Whether a provider may take part in a given item, by rendering and claiming it or by referring a patient for it, comes down to one thing: the recognition Medicare holds for them. A specialty, a field within it, or a specific credential. RebateRight resolves any provider to their recognitions, then answers, item by item, whether they qualify.
This page maps the recognitions those answers sit on. The map holds three kinds of entry:
Explore the map, then read how the model works below.
Explore the map
Provider recognitions: 19AB Exemption · Aboriginal and Torres Strait Islander Health Practitioner · Acupuncture endorsed medical practitioner · Approved dental practitioner · Audiologist · Cardiac lead extraction recognised (CSANZ Lead Extraction Certification Committee) · Cardiac MRI recognised (Conjoint Committee for Certification in Cardiac MRI) · Chinese Medicine Practitioner · Chiropractor · Consultant paediatrician · Consultant physician · Consultant physician – cardiology · Consultant physician – clinical genetics · Consultant physician – clinical pharmacology · Consultant physician – community child health · Consultant physician – endocrinology · Consultant physician – gastroenterology and hepatology · Consultant physician – general medicine · Consultant physician – general paediatrics · Consultant physician – geriatric medicine · Consultant physician – haematology · Consultant physician – immunology and allergy · Consultant physician – infectious diseases · Consultant physician – intensive care · Consultant physician – medical oncology · Consultant physician – neonatal and perinatal medicine · Consultant physician – nephrology · Consultant physician – neurology · Consultant physician – nuclear medicine · Consultant physician – occupational medicine · Consultant physician – paediatric cardiology · Consultant physician – paediatric emergency medicine · Consultant physician – palliative medicine · Consultant physician – psychiatry · Consultant physician – rehabilitation medicine · Consultant physician – respiratory and sleep medicine · Consultant physician – rheumatology · CT coronary angiography recognised (Conjoint Committee for CTCA) · Dental Practitioner · Dental radiologist · Diabetes Educator · Dietitian · Endodontist · Exercise Physiologist · Forensic Dentist · Gastrointestinal endoscopy recognised (Conjoint Committee for GI Endoscopy) · General Practitioner · Medical practitioner · Medical Radiation Practitioner · Medicare benefits not payable · Midwife · Non-specialist medical practitioner · Nuclear medicine credentialled (Joint Nuclear Medicine Credentialling, JNMCAC) · Nurse · Nurse practitioner · Occupational Therapist · Optometrist · Oral and maxillofacial pathologist · Oral and maxillofacial surgeon · Oral medicine specialist · Oral surgeon · Orthodontist · Orthoptist · Osteopath · Paediatric dentist · Paramedicine · Periodontist · Pharmacist · Physiotherapist · Podiatric surgeon · Podiatrist · Practitioner · Prosthodontist · Psychologist · Social Worker · Specialist anaesthetist · Specialist cardio-thoracic surgeon · Specialist cardiologist · Specialist clinical geneticist · Specialist clinical pharmacologist · Specialist dermatologist · Specialist emergency physician · Specialist endocrinologist · Specialist gastroenterologist and hepatologist · Specialist general physician · Specialist general practitioner · Specialist general surgeon · Specialist geriatrician · Specialist gynaecological oncologist · Specialist haematologist · Specialist immunologist and allergist · Specialist in addiction medicine · Specialist in maternal fetal medicine · Specialist in public health dentistry · Specialist in special needs dentistry · Specialist infectious diseases physician · Specialist intensive care physician · Specialist medical administrator · Specialist medical oncologist · Specialist Medical Practitioner · Specialist nephrologist · Specialist neurologist · Specialist neurosurgeon · Specialist nuclear medicine physician · Specialist obstetrician and gynaecologist · Specialist occupational and environmental physician · Specialist ophthalmologist · Specialist orthopaedic surgeon · Specialist otolaryngologist · Specialist paediatric surgeon · Specialist paediatrician · Specialist pain medicine physician · Specialist palliative medicine physician · Specialist pathologist · Specialist physician · Specialist plastic surgeon · Specialist psychiatrist · Specialist public health physician · Specialist radiation oncologist · Specialist radiologist · Specialist rehabilitation physician · Specialist respiratory and sleep medicine physician · Specialist rheumatologist · Specialist sexual health physician · Specialist sport and exercise physician · Specialist surgeon · Specialist urogynaecologist · Specialist urologist · Specialist vascular surgeon · Speech Pathologist · TAVI accredited practitioner · Ten Year Moratorium (Medicare Benefits Not Payable) · Thrombectomy recognised (Conjoint Committee for Interventional Neuroradiology) · TMVr accredited practitioner
Search a recognition by name, or open a branch to see the fields and credentials beneath it. A provider matches an item when a recognition they hold sits at, or below, one the item accepts.
Specialist or consultant physician
A senior doctor can hold either of two Medicare recognitions, and some items care which one.
- Specialist. Earned by fellowship of a specialist medical college. A radiologist, dermatologist, or surgeon is recognised as a specialist.
- Consultant physician. Earned by fellowship of the Royal Australasian College of Physicians or the Royal Australian and New Zealand College of Psychiatrists. A cardiologist, for instance, is a consultant physician, and may hold specialist recognition as well.
The two are not interchangeable. An item may pay a specialist, pay a consultant physician, or accept either, and a claim billed under the wrong one is not paid. The Atlas keeps them on separate branches for exactly that reason.
Fields within a recognition
Under each recognition sit the fields: cardiology, neurology, nephrology, and the rest. Where an item names a field, for example “a specialist or consultant physician in the specialty of cardiology”, RebateRight checks for that field, not the broad class.
Credentials, beyond the specialty
Some items ask for more than a specialty. They require a credential the provider has earned for that specific work: certification in cardiac magnetic resonance imaging, nuclear medicine credentialling, accreditation to perform a transcatheter valve procedure. Holding the specialty is not enough on its own. The provider needs the credential, and RebateRight checks for it directly. These sit in their own branch of the map, marked credential.
The same map, two decisions
A provider’s recognition answers two separate questions, and RebateRight reads both from this one map.
- Who may render and claim. Before a claim is lodged, the recognition decides whether the servicing provider may perform the item and bill it. A claim billed by a provider the item does not accept is rejected; RebateRight catches that up front, so it is right the first time.
- Who may refer. Some items are payable only when the referral comes from a provider with the right recognition, such as a specialist or a consultant physician in a named field. The same map decides whether the referrer qualifies.
