Medicare Eligible Services & Medicare Online Claiming

Referrals

Advised Medicare rebates can not be claimed unless

  • you have provided a valid referral letter for your child prior to the start of the appointment.

  • your child attends the appointment

After payment of the appointment fee, we will lodge a claim on your behalf unless you advise us otherwise. Your rebate will normally be paid into your bank account nominated to Medicare by the next business day.

Neonatal Care Invoices:

Your obstetrician has referred your baby. Once your invoice is paid, a Medicare Claim can be lodged as soon as we have your baby’s Medicare number. For more information, go to newborn care in hospital.

REFERRALS & MEDICARE ELIGIBILITY FOR REBATES

It is your responsibility to ensure we have a valid medical referral for your child before the appointment's commencement to ensure eligibility for Medicare rebates.

A medical referral helps specialist doctors provide care for your child.

You cannot claim Medicare rebates without a valid referral for your child. In some situations, a smaller rebate may be claimed.

When will my referral expire?

GP referrals last 12 months from the date when they are first used.

Specialist referrals last 3 months.

  • For example, your GP or specialist writes your child’s referral on 01 January 2019.

    Your first appointment with the paediatrician is on 30 March 2019.

    • This GP referral expires on 29 March 2020. (not valid on 30 March)

    • Your specialist referral expires on 29 June 2019 (not valid on 30 June)

Families can organise a referral up to 12 months before a scheduled appointment, keep it until needed in your records or provide it to us to file in your child’s record so it is ready to use when needed.

Obstetrician Referrals for Newborns. This referral is for 3 months from your baby’s birth. After this time, your GP can provide a referral for your baby if needed, which will last for 12 months. Your baby’s first obstetrician referral is normally recorded in the hospital’s and doctors’ notes.

Indefinite Referrals are tricky. Your GP may intend their referral to have an indefinite term up to age 18 or up to the time when a particular medical concern has been resolved. If the indefinite term is not clearly identified at the top of the letter or with similar prominence, the referral will probably be filed as a standard GP referral for 12 months. If this happens, your child will need a new referral after 12 months.

Medicare rules do not allow an indefinite referral to be used for a condition not included in that referral. So if your child has an indefinite referral for ASD management but wants to consult about headaches, you should supply a new referral from your GP.

Medicare recognised referrers? Medicare only recognises referrals from Registered Medical Practitioners. Letters from your Clinical Psychologist, Occupational Therapist or other Allied Health providers often have great clinical value but can not be used as a Medicare referral. Some Nurse Practitioners are able to make Medicare referrals, but most nurses, including CAFHs nurses, cannot.

Separate referral for parents? A parent should obtain their own GP referral if they wish to see the paediatrician without the child attending to ensure access to the normal rebates.

Backdating or seeking a referral after your appointment?

Medicare does not permit GPs or Specialists to backdate any referral or to request a backdated referral.

Nor does Medicare permit the lodgement of a rebate claim linked to a backdated or otherwise invalid referral.

Sometimes an existing valid referral has been left at home, or the GP has forgotten to fax a previously written referral in time. In this case, families may seek to provide this referral as soon as possible and no later than 4 pm on the same day as the appointment. Whether the referral is recorded for Medicare purposes will be at the discretion of Practice Management in light of the circumstances, the content of the referral, the apparent time and date it was provided and Medicare rules. A referral supplied to us under these circumstances would not be considered valid if the date of issue is the same as the date of the specialist appointment.

Even if the referral is found to be valid in these situations, the practice cannot guarantee that the referral will be filed and used for claim lodgement due to the complexity and nature of the daily procedures involved. Where a valid referral is not provided, our policy requires that immediately following an appointment, the service is invoiced and then claimed against the applicable item- in this case, an “un-referred item”. It is not possible to guarantee that this can be changed later in the day.

To avoid difficulties and disappointment, families are urged to ensure that a current referral has been provided at least 7 days prior to the commencement of the appointment and preferably at the time of booking.

THE REFERRAL LETTER-KEY REQUIREMENTS:

  • Addressed to a provider in person or to “ Paediatrician” or “Paediatric Neurologist, Occupational Therapist etc.

