Medicare Benefits Schedule - Note AN.14.3

Publication date: 1 November 2025 

SUMMARY 

This note sets out the requirements for health assessment services for eligible patients experiencing signs or symptoms relating to menopause or perimenopause.
  
USE OF THE ITEMS 

Health assessment items are used to assess eligible patients’ health and physical, psychological and social function. This includes the medical practitioner’s consideration of whether relevant health care and education should be offered to the patient to improve their health or function.
 
The specific requirements of the menopause and perimenopause health assessment are set out in the Health Insurance (Section 3C General Medical Services – Menopause and Perimenopause Health Assessment Services) Determination 2025 (the Determination) and the Health Insurance (General Medical Services Table) Regulations 2021 (the Regulations). 

The Determination requires that a menopause and perimenopause health assessment must include, but is not limited to: 

• collection of relevant information, including taking a patient history to determine pre-, peri- or post-menopausal status, patient wellbeing and contraindications for management; and 
  
  
• a basic physical examination, including recording blood pressure, and review of height and weight; and
  
  
• initiating investigations and referrals as clinically indicated, with consideration given to the need for cervical screening, mammography and bone densitometry; and 
  
  
• discussion of management options including non-pharmacological and pharmacological strategies including risks and benefits; and
  
  
• implementing a management plan which includes patient centred symptoms management; and 
  
  
• providing the patient with preventative health care advice and information as clinically indicated, including advice on physical activity, smoking cessation, alcohol consumption, nutritional intake and weight management.  

The items apply only to a service provided in the course of a personal attendance by a single general practitioner (GP) or prescribed medical practitioner (PMP) on a single patient.
  
Information on practitioner types is available in Note GN.4.13 for GPs and AN.7.1 for PMPs. 

Medical practitioners may refer to A Practitioner’s Toolkit for Managing Menopause for guidance with this assessment.

Is a health assessment a health screening service? 

No. Clause 2.15.14 of the Regulations specifies that a health assessment must not include a screening service.
 
The Health Insurance Act 1973 (the Act) defines a health screening service as a medical examination or test that is not reasonably required for the management of the medical condition of the patient.

A health screening service does not include a medical examination or a test on a symptomless patient by the that patient’s own medical practitioner in the course of normal medical practice, to ensure the patient receives any medical advice or treatment necessary to maintain their state of health. 

Further information is available in Note GN.13.33. 

Can another person assist the medical practitioner to undertake the health assessment? 

Yes. Clause 2.15.14 of the Regulations states that practice nurses, Aboriginal and Torres Strait Islander health workers and Aboriginal and Torres Strait Islander health practitioners may assist in accordance with accepted medical practice under the supervision of the medical practitioner. 

Assistance provided must be in accordance with accepted medical practice and under the supervision of the GP or PMP. This may include activities associated with: 

• information collection, and 
  
  
• providing patients with information about recommended interventions, at the direction of the medical practitioner. 

The GP or PMP should be satisfied that the assisting health professional has the necessary skills, expertise and training to collect the information required for the health assessment.

MBS items for Health Assessments are for a complete service. On behalf of items, such as item 10997 and 10987, may not be claimed when assisting with the provision of a health assessment service. 

Additional advice on the use of other health professionals’ time when undertaking health assessments can be found in the AskMBS Advisory – General Practice Services 1. 

A Practice nurse means a registered or an enrolled nurse who is employed by, or whose services are otherwise retained by, a general practice or by a health service to which a direction made under subsection 19(2) of the Act applies.

For the purpose of items 695 and 19000, an Aboriginal and Torres Strait Islander health practitioner means a person who:

• is registered as an Aboriginal and Torres Strait Islander health practitioner with the Aboriginal and Torres Strait Islander Health Practice Board of Australia, and
  
  
• is employed by, or whose services are otherwise retained by, a medical practitioner in a general practice, or a health service to which a direction made under subsection 19(2) of the Act applies. 

For the purpose of items 695 and 19000, an Aboriginal and Torres Strait Islander health worker means a person who:

• has a Certificate III or above in Aboriginal and/or Torres Strait Islander Primary Health Care from the Health (HLT) training package, and 
  
  
• is engaged by a medical practitioner in a general practice or a health service to which a direction made under subsection 19(2) of the Act applies. 

Can a patient be eligible for more than one category of health assessment?

Where eligible, a patient may receive both a menopause and perimenopause health assessment service and a separate time tiered or Aboriginal and Torres Strait Islander health assessment service (for example, a Type 2 diabetes risk evaluation). There is no minimum interval of time between the provision of the different health assessments. 

Attendance time for the completion of a health assessment service cannot be billed under multiple items. Practitioners are required to satisfy themselves that they have met the requirements of each individual MBS item descriptor prior to billing.  

Information on MBS time-tiered health assessment services is available at AN.0.36.

Can I include additional time required for communications (e.g. with an interpreter) in the time taken for the health assessment?

Yes, a wide range of factors may affect the time needed to communicate effectively with a patient during a consultation. These include, but are not limited to, situations where a language barrier exists between the medical practitioner and patient (including when an interpreter is required), or when a patient has hearing problems, difficulty with speech, an intellectual disability, and/or dementia.

When claiming MBS items with time requirements, the total consultation time includes the time required to communicate effectively with the patient. Where more time than usual is required to communicate effectively with a particular patient, it is considered reasonable to claim a longer attendance item than might otherwise be expected for the service. 

In such situations, medical practitioners should make a brief record in the patient’s notes including details about why the additional time was required. For example, stating ‘consultation extended due to use of interpreter’ and, if relevant, citing the Translating and Interpreting Service (TIS) job number. 

