Medicare & rebates
Accessing psychiatric care shouldn't mean navigating confusing Medicare rules on your own.
Whether you're attending with a referral, claiming a Medicare rebate or simply wanting to understand how the Medicare Safety Net works, we've created this guide to answer the questions we are asked most often.
Our aim is to make the administrative side of your care as clear and straightforward as possible, so you can focus on what matters most: your health.
Medicare rebates available
Dr Priyomi Stevenson provides eligible specialist psychiatric consultations under Medicare.
With a valid referral, your consultation may attract a Medicare rebate and contribute towards your Medicare Safety Net.
On this page
Medicare
Referrals
& Rebates
Medicare Safety
Net Explained
Safety Net
In Practice
Registering Your
Family
More
Questions
medicare referrals and rebates
What is a Medicare rebate?
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Do I need a referral?
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Can I attend privately?
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Will I receive a Medicare rebate?
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Why does the Medicare rebate vary?
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What is the Medicare Safety Net?
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How can the Extended Medicare Safety Net reduce my out-of-pocket costs and increase my rebates over time?
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understanding medicare
Making Sense of Medicare
We recommend reading this section in order.
Medicare uses several terms that are easy to misunderstand, including Medicare item numbers, Schedule Fees, rebates, gap amounts and out-of-pocket costs. Each of these affects how the Safety Nets are calculated.
We will explain each term as it becomes relevant, using the same consultation throughout so you can see where each number comes from.
We will cover:
how Medicare normally calculates what it pays you back
how the Original Medicare Safety Net works
how the Extended Medicare Safety Net works
what the difference between the two could mean for your out-of-pocket costs
how eligible medical costs can be combined if you register as a Medicare Safety Net family
The sections build on one another, so reading them in order will make the calculations that follow much easier to understand.
how does Medicare normally calculate your rebate?
What is a Medicare item number?
Medicare gives different types of medical services their own identifying numbers. These are called Medicare item numbers.
The item number tells Medicare what type of service you received and is used to determine how much Medicare will pay you back.
In psychiatry, there is not one Medicare item number that applies to every appointment. The appropriate item can depend on the type of referral you have, whether this is your first appointment with Dr Stevenson, how long your consultation lasts, whether it is provided by telehealth or in person, and the type of care recommended following your assessment.
This means your Medicare item number, and therefore your exact Medicare rebate, may not always be known before your consultation.
This is particularly relevant to an initial psychiatric assessment. Although Dr Stevenson's consultation fee is the same, different Medicare items can apply depending on the service provided and what is clinically appropriate following your assessment.
For example, Medicare item 291, or its telehealth equivalent item 92435, may apply when you have been referred for a comprehensive psychiatric assessment and management plan and Dr Stevenson determines that your ongoing care can appropriately be managed by your referring practitioner. If ongoing specialist psychiatric care with Dr Stevenson is required, a different Medicare item may apply.
Your previous psychiatry claims can also matter
Some Medicare items have rules about how often they can be used.
For example, Medicare item 291 and its telehealth equivalent 92435 cannot be claimed if you have already received a service under either item 291 or 92435 during the preceding 12 months.
Importantly, this rule applies to whether you have received that service, not whether Dr Stevenson was the psychiatrist who provided it. This means that if another psychiatrist has already provided and claimed a 291 or 92435 service for you within the preceding 12 months, Dr Stevenson cannot simply claim another 291 or 92435 for your consultation during that period.
This does not necessarily mean that you cannot receive a Medicare rebate. A different Medicare item may apply to your consultation, depending on the service provided, your previous Medicare claims and the Medicare requirements that apply.
The rules are different for different Medicare items, and you do not need to work this out yourself.
Dr Stevenson does not choose an item number based on which one provides the highest rebate. The item claimed must accurately reflect the service provided and meet Medicare's requirements.
For these reasons, any Medicare rebate discussed before your appointment should be considered an estimate. The appropriate Medicare item, and therefore the amount Medicare pays you back, may only be confirmed once your consultation has taken place.
View your Medicare claims history through myGov →
What is a Medicare Schedule Fee?
