How to bill for anaesthetic services — the complete guide for Australian anaesthetists in private practice.
To bill an anaesthetic in Australia, pick the anaesthesia item that matches the surgeon's MBS item. Add time units (one per 15 minutes for the first two hours, then one per 10 minutes) and modifiers such as ASA 3+ or age. Multiply by your unit rate, get informed financial consent, then claim Medicare and the patient's fund.
Written by Dr Brad Hindson, MBBS FANZCA Updated 7 May 2026
takeaways
Fees are unit-based. Base units + time units + ASA modifier + other modifiers, multiplied by your per-unit dollar rate.
Time units: 1 per 15 min for the first 2 hours, then 1 per 10 min thereafter — from start of exclusive care to PACU handover.
ASA 3 adds one unit, ASA 4 adds two, ASA 5 adds three. ASA 1 and 2 add nothing — document your reason.
Get the surgeon's MBS item in writing. Reusing the previous case's number is the error we see most on intake.
Tell patients your fee in a timely manner. That is what the Medical Board’s Code of Conduct (s. 4.5.3) asks. No law sets a number of days; good practice is a written estimate well before the day.
Outsourcing suits most anaesthetists in private practice. The rules can be learned; the time goes on follow-up. See why outsourcing anaesthetic billing is smart.
Anaesthesia billing in Australia: how a fee is calculated.
Anaesthetic billing in Australia uses a relative value system. Every fee is built from four ingredients, then multiplied by a per-unit dollar value set by your fee schedule. That value varies by anaesthetist and fee schedule (including your health-fund agreements), and the patient sees it in their informed financial consent.
- Base units — assigned to each surgical procedure under the MBS
- Time units — one for every 15 minutes of anaesthesia for the first 2 hours, then one for every 10 minutes thereafter
- Physical status modifier — +1 for ASA 3 (item 25000), +2 for ASA 4 (item 25005), +3 for ASA 5 (item 25010)
- Age modifier — +1 unit for patients under 4 (item 25013) or aged 75+ (item 25014)
- Emergency modifiers — +2 units for in-hours emergency (item 25020), or a 50% fee loading for after-hours emergency (item 25025). The two are mutually exclusive.
- Pre-anaesthesia consult — item 17610 (≤15 min, +2 RVG units) or 17615 (15–30 min, +4 RVG units). Charged at units × per-unit rate, but listed separately on the invoice and not subject to the after-hours loading.
This is the Relative Value Guide (RVG) approach — the same model used by the ASA in the United States, adapted for the Australian MBS. Most rejections come from one of these components being wrong.
From the MBS schedule for the surgical item number.
From start of exclusive care to PACU handover. 1 unit per 15 min for the first 2 hrs, then 1 unit per 10 min.
Item 25000 (ASA 3) · 25005 (ASA 4) · 25010 (ASA 5).
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Item 25013 (under 4) or 25014 (75+).
Items 25020 (in-hours, +2 units) or 25025 (after-hours, 50% fee loading on subtotal). Mutually exclusive — only one applies. The MBS after-hours window is 8pm–8am on weekdays, plus all of Saturday, Sunday and public holidays, with more than 50% of the anaesthetic time falling within that window.
Consult priced at units × your per-unit rate. Not subject to the after-hours loading.
A worked example, in writing
Take a 3-hour anaesthetic for a procedure with 5 base units, an ASA 3 patient, no age or emergency modifier, at $80 per unit:
- Base units: 5
- Time units: 14 (8 for the first 2 hours at one per 15 minutes, then 6 for the last 60 minutes at one per 10 minutes)
- ASA 3 modifier: +1 (item 25000)
- Total: 20 units × $80 = $1,600
Add a pre-anaesthesia consult under item 17610 (+2 units) and the invoice shows a separate $160 line, for $1,760 in total. Your own base units come from the anaesthetic item that matches the surgeon's MBS item, and your unit rate from your fee schedule and fund agreements.
What is the RVG unit rate in Australia?
There is no single RVG unit rate — each anaesthetist sets their own. At 1 November 2026 the MBS values one unit at $23.70, and Medicare pays $17.80 of that for an in-hospital service. Health fund gap schemes pay about $39 to $45 a unit, and the AMA fee is $110 a unit.
