providing appropriate preventative health care**\n- **Eligibility Requirement**: The service must be performed by the patient\u2019s **eligible telehealth practitioner**. Ensure compliance with legislative definitions and exemptions.\n- **Fee Structure**: \n  - **Schedule Fee**: $45.05\n  - **Benefit**: 100% = $45.05\n  - **Extended Medicare Safety Net Cap**: $135.15\n- **Documentation**: Maintain **appropriate and contemporaneous records** of the service provided, including:\n  - Details of the patient history taken\n  - Investigations arranged\n  - Management plans implemented\n  - Preventative health care advice given\n- **Claiming Principles**: \n  - Claim the item that **best describes** the service provided.\n  - If a more specific MBS item exists for the service, that item should be claimed instead.\n  - General attendance items should only be claimed when no other MBS item applies.\n- **Professional Attendance Definition**: Ensure the service includes:\n  - Evaluating the patient\u2019s condition\n  - Formulating a management plan\n  - Providing advice about the patient\u2019s condition and treatment\n  - Recording clinical details of the service\n- **Personal Attendance Clarification**: \n  - The patient must be present during the service.\n  - Only time spent directly with the patient counts towards the attendance.\n  - Services cannot be provided on behalf of the practitioner by another health professional.\n- **Audit Prevention**: \n  - Ensure all claims are substantiated with clear documentation.\n  - Regularly review compliance with MBS guidelines to avoid discrepancies.\n  - Stay updated on any changes to MBS Item 91891 and related legislative requirements.",
    "updated": "2026-07-04"
  },
  "92004": {
    "content": "HEADING: MBS Item 92004 Compliance Summary\n\n- Item 92004 pertains to **video attendance** by a general practitioner for a **health assessment** of patients who are of **Aboriginal or Torres Strait Islander descent**.\n- Ensure the patient has not received a service under this item or related items (715, 228, 92011) in the **preceding 9 months**.\n- The assessment must include the following components:\n  - **Recognising the patient\u2019s health priorities**.\n  - **Taking the patient\u2019s medical history**.\n  - **Undertaking relevant physical examinations**.\n  - **Arranging or conducting required investigations**.\n  - **Assessing the patient** based on the information gathered.\n  - **Initiating necessary interventions and referrals**.\n  - **Developing and documenting a management plan** for the patient\u2019s health, including follow-up.\n  - **Offering a written report** of the health assessment to the patient or their carer, if appropriate and agreed upon.\n  - If the report offer is accepted, ensure it is **provided to the patient or carer**.\n  - **Document the health assessment** in the patient\u2019s medical records.\n- The **schedule fee** for this item is **$254.10**, with a benefit of **100%**.\n- Adhere to the principles of **informed patient consent** as outlined by the Medical Board of Australia.\n- Reference current **Australian preventive health guidelines** that are culturally and clinically appropriate for Aboriginal and Torres Strait Islander patients.\n- Tailor approaches to align with **community priorities** and local health issues, ensuring compliance with best practices in primary care.\n- Maintain thorough documentation to support the delivery of services and to facilitate **audit prevention**.",
    "updated": "2026-07-04"
  },
  "92024": {
    "content": "HEADING: MBS Item 92024 Overview\n\n- MBS Item **92024** is currently not listed in the Medicare Benefits Schedule.\n- Ensure to verify the **current status** of MBS items regularly to avoid billing errors.\n\nHEADING: Billing Compliance Considerations\n\n- Confirm that the **item number** is valid and applicable for the services rendered.\n- Maintain accurate **documentation** of patient consultations and treatments to support claims.\n- Ensure that the service provided aligns with the **criteria** set out in the MBS for any applicable item.\n- Be aware of any **recent changes** or updates to the MBS that may affect billing practices.\n\nHEADING: Audit Prevention Strategies\n\n- Regularly conduct **internal audits** of billing practices to ensure compliance with MBS guidelines.\n- Train staff on the importance of using **correct item numbers** and understanding the services they correspond to.\n- Implement a system for **tracking changes** in the MBS to stay informed about item availability and requirements.\n- Establish a protocol for **reviewing claims** before submission to ensure all necessary documentation is included.\n\nHEADING: Additional Recommendations\n\n- Consult with a **medical compliance expert** if there are uncertainties regarding billing for specific services.\n- Encourage open communication within the practice regarding **billing practices** and any potential issues.\n- Utilize available resources, such as the **Department of Health and Aged Care**, for guidance on MBS items and compliance.",
    "updated": "2026-07-04"
  },
  "92025": {
    "content": "HEADING: MBS Item 92025 Overview\n\n- MBS Item **92025** is a specific item under the Medicare Benefits Schedule relevant to Australian General Practice.\n- It is essential to ensure that the item is billed correctly to avoid compliance issues and potential audits.\n\nHEADING: Key Billing Compliance Points\n\n- Confirm that the **service** provided aligns with the description and requirements of MBS Item **92025**.\n- Ensure that the **patient's eligibility** for the service is verified prior to billing.\n- Maintain accurate and detailed **clinical documentation** that supports the necessity of the service rendered.\n- Document any **referrals** or consultations that are relevant to the service billed under Item **92025**.\n- Be aware of any **amendments** or updates to the item description or billing guidelines that may affect compliance.\n- Regularly review billing practices to ensure adherence to **Medicare guidelines** and avoid discrepancies.\n- Implement a system for **auditing** claims submitted under Item **92025** to identify and rectify potential errors proactively.\n- Train staff on the importance of compliance with MBS Item **92025** to minimize the risk of billing errors.\n\nHEADING: Audit Prevention Strategies\n\n- Conduct **internal audits** periodically to assess compliance with MBS Item **92025**.\n- Utilize checklists to ensure all necessary documentation is collected and maintained for each claim.\n- Establish a clear protocol for addressing any **discrepancies** or queries from Medicare regarding claims.\n- Keep abreast of any changes in the **Medicare Benefits Schedule** that may impact billing practices.\n- Foster a culture of compliance within the practice to ensure all team members understand the importance of accurate billing.",
    "updated": "2026-07-04"
  },
  "92026": {
    "content": "HEADING: MBS Item 92026 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 92026 pertains to a **telehealth attendance service** provided by a general practitioner (GP) via video, specifically for contributing to or reviewing a **multidisciplinary care plan** prepared by another provider.\n\n- **Eligibility Requirements**: \n  - The service must be performed by the **patient\u2019s eligible telehealth practitioner**.\n  - Patients must have at least one **chronic condition** that has been present for at least **6 months** or is terminal.\n\n- **Service Limitations**: \n  - This item does not apply to services associated with items **235 to 240** or **735 to 758** of the general medical services table.\n  - Ensure that the service is **clinically relevant** and necessary for the appropriate treatment of the patient.\n\n- **Billing Details**: \n  - **Schedule Fee**: $84.25\n  - **Medicare Benefit**: 100% = $84.25\n  - **Extended Medicare Safety Net Cap**: $252.75\n\n- **Documentation Requirements**: \n  - Maintain thorough documentation of the **multidisciplinary care plan** and the patient's chronic condition.\n  - Ensure that the patient's eligibility for the service is clearly documented in the medical records.\n\n- **Audit Prevention**: \n  - Regularly review billing practices to ensure compliance with MBS requirements.\n  - Confirm that all services billed under this item are supported by appropriate clinical justification and documentation.\n  - Be aware of the specific eligibility criteria and ensure that all claims are substantiated by the patient's medical history and treatment plan.\n\n- **Additional Notes**: \n  - Familiarize yourself with the **explanatory notes** (AN.15.3, AN.15.7, AN.36.2) related to this item for comprehensive understanding and compliance.\n  - Ensure that patients registered with a practice through **MyMedicare** access these services through their registered practice.",
    "updated": "2026-07-04"
  },
  "92027": {
    "content": "HEADING: MBS Item 92027 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 92027 covers telehealth attendance services provided by a general practitioner (GP) via video for multidisciplinary care plans related to patients in residential aged care facilities or those transitioning from hospital care.\n\n- **Eligibility Criteria**: \n  - The service must be performed by the patient\u2019s **eligible telehealth practitioner**.\n  - Patients must have at least one **chronic medical condition** that has been present for at least 6 months or is terminal.\n\n- **Service Requirements**: \n  - The service must be clinically relevant and necessary for the appropriate treatment of the patient, as defined by the **Health Insurance Act 1973**.\n  - The GP must ensure that the service aligns with the **Medicare Benefits Schedule** (MBS) guidelines and is not associated with other specific MBS items (items 235 to 240 or 735 to 758).\n\n- **Billing Information**: \n  - The scheduled fee for Item 92027 is **$84.25**, with a benefit of **100%** coverage.\n  - Extended Medicare Safety Net Cap is **$252.75**.\n\n- **Documentation Requirements**: \n  - Maintain thorough documentation of the patient's condition, the necessity of the multidisciplinary care plan, and the telehealth service provided.\n  - Ensure that all notes and records reflect the **clinical relevance** of the service rendered.\n\n- **Audit Prevention Tips**: \n  - Regularly review patient eligibility and ensure compliance with MBS item requirements.\n  - Conduct internal audits to verify that services billed under Item 92027 meet all legislative and clinical guidelines.\n  - Train staff on the importance of accurate documentation and adherence to MBS criteria to minimize the risk of non-compliance.\n\n- **Additional Notes**: \n  - Be aware of the specific **explanatory notes** associated with this item for further details on eligibility and service requirements.\n  - Ensure that patients registered with MyMedicare access these services through their registered practice to comply with MBS regulations.",
    "updated": "2026-07-04"
  },
  "92028": {
    "content": "HEADING: MBS Item 92028 Summary for Billing Compliance\n\n- MBS Item **92028** is currently **not listed** in the Medicare Benefits Schedule.\n- Ensure that any billing for this item is **thoroughly reviewed** to avoid claims for non-existent services.\n- Verify the **correct item number** before submitting claims to prevent **audit risks**.\n- Maintain **accurate records** of consultations and services provided to support any claims made.\n- Stay updated with the **Medicare Benefits Schedule** for any future changes or additions to item listings.\n- Implement a **compliance check** process to ensure that all billed items are valid and supported by appropriate documentation.\n- Educate staff on the importance of **billing accuracy** and the implications of incorrect claims on practice compliance.",
    "updated": "2026-07-04"
  },
  "92142": {
    "content": "HEADING: Summary of MBS Item 92142 for Billing Compliance\n\n- **Item Description**: MBS Item 92142 pertains to video attendance services for patients under 25 years with complex neurodevelopmental disorders or disabilities, requiring a minimum duration of **45 minutes**.\n\n- **Eligibility Criteria**: \n  - The service is applicable to patients aged **under 25**.\n  - The general practitioner (GP) must have conducted a **comprehensive assessment** leading to a diagnosis of an eligible disability.\n\n- **Service Requirements**:\n  - The GP must develop a **treatment and management plan** that includes:\n    - Documentation of the **confirmed diagnosis**.\n    - Findings from any assessments related to the diagnosis.\n    - A **risk assessment**.\n    - Treatment options, which may include **biopsychosocial recommendations**.\n  - A copy of the treatment plan must be provided to **allied health providers** as appropriate.\n\n- **Claim Limitations**:\n  - This item can only be claimed **once per patient\u2019s lifetime**.\n  - It is not claimable if the patient has previously received payment under specific other MBS items (e.g., items 135, 137, 139, 289, 92140, 92141, or 92434).\n\n- **Legislative Compliance**:\n  - The service must be performed by the patient\u2019s **eligible telehealth practitioner**.\n  - Ensure adherence to the definitions and requirements outlined in **Note AN.1.1**.\n\n- **Fee Structure**:\n  - The schedule fee for this item is **$161.05**, with a benefit of **100%** coverage.\n\n- **Audit Prevention Tips**:\n  - Maintain thorough documentation of the **comprehensive assessment** and all components of the treatment and management plan.\n  - Ensure that the patient\u2019s eligibility for the service is clearly established and documented.\n  - Verify that the service is not being claimed for patients who have previously accessed the item or related items.\n  - Keep records of referrals to allied health practitioners, ensuring compliance with the specified number of services and review requirements.\n\n- **Multi-disciplinary Approach**:\n  - If additional assessments are needed, the GP may refer to eligible allied health practitioners, ensuring that referrals are documented and specify the intent and number of services.\n\n- **Importance of Accurate Diagnosis**:\n  - Emphasize the need for early identification and intervention for eligible disabilities to promote positive long-term outcomes, ensuring that assessments are comprehensive and consider both physical and developmental aspects.",
    "updated": "2026-07-04"
  },
  "13": {
    "content": "HEADING: MBS Item 13 Summary for Billing Compliance\n\n- MBS Item 13 pertains to **consultation services** provided by General Practitioners (GPs).\n- Ensure that the **service provided** aligns with the description and requirements outlined in the MBS.\n- Verify that the **patient's medical history** and presenting issues justify the consultation.\n- Maintain accurate and detailed **clinical notes** that reflect the consultation process and outcomes.\n- Document any **referrals** or follow-up actions taken during the consultation.\n- Confirm that the **billing** is performed within the appropriate timeframe and adheres to the MBS guidelines.\n- Be aware of any **changes** to the item number or description that may affect billing practices.\n- Regularly review and update **practice policies** to ensure compliance with MBS requirements.\n- Conduct periodic **audits** of billing practices to identify and rectify any discrepancies or non-compliance issues.\n- Provide ongoing **training** for staff on MBS billing requirements to minimize errors and enhance compliance.",
    "updated": "2026-07-04"
  },
  "93700": {
    "content": "HEADING: MBS Item 93700 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 93700 is currently not listed in the Medicare Benefits Schedule, indicating it may not be billable.\n- **Verification**: Always confirm the **current status** of MBS items through the official Medicare Benefits Schedule to ensure accurate billing.\n- **Documentation**: Maintain thorough **documentation** of all consultations and services provided, as this supports compliance and justifies claims.\n- **Audit Preparedness**: Be prepared for potential audits by ensuring that all claims are backed by **appropriate clinical notes** and relevant patient information.\n- **Billing Accuracy**: Double-check that the **correct item number** is used for billing to avoid discrepancies and potential penalties.\n- **Updates**: Stay informed about any **updates or changes** to the MBS, as this can affect billing practices and compliance requirements.\n- **Training**: Regularly train staff on **billing procedures** and compliance to minimize errors and enhance understanding of MBS items.\n- **Consultation Types**: Ensure that the type of consultation aligns with the **requirements** for any billable item, as misalignment can lead to claim rejections.\n- **Patient Eligibility**: Verify patient eligibility for services under Medicare to ensure that claims are valid and compliant with regulations.",
    "updated": "2026-07-04"
  },
  "93690": {
    "content": "HEADING: MBS Item 93690 Summary for Billing Compliance\n\n- MBS Item **93690** is currently **not listed** in the Medicare Benefits Schedule.\n- Ensure that you verify the **current status** of MBS items before billing to avoid errors.\n- Maintain accurate records of **services provided** and ensure they align with the MBS guidelines.\n- Regularly check for updates or changes to the MBS that may affect billing practices.\n- Document all patient interactions and services in detail to support claims and prevent audits.\n- Be aware of the **criteria** for billing any MBS item, including eligibility and service requirements.\n- Implement a system for **tracking** MBS item usage to identify any discrepancies or patterns that may trigger audits.\n- Train staff on the importance of **compliance** with MBS billing to minimize the risk of incorrect claims.\n- Consult with a medical compliance expert if there are uncertainties regarding billing for MBS items.",
    "updated": "2026-07-04"
  },
  "93703": {
    "content": "HEADING: MBS Item 93703 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 93703 is currently not listed in the Medicare Benefits Schedule, indicating it may not be billable.\n- **Verification**: Always verify the current status of MBS items through the official MBS Online platform to ensure accurate billing.\n- **Documentation**: Maintain thorough documentation of any consultations or services provided that may relate to this item, even if it is not billable.\n- **Audit Prevention**: Regularly review billing practices to ensure compliance with MBS guidelines and avoid potential audits.\n- **Updates**: Stay informed about any changes to the MBS, including new items or amendments to existing items, to ensure compliance.\n- **Consultation**: If in doubt about the applicability of MBS Item 93703 or any other item, consult with a medical billing expert or the Department of Health and Aged Care.\n- **Record Keeping**: Keep detailed records of all patient interactions and services rendered, as this can support compliance in case of an audit.\n- **Training**: Ensure that all staff involved in billing are trained on the latest MBS items and compliance requirements to minimize errors.",
    "updated": "2026-07-04"
  },
  "93693": {
    "content": "HEADING: MBS Item 93693 Summary for Billing Compliance\n\n- MBS Item **93693** is currently not listed in the Medicare Benefits Schedule, indicating it may not be billable.\n- Ensure to verify the **current status** of MBS Item 93693 through the official Medicare Benefits Schedule resources before attempting to bill.\n- If the item is not billable, avoid using it in billing to prevent **audit risks** and potential financial penalties.\n- Maintain accurate and up-to-date records of all services provided, ensuring they align with **billable items** in the MBS.\n- Regularly review the MBS for any updates or changes to item numbers and descriptions to ensure compliance.\n- Document all patient interactions and services thoroughly to support any claims made under billable items.\n- Consult with a compliance officer or legal advisor if there is uncertainty regarding the use of MBS Item 93693 or any other item.",
    "updated": "2026-07-04"
  },
  "92136": {
    "content": "HEADING: MBS Item 92136 Summary for Billing Compliance\n\n- Item 92136 is for **telehealth attendance** services specifically for **non-directive pregnancy support counselling**.\n- The service must be provided by a **general practitioner (GP)** registered with the Chief Executive Medicare and meeting **credentialing requirements**.\n- The counselling session must be a **video attendance** lasting at least **20 minutes**.\n- Eligible patients include those who are **currently pregnant** or have been pregnant in the **12 months preceding** the service.\n- The **fee** for this item is **$91.65**, with a **100% benefit** available.\n- Patients are limited to **three MBS non-directive pregnancy counselling services** per pregnancy, regardless of the provider type.\n- It is crucial to ensure that the counselling provided is **non-directive**, meaning the GP should not impose their views or values on the patient.\n- GPs must provide **unbiased, evidence-based information** about all options and services available to the patient.\n- To verify a patient's eligibility for services, GPs can use **Health Professional Online Services (HPOS)** or contact **Services Australia**.\n- Only the patient who is pregnant or has been pregnant in the last 12 months can be counselled; partners may attend only with the patient\u2019s **consent**.\n- Maintain accurate records of the counselling sessions to support compliance and prevent audits.\n- Ensure that the service aligns with the definitions and requirements outlined in the **Health Insurance (General Medical Service Table) Regulations 2021** and the **Telehealth Attendance Determination 2021**.",
    "updated": "2026-07-04"
  },
  "92138": {
    "content": "HEADING: MBS Item 92138 Summary for Billing Compliance\n\n- Item 92138 is for **telehealth attendance** services specifically related to **non-directive pregnancy support counselling**.\n- The service must be provided by a **general practitioner (GP)** registered with the Chief Executive Medicare and meeting credentialing requirements.\n- The counselling session must be at least **20 minutes** in duration to qualify for billing.\n- Eligible patients include those who are **currently pregnant** or have been pregnant within the **last 12 months**.\n- The fee for this service is **$91.65**, with a **100% benefit** available.\n- Patients are limited to a maximum of **three counselling services** per pregnancy, regardless of the provider type.\n- It is essential to verify a patient's eligibility for the service using **Health Professional Online Services (HPOS)** or by contacting Services Australia.\n- Non-directive counselling means the GP must provide **unbiased information** and not impose their views on the patient regarding pregnancy decisions.\n- The service should be conducted in a **confidential** manner, allowing the patient to explore their feelings and concerns.\n- Partners may attend the session with the patient's **consent**, but the counselling is focused solely on the individual who is pregnant or has been pregnant.\n- Ensure accurate documentation of the counselling session, including duration and content discussed, to support compliance and prevent audits.\n- Familiarize yourself with the relevant **Regulations** and **Telehealth Attendance Determination** to ensure adherence to guidelines.",
    "updated": "2026-07-04"
  },
  "92731": {
    "content": "HEADING: MBS Item 92731 Summary for Billing Compliance\n\n- Item 92731 pertains to **phone consultations** for services related to **blood borne viruses**, **sexual**, or **reproductive health**.\n- The consultation duration must not exceed **5 minutes**.\n- Eligible activities include:\n  - **Taking a short patient history**\n  - **Arranging necessary investigations**\n  - **Implementing a management plan**\n  - **Providing preventive health care**\n- Consultations related to **assisted reproductive technology** and **antenatal care** are **excluded** from this item.\n- The **schedule fee** for this item is **$20.55**, with a **100% benefit** payable.\n- Practitioners must maintain **adequate and contemporary notes** to support the service provided.\n- This item is designed to enhance **patient access** to medical services, particularly where privacy or service availability may be barriers.\n- Practitioners must be located at a **medical practice** or have a formal agreement with a medical practice that provides **onsite face-to-face services**.\n- It is important to ensure that the service provided aligns with the **clinical relevance** criteria to avoid audit issues.\n- The item is part of a broader category of **telehealth attendance services** and should not replace routine services from a patient\u2019s usual practitioner.",
    "updated": "2026-07-04"
  },
  "92715": {
    "content": "HEADING: Summary of MBS Item 92715 for Billing Compliance\n\n- Item 92715 is a **telehealth service** for general practitioners, specifically for consultations related to **blood borne viruses**, **sexual**, or **reproductive health**.\n- The consultation must be conducted via **video** and is limited to a duration of **not more than 5 minutes**.\n- Eligible services include:\n  - **Taking a short patient history**\n  - **Arranging necessary investigations**\n  - **Implementing a management plan**\n  - **Providing preventive health care**\n- Consultations related to **assisted reproductive technology** and **antenatal care** are **not covered** under this item.\n- The **schedule fee** for Item 92715 is **$20.55**, with a **100% benefit** available.\n- Practitioners must maintain **adequate and contemporary notes** to support the services provided.\n- There is no requirement for the patient to have an **established clinical relationship** with the practitioner, although established relationships are permitted.\n- Practitioners must be located at a **medical practice** or have a formal agreement with a medical practice that provides **onsite face-to-face services**.\n- This item is part of a broader category of **24 MBS items** for video or phone services related to blood borne viruses and sexual or reproductive health.\n- Ensure compliance with all **documentation** and **record-keeping** requirements to prevent audit issues.",
    "updated": "2026-07-04"
  },
  "92734": {
    "content": "HEADING: MBS Item 92734 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 92734 covers phone consultations for services related to **blood borne viruses**, **sexual health**, or **reproductive health** by a general practitioner.\n- **Duration**: The consultation must last **more than 5 minutes** but not exceed **20 minutes**.\n- **Clinically Relevant Activities**: The consultation may include:\n  - **Taking a patient history**\n  - **Arranging necessary investigations**\n  - **Implementing a management plan**\n  - **Providing preventive health care**\n- **Exclusions**: Consultations related to **assisted reproductive technology** and **antenatal care** are not covered under this item.\n- **Fee Structure**: \n  - **Schedule Fee**: $45.05\n  - **Medicare Benefit**: 100% of the schedule fee ($45.05)\n  - **Extended Medicare Safety Net Cap**: $135.15\n- **Clinical Relationship**: Patients do not need to have an established clinical relationship with the practitioner to access this service, although established relationships are permitted.\n- **Documentation Requirements**: Practitioners must maintain **adequate and contemporary notes** to support the service provided.\n- **Practice Location**: Practitioners must be located at a medical practice or have a formal agreement with a medical practice that provides **onsite face-to-face services**.\n- **Audit Prevention**: Ensure all consultations are documented clearly, including the duration and content of the consultation, to support compliance and prevent audit issues.",
    "updated": "2026-07-04"
  },
  "92718": {
    "content": "HEADING: MBS Item 92718 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 92718 covers video consultations by a **General Practitioner** (GP) for services related to **blood borne viruses**, **sexual health**, or **reproductive health** lasting more than **5 minutes** but not exceeding **20 minutes**.\n\n- **Clinical Relevance**: The consultation must include clinically relevant activities such as:\n  - **Taking a patient history**\n  - **Arranging necessary investigations**\n  - **Implementing a management plan**\n  - **Providing preventive health care**\n\n- **Exclusions**: Consultations related to **assisted reproductive technology** and **antenatal care** are **not covered** under this item.\n\n- **Fee Structure**: \n  - **Schedule Fee**: $45.05\n  - **Medicare Benefit**: 100% = $45.05\n  - **Extended Medicare Safety Net Cap**: $135.15\n\n- **Eligibility Criteria**: \n  - Practitioners must be located at a **medical practice** or have a formal agreement with a medical practice that provides **onsite face-to-face services**.\n  - Patients do not need to have an **established clinical relationship** with the GP to access these services.\n\n- **Documentation Requirements**: \n  - Practitioners must maintain **adequate and contemporary notes** to support the services provided.\n  - Documentation should clearly reflect the **clinical relevance** of the consultation to justify billing.\n\n- **Audit Prevention**: \n  - Ensure compliance with the **scope of services** outlined in the item description.\n  - Regularly review documentation practices to ensure they meet **Medicare requirements**.\n  - Avoid billing for services that fall outside the defined scope, particularly those related to **assisted reproductive technology** and **antenatal care**.\n\n- **Related Items**: Familiarize with associated MBS items (92715, 92716, 92717, etc.) to ensure proper billing practices and avoid confusion during consultations.",
    "updated": "2026-07-04"
  },
  "92737": {
    "content": "HEADING: MBS Item 92737 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 92737 covers phone consultations for services related to **blood borne viruses**, **sexual health**, or **reproductive health** by a general practitioner.\n- **Duration**: The consultation must last **more than 20 minutes** but not exceed **40 minutes**.\n- **Clinical Relevance**: The consultation should include clinically relevant activities such as:\n  - **Taking a detailed patient history**\n  - **Arranging necessary investigations**\n  - **Implementing a management plan**\n  - **Providing preventive health care**\n- **Exclusions**: Consultations related to **assisted reproductive technology** and **antenatal care** are **not covered** under this item.\n- **Fee Structure**: The schedule fee for this item is **$87.10**, with a 100% benefit payable.\n- **Extended Medicare Safety Net Cap**: The cap for this item is **$261.30**.\n- **Clinical Relationship**: Patients do not need to have an established clinical relationship with the practitioner to access this service, but practitioners with an established relationship may also use this item.\n- **Documentation Requirements**: Practitioners must maintain **adequate and contemporary notes** to support the service provided, ensuring compliance and audit readiness.\n- **Practice Location**: Practitioners must be located at a medical practice or have a formal agreement with a medical practice that provides **onsite face-to-face services** to patients.\n- **Audit Prevention**: Ensure all consultations are documented accurately, including the duration and content of the consultation, to prevent potential audits and ensure compliance with Medicare guidelines.",
    "updated": "2026-07-04"
  },
  "92721": {
    "content": "HEADING: MBS Item 92721 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 92721 covers video consultations for services related to **blood borne viruses**, **sexual**, or **reproductive health** by a general practitioner.\n- **Duration Requirement**: The consultation must last **more than 20 minutes** but not exceed **40 minutes**.\n- **Clinically Relevant Activities**: The consultation must include at least one of the following:\n  - **Taking a detailed patient history**\n  - **Arranging necessary investigations**\n  - **Implementing a management plan**\n  - **Providing appropriate preventive health care**\n- **Exclusions**: Consultations related to **assisted reproductive technology** and **antenatal care** are **not covered** under this item.\n- **Fee Structure**: The schedule fee is **$87.10**, with a **100% benefit** equating to the full fee.\n- **Extended Medicare Safety Net Cap**: The cap for this item is **$261.30**.\n- **Clinical Relationship**: Patients do not need to have an established clinical relationship with the practitioner to access this service, but practitioners with an established relationship may still use this item.\n- **Documentation Requirements**: Practitioners must maintain **adequate and contemporary notes** to support the service provided, which is crucial for audit prevention.\n- **Practice Location**: Practitioners must be located at a medical practice or have a formal agreement with a medical practice that provides **onsite face-to-face services**.\n- **Audit Prevention Focus**: Ensure all consultations are documented thoroughly, including the rationale for the consultation, to mitigate risks during audits.",
    "updated": "2026-07-04"
  },
  "92740": {
    "content": "HEADING: MBS Item 92740 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 92740 covers phone consultations for services related to **blood borne viruses**, **sexual**, or **reproductive health** provided by a general practitioner.\n- **Duration Requirement**: The consultation must last at least **40 minutes** and include clinically relevant components such as:\n  - Taking an **extensive patient history**\n  - Arranging necessary **investigations**\n  - Implementing a **management plan**\n  - Providing appropriate **preventive health care**\n- **Exclusions**: Consultations related to **assisted reproductive technology** and **antenatal care** are **not covered** under this item.\n- **Fee Structure**: \n  - Schedule Fee: **$128.35**\n  - Benefit: **100%** of the fee, equating to **$128.35**\n  - Extended Medicare Safety Net Cap: **$385.05**\n- **Clinical Relationship**: Patients do not need to have an established clinical relationship with the practitioner to access this service, but practitioners with an established relationship may also use this item.\n- **Documentation Requirements**: Practitioners must maintain **adequate and contemporary notes** to support the service provided, which is crucial for compliance and audit prevention.\n- **Practice Location**: Practitioners must be located at a **medical practice** or have a formal agreement with a medical practice that provides **onsite face-to-face services** to patients.\n- **Audit Prevention**: Ensure all consultations are documented thoroughly, including the rationale for the duration and content of the consultation, to mitigate risks during audits.",
    "updated": "2026-07-04"
  },
  "92724": {
    "content": "HEADING: MBS Item 92724 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 92724 pertains to video consultations for services related to **blood borne viruses**, **sexual health**, or **reproductive health** provided by a general practitioner.\n- **Duration Requirement**: The consultation must last at least **40 minutes**.\n- **Clinically Relevant Activities**: The consultation should include any of the following:\n  - **Taking a detailed patient history**\n  - **Arranging necessary investigations**\n  - **Implementing a management plan**\n  - **Providing appropriate preventive health care**\n- **Exclusions**: Consultations related to **assisted reproductive technology** and **antenatal care** are not covered under this item.\n- **Fee Structure**: The scheduled fee for this item is **$128.35**, with a benefit of **100%** payable.\n- **Extended Medicare Safety Net Cap**: The cap for this item is **$385.05**.\n- **Clinical Relationship**: This item allows for consultations without an established clinical relationship, but practitioners with an established relationship may also use it.\n- **Documentation Requirement**: Practitioners must maintain **adequate and contemporary notes** to support the service provided.\n- **Practice Location**: Practitioners must be located at a medical practice or have a formal agreement with a medical practice that provides **onsite face-to-face services**.\n- **Audit Prevention**: Ensure compliance by:\n  - Documenting all relevant patient interactions and clinical decisions.\n  - Verifying that the consultation meets the **40-minute duration** and includes clinically relevant activities.\n  - Avoiding billing for excluded services such as antenatal care or assisted reproductive technology.\n- **Related Items**: Familiarize with related MBS items for comprehensive billing practices.",
    "updated": "2026-07-04"
  },
  "699": {
    "content": "HEADING: MBS Item 699 Overview\n\n- **Item Description**: Item 699 pertains to a **heart health assessment** for patients aged **30 years and over** conducted by a **general practitioner** (GP) in consulting rooms.\n- **Duration**: The assessment must last at least **20 minutes**.\n\nHEADING: Key Components of the Assessment\n\n- **Information Collection**: Must include taking a **patient history** and conducting a **basic physical examination**.\n- **Essential Measurements**: Must include **recording blood pressure** and **cholesterol levels**.\n- **Interventions**: Initiate necessary **interventions** and **referrals** as indicated.\n- **Management Plan**: Implement a **management plan** tailored to the patient's needs.\n- **Preventative Advice**: Provide the patient with **preventative health care advice** and information.\n\nHEADING: Billing Compliance Guidelines\n\n- **Fee Structure**: The schedule fee for Item 699 is **$87.10**, with a benefit of **100%**.\n- **Claim Frequency**: This item can be claimed **once per patient** in a **12-month period**.\n- **Previous Assessments**: Cannot claim if the patient has had a health assessment service (excluding specific Aboriginal and Torres Strait Islander assessments) in the previous **12 months**.\n\nHEADING: Patient Eligibility and Consent\n\n- **Eligibility**: Available to all **Medicare eligible patients** aged **30 years and over** who may benefit from the assessment.\n- **Consent Requirement**: Obtain and document **patient consent** before commencing the assessment. If the patient cannot consent, a parent, carer, or representative must provide consent.\n- **Documentation**: Consent must be noted in the **patient's records**.\n\nHEADING: Assessment Limitations\n\n- **Inpatient Exclusion**: Not available for patients who are **in-patients** of a hospital or in **residential aged care facilities**.\n- **Usual Doctor**: The assessment should ideally be conducted by the patient's **usual doctor**, defined as the GP providing the majority of care over the past or next 12 months.\n\nHEADING: Record Keeping and Audit Prevention\n\n- **Retention of Records**: A copy of the heart health assessment must be retained for a minimum of **two years** post-service.\n- **Assistance from Health Professionals**: Other qualified health professionals may assist but must do so under the **supervision** of the GP and in accordance with accepted medical practice.\n- **Separate Consultations**: Do not conduct a separate consultation for unrelated health issues during the heart health assessment.\n\nHEADING: Compliance Best Practices\n\n- **Thorough Documentation**: Ensure all components of the assessment are well-documented to support claims.\n- **Regular Training**: Keep staff updated on MBS guidelines and compliance requirements to prevent billing errors.\n- **Audit Preparedness**: Regularly review patient records and billing practices to ensure adherence to MBS Item 699 requirements and mitigate audit risks.",
    "updated": "2026-07-04"
  },
  "715": {
    "content": "HEADING: MBS Item 715 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 715 pertains to health assessments for patients of **Aboriginal or Torres Strait Islander descent** conducted by a general practitioner (GP).\n- **Service Location**: The assessment can occur in **consulting rooms** or other non-hospital settings.\n- **Key Components of the Assessment**:\n  - **Recognising health priorities** of the patient.\n  - **Taking a comprehensive medical history**.\n  - **Conducting relevant physical examinations**.\n  - **Arranging or performing necessary investigations**.\n  - **Assessing the patient** based on gathered information.\n  - **Initiating interventions and referrals** as needed.\n  - **Developing and documenting a health management plan**, including follow-up strategies.\n  - **Offering a written report** of the assessment to the patient or their carer, if appropriate and agreed upon.\n  - **Providing the report** if the offer is accepted.\n  - **Documenting the assessment** in the patient's medical records.\n\n- **Eligibility Criteria**: This item is applicable only if no similar health assessment service (items 228, 92004, or 92011) has been provided to the patient in the **preceding 9 months**.\n- **Fee Structure**: The schedule fee for Item 715 is **$254.10**, with a 100% benefit coverage.\n- **Extended Medicare Safety Net Cap**: The cap for this item is set at **$500.00**.\n- **Informed Consent**: Practitioners must adhere to the principles of **informed patient consent** as outlined in the Medical Board of Australia's guidelines.\n- **Cultural Competence**: Assessments should align with **current Australian preventive health guidelines** that are culturally and clinically appropriate for Aboriginal and Torres Strait Islander patients.\n- **Audit Prevention**: Ensure thorough documentation of all assessment components and patient interactions to support compliance and prevent audit issues. Regularly review billing practices to ensure adherence to MBS requirements.",
    "updated": "2026-07-04"
  },
  "9": {
    "content": "HEADING: MBS Item 9 Overview\n\n- MBS Item 9 is currently **not available** in the Medicare Benefits Schedule.\n- Ensure to **verify** the item number before billing to avoid errors.\n- Regularly check the **MBS Online** for updates or changes to item availability.\n- Maintain accurate records of **services provided** to support any claims made.\n- Be aware of the **audit risks** associated with billing for unavailable items.\n- Ensure that all claims are based on **current MBS guidelines** to prevent compliance issues.\n- Document any **patient interactions** and services rendered thoroughly to support billing claims.\n- Stay informed about **Medicare updates** and changes to billing practices to ensure compliance.",
