MBS billing guide for GPs

For health professionals

Accurate as of 7 Nov 2026. Next update after the 1 Mar 2027 MBS changes.

Items, schedule fees, rules and worked examples for Australian general practice, updated for the 2025–26 changes: GPCCMP, the new bulk-billing incentives, Better Access and telehealth.

Disclaimer. General information for Australian GPs, not financial, legal or billing advice. The MBS item descriptors, explanatory notes and Services Australia rules are the authority, and they change. Always check MBS Online and AskMBS (askMBS@health.gov.au) before claiming; you are responsible for every claim made under your provider number. Fees are MBS schedule fees from 1 July 2026 (2.6% indexation), rounded. Unreferred GP attendances pay 100% of the schedule fee; most procedures pay 85% out of hospital.

Quick reference

Item — what — schedule fee from 1 Jul 2026 — key rule. Procedures pay 85% out of hospital (benefit in brackets).

Standard attendances

• 3 — Level A, simple problem — $20.55 — single BBI only.
• 23 — Level B, 6–19 min — $45.05 — triple BBI if bulk billed.
• 36 — Level C, 20–39 min — $87.10 — only time with the patient present counts (AN.0.9).
• 44 — Level D, 40–59 min — $128.35 — record the time.
• 123 — Level E, 60+ min — $207.90 — video 91920; no phone item.

Telehealth

• Video 91790 / 91800 / 91801 / 91802 / 91920 — Levels A–E — same fees as 3/23/36/44/123 — face-to-face in last 12 months, MyMedicare, or an exemption.
• Phone 91890 / 91891 — Levels A–B — $20.55 / $45.05 — same relationship rule.
• Phone 91900 / 91910 — Levels C–D — $87.10 / $128.35 — MyMedicare-registered with your practice only.

After-hours (in rooms)

• 5000 / 5020 / 5040 / 5060 / 5071 — Levels A–E — $34.70 / $58.65 / $100.55 / $140.95 / $239.45 — weekdays before 8 am or after 8 pm; Saturday before 8 am or after 1 pm; Sundays and public holidays (AN.0.19).
• 585 — urgent after-hours (GP) — $155.40 — patient-requested, urgent, same after-hours period. 599 unsociable hours — $183.15.

Bulk-billing incentives

• Single: 10990 (MM1), 10991 (MM2), 75855–75858 (MM3–7), 10992 (crossover) — with Level A, procedures, 965/967, health assessments, MHTP.
• Triple: 75870–75876 (75872 crossover) — with Level B and face-to-face Levels C–E, including after-hours.
• MyMedicare telehealth triple: 75880–75885 — with video C–E and phone C–D for registered patients.
• Bulk billed only, one BBI per item, never with pathology or imaging (MN.1.1). Amounts: see section 2.

Care planning and medication review

• 965 — prepare GPCCMP (video 92029, phone 92033) — $160.60 — once per 12 months; MyMedicare practice or usual GP.
• 967 — review GPCCMP (video 92030, phone 92034) — $160.60 — once per 3 months; no general attendance same day.
• 729 / 731 — contribute to another provider's plan (community / residential care home) — $84.25.
• 900 — HMR/DMMR — $185.35 — once per 12 months unless a significant change needs a new review.

Health assessments

• 701 / 703 / 705 / 707 — under 30 / 30–44 / 45–59 / 60+ min — $71.00 / $165.05 / $227.75 / $321.75 — eligible groups only, including the Healthy Kids Check at age 3 from 1 Nov 2026; nurse may assist, GP must see the patient.
• 715 — Aboriginal and Torres Strait Islander health assessment — $254.10 — not within 9 months of the last.
• 699 — Heart Health Check, 20+ min, age 30+ — $87.10.
• 695 — menopause/perimenopause assessment, 20+ min — $104.55.

Mental health

• 2700 / 2701 — MHTP, no training, 20–39 / 40+ min — $85.80 / $126.35.
• 2715 / 2717 — MHTP, with training, 20–39 / 40+ min — $108.95 / $160.50 — video 92112/92113/92116/92117; no phone.
• MHTP review — bill 23/36/44/123 by time (2712 removed 1 Nov 2025).

