MBS item scrutiny profile
MBS Item 55113 — PSR scrutiny profile
Appears in 2 published determinations since 2021, with related issues and repayments shown only where recorded.
Scrutiny profile
Co-occurring issue categories
- Inadequate documentation2
- After-hours billing1
- Clinical appropriateness1
- Duplicate billing1
- Procedural consent1
Specialties involved
- Cardiology1
- General Practice1
Repayment range
Calculated only across the 2 published cases where a repayment amount is recorded.
Published cases mentioning item 55113
What survives review
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.
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.
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.
Duplicate billing
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.