    "updated": "2026-07-04"
  },
  "10987": {
    "content": "HEADING: MBS Item 10987 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 10987 pertains to follow-up services provided by a **practice nurse** or an **Aboriginal and Torres Strait Islander health practitioner** on behalf of a medical practitioner for Indigenous patients who have received a health check.\n  \n- **Eligibility Criteria**:\n  - The service must be provided **on behalf of** and **under the supervision** of a medical practitioner.\n  - The patient must **not be an admitted patient** of a hospital.\n  - The service must be **consistent with the needs** identified through the health assessment.\n\n- **Service Limitations**:\n  - A maximum of **10 services** can be billed per patient in a **calendar year**.\n  \n- **Fee Structure**:\n  - The schedule fee for this item is **$28.70**.\n  - The benefit is **100%**, equating to **$28.70**.\n\n- **Extended Medicare Safety Net Cap**: The cap for this item is **$86.10**.\n\n- **Documentation Requirements**:\n  - Ensure thorough documentation of the **supervision** provided by the medical practitioner.\n  - Maintain records that demonstrate the service is **consistent with the health assessment needs**.\n\n- **Audit Prevention Tips**:\n  - Regularly review billing practices to ensure compliance with the **eligibility criteria**.\n  - Confirm that the services billed under this item are not duplicated or claimed in conjunction with other health assessment items.\n  - Train practice staff on the specific requirements of MBS Item 10987 to avoid inadvertent billing errors.\n\n- **Compliance with Regulations**: Familiarize yourself with the **Health Insurance Act 1973** and relevant **Regulations** to ensure adherence to guidelines regarding health assessments and follow-up services. \n\n- **Assistance by Other Health Professionals**: Understand that while practice nurses and Aboriginal health practitioners can assist, their involvement must be under the **supervision** of the medical practitioner and must adhere to accepted medical practice standards. \n\n- **Avoiding Misclassification**: Ensure that services provided are not misclassified as **health screening services**, which are defined separately under the regulations. \n\nBy adhering to these guidelines, compliance with MBS Item 10987 can be maintained, reducing the risk of audits and ensuring appropriate billing practices.",
    "updated": "2026-07-04"
  },
  "10": {
    "content": "HEADING: MBS Item 10 Summary for Billing Compliance\n\n- MBS Item 10 is currently not available in the Medicare Benefits Schedule.\n- Ensure to verify the **current status** of MBS Item 10 through the official MBS Online platform.\n- Maintain accurate **documentation** for all services rendered, even if the item is not billable.\n- Regularly check for updates or changes to the MBS that may affect billing practices.\n- Be aware of the **audit risk** associated with billing for non-existent or unavailable items.\n- Ensure that all claims submitted are for services that are **clearly defined** and supported by appropriate clinical documentation.\n- Keep records of any **communication** with Medicare regarding MBS Item 10 for future reference.\n- Train staff on the importance of verifying item availability before processing claims to prevent billing errors.",
    "updated": "2026-07-04"
  },
  "900": {
    "content": "HEADING: MBS Item 900 Compliance Summary\n\n- **Item Description**: MBS Item 900 pertains to the participation of a general practitioner in a Domiciliary Medication Management Review (DMMR) for patients with chronic medical conditions or complex medication regimens.\n\n- **Eligibility Criteria**:\n  - Patient must have a **chronic medical condition** or a **complex medication regimen**.\n  - Patient must not have their **therapeutic goals met**.\n  - Consent from the patient is required for the review.\n\n- **Service Requirements**:\n  - The GP must **physically assess** the patient.\n  - Following assessment, the GP must:\n    - Refer the patient to a **community pharmacy** or an **accredited pharmacist** for the DMMR.\n    - Provide relevant **clinical information** for the DMMR.\n    - Discuss the DMMR results with the reviewing pharmacist, including suggested medication management strategies.\n    - Develop a **written medication management plan** in consultation with the patient.\n    - Provide the written plan to a community pharmacy chosen by the patient.\n\n- **Frequency of Service**:\n  - DMMR can be billed **once every 12 months** for a patient.\n  - If there is a **significant change** in the patient\u2019s condition or medication regimen, a new DMMR may be warranted sooner than 12 months.\n  - Documentation must indicate **exceptional circumstances** if billing occurs sooner than the 12-month period.\n\n- **Billing Compliance**:\n  - Claims can only be submitted after all DMMR requirements are completed.\n  - Ensure that the patient\u2019s invoice or digital claim indicates **exceptional circumstances** if applicable.\n  - Maintain **adequate and contemporaneous records** detailing the nature of any exceptional circumstances.\n\n- **Claiming Other Services**:\n  - Other clinically relevant services can be billed on the same day as the DMMR, provided they are distinct and do not have restrictions against same-day claiming.\n\n- **Audit Prevention**:\n  - Ensure all documentation is complete and accurate to support claims.\n  - Regularly review compliance with MBS requirements to prevent discrepancies during audits.\n  - Train staff on the specific requirements of MBS Item 900 to ensure adherence to billing protocols.",
    "updated": "2026-07-04"
  },
  "903": {
    "content": "HEADING: MBS Item 903 Overview\n\n- **Item 903** pertains to the participation of a general practitioner in a **Residential Medication Management Review (RMMR)** for patients in a residential aged care facility.\n- The **fee** for this service is **$126.90**, with a **100% benefit** available.\n\nHEADING: Eligibility Criteria\n\n- RMMRs can only be billed if the patient has not received this service or **Item 249** in the preceding **12 months**, unless there has been a **significant change** in the patient's medical condition or medication management plan.\n- Ensure that the patient is a **care recipient** in a **residential aged care facility** as defined by the **Aged Care Act 2024**.\n\nHEADING: Service Requirements\n\n- The GP must **personally attend** the patient as part of the RMMR service.\n- The GP must obtain the **resident\u2019s consent** for the review and collaborate with the **pharmacist** throughout the process.\n- The GP is responsible for providing relevant clinical information and participating in any necessary **post-review discussions** with the pharmacist.\n\nHEADING: Documentation and Record Keeping\n\n- Document all discussions, consent, and clinical information provided during the RMMR.\n- Maintain records of any **significant changes** in the patient's condition that justify an earlier review.\n- If claiming under **exceptional circumstances**, clearly indicate this on the patient's invoice or digital claim, and document the reasons in the patient's records.\n\nHEADING: Audit Prevention Tips\n\n- Ensure compliance with the **12-month rule** for RMMRs to avoid billing errors.\n- Verify that all required elements of the service are completed, including consent and collaboration with the pharmacist.\n- Regularly review documentation practices to ensure all necessary information is recorded accurately and comprehensively.\n- Stay updated on any changes to the **Medicare Benefits Schedule** and relevant regulations to maintain compliance.",
    "updated": "2026-07-04"
  },
  "721": {
    "content": "HEADING: MBS Item 721 Overview\n\n- MBS Item 721 is designated for **specific medical services** provided by General Practitioners (GPs).\n- Ensure that the service rendered aligns with the **criteria outlined** in the MBS for Item 721.\n- Verify that the patient meets the **eligibility requirements** for the service before billing.\n\nHEADING: Documentation Requirements\n\n- Maintain **comprehensive records** of the consultation, including patient history and clinical findings.\n- Document the **reason for the service** and any relevant discussions with the patient.\n- Ensure that all documentation is **clear, legible, and complete** to support the billing claim.\n\nHEADING: Billing Compliance\n\n- Confirm that the service billed under Item 721 is **not duplicated** with other MBS items for the same patient on the same day.\n- Be aware of the **fee schedule** associated with Item 721 and ensure accurate billing.\n- Regularly review and update knowledge on any **changes to MBS Item 721** to maintain compliance.\n\nHEADING: Audit Prevention Strategies\n\n- Conduct **internal audits** of billing practices to identify any discrepancies or patterns that may raise red flags.\n- Train staff on the importance of **accurate coding** and the implications of incorrect billing.\n- Implement a system for **tracking claims** submitted under Item 721 to ensure they are supported by appropriate documentation.\n\nHEADING: Patient Communication\n\n- Clearly communicate to patients the **nature of the service** being provided and its relevance to their health.\n- Obtain **informed consent** where applicable, ensuring patients understand the service and any associated costs.\n- Encourage patients to ask questions to ensure they are fully informed about the service being billed.\n\nHEADING: Continuous Education\n\n- Stay updated with the **latest guidelines** from the Department of Health and Aged Care regarding MBS Item 721.\n- Participate in **professional development** opportunities focused on billing compliance and MBS updates.\n- Engage with peer networks to share insights and best practices related to MBS Item 721 billing.",
    "updated": "2026-07-04"
  },
  "723": {
    "content": "HEADING: MBS Item 723 Summary for Billing Compliance\n\n- MBS Item 723 pertains to **specific medical services** provided by General Practitioners (GPs).\n- Ensure that the service billed under Item 723 is **clinically appropriate** and meets the criteria outlined in the Medicare Benefits Schedule.\n- Document all **clinical indications** and patient details thoroughly to support the necessity of the service.\n- Verify that the service aligns with the **Medicare guidelines** to avoid potential audit issues.\n- Maintain accurate **patient records** that reflect the service provided, including any relevant assessments or treatments.\n- Be aware of the **fee schedule** associated with Item 723 and ensure billing reflects the correct amount.\n- Regularly review updates to the **Medicare Benefits Schedule** to stay informed about any changes to Item 723.\n- Implement a **compliance checklist** for billing Item 723 to ensure all requirements are met before submission.\n- Train staff on the importance of **accurate coding** and documentation to minimize the risk of billing errors.\n- Conduct periodic **internal audits** to assess compliance with MBS Item 723 and identify areas for improvement.",
    "updated": "2026-07-04"
  },
  "732": {
    "content": "HEADING: MBS Item 732 Overview\n\n- MBS Item 732 pertains to **consultation services** provided by General Practitioners (GPs).\n- It is essential to ensure that the **service provided** aligns with the specific requirements outlined in the MBS for this item.\n\nHEADING: Billing Compliance Guidelines\n\n- Confirm that the **consultation** meets the criteria for Item 732, which typically involves a **comprehensive assessment** of the patient's condition.\n- Ensure that the **duration** of the consultation is appropriate, as longer consultations may warrant different billing items.\n- Document all relevant **clinical details** in the patient's medical record to support the billing of Item 732.\n- Verify that the **patient's eligibility** for Medicare benefits is confirmed prior to billing.\n- Maintain clear and concise **notes** that justify the use of Item 732, including any specific **diagnoses** or **treatment plans** discussed during the consultation.\n\nHEADING: Audit Prevention Strategies\n\n- Regularly review billing practices to ensure compliance with the **latest MBS guidelines** and updates.\n- Conduct internal audits of patient records to ensure that the documentation supports the services billed under Item 732.\n- Provide ongoing **training** for staff on the importance of accurate billing and documentation practices.\n- Implement a system for **tracking** consultations billed under Item 732 to identify any patterns that may raise audit flags.\n- Stay informed about any changes to the MBS that may affect the billing of Item 732 to ensure continued compliance.",
    "updated": "2026-07-04"
  },
  "729": {
    "content": "HEADING: MBS Item 729 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 729 pertains to the contribution by a general practitioner to a multidisciplinary care plan prepared by another provider or a review of such a plan.\n- **Eligibility**: This item is applicable for patients with at least one chronic condition that has been present for a minimum of **6 months** or is terminal. \n- **Clinical Relevance**: Services billed under this item must be **clinically relevant**, meaning they are necessary for the appropriate treatment of the patient as defined by the Health Insurance Act 1973.\n- **Fee Structure**: The scheduled fee for Item 729 is **$84.25**, with a benefit of **100%** coverage.\n- **Audit Prevention**: Ensure that:\n  - Documentation supports the patient's eligibility for a chronic condition.\n  - The service provided is clearly linked to the management of the chronic condition.\n  - The multidisciplinary care plan is properly documented and reflects collaboration with other healthcare providers.\n- **Patient Registration**: Patients registered with MyMedicare must access these services through their registered practice; non-registered patients may access services from their usual GP.\n- **Associated Items**: Be aware of related MBS items (e.g., 735, 739, 743, 747, 750, 758) that may not be billed in conjunction with Item 729.\n- **Review and Update**: Regularly review the explanatory notes and updates related to MBS Item 729 to ensure compliance with any changes in guidelines or eligibility criteria.",
    "updated": "2026-07-04"
  },
  "731": {
    "content": "HEADING: MBS Item 731 Summary for Billing Compliance\n\n- Item 731 pertains to **multidisciplinary care plans** for patients in residential aged care facilities or those transitioning from hospital care.\n- The **fee for Item 731** is **$84.25**, with a 100% benefit available.\n- Ensure that the service provided is **clinically relevant** and necessary for the patient's treatment, as per the Health Insurance Act 1973.\n- Patient eligibility requires at least **one chronic condition** present for **6 months or more**, or a terminal condition.\n- The GP must use **clinical judgment** to determine the appropriateness of a multidisciplinary care plan for the patient.\n- Services must be rendered in accordance with **Medicare guidelines** to avoid audit risks.\n- Document all interactions and decisions regarding the development or review of care plans to support billing claims.\n- Ensure that the patient is either registered with the practice through **MyMedicare** or is accessing services from their usual medical practitioner.\n- Be aware of associated notes and guidelines (AN.15.3, AN.15.4, AN.15.6, AN.15.8, AN.36.2) for detailed requirements and compliance.\n- Regularly review and update practice protocols to align with any changes in MBS item descriptions or fees to maintain compliance.",
    "updated": "2026-07-04"
  },
  "139": {
    "content": "HEADING: MBS Item 139 Summary for Billing Compliance\n\n- Item 139 is for **professional attendance** by a general practitioner for patients under **25 years of age** with an **eligible disability**.\n- The attendance must last at least **45 minutes** and occur at a location other than a hospital.\n- The service is **claimable once in a patient\u2019s lifetime**.\n- A comprehensive assessment must be undertaken, which may include information from **eligible allied health providers**.\n- The general practitioner must develop a **treatment and management plan** that includes:\n  - Documentation of the **confirmed diagnosis**.\n  - Findings from any assessments performed.\n  - A **risk assessment**.\n  - Treatment options, which may include **biopsychosocial recommendations**.\n- A copy of the treatment and management plan must be provided to **one or more allied health providers** if appropriate.\n- The fee for this item is **$161.05**, with a 100% benefit.\n- Ensure that the patient has not previously received payment under this item or related items (135, 137, 289, 92140, 92141, 92142, or 92434).\n- The item is intended for **diagnosis and treatment** of eligible disabilities, promoting early identification and intervention.\n- A multi-disciplinary approach may be necessary for accurate assessment and diagnosis.\n- The GP can refer patients to **eligible allied health practitioners** for a total of **20 MBS treatment services** per patient\u2019s lifetime.\n- Each referral to allied health practitioners must be accompanied by a **separate referral letter** specifying the intent and number of services.\n- After four allied health assessment services, a **review** by the referring GP is required to authorize any additional services.\n- Maintain thorough documentation of all assessments, diagnoses, and treatment plans to support compliance and prevent audit issues.",
    "updated": "2026-07-04"
  },
  "10997": {
    "content": "HEADING: MBS Item 10997 Summary for Billing Compliance\n\n- **Service Description**: Item 10997 covers services provided by a **practice nurse** or an **Aboriginal and Torres Strait Islander health practitioner** to a person with a **chronic condition** under the supervision of a **medical practitioner**.\n\n- **Eligibility Criteria**:\n  - The service must be provided on behalf of and under the **supervision** of a medical practitioner.\n  - The patient must **not** be an admitted patient of a hospital.\n  - The patient must have a **GP chronic condition management plan** prepared or reviewed within the last **18 months**, or:\n    - A **GP management plan** or **team care arrangements** prepared before **1 July 2025** (valid until 30 June 2027).\n    - A **multidisciplinary care plan** in place.\n  - The service must be **consistent** with the management plan or arrangements.\n\n- **Service Limitations**: \n  - A maximum of **5 services** can be billed under this item, item 92301, or item 93203 in a **calendar year**.\n\n- **Billing Details**:\n  - **Schedule Fee**: $14.35\n  - **Medicare Benefit**: 100% of the schedule fee ($14.35).\n  - **Extended Medicare Safety Net Cap**: $43.05.\n\n- **Audit Prevention Tips**:\n  - Ensure that the **chronic condition management plan** is current and documented within the required timeframe.\n  - Verify that the service provided aligns with the **patient's management plan** to avoid discrepancies.\n  - Maintain clear records of **supervision** by the medical practitioner for compliance.\n  - Limit billing to the maximum allowable services per calendar year to prevent overbilling issues.\n  - Regularly review and update practice protocols to ensure adherence to MBS requirements and guidelines.",
    "updated": "2026-07-04"
  },
  "11505": {
    "content": "HEADING: MBS Item 11505 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 11505 pertains to the measurement of **spirometry** that includes a permanently recorded tracing, performed before and after inhalation of a **bronchodilator**.\n- **Indications**: This item is applicable for confirming the diagnosis of:\n  - **Asthma**\n  - **Chronic Obstructive Pulmonary Disease (COPD)**\n  - Other causes of **airflow limitation**\n- **Recording Requirements**: The service must involve **three or more recordings** made during each testing occasion.\n- **Frequency of Billing**: This item can only be billed **once in any 12-month period** for each patient.\n- **Fee Structure**: \n  - Schedule Fee: **$49.30**\n  - 75% Benefit: **$37.00**\n  - 85% Benefit: **$41.95**\n- **Quality Standards**: \n  - Spirometry services must meet **international quality standards** as outlined in the relevant literature.\n  - Properly performed spirometry is essential for confirming airflow limitation and diagnosing asthma and/or COPD.\n- **Training Requirements**: \n  - Personnel performing spirometry must have undergone appropriate **training** and be qualified to perform the procedure to recommended standards.\n- **Documentation**: \n  - Maintain thorough records of the spirometry tests, including the **pre/post bronchodilator** results and adherence to **repeatability criteria**.\n- **Audit Prevention**: \n  - Ensure that spirometry is not repeated if the diagnosis has already been confirmed by properly performed tests.\n  - Follow guidelines from the **National Asthma Council** and other relevant organizations to ensure compliance and quality of care.\n- **Related Items**: Be aware of associated items such as **11506** and **11512** for comprehensive billing practices.",
    "updated": "2026-07-04"
  },
  "11506": {
    "content": "HEADING: MBS Item 11506 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 11506 covers the measurement of **spirometry** that includes a permanently recorded tracing, performed before and after inhalation of a **bronchodilator**.\n  \n- **Indications for Use**: This item is applicable for:\n  - Confirming diagnosis of **chronic obstructive pulmonary disease (COPD)**.\n  - Assessing **acute exacerbations of asthma**.\n  - Monitoring **asthma** and **COPD**.\n  - Assessing other causes of **obstructive lung disease** or the presence of **restrictive lung disease**.\n\n- **Fee Structure**: \n  - Schedule Fee: **$24.60**\n  - Medicare Benefits: \n    - 75% = **$18.45**\n    - 85% = **$20.95**\n\n- **Quality Standards**: \n  - Spirometry services must meet **international quality standards** as outlined in the **Eur Respir J 2005**.\n  - Properly performed spirometry is essential for confirming airflow limitation and diagnosing asthma and/or COPD.\n\n- **Training Requirements**: \n  - Personnel performing spirometry must have completed a **substantial course of study and training** in respiratory medicine endorsed by a professional medical organization.\n  - Appropriate records of training should be maintained.\n\n- **Testing Requirements**: \n  - Patients must have **three acceptable tests** for each testing period (pre/post bronchodilator).\n  - Tests must meet **repeatability criteria** with the best effort recorded.\n\n- **Reversibility Testing**: \n  - Reversibility testing is the standard required for asthma diagnosis.\n  - The diagnosis of COPD is confirmed with **post bronchodilator spirometry**.\n\n- **Audit Prevention**: \n  - Ensure that spirometry is not repeated when the diagnosis has been previously confirmed by properly performed spirometry.\n  - Maintain thorough documentation of training, testing procedures, and results to support compliance and prevent audit issues.\n\n- **Related Items**: Be aware of related items such as **11505** and **11512** for comprehensive billing practices.",
    "updated": "2026-07-04"
  },
  "11707": {
    "content": "HEADING: MBS Item 11707 Summary for Billing Compliance\n\n- **Item Description**: Item 11707 covers **twelve-lead electrocardiography (ECG) trace only** performed by a medical practitioner, specifically for forwarding to a specialist or consultant physician for a formal report.\n\n- **Eligibility Criteria**:\n  - The ECG trace must be provided to a **specialist or consultant physician** for a formal report.\n  - The service must not be associated with any of the following items: **12203, 12204, 12205, 12207, 12208, 12210, 12213, 12215, 12217, 12250**.\n  - The service must not be related to items **12218 or 12219**.\n  - The service is not applicable if provided as part of an **episode of hospital treatment** or **hospital-substitute treatment**.\n\n- **Claiming Limitations**:\n  - The service can be claimed **not more than twice on the same day**.\n  - Ensure that the service is not claimed in conjunction with any hospital treatment items (11704, 11705, 11714).\n\n- **Fee Structure**:\n  - Schedule Fee: **$22.00**\n  - Benefit: **85% = $18.70**\n\n- **Documentation Requirements**:\n  - Maintain clear documentation that the ECG trace was performed for the purpose of forwarding to a specialist for a formal report.\n  - Ensure that the clinical indication for the ECG is documented in the patient's records.\n\n- **Audit Prevention Tips**:\n  - Verify that the ECG trace is not part of a hospital treatment episode before claiming.\n  - Ensure that the service is not co-claimed with any other attendance or diagnostic items unless exceptional clinical circumstances apply.\n  - Avoid any financial relationships between the requesting practitioner and the specialist providing the report to comply with MBS guidelines.\n\n- **Clinical Decision Making**:\n  - The request for the ECG must be based solely on **clinical decision-making** and not influenced by financial relationships.\n  - Document the clinical context and significance of the ECG findings in the patient's medical records to support the necessity of the service.\n\n- **Additional Notes**:\n  - Item 11707 is specifically for **trace only**; it does not include interpretation or clinical notes, which are covered under other items (e.g., Item 11714).\n  - Ensure compliance with all MBS guidelines to avoid potential audits and claims rejections.",
    "updated": "2026-07-04"
  },
  "12": {
    "content": "HEADING: MBS Item 12 Summary for Billing Compliance\n\n- MBS Item 12 pertains to **specific services** provided by General Practitioners (GPs).\n- Ensure that the **service provided** aligns with the description outlined in the MBS for Item 12.\n- Verify that the **patient's clinical need** justifies the use of this item to avoid audit discrepancies.\n- Maintain accurate **documentation** of the service, including:\n  - Date of service\n  - Patient details\n  - Clinical notes supporting the necessity of the service\n- Confirm that the **billing** is performed in accordance with the latest MBS guidelines to prevent potential compliance issues.\n- Be aware of any **amendments** or updates to the item description or billing requirements that may affect compliance.\n- Regularly review **billing practices** to ensure adherence to MBS standards and reduce the risk of audits.\n- Engage in **continuous education** regarding MBS items to stay informed about changes that may impact billing compliance.",
    "updated": "2026-07-04"
  },
  "11607": {
    "content": "HEADING: MBS Item 11607 Summary for Billing Compliance\n\n- **Item Description**: Continuous ambulatory blood pressure recording for 24 hours or more.\n- **Eligibility Criteria**:\n  - Patient must have a **clinic blood pressure measurement** indicating:\n    - Systolic blood pressure between **140 mmHg and 180 mmHg**.\n    - Diastolic blood pressure between **90 mmHg and 110 mmHg**.\n  - Patient must **not** have commenced **anti-hypertensive therapy**.\n- **Recording Requirements**:\n  - Must include the patient\u2019s **resting blood pressure**.\n  - Conducted using **microprocessor-based analysis equipment**.\n  - Interpretation and report must be completed by the **same medical practitioner**.\n- **Treatment Plan**:\n  - A comprehensive written plan must be prepared, including:\n    - Patient's **diagnosis**.\n    - **Management goals** agreed upon by the patient.\n    - **Interventions** including lifestyle modifications.\n    - Any necessary **treatment**.\n    - Arrangements for **review** of the plan.\n  - The practitioner must:\n    - Explain the plan to the patient and carer (if applicable).\n    - Record the plan and the patient's agreement.\n    - Offer a copy of the plan to the patient and carer.\n    - Add a copy to the patient's **medical records**.\n- **Claiming Guidelines**:\n  - Equipment used must be listed on the **Australian Register of Therapeutic Goods**.\n  - Equipment must be **recalibrated** as per manufacturer recommendations.\n  - Separate consultations for the treatment plan should only occur if **clinically indicated**.\n  - If a separate consultation is conducted, annotate the invoice or Medicare voucher appropriately.\n- **Frequency of Claiming**: Applicable only **once in any 12-month period**.\n- **Fee Structure**:\n  - Schedule Fee: **$123.20**.\n  - Benefit: **75% = $92.40**, **85% = $104.75**.\n- **Audit Prevention**: Ensure all documentation is complete, accurate, and compliant with the outlined requirements to avoid potential audits and claims rejection.",
    "updated": "2026-07-04"
  },
  "24": {
    "content": "HEADING: MBS Item 24 Summary for Billing Compliance\n\n- Item 24 pertains to **Level B professional attendance** by a general practitioner (GP).\n- The attendance must last at least **6 minutes** but less than **20 minutes**.\n- Services included in this item must be **clinically relevant** and can involve:\n  - Taking a **patient history**\n  - Performing a **clinical examination**\n  - Arranging necessary **investigations**\n  - Implementing a **management plan**\n  - Providing appropriate **preventive health care**\n- The item is applicable for **one or more health-related issues** during a single attendance.\n- Documentation must be **appropriate** and **contemporaneous** for all services provided.\n- The fee structure includes:\n  - The fee for item 23, plus **$31.50** divided by the number of patients seen (up to a maximum of **six patients**).\n  - For **seven or more patients**, the fee for item 23 plus **$2.50** per additional patient.\n- Ensure that the item is claimed only when **no other MBS item** applies to the service provided.\n- It is essential to select the **most specific MBS item** that accurately reflects the service rendered.\n- Maintain **accurate records** of the services provided to support claims and prevent audits.\n- Understand that **personal attendance** is defined as a service provided to a single patient by a single medical practitioner on one occasion.\n- Benefits are not payable if more than one medical practitioner is involved in the attendance for the same patient.\n- Be aware of the **Extended Medicare Safety Net Cap**, which is **300% of the derived fee** for this item or **$500**, whichever is lesser.",
    "updated": "2026-07-04"
  },
  "73812": {
    "content": "HEADING: Summary of MBS Item 73812 for Billing Compliance\n\n- Item 73812 pertains to the **quantitation of glycated haemoglobin (HbA1c)** in the management of established diabetes.\n- This service is classified under **Category 6 - Pathology Services**.\n- The test must be performed:\n  - As a **point-of-care test**.\n  - By or on behalf of a **medical practitioner** in a **general practice** accredited to the **Royal Australian College of General Practitioners Standards** for point-of-care testing.\n  - Using a method certified by the **National Glycohemoglobin Standardization Program (NGSP)**, with instrumentation having a total coefficient variation of less than **3.0%** at **48 mmol/mol (6.5%)**.\n- The service is limited to **no more than 3 times per 12 months** per patient.\n- The **Schedule Fee** for this item is **$11.80**.\n- The **Medicare Benefit** is:\n  - **75%** = **$8.85**\n  - **85%** = **$10.05**\n- Important to note that Item 73812 does not apply if the patient has received:\n  - 4 other services in the last 12 months that include Item 73812, Item 66551, or Item 73826.\n- Ensure proper documentation and patient records to support compliance with the **12-month limitation** and **accreditation requirements**.\n- Regularly review and update practice protocols to align with the **National General Practice Accreditation Scheme** standards to avoid audit issues.",
    "updated": "2026-07-04"
  },
  "73826": {
    "content": "HEADING: MBS Item 73826 Summary for Billing Compliance\n\n- **Item Description**: Quantitation of glycated haemoglobin (HbA1c) performed by a participating nurse practitioner in the management of established diabetes.\n- **Conditions for Billing**:\n  - Must be performed as a **point-of-care test**.\n  - Conducted by a **nurse practitioner** in a general practice accredited to the **Royal Australian College of General Practitioners Standards** for point-of-care testing.\n  - Utilizes a method and instrument certified by the **National Glycohemoglobin Standardization Program (NGSP)**, with a total coefficient variation of less than **3.0%** at 48 mmol/mol (6.5%).\n- **Frequency Limitations**: Applicable **not more than 3 times per 12 months** per patient.\n- **Schedule Fee**: $11.80.\n- **Medicare Benefits**:\n  - 75% benefit = $8.85.\n  - 85% benefit = $10.05.\n- **Request for Service**:\n  - Must be in response to a **written request** from the treating practitioner or confirmed in writing within **14 days** if oral.\n  - Must be determined necessary by an **Approved Pathology Practitioner**.\n- **Provision of Service**:\n  - Must be provided by or on behalf of an **Approved Pathology Practitioner**.\n  - Conducted in a **pathology laboratory** accredited for the service.\n  - The laboratory must be owned by an **Approved Pathology Authority**.\n- **Audit Prevention**:\n  - Ensure compliance with all **accreditation standards** and **certification requirements**.\n  - Maintain accurate records of patient services to avoid exceeding the **3 times per 12 months** limit.\n  - Confirm that all requests for service meet the necessary **written confirmation** criteria.\n  - Verify that the service is performed in an **accredited laboratory** to ensure eligibility for Medicare benefits.\n- **Exclusions**: Item 73826 does not apply if the patient has received **4 other specified services** (including item 73826) in the last **12 months**.",
    "updated": "2026-07-04"
  },
  "2700": {
    "content": "HEADING: MBS Item 2700 Summary for Billing Compliance\n\n- Item 2700 is for **professional attendance** by a general practitioner (GP) for the preparation of a **Mental Health Treatment Plan**.\n- The duration of the consultation must be **at least 20 minutes but less than 40 minutes**.\n- The **schedule fee** for this item is **$85.80**, with a benefit of **75% equating to $64.35** and **100% at $85.80**.\n- Ensure that the patient is eligible under the **Better Access initiative** and that they are registered with **MyMedicare** or are receiving care from their **usual medical practitioner**.\n- Maintain **adequate and contemporaneous records** of the consultation to support the billing and to comply with audit requirements.\n- The service can be provided to **private inpatients** being discharged from hospital, but must be claimed at the **75% MBS benefit** if part of hospital treatment.\n- It is recommended that GPs providing these services have undertaken **mental health skills training** to ensure quality care.\n- There are **16 MBS items** related to Mental Health Treatment Plans; ensure correct item usage based on the practitioner's training status.\n- Be aware of the **associated items** for mental health services to avoid billing errors.\n- Regularly review and stay updated on the **explanatory notes** related to MBS Item 2700 to ensure compliance with any changes in guidelines or requirements.",
    "updated": "2026-07-04"
  },
  "2701": {
    "content": "HEADING: MBS Item 2701 Summary for Billing Compliance\n\n- Item 2701 pertains to **professional attendance** by a general practitioner (GP) for the preparation of a **Mental Health Treatment Plan**.\n- The consultation must last at least **40 minutes** to qualify for billing under this item.\n- The **schedule fee** for Item 2701 is **$126.35**, with a Medicare benefit of **75%** equating to **$94.80** and **100%** at **$126.35**.\n- This item is part of the **Better Access initiative**, aimed at providing mental health support.\n- Services can be billed by a GP or a **prescribed medical practitioner (PMP)** at the patient's **MyMedicare registered practice** or by their usual medical practitioner.\n- Ensure that the patient meets the **eligibility requirements** outlined in the explanatory notes, particularly regarding their MyMedicare registration.\n- There is **no limitation** on the number of health-related issues that can be addressed during the consultation, provided that the service requirements are met.\n- It is crucial to maintain **adequate and contemporaneous records** of the consultation to support the billing of this item.\n- GPs who have not undertaken **mental health skills training** can use this item, but it is strongly recommended to have appropriate training for effective service delivery.\n- The item is associated with other MBS items for mental health treatment, including 2700, 2715, and others, which may be relevant for comprehensive patient care.\n- Be aware of the **Extended Medicare Safety Net Cap** of **$379.05** for patients who may exceed this threshold in their mental health treatment.\n- Regularly review and stay updated on any changes to the MBS and associated explanatory notes to ensure compliance and prevent audit issues.",
    "updated": "2026-07-04"
  },
  "2715": {
    "content": "HEADING: MBS Item 2715 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 2715 pertains to professional attendance by a general practitioner (GP) for the preparation of a **Mental Health Treatment Plan**.\n- **Duration Requirement**: The attendance must be between **20 to 40 minutes** in duration.\n- **Eligibility**: Services are available to patients who meet the eligibility criteria under the **Better Access Initiative** and can be provided by a GP or prescribed medical practitioner (PMP) at the patient's MyMedicare registered practice or by their usual medical practitioner.\n- **Fee Structure**: \n  - Schedule Fee: **$108.95**\n  - Medicare Benefit: \n    - 75% = **$81.75**\n    - 100% = **$108.95**\n- **Extended Medicare Safety Net Cap**: The cap for this item is **$326.85**.\n- **Documentation**: It is crucial to maintain **adequate and contemporaneous records** of the consultation and the Mental Health Treatment Plan to support billing and prevent audits.\n- **Training Requirement**: GPs must have undertaken **mental health skills training** to bill for this item, emphasizing the importance of appropriate training in mental health care.\n- **Service Limitations**: There is no limitation on the number of health-related issues that can be addressed during the consultation, provided the service requirements are met.\n- **Associated Items**: Familiarize yourself with associated items (e.g., 2700, 2701, 2717) to ensure comprehensive billing practices.\n- **Patient Care**: The Mental Health Treatment Plan should document the care needs of patients with a clinically diagnosed mental disorder, ensuring a structured approach to treatment management.\n- **Audit Prevention**: Regularly review billing practices and ensure compliance with MBS guidelines to minimize the risk of audits and potential penalties.",
    "updated": "2026-07-04"
  },
  "2717": {
    "content": "HEADING: MBS Item 2717 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 2717 pertains to a professional attendance by a general practitioner (GP) for the preparation of a **Mental Health Treatment Plan** lasting at least **40 minutes**.\n\n- **Eligibility**: Services are available to patients who meet the eligibility requirements under the **Better Access Initiative**. This includes patients enrolled in **MyMedicare** or those receiving care from their usual medical practitioner.\n\n- **Training Requirement**: Only GPs who have undertaken **mental health skills training** recognized by the **General Practice Mental Health Standards Collaboration** can bill for this item.\n\n- **Fee Structure**: \n  - Schedule Fee: **$160.50**\n  - Medicare Benefit: \n    - 75% = **$120.40**\n    - 100% = **$160.50**\n  \n- **Documentation**: It is crucial to maintain **adequate and contemporaneous records** of the consultation to support the billing of this item and to demonstrate compliance with service requirements.\n\n- **Service Scope**: There is no limitation on the number of health-related issues that can be addressed during the consultation, provided the service requirements are met.\n\n- **Associated Items**: Familiarize yourself with associated MBS items (e.g., 2700, 2701, 2715) for comprehensive billing practices related to mental health treatment.\n\n- **Audit Prevention**: Ensure that all claims for Item 2717 are supported by:\n  - Clear documentation of the **40-minute consultation**.\n  - Evidence of **mental health skills training**.\n  - Compliance with the **Better Access Initiative** eligibility criteria.\n\n- **Patient Management**: The Mental Health Treatment Plan should clearly identify and document the care needs of patients with clinically diagnosed mental disorders, ensuring a structured approach to their treatment.\n\n- **Review and Follow-Up**: Regularly review the Mental Health Treatment Plan and provide ongoing management as necessary, ensuring that all follow-up consultations are also documented and compliant with MBS requirements.",
    "updated": "2026-07-04"
  },
  "2712": {
    "content": "HEADING: MBS Item 2712 Overview\n\n- MBS Item **2712** is a specific item listed in the **Medicare Benefits Schedule** for Australian General Practice.\n- As of the latest update, there are **no records** found for Item 2712, indicating it may be **inactive** or **not applicable**.\n\nHEADING: Billing Compliance Considerations\n\n- Ensure that Item 2712 is **not billed** if it is currently **inactive** or **not listed** in the MBS.\n- Regularly check the **Medicare Benefits Schedule** for updates or changes to item statuses to avoid billing errors.\n- Maintain accurate and up-to-date records of all billed items to support compliance during audits.\n- Document the **clinical rationale** for any services provided, ensuring they align with the requirements of the MBS.\n- Be aware of the **specific criteria** that must be met for billing any MBS item, including Item 2712, to prevent potential audit issues.\n\nHEADING: Audit Prevention Strategies\n\n- Conduct regular training for staff on the **Medicare billing process** and the importance of verifying item eligibility.\n- Implement a **checklist** for billing procedures that includes verification of item status in the MBS.\n- Utilize **software tools** that integrate with MBS updates to flag any discrepancies in billing practices.\n- Establish a **review process** for claims submitted to ensure compliance with MBS guidelines and prevent billing of inactive items.",
