Eligible Services

ADF Family Health > Provider Assistance > Eligible Services

If you are not sure if your service is eligible for reimbursement contact 1300 561 454 for clarification.

The Program provides benefits toward eligible services detailed below:

General Practice Service (GP)

GP services are conducted by your general practitioner within their general practice setting. To be eligible for claiming, all services must have been allocated a Medicare Benefits Schedule item number at the time of payment.

All approved claims for a GP service will be deducted from your family’s unlimited allocations for these services.

Specialist Services

Specialist services are provided by Specialists or Consultant physicians within their consulting rooms or a hospital setting. Specialist services must have been allocated a Medicare Benefits Schedule item number at the time of payment.

All approved claims for a Specialist service must be accompanied by a Medicare Statement of Benefits before they are submitted to ADF Family Health for approval and the benefit will be deducted from your families allocations of funds i.e. $400 per Dependant.

Diagnostic and Radiology Services

All diagnostic and radiology services, where there is an MBS item number, are eligible. Service can include, X-rays, MRI, pathology and ultrasound.

All approved claims will be deducted from your families allocations of funds i.e. $400 per Dependant.

Allied Services

Allied Health Services provide a broad range of treatments to improve th ehealth and wellbeing of the patients they support. The ADF Family Health Program will pay the gap on the below Allied Health services when they are provided by a certified practitioner.

All approved claims for an allied service will be deducted from your families allocations of funds i.e. $400 per Dependant.

If you have private health insurance, click here to learn how to reduce your out of pocket expenses.

Allied Service	Description of Services
Audiology	All services conducted by a certified practitioner
Chiropractic	All services conducted by a certified practitioner
Dental	All items that are listed by the Australian Dental Association (ADA) (items will be paid in line with ADA and independent reasonability rules) Dental items provided at school
Exercise Physiology	All services conducted by a certified practitioner
Medically Prescribed Appliances (MPA)	Medically Prescribed Appliances (MPA) – MPA must not have a GST applied and claims must be accompanied by a written recommendation/prescription from a certified practitioner.
Occupational Therapy	All services conducted by a certified practitioner
Optical	All prescription-lenses, frames when accompanied with prescription lenses, contact lenses and lens coatings on prescription lenses.
Osteopathy	All services conducted by a certified practitioner
Physiotherapy	All services ; Ante/Post – Natal classes provided by a registered physiotherapist or midwife
Podiatry and Chiropody	All services conducted by a certified practitioner
Psychology	All services conducted by a certified practitioner, including; Psychometric testing, cognitive behavioural assessment Psychology service with a social worker when an item number is provided Psychology service via video link when an item number is provided
Remedial Massage	All services conducted by a certified practitioner
Other Services	Medicare eye test within a two year period Emergency department consultation (GP not in a GP setting)