| Payer or schedule | Per unit | What it means |
|---|---|---|
| MBS schedule fee | $23.70 | The Medicare Benefits Schedule value of one unit. Unchanged in the 1 November 2026 MBS; indexed each 1 July. |
| Medicare benefit, in hospital (75%) | $17.80 | What Medicare pays per unit for a private in-hospital service. |
| AHSA Access Gap Cover | $39.60 $38.60 in WA | Shared by the AHSA member funds (including GMHBA, CBHS, Defence Health, and HBF outside WA). |
| Bupa Medical Gap Scheme | $39.25 | Total paid per unit, Medicare plus fund, when you bill through the fund’s scheme. Known gaps are capped at $500. |
| Medibank GapCover | $39.15 | |
| nib MediGap | $39.14 | |
| HCF Medicover | $39.10 | |
| St.LukesHealth | $40.75 | |
| nib GapSure | $45.00 | Highest scheme rate, but procedures under 5 base units must be billed with no gap. |
| AMA List of Medical Services and Fees | $110.00 | The AMA fee, indexed each 1 November. Billing above the scheme rates means billing outside the gap scheme. |
Fund figures are per-unit equivalents taken from each fund’s published anaesthesia schedule (checked July 2026); they vary slightly from item to item. HBF in WA runs its own no-gap schedule. Rates checked by Dr Brad Hindson, MBBS FANZCA, against the MBS file effective 1 November 2026.
Your own rate is a business decision: billing at a scheme rate keeps patients out of pocket by nothing or by a capped known gap, while billing nearer the AMA fee means a larger gap and a clearer informed financial consent conversation. Our pricing page shows what we charge to run it for you.
ASA scores in anaesthesia and when they add billing units.
ASA scores classify the patient's preoperative physical status. Only ASA 3 and above add billing units — but the classification has to be defensible in your record, because health funds increasingly request supporting notes.
Worked case: A 67-year-old with obstructive sleep apnoea, type 2 diabetes and hypertension presenting for total hip replacement is appropriately ASA 3, provided those comorbidities materially affect perioperative risk — and provided that's stated in your record.
Anaesthesia time units — start to handover.
Anaesthesia time has its own set of MBS rules, and they're not what most registrars assume. Under the MBS rules, time is counted at two rates depending on case length, and the start and end points are tightly defined.
The two-tier rule
- First 2 hours: 1 time unit per 15 minutes (or part thereof)
- Beyond 2 hours: 1 time unit per 10 minutes (or part thereof)
So a 3-hour case isn't 12 units — it's 14 (8 units for the first 2 hours, then 6 more for the remaining 60 minutes at 1/10). A 5-hour case isn't 20 units — it's 26 (8, then 18 for the last three hours — MBS item 23220). Calculators that use a flat 1/15 rule silently underbill every case longer than 2 hours.
When time starts and ends
Per MBS, anaesthesia time begins when the anaesthetist commences exclusive and continuous care of the patient, and ends when the patient is safely placed under the supervision of other personnel. In practical terms, that's:
- Pre-oxygenation, induction, line placement and regional blocks performed by you
- The surgical anaesthetic itself
- Emergence from anaesthesia
- PACU handover until clinical responsibility transfers to recovery staff
The most common time-unit error is under-recording — particularly the pre-induction and handover windows. Both are billable, both are routinely missed, and across a year that's a meaningful number of units left uncounted.
Choosing the right MBS item number for the procedure.
Each surgical procedure maps to a corresponding anaesthetic item number under the Medicare Benefits Schedule, which determines your base unit count. Get the item wrong and the whole calculation is wrong — even if your time and ASA were correct.
The two-step rule
- Get the surgeon's MBS item number for the operation, in writing where possible
- Match it to the corresponding anaesthetic item number from the MBS schedule
The pitfall almost everyone falls into early in private practice is reusing the previous case's item number because the surgeries look similar. They're often not. A laparoscopic cholecystectomy and an open cholecystectomy attract different anaesthetic items, even though both target the gallbladder — the difficulty (and therefore the base unit value) is materially different. If you're not certain, ask the surgeon's room before the list, not after the fact.
Getting consent for the fee.
Before an elective case, the patient needs your fee and their likely out-of-pocket cost. The Medical Board’s Code of Conduct (section 4.5.3) asks doctors to make sure patients are informed about fees and charges “in a timely manner”, so they can decide whether to proceed. No law sets a number of days. Good practice is a written estimate, well before the day, in line with ASA PS04 Informed Financial Agreement. For the anaesthetists we bill for, IFC goes to the patient 7 days before surgery.
Where claims go wrong.
Most lost anaesthetic revenue isn’t a dramatic rejection. It’s small errors repeated every list: the wrong item number reused from the previous case, an ASA 3 or 4 modifier left off, pre-induction and handover time not recorded, items lodged out of order, and rejected claims nobody follows up. Each has a simple habit that prevents it. Our billing mistakes guide sets out the rule behind each one and a monthly self-check.
Billing in public versus private settings.
Anaesthetic billing rules are different depending on where the case is performed and how the patient is admitted — and this is one of the trickier areas for anaesthetists who split their week.
Public hospitals
Standard public-hospital cases generally aren't separately billable — you're paid through your VMO contract or salary. The exception is a privately admitted patient in a public hospital, where billing is permitted and expected, provided the patient was formally booked as private with their own cover.
Private hospitals
You must provide IFC. You bill either the fund (under no-gap or known-gap arrangements), Medicare directly, or the patient — depending on the scheme you've signed up to. If you've registered with health-fund schemes, you're bound by their out-of-pocket caps and rules; many anaesthetists don't realise they've inadvertently breached a no-gap rule by charging a higher fee than the scheme allows.