    "updated": "2026-07-04"
  },
  "2713": {
    "content": "HEADING: MBS Item 2713 Overview\n\n- MBS Item **2713** is currently **not listed** in the Medicare Benefits Schedule.\n- Ensure to **verify** the status of MBS Item 2713 through the official MBS Online platform for any updates or changes.\n- As there are **no records** found for this item, it is crucial to avoid billing for this item to prevent potential **audit issues**.\n- Always check for the **correct item numbers** and their descriptions before submitting claims to Medicare.\n- Maintain accurate and up-to-date records of all services provided to ensure compliance with Medicare billing requirements.\n- In the absence of a valid item number, consider alternative MBS items that may be applicable to the services rendered.\n- Regularly review the MBS for any **new items** or amendments that may affect billing practices.\n- Document all patient interactions and services thoroughly to support any claims submitted to Medicare.",
    "updated": "2026-07-04"
  },
  "2729": {
    "content": "HEADING: MBS Item 2729 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 2729 is currently not available in the Medicare Benefits Schedule, indicating it may be a deleted or renumbered item.\n- **Billing Compliance**: Ensure that billing for services aligns with the current MBS listings to avoid claims rejection.\n- **Audit Prevention**: \n  - Regularly verify the status of MBS items to confirm their availability and correct usage.\n  - Maintain accurate records of services provided and ensure they correspond with the MBS items billed.\n- **Documentation**: \n  - Keep detailed clinical notes that justify the use of any MBS item billed, especially if it is a complex or high-value item.\n  - Ensure that all patient interactions and treatments are documented in accordance with Medicare guidelines.\n- **Updates and Changes**: \n  - Stay informed about any amendments or changes to the MBS, including new items or deletions, to ensure compliance.\n  - Subscribe to updates from the Department of Health and Aged Care for the latest information on MBS items.\n- **Training and Education**: \n  - Regularly train staff on MBS compliance and billing practices to minimize errors and enhance understanding of the MBS.\n- **Consultation**: \n  - If in doubt about the billing of a specific item, consult with a medical compliance expert or refer to the MBS for clarification.",
    "updated": "2026-07-04"
  },
  "4": {
    "content": "HEADING: MBS Item 4 Summary for Billing Compliance\n\n- MBS Item 4 pertains to **Level A professional attendance** by a general practitioner (GP) in settings where no other item applies.\n- This item is applicable for **short patient history** and, if necessary, **limited examination and management**.\n- The attendance must occur on **one occasion** for **one or more patients** at the same location.\n- The fee structure includes:\n  - The fee for **Item 3** plus **$31.50** divided by the number of patients seen (up to a maximum of six patients).\n  - For **seven or more patients**, the fee for Item 3 plus **$2.50** per additional patient.\n- Ensure compliance with the **Extended Medicare Safety Net Cap**, which is **300% of the derived fee** for this item or **$500**, whichever is lesser.\n- Claims should only be made when **no other MBS item** accurately reflects the service provided.\n- Maintain **appropriate and contemporaneous records** of all services rendered, including:\n  - Patient history\n  - Clinical examination\n  - Investigations arranged\n  - Management plans implemented\n  - Preventive health care provided\n- Understand the distinction between **professional** and **personal attendances**:\n  - Professional attendance includes evaluating, formulating management plans, and providing advice.\n  - Personal attendance requires the patient to be present, and only time spent with the patient counts towards the attendance.\n- Be aware that benefits are not payable if more than one medical practitioner provides an attendance on the same patient at the same time.\n- For telehealth services, ensure compliance with modified requirements for attendance by a single health professional on a single person.\n- Regularly review and update knowledge on MBS guidelines to prevent audit issues and ensure accurate billing practices.",
    "updated": "2026-07-04"
  },
  "7": {
    "content": "HEADING: MBS Item 7 Overview\n\n- MBS Item 7 pertains to **consultation services** provided by General Practitioners (GPs).\n- It is essential to ensure that the **consultation** meets the criteria outlined in the MBS for appropriate billing.\n- The item is applicable for **face-to-face consultations** with patients.\n\nHEADING: Billing Compliance Guidelines\n\n- Ensure that the **consultation duration** aligns with the requirements for Item 7.\n- Document the **clinical details** of the consultation thoroughly in the patient's medical record.\n- Verify that the **reason for the consultation** is clearly stated and justifiable.\n- Maintain accurate records of any **referrals** or follow-up actions taken during the consultation.\n- Ensure that the **patient's consent** is obtained and documented, particularly for any procedures performed.\n- Review the **Medicare Benefits Schedule** regularly for any updates or changes to Item 7.\n\nHEADING: Audit Prevention Strategies\n\n- Conduct regular **internal audits** of billing practices to ensure compliance with MBS Item 7.\n- Train staff on the importance of **accurate documentation** and the implications of incorrect billing.\n- Implement a system for **tracking consultations** to ensure all eligible services are billed correctly.\n- Establish a protocol for addressing any discrepancies or **billing errors** promptly.\n- Stay informed about **Medicare compliance updates** and changes to MBS items to mitigate audit risks.",
    "updated": "2026-07-04"
  },
  "90250": {
    "content": "HEADING: MBS Item 90250 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 90250 pertains to the professional attendance by a general practitioner to prepare an **eating disorder treatment and management plan** (EDTMP) lasting at least **20 minutes but less than 40 minutes**.\n  \n- **Fee Structure**: The schedule fee for Item 90250 is **$85.80**, with a benefit of **100%** payable by Medicare.\n\n- **Eligibility Criteria**: The service is applicable for patients diagnosed with **anorexia nervosa, bulimia nervosa, binge-eating disorder**, and other specified eating disorders who meet the eligibility criteria.\n\n- **Plan Validity**: The EDTMP is valid for **12 months** from the date of service. If the plan expires, the patient is not eligible for further eating disorder treatment services.\n\n- **Preparation Requirements**: The preparation of the EDTMP must include:\n  - Discussion of the patient\u2019s **medical and psychological health** with the patient and, if appropriate, their family/carer.\n  - Identification and discussion of **referral and treatment options**.\n  - Agreement on **treatment goals** with the patient and family/carer.\n  - Planning for **patient and family education**.\n  - Development of a **crisis intervention and relapse prevention plan**.\n  - Arrangements for **referrals, treatment, and follow-up**.\n  - Documentation of assessment results, patient needs, goals, and review dates.\n\n- **Assessment Requirements**: The practitioner must perform or review necessary assessments to confirm the patient meets eligibility criteria. This includes:\n  - Taking a relevant **history** (biological, psychological, social).\n  - Conducting a **medical review** and physical examination.\n  - Assessing **mental state** and identifying any comorbid conditions.\n  - Evaluating **eating disorder behaviors** and associated risks.\n\n- **Audit Prevention**: To prevent audits:\n  - Ensure thorough documentation of all discussions, assessments, and plans.\n  - Confirm that the time spent preparing the EDTMP does not overlap with time spent on assessments.\n  - Maintain clear records of patient eligibility and treatment goals.\n  - Regularly review and update the EDTMP as necessary within the 12-month period.\n\n- **Provider Eligibility**: Services can be rendered by:\n  - General practitioners and non-specialist medical practitioners who can provide general practitioner services under Group A1 of the MBS.\n\n- **Best Practice**: It is recommended that a **comprehensive physical assessment** be performed to support ongoing patient management and monitoring.\n\nBy adhering to these guidelines, compliance with MBS Item 90250 can be maintained, reducing the risk of audit issues.",
    "updated": "2026-07-04"
  },
  "90251": {
    "content": "HEADING: MBS Item 90251 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 90251 covers professional attendance by a general practitioner to prepare an **eating disorder treatment and management plan** (EDTMP) lasting at least **40 minutes**.\n- **Fee Structure**: The schedule fee is **$126.35**, with a benefit of **100%** payable by Medicare.\n- **Eligibility Criteria**: The service is applicable for patients diagnosed with **anorexia nervosa**, **bulimia nervosa**, **binge-eating disorder**, and other specified eating disorders who meet the eligibility criteria.\n- **Plan Expiry**: The EDTMP is valid for **12 months** from the date of service; services are not available if the plan has expired.\n- **Preparation Requirements**: The preparation of the EDTMP must include:\n  - Discussion of the patient\u2019s **medical and psychological health** with the patient and, if appropriate, their family/carer.\n  - Identification and discussion of **referral and treatment options**.\n  - Agreement on **treatment goals** with the patient and family/carer.\n  - Planning for **patient and family education**.\n  - Development of a **crisis intervention and relapse prevention plan**.\n  - Arrangements for **referrals, treatment, and follow-up**.\n  - Documentation of assessment results, patient needs, goals, actions, and review dates.\n  - Discussion of the need for **higher intensity psychological treatment** if required.\n- **Assessment Requirements**: The practitioner must perform or review necessary assessments to confirm the patient meets eligibility criteria, including:\n  - Comprehensive **medical review** and **physical examination**.\n  - Assessment of **mental state** and identification of **comorbid conditions**.\n  - Evaluation of **eating disorder behaviors** and associated risks.\n  - Assessment of **family and carer support**.\n- **Documentation**: Accurate and thorough documentation is essential to support the claim, including:\n  - Detailed notes on patient assessments and discussions.\n  - Clear records of treatment goals and plans.\n  - Evidence of compliance with the **12-month review requirement**.\n- **Audit Prevention**: Ensure all elements of the service are documented and that the time spent preparing the EDTMP is clearly distinguished from any assessment time to avoid potential audit issues.",
    "updated": "2026-07-04"
  },
  "90252": {
    "content": "HEADING: MBS Item 90252 Compliance Summary\n\n- **Item Description**: MBS Item 90252 pertains to the professional attendance by a general practitioner for the preparation of an **eating disorder treatment and management plan** (EDTMP) lasting at least **20 minutes but less than 40 minutes**.\n\n- **Eligibility Requirements**: The practitioner must have successfully completed **mental health skills training** to bill this item.\n\n- **Fee Structure**: The schedule fee for Item 90252 is **$108.95**, with a benefit of **100%** payable by Medicare.\n\n- **Service Duration**: Ensure that the consultation lasts **at least 20 minutes** but does not exceed **40 minutes** to meet billing criteria.\n\n- **Patient Eligibility**: The patient must have a diagnosis of **anorexia nervosa, bulimia nervosa, binge-eating disorder**, or other specified eating disorders to qualify for this service.\n\n- **Plan Expiry**: The EDTMP is valid for **12 months** from the date of service. If the plan expires, further psychological treatment services are not available until a new plan is created.\n\n- **Documentation Requirements**: Comprehensive documentation must include:\n  - Patient\u2019s **medical and psychological health status**.\n  - Discussion of **referral and treatment options**.\n  - Agreement on **treatment goals** with the patient and family/carer.\n  - Plans for **patient and family education**.\n  - Crisis intervention and relapse prevention strategies.\n  - Arrangements for **referrals and follow-up**.\n  - Detailed notes on **assessments, goals, and review dates**.\n\n- **Assessment Components**: A thorough assessment should include:\n  - Relevant **history** (biological, psychological, social).\n  - **Eating disorder diagnostic assessment**.\n  - **Medical review** including physical examination.\n  - **Mental state assessment** and identification of comorbid conditions.\n  - Evaluation of **eating disorder behaviors** and associated risks.\n\n- **Audit Prevention**: To prevent audits, ensure:\n  - All eligibility criteria are met and documented.\n  - Time spent on assessments is **not included** in the time for preparing the EDTMP.\n  - Maintain clear and comprehensive records of all discussions and plans made during the consultation.\n\n- **Best Practice**: It is recommended to perform a **comprehensive physical examination** to support ongoing patient management and monitor medical and nutritional status effectively.",
    "updated": "2026-07-04"
  },
  "90253": {
    "content": "HEADING: MBS Item 90253 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 90253 covers professional attendance by a general practitioner to prepare an **eating disorder treatment and management plan** (EDTMP) lasting at least **40 minutes**.\n- **Eligibility**: The practitioner must have successfully completed **mental health skills training** to bill this item.\n- **Fee Structure**: The schedule fee is **$160.50**, with a benefit of **100%** payable by Medicare.\n- **Extended Medicare Safety Net**: The cap for this item is **$481.50**.\n- **Patient Eligibility**: The patient must have a diagnosis of **anorexia nervosa**, **bulimia nervosa**, **binge-eating disorder**, or other specified eating disorders to qualify for the service.\n- **Plan Validity**: The EDTMP is valid for **12 months** from the date of service; services are not available if the plan has expired.\n- **Preparation Requirements**: The plan must include:\n  - Discussion of the patient\u2019s **medical and psychological health**.\n  - Identification of **referral and treatment options**.\n  - Agreement on **treatment goals** with the patient and family/carer.\n  - Planning for **patient and family education**.\n  - A **crisis intervention** and/or **relapse prevention** plan.\n  - Arrangements for **referrals** and **follow-up**.\n  - Documentation of assessment results, patient needs, goals, and review dates.\n- **Assessment Components**: A comprehensive assessment should include:\n  - Relevant **history** (biological, psychological, social).\n  - **Eating disorder diagnostic assessment**.\n  - **Medical review** including physical examination.\n  - **Mental state assessment** and identification of comorbid conditions.\n  - Assessment of **eating disorder behaviors** and associated risks.\n  - Evaluation of **family and/or carer support**.\n- **Audit Prevention**: Ensure all documentation is thorough and includes:\n  - Evidence of the **40-minute consultation**.\n  - Clear records of discussions and agreements with the patient and family.\n  - Comprehensive assessment details to justify the service provided.\n- **Best Practice**: It is recommended to perform a **comprehensive physical assessment** to support ongoing management and monitoring of the patient's condition.",
    "updated": "2026-07-04"
  },
  "90264": {
    "content": "HEADING: MBS Item 90264 Summary for Billing Compliance\n\n- Item 90264 pertains to **professional attendance** by a general practitioner for the **review of an eating disorder treatment and management plan**.\n- The **scheduled fee** for this item is **$85.80**, with a benefit of **100%** payable.\n- This item is part of the **Eating Disorder Services** category and is specifically for **reviewing treatment plans**.\n- Ensure that the patient has had an **Eating Disorder Treatment and Management Plan (EDTMP)** within the **previous 12 months** to qualify for this item.\n- The review must include:\n  - **Patient agreement** for the service.\n  - **Referral** to a psychiatrist or paediatrician if not previously initiated.\n  - A systematic review of the patient\u2019s progress against the **EDTMP goals**.\n  - Discussion with the patient and/or their family/carer regarding the effectiveness of the treatment.\n  - **Modification** of the EDTMP if necessary.\n  - **Crisis intervention and relapse prevention** planning, if appropriate.\n  - Review of reports from allied mental health professionals regarding the patient\u2019s treatment response.\n- Document all findings and recommendations thoroughly to support the claim.\n- It is essential to maintain **ongoing communication** with the patient and other healthcare providers as part of the management plan.\n- Claims for ongoing patient reviews should be submitted under the appropriate item, not under 90264.\n- Be aware that if the EDTMP has not been claimed, Services Australia will not recognize the patient's eligibility for this item.\n- If there is uncertainty regarding a patient's eligibility, contact Services Australia for confirmation of previous claims related to eating disorder services.",
    "updated": "2026-07-04"
  },
  "30003": {
    "content": "HEADING: MBS Item 30003 Summary for Billing Compliance\n\n- Item 30003 pertains to the **dressing of burns** involving **1% or more but less than 3%** of total body surface.\n- The procedure must be performed **without anaesthesia** and requires the presence of a **medical practitioner**.\n- Each attendance where the procedure is performed is billable under this item.\n- The item is **not applicable** for skin reactions that are secondary to **radiotherapy**.\n- The **schedule fee** for Item 30003 is **$43.50**.\n- Medicare benefits are structured as follows:\n  - **75% benefit** = **$32.65**\n  - **85% benefit** = **$37.00**\n- Ensure accurate documentation of the **percentage of body surface** affected by burns to support billing.\n- Maintain records of **attendance** and **procedures performed** to comply with audit requirements.\n- Be aware of the **Multiple Operation Rule** which may affect billing if multiple procedures are performed.\n- Regularly review updates to the MBS to ensure compliance with any changes in item descriptions or fees.",
    "updated": "2026-07-04"
  },
  "30026": {
    "content": "HEADING: MBS Item 30026 Summary for Billing Compliance\n\n- Item 30026 pertains to the **repair of superficial wounds** not exceeding **7 cm** in length, specifically for wounds that are not located on the face or neck.\n- The procedure must be performed using **suture, tissue adhesive resin**, or **clips**; it does not cover wound repairs conducted at the time of surgery.\n- Ensure that the wound is classified as **superficial**, affecting only the skin and subcutaneous tissue, and not involving deeper tissues such as fascia or muscle.\n- The **schedule fee** for Item 30026 is **$62.55**, with benefits payable at **75%** ($46.95) and **85%** ($53.20).\n- Be aware of the **Multiple Operation Rule** which may affect billing if multiple procedures are performed during the same session.\n- Review the **associated notes** (TN.8.6) to confirm that the service provided does not overlap with other items in Group T4, particularly regarding debridement of traumatic wounds.\n- Maintain thorough documentation of the procedure, including the method of repair and the characteristics of the wound, to support compliance and prevent audit issues.\n- Regularly update knowledge on any changes to the MBS, including fee adjustments and item descriptions, to ensure accurate billing practices.",
    "updated": "2026-07-04"
  },
  "30029": {
    "content": "HEADING: MBS Item 30029 Summary for Billing Compliance\n\n- Item 30029 pertains to the **repair of wounds** that are not on the face or neck, specifically for small wounds not exceeding **7 cm in length**.\n- The procedure involves **deeper tissue** repair and is not applicable for wound closure performed at the time of surgery.\n- The item is categorized under **Category 3 - Therapeutic Procedures** and falls within **Group T8 - Surgical Operations**.\n- The **schedule fee** for Item 30029 is **$107.75**, with benefits payable at **75% ($80.85)** and **85% ($91.60)**.\n- Ensure that the repair is conducted using **suture, tissue adhesive resin**, or **clips** as specified; other methods may not be covered.\n- This item does not cover **debridement** that is part of an operative approach to treat fractures; refer to Item 30023 for such cases.\n- The terms **'superficial'** and **'deeper tissue'** are defined in the context of the item, with superficial affecting skin and subcutaneous tissue, while deeper includes fascia and muscle.\n- Be aware of the **Multiple Operation Rule** which may affect billing if multiple procedures are performed.\n- Maintain thorough documentation of the procedure, including the **length of the wound** and the **method of repair**, to support compliance and prevent audit issues.\n- Regularly review updates to the MBS and associated notes to ensure adherence to current billing practices and guidelines.",
    "updated": "2026-07-04"
  },
  "30032": {
    "content": "HEADING: MBS Item 30032 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 30032 pertains to the **repair of a wound** on the **face or neck**, specifically for wounds that are **not more than 7 cm long** and are classified as **superficial**.\n- **Fee Structure**: The schedule fee for this item is **$98.70**. The benefit payable is **75%** of the fee, amounting to **$74.05**, and **85%** of the fee is **$83.90**.\n- **Eligibility Criteria**: This item is applicable for **wound repairs** that are performed using **suture, tissue adhesive resin**, or **clips**. It does not cover repairs conducted at the time of surgery.\n- **Exclusions**: Benefits are not payable for **debridement** that is part of an operative approach to treat fractures. Ensure that the procedure does not fall under this exclusion to maintain compliance.\n- **Definition of Terms**: \n  - **Superficial**: Refers to wounds affecting the **skin and subcutaneous tissue**, including fat.\n  - **Deeper tissue**: Refers to all tissues deep to but not including subcutaneous tissue, such as **fascia and muscle**.\n- **Audit Prevention**: \n  - Ensure accurate documentation of the **wound size** and **location** to justify the use of Item 30032.\n  - Maintain clear records of the **technique used** for the repair (suture, adhesive, or clips) to support claims.\n  - Regularly review compliance with the **exclusions** and **definitions** provided in the MBS to avoid billing errors.\n- **Related Items**: Familiarize yourself with related items (30023, 30026, 30029, 30035, 30038, 30042, 30045, 30049) for comprehensive understanding and correct billing practices.",
    "updated": "2026-07-04"
  },
  "30035": {
    "content": "HEADING: MBS Item 30035 Summary for Billing Compliance\n\n- Item 30035 pertains to the **repair of wounds** on the face or neck, specifically for wounds that are **not more than 7 cm long** and involve **deeper tissue**.\n- The procedure must be performed using **suture, tissue adhesive resin**, or **clips**; it does not cover wound closure at the time of surgery.\n- The **schedule fee** for Item 30035 is **$140.70**, with benefits payable at **75% ($105.55)** and **85% ($119.60)**.\n- Ensure compliance with the **Multiple Operation Rule** when billing for this item, as it may affect the fee structure.\n- The term **'superficial'** refers to wounds affecting skin and subcutaneous tissue, while **'deeper tissue'** includes fascia and muscle.\n- Benefits are not payable for **debridement** that is part of an operative approach to treat fractures; this is covered under Item 30023.\n- Maintain accurate documentation of the **procedure performed**, including the method of repair, to support claims and prevent audits.\n- Regularly review the **explanatory notes** associated with Item 30035, particularly paragraph **TN.8.6**, to ensure understanding of the item\u2019s requirements and limitations.\n- Be aware of related items (30023, 30026, 30029, 30032, 30038, 30042, 30045, 30049) for comprehensive billing practices and to avoid potential compliance issues.",
    "updated": "2026-07-04"
  },
  "30061": {
    "content": "HEADING: MBS Item 30061 Summary for Billing Compliance\n\n- Item 30061 pertains to the **removal of superficial foreign bodies** from the body, including the **cornea or sclera**, as an independent procedure.\n- This item falls under **Category 3 - Therapeutic Procedures** and is classified within **Group T8 - Surgical Operations**.\n- The **schedule fee** for Item 30061 is **$28.15**.\n- The **Medicare benefit** for this item is structured as follows:\n  - **75% benefit**: $21.15\n  - **85% benefit**: $23.95\n- The item has been in effect since **01-Dec-1991**, with the schedule fee last updated on **01-Jul-2026**.\n- Ensure that the procedure is documented as an **independent procedure** to comply with billing requirements.\n- Be aware of the **Multiple Operation Rule** when billing for this item in conjunction with other procedures.\n- Maintain accurate and thorough **clinical documentation** to support the necessity of the procedure and the billing claim.\n- Regularly review and stay updated on any changes to the **MBS** to ensure compliance and prevent audit issues.",
    "updated": "2026-07-04"
  },
  "30064": {
    "content": "HEADING: MBS Item 30064 Summary for Billing Compliance\n\n- Item 30064 pertains to the **removal of a subcutaneous foreign body** requiring incision and exploration.\n- This procedure includes **closure of the wound** if performed, and is classified as an **independent procedure**.\n- The **schedule fee** for this item is **$131.55**.\n- The **Medicare benefit** is structured as follows:\n  - **75% benefit**: $98.70\n  - **85% benefit**: $111.85\n- Ensure that the procedure is documented thoroughly to support the **medical necessity** of the intervention.\n- Verify that the **Multiple Operation Rule** is adhered to when billing for multiple procedures performed during the same session.\n- Maintain accurate records of the **incision and exploration** performed, as well as any additional procedures, to prevent audit discrepancies.\n- Confirm that the procedure aligns with the **clinical guidelines** and is justified based on the patient's condition.\n- Regularly review billing practices to ensure compliance with the latest updates to the **Medicare Benefits Schedule**.",
    "updated": "2026-07-04"
  },
  "30071": {
    "content": "HEADING: MBS Item 30071 Summary for Billing Compliance\n\n- **Item Description**: Item 30071 refers to a **diagnostic biopsy of skin** performed as an independent procedure, with the requirement that the biopsy specimen is sent for **pathological examination**.\n\n- **Fee Structure**: \n  - Schedule Fee: **$62.55**\n  - Benefit: \n    - 75% = **$46.95**\n    - 85% = **$53.20**\n  - Extended Medicare Safety Net Cap: **$50.05**\n\n- **Eligibility Criteria**: \n  - The biopsy must be necessary to **confirm a diagnosis** and facilitate appropriate management of the lesion.\n  - The procedure must be performed independently, not as part of another surgical operation.\n\n- **Multiple Operation Rule**: \n  - Ensure compliance with the **Multiple Operation Rule** when billing for this item, particularly in relation to anaesthesia.\n\n- **Aftercare Period**: \n  - The aftercare period for Item 30071 is **2 days**, which differs from the standard aftercare period for skin excisions (10 days).\n\n- **Documentation Requirements**: \n  - Maintain clear documentation that the biopsy was performed for **diagnostic purposes** and that the specimen was sent for pathological examination.\n  - Ensure that the clinical notes justify the need for the biopsy and the subsequent management plan.\n\n- **Audit Prevention**: \n  - Regularly review billing practices to ensure adherence to the specific requirements of Item 30071.\n  - Be aware of related items (30072, 30078, etc.) and ensure correct item usage to avoid billing errors.\n\n- **Important Notes**: \n  - Needle aspiration biopsy is billed on an **attendance basis** and should not be claimed under Item 30071.\n  - If a shave biopsy results in a definitive excision, only Item 30071 or 30072 can be claimed.\n\n- **Compliance Best Practices**: \n  - Conduct periodic audits of biopsy claims to ensure compliance with MBS guidelines.\n  - Provide training for staff on the specific requirements and documentation needed for Item 30071 to minimize the risk of non-compliance.",
    "updated": "2026-07-04"
  },
  "30072": {
    "content": "HEADING: MBS Item 30072 Summary for Billing Compliance\n\n- **Item Description**: Item 30072 pertains to the **diagnostic biopsy of mucous membrane** as an independent procedure, requiring the biopsy specimen to be sent for **pathological examination**.\n\n- **Fee Structure**: \n  - Schedule Fee: **$62.55**\n  - Benefit: \n    - 75% = **$46.95**\n    - 85% = **$53.20**\n\n- **Eligibility Criteria**: \n  - The biopsy must be performed to **confirm a diagnosis** and facilitate appropriate management of the lesion.\n  - Only applicable if the biopsy results in a definitive excision of the lesion.\n\n- **Aftercare Period**: \n  - The aftercare period for this item is **2 days**, which is shorter than the standard aftercare period for skin excisions (10 days).\n\n- **Multiple Operation Rule**: \n  - Ensure compliance with the **Multiple Operation Rule** when billing for this item, particularly in relation to anaesthesia.\n\n- **Documentation Requirements**: \n  - Maintain thorough documentation that includes the **indication for the biopsy**, the procedure performed, and confirmation that the specimen was sent for pathological examination.\n\n- **Audit Prevention**: \n  - Regularly review billing practices to ensure adherence to the specific requirements of Item 30072.\n  - Be aware of related items (30071, 30078, etc.) to avoid incorrect billing and potential audits.\n\n- **Important Notes**: \n  - Needle aspiration biopsy is billed on an **attendance basis** and does not fall under Item 30072.\n  - Ensure that all procedures are justified and documented to support claims made under this item.",
    "updated": "2026-07-04"
  },
  "30107": {
    "content": "HEADING: MBS Item 30107 Summary for Billing Compliance\n\n- Item 30107 pertains to the **excision of a ganglion** and is classified under **Category 3 - Therapeutic Procedures**.\n- The item is specifically for **general excision** of ganglia, excluding services associated with other items in the same group.\n- The **schedule fee** for Item 30107 is **$263.15**.\n- The **Medicare benefit** for this item is structured as follows:\n  - **75% benefit**: $197.40\n  - **85% benefit**: $223.70\n- Ensure that the procedure is performed in accordance with the **Multiple Operation Rule** when applicable.\n- Item 30107 has been in effect since **01-Dec-1991**, with updates to the description on **01-Jul-2021** and the schedule fee on **01-Jul-2026**.\n- Maintain accurate documentation of the procedure to support claims and prevent audit discrepancies.\n- Verify that the service provided aligns with the description of Item 30107 to avoid billing errors.\n- Regularly review updates to the MBS to ensure compliance with any changes in item descriptions or fees.",
    "updated": "2026-07-04"
  },
  "30192": {
    "content": "HEADING: MBS Item 30192 Summary for Billing Compliance\n\n- Item 30192 pertains to the **treatment of premalignant skin lesions**, including solar keratoses, using **ablative techniques** for **10 or more lesions**.\n- The **schedule fee** for this item is **$47.30**, with benefits payable at **75% ($35.50)** and **85% ($40.25)**.\n- Ensure that the treatment involves **10 or more lesions** to qualify for this item; treatment of fewer than 10 lesions must be billed on an **attendance basis**.\n- The item falls under **Category 3 - Therapeutic Procedures** and is classified within **Group T8 - Surgical Operations**.\n- Be aware of the **Multiple Operation Rule** which may apply when multiple lesions are treated.\n- Treatment of **seborrheic keratoses** and other similar conditions by any means will only attract benefits on an **attendance basis**.\n- For warts and molluscum contagiosum, benefits are also on an **attendance basis** unless specific conditions apply, such as:\n  - Admission to an **operating theatre** for treatment.\n  - Recurrence after treatment under item 30189.\n  - Treatment of palmar and plantar warts by laser in an **accredited facility**.\n- Maintain accurate documentation to support the number of lesions treated and the method of treatment to prevent audit issues.\n- Regularly review updates to the MBS and associated notes to ensure compliance with billing practices.",
    "updated": "2026-07-04"
  },
  "30196": {
    "content": "HEADING: MBS Item 30196 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 30196 pertains to the removal of malignant neoplasms of skin or mucous membrane through techniques such as **serial curettage**, **carbon dioxide laser**, or **erbium laser excision-ablation**.\n\n- **Histopathological Requirement**: Malignancy must be **proven by histopathology** or confirmed by a **specialist** in dermatology or plastic surgery. Documentation must be retained to support this.\n\n- **Multiple Lesions**: For multiple lesions in the same anatomical region, histopathological proof is satisfied if **one lesion** from that region is tested and proven malignant.\n\n- **Anatomical Regions Defined**: The anatomical regions include areas such as the **hand, forearm, upper arm, shoulder, trunk, abdomen, buttock, genital area, legs, neck, face**, and **scalp**.\n\n- **Documentation**: It is crucial to maintain **detailed documentation** of the malignancy confirmation, either through histopathology or specialist opinion, to ensure compliance and prevent audit issues.\n\n- **Fee Structure**: The schedule fee for Item 30196 is **$151.10**, with benefits of **75%** ($113.35) and **85%** ($128.45) applicable.\n\n- **Audit Prevention**: Ensure all claims are supported by appropriate documentation to avoid potential audits. This includes retaining evidence of malignancy and confirming the procedure performed aligns with the item description.\n\n- **Guidelines Reference**: Refer to the Department of Health guidelines for substantiating proof of malignancy to ensure compliance with MBS requirements. \n\n- **Related Items**: Be aware of related items such as **Item 30202**, which may have similar requirements and documentation needs. \n\n- **Compliance Check**: Regularly review billing practices against MBS Item 30196 to ensure adherence to guidelines and prevent discrepancies during audits.",
    "updated": "2026-07-04"
  },
  "30202": {
    "content": "HEADING: MBS Item 30202 Summary for Billing Compliance\n\n- Item 30202 pertains to the **removal of malignant neoplasms** of skin or mucous membrane using **liquid nitrogen cryotherapy**.\n- The procedure must be performed using **repeat freeze-thaw cycles**.\n- **Histopathological proof of malignancy** is required, or confirmation from a **specialist in dermatology or plastic surgery**.\n- If multiple lesions are treated in the same anatomical region, only one lesion needs to be **histologically tested** for malignancy.\n- An **anatomical region** is defined broadly, including areas such as the hand, forearm, face, and trunk.\n- The **Schedule Fee** for this item is **$57.80**, with benefits of **75% = $43.35** and **85% = $49.15**.\n- Ensure **documented evidence** of malignancy is retained to support claims for this item.\n- Familiarize yourself with the **guidelines** available on the Department of Health website regarding proof of malignancy.\n- Adhere to the **Multiple Operation Rule** when billing for multiple procedures to avoid compliance issues.\n- Regularly review and update your knowledge on any changes to the MBS or associated guidelines to maintain compliance.",
    "updated": "2026-07-04"
  },
  "30216": {
    "content": "HEADING: MBS Item 30216 Summary for Billing Compliance\n\n- Item 30216 pertains to the **aspiration of a hematoma** and falls under Category 3 - **Therapeutic Procedures**.\n- The **schedule fee** for this item is **$32.75**.\n- Medicare benefits for this item are structured as follows:\n  - **75% benefit**: $24.60\n  - **85% benefit**: $27.85\n- The **Extended Medicare Safety Net Cap** for this item is **$26.20**.\n- The item has been in effect since **01-Dec-1991**, with the schedule fee updated on **01-Jul-2026**.\n- Ensure that the procedure is performed in accordance with the **Multiple Operation Rule** and that appropriate **anaesthesia** is considered if applicable.\n- Documentation must clearly indicate the **medical necessity** for the aspiration of the hematoma to support billing.\n- Maintain accurate records of the procedure, including **patient consent**, **clinical indications**, and **outcomes**, to prevent audit issues.\n- Regularly review billing practices to ensure compliance with the latest **MBS updates** and guidelines.",
    "updated": "2026-07-04"
  },
  "30219": {
    "content": "HEADING: MBS Item 30219 Summary for Billing Compliance\n\n- Item 30219 pertains to the **incision and drainage** of a **haematoma, furuncle, small abscess**, or similar lesion that does not require hospital admission.\n- The **Schedule Fee** for this item is **$32.75**, with benefits of **75%** equating to **$24.60** and **85%** equating to **$27.85**.\n- This item is categorized under **Category 3 - Therapeutic Procedures** and falls within **Group T8 - Surgical Operations**.\n- Ensure that the procedure is performed in accordance with the **Multiple Operation Rule** to avoid billing discrepancies.\n- **Aftercare** is generally included in the Schedule fee for this item; therefore, additional consultations during the aftercare period are typically **not claimable** unless they meet specific criteria.\n- If aftercare is required for a condition unrelated to the initial procedure, it must be clearly identified as **'Not normal aftercare'** with a brief explanation to be eligible for claims.\n- Consultations related to **cosmetic procedures** or services that do not attract Medicare benefits are **not claimable** under this item.\n- For **public patients**, aftercare related to their hospital treatment is provided free of charge, and no Medicare benefits are payable unless they choose to consult a private practitioner independently.\n- Maintain accurate documentation of the procedure and any subsequent consultations to support claims and prevent audit issues.\n- Be aware that **surgical procedures performed primarily for cosmetic reasons** are not eligible for Medicare benefits unless specific medical reasons apply. \n\nThis summary serves as a guideline for compliance with billing practices related to MBS Item 30219, ensuring adherence to Medicare regulations and minimizing the risk of audits.",
    "updated": "2026-07-04"
  },
  "41500": {
    "content": "HEADING: MBS Item 41500 Summary for Billing Compliance\n\n- Item 41500 pertains to the **removal of foreign bodies** from the ear, nose, or throat, excluding ventilating tubes.\n- The **scheduled fee** for this item is **$98.70**.\n- Benefits payable are **75%** of the fee, equating to **$74.05**, and **85%** of the fee, equating to **$83.90**.\n- This item falls under **Category 3 - Therapeutic Procedures** and is classified within **Group T8 - Surgical Operations**.\n- Ensure that the procedure performed is specifically for the **removal of foreign bodies** and not for the removal of a **ventilating tube**, as benefits are not payable for the latter under this item.\n- Be aware of the **Multiple Operation Rule** which may affect billing if multiple procedures are performed during the same session.\n- Maintain thorough documentation of the procedure performed, including **clinical justification** for the removal of the foreign body.\n- Regularly review and stay updated on any changes to the MBS, particularly regarding fee updates and item descriptions.\n- Implement internal audits to ensure compliance with MBS guidelines and to prevent billing errors related to this item.",
    "updated": "2026-07-04"
  },
  "75": {
    "content": "HEADING: MBS Item 75 Overview\n\n- MBS Item 75 pertains to **consultations** provided by General Practitioners (GPs).\n- It is specifically for **standard consultations** that are not longer than 20 minutes.\n- The item is applicable for **patients** who are **new** or **returning** for ongoing care.\n\nHEADING: Billing Compliance Guidelines\n\n- Ensure that the **consultation duration** does not exceed 20 minutes to qualify for Item 75.\n- Document the **reason for the consultation** clearly in the patient's medical record.\n- Record any **relevant clinical findings** and **management plans** discussed during the consultation.\n- Verify that the patient\u2019s **Medicare eligibility** is current and valid before billing.\n- Use the correct **item number** when submitting claims to avoid billing errors.\n- Be aware of any **exclusions** or **limitations** related to Item 75, such as specific conditions or circumstances that may not be covered.\n- Maintain **accurate and detailed records** to support the billing of Item 75 in case of an audit.\n- Regularly review and stay updated on any changes to the **Medicare Benefits Schedule** that may affect Item 75.\n\nHEADING: Audit Prevention Strategies\n\n- Conduct regular **internal audits** of billing practices to ensure compliance with MBS Item 75.\n- Train staff on the importance of **accurate documentation** and the implications of incorrect billing.\n- Implement a system for **tracking consultation times** to ensure adherence to the 20-minute limit.\n- Establish a protocol for **reviewing patient records** before billing to confirm that all necessary documentation is complete.\n- Encourage open communication among staff regarding any uncertainties related to billing Item 75.",
    "updated": "2026-07-04"
  },
  "85": {
