Clarifying MBS Items that are Hospital Only Services - Tranche 2

The 75% benefit level is for in hospital only services. The 85% benefit level is for out of hospital services.

Several MBS items for specialist procedural services that should only be provided as hospital treatment and billed at 75% of the schedule fee are still able to be claimed at the 85% benefit.

In two consultation phases with clinical peak bodies and specialist colleges, items for the removal of the 85% benefit were identified. The Department of Health, Disability and Ageing also wrote to each state or territory health department to advise of the consultation being undertaken.

In phase one, 55 clinical bodies and specialist colleges were consulted. Of the 965 items reviewed, 833 items lost the 85% benefit. The changes were implemented on 1 March 2025.

In phase 2, the department consulted with 60 clinical peak bodies and specialist colleges. Outcomes of the consultation resulted in a list of 129 MBS items that will have the 85% benefit removed. This means the Extended Medicare Safety Net no longer applies to these items. 43 MBS items will have the 75% benefit removed.

The changes will ensure the MBS items reflect the settings in which they should be provided and will reduce incorrect billing of out-of-hospital services.

Further information can be found in the Quick Reference Guide below:

PDF Version - Quick Reference Guide - Clarifying MBS Items that are Hospital Only Services - Tranche 2.pdfWord Version - Quick Reference Guide - Clarifying MBS Items that are Hospital Only Services - Tranche 2.DOCX