Billing pregnancy ultrasound services under Medicare

29 November 2017

Health professionals, make sure you know the rules when billing pregnancy ultrasound services.

The Medicare Benefits Schedule (MBS) lists the requirements you need to meet before you bill a pregnancy ultrasound service under Medicare.

You can find the rules and limitations in MBS item descriptors 55700 to 55775.

These include:

  • patient clinical indications
  • limitations on the number of services that can be claimed for a pregnancy
  • pre-requisite services needed for the same pregnancy
  • services that can’t be billed together

It’s important you know these rules and limitations before you bill your patients and Medicare.

Services that don’t meet these rules will be rejected and won’t get a Medicare benefit.

You can check if your patient is eligible for a Medicare service by using the MBS item checker in HPOS.

Next steps

For more information about pregnancy ultrasound requirements see Mbsonline.gov.au.

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Page last updated: 1 December 2017