> For clean Markdown of any page, append .md to the page URL.
> For a complete documentation index, see https://docs.rebateright.com.au/llms.txt.
> For AI client integration (Claude Code, Cursor, etc.), connect to the MCP server at https://docs.rebateright.com.au/_mcp/server.

# Eligibility check coverage

RebateRight checks the full Medicare Benefits Schedule. This page explains what we check on every item, and what each result means — so you know exactly what you're getting before you rely on it.

## What we check on every MBS item

We check the **full MBS — all 6,039 items, with nothing skipped**. On every item, every time, RebateRight:

* **Verifies the patient with Medicare** — that the card is valid and the patient's details match Services Australia's records.
* **Checks the patient's age** against the item's age rules.
* **Checks referral requirements** — whether a referral is needed, and whether the referrer is eligible.
* **Checks the item's eligibility rules** — patient sex, in-hospital vs out-of-hospital, and more.
* **Applies hundreds of Medicare rules** through our rules engine, with the exact reason on every result.

For most items we then confirm the result **live with Services Australia**. For the rest, that live confirmation isn't available — so we give you our own assessment, clearly labelled. Here's how that breaks down.

## How confident each result is

Every result is one of three kinds:

* **Confirmed** — *about 87% of items.* Confirmed live with Services Australia. The strongest result.
* **Indicative** — *about 13% of items.* Services Australia doesn't verify these items online, so the result is RebateRight's own assessment from all the checks above. A strong guide, not a confirmed answer.
* **Indicative, with a frequency limit** — *about 2.7% of items (part of the indicative group).* These items cap how often they can be claimed, and we can't check that cap — confirming it needs the patient's Medicare claim history, which Services Australia doesn't share for these items. We still run our checks: if one fails, you get a clear **not eligible** with the reason; only when they all pass do we return **cannot determine**, rather than guess.

The indicative carve-out is named in section 7 of [our Licence Agreement](https://rebateright.com.au/legal/terms#limits-we-name-up-front).

## Check whether your items are affected

**165 of 6,039 MBS items (about 2.7%)** are *indicative items with a frequency limit* — items that cap how often they can be claimed. Most are common GP, allied-health, mental-health, and telehealth services. On these items, RebateRight still runs all of [its own checks](#what-we-check-on-every-mbs-item): patient verification, age, referral, and more.

