Education guide - Indefinite referrals - what you need to know

Information for specialists and general practitioners about indefinite referrals.

Valid referral periods

Referrals from a general practitioner (GP) are valid for 12 months, unless stated differently on the referral letter or note. For example, a referral could be valid for 3, 6 or 18 months, or be indefinite.

A GP may write an indefinite referral for a chronically ill patient who is in the continuing care and management of a specialist or consultant physician for a specific condition, for example, glaucoma.

Referrals from specialists and consultant physicians are valid for 3 months unless the referred patient is an admitted patient. The referral for admitted patients is valid for 3 months, or the duration of the admission, whichever is the longer.

Requirements for new referrals

Where an indefinite referral exists, a specialist or consultant physician shouldn’t request, and a GP shouldn’t issue, a new referral unless a new condition has developed.

For example, a patient regularly reviewed for glaucoma will need a new referral if they’ve developed a pterygium and need surgery. An initial attendance item for the new referral would be payable.

Billing consultations

The renewal of a referral, for example, where it has expired after 12 months, for the same condition doesn’t mean a specialist or consultant physician can bill another initial consultation. The renewal of a referral is to make sure Medicare benefits are paid at specialist or consultant referred rates, rather than at unreferred rates.

More information

Online:

Contact us for Medicare provider enquiries.

Read more information about our website disclaimer.

Page last updated: 15 September 2016

This information was printed Saturday 3 December 2016 from humanservices.gov.au/health-professionals/enablers/education-guide-indefinite-referrals-what-you-need-know It may not include all of the relevant information on this topic. Please consider any relevant site notices at humanservices.gov.au/siteinformation when using this material.