Medivik Paediatrician Price & Medicare Rebates

Welcome to Medivik!

Below you’ll find a clear guide to our private paediatrician price, applicable Medicare rebates, and how the billing process works.

DISCLAIMER: The information on this page is intended as a general guide only. Actual consultation fees and charges for reports, forms, letters, or other personal requests may vary depending on the complexity of the condition, the time required, and the nature of the service provided. Parents and carers are welcome to confirm the expected cost of their appointment or request with Dr Akkera at the beginning of the consultation.

Medivik Paediatric Appointment Fees

Our consultation fees are designed to support thorough, individualised paediatric care, including developmental assessments, ongoing management, and routine follow-up appointments. The table below provides a general guide to our standard appointment types, Medicare rebates, and expected out-of-pocket costs for families attending Medivik.

Service	Purpose	Gross Fee	Medicare Rebate	Gap Fee
First Visit or Annual Consultation MBS 132 \| Telehealth 92422	Initial or annual consultation billed once per year. This 40-minute appointment is generally used for comprehensive assessment, diagnosis review, treatment planning, and ongoing management discussions.	$650.00	$265.60	$384.40
Follow Up MBS 116 \| Telehealth 91825	Routine consultation of up to 20 minutes for treatment monitoring, medication or lab tests review, script renewals, and general follow-up care.	$300.00 - $400.00	$78.00 - $137.00	$222.00 - $263.00
ADHD or Autism Assessment MBS 132 \| Telehealth 92422	A comprehensive assessment covering developmental, medical, and family history, physical examination, clinical observation, and a detailed treatment and management plan.	$650.00	$265.60	$384.40

Understanding Medicare Rebates

What Is the Gap Fee?

The gap fee is your net out-of-pocket cost for a consultation once Medicare’s rebate has been applied. It is the consultation fee minus the rebate Medicare pays back to you.

In practice, you pay the full consultation fee on the day of your appointment. Immediately after the consultation finishes, our reception team processes the Medicare rebate through Easyclaim, and that rebate is paid back into your nominated bank account, usually within a few minutes. What remains is your gap fee, which is the figure shown against each consultation type in our pricing table above.

NOTE: A current GP referral is required in order to claim a Medicare rebate on your consultation. Without a valid referral you can still attend the appointment, but the full consultation fee will apply and no rebate will be available.

Medicare Safety Net: Reducing the Cost of Ongoing Care

For families managing ongoing conditions such as ADHD, autism, or developmental concerns, the Medicare Safety Net can significantly reduce the long-term cost of specialist paediatric care.

Essentially, Medicare keeps a running total of your family’s out-of-pocket medical costs across the calendar year. Once the annual threshold is reached, Medicare automatically increases the rebate on eligible out-of-hospital services, covering 80% of the gap up to the Medicare item cap for the rest of the year.

NOTE: Most families reach the standard Extended Medicare Safety Net threshold of $2,699.10 around the fifth or sixth paediatric appointment of the year. Families with a concession card or Family Tax Benefit Part A usually reach the lower concessional threshold of $834.50 much earlier, often around the second or third appointment.

At Medivik, a typical year of care involving an annual review and multiple progress appointments often results in around $1,400 to $1,800 in out-of-pocket costs. Many families may reach the Safety Net sooner, as Medicare also counts eligible GP visits, specialist appointments, scans, pathology, and other Medicare-subsidised healthcare expenses across the household.

Medicare Safety Net Thresholds 2025

Safety Net	2025 Threshold	Who It Applies To	What Counts	Benefit Once Crossed
Extended Medicare Safety Net (General)	$2,699.10	Everyone not on the concessional threshold	Total out-of-pocket costs for out-of-hospital services	Medicare pays 80% of the gap (up to the item cap) for the rest of the calendar year
Extended Medicare Safety Net (Concessional / FTB Part A)	$861.20	Concession card holders and families on Family Tax Benefit Part A	Total out-of-pocket costs for eligible services	The same 80% benefit at a much lower threshold

To ensure every family member’s costs are counted toward the same threshold, register your family as a single unit with Medicare. This can be checked or updated through myGov, the Medicare app, or by calling Medicare directly. Thresholds reset on 1 January each year.

