In short: A free check of a GP’s attendance day counts against the Medicare 80/20 rule and 30/20 phone rule (prescribed pattern of services) that trigger referral to the Professional Services Review.
Eighty or more attendance items on twenty or more days in a year is a prescribed pattern of services: deemed inappropriate practice and referred to the Professional Services Review. Thirty phone attendances on twenty days is the same. Put a doctor’s real numbers in and see where they sit.
Free · Nothing stored · Two minutes
Use a doctor’s real numbers from the appointment book or Cubiko. Count attendance items rendered, not patients seen.
Pick the closest pattern; the exact count matters less than the heavy days below.
Items rendered, not patients seen — from the book or Cubiko.
A practitioner “renders or initiates 80 or more relevant professional attendance services on each of 20 or more days in a 12-month period” — or “30 or more relevant phone services on each of 20 or more days” — is deemed to have engaged in inappropriate practice “except in exceptional circumstances”, and the delegate “is required by the Health Insurance Act 1973 to request the Director of Professional Services Review to review” them. The request is the start of a process, not a finding. But it is a process nobody wants, and the practices we audit almost never know which of their doctors is close, because nobody counts days.
What we set up: a monthly Cubiko or Bp report per doctor of attendance items by day, a flag at 70, and a conversation about session length and booking templates long before anyone is at 80. For the doctors who are high because patients are short and simple, the answer is usually a Level A/B mix and roster change, not fewer patients.
A general practitioner who renders or initiates 80 or more relevant professional attendance services on each of 20 or more days in a 12-month period is deemed to have engaged in inappropriate practice, except in exceptional circumstances. The delegate must then request the Director of Professional Services Review to review the practitioner. It is a prescribed pattern under the Health Insurance (Professional Services Review Scheme) Regulations 2019.
The same structure for phone attendances: 30 or more relevant phone services on each of 20 or more days in a 12-month period. It commenced on 1 October 2022, when telehealth was made permanent.
For 80/20, Group A GP and other medical practitioner attendance items, including video and phone consultations since 1 July 2022; COVID-19 vaccine suitability assessment and management items were excluded. For 30/20, the phone attendance items. Chronic condition plans and health assessments are not standard attendance items but the Department publishes the list, and a practitioner who is close should check it rather than rely on this summary.
No. The prescribed pattern is an automatic trigger; the PSR also reviews practitioners referred for other reasons — high servicing relative to peers, item patterns, care plan volumes, referrals from Medicare compliance. Seventy-nine a day, every day, is not a safe harbour. This tool is a floor check, not a target.
An estimate from the numbers you enter, for planning conversations only. It is not billing, legal, tax or financial advice. Verify every item number and rebate on MBS Online before you bill.
Your day counts and the result. Jamal gets a copy; no mailing list.
On its way. If you ticked the box, expect a call or text from 0403 275 771.