How to bill a telehealth consult: a step-by-step guide for clinicians

Billing a telehealth consult is the same discipline as billing an in-person one, with a few telehealth-specific checks bolted on. Get four things right — eligibility, the item, the billing choice, and the claim — and the rest follows.

Here’s the workflow, with the authoritative source for each step so you can confirm the current rules rather than relying on memory.

Step 1: Confirm eligibility before you consult

Eligibility is the step that most often trips up a telehealth claim, so do it first.

• Check the existing-relationship requirement. For GP telehealth, the patient generally needs a face-to-face service with you or another GP at your practice in the previous 12 months, unless an exemption applies (Services Australia). The detail — and the exemptions — are in the telehealth 12-month rule.
• Know where your item differs. Many specialist telehealth items don’t carry the same relationship test, and some programs (mental health, allied health) have their own conditions. Confirm the rule for the specific item you’ll claim.
• Confirm Medicare eligibility. The patient needs valid Medicare (or DVA) cover for the service to be claimable at all.

The cheapest billing error to prevent is the one you catch before the consult. Verifying the existing relationship and the patient’s Medicare status up front avoids a rejected claim — or a service you can’t lawfully claim — after the fact.

Step 2: Choose the right item

Telehealth items vary by three things: provider type, video vs phone, and consultation level (length and complexity). Pick the item that matches all three (Services Australia).

A few specifics worth holding in mind:

• Video and phone are separate items — claim the one that matches how the consult actually happened.
• Longer phone items (Level C and above) are generally limited to patients registered with your practice through MyMedicare (see MyMedicare and telehealth).
• The item’s descriptor and explanatory notes carry conditions that can affect eligibility — read them, don’t assume.

For how the items are organised across the schedule, see telehealth MBS item numbers. Because numbers and fees change with each MBS update, verify the exact item on MBS Online before claiming rather than quoting a fixed code.

Step 3: Decide bulk bill or private

Once you’ve identified the item, decide how you’ll bill it — this is a practice policy decision, not a Medicare one.

• Bulk bill. The patient assigns their Medicare benefit to you, you accept it as full payment, and you claim it directly. No gap can be charged for that service. Eligible bulk-billed services may also attract bulk billing incentives.
• Private / mixed. You charge your fee, the patient pays, and they claim the rebate back. Any amount above the rebate is their gap.

The mechanics of assignment of benefit and incentives are covered in how does bulk billing work. Whatever you choose, be transparent with the patient about any out-of-pocket cost before the consult.

Step 4: Submit the claim correctly

Telehealth claims are lodged much like in-person ones, with one channel restriction to remember.

• Submit through your practice-management software or a Medicare online claiming channel.
• You can’t use Medicare Easyclaim to bulk bill telehealth items (Services Australia) — route bulk-billed telehealth through online claiming instead.
• Capture the patient’s assignment of benefit for bulk-billed services (signature or terminal confirmation).

If a claim is rejected, the reason usually traces back to Step 1 or Step 2 — an eligibility gap or a mismatched item.

Document as you bill

Good notes protect the claim. Alongside your usual clinical record, note that the service was delivered by video or phone, that consent to telehealth was obtained, who was present, and — where relevant — how the existing-relationship requirement was met or which exemption applied. If a remote assessment is later queried, that record is your defence.

This matters because telehealth items are a recognised focus of Medicare compliance activity. A claim that isn’t supported by the record — the modality, the eligibility basis, the clinical content of the consult — is the kind that gets questioned or recovered. Contemporaneous notes that match the item you claimed are the simplest protection, and they cost nothing but a few seconds during the consult.

A quick pre-consult checklist

Before the consult starts, run through:

1. Medicare/DVA cover — is the patient eligible, with valid details?
2. Existing relationship — met, or an exemption that applies (for GP telehealth)?
3. Modality — will this be video or phone, and is the intended item available for that mode?
4. MyMedicare — for a longer phone consult, is the patient registered with your practice?
5. Billing choice — bulk bill or private, and has any gap been explained to the patient?

Two minutes here prevents most of the rework that happens after a rejected claim.

A note on DVA telehealth

Telehealth is also claimable for eligible DVA patients, and the claiming pathway sits alongside MBS on the same Services Australia guidance (Services Australia). The item structures and conditions can differ from MBS, so confirm the DVA arrangements for the specific service rather than assuming they mirror Medicare exactly.

Where the platform fits in

Your software doesn’t set the item or the rebate, but it does determine whether the “video” you’re billing actually connects. MedCall is made for Australian clinicians: the patient joins a secure, Australian-hosted video consult by tapping a texted link, with no app and no account, while your booking, notes and billing stay in the practice-management system you already claim through. Less time on “can you hear me?”, more on the consult you’re billing.

The bottom line

To bill a telehealth consult: confirm eligibility (especially the existing-relationship rule), choose the item that matches provider type, modality and level, decide bulk bill or private, and lodge through the right channel — not Easyclaim for bulk-billed telehealth. Document the modality and consent as you go. Get those four steps into a repeatable routine and telehealth billing becomes as reliable as your in-person claiming. Rules and items change, so confirm each step against the current Services Australia guidance and MBS Online before you claim.