Procedures and tests

• 30026 / 30029 — wound repair up to 7 cm, not face/neck, superficial / deeper — $62.55 ($53.20) / $107.75 ($91.60).
• 30032 / 30035 — face/neck, superficial / deeper — $98.70 ($83.90) / $140.70 ($119.60).
• Skin excisions (histology required) — e.g. 31365 malignant, other sites, under 15 mm, $189.45 ($161.05); 31366 non-malignant, same, $114.30 ($97.20); 31361 malignant, face/neck/scalp/distal limbs, under 14 mm, $223.45 ($189.95).
• 30071 — skin biopsy, sent for histology — $62.55 ($53.20).
• 30219 — I&D of abscess/haematoma — $32.75 ($27.85).
• LARC — 14206 implant $103.00 ($87.55); 30062 implant removal $107.90 ($91.75); 35503 IUD $221.55 ($188.35); 35501 adds 40% if everything at the visit is bulk billed.
• Ear — 41500 foreign body (not simple syringing) $98.70 ($83.90); 41647 microscope ear toilet $131.55 ($111.85), only with another ear disorder.
• Epistaxis — 41677 cautery/packing — $107.75 ($91.60).
• Joint injections — no MBS item since 2009 (50124/50125 removed); bill the consult time.
• ECG — 11714 trace + your interpreted note $29.00 ($24.65); 11707 trace sent for report $22.00 ($18.70).
• Spirometry — 11506 pre/post monitoring $24.60 ($20.95); 11505 diagnostic, once per 12 months, $49.30 ($41.95).
• Fractures / plaster — no standalone cast item; the fracture item covers the cast, e.g. 47361 distal radius/ulna $157.75 ($134.10), 47354 scaphoid $202.90 ($172.50). Descriptors and aftercare rules differ by item: check MBS Online before relying on this.

Practice nurse

• 10997 — chronic condition follow-up — $14.35 (100% benefit; check MBS Online for changes) — max 5 per calendar year; needs a GPCCMP or multidisciplinary plan; not for helping with the plan or a health assessment.
• 10987 — Aboriginal and Torres Strait Islander follow-up after a 715 — max 10 per calendar year.

What's changed

• Phone GPCCMP items from 1 Nov 2026. 92033 (prepare) and 92034 (review), $160.60 each; prescribed practitioners 92063/92064, $128.55. Same MyMedicare/usual-GP rule as face-to-face; not subject to the 12-month telehealth relationship rule (AN.0.47).
• Medicare Healthy Kids Check from 1 Nov 2026. For 3-year-olds, once per child, billed with 701–707 by time (224–227 for prescribed practitioners).
• ABPM 11607 extended to children from 1 Nov 2026. Ages 5 to under 18 with clinic BP between the 95th percentile and 95th percentile + 30 mmHg on consecutive visits.
• Other 1 Nov 2026 changes: nurse practitioners can request DEXA (12306–12322); 14245 can be given by a qualified health practitioner for the prescriber; 73813 provider definitions widened; "residential aged care facility" is now "residential care home"; 10997 typo correction only.
• Bulk-billing incentives (BBIs) now apply to every Medicare-eligible patient (from 1 Nov 2025), not just under-16s and concession card holders. The triple BBI applies to Level B and longer consults.
• New Bulk Billing Practice Incentive Program (BBPIP) (from 1 Nov 2025). It pays a 12.5% quarterly loading, split 50/50 between GP and practice, but only if the practice bulk bills every eligible service for every patient.
• GPMP/TCA/review items (721/723/732) ceased on 1 July 2025. Replaced by the GP chronic condition management plan (GPCCMP): 965 to prepare and 967 to review, same fee. No team requirement for allied health.
• Mental health items 2712 and 2713 were removed on 1 Nov 2025. Reviews and ongoing mental health consults are now 23/36/44/123 with BBI. The old "23 + split 2713" combination is gone.
• MHTP, GPCCMP and their telehealth versions must come from the patient's MyMedicare practice or usual GP.
• Level E (item 123, 60+ minutes) has existed since Nov 2023. Video equivalent 91920; no phone version.
• Telehealth: needs a face-to-face visit in the last 12 months or MyMedicare registration at your practice. Phone Level C/D (91900/91910) are MyMedicare only, and MHTP telehealth is no longer exempt.
• Ceased: smoking cessation items (93680 series) on 31 Dec 2023; COVID vaccine suitability items (93644, 10660 etc.) on 1 July 2025; COVID antiviral item 93716.
• LARC rebates roughly doubled to tripled on 1 Nov 2025. New 40% bulk-billing loading (35501); implant removal (30062) no longer "independent procedure only".
• Heart Health Check 699 extended to June 2028. New menopause health assessment 695 (20+ min) until July 2027.
• Skin excisions (31356–31383) now cover healing by secondary intention.
• All fees re-based to 1 July 2026.

1. Standard consults

Time tiers (in rooms / video / phone)

• Level A — 3 / 91790 / 91890 — under 6 min, simple problem — $20.55
• Level B — 23 / 91800 / 91891 — 6 to 19 min — $45.05
• Level C — 36 / 91801 / 91900* — 20 to 39 min — $87.10
• Level D — 44 / 91802 / 91910* — 40 to 59 min — $128.35
• Level E — 123 / 91920 / no phone item — 60+ min — $207.90
• *Phone 91900/91910 only for patients registered in MyMedicare with your practice.