    "content": "HEADING: MBS Item 85 Summary for Billing Compliance\n\n- MBS Item 85 pertains to **consultation services** provided by General Practitioners (GPs).\n- Ensure that the **service provided** aligns with the description and requirements outlined in the MBS.\n- Verify that the **patient's clinical need** justifies the consultation to avoid potential audit issues.\n- Maintain accurate and detailed **clinical documentation** to support the billing of Item 85.\n- Confirm that the **time spent** on the consultation meets the minimum requirements for billing this item.\n- Be aware of any **exclusions** or **limitations** associated with Item 85 to prevent billing errors.\n- Regularly review and stay updated on any **changes** to the MBS that may affect Item 85.\n- Implement a robust **internal audit process** to ensure compliance with billing practices related to Item 85.\n- Educate staff on the importance of **correct coding** and documentation to minimize the risk of audits.\n- Ensure that all claims for Item 85 are submitted in accordance with **Medicare guidelines** to avoid penalties.",
    "updated": "2026-07-04"
  },
  "100": {
    "content": "HEADING: MBS Item 100 Overview\n\n- MBS Item 100 pertains to **general practitioner (GP) consultations**.\n- It is primarily used for **face-to-face consultations** with patients.\n- The item is applicable for **initial consultations** or **follow-up visits**.\n\nHEADING: Billing Compliance Guidelines\n\n- Ensure that the **consultation is medically necessary** and appropriately documented.\n- Record the **reason for the consultation** in the patient's medical record.\n- Document any **examinations performed** and **treatment provided** during the consultation.\n- Verify that the **time spent** with the patient aligns with the billing requirements for Item 100.\n- Ensure that the **patient's consent** is obtained and documented, especially for any procedures performed.\n- Maintain accurate and complete **patient records** to support the billing of Item 100.\n- Be aware of any **exclusions** or **limitations** associated with Item 100 to avoid billing errors.\n\nHEADING: Audit Prevention Strategies\n\n- Regularly review billing practices to ensure compliance with **Medicare guidelines**.\n- Conduct internal audits of **patient records** to ensure documentation supports the services billed.\n- Provide ongoing training for staff on **MBS item requirements** and **billing procedures**.\n- Stay updated on any changes to the **Medicare Benefits Schedule** that may affect Item 100.\n- Implement a system for **tracking consultations** to ensure all services rendered are billed appropriately.",
    "updated": "2026-07-04"
  },
  "21": {
    "content": "HEADING: MBS Item 21 Summary for Billing Compliance\n\n- MBS Item 21 pertains to **consultation services** provided by General Practitioners (GPs).\n- Ensure that the **consultation** is conducted in accordance with the **Medicare guidelines** to avoid billing discrepancies.\n- Verify that the **patient's medical history** and **reason for visit** are clearly documented in the medical record.\n- Confirm that the **duration** of the consultation meets the requirements specified for Item 21.\n- Maintain accurate records of any **examinations** or **procedures** performed during the consultation.\n- Ensure that the **clinical notes** reflect the **complexity** of the case, justifying the billing of Item 21.\n- Be aware of the **timeframes** for billing Item 21 to ensure compliance with Medicare regulations.\n- Regularly review billing practices to identify any potential **audit risks** associated with Item 21.\n- Stay updated on any changes to the **Medicare Benefits Schedule** that may affect Item 21 billing.\n- Conduct periodic training for staff on the importance of **accurate documentation** and compliance with MBS requirements.",
    "updated": "2026-07-04"
  },
  "50": {
    "content": "HEADING: MBS Item 50 Overview\n\n- MBS Item 50 pertains to **general practitioner (GP) consultations**.\n- It is essential to ensure that the **consultation meets the criteria** outlined in the MBS for appropriate billing.\n- The item is typically used for **standard consultations** that do not involve complex procedures or extensive time commitments.\n\nHEADING: Billing Compliance Guidelines\n\n- Ensure that the **consultation duration** aligns with the requirements for Item 50, typically a **minimum of 20 minutes**.\n- Document the **reason for the consultation** clearly in the patient's medical record to justify the billing.\n- Include any relevant **clinical findings** and **management plans** discussed during the consultation.\n- Verify that the patient\u2019s **Medicare eligibility** is current and that they are not exceeding the **annual limit** for consultations.\n- Maintain accurate records of **patient demographics** and **visit details** to support claims if audited.\n\nHEADING: Audit Prevention Strategies\n\n- Regularly review and update **clinical documentation practices** to ensure compliance with MBS requirements.\n- Conduct **internal audits** of billing practices to identify any discrepancies or patterns that may raise red flags.\n- Provide ongoing **training for staff** on MBS item descriptors and billing procedures to minimize errors.\n- Implement a system for **tracking consultations** to ensure that all billed services are supported by appropriate documentation.\n- Stay informed about any changes to the MBS that may affect Item 50 billing to ensure ongoing compliance.",
    "updated": "2026-07-04"
  },
  "179": {
    "content": "HEADING: MBS Item 179 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 179 pertains to professional attendance at consulting rooms lasting no more than **5 minutes** by a prescribed medical practitioner in an eligible area.\n- **Fee Structure**: The scheduled fee for Item 179 is **$16.50**, with a benefit of **100%** equating to **$16.50**.\n- **Eligibility**: This item is applicable when **no other MBS item** applies to the service provided.\n- **Documentation Requirements**: Maintain **appropriate and contemporaneous records** of the service, including:\n  - Patient history\n  - Clinical examination\n  - Any investigations arranged\n  - Management plan implemented\n  - Preventive health care provided\n- **Professional Attendance Definition**: Ensure that the service includes evaluating the patient\u2019s condition, formulating a management plan, and providing advice or preventive care.\n- **Personal Attendance Criteria**: Confirm that the service is provided during a **personal attendance** where:\n  - The patient must be present.\n  - Only time spent directly with the patient counts towards the attendance.\n  - Services cannot be provided on behalf of the medical practitioner by another health practitioner.\n- **Audit Prevention**: To avoid audits, ensure:\n  - Accurate use of Item 179 only when no other specific item applies.\n  - Clear documentation of all aspects of the consultation.\n  - Compliance with the definition of professional and personal attendance.\n- **Telehealth Considerations**: For telehealth services, ensure compliance with modified personal attendance requirements, confirming it is a single health professional attending to a single patient.\n- **Extended Medicare Safety Net**: Be aware of the **Extended Medicare Safety Net Cap** of **$49.50** for eligible patients.\n- **Regular Updates**: Stay informed about updates to the MBS and any changes to item descriptions or fees, as the last update was on **01-Nov-2023**.",
    "updated": "2026-07-05"
  },
  "181": {
    "content": "HEADING: MBS Item 181 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 181 pertains to professional attendance by a prescribed medical practitioner lasting no more than **5 minutes** for one or more patients at one location on one occasion.\n  \n- **Eligibility**: This item applies when no other MBS item is appropriate for the service provided. Ensure that the service does not fall under any other specific MBS item.\n\n- **Fee Structure**: \n  - The fee is calculated as the fee for **Item 179** plus **$25.25** divided by the number of patients seen, up to a maximum of **six patients**.\n  - For **seven or more patients**, the fee is the fee for Item 179 plus **$2.00** per additional patient.\n\n- **Documentation Requirements**: \n  - Maintain **appropriate and contemporaneous records** of the service provided, including patient history, clinical examination, management plans, and preventive health care advice.\n  - Ensure that the records clearly reflect the nature of the attendance and the services rendered.\n\n- **Professional Attendance Definition**: \n  - Professional attendance includes evaluating the patient\u2019s condition, formulating management plans, providing advice, and recording clinical details.\n  - Ensure that the service provided aligns with the definition of professional attendance as per the regulations.\n\n- **Audit Prevention**: \n  - Claim the item that best describes the service provided; avoid claiming Item 181 if a more specific item exists.\n  - Ensure compliance with the requirement that the attendance is by a **single medical practitioner** on a **single patient** at a time, especially in the context of telehealth services.\n\n- **Extended Medicare Safety Net**: Be aware that the cap for this item is **300%** of the derived fee or **$500**, whichever is lesser.\n\n- **General Principles**: Familiarize yourself with the general principles of claiming attendance items, including the necessity of attending to the patient and performing at least one of the required actions (history taking, examination, etc.).\n\n- **Compliance Checks**: Regularly review billing practices against MBS guidelines to ensure adherence and prevent potential audits or discrepancies.",
    "updated": "2026-07-05"
  },
  "185": {
    "content": "HEADING: MBS Item 185 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 185 covers professional attendance at consulting rooms lasting more than 5 minutes but not more than 25 minutes by a prescribed medical practitioner in an eligible area.\n- **Fee Structure**: The schedule fee is **$35.95**, with a benefit of **100%** equating to **$35.95**.\n- **Eligibility**: This item applies when no other MBS item is applicable for the service provided.\n- **Documentation Requirements**: Maintain **appropriate and contemporaneous records** of the service, including:\n  - Patient history\n  - Clinical examination\n  - Arranging investigations\n  - Management plan implementation\n  - Preventive health care advice\n- **Professional Attendance Definition**: Includes evaluating the patient's condition, formulating management plans, and providing advice about treatment.\n- **Personal Attendance Definition**: Requires the patient to be present; time spent with the patient is the only time counted towards the attendance.\n- **Audit Prevention**: \n  - Ensure that the service provided aligns with the description of Item 185 and that no other specific MBS item applies.\n  - Avoid claiming this item if a more specific item exists for the service rendered.\n  - Confirm that only one medical practitioner is involved in the attendance to avoid non-compliance.\n- **Telehealth Considerations**: For telehealth services, ensure compliance with modified personal attendance requirements, confirming it is a single health professional attending to a single patient.\n- **Extended Medicare Safety Net**: Be aware of the cap of **$107.85** for patients eligible under the Extended Medicare Safety Net.\n- **Regular Training**: Engage in ongoing training and updates regarding MBS items and billing practices to ensure compliance and reduce audit risks.",
    "updated": "2026-07-05"
  },
  "187": {
    "content": "HEADING: MBS Item 187 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 187 pertains to professional attendance by a prescribed medical practitioner lasting more than 5 minutes but not exceeding 25 minutes, applicable to one or more patients at one location on one occasion.\n\n- **Eligibility**: This item is applicable only when no other MBS item applies to the service provided.\n\n- **Fee Structure**: \n  - The fee is calculated as the fee for Item 185 plus **$25.25** divided by the number of patients seen, up to a maximum of **six patients**.\n  - For **seven or more patients**, the fee is the fee for Item 185 plus **$2.00** per additional patient.\n\n- **Documentation Requirements**: \n  - Maintain **appropriate and contemporaneous records** of the service provided, including patient history, clinical examination, investigations arranged, management plans, and preventive health care advice.\n  - Ensure that the records clearly reflect the nature of the attendance and the services rendered.\n\n- **Professional Attendance Definition**: \n  - Professional attendance includes evaluating the patient\u2019s condition, formulating management plans, providing treatment advice, and recording clinical details.\n\n- **Audit Prevention**: \n  - Ensure that the service claimed under Item 187 is the **most appropriate item** for the service provided; if a more specific item exists, it should be claimed instead.\n  - Avoid claiming this item if the attendance does not meet the time and service requirements outlined in the MBS.\n\n- **Telehealth Considerations**: \n  - For telehealth services, ensure compliance with modified requirements for personal attendance, which stipulates that the service must be provided by a single health professional to a single patient.\n\n- **Extended Medicare Safety Net**: \n  - Be aware that the cap for the Extended Medicare Safety Net is **300% of the derived fee** for this item or **$500**, whichever is lesser.\n\n- **Compliance with General Principles**: \n  - Follow the general principles for claiming attendance items, ensuring that the service provided is accurately reflected in the item claimed to prevent audit issues.",
    "updated": "2026-07-05"
  },
  "189": {
    "content": "HEADING: MBS Item 189 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 189 covers professional attendance at consulting rooms lasting more than 25 minutes but not more than 45 minutes by a prescribed medical practitioner in an eligible area.\n- **Fee Structure**: The schedule fee is **$69.70**, with a benefit of **100%** equating to **$69.70**.\n- **Eligibility**: This item applies when no other MBS item is applicable to the service provided.\n- **Documentation Requirements**: Maintain **appropriate and contemporaneous records** of the service, including:\n  - Patient history\n  - Clinical examination\n  - Arranging necessary investigations\n  - Implementing a management plan\n  - Providing preventive health care\n- **Professional Attendance Definition**: Includes evaluating the patient\u2019s condition, formulating management plans, and providing advice about treatment.\n- **Personal Attendance Definition**: Requires the patient to be present; only time spent with the patient counts towards the attendance.\n- **Audit Prevention**: Ensure that:\n  - The service provided aligns with the description of Item 189.\n  - No other specific MBS item applies to the service.\n  - Claims are made only for services that meet the time and attendance criteria.\n- **Telehealth Considerations**: For telehealth services, ensure compliance with modified personal attendance requirements, confirming that the service is provided by a single health professional to a single patient.\n- **Extended Medicare Safety Net**: Be aware of the cap of **$209.10** for patients eligible under the Extended Medicare Safety Net.\n- **Regular Training**: Stay updated with MBS changes and attend training sessions to ensure compliance with billing practices.",
    "updated": "2026-07-05"
  },
  "191": {
    "content": "HEADING: MBS Item 191 Summary for Billing Compliance\n\n- Item 191 is applicable for **professional attendance** lasting more than **25 minutes** but not exceeding **45 minutes**.\n- This item is for **prescribed medical practitioners** in an **eligible area** and is not applicable for services at consulting rooms or residential aged care facilities.\n- The fee structure includes the fee for **item 189** plus **$25.25** divided by the number of patients seen, with a maximum of **six patients**. For **seven or more patients**, the fee for item 189 plus **$2.00** per additional patient applies.\n- Ensure that the service provided does not fall under any other specific MBS item; if a more specific item exists, it should be claimed instead.\n- Maintain **appropriate and contemporaneous records** of the service provided, including patient history, clinical examination, investigations arranged, management plans implemented, and preventive health care provided.\n- Claims must reflect the **best description** of the service provided; if no other item applies, item 191 can be claimed.\n- Professional attendance must involve direct interaction with the patient; services cannot be provided by another health practitioner on behalf of the medical practitioner.\n- For telehealth services, ensure compliance with modified requirements for personal attendance, which still necessitates a single health professional attending to a single patient.\n- Be aware of the **Extended Medicare Safety Net Cap**, which is **300%** of the derived fee for this item or **$500**, whichever is lesser.\n- Regularly review billing practices to ensure adherence to MBS guidelines and prevent potential audits or compliance issues.",
    "updated": "2026-07-05"
  },
  "203": {
    "content": "HEADING: MBS Item 203 Summary for Billing Compliance\n\n- MBS Item 203 is for **professional attendance** lasting more than **45 minutes but not more than 60 minutes** by a prescribed medical practitioner in an eligible area.\n- The **schedule fee** for Item 203 is **$102.65**, with a benefit of **100%** equating to the same amount.\n- This item should only be claimed when **no other MBS item** applies to the service provided.\n- Ensure that the service provided meets the criteria for a **general attendance**, which includes:\n  - Taking a **patient history**\n  - Performing a **clinical examination**\n  - Arranging necessary **investigations**\n  - Implementing a **management plan**\n  - Providing appropriate **preventive health care**\n- Maintain **appropriate and contemporaneous records** of the service, including details of the patient's condition and the management plan.\n- The service must be a **personal attendance**, meaning:\n  - The patient must be present during the consultation.\n  - Only time spent directly with the patient counts towards the attendance.\n  - Services cannot be provided on behalf of the medical practitioner by another health practitioner.\n- Benefits are not payable if more than one medical practitioner provides an attendance on the same patient at the same time.\n- For telehealth services, ensure compliance with modified requirements for personal attendance.\n- Always refer to the **most specific MBS item** available for the service provided; if a more specific item exists, it should be claimed instead of Item 203.\n- Regularly review and stay updated on any changes to the MBS and associated notes to ensure compliance and prevent audit issues.",
    "updated": "2026-07-05"
  },
  "206": {
    "content": "HEADING: MBS Item 206 Summary for Billing Compliance\n\n- Item 206 is applicable for **professional attendance** lasting more than **45 minutes** but not exceeding **60 minutes**.\n- This item is intended for **prescribed medical practitioners** in an **eligible area** and is not applicable for consultations in **consulting rooms** or **residential aged care facilities**.\n- The fee structure includes:\n  - The fee for item 203, plus **$25.25** divided by the number of patients seen (up to a maximum of **six patients**).\n  - For **seven or more patients**, the fee for item 203 plus **$2.00** per additional patient.\n- Ensure that the service provided does not fall under any other specific MBS item; the most appropriate item must be claimed.\n- General attendance items require that the practitioner performs at least one of the following:\n  - Taking a **patient history**.\n  - Performing a **clinical examination**.\n  - Arranging necessary **investigations**.\n  - Implementing a **management plan**.\n  - Providing appropriate **preventive health care**.\n- Maintain **appropriate and contemporaneous records** of the service provided, including clinical details.\n- Understand the distinction between **professional** and **personal attendances**:\n  - Professional attendance includes evaluating, advising, and managing a patient's condition.\n  - Personal attendance applies to services provided to a single patient by a single practitioner at one time.\n- Be aware of the **Extended Medicare Safety Net Cap**, which is **300%** of the derived fee for this item or **$500**, whichever is lesser.\n- Regularly review and stay updated on MBS guidelines to ensure compliance and prevent audit issues.",
    "updated": "2026-07-05"
  },
  "214": {
    "content": "HEADING: MBS Item 214 Summary for Billing Compliance\n\n- **Item Description**: Professional attendance by a prescribed medical practitioner for a period of **not less than one hour but less than two hours** on a patient in **imminent danger of death**.\n- **Eligibility**: Only applicable to **prescribed medical practitioners** who are not general practitioners, specialists, or consultant physicians.\n- **Fee Structure**: \n  - Schedule Fee: **$212.20**\n  - Benefit: \n    - 75% = **$159.15**\n    - 100% = **$212.20**\n- **Extended Medicare Safety Net Cap**: **$500.00**.\n- **Conditions for Claiming**:\n  - Patient must be in **imminent danger of death**.\n  - If attendance is not continuous, total time of attendance is considered.\n  - Multiple practitioners can claim if they provide concurrent attendance.\n- **Audit Prevention**:\n  - Ensure documentation clearly indicates the patient was in **imminent danger of death**.\n  - Maintain accurate records of the **duration of attendance**.\n  - Avoid billing for services related to the issuance of a **death certificate**; only the attendance component is claimable.\n- **Compliance Reminder**: Regularly review and understand the definitions and requirements outlined in **AN.7.1** and **AN.7.3** to ensure adherence to billing guidelines.",
    "updated": "2026-07-05"
  },
  "215": {
    "content": "HEADING: MBS Item 215 Summary for Billing Compliance\n\n- **Item Description**: Professional attendance by a prescribed medical practitioner for a period of **not less than 2 hours but less than 3 hours** on a patient in **imminent danger of death**.\n- **Eligibility**: Only **prescribed medical practitioners** can bill this item, which excludes general practitioners, specialists, and consultant physicians.\n- **Fee Structure**: \n  - Schedule Fee: **$353.55**\n  - Benefit: \n    - 75% = **$265.20**\n    - 100% = **$353.55**\n- **Extended Medicare Safety Net Cap**: **$500.00** applies to this item.\n- **Conditions for Claiming**:\n  - The patient must be in **imminent danger of death**.\n  - If attendance is not continuous, the total time of attendance is considered.\n  - Multiple practitioners can claim if they provide concurrent attendance.\n- **Audit Prevention**:\n  - Ensure documentation clearly states the patient's **imminent danger of death**.\n  - Maintain accurate records of the **total duration** of attendance.\n  - Avoid billing for the issuance of a **death certificate**; only the attendance component is claimable.\n- **Compliance Reminder**: Regularly review the eligibility criteria for **prescribed medical practitioners** to ensure compliance with billing practices.",
    "updated": "2026-07-05"
  },
  "218": {
    "content": "HEADING: Summary of MBS Item 218 for Billing Compliance\n\n- MBS Item 218 pertains to **professional attendance** by a prescribed medical practitioner for a duration of **not less than 3 hours but less than 4 hours**.\n- This item is applicable only when the patient is in **imminent danger of death**.\n- The **schedule fee** for Item 218 is **$494.65**.\n- Medicare benefits are structured as follows:\n  - **75% benefit**: $371.00\n  - **100% benefit**: $494.65\n- The **Extended Medicare Safety Net Cap** for this item is **$500.00**.\n- A **prescribed medical practitioner** is defined as:\n  - Not a general practitioner, specialist, or consultant physician.\n  - Registered under section 3GA of the Act or covered by an exemption under subsection 19AB(3).\n  - A practitioner who first became registered before **1 November 1996**.\n- Key conditions for claiming Item 218:\n  - The patient must be in **imminent danger of death**.\n  - If attendance is not continuous, the total time of attendance is considered.\n  - Multiple practitioners can claim if they provide concurrent attendance.\n- **Important Note**: Medicare benefits are not payable for the issuance of a **death certificate**; however, attendance leading to the determination of life being extinct can be claimed under the appropriate attendance item.\n- Ensure accurate documentation of the **patient's condition** and the **duration of attendance** to support claims and prevent audits.\n- Regularly review compliance with the **MBS guidelines** to avoid billing errors and potential penalties.",
    "updated": "2026-07-05"
  },
  "219": {
    "content": "HEADING: MBS Item 219 Summary for Billing Compliance\n\n- **Item Description**: Professional attendance by a prescribed medical practitioner for a period of **not less than 4 hours but less than 5 hours** on a patient in **imminent danger of death**.\n- **Fee Structure**: \n  - Schedule Fee: **$636.40**\n  - Benefit: \n    - 75% = **$477.30**\n    - 100% = **$636.40**\n- **Eligibility Criteria**: \n  - The patient must be in **imminent danger of death**.\n  - Attendance must be for a **continuous period**; if not, total time of attendance is considered.\n  - Multiple practitioners can claim if they provide **concurrent attendance**.\n- **Prescribed Medical Practitioner Definition**: \n  - Not a **general practitioner**, specialist, or consultant physician.\n  - Must be registered under **section 3GA** of the Act or covered by an exemption under **subsection 19AB(3)**.\n  - Must have first become a medical practitioner before **1 November 1996**.\n- **Audit Prevention Tips**: \n  - Ensure documentation clearly states the **imminent danger of death** for the patient.\n  - Maintain accurate records of the **total duration** of attendance.\n  - Verify that the practitioner meets the definition of a **prescribed medical practitioner**.\n  - Be aware that **Medicare benefits** are not payable for the issuance of a **death certificate**; only the attendance component is claimable.\n- **Extended Medicare Safety Net Cap**: **$500.00** applies to this item. \n\nThis summary serves as a guide to ensure compliance with billing for MBS Item 219 and to prevent potential audits.",
    "updated": "2026-07-05"
  },
  "220": {
    "content": "HEADING: MBS Item 220 Summary for Billing Compliance\n\n- **Item Description**: Professional attendance by a prescribed medical practitioner for a period of **5 hours or more** on a patient in **imminent danger of death**.\n- **Fee Structure**: \n  - Schedule Fee: **$707.00**\n  - Medicare Benefit: \n    - 75% = **$530.25**\n    - 100% = **$707.00**\n- **Eligibility Criteria**: \n  - The patient must be in **imminent danger of death**.\n  - Attendance must be for a **continuous period** of 5 hours or more.\n  - If attendance is not continuous, total time of attendance is considered.\n- **Multiple Practitioners**: If multiple prescribed medical practitioners provide personal attendance concurrently, each may claim the attendance fee.\n- **Exclusions**: \n  - Medicare benefits are **not payable** for the issuance of a death certificate.\n  - Attendance can be claimed if it is determined that life is extinct, but only under the appropriate attendance item.\n- **Compliance Tips**: \n  - Ensure documentation clearly states the **imminent danger** status of the patient.\n  - Maintain accurate records of the **total time** spent in attendance.\n  - Verify that the medical practitioner meets the definition of a **prescribed medical practitioner** as per the guidelines.\n- **Audit Prevention**: \n  - Regularly review billing practices to ensure adherence to the criteria for claiming Item 220.\n  - Conduct internal audits to confirm that all claims are supported by appropriate documentation and meet the necessary conditions.",
    "updated": "2026-07-05"
  },
  "224": {
    "content": "HEADING: MBS Item 224 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 224 covers a brief health assessment performed by a prescribed medical practitioner, lasting no more than **30 minutes**.\n- **Key Components**: The assessment must include:\n  - **Collection of relevant information** (taking a patient history)\n  - **Basic physical examination**\n  - **Initiation of interventions and referrals** as indicated\n  - **Provision of preventive health care advice** and information\n- **Fee Structure**: The schedule fee for Item 224 is **$56.85**, with a benefit of **100%** equating to the full fee.\n- **Eligibility**: This item is applicable only to specific patient cohorts, including:\n  - Individuals aged **45-49 years** at risk of chronic disease\n  - Patients aged **75 years and older**\n  - Residents of **aged care facilities**\n  - Individuals with an **intellectual disability**\n  - **Refugees** and humanitarian entrants\n  - **Veterans** for one-off assessments\n- **Audit Prevention**: To ensure compliance and prevent audits:\n  - Confirm that the assessment does not exceed **30 minutes**.\n  - Ensure all components of the assessment are documented thoroughly.\n  - Verify that the patient falls within the eligible cohorts specified for Item 224.\n  - Avoid including any **screening services** as defined by the Health Insurance Act 1973.\n  - Maintain clear records of any assistance provided by practice nurses or health workers, ensuring it is under the **supervision** of the GP.\n- **Documentation**: Keep detailed records of:\n  - Patient history and relevant information collected\n  - Findings from the physical examination\n  - Any referrals or interventions initiated\n  - Preventive health advice given to the patient\n- **Compliance with Regulations**: Adhere to the guidelines set forth in the Health Insurance (General Medical Services Table) Regulations 2021, particularly regarding the definition of health assessments versus health screenings.",
    "updated": "2026-07-05"
  },
  "225": {
    "content": "HEADING: MBS Item 225 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 225 covers a **standard health assessment** performed by a prescribed medical practitioner, lasting **more than 30 minutes but less than 45 minutes**.\n- **Key Components**: The assessment must include:\n  - **Detailed information collection**, including taking a patient history.\n  - An **extensive physical examination**.\n  - **Initiating interventions and referrals** as indicated.\n  - Providing a **preventive health care strategy** for the patient.\n- **Fee Structure**: The schedule fee for Item 225 is **$132.05**, with a benefit of **100%** equating to the same amount.\n- **Eligibility**: This item is applicable only to specific patient cohorts, including:\n  - Individuals aged **45-49 years** at risk of chronic disease.\n  - Patients aged **75 years and older**.\n  - Residents of **aged care facilities**.\n  - Individuals with an **intellectual disability**.\n  - **Refugees and humanitarian entrants**.\n  - **Veterans** for one-off assessments.\n- **Audit Prevention**: To ensure compliance and prevent audits:\n  - Confirm that the **time spent** with the patient is accurately recorded (between **30-45 minutes**).\n  - Ensure that all **required components** of the assessment are completed and documented.\n  - Verify that the patient falls within the **eligible cohorts** for this item.\n  - Avoid using this item for **health screening services**, as defined by the Health Insurance Act 1973.\n- **Assistance in Assessments**: Other healthcare professionals, such as **practice nurses** or **Aboriginal health workers**, may assist in the assessment under the **supervision** of the GP, ensuring compliance with accepted medical practices.\n- **Documentation**: Maintain thorough documentation of the assessment process, including:\n  - Patient history.\n  - Findings from the physical examination.\n  - Any interventions or referrals made.\n  - The preventive health care strategy provided to the patient.",
    "updated": "2026-07-05"
  },
  "226": {
    "content": "HEADING: MBS Item 226 Summary for Billing Compliance\n\n- Item 226 pertains to **long health assessments** conducted by a prescribed medical practitioner (PMP) or general practitioner (GP).\n- The assessment must last **at least 45 minutes but less than 60 minutes**.\n- Key components of the assessment include:\n  - **Comprehensive information collection**, including taking a detailed patient history.\n  - **Extensive examination** of the patient's medical condition and physical function.\n  - **Initiation of interventions and referrals** as clinically indicated.\n  - Provision of a **basic preventive health care management plan** for the patient.\n- The **scheduled fee** for Item 226 is **$182.15**, with a benefit of **100%** of the fee.\n- Ensure compliance with the **Extended Medicare Safety Net Cap** of **$500.00**.\n- Health assessments are only available to **specific patient cohorts**; refer to associated notes for eligibility criteria.\n- The assessment must be conducted during a **personal attendance** by a single GP or PMP for a single patient.\n- Avoid using this item for **health screening services**, as defined by the Health Insurance Act 1973.\n- Additional requirements may apply based on the **patient cohort**; consult relevant notes for specifics.\n- Assistance from practice nurses or Aboriginal and Torres Strait Islander health workers is permitted, provided it is under the **supervision of the medical practitioner**.\n- Maintain accurate documentation of the assessment process to support billing and prevent audits.\n- Regularly review and stay updated on any changes to the MBS and associated notes to ensure ongoing compliance.",
    "updated": "2026-07-05"
  },
  "227": {
    "content": "HEADING: MBS Item 227 Overview\n\n- **Item 227** pertains to a **prolonged health assessment** conducted by a prescribed medical practitioner (PMP) or general practitioner (GP).\n- The assessment must last at least **60 minutes** and includes comprehensive activities.\n\nHEADING: Key Components of the Assessment\n\n- **Comprehensive Information Collection**: Involves taking a detailed patient history.\n- **Extensive Examination**: Requires a thorough examination of the patient's **medical condition**, as well as their **physical, psychological, and social function**.\n- **Interventions and Referrals**: The practitioner must initiate appropriate interventions and referrals based on the assessment findings.\n- **Preventive Health Care Management Plan**: A comprehensive plan must be provided to the patient to address their health needs.\n\nHEADING: Billing Compliance Guidelines\n\n- **Correct Item Usage**: Ensure that Item 227 is billed only when the assessment meets the **60-minute** duration requirement.\n- **Eligible Patient Cohorts**: Confirm that the patient falls within the specified cohorts eligible for this health assessment, as outlined in associated notes (AN.0.36 to AN.0.42).\n- **Documentation**: Maintain thorough documentation of the assessment process, including history taken, examinations conducted, and management plans provided.\n- **No Screening Services**: Ensure that the assessment does not include any **health screening services**, as defined by the Health Insurance Act 1973.\n- **Assistance Compliance**: If assistance is provided by practice nurses or health workers, ensure it is under the **supervision** of the medical practitioner and adheres to accepted medical practice.\n\nHEADING: Audit Prevention Strategies\n\n- **Regular Training**: Conduct regular training sessions for staff on MBS compliance and the specific requirements of Item 227.\n- **Internal Audits**: Implement periodic internal audits to review billing practices and ensure adherence to MBS guidelines.\n- **Patient Records Review**: Regularly review patient records to ensure that all necessary documentation is complete and accurately reflects the services billed.\n- **Stay Updated**: Keep abreast of any updates or changes to the MBS and associated notes to ensure ongoing compliance.",
    "updated": "2026-07-05"
  },
  "228": {
    "content": "HEADING: MBS Item 228 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 228 covers professional attendance by a prescribed medical practitioner for a health assessment of a patient of **Aboriginal or Torres Strait Islander descent**.\n- **Service Location**: The service can be provided in **consulting rooms** or other locations, excluding hospitals and residential aged care facilities.\n- **Assessment Components**: The health assessment must include:\n  - **Recognising** the patient\u2019s health priorities.\n  - **Taking** the patient\u2019s medical history.\n  - **Undertaking** relevant physical examinations.\n  - **Arranging** or conducting necessary investigations.\n  - **Assessing** the patient based on the gathered information.\n  - **Initiating** necessary interventions and referrals.\n  - **Developing** and documenting a management plan for the patient\u2019s health, including follow-up.\n  - **Offering** a written report of the health assessment to the patient or their carer, if appropriate.\n  - **Providing** the report if the offer is accepted.\n  - **Documenting** the health assessment in the patient\u2019s medical records.\n- **Eligibility Criteria**: This item is applicable only if no similar service (items 715, 92004, or 92011) has been provided to the patient in the **preceding 9 months**.\n- **Fee Structure**: The schedule fee for this item is **$203.25**, with a 100% benefit coverage.\n- **Extended Medicare Safety Net Cap**: The cap for this item is **$500.00**.\n- **Informed Consent**: Practitioners must adhere to the principles of **informed patient consent** as outlined in the Medical Board of Australia\u2019s Good Medical Practice.\n- **Cultural Considerations**: Health assessments should be tailored to meet the **cultural and clinical needs** of Aboriginal and Torres Strait Islander patients, referencing current preventive health guidelines.\n- **Audit Prevention**: Ensure thorough documentation of all assessment components and patient interactions to support compliance and prevent audit discrepancies.",
    "updated": "2026-07-05"
  },
  "235": {
    "content": "HEADING: MBS Item 235 Summary for Billing Compliance\n\n- **Item Description**: Item 235 covers attendance by a prescribed medical practitioner as part of a multidisciplinary case conference team to organize and coordinate various types of case conferences.\n- **Duration Requirement**: The conference must last for **at least 15 minutes but less than 20 minutes**.\n- **Eligible Conferences**: Includes community case conferences, multidisciplinary case conferences in residential aged care facilities, and multidisciplinary discharge case conferences.\n- **Fee Structure**: \n  - Schedule Fee: **$67.75**\n  - 75% Benefit: **$50.85**\n  - 100% Benefit: **$67.75**\n- **Extended Medicare Safety Net Cap**: **$203.25** applies to this item.\n- **Prescribed Medical Practitioner Definition**: \n  - Not a general practitioner, specialist, or consultant physician.\n  - Must be registered under section 3GA of the Act or covered by an exemption under subsection 19AB(3).\n  - Must have first become a medical practitioner before **1 November 1996**.\n- **Audit Prevention Tips**:\n  - Ensure accurate documentation of the **duration** of the conference to meet the time requirement.\n  - Confirm that the practitioner is classified as a **prescribed medical practitioner** as per the guidelines.\n  - Maintain clear records of the **type of case conference** conducted and the participants involved.\n  - Regularly review compliance with the **Medicare Benefits Schedule** updates to avoid billing errors.\n- **Related Items**: Be aware of associated items (e.g., 231, 232, 236) to ensure correct billing practices and avoid overlaps.",
    "updated": "2026-07-05"
  },
  "236": {
    "content": "HEADING: MBS Item 236 Summary for Billing Compliance\n\n- **Item Description**: Attendance by a prescribed medical practitioner as part of a multidisciplinary case conference team to coordinate community or residential aged care facility case conferences.\n- **Duration Requirement**: Conference must last for **at least 20 minutes** but **less than 40 minutes**.\n- **Exclusions**: This item cannot be billed in conjunction with specific other MBS items (e.g., items 231, 232, 392, etc.).\n- **Fee Structure**: \n  - Schedule Fee: **$115.85**\n  - Benefit: \n    - 75% = **$86.90**\n    - 100% = **$115.85**\n- **Extended Medicare Safety Net Cap**: **$347.55**.\n- **Prescribed Medical Practitioner Definition**: \n  - Not a general practitioner, specialist, or consultant physician.\n  - Must be registered under section 3GA of the Act or covered by an exemption under subsection 19AB(3).\n  - Must have first become a medical practitioner before **1 November 1996**.\n- **Documentation**: Ensure thorough documentation of the case conference, including:\n  - Participants involved.\n  - Duration of the conference.\n  - Purpose and outcomes discussed.\n- **Audit Prevention**: \n  - Verify eligibility of the practitioner billing the item.\n  - Confirm compliance with duration and exclusion criteria.\n  - Maintain accurate records to support billing claims and facilitate audits.",
    "updated": "2026-07-05"
  },
  "237": {
    "content": "HEADING: MBS Item 237 Summary for Billing Compliance\n\n- **Item Description**: Attendance by a prescribed medical practitioner as part of a multidisciplinary case conference team to organize and coordinate various types of case conferences, lasting at least **40 minutes**.\n  \n- **Eligible Conferences**:\n  - Community case conference\n  - Multidisciplinary case conference in a residential aged care facility\n  - Multidisciplinary discharge case conference\n\n- **Fee Structure**:\n  - Schedule Fee: **$193.00**\n  - Benefit: \n    - 75% = **$144.75**\n    - 100% = **$193.00**\n  - Extended Medicare Safety Net Cap: **$500.00**\n\n- **Eligibility Criteria**:\n  - Must be a **prescribed medical practitioner** (not a GP, specialist, or consultant physician).\n  - Must be registered under section **3GA** of the Act or covered by an exemption under subsection **19AB(3)**.\n  - Practitioners who first became medical practitioners before **1 November 1996** are also eligible.\n\n- **Audit Prevention Tips**:\n  - Ensure the conference lasts at least **40 minutes** to qualify for billing.\n  - Confirm that the practitioner is classified as a **prescribed medical practitioner**.\n  - Maintain accurate documentation of the case conference details, including participants and duration.\n  - Avoid billing for services associated with other specified MBS items (231, 232, 392, etc.) during the same conference.\n\n- **Documentation Requirements**:\n  - Keep records of the case conference agenda, participant list, and minutes to support billing claims.\n  - Document the rationale for the multidisciplinary approach and the specific roles of each participant.\n\n- **Compliance Reminder**:\n  - Regularly review MBS updates and changes to ensure ongoing compliance with billing practices.",
