Medicare Web Services Resources Links

Medicare Web Services Resources Links

Impulse Ensures that at all times our application follows all of the Medicare billing rules.

Medicare provides extra resources for clients to ensure transactions with Medicare are explained. 

Medicare Claiming
The agency website contains education resources, services and help topics for health professionals:

Derived Fee Items
The MBS includes a number of items which only apply when associated with another item in the Schedule.
  1. These items are commonly referred to as 'derived fee' or 'aggregate' items.
  2. The associated services are known as 'base' items. 
  3. Derived fee items modify the schedule fee and Medicare benefit of the service (base item) they are associated with.
  4. They do not have a separate schedule fee or Medicare benefit and must be paid in association with a base item in the same claim.
  5. Information on derived fee items can be found in the Education Guides. For example; instructions for claiming item 31340 is covered in the education guide
  6. Billing skin lesion treatment and biopsy items under Medicare; instructions for claiming item 30001 can be found in the education guide - Billing abandoned or
  7. discontinued surgery.

Abbreviations for Text Fields
To provide more information about a service, an abbreviation can be supplied in place of the full description.

Multiple Attendance Items
Number Of Patients Seen must be set for any service that is a multiple attendance item.
  1. Note: IMCW AG/SC/MB/MO claims containing multiple attendance items, submitted with a serviceTypeCode of 'S' [Specialist] and the numberOfPatientsSeen set, will be rejected with
  2. reason code 402 - 'Benefit not payable - number of patients attended required'.
  3. All multiple attendance items for IMCW AG/SC/MB/MO claims should be submitted with a serviceTypeCode of 'O' [GP] to ensure correct assessment of the claim.

LSPN registration for Diagnostic Imaging (DI) and Radiation Oncology (RO) services
  1. Practitioners must quote the LSPN of the registered practice site or mobile equipment base on patient accounts, receipts or bulk billing assignment forms in order for those services to be eligible for a Medicare benefit.

Medicare reason codes - 3 digit codes

  1. HW027 Online claiming provider agreement Used to register the first provider number for online claiming
  2. HW052 Banking details online claiming Used to register EFT details for additional provider location/s for online claiming

Medicare Benefits Schedule (MBS)
The Medicare Benefits Schedule (MBS) is a listing of the Medicare services subsidised by the Australian government.

The explanatory notes in the MBS provide more information on the following:
  1. Multiple Attendances
  2. Diagnostic Imaging items including LSPN and Diagnostic Imaging Multiple Service Rules
  3. Assistant Services
  4. Derived Fee Items
  5. Determining Service Types and Characteristics
  6. Relative Value Guide
  7. Multiple Operation Rule
  8. Pathology Episode Coning and multiple service exemptions
Department of Veterans’ Affairs (DVA)
Please refer to the DVA Fee Schedules for Medical Services book for correct fees.
Fee schedules updates and corrections and derived fee ready reckoners are available from the DVA website at:


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