Private Health Fund receipts service items

Defence Health regularly reviews claims to ensure benefits are paid accurately and appropriately. In a recent review we noticed some providers charging initial consultations for some of our members who are being seen for subsequent consultations, resulting in the fund paying higher benefits than appropriate. Whilst this is acceptable if treating a new condition, they are finding this is not often the case.

Feedback from similar providers suggests there may be some confusion relating to the codes. Unlike Medibank Private whose codes are based on timed consultations we would like to point out that all other funds use 105 as an initial consultation or new condition and 205 for subsequent appointments (see below HICAPS table):

Please note, using incorrect codes may result in the health funds seeking a refund from providers in the future who continue to bill incorrectly. The private health funds will continue to monitor services provided by members to ensure correct benefits are being paid accurately.

The private health funds thank Approved Providers who are using the correct codes.

For further information please email info@massagemyotherapy.com.au