Medicare services for eligible midwives

Information for eligible midwives about billing Medicare Benefits Schedule (MBS) items and referring or requesting patients for Medicare services.

If you’re a participating midwife, you can get Medicare benefits for services you provide. These are for clinically relevant services appropriate for treating your patient.

You can request certain pathology and diagnostic imaging services for your patients. You can also refer them to an obstetrician and a paediatrician for a clinical need.

Make sure you read the relevant MBS item descriptions and explanatory notes on the MBS Online website.

Midwife MBS item numbers

You can find Midwife items in:

The items include services for:

  • assessing and preparing a maternity care plan
  • antenatal attendances
  • intrapartum attendances
  • postnatal attendances, up to 6 weeks after delivery.

To get a payment, you must perform the service, meet the description and all requirements of the MBS item.

When selecting time-based items, you can’t include time the patient wasn’t receiving active attention. This includes the time you take:

  • to travel to the patient’s home
  • for a break
  • completing patient records.

Non-billable services

You can’t bill MBS items for:

  • services provided where the patient isn’t in attendance, such as the issuing of repeat prescriptions
  • group sessions.

Midwife eligibility

To bill MBS items for services you provide in private practice you need to be all of the following:

  • a participating midwife - this means you’re an eligible midwife who provides services in collaborative arrangements
  • recognised as an eligible midwife
  • a midwife with relevant Ahpra endorsement.

The relevant Ahpra endorsement must state either:

  • ‘an endorsed midwife qualified to prescribe schedule 2, 3, 4 and 8 medicines and to provide associated services required for midwifery practice in accordance with relevant state and territory legislation’
  • ‘endorsed as qualified to prescribe schedule 2, 3, 4 and 8 medicines required for midwifery practice across pregnancy, labour, birth and postnatal care, in accordance with relevant State and Territory legislation’.

If you’re an eligible midwife, you may be able to apply online for your additional Medicare provider number and PBS prescriber number. Read more about eligibility and how to apply online.

As a participating midwife you must have a Medicare provider number to bill MBS items. You need a separate provider number for each location you’re practising at.

Alternatively, you can use the Application for a Medicare provider number and/or PBS prescriber number for a midwife or nurse practitioner form if you need to apply for a provider number.

Private practice

You need to work in private practice to bill MBS items. This allows you to either charge your patient a fee, or bulk bill the service.

You’re not working in private practice if you provide a service on behalf of a state or territory government.

You can’t charge a public patient a fee for a service you provide in a public hospital.

Professional indemnity insurance

You must have appropriate professional indemnity insurance. This is set out in the Health Practitioner Regulation National Law for each state or territory. The insurance can be organised by you or by a third party such as your employer.

Read more about professional indemnity insurance on the Nursing and Midwifery Board of Australia website.

Collaborative arrangement

Collaborative arrangements must be in place when you provide a Medicare service to your patient. You don’t need to provide the details of your collaborative arrangements to us.

You can have a collaborative arrangement with a medical practitioner in private practice or in the public sector.

For safe and high quality maternity care, the collaborative arrangement must cover clinically relevant:

  • consultations with an obstetric medical practitioner
  • referral of a patient to an obstetric medical practitioner or hospital-authorised medical practitioner
  • transfer of the patients care to an obstetric medical practitioner or hospital-authorised medical practitioner.

The collaborative arrangement may apply to one or more patients.

There are specific requirements you must meet for different types of collaborative arrangements.

Type of arrangement Requirements Number of patients the arrangement applies to

You’re employed as a midwife by either:

  • an obstetric specified medical practitioner
  • an entity, such as a community health centre or a medical practice but not a hospital, that also employs one or more obstetric specified medical practitioners.

