The final months of 2025 will herald the introduction of several Medicare billing reforms, with a range of changes applying to specialists from across disciplines from November 1.
While attention may be largely focused on the introduction of the government’s flagship bulk-billing incentives policy, the list of upcoming changes to the MBS will also impact how specialists treat and communicate with their patients.
Here are some of the most important updates:
New phone items for specialists and consultant physicians
In a policy move hailed as win by the RACP, nine new phone consultation items will be added for specialists from November 1 [link here].
The change, which was introduced following recommendations from the MBS Review Advisory Committee, will restore subsidised phone consultations that were removed in 2022 despite large protests from the sector.
The new item numbers will give specialists and their patients more freedom about how to conduct follow-ups, given these consults are currently available only as face-to-face or video appointments.
For example, the introduction of MBS item number 92443 covers phone attendance in specialties other than psychiatry of 20 minutes, for review of a patient with at least two comorbidities after their first attendance. The schedule fee will be set at $156.45.
Greatest Permissible Gap indexation
The greatest permissible gap (GPG) figure, capping out-of-pocket fees for out-of-hospital Medicare services, will be indexed on November 1 in line with the consumer price index for the June quarter.
The Health Insurance Act 1973 sets out the terms of the GPG rules, which requires the difference between the MBS fee for an item and the 85% Medicare benefit must not be larger than a specified dollar figure.
This change will bring that figure from $102.40 to $104.50 from November 2025, the department has confirmed.
Changes to Aboriginal health worker terminology
From November 1, terminology used to describe MBS items for services provided by Aboriginal and Torres Strait Islander health workers will change to reflect healthcare these practitioners provide.
A new term, ‘Aboriginal and Torres Strait Islander Primary Health Professionals’, will be introduced to identify services provided by these workers.
The MBS will also distinguish Aboriginal and Torres Strait Islander workers from general allied health workers throughout MBS item descriptors.
“Updating the terminology used by the Aboriginal and Torres Strait Islander health care professionals will strengthen the identity of these professions so they are appropriately recognised for providing holistic primary health care services to Aboriginal and Torres Strait Islander people,” the department said in an information sheet [link here].
These changes have been championed by the National Association of Aboriginal and Torres Strait Islander Health Workers and Practitioners (NAATSIHWP) and several other healthcare organisations.
Diagnostic and pathology changes
November will also bring 15 changes to diagnostic and pathology service billing that may affect clinicians in specialties like oncology and gastroenterology.
These include the long-awaited introduction of a Medicare item number for DPYD genetic testing to predict possible fluoropyrimidine-induced toxicity in cancer patients, and a new faecal calprotectin testing item for patients with irritable bowel disease.
The full list of general and pathology service changes can be found at MBS Online [link here].