Medicare Benefits Schedule - Note MN.1.1

SUMMARY

Bulk billing incentives (BBIs) are additional payments made to medical practitioners when they bulk bill eligible patients for unreferred services (NB this includes almost all general practice services).

Eligible patients are:

• Under 16 years of age, or
• A Commonwealth concession card holder. Information on Commonwealth concession cards is available from Services Australia.

Admitted hospital patients are not eligible for BBIs.

The specific BBI item that should be co-claimed with an eligible medical service depends on:

• The geographic location of the practice (by Modified Monash area). This can be checked on the Health Workforce Locator.
• The specific medical service (MBS item) provided, and
• In some cases, whether the patient is enrolled at the practice providing the service through the MyMedicare program. Information on MyMedicare is available on the Department of Health and Aged Care’s website.

Claiming tables are available for each Modified Monash area:

• MN.1.3 – Modified Monash 1
• MN.1.4 – Modified Monash 2
• MN.1.5 – Modified Monash 3-4
• MN.1.6 – Modified Monash 5
• MN.1.7 – Modified Monash 6
• MN.1.8 – Modified Monash 7

USE OF THE ITEMS

BBIs can be claimed when a medical practitioner bulk bills an unreferred service to an eligible patient.

What is an unreferred service?

The Health Insurance (General Medical Services Table) Regulations 2021 defines an unreferred service as a "medical service provided by, or on behalf of, a medical practitioner to a patient who has not been referred to the practitioner for the service.”

Which bulk billing incentive should be used?

There are 20 BBI items broken into three categories. Each category includes a BBI item number for use in each Modified Monash area (see table below). The Modified Monash area used to determine the appropriate BBI is the area where the medical practitioner’s practice is located. BBI items within each category should be used with:

• Category 1: for all eligible patients, any unreferred services not covered by category 2 or 3 including, but not limited to:
  • Level A general attendances (and equivalents)
  • Level C, D, E telehealth (telephone and video) attendances where the patient is not enrolled with the practice through MyMedicare
  • Chronic disease management and health assessment items
  • Better Access mental health and eating disorder items
  • Antenatal attendances 
  • Minor procedures
• Category 2: for all eligible patients, any Level B general attendances (face to face, telephone, telehealth (video)), and Level C, D and E face to face consultations. This category also includes the equivalent items used in residential aged care facilities, out of consulting rooms, and after hours
• Category 3: for eligible patients enrolled in MyMedicare only, Level C, D and E telehealth (video) and Level C and D telephone

Note: BBIs cannot be claimed in conjunction with a COVID vaccine support item.

The practice location is the location associated with the Medicare provider number used by the medical practitioner when providing the service. In general, the practice location associated with the provider number is used regardless of where the medical service is provided (e.g. out of consulting rooms, in a residential aged care facility) or, in the case of telehealth, the location of the patient. However, for the after-hours BBIs (10992 and 75872), both the practice location and the patient location are considered. These items can only be claimed with specific after-hours MBS items in limited circumstances.

Additional information on the after-hours BBIs – MBS items 10992 and 75872

Items 10992 and 75872 can only be claimed in conjunction with specified after-hours MBS items. In addition to the standard requirements for use of BBIs, the following additional requirements apply:

• The service is not provided in consulting rooms
• The service is provided in a Modified Monash 2-7 area, and
• The service is provided by, or on behalf of, a medical practitioner whose practice is in a Modified Monash 1 area.

CO-CLAIMING RESTRICTIONS

BBIs must be claimed in conjunction with an eligible MBS item. BBIs can only be claimed when an eligible patient is bulk billed for the medical service. Only one BBI can be claimed in conjunction with each medical service (i.e. each MBS item) that is provided.

BBIs cannot be claimed in conjunction with MBS COVID vaccine support items.

BBIs cannot be claimed in conjunction with diagnostic imaging or pathology services. A separate set of incentives are available to use in conjunction with diagnostic imaging and pathology services.

ELIGIBLE PATIENTS

Bulk billed patients eligible for the BBI are:

• Under 16 years of age, or
• A Commonwealth concession card holder. Information on Commonwealth concession cards is available on the Services Australia website.

Admitted hospital patients are not eligible for BBIs.

