Nurse Practitioner MBS Item Numbers: A Practical 2026 Guide
Nurse practitioner MBS billing involves more than matching consult duration to a code. Attendances, telehealth, procedures, case conferences, tests and specialist video support each carry different descriptors and evidence requirements. Current item numbers, schedule fees and claiming rules help nurse practitioners and practice teams tie each billing decision to the service delivered.
Nurse practitioner consultation item numbers
The core attendance items use the same schedule fee for an equivalent in-person, video or phone service. The fees and 85% benefits below are the amounts in the MBS after the 1 July 2026 fee update. The official attendance overview contains the complete descriptors and associated notes.
| Attendance tier | In person | Video | Phone | Schedule fee | 85% benefit |
|---|---|---|---|---|---|
| Obvious, straightforward problem requiring a short history and limited management | 82200 | 91192 | 91193 | $14.95 | $12.75 |
| At least 6 minutes and less than 20 minutes | 82205 | 91178 | 91189 | $32.65 | $27.80 |
| At least 20 minutes and less than 40 minutes | 82210 | 91179 | 91190 | $61.80 | $52.55 |
| At least 40 minutes and less than 60 minutes | 82215 | 91180 | 91191 | $91.20 | $77.55 |
| At least 60 minutes | 82216 | 91206 | No separate item | $137.85 | $117.20 |
The short attendance is defined by the straightforward nature of the service rather than a time threshold. A four-minute consult does not automatically qualify for 82200, 91192 or 91193.
There is no 60-minute phone equivalent. Item 91191 covers a phone attendance lasting at least 40 minutes. For in-person and video services, the 60-minute items are 82216 and 91206.
The schedule fee is a government reference amount. It is not a required private fee. If you bulk bill, the patient assigns the Medicare benefit as full payment for the service. If you privately bill, the patient's out-of-pocket cost depends on your fee and the benefit payable.
Who can bill nurse practitioner MBS items?
The MBS uses the term participating nurse practitioner. To bill services in private practice, a nurse practitioner must:
- be endorsed as a nurse practitioner and meet the Nursing and Midwifery Board of Australia registration standards
- hold professional indemnity insurance
- have a Medicare provider number for each practice location
- work in private practice, or in a public facility covered by a subsection 19(2) exemption.
These items cannot be billed for a public patient receiving a service in a public hospital. Services must also be clinically relevant and meet every part of the item descriptor. The full provider and setting rules are set out in the Services Australia guidance.
For time-tiered items, count only the time in which the patient receives active attention. Travel, breaks and time spent completing the record after the patient interaction do not count towards the attendance duration.
Telehealth rules for video and phone items
The nine nurse practitioner telehealth items are 91192, 91178, 91179, 91180 and 91206 for video, and 91193, 91189, 91190 and 91191 for phone.
To claim one of these items, the nurse practitioner must be the patient's eligible telehealth practitioner. This usually means either:
- the nurse practitioner provided the patient with a face-to-face service in the preceding 12 months, or
- the patient received an MBS-billed face-to-face service arranged by the same practice in the preceding 12 months.
The MBS provides exemptions for defined circumstances, including children under 12 months, people experiencing homelessness, specified blood-borne virus and sexual or reproductive health services, people in declared natural disaster areas, and services from a nurse practitioner at an Aboriginal Medical Service or Aboriginal Community Controlled Health Service. The exemption and clinical reasoning must be recorded in the patient's clinical notes. A previous phone or video consultation does not count as a face-to-face service for this rule. The telehealth eligibility note gives the full definitions and exceptions.
Case conference item numbers
A nurse practitioner can claim the chronic condition management case conference items as a participating team member.
| Item | Case conference duration | Schedule fee | 85% benefit |
|---|---|---|---|
| 10955 | 15 to less than 20 minutes | $58.50 | $49.75 |
| 10957 | 20 to less than 40 minutes | $100.30 | $85.30 |
| 10959 | At least 40 minutes | $166.85 | $141.85 |
The patient's GP or prescribed medical practitioner must organise the conference and invite the nurse practitioner. The team must include that medical practitioner and at least two other members who provide different kinds of care. The same item number applies whether participation is in person, by video or by phone.
The claiming nurse practitioner should record the date, start and end times, participants and matters discussed. An item generally cannot be claimed if the service was performed in the preceding three months, unless a significant change in the patient's clinical condition or care circumstances creates an exceptional circumstance. See the case conferencing rules for the full team, consent and frequency requirements.
