AItem Number Medicare Benefit Item Description

Group A11 – After Hours

GP After Hours Between 11pm – 7am

(not more than 1 patient on the 1 occasion)599 $144.30 At Consulting rooms

-patient requires urgent treatment; GP needs to specifically open rooms. -patient requires urgent treatment.

GP Transitional Hours

597 $122.45 At a place other than, or in consult rooms -patients condition requires urgent treatment

– Mon to Fri – 7am-8am and 6pm – 11am-Sat – 7am-8am and 12pm – 1pm; Sun and public holiday – 7am – 11am

Group 22 – After Hours Attendances to which no other item applies

Public holiday, Sunday, before 8am or after 1pm on Saturday or before 8am or after 8pm any other day5000 $27.35 Level A consult in rooms5003 Level A consult elsewhere (excluding hospital and aged care)5010 Level A consult in aged care facility5020 $46.25 Level B consult in rooms5023 Level B consult elsewhere (excluding hospital and aged care)5028 Level B consult in aged care facility5040 $79.15 Level C consult in rooms5043 Level C consult elsewhere (excluding hospital and aged care)5049 Level C consult in aged care facility5060 $110.1

0Level D consult in rooms

5063 Level D consult elsewhere (excluding hospital and aged care)5067 Level D in aged care facility

Asthma Cycle of Care

(note: benefits are payable for only one service including – 2546, 2547, 2552, 2553, 2558, 2559, 2664, 2666, 2668, 2673, 2675, 2677 – in a 12mo period

Asthma cycle of care must include:- = or > 2 asthma related consults within 12mo for patient with mod/severe asthma(at least one of

which is a consult which was planned at a previous consultation)- Severity – symptoms on most days or use of preventor or bronchodilator at least 3x per week or

hospital attendance or admission following acute exacerbation- Documented diagnosis and assessment of level of asthma control and severity of asthma

- Review of patient use of and access to asthma related medication and devices.- Written asthma action plan

- Provision of asthma self management education- Once every 12months

2546 $34.90 Level B Consult for Asthma cycle of care – in rooms2547 Level B consult for asthma cycle of care – not in rooms2552 $67.65 Level C consult for asthma cycle of care – in rooms2553 Level C consult for asthma cycle of care – not in rooms2558 $99.55 Level D consult for asthma cycle of care – in rooms2559 Level D consult for asthma cycle of care – not in rooms

11610 $61.30 Ankle Brachial indices (using Doppler)16500 $38.55 Antenatal Attendance16591 $116.70 Antenatal – beyond 20wk – planning and management (only once)11306 $21.10 Audiometry

BItem Number Medicare Benefit Item description

30003 $34.90 Burns Dressing30006 $44.75 Burns Dressing - extensive30071 $42.75 Biopsy

(after care is 2 days)10990 Bulk Billing Incentive:

<16yo; pensioner; health care card holders

CItem Number Medicare Benefit Item Description

2501 $34.30 Cervical Smear – Level B2504 $65.20 Cervical Smear – Level C2507 Cervical Smear – Level D

30192 $32.35 Cryotherapy – 10 or more premalignant lesions

Chronic Disease ManagementSee entries under – GP management plan; team care arrangements; multidisciplinary care plans and case

conferencesA patient who has at least one medical condition that is likely to be present >6mo or terminal.

Team includes medical practitioner & at least 2 other members, each of whom provides a different service

Case conferences - Multidisciplinary- Not a service where 731 applies

735 $66.60 Community Case Conference - Organised and coordinated by GP- 15-20min duration

739 $114.1 Community Case Conference - Organised and coordinated by GP- 20-40min duration

743 $190.20 Community case conference - Organised and coordinated by GP- >40min duration

747 $48.95 Community Case conference – participation by GP- 15-20min

750 $83.90 Community Case Conference – participation by GP- 20-40min

758 $139.40 Community Case Conference – participation by GP- >40min

DItem Number Medicare Benefit Item Description

Diabetes Cycle of care (established DM)The following must be completed over a period of at least 11mo and up to 13mo:-