Deposits and Cancellations

Deposits are credited toward your consultation fee on the day of the appointment.

The cancellation policy is straightforward. At least one week’s notice allows a free cancellation or reschedule, with the deposit either refunded or rolled over to the new appointment. Cancellations or reschedules within one week of the original appointment date will result in the deposit being forfeited.

In the case of a genuine emergency, contact us as soon as your circumstances allow. These situations are reviewed individually, and we will always work toward a fair outcome.

Frequently Asked Questions

Do I need a referral to see a paediatrician at Medivik?

Yes. Under current Medicare requirements, a valid referral from a GP or another specialist is needed to claim Medicare rebates for specialist paediatric appointments. GP referrals are generally valid for 12 months, while specialist referrals are usually valid for 3 months unless marked as indefinite.

Will my private health insurance cover paediatrician fees or the gap?

Usually not. Private health insurance generally does not cover outpatient specialist consultations provided outside a hospital setting. While some policies may cover inpatient hospital care, Medicare remains the primary rebate system for paediatric specialist appointments in private clinics.

Can NDIS funds be used to cover paediatrician consultations?

No. The NDIS does not fund Medicare-claimable medical services, including paediatrician consultations. However, NDIS funding may cover eligible allied health supports such as speech pathology, occupational therapy, psychology, or behavioural therapy where appropriate under a participant’s plan.

How long does the rebate take to reach my bank account?

In most cases, Medicare rebates are processed automatically on the same day once payment has been finalised at reception. The rebate is usually deposited into your nominated bank account within 1 to 2 business days, depending on your bank and Medicare account details.

Does the Medicare Safety Net apply to past visits once the threshold is reached?

No. The Extended Medicare Safety Net only applies to eligible services provided after the threshold has been reached within the same calendar year. Earlier appointments are not retrospectively adjusted or reimbursed at the higher rebate rate.

Can you help with NDIS, school forms, and other medical reports?

Yes. Dr Akkera can assist with medical reports, school documentation, NDIS supporting letters, and other administrative requests where clinically appropriate. Additional fees may apply depending on the complexity, length, and time required to complete the documentation.

If my child is not yet on Medicare (e.g., newborn), can I still claim later?

Yes, in many cases. If your child is eligible for Medicare but has not yet been added to a Medicare card at the time of the appointment, you can usually submit the claim later once Medicare registration has been completed and the service falls within Medicare’s allowable claiming period.

Downloads

Medikids Fee Schedue (PDF)

Medicare Safety Net Fact Sheet (2025)

Autism Item 135 Fact Sheet

Understanding Pediatrician Price Codes: MBS Items

On your invoice and Medicare claim, each service is represented by an MBS item number. Here we explain what each relevant item code means in plain language:

MBS Item	When It's Used
110	Your child's first appointment with our pediatrician for a new referral. Standard consultation for general pediatric concerns like growth, development, or health issues.
132	Comprehensive first appointment (40+ minutes) for children with multiple or complex health issues. Includes a detailed treatment and management plan. Aside from initial appointments, a child's annual consultation can also fall under this category. Can only be claimed once per patient per 12 months per doctor.
133	Longer follow-up appointment (20+ minutes) to review or update a management plan created under Item 132. Typically used up to twice in a 12-month period; after that, follow-ups revert to Item 116.
116	Regular follow-up appointment after your your first view visits and usually follows two 133s. Used for ongoing care, reviewing test results, adjusting medications, or monitoring progress.
119	Short check-in appointment for minor issues. Used for quick updates, prescription renewals, weight checks, or brief questions that don't require a full physical examination. Lower fee and rebate than standard follow-ups.
135	One-off assessment to diagnose autism, ADHD, or other complex neurodevelopmental conditions. Includes a formal management plan that unlocks up to 20 Medicare-rebated therapy sessions (speech, OT, psychology) per child's lifetime.
91824 / 91825 / 91826 / 91836 / 92422 / 92423 / 92140	These are the telehealth codes for video or phone appointments. You get the same Medicare rebate whether you see us in person, by video, or by phone.