Medicare provider number legislation
MedicareMedicare is Australia's health care system. Medicare ensures that all Australians have access to free or low-cost medical, optometrical and hospital care while being free to choose private health services and in special circumstances allied health services.
Medicare provides access to:
- free treatment as a public (Medicare) patient in a public hospital
- free or subsidised treatment by practitioners such as doctors, including specialists, participating optometrists or dentists (specified services only).
Accessing MedicareTo access Medicare, you need a Medicare provider number. This number allows your patients to claim Medicare benefits for the services you provide.
Your eligibility to access a Medicare benefit will change as you progress through your career in Australia. The eligibility requirements are set out in the Health Insurance Act 1973 (the Act).
The key sections of the Act that determine a doctor’s eligibility for a Medicare benefit are Section 19AA and Section 19AB.
Doctors restricted by section 19AA of the Act who wish to provide general practice services and do not hold a specialist GP qualification require an approved placement on a training or workforce program to access the MBS.
Vocational Specialty (Section 19AA)From 1996, doctors wishing to access a Medicare benefit are required to have Fellowship of an Australian medical specialist college. These requirements are set out in Section 19AA of the Act. Section 19AA encourages vocational specialty with an aim to improve the quality of doctors working in Australia.
Doctors who do not hold a specialist qualification are unable to access Medicare benefits unless they participate in an approved training or workforce program. These programs are sometimes known as ‘3GA programs’. This is a reference to Section 3GA of the Act.
Doctors who wish to provide general practice services before they attain vocational recognition must participate in an approved placement under a program identified in section 3GA of the Health Insurance Act 1973 (the Act). The 3GA training programs lead towards GP Fellowship.
Workforce and Training Programs (3GA Programs)Medical Practitioners undertaking placements on approved workforce or training programs, set out in Section 3GA of the Act, can access a Medicare benefit at a specific practice location for the period of the approved placements.
Programs under section 3GA have been designed to support doctors during specialist training and to meet the workforce needs of the Australian communities. Some examples of 3GA programs are:
General Practice Training Programs
- Royal Australian College of General Practitioners Fellowship Program (PEP stream)
- Australian College of Rural and Remote Medicine Fellowship Program (IP stream)
- Australian General Practice Training Program - AGPT
- Remote Vocational Training Scheme - RVTS
- More Doctors For Rural Australia Program - MDRAP
- Approved Medical Deputising Service Program – AMDS
- Rural Locum Relief Program - RLRP
- Special Approved Placement Program - SAPP
- Approved Private Emergency Department – APED
- Specified specialist medical colleges training programs
Restrictions for Overseas Trained Doctors & Foreign Graduates of an Accredited Medical School (Section 19AB)Section 19AB limits Medicare access for Overseas Trained Doctors (OTDs) and Foreign Graduates of an Accredited Medical School (FGAMS) who became permanent Australian residents or citizens on or after 1 January 1997. These doctors are required to work in a District of Workforce Shortage (DWS) for a minimum period of 10 years. These restrictions are commonly known as the 10 year moratorium.
ScalingFor more information on Scaling see the scaling page.
Medicare Provider NumbersTo work as a doctor in Australia, you may need to have a Medicare provider number. This number allows your patients to claim Medicare rebates for the services you provide.
A Medicare provider number may allow you to:
- raise referrals for specialist services; and
- make requests for pathology or diagnostic imaging services.
- attract Medicare rebates for professional services rendered (that is, treat private patients).
A Medicare provider number uniquely identifies both you and the place you work.
How to apply for a provider numberMedicare provider numbers are issued by Medicare Australia after an OTD has been offered a medical job in Australia. You’ll find application forms on the Medicare website.
Provider number application forms
Contact Medicare Australia for more information
Phone: 132 150 (within Australia)
Email: firstname.lastname@example.org (Type 'Application for Medicare provider number' in the subject heading, and include which State or territory you’ll be working in in the body of the email.)
SpecialistsSpecialists requiring access to Medicare rebates that attract a higher 'specialist' payment need to apply for recognition as a specialist for Medicare billing purposes.
Phone: 132 150 (within Australia)