Medicare Benefits Schedule - Item 75858

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View Associated Notes

Category 8 - MISCELLANEOUS SERVICES

75858

75858 - Additional Information

Item Start Date:
01-Jan-2022
Description Updated:
01-Nov-2023
Schedule Fee Updated:
01-Nov-2023

Group
M1 - Management Of Bulk-Billed Services
Subgroup
1 - Management of general bulk billed services

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)


Associated Notes

Category 8 - MISCELLANEOUS SERVICES

MN.1.1

Bulk Billing Incentives

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.

 

Practice Location:

MM1

Metropolitan Areas

MM1

(but service is provided after hours in MM 2-7)

MM2

Regional centres

MM3-4

Large or medium rural towns

 

MM5

Small rural towns

 

MM6

Remote communities

MM7

Very remote communities

 

 

Level B, C, D, E (face to face)

 

Level B (telephone and telehealth (video))

75870 75872 75871 75873 75874 75875 75876
Level C, D, E telehealth (telephone and video) and the patient is enrolled in MyMedicare 75880 NA 75881 75882 75883 75884 75885
All other eligible services not covered above 10990 10992 10991 75855 75856 75857 75858

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

Category 8 - MISCELLANEOUS SERVICES

MN.1.8

Bulk Billing Incentives for Eligible Patients in Modified Monash Area 7

General Practitioners1

Bulk billing incentives for eligible patients2 – Modified Monash 7 (Very Remote Communities)3

Applicable BBI Item 75858 75876 75885 (MyMedicare enrolled patients only)
Standard hours consultations - in consulting rooms 3 23, 36, 44, 123  
Standard hours consultations - out of consulting rooms 4 24, 37, 47, 124  
Standard hours consultations - residential aged care facility 90020 90035, 90043, 90051, 90054  
Telehealth - video

91790 (all)

 

91801, 91802, 91920 if not MyMedicare enrolled

91800 91801, 91802, 91920
Telehealth - phone 91890 91891 91900, 91910
After hours consultations - in consulting rooms 5000 5020, 5040, 5060, 5071  
After hours consultations - out of consulting rooms 5003 5023, 5043, 5063, 5076  
After hours consultations - residential aged care facility 5010 5028, 5049, 5067, 5077  
Other All other “unreferred services”4, including but not limited to: chronic disease management items, Better Access mental health items, health assessments, minor procedures etc.    

1 For the definition of GP for MBS purposes see GN.4.13

2 Bulk billing incentives can be claimed you bulk bill a child under 16 or a Commonwealth Concession Card holder www.servicesaustralia.gov.au/concession-and-health-care-cards

3 Practice located in Modified Monash area www.health.gov.au/resources/apps-and-tools/health-workforce-locator/app

4 Bulk billing incentives cannot be claimed for the provision of COVID vaccine support services

 

 

Medical Practitioners1

Bulk billing incentives for eligible patients2 – Modified Monash 7 (Very Remote communities)3

Applicable BBI Item 75858 75876 75885 (MyMedicare enrolled patients only)
Standard hours consultations - in consulting rooms 52, 179 53, 54, 57, 151, 185, 189, 203, 301  
Standard hours consultations - out of consulting rooms 58, 181 59, 60, 65, 165, 187, 191, 206, 303  
Standard hours consultations - residential aged care facilities 90092, 90183 90093, 90095, 90096, 90098, 90188, 90202, 90212, 90215  
Telehealth - video

91792, 91794 (all)

 

91804, 91805, 91923, 91807, 91808, 91926 if not MyMedicare enrolled

91803, 91806 91804, 91805, 91923, 91807, 91808, 91926
Telehealth - phone 91892 91893 91903, 91913, 91906, 91916
After hours consultations - in consulting rooms 5200, 733 5203, 5207, 5208, 5209, 737, 741, 745, 2197  
After hours consultations - out of consulting rooms 5220, 761 5223, 5227, 5228, 5261, 763, 766, 769, 2198  
After hours consultations - residential aged care facility 5260, 772  5263, 5265, 5267, 5262, 776, 788, 789, 2200  
Other All other “unreferred services”4 Including but not limited to: chronic disease management items, Better Access mental health items, health assessments, minor procedures etc.    

1 Items in italics can only be claimed by prescribed medical practitioners, that is, medical practitioners that are not GPs, specialists or consultant physicians. Other items can be claimed by medical practitioners that are not GPs.

2 Bulk billing incentives can be claimed when you bulk bill a child under 16 or a Commonwealth Concession Card holder www.servicesaustralia.gov.au/concession-and-health-care-cards

3 Practice located in Modified Monash area www.health.gov.au/resources/apps-and-tools/health-workforce-locator/app

4 Bulk billing incentives cannot be claimed for the provision of COVID vaccine support services

Related Items: 3 4 23 24 36 37 44 47 52 53 54 57 58 59 60 65 123 124 151 165 179 181 185 187 189 191 203 206 301 303 733 737 741 745 761 763 766 769 772 776 788 789 2197 2198 2200 5000 5003 5010 5020 5023 5028 5040 5043 5049 5060 5063 5067 5071 5076 5077 5200 5203 5207 5208 5209 5220 5223 5227 5228 5260 5261 5262 5263 5265 5267 75858 75876 75885 90020 90035 90043 90051 90054 90092 90093 90095 90096 90098 90183 90188 90202 90212 90215 91790 91792 91794 91800 91801 91802 91803 91804 91805 91806 91807 91808 91890 91891 91892 91893 91900 91903 91906 91910 91913 91916 91920 91923 91926


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