Medicare | Billings | A1, A2 & A7 Rates | Bulk, Mixed & Private
This is a CORE BLOG and you can refer to related blogs in the FAQs at the bottom.
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Date Updated: 2026-06-16
What is Medicare?
Medicare is an insurance initiative sponsored by the Australian government to financially support people for their medical fees. So to access free or subsidised healthcare, Doctors must have a Provider Number that represents them and their practice location.
As a GP, you’ll need an eligible Medicare provider number to offer Medicare-rebatable services to your patients. This means meeting any applicable 19AA and 19AB requirements. Provider numbers are issued to an individual GP and are specific to the practice location where they work.
What is a Provider Number?
A Medicare provider number is required if you bill, prescribe, refer or request services that are eligible for a Medicare benefit.
A Refer and Request provider number does not let you bill items to Medicare but will allow you to provide services in a private billing setting as well as refer your patients to other practitioners and send requests for diagnostic tests.
This means that your patients will have to pay your entire bill and will not be able to have the appointment subsidised by Medicare. You can read more about it here.
How do I get a Medicare Provider Number?
You can apply online through your Provider Digital Access (PRODA) account to access Health Professional Online Services (HPOS). You can also apply to Medicare using the relevant form (HW019 form for Medical Practitioners), along with your supporting documents.
Ensure you’re also meeting the requirements for Medicare. Requirements include:
- 19AA
- An Australian Permanent Resident or Citizen who is Non VR is restricted by 19AA & must participate in a 3GA Program. Read more about 19AA here
- 19AB
- An IMG will be restricted by 19AB and be required to work in a DPA location in order to access Medicare benefits. Read more about 19AB here.
- Current AHPRA Registration
- Current Visa
What are A1, A2 & A7 Rates?
The A1, A2 and A7 Medicare Rates were created to reflect recognised levels of expertise, reward and incentivise investment in postgraduate specialist qualifications, and encourage more doctors to work in regional, rural and remote areas.
You can read more about A1, A2 & A7 Rates here, but here is a summary of their differences:
- A1 Medicare rates are the highest amounts Medicare will pay for a service. For example, for a standard A1 consult, Medicare will pay $43.90.
- A2 rates operate at 60% of the A1 Medicare rate, meaning that for a standard consult, a doctor billing A2 rates will only receive $21.
- A7 rates operate at 80% of the A1 Medicare rate, meaning that for a standard consult, a doctor billing A7 rates will receive $35.05.
You will also need to bill different item numbers depending on what A rate you are eligible for. To see different item numbers, we have compiled a list which you can see here.
What are the differences between Bulk Billing, Private Billing and Mixed Billing?
Bulk billing means the patient will not pay after consultation. The government will cover for the patient’s medical service as a benefit from Medicare.
Mixed Billing means that the patient will pay the consultation fee in the clinic, but they will receive a rebate back from Medicare with usually the clinic refunding process. Patients can also manually claim it, but that rarely happens.
As a Mixed Billing Clinic, they are defined as:
- Privately billing some patients, and
- Have a bulk billing policy for certain demographics
- Example: Under 16s and DVA card holders get Bulk Billed
Privately Billing to Medicare means that the patient pays the consultation fee in the clinic, but they will receive a rebate back from Medicare with usually the clinic refunding process. Patients can also manually claim it, but that rarely happens.
This is similar to Mixed Billing, however, a ‘Private Billing’ medical centre requires all patients to pay a fee for their consultation. Some practices have ‘concession fees’ for those with concession cards. This is commonly less than the usual patient consultation fees.
Privately Billing Without Medicare means that the patient pays the consultation fee in the clinic, but cannot claim a Medicare rebate. This is because a Doctor is not meeting the 19AA and/or 19AB criteria,so they will not have access to Medicare rebates. Read more here.
We Can Help You
Here at People Medical Consulting, we have a passion for guiding medical practitioners through their career pathways to Australia. We have extensive experience in assisting medical facilities in recruiting doctors from local and overseas who will best suit their requirements.
We provide Document Assistance for those requiring support for their PESCI with IME, ACRRM or RACGP, registration and all other mandatory AHPRA requirements, fellowship program related forms and letters, application for Medicare provider and prescriber numbers, application for 19AB or 19AA exemptions and preparation of employment documents.
If you want to talk to someone about your pathway or practice management—book a consultation with us below, or if you need Recruitment or Document Assistance, contact us at help@peoplemedical.com.au or click the buttons below. We’d be glad to help you!
Information from this blog has been taken directly from:
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