Long-acting reversible contraception items
The nurse practitioner long-acting reversible contraception (LARC) items commenced on 1 November 2025.
| Item | Service | Schedule fee | Benefit |
|---|---|---|---|
| 82201 | Intra-uterine device insertion | $221.55 | 75%: $166.20; 85%: $188.35 |
| 82202 | Etonogestrel subcutaneous implant removal | $107.90 | 75%: $80.95; 85%: $91.75 |
| 82203 | Hormone or living tissue implantation by cannula | $103.00 | 75%: $77.25; 85%: $87.55 |
| 82204 | Bulk-billing loading for 82201, 82202 or 82203 | 40% of the relevant procedure fee | Derived |
| 82206 | Procedure commenced then discontinued on clinical grounds | 50% of the applicable procedure fee | Derived |
Item 82204 is payable only when the relevant LARC procedure, any associated Group M14 Subgroup 1 attendance and any item 73832 or 73833 service claimed at that appointment are bulk billed. Items 82201 and 82202 can both be claimed when removal and insertion occur at the same appointment, with the multiple operation rule applied. A standalone IUD removal is billed under an appropriate attendance item and does not attract 82204.
Item 82206 applies to a commenced 82201 or 82202 procedure that is discontinued for clinical reasons or circumstances beyond the nurse practitioner's control. It does not apply to 82203. The record must explain the intended procedure and why it stopped. The LARC explanatory notes cover co-claiming, the loading and discontinued procedures.
Burns and reconstructive procedure items
Three procedure items sit in Group M14 alongside the attendance and LARC items.
| Item | Service | Schedule fee | Benefit |
|---|---|---|---|
| 82226 | Dressing a burn involving at least 1% and less than 3% of total body surface | $43.50 | 75%: $32.65; 85%: $37.00 |
| 82227 | Dressing a burn involving at least 3% and less than 10% of total body surface | $55.60 | 75%: $41.70; 85%: $47.30 |
| 82228 | Intradermal colouring of a nipple, areola or both after breast reconstruction, or for congenital absence | $236.80 | 75%: $177.60; 85%: $201.30 |
The burn items cover each attendance at which the procedure is performed and exclude skin reactions secondary to radiotherapy.
Patient-end support for specialist video consultations
Eight items, beginning with item 82250, commenced on 1 March 2026 for a participating nurse practitioner who is physically with a non-admitted patient while a specialist or consultant physician provides a separate video consultation. The nurse practitioner must remain in the same room as the patient for the whole attendance.
| Duration | At consulting rooms | At another place | Schedule fee | 85% benefit |
|---|---|---|---|---|
| 6 to less than 20 minutes | 82250 | 82251 | $53.15 | $45.20 |
| 20 to less than 40 minutes | 82252 | 82253 | $82.35 | $70.00 |
| 40 to less than 60 minutes | 82254 | 82255 | $111.75 | $95.00 |
| At least 60 minutes | 82256 | 82257 | $158.35 | $134.60 |
These are patient-end clinical support items. They do not replace the ordinary video attendance items for a consult delivered by the nurse practitioner.
Assistance at operations item numbers
Since 1 November 2025, participating nurse practitioners have had seven items for surgical assistance. An operation must be marked “Assist.” in Group T8 for the relevant assistance item to apply. Only one Medicare benefit is payable when more than one person assists the surgeon.
| Item | Service or fee basis |
|---|---|
| 93718 | Assistance where the operation fee or aggregate eligible operation fees do not exceed $668.25; schedule fee $103.25 |
| 93719 | Assistance where the operation fee or aggregate exceeds $668.25; 20% of the applicable surgeon fees |
| 93720 | Assistance at a caesarean section; schedule fee $149.25 |
| 93721 | Combined assistance at eligible operations and a caesarean section; derived fee |
| 93722 | Assistance at specified interventional obstetric procedures; 20% of the applicable practitioner fees |
| 93723 | Assistance at specified cataract and intraocular lens surgery; schedule fee $326.05 |
| 93724 | Assistance at cataract and intraocular lens surgery for specified complex circumstances; schedule fee $215.20 |
The assistance rules explain the multiple operation formula and the conditions attached to each item.
Pathology items nurse practitioners can request or perform
Requesting a pathology service and performing a simple test are different MBS activities.
