⚠️ Standards vary by state, industry, and commodity. Requirements (especially in mining) differ between NSW, Qld and WA and change over time. Always verify against the current regulation and the relevant standard before assessing or signing.
⚠️ Billing: not a Medicare service
Medicare benefits are payable only for clinically relevant services. A pre-employment screening is rendered for a third party (the employer), not for the patient's own care, and the Medicare Benefits Schedule expressly treats pre-employment screening as outside clinically relevant services. There is no MBS item for it.
The pre-employment screening itself is not Medicare-rebatable — it's billed privately, usually to the employer. If, during the assessment, you separately identify and manage a clinical problem for the patient's own care, that is a distinct clinically-relevant service billed under the normal MBS rules. The screening and any incidental clinical care should be billed and documented separately.
Set your own fee for the screening. Confirm in advance who is paying (employer vs candidate) and what the report will contain.
The standards you're assessing against
Generic pre-employment medicals are assessed against the role's inherent requirements, but several industries have defined national or state standards:
- Commercial drivers — Austroads Assessing Fitness to Drive (commercial vehicle standards).
- Rail safety workers — National Standard for Health Assessment of Rail Safety Workers (category 1/2/3 by safety-criticality).
- Aviation — CASA. Class 1/2/3 certificates require a DAME; a Basic Class 2 is assessed against the Austroads commercial driving standard by a suitably qualified practitioner.
- Mining — by state:
- NSW — Coal Board Medical (Order 43) under the coal mine health and safety regulation: respiratory questionnaire, spirometry, chest X-ray, audiometry, examination; repeated for ongoing surveillance.
- Qld — Coal Mine Workers' Health Scheme (coal), plus respiratory health surveillance for mineral mines and quarries (a periodic cycle, dual-read chest X-ray and spirometry).
- WA — no single "coal board" medical (WA mining is largely non-coal). Health surveillance runs under the WHS (Mines) Regulations 2022 and DMIRS' Guide for Medical Practitioners for hazardous exposures (e.g. silica, diesel exhaust); pre-employment medicals are otherwise employer- and role-driven.
Many of these require additional accreditation or training to perform and sign (for example, the NSW coal order nominated medical adviser arrangements). Check the relevant scheme's requirements before taking on assessments.
Consent, privacy & the dual relationship
- The employer is the client; the candidate is the examinee. Make the purpose and the limits of the assessment clear at the outset.
- Obtain informed consent for the assessment and for disclosure to the employer.
- The employer generally receives a fitness determination (fit / fit with restrictions / not fit for the role), not the full clinical record. Disclose only what is necessary and consented to.
- Handle records consistent with the Privacy Act and the relevant scheme's requirements.
- Be alert to the dual-relationship issue if the examinee is also your own patient.