Now that we understand what a Medicare item number is, the next step is understanding the dollar amount Medicare attaches to that item.
Each Medicare item number has its own dollar amount set by the Australian Government. This amount is called the Medicare Schedule Fee.
The name can be confusing because it sounds like it is the fee your doctor should charge. It isn't.
The Medicare Schedule Fee is not Dr Stevenson's consultation fee, and it is not a recommended price for your appointment.
It is a separate amount Medicare uses when calculating how much it will pay you back.
What does this look like in practice?
To make this easier to understand, we will use an eligible 60-minute telehealth review as an example. We will continue using this same example as we explain how Medicare rebates and the Medicare Safety Nets work below.
Dr Stevenson's fee for a 60-minute review is $800.
For this example, we are using Medicare item 91830, which may apply to an eligible 60-minute psychiatry review by video. Under the 2026 Medicare Benefits Schedule, the Australian Government has set the Schedule Fee for this item at $223.15.
You pay Dr Stevenson's consultation fee of $800. Medicare, however, uses the $223.15 Schedule Fee attached to the item in our example when calculating how much it will pay you back.
In this example, your Medicare rebate is calculated from $223.15, not from Dr Stevenson's $800 consultation fee.
About the example on this page
We use the same 60-minute telehealth review throughout this page so you can follow each step of the Medicare and Safety Net calculations.
The Medicare figures in this example are based on the 2026 Medicare Benefits Schedule. Medicare item numbers, Schedule Fees, rebate amounts and Safety Net thresholds are determined by the Australian Government and may change over time. Dr Stevenson does not set or control these amounts.
The $800 consultation fee used in this example is based on Dr Stevenson's practice fee at the time this page was updated. Practice fees are set separately by Dr Stevenson and may also change over time.
The Medicare item and rebate that apply to your own consultation may be different depending on the service provided and the Medicare requirements that apply to you.
For Dr Stevenson's current consultation fees, please see Fees & Appointments.
Medicare information and worked examples last updated September 2026.
How does Medicare work out how much to pay you back?
Now that we know what a Schedule Fee is, we can use it to understand how Medicare calculates your rebate.
Medicare has different rules for how much of the Schedule Fee it pays for different types of medical services.
For many specialist services provided outside hospital, including the psychiatry consultation in our example, Medicare ordinarily pays 85% of the Schedule Fee. This 85% is the standard Medicare payment level that applies to these services.
The 85% is set under Medicare. It is not determined by Dr Stevenson, and it is not related to how much Dr Stevenson charges.
Most importantly, Medicare is not paying 85% of your actual consultation fee. It is paying 85% of the Schedule Fee attached to the Medicare item.
What does this look like in practice?
Let's continue with the same 60-minute telehealth review.
Dr Stevenson's fee for the 60-minute review is $800.
For the Medicare item in our example, the 2026 Schedule Fee is $223.15. Medicare ordinarily pays approximately 85% of this amount:
$223.15 Schedule Fee × 85%
= $189.70 Medicare rebate
You pay Dr Stevenson's $800 consultation fee. After your consultation, your Medicare claim is submitted and Medicare pays the $189.70 rebate back to you.
So, after receiving your Medicare rebate:
$800 consultation fee − $189.70 Medicare rebate
= $610.30 out-of-pocket cost
Your out-of-pocket cost is the amount the consultation has ultimately cost you after Medicare has paid you back. In this example, that is $610.30.
When your claim is submitted electronically through Medicare Online, Medicare advises that your rebate is usually paid into your nominated bank account by the next working day, although some claims may take longer to process.
Why does the 85% matter?
Later on this page, you will see that reaching the Original Medicare Safety Net can increase Medicare's payment from 85% to 100% of the Schedule Fee for eligible out-of-hospital services.
Importantly, 100% still means 100% of Medicare's Schedule Fee, not 100% of Dr Stevenson's consultation fee.
MEDICARE SAFETY NET EXPLAINED
How the Medicare Safety Net can help.
Now that we understand how Medicare calculates your ordinary rebate, we can look at what can happen when you have eligible medical costs throughout the year.
Medicare has two Safety Nets: the Original Medicare Safety Net and the Extended Medicare Safety Net.
