The short answer
For a Medicare rebate, yes. You need a valid referral, usually from your GP, for the referred Medicare rate, and without one you'll usually pay more. A GP referral lasts 12 months from your first appointment unless your GP writes a different period, and your GP can make it indefinite if you need ongoing care.
On this page
Do you need a referral to see a rheumatologist?
To get a Medicare rebate at the referred rate, yes. You can see a specialist without a referral, but the Medicare item they can bill is lower, so your out-of-pocket cost is likely to be higher [1].
A rheumatologist is a specialist doctor who diagnoses, treats and manages diseases affecting the joints, muscles and bones [8]. They train as physicians through the Royal Australasian College of Physicians, followed by at least three years of specialist rheumatology training [8]. Conditions they treat include [8]:
- rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis
- gout and osteoarthritis
- osteoporosis
- lupus, vasculitis and myositis
The Australian Rheumatology Association suggests seeing your GP if joint or muscle pain, stiffness or swelling doesn't improve within a few weeks. Your GP then decides whether a referral is needed [8].
When to go to hospital instead
Some joint symptoms can't wait for a specialist appointment. Victoria's public hospital referral criteria direct people to an emergency department, not a clinic, for [9]:
- one or more acutely painful, hot, swollen joints, especially with a fever
- suspected sepsis in someone with rheumatoid arthritis
- unexplained illness or fever while taking biologic or immunosuppressant medicines
If you're seriously unwell, call 000 or go to your nearest emergency department.
Why an early referral can matter
If your GP suspects inflammatory arthritis, they'll usually refer you to a rheumatologist [10]. Starting treatment early in rheumatoid arthritis gives better long-term results, and first-line medicines are ideally started within 3 months of symptoms beginning [10]. Before referring, your GP may order blood tests and X-rays [10].
Who can refer you to a rheumatologist?
GPs are the main source of specialist referrals [1]. Other specialists, such as a dermatologist or an orthopaedic surgeon, can also refer you, in consultation with or by notifying your GP [1]. Nurse practitioners can refer in certain circumstances [1].
The referring practitioner must have consulted with you and considered whether you need the referral, though not necessarily at the same visit [2]. A specialist's referral must also name your GP or practice, or say that you can't or won't nominate one [2].
What should a rheumatology referral include?
Every valid referral includes the reason for referral, relevant clinical information, the date and the referring practitioner's signature [1][3]. It can be on paper or electronic [1].
For inflammatory arthritis, Victoria's public hospital criteria give a good picture of what a specialist wants to see. They ask for [9]:
- which joints are affected, when symptoms started, and how long they've lasted
- previous treatment and how it went
- full blood examination, ESR and CRP results
- details of any skin condition, if psoriatic arthritis is suspected
- all current medicines, including over-the-counter medicines, herbs and supplements
- pregnancy status or plans
If available, they also want rheumatoid factor, anti-CCP antibody results, relevant X-rays, liver function and kidney tests, and how the condition affects work, study or caring [9]. Those criteria are for public clinics in Victoria, but they're a useful checklist for any rheumatology referral. See also what goes in a referral letter.
Does the referral need to name a specific rheumatologist?
No. For private rooms and other community settings, a referral doesn't need to name a specialist [1][3]. If it names one, you can still see another rheumatologist without a new referral, unless you've already started seeing the named one [1]. If you'll be a private patient in a public hospital outpatient clinic billed to Medicare, the referral must be addressed to a named specialist [1].
How long does a rheumatologist referral last?
| Who wrote it | How long it lasts |
|---|---|
| Your GP | 12 months, unless the GP states a shorter, longer or indefinite period [1] |
| Another specialist | 3 months, or the length of a hospital admission if you're an admitted patient [1][3] |
The period starts from your first rheumatology appointment, not the date on the letter [1][3]. If you need ongoing care, your GP can refer you for longer than 12 months or indefinitely, which saves you getting a new referral every year [3]. "Indefinite" is the preferred wording [1]. A new, unrelated condition needs a new referral [1]. More detail is in how long a referral lasts.
What will Medicare cover, and what will you pay?
