This guide aims to help GPs and GP trainees understand how bulk billing incentives apply to different consultation types and how MyMedicare enrolment affects item eligibility. This guide will focus on services provided in Modified Monash 1 areas.
Understanding Bulk Billing Incentives in MM1 Areas
General Practitioners practicing in Modified Monash 1 (metropolitan) areas can access three different bulk billing incentives when bulk billing eligible patients:
- Item 10990: Standard bulk billing incentive
- Item 75870: Enhanced “triple” bulk billing incentive.
- Item 75880: MyMedicare-specific bulk billing incentive (for enrolled patients only)
Patients eligible for BBIs include:
- Children under 16 years of age
- Commonwealth Concession Card holders
The Impact of MyMedicare Enrolment
MyMedicare enrolment has significant implications for both the consultation items you can claim and the bulk billing incentives available.
How MyMedicare Affects Telehealth Services
Video Consultations
- For patients NOT enrolled in MyMedicare:
- All levels (A through E) are available.
- BBI item 10990 applies to Level A, C, D and E consultations.
- BBI item 75870 applies to Level B consultations only.
- For patients enrolled in MyMedicare:
- All levels (A through E) are available.
- BBI item 10990 applies to Level A
- BBI item 75870 applies to Level B consultations only.
- BBI item 75880 applies to Levels C, D, and E
Phone Consultations
- For patients NOT enrolled in MyMedicare:
- Only Level A (91890) and Level B (91891) are available.
- BBI item 10990 applies to Level A
- BBI item 75870 applies to Level B
- For patients enrolled in MyMedicare:
- Level A (91890) and Level B (91891) are available.
- Extended options including Level C (91900) and Level D (91910)
- BBI item 10990 applies to Level A
- BBI item 75870 applies to Level B
- BBI item 75880 applies to Levels C and D
Note: There are no Level E phone consultation items available, regardless of enrolment status.
Consultation Item Numbers by Time Tiers (Levels A-E)
Standard Hours (In Consulting Rooms)
Standard Hours (Outside Consulting Rooms)
Residential Aged Care Facility
Telehealth – Video Consultations
Telehealth – Phone Consultations
After Hours (In Consulting Rooms)
Frequently Asked Questions
How does MyMedicare enrolment affect phone and video item eligibility?
MyMedicare enrolment significantly expands the telehealth options available to patients:
- Video consultations: Without MyMedicare enrolment, all levels except Level B are only eligible for the standard BBI. With enrolment, Levels B through E are eligible to the enhanced or MyMedicare-specific BBI.
- Phone consultations: Without MyMedicare enrolment, only Level A and B consultations are available. With enrolment, patients can access Levels A through D with respective BBI as outlined above.
Which incentive applies to each Standard Hours consultation item number if the patient is enrolled in MyMedicare vs. not enrolled?
- For Level A consultations: BBI item 10990 applies regardless of MyMedicare enrolment status.
- For Levels B, C, D, and E: BBI item 75870 applies regardless of MyMedicare enrolment status.
What is the “usual medical practitioner” requirement for telehealth services?
To access telehealth (video and phone) items, patients must see their “usual medical practitioner” unless an exemption applies. This requirement ensures continuity of care and is in addition to the MyMedicare enrolment requirements for longer consultation items.
Can I claim a bulk billing incentive for all Medicare services provided to eligible patients?
No, bulk billing incentives cannot be claimed for all services. For example, they cannot be claimed for COVID vaccine support services. Bulk billing incentives can be claimed when a medical practitioner bulk bills an unreferred service to an eligible patient. Unreferred services include standard consultations, chronic disease management items, mental health items, health assessments, and minor procedures. The Health Insurance (General Medical Services Table) Regulations 2021 defines an unreferred service as a “medical service provided by, or on behalf of, a medical practitioner to a patient who has not been referred to the practitioner for the service.” This includes almost all general practice services.
Key Points to Remember
- MyMedicare enrolment enables access to longer telehealth consultation items, particularly for phone consultations.
- Three different bulk billing incentives are available (10990, 75870, and 75880), with specific application rules based on:
- Consultation level (A through E)
- MyMedicare enrolment status
- Consultation type (face-to-face, video, or phone)
- Time-tiered consultation items follow a consistent pattern:
- Level A: Brief, straightforward
- Level B: 6-20 minutes
- Level C: 20+ minutes
- Level D: 40+ minutes
- Level E: 60+ minutes
- Telehealth consultations have additional requirements:
- “Usual medical practitioner” requirement
- MyMedicare enrolment for longer consultations
Understanding the interplay between consultation item numbers, MyMedicare enrolment, and bulk billing incentives is essential for GPs practicing in metropolitan areas. By correctly applying these items, practitioners can maximise reimbursement while providing accessible care to vulnerable populations.
Disclaimer
This guide is provided for educational and informational purposes only. It represents our interpretation of the Medicare Benefits Schedule (MBS) at the time of writing but should not be considered a definitive or official interpretation of Medicare legislation, regulations, or policies. The MBS and related policies are subject to change, and the official MBS documentation should always be consulted for the most current and accurate information.
The responsibility for correct Medicare billing remains solely with the healthcare provider. Any decisions made based on the information in this guide are the responsibility of the practitioner. The authors and publishers of this guide accept no liability for any loss, damage, or injury resulting from the use of this information. We strongly recommend that practitioners verify all billing practices with the Department of Health and Aged Care, Services Australia, or through appropriate professional channels before implementation.
For definitive guidance, please refer to the official MBS Online website, relevant legislation, and other official government resources.
