Technical information

Description of Medicare-subsidised GP, allied health, specialist and diagnostic imaging services

For detailed information on the Medicare Benefits Schedule (MBS) services and item types, see the Australian Government Department of Health: MBS Online Website

GP attendances

Reported services

Description

BTOS/Group/subgroup/
item included(a)

GP attendances (total)

GP attendances include Enhanced Primary Care, After-hours GP attendances, Practice Incentive Program (PIP) services, and ‘Other’ GP services. These services are Medicare-subsidised patient/doctor encounters, such as visits and consultations, for which the patient has not been referred by another doctor. These services can be provided by a GP or other medical practitioner. Excludes services provided by practice nurses and Aboriginal and Torres Strait Islander health practitioners on a GP’s behalf.

BTOS 101, 102, 103(b) (GP subtotals: Enhanced Primary Care, After-hours GP attendances, PIP services, and Other)

GP – Enhanced Primary Care

Reported services

Description

BTOS/Group/subgroup/
item included(a)

GP subtotal – Enhanced Primary Care

GP subtotal – Enhanced Primary Care includes Health Assessments, Chronic Disease Management Plans, Multidisciplinary Case Conferences, Domiciliary and Residential Medication Management Reviews, and Mental Health services (including preparation or review of mental health treatment plans, extended consultations related to a mental health issue but excluding focussed psychological strategies and family group therapy).

These services are designed to provide a structured approach for GPs to care for people with chronic conditions and complex care needs, and to improve coordination of care for people who require multidisciplinary, team-based care.

BTOS 102(b)

GP Health Assessment

Health assessment of a patient's physical and psychological health and function and recommendation of preventive health care or education to improve that patient's health and physical, psychological and social function. Eligible patients include: people of Aboriginal and Torres Strait Islander descent, people who have an intellectual disability, refugees and humanitarian entrants, residents of residential aged care facilities, people aged 75 years or older, and people aged 40-49 years with a high risk of developing type 2 diabetes or at risk of developing another chronic disease.

Group A14

GP Chronic Disease Management Plan

Services relating to the preparation, coordination and review of a GP Management Plan for patients with a chronic or terminal medical condition. A chronic medical condition is one that has been, or is likely to be, present for six months or longer. Services also include the coordination and review of Team Care Arrangements and contribution to Multidisciplinary Care Plans. 

Subgroup A15.1

GP Multidisciplinary Case Conference

Service where a medical practitioner (not including a specialist or consultant physician) organises and coordinates, or participates in, multidisciplinary case conferences for patients who have a chronic condition that has been (or is likely to be) present for 6 months or longer, or is terminal, and who has complex multidisciplinary care needs. Case conferences generally involve the patient’s usual GP and at least two other providers, such as allied health professionals, other medical practitioners, home and community service providers, and care organisers (e.g. “meals on wheels” providers).

Part of subgroup A15.2 (only items: 735–758)

Medication Management Review (domiciliary)

Also known as Home Medicines Review. Available for people living in the community who are at risk of medication misadventure. Intended to maximise an individual patient's benefit from their medication regimen, and prevent medication-related problems through a team approach, involving the patient's GP and preferred community pharmacy or accredited pharmacist.

Item 900

Medication Management Review (residential)

A collaborative medication management service available to permanent residents of a Residential Aged Care Facility for whom quality use of medicines may be an issue or who are at risk of medication misadventure.

Item 903

GP Mental Health

Early intervention, assessment and management of patients with mental disorders by GPs or other medical practitioners (who are not specialists or consultant physicians). These services include assessments, planning patient care and treatments, referring to other mental health professionals, ongoing management and review of the patient’s progress.

This group comprises MBS items for the preparation and review of GP Mental Health Treatment Plans as well as extended consultations related to mental health issues, excluding GP Focussed Psychological Strategies and Family Group Therapy.

Subgroup A20.1

 

GP – After-hours GP attendances

Reported services

Description

BTOS/Group/subgroup/
item included(a)

GP subtotal – After-hours GP attendances

GP subtotal – After-hours GP attendances include urgent and non-urgent after-hours GP care.

GP attendances provided on a public holiday, a Sunday, before 8am or after 1pm on a Saturday (after 12pm for urgent care or at a place other than a consulting room), or before 8am or after 8pm on a weekday (after 7pm for urgent care or at a place other than a consulting room).

Group A11, A22, A23 (all items/groups below)

After-hours GP (urgent)

After-hours GP attendance where the patient’s medical condition requires urgent assessment to prevent deterioration or potential deterioration in health and the assessment cannot be delayed until the next in-hours period. Eligibility requirements changed on 1 March 2018, which may affect comparability over time. Prior to this date, patients required urgent medical treatment (rather than assessment) to be eligible, and could book an urgent after-hours service two hours in advance (booking option no longer available).

