Australian private health fund fee schedules & gap rates
Find official medical fee schedules, GapCover, MediGap, Medicover and Access Gap Cover resources in one place. Search by health fund, choose the relevant state where required, then open the official source to check the applicable schedule and MBS item number.
Latest verified schedule updates
AHSA Access Gap Cover schedules updated.
Medibank and ahm GapCover rates updated.
nib, HCF, Bupa and GU Health provider resources remain available through their official portals.
Official fee schedule directory
| Health fund / scheme | Arrangement | State | Official schedule |
|---|---|---|---|
| Bupa Bupa Australia Medical Gap Scheme | Direct insurer | Australia | Open official schedule |
| Medibank GapCover | Direct insurer | Australia | Open current rates |
| ahm GapCover schedule of benefits | Direct insurer | Australia | Open schedule / Excel links |
| HCF Medicover | Direct insurer | Australia | Open provider schedule |
| nib MediGap | Direct insurer | Australia | Open current schedule |
| GU Health Medical Gap Network | Direct insurer | State-based | Open provider resources |
| AHSA participating funds Access Gap Cover — includes many participating not-for-profit funds | Shared scheme | State-based | Open Access Gap schedules |
| CBHS Access Gap Cover via AHSA | AHSA | State-based | Open AHSA schedule |
| Defence Health Access Gap Cover via AHSA | AHSA | State-based | Open AHSA schedule |
| Teachers Health / Doctors’ Health Fund Access Gap Cover via AHSA | AHSA | State-based | Open AHSA schedule |
| Australian Unity Access Gap Cover resources | AHSA | State-based | Open AHSA schedule |
| HBF Provider arrangements vary by location; AHSA applies outside WA in relevant arrangements | Mixed | State-dependent | Open HBF provider page |
| RT Health Medicover | Direct insurer | State-based | Open provider resources |
Search by MBS item number
Enter an MBS item number to open the most relevant official fund schedule sources. DEVZ does not calculate or guarantee the payable benefit because scheme eligibility and provider participation can change the amount paid.
How to use a health fund schedule safely
How to read a private health fund fee schedule →
Check effective date, state, item number and provider participation.
MBS fee vs health fund gap fee →
Understand why the MBS fee and a fund’s scheme rate are not the same thing.
No Gap vs Known Gap billing →
A practical overview for specialists and practice teams.
Access Gap Cover explained →
How AHSA schedules work and why provider-number location matters.
Need help billing a health fund?
DEVZ Solutions manages inpatient Medicare and private health fund billing for Australian specialists, with a 3.5% service fee plus GST and payments directed to your nominated account.
See why our billing service is 3.5% → Discuss your billing needs →