Eligible specialist medical services

Eligible services

To be eligible for PATS you must meet the recipient eligibility criteria and be attending one of the following services:

• Most Medicare-eligible specialist medical services
• Audiology appointments related to cochlear implants or an infant hearing test if they were not performed at birth or if an abnormality was detected and follow up is required (this does not include general hearing tests or hearing aids)
• Next Step or equivalent medical specialist supported inpatient treatment for addiction (travel subsidy only)
• Rehabilitation medicine
• Complex wheelchair assessment and review
• Cleft lip and cleft palate treatment listed in the Medicare Benefits Schedule
• Radiological services not available locally (if Medicare-approved)

Some treatments where a specialist may not be present during the appointment are eligible for assistance, including:

• Medical imaging, mammography
• Refractive surgical eye procedures
• Fitting of artificial eyes or prostheses

The following are not eligible for PATS:

• Treatment that is available locally including services that are able to be delivered by telehealth
• Treatment not covered by a Medicare Benefits Schedule (MBS) item number
• Treatment in an emergency department, unless referred to see a specialist in the emergency department
• Non-specialist medical treatment, including treatment by a general practitioner or nursing services
• Services provided by a general practitioner at a skin clinic
• Allied health services
• Second opinions, unless requested by the treating medical specialist
• Consultations required for legal purposes or educational support services
• Cosmetic surgery and complementary health treatments (acupuncture, herbal therapy etc.)
• Residential care services
• Services related to surrogacy arrangements
• Workplace medical assessments
• Any procedures on the WA Department of Health Excluded Procedures List

Eligible treating medical specialist

An eligible medical specialist is a medical practitioner who:

• Is registered with Medicare Australia as a specialist
• Is registered with AHPRA as a specialist within the field of the recipient’s appointment.
• Is employed as a specialist by a hospital or health service, including doctors in training.

The list of recognised specialist services within Australia is listed in the Schedule 1 of the Health Insurance Regulations 2018 (Commonwealth)

Dental procedure eligibility

PATS provides limited assistance for people receiving dental services. If you are attending one of the following procedures, you may be eligible for PATS:

• Dental services for people over eight years of age if you need hospital-based dental services and have a significant medical co-morbidity, or if you have special needs and require general anaesthetic.
• Oral maxillofacial surgery, including the management of facial trauma, such as a jaw fracture, serious dento-facial infections and oral malignancy (cancer). This does not include wisdom teeth removal, even if performed by an Oral and Maxillofacial specialist.
• Dental services for children (eight years or under) if they need hospital-based management of severe dental trauma or severe dento-facial infections, such as cellulitis, or if they have a significant medical co-morbidity or other serious conditions, or require general anaesthetic.

The following dental services are not eligible for PATS:

• General dental or orthodontic services
• Wisdom teeth extraction, even if general anaesthetic or sedation is required
• Orthodontic treatment (braces)
• Non-surgical temporo-mandibular (jaw) joint treatment
• Implant surgery or crown and bridge treatment
• Endodontics (root canal therapy)
• Periodontal (gum) surgery or treatment
• Routine oral medicine services
• Imaging provided as part of general dental care