It is important to know when Medicare benefits are not applicable. Full details are provided at https://www9.health.gov.au/mbs/fullDisplay.cfm?type=note&q=GN.13.33&qt=noteID. Here is a summary
- Non-Covered Medical Services:
- Telephone consultations are generally excluded, except for COVID-19 telehealth services.
- Repeat prescriptions are not covered if the patient doesn’t visit the clinic.
- Group attendances are generally not covered unless specifically mentioned.
- Non-therapeutic cosmetic surgery and euthanasia-related services do not attract benefits.
- However, counselling related to euthanasia is covered.
- Exclusions Based on Funding or Liability:
- Services in public hospitals or covered by other insurers (like compensation for injuries) are not eligible for Medicare benefits.
- Services provided for compensable injuries or illnesses are excluded when liability is accepted by an insurer.
- Medical examinations for insurance, employment, or legal purposes, and mass immunizations are also excluded.
- Specific Treatment Exclusions:
- Treatments such as chelation therapy (except for heavy-metal poisoning), obesity management using specific hormones, and hyperbaric oxygen therapy for multiple sclerosis are not covered.
- Other notable exclusions include tattoo removal, certain organ transplants, and experimental therapies like microwave cancer therapy.
- Pain Management Post-Operation:
- Procedures related to pain pumps, such as cannulation, catheterization, and reservoir refilling post-operation, are not covered.
- Specific Non-Medicare Services:
- Services provided concurrently with certain procedures like blood product injections, stem cell therapies, and a list of specified surgeries and treatments are excluded.
- Health Screening Services:
- Routine health screenings are typically not covered unless deemed medically necessary.
- Listed exclusions are:
- multiphasic health screening;
- mammography screening except as provided for in Items 59300/59303;
- testing of fitness to undergo physical training program, vocational activities or weight reduction programs;
- compulsory examinations and tests to obtain a flying, commercial driving, diving or other licence;
- entrance to schools and other educational facilities;
- for the purposes of legal proceedings;
- compulsory examinations for admission to aged persons’ accommodation.
- Exceptions include:
- screenings as part of standard medical practice,
- national health initiatives,
- private driver’s licencing,
- occupational exposure screening,
- job-related needs for unemployed people
- Dependents and Partners:
- Medicare does not cover services provided to medical practitioners’ dependents or partners, as defined legally or by educational and financial dependence.