Factsheet - New MBS Items at RACF (PDF 444 KB)
Factsheet - New MBS Items at RACF (DOC 490 KB)
What are the new services?
From 1 March 2019, new Medicare rebates will be available for the provision of professional services by a general practitioner (GP) or medical practitioner at a RACF. This includes a one off single call-out fee and new standard Level A to D MBS attendance items.
What is the new single call-out fee?
The new Medicare items (MBS items 90001 and 90002) provide a $55 fee for GPs and a $40 fee for medical practitioners to attend a RACF. Doctors are then able to claim a standard Level A to D MBS item for each RACF resident attended to. The call-out fee is for the initial attendance at one RACF, on one occasion, applicable only to the first patient seen on the RACF visit.
The single call-out fee reflects the costs doctors incur when providing professional services during a visit to a RACF. The single call-out fee items will have their Medicare benefit paid at 100% of the schedule fee. If doctors do not bill the single call-out fee, the benefit will not be paid.
What are the patient eligibility requirements?
The Medicare benefit for the single call-out fee and the associated general consultation (either Level A to D) applies only for patients within a RACF who have a general consultation with a doctor in person. The bulk billing incentive only applies to the attendance item, not to the single call-out fee.
Are there any restrictions on the number of services?
The single call-out fee is payable only for the first patient seen at that RACF on any one occasion. If a doctor has to return to the RACF facility twice or more on the same day and the attendances are not a continuation of an earlier episode of treatment, another call-out fee would apply per subsequent RACF visit.
MBS items 90001 and 90002 are not to be used with existing derived fee services such as for afterhours, urgent afterhours, or telehealth services. The bulk billing incentive cannot be billed to MBS item 90001 or 90002.
Will there still be a derived fee for visiting a RACF?
From 1 March 2019, standard Level A to D MBS items rebates for RACF residents will be exempt from the derived fee model. Doctors will now bill for attendance/s, plus the new single call-out fee following a RACF attendance. The ready reckoner model will continue to apply to other RACF items (i.e. after hours, and patient end support at video conferencing).
What happens to the previous GP RACF derived fee model?
This new simplified arrangement replaces the derived fee model which was based on a sliding scale related to the number of patients seen. The new items will be paid at 100% of the MBS fee and will be listed in Group A35 of the MBS.
From 1 March 2019:
The following table outlines the 12 attendance items to replace the existing 12 ready reckoner items for the provision of professional services by GPs and medical practitioners at a RACF.
· RACF derived fee MBS items 20, 35, 43, 51, 92, 93, 95, 96, 183, 188, 202 and 212 will be obsolete
· GP’s attending at a RACF will use MBS items 90020, 90035, 90043, 90051; and
· Medical practitioners attending at a RACF will use MBS items 90092, 90093, 90095, 90096, 90183, 90188, 90202, 90212
· When claiming the new attendance items there is no longer a requirement to transmit the number of patients seen.
Are the new items geographically conditional on the RACF location?
Yes, but only for medical practitioner attendance items. GP attendance items are not geographically restricted.
|Current item (obsolete from 1 March 2019)||New item from 1 March 2019||Fee/Benefit ||Provider|
|20||90020||$17.20/(100% of fee)||GP |
|35||90035||$37.60/(100% of fee)||GP |
|43||90043||$72.80/(100% of fee)||GP |
|51||90051||$107.15/(100% of fee)||GP |
|92||90092||$8.50/(100% of fee)||Medical practitioner MM 1 |
|93||90093||$16/(100% of fee)||Medical practitioner MM 1 |
|95||90095||$35.50/(100% of fee)||Medical practitioner MM 1 |
|96||90096||$57.50/(100% of fee)||Medical practitioner MM 1 |
|183||90183||$13.75/(100% of fee)||Medical practitioner MM 2-7 |
|188||90188||$30.10/(100% of fee)||Medical practitioner MM 2-7 |
|202||90202||$58.25/(100% of fee)||Medical practitioner MM 2-7 |
|212||90212||$85.70/(100% of fee)||Medical practitioner MM 2-7 |
If a medical practitioner attends a RACF located in a MM1 area, MBS items 90092, 90093, 90095, 90096 apply, and for a RACF located in a MM2-7 area, MBS items 90183, 90188, 90202, 90212 apply. You can find the MM classification of a RACF location by using the Modified Monash Model locator.
Find out more
The full item descriptor and information on other changes to the MBS can be found at the MBS Online website or by emailing ASKMBS@health.gov.au.