Medicare Benefits Schedule - Note CN.0.2

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Where Medicare Benefits are not Payable

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.


  • Assist - Addition/Deletion of (Assist.)
  • Amend - Amended Description
  • Anaes - Anaesthetic Values Amended
  • Emsn - EMSN Change
  • Fee - Fee Amended
  • Renum - Item Number Change (renumbered)
  • New - New Item
  • NewMin - New Item (previous Ministerial Determination)
  • Qfe - QFE Change