    "updated": "2026-07-05"
  },
  "238": {
    "content": "HEADING: MBS Item 238 Summary for Billing Compliance\n\n- Item 238 pertains to **attendance by a prescribed medical practitioner** as part of a **multidisciplinary case conference**.\n- The conference must last for **at least 15 minutes but less than 20 minutes**.\n- Eligible settings include:\n  - **Community case conferences**\n  - **Multidisciplinary case conferences in residential aged care facilities**\n  - **Multidisciplinary discharge case conferences**\n- The item is not applicable if associated with specific other MBS items (231, 232, 392, etc.).\n- The **schedule fee** for Item 238 is **$49.75**.\n- The **Medicare benefit** is:\n  - **75% = $37.35**\n  - **100% = $49.75**\n- Ensure that the practitioner is a **prescribed medical practitioner**, defined as:\n  - Not a general practitioner, specialist, or consultant physician.\n  - Registered under section 3GA of the Act or covered by an exemption under subsection 19AB(3).\n  - Practicing in the specified location and circumstances.\n- Maintain accurate documentation of the **duration** and **type of conference** attended to support billing.\n- Regularly review compliance with **MBS guidelines** to prevent audit issues.\n- Be aware of the **Extended Medicare Safety Net Cap** of **$149.25** for additional billing considerations.",
    "updated": "2026-07-05"
  },
  "239": {
    "content": "HEADING: MBS Item 239 Summary for Billing Compliance\n\n- **Item Description**: Attendance by a prescribed medical practitioner as part of a multidisciplinary case conference team.\n- **Conference Types**: Includes community case conferences, multidisciplinary case conferences in residential aged care facilities, and multidisciplinary discharge case conferences.\n- **Duration Requirement**: Conference must last for **at least 20 minutes but less than 40 minutes**.\n- **Exclusions**: Not applicable if associated with services from items 231, 232, 392, 393, 729, 731, 965, 967, 92029, 92030, 92060, or 92061.\n- **Fee Structure**: \n  - Schedule Fee: **$85.25**\n  - 75% Benefit: **$63.95**\n  - 100% Benefit: **$85.25**\n- **Extended Medicare Safety Net Cap**: **$255.75**.\n- **Prescribed Medical Practitioner Definition**: \n  - Not a general practitioner, specialist, or consultant physician.\n  - Must be registered under section 3GA of the Act or covered by an exemption under subsection 19AB(3).\n  - Must have first become a medical practitioner before **1 November 1996**.\n- **Audit Prevention Tips**:\n  - Ensure the conference duration is accurately recorded and falls within the specified time frame.\n  - Verify that the practitioner billing for this item meets the definition of a prescribed medical practitioner.\n  - Confirm that the service is not linked to any excluded items to avoid billing errors.\n  - Maintain clear documentation of the conference details, including participants and topics discussed, to support claims.",
    "updated": "2026-07-05"
  },
  "240": {
    "content": "HEADING: MBS Item 240 Summary for Billing Compliance\n\n- **Item Description**: Item 240 pertains to attendance by a prescribed medical practitioner as part of a multidisciplinary case conference team.\n- **Eligible Conferences**: The item covers participation in:\n  - Community case conferences\n  - Multidisciplinary case conferences in residential aged care facilities\n  - Multidisciplinary discharge case conferences\n- **Duration Requirement**: The conference must last for at least **40 minutes** to qualify for billing under this item.\n- **Exclusions**: This item cannot be billed in conjunction with services related to specific items (e.g., 231, 232, 392, etc.).\n- **Fee Structure**: \n  - Schedule Fee: **$141.90**\n  - Benefit: \n    - 75% = **$106.45**\n    - 100% = **$141.90**\n- **Extended Medicare Safety Net Cap**: The cap for this item is **$425.70**.\n- **Prescribed Medical Practitioner Definition**: \n  - Must not be a general practitioner, specialist, or consultant physician.\n  - Must be registered under section 3GA of the Act or covered by an exemption under subsection 19AB(3).\n  - Practitioners who first became registered before **1 November 1996** are also eligible.\n- **Audit Prevention Tips**:\n  - Ensure accurate documentation of the conference duration (minimum 40 minutes).\n  - Verify that the practitioner billing under this item meets the prescribed medical practitioner criteria.\n  - Maintain records of all multidisciplinary case conferences attended, including participants and topics discussed.\n  - Regularly review billing practices to ensure compliance with exclusions and eligibility criteria.",
    "updated": "2026-07-05"
  },
  "243": {
    "content": "HEADING: Summary of MBS Item 243 for Billing Compliance\n\n- **Item Description**: Item 243 pertains to attendance by a prescribed medical practitioner as a member of a case conference team to lead and coordinate a multidisciplinary case conference for a patient with cancer.\n- **Duration Requirement**: The case conference must last at least **10 minutes**.\n- **Team Composition**: Must include at least **3 other medical practitioners** from different areas of medical practice, along with allied health or other relevant health professionals.\n- **Eligibility Criteria**: \n  - The patient must have a **malignancy** of a solid organ or tissue or a systemic cancer (e.g., leukaemia, lymphoma).\n  - Non-melanoma skin cancer patients are **excluded**.\n  - The billing practitioner must be a **treating doctor** who has treated or diagnosed the patient's cancer within the past 12 months or expects to do so within the next 12 months.\n- **Billing Limitations**: \n  - Only **one practitioner** can claim Item 243 for each patient case conference.\n  - The practitioner must be the one who leads and coordinates the conference and ensures proper record-keeping.\n- **Patient Notification**: Patients must be informed that a charge will be incurred for the case conference, which is eligible for a Medicare benefit.\n- **Communication Requirement**: Participants must communicate throughout the case conference, either **face-to-face**, by **telephone**, or via **video link**.\n- **Allied Health Participation**: Suitable allied health practitioners may include various professionals such as dieticians, psychologists, physiotherapists, and others listed in the guidelines.\n- **Billing Frequency**: Generally, no more than **two case conferences** per patient per year should be billed by a practitioner.\n- **Purpose of Conference**: The case conference is specifically for developing a **cancer treatment plan** and should not be billed for other purposes, such as community or discharge case conferences.\n- **Audit Prevention**: Ensure compliance with all eligibility criteria and documentation requirements to prevent audits and potential penalties.",
    "updated": "2026-07-05"
  },
  "244": {
    "content": "HEADING: MBS Item 244 Summary for Billing Compliance\n\n- **Item Description**: Item 244 pertains to attendance by a prescribed medical practitioner as part of a multidisciplinary case conference for patients with cancer, aimed at developing a treatment plan.\n- **Duration Requirement**: The case conference must last at least **10 minutes**.\n- **Team Composition**: Must include at least **4 medical practitioners** from different areas of practice, along with allied health or relevant health professionals.\n- **Eligible Patients**: Covers private patients with a malignancy of a solid organ or tissue or systemic cancers (e.g., leukaemia, lymphoma), excluding non-melanoma skin cancers.\n- **Treating Doctor Criteria**: The billing practitioner must be a **treating doctor** who has treated or diagnosed the patient's cancer within the past 12 months or expects to do so within the next 12 months.\n- **Non-Treating Clinicians**: Non-treating clinicians, allied health providers, and support staff are **not eligible** to bill this item.\n- **Billing Limitations**: Only **one practitioner** can claim item 871 for each patient case conference, typically the lead treating doctor.\n- **Patient Notification**: Patients must be informed that a charge will be incurred for the case conference, which is eligible for a Medicare benefit.\n- **Communication Requirement**: Participants must communicate throughout the case conference via face-to-face, telephone, or video link.\n- **Allied Health Eligibility**: Suitable allied health practitioners include various professionals such as dieticians, psychologists, and physiotherapists, among others.\n- **Billing Frequency**: Generally, no more than **two case conferences** per patient per year should be billed by a practitioner.\n- **Purpose of Conference**: The case conference is specifically for developing a **cancer treatment plan** and should not be billed for other purposes (e.g., community or discharge case conferences).\n- **Audit Prevention**: Ensure compliance with all eligibility criteria and documentation requirements to prevent audits and potential penalties.",
    "updated": "2026-07-05"
  },
  "245": {
    "content": "HEADING: MBS Item 245 Overview\n\n- MBS Item 245 pertains to **Domiciliary Medication Management Reviews (DMMRs)** for patients living in a community setting.\n- The service is applicable for patients with a **chronic medical condition** or a **complex medication regimen** who are not meeting their **therapeutic goals**.\n\nHEADING: Key Requirements for Billing Compliance\n\n- The GP must **physically assess** the patient and obtain their **consent** before proceeding with the DMMR.\n- Following the assessment, the GP must:\n  - Refer the patient to a **community pharmacy** or an **accredited pharmacist** for the DMMR.\n  - Provide relevant **clinical information** necessary for the DMMR.\n  - Discuss the DMMR results with the pharmacist, including suggested **medication management strategies**.\n  - Develop a **written medication management plan** in consultation with the patient.\n  - Provide the written plan to a community pharmacy chosen by the patient.\n\nHEADING: Frequency and Limitations\n\n- A DMMR can be billed **once every 12 months** for a patient, unless there are **exceptional circumstances** such as significant changes in the patient's condition or medication regimen.\n- If exceptional circumstances apply, the GP must document these in the patient's records and indicate them on the invoice or claim.\n\nHEADING: Documentation and Record Keeping\n\n- Ensure that all records are **adequate** and **contemporaneous**, detailing the nature of the exceptional circumstances if applicable.\n- Claims can only be submitted after all components of the DMMR have been completed.\n\nHEADING: Additional Billing Considerations\n\n- GPs may bill for another service on the same day as the DMMR, provided both services are **clinically relevant** and distinct.\n- Ensure that the other service does not have restrictions on same-day billing.\n\nHEADING: Audit Prevention Strategies\n\n- Maintain thorough documentation of the patient's assessment, consent, and the DMMR process to support compliance during audits.\n- Regularly review billing practices to ensure adherence to MBS guidelines and avoid potential discrepancies.",
    "updated": "2026-07-05"
  },
  "249": {
    "content": "HEADING: Summary of MBS Item 249 for Billing Compliance\n\n- Item 249 pertains to **Residential Medication Management Reviews (RMMRs)** conducted by a prescribed medical practitioner for patients in residential aged care facilities.\n- The **fee for Item 249** is **$101.45**, with a **100% benefit** available.\n- RMMRs are collaborative services involving both a **prescribed medical practitioner** and a **pharmacist** to assess medication management needs.\n- A **significant change** in a resident\u2019s medical condition or medication management plan is required to bill this item if the resident has had an RMMR in the past **12 months**.\n- The medical practitioner must **personally attend** the patient as part of the RMMR service; third-party communication is only supplementary.\n- Key responsibilities of the medical practitioner include:\n  - Discussing the review with the resident and obtaining consent.\n  - Collaborating with the pharmacist regarding the review.\n  - Providing relevant clinical information or the latest comprehensive medical assessment.\n  - Participating in post-review discussions if necessary, unless there are no significant changes.\n  - Developing or revising the resident\u2019s medication management plan in collaboration with the pharmacist.\n  - Offering copies of the medication management plan to the resident and relevant nursing staff.\n- Ensure documentation is thorough and includes all discussions and agreements made during the review process to support compliance.\n- Regularly review and update knowledge on the **Health Insurance (General Medical Services Table) Regulations** to remain compliant with billing practices.\n- Be aware of the **Extended Medicare Safety Net Cap** of **$304.35** for additional billing considerations.\n- Maintain clear communication with nursing staff regarding the medication management plan to ensure proper implementation and follow-up.",
    "updated": "2026-07-05"
  },
  "272": {
    "content": "HEADING: MBS Item 272 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 272 pertains to professional attendance by a prescribed medical practitioner (PMP) who has not undertaken mental health skills training, lasting at least **20 minutes but less than 40 minutes** for the preparation of a **GP mental health treatment plan**.\n\n- **Fee Structure**: \n  - Schedule Fee: **$68.65**\n  - Medicare Benefit: \n    - 75% = **$51.50**\n    - 100% = **$68.65**\n  - Extended Medicare Safety Net Cap: **$205.95**\n\n- **Eligibility Criteria**: \n  - Services are available to patients who meet the relevant eligibility requirements under the **Better Access initiative**.\n  - Must be provided by a GP or PMP at the patient\u2019s **MyMedicare registered practice** or by their usual medical practitioner.\n  - Includes private inpatients being discharged from hospital, with claims made at the **75% MBS benefit** if part of hospital treatment.\n\n- **Documentation Requirements**: \n  - Maintain **adequate and contemporaneous records** of the consultation, including details of the mental health treatment plan.\n  - Ensure that the **time spent** with the patient is accurately recorded to justify the billing.\n\n- **Training Recommendations**: \n  - It is **strongly recommended** that GPs and PMPs providing mental health treatment have appropriate mental health training to ensure quality care and compliance with MBS requirements.\n\n- **Associated Items**: \n  - Familiarize with related MBS items for mental health treatment plans, including items **2700, 2701, 2715, 2717, 276, 281, 282**, and video items **92112 to 92123**.\n\n- **Audit Prevention**: \n  - Regularly review billing practices to ensure compliance with MBS guidelines.\n  - Conduct internal audits to verify that all claims are supported by appropriate documentation and meet the eligibility criteria.\n  - Stay updated on any changes to the MBS and associated explanatory notes to avoid billing errors. \n\n- **Key Principles**: \n  - Understand the **time-tiered professional attendance items** and their specific requirements as outlined in the explanatory notes.\n  - Address multiple health-related issues during consultations as long as the service requirements are met. \n\nBy adhering to these guidelines, GPs can ensure compliance with MBS Item 272 and minimize the risk of audits or billing discrepancies.",
    "updated": "2026-07-05"
  },
  "276": {
    "content": "HEADING: MBS Item 276 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 276 covers professional attendance by a prescribed medical practitioner (PMP) lasting at least **40 minutes** for the preparation of a **GP mental health treatment plan**.\n- **Eligibility**: Services are available to patients who meet the relevant eligibility requirements, including those enrolled in **MyMedicare** or receiving care from their usual medical practitioner.\n- **Training Requirement**: The item is specifically for practitioners who **have not undertaken mental health skills training**. It is strongly recommended that GPs and PMPs providing mental health treatment have appropriate training.\n- **Fee Structure**: The schedule fee is **$101.05**, with a benefit of **75%** equating to **$75.80** and **100%** at **$101.05**.\n- **Extended Medicare Safety Net Cap**: The cap for this item is **$303.15**.\n- **Documentation**: Maintain **adequate and contemporaneous records** of the consultation to support the billing of this item and ensure compliance with Medicare requirements.\n- **Service Requirements**: The service must be provided in a **MyMedicare registered practice** or by the patient\u2019s usual medical practitioner, ensuring continuity of care.\n- **Multiple Issues**: There is no limitation on the number of health-related issues that can be addressed during the consultation, provided the service requirements are met.\n- **Audit Prevention**: Ensure compliance with all relevant explanatory notes (e.g., AN.0.56, AN.0.78) to prevent audits and potential penalties. Regularly review billing practices against current guidelines.\n- **Associated Items**: Be aware of associated items (e.g., 272, 281, 282) for comprehensive billing practices related to mental health treatment plans.",
    "updated": "2026-07-05"
  },
  "277": {
    "content": "HEADING: MBS Item 277 Summary for Billing Compliance\n\n- MBS Item 277 pertains to specific **consultation services** provided by General Practitioners (GPs).\n- Ensure that the **service provided** aligns with the description and requirements outlined in the MBS for Item 277.\n- Verify that the **patient's clinical need** justifies the use of this item, as it is essential for compliance and audit prevention.\n- Maintain thorough **documentation** of the consultation, including patient history, examination findings, and treatment plans, to support the billing of Item 277.\n- Confirm that the **time spent** on the consultation meets the minimum requirements specified for Item 277.\n- Be aware of any **exclusions** or **limitations** associated with Item 277 to avoid billing errors.\n- Regularly review and stay updated on any **changes** to the MBS that may affect Item 277, including fee adjustments or amendments to item descriptors.\n- Implement a **checklist** for billing Item 277 to ensure all criteria are met before submission to Medicare.\n- Conduct periodic **audits** of billing practices to identify and rectify any discrepancies related to Item 277.\n- Educate all staff involved in billing on the specific requirements and compliance measures related to MBS Item 277 to minimize the risk of audit issues.",
    "updated": "2026-07-05"
  },
  "279": {
    "content": "HEADING: MBS Item 279 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 279 pertains to specific medical services provided by General Practitioners (GPs).\n- **Eligibility**: Ensure that the service provided meets the criteria outlined in the MBS for Item 279.\n- **Documentation**: Maintain thorough documentation of the patient's medical history, the service provided, and the rationale for the service to support billing.\n- **Clinical Justification**: Clearly document the **clinical necessity** for the service to avoid audit issues.\n- **Billing Accuracy**: Verify that the billing aligns with the service provided and that Item 279 is the correct item for the service rendered.\n- **Patient Consent**: Obtain and document **informed consent** from the patient prior to the service to ensure compliance.\n- **Record Keeping**: Keep records for a minimum of **seven years** as per Medicare requirements to facilitate any potential audits.\n- **Training and Updates**: Regularly train staff on MBS updates and compliance requirements to ensure adherence to billing practices.\n- **Audit Preparedness**: Conduct internal audits periodically to ensure compliance with MBS Item 279 and identify any discrepancies before external audits occur.\n- **Consultation Requirements**: Ensure that the service is provided in accordance with the **consultation requirements** specified in the MBS for Item 279.",
    "updated": "2026-07-05"
  },
  "281": {
    "content": "HEADING: MBS Item 281 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 281 covers professional attendance by a prescribed medical practitioner (PMP) who has completed mental health skills training, lasting between **20 to 40 minutes** for the preparation of a **GP mental health treatment plan**.\n\n- **Fee Structure**: \n  - Schedule Fee: **$87.15**\n  - Medicare Benefit: \n    - 75% = **$65.40**\n    - 100% = **$87.15**\n  - Extended Medicare Safety Net Cap: **$261.45**\n\n- **Eligibility Requirements**: \n  - Services are available to patients who meet the eligibility criteria under the **Better Access initiative**.\n  - Must be provided by a GP or PMP at the patient\u2019s **MyMedicare registered practice** or by their usual medical practitioner.\n\n- **Documentation**: \n  - Maintain **adequate and contemporaneous records** of the consultation, including the time spent and the content of the mental health treatment plan.\n  - Ensure documentation reflects the **clinical necessity** of the service provided.\n\n- **Training Requirement**: \n  - It is strongly recommended that GPs and PMPs providing mental health treatment have completed **appropriate mental health training** recognized by the General Practice Mental Health Standards Collaboration.\n\n- **Service Limitations**: \n  - There is no limitation on the number of health-related issues that can be addressed during the consultation, provided the service requirements are met.\n\n- **Audit Prevention**: \n  - Ensure compliance with all **MBS guidelines** and explanatory notes to avoid potential audits.\n  - Regularly review billing practices and documentation to ensure alignment with MBS requirements.\n\n- **Associated Items**: \n  - Familiarize with associated MBS items for mental health treatment plans (e.g., Items 272, 276, 281, 282) to ensure comprehensive billing practices.\n\n- **Patient Care**: \n  - Focus on providing quality care and early intervention for patients with **diagnosable mental disorders** as defined by the World Health Organization.\n\n- **Consultation Types**: \n  - Be aware of different consultation types available for GPs and PMPs, including face-to-face and video consultations, and ensure appropriate billing based on the service provided.",
    "updated": "2026-07-05"
  },
  "282": {
    "content": "HEADING: MBS Item 282 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 282 covers professional attendance by a prescribed medical practitioner (PMP) who has completed mental health skills training, lasting at least **40 minutes** for the preparation of a **GP mental health treatment plan**.\n\n- **Fee Structure**: \n  - Schedule Fee: **$128.45**\n  - Medicare Benefit: \n    - 75% = **$96.35**\n    - 100% = **$128.45**\n  \n- **Eligibility Criteria**: \n  - Services are available to patients who meet the eligibility requirements under the **Better Access initiative**.\n  - Must be provided by a GP or PMP at the patient\u2019s **MyMedicare registered practice** or by their usual medical practitioner.\n  - Includes private inpatients being discharged from hospital.\n\n- **Documentation Requirements**: \n  - Maintain **adequate and contemporaneous records** of the consultation and treatment plan.\n  - Document the **time spent** (minimum of 40 minutes) to support the billing of this item.\n\n- **Training Requirement**: \n  - It is strongly recommended that GPs and PMPs providing mental health treatment have **appropriate mental health training** recognized through the General Practice Mental Health Standards Collaboration.\n\n- **Service Limitations**: \n  - There is **no limitation** on the number of health-related issues that can be addressed during the consultation, provided the service requirements are met.\n\n- **Audit Prevention**: \n  - Ensure compliance with the **time requirement** and **training qualifications** to avoid potential audits.\n  - Regularly review and update knowledge on the **Better Access initiative** and associated MBS items to ensure adherence to current guidelines.\n\n- **Associated Items**: \n  - Familiarize with related MBS items for mental health treatment plans (e.g., Items 2700, 2701, 2715, 2717, etc.) to ensure comprehensive billing practices.\n\n- **Consultation Context**: \n  - The mental health treatment plan should be structured to identify and document care needs for patients with clinically diagnosed mental disorders, ensuring a **structured approach** to treatment management.",
    "updated": "2026-07-05"
  },
  "283": {
    "content": "HEADING: MBS Item 283 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 283 covers professional attendance by a prescribed medical practitioner for providing **focussed psychological strategies** for mental disorders.\n- **Duration Requirement**: The consultation must last at least **30 minutes** but less than **40 minutes**.\n- **Eligibility**: Only **prescribed medical practitioners** registered with the Chief Executive Medicare and meeting credentialing requirements can bill this item.\n- **Fee Structure**: The schedule fee for Item 283 is **$88.85**, with a benefit of **100%** equating to the full fee.\n- **Extended Medicare Safety Net**: The cap for the Extended Medicare Safety Net is **$266.55**.\n- **Better Access Initiative**: This item is part of the **Better Access Initiative**, which allows eligible patients to access mental health treatment services.\n- **Claim Limits**: Patients can claim up to **10 individual** and **10 group therapy** sessions per calendar year under this initiative.\n- **Documentation**: Ensure thorough documentation of the patient's mental health assessment and the strategies provided during the consultation to support billing.\n- **Referral Requirements**: Be aware of any **referral requirements** for Better Access treatment services, as outlined in the associated explanatory notes.\n- **Audit Prevention**: Maintain compliance by ensuring that all consultations meet the specified duration and eligibility criteria to avoid potential audits or claim rejections.",
    "updated": "2026-07-05"
  },
  "285": {
    "content": "HEADING: MBS Item 285 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 285 covers professional attendance by a prescribed medical practitioner for providing **focussed psychological strategies** for mental disorders, lasting **30 to 40 minutes**.\n  \n- **Eligibility**: Only **prescribed medical practitioners** registered with the Chief Executive Medicare and meeting credentialing requirements can provide this service.\n\n- **Fee Structure**: \n  - The fee is the amount for **Item 283** plus **$24.90**, divided by the number of patients seen, up to a maximum of **six patients**.\n  - For **seven or more patients**, the fee is the amount for Item 283 plus **$1.95 per patient**.\n\n- **Audit Prevention**: \n  - Ensure that the **duration** of the consultation is accurately recorded as **30 to 40 minutes** to meet the requirements.\n  - Maintain documentation of the **mental disorder assessment** conducted by a medical practitioner prior to providing focussed psychological strategies.\n  - Verify that the patient is eligible under the **Better Access Initiative** and that the service aligns with their **Mental Health Treatment Plan**.\n\n- **Extended Medicare Safety Net**: The cap is set at **300% of the derived fee** for this item or **$500**, whichever is lesser.\n\n- **Documentation**: Keep comprehensive records of all consultations, including patient details, assessment notes, and treatment plans to support claims and facilitate audits.\n\n- **Compliance with Regulations**: Familiarize yourself with the **Health Insurance (General Medical Services Table) Regulations 2021** and ensure adherence to all legislative requirements for eligible GPs and PMPs.\n\n- **Referral Requirements**: Be aware of the referral requirements for Better Access Treatment Services to ensure compliance with MBS guidelines.\n\n- **Training and Credentialing**: Regularly update training and credentialing to maintain eligibility for providing these services under the MBS.",
    "updated": "2026-07-05"
  },
  "286": {
    "content": "HEADING: MBS Item 286 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 286 pertains to professional attendance by a prescribed medical practitioner for providing **focussed psychological strategies** for mental disorders, lasting at least **40 minutes**.\n- **Eligibility**: Only **prescribed medical practitioners** registered with the Chief Executive Medicare and meeting credentialing requirements can bill this item.\n- **Fee Structure**: The schedule fee for Item 286 is **$127.10**, with a **100% benefit** available to eligible patients.\n- **Service Requirements**: \n  - The service must be for **mental disorders** assessed by a medical practitioner.\n  - The consultation must last a minimum of **40 minutes** to qualify for billing.\n- **Audit Prevention**: \n  - Ensure accurate documentation of the **duration** of the consultation to meet the minimum time requirement.\n  - Maintain clear records of the **mental health assessment** conducted prior to the service.\n  - Verify that the patient is eligible under the **Better Access Initiative** and that the service aligns with their mental health treatment plan.\n- **Extended Medicare Safety Net**: The cap for this item is **$381.30**, which may affect patient out-of-pocket costs.\n- **Compliance with Regulations**: Familiarize yourself with the **Health Insurance (General Medical Services Table) Regulations 2021** for legislative requirements related to billing this item.\n- **Referral Requirements**: Be aware of the referral requirements for Better Access treatment services, as outlined in the associated explanatory notes.\n- **Record Keeping**: Maintain comprehensive records of all consultations, including patient details, assessment notes, and treatment plans, to support compliance and facilitate audits.",
    "updated": "2026-07-05"
  },
  "287": {
    "content": "HEADING: MBS Item 287 Summary for Billing Compliance\n\n- Item 287 pertains to **professional attendance** by a prescribed medical practitioner at a location other than consulting rooms.\n- The service must involve **focussed psychological strategies** for mental disorders that have been assessed by a medical practitioner.\n- Each session must last at least **40 minutes** to qualify for billing under this item.\n- The fee structure includes the fee for item 286, plus an additional **$24.90** divided by the number of patients seen, with a maximum of **six patients**.\n- For **seven or more patients**, the fee for item 286 plus **$1.95 per patient** applies.\n- Ensure that the practitioner is **registered** with the Chief Executive Medicare and meets the **credentialing requirements** for this service.\n- Compliance with the **Better Access Initiative** is essential, which allows Medicare benefits for selected mental health treatment services.\n- Maintain accurate records of patient assessments and treatment plans to support claims under this item.\n- Be aware of the **Extended Medicare Safety Net Cap**, which is **300% of the derived fee** for this item or **$500**, whichever is lesser.\n- Regularly review the **explanatory notes** associated with this item to stay updated on any changes in eligibility or billing requirements.\n- Ensure that all services provided are in line with the **legislative requirements** outlined in the Health Insurance (General Medical Services Table) Regulations 2021.\n- Document all patient interactions and treatment details thoroughly to prevent audit issues and ensure compliance with Medicare guidelines.",
    "updated": "2026-07-05"
  },
  "392": {
    "content": "HEADING: MBS Item 392 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 392 pertains to professional attendance by a prescribed medical practitioner to prepare a **GP chronic condition management plan** for a patient.\n- **Fee Structure**: \n  - Schedule Fee: **$128.55**\n  - Benefit: \n    - 75% = **$96.45**\n    - 100% = **$128.55**\n- **Eligibility**: \n  - Applicable for patients with **chronic conditions** who would benefit from a structured management approach.\n  - Not available for residents of **residential aged care facilities**; they may qualify for a multidisciplinary care plan instead.\n- **Preparation Requirements**: \n  - The plan must include:\n    - Description of the patient\u2019s **chronic condition** and health care needs.\n    - **Health and lifestyle goals** developed collaboratively with the patient.\n    - Actions to be taken by the patient.\n    - Anticipated treatments and services needed.\n    - Referrals for **multidisciplinary care** if applicable.\n    - Arrangements for **reviewing the plan**.\n- **Consent and Documentation**: \n  - Obtain and document the patient\u2019s **consent** for sharing information with the multidisciplinary team.\n  - Provide a copy of the plan to the patient and their carer if appropriate.\n  - Ensure a copy is added to the patient\u2019s **medical records**.\n- **Audit Prevention**: \n  - Maintain thorough documentation of all discussions, decisions, and patient consent.\n  - Regularly review and update the management plan as required, ensuring compliance with the defined processes.\n  - Ensure that the goals set in the plan are **realistic** and that progress is documented during reviews.\n- **Review Process**: \n  - Regularly assess the patient\u2019s progress towards their goals and update the plan as necessary.\n  - Document any changes and obtain consent for sharing updated information with the multidisciplinary team.\n- **Compliance Notes**: \n  - Familiarize with the relevant **explanatory notes** (AN.0.47, AN.15.3, AN.15.4, AN.15.5, AN.15.6, AN.36.2) for detailed guidance on compliance and billing practices.",
    "updated": "2026-07-05"
  },
  "393": {
    "content": "HEADING: MBS Item 393 Summary for Billing Compliance\n\n- **Item Description**: Item 393 covers professional attendance by a prescribed medical practitioner to review a GP chronic condition management plan.\n- **Fee Structure**: \n  - Schedule Fee: **$128.55**\n  - Benefit: \n    - 75% = **$96.45**\n    - 100% = **$128.55**\n- **Eligibility**: \n  - Applicable for patients with one or more **chronic conditions**.\n  - Not available for residents of **residential aged care facilities**.\n- **Review Process**: \n  - Must discuss and document the patient\u2019s **progress** towards goals.\n  - Evaluate if updates to the management plan are necessary based on progress and multidisciplinary team input.\n- **Documentation Requirements**: \n  - Record patient\u2019s **consent** for sharing information with multidisciplinary team members.\n  - Offer a copy of the updated plan to the patient and their carer, if appropriate.\n  - Ensure all discussions and updates are documented in the patient\u2019s **medical records**.\n- **Audit Prevention**: \n  - Ensure compliance with the **Health Insurance (General Medical Services Table) Regulations 2021**.\n  - Maintain clear and thorough documentation to support the review process and any updates made to the management plan.\n  - Regularly review the appropriateness of goals and progress to avoid discrepancies during audits.\n- **Transition Information**: \n  - GP chronic condition management plans replaced GP Management Plans and Team Care Arrangements as of **1 July 2025**.\n  - Be aware of transition arrangements for existing plans as outlined in the associated notes.",
    "updated": "2026-07-05"
  },
  "733": {
    "content": "HEADING: MBS Item 733 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 733 covers a professional attendance at consulting rooms lasting no more than **5 minutes** by a prescribed medical practitioner when no other item applies.\n- **Fee Structure**: The schedule fee is **$27.75**, with a benefit of **100%** equating to **$27.75**.\n- **Eligibility**: This item is applicable for **after-hours attendances** and is categorized under **Group A7** for acupuncture and non-specialist practitioner items.\n- **Documentation Requirements**: Maintain **appropriate and contemporaneous records** of the service provided, including:\n  - Patient history\n  - Clinical examination\n  - Arranging investigations\n  - Management plan implementation\n  - Preventive health care advice\n- **Claiming Guidelines**: Only claim Item 733 if:\n  - No other MBS item accurately reflects the service provided.\n  - The attendance meets the criteria for a **general attendance item**.\n- **Professional Attendance Definition**: Ensure the service includes evaluating the patient\u2019s condition, formulating management plans, and providing advice.\n- **Personal Attendance Definition**: Confirm that the service is provided in a **personal attendance** context, meaning:\n  - The patient must be present.\n  - Only time spent directly with the patient counts towards the attendance.\n  - No other health practitioner can provide the service on behalf of the medical practitioner.\n- **Audit Prevention**: To prevent audits:\n  - Ensure accurate documentation of all services rendered.\n  - Verify that the service aligns with the definitions of professional and personal attendance.\n  - Avoid claiming this item if a more specific MBS item applies to the service provided.\n- **Extended Medicare Safety Net**: Be aware of the **cap of $83.25** under the Extended Medicare Safety Net for eligible patients.\n- **Compliance with Guidelines**: Regularly review the explanatory notes (AN.0.9, AN.7.1, etc.) for updates and clarifications regarding the use of general attendance items.",
    "updated": "2026-07-05"
  },
  "737": {
    "content": "HEADING: MBS Item 737 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 737 covers professional attendance at consulting rooms lasting more than 5 minutes but not exceeding 25 minutes by a prescribed medical practitioner, where no other item applies.\n- **Fee Structure**: The schedule fee is **$46.85**, with a benefit of **100%** equating to **$46.85**.\n- **Eligibility**: This item is applicable for **after-hours attendances** and is categorized under **Group A7** for acupuncture and non-specialist practitioner items.\n- **Documentation Requirements**: Maintain **appropriate and contemporaneous records** of the service provided, including:\n  - Patient history\n  - Clinical examination\n  - Arranging investigations\n  - Management plan implementation\n  - Preventive health care advice\n- **Claiming Protocol**: Only claim Item 737 if:\n  - No other specific MBS item applies to the service provided.\n  - The service meets the criteria for a general attendance item.\n- **Professional Attendance Definition**: Ensure the service includes evaluation of the patient\u2019s condition, management planning, and advice regarding treatment.\n- **Personal Attendance Definition**: Confirm that the service is provided during a personal attendance by a single medical practitioner to a single patient, with the patient present.\n- **Audit Prevention**: To avoid audits:\n  - Ensure accurate documentation of all services rendered.\n  - Verify that the claimed service aligns with the description of Item 737.\n  - Avoid claiming this item if a more specific MBS item is applicable.\n- **Extended Medicare Safety Net**: Be aware of the cap of **$140.55** under the Extended Medicare Safety Net for eligible patients.\n- **Compliance with Guidelines**: Familiarize yourself with the explanatory notes (AN.0.9, AN.7.1, etc.) for detailed guidance on using time-tiered professional attendance items.",
    "updated": "2026-07-05"
  },
  "741": {
    "content": "HEADING: MBS Item 741 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 741 covers professional attendance at consulting rooms lasting more than 25 minutes but not exceeding 45 minutes by a prescribed medical practitioner, where no other item applies.\n- **Fee Structure**: The schedule fee is **$80.45**, with a benefit of **100%** equating to **$80.45**.\n- **Eligibility**: This item is applicable for after-hours attendances and is categorized under Group A7 for acupuncture and non-specialist practitioner items.\n- **Documentation Requirements**: Maintain **appropriate and contemporaneous records** of the service provided, including:\n  - Patient history\n  - Clinical examination\n  - Investigations arranged\n  - Management plan implemented\n  - Preventive health care provided\n- **Claiming Guidelines**: Only claim Item 741 when:\n  - No other specific MBS item applies to the service provided.\n  - The service meets the criteria for a general attendance item.\n- **Professional Attendance Definition**: Ensure the service includes evaluation, management planning, and advice regarding the patient's condition.\n- **Personal Attendance Definition**: Confirm that the service is provided during a personal attendance, meaning:\n  - The patient must be present.\n  - Only time spent directly with the patient counts towards the attendance.\n  - Services cannot be provided on behalf of the medical practitioner by another health professional.\n- **Audit Prevention**: To prevent audits:\n  - Ensure accurate documentation of all services rendered.\n  - Verify that the claimed service aligns with the description of Item 741.\n  - Avoid claiming this item if a more specific MBS item is applicable.\n- **Extended Medicare Safety Net**: Be aware of the cap of **$241.35** for the Extended Medicare Safety Net, which may affect patient benefits.\n- **Compliance Resources**: Refer to explanatory notes AN.0.9, AN.7.1, and AN.7.2 for further guidance on using time-tiered professional attendance items.",
    "updated": "2026-07-05"
  },
  "745": {
