Bulk Billing Incentives

Publication Date: 1 January 2026

SUMMARY

Bulk billing incentives (BBIs) are additional payments made to medical practitioners when they bulk bill unreferred services.

Admitted hospital patients are not eligible for BBIs.

The specific BBI item that should be co-claimed with an eligible medical service depends on:

• The geographic location of the practice (by Modified Monash area). This can be checked on the Health Workforce Locator.
  The specific medical service (MBS item) provided, and
  In some cases, whether the patient is registered at the practice providing the service through the MyMedicare program. Information on MyMedicare is available on the Department of Health, Disability and Ageing's website.

Claiming tables are available for each Modified Monash area:

• MN.1.3 – Modified Monash 1
• MN.1.4 – Modified Monash 2
• MN.1.5 – Modified Monash 3-4
• MN.1.6 – Modified Monash 5
• MN.1.7 – Modified Monash 6
• MN.1.8 – Modified Monash 7

USE OF THE ITEMS

BBIs can be claimed when a medical practitioner bulk bills an unreferred service.

What is an unreferred service?

The Health Insurance (General Medical Services Table) Regulations 2021 defines an unreferred service as a "medical service provided by, or on behalf of, a medical practitioner to a patient who has not been referred to the practitioner for the service.”

Which bulk billing incentive should be used?

There are 20 BBI items broken into three categories. Each category includes a BBI item number for use in each Modified Monash area (see table below). The Modified Monash area used to determine the appropriate BBI is the area where the medical practitioner’s practice is located. BBI items within each category should be used with:

• Category 1: any unreferred services not covered by category 2 or 3 including, but not limited to:
  • Level A general attendances (and equivalents)
  • Level C, D, E telehealth (phone and video) attendances where the patient is not registered with the practice through MyMedicare
  • Chronic condition management and health assessment items
  • Better Access mental health and eating disorder items
  • Antenatal attendances 
  • Minor procedures
• Category 2: any Level B general attendances (face to face, phone, video), and Level C, D and E face to face consultations. This category also includes the equivalent items used in residential aged care facilities, out of consulting rooms, and after hours
• Category 3: for patients registered with the practice through MyMedicare only, Level C, D and E video and Level C and D phone

The practice location is the location associated with the Medicare provider number used by the medical practitioner when providing the service. In general, the practice location associated with the provider number is used regardless of where the medical service is provided (e.g. out of consulting rooms, in a residential aged care facility) or, in the case of telehealth (phone and video), the location of the patient. However, for the after-hours BBIs (10992 and 75872), both the practice location and the patient location are considered. These items can only be claimed with specific after-hours MBS items in limited circumstances.

Practice Location:	MM1 Metropolitan Areas	MM1 (but service is provided after hours in MM 2-7)	MM2 Regional centres	MM3-4 Large or medium rural towns	MM5 Small rural towns	MM6 Remote communities	MM7 Very remote communities
Level B, C, D, E (face to face)   Level B (phone and video)	75870	75872	75871	75873	75874	75875	75876
Level C, D, E (phone and video) and the patient is registered in MyMedicare	75880	NA	75881	75882	75883	75884	75885
All other eligible services not covered above	10990	10992	10991	75855	75856	75857	75858

Additional information on the after-hours BBIs – MBS items 10992 and 75872

Items 10992 and 75872 can only be claimed in conjunction with specified after-hours MBS items. In addition to the standard requirements for use of BBIs, the following additional requirements apply:

• The service is not provided in consulting rooms
• The service is provided in a Modified Monash 2-7 area, and
• The service is provided by, or on behalf of, a medical practitioner whose practice is in a Modified Monash 1 area.

CO-CLAIMING RESTRICTIONS

BBIs must be claimed in conjunction with an eligible MBS item. BBIs can only be claimed when the patient is bulk billed for the medical service. Only one BBI can be claimed in conjunction with each medical service (i.e. each MBS item) that is provided.

BBIs cannot be claimed in conjunction with diagnostic imaging or pathology services. A separate set of incentives are available to use in conjunction with diagnostic imaging and pathology services.

ELIGIBLE PATIENTS

All patients eligible for Medicare are eligible for BBIs when relevant services are bulk billed. Admitted hospital patients are not eligible for BBIs.

ELIGIBLE PRACTITIONERS

All medical practitioners who bulk bill a relevant medical service can claim BBIs.

Different BBIs are payable for practice locations in different Modified Monash areas. The relevant Modified Monash area is determined by the location associated with the medical practitioner's provider number used to provide the service. This means that if the service is provided away from the practice location (e.g. in a residential aged care facility or home visits), the location of the practice, not the location of the consultation, is used to determine the relevant Modified Monash area for BBI purposes (except in relation to items 10992 and 75872).

The Modified Monash area for your practice can be checked on the Health Workforce Locator.

RECORD KEEPING AND REPORTING REQUIREMENTS

Medicare benefits are patient benefits. It is a legal requirement that the patient assigns their benefit to the medical practitioner when a service is bulk billed. Information about recording assignment of benefit is available on the Services Australia website.

The Department of Health, Disability and Ageing undertakes regular post payment auditing to ensure that BBIs are claimed appropriately. Practitioners should ensure they keep relevant and contemporaneous records.

RELEVANT LEGISLATION

BBIs are specified in the Health Insurance (General Medical Services Table) Regulations 2021.