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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:
- Category 8 – Miscellaneous Services
- Group M13 Midwifery services
- Group M19 Midwifery telehealth and phone services.
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:
- a participating midwife; this means you’re an eligible midwife who provides services in collaborative arrangements
- recognised as an eligible midwife.
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 practicing at.
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:
|
Requirements you must meet include the following:
|
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:
You must also plan for when you need to:
You must also document the following in your patient's records:
If you give a copy of any of the following to the named medical practitioner, you need to record confirmation they’ve received:
|
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:
|
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:
- the schedule at MBS Online
- education services for health professionals
- our website disclaimer.
Contact us for Medicare item interpretation.
Provide your feedback on our education resources.