01 · The short answer
An anaesthetic fee is counted in units
The MBS prices every anaesthetic service in units, under the relative value guide (RVG). The procedure sets the base units, anaesthesia time sets the time units, and the patient and circumstances add modifying units. Multiply the total by the unit value to get the MBS schedule fee.
| Who pays | Per unit | Basis |
|---|---|---|
| Medicare, in hospital | $17.80 | 75% of the $23.70 schedule fee. |
| Medicare and the health fund together, no-gap or known-gap | $38 to $45 | The fund’s scheme rate. Medicare pays its $17.80 and the fund pays the rest. Each fund publishes its rate; see getting paid. |
| The patient | Any gap | The difference between your fee and what Medicare and the fund pay, agreed in writing beforehand. This is informed financial consent (IFC). |
Every RVG item has one condition: the anaesthesia start and end times must be recorded in writing.
Every fee on this page is indicative at the time of writing
The MBS at 1 July 2026, and fund rates as published then. Fees and schedules change. Check your fee schedules for the exact amounts.
02 · Step 1
Choose the base item
Each anaesthetic takes one base item, chosen by the site of the surgery. The MBS words each one “initiation of management of anaesthesia for…”. Group T10 lists them by region, from head to lower leg, plus two dental items (22900, 22905). When the surgeon does more than one procedure, claim only the base item with the most units.
| Item | Surgery | Units | Schedule fee |
|---|---|---|---|
| 20100 | Skin and superficial tissues of the head | 5 | $118.50 |
| 20320 | Deep tissues of the neck: thyroid, larynx, trachea | 6 | $142.20 |
| 20402 | Breast reconstruction | 5 | $118.50 |
| 20706 | Laparoscopic procedures in the upper abdomen, including cholecystectomy | 7 | $165.90 |
| 20740 | Upper gastrointestinal endoscopy | 5 | $118.50 |
| 20790 | Open procedures within the upper abdomen | 8 | $189.60 |
| 20810 | Lower intestinal endoscopy | 4 | $94.80 |
| 20841 | Bowel resection, open or laparoscopic | 8 | $189.60 |
| 21214 | Primary total hip replacement | 10 | $237.00 |
| 21402 | Knee replacement | 7 | $165.90 |
The full list is on MBS Online, Group T10.
03 · Step 2
Count the time units
Anaesthesia time starts when you begin exclusive and continuous care of the patient for anaesthesia, and ends when you are no longer in professional attendance, with the patient safely under the supervision of other staff. It is not the surgical time or the theatre booking.
First 2 hours: 1 unit per 15 minutes, or part.
Beyond 2 hours: 1 unit per 10 minutes, or part.
| Anaesthesia time | Working | Units | Time item | Schedule fee |
|---|---|---|---|---|
| 0:45 | 3 × 15 min | 3 | 23035 | $71.10 |
| 1:30 | 6 × 15 min | 6 | 23065 | $142.20 |
| 2:00 | 8 × 15 min | 8 | 23085 | $189.60 |
| 2:01 | 8 + 1 part-block of 10 min | 9 | 23091 | $213.30 |
| 2:25 | 8 + 25 min ÷ 10, rounded up | 11 | 23111 | $260.70 |
| 4:35 | 8 + 155 min ÷ 10, rounded up | 24 | 23200 | $568.80 |
| 6:00 | 8 + 24 | 32 | 23280 | $758.40 |
| 24:00 | 8 + 132 | 140 | 24136 | $3,318.00 |
The time units go on the claim as one time item (23010 to 24136), chosen by the total time. Claim it with the base item, never alone.
04 · Step 3
Add the modifying units
Modifiers add units for the patient and the circumstances. Never claim one on its own.
| Item | When | Units |
|---|---|---|
| 25000 | ASA 3: severe systemic disease that significantly limits activity | +1 |
| 25005 | ASA 4: severe systemic disease that is a constant threat to life | +2 |
| 25010 | ASA 5: moribund, not expected to survive 24 hours with or without the operation | +3 |
| 25013 | Patient under 4 years | +1 |
| 25014 | Patient 75 years or older | +1 |
| 25020 | Emergency, in hours: immediate treatment without which there would be a significant threat to life or a body part | +2 |
ASA 2 has no modifier. Procedures you perform during the anaesthetic carry their own units:
| Item | Service | Units |
|---|---|---|
| 22002 | Administration of blood or bone marrow | 4 |
| 22007 | Fibreoptic intubation for a difficult airway | 4 |
| 22008 | Double-lumen tube or bronchial blocker | 4 |
| 22012 / 22014 | Invasive pressure monitoring, first / subsequent | 3 / 3 |
| 22020 | Central venous catheter | 4 |
| 22025 | Arterial line, for a high-risk patient or procedure | 4 |
| 22031 / 22036 | Epidural or intrathecal injection for post-operative pain, initial / subsequent | 5 / 3 |
| 22041 | Plexus or nerve block for post-operative pain | 2 |
| 22051 | Intra-operative transoesophageal echo | 9 |
05 · Step 4
Apply the after-hours emergency loading
Emergency means the same here as for 25020 above. After hours is 8 pm to 8 am on a weekday, or any time on a Saturday, Sunday or public holiday. The loading applies when more than half of the anaesthesia time falls after hours. Exactly half does not qualify.
