Medicare partially covers IVF Fresh Cycle. A rebate applies to the specialist and procedure fees when billed under the correct MBS item numbers, but you'll typically still have an out-of-pocket gap. The exact amount depends on your provider, their fee structure, and whether you hold private health insurance.
Clinical Eligibility:IVF Fresh Cycle may attract a Medicare rebate when performed for a documented medical necessity. Eligibility is assessed on a case-by-case basis by your treating specialist. Procedures performed purely for cosmetic or elective reasons without clinical indication are unlikely to be covered.
Official MBS item numbers and schedule fees from Medicare Benefits Schedule Online.
| Item | Description | Schedule Fee | Benefit (75%) | Gap |
|---|---|---|---|---|
| 13200 | ART superovulated treatment cycle, stimulation, monitoring, counselling, embryology (first cycle/year) | $3,629 | $2,722 | $907 |
| 13212 | Oocyte retrieval for assisted reproductive technologies | $414 | $310 | $103 |
| 13218 | Preparation of frozen/donated embryos for transfer, including counselling | $926 | $694 | $231 |
A GP referral is required before you can see a specialist for IVF Fresh Cycle 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 IVF Fresh Cycle 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.
IVF Fresh Cycle is partially 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 IVF Fresh Cycle. The referral is also required for Medicare claims to be processed correctly.
Private health insurance can reduce out-of-pocket costs for IVF Fresh Cycle 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...