Make sure you read the relevant Medicare Benefits Schedule (MBS) item descriptions and explanatory notes at MBS Online.
About these services
Medical practitioners can refer eligible patients with chronic diseases to allied health practitioners. Allied health practitioners can claim Medicare benefits for some services.
To claim Medicare benefits for these services:
- an eligible allied health practitioner must deliver the service
- the allied health practitioner must bill the services using the correct MBS item number
- the patient must be eligible
- a medical practitioner must refer the patient
- the allied health practitioner must give reports to the referring medical practitioner.
Eligible patients can access 5 services per calendar year. The 5 services may be either:
- 1 type of service, for example 5 physiotherapy services
- a combination of different types of services, for example 1 dietetic and 4 podiatry services.
Eligible allied health professionals and relevant MBS item numbers
These allied health professionals are eligible to provide services relating to these item numbers:
- Aboriginal Health Workers or Aboriginal and Torres Strait Islander Health Practitioners - item 10950
- Audiologists - item 10952
- Chiropractors - item 10964
- Diabetes educators - item 10951
- Dietitians - item 10954
- Exercise physiologists - item 10953
- Mental health workers - item 10956
- Occupational therapists - item 10958
- Osteopaths - item 10966
- Physiotherapists - item 10960
- Podiatrists - item 10962
- Psychologists - item 10968
- Speech pathologists - item 10970.
To claim these items the allied health professional must:
- personally attend the appointment for at least 20 minutes
- treat the patient 1-to-1 and not through group treatment.
Patients are eligible for these allied health services if their medical practitioner has completed:
- a general practitioner management plan (GPMP) - item 229 or 721
- team care arrangements (TCAs) - item 230 or 723.
If the patient is a permanent resident of a residential aged care facility (RACF), their medical practitioner must have contributed to:
- a multidisciplinary care plan prepared for them by the RACF
- a review of the care plan - item 232 or 731.
Hospital in-patients are not eligible for these services.
Checking patient eligibility
You can check a patient’s eligibility:
- by using the MBS Online Items Checker in HPOS to
- view and check patient eligibility based on their MBS history
- check your own eligibility for claiming MBS items
- check claiming conditions for MBS items
- by calling us to confirm how many allied health services the patient has already claimed.
The referring medical practitioner determines the number and combination of services that are appropriate for the patient. Only the referring medical practitioner can determine whether the patient’s chronic condition would benefit from allied health services. It isn’t appropriate for allied health professionals to:
- provide a partly-completed referral form to a referring medical practitioner for signing
- pre-empt the decision about the services that the patient requires.
Medical practitioners must use the Department of Health referral form or a form that contains the same components.
Patients need a separate referral form for each allied health service type. The referral is valid for the number of services outlined in the referral. Patients and practitioners can only claim Medicare benefits for this number of services.
The allied health professional should keep a copy of the referral form for 2 years.
The allied health practitioner must provide a written report to the referring medical practitioner after the first and last service. They can provide the reports more often if clinically necessary.
Reports should include:
- investigations, tests and assessments carried out
- treatment provided
- recommendations on how to manage the patient’s condition in the future.
Read more about:
- the Schedule at MBS Online
- education services for health professionals
- resources on chronic disease management
- our website disclaimer.
Contact us for Medicare provider enquiries.
Provide your feedback on our education resources.