Group A11

After-hours GP (non-urgent)

After-hours GP attendance for non-urgent assessment and treatment. These vary in time and complexity. Includes home visits and visits to Residential Aged Care Facilities.

Groups A22, A23

GP – Practice Incentive Program (PIP) services

Reported services

Description

BTOS/Group/subgroup/
item included(a)

GP subtotal – Practice Incentive Program (PIP) services

GP subtotal PIP includes services provided as part of the Practice Incentive Program.

This program aims to support general practice activities including continuous improvements, quality care, enhance capacity and improve access and health outcomes for patients. A practice must be accredited, or registered for accreditation to participate in PIP services. Includes cervical smear, diabetes mellitus annual cycle of care and asthma cycle of care PIP services.

Group A18, A19 (all items/groups below)

Cervical smear PIP

A service where a cervical smear is taken from a person between the age of 24 years and 9 months and 74 years inclusive who has not had a cervical smear in the last four years. Eligibility requirements changed on 1 December 2017, which may affect comparability over time. Prior to this date, people aged between 20 and 69 years inclusive who have not had a cervical smear in the last four years could receive the service.

Subgroups A18.1, A19.1

Diabetes Mellitus Annual Cycle of Care PIP

This service aims to encourage GPs to provide earlier diagnosis and effective management of people with established diabetes mellitus. The Annual Diabetes Cycle of Care must be completed over a period of 11 to 13 months, and includes (but is not limited to) measuring patients’ blood pressure, cholesterol and HbA1c, examining eyes and feet and reviewing diet, physical activity and medications. Completion of a Diabetes Cycle of Care through the use of these items will initiate a Diabetes Service Incentive Payment (SIP) through the PIP.

Subgroups A18.2, A19.2

Asthma Cycle of Care PIP

At a minimum the Asthma Cycle of Care includes at least 2 asthma related consultations within 12 months for a patient with moderate to severe asthma. This includes diagnosis and assessment of level of asthma control and severity of asthma, review of the patient's use of and access to asthma related medication and devices, provision of an asthma action plan and asthma self-management education.

Subgroups A18.3, A19.3

GP – Other

Reported services

Description

BTOS/Group/subgroup/
item included(a)

GP subtotal – Other

GP subtotal – Other includes: GP Short (Level A), GP Standard (Level B), GP Long (Level C), GP Prolonged (Level D), Other non-referred medical practitioner, GP Focussed Psychological Strategies and Family Group Therapy, GP Prolonged - Imminent danger of death, GP Acupuncture, GP Pregnancy support counselling and GP Telehealth (patient-end support) services. These are non-referred attendances by a GP or other medical practitioner. Does not include after-hours GP enhanced primary care and PIP services.

Groups A1, A2, A5, A6, A7, A16, A27, A30 and subgroup A20.2 (all items/groups below)

GP Short (Level A)

Professional attendance by a GP for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management.

Items 3, 4, 20

GP Standard (Level B)

Professional attendance by a GP lasting less than 20 minutes, involving (where clinically relevant) taking patient history, performing a clinical examination, arranging any necessary investigation, implementing a management plan, and/or providing appropriate preventive health care.

Items 23, 24, 35

GP Long (Level C)

Professional attendance by a GP lasting at least 20 minutes, involving (where clinically relevant) taking detailed patient history, performing a clinical examination, arranging any necessary investigation, implementing a management plan, and/or providing appropriate preventive health care.

Items 36, 37, 43

GP Prolonged
(Level D)

Professional attendance by a GP lasting at least 40 minutes, involving (where clinically relevant) taking extensive patient history, performing a clinical examination, arranging any necessary investigations, implementing a management plan, and/or providing appropriate preventive health care.

Items 44, 47, 51

Other Non-referred Medical Practitioner

Non-referred professional attendance by a medical practitioner who is not a vocationally registered GP. These services are broadly similar to the other GP services included in this report. Includes services provided to patients in the community and residential aged care facilities.

Groups A2, A16

GP Focussed Psychological Strategies and Family Group Therapy

Includes Focussed Psychological Strategies for patients with assessed mental disorders by an eligible GP, and family group therapy. The provision of Focussed Psychological Strategies to a patient must be made either in the context of a GP Mental Health Treatment Plan, shared care plan or a psychiatrist assessment and management plan.

