MBS item scrutiny profile
MBS Item 10997 — PSR scrutiny profile
Appears in 5 published determinations since 2022, with related issues and repayments shown only where recorded.
Scrutiny profile
Co-occurring issue categories
- Chronic disease management5
- Inadequate documentation5
- Clinical appropriateness3
- Excessive servicing3
- MBS requirement breach3
- Mental health treatment plan1
- Time based billing1
Specialties involved
- General Practice5
Repayment range
Calculated only across the 5 published cases where a repayment amount is recorded.
Published cases mentioning item 10997
Agreement 16: General Practitioner (Diagnostic Ordering)
Section 92 agreement with repayment
$210,000
Agreement 3: General Practitioner (CDM Services)
Section 92 agreement with repayment
$57,000
Agreement 5: General Practitioner (Multiple Services)
Section 92 agreement with repayment
$319,000
Agreement 2: General Practitioner
Section 92 agreement with repayment
$90,000
Final determination: General Practitioner - Health Assessments
Final determination with repayment and disqualification
$262,500
What survives review
Chronic disease management
Keep the source record clear enough for an external peer to connect the patient need, the service provided, and the item claimed.
Documentation has to stand alone
The note should show the presenting problem, assessment, clinical reasoning, time or complexity when relevant, and the plan without relying on memory.
Show the clinical input
For higher-value or repeated services, the record should make the practitioner contribution visible rather than just recording an administrative event.
Excessive servicing
Keep the source record clear enough for an external peer to connect the patient need, the service provided, and the item claimed.
Educational disclaimer
This educational module is based on publicly available PSR case-outcome material. It is general educational information only and does not constitute legal advice, billing advice, or a substitute for reviewing the MBS, PSR material, or obtaining professional advice.