| Item  | Description                                                                                      |
| ----- | ------------------------------------------------------------------------------------------------ |
| 139   | Professional attendance lasting at least 45 minutes, at a place other than a hospital, by a gen… |
| 145   | Professional attendance lasting more than 60 minutes at a place other than consulting rooms or…  |
| 147   | Professional attendance lasting more than 30 minutes at a place other than consulting rooms or…  |
| 177   | Professional attendance on a patient who is 30 years of age or over for a heart health assessme… |
| 228   | Professional attendance by a prescribed medical practitioner at consulting rooms or in a place…  |
| 245   | Participation by a prescribed medical practitioner in a Domiciliary Medication Management Revie… |
| 249   | Participation by a prescribed medical practitioner in a residential medication management revie… |
| 291   | Professional attendance lasting more than 45 minutes at consulting rooms by a consultant physic… |
| 293   | Professional attendance lasting more than 30 minutes, but not more than 45 minutes, at consulti… |
| 296   | Professional attendance lasting more than 45 minutes by a consultant physician in the practice…  |
| 299   | Professional attendance lasting more than 45 minutes by a consultant physician in the practice…  |
| 300   | Professional attendance by a consultant physician in the practice of the consultant physician’s… |
| 302   | Professional attendance by a consultant physician in the practice of the consultant physician’s… |
| 304   | Professional attendance by a consultant physician in the practice of the consultant physician’s… |
| 306   | Professional attendance by a consultant physician in the practice of the consultant physician’s… |
| 308   | Professional attendance by a consultant physician in the practice of the consultant physician’s… |
| 310   | Professional attendance by a consultant physician in the practice of the consultant physician’s… |
| 312   | Professional attendance by a consultant physician in the practice of the consultant physician’s… |
| 314   | Professional attendance by a consultant physician in the practice of the consultant physician’s… |
| 316   | Professional attendance by a consultant physician in the practice of the consultant physician’s… |
| 318   | Professional attendance by a consultant physician in the practice of the consultant physician’s… |
| 319   | Professional attendance by a consultant physician in the practice of the consultant physician’s… |
| 699   | Professional attendance on a patient who is 30 years of age or over for a heart health assessme… |
| 701   | Professional attendance by a general practitioner to perform a brief health assessment, lasting… |
| 703   | Professional attendance by a general practitioner to perform a standard health assessment, last… |
| 705   | Professional attendance by a general practitioner to perform a long health assessment, lasting…  |
| 707   | Professional attendance by a general practitioner to perform a prolonged health assessment (las… |
| 715   | Professional attendance by a general practitioner, at consulting rooms or in a place other than… |
| 900   | Participation by a general practitioner (not including a specialist or consultant physician) in… |
| 903   | Participation by a general practitioner (not including a specialist or consultant physician) in… |
| 10910 | Professional attendance of more than 15 minutes in duration, being the first in a course of att… |
| 10911 | Professional attendance of more than 15 minutes in duration, being the first in a course of att… |
| 10921 | All professional attendances after the first, being those attendances regarded as a single serv… |
| 10924 | All professional attendances after the first, being those attendances regarded as a single serv… |
| 10926 | All professional attendances after the first, being those attendances regarded as a single serv… |
| 10927 | All professional attendances after the first, being those attendances regarded as a single serv… |
| 10928 | All professional attendances after the first, being those attendances regarded as a single serv… |
| 10929 | All professional attendances after the first, being those attendances regarded as a single serv… |
| 10931 | A flag fall service to which an item in Subgroup 1 of Group A10 applies (other than this item),… |
| 10938 | Full quantitative computerised perimetry (automated absolute static threshold), with bilateral…  |
| 10939 | Full quantitative computerised perimetry (automated absolute static threshold) with unilateral…  |
| 10940 | Full quantitative computerised perimetry (automated absolute static threshold), with bilateral…  |
| 10941 | Full quantitative computerised perimetry (automated absolute static threshold) with unilateral…  |
| 10942 | Testing of residual vision to provide optimum visual performance for a patient who has best cor… |
| 10943 | Additional testing to confirm diagnosis of, or establish a treatment regime for, a significant…  |
| 10944 | Complete removal of embedded foreign body (including a rust ring, if present) from the cornea—n… |
| 10950 | Aboriginal and Torres Strait Islander health and wellbeing service provided to a patient by an…  |
| 10951 | Diabetes education health service provided to a patient by an eligible diabetes educator if: (a… |
| 10952 | Audiology health service provided to a patient by an eligible audiologist if: (a) the patient h… |
| 10953 | Exercise physiology health service provided to a patient by an eligible exercise physiologist i… |
| 10954 | Dietetics health service provided to a patient by an eligible dietitian if: (a) the patient has… |
| 10956 | Mental health service provided to a patient by an eligible mental health worker if: (a) the pat… |
| 10958 | Occupational therapy health service provided to a patient by an eligible occupational therapist… |
| 10960 | Physiotherapy health service provided to a patient by an eligible physiotherapist if: (a) the p… |