Rules worth remembering

• Only time with the patient present (or on the phone/video) counts, including notes, scripts and referrals written while they're there. Paperwork, My Health Record uploads or calls to relatives after they leave don't count, and procedure time is excluded (AN.0.9).
• No limit on problems per consult, as long as the notes support it.
• Use a time-tiered item only when no more specific item exists (e.g. Implanon insertion is 14206, not a 23 or 36).
• Same problem returning the same day (e.g. after an X-ray): combine the times into one consult.
• Unrelated problems at separate visits the same day: bill both, annotated "not related" with times.

The "22-minute" dilemma

• Genuinely 20+ minutes of documented work is a 36. Don't downcode out of habit.
• Under 20 minutes is a 23. Don't pad.
• Private 36 plus a gap is still valid fee-setting, but BBI only applies if the service is bulk billed.

Family / multiple patients

• If you actually assess and manage a second family member, document it in their own file and bill it separately.
• Saying hello to a parent while vaccinating a baby isn't a consult.

2. Bulk-billing incentives and BBPIP

Who: all Medicare-eligible patients from 1 Nov 2025. The service must be bulk billed; no BBI if any gap is charged for that service.

Triple BBI (with 23, 36, 44, 123, after-hours and RACF equivalents, video 91800, phone 91891)

• MM1: 75870
• MM2: 75871
• MM3–4: 75873
• MM5: 75874
• MM6: 75875
• MM7: 75876
• Crossover / after-hours MM2–7: 75872

Triple BBI for MyMedicare telehealth (with video 91801/91802/91920 and phone 91900/91910; patient MyMedicare-registered at your practice): 75880 (MM1) to 75885 (MM7).

Single (standard) BBI

• 10990 (MM1), 10991 (MM2), 10992 (crossover), 75855–75858 (MM3–7).
• With Level A, 965/967, health assessments, MHTP, minor procedures and other unreferred services.
• Also with longer video consults for patients not in MyMedicare.

Amounts

• Amounts rise with the Modified Monash (MM) category, and the triple BBI pays about three times the single. Schedule fees from 1 July 2026 (MBS Online shows an 85% benefit, in brackets); check MBS Online for later changes.
• Single: 10990 MM1 $8.80 ($7.50); 10991 MM2 and 10992 crossover $13.35 ($11.35); 75855 MM3–4 $14.10 ($12.00); 75856 MM5 $15.10 ($12.85); 75857 MM6 $15.85 ($13.50); 75858 MM7 $16.95 ($14.45).
• Triple: 75870 MM1 $26.35 ($22.40); 75871 MM2 and 75872 crossover $40.10 ($34.10); 75873 MM3–4 $42.60 ($36.25); 75874 MM5 $45.30 ($38.55); 75875 MM6 $47.80 ($40.65); 75876 MM7 $50.75 ($43.15).
• Triple, MyMedicare telehealth: 75880 (MM1) to 75885 (MM7) pay the same as 75870, 75871, 75873–75876.
• Rural loadings 150% (MM2) to 190% (MM7) of the MM1 value.

Bulk Billing Practice Incentive Program (BBPIP)

• Extra 12.5% of MBS benefits on eligible services, quarterly, split 50/50 between GP and practice.
• Practice must be MyMedicare-registered, bulk bill every eligible service for every patient, display signage, and be listed as bulk billing on Healthdirect.
• Register through MyMedicare in HPOS/PRODA.
• The practice must bulk bill every eligible service; there are no partial or pro-rata payments and no stated tolerance, so one privately billed eligible service puts the quarter at risk. Only patients who genuinely can't be bulk billed (e.g. no Medicare number yet) are excepted.
• Gap fees are allowed on items not on the eligible services list, which currently includes no procedures (e.g. 30071, LARC, skin excisions, ECG). Consumable fees on eligible services are not allowed.
• Practical effect: at a BBPIP practice, "private bill the presenting complaint, then split bulk bill the extras" is dead. At a mixed-billing practice it still works, but BBI is only paid on the bulk-billed transaction.

3. Chronic disease — GPCCMP (from 1 July 2025)

Items

• 965 prepare a plan (video 92029): $160.60.
• 967 review a plan (video 92030): $160.60.
• Phone (from 1 Nov 2026): 92033 prepare, 92034 review ($160.60); prescribed practitioners 92063/92064 ($128.55). Same MyMedicare/usual-GP rule; no 12-month relationship rule (AN.0.47).
• Prescribed (non-VR) practitioners use 392/393 (video 92060/92061).

Eligibility

• At least one condition present, or expected to last, 6+ months, or a terminal condition. No fixed list.
• If you're unsure it qualifies, it probably doesn't.

Who can bill

• MyMedicare-registered patients: their registered practice only.
• Unregistered patients: their usual GP (the practice providing most of their care over 12 months).

