The short answer
- Your fee comes from the surgeon’s items. Add up the “(Assist.)” items you assisted at under the Multiple Operation Rule. At or below $668.25, bill item 51300 ($103.25). Above it, bill item 51303: one fifth of that total.
- Medicare pays 75% in hospital. The health fund pays the rest. On the fund’s no-gap schedule the two together pay about 1.4 times your schedule fee.
- You choose how to bill. No-gap: the patient pays nothing. Known-gap: the patient pays up to $500 per procedure. Out-of-pocket: any fee, with written consent before the list.
- Calculate to the cent. A no-gap fee even a few cents above the fund’s figure is paid only at the MBS amount.
Step 1
Work out your fee
Your fee is set by the surgeon’s items, not by your time. Two MBS items apply (items 51300 and 51303). Which one depends on your abated total: the “(Assist.)” items you assisted at, added up under the Multiple Operation Rule.
| Your abated total | Item | Your schedule fee |
|---|---|---|
| $668.25 or less | 51300 | $103.25, fixed |
| Over $668.25 | 51303 | One fifth of your abated total |
The threshold and the fixed fee are indexed each July.
The Multiple Operation Rule
Highest-fee item: 100%
Next highest: 50%
Every other item: 25% each
Example: three “(Assist.)” items at $1,500, $900 and $600
$1,500 × 100% = $1,500
$900 × 50% = $450
$600 × 25% = $150
Abated total = $2,100, over $668.25, so item 51303
Your fee = $2,100 ÷ 5 = $420.00
Items without “(Assist.)” drop out, so your total can be lower than the surgeon’s, and can fall under the threshold when the surgeon’s does not. Surgical assistants and the Multiple Operation Rule works through it. FreshClaim’s surgical assistant billing sets the item and fee from the surgeon’s items.
Check for “(Assist.)” before the list
If the surgeon’s item does not carry “(Assist.)”, there is no Medicare or fund benefit, whatever the patient’s cover. The claim is rejected, and this is not a recoverable gap.
Step 2
See who pays it
For a privately insured patient admitted to hospital, Medicare pays 75% of your schedule fee and the health fund pays the other 25%. If you are signed up to the fund’s no-gap or known-gap scheme, the fund pays more, up to its own schedule: about 1.4 times the MBS fee.
| Paid by | How it is worked out | Amount |
|---|---|---|
| Medicare | 75% of your schedule fee | $315 |
| Health fund | 25% of your schedule fee | $105 |
| Health fund, no-gap or known-gap scheme | A further 40% of your schedule fee | $168 |
| Total at the fund’s no-gap schedule | About 1.4 × your schedule fee | $588 |
Round the way the fund does
Funds set a fixed amount for item 51300. For item 51303 they take your abated total, divide it by five and apply their multiplier, around 1.4. Round at each step as the fund does, starting with the abated total, which is rounded up to the next 5 cents. If your no-gap fee comes out even a few cents above the fund’s figure, the fund pays only the MBS amount.
A minority of funds, usually on lower-tier or restricted products, do not take part in the gap scheme. For their members, anything above the Medicare benefit is out of pocket, even a known gap. Check before quoting, or ask the patient to check with their fund. An uninsured patient gets the Medicare benefit only, whatever your fee.
Step 3
Choose how to bill
| Billing mode | Your fee | Patient pays | Consent |
|---|---|---|---|
| No-gap | At or below the fund’s no-gap schedule | Nothing | Tell the patient your fee |
| Known-gap | The fund’s known-gap schedule, plus up to $500 | Up to $500 per procedure | Written, before the list |
| Out-of-pocket | Any amount you set | Your fee, less Medicare and the fund | Written, before the list |
No-gap is the least admin and collects best, but your income is capped at the fund’s schedule. Out-of-pocket bills collect at materially lower rates.
The $500 known-gap limit
- It is $500 per procedure, not per item.
- Most funds’ known-gap schedule is the same as their no-gap schedule. HCF and Bupa set their own, and pay marginally less once the patient is charged, so measure the $500 from their known-gap figure.
- Go over $500 by any amount and the fund pays only up to the MBS schedule fee. The patient pays everything above that.
