Eligibility for health professionals

We determine eligibility for Medicare benefits using the Health Insurance Act 1973 (the Act) and related regulations.

Your eligibility for Medicare benefits depends on the field of work you’re in. Different fields have different eligibility requirements.

We’ll assess your application. If you meet all the eligibility requirements, we’ll update your Medicare provider record to show your new status.

We’ll send you a letter to let you know when your application has been finalised. The letter will tell you the date you’ll be eligible to start claiming the MBS items.

If you’re applying for Medicare provider number online you must understand your legislative requirements:

  • You must apply for a unique provider number for each place of practice and profession you practise in.
  • You can apply for an additional provider number for a different location or at the same location.
  • You can’t claim a Medicare benefit until we’ve issued your provider number for that location.
  • You can’t use anyone else’s Medicare provider number.
  • You’re not eligible to claim Medicare benefits if we’ve suspended your membership or registration or if it has expired.
  • You’re not eligible if your membership level has changed.
  • If you don’t have access to Medicare, you must let patients know before you treat them that they won’t get Medicare benefits for your services.

To provide a service that gets a Medicare benefit, you as a health professional must:

  • have a Medicare provider number for each practice location
  • meet eligibility requirements set out in the Health Insurance Act 1973 or the relevant legislation relating to your specific health profession
  • have been advised in writing that you’re eligible to access Medicare benefits for your services.

If you don’t meet these requirements, you can still practise medicine. You still have to satisfy the requirements set out by your registration body. You can’t claim a Medicare benefit for your services.

You must let patients know they won’t get a Medicare benefit before you provide a service to them. It’s an offence to provide a service without doing this.

You can’t access full Medicare benefits until you meet the general practitioner (GP) and specialist eligibility requirements. Until then, you’ll have limited access to Medicare benefits. As an intern, registrar or trainee, you can still get a Medicare provider number.

To satisfy section 19AA of the Health Insurance Act 1973 and be eligible for a Medicare provider number, you must be either:

  • vocationally recognised as a specialist, consultant physician or specialist general practitioner
  • registered on the Vocational Register with general registration with the Australian Health Practitioner Regulation Agency (Ahpra)
  • registered in an approved placement under section 3GA of the Act
  • first registered before 1 November 1996 - some exclusions apply - you can find more information on the Federal Register of Legislation website
  • a temporary resident doctor with an exemption under section 19AB of the Act, working according to that exemption.

You can claim Medicare benefits if you meet all of the following:

  • you’re recognised as a nurse practitioner or midwife
  • work in private practice
  • work in a public facility that has an exemption under subsection 19(2) of the Health Insurance Act 1973
  • have a collaborative care arrangement in place.

To claim Medicare benefits, allied health professionals must:

An allied health professional is also eligible for registration under the allied health professional initiative if they’re employed by an Aboriginal and Torres Strait Islander Community Controlled Health Service, or a state or territory clinic that has an exemption under subsection 19(2) of the Act.

Allied health professionals who may qualify include:

  • Aboriginal health workers
  • audiologists
  • chiropractors
  • diabetes educators
  • dietitians
  • exercise physiologists
  • mental health nurses
  • occupational therapists
  • orthoptists
  • osteopaths
  • physiotherapists
  • podiatrists
  • psychologists
  • social workers
  • speech pathologists.

To claim Medicare benefits, dental practitioners must:

  • meet the qualification requirements set out in the Health Insurance (Dental Services) Determination 2007
  • be registered with Ahpra or a respective board or organisation
  • be recognised as a dental practitioner in their field by us
  • be in private practice
  • be working in a private capacity.

Dental prosthetists can register for a Medicare provider number but can’t use their provider number for Medicare billing.

To claim Medicare benefits, optometrists must:

  • meet the qualification requirements set out in the Health Insurance (Optometric Services) Determination 2016
  • be registered with Ahpra or a respective board or organisation
  • be recognised as an optometrist by us
  • be in private practice
  • be working in a private capacity.

Processing times for applications

We’ll send you a letter to let you know when your Medicare benefits application has been finalised.

Most Medicare provider number applications take up to 28 days to process from the date we get your application. Some applications may take longer if the Department of Health and Aged Care needs to assess them.

Page last updated: 24 June 2024.
QC 74156