For practices participating in the COVID-19 vaccination rollout, there are four types of Medicare item numbers specifically associated with the provision of COVID-19 vaccinations:
- 1 Vaccine Suitability Assessment Services
- 2 In-Depth Patient Assessments
- 3 Flag-Fall Arrangements
- 4 Vaccine Booster Incentive.
These Medicare items are only available for participating practices.
Vaccinations must be bulk-billed for everyone living in Australia who is Medicare-eligible, including all Australian citizens, permanent residents, and most visa-holders.
Vaccine Suitability Assessment (VSA) Services
The Department of Health has released information about these 16 item numbers.
The services have to be billed in the name of the supervising GP, who must be present at the location at which the service is undertaken (including for the observation time).
The services can be undertaken face-to-face by a suitably qualified health professional. However, the supervising GP must accept full responsibility for the service.
The assessment cannot be done by telehealth.
A supply of the vaccine must be available for immediate administration. However, the item number should be billed if a patient declines the vaccine after the assessment has been performed.
If a patient undergoes a VSA and declines the vaccine at that visit but then returns to have the vaccine on another day, a second VSA can be billed when they return.
You need to ensure you comply with record-keeping requirements to demonstrate a VSA has been conducted appropriately, including:
- patient name
- separate dated entry for each attendance for a VSA
- recording of consent
- clinical information adequate to explain the service
- be sufficiently comprehensible so another doctor can rely on the record to effectively undertake ongoing care as it relates to COVID-19 vaccinations.
In-Depth Patient Assessments
The Department of Health has released information about these two item numbers:
- must be billed in conjunction with a Vaccine Suitability Assessment Service.
- can only be claimed where an in-depth clinical assessment regarding a patient’s individual health risks and benefits associated with receiving a COVID-19 vaccine is undertaken.
- must take at least 10 minutes.
- can only be claimed once per patient, at either the first or second dose. It cannot be claimed if it has already been claimed by another doctor.
The doctor must attend the patient in person, you cannot delegate this task to anyone else. Please note that you cannot undertake the assessment by telehealth.
Flag-Fall Arrangements
The Department of Health has released information about this item number, which:
- can ONLY be billed when a doctor is performing a COVID-19 vaccine suitability service in:
- a residential aged care facility
- a residential disability facility setting
- a patient’s place of residence
- must ONLY be billed in conjunction with the first patient seen on each occasion the doctor attends the facility
- is NOT available for other site visits external to a doctor’s practice.
Vaccine Booster Incentive
The Department of Health has released information about this item number.
It is to be claimed in conjunction with the appropriate Vaccine Suitability Assessment Service item when a patient receives a third or booster dose. It cannot be claimed for second doses.
Bulk-billing incentives
Bulk-billing incentives (double for dose one, single for dose two) will be incorporated into the value of the items and will not need to be claimed separately ($10 per dose).
The double payment of the bulk-billing incentive for the first dose is in recognition that some patients will need longer explanations about the vaccine than others.
Where both doses have been provided to the patient by the practice, the practice will be eligible for a PIP incentive of $10 (per patient) on completion of the second dose.