ELIGIBLE PRACTITIONERS

All medical practitioners who bulk bill a relevant medical service to an eligible patient can claim BBIs.

Different BBIs are payable for practice locations in different Modified Monash areas. The relevant Modified Monash area is determined by the location associated with the medical practitioner's provider number used to provide the service. This means that if the service is provided away from the practice location (e.g. in a residential aged care facility or home visits), the location of the practice, not the location of the consultation, is used to determine the relevant Modified Monash area for BBI purposes (except in relation to items 10992 and 75872).

The Modified Monash area for your practice can be checked on the Health Workforce Locator.

RECORD KEEPING AND REPORTING REQUIREMENTS

Medicare benefits are patient benefits. It is a legal requirement that the patient assigns their benefit to the medical practitioner when a service is bulk billed. Information about recording assignment of benefit is available on the Services Australia website.

When claiming BBIs, medical practitioners should ensure that the patient is under 16 or has a valid Commonwealth Concession Card.

The Department of Health and Aged Care undertakes regular post payment auditing to ensure that BBIs are claimed appropriately. Practitioners should ensure they keep relevant and contemporaneous records.

RELEVANT LEGISLATION

BBIs are specified in the Health Insurance (General Medical Services Table) Regulations 2021.

Related Items: 10990 10991 10992 75855 75856 75857 75858 75870 75871 75872 75873 75874 75875 75876 75880 75881 75882 75883 75884 75885

• Next - Note MN.1.3

A medical service to which an item in this Schedule (other than this item) applies, if:
(a) the service is an unreferred service; and
(b) the service is provided to a person who is:
(i) under the age of 16; or
(ii) a concessional beneficiary; and
(c) the person is not an admitted patient of a hospital; and
(d) the service is bulk-billed in relation to the fees for:
(i) this item; and
(ii) any other item in this Schedule applying to the service;
other than a service associated with a service:
(e) to which another item in this Group applies; or
(f) that is a general practice support service; or
(g) that is a MyMedicare service

Fee: $8.10 Benefit: 85% = $6.90

(See para MN.1.1, MN.1.3 of explanatory notes to this Category)

A medical service to which an item in this Schedule (other than this item) applies, if:
(a) the service is an unreferred service; and
(b) the service is provided to a person who is:
(i) under the age of 16; or
(ii) a concessional beneficiary; and
(c) the person is not an admitted patient of a hospital; and
(d) the service is bulk-billed in relation to the fees for:
(i) this item; and
(ii) any other item in this Schedule applying to the service; and
(e) the service is provided at, or from, a practice location in a Modified Monash 2 area;
other than a service associated with a service:
(f) to which another item in this Group applies; or
(g) that is a general practice support service; or
(h) that is a MyMedicare service

Fee: $12.25 Benefit: 85% = $10.45

(See para MN.1.1, MN.1.4 of explanatory notes to this Category)

A medical service to which:

(a) item 585, 588, 591, 594, 599, 600, 5003, 5010, 5220 or 5260 applies; or
(b) item 761 or 772 applies (see the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018);

if:

(c) the service is an unreferred service; and

(d) the service is provided to a person who is under the age of 16 or is a concessional beneficiary; and

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

(f) the service is not provided in consulting rooms; and

(g) the service is provided in any of the following areas:

(i) a Modified Monash 2 area;

(ii) a Modified Monash 3 area;

(iii) a Modified Monash 4 area;

(iv) a Modified Monash 5 area;

(v) a Modified Monash 6 area;

(vi) a Modified Monash 7 area; and

(h) the service is provided by, or on behalf of, a medical practitioner whose practice location is not in an area mentioned in paragraph (g); and

(i) the service is bulk‑billed in relation to the fees for:

(i) this item; and

(ii) the other item mentioned in paragraph (a) or (b) applying to the service

Fee: $12.25 Benefit: 85% = $10.45

(See para MN.1.1, MN.1.3 of explanatory notes to this Category)

A medical service to which an item in this Schedule (other than this item) applies, if:
(a) the service is an unreferred service; and
(b) the service is provided to a person who is:
(i) under the age of 16; or
(ii) a concessional beneficiary; and
(c) the person is not an admitted patient of a hospital; and
(d) the service is bulk-billed in relation to the fees for:
(i) this item; and
(ii) any 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;
other than a service associated with a service:
(f) to which another item in this Group applies; or
(g) that is a general practice support service; or
(h) that is a MyMedicare service

