What is actually being proposed?
Record the procedure, appointment or test name, the clinical setting and any service code you have.
Core AU · Medical Costs Finder · MBS · PBS · ClinicalAtlas AU
Understand the whole cost pathway, not just one number.
Start with the service you are considering, then separate the Medicare item, provider fee, private-cover position and medicine costs. Compass keeps those layers connected without pretending they are the same thing.
Start with what you know
You do not need the whole answer before you begin.
Choose the entry point that matches the information already in front of you.
01
I know the procedure or service
Search the government-derived procedure catalogue by name, category or service code.
Find the service → 02I have an MBS item number
Check the Medicare descriptor, schedule fee and benefit fields in the Core AU MBS layer.
Search MBS → 03I am checking a medicine
Search the current cached PBS schedule by medicine, item code or programme.
Search PBS → 04I need to prepare for a quote or appointment
Organise the service, provider, MBS items, medicines and private-cover questions before you consent.
Prepare the questions →The cost pathway
One episode of care can touch several different systems.
This is the part people often have to reconstruct themselves. Compass keeps each layer separate, then shows how to move between them.
Which MBS item numbers are expected?
The MBS describes Medicare services and reference benefits. One treatment episode can involve several MBS items.
What will each provider charge?
The doctor's actual fee can differ from the MBS schedule fee. Ask for a written estimate and identify other clinicians involved.
What will the health fund and hospital cover?
For private hospital care, check the hospital agreement, excess, exclusions, waiting periods and known-gap or no-gap arrangements.
Are medicines part of the pathway?
PBS listing, restrictions and patient contributions are a separate layer from MBS services and provider fees.
What do you need before you consent?
Bring the service name, likely MBS items, medication list, fund details and questions together before relying on a cost estimate.
Working principle: Cost navigation should help you ask better questions and preserve a reliable record. It should not decide which treatment or clinician is right for you.
The information on the Medical Costs Finder is a guide only and should not be used as a quote or medical diagnosis. Provider charges, Medicare benefits, hospital costs, private-health benefits and PBS rules are separate questions and can change independently.
Safety Nets & concessions
Medicare Safety Nets are not the PBS Safety Net.
Core AU keeps medical-service thresholds and medicine thresholds separate so the correct rule is applied.
OMSN
Original Medicare Safety Net
2026 threshold $594.4. 100% of the MBS schedule fee for eligible out-of-hospital services.
Official threshold → EMSN_GENERALExtended Medicare Safety Net — General
2026 threshold $2699.1. 80% of eligible out-of-pocket costs, subject to EMSN benefit caps where they apply.
Official threshold → EMSN_CONCESSIONAL_FTBAExtended Medicare Safety Net — Concessional and Family Tax Benefit Part A
2026 threshold $861.2. 80% of eligible out-of-pocket costs, subject to EMSN benefit caps where they apply.
Official threshold → PBSPBS Safety Net
2026: $277.2 concession · $1748.2 general.
Official PBS thresholds →Greatest Permissible Gap: $104.5 from 2025-11-01. For affected items, the Medicare benefit is the schedule fee less the GPG amount rather than simply 85% of the schedule fee.
Core AU source health
3/3 connected health sources healthy.
Medicare Benefits Schedule
6046 indexed rows
Pharmaceutical Benefits Scheme
14964 indexed rows · PBS schedule 4333
Medical Costs Finder
155 procedures · 5 dated snapshots
Prepare before the appointment or quote
Bring the information together before you ask “what will this cost me?”
This uses the same human-centred navigation idea behind Sentrix's condition-specific work: organise the evidence and questions so the next conversation is more useful.
Useful to have in front of you
- Referral or specialist letter, if you have one.
- The exact procedure, test or appointment name.
- Any MBS item numbers or Medical Costs Finder service code already supplied.
- A current medication list and PBS item code if a medicine cost is part of the question.
- Private health insurer and product details for planned private treatment.
- A short list of questions: provider fee, Medicare benefit, hospital charge, other clinicians, likely out-of-pocket amount and what could change the estimate.
Clinician pathway
Which type of clinician is involved?
83 AU clinician roles mapped in ClinicalAtlas AU, with AHPRA context.
Private cover
Health-fund directory
32 curated fund entries; verify current cover with the fund and official comparison sources.
Medicines
PBS schedule search
14964 cached item rows.
Medicare services
MBS item search
6046 ingested item records.
Condition pathways
Connect the condition to access and cost
ClinicalAtlas AU links condition pathways to MBS services, PBS medicines, medicine scheduling and Medical Costs Finder records. Sleep-wake pathways are the first live example.
