UPDATED MEDICAL FEES
Effective 1 July 2025
OPSMC Fee Update: Lower Out-of-Pocket Costs for Specialist Care
Effective 1 July 2025, OPSMC has introduced updated specialist billing aligned with new Medicare item numbers. This change improves affordability and access to high-level care with a GP referral.
What's Changing?
Sport and Exercise Medicine Physicians (SEMPs) at OPSMC can now access Group A4 Medicare item numbers — the same as other consultant physicians like cardiologists and neurologists.
Higher Medicare rebates for patients
More comprehensive and longer consultations available
Reduced out-of-pocket costs for initial consults
Updated Fees (Effective 1 July 2025)
| Consultation Type | MBS Item | Cost | Medicare Rebate | Max Out-of-Pocket |
|---|---|---|---|---|
| Initial – Standard | 110 | $340.00 | $148.35 | $191.65 |
| Initial – Extended | 132 | $451.00 | $259.40 | $191.60 |
| Review | 116 | $190.00 | $74.25 | $115.75 |
| Minor Review | 119 | $100.00 | $42.30 | $57.70 |
| Extended Review | 133 | $250.00 | $129.90 | $121.10 |
Initial consults that previously cost $205.85 are now capped at $191.60 out-of-pocket with a valid GP referral.
Updated Fees (Effective 1 July 2025)
| Consultation Type | MBS Item | Cost | Medicare Rebate | Max Out-of-Pocket |
|---|---|---|---|---|
| Initial – Standard | 110 | $340.00 | $148.35 | $191.65 |
| Initial – Extended | 132 | $451.00 | $259.40 | $191.60 |
| Review | 116 | $190.00 | $74.25 | $115.75 |
| Minor Review | 119 | $100.00 | $42.30 | $57.70 |
| Extended Review | 133 | $250.00 | $129.90 | $121.10 |
Initial consults that previously cost $205.85 are now capped at $191.60 out-of-pocket with a valid GP referral.
Why Is This Happening?
This change follows a Medicare Benefits Schedule (MBS) Review by the Department of Health and Aged Care.
Recognised SEMPs as equivalent to consultant physicians
Acknowledged the complexity and length of sports medicine consults
Recommended higher rebates to reduce financial barriers for patients
OPSMC's Approach
We’ve capped out-of-pocket costs for initial consults
We believe in passing the savings on to patients.
We're keeping specialist access affordable for more people
We're supporting patients with flexible billing options for extended consults
What You Need to Know?
See your GP first. A valid GP referral ensures you receive the maximum rebate.
You may be eligible for extended consults. These are sometimes determined during the appointment based on your needs.
No surprise fees. If a longer consult (item 132) is needed, the doctor will explain why — your out-of-pocket cost will still be capped at $191.60.
Registrar Fees
Sport and Exercise Medicine Physician Registrars (doctors in specialist training) are not included in the recent Medicare item number changes.
Registrar consultations will continue to be billed under Group A2 item numbers
Fees for registrar appointments remain unchanged and are separate from consultant physician billing
GP referrals are not required, but are strongly recommended to support continuity of care and Medicare rebate eligibility
OPSMC's Approach
We’ve capped out-of-pocket costs for initial consults
We believe in passing the savings on to patients.
We're keeping specialist access affordable for more people
We're supporting patients with flexible billing options for extended consults
What You Need to Know?
See your GP first. A valid GP referral ensures you receive the maximum rebate.
You may be eligible for extended consults. These are sometimes determined during the appointment based on your needs.
No surprise fees. If a longer consult (item 132) is needed, the doctor will explain why — your out-of-pocket cost will still be capped at $191.60.
Registrar Fees
Sport and Exercise Medicine Physician Registrars (doctors in specialist training) are not included in the recent Medicare item number changes.
Registrar consultations will continue to be billed under Group A2 item numbers
Fees for registrar appointments remain unchanged and are separate from consultant physician billing
GP referrals are not required, but are strongly recommended to support continuity of care and Medicare rebate eligibility
Summary
- Bigger rebates
- Better access to expert care
- Lower out-of-pocket costs
- More time with your specialist
With a GP referral, seeing a specialist at OPSMC now costs less.
Want further information?
Contact our friendly administration team if you need help understanding
your appointment type or referral requirements.
Want further information?
Contact our friendly administration team if you need help understanding
your appointment type or referral requirements.