H-ST Criteria for MBS Items

1. H-ST Criteria for MBS Items Legislative Criteria: • The item must have an 85% benefit listed in the MBS book • Services identified in Groups T1 to T11 of the general medical services table • Oral and maxillofacial services set out in Groups O1 to O11 of the general medical services table • Services in the pathology services table or in the diagnostic imaging services table that are integral to the provision of the services that qualify for Hospital-Substitute Treatment • The words ‘hospital-substitute treatment’ should be written on the account as required by the Health Insurance Regulations 1975 as amended. Doctors providing services under such a program should ask the patient if they want to use their private health insurance or claim from Medicare only. If they wish to use their private health insurance, the doctor should indicate on the account that the services form part of H-ST.

2. Assessing Requirements • Medicare is not able to flag, identify or code H-ST items • Doctors are required by legislation to mark the accounts with the words ‘Hospital-Substitute Treatment’ • Claims will be sent to the fund first • Funds must flag HS-T services • Once the fund receives a claim for H-ST and before submitting to Medicare, the assessor will need to flag the item as H-ST • The claims system should then prompt the assessor to enter a facility provider number • The claim can then be submitted to Medicare via Simplified Billing