Fee: $13.00 Benefit: 85% = $11.05

(See para MN.1.1, MN.1.5 of explanatory notes to this Category)

A medical service to which an item in this Schedule (other than this item) applies, if:
(a) the service is an unreferred service; and
(b) the service is provided to a person who is:
(i) under the age of 16; or
(ii) a concessional beneficiary; and
(c) the person is not an admitted patient of a hospital; and
(d) the service is bulk-billed in relation to the fees for:
(i) this item; and
(ii) any other item in this Schedule applying to the service; and
(e) the service is provided at, or from, a practice location in a Modified Monash 5 area;
other than a service associated with a service:
(f) to which another item in this Group applies; or
(g) that is a general practice support service; or
(h) that is a MyMedicare service

Fee: $13.85 Benefit: 85% = $11.80

(See para MN.1.1, MN.1.6 of explanatory notes to this Category)

A medical service to which an item in this Schedule (other than this item) applies, if:
(a) the service is an unreferred service; and
(b) the service is provided to a person who is:
(i) under the age of 16; or
(ii) a concessional beneficiary; and
(c) the person is not an admitted patient of a hospital; and
(d) the service is bulk-billed in relation to the fees for:
(i) this item; and
(ii) any other item in this Schedule applying to the service; and
(e) the service is provided at, or from, a practice location in a Modified Monash 6 area;
other than a service associated with a service:
(f) to which another item in this Group applies; or
(g) that is a general practice support service; or
(h) that is a MyMedicare service

Fee: $14.60 Benefit: 85% = $12.45

(See para MN.1.1, MN.1.7 of explanatory notes to this Category)

A medical service to which an item in this Schedule (other than this item) applies, if:
(a) the service is an unreferred service; and
(b) the service is provided to a person who is:
(i) under the age of 16; or
(ii) a concessional beneficiary; and
(c) the person is not an admitted patient of a hospital; and
(d) the service is bulk-billed in relation to the fees for:
(i) this item; and
(ii) any other item in this Schedule applying to the service; and
(e) the service is provided at, or from, a practice location in a Modified Monash 7 area;
other than a service associated with a service:
(f) to which another item in this Group applies; or
(g) that is a general practice support service; or
(h) that is a MyMedicare service

Fee: $15.55 Benefit: 85% = $13.25

(See para MN.1.1, MN.1.8 of explanatory notes to this Category)

Professional attendance (the attendance service) by a general practitioner, a medical practitioner or a prescribed medical practitioner, at which a general practice support service is provided, if:
(a) the attendance service is provided to a patient who is under the age of 16 or who is a concessional beneficiary; and
(b) the patient is not an admitted patient of a hospital; and
(c) the attendance service is bulk-billed in relation to the fees for:
(i) this item; and
(ii) the general practice support service item applying to the attendance service;
other than an attendance service associated with a service to which item 10990, 10991, 10992, 75855, 75856, 75857, 75858, 75871, 75872, 75873, 75874, 75875, 75876, 75880, 75881, 75882, 75883, 75884 or 75885 applies

Subgroup 2
NOTE: this item can be claimed with face to face level B, C, D and E general attendance items, and level B telehealth and telephone general attendance items.

Fee: $24.25 Benefit: 85% = $20.65

(See para MN.1.1, MN.1.3 of explanatory notes to this Category)

Professional attendance (the attendance service) by a general practitioner, a medical practitioner or a prescribed medical practitioner, at which a general practice support service is provided, if:
(a) the attendance service is provided to a patient who is under the age of 16 or who is a concessional beneficiary; and
(b) the patient is not an admitted patient of a hospital; and
(c) the attendance service is bulk-billed in relation to the fees for:
(i) this item; and
(ii) the general practice support service item applying to the attendance service; and
(d) the attendance service is provided at, or from, a practice location in a Modified Monash 2 area;
other than an attendance service associated with a service to which item 10990, 10991, 10992, 75855, 75856, 75857, 75858, 75870, 75872, 75873, 75874, 75875, 75876, 75880, 75881, 75882, 75883, 75884 or 75885 applies

Subgroup 2
NOTE: this item can be claimed with face to face level B, C, D and E general attendance items, and level B telehealth and telephone general attendance items.

