View Associated Notes
Category 1 - PROFESSIONAL ATTENDANCES
93637 - Additional Information
Professional attendance by a medical practitioner (other than a general practitioner) for the purpose of assessing a patient’s suitability for the first dose of a COVID-19 vaccine if all of the following apply:
(a) one or both of the following is undertaken, where clinically relevant:
(i) a short patient history;
(ii) limited examination and management;
(b) the service is bulk-billed;
(c) the service is provided at, or from, a practice location in:
(i) a Modified Monash 2 area; or
(ii) a Modified Monash 3 area; or
(iii) a Modified Monash 4 area; or
(iv) a Modified Monash 5 area; or
(v) a Modified Monash 6 area; or
(vi) a Modified Monash 7 area;
(d) the service is rendered in an after-hours period
Note: Effective 31 May 2021, age restrictions on the use of this item have been removed.
Fee: $51.60 Benefit: 85% = $43.90
(See para AN.44.1 of explanatory notes to this Category)
Category 1 - PROFESSIONAL ATTENDANCES
MBS COVID-19 Vaccine Support Services
Attendance items to assess a patient’s suitability for a COVID-19 vaccine (items 93624, 93625, 93626, 93627, 93634, 93635, 93636, 93637, 93644, 93645, 93646, 93647, 93653, 93654, 93655, 93656)
Attendance items for in-depth patient assessment services co-claimed with a vaccine suitability assessment service and provided where additional assessment and advice is required, including in relation to the patient’s individual risks and benefits associated with receiving a COVID-19 vaccine (items 10660 and 10661).
Flag-fall item co-claimed with a vaccine suitability assessment service provided as an initial attendance at a residential aged care facility (RACF), residential disability facility setting or a patient’s place of residence, on one occasion (item 90005).
The items are established under Health Insurance (Section 3C General Medical Services – General Practice Attendance for Assessing Patient Suitability for a COVID-19 Vaccine) Determination 2021.
The items can only be billed to Medicare if a dose of a COVID-19 vaccine is available to be given immediately to the patient who is to be assessed. Medical practices that do not have access to supplies of a COVID-19 vaccine for immediate delivery to patients cannot use any of the COVID-19 vaccine items.
In this explanatory note:
- Other Medical Practitioner (OMP) includes specialist medical practitioners and consultant physicians working in a general practice setting in their capacity as medical practitioners who are not vocationally registered general practitioners (GPs); and
- Suitably qualified health professional refers to a person, including a registered nurse, who is registered in a health profession regulated under the Health Practitioner Regulation National Law. More information is available at the AHPRA website at https://www.ahpra.gov.au/.
MBS items 93624, 93625, 93634, 93635, 93644, 93645, 93653, 93654 and 10660 relate to attendances rendered by medical practitioners who are:
- listed on the Vocational Register of General Practitioners maintained by the Department of Human Services; or
- holders of the Fellowship of the Royal Australian College of General Practitioners (FRACGP) who participate in, and meet the requirements of the RACGP for continuing medical education and quality assurance as defined in the RACGP Quality Assurance and Continuing Medical Education program; or
- holders of the Fellowship of the Australian College of Rural and Remote Medicine (FACRRM) who participate in, and meet the requirements of the ACRRM for continuing medical education and quality assurance as defined in ACRRM's Professional Development Program; or
- undertaking an approved placement in general practice as part of a training program for general practice leading to the award of the FRACGP or training recognised by the RACGP as being of an equivalent standard; or
- undertaking an approved placement in general practice as part of a training program for general practice leading to the award of the FACRRM or training recognised by ACRRM as being of an equivalent standard.
MBS items 93626, 93627, 93636, 93637, 93646, 93647, 93655, 93656 and 10661 relate to attendances rendered by a medical practitioner who is not a general practitioner. This includes specialist medical practitioners and consultant physicians working in a general practice setting in their capacity as OMPs. The items are not available to specialists and consultant physicians working in their capacity as specialist practitioners.
MBS item 90005 may be billed in association with MBS items 93624, 93625, 93626, 93627, 93634, 93635, 93636, 93637, 93644, 93645, 93646, 93647, 93653, 93654, 93655 or 93656.
