How Do Medicare Rebates Work for Virtual Menopause Care?

Last Updated: November 7, 2026

Table of Contents

• Medicare Rebates for Virtual Menopause Care: Where to Start
• What MBS Item 695 Menopause Health Assessments Cover
  • What the assessment involves
  • How it differs from a standard consultation
  • Preparing for a virtual assessment
• Step 1: Check Whether Your Virtual Appointment Qualifies
  • A four-point pre-payment checklist
  • Eligibility by age, symptoms and early menopause
  • Telehealth-specific limitations and exceptions
• Step 2: Confirm the Item, Fee and Likely Out-of-Pocket Cost Before You Book
• Step 3: Claim the Rebate and Prepare for Your Virtual Assessment
• Why Ongoing Menopause Care Can Change Your Rebate Picture
• Book Your Initial Consult With UnPause's Menopause Experts
• Frequently Asked Questions

Medicare Rebates for Virtual Menopause Care: Where to Start

If you are in your 40s or 50s and getting a menopause consult by video, you may be able to claim a Medicare rebate.

Many women feel unsure about what Medicare covers, and that uncertainty can make it harder to book. The good news is that the process is more manageable than it first looks.

Here is the short version:

• Check that your virtual appointment qualifies.
• Confirm the item, fee and likely out-of-pocket cost before you book.
• Claim the rebate and prepare for your assessment.

Our team of AHPRA-registered menopause expert doctors can help you work through this. You can read more about our team and their qualifications before you book.

What MBS Item 695 Menopause Health Assessments Cover

MBS item 695 is the Medicare Benefits Schedule item linked to menopause and perimenopause health assessments. It is designed to give you a structured look at your symptoms, health history and treatment options with a GP or qualified health professional. Understanding what the assessment actually involves helps you judge whether it is the right appointment for you, and what you should prepare before it.

What the assessment involves

A health assessment is not the same as a standard consultation. In general terms, a structured menopause health assessment is intended to cover the menopause journey as a whole rather than a single presenting complaint, and may include:

• Symptom review. A detailed discussion of your symptoms, hot flushes, sleep changes, mood shifts, joint pain, changes to periods, brain fog and others, including when they started, how often they occur and how they affect daily life.
• Medical and family history. Your personal history, relevant family history, and any conditions that influence treatment options.
• Medication and supplement review. What you are currently taking, including over-the-counter products, so interactions and alternatives can be considered.
• Lifestyle and risk factors. Factors such as sleep, activity, alcohol intake and bone health that shape the advice you receive.
• Treatment options. A discussion of the range of options available to you, including non-hormonal approaches and menopausal hormone therapy where appropriate, with the risks and benefits explained.
• A documented plan. A summary of what was agreed, what to try next, and when to review.

Ask the provider how long the appointment is scheduled for, so you can plan a private space and enough time without interruptions.

How it differs from a standard consultation

A standard consultation is typically shorter and focused on one issue. A health assessment is a planned, comprehensive review that pulls together your history, symptoms and options into a single documented plan. That difference matters for two reasons: the item and rebate are different, and the preparation you do beforehand is different. For an assessment, it is worth writing down your full symptom history in advance rather than raising one concern at a time.

Preparing for a virtual assessment

A virtual assessment generally works best when you prepare for it as you would an in-person appointment. Before the day:

• Have your Medicare card within reach.
• Write down your symptoms, when they started and how they affect your daily life.
• List any medicines or supplements you take.
• Note any questions you want to ask about treatment options.
• Test your camera, microphone and internet connection in advance.
• Find a private, quiet space with good lighting.

A little preparation helps your appointment run smoothly. It also gives you a clear record to bring to future consults.

Check with the provider before booking so you know exactly what the appointment includes. For official details on eligibility and item rules, see the Medicare Benefits Schedule on health.gov.au. Australian Government Department of Health, Disability and Ageing, Medicare Benefits Schedule

Step 1: Check Whether Your Virtual Appointment Qualifies

Before you pay anything, confirm that your virtual appointment is eligible for a Medicare rebate. Eligibility depends on your circumstances, the item your provider intends to bill, and whether the appointment is delivered in a way Medicare recognises as telehealth. The practical way to do this is to verify four things in order, before you hand over any payment.

A four-point pre-payment checklist

Work through these in sequence. If any answer is unclear, ask the provider to confirm in writing before you book.

1. Provider status. Is the practitioner a registered Australian health professional who is eligible to bill Medicare for this service? Ask for the provider number they will use and confirm it matches the practitioner you will actually see. A common pattern is for a clinic to advertise a service but bill under a different practitioner's number, confirm the name on the invoice matches the person on your screen.
2. Appointment type. Is the appointment a structured menopause and perimenopause health assessment, or a standard consultation? These are billed under different items and carry different rebates. Ask the provider to name the item number they intend to use, not just describe the appointment. For a closer look at how Medicare, private health insurance and telehealth rebates apply to your care, read whether perimenopause treatment is covered by insurance.
3. Telehealth eligibility for that item. Not every item is available by video, and some items carry conditions on how the service is delivered. Ask directly: "Is this item available by video for my situation, and are there any conditions I need to meet?" The Australian Government's telehealth guidance on health.gov.au sets out which services are eligible, and it is worth reading the relevant section before you book.
4. Billing method. Will the provider bulk bill, or will you pay upfront and claim the rebate yourself? This determines what you pay on the day and how quickly the rebate reaches you. Ask which method applies and what you will be asked to pay at the time of booking.

