Benefit Calculator | RebateRight

How much does Medicare pay for this MBS item, per patient and in total?

That is the question this endpoint answers. Send the item, how many patients were seen and whether the service is in hospital. It works out the schedule fee, the benefit for one patient and the total for the patients seen, with the working behind every figure.

This endpoint needs no patient details. To check whether a particular patient can claim the item, use Eligibility Check, which quotes the same benefit.

What you get back

Field	What it holds
`ScheduleFee`	The MBS fee for one patient. `"53.35"`
`Benefit`	What Medicare pays for one patient. `"53.35"`
`TotalBenefit`	`Benefit` multiplied by `PatientsSeen`. `"160.05"`
`Reason`	How the figures were worked out, in one sentence you can show as it is.
`ReasonCode`	A code for that reason, for analytics only.

The response also carries ItemNumber, PatientsSeen and InHospitalTreatment, with any default filled in, so you always see which values were used.

Every request field is optional

Field	When omitted
`ItemNumber`	`23`, a standard GP consultation
`PatientsSeen`	`1`
`InHospitalTreatment`	`false`, out of hospital

An empty body {} is a valid request.

How the benefit is worked out

Published fee. The benefit is the amount the MBS publishes for the item. Where an item pays differently in and out of hospital, InHospitalTreatment decides which amount applies.

Derived fee. Some attendance items, such as a general practitioner seeing several residents in one visit to an aged care facility, have a fee that depends on PatientsSeen. The fee follows the item’s rule in the MBS, as published in the Ready Reckoner, and Medicare pays 100% of it. Reason shows the arithmetic.

When there is no figure

When the benefit cannot be worked out, the response is still 200: Benefit and TotalBenefit are null, and Reason and ReasonCode say why. Only a body that cannot be parsed, or that names a field this endpoint does not recognise, returns 400.

<Card title="How much does Medicare pay for this MBS item, per patient and in total?"> That is the question this endpoint answers. Send the item, how many patients were seen and whether the service is in hospital. It works out the schedule fee, the benefit for one patient and the total for the patients seen, with the working behind every figure. </Card> This endpoint needs no patient details. To check whether a particular patient can claim the item, use [Eligibility Check](/api-reference/medicare-eligibility/eligibility-check), which quotes the same benefit. ## What you get back | Field | What it holds | |---|---| | `ScheduleFee` | The MBS fee for one patient. `"53.35"` | | `Benefit` | What Medicare pays for one patient. `"53.35"` | | `TotalBenefit` | `Benefit` multiplied by `PatientsSeen`. `"160.05"` | | `Reason` | How the figures were worked out, in one sentence you can show as it is. | | `ReasonCode` | A code for that reason, for analytics only. | The response also carries `ItemNumber`, `PatientsSeen` and `InHospitalTreatment`, with any default filled in, so you always see which values were used. ## Every request field is optional | Field | When omitted | |---|---| | `ItemNumber` | `23`, a standard GP consultation | | `PatientsSeen` | `1` | | `InHospitalTreatment` | `false`, out of hospital | An empty body `{}` is a valid request. ## How the benefit is worked out **Published fee.** The benefit is the amount the MBS publishes for the item. Where an item pays differently in and out of hospital, `InHospitalTreatment` decides which amount applies. **Derived fee.** Some attendance items, such as a general practitioner seeing several residents in one visit to an aged care facility, have a fee that depends on `PatientsSeen`. The fee follows the item's rule in the MBS, as published in the Ready Reckoner, and Medicare pays 100% of it. `Reason` shows the arithmetic. ## When there is no figure When the benefit cannot be worked out, the response is still `200`: `Benefit` and `TotalBenefit` are `null`, and `Reason` and `ReasonCode` say why. Only a body that cannot be parsed, or that names a field this endpoint does not recognise, returns `400`.

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. Defaults to 23, a standard GP consultation (Level B), when omitted.

PatientsSeenintegerOptional

How many patients the practitioner sees on the same occasion at the same place. TotalBenefit is the benefit multiplied by this number, and on group attendance items the fee itself depends on it. Defaults to 1 when omitted. A value below 1 returns 200 with ReasonCode InvalidRequest.

How many patients the practitioner sees on the same occasion at the same place. `TotalBenefit` is the benefit multiplied by this number, and on group attendance items the fee itself depends on it. 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. Decides the benefit on items that pay differently in and out of hospital. Defaults to false when omitted.

Response

ItemNumberstring

The item the figures are for, with the default applied if you omitted it.

PatientsSeeninteger

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

InHospitalTreatmentboolean

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

ScheduleFeestring or null

The MBS schedule fee for one patient, in dollars, as a string such as "53.35". It is null when the fee could not be determined.

Benefitstring or null

What Medicare pays for one patient, in dollars, as a string such as "53.35". It is null when the benefit could not be worked out, and Reason says why.

TotalBenefitstring or null

Benefit multiplied by PatientsSeen. It is null whenever Benefit is.

Reasonstring

How the figures 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 the benefit were worked out.
`InvalidRequest`	A request value is not allowed, such as `PatientsSeen` below `1`. `Reason` names it.
`ItemNotFound`	The item number is not in the current MBS.
`ScheduleFeeNotAvailable`	The item exists but the MBS data has no fee for it.
`FeeDependsOnOtherServices`	The fee depends on details this endpoint does not have, such as the other services performed or the time taken. `Reason` quotes the MBS rule.
`BenefitNotDetermined`	The fee is known but the benefit could not be determined.

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