Decision support
Questions to ask before consent
Use the structured government cost guide to prepare provider, hospital, Medicare and private-cover questions before relying on an estimate.
Procedure catalogue
Find the service before you compare the numbers.
Search by procedure, service code or description, or browse the Medical Costs Finder clinical categories.
19 results
Open a procedure to see the decision path and live government cost link.
Breast surgery (medically necessary)
H98
Axilla lymph node biopsy (armpit) with or without excision in the setting of breast cancer
A procedure to remove a piece of lymph tissue from the armpit. The tissue is tested for cancer cells.
Open procedure pathway →
Breast surgery (medically necessary)
H126
Bilateral mastectomy for gynecomastia
Surgery to remove excessive breast tissue in a male (not due to obesity). This may include liposuction.
Open procedure pathway →
Breast surgery (medically necessary)
H128
Bilateral removal of breast prosthesis and capsulectomy
Surgery to remove a breast implant or breast tissue expander. Any tissue removed is sent for testing. This is often performed on both breasts. This procedure does not apply when a breast implant is re-inserted.
Open procedure pathway →
Breast surgery (medically necessary)
H24
Breast biopsy
A procedure where a sample of tissue is taken from the breast. The tissue is tested for abnormal cells.
Open procedure pathway →
Breast surgery (medically necessary)
H95
Breast reconstruction using prosthesis and muscle flap
A breast reconstruction using a local muscle and skin flap from the back to cover a permanent implant and reconstruct a single breast. This can be done at the same as a mastectomy, or as a separate procedure after the breast has been removed.
Open procedure pathway →
Breast surgery (medically necessary)
H97
Breast reconstruction with removal of tissue expansion unit and insertion of prosthesis
The second of two surgeries to reconstruct one breast. The specialist will remove the tissue expander and insert a permanent implant to recreate the breast. This surgery follows 3 to 6 months after the service “Breast reconstruction with tissue expansion”.
Open procedure pathway →
Breast surgery (medically necessary)
H182
Breast reconstruction with removal of tissue expansion unit and insertion of prosthesis (double)
The second of two surgeries to reconstruct both breasts following mastectomy. This surgery follows 3 to 6 months after the service “Breast reconstruction with tissue expansion (double)”. The specialist will remove the tissue expanders and insert permanent implants to recreate the breasts.
Open procedure pathway →
Breast surgery (medically necessary)
H96
Breast reconstruction with tissue expansion
The first of two surgeries to recreate one breast. At the same time as, or after a mastectomy, the specialist inserts an expandable/empty breast implant. They inflate the expander over 6-8 weeks, until it reaches the size you both agree on. Once ready, the expander is replaced with a definitive implant. The procedure is followed 3-6 months later with “Breast reconstruction with removal of tissue expansion unit and insertion of prosthesis”.
Open procedure pathway →
Breast surgery (medically necessary)
H183
Breast reconstruction with tissue expansion (double)
The first of two surgeries required to reconstruct both breasts following mastectomy. This surgery can be completed at the same time as a mastectomy or separately at a later time. The specialist inserts an expandable tissue implant under the skin after removing the breast. An expandable tissue implant is a deflated balloon which the surgeon will inflate about 3-6 times. After about 6 to 8 weeks, it will reach the breast size agreed with surgeon. The second of two surgeries occurs about 3 to 6 months later. It is called “Breast reconstruction with removal of tissue expansion unit and insertion of prosthesis (double)”.
Open procedure pathway →
Breast surgery (medically necessary)
H122
Breast reduction
Surgery to make the breasts smaller for medical purposes only. It also involves repositioning of the nipple.
Open procedure pathway →
Breast surgery (medically necessary)
H185
Breast tumour excision - lumpectomy (cancerous) with breast reshaping
Surgery to cut out a cancerous growth of the breast (lumpectomy). During the surgery, the breast is also re-shaped.
Open procedure pathway →
Breast surgery (medically necessary)
H137
Excision of breast tumour/lumpectomy (cancerous)
Surgery to cut out a cancerous growth of the breast (lumpectomy). You may need an ultrasound or mammogram on the day of surgery to help the surgeon find your tumour, if they cannot feel a lump. The whole tissue is sent for testing (biopsy).
Open procedure pathway →
Breast surgery (medically necessary)
H23
Excision of breast tumour/lumpectomy (non-cancerous)
Surgery to cut out a non-cancerous growth of the breast (open biopsy or excision of benign lesion) which is up to 50 mm in size. This includes benign lesions such as fibroadenomas.
Open procedure pathway →
Breast surgery (medically necessary)
H113
Lymph nodes axilla excision
Surgery to remove the lymph nodes in the armpit (axilla). This procedure is often performed with other breast operations. The addition surgeries may include removal of the breast or removal of a cancerous growth in the breast and incur separate fees.
