Fees for non-admitted patients
Where an eligible person receives public hospital services as a public patient no charges will be raised, except for the following services provided to non-admitted patients:
- dental services
- spectacles and hearing aids
- surgical supplies
- prostheses – however, this does not include the following classes of prostheses, which must be provided free of charge:
- artificial limbs
- prostheses which are surgically implanted, either permanently or temporarily or are directly related to a clinically necessary surgical procedure
- external breast prostheses funded by the National External Breast Prostheses Reimbursement Program
- other services as agreed between the Commonwealth and Victoria
Upon an admitted patient separation, a health service may raise fees for:
- pharmaceuticals at a level consistent with the Pharmaceutical Benefits Scheme statutory co-payments
- aids, appliances and home modifications
MBS arrangements for funding of MRI apply to public and private non-admitted patients (eligibility conditions apply). Information is available at Improving access to Magnetic Resonance Imaging (MRI) Services factsheet.
Dental fees
The Dental Health Program funding model is activity-based, using the Australian Dental Association service item codes, rather than courses of care. Performance is measured in terms of Dental Weighted Activity Units (DWAU), calculated using weighted Australian Dental Association item codes.
Funding is aligned to DWAUs to ensure that state activity targets are met.
Participation in Commonwealth initiatives
The Child Dental Benefits Schedule is a means-tested benefit scheme (Family Tax Benefit-A) for children ages 2–17, covering preventative and basic dental treatment.
Eligible children have access to a benefit cap of $1,000 over a two-calendar-year period. A three-year extension to public sector access to the Child Dental Benefits Schedule until 31 December 2022 was announced in the 2019–20 Commonwealth Budget.
Dental Health Program fees policy
Fees for public dental services apply to:
- people 18 years old and over who are Health Care or Pensioner Concession Card holders or dependents of concession card holders
- children from birth to 12 years who are not Health Care or Pensioner Concession Card holders and are not dependents of concession card holders.
Further information on the policy, including a fees schedule and exemptions, is available at dental health.
Refer also Department of Health and Human Services policy and funding guidelines
Pharmaceutical fees
Health services are required to provide pharmaceuticals at no charge to their admitted public and private patients. Health services participating in the programs outlined below can access reimbursements for pharmaceuticals and charge patient co-payments, where applicable.
Pharmaceutical reform
Pharmaceutical reforms are designed to make it safer, easier and more convenient for patients to receive adequate medication, and to bring public health services onto a more equal footing with private hospitals.
Health services participating in the Pharmaceutical Reform Agreement have access to the Commonwealth-funded Pharmaceutical Benefits Scheme and the Repatriation Schedule of Pharmaceutical Benefits for non-admitted and admitted patients on discharge, as well as a Commonwealth-subsidised list of pharmaceuticals for same-day admitted patients requiring chemotherapy. These health services are required to incorporate the Australian Pharmaceutical Advisory Council’s guidelines into their practice to achieve the continuum of quality use of medicines between the health service and the community.
Find out more.
Refer also Department of Health and Human Services policy and funding guidelines Volume 2: Health operations, Chapter 2
Non-admitted compensable patient fees (WorkSafe)
These fees are revised annually in agreement with WorkSafe. Refer to the drop down list section below for the fee schedule for allied health and medical services.