COVID MBS items Explainer and FAQs, No. 64, 18 July 2022


Dear Doctors and Health Care Workers

Hot off the press there are two new covid telephone item numbers for GPs which will commence tomorrow, and we also have an update about the 80/20 rule.

First the two new GP items.

We received an updated MBS file late this afternoon and in it were the two new covid anti-viral item numbers, 93716 (for GPs) and 93717 (for OMPs). The relevant determination has also hit the Federal Register today. Here’s the link

Key points:

  • The Determination will sunset on 31 October 2022
  • Modality is telephone
  • No co-claiming with other attendance items
  • Outpatients only
  • Minimum time taken is 20 minutes for GPs and 25 minutes for OMPs
  • Reimbursed at 85% of the schedule fee
  • The patient’s COVID-19 infection has been confirmed by either PCR or RAT

80/20 rule update

We reported recently that the updated version of the 80/20 rule has been postponed, together with implementation of the 30/20 rule.

Well, while both rules still appear as ‘in force’ on the Federal Register, a review of Medicare’s online material indicates that only the 30/20 rule will be delayed until 1 October 2022, but the new 80/20 rule is apparently going to be enforced.

So, what is the new 80/20 rule? Well basically, from 1 July 2022, rather than applying only to face to face services, video and telephone services are also now included in the prescribed pattern of services. It applies to GP services only.

Please be careful out there with your billing everyone. The Medicare and PSR investigations have been unrelenting of late.

Stay well everyone.

Margaret and the Synapse team.

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