12Referral requirements for allied health and other primary health care services

12 Referral requirements for allied health and other primary health care services

(1) This section applies to a referral prepared on or after 1 July 2025 for a service to which an item in Subgroup 1 of Group M3, Group M8, Group M9, Subgroup 1 of Group M10 or Group M11 applies. (1A) This section applies to a referral prepared on or after 1 November 2025 for a service to which an item in Group M6 or Subgroup 1 of Group M7 applies. General (2) Subject to subsection (5), the following particulars are prescribed for the purposes of a referral mention in subsection (1) and (1A): (a) the name of the referring practitioner; (b) the address of the place of practice, or the provider number in respect of the place of practice, of the referring practitioner; (c) the date on which the patient was referred by the referring practitioner to the treating practitioner; (d) the period of validity of the referral under subsection (7), if relevant. (3) A referral mentioned in subsection (1) and (1A) must be: (a) in writing; (b) signed by the referring practitioner; and (c) dated. (4) A referral mentioned in subsection (1) and (1A) must explain the reasons for referring the patient, including any information about the patient’s condition that the referring practitioner considers necessary to give to the treating practitioner. (5) In this section: (a) referring practitioner means: (i) the person making the referral; or (ii) for the purposes of items in Group M6 or Subgroup 1 of Group M7: (A) a general practitioner or a prescribed medical practitioner who has referred the patient as part of a GP Mental Health Treatment Plan or psychiatrist assessment and management plan, at the general practice in which the patient is enrolled in MyMedicare; or (B) regardless of whether the patient is enrolled in MyMedicare, by the patient’s usual medical practitioner, who has referred the patient as part of a GP Mental Health Treatment Plan or psychiatrist assessment and management plan, or (C) a specialist or consultant physician specialising in the practice of their field of psychiatry; or (D) a specialist or consultant physician specialising in the practice of their field of paediatrics; and (b) treating practitioner means the person performing the service to which the patient is referred; and

Note: For the purposes of this subsection, usual medical practitioner has the meaning given by clause 7.1.1 of the general medical services table. Lost referrals (6) If a service mentioned in an item in subsection (1) and (1A) is rendered on the basis of a lost, stolen or destroyed referral: (a) paragraphs (2)(a) to (d) do not apply; and (b) the words “lost referral” are a prescribed particular. Period of validity for referrals (7) For the purposes of a referral for a service to which an item in Subgroup 1 of Group M3 or an item in Group M9 or M11 applies: (a) if the referral states it is valid for a fixed period, it is valid until the end of that period after the first service rendered in accordance with the referral; (b) if the referral does not state a time for which it remains valid, it is valid until 18 months after the first service rendered in accordance with the referral. (7A) For the purposes of a referral for a service to which an item in Group M6 or Subgroup 1 of Group M7 applies, the referral is valid until the end of the number of sessions in the course of treatment the referring practitioner recommends up to the maximum session limit for each course of treatment.