Guide 03 of 05Field: Referral
Specialist referrals for fertility care and Medicare
For certain services by specialists and consultant physicians, the Medicare benefit depends on acceptable evidence that the service followed a referral from another practitioner. This guide covers what counts as a referral, what it must include and how long it lasts.
General information, not medical or legal advice. Services Australia’s page on referrals for specialist treatment sets out the legal obligations on doctors who refer under Medicare, and healthdirect’s page on referrals explains them for patients.
Definition
What counts as a referral
healthdirect describes a referral as a letter that your doctor, or another health professional, writes to a second health professional or service, asking for expert help with diagnosis or treatment.
Medicare’s own definition, in MBS note GN.6.16, is a request to a specialist or consultant physician to investigate, give an opinion on, treat or manage a patient’s condition, or to carry out particular examinations or tests. The note treats the general practitioner as the main source of referrals, and says referrals between specialists should usually happen in consultation with the patient’s GP.
Medicare benefit is payable for an attendance even when it is held only to write a referral, the note says, but no benefit is payable for any charge for a referral written without seeing the patient.
Contents
What the referral must include
Services Australia sets out the contents for doctors:
“When referring a patient to a specialist or consultant physician for treatment, the referral must include:
Services Australia, referrals for specialist treatment
- relevant clinical information about your patient’s condition for investigation, opinion, treatment and management
- the date of the referral
- signature of the referring health professional.”
It adds: “You don’t need to refer to a specific specialist or consultant physician. Patients can choose where to present the referral.”
Under GN.6.16, the specialist must keep the referral for 2 years from the date of the service, and a hospital must keep the records that show it for the same time.
Periods
How long a referral lasts
| Referral from | How long it lasts |
|---|---|
| A GP | 12 months from the specialist’s first meeting with the patient, unless the referral notes a different length. |
| A GP, for ongoing care | Beyond 12 months, or with no end date, if the patient needs ongoing care. A new or unrelated condition needs a new referral. |
| A specialist | 3 months, for a specialist or consultant physician’s referral, unless the patient is admitted. |
| A specialist, patient admitted | The length of the admission. |
| Lost or destroyed | A written referral that is lost, stolen or destroyed is valid for one attendance only. |
The period starts when the specialist first meets the patient, not on the date the referral was written. GN.6.16 adds that referrals for longer than 12 months are for patients whose clinical condition needs a specialist’s continuing care and management for a specific condition.
A referral covers a single course of treatment for the condition it was written for. GN.6.16 defines that course as the specialist’s first attendance and the management or treatment that follows, until the patient is referred back to the doctor who referred them.
Unreferred visits
Seeing a specialist without one
healthdirect says many specialists will still see you without a referral, though some might not. With one, it says, Medicare should pay at least some of what further tests or treatment advice cost. Without a valid referral, MBS note GN.6.16 says, specialist attendances attract Medicare benefits at unreferred rates rather than the referred rates.
The specialist rate also depends on the register. The Medical Board says Medicare uses the public specialist register to check that a doctor has specialist registration, so that their patients can get a specialist-level rebate. What the Specialists Register shows explains that register, and Checking a doctor’s registration covers the general one.