Medicare billing restrictions
All doctors in Australia must meet certain requirements to be able to bill patients under Medicare. Read about the requirements and legislation doctors are subject to under sections 19AA and 19AB of the Health Insurance Act 1973.
Who is eligible to bill patients under Medicare?
You will also need to have a Medicare provider number if you wish to claim Medicare benefits for your patients.
Eligibility to access Medicare benefits is determined by the Health Insurance Act 1973 (the Act) and related regulations.
You must satisfy the requirements of sections 19AA and 19AB of the Act before you will be granted access to Medicare benefits.
Section 19AA of the Act
Section 19AA of the Act requires doctors who are permanent residents or citizens of Australia to become vocationally recognised in a medical speciality.
Under 19AA, you cannot access Medicare benefits unless you are:
- a permanent resident or citizen who is vocationally recognised
- a permanent resident or citizen on an approved 3GA training or workforce program
- a temporary resident international medical graduate with an s19AB(3) exemption
Read more about s19AA and how to meet its requirements, including a list of approved programs.
Section 19AB of the Act
Under section 19AB, temporary resident international medical graduates can work in certain locations to access Medicare benefits even if they are not vocationally recognised, as long as they meet the eligibility requirements.
An international medical graduate is someone who:
- got their degree outside of Australia or New Zealand
- enrolled in a degree in Australia or New Zealand as a temporary resident
Read more about 19AB and the locations international medical graduates must work in.
10 year moratorium scaling
Under 19AB, international medical graduates must work in a priority area for a minimum of 10 years to provide services covered by Medicare.
International medical graduates can reduce the time they must work in a priority area by working in an area eligible for moratorium scaling.
Read about 10 year moratorium scaling and eligible locations.