Does Medicare Pay for an Anaesthetist? The 2026 patient guide.
Yes — Medicare pays a rebate for anaesthesia, but only 75% of the MBS schedule fee when you're a private inpatient. Anaesthetists charge above that rate; the difference is the “gap.” Most private patients pay nothing because the anaesthetist uses their fund's no-gap or known-gap scheme. About 1 in 4 patients pay an average gap of $140.
Here's exactly how the system works, what you'll likely pay, and how to make sure you're not caught off guard.
takeaways
Medicare pays 75% of the MBS schedule fee — not 75% of what the anaesthetist actually charges.
Your fund pays at least 25% of the MBS fee by law — and more if your anaesthetist uses their gap scheme.
The MBS unit fee is $23.10 (from 1 July 2025); your anaesthetist typically charges $55–$80 per unit.
Most major funds cap your gap at $500 per doctor — but only if your anaesthetist participates in the scheme.
3 in 4 private patients pay nothing. The 1 in 4 who do pay average $140.
Ask one question before surgery: “Do you participate in my fund's gap scheme for this procedure?”
So — does Medicare pay for the anaesthetist?
Yes, but only partly. When you're admitted as a private patient, Medicare pays 75% of the Medicare Benefits Schedule (MBS) fee for each anaesthesia item, and your private health fund must, by law, pay at least the remaining 25%. Together that covers 100% of the MBS fee — but the MBS fee sits well below what most anaesthetists actually charge, so there's often a difference left over. That difference is the gap.
Why does the gap exist at all? The MBS unit fee was effectively frozen between 2012 and 2019 while the real cost of running a practice kept rising. To stay viable, anaesthetists charge above the MBS rate — and the government rebate hasn't caught up. The gap is the space between what an anaesthetist charges and what Medicare and your fund pay between them.
For most patients, that gap never reaches your pocket. If your anaesthetist participates in your health fund's no-gap or known-gap scheme, the fund tops up the payment and you pay either nothing or a capped amount (usually a maximum of $500). It's only when an anaesthetist doesn't use a scheme — or charges above the known-gap ceiling — that a larger bill can land.
So the real question isn't “does Medicare pay for an anaesthetist?” It's “will my anaesthetist use my fund's gap scheme?” — and that's a question you can ask before your surgery.
An anaesthetist's fee isn't a single number — it's units × dollars.
Every anaesthetic in Australia is billed under the Relative Value Guide. Four ingredients, multiplied by a per-unit dollar value.
Base units
Set by the MBS for each operation — reflects its inherent complexity.
Time units
One unit per 15 minutes for the first 2 hours, then one per 10 minutes after.
ASA modifier
Sicker patients add units (ASA 3 +1, ASA 4 +2, ASA 5 +3).
Other modifiers
Age (under 4 or 75+), emergency, after-hours, additional monitoring.
The five different “unit values” patients see fragments of on their statements:
| Reference unit | 2025–26 value | Who sets it |
|---|---|---|
| MBS schedule fee (1 basic unit) | $23.10 | Australian Government |
| Medicare rebate (75% of MBS) | $17.35 / unit | — |
| AMA recommended fee | ~$110 / unit | Australian Medical Association |
| Fund no-gap scheme rate | $36–$45 / unit | Each health fund |
| Typical anaesthetist charge | $55–$80 / unit | Each individual anaesthetist |
The “gap” is the space between the fourth and fifth rows — what an anaesthetist charges minus what their fund pays. Your fund's scheme is what closes it.
Medicare pays 75%. Your fund pays 25%. Everything else is the gap.
Medicare pays 75% of the MBS schedule fee; your fund must pay at least the other 25%. Combined that's 100% of the MBS fee — but not 100% of what the anaesthetist charges. Here's a worked example where the MBS fee is $400, the fund's no-gap threshold is $700, and the known-gap ceiling is $1,200.
| Anaesthetist charges | Medicare + fund pays | Fund top-up | You pay | Scheme |
|---|---|---|---|---|
| $400 | $400 | — | $0 | At MBS |
| $650 | $400 | $250 | $0 | No-gap |
| $800 | $400 | $300 | $100 | Known-gap |
| $1,200 | $400 | $300 | $500 | Known-gap (cap) |
| $1,300 | $400 | $0 | $900 | No scheme — full gap |
The last row is the cliff. At $1,201 the fund drops back to its 25% minimum and the gap balloons by hundreds — not by $1.
Estimate your anaesthetist gap before you say yes.
Pick your state, fund, procedure and the anaesthetist's per-unit fee. The estimator shows what Medicare and your fund will cover, what you'll likely pay, and how your fund compares to others in the same state.
Anaesthetist fee gap estimator
Estimates based on the ASA Relative Value Guide 2025. Major funds cap your out-of-pocket at $500 per anaesthetist per procedure when the anaesthetist participates in the fund's known-gap scheme.
