Medicare Benefits Schedule - Note MN.1.1

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Category 8 - MISCELLANEOUS SERVICES

MN.1.1

Additional Bulk Billing Payment for General Medical Services - (Items 10990 and 10991)

Item 10990 can only be claimed where all of the conditions set out in paragraphs (a) to (d) of item 10990 have been met.

Item 10991 can only be claimed where all of the conditions set out in paragraphs (a) to (e) of item 10991 have been met.

-                  Item 10991 can only be used where the service is provided at, or from, a practice location that is listed in item 10991.  This includes all regional, rural and remote areas (RRMA 3 to 7 under the Rural Remote Metropolitan Areas classification system), all of Tasmania and those areas covered by a Statistical Subdivision (SSD) or Statistical Local Areas (SLA) listed in item 10991 (SSDs and SLAs are specified in the Australian Standard Geographical Classification (ASGC) 2002).  If you are not sure whether your practice location is in an eligible area, you can call the Department of Human Services on 132 150.

-                  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, item 10991 can only be claimed in respect of those services provided at, or from, the eligible practice location.

Item 10990 and item 10991 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 or 64991) or pathology services (item 74990 or 74991).

Item 10990 or item 10991 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, 10990 or 10991, are satisfied.  For example, item 10990 or 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, 10984, 10986, 10987 and 10997).  In some cases, this will mean that item 10990 or 10991 can be claimed more than once in respect of a patient visit.

Item 10990 or 10991 can not 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 Human Services will undertake regular post payment auditing to ensure that the additional bulk billing payment is being claimed correctly.  Centrelink data will be used to verify concessional status and Medicare records will be used to confirm patient age.

Related Items: 10990 10991


Related Items

Category 8 - MISCELLANEOUS SERVICES

10990

10990 - Additional Information

Item Start Date:
01-Feb-2004
Description Start Date:
01-Nov-2007
Schedule Fee Start Date:
01-Jul-2017

A medical service to which an item in this table (other than this item or item 10991) 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 Commonwealth concession card holder; 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 table applying to the service

Fee: $7.30 Benefit: 85% = $6.25

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

Category 8 - MISCELLANEOUS SERVICES

10991

10991 - Additional Information

Item Start Date:
01-May-2004
Description Start Date:
01-Nov-2007
Schedule Fee Start Date:
01-Jul-2017

A medical service to which an item in this table (other than this item or item 10990) 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 Commonwealth concession card holder;         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 table applying to the service: and

(e)    the service is provided at, or from, a practice location in:

    (i)    a regional, rural or remote area; or

    (ii)    Tasmania; or

    (iii)    A geographical area included in any of the following SSD spatial units:

        (A)    Beaudesert Shire Part A

        (B)    Belconnen

        (C)    Darwin City

        (D)    Eastern Outer Melbourne

        (E)    East Metropolitan, Perth

        (F)    Frankston City

        (G)    Gosford-Wyong

        (H)    Greater Geelong City Part A

        (I)    Gungahlin-Hall

        (J)    Ipswich City (part in BSD)

        (K)    Litchfield Shire

        (L)    Melton-Wyndham

        (M)    Mornington Peninsula Shire

        (N)    Newcastle

        (O)    North Canberra

        (P)    Palmerston-East Arm

        (Q)    Pine Rivers Shire

        (R)    Queanbeyan

        (S)    South Canberra

        (T)    South Eastern Outer Melbourne

        (U)    Southern Adelaide

        (V)    South West Metropolitan, Perth

        (W)    Thuringowa City Part A

        (X)    Townsville City Part A

        (Y)    Tuggeranong

        (Z)    Weston Creek-Stromlo

        (ZA)    Woden Valley

        (ZB)    Yarra Ranges Shire Part A; or

    (iv)    the geographical area included in the SLA spatial unit of Palm Island (AC)

Fee: $11.00 Benefit: 85% = $9.35

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


Legend

  • 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