MBS item scrutiny profile
MBS Item 5049 — PSR scrutiny profile
Appears in 2 published determinations since 2024, with related issues and repayments shown only where recorded.
Scrutiny profile
Co-occurring issue categories
- After-hours billing1
- Chronic disease management1
- Clinical appropriateness1
- Inadequate documentation1
- Inappropriate billing and prescribing1
- Mental health treatment plan1
Specialties involved
- General Practice1
- Unknown1
Repayment range
Calculated only across the 2 published cases where a repayment amount is recorded.
Published cases mentioning item 5049
Section 92 agreement with General Practitioner for inappropriate MBS and PBS item use
Practitioner acknowledged inappropriate practice, agreed to repay $135,000 and be counselled and reprimanded by Associate Director
$135,000
Final determination: General Practitioner 1
Final determination with repayment and disqualification
$610,000
What survives review
After-hours billing
Keep the source record clear enough for an external peer to connect the patient need, the service provided, and the item claimed.
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.
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.
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.
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.