Medicare Benefits Schedule
What is the MBS?
The benefits you receive from Medicare are based on a Schedule of fees for medical services set by the Australian Government. The MBS lists a wide range of consultations, procedures and tests.
The schedule fee is the amount the Government considers appropriate for one of these services. Health consumers can claim 100% of this fee as a rebate for general practice services and 85% of non-GP services from Medicare when the services are provided out of hospital. For services provided in a private hospital Medicare will rebate 75% of the Schedule fee. This doesn’t mean that the service provider (for example a doctor, pathologist or physiotherapist) will not charge you more than the Schedule fee, so you will often have to pay a ‘gap fee.’
If you attend a public hospital you will not be charged for care and treatment or aftercare relating to your public hospital treatment.
The MBS provides benefits for:
consultation fees for doctors, including specialists
tests and examinations by doctors needed to treat illnesses, including X-rays and pathology tests
eye tests performed by optometrists
most surgical and other therapeutic procedures performed by doctors
some surgical procedures performed by approved dentists
specified items under the Cleft Lip and Palate Scheme
specified items for allied health services (ie chronic disease management items , better access to GPs, psychologists and psychiatrists through the MBS initiative items, and items for children with pervasive developmental disorders)
The MBS does not cover:
private patient hospital costs (for example, theatre fees or accommodation)
dental examinations and treatment (except specified items introduced for allied health services as part of the Enhanced Primary Care (EPC) program)
ambulance services
home nursing
acupuncture (unless part of a doctor's consultation)
glasses and contact lenses
hearing aids and other appliances
the cost of prostheses (except External Breast Prostheses covered by the External Breast Prostheses Reimbursement Program)
medicines (The PBS is the system that provides subsidies for prescription medication)
medical and hospital costs incurred overseas
medical costs for which someone else is responsible (for example a compensation insurer, an employer, a government or government authority)
medical services which are not clinically necessary
surgery solely for cosmetic reasons
examinations for life insurance, superannuation or membership of a friendly society
eye therapy
For further information please visit Medicare Australia or Medicare Benefits Schedule online.
