The Bulk Billing Practice Incentive Program from 1 November 2025 pays a 12.5% loading on MBS benefits for practices that bulk bill every eligible patient for every eligible service. Whether to switch depends on patient mix, location, consultation length and exit timeline. Five practice profiles gain from full bulk billing; four are better off staying mixed.
The billing model question has never been more loaded. Since 1 November 2025, the federal government's Bulk Billing Practice Incentive Program (BBPIP) has changed the financial calculus for every practice owner in Australia. Some clinics are better off switching to full bulk billing. Others will lose money doing so. The answer depends on your patient mix, your location, your consultation patterns, and, critically, what you plan to do with the practice over the next five years.
This post unpacks the recent Medicare changes, walks through the numbers and maps out which practices stand to gain from each model. It also connects billing decisions to practice valuation, because the two are inseparable.
What changed in November 2025
Two things happened at once:
Eligibility for the bulk billing incentive (BBI) was expanded to all Australians with a valid Medicare card. Previously, it only applied to GPs who bulk-billed children under 16 and concession card holders. Now, a GP can claim the BBI for any bulk-billed patient, regardless of age or concession status.
The government launched the BBPIP. Practices that register for the program and bulk bill every eligible patient for every eligible service receive an additional 12.5% loading on MBS benefits paid. That 12.5% is split 50:50 between the GP and the practice. First payments were made in January 2026.
The combined effect: a standard consultation (item 23) at a metropolitan bulk billing practice now attracts approximately $69.56 in total Medicare payments, up from $42.85 before the reforms. For regional and rural practices, the same consult can attract up to $84.86, depending on location.
The numbers behind the government's pitch
The government's modelling, based on 2023-24 Medicare data across 140 million GP services, claims that from November 2025, a metropolitan GP who bulk bills every patient will earn approximately $403,805 annually (after a 30% practice fee). That is roughly $5,300 more than a mixed billing GP would charge for the same number of services. In rural areas, the gap widens to almost $24,000 in favour of the bulk billing GP.
These figures use the General Practice Registrars Australia earnings calculator and assume standard item 23 consultations. The calculator itself carries a disclaimer that it is 'an indicative guide only' and 'does not fully reflect the complexity of billing or working in general practice'.
It is also worth noting that this tool is not validated and does not align with previous ATO data on average GP gross earnings, and that GPRA is a fully government-funded organisation. It is worth taking these figures with a pinch of salt, if not an ocean full of salt. Certainly, most GPs do not feel that these figures represent their average earnings.
The RACGP has been vocal about the limitations. President Dr Michael Wright described some of the government's figures as a 'misrepresentation' that ignores the full complexity of providing care. A poll of nearly 1,400 GPs found 71.6% wanted the full 12.5% loading paid to GPs, not split with practices.
Early uptake: what happened
By the end of November 2025, approximately 2,902 practices had registered for BBPIP. Of those, 1,675 (58%) were already fully bulk billing. Only 1,092 were previously mixed billing practices, making the switch.
In metropolitan areas, the numbers were particularly modest: just 622 of 4,720 metro practices indicated they would change from mixed billing to full bulk billing (around 13%).
Rural and regional areas showed stronger interest, with the highest proportional uptake in small rural towns, where over 60% of the 243 interested clinics were not previously bulk billing all patients.
By February 2026, the government reported 3,400 registered Medicare bulk billing practices nationally, with about 1,300 previously mixed billing. The national bulk billing rate jumped to 81.4%, up from 77.6% a year earlier. For 16 to 64 year olds, there was a 6.9 percentage point increase, the largest quarterly jump on record.
That said, this followed a period where bulk billing had been essentially flatlined. In November 2025, just before BBPIP took effect, quarterly Medicare data showed the rate stuck at 77.6%, the same as a year earlier, and out-of-pocket costs had exceeded $50 for the first time.
The broader billing trend
The trajectory leading up to BBPIP is worth understanding. Between 2022 and the end of 2023, the proportion of GPs predominantly bulk billing fell from 60% to 26%, according to Cubiko's Touchstone report across 811 practices. Average private fees rose from $72.92 to $81.21 over the same period.
The tripling of the bulk billing incentive in November 2023 had a measurable but limited effect on concessional patient bulk billing. It was not enough to reverse the overall shift towards mixed billing.
At the time of writing Best practice: a GP's guide to business, only 20.7% of GP clinics bulk billed new adult patients without concessions, down from 35.7% two years prior. The average gap fee was $43 and rising at 5 to 7% annually.
The BBPIP has clearly moved the needle. Whether it sustains momentum through 2026 and beyond is the open question.
Five scenarios where switching to full bulk billing makes sense
Not every practice will benefit. But for certain clinic profiles, the financial case is strong.
1. High-volume metro practices already bulk-bill 90%+ of patients
If you are already bulk billing most patients, the revenue lost by dropping gap fees on the remaining 10% may be more than offset by the 12.5% BBPIP loading across all services. A William Buck case study illustrates this: a GP seeing 32 patients a day and already bulk billing 81.25% loses around $65 per day in take-home pay by switching to universal bulk billing, but the practice gains marginally. The combined BBPIP payment significantly narrows the gap.
The tipping point sits around 90% existing bulk billing. Below that, the surrendered gap fee revenue is too large. Above that, you are already close to qualifying. Some calculations failed to account for the fact that non-universal bulk billing practices still receive the extra bulk billing incentive for patients whom they choose to bulk bill. Additionally, some practices failed to account for the fact that the 2 x 6.25% is not applied to all Medicare-eligible services. Rather, it is only paid on the so-called 'nonpreferred services.'