- 2x in 12mo – Wt, BMI, BP, feet exam- Once in 12mo – HbA1c, lipids, microalbuminuria

- Every 2years – ophthalmology review- Self care, education, r/v diet, r/v activity levels, smoking and review medication

2517 $34.90 Level B consult in rooms - <20min2518 Level B consult else where - <20min2521 $67.65 Level C consult in rooms - >20min2522 Level C consult elsewhere >20min2525 $99.55 Level D consult in rooms >40min2526 Level D elsewhere >40min

DislocationsNot requiring a general anaesthetic

Closed reductions only)47003 Clavicle47015 Shoulder47018 Elbow47036 Interphalangeal Joint47042 MCPJ47069 Toe

EItem Description Medicare Benefit Item Description

11700 $30.05 ECG – 12 Lead

ExcisionsAfter care period is usually 10/7

30186 (<10)30185 (>10)

$38.85 Plantar Wart – excisionDefinitive removal excluding ablative methods alone

31205 $78.05 Lesion <10mm rest of body – tumour, cyst, ulcer or scar (not wart or seb k)

31210 $100.70 Lesion 10-20mm rest of body – tumour, cyst, ulcer or scar(not wart or seb k)

31215 $117.40 Lesion >20mm rest of body – tumour, cyst, ulcer or scar(not wart or seb k)

31220 $175.45 Tumour, cyst ulcer or scar4-10 lesions removed by surgical excision

(not wart or sebk)31230 $137.45 Lesion - nose, eyelid, lip, ear, digit, genitals

Removal by surgical excision (not shave excision)31235 $117.40 Lesion <10mm – face neck, lower leg

Removal by surgical excision (not shave excision)31240 $137.45 Lesion >10mm – face, neck, lower leg

Removal by surgical excision (not shave excision)31255 $181.05 BCC, SCC, KA <10mm – Nose, eyelid, lip, ear, digit, genitalia

Removal by surgical excision (not shave excision)(31256 – removal of residual lesion)

(31258 – removal of recurrent lesion)31260 $258.10 BCC, SCC, KA >10mm – Nose, eyelid, lip, ear, digit, genitalia

Removal by surgical excision (not shave excision)(31261 – removal or residual lesion)

(31263 – removal of recurrent lesion)31265 $150.90 BCC, SCC, KA <10mm – face, neck, lower leg

Removal by surgical excision (not shave excision)(31266 – removal of residual lesion)

(31268 – removal of recurrent lesion)31270 $211.85 BCC, SCC, KA 10-20mm – face, neck, lower leg

Removal by surgical excision (not shave excision)(31271 – removal of residual lesion)

(31273 – removal of recurrent lesion)31275 $244.75 BCC, SCC, KA >20mm – face, neck, lower leg

Removal by surgical excision (not shave excision)(31276 – removal of residual lesion)

(31278 – removal of recurrent lesion)31280 $127.50 BCC, SCC, KA <10mm – rest of body

Removal by surgical excision (not shave excision)(31281 – removal of residual lesion)

(31283 – removal of recurrent lesion)31285 $174.20 BCC, SCC, KA 10-20mm – rest of body

Removal by surgical excision (not shave excision)

(31286 – removal of residual lesion)(31288 – removal of recurrent lesion)

31290 $201.10 BCC, SCC, KA >20mm – rest of bodyRemoval by surgical excision (not shave excision)

(31291 – removal of residual lesion)(31293 – removal of recurrent lesion)

31300 $261.65 Malignant Melanoma <10mm – nose, eyelid, lip, ear, digit, genitalia

(includes other locally aggressive tumours)(needs to be definitive excision)

31305 Malignant Melanoma >10mm – as for 3130031310 Malignant melanoma <10mm – face, neck, lower limb

(includes other locally aggressive tumours)(needs to be definitive excision)

31315 Malignant Melanoma 10-20mm – as for 3131031320 Malignant Melanoma >20mm – as for 3131031325 Malignant melanoma <10mm – rest of body

(includes other locally aggressive tumours)(needs to be definitive excision)

