Medicare Benefits Schedule - Item 75855

A medical service to which an item in this table (other than this item or item 10990, 10991, 10992, 75856, 75857 or 75858) applies if:
(a) the service is an unreferred service; and
(b) the service is provided to a person who is under the age of 16 or is a concessional beneficiary; and
(c) the person is not an admitted patient of a hospital: and
(d) the service is bulk-billed in respect of the fees for:
     (i) this item and
     (ii) the other item in this Schedule applying to the service; and
(e) the service is provided at, or from, a practice location in:

      (i)  a Modified Monash 3 area; or

      (ii) a Modified Monash 4 area

Fee: $12.50 Benefit: 85% = $10.65

(See para MN.1.1 of explanatory notes to this Category)

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• Next - Item 75856

Items 10990, 10991, 75855, 75856, 75857 and 75858 can only be claimed where all of the conditions set out in the relevant item descriptor have been met. The items cover different geographical areas. 

Item 10990 should be claimed where the service is provided at, or from, a practice location that is in a MMM1 area under the Modified Monash Model classification system.

Item 10991 can only be used where the service is provided at, or from, a practice location that is in a MMM 2 area under the Modified Monash Model classification system. 

Item 75855 can only be used where the service is provided at, or from, a practice location that is in a MMM 3 or 4 area under the Modified Monash Model classification system.  

Item 75856 can only be used where the service is provided at, or from, a practice location that is in a MMM 5 area under the Modified Monash Model classification system.  

Item 75857 can only be used where the service is provided at, or from, a practice location that is in a MMM 6 area under the Modified Monash Model classification system.

Item 75858 can only be used where the service is provided at, or from, a practice location that is in a MMM 7 area under the Modified Monash Model classification system.  

A locator map that can be used to identify a medical practice's MMM classification is available at the DoctorConnect website at http://www.doctorconnect.gov.au/internet/otd/publishing.nsf/Content/locator

Practice location is the place associated with the medical practitioner's provider number from which the service has been provided.  This includes services performed either at the medical practitioner's surgery, or those services performed away from the surgery using the provider number for that surgery (eg home visits or visits to aged care facilities).

Where a medical practitioner has a practice location in both an eligible and ineligible area, the item should be claimed in respect of those services provided at, or from, the eligible practice location. 

The items can only be used in conjunction with items in the General Medical Services Table of the MBS.  There are similar items to be used in conjunction with diagnostic imaging services (item 64990, 64991, 64992, 64993, 64994 or 64995) or pathology services (item 74990, 74991, 75861, 75862, 75863 or 75864). 

Items 10990, 10991, 75855, 75856, 75857 or 75858 can be claimed for each item of service claimable under the MBS (other than diagnostic imaging services and pathology services), provided the conditions of the relevant item are satisfied.  For example, for item 10991 can be claimed in conjunction with attendance items, procedural items (other than diagnostic imaging or pathology items) or services provided by a practice nurse on behalf of a medical practitioner (items 10983, 10987 and 10997).  In some cases, this will mean that a bulk-billing incentive item can be claimed more than once in respect of a patient visit. 

The bulk-billing incentive items cannot be claimed in conjunction with each other. 

Where a Medicare benefit is not payable for a particular service (eg because the patient has exceeded the number of allowable services in a period of time), the additional bulk billing payment will not be paid for that service. 

All GPs whether vocationally registered or not are eligible to claim the additional bulk billing payment. 

Commonwealth concession card holder means a person listed on a Pensioner Concession Card, Health Care Card or Commonwealth Seniors Health Card issued by either Centrelink or the Department of Veterans' Affairs.  Gold or White Cards issued by the Department of Veterans' Affairs do not attract the additional bulk billing payment.  However, if a Gold or White Card holder also holds a recognised Commonwealth concession card and chooses to be treated under the Medicare arrangements, then that patient is an eligible concession card holder. 

Unreferred service means a medical service provided to a patient by, or on behalf of, a medical practitioner, being a service that has not been referred to that practitioner by another medical practitioner or person with referring rights. 

The Department of Health will undertake regular post payment auditing to ensure that the additional bulk billing payment is being claimed correctly.

Related Items: 10990 10991 75855 75856 75857 75858