MBS (Medicare Benefits Schedule)
The Medicare Benefits Schedule (MBS) is the Australian Government’s official list of medical services, procedures, and diagnostic tests that are eligible for a Medicare rebate. Every item on the list has a unique MBS item number, and a government-set fee called the Schedule fee.
Medicare covers only a portion of the scheduled fee, so patients may still need to pay the remaining amount charged by the provider.
How do MBS item numbers work?
When you see a GP, specialist, or other eligible health professional, they use specific MBS item numbers for the service they provide. That number is essentially a billing code. It identifies the type of service provided, the consultation length, and the setting, which Medicare then uses to calculate the reimbursement amount.
Each MBS item number comes with:
- A descriptor that clearly explains the service and specifies which healthcare providers are authorised to perform it.
- A Schedule fee, which represents the government’s standard price for the service.
- A Medicare rebate percentage indicating the amount Medicare will reimburse.
For example, a standard GP consultation, usually billed under item 23 or 36 based on duration, has a different Schedule fee and Medicare rebate compared to a longer or more complex appointment. The MBS contains thousands of item numbers for a wide range of healthcare services, including surgery, pathology tests, imaging, and mental health care plans.
Doctors may submit claims using the relevant MBS item number either by bulk-billing Medicare directly or by charging the patient, who can then claim the rebate. The complete MBS database is publicly available and searchable through mbsonline.gov.au.
What is the ‘Schedule fee’ vs the’ rebate’?
These two terms are often the main source of confusion when it comes to Medicare bills and gap payments.
The Schedule fee is the government’s standard benchmark price for a medical service. Listed in the MBS, it serves as a reference point for calculating the amount Medicare will reimburse. However, healthcare providers can set their own fees independently.
The Medicare rebate is the actual amount Medicare pays. It is calculated as a percentage of the Schedule fee.
| Scenario | Medicare rebate |
| GP consultations (out-of-hospital) | 100% of the Schedule fee |
| Non-GP out-of-hospital specialist | 85% of the Schedule fee |
| Public hospital public patient | 100% of relevant costs (hospital handles billing) |
| Private hospital treatment | 75% of the Schedule fee for medical services |
The gap is the difference between the provider’s charge and the amount Medicare reimburses. Since doctors and specialists are not legally bound to the Schedule fee, out-of-pocket expenses are common.
Are telehealth appointments on the MBS?
Yes. Many telehealth consultations are covered under the MBS, including some:
- GP appointments
- Specialist consultations
- Mental health services
- Nurse practitioner services
- Allied health appointments
To claim a Medicare rebate for a telehealth consultation, patients must satisfy the telehealth practitioner eligibility requirements.
- The patient must have had at least one in-person MBS service with the same doctor or another practitioner from the same practice within the preceding 12 months.
- The patient is registered with the practice through MyMedicare, which eliminates the need for an in-person consultation within the previous 12 months.
Some patient groups are excluded from the face-to-face attendance requirement and may receive MBS telehealth services from any eligible provider without an established prior relationship:
- Children under 12 months of age
- Patients who are homeless
- Patients accessing blood-borne virus, sexual and reproductive health services
- Patients in areas declared as natural disaster zones by a State or Territory government
- Patients of Aboriginal Medical Services or Aboriginal Community Controlled Health Services.
Medical Disclaimer: The content on this page is for informational purposes only.
