Estimate Example - Standard Gap

Scenario: The Doctor/Practice does not enter into an agreement with a Health Fund, nor opts into a scheme and charges their own fees. Therefore there will be an out-of-pocket expense for the patient, which will be displayed in the Gap Column of the New Estimate of Fees window.

The calculations are based on the following:

  • Doctor's fees will be displayed under Fee.
  • Medicare rebate of (75%) under Medicare.
  • Health Fund (25% of MBS Fee) will be displayed under Health Fund.
  • Gap Difference under Gap Column.


    Therefore if a practitioner charges above the Schedule Fee for Item 32090 please find example listed below:

    Practitioner Charges for Item 32090 $603.00
    Less Rebate

    Medicare ($376.90)

    Health Fund ($125.60)

    502.50
    Gap to pay $100.50