You do not need to choose between them. When you receive an eligible out-of-hospital medical service, that same service can contribute towards both Safety Nets at the same time.
Medicare keeps a separate running total for each Safety Net because each one counts your medical costs differently.
Each running total is working towards an amount called a threshold. A threshold is simply the amount your Safety Net running total needs to reach before Medicare begins paying you more back under that Safety Net.
Once you reach a threshold, Medicare can pay you more back for eligible out-of-hospital medical services for the remainder of that calendar year.
Why it is helpful to read the next sections in order
The two Safety Nets use the amounts we have just explained, including the Schedule Fee, your Medicare rebate and your out-of-pocket cost, but they use them in different ways.
We will use the same 60-minute telehealth review from our earlier example throughout, so you can see exactly how one consultation contributes towards each Safety Net and what changes once a threshold is reached.
We will first explain the Original Medicare Safety Net, then the Extended Medicare Safety Net, before putting the two side by side.
The sections build on one another, so we recommend reading them in order.
What is the Original Medicare Safety Net?
The Original Medicare Safety Net, or OMSN, keeps track of certain Medicare costs from eligible out-of-hospital medical services throughout the calendar year.
For the OMSN, Medicare does not count your full out-of-pocket cost towards the threshold.
Instead, it counts what Medicare calls your gap amount.
Your gap amount is the difference between your Medicare Schedule Fee and the Medicare rebate you have already received.
These gap amounts are added together throughout the calendar year to create your OMSN running total.
What does this look like in practice?
Let's continue with the same 60-minute telehealth review.
From our earlier example:
Medicare Schedule Fee
$223.15
Medicare rebate
$189.70
To work out how much this consultation adds to your Original Medicare Safety Net running total, Medicare calculates:
$223.15 Schedule Fee − $189.70 Medicare rebate = $33.45 gap amount
This means $33.45 is added to your Original Medicare Safety Net running total.
This is an important distinction. Your out-of-pocket cost for the consultation was $610.30, but the OMSN does not add that full $610.30 to your running total. For this consultation, it adds $33.45 to your running OMSN total.
What is the Original Medicare Safety Net threshold?
A threshold is the amount your Original Medicare Safety Net (OMSN) running total needs to reach before Medicare begins paying you more back under the Original Medicare Safety Net.
For 2026, the Original Medicare Safety Net threshold is $594.40.
As you receive eligible out-of-hospital medical care during the year, your eligible gap amounts continue to be added to your OMSN running total.
Once that running total reaches $594.40, you have reached the Original Medicare Safety Net for that calendar year.
What happens once you reach the OSMN threshold?
Before you reach the Original Medicare Safety Net (OMSN) threshold, Medicare ordinarily pays approximately 85% of the Schedule Fee for the specialist consultation in our example.
Once you reach the OMSN threshold, Medicare pays 100% of the Schedule Fee for eligible out-of-hospital services for the remainder of that calendar year.
What does this look like in practice?
Let's continue with the same 60-minute telehealth review from our earlier example
01
Before reaching the 2026 OSMN threshold of $594.40
Consult Fee
$800
Medicare Schedule Fee
$223.15
Medicare rebate
(85% of the Schedule Fee)
$189.70
Your out-of-pocket cost
$610.30
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After reaching the 2026 OSMN threshold of $594.40
Consult Fee
$800
Medicare Schedule Fee
$223.15
Medicare pays back
$223.15
Your out-of-pocket cost
$576.85
So, for this consultation, reaching the OMSN threshold means Medicare pays you $33.45 more back.
Importantly, 100% means 100% of Medicare's $223.15 Schedule Fee. It does not mean Medicare pays 100% of Dr Stevenson's $800 consultation fee.
The key point
The Original Medicare Safety Net counts the gap between Medicare's Schedule Fee and your ordinary Medicare rebate.
In our example, $33.45 from each eligible consultation is added to your OMSN running total.
Once you reach the OMSN threshold, Medicare increases its payment for eligible services from 85% to 100% of the Schedule Fee.
What is the Extended Medicare Safety Net?
The Extended Medicare Safety Net, or EMSN, is the second of Medicare's two Safety Nets.
Importantly, the EMSN does not replace the Original Medicare Safety Net. Medicare keeps track of your progress towards both Safety Nets at the same time.
This means the same eligible consultation can contribute towards both your OMSN and EMSN running totals concurrently. Medicare simply uses a different calculation for each one.
For patients paying private specialist fees, reaching the EMSN can result in a much larger increase in the amount Medicare pays back than reaching the Original Medicare Safety Net alone. This is because the EMSN takes your actual out-of-pocket costs into account, rather than only the difference between Medicare's Schedule Fee and your ordinary Medicare rebate.
Once you have reached the EMSN threshold, Medicare may begin paying you an additional amount for eligible out-of-hospital medical services for the remainder of the calendar year.
If you have also reached the Original Medicare Safety Net, the two Safety Nets can work together to increase the amount Medicare pays you back.
We will show you how this works after we have explained the EMSN calculation below.
What is the Extended Medicare Safety Net Threshold?
A threshold is the amount your Extended Medicare Safety Net running total needs to reach before Medicare begins paying you more back under the Extended Medicare Safety Net.
For 2026, there are two Extended Medicare Safety Net thresholds:
$2,699.10: This is the general EMSN threshold and applies to most people.
$861.20: This lower threshold applies to eligible concession cardholders and people or families eligible for Family Tax Benefit Part A.
As you receive eligible out-of-hospital medical care throughout the calendar year, your eligible out-of-pocket costs are added to your EMSN running total.
Remember, Medicare is tracking your OMSN and EMSN running totals at the same time. The same eligible consultation can therefore contribute towards both thresholds, even though a different amount is added to each running total.
In our 60-minute review example, the same consultation adds:
$33.45 towards your OMSN threshold and $610.30 towards your EMSN threshold
Once your EMSN running total reaches the threshold that applies to you, you have reached the Extended Medicare Safety Net. Medicare can then begin paying you an additional amount for eligible out-of-hospital medical services for the remainder of that calendar year.
If you have also reached the Original Medicare Safety Net, the two Safety Nets can work together to increase the amount Medicare pays you back.
We will show you how this works below, after first explaining how Medicare calculates the additional EMSN payment.
What counts towards the Extended Medicare Safety Net threshold?
The two Safety Nets are being tracked at the same time, but they count different amounts from the same consultation.
The Original Medicare Safety Net counts the difference between the Schedule Fee and your ordinary Medicare rebate. This is called your gap amount.
The Extended Medicare Safety Net counts your actual out-of-pocket cost for the eligible service.
Your out-of-pocket cost is the amount the service has ultimately cost you after receiving your ordinary Medicare rebate.
What does this look like in practice?
Let's continue with the same 60-minute telehealth review.
Dr Stevenson's consultation fee is: $800
Your ordinary Medicare rebate (85% of the Schedule Fee) is: $189.70
This leaves you with:
$800 consultation fee− $189.70 Medicare rebate = $610.30 out-of-pocket cost
For the Extended Medicare Safety Net, the full $610.30 is added to your EMSN threshold running total.
At the same time, as we saw in the previous section, $33.45 from this same consultation is added to your OMSN threshold running total.
So, from this one eligible consultation:
OMSN running total: + $33.45
EMSN running total: + $610.30
One Consultation. Two Safety Net running totals
You do not need to choose between the OMSN and EMSN. The same eligible consultation can contribute towards both Safety Nets at the same time.
Medicare simply calculates a different amount towards each threshold.
Brief Recap
Original Medicare Safety Net
2026 threshold
$594.40
The Original Medicare Safety Net looks at the difference between Medicare's Schedule Fee and the Medicare rebate it has already paid you.
Prior to reaching the OSMN threshold, if eligible you receive 85% of the Medicare Schedule Fee for the item number. After reaching the OSMN threshold, you receive 100% of the Medicare Schedule Fee threshold.
Extended Medicare Safety Net
2026 thresholds
The Extended Medicare Safety Net works alongside the Original Medicare Safety Net, but it counts your medical costs differently.
