Your Medicare rebate is the subsidy provided by the Australian Government for pathology services that are included in 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.
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 our pathology, 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.
To minimise out-of-pocket expenses, our pathology has 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:
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.
For doctor and hospital collected samples you may receive a message regarding an out-of-pocket payment. For more details and to understand the process, please visit: Out-of-pocket payment message.
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.
Patients whose specimen is collected at a doctor’s practice will also be notified and receive an invoice by message.
Your specimen collection is performed at one of our Collection Centres:
If your specimen collection is performed at one of our Collection Centres, we will require you to present your valid Medicare card at that time in order for us to be able to bulk bill any of the pathology services that are included in the MBS and where any applicable eligibility criteria are satisfied.
Your specimen collection is performed by a person other than our pathology collector:
If your specimen collection is performed by a party other than us, they will need to supply us with your valid Medicare card information and personal details in order for us to be able to bulk bill Medicare for any pathology services that are included in the MBS and where any eligibility criteria are satisfied.
Other than in respect of concessional patients, bulk billing is at our discretion.
Your specimen collection is performed at one of our Collection Centres:
If we can ascertain that your Medicare card is valid but your doctor has requested pathology services which are not included in the MBS, we will require that you pay for those non-eligible tests in full at the time of specimen collection.
If we can ascertain that your Medicare card is valid but your doctor has requested pathology services which are only eligible for a Medicare rebate depending on the satisfaction of certain criteria (including personal or clinical criteria), our collector will be able to advise you of this. If the applicable criteria are not satisfied, we will issue you with an invoice (usually by message) once testing has been completed and results sent to your doctor.
If we cannot ascertain that your Medicare card is valid, we will request that you pay for all your testing in full at the time of specimen collection.
Your specimen collection is performed by a person other than our pathology collector:
If your doctor has requested pathology services which are not included in the MBS or which are subject to Medicare eligibility criteria that are not satisfied, we will require that you pay for those services in full. We will issue you with an invoice (usually by message) once testing has been completed and results sent to your doctor.
If your doctor has not provided us with your valid Medicare card information and personal details we will require you to pay for this testing in full. We will issue you with an invoice (usually by message) once testing has been completed and results sent to your doctor.
If we requested that you pay for any or all of your pathology services, we will provide you with the necessary information for you to request an itemised receipt, which you will be able to use to claim your Medicare rebate for any tests eligible under the MBS.
An itemised receipt will be available as soon as all testing has been completed and the results sent to your doctor (typically 3 to 5 days after your specimen has been collected, depending on the complexity of testing requested) and your invoice has been paid in full.
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.
Inpatient pathology testing is pathology services performed while you are admitted as a private patient in a private hospital or in a recognised public hospital. Our pathology does not bulk bill for inpatient pathology testing.
If you are admitted to a private hospital and you are a holder of DVA Gold Card, your DVA concession eligibility will depend on whether the DVA has a contract with the relevant hospital you are attending. For more information on this, please contact the DVA directly.
Most major private health insurers cover any out-of-pocket expenses in respect of inpatient pathology testing that is eligible under the MBS. If you have private health insurance cover with one of these insurers, Our pathology will bill your testing directly to your private health insurer for payment.
If while you were an inpatient, pathology services that are not included in the MBS, that do not meet the MBS eligibility criteria or that are not covered under your private health insurance policy were performed, we will issue you with an invoice and require that you pay for those tests in full.
If you do not have private health insurance cover, or we do not receive the necessary personal details or information about your insurance coverage from the hospital, we will issue you with an invoice (usually by message) once testing has been completed.
If you are eligible to claim a Medicare rebate for the relevant pathology services, once your invoice is paid in full, we can issue you with an itemised receipt that you can use to claim your rebate.
If you are an overseas visitor with private health insurance (Overseas Visitor Health Cover or Overseas Student Health Cover) from one of the following health insurers, we may be able to bill all rebate-eligible pathology services directly to your insurer:
If you do not have insurance from one of the above health insurers, we will require you to pay for your pathology services in full at the time of specimen collection.
Your specimen collection is at one of our Collection Centres:
If you would like for us to bill your health insurer directly for any rebate-eligible tests, you will be asked to produce evidence of current health insurance cover with one of the health insurers in our Accepted Health Insurers list.
For evidence of current health insurance, at time of specimen collection, you will be asked to present:
Both of these will need to match the name on your doctor’s pathology request.
If we can ascertain that your health insurance cover is valid, we will endeavour to directly bill your health insurer for any pathology services that meet the rebate criteria of your health insurance.
If your doctor has requested pathology services which do not meet the rebate criteria under your private health insurance, we will require that you pay for those tests in full at the time of specimen collection.
If we cannot ascertain that you have current health insurance cover with a private health insurer that is in our Accepted Health Insurers list, we will require that you pay for all your pathology services in full at the time of specimen collection.
Your specimen collection is performed by a party other than our pathology:
If your doctor has requested pathology services which do not meet rebate criteria under your private health insurance, we will require that you pay for those tests in full.
We will endeavour to directly bill your health insurer for any pathology services that meet your rebate criteria provided that:
If your doctor has not provided us with your valid health insurance information and personal details, we will require you to pay for your pathology services in full. We will issue you with an invoice (usually by message) once testing has been completed and results sent to your doctor.
Claiming your rebate from your health insurer:
An itemised receipt will be available as soon as all testing has been completed and the results provided to your doctor (typically 3 to 5 days after your specimen has been collected, depending on the complexity of testing requested) and your invoice has been paid in full.
If you are a patient who is not covered by Medicare or by private health insurance we will require full payment for all pathology testing.
Your specimen collection is at one of our Collection Centres:
If you attend one of our Collection Centres, we will ask that you pay for all pathology services in full at the time of specimen collection.
Your specimen collection is performed by a person other than our pathology:
If your specimen is collected by a person other than our pathology, you will receive an invoice from us (usually by message).