| 10962 | Podiatry health service provided to a patient by an eligible podiatrist if: (a) the patient has… |
| 10964 | Chiropractic health service provided to a patient by an eligible chiropractor if: (a) the patie… |
| 10966 | Osteopathy health service provided to a patient by an eligible osteopath if: (a) the patient ha… |
| 10968 | Psychology health service provided to a patient by an eligible psychologist if: (a) the patient… |
| 10970 | Speech pathology health service provided to a patient by an eligible speech pathologist if: (a)… |
| 10987 | Follow up service provided by a practice nurse or Aboriginal and Torres Strait Islander health…  |
| 10997 | Service provided by a practice nurse or an Aboriginal and Torres Strait Islander health practit… |
| 11342 | Programming by video attendance of an auditory implant, or the sound processor of an auditory i… |
| 11345 | Programming by phone attendance of an auditory implant, or the sound processor of an auditory i… |
| 11707 | Twelve‑lead electrocardiography, trace only, by a medical practitioner, if: (a) the trace is pr… |
| 11714 | Twelve-lead electrocardiography, trace and clinical note, by a medical practitioner, if: (a) th… |
| 11716 | Note: the service only applies if the patient meets one or more of the following and the requir… |
| 11717 | Note: the service only applies if the patient meets one or more of the following and the requir… |
| 11723 | Note: the service only applies if the patient meets one or more of the following and the requir… |
| 11735 | Note: the service only applies if the patient meets one or more of the following and the requir… |
| 13104 | Planning and management of home dialysis (either haemodialysis or peritoneal dialysis), by a co… |
| 16400 | Antenatal service provided by a practice midwife, nurse or an Aboriginal and Torres Strait Isla… |
| 16408 | Postnatal attendance (other than attendance at consulting rooms, a hospital or a residential ag… |
| 57541 | Fee for a service rendered using first eligible x-ray procedure carried out during attendance a… |
| 73839 | Quantitation of HbA1c (glycated haemoglobin) performed for the diagnosis of diabetes in asympto… |
| 73840 | Quantitation of glycosylated haemoglobin performed in the management of established diabetes –…  |
| 81000 | Non‑directive pregnancy support counselling health service provided to a patient who is current… |
| 81005 | Non‑directive pregnancy support counselling health service provided to a patient, who is curren… |
| 81010 | Non‑directive pregnancy support counselling health service provided to a patient, who is curren… |
| 81100 | Diabetes education health service provided to a patient by an eligible diabetes educator for as… |
| 81105 | Diabetes education health service provided to a patient by an eligible diabetes educator, as a…  |
| 81110 | Exercise physiology health service provided to a person by an eligible exercise physiologist fo… |
| 81115 | Exercise physiology health service provided to a person by an eligible exercise physiologist, a… |
| 81120 | Dietetics health service provided to a person by an eligible dietitian for assessing the person… |
| 81125 | Dietetics health service provided to a person by an eligible dietitian, as a group service for…  |
| 81300 | Aboriginal and Torres Strait Islander health and wellbeing service provided to a patient of Abo… |
| 81305 | Diabetes education health service provided to a patient who is of Aboriginal or Torres Strait I… |
| 81310 | Audiology health service provided to a patient who is of Aboriginal or Torres Strait Islander d… |
| 81315 | Exercise physiology health service provided to a patient who is of Aboriginal or Torres Strait…  |
| 81320 | Dietetics health service provided to a patient who is of Aboriginal or Torres Strait Islander d… |
| 81325 | Mental health service provided to a patient who is of Aboriginal or Torres Strait Islander desc… |
| 81330 | Occupational therapy health service provided to a patient who is of Aboriginal or Torres Strait… |
| 81335 | Physiotherapy health service provided to a patient who is of Aboriginal or Torres Strait Island… |
| 81340 | Podiatry health service provided to a patient who is of Aboriginal or Torres Strait Islander de… |
| 81345 | Chiropractic health service provided to a patient who is of Aboriginal or Torres Strait Islande… |
| 81350 | Osteopathy health service provided to a patient who is of Aboriginal or Torres Strait Islander…  |
| 81355 | Psychology health service provided to a patient who is of Aboriginal or Torres Strait Islander…  |
| 81360 | Speech pathology health service provided to a patient who is of Aboriginal or Torres Strait Isl… |
| 82100 | Initial antenatal professional attendance by a participating midwife, lasting at least 60 minut… |
| 82115 | Professional attendance by a participating midwife, lasting at least 90 minutes, for assessment… |
| 82116 | Management of labour for up to 6 hours, not including birth, at a place other than a hospital i… |
| 82140 | Postnatal professional attendance by a participating midwife on a patient, not less than 4 week… |
| 82301 | Audiology health service, consisting of programming an auditory implant or the sound processor…  |
| 82302 | Audiology health service by video attendance for programming of an auditory implant, or the sou… |
| 82304 | Audiology health service by phone attendance for programming of an auditory implant, or the sou… |
| 91827 | Video attendance for a person by a consultant psychiatrist; if: (a) the attendance follows a re… |
| 91828 | Video attendance for a person by a consultant psychiatrist; if: (a) the attendance follows a re… |
| 91829 | Video attendance for a person by a consultant psychiatrist; if:(a) the attendance follows a ref… |
| 91830 | Video attendance for a person by a consultant psychiatrist; if: (a) the attendance follows a re… |
| 91831 | Video attendance for a person by a consultant psychiatrist; if: (a) the attendance follows a re… |