For patients paying private specialist fees, this Safety Net can make a more substantial difference because it takes into account what you are actually left paying out of pocket.
For patients receiving regular private specialist care, reaching the Extended Medicare Safety Net can therefore make a meaningful difference to ongoing out-of-pocket costs.
What happens once you reach the ESMN threshold?
Once you reach the EMSN threshold, Medicare can begin paying you an additional amount towards eligible out-of-hospital medical services for the remainder of that calendar year.
Your consultation fee does not change. What changes is the amount Medicare pays you back.
The additional EMSN payment is generally based on 80% of your out-of-pocket cost. However, Medicare places a limit on how much it can pay as an additional EMSN payment for each Medicare item. This limit is called the EMSN cap.
An EMSN cap is the maximum additional amount Medicare can pay under the Extended Medicare Safety Net for a particular Medicare item.
EMSN caps are set by the Australian Government under Medicare. They are not set by Dr Stevenson and are not based on Dr Stevenson's consultation fee.
Different Medicare items can have different EMSN caps. For the Medicare item used in our 60-minute telehealth example, the EMSN cap is $500.
Once you have reached the EMSN threshold, Medicare therefore compares two amounts 80% of your out-of-pocket cost and the EMSN cap for the Medicare item
Medicare pays the lower of these two amounts as your additional EMSN payment.
What does this look like in practice?
Let's continue with the same 60-minute telehealth review.
For this calculation, we are looking at the EMSN on its own. This example assumes that you have reached the EMSN threshold but have not yet reached the OMSN threshold.
Remember, Medicare has been tracking your progress towards both Safety Nets at the same time. Depending on the eligible medical care you have received during the year and the thresholds that apply to you, you may have reached both thresholds by this point.
If you have reached both, the OMSN and EMSN can work together to increase the amount Medicare pays you back. We will show you what happens when both thresholds have been reached in the next section.
We already know that your out-of-pocket cost before the EMSN applies is $610.30.
Medicare first calculates 80% of this amount:
80% of $610.30 = $488.24
Medicare then compares $488.24 with the $500 EMSN cap for the Medicare item in our example.
Because $488.24 is the lower amount, Medicare pays an additional EMSN payment of $488.24.
01
Before reaching the ESMN threshold
Consult Fee
$800
Medicare Schedule Fee
$223.15
Medicare rebate
(85% of the Schedule Fee)
$189.70
Your out-of-pocket cost
$610.30
02
After reaching the ESMN threshold
Consult Fee
$800
Medicare Schedule Fee
$223.15
Medicare rebate
(85% of the Schedule Fee)
$189.70
Additional EMSN payment
(80% of $610.30 = $488.24, below the $500 cap)
$488.24
Total Medicare pays to you:
($189.70 + 488.24)
$677.94
Your out-of-pocket cost
$122.06
What happens if you reach both the OSMN and ESMN Safety Net thresholds?
If you have reached both thresholds, both the OMSN and EMSN can apply to the same eligible consultation.
They work together, but each Safety Net does something different.
First, the OMSN increases the amount Medicare pays you back towards the consultation. This Medicare payment is deducted from your consultation fee to work out how much you are still out of pocket.
The EMSN is then calculated using this remaining out-of-pocket amount. Medicare may pay you an additional amount towards it.
This means that when both Safety Nets apply, you receive the higher Medicare payment available under the OMSN plus an additional payment under the EMSN.
Ultimately, Medicare pays you more back, leaving you with a lower out-of-pocket cost.
What does this look like in practice?
Let's continue with the same 60-minute telehealth review.
Dr Stevenson's consultation fee is $800.
Medicare Schedule Fee is $223.15.
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Consultation Fee
Dr Stevenson's consultation fee
Consultation fee
$800
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After the OMSN
Medicare pays you back 100% of the Schedule Fee
Medicare pays back
$223.15
Consult Fee - OMSN rebate
($800 - $223.15)
$576.85
$576.85 remains out of pocket
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Additional EMSN payment
The EMSN is calculated using the amount you are still out of pocket. Starting with the $576.85 remaining.
Calculation:
80% of $576.85
$461.48
ESMN cap for this item:
$500
Medicare pays the lower of these two amount back to you, which in this example is $461.48.