| Item | Who | Amount |
|---|---|---|
| 25025 | Anaesthetist | 50% of the fee for the base item + the time item + modifiers 25000 to 25014 + any 22002 to 22051 services |
| 25030 | Assistant anaesthetist | 50% of the assistance item + time + modifiers + 22002 to 22051 |
| 25050 | Perfusionist | 50% of 22060 + time + modifiers + 22002 to 22051 and 22065 to 22075 |
- The loading base leaves out the consultation and epidural items.
- An in-hours emergency takes 25020 (2 units) instead. Never claim both.
- The loading is always the last item on the claim.
06 · Step 5
Bill the pre-anaesthesia consultation
The consultation has a fixed fee, not units. Its level depends on duration and complexity. From 17615 up, the notes must hold a written anaesthesia plan. It needs no referral, and is payable whether or not the procedure goes ahead.
| Item | Duration | Content | Schedule fee |
|---|---|---|---|
| 17610 | Up to 15 min | Brief history, limited examination, routine surgery | $52.25 |
| 17615 | 16 to 30 min | Advanced surgery or complex medical problems; written plan | $103.95 |
| 17620 | 31 to 45 min | As 17615, plus evaluation of investigations | $144.00 |
| 17625 | Over 45 min | As 17620, plus discussion with other clinicians | $183.35 |
| 17690 | Add-on | A 17615 to 17625 consultation done in rooms before admission, not on the day of admission | + $48.00 |
A consultation that is not before an anaesthetic (17640 to 17655, same fees) needs a referral to be paid at the specialist rate. See Medicare referral rules for hospital claims.
07 · Step 6
Build the claim in order
Medicare reads an anaesthetic claim in sequence. Items out of order are rejected, and the claim goes no further. List them in this order:
- Consultation (17610 to 17690)
- Base item: the anaesthetist’s (20100 to 21997, 22900, 22905); or the assistant’s (25200, 25205); or the perfusionist’s (22060)
- Time item (23010 to 24136)
- Physical status (25000, 25005, 25010)
- Age (25013, 25014)
- Emergency in hours (25020)
- Services during the anaesthetic (22002 to 22051; 22055, 22065 to 22075)
- After-hours emergency loading, last (25025, 25030, 25050)
| Rule | What it means |
|---|---|
| One base item | Several procedures under one anaesthetic: claim the base item with the most units, once. |
| The assistant does not claim the base item | An assistant anaesthetist claims 25200 (emergency, imminent danger of death) or 25205 (complex elective, or a case over 6 hours): 5 units, plus the time item, the modifiers and any 22002 to 22051 service. |
| Abandoned anaesthetic | Anaesthesia given, surgery not started: 21990 (3 units, $71.10) plus the time item, with a note on the claim that the procedure was abandoned before it began. |
| Epidurals are a separate claim | Items 17680 and 18216 to 18227 are not co-claimed with the general anaesthetic items. See epidurals. |
| Times in writing | Start and end times recorded, or the RVG items do not apply. |
08 · Epidurals
Epidural and spinal infusions have their own items
Labour epidurals and other infusions are Group T7 items. They have fixed fees and their own time rule: the item covers the first hour of attendance, and each 15 minutes or part beyond it adds a fixed amount.
