Medicare rebates
How Medicare's specialist rebate works for a sports and exercise medicine consultation, what a GP referral gives you, and the bulk-billed MRI access that comes with seeing a specialist.
Medicare's specialist rebate covers part of the cost of a specialist consultation when a valid GP referral is in place. The structure is designed to support patients accessing specialist care affordably. Reception confirms costs at booking.
How specialist Medicare rebates work
For a specialist consultation with a valid GP referral, Medicare provides a rebate against the appropriate Medicare Benefits Schedule (MBS) item number. The most common items for a specialist sports medicine consultation are:
- MBS item 110: Initial specialist consultation
- MBS item 116: Subsequent specialist consultation
The Medicare rebate currently sits around $150 for an initial specialist consultation. The exact rebate is set by the federal government and changes periodically. The gap between the consultation fee and the rebate is the patient's out-of-pocket cost.
The table below shows the structure only, as an example. The consultation fee is advised by reception at booking.
| Initial consultation (example) | |
|---|---|
| Consultation fee | Advised by reception at booking |
| Less the Medicare rebate (MBS item 110) | around $150 |
| Your out-of-pocket cost (the gap) | the fee minus the rebate |
The referral matters
A GP referral does several things:
- Allows you to access the Medicare specialist rebate
- Allows the specialist to refer for investigations under specialist Medicare rebates (including bulk-billed MRI where eligible)
- Provides the clinical context, including your medical history, current medications, and the GP's assessment
- Closes the loop afterwards: a letter goes back to your GP summarising the assessment and plan
You can attend without a referral, but you will not be eligible for a Medicare rebate, and the specialist's ability to refer for investigations under specialist rebates is restricted.
Bulk-billed MRI
One practical advantage of specialist referral is that Sport and Exercise Medicine Physicians can request MRI under Medicare item numbers that are bulk-billed at some participating radiology providers. This usually means no out-of-pocket cost for the scan, though bulk-billing is at the radiology provider's discretion. GPs cannot refer for a Medicare-rebateable MRI for most musculoskeletal conditions. See imaging and investigations.
How to claim
Patients pay the full consultation fee at the time of the appointment. Our reception staff can lodge your Medicare rebate claim online at the time of payment, and Medicare usually returns the rebate to your nominated bank account within 24 to 48 hours.
Common questions
How much will the appointment cost?
Reception confirms the consultation fee and the expected Medicare rebate at booking.
Do you bulk-bill?
Specialist consultations are not bulk-billed. The Medicare rebate covers part of the consultation fee.
What if I have private health insurance?
Private health insurance generally does not cover outpatient specialist consultations. The Medicare rebate is the relevant subsidy. WorkCover and CTP claims are handled separately. The clinic does not bill the Department of Veterans' Affairs (DVA); DVA card holders attend as private patients. See WorkCover.
How long is a referral valid?
A standard GP referral lasts twelve months from the date of the first specialist consultation. A referral from another specialist lasts three months. A new referral is required after that for ongoing care.
Can I claim the rebate without a referral?
No. The Medicare specialist rebate requires a valid referral.
