Choosing the Right MBS Item
Picking the right MBS (Medicare Benefits Schedule) item number is the single most common source of Medicare rejections. The wrong item triggers an item-not-payable-for-provider rejection from Services Australia, which requires you to resubmit. Praxi's MBS item picker — built into the Medicare Submit Sheet on every invoice — narrows the catalogue to items you're actually allowed to claim, based on your AHPRA registration, profession, and the appointment metadata.
This page covers how the picker filters, what items map to which clinical scenarios, and where the AI suggestion fits in.
Endorsement scope matters
The MBS treats psychologists, occupational therapists, social workers, and other allied health practitioners as distinct provider types. Within psychology, your AHPRA endorsement further determines which item series you can bill against:
| Registration | Item series unlocked |
|---|---|
| Clinical Psychology endorsement | 80000–80024 (Better Access, clinical psychology services) |
| General Registration (Registered Psychologist) | 80100–80120 (Better Access, focussed psychological strategies) |
| Provisional Psychologist (intern) | Not directly billable — claims go via supervising psychologist |
| Social Worker (AASW accredited mental health) | 80165 / 80170 series (Better Access focussed psychological strategies) |
| Occupational Therapist (AHPRA + mental health endorsement) | 80125 series (Better Access focussed psychological strategies) |
Praxi reads your endorsement scope from Settings → Practitioner Profile. If you've recently completed a Clinical Psychology endorsement and the picker isn't showing the 80000–80024 series yet, update your profile — Praxi re-evaluates eligibility on every claim. The endorsement date is also stored on your provider record, so the picker uses your registration as it stood on the service date (not today's date) when you bill historical sessions.
Interns can't submit Medicare claims under their own provider number. The claim is submitted by the supervising psychologist, who is the rendering provider on the wire. Praxi's UI shows the intern as the practitioner of record on the appointment but routes the claim through the supervisor's provider number. The supervisor co-signs the clinical note before the claim unlocks.
How the Praxi MBS picker filters
When you open the Medicare Submit Sheet on an invoice, the item picker filters the full MBS catalogue down to the items that match all of the following:
- Practitioner endorsement scope — clinical vs general registration; AHPRA profession type.
- Profession type — psychologist, OT, social worker, etc. (each has a different item series).
- Service duration — read from the appointment length. Sessions of 50 minutes or more match standard items; shorter sessions match short consultation items where they exist.
- Session mode — in-person vs telehealth. Telehealth has its own item numbers (the 91000 series) with separate rules for video vs phone.
- Service setting — individual, group, or family/carer (with patient absent). Group items have lower per-attendee fees but separate caps.
- Funding source on the invoice — Medicare items only show when the client's funding is set to Medicare (or one of its sub-types like Better Access or EPC). DVA items only show for DVA-funded invoices.
The picker hides items you can't claim and labels items that are technically valid but uncommon for your profession. You can override the filter to see the full catalogue, but Praxi will re-validate at submission time — picking an item outside your endorsement results in a pre-submission blocker, not a wire rejection.
Common item scenarios
Use this reference as a starting point. The MBS schedule changes; Praxi syncs the latest schedule fees daily, but item numbers and eligibility rules are stable across years.
Better Access (Mental Health Care Plan / MHCP)
Better Access is the most common Medicare scheme Praxi practitioners bill against. It requires a GP-issued MHCP and a written referral. See Better Access (MHCP) Workflow for the full scheme rules.
| Item | Service | Provider | Mode |
|---|---|---|---|
| 80000 | Clinical psychology individual, 30–49 min, in consulting rooms | Clinical Psychology endorsement | In-person |
| 80100 | Focussed psychological strategies, individual, 20–49 min | Registered Psychologist | In-person |
| 91167 | Clinical psychology individual, 50+ min | Clinical Psychology endorsement | Telehealth video |
| 91183 | Focussed psychological strategies, individual, 30–49 min | Registered Psychologist | Telehealth phone |
| 91182 | Clinical psychology individual, 50+ min | Clinical Psychology endorsement | Telehealth phone |
| 80020 | Clinical psychology group, 4–10 patients, 60+ min | Clinical Psychology endorsement | In-person, group |
| 80125 | Focussed psychological strategies, individual, 20–50 min | Occupational Therapist | In-person |
| 80165 | Focussed psychological strategies, individual, 50+ min (non-rooms) | Social Worker | In-person |
| 80170 | Focussed psychological strategies, group, 4–10 patients, 60+ min | Social Worker | In-person, group |
EPC (Enhanced Primary Care) / Chronic Disease Management
EPC items require a GP-issued CDM care plan referral, not an MHCP. Each client gets a combined annual cap of 5 sessions across all allied health providers under their CDM plan.
