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COVID-19 bulk billing incentives for at risk patients

This article explains the different types of bulk billing incentive items for at risk patients, and when to apply them.

Which patients qualify as at risk regarding COVID-19?

Ultimately is it up to the practitioner to define who is at risk or not at risk, however, guidance has been made readily available on the Department of Health website.

At risk patients who are not under 16 or a Commonwealth concession cardholder

As of 20 April 2020, two new bulk billing incentive items have been added. These items can be used if a patient is at risk, but is not under the age of 16 or a Commonwealth concession cardholder.

These incentive items are:

  • 10981 (metro)
  • 10982 (regional).

NOTE  The consult item will not add these incentive items automatically. These items will need to be added manually to the invoice.

At risk patients who are under 16 or a Commonwealth concession cardholder

The older, more generic items can be used if a patient is at risk, and is under the are of 16 or a Commonwealth concession cardholder.

These incentive items are:

  • 10990 (metro)
  • 10991 (regional)

NOTE  The consult item will add these incentive items automatically. You do not need to add further incentive items.

Billing scenarios

Scenario 1: At risk patients who are not under 16 or a Commonwealth concession cardholder

  1. An at risk patient who is not under 16 or a Commonwealth concession cardholder visits the practice for an appointment.
  2. The patient gets billed the consult item as a bulk bill.
  3. The consult item does not add the 10990 or 10991 automatically.
  4. However, the patient meets the criteria for being at risk.
  5. The practice can add 10981 or 10982 manually.

Scenario 2: At risk patients who are under 16 or a Commonwealth concession cardholder

  1. An at risk patient who is under 16 or a Commonwealth concession cardholder visits the practice for an appointment.
  2. The patient gets billed the consult item as a bulk bill.
  3. The consult item adds 10990 or 10991 automatically.
  4. The practice should not add any further incentive items.