The telehealth 12-month rule: Medicare eligibility explained

For most GP telehealth in Australia, Medicare will only pay a rebate if the patient has an existing relationship with the practice — broadly, a face-to-face service with that GP, or another GP at the same practice, in the previous 12 months. This is what people mean by the “12-month rule”.

The Department of Health now frames it as the eligible telehealth practitioner requirement (it was previously called the “established clinical relationship” requirement), but the underlying idea is the same: telehealth is meant to support continuity of care, not replace a first-ever contact (Services Australia).

What the rule actually says

To claim a rebate for a GP telehealth consultation (video or phone), the patient generally must have had a face-to-face consultation with:

• the same GP, or
• another GP at the same practice,

within the last 12 months (Services Australia).

Two details do a lot of work here. First, the relationship is with the practice, not only the individual doctor — so a colleague covering the list can still meet the requirement if the patient saw the practice in person recently. Second, it has to be a genuine in-person service; a prior telehealth-only history doesn’t establish the relationship.

MyMedicare is now a second way in. Since 1 November 2025, a patient registered with your practice in MyMedicare can have a rebated telehealth consult with that practice even without a face-to-face visit in the last 12 months (MBS Online). The longer phone items (Level C and D) are only for MyMedicare-registered patients in any case. Our telehealth item numbers quick reference lists every item and which ones need MyMedicare.

The 12-month rule is about continuity, not paperwork. If the patient has physically been seen by your practice in the last year, you almost certainly meet it. If they haven’t, you need an exemption — or an in-person visit first.

Why the rule exists

The requirement was introduced when telehealth became a permanent part of the MBS. The policy intent is to keep telehealth anchored to an ongoing clinical relationship, where the GP has context on the patient, rather than enabling one-off, disconnected online consultations. That’s also why it applies mainly to general practice, where continuity is central.

It also has teeth. A GP telehealth service that doesn’t meet the requirement (and doesn’t fall under an exemption) isn’t payable, so a claim can be rejected up front or recovered later during compliance review. That makes it worth getting right before the consult rather than arguing it afterwards.

The exemptions

Some patients and situations are exempt from the 12-month requirement, because a “regular practice” relationship either doesn’t fit their circumstances or shouldn’t be a barrier to care. Exemptions include, among others:

• children under 12 months of age
• people experiencing homelessness
• patients receiving an urgent after-hours service
• certain services such as blood-borne virus, and sexual and reproductive health consultations
• people affected by a natural disaster

This is not the complete list, and the wording is updated from time to time. For the current, definitive version, check the AskMBS advisory on the eligible telehealth practitioner requirement, or confirm with the practice.

What counts as meeting the rule

A few practical questions come up constantly:

• Does a previous telehealth consult count? No. The qualifying service has to be face-to-face. A history of phone or video consults alone doesn’t establish the relationship.
• Does it have to be the same doctor? No. A face-to-face service with any GP at the same practice in the last 12 months generally satisfies the requirement — which is what makes shared care and locum cover workable.
• What if the 12 months has just lapsed? Then the patient typically needs an in-person visit (or an exemption) before a rebated telehealth consult. The clock is the previous 12 months from the date of the telehealth service.
• Whose responsibility is it? The practice’s, in practice. It’s the clinician claiming the item who needs to be satisfied the requirement is met and to document how.

If you’re unsure whether a given patient qualifies, the safe path is a short in-person appointment to reset the relationship, after which telehealth follow-ups are straightforward.

It mainly applies to GP telehealth

The 12-month rule is a general practice requirement. Many specialist and consultant physician telehealth items work differently and are not subject to the same existing-relationship test — a patient can often see a specialist by telehealth on referral without a prior in-person visit to that specialist.

Other programs — mental health, allied health under care plans, and so on — have their own eligibility conditions layered on top of the general rules. So “does the 12-month rule apply?” is really “which item am I claiming, and for whom?” For how the items themselves are organised, see telehealth MBS item numbers.

What it means in practice

For patients. If you have a usual GP or clinic you’ve visited in person in the last year, you can generally have a bulk-billed or rebated telehealth consult there. If you’re contacting a brand-new practice you’ve never physically attended, expect to be asked to come in first — unless an exemption applies. Whether the consult is then bulk billed is a separate question, covered in Is telehealth bulk billed?.

For clinicians. Confirm the existing relationship before you consult, note how it’s met (or which exemption applies), and be careful with new patients who present only by telehealth. Claims that don’t meet the requirement can be rejected or later recovered, so document your reasoning. A tidy step-by-step for the whole process is in how to bill a telehealth consult.

Where the platform fits in

Eligibility is a Medicare question, not a software one — no platform can create an existing relationship that isn’t there. What good software does is make the in-person and video sides of a relationship feel like one service. With MedCall, a patient who has been seen at your practice can join a follow-up video consult by tapping a texted link, with no app or account, while your records stay in your existing practice-management system. The relationship lives in your clinic; the platform just carries the call.

The bottom line

The telehealth 12-month rule — now the eligible telehealth practitioner requirement — means most GP telehealth needs a face-to-face visit to the same practice within the previous year, unless a specific exemption applies. It’s mainly a general practice rule, and specialists often differ. Because the exemptions and wording change, always confirm against the current Services Australia guidance and the AskMBS advisory before you rely on it.