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.