Subgroup A20.2, Group A6

GP Prolonged - Imminent danger of death

Prolonged attendance for a patient in imminent danger of death. Services range from at least 1 hour to 5 hours or more.

Group A5

GP Acupuncture

Professional attendance at which acupuncture is performed by a medical practitioner who is a qualified medical acupuncturist by application of stimuli on or through the surface of the skin by any means. For the purpose of payment of Medicare benefits "acupuncture" is interpreted as including treatment by means other than the use of acupuncture needles where the same effect is achieved without puncture, e.g. by application of ultrasound, laser beams, pressure or moxibustion, etc.

Items 173, 193, 195, 197, 199

GP Pregnancy Support Counselling

Non-directive pregnancy support counselling services provided to a person who is pregnant or who has been pregnant in the 12 months preceding the first service, by a medical practitioner (including a GP, but not including a specialist or consultant physician).

Group A27

GP Telehealth (patient-end support)

Provision of clinical support by a medical practitioner to a patient (in a telehealth eligible area) who is participating in a video conferencing consultation with a specialist or consultant physician.

Group A30

Nursing and Aboriginal Health Workers

Reported services

Description

BTOS/Group/subgroup/
item included(a)

Nursing and Aboriginal Health Workers (total)

Includes services provided by Practice Nurses, Aboriginal Health Workers, Midwives and Nurse Practitioners.

Groups M2, M12, M13, M14 (Practice Nurse/Aboriginal Health Worker, Midwifery and Nurse Practitioner items)

Practice Nurse/Aboriginal Health Worker

Service by a practice nurse, Aboriginal health worker or Aboriginal and Torres Strait Islander health practitioner provided on behalf of, and under the supervision of, a medical practitioner. This group includes telehealth patient-end support services. These services do not require a referral.

Groups M2, M12

Midwifery

Antenatal, intrapartum and postnatal care provided by participating midwives who have a collaborative arrangement with an authorised medical practitioner in place that must provide for consultation, referral or transfer of care as clinical needs dictate, to ensure safe, high quality maternity care. This group includes telehealth patient-end support services.

Group M13

Nurse practitioners

Services provided by nurse practitioners who have a collaborative arrangement with an authorised medical practitioner so they can assist if clinically relevant. Includes, but is not limited to, clinical examinations, implementing management plans, and telehealth patient-end support services.

Group M14

Allied Health attendances

Reported services

Description

BTOS/Group/subgroup/
item included(a)

Allied Health attendances (total)

Allied Health attendances total includes Medicare-subsidised primary health services provided by a broad range of health professionals who are not doctors, nurses or dentists, comprising all services provided in the Optometry, Mental Health Care, Physical Heath Care, and ‘Other’ allied health subtotals. These services are generally only available to patients with chronic, mental, developmental, and/or complex health conditions with a referral from a GP or specialist medical practitioner.

BTOS 150(c), 900 (Allied health subtotals: Optometry, Mental Health Care, Physical Health Care and Other)

Allied Health – Optometry

Reported services

Description

BTOS/Group/subgroup/
item included(a)

Allied Health subtotal – Optometry

Optometry services provided by eligible optometrists for the assessment of vision and diagnosis and treatment of other eye conditions. In general, asymptomatic patients aged less than 65 years are eligible for a Medicare-subsidised optometry service every 3 years, while asymptomatic patients aged 65 or over are eligible ever year. Some patients may be eligible for more frequent Medicare-subsidised services (e.g. patients with progressive disorders or significant changes in visual function). Prior to 1 January 2015 asymptomatic patients aged less than 65 years were eligible every 2 years. From 1 September 2015, includes patient-end telehealth support services, where optometrists can provide clinical support to their patient during video consultations with ophthalmologists. Does not include the purchase of glasses or contact lenses; cosmetic surgery; tests for fitness to undertake sporting, leisure or vocational activities; or attendances on behalf of teaching institutions on patients of supervised students of optometry.

BTOS 900

Allied Health – Mental Health Care

Reported services

Description

BTOS/Group/subgroup/
item included(a)

Allied Health subtotal – Mental Health Care

Allied Health subtotal – Mental Health Care includes assessment, treatment and management of patients with mental disorders by clinical psychologists, other psychologists and other allied mental health workers. Does not include psychiatry services. Note: From 1 November 2017, patients living in telehealth eligible areas (regional, rural and remote Australia) were able to claim telehealth psychological services.

Groups M6, M7, items 10956, 10968, 81325, 81355, 82000, 82015

Clinical Psychologist(d)

Psychological therapy services provided by eligible clinical psychologists. Includes individual attendances, group therapy, and telehealth video consultations. Note: Clinical psychologists may also claim services included in the ‘Other Psychologists’ and ‘Other Allied Mental Healthcategories.

