FOI 26-2618 – Medical Practitioners – Non-Referred MBS Telehealth Services Fact Sheet

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# Medical Practitioners – Non-Referred MBS Telehealth Services

Last updated: 23 October 2025

- This factsheet covers Medicare Benefits Schedule (MBS) telehealth (video and phone) services for non-referred medical attendances.
- It is a legislative requirement that medical practitioners billing the telehealth items listed in this factsheet only perform a telehealth service if they are the patient's eligible telehealth practitioner and have an established clinical relationship with the patient, unless an exemption applies (see *Eligibility Requirements*).
- A service may only be provided by telehealth where it is safe and clinically appropriate.
- Providers are expected to obtain informed financial consent from patients prior to providing the service, providing details regarding their fees, including any out-of-pocket costs.

# What are the changes?

From 1 November 2025, patients will be able to access all MBS telehealth services listed in this factsheet if they are registered with MyMedicare and the service is being performed by their registered practice (see the *Health Insurance (Section 3C General Medical Services – Telehealth Attendances) Determination 2021*). This means that patients only need to meet one of the eligibility pathways and do not need to meet the eligible telehealth practitioner requirement unless the telehealth service is not with their MyMedicare registered practice (see *tables* below).

From 1 November 2025, changes to Better Access general practitioner (GP) and prescribed medical practitioner (PMP) telehealth items include:

- the removal of mental health treatment plan (MHTP) review and ongoing mental health consultation items. General attendance items can be used for those purposes.
- MHTP items require the services be provided by either a GP or PMP at the general practice at which the patient is registered in MyMedicare or by the patient's usual medical practitioner (defined in regulations). Further information will available in explanatory note *AN.0.78* on MBS Online from 1 November 2025.
- The GP and PMP MHTP telehealth items are no longer exempt from MBS telehealth eligibility criteria (see also the *Better Access Factsheet*).

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- Focussed psychological strategies services by GPs will continue to be exempt from the MBS telehealth eligibility criteria.

In addition, this factsheet has been updated to reflect Chronic Condition Management (CCM) changes from 1 July 2025. These changes include that CCM items are no longer subject to the MBS telehealth eligible telehealth practitioner requirement. However, they do require that when a patient is registered under MyMedicare they must access GP chronic condition management services through the practice where they are registered. Patients that are not registered through MyMedicare can access the services through their usual medical practitioner (see AN.0.47 for further details from 1 November 2025).

# Why are the changes being made?

The introduction of MyMedicare as an alternative pathway was informed by the MBS Review Advisory Committee (MRAC) post-implementation review of MBS telehealth final report. The policy settings for MBS telehealth items are underpinned by current evidence and clinical advice on the best ways for telehealth to achieve the same outcomes as face-to-face service.

Mental health telehealth changes are a result of recommendations from the independent Better Access Evaluation by the University of Melbourne, published in December 2022, and the government's response to the Evaluation published in August 2024. Changes to MBS telehealth items align them with services available in-person. A full copy of the Evaluation of the Better Access initiative – final report and the Australian Government response to the Better Access evaluation is available in the resources section of the Department of Health, Disability and Ageing (the department) website.

Changes to the eligibility requirements for MBS GP CCM telehealth items are to align with equivalent services provided in-person.

# Information for providers

Telehealth provides more flexible options for healthcare. The MBS telehealth items have the same clinical requirements as equivalent face-to-face consultations, and the same fee and benefit values. The same high standards of care a patient should expect during a face-to-face consultation are also expected for telehealth consultations.

The policy settings for MBS telehealth items are underpinned by current evidence and clinical advice on the best ways for telehealth to achieve the same outcomes as a face-to-face service. This emphasises that higher quality care through telehealth is achieved when it is provided in the context of a continuous clinical relationship with a known patient for a known condition.

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A patient's participation in a previous telehealth consultation does not qualify them for ongoing MBS telehealth services. The eligible telehealth practitioner requirement is a rolling requirement. Practitioners should confirm that patients have either received an eligible face-to-face attendance, have met the MyMedicare requirement or, have met one or more of the relevant exemption criteria, prior to providing a telehealth attendance.

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.

Failure to meet the eligibility requirements or incorrect use of an exemption may result in incorrect MBS claiming or out-of-pockets costs for patients.

Providers do not need to be in their practice to provide telehealth services. Providers should use their provider number relevant to the appropriate practice and must provide safe services in accordance with normal professional standards.

Telehealth services contribute to Standardised Whole Patient Equivalent (SWPE) calculations which determine the value of Practice Incentives Program (PIP) and Workplace Incentive Program (WIP) payments. Including video and phone into the SWPE ensures that payments that support quality improvement activities and subsidies for allied health workers reflect contemporary practice.

Telehealth items listed in the Health Insurance (Professional Services Review Scheme) Regulations 2019 are included in the 'prescribed pattern of services' rules. A medical practitioner who renders or initiates 80 or more relevant services (as listed in the above regulations) on each of 20 or more days in a 12-month period (cumulative not consecutive) will be referred to the Director of Professional Services Review (PSR). Under the '30/20 rule', a medical practitioner who renders or initiates 30 or more relevant phone services per day on 20 or more days in a 12-month period (cumulative not consecutive) will be referred to the Director of PSR.

## Information for patients

To be eligible for MBS telehealth benefits, patients must have the telehealth service with their eligible telehealth practitioner, or meet an exemption criterion, or be registered in MyMedicare with the practice providing the service.

Patients are encouraged to speak to their doctor or general practice about the most appropriate consult for their circumstances. Patients interested in ongoing telehealth consultations are encouraged to maintain their access by having face-to-face consultations as required.

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# Eligibility Requirements (see AN.1.1)

MBS telehealth items in this factsheet are available for a wide range of consultations. All **Medicare eligible** Australians can receive most of these services if they either have the service with their eligible telehealth practitioner meaning an *established clinical relationship* with medical practitioner or practice or are registered in MyMedicare.

## MyMedicare

MyMedicare is a voluntary patient registration model that aims to formalise the relationship between patients and their preferred primary care teams. Eligibility for this pathway is separate to the eligible telehealth practitioner requirement. Longer telephone services for 20 and 40 min are only available for patients registered in MyMedicare. Please see [MyMedicare website](MyMedicare website) for more information on MyMedicare eligibility criteria.

## Eligible telehealth practitioner criteria

An eligible telehealth practitioner means the medical practitioner performing the service:

- has provided at least one MBS subsidised face-to-face service to the patient in the 12 months preceding the telehealth attendance; or
- the medical practitioner is located at a medical practice where the patient has received at least one MBS subsidised face-to-face service arranged by that practice in the 12 months preceding the telehealth attendances. This included services performed by another medical or nurse practitioner located at the practice, or by another health professional located at the practice, such as a practice nurse or Aboriginal and Torres Strait Islander health worker performing a service on behalf of a medical practitioner); or
- is a participant in the Approved Medical Deputising Service program, and the Approved Medical Deputising Service provider employing the medical practitioner has a formal agreement with a general practice that has provided at least one face-to-face service to the patient in the 12 months preceding the telehealth attendance.
- 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

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- a person isolating because of a COVID-related State or Territory public health order, or in COVID-19 quarantine because...