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What is a Medicare Benefits Schedule number?

25 August 2010

A Medicare Benefits Schedule (MBS) number is assigned to any medical service or procedure which attracts a Medicare rebate.  Services that do not have an MBS number will not receive the rebate and patients will need to pay the full cost of the service or procedure.

For in-hospital services, the Medicare rebate will pay 75% of the Medicare Benefits Schedule fee and if you have private health insurance your Health Fund pays the remaining 25% as a benefit towards your doctors’ bills.  Some doctors and specialists charge more than the MBS fee. If this happens, you have to pay the ‘gap’, which is the difference between the MBS fee and what the doctors charge.

The decision whether or not to grant an MBS number is made by the Health Minister on the advice of the Medical Services Advisory Committee (MSAC).

While Medicare rebates may be referred to as ‘public funding’, having an MBS number does not provide for public hospital funding for that procedure.  Whether or not to actually fund that procedure in the public hospital system is the decision of each State government, who administer the State public hospital systems.

Medicare does not pay for prostheses, but does provide a rebate to the medical practitioner (with a provider number) for their services relating to procedures that may use prostheses.


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