| 91837 | Phone attendance for a person by a consultant psychiatrist; if: (a) the attendance follows a re… |
| 91838 | Phone attendance for a person by a consultant psychiatrist; if: (a) the attendance follows a re… |
| 91839 | Phone attendance for a person by a consultant psychiatrist; if: (a) the attendance follows a re… |
| 91850 | Antenatal video service provided by a practice midwife, nurse or an Aboriginal and Torres Strai… |
| 91851 | Postnatal video attendance by an obstetrician or general practitioner (other than a service to…  |
| 91852 | Postnatal video attendance (other than a service to which any other item applies) if:(a) the at… |
| 91855 | Antenatal phone service provided by a practice midwife, nurse or an Aboriginal and Torres Strai… |
| 91856 | Postnatal phone attendance by an obstetrician or general practitioner (other than a service to…  |
| 91857 | Postnatal phone attendance (other than a service to which any other item applies) if: (a) the a… |
| 91868 | Video attendance by a consultant physician in the practice of the consultant physician’s specia… |
| 91869 | Video attendance by a consultant physician in the practice of the consultant physician’s specia… |
| 91870 | Video attendance by a consultant physician in the practice of the consultant physician's specia… |
| 91871 | Video attendance by a consultant physician in the practice of the consultant physician’s specia… |
| 91872 | Video attendance by a consultant physician in the practice of the consultant physician’s specia… |
| 91873 | Video attendance lasting at least 45 minutes by a consultant physician in the practice of the c… |
| 91879 | Phone attendance by a consultant physician in the practice of the consultant physician’s specia… |
| 91880 | Phone attendance by a consultant physician in the practice of the consultant physician’s specia… |
| 91881 | Phone attendance by a consultant physician in the practice of the consultant physician’s specia… |
| 92004 | Video attendance by a general practitioner for an Aboriginal and Torres Strait Islander health…  |
| 92011 | Video attendance by a prescribed medical practitioner for an Aboriginal and Torres Strait Islan… |
| 92029 | Video attendance by a general practitioner to prepare a GP chronic condition management plan fo… |
| 92112 | Video attendance, by a general practitioner who has not undertaken mental health skills trainin… |
| 92113 | Video attendance, by a general practitioner who has not undertaken mental health skills trainin… |
| 92116 | Video attendance, by a general practitioner who has undertaken mental health skills training, o… |
| 92117 | Video attendance, by a general practitioner who has undertaken mental health skills training, o… |
| 92118 | Video attendance by a medical practitioner (not including a general practitioner, specialist or… |
| 92119 | Video attendance by a medical practitioner (not including a general practitioner, specialist or… |
| 92122 | Video attendance by a medical practitioner, (not including a general practitioner, specialist o… |
| 92123 | Video attendance by a medical practitioner, (not including a general practitioner, specialist o… |
| 92140 | Video attendance lasting at least 45 minutes by a consultant physician in the practice of the c… |
| 92141 | Video attendance lasting at least 45 minutes by a specialist or consultant physician (not inclu… |
| 92142 | Video attendance lasting at least 45 minutes by a general practitioner (not including a special… |
| 92422 | Video attendance by a consultant physician in the practice of the consultant physician’s specia… |
| 92423 | Video attendance by a consultant physician in the practice of the consultant physician’s specia… |
| 92434 | Video attendance lasting at least 45 minutes by a consultant physician in the practice of the c… |
| 92435 | Video attendance lasting more than 45 minutes by a consultant physician in the practice of the…  |
| 92436 | Video attendance lasting more than 30 minutes, but not more than 45 minutes, by a consultant ph… |
| 92437 | Video attendance of more than 45 minutes in duration by a consultant physician in the practice…  |
| 92443 | Phone attendance by a consultant physician in the practice of the consultant physician’s specia… |
| 92444 | Phone attendance lasting more than 30 minutes, but not more than 45 minutes, by a consultant ph… |
| 92448 | Phone attendance of more than 30 minutes in duration by a consultant physician or specialist in… |
| 92623 | Video attendance of more than 60 minutes in duration by a consultant physician or specialist in… |
| 92624 | Video attendance of more than 30 minutes in duration by a consultant physician or specialist in… |
| 92762 | Video attendance for a person by an addiction medicine specialist in the practice of the addict… |
| 92763 | Video attendance for a person by an addiction medicine specialist in the practice of the addict… |
| 92767 | Video attendance for a person by a sexual health medicine specialist in the practice of the sex… |
| 92768 | Video attendance for a person by a sexual health medicine specialist in the practice of the sex… |
| 93000 | Video attendance by an eligible allied health practitioner or Aboriginal and Torres Strait Isla… |
| 93013 | Phone attendance by an eligible allied health practitioner or Aboriginal and Torres Strait Isla… |
| 93026 | Non directive pregnancy support counselling health service provided to a person who is currentl… |
| 93029 | Non directive pregnancy support counselling health service provided to a person, who is current… |
| 93048 | Video attendance provided to a person who is of Aboriginal or Torres Strait Islander descent by… |
| 93061 | Phone attendance provided to a person who is of Aboriginal or Torres Strait Islander descent by… |
| 93284 | Video attendance by an eligible dietitian to provide a dietetics health service to a person for… |
| 93285 | Video attendance by an eligible dietitian to provide a dietetics health service, as a group ser… |
| 93286 | Phone attendance by an eligible dietitian to provide a dietetics health service to a person for… |

