How do initial and subsequent consultation fees work?

Consultation fees are based on the type and scope of care provided, not simply how many times you attend or how long your referral lasts.

It is a common misunderstanding that once you have attended your first appointment, all future consultations will be charged at the lower follow-up fee.

In practice, Medicare consultation item numbers are determined by the clinical work performed during each consultation, rather than the number of visits.

As outlined in What is a single course of treatment?:

“A single course of treatment refers to the assessment and management of a specific condition.”

This means consultations are structured around what is being treated, not how many times you attend.

Consultations are generally billed as either an initial or a subsequent consultation.

As explained in Why do fees differ within a course of treatment?:

“An initial consultation is the first attendance for a particular condition, while subsequent consultations relate to ongoing care of that same condition.”

If your appointment involves reviewing progress, adjusting treatment, or monitoring an existing condition, it will generally be billed as a subsequent consultation.

A referral allows you to attend a specialist and access Medicare benefits, but it does not determine how the consultation is billed.

As outlined in Do I need a referral to see a dermatologist?:

“A referral is required to access Medicare rebates, however it does not determine the type of consultation performed.”

Many referrals are valid for 12 months, however this does not mean all consultations during that period are follow-ups.

Consultation type is determined by the clinical scope of the visit, not the duration of the referral.

If your consultation involves a new concern, a different condition, or a broader assessment, it is considered a new course of treatment.

As noted above, a course of treatment relates to a specific condition. When that changes, the consultation is no longer a continuation of the original episode of care.

This commonly includes:

• Requesting a full skin check

• Asking about new or unrelated concerns

• Wanting a general review to check for anything else

In these situations, a full consultation fee may apply again.

Referrals are generally provided for the assessment of a particular concern.

If a consultation involves a new or unrelated condition, this may fall outside the scope of the original referral. In some cases, this means Medicare benefits may not apply without a new referral.

A full skin check is a comprehensive examination of the entire skin and is significantly more detailed than reviewing a previously diagnosed condition.

It involves identifying new or unrelated findings, and is therefore considered a separate clinical assessment, rather than a follow-up.