Australian MBS guide

Inpatient Billing by Time in Australia

Some MBS services include time or duration requirements. “Billing by time” is therefore not a universal inpatient billing method: the exact MBS item wording and clinical service determine whether time matters and how it must be documented.

Start with the specific MBS item

Do not choose an item merely because a consultation or procedure lasted a certain number of minutes. First identify the service actually provided, then read the current MBS item descriptor and explanatory notes to determine whether duration is an element of that item.

Why time can matter

Depending on the MBS item, duration can be relevant to eligibility or to distinguishing between related items. Other items may be defined primarily by the nature of the service rather than elapsed time. There is no single “inpatient hourly rate” across the MBS.

Documentation principles

Where a time requirement applies, the practitioner's clinical record should support the service and applicable duration requirement. Billing administration should reflect the information documented and authorised by the treating practitioner rather than reconstructing a duration after the event simply to fit an item.

Hospital admission does not override item rules

Being an inpatient changes the claiming context but does not remove the requirements attached to the MBS service. The relevant descriptor, notes, provider requirements, patient status and other claiming conditions still need to be considered.

Medicare and private health insurance

For eligible medical services supplied to private patients in hospital, Medicare generally pays 75% of the MBS fee and private health insurance covers at least 25% of the MBS fee. This benefit structure is separate from whether a particular MBS item contains a time requirement.

Practical billing workflow

  • Confirm admitted-patient status.
  • Confirm the service supplied.
  • Check the current MBS descriptor and notes.
  • If duration is required, confirm the record supports it.
  • Check provider/location and referral details where relevant.
  • Apply the appropriate Medicare/private health claiming pathway.
  • Monitor assessment and reconcile payment.

Avoid these mistakes

  • Assuming all inpatient attendances are billed by time.
  • Using an old duration threshold from memory.
  • Choosing an item based only on elapsed time.
  • Failing to document information required by the applicable item.
  • Applying overseas time-based hospital billing concepts to Australian MBS claims.

Verify current requirements

Search the current item on MBS Online. For Medicare administrative guidance use Services Australia.

Related guides

Billing codes · Billing guidelines · Cheat sheet · Understanding MBS items

Educational information only. This page deliberately does not prescribe an item number or duration threshold without the specific service context. Always use the current MBS.