Business skills: menopause in the MBS

Overview 

From 1 July 2025, two new MBS item numbers were  introduced into the MBS schedule to support comprehensive assessment and management of menopause-related symptoms, including premature ovarian insufficiency and early menopause.  These services may be claimed under MBS item 695 when performed by general practitioners, or item 19000 when performed by prescribed medical practitioners (PMPs) for whom the same rules apply. Item 695 provides a rebate of $101.90 compared to $84.90 for the time-based MBS item 36.

Prior to this, no MBS item number specifically addressed menopause-related symptoms. Sessions that addressed these symptoms would have been billed under time-based item numbers or as part of other health assessments. 

Eligibility 

Item 695 applies to patients experiencing symptoms of or receiving treatment for:

• premature ovarian insufficiency
• early menopause
• perimenopause
• menopause
  
  

The new MBS item 695 

Item 695 provides $101.90 for a professional attendance lasting at least 20 minutes. The sessions should include, but are not limited to:

• history-taking to assess menopausal status and contraindications
• basic physical examination, including BP, weight and height
• relevant investigations and referrals (eg cervical screening, mammography, bone densitometry)
• discussion of management options, including HRT and non-pharmacological approaches
• implementation of a patient-centred management plan
• preventive health advice (eg physical activity, smoking, alcohol, nutrition)

This item supports comprehensive care and allows GPs to dedicate time to address symptoms, long-term risks, and lifestyle management. 

Support from nurses and Aboriginal health workers

To manage time effectively, practice nurses, Aboriginal health workers, and Aboriginal and Torres Strait Islander health practitioners may assist with information collection and patient education — under the supervision of the GP. The time spent by the health professional may be used to contribute towards the assessment. 

Billing considerations for item 695

• May be claimed once every 12 months
• Requires a minimum of 20 minutes consultation time  (doctor and other health professional time combined) 
• Eligible patients may receive a menopause health assessment and a separate time‑tiered or Aboriginal and Torres Strait Islander health assessment, with no minimum time interval between services
  
  

A seven‑step workflow for MBS item 695

1. Identify eligible patients: flag patients presenting with symptoms of premature ovarian insufficiency, early menopause, perimenopause, or menopause who have not had a similar assessment in the past 12 months.

2. Book sequential appointments: have appointments with assisting health professionals followed immediately by the GP — to ensure a combined consultation lasting at least 20 minutes.

3. Delegate pre-consult tasks: have practice nurses or Aboriginal health staff gather history, vitals (BP, height, weight), perform educational interactions, and prepare necessary questionnaires under GP supervision.

4. Follow a structured consultation format: during the session, ensure you follow the format outlined in the MBS.

5. Ensure accurate documentation: record consultation duration, visit components, and any extended communication needs (eg interpreter used), to support billing and compliance.

6. Effective time management: initial menopause assessments typically exceed the 20‑minute minimum required for item 695. For comprehensive initial work-ups, a time‑based long‑consult item may offer a more appropriate rebate. A shorter consultation meeting the eligibility criteria for item 695 could be used as part of a review.

7. Integrate with preventive care: Consider GPCCMP for appropriate patients. Menopause Health assessment (695) and GPCCMP (695) can be co-claimed where criteria for both items are met (see FastTrack GPCCMP).

References

1. Department of Health, Disability and Ageing. Medicare Benefits Schedule - Item 695. 2025. Available at: https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=695&qt=ItemID. (last accessed July 2025).
2. Department of Health, Disability and Ageing. Menopause and perimenopause health assessment services. 2025. Available at: https://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/650f3eec0dfb990fca25692100069854/aaf82019492e80d0ca258cab00090ef3/$FILE/PDF%20version%20-%20Menopause%20and%20Perimenopause%20Health%20Assessment%20items.pdf. (last accessed July 2025).
3. Federal Register of Legislation. Health Insurance (Section 3C General Medical Services - Menopause and Perimenopause Health Assessment Services) Determination 2025. 2025. Available at: https://www.legislation.gov.au/F2025L00583/asmade/text. (last accessed July 2025).
4. Department of Health, Disability and Ageing. ASKMBS Advisory: General practice services #1. 2025. Available at: https://www.health.gov.au/sites/default/files/2025-06/askmbs-advisory-1-general-practice-services_0.pdf. (last accessed July 2025).

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