What is the Medicare Benefits Schedule (MBS)

Healthcare in Australia is delivered by public and private sector entities and is funded by all levels of government, private health insurers, and out-of-pocket payments by individuals.

The Federal Government doesn’t directly fund health service provisions, it funds Medicare benefits. It also jointly funds public hospitals with the States and Territories and provides financial assistance to residential aged care facilities, and home and community care for the aged.

Medicare Benefits Schedule (MBS) benefits are payable for Consultations with doctors.

The Medicare Benefits Schedule

The MBS is a key component of the Medicare system. It lists a range of professional services, and allocates a unique item number to each service, along with a description of the service (the ‘descriptor’). In broad terms, the types of services on the MBS include consultation and procedural/therapeutic (including surgical) services, as well as diagnostic services.

Subsidies for services by eligible health professionals take the form of Medicare benefits paid to the patient. The MBS sets out the ‘Schedule fee’ for each service and the rate/s at which the benefit for that service is to be calculated, as well as providing guidance on the clinical and administrative conditions under which benefits can be claimed.

The Schedule fee is a fee-for-service set by the Australian Government and may differ from the provider’s actual fee. Although Medicare is a public scheme, the health professionals providing the services for which benefits are payable are engaged in private businesses – either self-employed, in partnerships, or, increasingly, in corporate entities, small and large. Under the Australian Constitution, the right of medical or dental professionals to set fees at their own discretion is guaranteed. The patient is liable for any difference between the MBS benefit for a service and the actual fee charged by the health professional. This difference is known as an ‘out-of-pocket’ cost.

Where the health professional accepts the patient’s assigned Medicare benefit as full payment for the service, there is no out-of-pocket cost to the patient.

For full information on the Medicare Benefits Scheme, click here.

MBS online Training

Medicare provides initial training on the MBS system here.