Medicare - Assessing - Your Health 011-42000000
Expand allThis document outlines general information about Medicare and assessing requirements.
Government intent
Medicare provides access to medical, allied health and hospital services for all Australian residents and certain categories of visitors to Australia. Services Australia administers the payment of Medicare benefits.
Under Medicare, benefits are paid for professional services listed in the Medicare Benefits Schedule (MBS) that are provided to eligible patients in and out of hospital.
Medicare benefits are payable only for 'clinically relevant' services rendered by an appropriate health practitioner. A 'clinically relevant' service is one which is generally accepted by the relevant profession as necessary for the appropriate treatment of the patient.
When a service is not clinically relevant, the fee and payment arrangements are a private matter between the practitioner and the patient.
Medical practitioners are free to set own fees for their professional service.
On this Page:
Medicare Benefits Schedule
The Medicare Benefits Schedule (MBS) is a listing of the professional services that attract a Medicare benefit.
For each services, it includes a unique item number, a description, the Schedule fee and Medicare benefit, together with a reference to an explanatory note relating to the item (if applicable).
The MBS is not a legal document. It operates under the Health Insurance Act 1973 (as amended) and, in cases of discrepancy, the legislation is the source for payments of Medicare benefits.
Medicare Benefits
In general, the Medicare benefit is 85% of the fee listed in the Medicare Benefits Schedule (MBS) for the service (known as the Schedule fee).
For attendances provided by GPs (or on behalf of a GP) to out of hospital patients, the Medicare benefit is 100% of the listed Schedule fee.
For professional services provided to private hospital patients (admitted to either a private or public hospital) the Medicare benefit is 75% of the listed Schedule fee.
Public patients admitted to public hospitals, receive free medical and hospital treatment funded under State/Territory arrangements, therefore are not entitled to Medicare benefits.
The Resources page contains a link to contact details for Medicare Benefits Schedule (MBS).
Contents
General assessing information for Medicare
Assessing Bulletins for Medicare
Professional attendances assessing rules in Medicare
Diagnostic procedures assessing rules in Medicare
Therapeutic procedures assessing rules in Medicare
Oral and maxillofacial assessing rules in Medicare
Diagnostic imaging assessing rules in Medicare
Understanding Pathology assessing rules in Medicare
Pathology processing for Medicare
Optometrical services assessing rules in Medicare