Specialist and consultant physician recognition

Why apply for recognition

You can bill and claim items in the Medicare Benefits Schedule (MBS) for private patients if you’re a recognised specialist or consultant physician.

Who can apply

You don’t need to apply for recognition as a specialist for Medicare purposes if your speciality is General Practice (GP). We’ll do this automatically. You should check who can get GP recognition if you want to bill and claim Medicare items.

You can apply for recognition 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.

This includes:

• overseas trained doctors (OTD)
• foreign graduates of an accredited medical school (FGAMS).

We’ll approve your application for 2 years if you apply using only your Ahpra registration.

You may not need to apply for recognition if you meet both of these:

• you’re a permanent resident or Australian citizen
• you’ve completed your specialist fellowship through an Australasian college.

Your college may contact us to tell us you’re a specialist if you meet this criteria. Ask your college if they notify us. This doesn’t apply to consultant physicians.

You may be subject to section 19AB of the Health Insurance Act 1973 (the Act). If you’re an OTD or a FGAMS check if you need a section 19AB exemption.

For Medicare purposes, you need a qualification in one of the specialties listed in the Health Insurance Regulations 2018 to apply.

What documents you need to apply

You need a Medicare provider number before we can process your application. If you don’t have a provider number, you can apply for one when you apply for specialist recognition.

If you’re a fellow you need the following supporting documents:

• a copy of your Ahpra registration
• confirmation of your fellowship showing the specialty you’re applying for and date of approval as a specialist or consultant physician.

Evidence we accept includes:

• your Australasian Specialist Medical College Fellowship certificate
• a letter from the relevant Australasian Specialist Medical College confirming you’re a fellow.

If you don’t have Australasian fellowship, you need a copy of your Ahpra specialist registration that lists your specialty.

If your Ahpra registration doesn’t list your specialty, you also need to provide a letter from Ahpra confirming both of these:

• you’re a registered specialist
• the period your registration is valid.

Change in residency status

If you’re a temporary resident and become a permanent Australian resident you must tell us immediately. This is because you need to:

• satisfy section 19AA of the Act by holding recognised post-graduate medical qualifications from the date your residency status changes or your eligibility for Medicare billing will stop
• reapply for specialist or consultant physician recognition
• apply for a 19AB exemption as a specialist or consultant physician.

If you don’t tell us about your change in residency status, it may mean you receive money you’re not entitled to. You may get a debt you need to pay back.

You’ll need to provide copies of documents confirming your new residency status and the date it changed.

How to apply

Complete the Application for recognition as a Specialist or Consultant Physician form.

When you do this you’ll need to return the form and supporting documents to us using the instructions on the form.

Additional qualifications

Nuclear Medicine and Positron Emission Tomography (PET) services

To bill or claim MBS items for Nuclear Imaging and Positron Emission Tomography you need to be accredited.

We recognise credentials from the Joint Nuclear Medicine Credentialling and Accreditation Committee (JNMCAC) of either:

• the Royal Australasian College of Physicians
• the Royal Australian and New Zealand College of Radiologists.

The JNMCAC will tell us when you’re added to the Register of Credentialled Nuclear Medicine Specialists. We’ll update your record.

Recognition as a nuclear medicine specialist allows you to bill and claim MBS items for Nuclear Medicine Imaging.

Recognition as a PET specialist won’t automatically allow you to bill or claim MBS items for PET services. You’ll need to complete a Statutory Declaration Positron Emission Tomography form to bill or claim MBS items for any PET services.

Diagnostic Radiology

To bill or claim MBS items for MRI services, you need to complete the Request to amend Location Specific Practice Number form.

We’ll tell you if you can bill or claim MBS items for MRI services when we process your application.

Sleep Medicine

To bill or claim MBS items for sleep apnoea, you need to provide advice from the Royal Australasian College of Physicians that you have either:

• obtained equivalent to Level I of the advanced training program in either Adult or Paediatric Sleep Medicine
• post-fellowship specialist recognition in sleep medicine.

You don’t need to pay an application fee to have this specialist recognition added to your provider record.

When you can start to claim Medicare benefits

You’ll get a letter when your application is complete. We’ll tell you when you can bill or claim MBS items as a specialist or consultant physician.

We won’t issue you with a specialist or consultant physician provider number because we’ll update your provider record to reflect your new specialist or consultant physician status. This will apply to all your provider number locations. Your provider number shows where you practise and not your specialisation.

Legislation and Ahpra registration determine if you can bill or claim Medicare benefits.