This calculator does NOT include:
- Age modifiers (under 4 years or over 75 years of age)
- ASA physical status modifiers (for significant medical conditions)
- Emergency or after-hours surcharges
- Add-on items: arterial line monitoring, central venous catheterisation, regional or nerve blocks for postoperative pain, transoesophageal echo, and others
Your final fee may be higher than shown. Always rely on your anaesthetist's written informed financial consent.
What's included
Base units, time units, your fund's no-gap rate, and the $500 known-gap cap.
What's not
ASA modifiers, age loadings, after-hours surcharges, arterial lines and nerve blocks.
What to do next
Call your anaesthetist's rooms for a written estimate, and ask if they use your fund's scheme.
Every fund has its own gap scheme — the differences are real, but smaller than you'd think.
All major funds run two tiers: no-gap up to a threshold, known-gap up to $500 above it. The per-unit values differ — but the bigger factor is whether your anaesthetist participates at all.
HBF (WA)
Highest rate, WA members only. No-gap scheme.
NIB GapSure
Flat rate. Mandatory no-gap for procedures under 5 base units.
AHSA funds
CBHS, Defence, GMHBA, Police Health and more. $500 cap.
HCF
No-gap and known-gap. Search via the Healthshare directory.
Bupa
Discretionary per case. $500 known-gap cap.
Medibank / ahm
Same rate for no-gap and known-gap. $500 cap.
Per-unit values current at 1 November 2025 indexation. Most funds sit within a $1–$3 band. Even an anaesthetist listed in your fund's directory can choose not to use the scheme for your procedure — so the phone call to their rooms is worth more than any directory.
Your postcode predicts your gap better than your fund does.
In Tasmania, about 1 in 12 anaesthetic services attracts a gap. In the ACT, it's nearly 1 in 2.
Why your anaesthetic bill has multiple line items.
An anaesthetist bills a separate item for each major part of the case. Here's what each one is.
i. The pre-anaesthesia consultation (items 17610–17625) — your pre-op assessment, billed by duration. Each has its own EMSN cap when performed out-of-hospital:
| Item | Duration | Schedule fee | Medicare 75% | EMSN cap |
|---|---|---|---|---|
| 17610 | ≤15 min | $50.95 | $38.25 | $152.85 |
| 17615 | 16–30 min | $101.30 | $76.00 | $303.90 |
| 17620 | 31–45 min | $140.35 | $105.30 | $421.05 |
| 17625 | >45 min | $178.70 | $134.05 | $500.00 |
Schedule fees current at 1 July 2025. EMSN caps apply only to out-of-hospital consultations.
ii. The surgical anaesthesia item — each operation maps to an MBS item with its own base unit count: knee arthroscopy 4 · cataract 5 · total knee replacement 7 · caesarean section 12 · heart bypass 20.
iii. Time units (per §02), iv. ASA physical-status modifiers (items 25000 / 25005 / 25010), v. age and emergency loadings, and vi. therapeutic add-ons (arterial line, nerve blocks, intra-operative echo) each appear as separate line items.
Four ways you could be admitted — and what each one costs.
Public patient, public hospital
No anaesthetist bill. Medicare and the state hospital cover it through bilateral funding; the anaesthetist is paid by salary or VMO contract.
You pay $0 for medical feesPrivate patient, private hospital
The standard scenario this guide assumes. The 75/25 rule applies and your fund's gap scheme decides what you pay.
$0 to $500, usuallyPrivate patient, public hospital
You elect to use private cover in a public facility — choice of doctor, anaesthetist bills separately, same gap mechanics.
Possible gapUninsured (self-funded)
Medicare pays 75% of MBS, no fund top-up, and no $500 cap. You pay everything above the rebate.
Often $1,000+Not on Medicare? The other ways anaesthesia gets paid.
WorkCover
State worker's compensation. Set fee schedules differ by state. No patient gap.
DVA
Gold or White Card holders. Uses MBS plus a DVA loading. No patient gap.
TAC (Victoria)
Motor-accident-related care. TAC pays in full. No patient gap.
ADF
Serving Defence members are covered through Defence arrangements.
If your anaesthetic falls under one of these schemes, the rest of this guide doesn't apply to you — the payer covers the full bill on a defined fee schedule.
Informed Financial Consent — what you're entitled to know, before you sign.
You have a right to a written estimate of fees and likely out-of-pocket cost before surgery — with the chance to query or refuse.
Medical Board Code of Conduct
Section 4.5 requires every AHPRA-registered doctor to inform you of fees in a timely manner. It's enforceable — breach can lead to disciplinary action up to deregistration.
Gap Cover Schemes Act 2000
Where a known-gap arrangement is used, the anaesthetist is legally obliged to provide a written estimate and seek your written acknowledgement.
ASA Position Statement PS04
The profession's gold standard: a written estimate of fees and likely out-of-pocket, given before the day of surgery, with your written acceptance.
