Medicare fully covers Endoscopy (Gastroscopy) when medically indicated and billed under the correct MBS item numbers. You may still have an out-of-pocket amount if your provider charges above the schedule fee. Ask your specialist to confirm the item numbers before treatment.
Clinical Eligibility:Medicare covers Endoscopy (Gastroscopy) when performed for a documented medical indication and billed under the appropriate MBS item numbers. Your treating specialist will confirm which item numbers apply to your specific circumstances.
Official MBS item numbers and schedule fees from Medicare Benefits Schedule Online.
| Item | Description | Schedule Fee | Benefit (75%) | Gap |
|---|---|---|---|---|
| 30473 | Gastroscopy, duodenoscopy or panendoscopy, with or without biopsy | $207 | $155 | $52 |
| 30478 | Gastroscopy with therapeutic intervention (polypectomy, banding, diathermy) | $287 | $215 | $72 |
A GP referral is required before you can see a specialist for Endoscopy (Gastroscopy) and access any Medicare rebate. Referrals to specialists are valid for 12 months (3 months for non-specific referrals).
Private health insurance can reduce out-of-pocket costs for Endoscopy (Gastroscopy) when performed in a private hospital setting. Your level of cover (Gold, Silver, Bronze) determines which clinical categories are included. Check waiting periods. Most new policies have a 12-month waiting period for obstetric and major dental procedures.
Get a referral from your GP. This is required for most specialist consultations and procedures.
At your specialist appointment, ask which MBS item numbers will be billed and confirm the expected out-of-pocket cost.
After treatment, your provider may submit the claim directly to Medicare (bulk billing), or you pay and claim yourself.
To self-claim: log in to myGov, go to Medicare, and select 'Make a claim'. Upload your receipt.
If you have private hospital cover, submit a separate claim to your health fund for any eligible hospital or extras costs.
Endoscopy (Gastroscopy) is fully covered by Medicare when billed under the appropriate MBS item numbers. You may still have an out-of-pocket gap depending on what your provider charges above the schedule fee.
Yes. In most cases you'll need a referral from your GP to see a specialist who can perform Endoscopy (Gastroscopy). The referral is also required for Medicare claims to be processed correctly.
Private health insurance can reduce out-of-pocket costs for Endoscopy (Gastroscopy) if the procedure is performed in a private hospital and your policy includes the relevant clinical category. Check your extras cover and waiting periods before booking.
Ask your specialist for the specific MBS item numbers they plan to use, then check the Medicare Benefits Schedule to find the schedule fee and rebate. The gap is the difference between your provider's fee and the Medicare benefit.
The Medicare gap is the amount you pay after the Medicare rebate is applied. If your provider charges above the schedule fee, the gap is the difference between their fee and what Medicare pays. Providers using the known gap scheme agree to cap gaps at disclosed amounts.
Get the Medicare Coverage Guide
Our plain-english PDF guide on how to understand MBS items and specialist fees.
Verifying your browser...