Why are there different Medicare Rates?
The A1, A2 and A7 Medicare Rates were created to reflect recognised levels of expertise, reward and incentivise investment in postgraduate specialist qualifications, and encourage more doctors to work in regional, rural and remote areas.
What are the differences between these Rates?
A1 Medicare rates are the highest amounts Medicare will pay for a service. For example, for a standard A1 consult, Medicare will pay $41.20.
A2 rates operate at 60% of the A1 Medicare rate, meaning that for a standard consult, a doctor billing A2 rates will only receive $21.
A7 rates operate at 80% of the A1 Medicare rate, meaning that for a standard consult, a doctor billing A7 rates will receive $52.
You will also need to bill different item numbers depending on what A rate you are eligible for.
What A-Rate are you eligible for?
Vocationally Registered General Practitioners and Doctors on a Fellowship Training Program such as RVTS, AGPT, FSP, PEP or ACRRM Independent Pathway are eligible to bill A1 Medicare Rates.
For Non- Vocationally Registered doctors, the rates you are eligible to bill depend on where you work and what services you provide.
For Non-VR Doctors working in a MMM 1 location, you will, for the most part, be billing A2 Medicare Rates. However for some longer consults, health assessments and other services you will be eligible to bill at the A7 rate.
For Non-VR doctors working in a MMM 2-7 location, you will be eligible to bill A7 Medicare Rates.
We have included the following table as a quick reference for you.
|Service type||MM 1 locations||MM 2-7 locations|
|Standard GP Consults||A2||A7.2|
|Chronic Disease Management||A7.6||A7.6|
|Standard GP Consults (PIP)||A19||A7.8|
|Standard After Hours||A7.10||A7.10|
|Pregnancy Support||A7.11 (must meet item credentialing)||A7.11 (must meet item credentialing)|
For more information, check out our MBS Items Quick Reference Guide which provides a snapshot of commonly billed items for General Practitioners!
Note: The information presented above has been gathered from MBS web pages and has been updated as of 25.07.2023.
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Information from this blog has been taken directly from: