Nurse practitioners in telehealth: scope, prescribing and referrals

The short answer: a nurse practitioner is a registered nurse whose registration carries an extra endorsement from the Nursing and Midwifery Board of Australia. Within their own scope of practice, they can assess and diagnose, order tests, prescribe under state and territory medicines law, and refer to specialists, including by telehealth. Regulators expect prescribing to follow a real-time video, phone or in-person consultation, and Ahpra advises patients that prescribing by telehealth is generally safest when they’ve seen the practitioner in person before. Medicare treats nurse practitioners differently from GPs in several ways.

This explainer isn’t legal, billing or clinical advice.

What is a nurse practitioner?

A nurse practitioner is a registered nurse endorsed by the Nursing and Midwifery Board of Australia (NMBA) to practise at an advanced clinical level. The NMBA’s standards for practice, in effect since 1 March 2021, describe nurse practitioners as able to practise independently while working collaboratively with other health professionals.

Under the NMBA’s registration standard, in effect since 1 June 2016 and still current, endorsement requires:

1. current general registration as a registered nurse, without conditions or undertakings relating to unsatisfactory professional performance or unprofessional conduct
2. the equivalent of three years’ full-time experience (5,000 hours) at an advanced clinical level in the past six years, not counting advanced practice hours that are part of an NMBA-approved program of study
3. an NMBA-approved master’s degree, or a substantially equivalent program, including pharmacology for prescribing
4. meeting the standards for practice.

Endorsed nurse practitioners must also meet extra recency of practice and continuing professional development (CPD) requirements.

“Nurse practitioner” is a protected title under the National Law, and the endorsement appears on Ahpra’s public register. Knowingly or recklessly using the title to suggest someone is registered when they aren’t is an offence. A registered nurse who claims a nurse practitioner endorsement they don’t hold can face disciplinary action, and it’s an offence for anyone to knowingly or recklessly claim that another person holds an endorsement they don’t. We explain the register in what “AHPRA-registered” means.

For the quarter ending 30 June 2026, 3,735 registered nurses held a nurse practitioner endorsement, up from 3,194 a year earlier. That counts endorsements, not people in the role. The Department of Health, Disability and Ageing’s nurses and midwives page, last updated in October 2025, says more than 2,600 nurse practitioners are employed in Australia, with more than 1,800 of them employed as nurse practitioners. The page doesn’t say when those figures were collected.

Nurse practitioners are also distinct from designated registered nurse prescribers, who hold a separate endorsement, in effect since 30 September 2025, for prescribing in partnership with an authorised health practitioner.

What can nurse practitioners do?

The NMBA’s examples of core nurse practitioner activities include advanced health assessment, including ordering and interpreting pathology and imaging; diagnosing and treating acute or chronic physical and mental health conditions; independent prescribing; and independent referral to GPs, medical specialists and allied health practitioners. Its standards say nurse practitioners can diagnose and start treatment without oversight from another health practitioner, and can start, adjust or stop medicines within their scope.

Scope is individual

That describes the profession, not every nurse practitioner. The NMBA defines an individual’s scope as what they are educated, authorised and competent to do, which can be narrower than the profession’s. It’s shaped by law, their workplace and its policies, the people they care for and the resources available. Expanding it means first gaining the skills, knowledge and education to stay safe. Two nurse practitioners with the same endorsement can have different scopes.

How does nurse practitioner prescribing work?

Beyond their individual scope, two sets of rules apply.

State and territory law. Prescribing authority comes from the drugs and poisons legislation of the state or territory where the nurse practitioner practises, not from the endorsement alone, and it varies:

• Victoria: nurse practitioners may prescribe any Schedule 2, 3, 4 or 8 medicine within their scope, but need a permit for some Schedule 8 treatment and must check the SafeScript monitoring system before prescribing a Schedule 8 medicine.
• Queensland: the regulation that authorises nurse practitioners to prescribe excludes a list of “restricted medicines”, apart from some continuing treatment in hospitals and custodial facilities. A nurse practitioner can hold a separate prescribing approval to prescribe a medicine the regulation doesn’t cover, such as a restricted medicine, for the patients and circumstances the approval states.
• New South Wales: nurse practitioners prescribe under a March 2020 authority covering Schedule 2, 3, 4 and 8 medicines within their scope, though NSW Health notes an additional authority may be needed for certain Schedule 4 and Schedule 8 medicines. New laws commence on 5 November 2026. From then, unless an exemption applies, nurse practitioners must apply to NSW Health for approval to prescribe some Schedule 4 and Schedule 8 medicines, such as any Schedule 8 medicine for a person with substance dependence.

