The 1 January 2023 Medicare Benefits Schedule (MBS) files are available on the January 2023 Downloads page.
Summary of Change for 1 January 2023
From 1 January 2023 there will be several changes to the Medicare Benefits Schedule (MBS). These changes include indexation of the Extended Medicare Safety Net as well as minor administrative and policy changes.
Details of the changes are as follows:
Extended Medicare Safety Net (EMSN)
The EMSN provides an additional Medicare benefit once an annual threshold in out-of-pocket costs for out-of-hospital services has been reached. Out-of-hospital services include general practitioner, specialist and allied health attendances as well as many pathology and diagnostic imaging services. The Original Medicare Safety Net (OMSN) and EMSN thresholds are indexed annually on 1 January in line with the CPI (September Quarter). In addition to applying indexation, the latest changes also include:
- · Indexation of the fixed dollar EMSN benefit cap;
· Application of EMSN benefit caps to recently listed attendance items consistent with the general capping arrangements for attendance services; and
· Application of fixed EMSN benefit caps to recently listed obstetric telehealth services and obstetric ultrasound services.
2023 Medicare Safety Nets Thresholds
Who it’s for
What counts towards the threshold
What benefit you’ll get back
|Original Medicare Safety Net (OMSN)||$531.70||Everyone in Medicare||Your gap amount for the calendar year.||100% of the schedule fee for out of hospital services.|
|Extended Medicare Safety Net (EMSN)- General||$2,414.00||Everyone in Medicare||Your out of pocket amount for the calendar year.||80% of out of pocket costs or the EMSN benefit caps for out of hospital services.|
|Extended Medicare Safety Net (EMSN) - Concessional and Family Tax Benefit Part A||$770.30||Concession cardholders and families eligible for Family Tax Benefit Part A||Your out of pocket amount for the calendar year.||80% of out of pocket costs or the EMSN benefits caps for out of hospital services.|
Extension of COVID-19 services
A range of COVID-19 health measures are being extended for a further twelve months, to 31 December 2023. This extension will include Medicare-subsidised telehealth (for the assessment and management of a person with COVID‑19 infection of recent onset, for the purposes of determining the patient’s eligibility for receiving a COVID‑19 oral antiviral treatment), vaccine suitability items, pathology and diagnostic imaging services.
In addition, pathology items 69506, 69507, 69511 and 69512 have been amended to allow pathology providers to charge fees in excess of the schedule fee for services provided in-hospital under these items and associated items 69508, 69509, 69510, 69513, 69514 and 69515.
Cessation of services from 1 January 2023
As Australia moves into the next phase of living with the COVID-19 virus, further changes to the MBS will occur from 1 January 2023, this includes:
Additional Better Access item changes to remove the additional 10 mental health support services from 1 January 2023. From 2020, 10 additional Medicare-subsidised psychological therapy sessions were made available to eligible people whose mental health has been adversely impacted by COVID-19. These services were in addition to the initial 10 Better Access treatment services under the existing Better Access to Psychiatrists, Psychologists and General Practitioners through the MBS (Better Access) initiative. From 1 January 2023, these additional mental health support services will cease. Eligible people will still be able to access 10 Medicare-subsidised psychological therapy sessions.
COVID-19 GP management support service changes to remove item 93715 from 31 December 2022. MBS item 93715 was temporarily listed on the MBS to support medical practitioners providing clinically relevant treatment to COVID-19 positive patients from 8 November 2021 until 31 December 2022. General attendance services via face to face and telehealth continue to be available to patients.
The purpose of the Health Insurance (Extended Medicare Safety Net) Amendment (Indexation) Determination 2022 is to amend the Health Insurance (Extended Medicare Safety Net) Determination 2017 to provide an additional benefit for Australian families and singles who incur high out-of-pocket costs for Medicare eligible out-of-hospital services.
The purpose of the Health Insurance Legislation Amendment (2022 Measures No. 5) Determination 2022 is to:
- · extend the cessation date for the Health Insurance (General Practice COVID-19 Treatment) Determination 2022 (the COVID-19 Treatment Determination) from 31 December 2022 to
31 December 2023; and
· extend the Health Insurance (Section 3C Pathology Services – COVID 19) Determination 2020 (the Pathology COVID-19 Determination) from 31 December 2022 to 31 December 2023 and remove the requirement that fees charged for in-hospital services cannot exceed the schedule fee.
Please note that this news page is correct at the date of publication listed under “Page last updated” and does not account for any updates to the MBS since this time.