The Potential Impact of Level E Consultations

The Federal Budget of 2023 has introduced a new Level E consult for appointments longer than 60+ minutes. Anecdotally speaking to General Practitioners, we don’t know many that would ever have a consult go longer than 60+ minutes. And so, we decided to dive deep into the data to see if there is any financial impact on a general practice with the introduction of Level E consults.

With the help of Touchstone, Cubiko’s industry benchmarking tool, let’s take a detailed look at the potential financial implications of this change and what it could mean for your practice.

The New Consultation Landscape

The Medicare Benefits Schedule (MBS) now includes five levels of consultation for general practitioners:

  • Level A consult Item 3 (short consult): $18.20 to $18.95
  • Level B consult Item 23 (less than 20 minutes): $39.75 to $41.40
  • Level C consult Item 36 (20 minutes to 40 minutes): $76.95 to $80.10
  • Level D consult (40 minutes to 60 minutes): $113.30 to $118.00
  • Level E consult (60 minutes+): New category, approximately $184
One of the additions in the Federal Budget was the introduction of the Level E consult. The new consultation landscape now includes a Medicare rebate for 60-minute consultations, offering financial rebate for practices catering to patients needing more comprehensive care. The RACGP’s detailed breakdown provides further insight into changes from the Federal Budget.

Touchstone dataset: The financial impact of Level E for today’s world

What is the Touchstone Dataset?

Firstly, let’s go into detail about the Touchstone dataset before analysing the potential for Level E consults. Touchstone is a feature within the Cubiko product that allows General Practices to opt-in their financial and billing data to a de-identified, aggregated data set. At the time of writing, the Touchstone data set has 640 medical practices opted-in, one of the largest benchmarking datasets for Australian primary care.

Each practice that opts-in elects their State, Modified Monash Model, Primary Health Network, Billing Model (Mixed or Bulk-billing), whether they’re a teaching practice and their Doctor FTE. Cubiko securely stores the Touchstone dataset and returns the benchmarks to our customers who opt-in with the product. It is completely de-identified and aggregated, and there are frequency and cell dominance rules. This ensures the data can never be de-identified, there is also a minimum practice size count that is randomised when applying filters.

Touchstone, as of writing, has a breakdown of:


  • 72% mixed and/or private billing practices, and 28% Bulk-billing practices.
  • 53% are Teaching practices
  • The most dominant FTE size is 5-9 GP FTE

Similarities between the practices in the dataset are that they all use Cubiko, and they all use Best Practice. Although Cubiko integrates MedicalDirector, Touchstone is not currently available to these practices. 

Does anyone bill a Level D consult over 60 minutes?

In analysing the Touchstone dataset, the short answer is; not really.

The average medical practice in the Touchstone dataset bills 16 Level D consults that are over 60+ minutes every month. This is the average from May 2021, to March 2023. Below we’ll break down the differences across the Touchstone dataset:

  • Australian average of potential Level E consults per month: 16
  • Mixed billing average of potential Level E consults per month: 15
  • Bulk-billing average of potential Level E consults per month: 18

Regarding billings, the impact for practices can be measured by taking the increased incentive of a Level D consult and adding the difference between that and the new Level E consult. This is a billings increase of $66 per consult. On average per each of those practice types across Touchstone, this can be viewed as:

  • Australian average increase in billings from Level E consults per month: $1,056
  • Mixed billing average increase in billings from Level E consults per month: $990
  • Bulk-billing average increase in billings from Level E consults per month: $1188

The billing impact for a general practice is minimal.

Some assumptions are made for this financial analysis, such that General Practices won’t increase the number of consults above 60+ minutes to increase billings further. Even then, it could be that the billing impact as a whole is still minimal.

You can run your own analysis of the addition of Level E consults. In Cubiko we have built a new metric that takes the eligible consults over the last 12 months, and adds the additional billings from a Level E for an annual figure. Note the screenshot below is a made-up dataset and not reflective of an average General Practice.

Final remarks on the introduction of Level E consults

Overall it is a positive step for the introduction of Level E consults. It will lead to some billing increases for general practices, allowing them to spend more time with patients for even greater patient care. The number of consults already exceeding 60+ minutes is minimal; therefore, based on today’s data, the financial impact is minimal. We would also like to note that there is an increasing challenge of access to primary health with General Practitioner workforce shortages that longer consults for access to healthcare may not be the answer. We’ll leave that last point something to think about regarding the Federal Budget!

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