Fee: $36.90 Benefit: 85% = $31.40

(See para MN.1.1, MN.1.4 of explanatory notes to this Category)

Professional attendance (the attendance service) if:
(a) item 763, 766, 769, 776, 788, 789, 2198, 2200, 5023, 5028, 5043, 5049, 5063, 5067, 5076, 5077, 5223, 5227, 5228, 5261, 5263, 5265, 5267 or 5262 applies; and
(b) the attendance service is an unreferred service; and
(c) the attendance service is provided to a patient who is under the age of 16 or who is a concessional beneficiary; and
(d) the patient is not an admitted patient of a hospital; and
(e) the attendance service is not provided in consulting rooms; and
(f) the attendance service is provided in any of the following areas:
(i) a Modified Monash 2 area;
(ii) a Modified Monash 3 area;
(iii) a Modified Monash 4 area;
(iv) a Modified Monash 5 area;
(v) a Modified Monash 6 area;
(vi) a Modified Monash 7 area; and
(g) the attendance service is provided by, or on behalf of, a general practitioner, a medical practitioner or a prescribed medical practitioner whose practice location is not in an area mentioned in paragraph (f); and
(h) the attendance service is bulk-billed in relation to the fees for:
(i) this item; and
(ii) an item mentioned in paragraph (a) that applies to the service

Fee: $36.90 Benefit: 85% = $31.40

(See para MN.1.1, MN.1.3 of explanatory notes to this Category)

Professional attendance (the attendance service) by a general practitioner, a medical practitioner or a prescribed medical practitioner, at which a general practice support service is provided, if:
(a) the attendance service is provided to a patient who is under the age of 16 or who is a concessional beneficiary; and
(b) the patient is not an admitted patient of a hospital; and
(c) the attendance service is bulk-billed in relation to the fees for:
(i) this item; and
(ii) the general practice support service item applying to the attendance service; and
(d) the attendance service is provided at, or from, a practice location in:
(i) a Modified Monash 3 area; or
(ii) a Modified Monash 4 area;
other than an attendance service associated with a service to which item 10990, 10991, 10992, 75855, 75856, 75857, 75858, 75870, 75871, 75872, 75874, 75875, 75876, 75880, 75881, 75882, 75883, 75884 or 75885 applies

Subgroup 2
NOTE: this item can be claimed with face to face level B, C, D and E general attendance items, and level B telehealth and telephone general attendance items.

Fee: $39.20 Benefit: 85% = $33.35

(See para MN.1.1, MN.1.5 of explanatory notes to this Category)

Professional attendance (the attendance service) by a general practitioner, a medical practitioner or a prescribed medical practitioner, at which a general practice support service is provided, if:
(a) the attendance service is provided to a patient who is under the age of 16 or who is a concessional beneficiary; and
(b) the patient is not an admitted patient of a hospital; and
(c) the attendance service is bulk-billed in relation to the fees for:
(i) this item; and
(ii) the general practice support service item applying to the attendance service; and
(d) the attendance service is provided at, or from, a practice location in a Modified Monash 5 area;
other than an attendance service associated with a service which item 10990, 10991, 10992, 75855, 75856, 75857, 75858, 75870, 75871, 75872, 75873, 75875, 75876, 75880, 75881, 75882, 75883, 75884 or 75885 applies

Subgroup 2
NOTE: this item can be claimed with face to face level B, C, D and E general attendance items, and level B telehealth and telephone general attendance items.

Fee: $41.65 Benefit: 85% = $35.45

(See para MN.1.1, MN.1.6 of explanatory notes to this Category)

Professional attendance (the attendance service) by a general practitioner, a medical practitioner or a prescribed medical practitioner, at which a general practice support service is provided, if:
(a) the attendance service is provided to a patient who is under the age of 16 or who is a concessional beneficiary; and
(b) the patient is not an admitted patient of a hospital; and
(c) the attendance service is bulk-billed in relation to the fees for:
(i) this item; and
(ii) the general practice support service item applying to the attendance service; and
(d) the attendance service is provided at, or from, a practice location in a Modified Monash 6 area;
other than an attendance service associated with a service to which item 10990, 10991, 10992, 75855, 75856, 75857, 75858, 75870, 75871, 75872, 75873, 75874, 75876, 75880, 75881, 75882, 75883, 75884 or 75885 applies

Subgroup 2
NOTE: this item can be claimed with face to face level B, C, D and E general attendance items, and level B telehealth and telephone general attendance items.

