Billing menopause care properly: 695, care plans and LARC

How GPs can bill perimenopause and menopause care compliantly with MBS item 695, chronic condition plans and LARC, with a free template.

World Menopause Day is on 18 October. It's a good moment to ask an honest question: is your practice set up to provide, and be paid for, good menopause care?

Women in perimenopause and menopause often arrive with a long list: hot flushes, sleep, mood, cycles, bone health, cardiovascular risk, sexual health, contraception. Trying to cover that in a standard consult isn't good for the patient or the GP. Since 1 July 2025, the MBS gives us a better option.

What item 695 is

Item 695 is a menopause and perimenopause health assessment for GPs, lasting at least 20 minutes. (Item 19000 is the equivalent for prescribed medical practitioners, with a lower rebate.) It's for patients with symptoms of perimenopause or menopause, or who are being treated for them, including early menopause and premature ovarian insufficiency.

The assessment includes:

Taking a history to establish menopausal status, wellbeing and any contraindications to management

A basic physical examination, including blood pressure, height and weight

Developing and documenting a management plan with the patient

It's currently a temporary item for an initial two-year period, which is all the more reason to use it well now.

The rules that trip people up

It should be the patient's usual GP

Health assessments are meant to be accessed through the patient's usual GP or practice where reasonably practicable. This is a continuity item, not a one-off.

Nurses can help, but not bill separately

Your practice nurse can assist with parts of the assessment, such as measurements and history questionnaires. However, "on behalf of" items like 10997 can't be claimed for assisting with a health assessment.

Don't double-count time

A patient may be eligible for both a menopause assessment and a separate time-tiered health assessment. But the same attendance time can't be billed under two items. A separate standard consult on the same occasion also isn't appropriate unless it's clinically necessary.

A practical workflow many GPs use: an initial consult to take the history and order bloods, then a longer, planned appointment to complete the assessment and management plan, billed as 695.

Where chronic condition management plans fit

Menopause itself isn't automatically a chronic condition for care planning purposes. But many patients in this age group have conditions that are, and those should be planned for properly. If a patient is eligible, a GP Chronic Condition Management Plan (965) and planned reviews (967) can sit alongside menopause care. Keep the documentation clearly separate, so each service stands on its own.

LARC: don't leave the procedure unbilled

For many perimenopausal women, a hormonal IUD is part of both contraception and symptom management. Insertion is a procedure with its own MBS item. If there's a separate, clinically necessary consultation on the same day, that can also be billed. What gets missed most often is the time spent counselling beforehand, and planning the insertion as a proper procedure appointment rather than squeezing it in. Check the current descriptors for insertion items and any bulk billing incentive rules that apply to your patients.

What about fees?

A good menopause assessment takes time, often more than the minimum 20 minutes. Many practices privately bill 695, and I recommend considering it. Whatever you decide, make sure your fees are explained to the patient before the appointment.

Make it easy for your team

We've built a free 695 template to help GPs structure the assessment and document it well. You can download it from the Better Billing website.

Download the free 695 template at betterbilling.com.au, and if you'd like your team or PHN to go deeper on women's health billing, get in touch about our webinars.