    "content": "HEADING: MBS Item 745 Summary for Billing Compliance\n\n- Item 745 is for **professional attendance** at consulting rooms lasting **more than 45 minutes but not more than 60 minutes**.\n- This item is applicable only when **no other MBS item** applies to the service provided.\n- The **schedule fee** for Item 745 is **$112.80**, with a benefit of **100%** equating to **$112.80**.\n- Ensure that the service provided meets the criteria for a **general attendance item**, which includes:\n  - Taking a **patient history**\n  - Performing a **clinical examination**\n  - Arranging necessary **investigations**\n  - Implementing a **management plan**\n  - Providing appropriate **preventive health care**\n- Maintain **appropriate and contemporaneous records** of the service provided, including clinical details.\n- The service must be a **professional attendance**, meaning it involves evaluating the patient's condition, formulating management plans, and providing advice.\n- A **personal attendance** is required, meaning the patient must be present during the consultation, and only time spent directly with the patient counts towards the attendance.\n- Benefits are not payable if more than one medical practitioner provides an attendance on the same patient at the same time.\n- For telehealth services, ensure compliance with modified requirements for personal attendance.\n- Always select the item that **best describes the service** provided; if a more specific item exists, it should be claimed instead of Item 745.\n- Regularly review and stay updated on the **explanatory notes** associated with Item 745 to ensure compliance with billing practices.",
    "updated": "2026-07-05"
  },
  "761": {
    "content": "HEADING: MBS Item 761 Summary for Billing Compliance\n\n- Item 761 pertains to **professional attendance** by a prescribed medical practitioner in after-hours settings.\n- The attendance must last **not more than 5 minutes** and can involve **one or more patients** on a single occasion.\n- The fee structure includes:\n  - For up to **six patients**: the fee for item 733 plus **$24.90** divided by the number of patients seen.\n  - For **seven or more patients**: the fee for item 733 plus **$1.95** per additional patient.\n- Ensure that the service provided does not fall under any other specific MBS item; this item is only applicable when **no other item applies**.\n- Maintain **appropriate and contemporaneous records** of the attendance, including:\n  - Patient history\n  - Clinical examination\n  - Management plan\n  - Preventive health care advice\n- Claims should reflect the **best description** of the service provided; use more specific items when applicable.\n- Be aware of the **Extended Medicare Safety Net Cap**, which is **300% of the derived fee** for this item or **$500**, whichever is lesser.\n- Ensure compliance with the definition of a **professional attendance**, which includes evaluating the patient's condition, formulating management plans, and providing advice.\n- Avoid billing for services that do not meet the criteria for professional attendance, such as those involving multiple practitioners or services provided by another health practitioner on behalf of the medical practitioner.\n- Regularly review and update knowledge on MBS guidelines to prevent audit issues and ensure compliance with billing practices.",
    "updated": "2026-07-05"
  },
  "772": {
    "content": "HEADING: MBS Item 772 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 772 pertains to professional attendance at a residential aged care facility or consulting rooms within such a facility, specifically for patients accommodated there.\n- **Duration**: The attendance must be **not more than 5 minutes** in duration.\n- **Patient Limit**: Claims can be made for **up to six patients** seen during one attendance. For **seven or more patients**, a different fee structure applies.\n- **Fee Structure**: \n  - For six or fewer patients: Fee for item 733 plus **$44.75 divided by the number of patients**.\n  - For seven or more patients: Fee for item 733 plus **$3.15 per patient**.\n- **Claiming Conditions**: This item should only be claimed when **no other MBS item** applies to the service provided.\n- **Documentation**: It is crucial to maintain **appropriate and contemporaneous records** of the service, including patient history, clinical examination, and management plans.\n- **Professional Attendance Definition**: Ensure that the service includes evaluating the patient's condition, formulating a management plan, and providing preventive health care.\n- **Audit Prevention**: \n  - Verify that the service provided aligns with the description of Item 772 and that no other specific MBS item applies.\n  - Ensure compliance with the **time limit** and **patient count** to avoid discrepancies.\n  - Maintain clear documentation to support the claim, including details of the attendance and services rendered.\n- **Extended Medicare Safety Net Cap**: Be aware that the cap is **300% of the derived fee** for this item or **$500**, whichever is lesser.\n- **General Principle**: Always claim the item that **best describes the service** provided to ensure compliance with MBS guidelines.",
    "updated": "2026-07-05"
  },
  "776": {
    "content": "HEADING: MBS Item 776 Summary for Billing Compliance\n\n- MBS Item 776 is applicable for **professional attendance** at a **residential aged care facility** or consulting rooms within such a facility.\n- The attendance must be **more than 5 minutes** but **not more than 25 minutes** in duration.\n- This item is specifically for **prescribed medical practitioners** and is not applicable to self-contained units.\n- The fee structure includes:\n  - For up to **six patients**, the fee is the fee for item 737 plus **$44.75** divided by the number of patients seen.\n  - For **seven or more patients**, the fee is the fee for item 737 plus **$3.15** per patient.\n- Ensure that the attendance is for **one occasion** at one residential aged care facility.\n- Maintain **appropriate and contemporaneous records** of the attendance, including:\n  - Patient history\n  - Clinical examination\n  - Management plan\n  - Preventive health care provided\n- Claims should only be made when **no other MBS item** applies that better describes the service provided.\n- It is crucial to ensure that the service provided aligns with the definition of a **professional attendance** as per the regulations.\n- Be aware of the **Extended Medicare Safety Net Cap**, which is **300% of the derived fee** for this item or **$500**, whichever is lesser.\n- Regularly review and update knowledge on MBS guidelines to prevent audit issues and ensure compliance with billing practices.",
    "updated": "2026-07-05"
  },
  "788": {
    "content": "HEADING: MBS Item 788 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 788 pertains to professional attendance by a prescribed medical practitioner at a residential aged care facility, requiring a duration of more than **25 minutes** but not exceeding **45 minutes**.\n\n- **Eligibility**: This item applies to attendances at residential aged care facilities, excluding self-contained units, and is intended for situations where no other MBS item applies.\n\n- **Fee Structure**: \n  - The fee is calculated as the fee for item **741** plus **$44.75** divided by the number of patients seen, up to a maximum of **six patients**.\n  - For **seven or more patients**, the fee is the fee for item **741** plus **$3.15** per additional patient.\n\n- **Documentation Requirements**: \n  - Maintain **appropriate and contemporaneous records** of the service provided, including patient history, clinical examination, management plan, and preventive health care advice.\n  - Ensure that the attendance is documented clearly to reflect the time spent and services rendered.\n\n- **Audit Prevention**: \n  - Claim only when the service provided aligns with the description of Item 788 and no other specific MBS item applies.\n  - Avoid claiming for services that do not meet the time requirement or are provided in self-contained units.\n  - Ensure that the number of patients seen does not exceed the limits set for the fee calculation.\n\n- **General Principles**: \n  - The item that best describes the service should be claimed. If a more specific item exists, it should be used instead of Item 788.\n  - Claims should reflect the actual service provided, ensuring compliance with MBS guidelines to prevent audit issues.\n\n- **Extended Medicare Safety Net**: \n  - Be aware that the cap for this item is **300%** of the derived fee or **$500**, whichever is lesser, which may affect billing practices.\n\n- **Professional Attendance Definition**: \n  - Understand that professional attendance includes evaluating the patient\u2019s condition, formulating management plans, and providing preventive health care, all of which must be documented.\n\n- **Compliance with Regulations**: \n  - Familiarize yourself with the definitions and requirements outlined in the MBS to ensure adherence to billing regulations and avoid potential penalties.",
    "updated": "2026-07-05"
  },
  "789": {
    "content": "HEADING: MBS Item 789 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 789 pertains to professional attendance by a prescribed medical practitioner at a residential aged care facility, requiring a duration of more than 45 minutes but not exceeding 60 minutes.\n\n- **Eligibility**: This item is applicable only when no other MBS item applies to the service provided.\n\n- **Patient Limit**: The item allows billing for attendance on **up to six patients** during one visit. For **seven or more patients**, a different fee structure applies.\n\n- **Fee Structure**: \n  - For six or fewer patients: Fee for item 745 plus **$44.75** divided by the number of patients seen.\n  - For seven or more patients: Fee for item 745 plus **$3.15** per additional patient.\n\n- **Documentation Requirements**: \n  - Maintain **appropriate and contemporaneous records** of the service provided.\n  - Document patient history, clinical examination, management plans, and preventive health care advice.\n\n- **Professional Attendance Definition**: \n  - Includes evaluating the patient's condition, formulating management plans, providing treatment advice, and recording clinical details.\n\n- **Audit Prevention**: \n  - Ensure that the service provided aligns with the description of Item 789 and that no other MBS item is applicable.\n  - Verify that the duration of the attendance meets the time requirements.\n  - Keep detailed records to support the billing of this item, as inadequate documentation may lead to audit issues.\n\n- **Extended Medicare Safety Net**: The cap for this item is **300% of the derived fee** or **$500**, whichever is lower.\n\n- **Compliance with Guidelines**: Familiarize yourself with the relevant explanatory notes (AN.0.9, AN.0.11, etc.) to ensure adherence to billing practices and avoid potential compliance issues.",
    "updated": "2026-07-05"
  },
  "792": {
    "content": "HEADING: MBS Item 792 Summary for Billing Compliance\n\n- Item 792 pertains to **non-directive pregnancy support counselling** provided by a prescribed medical practitioner (PMP) in a general practice setting.\n- The service is available for individuals who are **currently pregnant** or have been pregnant within the **last 12 months**.\n- The **minimum duration** for the consultation must be at least **20 minutes** to qualify for billing under this item.\n- The **scheduled fee** for Item 792 is **$73.35**, with a **100% benefit** available for eligible patients.\n- This item is categorized under **Category 1 - Professional Attendances** and is part of the **Group A7 - Acupuncture and Non-Specialist Practitioner Items**.\n- Non-directive counselling is defined as a process where the practitioner provides **unbiased information** without imposing their own views or values on the patient.\n- A patient is eligible for a **maximum of three counselling services** per pregnancy, regardless of the provider type.\n- It is essential to verify a patient's eligibility for the service through **Health Professional Online Services (HPOS)** or by contacting Services Australia.\n- The service must be conducted in a **confidential environment**, allowing the patient to explore their concerns regarding their pregnancy.\n- Partners may attend the session with the patient\u2019s **consent**, but the counselling is strictly for the individual who is pregnant or has been pregnant in the past year.\n- Ensure compliance with the **Health Insurance (General Medical Service Table) Regulations 2021** and the **Telehealth Attendance Determination 2021** for telehealth services.\n- Maintain accurate records of the counselling sessions, including duration and content discussed, to support billing and audit requirements.",
    "updated": "2026-07-05"
  },
  "10983": {
    "content": "HEADING: Summary of MBS Item 10983 for Billing Compliance\n\n- Item 10983 pertains to **video conferencing consultation support services** provided by a practice nurse, Aboriginal and Torres Strait Islander health worker, or health practitioner on behalf of a medical practitioner.\n- The service is intended for patients who are **not admitted patients** and are participating in a video consultation with a **specialist, consultant physician, or psychiatrist**.\n- The **schedule fee** for this item is **$38.85**, with a benefit of **100%** payable.\n- Claims for this item can only be made when:\n  - A **Medicare eligible specialist service** is claimed.\n  - The service is rendered **in Australia**.\n  - The service is necessary for the provision of the specialist service.\n- It is essential that the **specialist** determines the clinical appropriateness of the video consultation.\n- Claims are **not payable** for services rendered to admitted hospital patients, including those in hospital-in-the-home programs.\n- Benefits are not available for **telephone or email consultations**.\n- A **visual and audio link** must be established between the patient and the remote practitioner; failure to do so means no benefit is payable.\n- Practitioners must maintain **contemporaneous notes** of the consultation, including:\n  - Confirmation that the service was performed via video conference.\n  - Date and time of the consultation.\n  - Participants involved in the consultation.\n- Only clinical details recorded at the time of the consultation are considered valid; later additions do not count.\n- Multiple video consultations on the same day may be billed if they are not a continuation of previous consultations, and times must be documented.\n- Video consultations are subject to the same **aftercare rules** as face-to-face consultations.\n- The referral process for video consultations mirrors that of traditional consultations.\n- Practitioners must ensure that the technology used complies with applicable laws regarding **security and privacy**.\n- The supporting practitioner does not need to be present for the entire consultation; only the time spent assisting the patient is billable.\n- For Aboriginal and Torres Strait Islander health workers, a **Certificate III or above** in Aboriginal and/or Torres Strait Islander Primary Health Care is required to fulfill the role under this item. \n\nThis summary aims to ensure compliance and prevent audits by adhering to the specific requirements and documentation standards set forth in the MBS for Item 10983.",
    "updated": "2026-07-05"
  },
  "11731": {
    "content": "HEADING: MBS Item 11731 Summary for Billing Compliance\n\n- **Item Description**: Item 11731 covers implanted electrocardiogram loop recording by a medical practitioner, including reprogramming, data retrieval, analysis, interpretation, and reporting.\n- **Indications**: This service is applicable for patients with:\n  - **Cryptogenic stroke**\n  - **Recurrent unexplained syncope**\n- **Frequency Limitation**: The service can only be billed **once in any 4-week period**.\n- **Fee Structure**: \n  - Schedule Fee: **$41.60**\n  - Medicare Benefit: \n    - 75% = **$31.20**\n    - 85% = **$35.40**\n- **Exclusions**: This item is not applicable to services covered by **item 38285**.\n- **Patient Eligibility**: \n  - Permissible for **babies, young children**, and patients with cognitive or expressive language impairments when other investigation methods have been insufficient.\n- **Reporting Requirements**: \n  - A formal report must include discussions of results, findings, or interpretations.\n  - Discussions with patients regarding findings do not constitute a consult and should not be billed as such.\n- **Audit Prevention Tips**:\n  - Ensure documentation clearly indicates the **indication for the procedure** (cryptogenic stroke or recurrent syncope).\n  - Maintain records of the **4-week interval** between services for the same patient.\n  - Document any discussions regarding the study's safety or appropriateness as part of the service, not as a separate consult.\n  - Verify that the service is not claimed if it overlaps with item 38285.",
    "updated": "2026-07-05"
  },
  "19000": {
    "content": "HEADING: MBS Item 19000 Compliance Summary\n\n- **Item Description**: MBS Item 19000 pertains to a **Menopause and Perimenopause Health Assessment** conducted by a prescribed medical practitioner, requiring a minimum duration of **20 minutes**.\n  \n- **Key Components of the Assessment**:\n  - **Patient History**: Collect relevant information to determine the patient's menopausal status and overall wellbeing.\n  - **Physical Examination**: Conduct a basic physical examination, including **blood pressure**, **height**, and **weight** measurements.\n  - **Investigations and Referrals**: Initiate necessary investigations and referrals, considering cervical screening, mammography, and bone densitometry.\n  - **Management Options Discussion**: Discuss both **non-pharmacological** and **pharmacological** management strategies, including their risks and benefits.\n  - **Management Plan Implementation**: Develop and implement a patient-centered management plan focused on symptom management.\n  - **Preventative Health Care Advice**: Provide advice on lifestyle factors such as **physical activity**, **smoking cessation**, **alcohol consumption**, **nutrition**, and **weight management**.\n\n- **Billing Compliance**:\n  - Ensure the service is provided during a **personal attendance** by a single GP or prescribed medical practitioner.\n  - Verify that the assessment does not include any **health screening services** as defined by the Health Insurance Act 1973.\n  - Document all components of the assessment thoroughly to support billing and prevent audit issues.\n\n- **Assistance in Assessment**: \n  - Other health professionals, such as practice nurses, may assist under the supervision of the GP or PMP, provided they have the necessary skills and training.\n\n- **Audit Prevention**:\n  - Maintain comprehensive records of patient interactions, assessments, and management plans to substantiate claims.\n  - Regularly review compliance with the specific requirements outlined in the **Health Insurance Determination** and **Regulations** to ensure adherence to guidelines.\n\n- **Fee Information**: The scheduled fee for Item 19000 is **$83.60**, with a benefit of **100%** coverage. Ensure accurate billing to reflect this fee structure. \n\n- **Resources**: Refer to the **Practitioner\u2019s Toolkit for Managing Menopause** for additional guidance on conducting assessments and ensuring compliance with MBS requirements.",
    "updated": "2026-07-05"
  },
  "90183": {
    "content": "HEADING: MBS Item 90183 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 90183 pertains to professional attendance at a residential aged care facility for patients who are care recipients but not residents of self-contained units.\n- **Duration**: The attendance must last **not more than 5 minutes**.\n- **Eligibility**: The service is applicable for **one or more patients** at a single residential aged care facility on one occasion by a **prescribed medical practitioner** in an eligible area.\n- **Fee Structure**: The scheduled fee for this item is **$16.50**, with a benefit of **100%** equating to **$16.50**.\n- **Extended Medicare Safety Net Cap**: The cap for this item is **$49.50**.\n- **Claiming Guidelines**: \n  - This item should only be claimed when **no other MBS item** applies to the service provided.\n  - Ensure that the service claimed is the one that **best describes** the attendance.\n- **Documentation Requirements**: \n  - Maintain **appropriate and contemporaneous records** of the attendance.\n  - Document any actions taken during the attendance, such as taking a patient history, performing a clinical examination, or providing preventive health care.\n- **Audit Prevention**: \n  - Ensure compliance with the definition of **professional attendance** as outlined in the regulations.\n  - Avoid claiming this item if another, more specific MBS item applies to the service provided.\n  - Be cautious of the **time limit** and ensure that the attendance does not exceed 5 minutes.\n- **General Principles**: \n  - Understand that general attendance items are for services where no other specific item applies.\n  - Familiarize yourself with the definitions of **professional** and **personal attendance** to ensure correct billing practices.",
    "updated": "2026-07-05"
  },
  "90188": {
    "content": "HEADING: MBS Item 90188 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 90188 covers professional attendance at a residential aged care facility for patients who are care recipients, lasting more than 5 minutes but not exceeding 25 minutes.\n\n- **Eligibility**: The service must be provided by a **prescribed medical practitioner** in an **eligible area** and cannot be for patients residing in self-contained units.\n\n- **Fee Structure**: The scheduled fee for this item is **$35.95**, with a benefit of **100%** payable by Medicare.\n\n- **Claiming Conditions**: \n  - This item should only be claimed when **no other MBS item** applies to the service provided.\n  - Ensure that the service provided aligns with the description of a **general attendance** item.\n\n- **Documentation Requirements**: \n  - Maintain **appropriate and contemporaneous records** of the service, including patient history, clinical examination, management plan, and preventive health care provided.\n  - Document the **duration** of the attendance to confirm it falls within the specified time frame.\n\n- **Audit Prevention**: \n  - Ensure that the service provided is accurately reflected by the item claimed; if a more specific item exists, it should be used instead.\n  - Avoid claiming for services that do not meet the criteria for professional attendance, such as those provided by another health practitioner on behalf of the medical practitioner.\n\n- **General Principles**: \n  - Understand that general attendance items are applicable in various settings, including consulting rooms and residential aged care facilities.\n  - Be aware of the definitions of **professional** and **personal attendance** to ensure compliance with MBS regulations.\n\n- **Extended Medicare Safety Net**: The cap for this item under the Extended Medicare Safety Net is **$107.85**.\n\n- **Regular Updates**: Stay informed about any updates to the MBS, including changes to item descriptions, fees, and eligibility criteria.",
    "updated": "2026-07-05"
  },
  "90202": {
    "content": "HEADING: MBS Item 90202 Summary for Billing Compliance\n\n- Item 90202 is applicable for **professional attendance** at a **residential aged care facility** for patients who are care recipients but not residents of self-contained units.\n- The attendance must last **more than 25 minutes but not more than 45 minutes**.\n- The service can be claimed for **one or more patients** during a single visit to the facility.\n- The **scheduled fee** for this item is **$69.70**, with a benefit of **100%** of the fee.\n- Ensure that the service provided does not fall under another specific MBS item; if it does, that item should be claimed instead.\n- Maintain **appropriate and contemporaneous records** of the attendance, including:\n  - Patient history\n  - Clinical examination\n  - Any investigations arranged\n  - Management plan implemented\n  - Preventive health care provided\n- Claims should only be made for **professional attendances**, which involve evaluating the patient's condition, formulating management plans, and providing advice.\n- Ensure that the attendance is conducted by a **prescribed medical practitioner** in an eligible area.\n- Be aware of the **Extended Medicare Safety Net Cap** of **$209.10** for this item.\n- Review the relevant **explanatory notes** (AN.0.9, AN.7.1, AN.7.2, AN.35.2, MN.1.4, MN.1.5, MN.1.6, MN.1.7, MN.1.8) for further guidance on compliance and billing practices.\n- Avoid billing for services that do not meet the criteria for professional attendance, as this may lead to audit issues.\n- Ensure that only one medical practitioner provides the attendance for each patient at the same time to comply with billing regulations.",
    "updated": "2026-07-05"
  },
  "90212": {
    "content": "HEADING: MBS Item 90212 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 90212 pertains to professional attendance at a residential aged care facility for patients who are care recipients, lasting between **45 to 60 minutes**.\n- **Eligibility**: The service must be provided by a **prescribed medical practitioner** in an eligible area and cannot be for patients residing in self-contained units.\n- **Fee Structure**: The schedule fee is **$102.65**, with a benefit of **100%** equating to the same amount.\n- **Claiming Conditions**: This item should only be claimed when no other specific MBS item applies to the service provided.\n- **Documentation Requirements**: Maintain **appropriate and contemporaneous records** of the service, including:\n  - Patient history\n  - Clinical examination\n  - Investigations arranged\n  - Management plan implemented\n  - Preventive health care provided\n- **Audit Prevention**: Ensure compliance with the following to avoid audits:\n  - Verify that the attendance duration is accurately recorded (between **45 to 60 minutes**).\n  - Confirm that the patient is a care recipient and not residing in a self-contained unit.\n  - Ensure that the service provided aligns with the definition of a **professional attendance**.\n  - Avoid claiming this item if another more specific MBS item is applicable.\n- **General Principles**: Familiarize yourself with the general principles of MBS item usage, including the requirement that the item claimed must best describe the service provided.\n- **Extended Medicare Safety Net**: Be aware of the **Extended Medicare Safety Net Cap** of **$307.95** for this item, which may affect patient out-of-pocket costs.\n- **Compliance with Regulations**: Adhere to the regulations regarding personal attendance, ensuring that only one medical practitioner provides the service to a single patient at a time.",
    "updated": "2026-07-05"
  },
  "91178": {
    "content": "HEADING: MBS Item 91178 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 91178 pertains to video attendance by a participating nurse practitioner lasting between **6 to 20 minutes**.\n- **Clinical Relevance**: The service must include clinically relevant activities such as:\n  - **Taking a short history**\n  - **Arranging necessary investigations**\n  - **Implementing a management plan**\n  - **Providing preventive health care**\n  \n- **Fee Structure**: \n  - **Schedule Fee**: $32.65\n  - **Medicare Benefit**: 85% of the fee, equating to **$27.80**.\n  - **Extended Medicare Safety Net Cap**: $97.95.\n\n- **Eligibility Criteria**: \n  - Patients must be **registered with MyMedicare** and receive the service from their registered practice.\n  - The nurse practitioner must be an **eligible telehealth practitioner**, having provided a face-to-face service to the patient within the last **12 months**.\n  - Exemptions apply for specific patient categories, including:\n    - Patients under **12 months old**\n    - Individuals experiencing **homelessness**\n    - Patients in **natural disaster areas**\n    - Patients isolating due to **COVID-related orders**.\n\n- **Documentation Requirements**: \n  - If an exemption is claimed, it must be **documented** in the patient's clinical notes at the time of service for **audit compliance**.\n  \n- **Audit Prevention Tips**:\n  - Ensure all **eligibility criteria** are met before billing.\n  - Maintain accurate and detailed **clinical notes** to support the service provided.\n  - Regularly review patient registration status with **MyMedicare**.\n  - Confirm that the service aligns with the **clinical relevance** outlined in the item description. \n\n- **Compliance Monitoring**: \n  - Regularly audit billing practices to ensure adherence to MBS guidelines.\n  - Provide training for staff on the requirements and documentation for telehealth services.",
    "updated": "2026-07-05"
  },
  "91179": {
    "content": "HEADING: MBS Item 91179 Summary for Billing Compliance\n\n- Item 91179 pertains to **video attendance** by a **participating nurse practitioner** lasting at least **20 minutes**.\n- The service must include clinically relevant activities such as:\n  - **Taking a detailed history**\n  - **Arranging necessary investigations**\n  - **Implementing a management plan**\n  - **Providing appropriate preventive health care**\n- The **schedule fee** for this item is **$61.80**, with a benefit of **85%** equating to **$52.55**.\n- Ensure compliance with **MyMedicare** registration:\n  - The patient must be registered with **MyMedicare** and receiving the service from their registered practice.\n  - The practitioner must have provided a **face-to-face service** to the patient within the last **12 months**.\n- Exemptions apply for specific patient circumstances, including:\n  - Patients under **12 months old**\n  - Patients experiencing **homelessness**\n  - Patients in **natural disaster** affected areas\n  - Patients isolating due to **COVID-related** public health orders\n- Document any exemptions in **clinical notes** at the time of service to ensure compliance during audits.\n- The service must be billed to the **MBS** and can be performed by another medical or nurse practitioner at the practice.\n- Be aware that previous video or phone consultations do not count as a **face-to-face service** for ongoing telehealth eligibility.\n- Review associated notes (AN.1.1, MN.0.1, MN.14.15) for further guidance on eligibility and compliance requirements.",
    "updated": "2026-07-05"
  },
  "91180": {
    "content": "HEADING: MBS Item 91180 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 91180 covers video attendance by a participating nurse practitioner lasting at least 40 minutes, including clinically relevant activities such as taking an extensive history, arranging investigations, implementing management plans, and providing preventive health care.\n\n- **Fee Structure**: \n  - Schedule Fee: **$91.20**\n  - Benefit: **85%** = **$77.55**\n  - Extended Medicare Safety Net Cap: **$273.60**\n\n- **Eligibility Criteria**: \n  - Patients must be registered in **MyMedicare** and receive telehealth services from their registered practice.\n  - The service must be billed to the MBS and can be performed by another medical or nurse practitioner at the practice.\n  - The practitioner must have provided a face-to-face service to the patient within the last **12 months**.\n\n- **Exemptions**: \n  - Certain patients are exempt from the eligible telehealth practitioner requirement, including:\n    - Individuals under **12 months** of age.\n    - Persons experiencing **homelessness**.\n    - Patients in **natural disaster** affected areas.\n    - Individuals isolating due to **COVID-related** public health orders.\n    - Specific Medicare services such as urgent after-hours services and mental health treatment items.\n\n- **Documentation Requirements**: \n  - If an exemption applies, it must be documented and specified in the patient\u2019s clinical notes at the time of service to ensure compliance during audits.\n\n- **Audit Prevention Tips**: \n  - Ensure all patient registrations in **MyMedicare** are current and verified.\n  - Maintain accurate records of face-to-face consultations within the required timeframe.\n  - Document any exemptions clearly in clinical notes to support billing claims.\n  - Regularly review billing practices against MBS guidelines to ensure compliance and avoid potential audits.",
    "updated": "2026-07-05"
  },
  "91189": {
    "content": "HEADING: Summary of MBS Item 91189 for Billing Compliance\n\n- **Item Description**: MBS Item 91189 covers phone attendance by a participating **nurse practitioner** lasting at least **6 minutes** and less than **20 minutes**.\n- **Clinical Relevance**: The service must include clinically relevant activities such as:\n  - Taking a **short history**\n  - Arranging necessary **investigations**\n  - Implementing a **management plan**\n  - Providing appropriate **preventive health care**\n- **Fee Structure**: \n  - Schedule Fee: **$32.65**\n  - Benefit: **85%** = **$27.80**\n  - Extended Medicare Safety Net Cap: **$97.95**\n- **Eligibility Criteria**: \n  - The nurse practitioner must be the patient\u2019s **eligible telehealth practitioner**.\n  - Eligibility is defined by having provided a **face-to-face service** to the patient in the last **12 months** or being located at a practice where the patient has received at least one MBS billed face-to-face service in the preceding **12 months**.\n  - Exemptions apply for specific patient groups, including:\n    - Patients under **12 months**\n    - Individuals experiencing **homelessness**\n    - Patients receiving treatment through **Blood Borne Virus**, **Sexual or Reproductive Health** telehealth\n    - Patients in **natural disaster** affected areas\n    - Patients isolating due to **COVID-related** public health orders\n- **Documentation Requirements**: \n  - Providers must document the **exemption** and clinical reasoning in patient clinical notes.\n  - Previous participation in a video or phone consultation does not count as a **face-to-face service** for ongoing telehealth eligibility.\n- **Audit Prevention**: \n  - Ensure compliance with eligibility criteria to avoid billing errors.\n  - Maintain thorough documentation to support claims and demonstrate adherence to legislative requirements.\n  - Regularly review patient records to confirm that face-to-face service requirements are met prior to telehealth consultations.",
    "updated": "2026-07-05"
  },
  "91190": {
    "content": "HEADING: MBS Item 91190 Summary for Billing Compliance\n\n- Item 91190 pertains to **phone attendance** by a **participating nurse practitioner** lasting at least **20 minutes**.\n- The service must include clinically relevant activities such as:\n  - **Taking a detailed history**\n  - **Arranging necessary investigations**\n  - **Implementing a management plan**\n  - **Providing appropriate preventive health care**\n- The **schedule fee** for this item is **$61.80**, with a benefit of **85%** equating to **$52.55**.\n- Ensure compliance with the **Extended Medicare Safety Net Cap** of **$185.40**.\n- Eligibility criteria for the nurse practitioner include:\n  - Must have provided a **face-to-face service** to the patient in the last **12 months**.\n  - Alternatively, the nurse practitioner must be at a practice where the patient has received at least one MBS billed face-to-face service in the preceding **12 months**.\n- Exemptions to the eligibility criteria include:\n  - Patients under **12 months** of age.\n  - Patients experiencing **homelessness**.\n  - Patients receiving treatment through **Blood Borne Virus**, **Sexual or Reproductive Health** telehealth.\n  - Patients in **natural disaster** affected areas.\n  - Patients isolating due to **COVID-related** public health orders.\n- It is a **legislative requirement** to document in patient clinical notes:\n  - The **exemption** and the **clinical reasoning** for the telehealth service.\n- Previous participation in a video or phone consultation does not count as a **face-to-face service** for ongoing telehealth eligibility.\n- Related items include 91178, 91179, 91180, 91189, 91191, 91192, 91193, and 91206.\n- Ensure that all documentation is thorough and accurate to prevent audit issues and ensure compliance with MBS requirements.",
    "updated": "2026-07-05"
  },
  "91191": {
    "content": "HEADING: MBS Item 91191 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 91191 covers phone attendance by a participating nurse practitioner lasting at least **40 minutes** with clinically relevant activities.\n- **Eligible Activities**: Must include at least one of the following:\n  - **Taking an extensive history**\n  - **Arranging necessary investigations**\n  - **Implementing a management plan**\n  - **Providing appropriate preventive health care**\n  \n- **Fee Structure**: \n  - **Schedule Fee**: $91.20\n  - **Medicare Benefit**: 85% = $77.55\n  - **Extended Medicare Safety Net Cap**: $273.60\n\n- **Eligibility Criteria**: \n  - Nurse practitioners must have provided a **face-to-face service** to the patient within the last **12 months**.\n  - Alternatively, the nurse practitioner must be at a practice where the patient has received at least one MBS billed face-to-face service in the past **12 months**.\n  - Exemptions apply for specific patient groups (e.g., under 12 months, experiencing homelessness, etc.).\n\n- **Documentation Requirements**: \n  - Clinical notes must document the **exemption** and the **clinical reasoning** for the service.\n  - Ensure that a patient\u2019s previous participation in a video or phone consultation does not count as a face-to-face service for ongoing telehealth eligibility.\n\n- **Audit Prevention Tips**: \n  - Verify that all eligibility criteria are met before billing.\n  - Maintain thorough documentation of the service provided, including the duration and the specific activities performed.\n  - Regularly review patient records to ensure compliance with the face-to-face service requirement.\n  - Stay updated on any changes to the MBS guidelines or eligibility criteria to avoid billing errors.",
    "updated": "2026-07-05"
  },
  "91192": {
    "content": "HEADING: MBS Item 91192 Compliance Summary\n\n- **Item Description**: MBS Item 91192 covers video attendance by a participating nurse practitioner for an obvious problem requiring a straightforward task, short patient history, and limited management.\n\n- **Eligibility Criteria**: \n  - Nurse practitioners must be the patient's eligible telehealth practitioner.\n  - Eligible practitioners must have provided a face-to-face service to the patient in the last 12 months or be located at a practice where the patient received at least one MBS billed face-to-face service in the past year.\n  - Exemptions apply for specific patient groups, including those under 12 months, experiencing homelessness, receiving treatment for Blood Borne Virus, or affected by natural disasters.\n\n- **Documentation Requirements**: \n  - Providers must document the exemption and clinical reasoning in patient clinical notes.\n  - Previous participation in a video or phone consultation does not count as a face-to-face service for ongoing telehealth eligibility.\n\n- **Service Duration**: \n  - The service must be straightforward and typically requires limited examination and management.\n  \n- **Billing Compliance**: \n  - Ensure the service aligns with the description of an \"obvious problem\" and is straightforward in nature.\n  - Verify that the service duration meets the requirements for billing under this item.\n  \n- **Fee Structure**: \n  - Schedule Fee: $14.95\n  - Benefit: 85% = $12.75\n  - Extended Medicare Safety Net Cap: $44.85\n\n- **Referral Limitations**: \n  - Nurse practitioners can refer private patients to specialists and consultant physicians but cannot refer to allied health practitioners or Aboriginal and Torres Strait Islander primary health care workers for MBS benefits.\n\n- **Audit Prevention**: \n  - Regularly review patient eligibility and documentation to ensure compliance with MBS requirements.\n  - Maintain accurate records of face-to-face services and any exemptions claimed to avoid potential audit issues.",
    "updated": "2026-07-05"
  },
  "91193": {
    "content": "HEADING: MBS Item 91193 Summary for Billing Compliance\n\n- Item 91193 pertains to **phone attendance** by a participating **nurse practitioner** for straightforward problems requiring limited patient history and management.\n- The **schedule fee** for this item is **$14.95**, with an **85% benefit** of **$12.75**.\n- This item is classified under **Category 8 - MISCELLANEOUS SERVICES** and is part of **Group M18 - Allied Health and other primary health care telehealth services**.\n- Ensure that the **nurse practitioner** is an **eligible telehealth practitioner**, having provided a face-to-face service to the patient within the last **12 months** or meeting specific exemptions.\n- Document in **clinical notes** the reason for any exemptions related to the eligible telehealth practitioner requirement.\n- Exemptions include patients under **12 months**, those experiencing **homelessness**, receiving treatment for **Blood Borne Virus**, or living in **natural disaster areas**.\n- A patient\u2019s previous participation in a **video or phone consultation** does not count as a face-to-face service for ongoing telehealth eligibility.\n- The service must be for an **obvious problem** that is **straightforward** in nature, with limited examination and management required.\n- Ensure compliance with the **referral requirements**; nurse practitioners can refer patients to specialists but not to allied health practitioners or Aboriginal and Torres Strait Islander health workers for benefits to apply.\n- Maintain accurate and thorough **clinical documentation** to support billing and to prevent audits or compliance issues.",
    "updated": "2026-07-05"
  },
  "91196": {
