Medicare Benefits Schedule - Note MN.1.2

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Category 8 - MISCELLANEOUS SERVICES

MN.1.2

After-hours services provided in areas eligible for the higher bulk billing payment - (Item 10992)

After-hours services provided in areas eligible for the higher bulk billing payment - (Item 10992)

Item 10992 can only be claimed where all of the conditions set out in paragraphs (a) to (g) of item 10992 have been met:

· Item 10992 must be claimed in conjunction with one of the items 585, 588, 591, 594, 599, 600, 761, 763, 766, 769, 772, 776, 788, 789, 5003, 5010, 5023, 5028, 5043, 5049, 5063, 5067, 5220, 5223, 5227, 5228, 5260, 5263 5265, or 5267.  These items are for services provided after-hours outside of consulting rooms or hospital.

· Item 10992 can only be used where the service is provided in one of the eligible areas listed in item 10992 by a medical practitioner whose practice location (i.e. the location associated with the medical practitioner's provider number) is not in one of these areas.

Medical practitioners whose practice location is inside one of these listed locations should claim item 10991 for eligible services.

Item 10992 cannot be claimed in conjunction with item 10990 or 10991.

Where a Medicare benefit is not payable for a particular service the payment for item 10992 will not be paid for that service.

All GPs, whether vocationally recognised 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: 10992


Related Items

Category 8 - MISCELLANEOUS SERVICES

10992

10992 - Additional Information

Item Start Date:
01-Jan-2005
Description Start Date:
01-Mar-2018
Schedule Fee Start Date:
01-Jul-2018

A medical service to which item 585, 588, 591, 594, 599, 600, 761, 763, 766, 769, 772, 776, 788, 789, 5003, 5010, 5023, 5028, 5043, 5049, 5063, 5067, 5220, 5223, 5227, 5228, 5260, 5263, 5265 or 5267 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 not provided in consulting rooms; and

(e)    the service is provided in one of the following eligible areas:

    (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)

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

(g)    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: $11.15 Benefit: 85% = $9.50

(See para MN.1.2 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