The PBS. Endorsement doesn’t give automatic access to the Pharmaceutical Benefits Scheme (PBS) or Medicare; each needs separate Commonwealth approval. For the PBS, a nurse practitioner must be an authorised nurse practitioner, and can then write PBS prescriptions only for medicines whose listing specifies “NP”, within any conditions on the listing, such as sharing care with a medical practitioner. Other prescriptions are private.

What has changed since 2024?

• 1 July 2024: fees for nurse practitioner consultation items, including video and phone items, rose by 30%.
• 1 November 2024: the legislated requirement for a collaborative arrangement with a medical practitioner, to provide Medicare-subsidised care or write PBS prescriptions, was removed. The Department’s PBS review page says consultation, referral and transfer of care between health professionals are still expected to continue.
• 1 March 2025: new items for nurse practitioner consultations of 60 minutes or more, face to face and by video.
• 1 June 2025: most PBS listings that limited nurse practitioners to “continuing therapy only” changed so they can also start treatment, some only where care is shared with a medical practitioner. Further changes followed on 1 October 2025, 1 January 2026 and 1 February 2026, without changing nurse practitioners’ scope.
• 1 November 2025: unless the service is exempt, most nurse practitioner video and phone items became subject to the eligible telehealth practitioner rule, which requires the patient to have had a Medicare-billed face-to-face service with that nurse practitioner or their practice in the previous 12 months. Bulk billing incentives were extended to all Medicare-eligible patients for services by medical practitioners, and Better Access mental health treatment plans and referrals were tied to the patient’s MyMedicare practice or usual medical practitioner.

Specialist referrals aren’t new: nurse practitioners who provide Medicare services have been able to refer, with Medicare benefits at referred rates, since 1 November 2010.

What regulators expect of telehealth

Nurse practitioners follow the telehealth guidance shared by Ahpra and the National Boards, last updated on 7 October 2025. It sets the same expectations as for face-to-face care. Practitioners should use telehealth only when they’re competent to, it’s safe and clinically appropriate, and it suits the patient. They should confirm the patient’s identity, get informed consent and keep clear records. The individual practitioner, not their employer or business, is responsible for the care.

When someone needs to be seen in person

The guidance says telehealth isn’t appropriate for all consultations. Practitioners should assess, and regularly re-assess, whether good care can only be given in person, and help the patient access other care, such as a face-to-face consultation, when telehealth can’t provide it. Ahpra tells patients that virtual care doesn’t replace face-to-face care and that they can choose a face-to-face consultation. The Department’s nurse practitioner telehealth factsheet reports the MBS Review Advisory Committee’s finding that face-to-face care remains the preferred standard of clinical care, particularly for patients with complex health conditions.

Prescribing only after a real-time consultation

The National Boards’ telehealth guidance says it isn’t good practice to prescribe for someone the practitioner has never consulted face to face, by video or by phone, such as on a request made only by text, email or health questionnaire. The Boards don’t treat an online chat as a real-time consultation. A joint statement from Ahpra and the nursing, medical and pharmacy boards says good prescribing includes a real-time assessment, whatever the model of care.

The Boards’ expectation is a real-time consultation, not necessarily an earlier in-person visit. But Ahpra’s advice for patients says prescribing during a virtual care consultation is generally safest when the patient has seen the practitioner in person before. The Boards’ October 2025 update also says their new telehealth case studies identify “common mistakes like prescribing in an initial telehealth consultation”.

Prescribing across state borders

Registration is national; prescribing law isn’t. The telehealth guidance tells prescribers to comply with each relevant jurisdiction’s requirements, especially for interstate patients, without saying which law applies. The ACT tells its nurse practitioners that for telehealth they must follow the law of the state or territory where the patient lives, particularly for medicines, poisons and therapeutic goods. Since 16 February 2026, Tasmania has required prescribers outside the state to check TasScript before prescribing a monitored medicine for a Tasmanian resident, and to meet Tasmanian prescription and authority-to-prescribe requirements. A nurse practitioner prescribing across a border needs to check the rules both where they practise and where the patient is.