Remainder amount after the OSMN rebate is deducted ($576.85) minus the lesser of the ESMN cap or 80% of the remainder ($461.48)
$115.37
Your out of pocket
$115.37
In this example, Medicare paid back the OSMN payment of $223.15 as well as the additional payment of $461.48. The total Medicare paid back to you was $684.63. Your final out of pocket cost for this consultation was $115.37 ($800- $684.13).
Putting it all together (Recap)
Using our example of a 60-minute, $800 telehealth consult:
Before either Safety Net
After OMSN only
After EMSN only
After both OMSN + EMSN
Dr Stevenson’s consultation fee
$800.00
$800.00
$800.00
$800.00
Medicare Schedule Fee
$223.15
$223.15
$223.15
$223.15
Medicare payment
$189.70
$223.15
$189.70
$223.15
Additional EMSN payment
$0
$0
$488.24
$461.48
Total Medicare paid back to you
$189.70
$223.15
$677.94
$684.63
85% of Schedule Fee only
100% of Schedule Fee only
85% of Schedule Fee + Additional EMSN payment
100% of Schedule Fee + Additional EMSN payment
Your out-of-pocket cost
$610.30
$576.85
$122.06
$115.37
The safety net in practice
Medicare rules can feel abstract until you see what they could mean in practice. Here is a fictional example of someone receiving ongoing psychiatric care.
Meet Sarah*
Sarah is referred for an initial psychiatric assessment and then attends a 60-minute follow-up appointment each month.
Sarah, her partner and their two children have registered together as a Medicare Safety Net family.
Throughout the year, the family has a number of medical expenses. Sarah attends her psychiatric appointments and sees her GP, her partner has several medical appointments, and one of their children sees a paediatrician.
Because they are registered as a Medicare Safety Net family, eligible healthcare costs across the whole family can contribute towards the same family Safety Net threshold. This means Sarah does not need to reach the threshold through her psychiatric care alone. Eligible costs from her partner and children can also help the family reach it sooner.
Once the family reaches its applicable Extended Medicare Safety Net threshold, Medicare may begin paying higher benefits towards eligible medical services for family members for the remainder of the calendar year.
01
Sarah’s initial assessment
90-minute initial assessment
Consultation fee
$1,200
Medicare pays back
approx. $269
Sarah pays out of pocket
approx. $931
Because Sarah will be receiving ongoing psychiatric care, this example uses the standard new-patient rebate rather than the higher assessment and management plan rebate.
The Medicare item that applies will depend on the care provided and your eligibility.
02
Her monthly appointments
60-minute follow-up each month
Consultation fee
$625
Medicare pays back
approx. $190
Sarah pays out of pocket
approx. $435
During the year, Sarah also sees her GP and another specialist. Her partner has medical appointments, and one of their children sees a paediatrician.
Because they are registered as a Medicare Safety Net family, their eligible healthcare costs can be combined.
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After reaching the Original Medicare Safety Net and the Extended Medicare Safety Net
Sarah attends the same 60-minute follow-up appointment. Same appointment, higher rebate.
Consultation fee
$625
Medicare pays back
$538
Sarah pays out of pocket
$87
In this example, Sarah’s out-of-pocket cost for the same appointment falls from approximately $435 to $87.
The higher Safety Net benefits can continue for eligible services for the remainder of the calendar year. Sarah* and her family are fictional and these figures are examples only. Figures are based on 2026 Medicare Rebates.
Registering your family
If you’re part of a couple or family, registration matters.
Being on the same Medicare card does not automatically mean your healthcare costs will be combined for the Medicare Safety Net.
Register your Medicare Safety Net family →
Does everyone on my Medicare card count towards my Safety Net?
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Do I need to register for the Medicare Safety Net or Extended Medicare Safety Net?
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How do I register my Medicare Safety Net family?
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More questions
Still have questions?
Find answers to more common questions about Medicare, rebates and the Safety Net.
Does the Safety Net apply to all my medical expenses?
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When does the Safety Net reset?
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Can I track my Safety Net progress?
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Where can I get more information?
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