Education guide - Claiming bulk bill incentive items

Information about basic eligibility for claiming bulk bill incentive payments.

Make sure you read the relevant Medicare Benefits Schedule (MBS) item descriptions and explanatory notes at MBS Online.

Medical practitioner eligibility for claiming bulk bill incentive items

All medical practitioners, vocationally registered or not, can claim bulk bill incentive items on eligible unreferred services.

Specialists and consultant physicians are also eligible if they:

  • hold both medical practitioner and specialist Medicare recognition for their qualifications, and
  • provide services to patients in their capacity as medical practitioners

Medical practitioners can only claim bulk bill incentive items if they have met the conditions in the item descriptor. In general, if a health professional provides a bulk billed service, they can claim additional MBS items if:

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

If a Medicare benefit isn’t payable for a service, it’s also not payable for the associated bulk billed incentive item.

The table below gives some explanations for terms on this page.

Term Explanation
Unreferred service When a medical practitioner, or someone acting on their behalf, provides a medical, diagnostic imaging or pathology service that wasn’t referred by a person with referring rights.
Commonwealth concession cardholder

A person who holds one of the following cards issued by Centrelink or the Department of Veterans’ Affairs (DVA):

  • Pensioner Concession Card
  • Health Care Card, or
  • Commonwealth Seniors Health Card

DVA Gold or White Cards aren’t recognised Commonwealth concession cards. DVA Gold or White card holders must hold a concession card listed above to be treated under Medicare arrangements.

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

For items 10991, 10992, 64991 and 74991, additional conditions apply to the location where the medical practitioner provided the service. Refer to MBS Online for details.

Checking a patient’s concessional eligibility

A patient is eligible for a concession if they hold a valid Commonwealth concession card at the date of service.

You can check if a patient’s eligible for a concession in real time:

We base a patient’s concessional eligibility on the information that we know at the time you check.

You can also check if a patient’s eligible for a concession 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

More information

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Page last updated: 20 August 2018