We aim to be upfront about costs. Your total cost for surgery can include separate fees from the hospital, anaesthetist, pathology and imaging providers (depending on what you need).
Quick answers
Do I need a GP referral?
Usually, yes. A valid referral is generally required to claim Medicare benefits for specialist consultations. Referrals from a GP Specialist last 12 months from when they were first used. Referrals from non-GP specialists last 3 months from when they were first used.
Will I get a Medicare rebate?
Usually, yes (when you have a valid referral and the consultation is eligible for Medicare).
Does private health insurance cover my consultation?
Private health insurance generally does not cover outpatient specialist consultation fees. It may cover hospital admission costs depending on your level of cover and excess.
Can you give me an estimate before I book?
Yes. If you tell us the reason for referral and where you want to be seen, we can provide an estimate of likely out-of-pocket costs.
You can also use the Australian Government’s Medical Costs Finder to understand typical costs across Australia (as a guide only).
Consultation fees and Medicare rebates
Medicare rebates for specialist attendances are based on the Medicare Benefits Schedule (MBS). For out-of-hospital appointments (e.g. consulting rooms), the medicare benefit is typically 85% of the MBS schedule fee.
Initial specialist consultation — MBS item 104
This is generally the first appointment in a course of treatment after referral.
- Medicare benefit (out-of-hospital, 85%): $86.15
Reference: MBS Item 104 (official).
Subsequent specialist consultation — MBS item 105
This is generally a follow-up appointment in the same course of treatment.
- Medicare benefit (out-of-hospital, 85%): $43.35
Reference: MBS Item 105 (official).
What is the “gap” (out-of-pocket cost)?
Your out-of-pocket cost is usually:
Practice fee − Medicare rebate = out-of-pocket cost.
If you’d like, our team can provide an estimate before booking.
If you’re likely to have multiple out-of-hospital services in a calendar year, you may also want to read about the Medicare Safety Net.
Procedure and test costs
Many urology procedures involve multiple billers. Depending on what’s done and where, you may receive separate accounts from:
- Our practice (urologist fees)
- Hospital (admission/theatre costs; day stay vs overnight; devices/implants if relevant)
- Anaesthetist
- Pathology (e.g., biopsy specimens)
- Radiology (e.g., CT, MRI)
What we do to keep this predictable
- For planned procedures, we can usually provide a written estimate of our practice fees.
- We’ll also flag which other providers commonly bill separately so you can check likely costs in advance.
Private health insurance (when it matters)
Private health insurance usually matters most for hospital admissions, not clinic visits.
If you’re having a procedure in a private hospital, your likely variables include:
- your policy excess/co-payment
- whether the hospital and anaesthetist participate in your insurer’s “known gap/no gap” arrangements
- whether an implant/device is involved (for some procedures)
Useful reference: PrivateHealth.gov.au — medical gap payments.
Cancellations and payments
- Payment is usually required on the day of your consultation unless arranged otherwise.
- If you need to cancel or reschedule, please give as much notice as possible so we can offer the appointment to another patient.
Questions?
If you contact our team with your referral reason (or the GP letter), your preferred location (Prince of Wales Private Hospital / Chris O’Brien Lifehouse), and whether you have private health insurance, we can usually give a clear estimate of what to expect.