Medicare Benefits Schedule - Note AN.14.4

Publication date: 1 November 2026

SUMMARY

Time-tiered health assessment items may be used to undertake a Medicare Healthy Kids Check.

Note: The requirements below must be met in addition to common principles for time-tiered health assessment items, contained in AN.0.36.

USE OF THE ITEMS

The specific requirements of the Medicare Healthy Kids Check are set out in clause 2.15.11 of the Health Insurance (General Medical Service Table) Regulations 2021 (the Regulations).

The Regulations specify that a Medicare Healthy Kids Check is the assessment of:

• the patient’s physical, social and emotional development, health and wellbeing; and
• whether health care (including preventive health care), education, referrals or other assistance should be offered to the patient, or the patient’s parent or carer, to improve the patient’s physical, social and emotional development, health and wellbeing.

The Regulations also state that the Medicare Healthy Kids Check must include:

• taking a relevant history, including the following:
  • the patient’s medical history, including previous presentations, hospital admissions, medication, immunisation status and allergies;
  • the patient’s behaviours and wellbeing;
  • an assessment of the patient against age-appropriate developmental milestones;
  • the patient’s family relationships, social circumstances, care arrangements and engagement in early childhood education and care;
  • the patient’s family environment and exposures, including nutrition, physical activity, screen use, sleep hygiene and sleep patterns;
  • the patient’s toileting, including bowel habits and urinary continence;
• undertaking a basic physical examination of the patient, including by:
  • examining the patient’s eyesight, hearing and oral health (teeth and gums); and
  • undertaking measurements of the patient’s height and weight to assess the patient’s growth against published centile charts, including body mass index;
• assessing the patient using the information gained in the health assessment;
• providing advice to the patient’s parent or carer to support:
  • the patient’s physical, social and emotional development, health and wellbeing; and
  • the patient’s family to engage in activities that support the best potential outcomes for the patient’s physical, social and emotional development, health and wellbeing;
• making or arranging any necessary interventions and referrals for the patient;
• adding a record of the health assessment to the patient’s medical record;
• offering a written report on the health assessment to the patient’s parent or carer, with recommendations on matters covered by the health assessment.

There are a range of publicly available, evidence-based guidelines that practitioners may wish to use when conducting a Medicare Healthy Kids Check, as relevant to the child. These include but are not limited to the:

• Royal Australian College of General Practitioners (RACGP)’s Guidelines for preventive activities in general practice (Red Book)
• National Mental Health Commission’s National guidelines for including mental health and wellbeing in early childhood checks
• Relevant state or territory child health guides (e.g. NSW/SA/ACT Blue Book, Queensland Red Book, Victorian Green Book, WA Purple Book)
• National Aboriginal Community Controlled Health Organisation (NACCHO) and RACGP’s National guide to preventive healthcare for Aboriginal and Torres Strait Islander people (NACCHO/RACGP guidelines), and,
• Central Australian Rural Practitioners Association (CARPA) Standard Treatment Manual.

Practitioners may also wish to refer to the National Immunisation Program Schedule and advice of bodies such as the Australian Technical Advisory Group on Immunisation as guides when conducting patient assessments to current clinical standards. 

It remains the responsibility of the treating practitioner to ensure all requirements of the Medicare Healthy Kids Check are met.

What is a “basic” physical examination of eyesight, hearing and oral health?

Practitioners should undertake basic, age-appropriate examinations, paying particular attention to any concerns raised by the child’s parent or carer. Specific recommendations for examination vary between guidelines, but typically include items such as:

• Checking visual acuity, for example using Lea (NACCHO/RACGP guidelines) or paediatric Snellen charts
• Screening for amblyopia or its risk factors (Red Book)
• Examining the appearance of the ear canal and ear drum using otoscopy (NACCHO/RACGP guidelines and CARPA)
• Tuning fork test (CARPA)
• Lift the lip check.

What measure of body mass index (BMI) should I use to assess the child’s growth?

Practitioners should track a child’s BMI using age and gender appropriate BMI centile charts. Adult BMI charts and calculators should not be used.

How should the child’s family and care arrangements be considered as part of this assessment?

When assessing child development, practitioners should consider the child within their family and social context which may include factors such as parental mental health concerns, housing and food security, and changes or stresses that have occurred in the family. However, the focus of the assessment must be on the child, rather than a broader “family consultation”.

If appropriate, practitioners can recommend follow up consultation with other family members for any matters identified or raised during the child’s Medicare Healthy Kids Check.

I am worried about a child and would like to assess their development across all domains. They turn 3 years old in 4 weeks’ time. Can I use the Medicare Healthy Kids Check items now?

No. Patients are eligible for a Medicare Healthy Kids Check using an MBS health assessment item number when they are 3 years old i.e. from their third birthday to the end of the day before their fourth birthday.

However, a GP can undertake any assessment of a child at any time using standard consultation items (see AN.0.9). These items can be used for clinically relevant services when there is not a more specific MBS item that applies, provided all requirements of the item are met.

I’m in New South Wales. I’m performing a health check on a 3-year-old in accordance with the child’s My Personal Health Record (‘blue book’). Which MBS item should I bill?

If all requirements of the Medicare Healthy Kids Check are met, and the child has not already had a Medicare Healthy Kids Check, medical practitioners should bill the Medicare Healthy Kids Check using the appropriate time-tiered MBS health assessment item.

If not all requirements of the Medicare Healthy Kids Check are met, the practitioner may bill the appropriate time-tiered professional attendance item (see AN.0.9), provided they meet the requirements of the item.

Practitioners are required to satisfy themselves that each service they provide meets the legislative requirements of that service.

I have identified a potential developmental concern during a Medicare Healthy Kids Check. What should I do next?

Where a developmental concern is identified, it may be appropriate for GPs to provide advice to the child’s parent or carer and monitor the child for a period of time to determine whether the child requires further assessment or support.

Where further assessment or support is required, GPs should consider relevant referral pathways that are available. This may include:

• Referral to another health practitioner for assessment and management of conditions, including dentists, optometrists and audiometrists, if indicated
• Referral to a non-GP specialist (e.g. a paediatrician)
• For children with eligible disabilities (including some speech and language disorders), referral to allied health services following development of a treatment and management plan (see MBS item 139)
• Referral to Thriving Kids support services delivered by state and territory programs
• Referral to a local child and family hub or maternal, child and family health service
• For some children, supports may include referral to other community services, such as playgroups.

Practitioners can use their local Health Pathways to identify referral pathways and services.

Practitioners should also provide advice and resources to the parent or carer to assist them to support the child’s developmental needs in everyday settings and complement any professional services.

Are there resources I can provide to parents and carers to support the child?

Practitioners are encouraged to refer parents and carers to high quality, reputable resources, such as the Raising Children Network and other relevant services, to assist the family to engage in activities that support the child’s physical, social and emotional development, health and wellbeing.

I completed a Medicare Healthy Kids Check for a child today. I identified a developmental concern and have provided the parents with some strategies to implement at home. I would like to reassess the child’s progress after a period of time to consider whether additional referrals are required. What should I bill for the follow-up?

The Medicare Healthy Kids Check is available once only for an eligible child. Any further assessment or follow-up may be conducted using time-tiered professional attendance items (see AN.0.9) or other relevant items, provided all requirements of the item are met.

I completed a Medicare Healthy Kids Check for a child today. I identified some potential developmental delays, however, the child had a cold at the time, which may have contributed to their presentation on the day. I would like to reassess some things on another day. What should I bill for the follow-up?

The Medicare Healthy Kids Check is available once only for an eligible child. Any further assessment or follow-up may be conducted using time-tiered professional attendance items (see AN.0.9) or other relevant items, provided all requirements of the item are met.

My patient is eligible for more than one category of health assessment. Which health assessment should I do?

Having a Medicare Healthy Kids Check does not affect a child’s eligibility for other types of health assessment.

