Assignment of benefit in Medicare bulk billing 011-25092442

Assignment agreement particulars

An approved assignment of benefit form will no longer be required. However, the agreement must specify particular information as set out in the Health Insurance Regulations 2018. The information required is dependent on the type of assignment.

Note: the below does not apply to for CDBS claims made under the Dental Benefits Act 2008.

Pre-assignment

Table 1

Pathology (excluding Group 9)	Diagnostic Imaging	All other MBS services (including Group P9)
Patient name	Patient name	Patient name
Date of assignment	Date of assignment	Date of assignment
Assignment Type: Pre-assignment	Assignment Type: Pre-assignment	Assignment Type: Pre-assignment
Is the assignor the patient: Yes or No	Is the assignor the patient: Yes or No	Is the assignor the patient: Yes or No
Date of first specimen collection	Date of imaging procedure	Details of the professional
Statement of assignor’s agreement*	Statement of assignor’s agreement (R type services)	Date of service
Description of the service	Assignment Type: Pre-assignment	Assignment Type: Pre-assignment
	Description of the service	Basic service description

Post-assignment

Table 2

Pathology (excluding Group 9)	Diagnostic Imaging	All other MBS services (including Group P9)
Patient name	Patient name	Patient name
Date of assignment	Date of assignment	Date of assignment
Assignment Type: Post assignment	Assignment Type: Post assignment	Assignment Type: Post assignment
Is the assignor the patient: Yes or No	Is the assignor the patient: Yes or No	Is the assignor the patient: Yes or No
Date of first specimen collection	Date of imaging procedure	Details of the professional
Details of the professional (per Section 54 of the HIR)	Details of the professional	Date of service
MBS item/s	MBS item/s	MBS item/s

MBS Online

MBS Online - November 2025 Downloads

Examples on a pre-assignment agreement

For Pathology (Excluding Group 9)

I assign my right to benefits to the approved pathology practitioner who will render the requested pathology services(s) and any eligible pathologist determinable service(s) established as necessary by the practitioner.

For Diagnostic Imaging

I assign my right to benefits to the diagnostic imaging provider who will render the requested diagnostic imaging services(s) and any eligible determinable service(s) established as necessary by the diagnostic imaging provider.

Forms

Application for bulk bill claim adjustment form (DB018)

Application for late lodgement of a claim for assigned Medicare benefits (DB019)

Assignment of benefit Medicare bulk bill Webclaim form (DB020)

Bulk bill voucher - electronically transmitted claims form (DB4E)

Medicare stationery order form (DB6Ba)

Contact details

Medicare Claims and Assessing

Bulk bill claims

Services Australia website

Assignment of benefit

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