Frequency

• 965: once per 12 months, and only if a new plan is clinically needed. More often only in exceptional circumstances (e.g. significant change), noted on the claim.
• 967: up to every 3 months if clinically relevant.
• A new 965 must be at least 3 months after the last review. Earlier services need "exceptional circumstances" on the claim and the reason in the notes (AN.0.47).

Plan content: consent, agreed goals and actions, services and referrals, a review date, and a copy offered to the patient. Every element complete before you claim.

Same day: you can't bill 965/967 with a general attendance (3/23/36 etc.) for the same patient on the same day. Single BBI applies if bulk billed.

Allied health

• Up to 5 individual services per calendar year (10 for Aboriginal and Torres Strait Islander patients). Up to 8 group services for type 2 diabetes.
• Referral is a normal signed letter with reason and clinical details. No need to name a provider or number of sessions; valid 18 months unless you say otherwise.
• The plan must have been prepared or reviewed in the last 18 months.
• No team or "acceptance" step any more. The allied health provider reports back to you.

Transition

• GPMP/TCA plans made before 1 July 2025 stay valid for allied health until 30 June 2027.
• When an old plan comes up for review, do a new 965 (not a 967).

Practice nurse follow-up

• 10997 (phone 93203, video 93201): up to 5 per calendar year with a GPCCMP (or an old plan until mid-2027). Fee $14.35 (100% benefit); check MBS Online for changes. Not claimable for helping prepare or review the plan.
• Aboriginal and Torres Strait Islander patients with a 715: 10987 (phone 93202, video 93200), up to 10 per year.

Tips

• Personalise every plan. Proformas with generic goals are the classic audit finding.
• Keep goals specific and measurable, and actually review them.
• Book the nurse first (20–40 min), then the GP. Nurse prep is fine, but the GP must see the patient.

Suggested cycle: 965 once a year; 967 every 3–6 months; 10997 nurse check-ins in between; add a health assessment (707/715/75+) and HMR (900) where eligible.

Other

• Contributing to someone else's multidisciplinary plan: 729 (community) and 731 (RACF), video 92026/92027, up to every 3 months.
• Case conferences: organise 735/739/743; participate 747/750/758.

4. Mental health (Better Access, from 1 Nov 2025)

MHTP preparation

• 2700 (20–39 min, no training): $85.80.
• 2701 (40+ min, no training): $126.35.
• 2715 (20–39 min, with GPMHSC training): $108.95.
• 2717 (40+ min, with training): $160.50.
• Video 92112/92113/92116/92117. There are no phone items for MHTP preparation.

Gone: 2712 (review) and 2713 (ongoing MH consult), plus telehealth versions.

Now: reviews, re-referrals and ongoing mental health consults are 23/36/44/123, with triple BBI if bulk billed. These usually pay more than the old 2712/2713.

Who can prepare or review an MHTP

• The patient's MyMedicare practice, or their usual GP.
• Telehealth MHTP needs the relationship rule (face-to-face in last 12 months or MyMedicare).
• Focussed psychological strategies (FPS) are exempt from both rules.

Sessions

• Up to 10 individual and 10 group sessions per calendar year.
• First referral up to 6 sessions; GP review and new referral before more.
• Reviews no more than every 3 months, and not within 4 weeks of the plan, unless there's a significant change. Most patients need about 2 a year.

New plans: MHTPs don't expire. Don't write a new one unless clinically needed; usually review and re-refer. The MBS note (AN.0.56) says a new plan generally shouldn't be prepared within 12 months of a previous one.

Building an MHTP over several visits

• You can do assessment work across consults and bill the MHTP when complete.
• Time already billed as a 23/36 can't be counted again toward the 2717 threshold (AN.0.56: time of a preceding consultation isn't counted toward the MHTP).

Same day

• MHTP plus an unrelated general consult the same day is only defensible as genuinely separate services, documented with times and "not related" (AN.0.56: both must be clinically relevant and distinct services).
• With 2713 gone, the old "23 PB + 2713 BB" split isn't needed. Bill one time-tiered consult for the whole visit.

Eating disorder plans: an EDTMP can sit alongside an MHTP (up to 40 sessions per 12 months) but doesn't add to the Better Access allowance.

Diagnosis tips

• Exclude organic causes and substances first.
• A provisional diagnosis or formulation is acceptable.
• Don't label transient stressors (grief, exam stress, breakups) as major depression.
• Labels affect insurance, ADF applications and self-image.

Veterans (DVA, from 1 July 2026): an extra $99.30 incentive is payable with MHTP preparation, or with a 20+ min consult reviewing an MHTP; up to 4 times in 12 months, at least 1 calendar month apart (DVA). Check the DVA fee schedules for the item number before claiming.

5. Health assessments

Time-based items (nurse time counts; GP must see the patient)

• 701: under 30 min — $71.00.
• 703: 30–44 min — $165.05.
• 705: 45–59 min — $227.75.
• 707: 60+ min — $321.75.

