Education guide – Medicare items 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 just 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 at MBS Online.

Midwife MBS item numbers

Midwife items are in Category 8 – Miscellaneous Services, Group M13 – Midwifery Services of the MBS.

The items include services for:

  • assessing and preparing a maternity care plan antenatal attendances
  • intra-partum attendances
  • post-natal 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. For example, you can’t include the time you take to travel to the patient’s home or your time 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
  • telephone attendances
  • 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.

You are an eligible midwife if you are registered or authorised under state or territory law to practice midwifery. You must also show you have the qualifications and experience to meet the Nursing and Midwifery Board of Australia’s registration standards.

As a participating midwife you also need to have:

  • a Medicare provider number
  • professional indemnity insurance.

Medicare provider number

You must have a Medicare provider number to bill MBS items. You need a separate provider number for each location you practice from.

Read more about applying for a Medicare 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 to them 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 make an arrangement with one of the following specified medical practitioners:

  • an obstetrician
  • a medical practitioner who provides obstetric services
  • a medical practitioner employed or engaged by a hospital authority and authorised by the hospital authority to participate in a collaborative arrangement.

The medical practitioner can be in private practice or in the public sector.

To ensure 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 1 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 1 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 1 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 1 patient, but the collaborative arrangement can be in place for 1 or more patients.

You have an agreement with 1 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 1 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 1 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 1 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 1 patient. The collaborating practitioner may supply acknowledgement of collaboration for 1 or more patients.

You’re employed by a hospital that also employs 1 or more obstetric specified medical practitioners.

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 an obstetric specified medical practitioner at the time you are treating your patient.

Applies to more than 1 patient.

Telehealth support services

You may be eligible to bill a MBS item for telehealth patient-end support services you provide.

MBS items 82150 - 82152 are available where you provide clinical support to a patient who has participated in a video conference with a specialist or paediatrician.

There are specific requirements you must meet to bill telehealth patient-end support items.

Read more about Telehealth Support Services by Health Professionals on MBS online.

Referring and requesting services

Referrals for specialist treatment

You can refer your patient to an obstetrician or paediatrician. The referral is valid for 1 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 you can’t request, they can either:

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

Read more about referring and requesting Medicare services.

Prescribing under the Pharmaceutical Benefits Scheme

Eligible midwives who’ve completed the approved midwifery-prescribing course can prescribe selected Pharmaceutical Benefits Scheme (PBS) listed medicines.

These medicines are on the Midwife PBS prescribing page.

More information

Read more about:

Contact us for Medicare provider enquiries.

Provide your feedback on our education resources.

Page last updated: 20 November 2020