Group M6

Other Psychologist(d)

Focussed Psychological Strategies and enhanced primary care services provided by any eligible psychologist, including clinical and other psychologists (i.e. fully registered psychologists in the relevant jurisdiction regardless of any specialist clinical training). Includes individual attendances, group therapy, and telehealth video consultations.

Group M7 (first half: 80100 – 80121); items 10968, 82000, 82015,  81355

Other Allied Mental Health(d)

Mental health services provided by other allied health professionals such as occupational therapists, mental health nurses, Aboriginal health workers and some social workers. Psychologists (clinical or other) may also provide some of these services, however they cannot be readily separated from the other mental health workers included in the group. These services cover Focussed Psychological Strategies—allied mental health (occupational therapist and social worker items) and enhanced primary care—allied health (mental health worker item). Includes individual attendances, group therapy, and telehealth video consultations.

Group M7 (second half: 80125 – 80171); items 10956, 81325

Allied Health – Physical Health Care

Reported services

Description

BTOS/Group/subgroup/
item included(a)

Allied Health subtotal – Physical Health Care

Allied Health subtotal – Physical Health Care includes physiotherapy, exercise physiology, chiropractic and osteopathy services provided to a person who has a chronic condition and complex care needs, and/or is of Aboriginal or Torres Strait Islander descent.

Items 10960, 81335, 10953, 81315, 81110, 81115, 10964, 81345, 10966, 81350

Physiotherapy(e)

Physiotherapy service involving the non-surgical treatment of musculoskeletal and related pain and movement issues. Provided by an eligible physiotherapist to a person who has a chronic condition and complex care needs, and/or is of Aboriginal or Torres Strait Islander descent.

Items 10960, 81335

Exercise Physiology

Exercise physiology service involving exercise-based interventions for a broad range of health conditions. Provided by an eligible exercise physiologist to a person who has a chronic condition and complex care needs, and/or is of Aboriginal or Torres Strait Islander descent. Includes individual and group services.

Items 10953, 81315, 81110, 81115

Chiropractic Services

Chiropractic service involving the non-surgical treatment of musculoskeletal and related pain and movement issues. Provided by an eligible chiropractor to a person who has a chronic condition and complex care needs, and/or is of Aboriginal or Torres Strait Islander descent.

Items 10964, 81345

Osteopathy

Osteopathy service involving the non-surgical treatment of musculoskeletal and related pain and movement issues. Provided by an eligible osteopath to a person who has a chronic condition and complex care needs, and/or is of Aboriginal or Torres Strait Islander descent.

Items 10966, 81350

Allied Health – Other

Reported services

Description

BTOS/Group/subgroup/
item included

Allied Health subtotal – Other

Allied Health subtotal – Other includes podiatry, dietetics, occupational therapy, speech pathology, diabetes education, audiology and other allied health services provided to a person who has a chronic, developmental, and/or complex health condition and/or is of Aboriginal or Torres Strait Islander descent.

Items 10962, 81340, 10954, 81320, 81120, 81125, 10958, 81330, 82010, 82025, 10970, 81360, 82005, 82020, 10951, 81305, 81100, 81105, 10952, 81310, 82300, 82306, 82309, 82312, 82315, 82318, 82324, 82327, 82332, 81000, 81005, 81010, 82030, 82035, 10950, 81300

Podiatry

Podiatry service involving diagnosis and treatment of disorders of the foot, ankle and lower extremity. Provided by an eligible podiatrist to a person who has a chronic condition and complex care needs, and/or is of Aboriginal or Torres Strait Islander descent.

Items 10962, 81340

Dietetics

Dietetics service provided by an eligible dietitian to help patients appropriately manage their diet and nutrition. Eligible patients include people who have a chronic condition and complex care needs, and/or are of Aboriginal or Torres Strait Islander descent. Includes individual and group services.

Items 10954, 81320, 81120, 81125

Occupational Therapy(f)

Occupational therapy service involving the assessment and intervention to develop, recover, or maintain meaningful activities, or occupations. Provided by an eligible occupational therapist to a person who has a chronic condition and complex care needs; and/or is of Aboriginal or Torres Strait Islander descent; or is a child aged under 15 years for the diagnosis or treatment of a pervasive developmental disorder (PDD) or an eligible disability.

Items 10958, 81330, 82010, 82025

Speech Pathology

Speech pathology service involving the diagnosis and treatment of communication disorders of eligible patients with a referral, including people with chronic and complex conditions, children aged under 13 years, or for the treatment of a PDD for children aged under 15 years.

