Accessing Medicare for health practitioners
Before being able to bill for Medicare Benefits Schedule (MBS) items under Medicare, health practitioners must:
- complete approved education
- be registered with the national board relevant to their profession
meet eligibility requirements set out in the Health Insurance Act 1973 or the relevant legislation relating to their health profession
- be recognised by Services Australia
- have a Medicare provider number to provide services
- claim benefits as required.
All health practitioners must meet Medicare compliance requirements to:
- prescribe or claim for supply of subsidised medicines
- bill or claim for subsidised services
- receive payments under Medicare.
We identify and investigate potential fraud, inappropriate practice and incorrect billing under Medicare through different types of compliance activities.
Read more about getting set up with Medicare and accessing Medicare benefits, including for:
- interns, registrars and trainees
- general practitioners, specialists and consultant physicians
- nurse practitioners and midwives
- allied health professionals
- dental practitioners
If you did your medical training overseas or did not have Australian citizenship when you registered, you must meet extra requirements to access Medicare.
Read more about services, payments and programs for health practitioners.
Accreditation and standards to access Medicare benefits
Pathology services must meet accreditation standards to ensure quality of care and the safety of patients.
Pathology services can only access Medicare MBS item benefits if:
- the laboratory is accredited
- an approved pathology practitioner provides the service
- the proprietor is an Approved Pathology Authority.
Learn more about pathology accreditation.
Diagnostic imaging services
Diagnostic imaging services must meet accreditation standards to ensure quality of care and the safety of patients.
Diagnostic imaging services can only access Medicare MBS item benefits if they:
- have a location specific practice number
- are accredited under the Diagnostic Imaging Accreditation Scheme
- have eligible equipment.
Learn more about diagnostic imaging accreditation.
Accessing Medicare subsidies for industry
Manufacturers and sponsors of a health service or product can apply for it to be listed on the MBS or Pharmaceutical Benefits Scheme (PBS) Schedule. We then conduct a health technology assessment to decide whether to subsidise it.
We’re building the Health Products Portal so we can work more efficiently with the medicines and technology sector. The portal will enable industry to make, track, pay for (where applicable), and manage submissions for new products and services to be listed on the MBS and PBS Schedule.