A participating nurse practitioner may request pathology services in Groups P1 to P8, plus items 73826 to 73837, where the service is necessary and within the nurse practitioner's scope of practice. A pathology request may be oral initially, but it must be confirmed in writing within 14 days.
The following Group P9 items specifically describe tests performed by a participating nurse practitioner:
| Item | Test performed by the nurse practitioner | Schedule fee | 85% benefit |
|---|---|---|---|
| 73825 | Molecular point-of-care detection of chlamydia, gonorrhoea and trichomonas | $117.65 | $100.05 |
| 73826 | Point-of-care HbA1c for established diabetes, subject to accreditation and frequency rules | $11.80 | $10.05 |
| 73828 | Semen examination for spermatozoa | $6.90 | $5.90 |
| 73829, 73830, 73831 | One, two, or three or more specified blood tests | $4.55, $6.35, $8.15 | $3.90, $5.40, $6.95 |
| 73832 | Urine microscopy, excluding dipstick testing | $4.55 | $3.90 |
| 73833 | Pregnancy test by one or more immunochemical methods | $10.15 | $8.65 |
| 73834 | Wet-film microscopy other than urine | $6.90 | $5.90 |
| 73835 | Microscopy of a Gram-stained film | $8.65 | $7.40 |
| 73836 | Chemical test for occult blood in faeces | $2.35 | $2.00 |
| 73837 | Microscopy for fungi in skin, hair or nails | $6.90 | $5.90 |
Each test still has its own equipment, accreditation, frequency and descriptor requirements. The requesting requirements distinguish the pathology services a nurse practitioner can request from the P9 services they can perform.
Diagnostic imaging item numbers nurse practitioners can request
Participating nurse practitioners can request a defined set of diagnostic imaging services. The current list is:
55036; 55065; 55066; 55070; 55071; 55076; 55080; 55600; 55700; 55704; 55768; 55812; 55844; 55848; 55850; 55852; 55856; 55858; 55860; 55862; 55864; 55866; 55868; 55870; 55872; 55874; 55876; 55878; 55880; 55882; 55884; 55886; 55888; 55890; 55892; 55894; 57410; 57413; 57509; 57515; 57521; 57523; 57527; 57703; 57709; 57712; 57715; 57721; 58503 to 58527; and 58903.
These are the imaging service items the provider claims. They are not additional attendance items for the nurse practitioner. The request must identify the service and include enough clinical information for the imaging provider to assess the indication and meet the descriptor. The diagnostic imaging note contains the authoritative code list.
Two current MBS notes differ on request formalities: the nurse practitioner note says the request must be signed and that all services on one request must be rendered within seven days after the first service, while the general diagnostic imaging note says no signature is required and gives a 14-day window. Until those notes are reconciled, a risk-assessed practice is to sign and date requests and use the shorter seven-day window for multiple services.
Specialist referrals from a nurse practitioner
A participating nurse practitioner can refer a private patient to a specialist or consultant physician when clinically indicated. The referral must be written, signed and dated, contain relevant clinical information, and reach the specialist before or at the consultation. It remains valid for 12 months from the first service provided under it.
A nurse practitioner referral does not make an allied health or Aboriginal and Torres Strait Islander primary health care service Medicare-rebatable. The referral requirements set this boundary explicitly.
A defensible billing and documentation workflow
Accurate billing starts with the service delivered. A repeatable end-of-consult workflow helps keep the claim aligned with the clinical record:
- Identify the service category. Separate an ordinary attendance from a procedure, case conference, patient-end support service or test.
- Establish provider, patient and setting eligibility. Record the provider number, private-practice setting and any item-specific patient requirements.
- Apply the modality rules. For telehealth, confirm the established clinical relationship or record the applicable exemption and reasoning.
- Use the actual active-attention time. Record start and end times where duration determines the item. Exclude travel, breaks and later record completion.
- Document the descriptor. Capture the clinically relevant history, examination, investigations, management plan, preventive care and outcome that support the item claimed.
- Apply co-claiming and derived-fee rules. This matters for LARC loading, discontinued procedures and assistance at multiple operations.
- Review before submitting. The nurse practitioner remains responsible for confirming that the service and record meet the MBS descriptor.
Lyrebird can capture the consult and turn it into a structured draft clinical note for your review. It supports the documentation step while leaving item selection, clinical judgement and sign-off with the nurse practitioner. For a broader reference covering common general practice codes, use our MBS item cheat sheet.
If your team wants to see how Lyrebird fits into nurse practitioner documentation and review, Contact us.