What good Informed Financial Consent includes
- The MBS item numbers that apply, and the Medicare rebate amount
- The anaesthetist's fee for each item
- Your expected out-of-pocket cost (a range is acceptable)
- A note on hospital and surgeon costs, or where to find them
- A recommendation to verify with your private health fund
- Delivered in writing, in advance — ideally at least two business days before the procedure
The Medicare Safety Net — often misunderstood, rarely useful here.
The Extended Medicare Safety Net (EMSN) pays 80% of out-of-pocket costs above an annual threshold once you cross it — $861.20 (concessional) or $2,699.10 (everyone else) in 2026, resetting each 1 January.
But most in-hospital anaesthesia doesn't count toward it. EMSN applies only to out-of-hospital services. Once you're admitted to hospital, the safety net effectively stops at the door — which is why patients who've reached their threshold are still surprised by an anaesthetist gap.
The exception is the pre-anaesthesia consultation, if it's done in the anaesthetist's rooms before admission. Those four items carry EMSN caps: 17610 $152.85 · 17615 $303.90 · 17620 $421.05 · 17625 $500.00.
Eight misunderstandings worth correcting before surgery.
Twelve questions worth asking before you say yes.
Take this to your pre-op appointments. Most anaesthetists welcome the conversation. Most patients never ask.
Ask the surgeon's office
- What out-of-pocket costs can I expect for the anaesthetist?
- Did you choose this anaesthetist for experience or availability?
- Do you work with anaesthetists who charge a lower fee?
- Could I use a different anaesthetist by moving the date or location?
Ask the anaesthetist's rooms
- Do you participate in my fund's gap scheme for this procedure?
- What's your per-unit fee, and roughly how many units will my procedure attract?
- What will I likely pay after Medicare and fund rebates?
- Will you provide written Informed Financial Consent before the procedure?
- Are there add-ons I should expect — after-hours, arterial line, nerve blocks?
- Will you bill the fund directly, or do I pay and claim back?
- Will you personally be the anaesthetist, or might a colleague substitute?
- Could you charge a lower unit price, or set up a payment plan?
You've had surgery and the bill is bigger than expected. Here's what to do.
Most billing disputes are misunderstandings, not disputes. Check the invoice line by line — each line should show an MBS item number, units billed, the rebate and the gap. If anything's missing, request an itemised invoice; you're entitled to one. Then work through these steps in order:
- Phone the anaesthetist's billing office or practice manager.
Most practices have discretion on hardship discounts. This resolves the majority of disputes.
- Contact your health fund.
They can confirm whether your anaesthetist was registered with the scheme and may re-process the claim under the gap arrangement.
- Commonwealth Ombudsman (Private Health Insurance) — 1300 362 072.
For disputes about how your fund handled the claim.
- AHPRA.
For complaints about a doctor's conduct, including a failure to provide Informed Financial Consent.
- Your state's health complaints commissioner.
HCCC (NSW), HCC (Vic), OHO (Qld) and equivalents, for other fee disputes.
Frequently asked questions about Medicare and your anaesthetist.
Fifteen questions patients actually ask — answered without sales-speak.
Does Medicare cover anaesthetist fees in a private hospital?
What is the Medicare rebate for an anaesthetist?
How much do I get back from Medicare for an anaesthetist?
Can I claim an anaesthetist on Medicare?
Are anaesthetist fees covered by Medicare?
Does Medicare cover anaesthesia in a public hospital?
What's the difference between no-gap and known-gap?
Is the $500 gap cap guaranteed?
Why is my friend's anaesthetist bill so different from mine?
Can I negotiate the anaesthetist's fee?
Can I choose my own anaesthetist?
What if my surgery was an emergency?
Why is the anaesthetic fee for a caesarean section so expensive?
What happens if my anaesthetist isn't in my fund's scheme?
Does my hospital excess cover the anaesthetist's bill?
Who wrote this, and why.
This guide is written and maintained by Fast Tracking Anaesthetic Billing Services, a specialist anaesthetic billing firm founded in 2018 and based in Bendigo, Victoria. We process anaesthesia claims for practices across Australia and have submitted more than 200,000 invoices through Medicare and the major private health funds, with a 99% first-pass acceptance rate.
Sources
- Services Australia — Relative Value Guide for anaesthesia
- MBS Online (mbsonline.gov.au)
- Department of Health — Medical Costs Finder
- PrivateHealth.gov.au — out-of-pocket costs
- Medical Board of Australia — Code of Conduct
- Health Legislation Amendment (Gap Cover Schemes) Act 2000
- Australian Society of Anaesthetists — Position Statement PS04
- AMA Fees List
- Bupa, Medibank, HCF, NIB, HBF and AHSA scheme documentation
- CHOICE — "How much will your anaesthesia cost?" (2024)
This page is general information for Australian patients seeking to understand anaesthetist fees in the private system. It is not medical, legal or financial advice and does not replace the Informed Financial Consent document you should receive from your own anaesthetist. Fund per-unit rates, MBS schedule fees, AMA recommended fees and EMSN thresholds change each year; figures are current at the review date above. If you're reading this more than 12 months after that date, verify the current rates with your fund and your anaesthetist.