Who can claim telehealth services

Medicare benefits are available for video and phone telehealth services.

They can be provided by:

• general practitioners
• medical practitioners
• specialists
• consultant physicians
• nurse practitioners
• participating midwives
• Aboriginal and Torres Strait Islander primary health care professionals
• allied health professionals
• dental practitioners in the practice of oral and maxillofacial surgery.

They’re also available throughout Australia for patients in an eligible residential aged care facility (RACF) and an Aboriginal Medical Service (AMS) .

Video services are preferred when a patient cannot attend a face to face consultation. Health professionals can also offer audio-only services through the telephone where clinically appropriate.

Separate items are available for the audio only services. No specific equipment is required to provide Medicare-compliant telehealth services.

Health professionals need to meet the clinical requirements and satisfy privacy laws. The MBS telehealth items have the same clinical requirements as the corresponding face to face consultation items.

Read more about MBS Telehealth Services on the MBS Online website.

General practitioners, prescribed medical practitioners and nurse practitioners

If you’re working in a general practice, you can only use telehealth items for patients who have either:

• an existing clinical relationship with you
• visited your practice for a face to face service in the last 12 months.

Some patients are exempt from this rule. This includes patients who meet any of the following:

• experiencing homelessness
• under 12 months of age
• treated at an AMS or an Aboriginal Community Controlled Health Service (ACCHS)
• in a natural disaster area
• requiring urgent care after hours services in unsociable hours
• receiving consultation for blood borne viruses, sexual or reproductive health (excluding consultations related to assisted reproductive technology or antenatal care)
• registered in MyMedicare at the practice providing the telehealth service
• in isolation or quarantine for COVID-19 due to a state or territory public health order.

Patients are also exempt to the rule if they access a service under specific MBS items for any of the following:

• mental health planning and treatment
• eating disorder management and treatment
• chronic condition management
• treatment at a Commonwealth Urgent Care Clinic
• obstetric attendance.

Patient-end support

You can claim a Medicare item for providing clinical patient-end support (PES) to a patient during a video consultation with a specialist or consultant physician, if you’re any of the following:

• a general practitioner (GP)
• a prescribed medical practitioner (PMP)
• a nurse practitioner
• an optometrist
• a practice nurse, an Aboriginal and Torres Strait Islander health worker or an Aboriginal and Torres Strait Islander health practitioner providing the PES service on behalf of, and under the supervision of, a GP or PMP.

Find out more about telehealth PES services on the MBS Online website.

Telehealth geographic requirements

Some group therapy MBS telehealth items have a geographic requirement. Check the item description for the service being provided.

Geographic requirements may refer to either or both of the following situations:

• the patient is at least 15km by road from the health professional at the time of their telehealth appointment
• the patient is in a telehealth eligible area.

To check if a location is eligible, use the DoctorConnect Health Workforce Locator map on the Department of Health, Disability and Ageing website. Select Modified Monash Model and enter the address of your patient’s location during the consultation.

There may be exceptions to geographic requirements if a patient is any of the following:

• living in an eligible RACF
• at an eligible AMS
• at an eligible ACCHS.

To be considered an eligible AMS or ACCHS, the practice must hold a current exemption granted under section 19(2) of the Health Insurance Act 1973.

To learn more about s19(2) exemptions, see COAG Section 19(2) Exemptions Initiative on the Department of Health, Disability and Ageing website.