| Item | Service | Schedule fee |
|---|---|---|
| 17680 | Consultation immediately before a labour epidural, where none has occurred | $103.95 |
| 18216 | Initial injection or commencement, up to 1 hour of attendance | $227.30 |
| 18219 | Attendance beyond the first hour | $227.30 + $22.75 per 15 min |
| 18222 / 18225 | Top-up or revision, 15 minutes or less / more than 15 minutes | $45.10 / $59.85 |
| 18226 | Labour, after hours: up to 1 hour | $340.90 |
| 18227 | Labour, after hours: beyond the first hour | $340.90 + $34.25 per 15 min |
Funds pay these on their own epidural rates, lower than their RVG rates. DVA and TAC pay fixed amounts. Approximate, for comparison only:
| Who pays | Epidural rate, against the schedule fee |
|---|---|
| Bupa, no-gap / known-gap | about 1.7× / 1.65× |
| Medibank | about 1.65× |
| HCF, no-gap / known-gap | about 1.6× / 1.55× |
| St Luke’s | about 1.55× |
| AHSA funds | about 1.55×; WA about 1.5× |
| nib | about 1.55× |
| GU Health | about 1.5× to 1.6× by state |
| DVA | about $355 (18216), $545 (18226); about $35 / $55 per 15 minutes beyond the hour |
| TAC | about $575 (18216), $885 (18226); about $58 / $87 per 15 minutes beyond the hour |
09 · Getting paid
What Medicare, the fund and the patient each pay
Medicare pays 75% of the schedule fee for an in-hospital service. The rest depends on how you bill the fund:
| Arrangement | The fund pays | The patient pays |
|---|---|---|
| No-gap | The rest of its no-gap rate for every item | Nothing |
| Known-gap | The rest of its known-gap rate, usually a little lower | A gap you set, within the fund’s cap, agreed in writing before the list |
| Outside the scheme | 25% of the schedule fee | Everything above the schedule fee |
Every RVG item is a whole number of units, so a fund’s scheme rate is easiest to read per unit. A fund’s rate is the total you receive, with Medicare’s 75% included. DVA and TAC pay their whole rate themselves. Approximate, for comparison only:
| Who pays | Per RVG unit | Against the $23.70 schedule |
|---|---|---|
| Medicare benefit | $17.80 | 0.75× |
| Medibank | about $38 | about 1.6× |
| Bupa, no-gap / known-gap | about $39 / $38 | about 1.65× / 1.6× |
| HCF, no-gap / known-gap | about $39 / $38 | about 1.65× / 1.6× |
| nib / nib Gapsure | about $38 / $45 | about 1.6× / 1.9× |
| AHSA funds | about $38 to $39 | about 1.6× to 1.65× |
| GU Health | about $40 to $42 by state | about 1.7× to 1.75× |
| St Luke’s | about $40 | about 1.7× |
| DVA | about $38 | about 1.6× |
| TAC | about $58 | about 2.45× |
Fees and schedules change. Check your fee schedules for the exact amounts.
Each fund prices the loading, the assistance items and epidural time from its own multiplier. Consultation items have their own fund rates.
10 · Worked examples
Three claims, item by item
A. Elective laparoscopic cholecystectomy
Tuesday, 09:00 to 11:25. 52 years, ASA 2. A 12-minute pre-anaesthesia consultation on the day.
| Item | What | Units | Schedule fee | Medicare 75% |
|---|---|---|---|---|
| 17610 | Consultation, up to 15 min | fixed | $52.25 | $39.20 |
| 20706 | Base: laparoscopic upper abdomen | 7 | $165.90 | $124.45 |
| 23111 | Time: 2:25 = 8 + 3 | 11 | $260.70 | $195.55 |
| ASA 2: no modifier. Daytime, elective: no loading. | ||||
| Total | 18 | $478.85 | $359.20 |
On a no-gap claim you receive the fund’s rate for each item instead of the schedule fee. Medicare pays its $359.20 and the fund pays the rest. At about $38 a unit plus the fund’s consultation rate, the total is roughly $770, and the patient pays nothing.
B. Emergency laparotomy, after hours
Tuesday, 22:40 to 01:05 for a bowel obstruction. 78 years, ASA 3. Brief consultation before induction.
| Item | What | Units | Schedule fee | Medicare 75% |
|---|---|---|---|---|
| 17610 | Consultation, up to 15 min | fixed | $52.25 | $39.20 |
| 20841 | Base: bowel resection | 8 | $189.60 | $142.20 |
| 23111 | Time: 2:25 | 11 | $260.70 | $195.55 |
| 25000 | ASA 3 | 1 | $23.70 | $17.80 |
| 25014 | 75 years or older | 1 | $23.70 | $17.80 |
| 25025 | After-hours emergency: all of the time is after 8 pm. 50% of (base + time + modifiers) = 50% of $497.70 | $248.85 | $186.65 | |
| Total | 21 + loading | $798.80 | $599.20 |
The consultation is outside the loading base. Had the case been at 15:00, 25020 (2 units, $47.40) would replace the loading.
