Clarifying MBS Items that are Hospital Only Services

A number of Medicare Benefits Schedule (MBS) items for specialist procedural services that should only be provided in a hospital setting are still able to be claimed at 85% benefit, for out of hospital services, rather than only having a 75% benefit.

Early in 2024, the Department conducted a review of the relevant sections of the MBS and identified 965 services that should only be conducted in hospital. The focus of the review was based on best clinical practice.

The Department consulted with 55 clinical peak bodies and specialist colleges to seek their expert advice on whether the items should only be conducted in a hospital or hospital equivalent setting. The Department also wrote to each state or territory health department to advise of the consultation being undertaken.

Based on the outcomes of the consultation, a list of 833 MBS items that will have the 85% benefit removed was finalised. Removal of the 85% benefit for these items was announced in the 2024-25 Budget and will take effect on 1 March 2025.

Further information is provided in the Quick Reference Guide below:
Word Version - Clarifying MBS Items that are Hospital Only Services (Word 231 KB)
PDF Version - Clarifying MBS Items that are Hospital Only Services (PDF 568 KB)