Telehealth Medicare Rules in Australia

Telehealth is now a normal part of healthcare in Australia, but Medicare rules can be confusing. Some telehealth consultations may be eligible for a Medicare benefit, some may be bulk billed, and some online services may be privately billed with no Medicare rebate.

The key point is that telehealth being available does not automatically mean a service is free, bulk billed, or Medicare-rebateable. Medicare eligibility depends on the service type, provider type, MBS item rules, patient eligibility, clinical suitability, and whether specific requirements are met.

For GP telehealth services, Medicare rules often require an existing clinical relationship with the practice. In many cases, this means the patient must have attended the same practice for a face-to-face service in the previous 12 months, although there are exemptions.

This guide explains telehealth Medicare rules in Australia, including when Medicare may apply, why some online services are private, what bulk billing means, what the existing relationship rule is, how video and phone consultations differ, and why clinical assessment still matters.

This information is general only. It does not replace Medicare advice, MBS billing advice, legal advice, medical advice, or guidance from your doctor, clinic, Medicare, Services Australia, or the Department of Health. If symptoms are severe, rapidly worsening, or make you feel unsafe, call 000 or seek urgent medical attention.

Key Points

• Medicare benefits may be available for eligible video and phone telehealth services.
• Not every telehealth consultation is bulk billed or Medicare-rebateable.
• GP telehealth Medicare items often require an existing clinical relationship with the practice.
• For many GP telehealth services, the patient must have attended the same practice face to face in the previous 12 months.
• There are exemptions to the existing relationship rule, including some urgent after-hours care, homelessness, young infants, some sexual and reproductive health consultations, natural disaster areas, MyMedicare registration and certain MBS items.
• Video is often preferred when a patient cannot attend face to face, but phone may be used where clinically appropriate.
• Bulk billing means the doctor accepts the Medicare benefit as full payment and the patient does not pay an out-of-pocket fee for that service.
• Private telehealth services may charge a fee and may not offer a Medicare rebate.
• Telehealth must still be clinically appropriate and safe.
• Dociva services may be privately billed depending on the service and assessment, and outcomes are subject to practitioner review.

Medical Certificates

What Is Telehealth Under Medicare?

Telehealth allows patients to consult a healthcare provider remotely, usually by phone or video. It may be used for medical advice, follow-up care, chronic disease support, mental health care, specialist review, prescription discussions, certificates, referrals, or care planning where appropriate.

The Australian Government Department of Health, Disability and Ageing explains that telehealth can involve consulting a healthcare provider by phone or video when a physical examination is not needed.

Medicare telehealth services are funded through the Medicare Benefits Schedule, often called the MBS. The MBS lists services that may attract Medicare benefits when the relevant requirements are met.

The MBS Online telehealth factsheet explains that ongoing MBS telehealth arrangements provide for a wide range of telephone and video services by qualified health practitioners.

However, Medicare rules are specific. A service must meet the relevant MBS item requirements before a Medicare benefit can be claimed.

Does Medicare Cover Telehealth in Australia?

Medicare may cover some telehealth services in Australia, but not all telehealth services.

Services Australia explains that Medicare benefits are available for video and phone telehealth services provided by eligible health professionals.

Eligible providers may include general practitioners, medical practitioners, specialists, consultant physicians, nurse practitioners, participating midwives, Aboriginal and Torres Strait Islander primary health care professionals, allied health professionals, and certain dental practitioners in oral and maxillofacial surgery.

Even where Medicare telehealth items exist, the patient and provider still need to meet the relevant requirements for the specific service.

Patients should ask before booking whether the consultation is bulk billed, privately billed with a Medicare rebate, or privately billed with no Medicare rebate.

What Is the Existing Clinical Relationship Rule?

For many GP telehealth services, Medicare rules require the patient to have an existing clinical relationship with the GP or practice.

Services Australia explains that, in general practice, telehealth items can usually only be used for patients who have either an existing clinical relationship with the provider or have visited the practice for a face-to-face service in the previous 12 months.

The Department of Health also explains that to be eligible for GP telehealth services, patients must generally have had a face-to-face consultation with their GP, or another GP in the same practice, in the 12 months before the telehealth service, with limited exceptions.

This rule is designed to support continuity of care and reduce unsafe one-off telehealth use where the provider does not know the patient or have access to relevant clinical context.

If you are using a telehealth provider for the first time, ask whether Medicare applies or whether the service is private.

Are There Exemptions to the 12-Month Face-to-Face Rule?

Yes. Some patients and services may be exempt from the usual existing clinical relationship requirement.

Services Australia lists exemptions including patients experiencing homelessness, patients under 12 months of age, patients treated at an Aboriginal Medical Service or Aboriginal Community Controlled Health Service, patients in a natural disaster area, certain urgent after-hours services in unsociable hours, some blood borne virus and sexual or reproductive health consultations, patients registered in MyMedicare at the practice, and patients in COVID-19 isolation or quarantine under a public health order.

