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 for patients who cannot attend a face to face consultation. Telephone-only services may be provided when clinically appropriate and when an MBS item is available.

The MBS telehealth items have the same clinical requirements as the corresponding face to face consultation items.

No specific equipment is needed to provide Medicare-compliant telehealth services.

You need to meet the clinical requirements and comply with privacy laws.

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 if either of the following apply:

• the patient is registered in MyMedicare and the telehealth service is from the patient’s registered practice
• you’re the patient’s eligible telehealth practitioner.

You qualify as a patients eligible telehealth practitioner if one of the following apply:

• you have provided the patient with a face to face MBS service in the past 12 months
• you work at a practice where the patient received a face to face MBS service in the past 12 months
• you are part of the Approved Medical Deputising Service (AMDS) Program, and that practice provided the patient with at least one face to face MBS service in the past 12 months.

Some patients are exempt from these rules, including those who meet any of the following criteria:

• are under 12 months of age
• are experiencing homelessness
• live in a natural disaster affected area
• are treated at an AMS or an Aboriginal Community Controlled Health Service (ACCHS)
• are in isolation or quarantine for COVID-19 due to a state or territory public health order.

Patients are also exempt if they access any of the following MBS services:

• an urgent care after hours service in unsociable hours
• specific mental health treatment
• eating disorder management and treatment
• preparing or reviewing a GP chronic condition management plan
• blood borne virus, sexual or reproductive health services (excluding services related to assisted reproductive technology or antenatal care)
• treatment provided under the Commonwealth Urgent Care Clinic Program.

You must document any relevant exemption and the clinical justification in the patient’s clinical notes. 

Find out more about the telehealth eligibility criteria on the MBS Online website.

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 who provides 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 MBS telehealth services have geographic requirements. Refer to the item description for the service being provided.

Geographic eligibility is determined according to Modified Monash Model (MMM) classifications.

At the time of the service, an eligible patient must meet both of the following:

• be at least 15km by road from the health professional
• be located within a telehealth eligible area.

To verify 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 where the patient is located at the time of the service.

Find out more about the Modified Monash Model on the Department of Health, Disability and Ageing website.