Your gap and the surgeon’s
Patients expect the surgeon’s fee, not a separate assistant’s bill, and complaints about your gap reach the surgeon. Where the surgeon charges a $500 gap, the assistant might charge $100, or the two agree a structure before the list. What matters most is that your gap matches what the surgeon has told the patient.
Step 4
Get the patient’s consent before the list
A known gap or an out-of-pocket fee needs the patient’s informed financial consent (IFC) before the procedure. Get it in writing: most gap schemes require that. For no-gap billing, still tell the patient your fee, as funds differ on whether they want that in writing too. Assistants are often booked late, which leaves little time for consent.
The consent states:
- your name and provider number
- the expected item numbers
- your fee
- the expected Medicare benefit and fund benefit
- the patient’s estimated out-of-pocket cost
Give the patient three figures: “Medicare and your fund will cover $X. My fee is $Y. You will pay $Z.” Ideally, the patient has time to ask questions and to seek a second quote.
For an out-of-pocket fee
- Give a written quote before the service, with the three figures above.
- Keep a record of consent: a signed IFC or a timestamped acceptance. Verbal consent alone will not support debt recovery or a complaint.
- Invoice and collect before the day of the procedure.
- Decide in advance what happens if the procedure does not go ahead: keep a cancellation fee, if your IFC says so, or refund in full. Tell the patient when they consent.
Making it workable
- A fee schedule card. One page of fees by procedure type, handed out by the surgeon’s rooms at booking.
- Phone consent, then a written record. For a late booking, call the patient the evening before, give the fee, then confirm by SMS or email.
Reference
Fee benchmarks
Your own fee depends on the surgeon’s items.
| Procedure type | Your abated total | Your schedule fee | Medicare (75%) | No-gap total (about 1.4×) | Possible out-of-pocket |
|---|---|---|---|---|---|
| Minor / below threshold | ≤ $668.25 | $103.25 (item 51300) | $77.45 | $144.55 | $100 – $150 |
| Moderate (e.g. laparoscopy) | $800 – $1,200 | $160 – $240 | $120 – $180 | $224 – $336 | $150 – $250 |
| Major (e.g. bowel resection) | $1,500 – $2,500 | $300 – $500 | $225 – $375 | $420 – $700 | $250 – $350 |
| Complex / cardiac / spinal | $2,500 – $4,000+ | $500 – $800+ | $375 – $600+ | $700 – $1,120+ | $350+ |
How to bill, by case type
- Standard elective case, insured patient: no-gap or known-gap. Low admin, high collection rate.
- Complex or long case, booked in advance: known-gap, or a modest out-of-pocket fee with written consent.
- Supra-specialist or revisional surgery: an out-of-pocket fee, with written consent before the case.
- Unplanned or emergency assist: the schedule fee. There is no time for consent in advance.
- Uninsured patient: the Medicare benefit only, whatever your fee. Allow for this before quoting.
- Unsure whether the fund is in the gap scheme: check before quoting, or ask the patient to.
Common questions
- How is a surgical assistant fee calculated in Australia?
The fee comes from the “(Assist.)” items the assistant was present for, added up under the Multiple Operation Rule: the abated total. At or below $668.25, item 51300 pays a fixed $103.25. Above that threshold, item 51303 pays one fifth of the abated total. Figures at 1 July 2026.
- What is the Multiple Operation Rule (MOR)?
The Medicare rule for several procedures in one operation. The highest-fee item is paid at 100% of its schedule fee, the next at 50% and each one after that at 25%.
- What is the maximum known-gap a surgical assistant can charge?
$500 per procedure, not per item. Charge more than $500 above the fund’s schedule and the fund pays only the MBS schedule fee. HCF and Bupa pay marginally less on a known-gap claim than on a no-gap claim, so measure the $500 from their known-gap figure.
- What is the difference between no-gap and known-gap billing?
With no-gap, the doctor charges at or below the health fund’s no-gap schedule and the patient pays nothing. With known-gap, the patient pays an agreed amount of up to $500 per procedure, consented to before treatment.
- Do all surgical items allow an assistant claim?
No. Only items marked “(Assist.)” in the MBS attract an assistant fee. A claim against any other item is rejected, with no Medicare or fund benefit.
FreshClaim derives the assistant fee from the surgical items
Enter the surgical items. FreshClaim derives the abated total and the assistant fee, prepares the known-gap consent, and issues and collects the patient invoice.
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