Mixed environments
The most common error in mixed work is billing a public-admitted patient privately. Always confirm admission status before lodging anything — the hospital admissions office is the source of truth, not the theatre list.
Should you do your own anaesthetic billing — or delegate it?
Outsourcing suits most anaesthetists in private practice. You can do it yourself — the unit maths is straightforward — but most of the work is in lodging, reconciling and following up, not the calculation. We set out the case in why outsourcing anaesthetic billing is smart.
The mistakes outlined above don't show up as missing money — they show up as rejected claims, downcodes and quiet under-billing that compound silently. That is where a professional billing service earns its fee: consistent modifier capture and weekly follow-up of rejected claims.
A professional anaesthetic billing service handles:
- Correct MBS item selection for every case
- Time-unit and modifier capture
- IFC drafting, sending and storage
- Claim lodgement to Medicare, funds and DVA
- Weekly follow-up of rejected and queried claims
- Patient invoicing, follow-up and reconciliation
- Individual monthly reporting for each anaesthetist
Frequently asked questions about anaesthetic billing.
What is the RVG unit rate in Australia?
There is no single RVG unit rate; each anaesthetist sets their own. At 1 November 2026 the MBS values one unit at $23.70, and Medicare pays $17.80 of that for an in-hospital service. Health fund gap schemes pay about $39 to $45 a unit, and the AMA fee is $110 a unit. See the rates by payer.
How is the anaesthetic Relative Value Guide (RVG) calculated?
The RVG fee is built from four components: base units (assigned per surgical procedure), time units (one per 15 minutes for the first 2 hours, then one per 10 minutes thereafter, rounded up), physical status modifiers (+1 for ASA 3, +2 for ASA 4, +3 for ASA 5), and other modifiers — +1 for patients under 4 or aged 75+, +2 units for in-hours emergency, or a 50% fee loading for after-hours emergency (mutually exclusive). The total unit count is multiplied by the per-unit dollar value set by your fee schedule. Try the calculator above to work out a specific case.
How much does anaesthesia cost per minute in Australia?
Anaesthesia is billed in time units, not minutes — and the rate steps up after 2 hours. For the first 2 hours, you get one unit per 15 minutes; beyond 2 hours the rate becomes one unit per 10 minutes, so the per-minute cost rises. The unit value itself varies by anaesthetist and fee schedule, and the patient’s informed financial consent sets out the actual fee. As an example only, at $80 per unit that works out to about $5.33 per minute for the first 2 hours and $8 per minute after that. Base units are charged on top of time at the same rate (base units × your unit rate), regardless of how long the procedure takes: at the same example rate, a procedure with 5 base units adds $400. See the worked example for a full case.
What is the difference between ASA 3 and ASA 4?
ASA 3 is a patient with severe systemic disease that limits activity but is not incapacitating — controlled diabetes with end-organ effects, COPD, severe obesity. ASA 4 is severe systemic disease that is a constant threat to life — recent MI, ongoing cardiac ischaemia, severe respiratory failure. ASA 3 adds one billing unit (item 25000); ASA 4 adds two (item 25005). ASA 5 (moribund, not expected to survive 24 hours) adds three (item 25010).
Do anaesthetists need informed financial consent?
Yes. The Medical Board of Australia’s Code of Conduct (section 4.5.3) asks doctors to make sure patients are informed about their fees and charges in a timely manner, so they can decide whether to proceed. No law sets a number of days. Good practice is a written estimate, well before the day; Fast Tracking sends IFC to patients 7 days before surgery. Our informed financial consent guide covers what to include and when.
What MBS item number do I use for anaesthesia?
There isn’t one anaesthesia item number — there are hundreds. Each surgical procedure has a corresponding anaesthetic MBS item with its own base-unit count. Get the surgical item number from the surgeon’s rooms in writing, then match it to the corresponding anaesthetic item in the MBS schedule. Don’t reuse the previous case’s number even if the surgeries look similar.
Can I bill a patient privately in a public hospital?
Only if the patient was formally admitted as a private patient with their own private health cover or election. Patients in public beds under the public system aren’t billable, even if the surgery is identical. The hospital’s admissions office is the source of truth on admission status — not the theatre list.
How long does it take to learn anaesthetic billing properly?
The mechanics — base units plus time plus ASA — can be picked up in an afternoon. The hard part is the long tail: which items pair with which procedures, which fund schemes you’re signed up to and what their no-gap caps are, how to write an appeal that gets a downcode reversed, and what to actually say in an IFC. That takes time and repetition in private practice.
Want your anaesthetic billing done for you?
Send us a message or book a quick call. We'll show you what your billing would look like with Fast Tracking — at no cost, no obligation, and no high-pressure sales process. You'll talk to a real person, not a sales agent.
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