ELIGIBLE PATIENTS 

Any patient who is eligible to receive Medicare benefits, has not received this service in the previous 12-month period, and is experiencing premature ovarian insufficiency, early menopause, perimenopause or menopause symptoms, or undergoing treatment for their symptoms.

ELIGIBLE PRACTITIONERS 

Health assessment items are available for different practitioner types: 

• the GP item 695 can be claimed by GPs only (see GN.4.13). 
  
  
• the PMP item 19000 can be claimed by PMPs only (see AN.7.1). 

Note: Clause 2.15.14 of the Regulations specifies patients must access health assessment services through their usual GP or PMP, if reasonably practicable. 

The patient’s usual GP or PMP means the practitioner: 

• who has provided the majority of services to the patient in the past 12 months, or
  
  
• who is likely to provide the majority of services to the patient in the following 12 months, or 
  
  
• is located at a medical practice that: 
  
  
  • has provided the majority of services to the patient in the past 12 months, or
    
    
  • is likely to provide the majority of services to the patient in the next 12 months. 

CO-CLAIMING RESTRICTIONS 

Clause 2.15.14 of the Regulations specifies a separate consultation must not be performed in conjunction with a health assessment, unless clinically necessary. 

RECORD KEEPING AND REPORTING REQUIREMENTS 

Providers are responsible for ensuring services claimed from Medicare using their provider number meet all legislative requirements and they may be required to submit evidence for compliance checks related to Medicare claims. Practitioners should ensure they keep adequate and contemporaneous records. For information on what constitutes adequate and contemporaneous records see GN.15.39. 

Clause 4.3 of the Act specifies that, where an item specifies the creation of a document (however described) and a document is created, the document must be retained for the period of 2 years. 

RELEVANT LEGISLATION 

Details about the legislative requirements of the MBS items can be found on the Federal Register of Legislation at www.legislation.gov.au. Menopause and perimenopause health assessment items are set out in the following regulatory instruments: 

• Health Insurance (Section 3C General Medical Services – Menopause and Perimenopause Health Assessment Services) Determination 2025 
  
  
• Health Insurance (General Medical Services Table) Regulations 2021 

Related Items: 695 10987 10997 19000

• Previous - Note AN.14.2
• Next - Note AN.15.1

Follow up service provided by a practice nurse or Aboriginal and Torres Strait Islander health practitioner, on behalf of a medical practitioner, for an Indigenous person who has received a health assessment if:

a)    The service is provided on behalf of and under the supervision of a

medical practitioner; and

b)    the person is not an admitted patient of a hospital; and

c)    the service is consistent with the needs identified through the health assessment;

    -    to a maximum of 10 services per patient in a calendar year

Fee: $27.95 Benefit: 100% = $27.95

(See para AN.14.3, MN.12.3 of explanatory notes to this Category)

Service provided by a practice nurse or an Aboriginal and Torres Strait Islander health practitioner to a person with a chronic condition, if:

(a) the service is provided on behalf of and under the supervision of a medical practitioner; and

(b) the person is not an admitted patient of a hospital; and

(c) the person has in place:

(i) a GP chronic condition management plan that has been prepared or reviewed in the last 18 months; or

(ii) until the end of 30 June 2027—a GP management plan, or team care arrangements, prepared before 1 July 2025; or

(iii) a multidisciplinary care plan; and

(d) the service is consistent with the plan or arrangements

Applicable up to a total of 5 services to which this item, item 92301 or item 93203 applies in a calendar year

Fee: $14.00 Benefit: 100% = $14.00

(See para AN.14.3, AN.15.3, AN.15.5, MN.12.4 of explanatory notes to this Category)

Menopause and Perimenopause Health Assessment

Professional attendance on a patient for the assessment and management of menopause or perimenopause by a general practitioner lasting at least 20 minutes and including, but not limited to:

a) collecting relevant information, including taking a patient history to determine pre-, peri- or post-menopausal status, patient wellbeing and contraindications for management; and

b) undertaking a basic physical examination, including recording blood pressure, and review of height and weight; and

c) initiating investigations and referrals as clinically indicated, with consideration given to the need for cervical screening, mammography and bone densitometry; and

d) discussing management options including non-pharmacological and pharmacological strategies including risks and benefits;

e) implementing a management plan which includes patient centred symptoms management; and

f) providing the patient with preventative health care advice and information as clinically indicated, including advice on physical activity, smoking cessation, alcohol consumption, nutritional intake and weight management.

Fee: $101.90 Benefit: 100% = $101.90

(See para AN.14.3 of explanatory notes to this Category)

Menopause and Perimenopause Health Assessment

Professional attendance on a patient for the assessment and management of menopause or perimenopause by a prescribed medical practitioner lasting at least 20 minutes and including, but not limited to:

a) collecting relevant information, including taking a patient history to determine pre-, peri- or post-menopausal status, patient wellbeing and contraindications for management; and

b) undertaking a basic physical examination, including recording blood pressure, and review of height and weight; and

c) initiating investigations and referrals as clinically indicated, with consideration given to the need for cervical screening, mammography and bone densitometry; and

d) discussing management options including non-pharmacological and pharmacological strategies including risks and benefits;

e) implementing a management plan which includes patient centred symptoms management; and

f) providing the patient with preventative health care advice and information as clinically indicated, including advice on physical activity, smoking cessation, alcohol consumption, nutritional intake and weight management.

Fee: $81.50 Benefit: 100% = $81.50

(See para AN.14.3 of explanatory notes to this Category)