Nurse practitioner Medicare rebates in Australia

This blog is for educational purposes only and does not replace professional medical advice or diagnosis. If you have health concerns, consult an AHPRA-registered telehealth doctor or request a medical certificate online if clinically appropriate. Please note: Hola Health does not currently offer Mental Health Care Plans.

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Overview 

A nurse practitioner (NP) is a nurse with extra training. NPs can assess, diagnose, and treat many health problems. They can also prescribe certain medications when clinically appropriate.  

Medicare helps pay for many NP services. This payment is called a Medicare rebate. In November 2024, the rules for Medicare rebates for NP services changed¹. These changes made it easier for eligible patients to access NP care.  

Medicare rules change often. This guide explains the 2024 changes, but always check the latest MBS information before you visit.  

What is Medicare billing for nurse practitioners? 

Medicare billing for NPs is based on the Medicare Benefits Schedule, or MBS. The MBS lists health services. Each service has its own item number².  

When a participating nurse practitioner provides a Medicare-eligible service and the relevant requirements are met, a Medicare benefit may be payable. 

1. Medicare rebates are linked to MBS item numbers. 
2. Not every NP service is Medicare-rebatable. 
3. The rebate may not cover the provider’s whole fee. 
4. Patients may have an out-of-pocket cost. 

What changed for nurse practitioners in 2024?  

Two major changes happened for NPs in 2024.  

From 1 July 2024, the schedule fees for several nurse practitioner MBS attendance and telehealth items increased. 

From 1 November 2024, legislative changes removed the former requirement for nurse practitioners to have a formal collaborative arrangement with a medical practitioner for Medicare-subsidised services and PBS prescribing⁵. 

These were changes introduced in 2024. Current MBS fees, item descriptions and eligibility requirements should be checked against the latest MBS information before relying on them. 

1. Higher Medicare benefits for NP consultations 
2. No legislated requirement for a collaborative arrangement with a medical practitioner 
3. Easier access to Medicare-subsidised NP care.  
4. Better access for patients, especially in rural and remote areas.  
    

These changes were a part of the Nurse Practitioner Workforce Plan and the Strengthening Medicare Report. The aim was to make primary healthcare easier to access.  

How much does Medicare pay for a nurse practitioner? 

Let’s understand these four terms:  

1. MBS schedule fee: The amount Medicare sets for a service. 
2. Medicare benefit (rebate): The amount Medicare pays back for that service. 
3. Provider fee: The amount the NP actually charges. This can be higher than the schedule fee.  
4. Gap payment: The difference between the provider fee and the Medicare benefit.

A Medicare rebate does not always mean your visit is bulk billed. It means Medicare pays part of the cost of the service⁴. 
The table below shows the selected nurse practitioner MBS attendance items and Medicare benefits.  

Note: Fees and Medicare benefits are subject to change. Check the current MBS before relying on these amounts. 

Item number	Consultation length	Schedule fee	Medicare benefit (85%)
82200	Short, straightforward problem	$14.95	$12.75
82205	At least 6 and under 20 minutes	$32.65	$27.80
82210	At least 20 minutes	$61.80	$52.55
82215	At least 40 minutes	$91.20	$77.55
82216	At least 60 minutes	$137.85	$117.20

Simple example: If the service is bulk billed, the provider accepts the Medicare benefit as full payment for that service and the patient does not pay a gap for that service. If the provider charges above the applicable benefit, the patient may have an out-of-pocket cost.  

Does Medicare cover telehealth with a nurse practitioner?  

Some NP telehealth consultations are eligible for a Medicare benefit. This includes video and phone consultations when MBS rules are met.  

Telehealth may not be suitable for every health concern. Depending on the symptoms and clinical assessment, an in-person examination, testing or other care may be required. 

1. Video consultations may attract a Medicare rebate 
2. Telephone consultations may be eligible in some circumstances 
3. You and your NP must both meet MBS eligibility rules 
4. Always confirm billing arrangements before your appointment 

Can nurse practitioners bulk bill?  

Bulk billing means the NP accepts the Medicare benefit as full payment for the service.  

1. Bulk billing means you pay no gap for that service. 
2. Being eligible for a rebate does not mean a service will be bulk billed 
3. Not every NP service is bulk billed. 
4. Billing policies can vary between providers. 
    

Medicare rebate vs bulk billing: What’s the difference? 

This is a common point of confusion. A Medicare rebate does not always mean your visit will be free.  
 
Quick comparison:  

1. Medicare rebate: Medicare contributes toward an eligible service. 
2. Bulk billing: The provider accepts the Medicare benefit as full payment. 
3. Gap payment: The patient pays the difference when the provider’s fee is higher than the Medicare rebate. 

If you have an urgent or serious health problem, call 000 for emergency help. Telehealth is not suitable for emergencies.  

Can nurse practitioners prescribe medicines?  

Some nurse practitioners may be authorized to prescribe certain medicines within their scope of practice and subject to applicable requirements. 
 
Eligible NPs who are authorised to prescribe can apply to become PBS prescribers4. This allows them to prescribe certain medicines when appropriate and within their area of practice.  
 
PBS prescribing rules can change, and some medicines may have additional requirements. Always check the latest PBS information.

What do the 2024 changes mean for patients?  

The 2024 changes may affect Medicare billing arrangements for some nurse practitioner services. Patients should check whether the particular service is Medicare-eligible, whether a Medicare benefit applies.  

You may want to know:  

1. Can I receive a Medicare rebate for this visit? 
2. Will the visit be bulk billed? 
3. How much will I need to pay? 
4. Can I use telehealth for this service? 
5. Is my particular service Medicare eligible? 

It is always best to ask the practice about billing before your appointment. 

What do the changes mean for nurse practitioners?  

These changes are also important for NPs providing Medicare-rebatable services.  

1. Choosing the correct MBS item number for each consultation. 
2. Meeting all billing and documentation requirements 
3. Ensuring services meet current Medicare eligibility rules 
4. Keeping up with MBS updates, since these are reviewed regularly.  
    

How to check current nurse practitioner MBS item numbers and fees

This guide explains the 2024 changes, but MBS items, fees, and rules are updated often. Always check the current, official information before relying on it.  

1. MBS item number 
2. Service description 
3. Schedule fee 
4. Medicare benefit 
5. Eligibility requirements  

You can search current item numbers on the MBS Online website.  

Conclusion 

Medicare support for Nurse Practitioners increased in 2024. Consultation fees went up, and NPs gained more independence to provide Medicare-subsidised care. However, a Medicare rebate does not mean the visit is free. Always check your NP’s billing arrangements and check current MBS rules before your appointment.