Referral requirements for allied health and other primary health care services

Publication date: 1 November 2025

SUMMARY

This note sets out the requirements for referring patients to MBS-supported allied health and other primary health care services. 

For Subgroup 1 of Group M3, Group M8, Group M9, Subgroup 1 of Group M10 or Group M11 (and telehealth equivalents) these requirements apply to referrals written on or after 1 July 2025.

For Group M6, Subgroup 1 of Group M7 and Subgroup 1, 2, 3, 4, 6, 7, 8 and 9 of Group M18, these requirements apply to referrals written on or after 1 November 2025.

APPLICATION OF REFERRAL REQUIREMENTS

The requirements outlined in this note apply to referrals written on or after 1 July 2025 for the following groups of allied health and Aboriginal and Torres Strait Islander health and wellbeing services and, where applicable, their telehealth (video and phone) equivalents:

• M3 (subgroup 1) – individual allied health and Aboriginal and Torres Strait Islander health and wellbeing services for patients with a chronic condition (referred under the chronic conditions management arrangements (see MN.3.1)

• M8 – pregnancy support counselling allied health services (see MN.8.1)

• M9 – allied health group services for patients with type 2 diabetes (referred under the chronic conditions management arrangements (see MN.9.1 and MN.9.2)

• M10 (subgroup 1) – complex neurodevelopmental disorders and eligible disabilities allied health services (see MN.10.1)

• M11 – allied health and Aboriginal and Torres Strait Islander health and wellbeing services for Aboriginal and Torres Strait Islander people (referred under the chronic conditions management arrangements or following an Aboriginal and Torres Strait Islander health assessment (see MN.11.1))

The requirements outlined in this note apply to referrals written on or after 1 November 2025 for the following groups of allied health services and, where applicable, their telehealth (video and phone) equivalents:

• M6 and M18 (subgroup 1 and 6) – Provision of psychological therapy services (see MN.6.2 and MN.7.5)

• M7 (subgroup 1) and M18 (subgroup 2, 3, 4, 7, 8, 9 – Provision of focussed psychological strategies (see MN.7.4 and MN.7.5)

As of 1 November 2025, these requirements do not apply to other MBS-supported allied health services, including eating disorder allied health services, or diagnostic audiology services.

REFERRAL REQUIREMENTS

The requirements for referrals are set out in the Health Insurance (Section 3C – Allied Health and Other Primary Health Care Services) Determination 2024 (the Determination) and mirror those for referrals to medical specialists and other MBS-supported services. The Determination requires the following “prescribed particulars” to be included in the referral:

• The name of the referring practitioner
  
  
• The address of the practice, or the practitioner’s provider number at that practice, of the referring practitioner
  
  
• The date on which the referring practitioner made the referral

The Determination also requires that referrals:

• Be in writing

• Signed by the referring practitioner (noting this can be an electronic signature)

• Dated, and

• Explain the reasons for referring the patient, including any information about the patient’s condition that the referring practitioner considers necessary to give the health professional.

For psychological therapy services and focussed psychological strategies services under the Better Access initiative (Group M6, Subgroup 1 of Group M7 and Subgroup 1, 2, 3, 4, 6, 7, 8 and 9 of Group M18), additional referral requirements are required for a patient to access mental health treatment services. Further information on referral requirements for Better Access treatment services can be found at MN.6.3.

How long is a referral valid?

Referrals for patients with chronic conditions (M3, M10 and M11 and telehealth equivalents) are valid for:

• The period of time stated in the referral, or
  
  
• If no timeframe is stated, 18 months.

These timeframes are measured from the date the first service is provided under the referral, not the date of the referral.

Referrals for a focussed psychological strategy service or psychological therapy service (Group M6, Subgroup 1 of Group M7 and Subgroup 1, 2, 3, 4, 6, 7, 8 and 9 of Group M18) are valid until the end of the number of sessions in the course of treatment the referring practitioner recommends up to the maximum session limit for each course of treatment.

Does the referral need to specify the number of services to be provided?

No for referrals for patients with the management of chronic conditions. From 1 July 2025 referrals do not need to specify the number of services to be provided. However, nothing prevents the referring medical practitioner from specifying the number of services to be provided under the referral if they choose to do so.

This recognises that some patients accessing allied health and Aboriginal and Torres Strait Islander health and wellbeing services may wish to access a higher number of services than are supported by the MBS. As the MBS benefits are the patient’s benefit, ultimately it is up to them to determine which services they would like to use their MBS benefit for.

