Medicare Item Numbers for After Hours GPs

The MBS item numbers below can be used for Telehealth Consultations by After Hours Doctors working in a Deputising Service. Both VR and non-VR Doctors can bill telehealth MBS items.

What is an item number 10992 and when can I bill it?

According to MBS Online a 10992 is a medical service to which:

A medical service to which:

(a) item 585, 588, 591, 594, 599, 600, 5003, 5010, 5023, 5028, 5043, 5049, 5063, 5067, 5220, 5223, 5227, 5228, 5260, 5263, 5265 or 5267 applies; or

(b) item 761, 763, 766, 769, 772, 776, 788 or 789 of a Schedule (within the meaning of the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018) applies;

if:

(c) the service is an unreferred service; and

(d) the service is provided to a person who is under the age of 16 or is a concessional beneficiary; and

(e) the person is not an admitted patient of a hospital; and

(f) the service is not provided in consulting rooms; and

(g) the service is provided in any of the following areas:

(i) a Modified Monash 2 area;

(ii) a Modified Monash 3 area;

(iii) a Modified Monash 4 area;

(iv) a Modified Monash 5 area;

(v) a Modified Monash 6 area;

(vi) a Modified Monash 7 area; and

(h) the service is provided by, or on behalf of, a medical practitioner whose practice location is not in an area mentioned in paragraph (g); and

(i) the service is bulk‑billed in relation to the fees for:

(i) this item; and

(ii) the other item mentioned in paragraph (a) or (b) applying to the service

Additional notes:

After-hours services provided in areas eligible for the higher bulk billing payment – (Item 10992)

Item 10992 can only be claimed where all of the conditions set out in the descriptor of item 10992 have been met:

• Item 10992 must be claimed in conjunction with one of the items 585, 588, 591, 594, 599, 600, 761, 763, 766, 769, 772, 776, 788, 789, 5003, 5010, 5023, 5028, 5043, 5049, 5063, 5067, 5220, 5223, 5227, 5228, 5260, 5263 5265, or 5267.  These items are for services provided after-hours outside of consulting rooms or hospital.
• Item 10992 can only be used where the service is provided in Modified Monash Model areas 2 to 7 by a medical practitioner whose practice location (i.e. the location associated with the medical practitioner’s provider number) is not in one of these areas.

A locator map that can be used to identify a medical practice’s MMM classification is available at the DoctorConnect website at http://www.doctorconnect.gov.au/internet/otd/publishing.nsf/Content/locator

Medical practitioners whose practice location is inside one of the those areas should claim item 10991, 75855, 75856, 75857 or 75858, depending on where the service was rendered.

Item 10992 cannot be claimed in conjunction with items 10990, 10991, 75855, 75856, 75857 or 75858.

Where a Medicare benefit is not payable for a particular service the payment for item 10992 will not be paid for that service.

All GPs, whether vocationally recognised or not, are eligible to claim the additional bulk billing payment.

Commonwealth concession card holder means a person listed on a Pensioner Concession Card, Health Care Card or Commonwealth Seniors Health Card issued by either Centrelink or the Department of Veterans’ Affairs.  Gold or White Cards issued by the Department of Veterans’ Affairs do not attract the additional bulk billing payment.  However, if a Gold or White Card holder also holds a recognised Commonwealth concession card and chooses to be treated under the Medicare arrangements, then that patient is an eligible concession card holder.

Unreferred service means a medical service provided to a patient by, or on behalf of, a medical practitioner, being a service that has not been referred to that practitioner by another medical practitioner or person with referring rights.

The Department of Health will undertake regular post payment auditing to ensure that the additional bulk billing payment is being claimed correctly.

Can all GPs claim a 10992 item number?

All GPs (VR and Non-VR) are able to claim the 10992 item number

What is an item number 10990 and when can I bill it?

For the purposes of Medicare an item 10990 can be billed when a patient has valid Concession card or the patient is under 16. An Item number 10990 is defined by Medicare as:

A medical service to which an item in this Schedule (other than this item or item 10991, 10992, 75855, 75856, 75857 or 75858) applies if:

(a) the service is an unreferred service; and

(b) the service is provided to a person who is under the age of 16 or is a concessional beneficiary; and

(c) the person is not an admitted patient of a hospital; and

(d) the service is bulk‑billed in relation to the fees for:

(i) this item; and

(ii) the other item in this Schedule applying to the service