31330 Malignant Melanoma 10-20mm – as for 3132531335 Malignant Melanoma >20mm – as for 31325

41647 $89.00 Ear Toilet- Using operating microscope and microinspection of TM

41656 $100.50 Epistaxis – post nasal haemorrhageArrest with post nasal packing

41677 $73.60 Epistaxis – arrest with cauterisation or packing or both(if done by cryotherapy – see 41680)

30071 $42.75 Excisional biopsy(After care is 2 days)

30195 $51.95 Benign neoplasm of skin-not wart, seb K, cyst or skin tag

-electrosurgical destruction, curettage, shave excision30196 $103.30 Malignant neoplasm of skin

- Proven by histology- Removal by serial excision, cryotherapy or diathermy

FItem Number Medicare Benefit Item Description

Family group therapy-professional attendance for group therapy of >1hour duration given under direct continuous supervision of a medical practitioner involving members of a family and persons with close personal relationships with

that family170 $110.90 2 patients171 $116.80 3 patients172 $142.15 4+ patients

Foreign Bodies41500 $66.30 Removal FB from ear

Not with syringe41659 $63.45 Removal FB from nose

Other than by simple probing30061 $19.25 Removal FB – superficial

- Incl cornea or sclera30064 $89.90 Removal FB – superficial – requiring incision and exploration

Including wound closure30067G $182.90 Removal FB in muscle tendon or other deep tissue(assist)42644 Removal of FB from cornea or sclera

Imbedded FBSubepithelial or intraepithelial and completely removed using needle

or surgical instrument and magnification

Fractures+/-Closed reduction

47300 Distal phalanx of finger/thumb47307 Distal phalanx of finger/thumb

Intraarticular fracture47312 Middle phalanx of finger47315 Middle phalanx of finger

Intra-articular fracture47324 Proximal fracture of finger/thumb47327 Proximal fracture of finger/thumb

Intra-articular fracture47336 Metacarpal fracture47339 Metacarpal fracture

Intra-articular47348 Carpus fracture (not scaphoid)47354 Scaphoid – treatment of fracture47360 Radius or ulna – distal

Cast immobilisation(47363 – with reduction)

47369 Radius – distal (colles, smiths,Bartons)Cast immobilisation

(47372 – with reduction)47378 Radius or ulna – shaft

Cast immobilisation47387 Radius and ulna – shaft (assist)

Cast immobilisation47405 Radius – fracture of head or neck

Closed reduction47423 Humerus – proximal

No reduction required47444 Humerus – shaft

No reduction required47462 Fracture of clavicle – Tx of fracture47471 Ribs – fracture of one or more rib

Each attendance47561 Tibial – shaft

Cast immobilisation47576 Fibular fracture47594 Ankle fracture47633 Fracture of 1 metatarsal

No reduction required47642 Fracture of 2 metatarsals

No reduction required47651 Fracture of 3 metatarsals

No reduction required47735 Nasal bone fracture

No reduction requiredEach attendance

GItem Number Medicare Benefit Item Description

GP Management Plans

721 $136.05 GP Management Plan- Not being a service to which items 735-758 apply- Condition likely to be present >6mo or terminal

- Only billed once every 12mo- Not within 3mo of claim for 729, 731 or 732 except if

significant change in patients condition or care circumstances that need a new plan

- Not for patient in RACF732 $68.00 GP Management Plan – Review

- Not being a service to which items 735-758 apply- Not claimed in last 3mo

- No claim in last 3mo for 729, 731, 732 except if significant change in condition or patient care

General Practitioner AttendancesNo other item applies

1 $120.30 Urgent attendance after hours – elsewhere2 $120.30 Urgent attendance after hours – in rooms3 $16.00 Level A – in rooms

Straightforward problem (short hx, limited exam, management)20 Level A – at aged care facility23 $34.90 Level B – in rooms

Involving taking selective history, exam and management for one or more problems or professional attendance of <20min involving

components of a service to which items for level C/D apply35 Level B – aged care facility36 $67.65 Level C – in rooms

Involves detailed history, exam of multiple systems, arranging any necessary investigation and implementing management plan for

one or more problems and lasting at least 20min or attendance of <40min for Level D items