Activities associated with the claiming of MBS items 93624, 93625, 93626, 93627, 93634, 93635, 93636, 93637, 93644, 93645, 93646, 93647, 93653, 93654, 93655 or 93656 can be undertaken by a GP, OMP or a suitably qualified health professional (including a registered nurse) working within their scope of practice.
Services rendered under MBS items 93624, 93625, 93626, 93627, 93634, 93635, 93636, 93637, 93644, 93645, 93646, 93647, 93653, 93654, 93655 or 93656 will only attract a Medicare rebate where the service is billed in the name of the supervising GP or OMP, who must be present at the location at which the vaccine suitability assessment service is undertaken and must accept full responsibility for the service.
GPs, OMPs and suitably qualified health professionals providing a COVID-19 vaccination to a patient are required to have undertaken mandatory COVID-19 vaccine training.
Note: Under these arrangements, a vaccination may be provided by an endorsed enrolled nurse employed by a medical practice where the endorsed enrolled nurse:
- is also under the supervision of a registered nurse; and
- has completed mandatory COVID-19 training.
Application of the items
The attendance items for assessing patient suitability for a COVID-19 vaccine may be claimed as follows:
MBS Items 93624, 93625, 93626 and 93627 apply to a professional attendance that:
- is provided in a business hours period for the purpose of assessing a patient’s suitability to receive the first dose of a COVID-19 vaccine; and
- is bulk billed.
MBS Items 93634, 93635, 93636, and 93637 apply to a professional attendance that:
- is provided in an after-hours period hours for the purpose of assessing a patient’s suitability to receive the first dose of a COVID-19 vaccine; and
- is bulk billed.
MBS Items 93644, 93645, 93646 and 93647 apply to a professional attendance that:
- is provided in a business hours period for the purpose of assessing a patient’s suitability to receive the second or subsequent dose of a COVID-19 vaccine; and
- is bulk billed.
MBS Items 93653, 93654, 93655 and 93656 apply to a professional attendance that:
- is provided in an after-hours period hours for the purpose of assessing a patient’s suitability to receive the second or subsequent dose of a COVID-19 vaccine; and
- is bulk billed.
For more information on what qualifies as after-hours see “Business hours and after-hours services” below.
MBS items 10660 and 10661 apply to a professional attendance that can only be claimed once per patient during their lifetime. The service is bulk billed.
MBS item 90005 applies only to the first service provided during a single attendance at a RACF, residential disability facility setting or a patient’s place of residence. The item is bulk-billed.
Third dose vaccination suitability assessment services for patients who are immunocompromised
MBS Items 93644, 93645, 93646, 93647, 93653, 93654, 93655 and 93656 can be used to provide a vaccine suitability assessment service to a patient who is immunocompromised and who requires a third dose of COVID-19 vaccine.
The same rules that apply to vaccine suitability assessments for second dose services apply to third dose assessment services. This includes the requirement that a COVID-19 vaccine be available for immediate administration to the patient, whether or not it is determined that the patient is suitable for a third dose of vaccine.
MBS flag fall item 90005 may also be claimed if all other eligibility requirements are met.
An in-depth patient assessment item (MBS items 10660 and 10661) may also used to provide an immunocompromised patient with in-depth clinical advice on the individual risks and benefits associated with receiving a COVID-19 vaccine, if all other if all other eligibility requirements are met and the patient has not already received the in-depth patient assessment service.
The additional PIP payment is not claimable for a vaccine suitability assessment service associated with a third dose of COVID-19 vaccine. The PIP payment remains payable only when the first and second vaccine doses are administered under the same general practice.
Immunocompromising conditions for which third primary dose of COVID-19 vaccine is recommended
Active haematological malignancy
Non-haematological malignancy with current active treatment including chemotherapy, radiotherapy, and/or hormonal therapy, but excluding immunotherapy with immune checkpoint inhibitors
Solid organ transplant with immunosuppressive therapy
Haematopoietic stem cell transplant (HSCT) recipients or chimeric antigen receptor T-cell (CAR-T) therapy within 2 years of transplantation:
- These patients require revaccination with 3 additional doses of COVID-19 vaccine, irrespective of doses given prior to transplantation, commencing generally ≥3-6 months after their transplant after discussion with their treating specialist.
- Those beyond 2 years from transplant should discuss with their treating specialist about the need for a 3rd dose.
Immunosuppressive therapies including:
- High dose corticosteroid treatment equivalent to >20mg/day of prednisone for ≥14 days in a month, or pulse corticosteroid therapy.
