Claiming of referred consultation services under Medicare in public hospitals

This information will help you understand your legal obligations when billing under Medicare for private consultation services in public hospitals.

Page last updated: 27 May 2016

Eligibility

  • under the Health Insurance Act 1973, we can't pay a Medicare benefit for a professional service funded under an arrangement with the Australian Government or a state or territory government
  • when you bill Medicare for consultation services, you must be the person who actually personally performed the service
  • Medicare services that must be personally performed are listed in the Medicare Benefits Schedule (MBS) and include MBS items 104, 105, 110, 116 and 119
  • if you are employed by a public hospital the service can only be billed under Medicare if you provide the service at a time when you are not being paid by the hospital
  • when you bill under Medicare for services you provide to a patient in a public hospital, make sure you understand and meet the requirements of the MBS. These include that:
    • an admitted patient has elected to be treated privately
    • a non-admitted patient has chosen to be treated as a private patient
    • the patient is eligible for a Medicare benefit
    • you have received a referral that is valid for the purposes of billing MBS consultation items, and
    • you bill the correct MBS item number for the service you provided

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