Medicare and Billing Information | Current as of April 20 2020

There are several options available for billing telehealth consultations. These include:

  • Temporary telehealth MBS items (bulk-billing no longer a requirement for any patient as of 20 April 2020 – see details below)
  • The existing telehealth videoconferencing MBS Item 99 for eligible patients, based primarily on their location i.e. in a telehealth eligible area OR in residential care OR is a patient at an Aboriginal Medical Service or ACCHO. Patient eligibility can be found on MBS Online.
  • Telehealth can also be conducted privately. Note there is no patient Medicare rebate.

It is imperative that informed financial consent principles and processes are applied to all telehealth consultations. Please refer to the College’s Telehealth guidance and the AMA’s Informed Financial Consent resources.

Temporary MBS Telehealth items

Temporary MBS Telehealth items (videoconferencing and phone) are available to all Australians.

The items are general in nature and have no relation to diagnosing, treating or suspecting COVID-19. The services will be available until 30 September 2020.

As of 20 April 2020, Specialists and allied health providers are no longer required to bulk-bill COVID-19 telehealth consultations where the service is provided to a concessional or vulnerable patient or a child under 16. Specialists and allied health providers may continue their usual billing practices.

GPs and Other Medical Practitioners must continue to bulk-bill the COVID-19 telehealth and telephone consultation services where the service is provided to a concessional or vulnerable patient or a child under 16 at the time the service is provided. For all other patients, these services may be bulk-billed.

Visit MBSOnline for more information. It is anticipated that revised MBSOnline factsheets and FAQs will be available shortly.

Specialist Services

Existing Items

face to face

Telehealth items

via video-conference

Telephone items

for when video-conferencing is not available

Specialist. Initial attendance1049182291832
Specialist. Subsequent attendance1059182391833

91822

Telehealth attendance for a person by a specialist in the practice of the specialist’s specialty if:

  1. the attendance follows referral of the patient to the specialist; and
  2. the attendance was of more than 5 minutes in duration; and
  3. the service is bulk-billed.

Where the attendance was other than a second or subsequent attendance as part of a single course of treatment.

Fee: $88.25 Benefit: 85% = $75.05

 

91823

Telehealth attendance for a person by a specialist in the practice of the specialist’s specialty if:

  1. the attendance follows referral of the patient to the specialist; and
  2. the attendance was of more than 5 minutes in duration; and
  3. the service is bulk-billed.

Where the attendance is after the first attendance as part of a single course of treatment.

Fee: $44.35 Benefit: 85% = $37.70

 

91832 

Phone attendance for a person by a specialist in the practice of the specialist’s specialty if:

  1. the attendance follows referral of the patient to the specialist; and
  2. the attendance was of more than 5 minutes in duration; and
  3. the service is bulk-billed.

Where the attendance was other than a second or subsequent attendance as part of a single course of treatment.

Fee: $88.25 Benefit: 85% = $75.05

 

91833 

Phone attendance for a person by a specialist in the practice of the specialist’s specialty if:

  1. the attendance follows referral of the patient to the specialist; and
  2. the attendance was of more than 5 minutes in duration; and
  3. the service is bulk-billed.

Where the attendance is after the first attendance as part of a single course of treatment.

Fee: $44.35 Benefit: 85% = $37.70

General Medicare guidance for telehealth billing

You do not need to be within your regular practice to provide telehealth. It can be provided from home. You should use your provider number for your primary location.

In determining whether telehealth is appropriate, Medicare requires the practitioner must:

  • Have the capacity to provide the full service through this means safely and in accordance with professional standards; and
  • Be satisfied that it is clinically appropriate to provide the service to the patient; and
  • Maintain a visual and audio link (or audio only for telephone) with the patient; and
  • Be satisfied that the software and hardware used to deliver the service meets the applicable laws for security and privacy
  • Only use telephone if video cannot be used.

MBSOnline’s Provider FAQ outlines particular Telehealth requirements regarding:

  • Documentation required
  • Assignment of benefit
  • Multiple attendances on the same day (co-claiming is precluded)
  • Prescriptions

The Department of Health provides an email service for questions around COVID-19 telehealth items: COVIDResponse@health.gov.au