Eligible groups

• Aged 45–49 with a chronic disease risk factor: once only.
• Aged 40–49 with high type 2 diabetes risk (AUSDRISK 12+ in the last 3 months): every 3 years.
• Aged 75+: every 12 months.
• Residential aged care residents: every 12 months.
• People with intellectual disability: every 12 months.
• Refugees and humanitarian entrants: once.
• Former ADF members: once.
• Medicare Healthy Kids Check (from 1 Nov 2026): aged 3, once only; bill 701–707 by time. Must cover milestones, behaviour, family and social situation, nutrition, screen use, sleep, toileting, vision, hearing, oral health, growth/BMI on centile charts, advice, referrals and a written report for the parent. Other ages, or a second assessment, use time-tiered consults.

715 — Aboriginal and Torres Strait Islander health assessment: every 9 months, any age, no minimum time. $254.10. Unlocks 10987 nurse follow-ups and 10 allied health sessions.

699 — Heart Health Check

• 20+ min, once per 12 months, $87.10. Extended to June 2028.
• Not if 701–707 was claimed in the previous 12 months (a 715 doesn't block it).
• Heart Foundation targets 45–79 (35+ with diabetes, 30+ for First Nations), but the MBS item only requires age 30+.
• Nurse time counts.

695 — Menopause / perimenopause health assessment: 20+ min, $104.55, until July 2027. Nurse can assist. Frequency: no limit in the MBS descriptor or Department fact sheet; some PHNs say annual. Check MBS Online and AskMBS before relying on this.

Tip: book a 30–60 min nurse appointment before the GP and aim for 705/707. A yearly "everything visit" (965/967 + health assessment + HMR referral) is still efficient — but the GPCCMP can't share a day with a general consult.

6. Women's health, pregnancy and LARC

Antenatal

• 16500 routine antenatal visit (video 91853, phone 91858): $56.45. No time or gestation limit.
• Can be billed with a 23 when pregnancy is first diagnosed and an unrelated issue is also managed.
• Unrelated problems at any antenatal visit (iron deficiency, STI, asthma) can add a 3/23.
• 16591 planning and management of pregnancy from 28 weeks (shared care, not doing the birth), once per pregnancy: $170.75.
• 16407 postnatal check at 4–8 weeks, 20+ min, including mental health and family violence screening (video 91851, phone 91856): $85.80.

Non-directive pregnancy support counselling

• 4001 (video 92136, phone 92138): $91.65.
• 20+ min, up to 3 per pregnancy, RACGP gplearning training required.
• Timing: 4001 + 23 needs at least 26 min in total; 4001 + 36 at least 40 min.

Other pregnancy items: urine pregnancy test 73806 ($10.15, no use limit); GP dating ultrasound under 12 weeks 55703 ($41.15).

LARC (much better paid since 1 Nov 2025)

• 14206 implant insertion: $103.00.
• 30062 implant removal: $107.90.
• 35503 IUD insertion: $221.55.
• IUD removal: no specific item; bill time-tiered.
• 35501 adds 40% to 14206/30062/35503 (and 35506) when the LARC item and every other item at that visit, including the consult, are bulk billed.
• Removal and reinsertion at the same visit: 30062 + 14206 (each with 35501 if bulk billed). The 2025 fact sheet allows both "if requirements are met" but doesn't address the same incision. Check MBS Online and AskMBS before relying on this; the conservative approach is a different site or arm.
• Consult + LARC is fine with a genuinely separate consult (e.g. CST, STI screen, contraception counselling): 23 + 14206 (+ 35501 if all bulk billed).
• Zoladex and other implants by cannula are also 14206.

Telehealth sexual and reproductive health / BBV items

• Video 92715/92718/92721/92724; phone 92731/92734/92737/92740.
• Tiers: under 5 min, 5–20, 20–40, 40+. Fees match Levels A–D.
• No 12-month relationship needed. Useful for contraception, STI, early medical abortion triage and menopause by phone.

7. Procedures and investigations

General rules

• Bill the procedure item, plus a consult only for a genuinely separate, documented consultation ("not related", with times).
• Normal aftercare is included in the procedure fee.
• Burns dressing without anaesthesia (30003, 30006) applies "if medical practitioner is present", each attendance at which the dressing is done; not for radiotherapy skin reactions. No consult if dressing was all you did.

