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Read the relevant item descriptions, fact sheets and explanatory notes on the MBS Online website.
If you’re a nurse practitioner, you can get Medicare benefits for services you provide. These are for clinically relevant services appropriate for treating your patient.
You can request certain pathology and diagnostic imaging services for your patients. You can also refer them to a specialist, as the clinical need arises.
Read more about which services you can refer and request in the following MBS explanatory notes:
- MN.14.15 Referral requirements
- MN.14.16 Requesting requirements
- IN.0.6 Requests for R-type Diagnostic Imaging Services.
Eligible nurse practitioners that have been issued with a prescriber number can prescribe selected listed medicines.
Find out more about nurse practitioner PBS prescribing on the PBS website.
Nurse practitioner MBS item numbers
You can find nurse practitioner items in:
- Category 8 - Group M3 Allied Health Services
- Category 8 - Group M14 - Nurse Practitioners
- Category 8 - Group M18 - Subgroup 5 Nurse practitioner telehealth services
- Category 8 - Group M18 - Sub Group 10 Nurse practitioner phone services.
The items include services for:
- attending and participating in chronic disease management case conference services
- face to face attendances
- telehealth attendances
- phone attendances.
Nurse practitioner services can be performed and billed through telehealth. Read more about Telehealth MBS items.
To get a payment, you must perform the service, meet the description and all requirements of the MBS item.
When billing time-based items, you can’t include time the patient wasn’t receiving active attention. This includes the time you take for any of these:
- to travel to the patient’s home
- for a break
- completing patient records.
Non-billable services
You can’t bill MBS items for either of the following:
- services provided where the patient isn’t in attendance, such as the issuing of repeat prescriptions
- group sessions.
Billing requirements
To bill MBS items for services you provide in private practice all of the following need to apply. You need to:
- have a Medicare provider number for each location you’re practicing at
- have professional indemnity insurance
- be registered with and satisfy the Registration Standards of the Nursing and Midwifery Board of Australia
- be endorsed as a nurse practitioner
- work in private practice or in a public facility that has an exemption under subsection 19(2) of the Health Insurance Act 1973.
If you’re an eligible nurse practitioner, you may be able to apply online for your additional Medicare provider number and PBS prescriber number.
As an eligible nurse practitioner you must have a Medicare provider number to bill MBS items. You need a separate provider number for each location you’re practicing at. Read more about eligibility for health professionals and apply for additional provider numbers.
If you need to apply for a provider number you can use the Application for a Medicare provider number and/or PBS prescriber number for a midwife or nurse practitioner form.
Private practice
You need to work in private practice or in a public facility that has an exemption under subsection 19(2) of the Health Insurance Act 1973 to bill MBS items. This allows you to either charge your patient a fee, or bulk bill the service.
You’re not working in private practice if you provide a service on behalf of a state or territory government.
You can’t bill a public patient for a service you provide in a public hospital.