## For developers

The same picture, in the API.

### Item metadata

`GET /MedicareItems` and `GET /MedicareItems/{itemNumber}` return:

* `EligibilityCheckLimitation` — `null` for confirmed items, `"Indicative"` for items Services Australia doesn't verify online.
* `ClaimHistoryLimitation` — the item's frequency-of-service limit, when it has one.

An item that's `"Indicative"` **and** has a `ClaimHistoryLimitation` is one that can return cannot-determine. To pull the current set, list `GET /MedicareItems` and keep those entries.

```json
GET /MedicareItems/701

{
  "ItemNumber": "701",
  "BenefitType": "_100",
  "EligibilityCheckLimitation": "Indicative",
  "ClaimHistoryLimitation": "Applicable according to MBS Note AN.0.36 ..."
}
```

### Eligibility responses

Each `Rebates` entry carries:

* `ReasonCode` — two parts joined by a pipe (a RebateRight code and a Medicare code), for example `RREligible|MedicareUnverifiedItem`. Indicative items carry `MedicareUnverifiedItem` as the Medicare part.
* `IsEligible` — `true` or `false` when RebateRight's own rules decide it (a failed rule gives `false` with the exact reason); `null` (cannot determine) when every rule passes but the frequency limit can't be checked.
* `Reason` — plain-English, with each sentence tagged `[RebateRight]` or `[Medicare]`.

Indicative (rules pass, no frequency limit):

```json
{
  "ItemNumber": "3",
  "IsEligible": true,
  "ReasonCode": "RREligible|MedicareUnverifiedItem",
  "Reason": "[RebateRight] All RebateRight eligibility checks have passed … [RebateRight] Services Australia doesn't verify this item online, so this result is indicative. It comes from RebateRight's own rules, not a confirmed Medicare check.",
  "Benefit": "20.05",
  "ItemScheduleFee": "20.05"
}
```

Indicative with a frequency limit (rules pass):

```json
{
  "ItemNumber": "701",
  "IsEligible": null,
  "ReasonCode": "RREligible|MedicareUnverifiedItem",
  "Reason": "[RebateRight] All RebateRight eligibility checks have passed … [RebateRight] Services Australia doesn't verify this item online, so this result is indicative. We can't check its frequency-of-service limit without the patient's claim history, which we don't receive, so we can't confirm eligibility.",
  "Benefit": "0",
  "ItemScheduleFee": "69.20"
}
```

`IsEligible: null` on its own doesn't mean indicative — a missing `ReferrerProviderNumber` also returns `null`. Match on `MedicareUnverifiedItem`.