2. Rural and regional practices (MM2 to MM7 locations)
The BBI is scaled by remoteness under the Modified Monash Model, with larger Medicare payments as communities get more remote. A standard consultation at a rural bulk billing practice can now attract almost double the pre-reform payment. For many rural clinics, particularly those in areas with limited competition and high concession card holder populations, full bulk billing under BBPIP represents a genuine income uplift.
3. Practices with high concession and paediatric patient loads
These practices were already receiving the triple BBI for most patients. The expansion to all Australians now means every patient is eligible for the incentive, and BBPIP adds a further 2 x 6.25% on top. If 70%+ of your patient base was already eligible for the BBI, the incremental cost of bulk billing the remainder is small relative to the combined incentive gain.
Four scenarios where mixed billing remains the stronger option
1. Practices with established private fee structures and loyal patient bases
If your patients already accept and pay gap fees of $40 to $60, and your DNA rates are low, you are generating significantly more per consultation than BBPIP can replace. The average private fee for a standard consultation reached $81.21 by the end of 2023 and has continued rising. A practice charging a $48 gap on a standard consult collects $91.90 total, compared with approximately $69.56 under full bulk billing with all incentives in a metro area. That is a $22 per consult difference, compounded across thousands of appointments annually.
2. Practices with a high proportion of long or complex consultations
The government's earnings modelling is built around standard level B consultations (item 23). For practices where a significant share of consultations are level C (item 36) or level D (item 44), the economics shift. Longer consultations attract higher rebates but also higher gap fees in mixed billing. The BBPIP 12.5% loading on a higher rebate partially compensates, but practices with an average consultation length approaching 20 minutes (or longer) typically generate more under mixed billing. The RACGP has noted that the government's modelling 'does not consider the non-patient-facing time that GPs undertake to ensure safe care'.
3. Metro practices in high-income catchments
Practices in affluent suburbs where patients have private health insurance, higher disposable income and established expectations around private billing have little to gain from switching. These clinics often charge gap fees well above the national average. Surrendering that revenue for a 12.5% loading on the MBS rebate alone represents a significant net loss.
The BBPIP also requires every GP at the practice to bulk bill every eligible patient for every eligible service. A single privately billed consultation disqualifies the entire practice from the quarterly BBPIP payment. That rigidity is a real operational risk in clinics where some GPs prefer mixed billing.
4. Practices where the owner-GP generates a large share of revenue
If the principal generates 40% or more of billings and currently charges private fees, switching to full bulk billing can substantially reduce owner income. This directly affects normalised EBITDA and, in turn, practice valuation. Every $10,000 decrease in annual EBITDA can reduce the sale price by $30,000 to $50,000, depending on the valuation multiple.
How your billing model affects practice valuation
In the current Australian market, general practices are typically valued at 2.5 to 4.5 times normalised EBITDA. Some corporates and private equity buyers have pushed to 5x for practices with strong growth profiles, multiple GPs, long leases and diversified income.
The billing model feeds into valuation in several ways.
EBITDA impact. Mixed billing practices generally result in higher per-hour billing ($385 versus $372 for bulk billing, based on national benchmarks). That higher per-hour yield, assuming similar overhead structures, flows through to a higher EBITDA. A higher EBITDA at the same multiple produces a higher sale price.
Risk profile. Buyers assess risk alongside profit. A fully bulk billing practice drawing income primarily from Medicare is, in one sense, lower risk: the payer is the government, and revenue is not dependent on patients' willingness or ability to pay out of pocket. On the other hand, the practice is entirely dependent on government policy settings. If rebates do not keep pace with costs, margins erode.
Mixed billing practices carry different risks: patient sensitivity to fee increases, competitive pressure from nearby bulk billing clinics, and the potential for volume loss if affordability tightens. Buyers weigh these factors on a case-by-case basis.
Buyer perception. Corporate buyers and investor groups tend to focus on EBITDA clarity, scalability and systems. A well-run mixed billing practice with documented fee schedules, benchmarked billings per hour, and a stable patient base will typically attract stronger multiples than a bulk billing practice with comparable revenue but thinner margins. Peer buyers, by contrast, may value the simplicity and alignment with community values of a bulk billing model.
Documentation factors more than the model. Regardless of the billing model you use, buyers want to see at least 3 years of clean financials, a clear EBITDA reconciliation with documented add-backs, and evidence that the revenue is sustainable. Practices that have recently switched billing models present a specific challenge: the financials are in transition, and buyers cannot easily establish a normalised baseline. If you are considering switching models, doing so at least 18 to 24 months before a planned sale gives you time to demonstrate a stable earnings trajectory under the new model.
What to do next
Run the numbers for your practice specifically. The government's BBPIP calculator provides tailored income estimates based on your consultation mix, billing model, location, and concessional patient proportion, and cannot be regarded as independent; seek independent advice or carefully do your own calculations. Cubiko, William Buck, Cutcher & Neale and other health-sector accounting firms offer detailed modelling that goes beyond the calculator's assumptions.
If you are considering a sale in the next one to five years, treat the billing model decision as part of your broader practice optimisation strategy. The chapter on financial optimisation in Best practice: a GP's guide to business sets out a framework for improving maintainable EBITDA through billing model evolution, CCM optimisation, cost control and technology, all of which feed into valuation.
The billing model you choose should reflect your patient demographics, your location, your cost structure and your exit timeline. There is no universal right answer, which is precisely why running a proper analysis is important.