COVID Vaccine Medicare Item Numbers and Their Requirements

MBS Item Numbers

From March 2021, 16 new MBS items will be available to enable GPs and suitably qualified health professionals to assess patients for their suitability to receive a COVID-19 vaccine.

The 16 new MBS COVID-19 vaccine suitability assessment items are categorised by: 

  • Practitioner (GP/OMP) +
  • Location (metropolitan/non-metropolitan) + 
  • Time Period (business/after hours) + 
  • Dose (first dose/second dose).

 MBS items 93624, 93625, 93626, 93627, 93634, 93635, 93636 and 93637 are available to assess patients’ suitability for the first dose of a COVID-19 vaccine dose.

 MBS items 93644, 93645, 93646, 93647, 93653, 93654, 93655 and 93656 are available to assess patients’ suitability for the second dose of a COVID-19 vaccine dose.

Services are available in Modified Monash Area 1 (metropolitan) and Modified Monash Area 2 to 7 (rural and remote) locations, in both the business hours and after-hours periods

Services rendered under the COVID-19 vaccine suitability assessment items will only attract a Medicare rebate where the service is billed in the name of the supervising GP, who must be present at the location at which the vaccine suitability assessment service is undertaken and must accept full responsibility for the service.

Vaccine Suitability Assessment

The vaccine suitability assessment service is free to patients and the MBS items must be bulk billed.

In order for a vaccine suitability assessment service to be billed to Medicare, the patient must receive a face-to-face attendance from the GP or suitably qualified health professional. Patients are expected to receive the MBS vaccine suitability assessment service twice, once at the same time they receive the first dose and again when they receive the second or subsequent dose of a COVID-19 vaccine.

A GP or a suitably qualified health professional is expected to use their clinical judgement to decide if a patient meets the eligibility criteria for receiving a COVID-19 vaccination, which are available on the Australian Government Department of Health website at https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/information-for-covid-19-vaccination-providers.

In cases where a patient is assessed as not being suitable (and does not receive a vaccination), the GP would still be able to bill Medicare for the vaccine assessment service, using the appropriate COVID-19 vaccine suitability assessment MBS item number.

Who can administer the vaccine?

A vaccination provided to a patient who has received a vaccination suitability assessment service can be

provided by a GP or suitably qualified health professional who is appropriately qualified and trained to provide an immunisation to the patient. This includes having completed any mandatory Commonwealth training associated with the delivery of COVID-19 vaccination services.

Under these arrangements, a vaccination may be provided by an endorsed enrolled nurse employed by a general practice where the endorsed enrolled nurse:

– is also under the supervision of a registered nurse; and

– has completed mandatory COVID-19 training.

Who is eligible to receive the suitability assessment service?

Under Phase 1B of the COVID-19 vaccination program, priority population groups include:

– people 70 years of age or older;

– other health care workers;

– Aboriginal and Torres Strait Islander people 55 years or older;

– people with an underlying medical condition, including people with a disability; and

– critical and high risk workers.

 It is a further requirement that an eligible patient be a person aged 18 years or older who is eligible for Medicare.

What do the new arrangements mean for GPs?

The GP must be present at the location at which the vaccine suitability assessment service is undertaken, and subsequent vaccination of the patient, and must accept full responsibility for the service. This includes any time in which the patient is under observation for adverse reactions following the administration of a vaccine.

If a patient is assessed as being suitable to receive a COVID-19 vaccine, it is expected the vaccine would be administered to the patient a short time after the assessment, on the same day.

The vaccine suitability assessment may include a short patient history, and limited examination and management, where this is clinically relevant.

In line with recommended clinical practice, patients receiving a vaccine must be observed for a period of time after vaccination to ensure there is no immediate adverse reaction.

How will the new MBS COVID-19 vaccine suitability assessment items be billed?

The MBS COVID-19 vaccine suitability assessment items can only be billed to Medicare by the GP.

For the service to be valid, a COVID-19 vaccine must be available for immediate delivery to a patient who is assessed as suitable.

The rebate for a first dose service is higher than the rebate for a second dose service.

This difference recognises that GPs and suitably qualified health professionals may need to spend more time obtaining the patient’s consent and providing information about the vaccine before delivering the first dose.

What are the record keeping and reporting requirements?  

Whenever a MBS COVID-19 vaccine suitability assessment service is provided, it is essential that the general practice record the reasons for the patient’s attendance and the outcomes of the consultation, including whether or not the patient received a COVID-19 vaccine. 

Can I co-claim the COVID-19 vaccine items with other general attendance items?  

Patients presenting with multiple clinical matters requiring attention should be encouraged to book a separate consultation, and preferably with their usual practice.  There may be some circumstances where deferral of treatment is not feasible or in the patient’s best interests; these include clinical matters where treatment cannot be deferred or opportunistic treatment for other conditions.  Standard MBS multiple same-day attendance rules apply for COVID-19 vaccination-related services. Co-claiming is only permitted where another GP service is provided that is unrelated to the vaccine assessment item. 

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