In addition to the Medicare Healthy Kids Check, Medicare-eligible 3-year-olds might be eligible for:

• an Aboriginal and Torres Strait Islander health assessment, every 9 months (see AN.0.43)
• a health assessment for a person with an intellectual disability, annually (see AN.0.41)
• a health assessment provided for a refugee or other humanitarian entrant, once only to an eligible patient (see AN.0.42).

Practitioners should consider which health assessment is most clinically relevant to determine the appropriate item to claim, noting that the specific requirements of each health assessment type are different.

If a child receives more than one health assessment each service must be clinically relevant for MBS benefits to be payable.

My patient missed their Medicare Healthy Kids Check appointment. They have now turned 4 years old and the family still needs a child health check to be performed to meet the Healthy Start for School requirements for Family Tax Benefit Part A purposes. What do I do?

You cannot use the MBS health assessment items to undertake the assessment once a child has turned 4. However, standard consultation items (see AN.0.9) may be used for any service where there is not a specific MBS item. When using a consultation MBS item you are required to meet the requirements of the consultation item, not the Medicare Healthy Kids Check item.

To meet the Healthy Start for School requirements, the child will need to receive an age-appropriate health check that meets the relevant state and territory requirements. Further information about the various state and territory requirements is available on the Services Australia website at Healthy Start for School health check - Family Tax Benefit - Services Australia.

My 3-year-old patient received a health check at their kindergarten. Are they eligible for a Medicare Healthy Kids Check?

Yes, if the patient has not yet received a Medicare Healthy Kids Check under the MBS. In considering the need for a Medicare Healthy Kids Check, GPs and prescribed medical practitioners need to ensure the service is clinically relevant.

Do I need to add a copy of the Medicare Healthy Kids Check to the child’s My Health Record?

GPs and prescribed medical practitioners are strongly encouraged to upload the Medicare Healthy Kids Check to the child’s My Health Record. However, as upload is not a requirement of the item it is not essential that the plan be uploaded prior to submitting an MBS claim.

ELIGIBLE PATIENTS

Medicare-eligible children who are 3 years old.

A Medicare Healthy Kids Check can only be claimed once for an eligible patient.

ELIGIBLE PRACTITIONERS

A Medicare Healthy Kids Check can be undertaken by a general practitioner (see GN.4.13) or a prescribed medical practitioner (see AN.7.1).

CO-CLAIMING RESTRICTIONS

A separate consultation must not be performed in conjunction with a Medicare Healthy Kids Check, unless clinically necessary.

To co-claim a health assessment item and another item, both items must be clinically necessary and distinct services.

RECORD KEEPING AND REPORTING REQUIREMENTS

Providers are responsible for ensuring services claimed from Medicare using their provider number meet all legislative requirements and they may be required to submit evidence for compliance checks related to Medicare claims. Practitioners should ensure they keep adequate and contemporaneous records. For information on what constitutes adequate and contemporaneous records see GN.15.39.

Clause 4.3 of the Health Insurance Act 1973 specifies that, where an item specifies the creation of a document (however described) and a document is created, the document must be retained for the period of 2 years.

RELEVANT LEGISLATION

Details about the legislative requirements of the MBS item(s) can be found on the Federal Register of Legislation at www.legislation.gov.au. Health assessment items are set out in the Health Insurance (General Medical Services Table) Regulations 2021.

Related Items: 224 225 226 227 701 703 705 707

• Previous - Note AN.14.3
• Next - Note AN.15.1

Professional attendance by a general practitioner  to perform a brief health assessment, lasting not more than 30 minutes and including:

(a) collection of relevant information, including taking a patient history; and

(b) a basic physical examination; and

(c) initiating interventions and referrals as indicated; and

(d) providing the patient with preventive health care advice and information

Fee: $71.00 Benefit: 100% = $71.00

(See para AN.0.36, AN.0.37, AN.0.38, AN.0.39, AN.0.40, AN.0.41, AN.0.42, AN.0.69, AN.14.4 of explanatory notes to this Category)

Professional attendance by a general practitioner to perform a standard health assessment, lasting more than 30 minutes but less than 45 minutes, including:

