COVID MBS items Explainer and FAQs, No. 62, 01 July 2022


Dear Doctors and Health Care Workers

Unsurprisingly, there was another 11th hour change announced late yesterday, and we have had a few excellent questions overnight. First though the announcement.

The Federal Health Minister, the Hon Mark Butler MP, has decided to postpone the introduction of the 30/20 and newly designed 80/20 rules for three months, till 30 September 2022. It hasn’t hit the Federal Register yet, but I expect it will be updated in the coming days. We will keep an eye on it for you, but you can relax based the Minister’s announcement. These new rules will not be enforced before 1 October 2022.

Now to the questions.

1.I am having difficulty understanding the 80/20 rule. If I render 4 X Item 91830’s 4 days a week on a regular basis, would I be breaching the rule?

 No. This will not break the rule. You have to consult 80 patients (including phone consults under the new rules coming in now in October) in a single day, and do this on 20 days in a year to break the rule.

2.You have indicated that most of the telephone items have been removed for specialists, however, I do not see 91834 and 91835 in your summary table. That is what most of us would use as haematologists on a telephone (not video) call. May I please confirm that these items are still permissible.

Good point! They are not there, and on close examination of the legislation it looks to me that the department has fallen behind with these updates and we will be receiving another file soon when they realise their error.

Have a look at this fact sheet, which was updated today, and you will see that items 91834 and 91835 are no longer there –$File/Factsheet-specialist-telehealth-1July%202022%20.pdf

This is confusing, but not surprising. Keep billing the relevant items while they are available, and we will keep an eye on updates for you. I expect they will officially disappear next week.

3.With the 30/20 rule, my taking is it only applies if the specialist makes over 30 phone consults on more than 20 days to be sent to PSR. So, if a consultant makes 4 calls a day, 3 days a week for 48 weeks – this would be considered reasonable practice under the Act? Thanks again for the very helpful advice, always appreciated

You would not breach the 30/20 rule based on the scenario you have described. Thank you also for your lovely comment.

 4.These items not deleted according to MBS online 91834, 91835, 92431, 92432 please clarify.

See above answer to question 2. Items 92431 and 92432 have also been removed from the 1 July Fact sheet. We think it is a departmental error and would not be surprised if your claims reject. But keep billing them while they appear to be available. We think the department will catch up and remove these items and we will receive an updated file very soon.

Have a great weekend everyone.

Margaret and the Synapse team.

< Back