Medicare and Billing Information | Current as of 20 January 2022
From 1 January 2022, patient access to specialist telehealth services is supported by permanent Medicare Benefits Schedule (MBS) arrangements. These permanent arrangements consolidate specialist telehealth into a single, national MBS telehealth program.
- Patients continue to be able to access specialist attendances performed either in person (face to face) or by video across all areas of Australia for out-of-hospital services.
- Patients can continue to access specialist services by phone for less complex or shorter subsequent attendances, with a practitioner they have seen before (MBS Item 91832 for initial attendances by telephone has ceased).
- MBS specialist services from 1 January 2022 are for out-of-hospital services.
- These new Australia-wide telehealth items replace the telehealth videoconferencing MBS Item 99 introduced in 2011 to encourage video telehealth in rural and remote areas.
Changes from 16 January 2022 – Reintroduction of some temporary items
On 16 January 2022, the Australian Government announced, in response to the recent surge in COVID-19 cases, temporary reinstatement of:
- Out-of-hospital initial attendance by phone item (MBS Item 91832)
- Inpatient videoconference and phone items for when the admitting practitioner is required to isolate because of public health orders (Items 91846, 91847, 91848, 91849).
MBS telehealth services do not need to be bulk billed. As with all MBS services, where a private fee is charged, it is imperative that informed financial consent principles and processes are applied. Please refer to the College’s Telehealth guidance and the AMA’s Informed Financial Consent resources
For more information on the new arrangements, implications for MBS billing practices and MBS item descriptors, view the Specialist Telehealth Service Factsheet available on MBS online.
| Specialist Services | Equivalent face to face item | Video item | Telephone item |
| Specialist. Initial attendance | 104 | 91822 | 91832 (temporarily reinstated) |
| Specialist. Subsequent attendance | 105 | 91823 | 91833 |
91822 Telehealth attendance for a person by a specialist in the practice of the specialist’s specialty if:
Where the attendance was other than a second or subsequent attendance as part of a single course of treatment. Fee: $90.35 Benefit: 85% = $76.80 |
91832 (Temporarily reinstated from 16 Jan 2022) Phone attendance for a person by a specialist in the practice of the specialist’s specialty if:
Where the attendance was other than a second or subsequent attendance as part of a single course of treatment. Fee: $90.35 Benefit: 85% = $76.80 |
91823 Telehealth attendance for a person by a specialist in the practice of the specialist’s specialty if:
Where the attendance is after the first attendance as part of a single course of treatment. Fee: $45.40 Benefit: 85% = $38.60 |
91833 Phone attendance for a person by a specialist in the practice of the specialist’s specialty if:
Where the attendance is after the first attendance as part of a single course of treatment. Fee: $45.40 Benefit: 85% = $38.60 |
Inpatient items (Temporarily reinstated from 16 Jan 2022) Inpatient videoconference and phone items (Items 91846, 91847, 91848, 91849) for when the admitting practitioner is required to isolate because of public health orders have been temporarily reinstated. See MBS Online for descriptors. |
General Medicare guidance for telehealth billing
You do not need to be within your regular practice to provide telehealth. It can be provided from home. You should use your provider number for your primary location.
In determining whether telehealth is appropriate, Medicare requires the practitioner must:
- Have the capacity to provide the full service through this means safely and in accordance with professional standards; and
- Be satisfied that it is clinically appropriate to provide the service to the patient; and
- Maintain a visual and audio link (or audio only for telephone) with the patient; and
- Be satisfied that the software and hardware used to deliver the service meets the applicable laws for security and privacy
- Only use telephone if video cannot be used.
MBS Online’s Provider FAQ outlines particular Telehealth requirements regarding:
- Documentation required
- Assignment of benefit
- Multiple attendances on the same day (co-claiming is precluded)
- Prescriptions
