Telehealth Medicare Rules in Australia: The 30/20 Rule, Bulk Billing and Eligibility

If you have been getting medical certificates or prescriptions via telehealth, you might have heard whispers about Medicare’s “30/20 rule” and wondered what on earth that means. Spoiler: it is not as complicated as it sounds, and more importantly, it does not stop you from accessing telehealth services when you need them.

This guide breaks down everything you need to know about Australia’s telehealth rules in 2026, including how they affect your ability to get bulk billed consultations and medical certificates online.

What Is the 30/20 Telehealth Rule?

The 30/20 rule is a Medicare compliance measure that limits how many phone consultations a GP can provide. Here is how it works: if a doctor conducts 30 or more phone consultations in a single day on 20 or more separate days within a 12-month period, they will be automatically referred to the Professional Services Review (PSR) for investigation.

Introduced on 1 October 2022, the rule exists to maintain quality standards in telehealth care. The government wanted to prevent doctors from running “phone mills”, exclusively providing quick phone consultations without ever seeing patients face to face or via video, which could compromise care quality.

Here is what matters for you: The 30/20 rule regulates doctors, not patients. You can still access phone consultations whenever you need them. The rule simply encourages your GP to balance phone consultations with video or in-person appointments.

Why Was the 30/20 Rule Introduced?

During COVID-19, telehealth consultations went through the roof. In 2020 to 2021, phone consultations made up 98% of all telehealth services provided by GPs. Makes sense. People were in lockdown, doctors’ clinics were closed or limited, and everyone was trying to avoid exposure.

But here is the thing the government became concerned about: what if phone-only medicine became the permanent norm? Their thinking was straightforward. Comprehensive healthcare often requires visual examination. A phone call might miss crucial symptoms that a video consultation or face to face visit would catch straight away. Things like skin rashes, breathing difficulties, mobility issues, or concerning physical changes.

The 30/20 rule nudges doctors toward using a mix of consultation types rather than relying solely on the phone. It is not perfect, but that is the intent.

How Does the 30/20 Rule Actually Work?

Let’s get into the specifics, because the devil’s in the details.

The threshold: A GP hits the limit if they provide 30 or more phone consultations in one day on 20 or more separate days within a rolling 12-month period. Notice that “in one day” bit. That is crucial. If a doctor does 29 phone consultations one day and 31 the next, only the 31-consultation day counts toward the 20-day threshold.

What counts: Only telephone-only consultations count toward the 30/20 rule. This is defined by specific MBS (Medicare Benefits Schedule) item numbers for telephone attendances. Video consultations? Do not count. Face to face appointments? Do not count. Only phone calls.

The consequence: Doctors who breach the threshold get automatically referred to the PSR, where their Medicare billing practices undergo peer review. This is not a slap on the wrist. It can result in warnings, repayment of Medicare benefits claimed, counselling, or in serious cases, suspension from Medicare billing. For a GP, that is basically losing the ability to bulk bill, which is career-ending for many practices.

Location matters: For any Medicare rebate to apply, whether for phone, video, or face to face consultations, both the doctor and patient must be physically located in Australia during the consultation. Medicare uses data matching with immigration records to verify this, so if you are overseas, you will not get the rebate. Worth knowing if you are planning an extended holiday.

What Does Not Count Toward the 30/20 Rule?

Some telehealth services are exempt from the 30/20 rule:

• COVID-19 oral antiviral suitability assessments (items 93716 and 93717)
• Services provided by nurse practitioners, midwives, and allied health practitioners
• Services provided on behalf of a medical practitioner, basically when a GP’s nurse or assistant calls you back (items 93202 and 93203)
• Obstetric services (items 91855 to 91858)

Video consultations are also exempt, which is intentional. The government sees video calls as significantly higher quality than phone-only consultations because doctors can actually see you. This is why you will notice a lot of telehealth providers now push video over phone. It is not just about quality, it is also about compliance.

The 80/20 Rule: Medicare’s Other Telehealth Compliance Measure

While we are talking about Medicare’s numerical rules, you should know about the 80/20 rule as well. This one has been around longer and casts a wider net.

The 80/20 rule: A GP is deemed to have engaged in “inappropriate practice” if they render 80 or more professional services per day on 20 or more days within a 12-month period.

Think about that for a second. 80 consultations in a day. If you are working an 8-hour shift, that is 10 patients per hour, or 6 minutes per patient. Even if some are quick (“yep, that is viral, rest up”), that is an exhausting, borderline impossible pace to maintain while providing quality care.

This rule used to only apply to face to face consultations. But from 1 July 2022, it was expanded to include all GP consultations, face to face, video, and telephone combined.

Why it matters: The 80/20 rule basically says a GP should not be churning through more than 80 patients per day on a regular basis. It is a quality control measure. If your doctor is routinely seeing 100 patients a day, there simply is not enough time to take a proper history, conduct an examination, explain treatment, or document everything properly.

Quick Comparison: 30/20 vs 80/20 Rule

Both rules work on a rolling 12-month basis, so it is continuously monitored. The government does not wait for the financial year to end. They are tracking this in real-time.

Can You Still Get Bulk Billed Telehealth Consultations?

Yes! And this is probably what most people actually care about. Bulk billing is still available for eligible telehealth consultations in 2026.

Here is what you need to know about bulk billing and telehealth:

Eligibility: You can get bulk billed telehealth if:

• You are a concession card holder (Commonwealth Seniors Health Card, Pensioner Concession Card, or Health Care Card)
• You are under 16 years old
• The consultation is with your regular GP (established clinical relationship, more on this below)
• You are accessing specific exempted services (mental health, sexual health, blood-borne virus consultations)

What gets bulk billed: This varies by practice. Some GPs bulk bill all patients for telehealth. Others only bulk bill concession card holders. A few do not bulk bill at all anymore. Always check with your GP or telehealth provider before booking.

