Medicare Benefits Schedule - Item 228

Professional attendance by a prescribed medical practitioner at consulting rooms or in a place other than a hospital or a residential aged care facility:

(a) for a health assessment of a patient who is of Aboriginal or Torres Strait Islander descent; and

(b) that includes the following:

(i) recognising the patient’s health priorities;

(ii) taking the patient’s medical history;

(iii) undertaking any relevant physical examinations;

(iv) undertaking or arranging any required investigations;

(v) assessing the patient using the information gained in the health assessment;

(vi) initiating any necessary interventions and referrals;

(vii) developing and documenting a plan to manage the patient’s health, including for follow‑up, based on the health assessment and the        patient’s priorities;

(viii) offering the patient (or the patient’s carer (if any) if the practitioner considers it appropriate and the patient agrees) a written report of the health assessment, with recommendations on matters covered by the health assessment and a strategy for the patient’s good health;

(ix) if the offer referred to in subparagraph (viii) is accepted—giving the report to the patient or the patient’s carer (as applicable);

(x) adding a record of the health assessment to the patient’s medical records

Applicable only if a service to which this item or item 715, 92004 or 92011 applies has not been provided to the patient in the preceding 9 months

Note:       For items 92004 and 92011, see the Telehealth Attendance Determination.

Fee: $198.10 Benefit: 100% = $198.10

(See para AN.0.43 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $500.00

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Health assessments for persons of Aboriginal and Torres Strait Islander descent (MBS Items 715, 228, 92004, 92011)

Publication date: 1 March 2026

SUMMARY

This note sets out requirements that apply to conducting a health assessment for persons of Aboriginal and Torres Strait Islander descent. This assessment is undertaken by GPs (see GN.4.13) and prescribed medical practitioners (see AN.7.1) to support the delivery of holistic care to patients throughout their life.

USE OF THE ITEMS

The Health Insurance (General Medical Services Table) Regulations 2021 (the Regulations) and the Health Insurance (Section 3C General Medical Services – Telehealth Attendances) Determination 2021 (the Telehealth Determination) define a health assessment for persons of Aboriginal and Torres Strait Islander descent as:

• an assessment of a patient's health and physical, psychological and social function, and
• based on this assessment, whether preventive health care, education and other assistance should be offered to the patient, or the patient's parent or carer, to improve the patient's health and physical, psychological or social function.

Under MBS items 715, 228, 92004 and 92011, a health assessment of a patient who is of Aboriginal or Torres Strait Islander descent must include:

1. recognising the patient’s health priorities
2. taking the patient’s medical history
3. undertaking any relevant physical examinations
4. undertaking or arranging any required investigations
5. assessing the patient using the information gained in the health assessment
6. initiating any necessary interventions and referrals
7. developing and documenting a plan to manage the patient’s health, including for follow up, based on the health assessment and the patient’s priorities
8. offering the patient (or the patient’s carer (if any) if the practitioner considers it appropriate and the patient agrees) a written report of the health assessment, with recommendations on matters covered by the health assessment and a strategy for the patient’s good health
9. if the offer referred to in subparagraph (viii) is accepted—giving the report to the patient or the patient’s carer (as applicable)
10. adding a record of the health assessment to the patient’s medical records

As part of good medical practice, GPs and prescribed medical practitioners should apply the principles of informed patient consent when considering a health assessment service. The Medical Board of Australia’s Good Medical Practice, a Code of Conduct for Doctors in Australia describes what is expected of all doctors registered to practise medicine in Australia, including informed consent.

Are there guidelines to support delivery of health assessments for persons of Aboriginal and Torres Strait Islander descent?

When delivering a health assessment for persons of Aboriginal and Torres Strait Islander descent, health practitioners should refer to current Australian preventive health guidelines which are culturally and clinically suitable to Aboriginal and Torres Strait Islander patient needs, are evidence-based and are generally accepted in primary care practice. Where appropriate, approaches should be tailored to community priorities and local epidemiology. For example, patients living in communities with a high prevalence of rheumatic heart disease.

