1 July MBS changes explained

After months of preparation, sweeping changes to Medicare items are now in place as the new financial year begins.
 
Headlining the reforms is a significant update to chronic disease management (CDM) items, as well as new items for menopause and perimenopause health assessments, and indexation rates.
 
Below, newsGP provides a summary of the key updates impacting general practice from 1 July.
 
Chronic disease management
From 1 July, existing items for GP Management Plans (229, 721, 92024, 92055), Team Care Arrangements (230, 723, 92025, 92056) and reviews (233, 732, 92028, 92059) will cease.
 
These have been replaced with new GP Chronic Condition Management Plan items (GPCCMP), with both the items for preparing a plan and reviewing a plan attracting a rebate of $156.55.
 
If a patient is registered for MyMedicare, they will need to receive their GPCCMP from their registered provider, while patients who are not registered for MyMedicare can receive these services from their usual GP.
 
The change will also see simplified requirements for referring a patient to an allied health service, meaning the requirement to consult with at least two collaborating providers and requirements for existing referral forms have been removed.
 
Patients that had a GP Management Plan or Team Care Arrangement in place prior to 1 July 2025 will be able to continue to access services consistent with those plans for two years.
 
The CDM changes come after the RACGP issued repeated calls for clarity, asking the Department of Health, Disability and Ageing (DoHDA) to give GPs enough time to prepare to implement the significant changes.
 
The changes were first announced in the May 2023 Federal Budget, but with details of the new item numbers still unconfirmed by last September, the start date was pushed back until 1 July 2025.
 
Menopause and perimenopause health assessments
Commencing 1 July, GPs will have access to item 695 for menopause and perimenopause health assessment services.
 
Item 19000 will apply to prescribing medical practitioners, described as being those practising in general practice but not vocationally registered with either of the colleges.
 
The MBS item fee is $101.90 for GPs and $81.50 for prescribing medical practitioners.
 
Announced as part of a $793 women’s health package revealed in the lead-up to this year’s Federal Election, the assessments are for patients experiencing premature ovarian insufficiency, early menopause, perimenopause and menopause.
 
The items attract a minimum service duration of 20 minutes, are available annually, and must include several clinical activities, such as a basic physical examination, discussion of management options, and implementing a management plan.
 
Indexation
From 1 July, an indexation factor of 2.4% will be applied to most MBS general medical services items, diagnostic imaging services, and pathology items in Group P12.
 
To reflect this, the RACGP’s MBS online tool has been updated to provide a full list of indexed MBS rebates.
 
COVID-19 support items
MBS COVID-19 vaccine support items are now no longer available, including 93644, 93645, 93646, 93647, 93653, 93654, 93655, 93656, 10660, 10661, 93660, 93661, and 90005.
 
GPs looking to offer COVID-19 vaccinations, vaccine assessments and vaccine counselling will need to do so with existing standard items.
 
Bulk billing will also no longer be mandatory for COVID-19 vaccinations, vaccine assessments or vaccine counselling, and the triple bulk-billing incentive can be co-claimed where these services are provided by billing a standard consultation item.
 
The first dedicated COVID-19 item numbers were introduced in March 2020, as part of a $2.4 billion health package to support Australia’s response to the emerging COVID-19 pandemic.
 
Then in March 2021, item numbers for COVID-19 vaccine suitability assessments were brought in.
 
Vitamin B12 testing
MBS items for vitamin B12 testing (66838 and 66839) will be amended on 1 July to clarify the appropriate testing pathway for these items.
 
These changes will see an 11-month frequency restriction implemented on the quantification of vitamin B12 markers such as homocysteine or methylmalonic acid (MBS item 66839).
 
There will also be a new exception item introduced for B12 testing to enable more frequent testing for those with a clinical need.
 
According to the DoHDA, the changes follow recommendations by the MBS Review Taskforce – Diagnostic Medicine Clinical Committee, which called for the aligning of the restriction for item 66839 to an existing one for item 66838.

Heart Health Assessments
Funded as part of the 2025–26 Federal Budget, the Government has extended access to temporary Heart Health Assessment items (MBS items 699 and 177) for the next three years, after which they are due to expire.

Urine testing
The MBS item for urine testing (69333) will be changed to reduce clinically unnecessary testing by requiring that asymptomatic urine testing only be performed when clinically indicated.
 
This change requires that urine testing and examination, including serial examinations, are only required when symptoms of a urinary tract infection or kidney disease are present.
 
Exceptions to this amendment are made for specified patient groups who may be asymptomatic, including those who are pregnant, younger than 16 years old, recipients of renal transplants, suffering from recurrent urinary tract infections, or being investigated for kidney disease.
 
For more detailed information, the RACGP has created a dedicated ‘1 July 2025 MBS updates’ webpage.
 
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chronic disease management COVID-19 Heart Health Assessments MBS Medicare Medicare Benefits Schedule vitamin B12 women’s health