Open procedure pathway →
Breast surgery (medically necessary)
H180
Nipple sparing mastectomy and breast reconstruction with prosthesis
Surgery to remove all breast tissue from one breast keeping the nipple (mastectomy). A sample of the tissue is sent for testing (biopsy). This is followed by an immediate breast reconstruction to recreate the breast using a permanent implant. This is where the same doctor performs all the surgery. If the breast removal and the breast reconstruction are done by separate doctors, then they incur separate fees.
Open procedure pathway →
Breast surgery (medically necessary)
H181
Nipple sparing mastectomy and breast reconstruction with prosthesis (double)
Surgery to remove all breast tissue from both breasts keeping the nipples (mastectomy). A sample of the tissue is sent for testing (biopsy). This is followed by an immediate breast reconstruction to recreate the breasts using permanent implants. This is where the same doctor performs all the surgery. If the breast removal and the breast reconstruction are done by separate doctors, then they incur separate fees.
Open procedure pathway →
Breast surgery (medically necessary)
H22
Total mastectomy
Surgery to remove an entire single breast (mastectomy). This includes removal of skin and nipple.
Open procedure pathway →
Breast surgery (medically necessary)
H184
Total mastectomy (double)
Surgery to remove both breasts (mastectomy). This includes removal of skin and nipple resulting in a flat chest wall.
Open procedure pathway →
Breast surgery (medically necessary)
H21
Unilateral breast reduction
Surgery to make one breast smaller and to change the position of the nipple. This is a reduction mammoplasty. The surgery is usually done on the non-cancerous breast so that it is more symmetrical with the reconstructed breast. This procedure can be done at the same time as the mastectomy or at a later date.
Open procedure pathway →Historical Medical Costs Finder data
Selected dated snapshots for sleep-related services.
Preserved with their source period for comparison and research. They are not current quotes.
2023-24
Q11003MBS 11003 · OH
89% no out-of-pocket cost · typical patient cost $190 · high $395
Open source-period record ↗2023-24
H55MBS 12203 · IH
96% no out-of-pocket cost · typical patient cost $20 · high $120
Open source-period record ↗2023-24
Q12203MBS 12203 · OH
67% no out-of-pocket cost · typical patient cost $225 · high $385
Open source-period record ↗2023-24
Q12250MBS 12250 · OH
86% no out-of-pocket cost · typical patient cost $150 · high $238
Open source-period record ↗2023-24
Q12254MBS 12254 · OH
62% no out-of-pocket cost · typical patient cost $363 · high $553
Open source-period record ↗Questions before consent
Know what each number means before comparing it.
Core AU structures the official Medical Costs Finder guidance into decision prompts and questions to ask.
Core concepts
Fees, out-of-pocket costs and bulk billing
A provider fee is the amount charged for a medical service. An out-of-pocket cost is the part the patient ultimately pays after applicable Medicare or insurer contributions. With bulk billing, the provider bills Medicare directly and accepts the Medicare benefit as full payment for that service, so the patient has no out-of-pocket cost for that service.
Before specialist care
Start with your GP and understand the referral
The guide positions the GP as a starting point for discussing health needs and referrals. Specialist fees can vary by clinician and location, and patients can discuss referral options when cost, location, waiting time or other preferences matter.
Treatment setting
Public and private treatment can produce different costs
The guide distinguishes public-patient hospital care, private hospital treatment and out-of-hospital private treatment. The treatment setting changes who may pay and which costs can remain with the patient.
Choosing care
Compare specialists on more than price
The guide suggests considering field of practice, location, accessibility and waiting time, cost, and communication or compatibility when discussing specialist options.
Before agreeing to treatment
Get informed financial consent
Before treatment, the guide recommends understanding the proposed treatment and approximate costs. That includes asking for written estimates and identifying Medicare, insurer and other-provider contributions before agreeing to treatment.
Insurance
Ask your private health insurer what the policy will actually pay
Private health insurance can affect hospital and specialist costs, but cover depends on the policy and treatment. The guide recommends checking benefits, waiting periods, excesses or co-payments and gap arrangements directly with the insurer.
Direct official lookup
Already have a Medical Costs Finder service code?
Open lookup ↓
Direct official lookup
Already have a Medical Costs Finder service code?
Use this only when you already have the government service code. Compass hands the request to the current Medical Costs Finder rather than storing a static indicative fee.
Government resources
Useful context beyond the fee table.
Source trail
Keep the authority visible.
Compass organises the journey; the current government schedules, provider quote and insurer response remain the sources you rely on for an actual decision.