MBS and telehealth
There are no changes to Telehealth Medicare Benefits Schedule (MBS) items. Providers will continue to receive higher Medicare benefits for Telehealth services.
Medicare benefits are available for video consultations between specialists and patients who are located in telehealth eligible areas. They are also available in eligible aged care facilities and Aboriginal Medical Services throughout Australia. Medicare benefits are also available for clinical support provided by a health professional who is with the patient during the video consultation.
Eligibility for telehealth
There is no formal application process for you to take part in a telehealth video consultation. You are eligible for telehealth if you:
- have a Medicare provider number and are in a private practice as a:
- consultant physician, or
- consultant psychiatrist
- have a Medicare provider number, provide support to a patient located in an eligible telehealth area during a video consultation with a specialist, and are in a private practice as a:
- medical practitioner
- nurse practitioner, or
- provide services on behalf of a medical practitioner using their provider number and are a:
- practice nurse, or
- Aboriginal Health Worker
- provide care and accommodation to residents under the Aged Care Act 1997, or
- hold a residential aged care service (RACS) ID
A general practitioner or another health professional with a Medicare provider number can also be with the patient during the telehealth consultation to provide clinical support. This is called a supported consultation.
At the time of the video consultation, there must be 15 km by road between a patient and a specialist, consultant physician, or consultant psychiatrist.
Geographic eligibility for telehealth services is determined by the Australian Standard Geographical Classification — Remoteness Area (RA) classification, which is a numerical system between 1 and 5. A telehealth eligible area is outside of a major city (RA1).
You can check if a location is telehealth eligible by using Search the map on the Department of Health DoctorConnect website. Choose the 'ASGC Remoteness Areas Layer' and enter the address of your patient's location during the consultation.
Exceptions to this are where a patient is:
- living in an eligible residential aged care facility
- at an eligible Aboriginal Medical Service (AMS), or
- at an eligible Aboriginal Community Controlled Health Service (ACCHS)
To be considered an eligible Aboriginal Medical Service or Aboriginal Community Controlled Health Service, the practice must hold a current exemption granted under section 19(2) of the Health Insurance Act 1973.
For more information regarding s19(2) exemptions, email the Department of Health at firstname.lastname@example.org.
MBS item numbers and payments
You can bill a range of telehealth Medicare Benefits Schedule (MBS) item numbers. These will allow your Medicare and Department of Veterans’ Affairs patients to claim a benefit, or you can be paid directly if you bulk bill.
There are currently 23 telehealth MBS items available to medical practitioners, nurse practitioners, midwives, practice nurses and Aboriginal Health Workers.
There are also currently 11 derived fee MBS item numbers available to specialists, consultant physicians and consultant psychiatrists. These items let you claim an existing attendance item number as a video consultation.
More information on MBS Video Consultation Items is available at MBSOnline on the Department of Health website.
Telehealth claims are paid into the bank account that you have registered with us against a provider number. All Medicare payments will be made by electronic funds transfer into this bank account.
You can register your bank account details using the Provider registration for Electronic Funds Transfer payments form (HW029).
Specialists, consultant physicians and consultant psychiatrists
You must submit telehealth claims separately to other non-telehealth claims. For example, you can only claim the base consultation (Item 104) and derived fee (Item 99) together. This makes sure the derived fee item number is allocated to the correct base consultation item.
Under regulation 13 of the Health Insurance Regulations 1975, all item numbers claimed must include the amount being charged, including telehealth derived fee item numbers.
Telehealth derived fee items cannot be bulk billed using Medicare Easyclaim.
Medical practitioners, Aboriginal health workers, practice nurses, nurse practitioners and midwives
Bulk billing a telehealth video consultation
Patients who have a telehealth video consultation with a specialist have the option to assign their right to a Medicare benefit to the specialist through an email agreement.
MBS Online for telehealth
More information about Telehealth: Specialist video consultations under Medicare is at MBS Online on the Department of Health website.