Education guide - Claiming bulk bill incentive items

Information about basic eligibility for claiming bulk bill incentive payments.

We recommend you also read the relevant Medicare Benefits Schedule (MBS) item descriptors and explanatory notes available at MBS Online website.

Bulk bill incentive eligibility requirements

Bulk bill incentive items can only be claimed where the item descriptor has been met. In general, if a health professional provides a bulk billed service or services to a patient, they can claim an additional MBS item or items where they meet the following conditions:

  • the service provided is an unreferred service, and
  • the service provided is for a person under the age of 16 or a Commonwealth concession card holder, and
  • the person isn't an admitted patient in a hospital, and
  • both the service and associated additional item are bulk billed

Where a Medicare benefit isn't payable for a particular service, for example, because the patient has exceeded the number of allowable services in a period of time, then the associated bulk bill incentive item is also not payable for that service.

Term Explanation
Unreferred service When either a medical, diagnostic imaging or pathology service is provided to a patient by, or on behalf of, a medical practitioner and the service hasn’t been referred to that practitioner by another medical practitioner or person with referring rights.
Commonwealth concession cardholder

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 (DVA).

DVA Gold or White Cards aren’t recognised Commonwealth concession cards. If DVA Gold or White cardholders choose to be treated under Medicare arrangements, they must hold 1 of the concession cards listed above to be eligible.

Medical practitioner eligibility for claiming bulk bill incentive items

All general practitioners (GPs), vocationally registered or not, can claim bulk bill incentive items on eligible unreferred services.

Specialists and consultant physicians who hold both GP and specialist Medicare recognition for their qualifications, and provide services to patients in their capacity as GPs, are also eligible.

Bulk bill incentive items

All bulk bill incentive items below are for unreferred services.

Medical service items

  • 10990
  • 10991
  • 10992

Diagnostic imaging service items

  • 64990
  • 64991

Pathology service items

  • 74990
  • 74991

Additional conditions apply to the location where the service was performed for items 10991, 10992, 64991 and 74991. Refer to the MBS Online website for details.

Checking a patient’s concessional eligibility

If a patient holds a valid Commonwealth concessional card at the date of service, they are considered concessional.

You can check a patient’s concessional status in real-time:

A patient’s concessional eligibility is based on the information known by us at the time you check.

You can also check a patient’s concessional status by:

  • viewing the patients concession card
  • confirming the patient is the person named on the concession card, and
  • making sure the concession card is valid and current

Be aware that we audit practices’ activities to make sure additional bulk billing payments are claimed correctly.

More information

Online:

Contact us for Medicare provider enquiries.

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Page last updated: 23 August 2016

This information was printed Saturday 3 December 2016 from humanservices.gov.au/health-professionals/enablers/education-guide-claiming-bulk-bill-incentive-items It may not include all of the relevant information on this topic. Please consider any relevant site notices at humanservices.gov.au/siteinformation when using this material.