COVID vaccination billing streamlined

Anastasia Tsirtsakis

2/02/2023 2:49:48 PM

Medicare rebates for COVID-19 vaccination have increased to compensate for the removal of booster and PIP payments.

Bulk billing will continue for COVID vaccinations.
GPs will be required to continue to bulk bill COVID-19 vaccinations.

As the world enters its fourth year of the COVID-19 pandemic, vaccination remains a key pillar of Australia’s strategy to keep the community safe.
With primary care continuing to be at the centre of these efforts, namely general practice, the Federal Government has extended funding for the vaccination program and updated the corresponding MBS item numbers and rebates.
Effective as of 1 February, the item numbers for first, second and subsequent doses have now been streamlined to one item number, with an increase to the rebate.
For COVID-19 vaccinations administered during business hours, item 93644 (MMM 1 areas) attracts a rebate of $35.10 – up from $31.55 for dose one and $24.85 for dose 2, while item 93645 (MMM 2–7 areas) is now $38.50, an increase from $38.25 for dose one and $28.25 for dose two.
Rebates for after-hours services have also been given a boost – 93653 (MMM 1 areas) is now $47.60, up from $43.95 and $37.35, and 93654 (MMM 2–7) attracts a rebate of $50.95 compared to $50.75 and $40.70 previously.
The flagfall item number (90005), for initial GPs attendances for COVID-19 vaccination at a residential aged care or disability facility, or a patient’s home, has seen the biggest rebate increase, up from $58.15 to $118.15.
The boost to the Medicare rebates incorporates the former booster incentive payment of $10.20, which has since been phased out, and also offsets the removal of the Practice Incentive Program (PIP) payment of $10.
However, with booster and subsequent doses now compromising the majority of vaccinations, the change to the PIP payment is not expected to have a significant impact on practices.
Dr Cathryn Hester, member of the RACGP Expert Committee – Funding and Health System Reform (REC–FHSR), welcomed the simplification of the MBS rules as ‘a positive’ for GPs.
‘A simplified, more streamlined approach to the MBS item numbers that are used for COVID-19 vaccinations is a move in the right direction from the Department of Health [DoH],’ she told newsGP.
‘This is consistent with COVID-19 vaccinations moving towards “business as usual” care in general practice and it is good to see this reflected in the MBS update.’
However, the Brisbane-based GP said she has one hesitation around the continued requirement for COVID-19 vaccinations to be bulk billed, not permitting practices to charge a gap fee.
‘The RACGP continues to advocate against item numbers that enforce bulk billing,’ she said.
‘This new control mechanism began in the height of COVID-19 and was generally tolerated by GPs at the time due to the unprecedented nature of the situation.
‘I’m concerned that enforced bulk billing of item numbers will creep into more common usage, which is clearly a very retrograde and harmful step for the viability of general practice.
‘I could see this resulting in practices having to absorb the costs of providing COVID-19 vaccination services and practices deciding not to provide this service.’
Asked whether she has concerns about the removal of the PIP payment, Dr Hester says she believes most practices involved in the vaccination program have develop ‘very sound, efficient processes’ around this.
‘This is how general practice was able to provide more vaccinations during COVID-19 than all the other providers combined, for a very small cost to the Federal Government,’ she said.
‘We will be able to utilise the efficient processes moving forward to provide very good vaccination service and coverage, not just for COVID-19, but also for yearly influenza immunisations.’
In addition to guidance on the RACGP website, Dr Hester pointed GPs taking part in the vaccination program to a new fact sheet released by the DoH.
‘[They have] produced a very good, clear fact sheet explaining the particulars of the new item number and how it can be co-claimed with other attendance item numbers,’ she said.
Meanwhile, to ensure Aboriginal and Torres Strait Island communities continue to be protected, the relevant COVID-19 vaccination programs are being extended to June 2024, in addition to the remote Point of Care Testing program.
The Government will also continue funding the provision of tailored and community led COVID-19 vaccine activities for culturally and linguistically diverse communities until 30 June, including the national bicultural health educator program, Health in My Language, to continue delivering vaccine education for migrant and refugee communities.
The guides in the RACGP’s MBS online tool have been updated to reflect the new changes. For more information on the change, visit the RACGP website.
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