There are also exemptions for specific MBS service types, including mental health planning and treatment, eating disorder management and treatment, chronic condition management, treatment at a Commonwealth Urgent Care Clinic, and obstetric attendance.

These exemptions are specific and may depend on the MBS item and patient circumstances.

If you are unsure whether an exemption applies, ask the clinic or provider before booking.

Bulk Billing, Medicare Rebates and Private Fees

Patients often use “Medicare covered”, “bulk billed” and “rebate available” as though they mean the same thing, but they are different.

Bulk billing means the provider accepts the Medicare benefit as full payment for the eligible service. The patient does not pay an out-of-pocket fee for that service.

A Medicare rebate means the patient may pay the provider's fee and then receive a Medicare benefit back, if the service is eligible and the claim is accepted.

A private telehealth service may charge a fee and may not offer a Medicare rebate. This can happen where the provider does not bill Medicare, where the service does not meet MBS item requirements, where the service is outside Medicare-funded care, or where the provider operates as a private service.

The Australian Government bulk billing guidance explains that not all GPs bulk bill all of the time, and that patients should check whether there will be out-of-pocket costs before seeing a doctor.

Does Telehealth Always Need to Be Bulk Billed?

No. Telehealth does not always need to be bulk billed.

Some providers bulk bill eligible telehealth services. Some charge a private fee with a Medicare rebate. Some charge a private fee without a Medicare rebate.

A provider may choose whether to bulk bill, subject to the service being Medicare-eligible and meeting relevant rules.

Patients should ask what the total cost is, whether Medicare applies, whether a rebate is available, and whether any gap payment will remain.

For online services, fees and refund arrangements should be explained clearly before payment.

Video vs Phone Telehealth and Medicare

Medicare telehealth can include both video and phone services, but the rules and MBS items may differ.

Services Australia explains that video services are preferred when a patient cannot attend a face-to-face consultation, while health professionals can also offer audio-only telephone services where clinically appropriate.

Separate MBS items may apply for audio-only services.

Video may be more suitable where visual assessment matters, such as rashes, swelling, movement, breathing pattern, wound appearance, general appearance, or communication cues.

Phone may be enough for some straightforward follow-ups, medication reviews, administrative care, discussion of results, or low-risk concerns, depending on the practitioner's assessment.

Clinical Suitability Still Comes First

Medicare eligibility is not the only issue. Telehealth must also be clinically appropriate.

The Medical Board of Australia explains that telehealth consultations use technology as an alternative to in-person consultations and that telehealth is not appropriate for every consultation.

A Medicare item may exist for a type of telehealth service, but the practitioner still needs to decide whether telehealth is safe for the patient's situation.

If the condition requires physical examination, urgent care, immediate treatment, pathology, imaging, wound care, procedures, or close monitoring, in-person care may be safer.

A responsible practitioner may decline to provide a certificate, prescription, referral, or treatment plan online if the situation cannot be assessed safely.

Book Online Consultation

What Services May Be Provided Through Telehealth?

Telehealth may be used for many types of healthcare where suitable. This may include GP consultations, specialist consultations, mental health care, allied health care, chronic condition reviews, medication discussions, follow-up appointments, care planning, referrals, pathology discussions, prescription support, and general medical advice.

However, not every telehealth service is Medicare-funded, and not every Medicare-funded service is appropriate for every patient.

Some online services focus on convenience and are privately billed. These may include medical certificate services, prescription services, referral services, documentation support, or general telehealth consultations.

Patients should check whether the service is a Medicare telehealth service, a private telehealth service, or a mixed-billing service.

The important question is not only “Can this be done online?” but also “Is this clinically suitable, and what will it cost?”

Are Online Medical Certificates Covered by Medicare?

Online medical certificate services may be private and may not attract a Medicare rebate.

A medical certificate may be issued through telehealth where clinically appropriate, but the availability of Medicare funding depends on the consultation type, provider, MBS rules, patient eligibility, and billing model.

Some providers may charge a private fee for certificate requests. Others may include certificates as part of a broader eligible consultation where clinically appropriate.

Patients should not assume that a certificate request is bulk billed or Medicare-rebateable simply because it is reviewed by a doctor.

Dociva medical certificate requests are subject to practitioner assessment and may be privately billed depending on the service. A certificate is not guaranteed.

Are Online Prescriptions Covered by Medicare?

Prescription discussions may occur during telehealth consultations, but this does not automatically mean the service is Medicare-funded or bulk billed.

A telehealth doctor may prescribe where clinically appropriate and legally permitted, but prescribing still depends on assessment, medicine safety, patient history, allergies, current medicines, monitoring needs, and whether telehealth is suitable.

Some prescription services are privately billed and may not attract a Medicare rebate.

The electronic prescription itself is not the same as a Medicare-funded consultation. It is a way of sending the prescription to the patient or pharmacy where conformant systems are used.

Patients should ask whether the consultation fee is private, whether Medicare applies, and whether there are any pharmacy costs or medicine costs.

Specialist Telehealth and Medicare

Specialist telehealth services may be eligible for Medicare benefits where the relevant MBS item requirements are met.

