Medicare Benefits Schedule - Note CN.0.2

Medicare benefits are not payable in respect of a professional service where the medical expenses for the service:‑

(a)        are paid/payable to a public hospital;

(b)        are for a compensable injury or illness for which the patient's insurer or compensation agency has accepted liability. (Please note that if the medical expenses relate to a compensable injury/illness for which the insurer/compensation agency is disputing liability, then Medicare benefits are payable until the liability is accepted);

(c)        are for a medical examination for the purposes of life insurance, superannuation, a provident account scheme, or admission to membership of a friendly society; or

(d)        are incurred in mass immunisation. 

Unless the Minister otherwise directs, Medicare benefits are not payable where:

(a)        the service is rendered by or on behalf of, or under an arrangement with the Australian Government, a State or Territory, a local government body or an authority established under Commonwealth, State or Territory law;

(b)        the medical expenses are incurred by the employer of the person to whom the service is rendered;

(c)        the person to whom the service is rendered is employed in an industrial undertaking and that service is rendered for  the purposes related to the operation of the undertaking; or

(d)        the services is a health screening service. 

Benefits are not payable for items 75150 to 75621 unless the patient was referred by letter of Referral by an eligible orthodontist.

• Previous - Note CN.0.1
• Next - Note CN.0.3