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Section 19AA of the Health Insurance Act 1973 (the Act) outlines eligibility requirements for GPs and medical specialists to claim Medicare benefits.
To satisfy section 19AA 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 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.
GP recognition
If you’re a specialist general practitioner and you want to access Medicare benefits, you’ll need a Medicare provider number. If you don’t have a one, check how to apply for a Medicare provider number.
From 16 June 2021, medical practitioner’s access to Medicare is determined by their continued registration status with the Australian Health Practitioner Regulation Agency (Ahpra). The changes include all of the following:
- medical practitioners with specialist registration in General Practice with Ahpra don’t need to apply to claim or bill A1 Medicare items
- we’ll work out if you can access GP Medicare items automatically
- if you don’t know your registration status, you can check using Ahpra’s public register.
We’ll send you a letter to confirm if you’re eligible to access GP Medicare items.
Vocational recognition
On 16 June 2021, the Vocational Register closed.
Your recognition as a general practitioner (GP) for Medicare purposes will continue if both of the following apply:
- you were on the Vocational Register on 16 June 2021
- you hold general medical registration with Ahpra.
You need to have continuous general medical registration with Ahpra to maintain this GP recognition. If you don’t hold general registration at any time:
- you’ll lose recognition as a GP with Medicare
- you’ll need an Ahpra registration in the specialty of general practice to be recognised as a GP in the future.
If you weren’t on the Vocational Register on 16 June 2021, you’ll need an Ahpra registration in the speciality of general practice. This will allow you to bill or claim Medicare items.
Specialist and Consultant Physician Recognition
You can be recognised as a medical specialist or consultant physician if you have one of the following:
- fellowship with an Australasian specialist college and either general or specialist registration with the Australian Health Practitioner Regulation Agency (Ahpra)
- specialist registration with Ahpra
- limited, area of need registration with Ahpra
- provisional, competent authority pathway (specialty) registration with Ahpra.
If you’re a medical specialist, you must have a Medicare provider number to apply for specialist or consultant physician recognition.
If you don’t have the provider number yet, you can apply for one. You can submit both applications at the same time.
Read more about getting recognition as a specialist or consultant physician.
Read more about getting recognition as a General Practitioner.
Recognised workforce or training programs
Medical training for GPs will be available through the:
- Australian College of Rural and Remote Medicine
- Royal Australian College of General Practitioners.
This program will let trainees access Medicare benefits while working in approved locations.
Find more information about 3GA workforce or training programs on the Department of Health and Aged Care website.
If you're in an approved program, apply for a provider number for your placement location. Your placement organisation must tell us about your placement. We can't register an approved 3GA program placement until they tell us about your placement.
Overseas trained doctors and foreign graduates eligibility requirements
There are specific requirements that overseas trained doctors and foreign graduates have to meet to get Medicare benefits.
OTDs are subject to Medicare provider number restrictions if they want to treat private patients. These restrictions affect where an OTD can work in Australia.
If you work in a District of Workforce Shortage you may be exempt from these restrictions.
We issue a Medicare provider number after an OTD gets a medical job in Australia. You can apply for a Medicare provider number as a medical practitioner.
Read more about eligibility requirements for overseas trained doctors and foreign graduates.
More information
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