43 Level C – aged care facility44 $99.55 Level D – in rooms

Involves exhaustive history, comprehensive exam of multiple systems, arranging investigations, implementing management plan in relation to 1 or more complex problems and lasting >40min OR a

professional attendance of >40min for implementation of management plan

51 Level D – aged care facility

HItem Number Medicare Benefit Item Description

Health AssessmentsBrief = <30min = item 701 - $56.00

Standard = 30-45min = item 703 - $130.10Long = 45-60min = item 705 - $179.45

Prolonged =>60min = item 707 – 253.60

(note – patient has not had payment made under this item or item 702, 704, 706 in last 12mo)75yo+ - health assessment

4yo health checkComprehensive medical assessment (CMA)

Permanent RACF residentNil CMA in last 12mo

Type 2 Diabetes risk evaluation40-49yo + high risk of type 2 DM

No risk evaluation in last 3 years under 717 or 713www.health.gov.au/preventionoftype2diabetes

45yo health check45-49yo at risk of chronic disease

Only payable onceRisk factors include – smoking, physical inactivity, poor nutrition,

alcohol use, high cholesterol, hypertension, impaired glucose tolerance, obesity, family hx of chronic disease

Refugee Health assessment-not being health assessment in patient with previous claim under

items 700, 702, 712, 714 or 716-within 12mo of arrival or receiving residency

-only payable oncePatient with intellectual disability

Must include:- dental check, aural exam, audiometry every 5yrs, ocular health, nutritional status, bowel and bladder function,

medications, osteoporosis risk factors (diet, exercise, vitD, FHx), seizure control, thyroid dis, signs of abuse, immunisations, ADL

support, dysphasia and GORD(consider breast screen, papsmear, testicular exam, lipid level,

prostate assessment)10986 4yo health check – by nurse

715 55yo+ with ATSI decent715 0-14yo with ATSI decent

No payment for this item in last 9moConsider FBC and audiometry

715 15-55yo with ATSI decentNo payment for this item in last 9mo

Include assessment for hearing loss, dipstick urine and ELFT

32147 $36.30 Haemorrhoid - Incision of perianal thrombosisB100 Holter monitor (BP only)

IItem Number Medicare Benefit Item Description

10993 $11.35 Immunisation by nurse14206 $34.25 Implanon/Zoladex implant30062 $58.45 Implanon removal30061 $18.90 IUD removal30219 $26.30 Incision and drainage – abscess

Includes haematoma, furuncleExcluding aftercare

MItem Number Medicare Benefit Item description

729

(or RACF – 731)

$66.35 Multidisciplinary Care Plans- Contribution of GP to multidisciplinary care plan prepared by

another or review of care plan prepared by another.- Not being a service to which items 734-779 apply

- Condition likely to be present for >6mo or terminal. - No claim within 12mo by same GP for 721 or 723.

- No claim within 30 – 729, 731 or 732 except if significant changes

- In consultation with two other collaborating medical providers

GP Mental Health treatment plans

2702(2710 if GP undertaken PIP training)

$128.20(2702)163.35(2710)

Preparation of a GP Mental Health treatment plan- Only one per 12mo

- Where 2713, 734 to 779 do not apply- Not within 3mo of claim for 2712 except if sign change

2712 $108.90 Review of GP Mental health plan- r/v of plan to which 2702/2710 applies or review psychiatrist

management plan to which 291 applies- every 3 months unless significant change- where 2713 or 734 to 779 do not apply

- not within 4 weeks of claim for 2702/27102713 $71.85 Consult in relation to mental health disorder

- involving history and providing treatment, advice &/or referral on patient in relation to mental health disorder

- lasting at least 20min- where items 2702, 2710 and 2712 do not apply

10990 Miscellaneous Charge Bulk billing incentive for patients who are <16yo, pensioner, health

care card holder

Medication management review- patient must be at risk of medication misadventure due to co-morbidities, age, or social

circumstances, complexity of treatment regimen (eg >12doses/day) or due to lack of knowledge or skill to use medicines to their best effect)