For information on which allied health and Aboriginal and Torres Strait Islander primary health care professionals are eligible to provide MBS services see AN.15.4.

Yes, for psychological therapy services and focussed psychological strategies services under the Better Access initiative (Group M6, Subgroup 1 of Group M7 and Subgroup 1, 2, 3, 4, 6, 7, 8 and 9 of Group M18 services), the referral should include the number of services the patient is being referred to in the course of treatment. Further information on referral requirements for Better Access treatment services can be found at MN.6.3.

Does the referral need to include the name of the health professional who is to provide the referred service?

No. The patient can take the referral to any eligible health professional of the same profession/type specified in the referral of their choosing. For example, a referral to physiotherapy services can be taken to any physiotherapist, but it cannot be used to access chiropractic services.

I am an allied health professional. Can I accept a referral with another allied health professional’s name on it?

Yes. The patient can choose to take their referral to any eligible allied health professional of the same profession/type specified in the referral.

I am an allied health professional. Am I required to accept a referral?

No. Acceptance of a referral is at the discretion of the individual practitioner, subject to anti-discrimination legislation. However, if the referral is not accepted after being presented to the practice it is important to inform the referring practitioner that the request cannot be accommodated.

I am an occupational therapist and I will be away when my patient is due for their next appointment. Can another practitioner in my practice provide the service or does the patient have to delay their appointment until I return?

Yes, your patient can see another practitioner in the practice under the same referral, provided the other practitioner is an eligible allied health professional of the same profession/type specified in the referral. In this circumstance the allied health professional that provides the service would need to report to the referring medical practitioner, if required.

The referral has to be signed and in writing. Does this mean it needs to be in hard copy?

No. The Electronic Transactions Act 1999 allows for documents required under Commonwealth Law, such as referrals under the Determination, to be signed and transmitted electronically.

Are there any differences in the requirements for referrals to allied health and Aboriginal and Torres Strait Islander primary health care professionals and medical specialists?

Yes, there are some differences in the requirements:

• For allied health and Aboriginal and Torres Strait Islander health and wellbeing services for patients with a chronic condition (M3, M10 and M11 and telehealth equivalents), the default length of a referral is 18 months from the date of the first service provided under the referral. This aligns with the requirement for patients with a GP chronic condition management plan to have had their plan put in place or reviewed within the last 18 months to continue to access services (see AN.0.47). For specialist services the default referral length is 12 months from the date of the first service provided under the referral
  
  
• For psychological therapy services and focussed psychological strategies services under the Better Access initiative (Group M6, Subgroup 1 of Group M7 and Subgroup 1, 2, 3, 4, 6, 7, 8 and 9 of Group M18 services), additional referral requirements are required for a patient to access mental health treatment services. Further information on referral requirements for Better Access treatment services can be found at MN.6.3.

• Referrals to allied health and Aboriginal and Torres Strait Islander primary health care professionals cannot be indefinite referrals. This is in recognition of the requirement of many allied health and Aboriginal and Torres Strait Islander health and wellbeing items to provide a report back to the referring medical practitioner after the last service on the referral
  
  
• There is no emergency exception to the requirement for a written referral to exist before allied health and Aboriginal and Torres Strait Islander health and wellbeing services are rendered unlike for specialist or consultant physician referred attendances.

What happens if the referral gets lost or destroyed?

A service can be provided on the basis of a lost, stolen or destroyed referral. However, this is not expected to be a common occurrence. In these circumstances the phrase ‘lost referral’ replaces the prescribed particulars.

Where the intended allied health or Aboriginal and Torres Strait Islander primary health care provider is known, referring practitioners are encouraged to send referrals electronically whenever possible to minimise the risk of lost referrals.

RECORD KEEPING AND REPORTING REQUIREMENTS

Providers are responsible for ensuring services claimed from Medicare using their provider number meet all legislative requirements and they may be required to submit evidence for compliance checks related to Medicare claims. Practitioners should ensure they keep adequate and contemporaneous records. For information on what constitutes adequate and contemporaneous records see GN.15.39.

Clause 4.3 of the Health Insurance Act 1973 specifies that, where an item specifies the creation of a document (however described) and a document is created, the document must be retained for the period of 2 years. 

RELEVANT LEGISLATION

Details about the legislative requirements of the MBS item(s) can be found on the Federal Register of Legislation at www.legislation.gov.au. Referral requirements for allied health and Aboriginal and Torres Strait Islander health and wellbeing services are set out in the Health Insurance (Section 3C – Allied Health and other Primary Health Care Services) Determination 2024.