Read the relevant item descriptions, fact sheets and explanatory notes at MBS Online.
When you bill an item, it’s your responsibility to do all of the following:
- understand the complete medical service principle
- select the correct item for the service you provide
- meet the conditions of the description of the item
- consider whether your peers would choose the same treatment for your patient.
If you bill an item incorrectly, you may get a penalty and need to repay the money.
For help with interpreting the MBS, contact AskMBS at the Department of Health and Aged Care website.
There are basic rules for billing multiple MBS item numbers.
Subsequent attendance with an item in Group T8
There are some subsequent attendance items which can’t be billed on the same day with any Group T8 surgical item either:
- equal to the applicable threshold
- greater than the applicable threshold.
These are attendance items 105, 116, 119, 386, 2806, 2814, 3010, 3014, 6009, 6011, 6013, 6015, 6019, 6052 or 16404.
Group T8 items include items 30001-51171.
You can bill specialist subsequent attendance items 111, 117 or 120, if all of the following apply:
- the procedure was not scheduled
- you couldn’t predict the procedure before the start of the attendance
- the service meets the item description.
You can bill subsequent attendance item 115 if all of the following apply:
- the attendance can’t be deferred due to a risk to the patient
- you couldn’t predict the attendance prior to the procedure
- the attendance is unrelated to the scheduled T8 surgical procedure
- the service meets the item description and requirements.
Co-claiming head and spine MRI scans
Only one MRI scan for the same region is payable at the same attendance. If the patient has more than one scan, the MBS item with the highest fee will attract a benefit.
You’ll get paid for more than one item where both of these apply:
- the requester states there is a clinical need for separate and distinct scans
- you indicate this on your claim.
You’ll need to provide supporting text with your claim if the services are performed at either:
- at separate attendances
- were clinically needed.
| Restrictions apply to MBS items in Category 5 | Item detail |
|---|---|
| Head MRIs - Group I5, Subgroup 1 to 5 | Items in range 63001 to 63131 restrict with each other |
| Spine MRIs - Group I5, Subgroup 6 to 10 | Items in range 63151 to 63280 restrict with each other |
Read more about this co-claiming limitation on the MBS Online website.
Where no other procedure is performed
You can bill an item containing the phrase ‘where no other procedure is performed’ when both:
- the procedure is performed in isolation on the patient
- no other procedure occurs at the time.
Items with this phrase are usually procedures for controlling post-operative bleeding and bladder catheterisation. You should bill these items for an independent, stand-alone service and not in association with a surgical procedure.
Multiple operation rule
The multiple operation rule (MOR) applies if you bill 2 or more MBS items from Category 3, Group T8 for surgical services performed on a patient on one occasion.
Amputation items in Subgroup 12 of Group T8 are not subject to this rule.
You can calculate the total schedule fee for all surgical items by applying the MOR. That is:
- 100% of the fee for the item with the highest schedule fee
- plus 50% of the fee for the item with the next highest schedule fee
- plus 25% of the fee for any further surgical items.
Applying this rule results in one total schedule fee for all surgical items billed. We calculate the Medicare benefit payable based on this schedule fee.
Read more about the Multiple Operation Rule on the MBS Online website.