    "content": "HEADING: MBS Item 91196 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 91196 covers video attendance for a focussed psychological strategies health service provided by an eligible social worker to a person other than the patient.\n- **Eligibility Criteria**:\n  - The service must be part of the **patient\u2019s treatment**.\n  - The patient must have been **referred** to the eligible social worker by a referring practitioner.\n  - The service duration must be **at least 20 minutes but less than 50 minutes**.\n- **Billing Details**:\n  - **Schedule Fee**: $74.55\n  - **Medicare Benefit**: 85% of the schedule fee, which is **$63.40**.\n  - **Extended Medicare Safety Net Cap**: $223.65.\n- **Service Limitations**:\n  - Medicare benefits are available for **up to 2 services** provided to another person per calendar year.\n  - These services do not need to be accessed consecutively and can occur at any stage of the patient\u2019s treatment.\n- **Claiming Process**:\n  - Claims must be raised against the **patient**, not the person receiving the service.\n  - Ensure that the service is documented as part of the patient\u2019s treatment plan.\n- **Patient Consent**: \n  - The patient must **consent** for the service to be provided to another person as part of their treatment.\n- **Clinical Appropriateness**:\n  - The referring practitioner must determine that involving another person in the treatment is **clinically appropriate**.\n- **Audit Prevention**:\n  - Maintain thorough documentation of the referral, patient consent, and service details to support claims.\n  - Ensure compliance with the **Better Access Initiative** requirements, including eligibility and service limits.\n- **Exclusions**:\n  - These items are not intended for providing mental health treatment to the family member or carer. If they require treatment, they should be referred to their GP or PMP for assessment.",
    "updated": "2026-07-05"
  },
  "91197": {
    "content": "HEADING: Summary of MBS Item 91197 for Billing Compliance\n\n- **Item Description**: MBS Item 91197 covers video attendance for a focussed psychological strategies health service provided by an eligible social worker to a person other than the patient.\n- **Eligibility Criteria**:\n  - The service must be part of the **patient\u2019s treatment**.\n  - The patient must be **referred** to the eligible social worker by a **referring practitioner**.\n  - The service must last at least **50 minutes**.\n- **Billing Details**:\n  - **Schedule Fee**: $105.25\n  - **Medicare Benefit**: 85% of the fee = $89.50.\n  - **Extended Medicare Safety Net Cap**: $315.75.\n- **Service Limitations**:\n  - Medicare benefits are available for **up to 2 services** provided to another person per calendar year.\n  - Services do not need to be accessed consecutively and can occur at any stage of the patient's treatment.\n- **Claiming Process**:\n  - Claims must be raised against the **patient**, not the individual receiving the service.\n  - Ensure that the service is documented as part of the patient\u2019s treatment plan.\n- **Provider Requirements**:\n  - The eligible GP or allied health professional must meet the relevant **provider eligibility requirements**.\n  - Refer to explanatory notes MN.6.2 and MN.7.4 for detailed provider criteria.\n- **Patient Consent**:\n  - The patient must **consent** for the service to be provided to another person as part of their treatment.\n- **Non-Eligibility for Family Members**:\n  - These items are not intended for providing mental health treatment to the family member or carer. They should seek their own assessment if needed.\n- **Audit Prevention Tips**:\n  - Maintain thorough documentation of referrals, patient consent, and service duration.\n  - Regularly review compliance with eligibility criteria to avoid billing errors.\n  - Ensure that the service provided aligns with the patient\u2019s treatment plan to support claims.",
    "updated": "2026-07-05"
  },
  "91204": {
    "content": "HEADING: MBS Item 91204 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 91204 pertains to phone attendance for a focussed psychological strategies health service provided by an eligible social worker to a person other than the patient.\n- **Eligibility Criteria**:\n  - The service must be part of the **patient\u2019s treatment**.\n  - The patient must have been **referred** to the eligible social worker by a **referring practitioner**.\n  - The service duration must be **at least 20 minutes but less than 50 minutes**.\n- **Fee Structure**:\n  - Schedule Fee: **$74.55**.\n  - Medicare Benefit: **85%** of the fee, equating to **$63.40**.\n  - Extended Medicare Safety Net Cap: **$223.65**.\n- **Audit Prevention**:\n  - Ensure proper documentation of the **referral** from the referring practitioner to substantiate the claim.\n  - Maintain accurate records of service duration to confirm compliance with the **20 to 50 minutes** requirement.\n  - Verify that the service is indeed part of the **patient\u2019s treatment plan** to avoid discrepancies.\n  - Regularly review eligibility criteria for both the social worker and the patient to ensure compliance with **Medicare guidelines**.\n- **Related Services**: Familiarize with associated notes under the **Better Access Initiative** for comprehensive understanding of mental health treatment services and their requirements.\n- **Record Keeping**: Keep detailed notes of each session, including the **date**, **duration**, and **content of the service** provided, to support claims and facilitate audits.",
    "updated": "2026-07-05"
  },
  "91205": {
    "content": "HEADING: MBS Item 91205 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 91205 covers phone attendance for a focussed psychological strategies health service provided by an **eligible social worker** to a person other than the patient.\n- **Eligibility Criteria**:\n  - The service must be part of the **patient\u2019s treatment**.\n  - The patient must be **referred** to the eligible social worker by a **referring practitioner**.\n  - The service must last at least **50 minutes**.\n- **Fee Structure**:\n  - Schedule Fee: **$105.25**.\n  - Medicare Benefit: **85%** of the fee, equating to **$89.50**.\n  - Extended Medicare Safety Net Cap: **$315.75**.\n- **Audit Prevention**:\n  - Ensure that all **referrals** are documented and meet the criteria for eligibility.\n  - Maintain accurate records of the **duration** of services provided to confirm they meet the minimum time requirement.\n  - Verify that the service is indeed part of the **patient\u2019s treatment plan** and document accordingly.\n  - Regularly review compliance with the **Better Access Initiative** guidelines to ensure adherence to all requirements.\n- **Associated Notes**: Familiarize yourself with relevant explanatory notes, particularly regarding the **Better Access Initiative** and the qualifications required for allied health professionals.\n- **Documentation**: Keep comprehensive records of all services rendered, including patient details, referral information, and session notes to support claims and facilitate audits.",
    "updated": "2026-07-05"
  },
  "91211": {
    "content": "HEADING: MBS Item 91211 Compliance Summary\n\n- **Item Description**: MBS Item 91211 covers short antenatal video attendance by a participating midwife, lasting at least **10 minutes**.\n- **Fee Structure**: The schedule fee is **$38.75**, with a benefit of **85%** equating to **$32.95**.\n- **Eligibility**: Only **participating midwives** can claim this item, and services must be provided via **telehealth** (video conferencing).\n- **Clinical Appropriateness**: Services must be **clinically relevant** and accepted by the midwifery profession as necessary for the patient's condition.\n- **Informed Financial Consent**: Providers must obtain **informed financial consent** from patients prior to service delivery, detailing fees and potential out-of-pocket costs.\n- **Single Patient Care**: Medicare benefits are payable only when the participating midwife provides care to **one patient at a time**.\n- **Documentation**: Maintain thorough documentation of the service provided, including **duration**, **patient consent**, and **clinical justification** for the telehealth service.\n- **Audit Preparedness**: Ensure compliance with all relevant guidelines to prevent audits, including adherence to the **minimum duration** and **clinical necessity** of the service.\n- **Related Items**: Familiarize with related MBS items (e.g., 82100, 82105) to ensure comprehensive understanding of maternity services and their requirements.\n- **Transition Period Awareness**: Be aware of any transition periods related to claiming requirements, particularly those affecting antenatal attendances prior to the implementation of new regulations.",
    "updated": "2026-07-05"
  },
  "91212": {
    "content": "HEADING: MBS Item 91212 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 91212 covers routine antenatal video attendance by a participating midwife, lasting at least **40 minutes**.\n- **Fee Structure**: The schedule fee for this item is **$89.00**, with a benefit of **85%** equating to **$75.65**.\n- **Eligibility**: Only **participating midwives** can bill for this item, and the service must be provided via **telehealth** (video).\n- **Clinical Relevance**: Services must be **clinically relevant** and accepted by the midwifery profession as necessary for the patient's treatment.\n- **Patient Interaction**: The participating midwife must provide care to **only one patient** at a time during the service.\n- **Informed Financial Consent**: Providers are required to obtain **informed financial consent** from patients before delivering the service, detailing fees and any out-of-pocket costs.\n- **Documentation**: Maintain thorough documentation of the service provided, including the **duration** and **clinical justification** for the antenatal attendance.\n- **Audit Prevention**: Ensure compliance with all requirements to avoid audits, including confirming that the service was safe and clinically appropriate for telehealth delivery.\n- **Related Items**: Familiarize yourself with related MBS items (e.g., 91211, 91214) to ensure proper billing and understanding of the service context.\n- **Transition Period Awareness**: Be aware of any transition periods related to claiming requirements, particularly regarding antenatal attendances prior to the care plan service (item 82115).",
    "updated": "2026-07-05"
  },
  "91214": {
    "content": "HEADING: MBS Item 91214 Compliance Summary\n\n- **Item Description**: MBS Item 91214 covers short postnatal video attendance by a participating midwife, lasting at least **20 minutes**.\n- **Fee Structure**: The schedule fee for this item is **$63.90**, with a benefit of **85%** equating to **$54.35**.\n- **Eligibility**: Only **participating midwives** can bill for this item, and services must be provided via **telehealth** (video conferencing).\n- **Clinical Relevance**: Services must be **clinically relevant** and accepted by the midwifery profession as necessary for the patient's treatment.\n- **Patient Interaction**: The midwife must provide care to **one patient at a time** during the service.\n- **Informed Financial Consent**: Providers must obtain **informed financial consent** from patients before the service, detailing fees and any out-of-pocket costs.\n- **Documentation**: Maintain thorough documentation of the service provided, including the **duration** and **clinical justification** for the telehealth consultation.\n- **Audit Preparedness**: Ensure compliance with all requirements to prevent audits, including verifying that the service was safe and clinically appropriate for telehealth delivery.\n- **Related Items**: Be aware of related MBS items for antenatal and postnatal care to ensure proper billing and avoid confusion.\n- **Transition Period Awareness**: Understand any transition periods that may affect eligibility or requirements for claiming this item, particularly in relation to antenatal attendances.",
    "updated": "2026-07-05"
  },
  "91215": {
    "content": "HEADING: MBS Item 91215 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 91215 covers routine postnatal video attendance by a participating midwife, lasting at least **40 minutes**.\n- **Fee Structure**: The schedule fee for this item is **$130.80**, with a benefit of **85%** equating to **$111.20**.\n- **Eligibility**: This item is applicable only for **telehealth services** provided to out-of-hospital patients.\n- **Clinical Appropriateness**: Services must be deemed **safe and clinically appropriate** for telehealth delivery.\n- **Informed Financial Consent**: Providers must obtain **informed financial consent** from patients before delivering the service, detailing fees and any potential out-of-pocket costs.\n- **Duration Requirement**: Ensure that the video attendance lasts a minimum of **40 minutes** to qualify for billing.\n- **Single Patient Care**: Medicare benefits are payable only when the participating midwife provides care to **one patient at a time** during the service.\n- **Documentation**: Maintain thorough documentation of the service provided, including the duration and clinical relevance, to support compliance and audit readiness.\n- **Audit Prevention**: Regularly review billing practices to ensure adherence to the requirements of MBS Item 91215, focusing on clinical necessity and proper consent procedures to mitigate audit risks.",
    "updated": "2026-07-05"
  },
  "91218": {
    "content": "HEADING: Summary of MBS Item 91218 for Billing Compliance\n\n- **Item Description**: MBS Item 91218 pertains to **short antenatal phone attendance** by a participating midwife, lasting at least **10 minutes**.\n- **Fee Structure**: The schedule fee for this item is **$38.75**, with a benefit of **85%** equating to **$32.95**.\n- **Eligibility**: This item is applicable only for **out-of-hospital patients** and must be provided by a **participating midwife**.\n- **Clinical Relevance**: Services must be **clinically relevant** and generally accepted by the midwifery profession as necessary for the patient's treatment.\n- **Informed Financial Consent**: Providers must obtain **informed financial consent** from patients prior to the service, detailing fees and any out-of-pocket costs.\n- **Telehealth Compliance**: Services may only be provided via telehealth if it is **safe and clinically appropriate** to do so.\n- **Documentation**: Maintain thorough documentation of the **duration** and **content** of the phone attendance to support the claim.\n- **Audit Prevention**: Ensure that the service is not provided to more than **one patient** at a time to comply with Medicare regulations.\n- **Related Items**: Familiarize with related MBS items (e.g., 91211, 91212) for comprehensive billing practices.\n- **Transition Period Awareness**: Be aware of any transition periods that may affect eligibility criteria for claiming this item. \n\nThis summary serves as a guide to ensure compliance with billing for MBS Item 91218 and to prevent potential audits.",
    "updated": "2026-07-05"
  },
  "91219": {
    "content": "HEADING: Summary of MBS Item 91219 for Billing Compliance\n\n- Item 91219 pertains to **routine antenatal phone attendance** provided by a participating midwife.\n- The service must last at least **40 minutes** to qualify for billing.\n- The **schedule fee** for this item is **$89.00**, with a benefit of **85%** equating to **$75.65**.\n- Ensure that the service is provided by a **participating midwife** and is clinically relevant to the patient's condition.\n- **Telehealth services** must be safe and clinically appropriate; ensure that the patient is not an admitted patient of a hospital.\n- Obtain **informed financial consent** from the patient before providing the service, detailing fees and any potential out-of-pocket costs.\n- The service can only be billed if the midwife is providing care to **one patient at a time** during the session.\n- Maintain accurate documentation of the service provided, including the duration and clinical relevance, to support claims and prevent audits.\n- Be aware of the **Extended Medicare Safety Net Cap** of **$267.00** for this item.\n- Regularly review and stay updated on any changes to the MBS items and associated notes to ensure compliance.",
    "updated": "2026-07-05"
  },
  "91221": {
    "content": "HEADING: MBS Item 91221 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 91221 pertains to **short postnatal phone attendance** by a participating midwife, lasting at least **20 minutes**.\n- **Fee Structure**: The schedule fee for this item is **$63.90**, with a benefit of **85%** equating to **$54.35**.\n- **Eligibility**: This item is applicable only for **postnatal care** provided via phone, ensuring it is **clinically appropriate** and safe for the patient.\n- **Documentation Requirements**: Maintain thorough documentation of the **duration** and **content** of the phone consultation to substantiate the claim.\n- **Informed Financial Consent**: Obtain **informed financial consent** from the patient prior to the service, detailing fees and any potential out-of-pocket costs.\n- **Single Patient Care**: Ensure that the midwife provides care to **only one patient** at a time during the service to comply with Medicare requirements.\n- **Clinical Relevance**: Services must be **clinically relevant** and accepted by the midwifery profession as necessary for the patient's condition.\n- **Audit Prevention**: Regularly review billing practices and documentation to ensure compliance with MBS guidelines, reducing the risk of audits and potential penalties.\n- **Associated Notes**: Familiarize yourself with related MBS items and guidelines, particularly those concerning **antenatal and postnatal care** to ensure comprehensive understanding and compliance.",
    "updated": "2026-07-05"
  },
  "91222": {
    "content": "HEADING: MBS Item 91222 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 91222 pertains to **routine postnatal phone attendance** by a participating midwife, requiring a minimum duration of **40 minutes**.\n- **Fee Structure**: The schedule fee for this item is **$130.80**, with a benefit of **85%** equating to **$111.20**.\n- **Eligibility**: Only **participating midwives** can bill for this item, and services must be clinically relevant and necessary for the patient's condition.\n- **Service Delivery**: The service must be provided via **telephone** and is intended for **out-of-hospital patients**.\n- **Informed Financial Consent**: Providers must obtain **informed financial consent** from patients before delivering the service, detailing fees and any potential out-of-pocket costs.\n- **Documentation Requirements**: Maintain thorough documentation of the service provided, including:\n  - Duration of the call (must be at least **40 minutes**).\n  - Clinical justification for the service.\n  - Patient consent for the service and associated costs.\n- **Audit Prevention**: To prevent audits:\n  - Ensure compliance with the **minimum duration** requirement.\n  - Confirm that the service is **clinically relevant** and necessary.\n  - Document all interactions and consent clearly to support claims.\n- **Related Items**: Familiarize with related MBS items for maternity services to ensure comprehensive understanding and compliance.\n- **Transition Period Awareness**: Be aware of any transition periods that may affect eligibility or claiming processes, particularly regarding antenatal attendances.\n\nBy adhering to these guidelines, compliance with MBS Item 91222 can be maintained, reducing the risk of audit issues.",
    "updated": "2026-07-05"
  },
  "91820": {
    "content": "HEADING: MBS Item 91820 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 91820 pertains to video attendance by a medical practitioner (excluding GPs, specialists, or consultant physicians) for providing **focussed psychological strategies** for assessed mental disorders.\n\n- **Eligibility Criteria**:\n  - The practitioner must be **registered with Chief Executive Medicare** and meet the **credentialing requirements** for this service.\n  - The service must last **at least 30 minutes** but **less than 40 minutes**.\n\n- **Billing Details**:\n  - **Schedule Fee**: $88.85\n  - **Medicare Benefit**: 100% of the schedule fee, equating to **$88.85**.\n  - **Extended Medicare Safety Net Cap**: $266.55.\n\n- **Audit Prevention Tips**:\n  - Ensure that the service provided meets the **minimum duration** of 30 minutes and does not exceed 40 minutes to avoid billing discrepancies.\n  - Confirm that the practitioner is **properly credentialed** and registered with Chief Executive Medicare before billing.\n  - Maintain thorough documentation of the service provided, including **patient assessments** and treatment plans, to support the billing claim.\n  - Regularly review compliance with the **Medicare Benefits Schedule** updates to ensure adherence to any changes in billing requirements or eligibility criteria.",
    "updated": "2026-07-05"
  },
  "91821": {
    "content": "HEADING: MBS Item 91821 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 91821 pertains to video attendance by a medical practitioner (excluding general practitioners, specialists, or consultant physicians) for providing **focussed psychological strategies** for assessed mental disorders.\n  \n- **Service Duration**: The service must last at least **40 minutes** to qualify for billing under this item.\n\n- **Practitioner Requirements**: The practitioner must be **registered with the Chief Executive Medicare** and meet the **credentialing requirements** for the provision of this service.\n\n- **Fee Structure**: The schedule fee for this item is **$127.10**, with a benefit of **100%** equating to the same amount.\n\n- **Extended Medicare Safety Net Cap**: The cap for the Extended Medicare Safety Net is **$381.30**.\n\n- **Audit Prevention Tips**:\n  - Ensure that the service duration is accurately recorded and meets the **minimum requirement** of 40 minutes.\n  - Verify that the practitioner is properly **credentialed** and registered with the Chief Executive Medicare before billing.\n  - Maintain thorough documentation of the **patient's assessed mental disorder** and the psychological strategies employed during the session.\n  - Regularly review billing practices to ensure compliance with the latest MBS updates and requirements.\n\n- **Compliance Monitoring**: Implement regular audits of billing practices related to Item 91821 to identify and rectify any discrepancies or non-compliance issues promptly.",
    "updated": "2026-07-05"
  },
  "91844": {
    "content": "HEADING: MBS Item 91844 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 91844 covers phone attendance by a medical practitioner (excluding GPs, specialists, or consultant physicians) for providing **focussed psychological strategies** for assessed mental disorders.\n- **Duration Requirement**: The service must last **at least 30 minutes but less than 40 minutes** to qualify for billing.\n- **Eligibility Criteria**: The practitioner must be **registered with the Chief Executive Medicare** and meet the credentialing requirements for this service.\n- **Fee Structure**: The schedule fee for this item is **$88.85**, with a 100% benefit available to eligible patients.\n- **Extended Medicare Safety Net Cap**: The cap for this item is **$266.55**.\n- **Audit Prevention**: Ensure that:\n  - The service duration is accurately recorded and meets the minimum time requirement.\n  - The practitioner\u2019s registration and credentialing status are verified and documented.\n  - Services are provided only to patients with **assessed mental disorders** as per the guidelines.\n  - Maintain thorough documentation of the service provided, including patient consent and treatment notes.\n- **Better Access Initiative**: This item is part of the **Better Access to Psychiatrists, Psychologists and General Practitioners** initiative, which allows eligible patients to claim benefits for mental health treatment services.\n- **Limitations**: Only eligible practitioners can provide these services; ensure compliance with the **Health Insurance (General Medical Services Table) Regulations 2021**.\n- **Referral Requirements**: Familiarize yourself with the referral requirements for Better Access treatment services to ensure compliance with MBS guidelines.\n- **Documentation**: Keep comprehensive records of all consultations and treatments provided under this item to support claims and facilitate audits.",
    "updated": "2026-07-05"
  },
  "91845": {
    "content": "HEADING: MBS Item 91845 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 91845 covers phone attendance by a medical practitioner (excluding GPs, specialists, or consultant physicians) for providing **focussed psychological strategies** for assessed **mental disorders**.\n  \n- **Eligibility Requirements**:\n  - The practitioner must be **registered with Chief Executive Medicare** and meet the **credentialing requirements** for this service.\n  - The service must last at least **40 minutes** to qualify for billing.\n\n- **Fee Structure**:\n  - Schedule Fee: **$127.10**\n  - Medicare Benefit: **100%** of the fee, equating to **$127.10**.\n  - Extended Medicare Safety Net Cap: **$381.30**.\n\n- **Audit Prevention**:\n  - Ensure that the service provided meets the **minimum duration** of 40 minutes to avoid non-compliance.\n  - Verify that the practitioner is **credentialed** and registered to provide this service to prevent billing errors.\n  - Maintain accurate and detailed **documentation** of the service provided, including the duration and nature of the psychological strategies employed.\n  - Regularly review and update knowledge of the **Better Access Initiative** and associated explanatory notes to ensure compliance with current regulations.\n\n- **Associated Notes**:\n  - Familiarize with relevant explanatory notes such as **AN.0.78** (Better Access Initiative) and **MN.7.4** (Provision of Focussed Psychological Strategies) for comprehensive understanding and compliance.\n  \n- **Limitations**:\n  - This item is not applicable for **General Practitioners**, **Specialists**, or **Consultant Physicians**; ensure correct item usage to avoid claim rejections.\n\n- **Patient Services**:\n  - Under the Better Access initiative, eligible patients can claim benefits for up to **10 individual** and **10 group therapy** mental health treatment services per calendar year. Ensure patients are informed of their entitlements and the services available to them.",
    "updated": "2026-07-05"
  },
  "91850": {
    "content": "HEADING: MBS Item 91850 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 91850 pertains to **antenatal video services** provided by a practice midwife, nurse, or an Aboriginal and Torres Strait Islander health practitioner.\n- **Supervision Requirement**: The service must be provided **on behalf of**, and **under the supervision of**, a **medical practitioner**.\n- **Service Limitations**: A maximum of **10 services** can be billed per pregnancy.\n- **Concurrent Services**: The antenatal video service cannot be performed in conjunction with another **antenatal attendance item** in Group T4 for the same patient on the same day by the same practitioner.\n- **Fee Structure**: The schedule fee for this item is **$32.65**, with a benefit of **85%** equating to **$27.80**.\n- **Extended Medicare Safety Net**: The cap for the Extended Medicare Safety Net is **$13.80**.\n- **Documentation**: Ensure proper documentation of the **supervision** by the medical practitioner and the **number of services** provided to avoid discrepancies during audits.\n- **Audit Prevention**: Regularly review billing practices to ensure compliance with the **maximum service limit** and **supervision requirements** to mitigate the risk of audit findings.",
    "updated": "2026-07-05"
  },
  "91852": {
    "content": "HEADING: MBS Item 91852 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 91852 pertains to postnatal video attendance services provided by a GP, obstetrician, or practice midwife under specific conditions.\n- **Eligibility Criteria**:\n  - Attendance must occur **between 1 week and 4 weeks** after the birth.\n  - The service must last at least **20 minutes**.\n  - The patient must have been **privately admitted** for the birth.\n  - The service must not be related to any other specified items (82130, 82135, 82140, 91214, 91215, 91221, or 91222).\n- **Provider Requirements**:\n  - The service can be rendered by:\n    - A **practice midwife** (under the supervision of the medical practitioner who attended the birth).\n    - An **obstetrician**.\n    - A **general practitioner**.\n- **Billing Compliance**:\n  - Ensure that the service is billed **only once** per pregnancy.\n  - Confirm that all eligibility criteria are met before billing to avoid audit issues.\n  - Maintain accurate documentation of the service duration and patient admission status.\n- **Fee Structure**:\n  - Schedule Fee: **$63.90**\n  - Medicare Benefit: **85%** of the fee, equating to **$54.35**.\n  - Extended Medicare Safety Net Cap: **$41.55**.\n- **Audit Prevention**:\n  - Regularly review billing practices to ensure compliance with the eligibility criteria.\n  - Keep detailed records of patient interactions and services rendered to support claims.\n  - Train staff on the specific requirements of MBS Item 91852 to minimize errors in billing.",
    "updated": "2026-07-05"
  },
  "91855": {
    "content": "HEADING: MBS Item 91855 Summary for Billing Compliance\n\n- Item 91855 pertains to **antenatal phone services** provided by a practice midwife, nurse, or Aboriginal and Torres Strait Islander health practitioner.\n- The service is limited to a **maximum of 10 services per pregnancy**.\n- The antenatal phone service must be provided **on behalf of, and under the supervision of, a medical practitioner**.\n- The service **cannot be performed in conjunction** with another antenatal attendance item in Group T4 for the same patient on the same day by the same practitioner.\n- The **schedule fee** for Item 91855 is **$32.65**.\n- The **Medicare benefit** is **85%**, equating to **$27.80**.\n- The **Extended Medicare Safety Net Cap** for this item is **$13.80**.\n- Ensure accurate documentation of the **supervision** by a medical practitioner to avoid compliance issues.\n- Maintain clear records of the **number of services** provided to each patient to ensure adherence to the **maximum limit**.\n- Review billing practices to confirm that no other antenatal attendance items are billed on the same day for the same patient to prevent **audit discrepancies**.",
    "updated": "2026-07-05"
  },
  "91857": {
    "content": "HEADING: MBS Item 91857 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 91857 pertains to **postnatal phone attendance** provided by a GP, obstetrician, or practice midwife under specific conditions.\n- **Eligibility Criteria**:\n  - Attendance must occur **between 1 week and 4 weeks** after the birth.\n  - The consultation must last at least **20 minutes**.\n  - The patient must have been **privately admitted** for the birth.\n  - The service must not be related to other specified items (82130, 82135, 82140, 91214, 91215, 91221, or 91222).\n- **Billing Limitations**: This item can be billed **once per pregnancy**.\n- **Fee Structure**:\n  - Schedule Fee: **$63.90**\n  - Medicare Benefit: **85%** of the fee, equating to **$54.35**.\n  - Extended Medicare Safety Net Cap: **$41.55**.\n- **Documentation Requirements**:\n  - Ensure accurate **record-keeping** of the consultation duration and content.\n  - Document the **patient's admission status** and confirm it was a private admission.\n  - Maintain records that demonstrate compliance with the **eligibility criteria** to prevent audit issues.\n- **Audit Prevention Tips**:\n  - Regularly review billing practices to ensure adherence to the **specific conditions** outlined for Item 91857.\n  - Train staff on the importance of **accurate documentation** and understanding of the item\u2019s requirements.\n  - Conduct periodic audits of claims submitted for this item to identify and rectify any discrepancies.",
    "updated": "2026-07-05"
  },
  "91862": {
    "content": "HEADING: Summary of MBS Item 91862 for Billing Compliance\n\n- Item 91862 pertains to **video attendance** by a medical practitioner for **focussed psychological strategies**.\n- The service must be provided to a **person other than the patient** as part of the patient\u2019s treatment plan.\n- The duration of the service must be **at least 30 minutes but less than 40 minutes**.\n- Practitioners must be **registered with the Chief Executive Medicare** and meet the **credentialing requirements** for this service.\n- The **schedule fee** for this item is **$88.80**, with a **100% benefit** available.\n- The **Extended Medicare Safety Net Cap** for this item is **$266.40**.\n- Ensure that documentation clearly reflects the **nature of the service**, including the **duration** and **recipient** of the service, to support compliance.\n- Maintain accurate records of **credentialing** and **training** to avoid potential audit issues.\n- Regularly review billing practices to ensure adherence to the **MBS guidelines** and avoid discrepancies that could trigger audits.",
    "updated": "2026-07-05"
  },
  "91863": {
    "content": "HEADING: MBS Item 91863 Summary for Billing Compliance\n\n- Item 91863 pertains to **video attendance** by a medical practitioner for **focussed psychological strategies**.\n- The service must be provided to a **person other than the patient** as part of the patient's treatment plan.\n- The **minimum duration** of the service is **40 minutes**.\n- Practitioners must be **registered with the Chief Executive Medicare** and meet the **credentialing requirements** for this service.\n- The **schedule fee** for this item is **$127.10**, with a benefit of **100%** equating to the full fee.\n- The **Extended Medicare Safety Net Cap** for this item is **$381.30**.\n- Ensure accurate documentation of the **patient's treatment plan** to justify the provision of this service.\n- Maintain records of the **duration** of the service to confirm compliance with the **40-minute minimum** requirement.\n- Regularly review and update knowledge of **credentialing requirements** to ensure ongoing eligibility for billing this item.\n- Be aware of potential **audit triggers**, such as billing for services not meeting the specified criteria or lack of proper documentation.",
    "updated": "2026-07-05"
  },
  "91866": {
    "content": "HEADING: MBS Item 91866 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 91866 pertains to **telehealth attendance services** for focused psychological strategies provided by a medical practitioner.\n- **Eligibility**: The practitioner must be **registered with the Chief Executive Medicare** and meet the **credentialing requirements** for this service.\n- **Service Requirements**:\n  - The service must be for **assessed mental disorders** and provided to a person other than the patient, as part of the patient's treatment.\n  - The duration of the service must be **at least 30 minutes but less than 40 minutes**.\n- **Fee Structure**: \n  - The schedule fee for this item is **$88.80**.\n  - The benefit is **100%**, equating to **$88.80**.\n- **Extended Medicare Safety Net Cap**: The cap for this item is **$266.40**.\n- **Audit Prevention**:\n  - Ensure that the service provided meets the **specific criteria** outlined in the item description to avoid potential audits.\n  - Maintain thorough documentation of the **patient's treatment plan** and the **duration of the service** to substantiate claims.\n  - Verify that the service is part of the **Better Access Initiative**, which allows for up to **10 individual and 10 group therapy sessions** per calendar year.\n- **Associated Notes**: Familiarize yourself with relevant explanatory notes, particularly **AN.0.78** and **MN.7.5**, which provide additional context on the Better Access initiative and family/carer participation.\n- **Compliance Check**: Regularly review compliance with the **Health Insurance (General Medical Services Table) Regulations 2021** to ensure adherence to legislative requirements for eligible GPs.",
    "updated": "2026-07-05"
  },
  "91867": {
    "content": "HEADING: MBS Item 91867 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 91867 covers **phone attendance** by a medical practitioner for providing **focussed psychological strategies** for assessed mental disorders to a person other than the patient, as part of the patient\u2019s treatment.\n- **Duration Requirement**: The service must last at least **40 minutes** to be eligible for billing.\n- **Eligibility**: The medical practitioner must be **registered** with the Chief Executive Medicare and meet the **credentialing requirements** for this service.\n- **Fee Structure**: The schedule fee for this item is **$127.10**, with a benefit of **100%** equating to the same amount.\n- **Extended Medicare Safety Net**: The cap for the Extended Medicare Safety Net is **$381.30**.\n- **Better Access Initiative**: This item is part of the **Better Access Initiative**, which allows Medicare benefits for selected mental health treatment services provided by eligible practitioners.\n- **Audit Prevention**: \n  - Ensure that the service provided meets the **40-minute minimum duration** requirement.\n  - Confirm that the practitioner is **credentialed** and registered with Medicare.\n  - Document the **patient's treatment plan** to justify the provision of services to a person other than the patient.\n  - Maintain clear records of the **service provided**, including the nature of the psychological strategies used.\n  - Regularly review compliance with **Medicare guidelines** and updates to the MBS to avoid billing errors.\n- **Associated Notes**: Familiarize with relevant explanatory notes (e.g., AN.0.78, MN.7.5) for comprehensive understanding and compliance with the Better Access initiative.",
    "updated": "2026-07-05"
  },
  "92060": {
    "content": "HEADING: MBS Item 92060 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 92060 pertains to video attendance by a prescribed medical practitioner to prepare a GP chronic condition management plan for a patient.\n- **Fee Structure**: The schedule fee is **$128.55**, with a benefit of **100%** equating to **$128.55**.\n- **Eligibility**: This item is applicable for patients with chronic conditions who would benefit from a structured management approach.\n- **Exclusions**: GP chronic condition management plans are **not available** to residents of residential aged care facilities.\n- **Documentation Requirements**: \n  - A **written plan** must be prepared that includes:\n    - Patient\u2019s chronic condition and healthcare needs.\n    - Health and lifestyle goals developed collaboratively with the patient.\n    - Actions to be taken by the patient.\n    - Anticipated treatments and services.\n    - Referrals for multidisciplinary care if necessary.\n    - Review arrangements, including proposed timeframes.\n- **Consent and Information Sharing**: \n  - Obtain **patient consent** for sharing relevant information with multidisciplinary team members.\n  - Document the patient's consent and agreement to the preparation of the plan.\n- **Patient Communication**: \n  - Offer a copy of the plan to the patient and their carer, if appropriate and agreed upon by the patient.\n- **Record Keeping**: \n  - Ensure a copy of the plan is added to the patient\u2019s medical records.\n- **Review Process**: \n  - Regularly review the plan to assess progress towards goals and make necessary updates.\n  - Document discussions regarding the patient\u2019s progress and any updates to the plan.\n- **Audit Prevention**: \n  - Maintain thorough documentation to support claims, including consent forms and records of discussions.\n  - Ensure compliance with all requirements outlined in the MBS explanatory notes to avoid potential audits or penalties.",
    "updated": "2026-07-05"
  },
  "92061": {
    "content": "HEADING: MBS Item 92061 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 92061 pertains to video attendance by a prescribed medical practitioner to review a GP chronic condition management plan.\n- **Eligibility**: This item is applicable for patients with chronic conditions who require a structured management plan.\n- **Fee Structure**: The schedule fee for Item 92061 is **$128.55**, with a benefit of **100%** coverage.\n- **Service Type**: This item falls under **Telehealth attendance services** specifically for GP management plans and multidisciplinary care plans.\n- **Review Process**: The review must include:\n  - Discussion of the patient's progress towards health goals.\n  - Assessment of the appropriateness of existing goals.\n  - Consideration of input from multidisciplinary team members, if applicable.\n- **Documentation Requirements**:\n  - Document the patient's consent for sharing information with the multidisciplinary team.\n  - Record updates to the management plan based on the review discussion.\n  - Offer a copy of the updated plan to the patient and their carer.\n- **Audit Prevention**:\n  - Ensure all elements of the review process are thoroughly documented to support claims.\n  - Maintain clear records of patient consent and agreements regarding the management plan.\n  - Regularly review and update the management plan as required, ensuring compliance with MBS guidelines.\n- **Exclusions**: GP chronic condition management plans are not available for patients in residential aged care facilities; they may qualify for a multidisciplinary care plan instead.\n- **Compliance Notes**: Familiarize yourself with the relevant explanatory notes (AN.0.47, AN.15.3, AN.15.4, AN.15.5, AN.15.6, AN.36.2) to ensure adherence to MBS requirements.",
    "updated": "2026-07-05"
  },
  "92118": {
    "content": "HEADING: MBS Item 92118 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 92118 pertains to video attendance by a medical practitioner for the preparation of a GP mental health treatment plan.\n- **Duration Requirement**: The consultation must last **at least 20 minutes but less than 40 minutes**.\n- **Eligible Practitioners**: This item is applicable for medical practitioners who are **not general practitioners, specialists, or consultant physicians** and have not undertaken mental health skills training.\n- **Fee Structure**: The schedule fee for this item is **$68.65**, with a benefit of **100%** coverage.\n- **Extended Medicare Safety Net Cap**: The cap for the Extended Medicare Safety Net is **$205.95**.\n- **Documentation**: Ensure thorough documentation of the consultation, including **duration, patient details, and treatment plan** specifics to support billing.\n- **Audit Prevention**: \n  - Confirm that the consultation meets the **time requirement** to avoid discrepancies.\n  - Verify that the practitioner is eligible under the specified criteria to prevent billing errors.\n  - Maintain clear records of the **mental health treatment plan** created during the session.\n- **Updates**: Be aware of the item\u2019s updates, with the last description update on **01-Mar-2025** and fee update on **01-Jul-2026**.\n- **Compliance Checks**: Regularly review billing practices against the MBS guidelines to ensure ongoing compliance and reduce the risk of audits.",
    "updated": "2026-07-05"
  },
  "92119": {
