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What Is the MBS Fee Schedule? How OSHC Rebates Are Calculated

What Is the MBS Fee Schedule? How OSHC Rebates Are Calculated

Published: 2026-06-11 Verified: 2026-06-11 by Editorial Desk

What Is the MBS Fee Schedule? How OSHC Rebates Are Calculated

The MBS (Medicare Benefits Schedule) is the Australian government’s list of medical services and the fees Medicare pays for them. OSHC rebates are calculated as a percentage of the MBS fee, not the amount you paid. If you visit a GP in Burwood and get charged $90, your Overseas Student Health Cover won’t look at that $90 when deciding your rebate. It looks at the MBS fee for that service — typically around $42 — and reimburses you a set percentage of that number. Everything above the MBS fee comes out of your own pocket. That’s the single biggest reason students get back less than they expected.

Key Takeaways

What Exactly Is the MBS?

The Medicare Benefits Schedule is published by the Australian Department of Health and Aged Care. It lists thousands of item numbers — each corresponding to a specific medical service, procedure, or test — and sets a government-determined fee for each. The schedule is updated at least once a year (usually in November) to account for indexation. For 2026, a level B general practitioner consultation is item 23 with a fee of $42.75. A standard specialist initial consultation is item 104, with a fee of $97.65.

Medicare uses these fees to calculate the benefit it pays Australian residents. Private insurers — including OSHC providers — also rely heavily on the MBS to determine what they’ll pay back to you.

How OSHC Uses the MBS as a Benchmark

When you hold an OSHC policy from Bupa, Medibank, Allianz Care, nib, or AHM, the insurer doesn’t promise to cover the full amount a doctor charges. It promises to cover a percentage of the MBS fee for listed services. This is the exact same structure Medicare uses for Australian citizens. The logic is that the government fee is meant to reflect a reasonable cost for the service.

Most comprehensive OSHC policies state they’ll pay “100% of the MBS fee” for GP and specialist consultations, pathology, and X-rays. Other services — like physiotherapy or dental — might not be tied to the MBS at all and instead have fixed annual limits ($300–$600 depending on the insurer). MBS is the backbone for medical out-of-hospital and in-hospital doctor visits.

Real-Life Rebate Calculations: GP and Specialist

Let’s break down two common scenarios for a student in Melbourne.

GP visit – item 23
You book an appointment at a medical centre in Carlton near the University of Melbourne. The clinic charges a private fee of $90 for a standard 15-minute consultation (item 23). The MBS fee for item 23 is $42.75.

Your insurer (say Allianz Care) pays 100% of the MBS fee — so $42.75 lands in your bank account once the claim is processed. You cover the remaining $47.25. That $47.25 is the “gap”.

Specialist initial consultation – item 104
You need to see a dermatologist in Parramatta. They charge $210 for an initial consultation. The MBS item 104 fee is $97.65. If your nib OSHC policy covers 100% of the MBS fee for specialist consultations, the rebate is exactly $97.65. You pay $112.35 out of pocket.

Some OSHC policies, especially older ones or budget-tier covers, only rebate 85% of the MBS fee. In that case, the GP rebate would be 85% × $42.75 = $36.34, leaving you with a $53.66 gap. Always check your particular policy’s Medical Benefits Schedule within the Product Disclosure Statement (PDS).

Why You Get Back Less Than You Paid: The MBS Gap

Australian medical practices are free to set their own fees, and you’ll often find that doctors charge well above the MBS rate. This is extremely common around university precincts where demand is high and appointment slots are short. The difference between what the doctor charges and what the MBS says is entirely your expense — that’s the MBS gap.

There’s no cap on the gap. A GP in Ultimo near UTS might charge $95, while one in a bulk-billing clinic in Footscray might charge exactly the MBS fee (or nothing extra for Medicare card holders, but as an international student you don’t have Medicare). If you can find a practitioner who bulk bills OSHC patients directly, you’ll pay zero gap. But that’s rare. Most clinics around Clayton (Monash) or Kensington (UNSW) charge a gap of $35–$55 for a standard consult.

UNILINK tracking data from 2025 shows that 82% of international student GP visits incurred an average gap of $42. For specialist visits, the average gap was $98.

Where to Look Up MBS Fees Yourself

Don’t rely on your insurer to tell you the MBS fee for a particular item — you can check it yourself before the appointment so there are no surprises.

Visit MBS Online (www.mbsonline.gov.au), run by the Department of Health. The site lets you search by item number or by keyword. You’ll see the current schedule fee listed next to each item. Bookmark it.

If your pathology form says “item 65070” for a blood test, you can enter it straight into MBS Online and see the $14.70 fee. Then you’ll know your insurer will pay either 100% or 85% of that, depending on your cover.

How Each Major Insurer Handles MBS Rebates

All five main OSHC providers use the MBS, but the percentage and conditions vary slightly.

All insurers process out-of-hospital claims within 5–10 business days if you lodge them via their app. Physical receipts can take up to 15 business days.

Example Walkthrough: The $90 GP Visit, MBS Item 23

You’re studying at UQ St Lucia and feel a sore throat coming on. You visit a nearby GP in Dutton Park. The practice charges $90 for a short consultation. The reception hands you an invoice with the item number 23.

You pay the full $90 at the counter, upload the receipt to the Bupa MyBupa app that evening, and the $42.75 hits your Australian bank account 5 business days later. The $47.25 is gone for good. That’s how every GP visit works unless the clinic bulk-bills OSHC directly — which is why it’s worth asking, “Do you bulk bill Allianz OSHC?” before you book.

Frequently Asked Questions

1. Can I go to any doctor I want, or do I need a referral to get OSHC rebates?
You can walk into any GP without a referral and still receive the MBS rebate. For specialist consultations, most OSHC providers still pay the MBS rebate without a referral, but actually seeing a specialist normally requires a GP referral anyway, and the specialist’s reception will ask for it.

2. What if the doctor’s fee is lower than the MBS fee?
Your insurer will only rebate the amount you actually incurred. If the doctor charges $38 and the MBS fee is $42.75, you’ll get back $38 (or 100% of the charged fee). You can’t profit from a service.

3. Do OSHC insurers apply a yearly excess to doctor visits?
For out-of-hospital GP and specialist consultations, no excess applies. The excess only kicks in if you’re admitted to hospital for treatment. Check your PDS for the exact hospital excess ($250 or $500).

4. How do I find an item number if the doctor doesn’t put it on the invoice?
Ask the clinic. The item number is mandatory for Medicare billing, but some practices forget to include it for OSHC patients. Without the item number, your insurer can’t process the claim. Phone the clinic and they’ll provide it.

5. Why does the MBS fee change from year to year?
The government indexes MBS fees on 1 November each year to keep up with the cost of healthcare. The 2026 fee for item 23 ($42.75) is a result of the 1 November 2025 indexation round.

Sources

Not personal advice. Verify with your insurer. Verified: 11 June 2026.