C. The assistant anaesthetist on a six-and-a-half-hour case
Elective aortic surgery. The assistant is present 08:00 to 14:30 to the exclusion of other patients. ASA 4.
| Item | What | Units | Schedule fee | Medicare 75% |
|---|---|---|---|---|
| 25205 | Assistance, service over 6 hours: replaces the base item | 5 | $118.50 | $88.90 |
| 23310 | Time: 6:30 = 8 + 27 | 35 | $829.50 | $622.15 |
| 25005 | ASA 4 | 2 | $47.40 | $35.55 |
| Total | 42 | $995.40 | $746.60 |
11 · Rejections
Where anaesthetic claims go wrong
Some mistakes stop the claim. Others are paid but leave an audit risk.
| Mistake | What happens |
|---|---|
| Items out of order | Medicare rejects them, and the claim goes no further. |
| 25020 and 25025 on the same claim | Rejected: one emergency modifier per episode. |
| The age modifier (25014) claimed for a patient under 75 | Medicare flags 25014 as an error and does not pay it, so the claim pays less than expected. |
| Two base items for one anaesthetic | Only the higher base item is paid. |
| Loading claimed on a session that was exactly half after hours | Not payable: the loading needs more than half the time after hours. |
| Time item missing, or on its own | The time item goes with a base item, never alone. |
| Epidural items on a general anaesthetic claim | They belong on a separate claim. |
| The assistant claims the base item | The assistant claims 25200 or 25205 instead. |
| Start and end times not in the record | Paid, but an audit risk: the RVG items apply only where the times are recorded. |
| Consultation level without the written plan | Paid, but an audit risk: 17615 to 17625 require a plan in the notes. |
Common questions
- How is an anaesthetic fee calculated in Australia?
In units. The base item for the surgery sets the base units, anaesthesia time sets the time units, and the patient’s ASA status, age and an emergency add modifying units. The total is multiplied by the RVG unit value, $23.70 at 1 July 2026, to give the schedule fee.
- What is an RVG unit worth?
The schedule fee is $23.70 a unit at 1 July 2026. Medicare pays 75% of that, $17.80, for an in-hospital service. Under a no-gap or known-gap arrangement, the fund’s rate is about $38 to $45 a unit in total. Medicare pays its $17.80 of that and the fund pays the rest. Indicative at the time of writing.
- How are anaesthetic time units counted?
From when the anaesthetist begins exclusive and continuous care of the patient until the patient is safely handed to other staff. The first two hours count one unit per 15 minutes or part; beyond two hours, one unit per 10 minutes or part. The total selects one time item from 23010 to 24136, claimed with the base item.
- What counts as after hours for an anaesthetic?
8 pm to 8 am on a weekday, or any time on a Saturday, Sunday or public holiday. The after-hours emergency loading (25025) applies when more than half of the anaesthesia time falls after hours and the case needed immediate treatment. It adds 50% of the fee for the base item, time item, modifiers and any 22002 to 22051 service.
- Do I need a referral for a pre-anaesthesia consultation?
No. Items 17610 to 17625 do not require a referral. A referral is required for other anaesthetist consultations (17640 to 17655) to be paid at the specialist rate.
- How much does a health fund pay per anaesthetic unit?
Under no-gap and known-gap schemes, most fund rates are about $38 to $40 a unit, and nib Gapsure about $45, against the $23.70 schedule fee. That is the total paid: Medicare pays $17.80 a unit and the fund pays the rest, about $20 to $27. TAC pays about $58 a unit itself. These are approximate at the time of writing; fees and schedules change.
- What does the assistant anaesthetist claim?
Not the base item. The assistant claims 25200 (an emergency with imminent danger of death) or 25205 (complex elective cases, or a service over 6 hours), worth 5 units, plus the time item, the modifiers and any 22002 to 22051 service.
- What is MBS item 21990?
An abandoned anaesthetic: anaesthesia given but the surgery not started. It carries 3 units ($71.10 at 1 July 2026) and is claimed with the time item, with a note that the procedure was abandoned before it began.
FreshClaim for anaesthetists
FreshClaim builds each anaesthetic claim this way.
- 1
Send the case from your phone
Scan the patient sticker, enter the items and send between cases. The day’s claims can be lodged before you leave the hospital.
- 2
Priced correctly before lodgement
FreshClaim applies time units, modifiers, the emergency and after-hours loadings and each fund’s rate, in the order Medicare expects.
- 3
See where every claim stands
Each claim shows its status from capture to payment. If Medicare or the fund rejects one, FreshClaim investigates, corrects and re-lodges it.
- 4
Known-gap billing, handled before the list
Send your theatre list ahead of time. FreshClaim prepares the informed financial consent, issues the patient invoice and manages prepayment.
- 5
Reconciliation and summaries
FreshClaim reconciles each payment and prepares your financial summaries.
2.85% + GST on ECLIPSE payments, charged only on what is paid.