| Item | Service | Provider |
|---|---|---|
| 10958 | Allied health individual session | Occupational Therapist |
| 10960 | Allied health individual session | Physiotherapist |
| 10968 | Allied health individual session | Psychologist (general registration) |
| 10970 | Allied health individual session | Speech Pathologist |
Group therapy
Group items count against a separate annual cap. A client can claim 10 individual Better Access sessions and 10 group Better Access sessions in the same calendar year — they don't draw down from each other.
Family and carer sessions
Family/carer items (e.g. 80165) cover sessions where the practitioner sees family members or carers in the patient's absence. These count toward the individual Better Access cap, up to a maximum of 2 per calendar year.
NDIS-funded sessions
NDIS-funded mental health work is not Medicare. NDIS uses a separate billing channel and rate structure. If the client's funding is NDIS, the MBS picker is hidden — see NDIS Invoicing instead.
What happens if you pick the wrong item
Praxi pre-validates the item against your endorsement scope at submission time. If you've selected an item outside your scope, you'll see a blocker on the Claim Readiness panel before the claim is sent — fix it and resubmit without ever touching Services Australia.
If the item is technically valid for your profession but doesn't match the clinical scenario (e.g. you billed a 50-minute item for a 30-minute session), Services Australia may still accept the claim and pay the benefit. The mismatch surfaces in compliance reviews, AHPRA notifications, or SA-led debt recovery actions. Claim accurately — the picker is a guide, not a guarantee.
If a claim slips past the pre-validation and SA rejects it, you'll see one of:
- Item not valid for your provider type — the item series doesn't match your profession.
- Item not payable for your provider — the item is valid for your profession but you don't have the specific endorsement (e.g. you billed an 80000 series item without a Clinical Psychology endorsement on file with SA).
Both rejections are usually resolved by reselecting the correct item and resubmitting. If SA's records show a different endorsement scope than AHPRA does, contact SA via OTS Helpdesk (1300 550 115) to update your provider record.
AI item suggestion
When you open the Medicare Submit Sheet, Praxi suggests the most likely item based on the appointment metadata — type, duration, mode, group setting. The suggestion includes the schedule fee and a confidence indicator:
- Green — high confidence. The appointment metadata matches one item cleanly (e.g. a 60-minute individual telehealth video appointment with a Clinical Psychology endorsement holder maps unambiguously to 91167).
- Amber — moderate confidence. Two or more items could apply. Praxi surfaces both and lets you choose.
- Red — low confidence. The appointment metadata is incomplete or ambiguous; the suggestion is a best guess only.
The AI suggestion is always practitioner-reviewed. Praxi never auto-submits a claim based on an AI item pick — every claim requires you to click Submit after reviewing the item. The suggestion is logged in the claim audit trail (including the AI confidence score) so the rationale is available for AHPRA or compliance review.
Cross-references
- Medicare Claiming — full MCOL workflow.
- Better Access (MHCP) — scheme rules, caps, GP-review milestones.
- GP Referral Lifecycle — when referrals are required and how to capture them.
- Bulk Bill Submission (BBSW) — bulk-billing workflow.
- Patient Claims (PCIW) — patient-claim workflow.
- Medicare Claiming Errors — item, referral, and the full set of rejection situations.
- Per-claim Audit Trail — where the item-suggestion record is stored.
Verified against the current Praxi product surface and the MBS Online schedule on 2026-05-14. Items and fees update with the MBS quarterly schedule release.