Rheumatologists set their own fees. With a valid referral, Medicare pays 85% of the schedule fee for a specialist consultation [6], and you pay any gap.
If your rheumatologist bills as a consultant physician, the first appointment is usually item 110, with a schedule fee of $183.35 and an 85% benefit of $155.85 (schedule fee updated 1 July 2026, checked November 2026) [4]. Ask the practice about their fees before you book.
Does private health insurance help?
Not for consultations in the rheumatologist's rooms. Health insurers can't contribute to out-of-hospital treatment for Medicare services [7].
Can you see a rheumatologist by telehealth?
Often, yes, particularly for follow-ups. Medicare has permanent telehealth items for specialists: first appointments can be by video and some follow-ups by phone where clinically appropriate [5]. A valid referral is still needed, but not a separate one for telehealth [5]. Ask the practice whether your first appointment can be by video or needs to be in person.
Referrals can be issued electronically [1], so you can get one through a telehealth GP consultation and have it sent to you or the rheumatologist.
Getting a referral
Referral GP offers telehealth consultations, by phone or video, with AHPRA-registered Australian GPs. If it's clinically appropriate, your GP can refer you to a rheumatologist and, where needed, request blood tests or imaging so your results are ready for the specialist.
A consultation doesn't guarantee a referral. Your GP decides what's clinically appropriate.
Bulk billed for eligible patients. If you're not eligible, a consultation fee may apply, and we'll confirm it with you before your consult.
Referral GP is not an emergency service.
This page is general information, not medical advice.
Common questions
Can a GP refer me to a rheumatologist?
How long does a rheumatologist referral last?
Can I see a rheumatologist without a referral?
What tests should I have before seeing a rheumatologist?
That's up to your GP. As a guide, Victoria's public hospital referral criteria for inflammatory arthritis ask for a full blood examination, ESR and CRP, with rheumatoid factor, anti-CCP antibodies and relevant X-rays if available [9].
Does private health insurance pay for a rheumatologist?
Not for appointments in the rheumatologist's rooms. Health insurers can't contribute to out-of-hospital treatment for Medicare services [7].
References
- MBS Online. Factsheet: Referrals for specialist services (July 2026). Accessed November 2026. mbsonline.gov.au/internet/mbsonline/publishing.nsf/650f3eec0dfb990fca2
- MBS Online. Explanatory note GN.6.16: Referral of patients to specialists or consultant physicians. Accessed November 2026. www9.health.gov.au/mbs/fullDisplay.cfm?type=note&q=GN.6.16&qt=noteID
- Services Australia. Referrals for specialist treatment (updated 15 August 2025). Accessed November 2026. servicesaustralia.gov.au/referrals-for-specialist-treatment
- MBS Online. Item 110: consultant physician initial attendance after referral (schedule fee updated 1 July 2026). Accessed November 2026. www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=110&qt=item
- MBS Online. Explanatory note AN.40.1: Specialist and consultant physician MBS telehealth attendance items. Accessed November 2026. www9.health.gov.au/mbs/fullDisplay.cfm?type=note&q=AN.40.1&qt=noteID
- privatehealth.gov.au (Commonwealth Ombudsman). What is covered. Accessed November 2026. privatehealth.gov.au/health_insurance/what_is_covered
- Medical Costs Finder (Australian Government). A guide to out-of-pocket medical costs. Accessed November 2026. medicalcostsfinder.health.gov.au/resources/a-guide-to-out-of-pocket-me
- Australian Rheumatology Association. What is a rheumatologist? Accessed November 2026. rheumatology.org.au/For-Patients/What-is-a-Rheumatologist
- Victorian Department of Health. Statewide referral criteria: inflammatory arthritis (updated 27 May 2025). Accessed November 2026. health.vic.gov.au/statewide-referral-criteria/inflammatory-arthritis
- NPS MedicineWise. Rheumatoid arthritis roadmap. Accessed November 2026. nps.org.au/bdmards/rheumatological-conditions/ra-roadmap
Published by Referral GP. Last updated 6 November 2026. This page is general information only and isn’t a substitute for advice about your own situation. If you or someone else is in danger, call 000.