Fee: $43.95 Benefit: 85% = $37.40

(See para MN.1.1, MN.1.7 of explanatory notes to this Category)

Professional attendance (the attendance service) by a general practitioner, a medical practitioner or a prescribed medical practitioner, at which a general practice support service is provided, if:
(a) the attendance service is provided to a patient who is under the age of 16 or who is a concessional beneficiary; and
(b) the patient is not an admitted patient of a hospital; and
(c) the attendance service is bulk-billed in relation to the fees for:
(i) this item; and
(ii) the general practice support service item applying to the attendance service; and
(d) the attendance service is provided at, or from, a practice location in a Modified Monash 7 area;
other than an attendance service associated with a service to which item 10990, 10991, 10992, 75855, 75856, 75857, 75858, 75870, 75871, 75872, 75873, 75874, 75875, 75880, 75881, 75882, 75883, 75884 or 75885 applies

Subgroup 2
NOTE: this item can be claimed with face to face level B, C, D and E general attendance items, and level B telehealth and telephone general attendance items.

Fee: $46.65 Benefit: 85% = $39.70

(See para MN.1.1, MN.1.8 of explanatory notes to this Category)

Professional attendance (the attendance service) by a general practitioner, a medical practitioner or a prescribed medical practitioner, at which a MyMedicare service is provided, if:
(a) the attendance service is provided to a patient:
(i) who is enrolled in MyMedicare at the general practice through which the attendance service is provided; and
(ii) who is under the age of 16 or who is a concessional beneficiary; and
(b) the patient is not an admitted patient of a hospital; and
(c) the attendance service is bulk-billed in relation to the fees for:
(i) this item; and
(ii) the MyMedicare service item applying to the attendance service;
other than an attendance service associated with a service to which item 10990, 10991, 10992, 75855, 75856, 75857, 75858, 75870, 75871, 75872, 75873, 75874, 75875, 75876, 75881, 75882, 75883, 75884 or 75885 applies

Subgroup 3
NOTE: this item can be claimed with level C, D, and E telehealth general attendance items, and level C and D telephone general attendance items, where the patient is registered with MyMedicare.

Fee: $24.25 Benefit: 85% = $20.65

(See para MN.1.1, MN.1.3 of explanatory notes to this Category)

Professional attendance (the attendance service) by a general practitioner, a medical practitioner or a prescribed medical practitioner, at which a MyMedicare service is provided, if:
(a) the attendance service is provided to a patient:
(i) who is enrolled in MyMedicare at the general practice through which the attendance service is provided; and
(ii) who is under the age of 16 or who is a concessional beneficiary; and
(b) the patient is not an admitted patient of a hospital; and
(c) the attendance service is bulk-billed in relation to the fees for:
(i) this item; and
(ii) the MyMedicare service item applying to the attendance service; and
(d) the attendance service is provided at, or from, a practice location in a Modified Monash 2 area;
other than an attendance service associated with a service to which item 10990, 10991, 10992, 75855, 75856, 75857, 75858, 75870, 75871, 75872, 75873, 75874, 75875, 75876, 75880, 75882, 75883, 75884 or 75885 applies

Subgroup 3
NOTE: this item can be claimed with level C, D, and E telehealth general attendance items, and level C and D telephone general attendance items, where the patient is registered with MyMedicare.

Fee: $36.90 Benefit: 85% = $31.40

(See para MN.1.1, MN.1.4 of explanatory notes to this Category)

Professional attendance (the attendance service) by a general practitioner, a medical practitioner or a prescribed medical practitioner, at which a MyMedicare service is provided, if:
(a) the attendance service is provided to a patient:
(i) who is enrolled in MyMedicare at the general practice through which the attendance service is provided; and
(ii) who is under the age of 16 or who is a concessional beneficiary; and
(b) the patient is not an admitted patient of a hospital; and
(c) the attendance service is bulk-billed in relation to the fees for:
(i) this item; and
(ii) the MyMedicare service item applying to the attendance service; and
(d) the attendance service is provided at, or from, a practice location in:
(i) a Modified Monash 3 area; or
(ii) a Modified Monash 4 area;
other than an attendance service associated with a service to which item 10990, 10991, 10992, 75855, 75856, 75857, 75858, 75870, 75871, 75872, 75873, 75874, 75875, 75876, 75880, 75881, 75883, 75884 or 75885 applies

Subgroup 3
NOTE: this item can be claimed with level C, D, and E telehealth general attendance items, and level C and D telephone general attendance items, where the patient is registered with MyMedicare.

