The Medicare Benefits Schedule (MBS) is a list of medical services subsidised by the Australian Government. Each service covered by the schedule has an Item Number. The MBS details how much Medicare will pay for each Item Number. The Medicare Schedule Fee is what you can expect Medicare and your Private Health Insurer to pay for a particular Item Number.
A gap is the difference between the Medicare Schedule Fee and the fee charged by the doctor. It represents an ‘out-of-pocket’ expense for the patient.
No Gap (or Gap-cover) is an agreement between private health insurance companies and medical specialists whereby the health insurer covers the cost of the service with no out-of-pocket expense to the patient for the doctor’s fees.
The AMA Schedule is a list of recommended fees for medical services published regularly by the Australian Medical Association (AMA). These fees are generally higher than the MBS.
An Item Number is a code which identifies a particular medical service. These numbers are used when generating accounts for patients, Medicare and insurance companies. A single operation may involve a number of different item numbers. If you need an operation, the relevant item numbers will appear on your “Estimate of Fees.”