Application for an initial Medicare
for an Allied Health Professional
Purpose of this form
An application from a physiotherapist, osteopath, chiropractor or
podiatrist for a provider/registration number using this form will be
This application is to be used only by an Allied Health Professional
treated as an application to participate in the allied health initiative
when applying for an initial Medicare provider/registration number.
and activate eligibility to request certain Diagnostic Imaging services
If you have an existing provider/registration number issued by
Medicare you should complete the Application for an additional
as listed in the MBS.
location Medicare provider/registration number form (HW062)
available from our website
Personal contact details (email and/or mail address
if different from practice location)
Access to Medicare benefits
Personal contact details are optional. If provided, your email or
Allied health professionals must apply for a unique provider/
mailing address will be used for general correspondence. These
registration number for each required location. In addition a separate
details must be kept up-to-date to ensure important Medicare
application form must also be completed for a unique provider/
Australia information reaches you.
registration number for each discipline in which they practice.
You can update your contact details on Medicare’s Provider Directory
Medicare provider/registration numbers are allocated to allied health
System using your health professional smart card or ikey issued by
professionals to enable them to participate in the Medicare allied
Medicare through the Health eSignature Authority (HeSA)
health and dental care initiative and to provide a method of
identifying the place from which a service is provided.
Medicare provider/registration numbers are also allocated to
For more information
physiotherapists, osteopaths, chiropractors or podiatrists for the
purposes of enabling these health professionals to request certain
For more information go to our website
diagnostic imaging services as set out in the Medicare Benefits
humanservices.gov.au/healthprofessionals or call 132 150
Schedule (MBS) Book. Please note that only these health
Monday to Friday, between 8.30 am and 5.00 pm, Australian Eastern
professionals may request such services. The allocation of a
provider/registration number will enable these health professionals
to participate in the allied health initiative as above and to request
Note: Call charges apply – calls from mobile phones may be charged
certain diagnostic imaging services. Please refer to the MBS for
at a higher rate.
The Health Insurance Regulations provide that, for Medicare
Filling in this form
purposes, a valid account/receipt must contain the practitioner’s
Please use black or blue pen
name and either:
Print in BLOCK LETTERS
the address of the place of practice from which the service was
Mark boxes like this
the provider number for the place of practice from which the
service was provided.
Returning your form
Allied health professionals should note that payment of claims could
Check that you have answered all the questions you need to answer
be delayed or disallowed where it is not possible from account
and that you have signed and dated this form.
details to clearly identify the services that qualify for Medicare
Send the complete form to:
benefits, or identify the allied health professional as a registered
allied health professional at the place of practice.
Department of Human Services
Provider Eligibility Section
Electronic funds transfer (EFT) payments
PO Box 9822
in your capital city
You can request that your Medicare and DVA benefits for bulk bill
claims be paid into a nominated bank account by completing the EFT
details at question 19.
NSW/ACT 02 9895 3439
08 8274 9307
03 9605 7984
08 9214 8201
An allied health professional applying for registration under the allied
07 3004 5634
health and dental initiative must be in private practice, and services
claimed under this initiative must be performed while working in a
Your application and supporting documentation should be
submitted to us as soon as possible prior to your proposed
An allied health professional is also eligible for registration under the
allied health and dental care initiative where they are employed by,
Your application will be returned if all relevant documentation/
or under contract to, an Aboriginal and Torres Strait Islander
information is not supplied.
Community Controlled Health Service or State/Territory clinic, that
Where applications are faxed, you must retain your original
has been granted an exemption under subsection 19(2) of the
documents for auditing purposes.
Health Insurance Act 1973.
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HW063.1503 (formerly 1449)