900 $146.00 Domiciliary Medication management review- patient living in community

- in liason with pharmacist- payable every 12mo except if significant change

- benefit not payable until all components have been rendered- (also known as home medicine review)

903 Domicilliary Medication management review – in RACF

NItem Number Medicare Benefit Item description

Nails of digits46531 $69.65 Ingrowing nail of finger or thumb

- Partial resection – but not including excision of nail bed47916 $69.65 Ingrowing nail of toe

-partial resection but not including excision of nail bed47904 Removal of nail of toe

10997 Nurse monitoring and support of a client with a chronic condition(5x per calendar year; for patient with GP Mx plan)

PItem Number Medicare Benefit Item Description

Prolonged attendances to which no other item appliesProfessional attendance (where no other item applies on a patient in imminent danger of death requiring

continuous attendance to the exclusion of all other patients160 $208.90 Duration 1-2hr161 $348.20 Duration 2-3hr

Papsmears-unscreened or significantly underscreened patient (ie>4yrs)

-20 – 69 years old-non inconjunction with 10994, 10995, 10998 or 10999

2501 $34.90 Level B Consult + papsmear2504 $67.65 Level C consult + papsmear2507 $99.55 Level D consult + papsmear

Pregnancy4001 $72.25 Pregnancy support counselling

- Need to meet medicare credentialling- Provision of non directive pregnancy support counselling to a

woman who is concerned about her pregnancy or a pregnancy that occurred in last 12mo

- Lasting >20min- May address any pregnancy related issues for which non

directive counselling is appropriate. - Maximum 3 sessions per patient per pregnancy

73806 $8.70 Pregnancy Test16591 Pregnancy over 20wks

Can only be claimed once per pregnancy

Focused Psychological Strategies- must have done higher level mental health training

- up to 12 planned sessions per year (comprising 2 groups of 6 sessions)- these 12 sessions are part of the 12 total psych sessions under GPMHCP

2721 $87.50 Surgery ConsultDuration 30-40min

2725 $125.20 Surgery Consult – extended attendance>40min

SItem Number Medicare Benefit Item Description

11506 $19.75 Spirometry- done before and after bronchodilator

Suturing

30026 $42.75 Body, superficial <7cm30029 $73.60 Body, deep superficial <7cm30032 $67.45 Face/neck – superficial <7cm30035 $96.15 Face/neck – deep <7cm30038 $73.60 Body superficial >7cm30041 $117.80 Body deep >7cm30045 $96.15 Face/neck superficial >7cm30048 $122.45 Face/neck deep >7cm

TItem Number Medicare Benefit Item description

723 $107.80 Team Care Arrangements- Not being a service to which items 735-758 apply- Condition likely to be present >6mo or terminal

- Nil claim in last 12mo- Nil claim in last 3mo for 732 except if significant change to

condition or care circumstances- Must involve 2 other health providers

- Not for RACF patients732 $66.80 Team Care Arrangement – Review

- Not being a service to which items 734-779 apply- No claim within 3mo

- No claim for 723 within 3mo except if significant change- Note- each service to which a 732 applies may be claimed in a

3mo period (unless significant change) & 732 can be claimed more than once in the same day – eg for TCA and GPMP

WItem number Medicare Benefit Item Description

10996 11.35 Wound management30185 (<10)30186(>10)

Warts – palmar or plantarDefinitive removal (excluding ablative methods)

Other Notes:

Level A consult = straight forward problem

Level B consult = selective history exam and management to 1 or more problems OR attendance less than or equal to 20min involving components of a Level C consult

Level C consult = detailed history, multisystem exam, investigation and management. At least 20min OR attendance less than or equal to 40min involving components to which a Level D consult applies.

Level D consult = exhaustive history, comprehensive exam, investigation and management of one or more complex problems and longer than 40min OR attendance of at least 40min for implementation of management plan.

All figures in this document are either the amount listed on the MBS or, where more than one amount is given, the 85% benefit has been used.

While every effort has been made to ensure that all information in this document is correct, misinformation may occur. If you find an error please let me know on melitacullen@hotmail.com