Common items (1 Jul 2026 fee, 85% benefit in brackets where shown; check MBS Online for the rest)

• Wound repair: 30026 superficial, not face/neck, up to 7 cm, $62.55 ($53.20); 30029 deeper tissue, not face/neck, up to 7 cm, $107.75 ($91.60); 30032 face/neck up to 7 cm, $98.70 ($83.90). Includes sutures, glue and clips.
• Foreign body: 30061 superficial (including cornea/sclera), $28.15 ($23.95); 30064 subcutaneous needing incision, $131.55 ($111.85); 41500 ear (other than simple syringing); nose 41659 (other than by simple probing).
• Abscess / haematoma: 30219 incision and drainage, $32.75 ($27.85); 30216 aspiration of haematoma, $32.75 ($27.85).
• Epistaxis: cautery or packing — 41677.
• Nail removal: 46513 finger or thumb (per nail); 47904 toe (47906 if in hospital).
• Abandoned procedure: 30001 (procedure discontinued on medical grounds; 50% of the intended item's fee).
• Ear toilet with microscope (41647): only with another ear disorder (restricted since 2023).
• Skin excisions: 31356–31383 now include healing by secondary intention.

Fractures: GP fracture items (47xxx) apply when you provide the treatment. Whether you can bill ongoing management after another service's ED care depends on each 47xxx item's attendance and aftercare rules. Check MBS Online before relying on this.

Investigations

• ECG: 11714 trace plus clinical note by the GP ($29.00); 11707 trace only, sent for report ($22.00); 11704 trace plus formal specialist report. 11714's conditions were updated on 1 Mar 2026: the note must state the indication and your interpretation, not just the machine read. Max twice a day.
• ABPM 11607 ($123.20): 24 h+ recording, not yet on antihypertensives, report and treatment plan by the same doctor; once per 12 months. From 1 Nov 2026 also ages 5 to under 18 (BP between the 95th percentile and 95th percentile + 30 mmHg on consecutive visits).
• Spirometry: 11505 full pre/post-bronchodilator, 3+ recordings, once per 12 months; 11506 pre/post for monitoring asthma/COPD or other lung disease, each occasion.
• ABI: 11610 ankle–brachial indices and arterial waveform analysis (bilateral Doppler or plethysmography) with trace and report.
• Urine BHCG: 73806.

Pathology: separate requests for private and Medicare-eligible tests. Vitamin D, iron studies, TFTs, HbA1c and hepatitis serology all have MBS criteria; if the patient doesn't meet them, tell them about the private fee.

8. Medication review

900 — home medication review (HMR/DMMR)

• Not more than once per 12 months, except where a significant change in the patient's condition or medication regimen requires a new DMMR; not if item 245 applied in the same 12 months (item 900 descriptor).
• GP refers to an accredited pharmacist, discusses the report with the patient, and agrees a plan.
• $185.35. RACF equivalent: 903. A GPCCMP requirement for items 900 and 245 from 1 July 2027 has been flagged: check MBS Online before relying on this.

Good candidates: 5+ medicines or 12+ doses a day; recent changes; narrow therapeutic index drugs or a suspected adverse reaction; poor adherence, recent discharge or multiple prescribers; literacy, vision or dexterity problems.

Workflow tip: use one pharmacist for all your HMRs and do a monthly call to discuss reports.

9. After-hours

In-rooms items

• 5000 (Level A): $34.70.
• 5020 (Level B): $58.65.
• 5040 (Level C): $100.55.
• 5060 (Level D): $140.95.
• 5071 (Level E): $239.45.
• Out-of-rooms and RACF versions exist (5003/5023…, 5010/5028…).

What counts (5000–5071 in rooms): weekdays before 8 am or after 8 pm, Saturdays before 8 am or after 1 pm, all day Sundays and public holidays. Other after-hours and urgent items start at 6 pm on weekdays (urgent: after 12 noon Saturdays).

Urgent after-hours call-outs (585 GP; 588/591 non-GP; 594 each extra patient; 599 GP in unsociable hours, 11 pm–7 am): condition must need urgent assessment, requested in the same after-hours period.

BBI: after-hours Level B+ consults attract the triple BBI.

10. Telehealth

Eligibility: a face-to-face service from you or your practice in the past 12 months, or MyMedicare registration with your practice. A previous telehealth visit doesn't count.

Exemptions (document which applies): under 12 months old; homeless; natural disaster area; AMS/ACCHS patients; isolating under a COVID public health order; urgent after-hours; BBV/sexual and reproductive health items; FPS; GPCCMP prep/review.

Phone vs video

• Phone Levels C and D (91900/91910) are MyMedicare only. No phone Level E.
• Phone GPCCMP prep/review (92033/92034) from 1 Nov 2026; see section 3.
• Video Levels C–E for non-MyMedicare patients attract only the single BBI.

Mental health: MHTP by telehealth is no longer exempt from the relationship rule.

30/20 rule: 30 or more phone services on 20 or more days in 12 months triggers a PSR referral.

Consent: the common "written consent and email a summary" advice is practice policy, not an MBS rule. Informed financial consent before the service is still required.

