MBS Aged Care: What It Is and What Providers Do

The MBS, or Medicare Benefits Schedule, is the Government's list of health services for which Medicare may pay a benefit. In MBS aged care terms, GP visits, nurse practitioner consultations, pathology and imaging are paid through Medicare to the practitioner who bills. They are not paid from your care subsidy or a client's Support at Home budget.

So your service does not claim these items. It still needs to know where the line sits, because access, consent, records and fee transparency remain your responsibility. This article is general information, not legal or billing advice.

Key Takeaways

The Medicare Benefits Schedule lists the health services Medicare may subsidise, and each service has an item number, a descriptor and a Schedule fee.
The practitioner bills Medicare, not the aged care provider. The Department's fact sheet on residential GP items says doctors employed by the home and nurses cannot claim them.
Support at Home does not fund care provided under other government programs such as Medicare, so a GP consultation is not drawn from a participant's budget.
Providers still own access, consent support, their own visit records and clear fee information.

What is the MBS, and who bills it?

The Department's Medicare provider handbook describes the MBS as the list of health services for which the Government may pay a Medicare benefit. Each service is an MBS item with a unique number, a descriptor, a Schedule fee and a benefit rate. Items sit in eight categories, including professional attendances, pathology, diagnostic imaging and a miscellaneous group that covers allied health and nurse practitioner services. Our MBS glossary entry covers the basics.

The registered practitioner bills, and the patient receives the benefit. When a practitioner bulk bills, the person assigns their benefit to the practitioner, who accepts it as full payment. The handbook says a bulk billing provider cannot charge the patient additional fees for that service, including practice or administration fees.

The MBS Online fact sheet on GP residential aged care items says those items are for Medicare-eligible GPs and other medical practitioners providing primary care in these homes. It says doctors employed by the home, specialists, consultant physicians, nurses and other allied health practitioners cannot claim them. The page was last updated in 2019, so treat it as background and check current items on MBS Online.

How does GP and nurse practitioner care reach people in aged care?

The arrangements introduced on 1 March 2019 added a call-out item for a doctor's travel to the home, billable only for the first person seen on a visit, plus attendance items for each person. Doctors who return the same day should keep evidence to support a second call-out, so a simple visit log on your side helps.

Since 1 July 2024, eligible GPs and practices registered with MyMedicare can also receive payments under the General Practice in Aged Care Incentive for regular visits and care planning with people who permanently live in residential aged care. Respite residents are not included. The payment goes to the practice, not to you, and the Department's resident FAQ says regular Medicare, bulk billing and out-of-pocket arrangements still apply as the practice decides.

Nurse practitioners bill under their own MBS items. MBS Online records changes to those items from 1 March 2025, including a revised structure for attendance items and two new long attendance items.

Medicare also subsidises consultations in person or by telehealth, and pathology tests. A visit may therefore be remote or may produce a test request. Your telehealth and digital health policy and pathology and diagnostic services policy should say how staff handle both. When medicines change, staff need to know who the prescriber is.

Where does Medicare end and aged care funding begin?

The handbook says that, in broad terms, Medicare benefits are not payable for medical services funded by another government source. In residential aged care, the Department funds care, everyday living and accommodation as separate components. The care component is a daily basic subsidy paid to the provider under the AN-ACC funding model. A GP consultation is Medicare. Your nursing and personal care are funded by the subsidy. ACFI was the earlier residential funding tool and is history.

Under Support at Home, the Department's program page states that the program does not fund care under other government programs such as Medicare. The Support at Home service list has clinical supports such as nursing and physiotherapy, independence services such as transport and support to attend appointments, and everyday living services. Supporting a client to attend a GP appointment can be a funded service. The consultation itself is Medicare. The Department notes you may need to help participants reach Medicare and the PBS.

The government pays the full cost of clinical supports, while participants contribute to independence and everyday living services. See participant contributions under Support at Home for how that works. Home Care Packages belong to the previous system.

MBS - What it covers: Listed health services such as GP attendances, pathology and imaging; Your role: Arrange access, support consent, keep records. Do not claim.
PBS - What it covers: Subsidised prescription medicines; Your role: Manage medicines safely with the prescriber.
AN-ACC - What it covers: Residential care subsidy paid to the provider; Your role: Deliver and record care funded by the subsidy.
Support at Home - What it covers: Services on the program service list within a participant's budget; Your role: Deliver listed services under the service agreement.

What must providers organise, support and record?

Access comes first: a time that suits the person, a private space, a staff member who can hand over relevant information, and a working connection for telehealth. After the visit, orders and medicine changes need to reach the right staff the same day.

Consent stays with the person. Where someone acts for them, know who. The Department's guidance on assignment of benefit says a practitioner must obtain a valid agreement before bulk billing. It also says residents of aged care homes can enter an enduring agreement covering future bulk billed services from the named GP, and a different GP may need a separate one. Ask the practice how agreements are recorded and who signed.

The practitioner keeps clinical records. You still need your own: date, practitioner, reason for the visit, outcome, orders and any change to the care plan. Your clinical governance framework policy is the place to define who records what and who reviews it.

How can double charging and fee transparency problems arise?

The risk is one service paid for twice, or a charge nobody can explain. A person may be asked for a practice fee on a service the practitioner says was bulk billed. A provider may list a charge that overlaps with care already funded by a subsidy or budget. Neither is yours to resolve as a billing matter, but you should be able to answer both.

Check that your agreements say what you charge for and that staff can explain it in plain language. Your fee transparency and financial governance policy should set out who staff escalate to when a person raises a charge.

What should you ask a visiting practitioner?

Will you bulk bill, or is there a private fee, and will the person be told before the visit?
Do you hold a valid assignment of benefit agreement, and who signed it?
Is this person registered with MyMedicare, and is a responsible GP named?
How will visit notes, orders and medicine changes reach our staff, and when?
Who requests pathology or imaging, and how are results returned?
How do we reach you between visits, including after hours?

What are the common confusions?

"Medicare covers everything." It does not. The Department lists ambulance services, most dental services, glasses, hearing devices and services not on the MBS as not covered.
"Our nurses can claim MBS items." The residential GP items cannot be claimed by nurses. Nurse practitioners have their own items.
"AN-ACC or the budget pays the doctor." AN-ACC funds care and Support at Home funds listed services. Neither pays for a Medicare-funded consultation.

Related Resources

Common Questions About MBS in Aged Care

1. What does MBS stand for in aged care?

MBS stands for Medicare Benefits Schedule. It is the list of health services for which the Government may pay a Medicare benefit, and it applies to people in aged care in the same way as to anyone enrolled in Medicare.

2. Can an aged care provider claim MBS items for GP visits?

No. The practitioner claims. The MBS Online fact sheet says doctors employed by the home cannot claim the residential GP items, nor can specialists, consultant physicians, nurses and other allied health practitioners.

3. Does Support at Home pay for GP visits?

No. The Department states that the program does not fund care under other government programs such as Medicare. Support to attend an appointment can be funded as an independence service.

4. Are nurse practitioner services on the MBS?

Yes. MBS Online has nurse practitioner items, and it published changes to them from 1 March 2025.

Know the Funder Before You Record the Service

Medicare pays practitioners for listed health services. Your aged care subsidy or a participant's Support at Home budget pays for the care and services you deliver. Keeping those two lines apart protects the person from being charged twice, and protects your records from confusion. Start by adding the visiting practitioner questions above to your next GP or nurse practitioner visit booking.

MBS in Aged Care: What the Medicare Benefits Schedule Is and How It Affects Providers