(a) detailed information collection, including taking a patient history; and

(b) an extensive physical examination; and

(c) initiating interventions and referrals as indicated; and

(d) providing a preventive health care strategy for the patient

Fee: $165.05 Benefit: 100% = $165.05

(See para AN.0.36, AN.0.37, AN.0.38, AN.0.39, AN.0.40, AN.0.41, AN.0.42, AN.0.69, AN.14.4 of explanatory notes to this Category)

Professional attendance by a general practitioner  to perform a long health assessment, lasting at least 45 minutes but less than 60 minutes, including:

(a) comprehensive information collection, including taking a patient history; and

(b) an extensive examination of the patient's medical condition and physical function; and

(c) initiating interventions and referrals as indicated; and

(d) providing a basic preventive health care management plan for the patient

Fee: $227.75 Benefit: 100% = $227.75

(See para AN.0.36, AN.0.37, AN.0.38, AN.0.39, AN.0.40, AN.0.41, AN.0.42, AN.0.69, AN.14.4 of explanatory notes to this Category)

Professional attendance by a general practitioner to perform a prolonged health assessment (lasting at least 60 minutes) including:

(a) comprehensive information collection, including taking a patient history; and

(b) an extensive examination of the patient's medical condition, and physical, psychological and social function; and

(c) initiating interventions or referrals as indicated; and

(d) providing a comprehensive preventive health care management plan for the patient

Fee: $321.75 Benefit: 100% = $321.75

(See para AN.0.36, AN.0.37, AN.0.38, AN.0.39, AN.0.40, AN.0.41, AN.0.42, AN.0.69, AN.14.4 of explanatory notes to this Category)

Professional attendance by a prescribed medical practitioner to perform a brief health assessment, lasting not more than 30 minutes and including:
(a) collection of relevant information, including taking a patient history; and
(b) a basic physical examination; and
(c) initiating interventions and referrals as indicated; and
(d) providing the patient with preventive health care advice and information

Fee: $56.85 Benefit: 100% = $56.85

(See para AN.0.36, AN.0.37, AN.0.38, AN.0.39, AN.0.40, AN.0.41, AN.0.42, AN.0.69, AN.14.4 of explanatory notes to this Category)

Professional attendance by a prescribed medical practitioner to perform a standard health assessment, lasting more than 30 minutes but less than 45 minutes, including:
(a) detailed information collection, including taking a patient history; and
(b) an extensive physical examination; and
(c) initiating interventions and referrals as indicated; and
(d) providing a preventive health care strategy for the patient

Fee: $132.05 Benefit: 100% = $132.05

(See para AN.0.36, AN.0.37, AN.0.38, AN.0.39, AN.0.40, AN.0.41, AN.0.42, AN.0.69, AN.14.4 of explanatory notes to this Category)

Professional attendance by a prescribed medical practitioner to perform a long health assessment, lasting at least 45 minutes but less than 60 minutes, including:
(a) comprehensive information collection, including taking a patient history; and
(b) an extensive examination of the patient’s medical condition and physical function; and
(c) initiating interventions and referrals as indicated; and
(d) providing a basic preventive health care management plan for the patient

Fee: $182.15 Benefit: 100% = $182.15

(See para AN.0.36, AN.0.37, AN.0.38, AN.0.39, AN.0.40, AN.0.41, AN.0.42, AN.0.69, AN.14.4 of explanatory notes to this Category)

Professional attendance by a prescribed medical practitioner to perform a prolonged health assessment, lasting at least 60 minutes, including:
(a) comprehensive information collection, including taking a patient history; and
(b) an extensive examination of the patient’s medical condition, and physical, psychological and social function; and
(c) initiating interventions and referrals as indicated; and
(d) providing a comprehensive preventive health care management plan for the patient

Fee: $257.40 Benefit: 100% = $257.40

(See para AN.0.36, AN.0.37, AN.0.38, AN.0.39, AN.0.40, AN.0.41, AN.0.42, AN.0.69, AN.14.4 of explanatory notes to this Category)