Examples include (but are not limited to) current editions of the National Guide to a Preventive Health Assessment for Aboriginal and Torres Strait Islander People and its associated templates, developed by the National Aboriginal Community Controlled Health Organisation (NACCHO) and the Royal Australian College of General Practitioners (RACGP), the Central Australian Rural Practitioners Association (CARPA) Standard Treatment Manual and the RACGP Guidelines for preventive activities in general practice (Red Book).

It is the responsibility of the medical practitioner to ensure all item requirements are met to bill the health assessment item.

Can another person assist the medical practitioner to undertake the health assessment?

Yes. The Regulations state that practice nurses, Aboriginal health workers and Aboriginal Torres and Strait Islander health practitioners may assist in conducting a health assessment, in accordance with accepted medical practice and under the supervision of the medical practitioner. This can include activities associated with:

• information collection, and
• providing patients with information about recommended interventions, at the direction of the medical practitioner.

It is a requirement that the GP or prescribed medical practitioner sees the patient as part of the service and are responsible for the service.

The GP or prescribed medical practitioner should be satisfied that the assisting health professional has the necessary skills, expertise and training to collect the information required for the health assessment.

The terms practice nurse, Aboriginal and Torres Strait Islander health practitioner and Aboriginal health worker are defined in the Regulations.

A practice nurse means a ‘registered or an enrolled nurse who is employed by, or whose services are otherwise retained by, a general practice or by a health service to which a direction made under subsection 19(2) of the [Health Insurance] Act applies.’

An Aboriginal and Torres Strait Islander health practitioner means a person: 

1. who is registered under the National Law in the Aboriginal and Torres Strait Islander health practice profession; and
2. who is employed by, or whose services are otherwise retained by, a medical practitioner in a general practice or a health service to which a direction made under subsection 19(2) of the [Health Insurance] Act applies.

Aboriginal and Torres Strait Islander health worker means a person:

1. who holds a qualification of Certificate III or higher in Aboriginal and/or Torres Strait Islander Primary Health Care from the Health (HLT) training package; and
2. who is engaged by a medical practitioner in a general practice or a health service to which a direction made under subsection 19(2) of the [Health Insurance] Act applies.

MBS items for a health assessment for persons of Aboriginal and Torres Strait Islander descent are for a complete service. Items 10987 and 10997 (see MN.12.4) cannot be claimed when a practice nurse or Aboriginal and Torres Strait Islander Primary Health Care Professional assist with the provision of a health assessment.

Can I refer patients for allied health services following a health assessment for person of Aboriginal and Torres Strait Islander descent?

Where a medical practitioner has undertaken a health assessment and identified a need for follow‑up allied health or Aboriginal and Torres Strait Islander health and wellbeing services, the medical practitioner may refer Aboriginal and Torres Strait Islander patients for up to 10 MBS-supported individual allied health or Aboriginal and Torres Strait Islander health and wellbeing services per calendar year (January to December).

The annual total limit of 10 individual health services per patient can include a combination of the following items, up to a maximum of 10 services:

• up to 5 services under a GP chronic condition management plan or, for residents of a residential aged care facility, under a multidisciplinary care plan (10950, 10951, 10952, 10953, 10954, 10956, 10958, 10960, 10962, 10964, 10966, 10968, 10970, 93000 and 93013 - MBS Group M3 and equivalent telehealth services) (see MN.3.1).
• up to 10 services under MBS Group M11 and equivalent telehealth services (81300 to 81360, 93048 and 93061) (see MN.11.1).

The 10 services can be made up of one type of service (e.g. 10 physiotherapy services) or a combination of different types of services (e.g. 2 dietetic and 8 podiatry services).

In addition, up to 10 follow up services may be provided by a practice nurse or Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner (MBS item 10987) for an Aboriginal and Torres Strait Islander person who has received a health assessment.

