Benefit Calculator | RebateRight

Returns the benefit Medicare pays for an MBS item. The schedule fee comes back with it.

Every request field is optional. An empty body {} is valid: it prices a standard GP consultation (item 23) for one patient, out of hospital. The response echoes the values it used, so you always see which defaults applied.

What the calculation takes into account

The benefit and schedule fee published for the item in the MBS in force today. Benefits are read from the published amounts rather than worked out as a percentage of the fee, so they match what Medicare pays on every item, including the high-fee ones where a percentage does not.
Whether the service is in hospital or out of hospital, for the items that pay differently in each.
How many patients were seen on the occasion, for the attendance items whose fee depends on it, such as a general practitioner seeing several residents in one visit to an aged care facility. These figures reproduce the official MBS Ready Reckoner exactly.

A request that cannot be priced still returns 200, with ReasonCode and Reason explaining why. Only an unparseable body returns 400.

To check whether a specific patient can claim an item, use Eligibility Check, which verifies the patient with Medicare and quotes the same benefit.

Returns the benefit Medicare pays for an MBS item. The schedule fee comes back with it. Every request field is optional. An empty body `{}` is valid: it prices a standard GP consultation (item `23`) for one patient, out of hospital. The response echoes the values it used, so you always see which defaults applied. ## What the calculation takes into account - The benefit and schedule fee published for the item in the MBS in force today. Benefits are read from the published amounts rather than worked out as a percentage of the fee, so they match what Medicare pays on every item, including the high-fee ones where a percentage does not. - Whether the service is in hospital or out of hospital, for the items that pay differently in each. - How many patients were seen on the occasion, for the attendance items whose fee depends on it, such as a general practitioner seeing several residents in one visit to an aged care facility. These figures reproduce the official MBS Ready Reckoner exactly. A request that cannot be priced still returns `200`, with `ReasonCode` and `Reason` explaining why. Only an unparseable body returns `400`. To check whether a specific patient can claim an item, use [Eligibility Check](/api-reference/medicare-eligibility/eligibility-check), which verifies the patient with Medicare and quotes the same benefit.

Authentication

x-api-keystring

API Key authentication via header

x-minor-idstring

API Key authentication via header

Request

This endpoint expects an object.

ItemNumberstringOptional

The MBS item number to price. Defaults to 23 (a standard GP consultation, Level B) when omitted.

PatientsSeenintegerOptional

How many patients the practitioner sees at the same place on the same occasion. Sets the per-patient fee on the attendance items whose fee depends on it, and multiplies TotalBenefit for every item. Defaults to 1 when omitted. A value below 1 returns 200 with ReasonCode InvalidRequest.

How many patients the practitioner sees at the same place on the same occasion. Sets the per-patient fee on the attendance items whose fee depends on it, and multiplies `TotalBenefit` for every item. Defaults to `1` when omitted. A value below `1` returns `200` with `ReasonCode` `InvalidRequest`.

InHospitalTreatmentbooleanOptional

Whether the service is provided to an in-hospital patient. Defaults to false when omitted, and the service is priced out of hospital.

Response

ItemNumberstring

The item that was priced, such as "5010", echoed back with the default applied if you omitted it.

PatientsSeeninteger

The patient count used, with the default applied if you omitted it.

InHospitalTreatmentboolean

The setting the calculation used.

ScheduleFeestring or null

The MBS schedule fee per patient, in whole dollars and cents such as "53.35". It is null when the fee could not be determined.

Benefitstring or null

What Medicare pays per patient, in whole dollars and cents such as "53.35". It is null when the benefit could not be calculated, and Reason says why.

TotalBenefitstring or null

Benefit multiplied by PatientsSeen: what Medicare pays across the whole occasion. It is null whenever Benefit is.

Reasonstring

How the amounts were worked out, in one sentence you can show as it is. Never parse it, because the wording changes.

ReasonCodestring

A code for that reason, for analytics only.

Code	Meaning
`Calculated`	The fee and benefit were calculated.
`InvalidRequest`	A request value failed validation; `Reason` says which.
`ItemNotFound`	The item number is not in the current MBS.
`ScheduleFeeNotAvailable`	The item exists but its fee is not available in the MBS data.
`FeeDependsOnOtherServices`	The item’s fee is derived from details this calculator does not have, such as the other services performed or the time taken. `Reason` quotes the schedule’s own rule.
`BenefitNotDetermined`	The fee is known but the benefit percentage could not be determined.

New codes appear as coverage grows and are not a breaking change.

Returns the benefit Medicare pays for an MBS item. The schedule fee comes back with it.

What the calculation takes into account

The benefit and schedule fee published for the item in the MBS in force today. Benefits are read from the published amounts rather than worked out as a percentage of the fee, so they match what Medicare pays on every item, including the high-fee ones where a percentage does not.
Whether the service is in hospital or out of hospital, for the items that pay differently in each.
How many patients were seen on the occasion, for the attendance items whose fee depends on it, such as a general practitioner seeing several residents in one visit to an aged care facility. These figures reproduce the official MBS Ready Reckoner exactly.

A request that cannot be priced still returns 200, with ReasonCode and Reason explaining why. Only an unparseable body returns 400.

To check whether a specific patient can claim an item, use Eligibility Check, which verifies the patient with Medicare and quotes the same benefit.

$	curl -X POST https://api.rebateright.com.au/CalculateBenefit \
>	-H "x-api-key: <apiKey>" \
>	-H "Content-Type: application/json" \
>	-d '{}'

1	{
2	"ItemNumber": "23",
3	"PatientsSeen": 1,
4	"InHospitalTreatment": false,
5	"ScheduleFee": "45.05",
6	"Benefit": "45.05",
7	"TotalBenefit": "45.05",
8	"Reason": "Medicare item 23 has a schedule fee of $45.05. Medicare pays a benefit of $45.05, as published in the MBS.",
9	"ReasonCode": "Calculated"
10	}