Requirements you must meet include the following:

  • you can be an employee, a contractor or have another type of written agreement regarding working arrangements
  • your employer must also employ an obstetric specified medical practitioner at the time you are treating your patient
  • you can consult with, refer or transfer care of your patient to a practitioner that doesn’t work for your employer.
Applies to more than one patient.
A patient is referred to you for midwifery treatment, in writing, by an obstetric specified medical practitioner. Before you treat the patient you have an arrangement in place which must cover consultation, referral and transfer of care if the clinical need arises. The referral applies to one patient, but the collaborative arrangement can be in place for one or more patients.
You have an agreement with one or more specified medical practitioners. The agreement must be in writing and is signed by yourself and the medical practitioners making the agreement. Applies to more than one patient.
You set out an arrangement in the patient’s written records.

You must document the following in your patient’s records:

  • the name of at least one named medical practitioner who is, or will be, collaborating with you in the patient’s care
  • you’ve told the patient you’ll provide midwifery services to them in collaboration with one or more named medical practitioners
  • acknowledgement by the named medical practitioner they’ll collaborate in the patient’s care. This doesn’t need to be supplied on an individual patient basis.

You must also plan for when you need to:

  • consult with an obstetric specified medical practitioner
  • refer the patient to an obstetric specified medical practitioner
  • transfer the patient’s care to an obstetric specified medical practitioner.

You must also document the following in your patient’s records:

  • details of when you have consulted with, communicated with, referred your patient to or transferred your patient’s care to the named medical practitioner or to another obstetric specified medical practitioner.

If you give a copy of any of the following to the named medical practitioner, you need to record confirmation they’ve received:

  • the hospital booking letter
  • the patient’s maternity care plan that you prepared
  • the results of diagnostic imaging or pathology tests
  • a discharge summary and record if you give this to the patient’s usual GP.
Patient records must be specific to one patient. The collaborating practitioner may supply acknowledgement of collaboration for one or more patients.
You’re an eligible midwife with credentials to provide midwifery services in a hospital.

Things to be aware of when dealing with the hospital:

  • you need to have completed a credentialing process at the hospital to assess your competence, performance and professional suitability
  • the hospital should have defined policies on clinical practices, that you’re approved to provide to your patients
  • the hospital needs to have granted you the ability to treat your own patients
  • the hospital must employ or engage an obstetric-specified medical practitioner at the time you are treating your patient.
Applies to more than one patient.

Telehealth and telephone services

You may be eligible to bill a MBS item for telehealth and telephone services you provide.

If you provide antenatal and postnatal services to a patient, you can bill the following MBS items if relevant:

This includes services through telehealth in a videoconference, or telephone when videoconferencing isn’t available. There are specific requirements you must meet to bill these items.

Find out more about continuing MBS telehealth services for participating midwives on the MBS online website.

Referring and requesting services

Referrals for specialist treatment

You can refer your patient to an obstetrician or paediatrician. The referral is valid for one pregnancy only for a period of 12 months after the first service. This referral covers the total confinement period of the referred pregnancy.

You will need to make a new referral if your patient has a subsequent pregnancy in a 12 month period.

You don’t need to issue a referral to transfer a patient’s care during the intra-partum period under items 16527 and 16528. However, you should record signed clinical notes approving the transfer of care.

Medicare benefits are not payable if you refer your patient for allied health services.

Requests for pathology or diagnostic imaging services

You can make a request for a pathology or diagnostic imaging service for the appropriate care of your patient. You may request one or more of these services.

Read more about which services you can request on the below MBS explanatory notes:

If your patient or their newborn needs a diagnostic or pathology service that you can’t request, they can either:

  • attend their GP
  • be referred to an obstetrician or paediatrician.

Read more about referring and requesting Medicare services.

Prescribing under the Pharmaceutical Benefits Scheme

Eligible midwives who’ve completed the approved midwifery-prescribing qualification and been issued with a prescriber number can prescribe selected listed medicines.

Find out what medicines midwives can prescribe on the PBS website.

More information

Read more about:

Contact us for Medicare item interpretation.

Provide your feedback on our education resources.

Page last updated: 12 October 2023.
QC 51363