Billing
Billing and the gap
How a private bill splits between Medicare, the fund and the patient.
Medicare pays a share of the MBS schedule fee. There is no cap on what a doctor charges. Whatever Medicare and the fund don’t pay is the gap.
A fee, split
Specialists and GPs billing privately
Fill in your details above to see your result.
Schedule fees from 1 July 2026. Source: MBS Online; privatehealth.gov.au.
Gap cover, bulk billing and provider numbers
Anyone billing Medicare
- Out of hospital, Medicare pays 85% of the schedule fee, or 100% for GP items. In hospital it pays 75%, and the patient’s fund at least 25% if the policy covers the item.
- No-gap: charge at or under the fund’s schedule and the patient pays nothing. Known gap: the patient pays a capped amount, such as up to $500 a doctor at Bupa.
- Bulk billing means taking the Medicare benefit as the whole fee, with no other charge. From 1 November 2025 a practice that bulk bills every eligible patient and is registered for MyMedicare gets 12.5% of those benefits on top, split with the GP.
- Once a patient’s out-of-pocket costs pass $2,699.10 in 2026, or $861.20 with a concession, Medicare pays up to 80% of further costs out of hospital, capped for some items.
- Patients can ask for a written estimate, with the item numbers, before treatment.
- You need a provider number for each place you practise. Services Australia takes up to 28 days to issue one.
Source: MBS Online, notes GN.7.17 and GN.10.27; Bupa; privatehealth.gov.au; Services Australia, September 2026.
What to know
What we do
- Split a fee between Medicare, the fund and the patient, from the published schedule
What we don’t
- Set your fees or say how to bill
NDIS providers
NDIS work as an allied health sole trader.
The NDIS pays for supports in a participant’s plan. How the plan is managed decides whether you must be registered. The NDIS sets a maximum hourly price for each therapy.
Hourly price limits, 2026–27
Therapy supports, from 1 July 2026
| Therapy | An hour | Change |
|---|---|---|
| Psychology | $252.99 | Up from $232.99 |
| Occupational therapy | $193.99 | Unchanged |
| Speech pathology | $193.99 | Unchanged |
| Podiatry | $188.99 | Cut from $193.99 on 1 July 2025 |
| Physiotherapy | $183.99 | Cut from $193.99 on 1 July 2025 |
| Dietetics | $178.99 | Down from $188.99 |
| Exercise physiology | $161.99 | Down from $166.99 |
National limits; remote and very remote areas are higher. Source: NDIS Pricing Schedule 2026–27, as reported by the professional associations. Check the schedule itself.
Registered or not
Physiotherapists, OTs, speech pathologists, psychologists and more
- Plans the NDIA manages pay registered providers only, through the provider portal. Participants who manage their own plan, or use a plan manager, can also use unregistered providers.
- Registering means an audit: a desktop verification audit for lower-risk supports, or a certification audit with a site visit for higher-risk ones. The auditor sets the fee.
- An NDIS Worker Screening Check lasts 5 years and works across Australia. It costs $112 in NSW, $139.20 in Victoria and $161.30 in Queensland.
- A support is GST-free when it is in the participant’s plan, under a written agreement and covered by the NDIS rules. Supports beyond what the plan sets are not.
- Payment requests on NDIA-managed plans are due within 90 days of the service booking ending; valid claims are usually paid in 2 to 3 business days.
Source: NDIS; NDIS Quality and Safeguards Commission; Service NSW, Victorian and Queensland worker screening, September 2026; ATO.
What to know
What we do
- Keep your NDIS screening check and registration dates
What we don’t
- Say whether to register with the NDIS