Fee: $39.20 Benefit: 85% = $33.35

(See para MN.1.1, MN.1.5 of explanatory notes to this Category)

Professional attendance (the attendance service) by a general practitioner, a medical practitioner or a prescribed medical practitioner, at which a MyMedicare service is provided, if:
(a) the attendance service is provided to a patient:
(i) who is enrolled in MyMedicare at the general practice through which the attendance service is provided; and
(ii) who is under the age of 16 or who is a concessional beneficiary; and
(b) the patient is not an admitted patient of a hospital; and
(c) the attendance service is bulk-billed in relation to the fees for:
(i) this item; and
(ii) the MyMedicare service item applying to the attendance service; and
(d) the attendance service is provided at, or from, a practice location in a Modified Monash 5 area;
other than an attendance service associated with a service to which item 10990, 10991, 10992, 75855, 75856, 75857, 75858, 75870, 75871, 75872, 75873, 75874, 75875, 75876, 75880, 75881, 75882, 75884 or 75885 applies

Subgroup 3
NOTE: this item can be claimed with level C, D, and E telehealth general attendance items, and level C and D telephone general attendance items, where the patient is registered with MyMedicare.

Fee: $41.65 Benefit: 85% = $35.45

(See para MN.1.1, MN.1.6 of explanatory notes to this Category)

Professional attendance (the attendance service) by a general practitioner, a medical practitioner or a prescribed medical practitioner, at which a MyMedicare service is provided, if:
(a) the attendance service is provided to a patient:
(i) who is enrolled in MyMedicare at the general practice through which the attendance service is provided; and
(ii) who is under the age of 16 or who is a concessional beneficiary; and
(b) the patient is not an admitted patient of a hospital; and
(c) the attendance service is bulk-billed in relation to the fees for:
(i) this item; and
(ii) the MyMedicare service item applying to the attendance service; and
(d) the attendance service is provided at, or from, a practice location in a Modified Monash 6 area;
other than an attendance service associated with a service to which item 10990, 10991, 10992, 75855, 75856, 75857, 75858, 75870, 75871, 75872, 75873, 75874, 75875, 75876, 75880, 75881, 75882, 75883 or 75885 applies

Subgroup 3
NOTE: this item can be claimed with level C, D, and E telehealth general attendance items, and level C and D telephone general attendance items, where the patient is registered with MyMedicare.

Fee: $43.95 Benefit: 85% = $37.40

(See para MN.1.1, MN.1.7 of explanatory notes to this Category)

Professional attendance (the attendance service) by a general practitioner, a medical practitioner or a prescribed medical practitioner, at which a MyMedicare service is provided, if:
(a) the attendance service is provided to a patient:
(i) who is enrolled in MyMedicare at the general practice through which the attendance service is provided; and
(ii) who is under the age of 16 or who is a concessional beneficiary; and
(b) the patient is not an admitted patient of a hospital; and
(c) the attendance service is bulk-billed in relation to the fees for:
(i) this item; and
(ii) the MyMedicare service item applying to the attendance service; and
(d) the attendance service is provided at, or from, a practice location in a Modified Monash 7 area;
other than an attendance service associated with a service to which item 10990, 10991, 10992, 75855, 75856, 75857, 75858, 75870, 75871, 75872, 75873, 75874, 75875, 75876, 75880, 75881, 75882, 75883 or 75884 applies

Subgroup 3
NOTE: this item can be claimed with level C, D, and E telehealth general attendance items, and level C and D telephone general attendance items, where the patient is registered with MyMedicare.

Fee: $46.65 Benefit: 85% = $39.70

(See para MN.1.1, MN.1.8 of explanatory notes to this Category)