Specialist care may require a valid referral for Medicare rebate purposes. Referral validity, referral source, specialist type, and item rules may affect billing.

Some specialist telehealth consultations may be privately billed with a Medicare rebate. Others may be bulk billed, and some may be privately billed without a Medicare rebate depending on the circumstances.

Patients should ask the specialist clinic about referral requirements, total fees, Medicare rebates, gap payments, cancellation fees, and whether the appointment will be by phone or video.

A telehealth specialist appointment is still a specialist medical consultation and should include appropriate assessment, documentation, and follow-up advice.

Telehealth and MyMedicare

MyMedicare is a voluntary patient registration system that links patients with their chosen general practice and preferred GP.

For some telehealth arrangements, MyMedicare registration may affect eligibility for certain services or exemptions, depending on the MBS item and service type.

Services Australia notes that patients registered in MyMedicare at the practice providing the telehealth service may be exempt from the usual existing clinical relationship requirement for certain GP telehealth items.

MyMedicare does not mean every telehealth service will be free, bulk billed, or automatically available.

If you are registered with MyMedicare, ask your practice how it affects telehealth access, billing, and care planning.

What Patients Should Ask Before Booking

• Is this a Medicare-funded telehealth consultation or a private service?
• Will the consultation be bulk billed?
• If it is not bulk billed, what is the total fee and expected Medicare rebate?
• Is there an out-of-pocket gap payment?
• Do I meet the 12-month face-to-face relationship rule or an exemption?
• Will the consultation be by phone or video?
• Is telehealth clinically suitable for my concern?
• What happens if the doctor decides I need in-person care?
• Will prescriptions, certificates, referrals, or forms cost extra?
• What is the refund policy if my request is not approved?

Asking these questions before booking can reduce confusion about Medicare, costs, refunds, clinical suitability, and expected outcomes.

Responsible services should be clear about fees and should not imply that payment guarantees a certificate, prescription, referral, or treatment outcome.

Privacy and Telehealth Medicare Services

Telehealth involves sharing health information through phone, video, online forms, clinical software, document upload systems, electronic prescriptions, or secure messaging.

Services Australia explains that health professionals using MBS telehealth items need to meet clinical requirements and satisfy privacy laws.

Patients can support privacy by choosing a private space, using their own device where possible, checking email addresses and phone numbers carefully, avoiding shared devices, and asking how documents or eScripts will be sent.

Providers should use appropriate systems, access controls, documentation processes, and privacy-conscious handling of patient information.

If privacy is important for the consultation, tell the practitioner before discussing sensitive information, especially if another person is nearby.

When Online Care May Not Be Enough

Telehealth has limits. A remote consultation may not be suitable for chest pain, severe breathing difficulty, signs of stroke, severe allergic reaction, heavy bleeding, significant injury, severe dehydration, sudden neurological symptoms, severe abdominal pain, severe infection symptoms, fainting, overdose concerns, suicidal thoughts, or any situation where you feel unsafe or rapidly deteriorating.

In those situations, call 000 or seek emergency care.

Telehealth may also be inappropriate when diagnosis depends on a physical examination, urgent investigation, close monitoring, wound care, procedures, imaging, or treatment that cannot be provided remotely.

A responsible online doctor may recommend in-person care instead of issuing the requested certificate, prescription, referral, test request, or treatment plan.

Medicare eligibility should never be the reason to delay urgent medical attention.

Common Mistakes to Avoid

• Assuming all telehealth appointments are bulk billed.
• Assuming every online doctor service is Medicare-rebateable.
• Not checking whether the 12-month face-to-face GP rule applies.
• Confusing bulk billing with a Medicare rebate.
• Assuming payment guarantees a prescription, certificate, referral, or diagnosis.
• Using telehealth when symptoms clearly require urgent or in-person care.
• Not asking whether the consultation will be by phone or video.
• Not checking whether follow-up, forms, certificates, referrals, or prescriptions cost extra.
• Assuming private services must offer a Medicare rebate.
• Not asking what happens if the practitioner decides telehealth is not suitable.

A safer telehealth experience starts with checking costs, Medicare eligibility, clinical suitability, practitioner registration, privacy, and next steps before booking.

More of Our Services

Using Dociva

Dociva supports access to online healthcare where telehealth is clinically appropriate. Depending on the service and assessment, this may include medical certificate requests, online consultations, prescription support, referral support, pathology request discussions, radiology request discussions, and general healthcare guidance.

Dociva services may be privately billed depending on the service. Patients should review the service fee and available information before submitting a request.

Dociva does not guarantee that a medical certificate, prescription, referral, pathology request, radiology request, treatment, diagnosis, or other outcome will be provided. Outcomes depend on practitioner assessment and clinical suitability.

If the practitioner decides telehealth is not suitable, they may ask for more information, recommend phone or video review, suggest in-person care, decline the request, or direct the patient to urgent care where appropriate.

Helpful places to start include online consultations, medical certificate application, prescription services, referrals, available services, and support.

Frequently Asked Questions (FAQs)