Items 10970, 81360, 82005, 82020

Diabetes Education

Diabetes education service to assist in managing diabetes by enhancing patient’s knowledge about diabetes and self-management. Provided by an eligible diabetes educator to a person who has a chronic condition and complex care needs, and/or is of Aboriginal or Torres Strait Islander descent. Includes individual and group services.

Items 10951, 81305, 81100, 81105

Audiology(e)

Audiology service involving the diagnosis, treatment, and monitoring of disorders of the auditory and vestibular systems. Provided by an eligible audiologist to a person who has a chronic condition and complex care needs; and/or is of Aboriginal or Torres Strait Islander descent; or for the diagnosis and/or treatment and/or management of ear disease or a related disorder; or for the detection of permanent congenital hearing impairment of an infant or child.

Items 10952, 81310, 82300, 82306, 82309, 82312, 82315, 82318, 82324, 82327, 82332

Other Allied Health

Medicare-subsidised allied health services not included in the above six sub-groups. Includes Aboriginal or Torres Strait Islander health services by an eligible Aboriginal health worker or eligible Aboriginal and Torres Strait Islander health practitioner; non-directive pregnancy support counselling services provided by an eligible psychologist, social worker or mental health nurse; and audiology, optometry, orthoptic or physiotherapy health services provided to a child aged under 13 years with a PDD or eligible disability. To protect confidentiality, these items were combined.

Items 81000, 81005, 81010, 82030, 82035, 10950, 81300

Diagnostic Imaging

Reported services

Description

BTOS/Group/subgroup/
item included(a)

Diagnostic Imaging services (total)

Medicare-subsidised diagnostic imaging procedures such as X-rays, computerised tomography scans, ultrasound scans, magnetic resonance imaging scans and nuclear medicine scans.

BTOS 600

Specialist attendances

Reported services

Description

BTOS/Group/subgroup/
item included(a)

Specialist attendances (total)

Specialist attendances include psychiatry services and early intervention services for children, as well as other specialist attendances not reported separately in this report. Specialist attendances are Medicare-subsidised referred patient/doctor encounters, such as visits, consultations, and attendances by video conference, involving medical practitioners who have been recognised as specialists or consultant physicians for Medicare benefits purposes.

BTOS 200 (Psychiatry, Early Intervention and other services — not reported separately)

Psychiatry

Medicare-subsidised services provided by a psychiatrist, including patient attendances (or consultations), group psychotherapy, tele-psychiatry, case conferences and electroconvulsive therapy. Electroconvulsive therapy may be provided by either a psychiatrist or another medical practitioner together with an anaesthetist.

Group A8, A15 (855, 857, 858, 861, 864, 866), T1.13 (14224)

Early Intervention Services for Children

Professional attendance of at least 45 minutes, by a consultant paediatrician, consultant physician or specialist of another discipline, or GP, for assessment, diagnosis and preparation of a treatment and management plan for a child aged under 13 years with autism, another PDD or another eligible disability. This may include referral to Medicare-subsidised allied health treatment services available through the Helping Children with Autism program.

Group A29

Sources: AHPA 2017; Department of Health 2018.

Notes

  1. Medicare codes are based on the 1 May 2018 Medical Benefits Schedule book (Department of Health 2018c). Broad Type of Service (BTOS) groups similar Medicare services. See Appendix B of the Technical note for services contained in each BTOS. MBS items can also be grouped into a hierarchy of ‘Group’ – ‘Subgroup’ – ‘Item’. MBS Groups start with a letter followed by a two numbers, e.g. Group A15. All items within a nominated group are included, unless stated. An MBS Subgroup is represented by a Group code followed by a full stop and a number, e.g. Subgroup A15.1. This indicates all items within the subgroup have been included, unless stated. Where a Group or Subgroup is followed by numbers in brackets (e.g. A15.2 (735–779)), only the MBS items in the brackets are included.

  2. Excludes item 6087 (Health Care Home MBS item) to protect confidentiality.

  3. Excludes items in groups N1, N2, N3 (Medicare Chronic Disease Dental Scheme), which ceased 1 December 2012.

  4. 'Clinical psychologist' refers to 'Clinical psychologist psychological therapy services'. 'Other psychologist' includes other psychology services that can be provided by clinical psychologists or other psychologists. Psychologists (clinical or other) also provide some ‘Other Allied Mental Health’ services.

  5. Does not include ‘Other Allied Health’ MBS items 82030 and 82035.

  6. Does not include the ‘Other Allied Mental Health’ MBS items 80145 and 80146 (Mental health services provided by occupational therapists).