MBS item scrutiny profile
MBS Item 90043 — PSR scrutiny profile
Appears in 2 published determinations since 2025, with related issues and repayments shown only where recorded.
Scrutiny profile
Co-occurring issue categories
- After-hours billing1
- Clinical appropriateness1
- Inadequate documentation1
- Inappropriate billing and prescribing1
- Incorrect item use1
- Telehealth compliance1
- Time based billing1
Specialties involved
- General Practice1
- Unknown1
Repayment range
Calculated only across the 2 published cases where a repayment amount is recorded.
Published cases mentioning item 90043
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
Agreement 4: General Practitioner (Residential Aged Care Services)
Section 92 agreement with repayment
$400,000
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.
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.
Inappropriate billing and prescribing
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.