Greatest Permissible Gap (GPG) 011-18111219
Expand allThis document outlines policy information for the Greatest Permissible Gap (GPG), also known as the Maximum Permissible Gap (MPG).
Greatest Permissible Gap (GPG)
The GPG is the maximum gap allowed between an item’s schedule fee and the out-of-hospital Medicare benefit amount payable for the service.
The GPG is a rule that sets a maximum gap dollar amount, where the Medicare benefit is increased until the difference is equal to the GPG.
For more information on the GPG or threshold, see Resources for a link to the Department of Health and Aged Care website.
The GPG is defined in Section 10(3) of the Health Insurance Act 1973, see References for a link to legislation.
Threshold
The GPG amount is indexed annually on 1 November in line with the Consumer Price Index see Resources for a link to the Department of Health and Aged Care website for the current threshold.
The GPG indexation is defined in Section 10A of the Health Insurance Act 1973, see References for a link to legislation.
Benefit
The benefit payable for those items meeting the threshold is the schedule fee less the GPG amount. The GPG amount is rounded up to the nearest multiple of 5 cents.
The GPG guarantees that the difference between the schedule fee for an item and the 85% Medicare benefit is not greater than a specified amount.
Eligibility
The GPG applies to all out-of-hospital Medicare services where the difference between the schedule fee and the Medicare benefit exceeds the GPG amount.
Services Australia automatically calculates and applies the benefit payable for any services impacted by the GPG.
Example of the GPG
In this example the GPG is set at $83.40
If the schedule fee for a service is $1000 then the 85% benefit would be $850 and the gap would be $150.
The GPG would apply and the claimant would receive $916.60 not $850.
(this is $1000 minus the GPG of $83.40 = $916.60)
Related links
QITI assessing information system