11. Workers compensation and insurance (NSW)

• Not MBS. Bill against the current SIRA fees order, updated each year (rates from 1 Feb 2026: consults AA010–AA045, certificate WCO001, return-to-work and case conferences WCO002).
• First WorkCover visits are rarely under 20 minutes. Check the time and bill the right tier.
• Bill case conferences, employer calls and report requests (WCO002).
• If a non-WorkCover issue comes up, close the WorkCover consult and open a separate Medicare one. Keeps WorkCover notes clean when records are requested.

12. Compliance, audits and common pitfalls

Audit triggers

• 80/20 rule: 80 or more attendance services on 20 or more days in 12 months, across all your provider numbers.
• 30/20 rule: phone services, as above.
• Top-percentile billing for your peer group, sudden jumps, or outlier patterns (e.g. very high 44 or 965 rates).
• Tip-offs and complaints.

Assignment of benefit (bulk billing consent)

• Verbal consent allowed in all settings until 1 July 2027.
• Enduring consent may be available for MyMedicare, RACF and ACCHO patients. Check MBS Online and Services Australia before relying on this.

Documentation habits

• Write notes in order: presenting complaint first, then each extra item.
• Time-stamp each component and record total time.
• For extra services, note "not related" or "clinically urgent".
• Finish notes contemporaneously.
• When unsure, bill the lower item. Only bill items whose requirements are met in full.
• Tell patients the fee up front, including when extra items are bulk billed.
• Spend 5 minutes at the end of each day checking billings and following up rejections.

Common pitfalls in 2026

• Still billing 721/723/732 (rejected since 1 July 2025) or 2712/2713 (removed 1 Nov 2025).
• Billing 965/967 with a 23/36 on the same day.
• MHTP or GPCCMP for a patient registered in MyMedicare elsewhere.
• Phone 91900/91910 for non-MyMedicare patients.
• Telehealth with no face-to-face visit in 12 months and no exemption documented.
• Claiming 35501 when the consult was privately billed.
• Generic template plans with unpersonalised goals.
• Charging a gap on a service and also claiming BBI.

Questions: askMBS@health.gov.au (interpretation) or the Services Australia provider line, 13 21 50 (claiming).

Worked examples

Fictional patients. Fees are 1 Jul 2026 schedule fees (85% benefit for procedures). BBIs are MM1 benefits (10990 $7.50, 75870 $22.40); check MBS Online for later changes.

1. Long consult plus skin excision (bulk billed, MM1)

• 68-year-old, 42 min on BP, diabetes medicines and a new lesion; you then excise a 9 mm suspected BCC on the back.
• Bill: 44 ($128.35) + 75870 ($22.40); 31365 ($161.05) + 10990 ($7.50).
• Total: $319.30.
• Watch out: excision time isn't part of the 42 min (AN.0.9). 31365 needs histology confirming malignancy; if benign, it's 31366 ($97.20).

2. Phone chronic-care review

• MyMedicare-registered patient with COPD and diabetes; GPCCMP made 4 months ago; you review it by phone.
• Bill: 92034 ($160.60) + 10990 ($7.50). 92034 is new: check MBS Online before relying on the BBI pairing.
• Total: $168.10.
• Watch out: no 91891/91900 for the same patient that day, and at least 3 months since the last 965/967 unless exceptional circumstances are noted.

3. Saturday afternoon, bulk-billed pensioner (MM1)

• Saturday 3 pm in rooms, chest infection, 24 min, bulk billed.
• Bill: 5040 ($100.55) + 75870 ($22.40).
• Total: $122.95.
• Watch out: a weekday 7 pm visit isn't after-hours for 5000-series (needs after 8 pm); it's a 36. Concession status no longer affects BBI.

4. Health assessment plus same-day consult

• 77-year-old; nurse 35 min + GP 15 min on a 75+ assessment (50 min); the patient also has a new hot, swollen knee needing separate assessment (8 min).
• Bill: 705 ($227.75) + 10990 ($7.50); 23 ($45.05) + 75870 ($22.40).
• Total: $302.70.
• Watch out: the consult must be clinically necessary and distinct (AN.0.36); document it separately. The nurse can't bill 10997 for assisting.

5. Mental health treatment plan

• MyMedicare-registered patient with depression; you (GPMHSC-trained) spend 45 min on the MHTP and psychology referral; bulk billed.
• Bill: 2717 ($160.50) + 10990 ($7.50). Review 3 months later: 36 ($87.10) + 75870 ($22.40).
• Total: $168.00 today.
• Watch out: time from an earlier consult can't count toward 40 min (AN.0.56); no phone MHTP items.

6. IUD insertion plus an unrelated problem

• Hormonal IUD insertion; you also assess new eczema (10 min); everything bulk billed.
• Bill: 35503 ($188.35) + 35501 + 10990 ($7.50); 23 ($45.05) + 75870 ($22.40).
• Total: $263.30 + 35501 (40% of the 35503 fee, per the LARC fact sheet). Check MBS Online for the exact 35501 amount.
• Watch out: 35501 is lost if any item at the visit is privately billed.