  • Show the name of the referring doctor, their practice address and provider number

  • indicate a reason for the referral

  • be dated and signed by the referring doctor

  • have an issue date and time no later than the day and start time of the appointment,

  • be provided before the start time of the appointment.

Video Appointments

appointments may be offered via Telehealth (VIDEO)

Our normal fees also apply for Video appointments. Medicare rebates can be claimed for these consultations if your child has been referred and attends. Video appointments are costlier to deliver than normal in- rooms consulting.

Medicare Rebates for Allied Health Services

Allied health appointments are only eligible for Medicare rebates if you have one of the following special referrals.

Referrals to Psychologists and Occupational Therapists for Mental Health -up to 10 rebates

  • Mental Health Care Plan (MHCP) from your GP/ or

  • Better Access to Mental Health Scheme Referral from your paediatrician or psychiatrist.
    These referrals enable access to Medicare rebates for up to 10 visits in total per calendar year with a Psychologist and/or an accredited Occupational Therapist.

GP team care plan referral is available for various allied health therapists’ appointments -up to 5 rebates.

  • Allied health include Speech Therapist, Dietitian, Physiotherapist, audiologist, podiatrist, Occupational Therapist or Psychologist

  • Chronic Diseases Management Plan (CDMP)/Enhanced Primary Care Plan (EPC)/Team Care Arrangement (TCA) from your GP. This referral enables access to Medicare rebates for up to 5 visits per calendar year with the allied health professionals nominated in the plan. See Medicare requirements and details here.

Referral to Allied Health for Diagnosis and Management Planning Input -up to 4 rebates.

  • -Helping Children with Autism Scheme (HCWA) from your paediatrician or psychiatrist (must be claimed before your child turns 25 years of age). This referral enables access to Medicare rebates for up to 4 diagnosis/treatment planning sessions.

  • -Better Start for Children with Disability Initiative from your paediatrician or GP (must be claimed before your child turns 25 years of age)

referrals for up to 20 rebated sessions of therapy until age 25 for specific eligible conditions:

  • HCWA referrals can be made by your child’s Paediatrician or Psychiatrist

  • Better Start referrals by your child’s paediatrician or GP.

Please see Visiting our Allied Health Professionals for more details on these plans.


Private Health Cover for Allied Health Appointments & HICAPS On-the-spot Claiming

ADF and Veteran parents

Our HICAPS terminal enables direct claiming using your Health Fund Card on the day of your allied health appointment. Levels of cover vary between and within funds so it is a good idea to contact your private health fund prior to your appointment to check if you have Extras cover for the particular service.

Private health funds do not cover appointments with medical doctors.

Where Medicare coverage is not available to a family, their overseas health fund may rebate the payment for the Doctor’s invoice. We provide a receipt you can present.

Allied Health Fees for the care of children of ADF and veteran parents are rebated by Medicare if applicable, or by your Health Fund. Our providers do not accept DVA Gold or White card for payment of their care of your child nor bill DVA directly for care provided to children under DVA arrangements. Where care is provided to a parent, the account should normally be settled and the receipts submitted to your fund or the DVA for possible reimbursement. ADF parents can access a gap cover scheme for the out of pocket costs of care of their dependent children.


National Disability Insurance Scheme (NDIS) Funding

Our allied health practitioners are able to provide NDIS services to children with funding packages but not all are NDIS registered. Please discuss this upon making your appointment. Provide us with your child’s NDIS details,NDIS number, and whether your funding package is agency, fund or self managed.

Disability, developmental problems and early intervention remain core aspects of paediatric health and disability care and our providers are skilled in assessing need and guiding intervention. Paediatrics at Burnside and its providers aim to provide assistance to families so as optimise referrals and pre-planning input for their NDIS participant child.


Fees are set to cover the real costs of providing quality care. Medicare rebates, health fund rebates and NDIS funding greatly help affordability for families.

Please read our Bookings, Fees and Cancellations Policy and Privacy Policy before booking and attending your appointment. Your are always welcome to clarify fees with staff.