A point-of-care reference, not a protocol: brief intervention, what's actually billable since the dedicated MBS items expired, PBS pharmacotherapy comparison, and the current (frequently-changing) vaping prescribing pathway.
Even a brief, non-judgemental prompt from a GP measurably increases quit attempts. The standard framework:
In practice, cessation counselling is billed the same way RACGP originally recommended before the temporary items existed: as part of a standard time-tiered attendance.
| Item | Descriptor | Fee |
|---|---|---|
| 3 | Level A — brief (<6 min) | $20.55 |
| 23 | Level B — standard (6–<20 min) | $45.05 |
| 36 | Level C — long (20–<40 min) | $87.10 |
| 44 | Level D — prolonged (≥40 min) | $128.35 |
If the patient already has (or qualifies for) a GP chronic condition management plan for another condition — COPD, cardiovascular disease, diabetes — structured cessation follow-up can sit inside that plan's review items 392 (prepare, $128.55) or 393 (review, $128.55), rather than needing to be its own consult. Don't create a plan solely to bill cessation counselling — it needs to genuinely meet chronic-disease-management criteria.
Practical implication: don't hold back a cessation conversation waiting for a special code — there isn't one. It's simply time well spent inside whatever attendance is already happening, which is worth protecting rather than rushing through.
Click a patient factor to highlight the relevant caution rows.
| Option | Effectiveness | PBS / course cap | Key caution |
|---|---|---|---|
| NRT (patch + gum/lozenge combo preferred) | Combination NRT roughly comparable to varenicline | $25.00 general / $7.70 concession; up to 12 weeks per 12 months | Safe in stable cardiovascular disease; caution within 6 weeks of an acute cardiac event |
| CVD note (NRT): use with medical supervision after a recent MI, unstable angina, severe arrhythmia or recent stroke — not an absolute contraindication once stable. | |||
| Pregnancy note (NRT): behavioural support first-line; NRT may be considered if that alone is unsuccessful, with explicit risk-benefit discussion. Intermittent forms preferred in breastfeeding, used immediately after a feed. | |||
| Varenicline | Most effective single-form pharmacotherapy | Authority prescription; up to 24 weeks per 12 months | Nausea (~30%), vivid dreams; safe in stable mental illness (EAGLES trial) |
| Mental health note (varenicline): considered safe in stable/past mental illness per the EAGLES trial; still monitor for mood change and report promptly. | |||
| Pregnancy/CVD note (varenicline): not recommended in pregnancy or breastfeeding; no substantive evidence of increased cardiovascular risk in the general population. | |||
| Bupropion | ~60% higher abstinence vs placebo | Authority prescription; up to 9 weeks per 12 months | Seizure risk (~0.1%) — contraindicated with seizure history |
| Seizure note (bupropion): contraindicated with a history of seizures or eating disorder; caution with other drugs lowering seizure threshold; 14-day MAOI washout required. | |||
| Pregnancy note (bupropion): not recommended in pregnancy. | |||
Combination NRT (patch + oral form) is more effective than either alone with no added safety signal. Varenicline + NRT patch improves abstinence over varenicline alone, at the cost of slightly more nausea/insomnia. Bupropion + NRT shows no additive benefit. ~50% of successful quitters relapse after stopping pharmacotherapy — plan a follow-up, not just a start date.
A GP-initiated Quitline referral (fax-back or online form via quit.org.au) gets a proactive callback rather than relying on the patient to call themselves — meaningfully better follow-through than "here's the number." Quitline: 13 78 48. Aboriginal and Torres Strait Islander counsellors, and interpreters, available on request.