7. Care plan plus practice nurse

• Nurse 30 min collecting history and measures, then GP 20 min completing a GPCCMP for a MyMedicare patient with diabetes and CKD; bulk billed. Two months later the nurse does a foot check and BP review per the plan.
• Bill: day 1, 965 ($160.60) + 10990 ($7.50); day 60, 10997 ($14.35).
• Total: $182.45.
• Watch out: no 10997 on day 1 (assisting the plan) and no 23 with the 965. 10997 can't be claimed with a BBI.

8. NSW workers compensation, first visit

• Warehouse worker with a back strain, 25 min, initial certificate of capacity.
• Bill: AA030 ($205.00) + WCO001 ($58.80 + GST = $64.68).
• Total: $269.68 to the insurer.
• Watch out: not Medicare. The initial certificate is payable once per claim. Treat an unrelated problem as a separate Medicare consult.

Audit risks

• 965/967 with a general attendance same day: not payable, same patient, same practitioner (Services Australia; AN.0.47).
• 965/967 frequency: plan once per 12 months, review once per 3 months, new plan at least 3 months after the last review; earlier only with "exceptional circumstances" on the claim and in the notes (AN.0.47; MBSM12).
• 10997: max 5 per calendar year, needs a plan, not for helping prepare or review the plan or a health assessment, not routinely with a consult (10997 fact sheet; AN.0.36).
• Time-based items: only time with the patient present counts; procedure time and after-visit paperwork don't (AN.0.9). Notes must support the level billed.
• Splitting services: a second same-day attendance must not continue the first; allow a reasonable gap and state each time on the account (AN.0.7).
• After-hours items: 5000-series only weekdays before 8 am/after 8 pm, Saturday before 8 am/after 1 pm, Sundays and public holidays (AN.0.19).
• BBI: only when that service is bulk billed, one per item, never with pathology or imaging, not for admitted patients (MN.1.1).
• Telehealth BBI and phone C/D: 75880–75885 and 91900/91910 only for patients registered in MyMedicare with your practice (MN.1.1; item descriptors).
• Telehealth relationship rule: face-to-face service in the last 12 months or MyMedicare, unless an exemption applies and is documented; MHTP isn't exempt (telehealth fact sheet).
• MyMedicare: a registered patient's GPCCMP (including video/phone) and MHTP must come from their registered practice; otherwise their usual GP (AN.0.47; Services Australia).
• Health assessment + consult: only when both are clinically necessary and distinct (AN.0.36).
• Volume: 80 or more attendances on 20 or more days (or 30/20 for phone) triggers PSR review (prescribed pattern of services).

Sources

• MBS Online — 1 July 2026 news (indexation 2.6%)
• RACGP — 1 July 2026 MBS update
• RACGP — 1 November 2025 MBS updates
• MBS Online — BBI changes 1 Nov 2025 fact sheet
• MBS Online — BBI scenarios
• Department of Health — BBPIP
• MBS Online — Better Access changes fact sheet
• Department of Health — Better Access FAQ (2026)
• Services Australia — GPCCMP billing rules
• HNECC PHN — CCM MBS user guide (Jul 2025)
• Primary Health Tasmania — GPCCM MBS user guide (Jul 2026)
• MBS Online — LARC item changes fact sheet
• University of Melbourne (CERSH) — SRH MBS Guide July 2026
• Department of Health — Telehealth fact sheet for GPs (2026)
• Department of Health — Prescribed pattern of services
• Murray PHN — MBS telehealth card (Jun 2026)
• CESPHN — Cessation of COVID-19 vaccine items
• Heart Foundation — Heart Health Check (699)
• MBS Online — Note MN.1.1, bulk billing incentives
• MBS Online — item 10990 (single BBI; also 10991, 10992, 75855–75858)
• MBS Online — item 75870 (triple BBI; also 75871–75876, 75880–75885)
• MBS Online — item 10997
• DVA — New mental health incentives for GPs and psychiatrists
• MBS Online — November 2026 news
• MBS XML, 1 Nov 2026
• MBS Book, Nov 2026 (AN.0.7, AN.0.9, AN.0.19, AN.0.36, AN.0.47, MN.1.1)
• MBS Online — Medicare Healthy Kids Check fact sheet
• Legislation — Chronic Condition Management Phone Services Determination 2026
• Services Australia — MBSM12 GP chronic condition management plans
• Department of Health — Correct billing of item 10997
• Services Australia — Practice nurse items
• MSAC 1176 — Joint injections (items 50124/50125 removed 2009)
• SIRA — 2026 general practitioner rates

Information only. General information for Australian GPs, not financial, legal or billing advice. Always check MBS Online and AskMBS before claiming. Fees are schedule fees from 1 July 2026.

Accurate as of 7 November 2026. Next update after the 1 March 2027 MBS changes.

maladywise.com/mbs-billing/