Medicare provider number for health professionals

Health professionals need a location based Medicare provider number to claim Medicare benefits.

Due to peak demand, Medicare provider number applications are taking approximately 15 business days to process from the date of receipt.

About Medicare provider numbers

This number is used for Medicare and Department of Veterans’ Affairs (DVA) claims processing.

A Medicare provider number lets you:

  • claim Medicare benefits for services you provide at a particular practice location
  • refer patients to another practice where they can claim a Medicare benefit, such as
    • to another health professional
    • for diagnostic imaging, or
    • for pathology services

Your Medicare provider number is used to identify you and your practice location when processing claims. You may need more than one Medicare provider number if you provide health services in different locations.

You can’t bill, refer, prescribe or request services until you have your Medicare Provider Number. You also can’t use another health professional’s Medicare provider number under any circumstances.

A provider number consists of:

  • a 3 to 6 digit number that identifies you, such as 123456, and
  • 2 additional characters that identify your practice location, such as 1A or AA

In this example, the Medicare provider number would be 1234561A.

If you’re registered in multiple health professions, we usually issue a separate number for each profession.

Apply for your initial Medicare provider number

If you’re a graduating health professional and have an intern position, or you’re a registered provider seeking access to Medicare benefits for the first time, you must apply for an initial Medicare provider number. This number identifies you as a health professional at your practice location.

It’s important to get your application in early.

December to April is peak processing time which could increase the processing timeframe.

If you’re a new health professional you must be registered with the Australian Health Practitioner Regulation Agency (AHPRA), or a relevant registration body, before you apply.

When you apply for a provider number, it’s important to give us your contact details and supporting documents. If you intend to claim Medicare benefits, please give us your bank account details to avoid delays in getting your benefit.

Different professionals have different forms to complete:

When applying for your provider number, you may also apply for a prescriber number. This number allows you to prescribe medicines listed in the Pharmaceutical Benefits Schedule (PBS) to your patients.

Processing times for applications

The processing time for applications can be up to 6 weeks. If you’re a new health professional you must have your provider number and Medicare eligibility before you start billing.

Make sure you use the most current forms on our website. Incorrect forms may be sent back to you and could delay you getting your Medicare provider number.

Applications are processed in the order we get them, and we have dedicated staff working to process these as quickly as possible.

It’s important to get your application in early.

December to April is peak processing time which could increase the processing timeframe.

You’ll get a letter from us once your application has been processed.

Allied health professionals registered with us can generally claim from the date the Medicare provider number is issued.

If you’re a General Practitioner or Specialist and registered your specialty with us, you can claim from the date we get your application if you’re not restricted by section 19AB. This means these providers can start working but should wait to lodge Medicare claims until their application is processed.

Using your Medicare provider number

Your Medicare provider number is used to identify you and your practice location when processing claims.

We’ll confirm in writing the type of access granted and your eligibility to access Medicare benefits. You need an additional Medicare provider number for each location where you provide, refer or request Medicare services.

Your Medicare provider number is also used for:

  • claiming benefits through DVA, and
  • determining eligibility for incentive payments

Let us know immediately when you stop practising at a certain location. This helps us maintain the integrity of your data.

You should only claim for Medicare benefits when you're working in a private capacity and there’s no other government funding for your services.

Apply for additional Medicare provider numbers

You need a different Medicare provider number for each location you provide health services. If you already have an initial Medicare provider number, it’s quick and easy to get additional Medicare provider numbers using Health Professional Online Services (HPOS).

You don’t need to submit a manual form as well.

You can also update your bank account details and contact details using HPOS.

Page last updated: 8 March 2018