    "content": "HEADING: MBS Item 92119 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 92119 pertains to video attendance by a medical practitioner (excluding GPs, specialists, or consultant physicians) for the preparation of a **GP Mental Health Treatment Plan**.\n- **Duration Requirement**: The consultation must be at least **40 minutes** in duration.\n- **Eligibility**: The practitioner must not have undertaken **mental health skills training**.\n- **Fee Structure**: The schedule fee for this item is **$101.05**, with a benefit of **100%** equating to the full fee.\n- **Extended Medicare Safety Net Cap**: The cap for this item is **$303.15**.\n- **Audit Prevention**:\n  - Ensure accurate documentation of the **consultation duration** to meet the minimum requirement.\n  - Verify that the practitioner has not completed **mental health skills training** to maintain compliance.\n  - Maintain clear records of the **patient's mental health status** and the rationale for the treatment plan.\n  - Regularly review billing practices to ensure adherence to the **MBS guidelines** and avoid potential discrepancies.\n- **Updates**: Be aware of the item\u2019s start date (30-Mar-2020) and the latest description update (01-Mar-2025) for compliance with current regulations.\n- **Billing Accuracy**: Double-check that the correct item number is used when billing to prevent errors and ensure proper reimbursement.",
    "updated": "2026-07-05"
  },
  "92120": {
    "content": "HEADING: MBS Item 92120 Summary for Billing Compliance\n\n- MBS Item **92120** is currently **not listed** in the Medicare Benefits Schedule.\n- Ensure that you verify the **current status** of MBS items before billing to avoid errors.\n- Regularly check for **updates** or changes to the MBS to maintain compliance.\n- Document any **consultations** or services provided that may relate to this item for future reference.\n- Maintain accurate **patient records** to support any claims made, should the item become available in the future.\n- Be aware of the **audit risks** associated with billing for unlisted items; ensure all claims are substantiated.\n- Consult with **Medicare guidelines** or a compliance expert if uncertain about billing practices related to MBS items.",
    "updated": "2026-07-05"
  },
  "92121": {
    "content": "HEADING: MBS Item 92121 Summary for Billing Compliance\n\n- MBS Item **92121** is currently **not listed** in the Medicare Benefits Schedule.\n- Ensure that any billing for this item is **thoroughly verified** against the latest MBS updates.\n- Regularly check the **MBS Online** platform for any changes or updates regarding item listings.\n- Maintain accurate records of all services provided, ensuring they align with **eligible MBS items**.\n- Implement a system for **tracking changes** in MBS items to prevent billing errors.\n- Educate staff on the importance of **compliance** with MBS guidelines to minimize audit risks.\n- Review billing practices regularly to ensure that only **eligible services** are claimed.\n- Document all patient interactions and services provided to support claims and defend against potential audits.",
    "updated": "2026-07-05"
  },
  "92122": {
    "content": "HEADING: MBS Item 92122 Summary for Billing Compliance\n\n- Item 92122 pertains to **telehealth attendance services** specifically for the preparation of a **GP mental health treatment plan**.\n- The service must be provided by a **medical practitioner** who has completed **mental health skills training**.\n- The duration of the video attendance must be **at least 20 minutes but less than 40 minutes**.\n- The scheduled fee for this item is **$87.15**, with a benefit of **100%** equating to the full fee.\n- The **Extended Medicare Safety Net Cap** for this item is **$261.45**.\n- Ensure that the patient is eligible for telehealth services and that the consultation meets the criteria outlined in the MBS.\n- Document the **duration** of the consultation clearly in the patient\u2019s medical record to support billing compliance.\n- Verify that the practitioner has the required **mental health skills training** documented and available for audit purposes.\n- Maintain accurate records of all telehealth consultations to facilitate compliance with Medicare requirements and prevent potential audits.\n- Regularly review and update knowledge of MBS items and associated billing requirements to ensure ongoing compliance.",
    "updated": "2026-07-05"
  },
  "92123": {
    "content": "HEADING: MBS Item 92123 Summary for Billing Compliance\n\n- Item 92123 pertains to **video attendance** by a medical practitioner for the preparation of a **GP mental health treatment plan**.\n- The service must be conducted by a **medical practitioner** who has completed **mental health skills training**.\n- The duration of the video attendance must be at least **40 minutes**.\n- The scheduled fee for this item is **$128.45**, with a benefit of **100%** equating to the full fee.\n- The **Extended Medicare Safety Net Cap** for this item is **$385.35**.\n- Ensure that the service is billed under the correct **category** (Category 1 - Professional Attendances) and **subgroup** (Subgroup 19 - GP Mental Health Treatment Plan \u2013 Video Services).\n- Maintain thorough documentation of the **mental health skills training** completed by the practitioner to support compliance.\n- Verify that the **duration** of the consultation is accurately recorded to meet the minimum requirement of **40 minutes**.\n- Regularly review billing practices to ensure adherence to the **Medicare Benefits Schedule** guidelines and prevent potential audits.\n- Be aware of the **start date** (30-Mar-2020) and the **description update** (01-Mar-2025) for accurate billing and compliance.",
    "updated": "2026-07-05"
  },
  "92150": {
    "content": "HEADING: MBS Item 92150 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 92150 covers video attendance by a medical practitioner (not a GP, specialist, or consultant physician) for the preparation of an **Eating Disorder Treatment and Management Plan (EDTMP)** lasting between **20 to 40 minutes**.\n\n- **Eligibility Criteria**: The patient must have a diagnosed eating disorder, such as **anorexia nervosa**, **bulimia nervosa**, or **binge-eating disorder**.\n\n- **Plan Requirements**: The EDTMP must include:\n  - An **opinion on diagnosis** of the patient's eating disorder.\n  - **Treatment options and recommendations** for managing the condition for the next **12 months**.\n  - An **outline of referral options** to allied health professionals and specialists.\n  - Provision of a **copy of the plan** and suitable **education** about the eating disorder to the patient and their carer, if applicable.\n\n- **Timeframe**: The service must be conducted within a **20 to 40-minute** timeframe to qualify for billing under this item.\n\n- **Fee Structure**: The scheduled fee for Item 92150 is **$68.65**, with a benefit of **100%** coverage.\n\n- **Documentation**: Ensure thorough documentation of:\n  - Patient's medical and psychological health status.\n  - Discussion of treatment and referral options.\n  - Goals agreed upon with the patient and their carer.\n  - Education provided to the patient and family.\n  - Crisis intervention and relapse prevention plans, if applicable.\n  - Review and follow-up arrangements.\n\n- **Audit Prevention**: To prevent audits:\n  - Confirm that the practitioner has not undergone mental health skills training, as this item is specifically for those without such training.\n  - Ensure that the EDTMP is completed within the specified time and includes all required components.\n  - Maintain clear and comprehensive records of all discussions and decisions made during the consultation.\n\n- **Expiry of Plan**: The EDTMP is valid for **12 months**; ensure timely reviews and updates to avoid service ineligibility after expiration.\n\n- **Referral to Other Services**: Be aware that the EDTMP triggers eligibility for additional psychological and dietetic services, which must be documented and managed appropriately. \n\n- **Compliance Check**: Regularly review billing practices against MBS guidelines to ensure ongoing compliance and avoid potential penalties.",
    "updated": "2026-07-05"
  },
  "92151": {
    "content": "HEADING: Summary of MBS Item 92151 for Billing Compliance\n\n- **Item Description**: MBS Item 92151 pertains to video attendance by a medical practitioner for the preparation of an **Eating Disorder Treatment and Management Plan (EDTMP)** lasting at least **40 minutes**.\n- **Eligibility**: The service is for patients diagnosed with specified eating disorders, including **anorexia nervosa**, **bulimia nervosa**, and **binge-eating disorder**.\n- **Plan Requirements**: The EDTMP must include:\n  - An **opinion on diagnosis** of the patient\u2019s eating disorder.\n  - **Treatment options** and recommendations for managing the condition over the next **12 months**.\n  - An outline of **referral options** to allied health professionals and specialists.\n  - Provision of a **copy of the plan** and suitable **education** about the eating disorder to the patient and their carer, if applicable.\n- **Fee Structure**: The schedule fee for this item is **$101.05**, with a benefit of **100%** payable by Medicare.\n- **Documentation**: Ensure thorough documentation of:\n  - Patient\u2019s medical and psychological health status.\n  - Discussion of referral and treatment options.\n  - Goals agreed upon with the patient and their family/carer.\n  - Education provided to the patient and family/carer.\n  - Crisis intervention and relapse prevention plans, if applicable.\n  - Arrangements for follow-up and review dates.\n- **Time Management**: The time spent preparing the EDTMP should not overlap with time spent on assessments or examinations. Ensure that these are documented separately.\n- **Expiry of Plan**: The EDTMP is valid for **12 months**. Services related to eating disorders are not available if the plan has expired.\n- **Audit Prevention**: To prevent audits:\n  - Maintain clear and comprehensive records of all discussions and decisions made during the consultation.\n  - Ensure that all components of the EDTMP are addressed and documented as per the requirements.\n  - Regularly review and update the plan as necessary, ensuring compliance with the guidelines set forth by the MBS.",
    "updated": "2026-07-05"
  },
  "92152": {
    "content": "HEADING: MBS Item 92152 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 92152 pertains to video attendance by a medical practitioner (excluding GPs, specialists, or consultant physicians) for the preparation of an **Eating Disorder Treatment and Management Plan (EDTMP)** lasting between **20 to 40 minutes**.\n\n- **Eligibility Criteria**: The patient must have a diagnosis of an eating disorder, such as **anorexia nervosa**, **bulimia nervosa**, or **binge-eating disorder**. The practitioner must have completed **mental health skills training**.\n\n- **Plan Requirements**: The EDTMP must include:\n  - An **opinion on the diagnosis** of the patient\u2019s eating disorder.\n  - **Treatment options and recommendations** for managing the condition for the next **12 months**.\n  - An **outline of referral options** to allied health professionals and specialists.\n  - Provision of a **copy of the plan** and suitable **education** about the eating disorder to the patient and their carer, if applicable.\n\n- **Fee and Benefits**: The schedule fee for Item 92152 is **$87.15**, with a benefit of **100%** coverage.\n\n- **Documentation**: Ensure thorough documentation of:\n  - Patient assessments and discussions regarding their medical and psychological health.\n  - Goals agreed upon with the patient and their family/carer.\n  - Crisis intervention and relapse prevention plans, if appropriate.\n  - Arrangements for referrals and follow-ups.\n\n- **Plan Validity**: The EDTMP is valid for **12 months**. Services related to eating disorders are not available if the plan has expired.\n\n- **Audit Prevention**: To prevent audits:\n  - Confirm that all components of the EDTMP are completed and documented.\n  - Ensure that the time spent on assessments is not included in the time for preparing the EDTMP.\n  - Maintain clear records of patient interactions, treatment plans, and follow-up arrangements.\n\n- **Best Practice**: It is recommended that practitioners perform a **comprehensive physical examination** to support ongoing management and monitoring of the patient\u2019s condition, which can be billed separately if not included in the EDTMP preparation time.",
    "updated": "2026-07-05"
  },
  "92153": {
    "content": "HEADING: MBS Item 92153 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 92153 covers video attendance by a medical practitioner (not a GP, specialist, or consultant physician) for the preparation of an Eating Disorder Treatment and Management Plan (EDTMP) lasting at least **40 minutes**.\n\n- **Eligibility Criteria**: The patient must have a diagnosed eating disorder, such as anorexia nervosa, bulimia nervosa, or binge-eating disorder, and meet specific eligibility requirements.\n\n- **Plan Requirements**: The EDTMP must include:\n  - An **opinion on diagnosis** of the patient\u2019s eating disorder.\n  - **Treatment options and recommendations** for managing the condition over the next **12 months**.\n  - An **outline of referral options** to allied health professionals and specialists.\n  - Provision of a **copy of the plan** and suitable education about the eating disorder to the patient and their carer, if applicable.\n\n- **Fee and Benefits**: The schedule fee for Item 92153 is **$128.45**, with a benefit of **100%** coverage.\n\n- **Documentation**: Ensure thorough documentation of:\n  - Patient assessments and discussions regarding medical and psychological health.\n  - Goals agreed upon with the patient and their family/carer.\n  - Crisis intervention and relapse prevention plans, if appropriate.\n  - Arrangements for referrals and follow-up reviews.\n\n- **Expiry of Plan**: The EDTMP is valid for **12 months**. Services are not available if the plan has expired.\n\n- **Audit Prevention**: \n  - Confirm that the practitioner has completed **mental health skills training**.\n  - Ensure that the time spent on assessments is **not included** in the time for producing the EDTMP.\n  - Maintain clear records of all discussions, assessments, and plans to support compliance during audits.\n\n- **Best Practices**: It is recommended that practitioners perform a **comprehensive physical examination** to enhance ongoing patient management and monitoring, which should be documented separately from the EDTMP preparation time.",
    "updated": "2026-07-05"
  },
  "92171": {
    "content": "HEADING: MBS Item 92171 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 92171 pertains to video attendance by a medical practitioner (excluding GPs) for the review of an eligible patient's eating disorder treatment and management plan.\n\n- **Eligibility Criteria**: \n  - The patient must have an **eating disorder treatment and management plan** prepared by a qualified medical practitioner.\n  - The review must include an assessment of the **efficacy of treatment** and a discussion with the patient regarding their needs.\n\n- **Documentation Requirements**: \n  - Modifications to the treatment plan must be **recorded in writing**.\n  - Recommendations may include:\n    - Continuing current treatment options.\n    - Altering treatment options, with new arrangements documented.\n\n- **Referral Protocol**: \n  - The practitioner must initiate referrals for a review by a **consultant physician** in psychiatry or paediatrics when appropriate.\n\n- **Patient Education**: \n  - The practitioner is required to offer the patient and their carer (if applicable):\n    - A copy of the updated treatment plan.\n    - Suitable education regarding the eating disorder.\n\n- **Billing Compliance**: \n  - Ensure that the service provided aligns with the specific requirements of Item 92171 to avoid audit issues.\n  - Maintain thorough documentation of all discussions, modifications, and referrals related to the treatment plan.\n\n- **Fee Structure**: \n  - The schedule fee for Item 92171 is **$68.65**, with a benefit of **100%** coverage.\n\n- **Audit Prevention**: \n  - Regularly review compliance with the item\u2019s requirements to mitigate the risk of audits.\n  - Ensure all documentation is complete, accurate, and readily available for review if required.",
    "updated": "2026-07-05"
  },
  "92177": {
    "content": "HEADING: MBS Item 92177 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 92177 pertains to **telehealth attendance services** for the **review of an eating disorder treatment and management plan** via phone by a medical practitioner (excluding GPs, specialists, or consultant physicians).\n\n- **Eligibility Criteria**: \n  - The patient must have an **eating disorder treatment and management plan** prepared by a qualified medical practitioner.\n  - The review must include an assessment of the **efficacy of treatment** and a discussion with the patient regarding their needs.\n\n- **Documentation Requirements**: \n  - Modifications to the treatment plan must be **documented in writing**.\n  - Recommendations may include:\n    - Continuing current treatment options.\n    - Altering treatment options, with new arrangements clearly documented.\n\n- **Referral Protocol**: \n  - The practitioner must initiate referrals for a review by a **consultant physician** in psychiatry or paediatrics when appropriate.\n\n- **Patient Education**: \n  - The practitioner is required to offer the patient and their carer (if applicable) a copy of the treatment plan and provide **suitable education** about the eating disorder.\n\n- **Billing Compliance**: \n  - Ensure that the service provided aligns with the **specific requirements** outlined in the item description to avoid audit issues.\n  - Maintain thorough documentation of all discussions, modifications, and referrals related to the treatment plan.\n\n- **Fee Structure**: \n  - The scheduled fee for Item 92177 is **$68.65**, with a benefit of **100%** coverage under Medicare.\n\n- **Audit Prevention**: \n  - Regularly review compliance with the item\u2019s requirements to mitigate the risk of audits.\n  - Ensure all documentation is complete, accurate, and readily available for review if required.",
    "updated": "2026-07-05"
  },
  "92186": {
    "content": "HEADING: MBS Item 92186 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 92186 covers video attendance by a medical practitioner (excluding GPs, specialists, or consultant physicians) for providing **eating disorder psychological treatment services** lasting between **30 to 40 minutes** for eligible patients under a treatment and management plan.\n\n- **Eligibility Criteria**: \n  - The patient must have a diagnosis of an **eating disorder** (e.g., anorexia nervosa, bulimia nervosa, binge-eating disorder).\n  - The treatment must be clinically indicated and part of an **Eating Disorder Treatment and Management Plan (EDTMP)**.\n\n- **Credentialing Requirements**: \n  - The medical practitioner must be registered with the **Chief Executive Medicare** and meet the credentialing requirements for this service.\n\n- **Billing Details**: \n  - The scheduled fee for Item 92186 is **$88.85**, with a benefit of **100%** payable by Medicare.\n  - Ensure that the service is billed correctly to avoid discrepancies during audits.\n\n- **Documentation Requirements**: \n  - Maintain thorough documentation of the **EDTMP**, including:\n    - Patient assessments and medical history.\n    - Goals agreed upon with the patient and their family/carer.\n    - Crisis intervention and relapse prevention plans.\n    - Details of referrals and follow-up arrangements.\n  - Document the **date of service** and ensure it aligns with the **EDTMP** validity period (12 months).\n\n- **Audit Prevention**: \n  - Regularly review patient records to ensure compliance with the **EDTMP** requirements.\n  - Confirm that the service provided aligns with the time duration specified (30-40 minutes) to avoid billing errors.\n  - Ensure that any comprehensive physical assessments are documented separately and do not overlap with the time billed for the EDTMP.\n\n- **Service Limitations**: \n  - Patients cannot access eating disorder treatment services if their **EDTMP** has expired.\n  - Be aware of the maximum limits for psychological treatment services (up to **40 services** in a 12-month period) and dietetic services (up to **20 services** in a 12-month period).\n\n- **Best Practices**: \n  - Conduct a comprehensive physical examination to support ongoing management and monitoring of the patient's medical and nutritional status.\n  - Engage in regular reviews and discussions with the patient regarding their treatment progress and any necessary adjustments to their plan. \n\nBy adhering to these guidelines, compliance with MBS Item 92186 can be maintained, minimizing the risk of audit issues.",
    "updated": "2026-07-05"
  },
  "92188": {
    "content": "HEADING: MBS Item 92188 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 92188 covers video attendance by a medical practitioner (excluding GPs, specialists, or consultant physicians) for providing **eating disorder psychological treatment services** lasting at least **40 minutes** for eligible patients under an **eating disorder treatment and management plan**.\n\n- **Eligibility Criteria**: \n  - The service must be provided to patients diagnosed with **anorexia nervosa**, **bulimia nervosa**, **binge-eating disorder**, or other specified eating disorders.\n  - The patient must have an **active eating disorder treatment and management plan (EDTMP)** that is not expired.\n\n- **Credentialing Requirements**: The medical practitioner must be registered with the **Chief Executive Medicare** and meet the **credentialing requirements** for this service.\n\n- **Fee Structure**: \n  - The schedule fee for Item 92188 is **$127.10**.\n  - The benefit payable is **100%**, equating to **$127.10**.\n  - The **Extended Medicare Safety Net Cap** is **$381.30**.\n\n- **Documentation Requirements**: \n  - Ensure comprehensive documentation of the **EDTMP**, including:\n    - Patient\u2019s medical and psychological health status.\n    - Goals agreed upon with the patient and family/carer.\n    - Crisis intervention and relapse prevention plans.\n    - Arrangements for referrals and follow-up.\n    - Results of assessments and treatment plans.\n  - Document the **duration** of the service to confirm it meets the **40-minute minimum** requirement.\n\n- **Audit Prevention Tips**: \n  - Regularly review patient records to ensure that the **EDTMP** is current and has not expired.\n  - Maintain clear and thorough documentation to support the medical necessity of the service provided.\n  - Ensure that the service is billed under the correct item number and that the practitioner meets all credentialing requirements.\n\n- **Best Practices**: \n  - Conduct a **comprehensive physical examination** as part of the assessment process, which should be documented separately from the time spent on the EDTMP.\n  - Engage with the patient and their family/carer throughout the treatment process to ensure understanding and compliance with the treatment plan.\n\n- **Compliance Monitoring**: \n  - Implement regular audits of billing practices related to Item 92188 to identify any discrepancies or areas for improvement.\n  - Stay updated on any changes to the MBS or relevant guidelines to ensure ongoing compliance.",
    "updated": "2026-07-05"
  },
  "92198": {
    "content": "HEADING: MBS Item 92198 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 92198 covers telehealth attendance services for eating disorder psychological treatment, provided by a medical practitioner (not a GP, specialist, or consultant physician) for eligible patients.\n- **Duration Requirement**: The service must last at least **30 minutes** but less than **40 minutes**.\n- **Eligibility Criteria**: Patients must have an **Eating Disorder Treatment and Management Plan (EDTMP)** in place, which must be current and not expired.\n- **Credentialing**: The medical practitioner must be registered with the Chief Executive Medicare and meet the **credentialing requirements** for this service.\n- **Fee Structure**: The schedule fee for this item is **$88.85**, with a benefit of **100%** payable by Medicare.\n- **Extended Medicare Safety Net**: The cap for the Extended Medicare Safety Net is **$266.55**.\n- **Documentation**: Ensure thorough documentation of the patient's assessment, treatment plan, and any discussions with the patient and their family/carer regarding goals and support services.\n- **Assessment Requirements**: A comprehensive assessment must include:\n  - Relevant medical and psychological history\n  - Eating disorder diagnostic assessment\n  - Medical review and physical examination\n  - Mental state assessment, including comorbid conditions\n- **Plan Development**: The EDTMP must outline:\n  - Goals of treatment\n  - Crisis intervention and relapse prevention strategies\n  - Arrangements for referrals and follow-up\n- **Audit Prevention**: \n  - Confirm that the service provided aligns with the clinical indications outlined in the EDTMP.\n  - Ensure that the time spent on the EDTMP does not overlap with time spent on other assessments.\n  - Regularly review and update the EDTMP to avoid expiration and ensure continued eligibility for services.\n- **Compliance Checks**: Regularly audit billing practices to ensure adherence to MBS guidelines and maintain accurate records to support claims.",
    "updated": "2026-07-05"
  },
  "92200": {
    "content": "HEADING: MBS Item 92200 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 92200 covers telehealth attendance services for eating disorder psychological treatment lasting at least **40 minutes**.\n- **Eligible Providers**: Only medical practitioners registered with Chief Executive Medicare and meeting credentialing requirements can provide this service. General practitioners, specialists, and consultant physicians are **excluded**.\n- **Patient Eligibility**: Services are available for patients with a valid **Eating Disorder Treatment and Management Plan (EDTMP)**. Ensure the plan is current and has not expired (valid for **12 months**).\n- **Clinical Indication**: Treatment must be clinically indicated under the patient's EDTMP. Document the rationale for the service provided.\n- **Documentation Requirements**: Maintain comprehensive records including:\n  - Patient's medical and psychological health status.\n  - Goals agreed upon with the patient and family/carer.\n  - Crisis intervention and relapse prevention plans.\n  - Details of referrals and follow-up arrangements.\n- **Assessment Protocol**: Conduct a thorough assessment including:\n  - Relevant history (biological, psychological, social).\n  - Eating disorder diagnostic assessment.\n  - Medical review and physical examination.\n  - Mental state assessment and identification of comorbid conditions.\n- **Billing Compliance**: \n  - Ensure the service duration is at least **40 minutes**.\n  - Do not include time spent on assessments in the billing for the EDTMP.\n  - Verify that the service aligns with the patient's treatment plan and is documented appropriately.\n- **Fee Structure**: The schedule fee for Item 92200 is **$127.10**, with a 100% benefit available.\n- **Extended Medicare Safety Net**: Be aware of the cap of **$381.30** for eligible patients under the Extended Medicare Safety Net.\n- **Audit Prevention**: Regularly review documentation practices and ensure compliance with MBS guidelines to minimize audit risks.",
    "updated": "2026-07-05"
  },
  "93000": {
    "content": "HEADING: MBS Item 93000 Summary for Billing Compliance\n\n- **Eligibility Criteria**: The patient must have a **chronic condition** and **complex care needs** managed by a medical practitioner (not a specialist).\n- **Management Plans**: Services must be based on a **GP chronic condition management plan** prepared or reviewed within the last **18 months**, or a **GP Management Plan and Team Care Arrangements** prior to **1 July 2025**, or a **multidisciplinary care plan**.\n- **Service Recommendation**: The service must be **recommended** in the patient\u2019s management plan or arrangements.\n- **Referral Requirement**: The patient must be **referred** to the eligible health practitioner by the medical practitioner.\n- **Individual Service**: The service must be provided to the patient **individually**.\n- **Duration**: The service must last at least **20 minutes**.\n- **Reporting Obligations**: After the service, the eligible health practitioner must provide a **written report** to the referring medical practitioner, detailing:\n  - If the service is the only service under the referral, report on that service.\n  - If it is the first or last service under the referral, report on that service.\n  - If neither applies but involves matters the referring practitioner should know, report on those matters.\n- **Service Limitations**: A maximum of **5 services** can be billed in a calendar year, including any services under related items.\n- **Fee Structure**: The schedule fee is **$74.55**, with an 85% benefit of **$63.40**.\n- **Extended Medicare Safety Net Cap**: The cap is set at **$223.65**.\n- **Audit Prevention**: Ensure all documentation is complete, including management plans, referrals, service duration, and reports, to prevent audit discrepancies.",
    "updated": "2026-07-05"
  },
  "93013": {
    "content": "HEADING: MBS Item 93013 Summary for Billing Compliance\n\n- **Eligibility Criteria**: The service must be provided by an **eligible allied health practitioner** or **Aboriginal and Torres Strait Islander primary health care professional**.\n- **Patient Requirements**: The patient must have a **chronic condition** and **complex care needs** managed by a medical practitioner (not a specialist).\n- **Management Plan**: The service must be based on a **GP chronic condition management plan** prepared or reviewed within the last **18 months**, or a **multidisciplinary care plan**.\n- **Referral Requirement**: The patient must be **referred** to the allied health practitioner by the medical practitioner.\n- **Service Delivery**: The service must be provided **individually** and last at least **20 minutes**.\n- **Reporting Obligations**: A **written report** must be provided to the referring medical practitioner after the service, detailing relevant information as specified.\n- **Service Limitations**: A maximum of **5 services** can be billed under this item in a calendar year, including any services under related items.\n- **Billing Fee**: The schedule fee for this item is **$74.55**, with an 85% benefit of **$63.40**.\n- **Extended Medicare Safety Net Cap**: The cap for this item is **$223.65**.\n- **Audit Prevention**: Ensure all documentation, including management plans and referrals, is complete and accurate to avoid compliance issues during audits. Maintain records of service duration and content of reports provided to referring practitioners.",
    "updated": "2026-07-05"
  },
  "93048": {
    "content": "HEADING: MBS Item 93048 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 93048 pertains to video attendance services provided to Aboriginal and Torres Strait Islander patients by eligible allied health practitioners or primary health care professionals.\n\n- **Eligibility Criteria**:\n  - A **medical practitioner** must have conducted a health assessment identifying the need for follow-up health services.\n  - The patient must have a **chronic condition** and complex care needs managed under:\n    - A **GP chronic condition management plan** prepared or reviewed in the last 18 months.\n    - A **GP Management Plan and Team Care Arrangements** prepared before 1 July 2025 (valid until 30 June 2027).\n    - A **multidisciplinary care plan**.\n  - The patient must be **referred** to the eligible health practitioner by a medical practitioner.\n  - The service must be provided **individually** and last at least **20 minutes**.\n\n- **Reporting Requirements**:\n  - After the service, the eligible health practitioner must provide a **written report** to the referring medical practitioner under specific conditions:\n    - If the service is the only service under the referral.\n    - If it is the first or last service under the referral.\n    - If it involves matters the referring practitioner would reasonably expect to be informed about.\n\n- **Service Limitations**:\n  - A maximum of **10 services** can be claimed per patient in a calendar year.\n  - This includes any services under related items (93000, 93013, 93061, etc.).\n\n- **Fee Structure**:\n  - Schedule Fee: **$74.55**\n  - Benefit: **85%** = **$63.40**\n  - Extended Medicare Safety Net Cap: **$223.65**\n\n- **Audit Prevention Tips**:\n  - Ensure all eligibility criteria are met before billing.\n  - Maintain thorough documentation of health assessments, management plans, and referrals.\n  - Confirm that the service duration is at least **20 minutes**.\n  - Provide timely and accurate written reports to referring practitioners as required.\n  - Monitor the number of services billed to ensure compliance with the **10 service limit** per calendar year.",
    "updated": "2026-07-05"
  },
  "93061": {
    "content": "HEADING: MBS Item 93061 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 93061 pertains to **phone attendance** provided to individuals of **Aboriginal and Torres Strait Islander descent** by eligible allied health or primary health care professionals.\n\n- **Eligibility Criteria**:\n  - A **medical practitioner** must have conducted a **health assessment** identifying the need for follow-up health services.\n  - The patient must have a **chronic condition** and complex care needs managed under:\n    - A **GP chronic condition management plan** prepared or reviewed in the last **18 months**.\n    - A **GP Management Plan** and **Team Care Arrangements** prepared before **1 July 2025** (valid until **30 June 2027**).\n    - A **multidisciplinary care plan**.\n  - The patient must be **referred** to the eligible health practitioner by a medical practitioner.\n  - The service must be provided **individually** and last at least **20 minutes**.\n\n- **Reporting Requirements**:\n  - A **written report** must be provided to the referring medical practitioner after the service, detailing:\n    - If the service is the only one under the referral, report on that service.\n    - If it is the first or last service under the referral, report on that service.\n    - If relevant matters arise that the referring practitioner should be informed about, report on those matters.\n\n- **Service Limitations**:\n  - A maximum of **10 services** can be claimed per patient in a **calendar year**.\n  - This includes services under related items (93000, 93013, 93048, etc.).\n\n- **Fee Structure**:\n  - The **schedule fee** for Item 93061 is **$74.55**.\n  - The benefit payable is **85%**, amounting to **$63.40**.\n  - The **Extended Medicare Safety Net Cap** is **$223.65**.\n\n- **Audit Prevention Tips**:\n  - Ensure all eligibility criteria are met before billing.\n  - Maintain thorough documentation of health assessments, management plans, and referrals.\n  - Confirm that the service duration is at least **20 minutes**.\n  - Provide timely and accurate written reports to referring practitioners.\n  - Monitor the number of services billed to ensure compliance with the **10 service limit** per calendar year.",
    "updated": "2026-07-05"
  },
  "93200": {
    "content": "HEADING: MBS Item 93200 Compliance Summary\n\n- **Item Description**: MBS Item 93200 covers follow-up video attendance services provided by a practice nurse or Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner for Indigenous patients who have received a health check.\n\n- **Eligibility Criteria**: \n  - Service must be provided on behalf of and under the **supervision** of a medical practitioner.\n  - Service must align with the **needs identified** through the patient's health assessment.\n\n- **Service Limitations**: \n  - Maximum of **10 follow-up services** can be claimed per eligible patient per calendar year (1 January to 31 December).\n  - Services must be consistent with the patient's health assessment and within the **scope of practice** of the health practitioner.\n\n- **Billing Compliance**: \n  - Ensure that the service is documented as being provided under the **supervision** of a medical practitioner.\n  - Maintain records that demonstrate the service aligns with the **identified needs** from the health assessment.\n  - Do not claim for time spent assisting with health assessments as separate services under this item.\n\n- **Ineligibility Notes**: \n  - Patients with a GP chronic condition management plan cannot access this item without having undergone a health assessment.\n  - Ensure that the patient has received an appropriate health assessment before billing for this service.\n\n- **Audit Prevention**: \n  - Regularly review patient records to confirm compliance with eligibility and service provision requirements.\n  - Train staff on the specific criteria and documentation needed to support claims for MBS Item 93200.\n  - Implement a checklist for verifying that all conditions are met before submitting claims to avoid potential audits and penalties.",
    "updated": "2026-07-05"
  },
  "93201": {
    "content": "HEADING: MBS Item 93201 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 93201 pertains to video attendance services provided by a practice nurse or Aboriginal and Torres Strait Islander health practitioner for patients with chronic conditions.\n- **Supervision Requirement**: The service must be provided **under the supervision** of a medical practitioner.\n- **Patient Eligibility**: Patients must have:\n  - A **GP chronic condition management plan** prepared or reviewed within the last **18 months**, or\n  - A **GP Management Plan and Team Care Arrangements** prepared before **1 July 2025** (valid until 30 June 2027), or\n  - A **multidisciplinary care plan**.\n- **Service Consistency**: The service must be **consistent** with the patient's management plan or arrangements.\n- **Fee Structure**: The schedule fee for this item is **$17.00**, with a benefit of **85%** equating to **$14.45**.\n- **Extended Medicare Safety Net Cap**: The cap for this item is **$51.00**.\n- **Documentation**: Ensure all documentation is complete and reflects the patient's eligibility and the service provided.\n- **Clinical Relevance**: All services billed under this item must be **clinically relevant** and necessary for the appropriate treatment of the patient, as defined by the Health Insurance Act 1973.\n- **Audit Prevention**: Maintain thorough records of:\n  - Patient eligibility criteria met.\n  - Details of the chronic condition management plan.\n  - Evidence of supervision by a medical practitioner.\n  - Consistency of the service with the management plan.\n- **Compliance Checks**: Regularly review billing practices to ensure adherence to MBS guidelines and avoid potential audits or penalties.",
    "updated": "2026-07-05"
  },
  "93202": {
    "content": "HEADING: MBS Item 93202 Summary for Billing Compliance\n\n- Item 93202 is for **follow-up phone attendance** provided by a practice nurse or Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner.\n- This service is specifically for **Indigenous patients** who have received a health check.\n- The service must be provided **under the supervision** of a medical practitioner.\n- Follow-up services must be **consistent with the needs** identified through the patient's health assessment.\n- The fee for this item is **$33.70**, with a benefit of **85%** equating to **$28.65**.\n- The service can be claimed **up to a maximum of 10 times** per eligible patient per calendar year (1 January to 31 December).\n- Ensure that the services provided are within the **accepted scope of practice** of the health practitioner and align with accepted medical practice.\n- Time spent by practice nurses or Aboriginal and Torres Strait Islander health practitioners assisting with health assessments **cannot be billed** separately under this item.\n- Patients must have received a **health assessment** to be eligible for this item; it is not available for patients with only a GP chronic condition management plan.\n- If a patient has received multiple health assessments in a calendar year, they are still limited to a maximum of **10 follow-up services**.\n- Maintain thorough documentation to support the **consistency** of services with the health assessment needs to prevent audit issues.\n- Review associated notes MN.12.3 and MN.12.6 for further compliance requirements and clarifications regarding the use of this item.",
    "updated": "2026-07-05"
  },
  "93203": {
    "content": "HEADING: MBS Item 93203 Summary for Billing Compliance\n\n- **Item Description**: MBS Item 93203 covers phone attendance services provided by a practice nurse or Aboriginal and Torres Strait Islander health practitioner for patients with chronic conditions.\n- **Supervision Requirement**: The service must be provided **on behalf of** and **under the supervision** of a medical practitioner.\n- **Patient Eligibility**: \n  - The patient must have a **GP chronic condition management plan** prepared or reviewed within the last **18 months**.\n  - Alternatively, until **30 June 2027**, the patient may have a **GP Management Plan** and **Team Care Arrangements** prepared before **1 July 2025**, or a **multidisciplinary care plan**.\n- **Service Consistency**: The service provided must be **consistent with** the patient's management plan or arrangements.\n- **Fee Structure**: \n  - The schedule fee for this item is **$17.00**.\n  - The benefit payable is **85%**, amounting to **$14.45**.\n- **Extended Medicare Safety Net Cap**: The cap for this item is **$51.00**.\n- **Documentation**: Ensure that all documentation related to the patient's chronic condition management plan is **accurate** and **up-to-date** to support billing.\n- **Clinical Relevance**: All services billed under this item must be **clinically relevant**, meaning they are necessary for the appropriate treatment of the patient.\n- **Audit Prevention**: \n  - Maintain thorough records of patient eligibility and management plans to defend against potential audits.\n  - Regularly review and update patient plans to ensure compliance with MBS requirements.\n- **Referral Protocol**: GPs can refer patients to specialists as part of the management of chronic conditions, ensuring that all referrals are documented and justified.",
    "updated": "2026-07-05"
  }
}