In March 2025, the Australian Government introduced a new wave of Medicare Benefits Schedule (MBS) updates. While MBS updates occur frequently, this round includes significant changes that directly impact anaesthetists operating in private practice.
If you bill Medicare, work across multiple service locations, or rely on telehealth, it’s crucial to understand the latest regulations to ensure your billing remains compliant—and profitable.
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Here are a few important updates to be aware of:
1. Removal of 85% Out-of-Hospital Benefit
Over 800 MBS items have been amended to remove the 85% out-of-hospital rebate. Now, the benefit will only be payable for services provided in a hospital setting.
What these MBS updates mean for you:
- Services delivered in day surgeries or non-hospital locations may not be eligible for full Medicare rebates.
- Accurate documentation of service location is more important than ever.
- You may need to update your gap fee policies and patient communication strategies.
2. Revised Telehealth Definitions
The term “telehealth attendance” has been replaced with “video attendance”, while “telehealth” becomes a catch-all term for both video and phone consultations.
This change specifically affects item number 92701, which applies only to video consultations and must meet the following criteria:
- 15 minutes or more
- Undergoing advanced surgery OR who has complex medical problems
- Taking a hisoptry and forming a written patient management plan
For further information on this item number change, please visit here.
Action items:
- Double-check you’re using the correct MBS item numbers for video vs phone services.
- Ensure your billing team is educated on the distinctions.
- Update pre-op or post-op telehealth workflows accordingly.
3. Steps to take now
- Review your service location definitions
- Ensure your billing software reflects updated item codes
- Train admin staff or medical secretaries
- Engage with a specialist billing company to audit your current process
If you’re unsure how these MBS updates and changes affect your practice, our team is here to help. Solo Practice Management specialises in anaesthetic billing and can guide you through the updates to ensure accurate, compliant claims—every time.
If you would like to reach out to one of our billing experts, please contact us here.