MBS Update: What Changed on 1 November 2026 – Phone Care Plans, Kids Checks and MMM

Bottom Line: Add 92033 and 92034 to your billing templates, start booking 3-year-olds for the Healthy Kids Check on items 701-707, and check your practice’s Modified Monash category today, because it sets your bulk-billing incentive.

Why the November MBS Changes Matter

Most of the November amendment is administrative, but four changes alter what happens in a general practice consultation room or on the practice’s bank statement. The phone items close a gap left by the July 2025 move from GP Management Plans to GP chronic condition management plans (GPCCMPs): until 1 November there was no MBS item for a phone care plan at all.

The Healthy Kids Check is the Medicare arm of the Government’s Thriving Kids initiative, which the RACGP has long advocated for. The Modified Monash realignment should not be overlooked: it can change practice revenue without any change in clinical behaviour.

The Change in Detail

Phone GPCCMP items 92033, 92034, 92063 and 92064

Fees match the face-to-face (965, 967, 392, 393) and video (92029, 92030, 92060, 92061) equivalents. Fees for 92033 and 92063 were checked against MBS Online on 1 November 2026.

The rules, per explanatory note AN.0.47:

• Not subject to the established clinical relationship rule. Instead, the MyMedicare and usual medical practitioner requirements apply: a MyMedicare-registered patient must use their registered practice
• Same frequency limits as other GPCCMP items: prepare no more than once every 12 months (and at least 3 months after the last review); review no more than once every 3 months
• Exceptional circumstances (a significant change in clinical condition or care circumstances) allow earlier services, documented in the record and flagged on the claim
• No same-day co-claiming with general attendance items such as 3, 4, 23 and 5000 for the same patient by the same practitioner
• Not available for people in residential care homes or admitted hospital patients
• Allied health access is unchanged: up to five services per calendar year

The Medicare Healthy Kids Check

There is no new item number. The check is a new health assessment type billed on the existing time-tiered items:

Per explanatory note AN.14.4:

• Eligibility: Medicare-eligible children from their third birthday to the day before their fourth birthday, once only
• Required components: history (including developmental milestones, behaviour, sleep, nutrition, activity, screen use, toileting and family circumstances), basic examination including eyesight, hearing, oral health, height, weight and BMI centile, assessment, advice, interventions and referrals, a record in the medical file, and offering a written report to the parent or carer
• Use paediatric BMI centile charts, never adult charts
• A kindergarten check does not prevent an MBS Healthy Kids Check
• Having the check does not affect eligibility for other health assessments, such as the Aboriginal and Torres Strait Islander health assessment
• If not all requirements are met, bill a time-tiered attendance item instead. Follow-up visits are billed as standard attendances

Practices cannot see claims made elsewhere, so ask the parent or caregiver whether the child has already had the check. As with other health assessments, practice nurses may assist the medical practitioner with undertaking the health assessment (AN.0.36).

Modified Monash 2023 and your bulk-billing incentive

MM location classifications across general medical and diagnostic imaging services now align with the 2023 Modified Monash categories. Bulk-billing incentive items are tied to MM category: 10990 (MM1), 10991 (MM2) and 75855-75858 (MM3 to MM7). If your practice’s category changed under the 2023 model, your incentive changed on 1 November with no action on your part. This can be checked by accessing the Health Workforce Locator.

Paediatric ABPM, item 11607

Ambulatory blood pressure monitoring now covers children and adolescents aged five to under 18, using age-, sex- and height-adjusted percentiles. More information about the requirements for this service can be found here.

Other changes worth knowing

• Item 14245: a qualified health practitioner can now give immunomodulating treatment on behalf of the prescribing practitioner
• Item 73813: wider definitions of eligible Aboriginal and Torres Strait Islander health worker and health professional for chlamydia, gonorrhoea and trichomonas point-of-care testing
• Items 12306-12322: participating nurse practitioners can refer for bone densitometry
• Items 73358-73360: paediatricians no longer need to consult a clinical geneticist before requesting childhood syndrome genetic testing
• “Residential aged care facility” becomes “residential care home” across the MBS, with no fee changes

Clinical and Practical Implications

The phone items are likely to be used most for reviews, where much of the between-visit work is already happening by phone. Two cautions apply. First, clinical appropriateness still matters: the Government’s position is that a phone plan must meet the same standard as a face-to-face one, and a review that needs examination should not be done by phone. Second, phone services count toward the 30/20 telephone attendance compliance threshold, so practices and GPs with high phone volume should monitor their totals.

What You Need to Do

1. Add items 92033, 92034, 92063 and 92064 to your billing software and fee schedule.
2. Brief reception staff that phone care plan bookings are now billable, and that MyMedicare-registered patients must use their registered practice.
3. Build a Healthy Kids Check template covering every AN.14.4 component, including the written report for parents.
4. Recall 3-year-olds from your patient list and ask parents whether the check has been done elsewhere.
5. Check your practice location in the Health Workforce Locator and confirm the correct bulk-billing incentive item.
6. Update templates and documents that use “residential aged care facility”.
7. Register for the RACGP Healthy Kids Check webinar on 26 November 2026 if your team is new to the check. Link can be found here.

Summary

• Effective date: 1 November 2026, now in force
• Phone GPCCMP items: 92033 and 92034 ($160.60), 92063 and 92064 ($128.55), 100% benefit
• No established clinical relationship rule; MyMedicare and usual practitioner rules apply
• Healthy Kids Check: items 701-707 (GP) and 224-227, once only, ages 3 to under 4
• Written report to the parent or carer must be offered
• Modified Monash 2023 realignment can change your bulk-billing incentive item
• Item 11607 ABPM now covers ages 5 to under 18
• Objective: bill new services correctly from day one and protect practice incentive revenue

Sources: MBS Online, Changes commencing 1 November 2026; MBS Online items 92033, 92063, 703 and 10990 and explanatory notes AN.0.47 and AN.14.4 (accessed 1 November 2026).

This article is for educational purposes for health professionals. Always check current MBS Online descriptors before billing.