Medicare rebate eligibility

Your Medicare rebate is the subsidy provided by the Australian Government for pathology services that are included in the the Medicare Benefits Schedule (MBS) and satisfy any eligibility criteria.

Most pathology services will be eligible for a Medicare rebate but some are not included in the MBS (or are only eligible if certain eligibility criteria, including clinical and/or personal criteria, are satisfied).

In the case of services that are eligible for a Medicare rebate, we may charge non-concessional patients an amount in excess of the relevant rebate.

If any of the pathology services requested by your doctor are not included in the MBS or you do not satisfy the applicable eligibility criteria, you will not receive a Medicare rebate.  

For more information about pathology services that are included in the MBS, eligibility and how to claim your Medicare rebate, visit the Medicare website at medicare.gov.au or contact Services Australia on 132 011.

Medicare rebate exclusions

In the case of pathology services that are not eligible for a Medicare rebate because they are not included in the MBS, you will incur a charge that will need to be paid at time of specimen collection (if your specimen is collected at one of our Collection Centres) or after testing has been finalised (if your specimen is collected by someone other than us, for example, by your doctor or a hospital).  

For pathology services where eligibility for a Medicare rebate is conditional on the satisfaction of certain criteria, you will incur a charge that will need to be paid after testing has been finalised if those criteria are not satisfied.

If you visit one of our Collection Centres, we will be able to inform you about any services that are not eligible for a Medicare rebate or are only eligible for a rebate if eligibility criteria are satisfied.  Your doctor should also be able to inform you about such services.

I am an out-patient (not admitted in hospital) with a valid Medicare card

Medicare rebates apply for most out-patient pathology services. However, some services are not included in MBS so that no Medicare rebate applies (or they are included in the MBS but only eligible for a Medicare rebate if certain eligibility criteria are satisfied).  

Concessional patients will be bulk billed and will not receive an account from our pathology for pathology services that are eligible for a Medicare rebate, and may be charged concessional fees for other services – see below. Non-concessional patients may be billed for pathology services that are eligible for a Medicare rebate.

Patients will be billed for pathology services that are not included in the MBS or where the eligibility criteria for a Medicare rebate are not satisfied. Patients whose specimen is collected at one of our Collection Centres will be informed of any services not included in the MBS, or that are subject to eligibility criteria, at the time of that collection.

I am an out-patient (not admitted in hospital) with a concessional card

If you are a concessional patient, you will be bulk billed and will not receive an account from our pathology for pathology services that are eligible for a Medicare rebate.  

If a person other than our pathology (for example, your doctor) is collecting your specimen, you must provide them with the necessary information from your Concession Card and your personal details, so that we can process your concessional rates accordingly.

Concessional patients are limited to nursing home patients and holders of a valid:

Health Care card

Pensioners card

DVA Gold card

Holders of a current Veteran Affairs Gold Card (DVA Gold Card) will not be privately billed by our pathology for any pathology services that are included in the MBS, even if MBS prescribes eligibility criteria that are not satisfied.

I am an in-patient (hospital patient)

I am a patient with overseas private health insurance

I am a patient without Medicare or private health insurance cover

If you are a patient who is not covered by Medicare or by private health insurance we will require full payment for all testing.

Your specimen collection is at one of our collection centres

If you attend one of our collection centers, we will ask that you pay for all testing in full at the time of specimen collection.

Your specimen collection is performed by a party other than us

If your specimen is collected by a person other than us, you will receive an invoice from us (usually by SMS).

Our out-of-pocket billing policy

To minimise out-of-pocket expenses, we have an out-of-pocket billing policy for collections undertaken in its Collection Centres in respect of most pathology services included in the MBS.

Under the out-of-pocket billing policy, the maximum out-of-pocket expense that will be charged in a single visit for pathology services:

(a)   that are included in the MBS and any eligibility criteria are satisfied; and

(b)   where the specimen is collected in our Collection Centres, is $320.

This maximum apples to out-patient testing only

Any pathology services that are not included in the MBS, or that are included in the MBS but in respect of which any eligibility criteria are not satisfied, are excluded from that $320 maximum amount. Fees over and above that maximum may be charged for such services.

The $320 maximum amount does not apply to a very limited number of pathology services that are included in the MBS. If you visit one of our Collection Centres, we will be able to inform you about any services that are not included in the maximum, despite being included in the MBS.