Identifying and definitional attributes
|Metadata item type:||Value Domain|
|Registration status:||Commonwealth Department of Health, Standardisation pending 20/11/2015|
The code set representing the level of entitlement applicable for a Pharmaceutical Benefits Scheme (PBS) item being processed, as at the date of supply of the item to the patient or PBS consumer.
Used to calculate the benefit payable to the claimant. The payment entitlement category code and the type of supplier of the item (pharmacy, public hospital etc.) are used to determine the level of patient contribution.
|Maximum character length:||2|
Collection and usage attributes
|Guide for use:|
CODE GE General consumer
General consumers must hold a Medicare card, and pay the full patient contribution for PBS prescription items unless they reach the applicable general Safety Net threshold in a given calendar year.
Under the Reciprocal Health Care Agreements, visitors from participating countries are treated as general consumers. To receive a pharmaceutical benefit, visitors must present either an interim Medicare card (blue), a Reciprocal Health Care Medicare card (pale green) or their passport.
CODE CO Concession card holder
The first level of reduced patient contribution for PBS items.
Concessional consumers must hold a Medicare card and at least one of the following cards from either Centrelink, the Department of Veterans' Affairs (DVA) or the Department of Human Services (DHS).
CODE PE Pensioner
The second level of reduced patient contribution for PBS items.
This code is only applicable to concession card holders (see Code 'CO' above) who reach or exceed the concessional Safety Net threshold in a given calendar year.
PBS items for consumers in this category are supplied free of charge for the remainder of the calendar year, with the consumer continuing to pay any applicable special patient contributions, brand premiums or therapeutic group premiums.
Safety Net consumers must hold a Safety Net Entitlement card ('SN' prefix on the number) issued by the Department of Human Services (DHS).
CODE RE Repatriation (Department of Veterans' Affairs)
Veterans' Affairs claims.
Repatriation consumers must hold one of the following cards from the Department of Veterans' Affairs (DVA).
CODE DB Prescriber Bag
Also known as Doctor's Bag, particularly in the context of historical data.
Items supplied on Prescriber Bag order forms. Consumers currently pay no contribution.
CODE OC Stoma
This code applies to those patients who are likely to claim benefits related to the provision of stoma-related aids and appliances.
Assistance in relation to stoma-related products is provided via the Stoma Appliance Scheme (SAS). The SAS provides assistance to Medicare-eligible Australian residents who have a temporary or permanent artificial body opening, whether created surgically or otherwise, which facilitates the removal of urine and products of the gastrointestinal tract where the person does not have normal gastrointestinal tract or bladder functions.
To receive subsidised stoma-related products a patient must be a member of a stoma association in Australia and hold an SAS entitlement card issued by Medicare through one of the associations.
CODE OP Paraplegic and quadriplegic
This code applies to those patients who claim PBS benefits related to the provision of paraplegic- or quadriplegic-related products.
Assistance in relation to paraplegic- or quadriplegic-related products is provided via the provisions of the National Health (Paraplegic and Quadriplegic Program) Special Arrangement 2010. The program provides assistance to Medicare-eligible Australian residents who have paraplegia or quadriplegia.
To receive subsidised paraplegic- or quadriplegic-related products a patient must be a member of an authorised paraplegic or quadriplegic association in Australia and hold an entitlement card issued by Medicare through one of the associations.
The payment type code is determined by the pharmacist at the time of supply and is indicated on the prescription form. For electronically submitted claims, the payment type code information is supplied from the pharmacy computer system. For manually entered claims, the payment type code is keyed by the operator.
Source and reference attributes
Department of Health
Department of Health 2015. Stoma Appliance Scheme web page. Department of Health, Canberra. Viewed 17 September 2015,
Office of Parliamentary Counsel, ComLaw website 2015. National Health (Paraplegic and Quadriplegic Program) Special Arrangement 2010 (PB 118 of 2010) (Cwth). Office of Parliamentary Counsel, Canberra. Viewed 17 September 2015,
Department of Human Services 2015. Pharmaceutical Benefits Scheme (PBS) Safety Net. Department of Human Services, Canberra. Viewed 22 September 2015,
|Data elements implementing this value domain:|
Pharmaceutical Benefits Scheme (PBS) prescription—patient category, entitlement code AA Commonwealth Department of Health, Standard 17/12/2015