Where Medicare treats nurse practitioners differently

Nurse practitioners in private practice can charge a fee or bulk bill, but some Medicare rules differ from those for GPs:

• Rebates: nurse practitioner consultation items pay 85% of the schedule fee; GP items such as item 23 pay 100%.
• Telehealth: since 1 November 2025, a nurse practitioner video or phone consultation generally attracts a Medicare benefit only if that nurse practitioner, or their practice, has given the patient a Medicare-billed face-to-face service in the previous 12 months, unless an exemption applies, such as for children under 12 months or for blood borne virus, sexual or reproductive health consultations. The MyMedicare pathway for GP telehealth doesn’t apply. Our telehealth bulk billing article lists every exemption.
• Bulk billing incentives: the general incentives and the Bulk Billing Practice Incentive Program are limited to services by medical practitioners. Item 82204 is a separate loading for certain bulk-billed nurse practitioner contraception procedures. A September 2026 draft report, open for consultation until 15 October 2026, recommends extending bulk billing incentives to nurse practitioner services for patients registered through MyMedicare with the practice providing the service; it isn’t policy.
• Referrals: a nurse practitioner’s specialist referral lasts up to 12 months from the first specialist service; GPs can refer for longer, including indefinitely. Medicare pays no benefit for allied health services a nurse practitioner refers a patient to.
• Plans and mental health: GP chronic condition management plans, mental health treatment plans and Better Access referrals sit with GPs and other doctors in general practice (Better Access also accepts psychiatrist and paediatrician referrals). Nurse practitioners can refer to a consultant psychiatrist.
• Tests: nurse practitioners can request pathology in Groups P1 to P8 within their scope, and a defined list of imaging: mostly ultrasound and plain X-ray, plus lung cancer screening CT, with no MRI items. MBS Online says that from 1 November 2026, they’ll also be able to refer for bone densitometry.

How My Digital Health governs clinical practice

My Digital Health has around 120 clinicians, including doctors, nurse practitioners, pharmacists, dietitians and allied health professionals. Our founder, CEO and Chief Clinical Officer, Christopher O’Donnell, is a nurse practitioner (FACN). Across our four brands:

• We verify every doctor’s, nurse practitioner’s and pharmacist’s Ahpra registration at onboarding and re-verify it annually.
• Prescribing happens only in a real-time phone or video consult. Asynchronous messages are for first replies and booking.
• Clinicians are paid per consult, with minimum consult times, not per script, and can decline to prescribe when it isn’t clinically appropriate.
• The Chief Clinical Officer is accountable for clinical safety and prescribing standards. Each brand’s clinical lead is responsible for supervision and day-to-day safety. A monthly Clinical Council of brand clinical leads reviews adverse events, prescribing patterns and complaints, and prescribing review runs continuously, with weekly sampling by those leads.
• The group holds QIP Health practice accreditation (against the RACGP Standards for general practices), NACOS accreditation and LegitScript certification.

See our clinical governance framework, or our careers page if you’re a nurse practitioner interested in working with us.

What this means for health funds and employers

For a health fund or employer considering a telehealth program that includes nurse practitioners:

• Law, competence and workplace policy set scope. A nurse practitioner’s scope is what they are educated, authorised and competent to do, shaped by the law and their workplace’s policies. Within those limits, nurse practitioners can assess, diagnose, order tests, prescribe where clinically appropriate and refer to specialists.
• Some Medicare pathways run through GPs, including chronic condition management plans, mental health treatment plans and Medicare-funded allied health referrals. A program needs a plan for how patients reach a GP.
• Medicare funding varies by patient. Nurse practitioner telehealth that meets neither the 12-month rule nor an exemption attracts no Medicare benefit, and a partner-funded program needs to allow for that.
• Clinical decisions stay with clinicians. The individual practitioner is responsible for the care, and it’s an offence under section 136 of the National Law for a person, including a private employer, to direct or incite a practitioner to do anything that amounts to unprofessional conduct or professional misconduct.
• Describe clinicians accurately. Name each clinician’s actual profession: section 119 of the National Law prohibits knowingly or recklessly claiming someone holds a registration or endorsement they don’t.

Clinicians as a Service explains how we provide white-label clinical teams to health funds, employers and digital health brands.

Common questions

Can a nurse practitioner prescribe by telehealth?

