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.