What does the MBS say about this item?
RebateRight returns an MBS item’s fee, benefit and place in the schedule, with who may claim it and how often.
MBS item 63507, an MRI scan of the head for a patient under 16. Schedule fee: $463.80. Benefit: 75% in hospital, 85% out of hospital. Age: younger than 16 years. Referral: needed, from a non-specialist medical practitioner. How often: 3 services in 12 months.
What is an MBS item?
An MBS item is one service in the Medicare Benefits Schedule (MBS), with a number, a description and a fee. Medicare pays a benefit for a service only under its item number.
MBS Item Lookup gives the item’s record before you bill. It also gives the limits on age, referral and frequency that the MBS sets in its rules and notes, each in a field of its own.
- Schedule fee
- The fee the MBS sets for an item. A derived fee is worked out from another item’s fee.
- Benefit
- What Medicare pays: 75%, 85% or 100% of the schedule fee, depending on the item and the setting.
- Claim limit
- How many times the item may be claimed in a given time.
How does MBS Item Lookup work?
Ask for one item by its number, or for every item in the current MBS. Both return the same record for each item.
One item
Send an item number, and get that item’s record. A number that is not in the current MBS gets a message saying so.
Every item
Get every item in the current MBS in one response, or one category at a time. Your software keeps the copy, and asks whether it is still current before it uses it.
The web app works the same way: it loads every item once, then looks each one up in its own copy.
What do you get?
The record carries the MBS’s description, fee and benefit. RebateRight adds who may claim the item and how often, so staff see each limit before the claim.
MBS item
63507
What the schedule says
MRI—scan of head for a patient under 16 years if the service is for:(a) an unexplained seizure; or(b) an unexplained headache if significant pathology is suspected; or(c) paranasal sinus pathology that has not responded to conservative therapy (R) (Contrast) (Anaes.)
Who can claim it.
- Age
- younger than 16 years
- Referral
- This item needs a referral from a provider recognised as ‘Non-specialist medical practitioner’.
- How often
- Items 63507 to 63522 and 63551 to 63560 have a limit of 3 services in 12 months. MBS note IN.0.18 explains the rule.
Fee.
- Benefit
- 75% in hospital, 85% out of hospital
Place in the schedule.
- Category
- Diagnostic imaging services (category 5)
- Group
- I5
- Subgroup
- 33
- In the schedule since
- 1 November 2012
When do you use it?
No patient needed
MBS Item Lookup answers what the MBS says about an item. To know whether a particular patient may claim it, run an eligibility check. To know what Medicare pays, use the Benefit Calculator.
In the web app and the API
Booking and billing staff use it in the web app, under MBS Item Lookup. Your own software sends the same request to the RebateRight API.
MBS Item Lookup is in every plan.
You pick the volume you need. The features stay the same.
Questions about MBS Item Lookup
Does MBS Item Lookup need patient details?
No. It needs only the MBS item number. To know whether a particular patient may claim the item, run an eligibility check.
How current are the items?
Every answer comes from the current MBS. When a new edition starts, the items, fees and rules change behind the same request, and MBS updates sets out what changed.
How many requests does it use?
Through the API, each submission is one request, whether it returns one item or every item. In the web app, MBS Item Lookup is unlimited.
Where can I use it?
You may use it in the web app, under MBS Item Lookup, and through the RebateRight API. Both are in every plan. The docs show the request and the response.
Know the item before you bill.
For 14 days you have the web app, the API and the test environment, with unlimited requests and no card.