Yes, within their scope and the law that applies, after a real-time video, phone or face-to-face consultation, and only where it’s clinically appropriate. Regulators don’t support prescribing from a questionnaire, text, email or online chat alone. The National Boards’ telehealth case studies identify prescribing in an initial telehealth consultation as a common mistake, and Ahpra advises patients that prescribing by telehealth is generally safest when they’ve seen the practitioner in person before.

Is a nurse practitioner the same as a doctor?

No. Nurse practitioners are registered nurses with an endorsement from the Nursing and Midwifery Board of Australia, and doctors are a separate profession registered by the Medical Board of Australia. Medicare also treats the two professions differently.

Can a nurse practitioner refer me to a specialist?

Yes. If the nurse practitioner provides Medicare services, Medicare pays benefits at referred rates, and the referral is valid for up to 12 months from your first appointment with the specialist.

Does Medicare cover telehealth with a nurse practitioner?

Generally only if that nurse practitioner, or their practice, has given you a Medicare-billed face-to-face service in the past 12 months, or an exemption applies, such as a sexual or reproductive health consultation.

How can I check that someone is a nurse practitioner?

Search Ahpra’s public register and look for a nurse practitioner endorsement on their registration. “Nurse practitioner” is a protected title.

References

1. Nursing and Midwifery Board of Australia. Nurse practitioner standards for practice: effective 1 March 2021; the glossary defines “nurse practitioner” and “independence”, and the orientating statements cover tests and medicines.
2. Nursing and Midwifery Board of Australia. Registration standard: Endorsement as a nurse practitioner: effective 1 June 2016; endorsement criteria and the definition of an approved program of study.
3. Nursing and Midwifery Board of Australia. Endorsements and notations: lists the 2016 registration standard as current; page reviewed 11 August 2026.
4. Nursing and Midwifery Board of Australia. Guidelines: for nurses applying for endorsement as a nurse practitioner: advanced practice hours, and endorsement after completing an approved program.
5. Nursing and Midwifery Board of Australia. Safety and quality guidelines for nurse practitioners: updated 1 November 2024; scope of practice, recency, CPD, Medicare and PBS access, and prescribing authority.
6. Queensland Government. Health Practitioner Regulation National Law Act 2009: the National Law, applied in each state and territory; sections 95 (nurse practitioner endorsement), 113 (protected titles), 119 (claims about registration and endorsement), 136 (directing or inciting unprofessional conduct or professional misconduct) and 225 (the national register).
7. Ahpra. Register of practitioners: the public register, including conditions that limit practice.
8. Nursing and Midwifery Board of Australia. Fact sheet: The use of health practitioner protected titles: page reviewed 25 January 2024.
9. Nursing and Midwifery Board of Australia and Ahpra. Nurse and midwife registration data table, June 2026 and June 2025: Table 5.1, nurse practitioner endorsements for the quarters ending 30 June.
10. Department of Health, Disability and Ageing. About nurses and midwives: nurse practitioner workforce figures; last updated 22 October 2025.
11. Nursing and Midwifery Board of Australia. Registered nurses and midwives with multiple endorsements or an endorsement and dual registration: the designated registered nurse prescriber endorsement; July 2026. See also Registration standard: Endorsement for scheduled medicines - designated registered nurse prescriber: in effect from 30 September 2025; page reviewed 11 August 2026.
12. Nursing and Midwifery Board of Australia. Fact sheet: Scope of practice and capabilities of nurses: examples of core nurse practitioner activities; updated May 2024.
13. Department of Health (Victoria). Nurse practitioners: legislative requirements and Schedule 8 permits and notifications: updated 1 October 2026 and 7 September 2026.
14. Queensland Government. Medicines and Poisons (Medicines) Regulation 2021 and Medicines and Poisons Act 2019: nurse practitioner authority (Regulation schedule 7), restricted medicines (Regulation section 9 and schedule 2, part 1), and prescribing approvals for stated medicines, patients and circumstances (Act, section 67).
15. NSW Health. Authority to prescribe for privately practicing nurse practitioners in NSW, Nurse prescribers: legislation changes and Frequently asked questions on the new Medicines, Poisons and Therapeutic Goods legislation: the current authority and the laws commencing 5 November 2026.
