MBS item 23 - clinical fact sheet and MCQ

This fact sheet addresses frequently asked questions and compliance considerations to help GPs ensure accurate billing of Medicare Benefits Schedule (MBS) item 23 (a Level B consultation). This is one of the most commonly used item numbers in general practice and is a key item number that features in Medicare compliance issues, with numerous cases involving practitioners repaying inappropriate claims.[1]

Item 23 applies to a professional attendance by a general practitioner for a standard consultation lasting more than 6 minutes but usually less than 20 minutes. 

From MBS Schedule: Professional attendance by a general practitioner at consulting rooms (other than a service to which another item in this Schedule applies), lasting at least 6 minutes and less than 20 minutes and including any of the following that are clinically relevant:

• taking a patient history;
• performing a clinical examination;
• arranging any necessary investigation;
• implementing a management plan;
• providing appropriate preventive health care;
• for one or more health-related issues, with appropriate documentation [2]

See further eligibility criteria Medicare Benefits Schedule - Item 23 

Eligibility and key features of item 23

• Duration: item 23 requires the consultation to be greater than 6 minutes but usually less than 20 minutes

• Nature of consultation: it must be a face-to-face professional service between the GP and the patient

• Documentation: detailed and accurate documentation is essential to justify the time spent and the nature of the service provided

• Complexity: item 23 is a Level B consultation and must be more complex than a Level A consultation (ie of higher complexity than “straightforward”)

Common compliance issues

1. Face-to-face requirement:

• the consultation must involve direct interaction between the GP and the patient. Services conducted entirely over the phone or via a message are not eligible
• note that the time requirement includes only the face-to-face time between GP and patient, not associated administration time or time spent outside of the consulting room, for example with a practice nurse
• clinically relevant administrative time with the patient in the room, for example while writing a referral letter, counts towards the time
• there is no time-based item for reviewing relevant information in MyHealthrecord and uploading a shared health or event summary. However, when performed as part of the consultation(ie when the patient is present), the time does count towards the overall time requirement

2. Time documentation and clinical complexity:

• clearly record the start and end times of the consultation or a statement that the duration exceeded 6 minutes
• the content of the consultation should reflect the complexity and duration claimed
• use a common sense approach to documentation, remembering the rule ‘if it isn’t in the notes it didn’t happen’. So, on reading the notes, if you were a third party such as an auditor, would it be clear that this consultation was not ‘straightforward’ (Level A or Item 3), but required at least 6 minutes and included the relevant parts of history, examination, investigation and management? For example “ Came for script. Irbesarten 150mg supplied” does not count as an item 23, even if the ‘clock’ says 6 minutes.

3. 80/20 rule:

• GPs cannot claim more than 80 professional attendance items per day (including item 23) for 20 or more days within a rolling 12-month period without triggering Medicare’s Practitioner Review Program
• some analytics services, such as Cubiko, will tell you if you are at risk from 80/20
• there is also a 30/20 rule that applies to item 91891 which is the telephone equivalent of item 23

4. Nature of service:

• item 23 applies only to standard consultations addressing health concerns or preventative health measures
• it should not be used for procedures, care plans, or health assessments covered by other MBS items

Frequently asked questions

1. Can a GP claim item 23 for consultations lasting exactly 6 minutes?
   No. The consultation must be longer than 6 minutes to meet the criteria.

2. What happens if the consultation exceeds 20 minutes?
   If the duration exceeds 20 minutes and meets the criteria for a Level C consultation, item 36 should be claimed instead

3. Can item 23 be claimed if part of the consultation is conducted by a nurse?
   No. The time counted for item 23 must be spent face-to-face between the GP and the patient. Time spent with a nurse is not billable under this item.

4. What constitutes adequate documentation?
   Records should include the presenting complaint, relevant history, examination findings, management plan, and follow-up details, alongside time-related entries.

Common pitfalls

• Claiming item 23 for consultations under 6 minutes

• Inadequate documentation of time or consultation content

• Billing item 23 for repeat prescriptions or referrals without additional patient assessment

• Over-reliance on item 23, potentially breaching the 80/20 rule

Example scenarios

• Correct use: a GP spends 10 minutes addressing a patient’s cough, taking history, examining the chest, and providing advice on management

• Incorrect use: a patient’s repeat prescription is processed without further discussion or assessment

Takeaway tips for GPs

• Always document time and content accurately to demonstrate time and complexity requirement

• Review compliance guidelines regularly to avoid inadvertent breaches

• Use alternative MBS items for services outside item 23’s scope

• Monitor billing patterns to ensure adherence to the 80/20 rule 

References 

[1] Australian Government Professional Services Review. PSR Director’s Update for July and August 2024. 2024. (last accessed March 2025).

[2] Australian Government Department of Health and Aged Care. MBS Benefits Schedule item 23. (last accessed March 2025).

[3] Australian Government Department of Health and Aged Care. MBS Benefits Schedule Note AN.0.9. 2023. (last accessed March 2025).

Claim your CPD

After reading the clinical summary above and reviewing the references, complete the quiz to gain 30 minutes of EA CPD and 30 minutes of RP CPD. 

You can either self-report CPD to your CPD home, or Medcast will track your learning via your personal CPD Tracker and you can download and report these points once a year. See our CPD Tracker FAQ.  

Quiz

Please log in or sign up for a free Medcast account to access the case study questions and achieve the CPD credits.