Referral requirements for Aboriginal and Torres Strait Islander health and wellbeing services (81300 to 81360, 93048 and 93061) are set out in the Health Insurance (Section 3C – Allied Health and Other Primary Health Care Services) Determination 2024 (the Allied Health Determination) and mirror those for referrals to medical specialists and other MBS-supported services. The Allied Health Determination requires the following “prescribed particulars” to be included in the referral:

• the name of the referring practitioner
• the address of the practice, or the practitioner’s provider number at that practice, of the referring practitioner, and
• the date on which the referring practitioner made the referral

The Allied Health Determination also requires that referrals:

• be in writing
• signed by the referring practitioner (noting this can be an electronic signature)
• dated, and
• explain the reasons for referring the patient, including any information about the patient’s condition that the referring practitioner considers necessary to give the health professional.

Further information on available allied health services is available in Note MN.11.1.

Is a health assessment a health screening service?

Clause 2.15.14 of the Regulations specifies that a health assessment must not include a screening service. The Health Insurance Act 1973 defines a health screening service as a medical examination or test that is not reasonably required for the management of the medical condition of the patient.

However, for the purposes of the MBS, Medicare benefits are payable for a medical examination or a test on a symptomless patient by the that patient’s own medical practitioner in the course of normal medical practice, to ensure the patient receives any medical advice or treatment necessary to maintain their state of health.

ELIGIBLE PATIENTS

Any patient who identifies as being of Aboriginal and/or Torres Strait Islander descent and would benefit from an assessment of this type may receive this service.

A health assessment for persons of Aboriginal and Torres Strait Islander descent cannot be claimed more than once every 9 months per eligible patient.

MBS items 715 and 228 cannot be billed for a patient who is an in-patient of a hospital or a care recipient in a residential aged care facility. MBS telehealth items 92004 and 92011 may be billed for patients in all community settings but may not be billed for an admitted patient of a hospital.

ELIGIBLE PRACTITIONERS

Health assessment items are available for different practitioner types:

• general practitioner items can be claimed by GPs only (see GN.4.13).
• prescribed medical practitioner items can be claimed by prescribed medical practitioners only (see AN.7.1).

Note: Clause 2.15.14 of the Regulations specifies patients must access health assessment services through their usual GP or prescribed medical practitioner, if reasonably practicable. The patient’s usual GP or prescribed medical practitioner means the practitioner:

• who has provided the majority of services to the patient in the past 12 months, or
• who is likely to provide the majority of services to the patient in the following 12 months, or
• is located at a medical practice that:
  • has provided the majority of services to the patient in the past 12 months, or
  • is likely to provide the majority of services to the patient in the next 12 months.

Telehealth items – 92004 and 92011

Telehealth items are subject to the established clinical relationship rule (see AN.1.1) which applies to most general practice telehealth items.

CO-CLAIMING RESTRICTIONS

Clause 2.15.14 of the Regulations specifies a separate consultation must not be performed in conjunction with a health assessment, unless clinically necessary.

To co-claim a health assessment item and another item, both items must be clinically necessary and distinct services and each independently meeting all relevant requirements set out in the item descriptors.

RECORD KEEPING AND REPORTING REQUIREMENTS

The Regulations state that health assessments for persons of Aboriginal and Torres Strait Islander descent must include:

• offering the patient (or the patient’s carer (if any) if the practitioner considers it appropriate and the patient agrees) a written report of the health assessment, with recommendations on matters covered by the health assessment and a strategy for the patient’s good health, and
• adding a record of the health assessment to the patient’s medical records.

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. MBS items for health assessments for persons of Aboriginal and Torres Strait Islander descent are set out in the following regulatory instruments:

• Health Insurance (General Medical Services Table) Regulations 2021 – items 715, 228
• Health Insurance (Section 3C General Medical Services – Telehealth Attendances) Determination 2021 – items 92004, 92011

Related Items: 228 715 92004 92011