16. Federal Register of Legislation. National Health Act 1953: sections 84, 84AAJ and 88(1E) on authorised nurse practitioners and PBS prescribing.
17. Pharmaceutical Benefits Scheme. Nurse practitioner PBS prescribing: last updated 1 October 2026.
18. Pharmaceutical Benefits Scheme. Review of PBS items for prescribing by nurse practitioners and endorsed midwives: changes on 1 November 2024, 1 June 2025, 1 October 2025, 1 January 2026 and 1 February 2026, and the expectation that consultation, referral and transfer of care will continue; last updated 1 February 2026.
19. MBS Online. Nurse practitioner MBS changes from 1 July 2024: fee increase and case conferencing.
20. Federal Register of Legislation. Health Legislation Amendment (Removal of Requirement for a Collaborative Arrangement) Act 2024: assented 31 May 2024; Schedule 1 commenced 1 November 2024.
21. MBS Online. Removal of legislated collaborative arrangements: last updated 30 October 2024.
22. MBS Online. Nurse practitioner MBS item changes 1 March 2025: items 82216 and 91206; last updated 24 January 2025.
23. MBS Online. Changes to Bulk Billing Incentive Items from 1 November 2025: last updated 1 September 2025.
24. MBS Online. November 2025 news: summary of MBS changes for 1 November 2025, including nurse practitioner telehealth and Better Access.
25. MBS Online. Note MN.14.1 and note GN.6.16: nurse practitioner services and specialist referrals since 1 November 2010.
26. Ahpra and National Boards. Telehealth: information for practitioners who provide virtual care: page reviewed 7 October 2025.
27. Ahpra and National Boards. Information for people about virtual care: page reviewed 15 September 2026.
28. MBS Online. Nurse Practitioner MBS Telehealth Services Eligibility: the 12-month rule, its exemptions, and the MBS Review Advisory Committee’s finding that face-to-face care remains the preferred standard; last updated 18 February 2026.
29. Nursing and Midwifery Board of Australia, Medical Board of Australia, Pharmacy Board of Australia and Ahpra. Joint statement on professional responsibilities for prescribing and dispensing medicines: June 2024.
30. Nursing and Midwifery Board of Australia. Patient safety paramount in updated telehealth guidance: 7 October 2025.
31. ACT Government. Nurse practitioners: last updated 17 December 2025.
32. Department of Health (Tasmania). Interstate prescribing in Tasmania: in effect from 16 February 2026; last updated 2 March 2026.
33. Services Australia. Nurse practitioner items: last updated 1 March 2026.
34. MBS Online. Item 82200 and item 23: schedule fees and benefits updated 1 July 2026.
35. Federal Register of Legislation. Health Insurance (Section 3C General Medical Services: Telehealth Attendances) Determination 2021: section 7, including the MyMedicare pathway, which applies to services by medical practitioners.
36. MBS Online. Item 10990 and note MN.1.1: bulk billing incentives are paid to medical practitioners.
37. Department of Health, Disability and Ageing. Bulk Billing Practice Incentive Program guidelines: published March 2026.
38. MBS Online. Item 82204: bulk billing loading for nurse practitioner contraception procedures, from 1 November 2025.
39. Department of Health, Disability and Ageing. Time-Tiered Primary Care Working Group draft final report: MBS Review Advisory Committee, September 2026; Recommendation 7; consultation closes 15 October 2026.
40. Federal Register of Legislation. Health Insurance Regulations 2018: sections 96 and 102 on nurse practitioner referrals.
41. MBS Online. Referrals for specialist services: factsheet, last updated August 2026.
42. MBS Online. Note MN.14.15: nurse practitioner referral requirements.
43. MBS Online. Item 965, item 2700 and note AN.0.30: GP chronic condition management plans, GP mental health treatment plans, and nurse practitioner referral to a consultant psychiatrist.
44. Department of Health, Disability and Ageing. Better Access initiative: last updated 6 February 2026.
45. MBS Online. Note MN.14.16, note IN.0.6 and item 57410: pathology and imaging that nurse practitioners can request.
46. MBS Online. November 2026 news: nurse practitioner referral for bone densitometry from 1 November 2026; page last updated 1 October 2026.
47. Ahpra and National Boards. Managing financial or commercial conflicts of interest: interim guidance, first published September 2026.
48. Medical Board of Australia. Medical Board of Australia: the national board that regulates medical practitioners.

Rules on prescribing, Medicare and telehealth change often. For the current position, check the sources above or MBS Online.