Ineligible patients

Hospital and health service costs for Medicare ineligible patients

Health services are required to set their own fees for patients who are not covered by Medicare, including overseas patients. Where possible, ineligible patients should be charged the full cost of their care.

When charging fees, hospitals should be aware that some overseas patients are entitled to financial assistance (for example because of Reciprocal Health Care Agreements).

Fees will vary between hospitals and may be determined on a Diagnostic Related Group (DRG) or bed day basis. Fees raised on a DRG basis may be calculated using the national weighted activity unit (NWAU) price weight.

Note: This is a guideline only and fees charged to Medicare ineligible patients are to be determined by individual health services.

Accommodation charge: fee per day

Patient classification type	Estimated average costs for 2023-24	Estimated average costs for 2024-25
Same day: single room	$387	$403
Same day: shared ward	$270	$281
Overnight: single room	$871	$908
Overnight: shared ward	$751	$783
Intensive Care Unit: 1-4 days	$6,070	$6,325
Intensive Care Unit: 5+ days	$5,582	$5,816
Coronary Care Unit: 1-4 days	$2,276	$2,372
Coronary Care Unit: 5+ days	$1,332	$1,388
Emergency department: admitted	$1,475	$1,537
Emergency department: non-admitted	$568	$592
Hospital in the home	$403	$420

Outpatient charge: fee per encounter

Patient classification	Estimated average costs for 2023-24	Estimated average costs for 2024-25
Medical	$341	$355
Allied health	$197	$205

Postnatal care charge: hourly rate

Patient classification	Estimated average costs for 2023-24	Estimated average costs for 2024-25
Medical	$103	$107

Further information:

The accommodation charges are based on the 2020-21 Victorian Cost Data Collection.

The non-admitted charges are based on prior year's charges.

The fee for postnatal care is based on community health nursing hourly rates, as average cost cannot be calculated with the available data.

These charges include an allowance for indexation and depreciation to estimate bed day and encounter costs for 2024-25.

A number of costs are excluded. Health services should ensure that they also charge for the following items:

Medical costs billed separately by the treating medical practitioner
Diagnostics, which should be charged at 100 per cent of the Medicare Benefits Schedule rate
Prostheses, in line with the Commonwealth’s schedule rate
Drugs, which should be charged at cost (only when a bed day fee applies – fees determined on a DRG basis already include costs for drugs).
Theatre fees. These are based on the TAC Schedule of Fees for Private Hospital Services (non-arrangement).

Reviewed 25 November 2024