- Multiple immunosuppressants where the cumulative effect is considered to be severely immunosuppressive.
- Selected conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDS):
- including mycophenolate, methotrexate (>0.4 mg/kg/week), leflunomide, azathioprine (>3mg/kg/day), 6-mercaptopurine (>1.5 mg/kg/day), alkylating agents (e.g. cyclophosphamide, chlorambucil), and systemic calcineurin inhibitors (e.g. cyclosporin, tacrolimus)
- excluding hydroxychloroquine or sulfasalazine when used as monotherapy
- Biologic and targeted therapies anticipated to reduce the immune response to COVID-19 vaccine:
- including B cell depleting agents (e.g. anti-CD20 monoclonal antibodies, BTK inhibitors, fingolimod), anti-CD52 monoclonal antibodies (alemtuzumab), anti-complement antibodies (e.g. eculizumab), anti-thymocyte globulin (ATG) and abatacept
- excluding agents with likely minimal effect on vaccine response such as immune checkpoint inhibitors, anti-integrins, anti-TNF-α, anti-IL1, anti-IL6, anti-IL17, anti-IL4 and anti-IL23 antibodies
Primary immunodeficiency including combined immunodeficiency and syndromes, major antibody deficiency (e.g., common variable immune deficiency (CVID) or agammaglobulinemia), defects of innate immunity (including phagocytic cells), defects of immune regulation, complement deficiencies and phenocopies of primary immunodeficiencies
Advanced or untreated HIV with CD4 counts <250/μL or those with a higher CD4 count unable to be established on effective antiretroviral therapy:
- a 3rd primary dose is not required for people living with HIV, receiving ART with CD4 counts ≥250/μL
Long term haemodialysis or peritoneal dialysis
MBS items 93624, 93625, 93626, 93627, 93634, 93635, 93636, 93637, 93644, 93645, 93646, 93647, 93653, 93654, 93655, 93656, 10660 and 10661 can be provided to any patient who is eligible for Medicare.
Administration of a COVID-19 vaccine
If, following a vaccine suitability assessment service, a patient is offered and agrees to receive a COVID-19 vaccination, the vaccine will be administered (with no other MBS item claimable for that administration). The GP, OMP or suitably qualified health professional responsible for administering the vaccine must be appropriately qualified and trained to provide immunisation to the patient. This includes having completed any mandatory Commonwealth training associated with the delivery of COVID-19 vaccination services.
- MBS Items 93624, 93626, 93634, 93636, 93644, 93646, 93653 and 93655 apply to a professional attendance delivered in a Modified Monash 1 (metropolitan) location.
- MBS Items 93625, 93627, 93635, 93637, 93645, 93647, 93654 and 93656 apply to a professional attendance delivered in a Modified Monash 2-7 (non-metropolitan) location.
A locator map to identify a medical practice's Modified Monash location is available at the DoctorConnect website at https://www.health.gov.au/resources/apps-and-tools/health-workforce-locator/health-workforce-locator.
Business hours and after-hours services
MBS Items 93624, 93625, 93626, 93627, 93644, 93645, 93646, and 93647 apply to a professional attendance that is provided:
- after 8am or before 8pm on a weekday;
- after 8am or before 1.00pm on a Saturday.
MBS Items 93634, 93635, 93636, 93637, 93653, 93654, 93655 and 93656 apply to a professional attendance that is provided:
- on a public holiday;
- on a Sunday;
- before 8am, or after 1pm on a Saturday;
- before 8am, or after 8pm on any day other than a Saturday, Sunday or public holiday.
Billing the COVID-19 vaccine suitability assessment items
The MBS COVID-19 vaccine suitability assessment items can only be billed to Medicare by a GP or OMP.
The rebate for a first dose service is higher than the rebate for a second dose service. This difference recognises that GPs, OMPs and other relevant health professionals may need to spend more time obtaining the patient’s consent and providing information about the vaccine before delivering the first dose.
No additional MBS attendance item can be used to bill Medicare for the time spent administering a vaccine following a suitability assessment service.
Co-claiming the COVID-19 vaccine suitability assessment items with other general attendance items
Patients presenting with multiple clinical matters requiring attention should be encouraged to book a separate consultation, and preferably with their usual medical practice. There may be some circumstances where deferral of treatment is not feasible or in the patient’s best interests; these include clinical matters where treatment cannot be deferred or opportunistic treatment for other conditions.
