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Read the relevant item descriptions, fact sheets and explanatory notes on the MBS Online website.
When you can bill attendance items
When you immunise your patient, you may be able to bill a Medicare Benefits Schedule (MBS) attendance item. You can only do this if other funding doesn’t cover the cost of giving it.
If you address an unrelated medical issue at the same time you give a mass immunisation vaccine, you can bill for this. You can only bill for the time you spend managing the unrelated medical condition.
If a mass immunisation program doesn’t cover the vaccine you’re giving, you can bill for both:
- time spent giving the vaccine
- managing the unrelated medical condition.
MBS items only cover medical services. This means you can’t bill Medicare for the vaccine itself.
Learn more about Medicare benefits and vaccinations on explanatory note GN.12.32 on the MBS Online website.
About mass immunisation programs
Funded mass immunisation programs cover the costs of giving vaccines. They can be funded by any of the following:
- the Australian Government
- a state government
- a private organisation.
There are no Medicare benefits for giving vaccines covered by these programs.
COVID-19 vaccine suitability assessment service
There are MBS items to assess if your patient can get the COVID-19 vaccine.
The MBS COVID-19 vaccine suitability assessment service is free for patients and must be bulk billed.
You can bill this service to Medicare when you’ve assessed your patient and any of the following:
- given them the vaccine
- not given them the vaccine for clinical reasons
- they don’t consent to the vaccine.
To provide a COVID-19 vaccine suitability assessment, the vaccine must be available immediately after in the same location. The supervising GP must be present.
You can bill an MBS attendance item if you address an unrelated medical issue at the same time you do this assessment. Find out more about billing multiple MBS items.
You can claim a flag fall service item 90005 if you travel to provide the service at a:
- residential aged care facility
- residential disability setting facility
- person’s place of residence.
You can only claim the flag fall service item for your first appointment at each location.
For more information, read about Medicare Support for COVID-19 Vaccinations on MBS Online.
Billing scenarios
There are common scenarios when billing for immunisations.
A patient attends your practice for a COVID-19 vaccine suitability assessment. They also request an urgent review of their chronic disease management (CDM) plan, so they can get a new referral for physiotherapy.
You determine in this case that it’s clinically relevant to provide both:
- a vaccine suitability assessment
- a CDM review service.
You must bulk bill the COVID-19 vaccine suitability assessment service. You can also co-claim an MBS attendance item for the CDM review.
You can choose how to bill the patient for the attendance item.
You see a patient to give them an influenza vaccine. The NIP doesn’t cover them for the influenza vaccine.
After taking your patient’s history, you give them the vaccine.
You can bill an MBS attendance item for the time you spend on both your patient history and giving the vaccine.
You can charge your patient for the cost of the influenza vaccine. You can’t bill Medicare for the vaccine itself.
You see a patient to give them an influenza vaccine. The NIP covers the cost of the vaccine but not the administration cost.
After taking your patient’s history, you give them the vaccine.
You can bill the appropriate attendance item for the medical service you provided. You can’t charge the patient a separate amount for the cost of the influenza vaccine.
You’re employed by a state or territory community health centre to administer vaccines. The service is not eligible for Medicare benefits as it’s a mass immunisation program.
You can’t bill an MBS item. You’re giving a vaccine under an arrangement with the state or territory.
You see a patient to give them an influenza vaccine. Your patient’s employer is covering the cost of the vaccine and the administration.
You can’t bill an MBS item. We can’t pay Medicare benefits if the employer of the patient pays for the medical expense.