Watch out: a provider who cannot name the item number, or who describes the appointment only in general terms, is a signal to slow down. The item number is the single most important piece of information for predicting your rebate, and a legitimate provider will confirm it before you pay.

Eligibility by age, symptoms and early menopause

Eligibility is not just about age. Rebate pathways can differ depending on your circumstances, so the provider needs to confirm which item fits your situation rather than assuming a single pathway applies to everyone. If you are unsure whether your symptoms meet the criteria, describe them in detail at the booking stage, the provider can then tell you which item is appropriate before the appointment is confirmed.

Telehealth-specific limitations and exceptions

Telehealth rebates have rules that do not apply to in-person visits. Some items have conditions on who can offer the service, how it is delivered and how it is billed. Some items have conditions on how and when they can be delivered by video.

If you would like to understand how UnPause handles these checks, you can review our frequently asked questions about Medicare rebates and fees or read more about our team and their qualifications before you book.

Step 2: Confirm the Item, Fee and Likely Out-of-Pocket Cost Before You Book

Before you book, ask for three things in writing: the Medicare item number, the consultation fee and the expected rebate. The gap between the fee and the rebate is your likely out-of-pocket cost.

Here is what to check:

Question to ask	Why it matters
Which Medicare item will be billed?	Different items carry different rebates
What is the total consultation fee?	This is the starting point for your cost
What rebate will Medicare pay?	Your rebate reduces what you pay
Is there a gap fee?	This is your likely out-of-pocket amount

Pricing depends on the appointment and billing arrangements. Check the current fee and gap on our website or with the team before you confirm, as prices can change.

Once you know your likely cost, compare it with your budget. Ask whether ongoing support is included, so you can judge the value of each appointment.

Step 3: Claim the Rebate and Prepare for Your Virtual Assessment

After your appointment, your provider bills Medicare. How the rebate is paid, whether directly to your bank account or applied at the time of billing, depends on how your provider bills Medicare.

To prepare for your virtual assessment:

• Have your Medicare card within reach.
• Write down your symptoms, when they started and how they affect your daily life.
• List any medicines or supplements you take.
• Note any questions you want to ask about treatment options.
• Test your camera, microphone and internet connection in advance.
• Find a private, quiet space with good lighting.

A little preparation helps your appointment run smoothly. It also gives you a clear record to bring to future consults.

Why Ongoing Menopause Care Can Change Your Rebate Picture

One assessment gives you a snapshot. Menopause symptoms often shift over months and years, so follow-up care can matter. Ongoing care can help you track changes and adjust treatment over time.

Our UnPause Posse membership is designed to support ongoing care between bigger appointments. You can see the full list of what is included on our site.

Ongoing care is also where treatment can be adjusted based on how you are responding.

Book Your Initial Consult With UnPause's Menopause Experts

If you are ready to get started, the next step is to book your initial consult. Our doctors are AHPRA-registered menopause expert doctors. You can meet the UnPause team and read about their backgrounds before you book.

Book your initial consult with UnPause to talk through your symptoms, your options and what Medicare may cover. Our team can help you understand the costs before you commit.

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References and sources:

• Australian Government Department of Health, Disability and Ageing, Medicare Benefits Schedule, health.gov.au
• Australian Government telehealth guidance, health.gov.au

Frequently Asked Questions

Are virtual menopause consultations covered by Medicare?

Some virtual menopause consultations may attract a Medicare rebate when they meet the requirements of the Medicare Benefits Schedule (MBS). Eligibility depends on the item used, the service provided and whether the appointment is delivered through telehealth under the applicable rules. Because requirements can change, check the current item details on the Services Australia website and confirm with your provider before booking. UnPause's team can explain how Medicare rebates apply to your appointment.

How do I claim a Medicare rebate for telehealth menopause appointments?

Rebates are generally claimed through the provider at the time of your appointment, provided they bill Medicare for the service. Make sure your Medicare card details are current and that you have confirmed the item number and fee before the consultation. Your out-of-pocket cost is the fee minus any rebate received. Ask your provider to explain the claim process before your appointment so there are no surprises afterwards.

Does UnPause offer Medicare-rebated telehealth services?

UnPause offers telehealth menopause and perimenopause consultations with AHPRA-registered doctors, and Medicare rebates may be available for eligible appointments. Whether a rebate applies depends on your individual circumstances and the service provided, so confirm eligibility with the UnPause team before booking. Our doctors are AHPRA-registered menopause expert doctors.

What is the Medicare Benefits Schedule (MBS) item for menopause health assessments?

The Medicare Benefits Schedule lists item numbers that describe specific services and the rebate that may apply to them. MBS item 695 is the item most often associated with menopause and perimenopause health assessments, but you should confirm the current item description, eligibility criteria and fee on the official Medicare Benefits Schedule website. Your doctor can advise which item, if any, applies to your consultation.