Standard MBS multiple same-day attendance rules apply to the COVID-19 vaccination suitability assessment services. Co-claiming is only permitted where another Medicare service is provided that is unrelated to the vaccine suitability assessment item. Payment of benefit may be made for more than one attendance on a patient on the same day by the same GP or OMP, provided the subsequent attendances are not a continuation of the initial or earlier attendances. Examples of other Medicare services include but are not restricted to: a standard consultation for a different presenting problem; provision of a time-tiered health assessment service; or review of a chronic disease management plan.
Before an additional attendance is provided to the patient the medical practice must obtain and record the patient’s informed financial consent to ensure that they (the patient) understand that there is no cost associated with the vaccine suitability assessment and/or the administration of the vaccine.
Patients must also be informed if any other service that they receive on the same occasion will be bulk-billed or will attract a co-payment.
Note: where a GP or OMP completes a vaccine suitability assessment, but the patient is found to be unsuitable on clinical grounds or declines to receive the vaccination, the service may be billed using the appropriate vaccine suitability assessment item. If the patient returns at a later date, it would be appropriate for another vaccine suitability assessment to be undertaken and a claim made for the relevant Medicare item.
MBS items 93624, 93625, 93626, 93627, 93634, 93635, 93636, 93637, 93644, 93645, 93646, 93647, 93653, 93654, 93655 and 93656 cannot be co-claimed with:
- MBS bulk billing incentive items 10990, 10991 and 10992; or
- MBS item 10988, for an immunisation service provided by an Aboriginal and Torres Strait Islander health practitioner on behalf of, and under the supervision of, a medical practitioner.
MBS item 90005 can only be claimed in association with items 93624, 93625, 93626, 93627, 93634, 93635, 93636, 93637, 93644, 93645, 93646, 93647, 93653, 93654, 93655 or 93656.
MBS item 10660 can only be claimed in association with items 93624, 93625, 93634, 93635, 93644, 93645, 93653 or 93654.
MBS item 10661 can only be claimed in association with items 93626, 93627, 93636, 93637, 93646, 93647, 93655 or 93656.
Record keeping and reporting requirements
Medical practices participating in the vaccine program need to comply with the record keeping requirements to substantiate a Medicare service.
For the purposes of Medicare, a patient or clinical record should be created or updated at the time a service is provided, or as soon as practicable afterwards. The record needs to:
- clearly identify the name of the patient;
- contain a separate entry for each attendance by the patient for the vaccination suitability assessment service and the date(s) on which the service was provided;
- record the patient’s consent to receive the vaccine;
- provide clinical information adequate to explain the service;
- be sufficiently comprehensible that another practitioner, relying on the record, can effectively undertake the patient’s ongoing care as it relates to COVID-19 vaccinations.
Where a patient receives a service using either MBS item 10660 or 10661 in association with a vaccine suitability assessment service, the reason for the service also needs to be recorded.
Medical practices participating in the Australian Government’s COVID-19 vaccination program will be required to update the vaccination status of a patient who has received the vaccine on the Australian Immunisation Register (AIR) portal within 2 business days. Information about the requirements for updating patient information on the AIR portal is available from the Services Australia website at https://www.servicesaustralia.gov.au/organisations/health-professionals/services/medicare/australian-immunisation-register-health-professionals/managing/help-using-air-online.
MBS items 93624, 93625, 93626, 93627, 93634, 93635, 93636, 93637, 93644, 93645, 93646, 93647, 93653, 93654, 93655 and 93656 apply only to a professional attendance where:
- the GP, OMP or suitably qualified health professional administering a COVID-19 vaccine is appropriately qualified and trained to provide immunisation to a patient; and
- a dose of COVID-19 vaccine is immediately available for administration to the patient at the practice location.
A service using the items cannot be provided as part of an episode of hospital treatment or hospital-substitute treatment.
- Assist - Addition/Deletion of (Assist.)
- Amend - Amended Description
- Anaes - Anaesthetic Values Amended
- Emsn - EMSN Change
- Fee - Fee Amended
- Renum - Item Number Change (renumbered)
- New - New Item
- NewMin - New Item (previous Ministerial Determination)
- Qfe - QFE Change