Eligibility criteria for MBS telehealth (video and phone)

It is a legislative requirement that medical practitioners billing non referred services (using items from Group A40 Subgroup 1, 2, 11, 13, 15, 16, 17, 19 and 20) must only perform a telehealth service if:

• the patient is registered in MyMedicare and the telehealth service is from the patient’s registered practice; or
• the provider qualifies as the patient’s eligible telehealth practitioner, or an exemption applies.  

The MyMedicare telehealth criteria is defined as: 

• the patient is registered with MyMedicare and is receiving the telehealth service from the MyMedicare practice they are registered with.

An eligible telehealth practitioner is defined as:

• the medical practitioner who performs the service has provided a face-to-face service to the patient in the last 12 months; or
• the medical practitioner who performs the service is located at a medical or nurse practitioner practice, and the patient has a face-to-face service arranged by that practice in the last 12 months. The service must be billed to the MBS and can be performed by another medical or nurse practitioner located at the practice, or a service performed on behalf of a medical practitioner by another health professional located at the practice (such as a practice nurse or Aboriginal and Torres Strait Islander health practitioner or Aboriginal and Torres Strait Islander health worker); or
• the medical practitioner who performs the service is a participant in the Approved Medical Deputising Service (AMDS) program, and the Approved Medical Deputising Service provider (AMDS provider) that employs the medical practitioner has a formal agreement with a medical practice that has provided at least one face-to-face service to the patient in the last 12 months.

A patient’s participation in a previous video or phone consultation does not constitute a face-to-face service for the purposes of ongoing telehealth eligibility. If an exemption is applicable providers are required to document and specify the exemption in patient clinical notes at the time of service for post audit compliance.

The eligible telehealth practitioner requirement does not apply to:

• a person who is under the age of 12 months,
• a person who is experiencing homelessness,
• a person living in a natural disaster affected area,
• a person who receives the service from a medical practitioner located at an Aboriginal Medical Service or an Aboriginal Community Controlled Health Service, or 
• a person isolating because of a COVID-related State or Territory public health order, or in COVID-19 quarantine because of a State or Territory public health order.

Or for the following specific Medicare Benefits Schedule services:

• An urgent after-hours service (in unsociable hours),
• Specific Mental health treatment items,
• Blood Borne Virus, Sexual or Reproductive Health telehealth items, and
• Preparing or reviewing a GP chronic condition management plan

A person who is experiencing homelessness means when a person does not have suitable accommodation alternatives, they are considered homeless if their current living arrangement:

(a) is in a dwelling that is inadequate; or

(b) has no tenure, or if their initial tenure is short and not extendable; or

(c) does not allow them to have control of, and access to space for social relations.

A person receiving mental health treatment services under the Better Access initiative through telehealth items means services must be claimed as specific eligible GP or eligible prescribed medical practitioner focussed psychological strategies items. Focussed psychological strategies services are available to any patient from any eligible GP and eligible prescribed medical practitioner as long as the patient has a Mental Health Treatment Plan, and the eligible GP and eligible prescribed medical practitioner has the appropriate training recognised by the General Practice Mental Health Standards Collaboration.  

A person receiving eating disorder psychological treatment services under the Eating Disorder Treatment and Management Plan (EDTMP) through telehealth items means services must be claimed as specific eligible GP or eligible prescribed medical practitioner focussed psychological strategies items. Eligible allied health professionals are also able to provide telehealth psychological eating disorder treatment services under the EDTMP (see also AN.36.2).

A person receiving treatment through Blood Borne Virus, Sexual or Reproductive Health telehealth items means services must be claimed as specific GP or prescribed medical practitioner telehealth items (see also AN.40.5).

The patient eligibility criteria (including MyMedicare and usual medical practitioner requirements) for a GP chronic condition management plan to be prepared or reviewed using items 92029, 92030, 92060 or 92061, the MyMedicare and usual medical practitioner requirements align with face-to-face items 392, 393, 965 and 967. See AN.0.47 for further information.

A person living in a natural disaster affected area is defined as a State or Territory local government area which is currently declared as a natural disaster area by a State or Territory Government until that declaration is deemed to have expired.

Providers must document in patient clinical notes any relevant exemption and the clinical reasoning.