For a full breakdown of which telehealth providers offer bulk billing, see our bulk billing telehealth guide.

The Established Clinical Relationship Rule

Right, this one trips people up constantly, so let’s break it down clearly.

For most Medicare-rebated telehealth consultations, you need an “established clinical relationship” with the doctor or medical practice.

What this actually means: You generally need to have had a face to face consultation at the same medical practice within the past 12 months to access bulk billed telehealth services from that practice. Not just “seen a doctor somewhere.” The same practice.

Why it exists: Continuity of care. Your doctor needs to know your medical history, have examined you in person at least once recently, and have your records on file. This reduces the risk of missing important context during a brief phone or video call. Makes sense in theory.

MyMedicare’s role: If you are registered with MyMedicare, a voluntary program that links you to a preferred GP and practice, this formally establishes your clinical relationship and can make accessing bulk billed telehealth consultations easier. Think of it as officially declaring “this is my doctor” to Medicare. Registration is free, and it can unlock longer consultation times and better continuity of care.

Exceptions to the Established Clinical Relationship Rule

There are important exceptions where you do not need a pre-existing relationship:

• Aboriginal Medical Services: Patients accessing care through Aboriginal Medical Services or Aboriginal Community Controlled Health Services
• COVID-19 isolation: People in quarantine or isolation due to public health orders (still technically applies, though obviously less relevant in 2026)
• Specific health services: Consultations for blood-borne viruses, sexual or reproductive health, pregnancy counselling, mental health services, and smoking cessation counselling

For medical certificates specifically: Here is the good news. Getting a medical certificate via telehealth does not always require an established relationship with a specific practice. While Medicare rebates do require the established relationship (unless you are exempt), private telehealth services can assess your condition remotely and issue valid certificates without the 12-month rule. You might pay out of pocket instead of getting a Medicare rebate, but you will still get your certificate, and it is still legally valid.

This is a crucial distinction that a lot of people miss.

How Do These Rules Affect You Getting a Medical Certificate?

If you need a medical certificate for work, Centrelink, or study, you might be wondering: can I still get one via telehealth with all these rules floating around?

Short answer: Yes, absolutely. No question.

The 30/20 and 80/20 rules regulate doctors, not patients. Your access to telehealth medical certificates remains completely unchanged. These compliance measures are about how doctors structure their practice, not about restricting patient access to care.

What this means in practice:

• You can still book a telehealth consultation when you are too unwell to see a GP in person
• You can still receive a medical certificate via phone or video consultation
• Bulk billing is still available if you are eligible
• Your certificate is legally valid regardless of whether the consultation was in-person, phone, or video

One thing to watch: Some GPs might prefer video consultations over phone calls to avoid hitting the 30/20 threshold. This is actually better for you anyway. Video consultations allow for visual assessment of symptoms. If you are claiming you have got a rash, or you are coughing badly, or you have injured your ankle, being able to show the doctor is obviously more useful than just describing it.

For more information on whether your employer can refuse a telehealth medical certificate, see our complete legal guide.

What Are the New Telehealth Rules in 2026?

As of February 2026, the telehealth landscape in Australia looks like this:

What is permanent:

• Telehealth consultations for GPs, specialists, and allied health practitioners (these were made permanent after being COVID-19 temporary measures)
• Mental health telehealth items
• Blood-borne virus and sexual/reproductive health telehealth items
• The 30/20 rule for phone consultations
• The expanded 80/20 rule including all consultation types
• Video consultations as a standard alternative to in-person care

What has changed recently:

• Most temporary COVID-19 telehealth exemptions have been removed (though some remain for isolation cases)
• Non-directive pregnancy counselling telehealth consultations no longer have exemptions from the established clinical relationship rule
• The government continues to monitor telehealth usage patterns and may adjust rules based on data

Need urgent help after hours? The government launched 1800MEDICARE (call 1800 633 422) in early 2026, offering free 24/7 health advice from registered nurses and after-hours GP telehealth for urgent issues. Worth knowing about if you need help outside business hours.

What is being actively monitored: Medicare compliance rules are seriously enforced. The Department of Health and Aged Care uses data matching to ensure both patients and doctors are physically located in Australia during consultations. They cross-reference with immigration records, check IP addresses, and can audit GPS data if needed.

Updated AHPRA guidance from late 2025 also emphasises real-time consultations (not questionnaire-based services) for safe prescribing and certificate issuance. You cannot just fill out a form and get a prescription anymore. You need to actually speak with a doctor.

The Bottom Line on Telehealth Rules

The 30/20 rule and other Medicare compliance measures might sound restrictive when you first hear about them, but they are actually designed to protect you as a patient. They ensure your doctor provides comprehensive care rather than rushing through phone-only consultations in a few minutes flat.

What you need to remember:

• You can still access telehealth medical certificates whenever you need them. Nothing has changed from your perspective.
• The rules regulate how doctors practice, not how patients access care.
• Video consultations are preferred over phone and do not count toward the 30/20 limit.
• Bulk billing is still available for eligible patients (concession card holders, children under 16, established patients).
• Your telehealth medical certificate has exactly the same legal standing as one from a face to face consultation.

Whether you are dealing with a cold, flu, mental health day, caring for a sick family member, or just need a certificate for work, getting a medical certificate via telehealth remains a quick, convenient, and completely legitimate option in 2026.

The government has made it clear that telehealth is here to stay. The rules around it might evolve (and they probably will), but the fundamental access to care remains solid.

For a full breakdown of what telehealth costs across different providers, see our complete pricing guide.