Private hospital (non-arrangement) services fees

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Effective 1 July 2019

For private hospital services provided on or after 1 July 2019
Service DescriptionTAC Item NumberMaximum
Payment
Rate

INPATIENT SERVICES

Advanced Surgical Patients 1 - 14 Days $779.00
15 + Days $599.45
General Surgical Patients 1 - 14 Days $697.58
15 + Days $599.45
Special Medical Patients 1 - 14 Days $697.58
15 + Days $590.86
General Medical Patients 1 - 14 Days $545.24
15 + Days $502.93
Psychiatric Patients 1 - 30 Days $697.58
  31 - 65 Days $590.86
66 + Days $502.93
Rehabilitation Patients 1 - 25 Days $680.70
  26 + Days $519.82
Intensive Care Unit^ 1 - 4 Days $1,902.73
5 + Days Original Patient Classification or High Dependency Unit 
Intensive Care Unit (Metropolitan)^ 1 - 4 Days $2,848.91
5 + Days Original Patient Classification or High Dependency Unit
Coronary Care Unit^ 1 - 4 Days $1,697.83
5 + Days Original Patient Classification or High Dependency Unit 
High Dependency Unit
Hospitals must seek recognition of HDU's from the TAC prior to any payments being considered.
1 - 3 Days $1,180.00
4 + Days Original Patient Classification 
Nursing Home Type Patient
Applies when an Acute Care Certificate is not submitted to TAC for a surgical or medical patient after 35 days hospitalisation or each period up to 31 days thereafter.  
 $192.97
Same Day Patient Bed Fee
Only applicable if a procedure or operation is performed.
 $269.36
Bed Leave / Hospital Leave Fee   75% of the applicable bed fee
Hospital in the Home HIT $390.66
Facility Fee - Emergency Department Patients
A facility fee is only payable to hospitals with an approved Emergency Department.
 $45.10
Theatre Fees   
Band 1A $108.43
  1 $340.81
  2 $483.94
  3 $607.83
  4 $794.72
  5 $1,072.51
  6 $1,339.39
  7 $1,804.02
  8 $2,402.93
  9A $2,624.66
  9 $3,508.17
  10 $4,795.09
  11 $5,240.34
  12 $6,596.97
  13 $7,454.52
  0 (Lithotripsy) $3,214.93
  Electroconvulsive Therapy $243.94
  (Individual approval is required for electroconvulsive therapies)  
Therapy Services Refer Outpatient Services
^Reimbursements will be made only to hospitals with approved facilities

OUTPATIENT SERVICES
These fee and item numbers also apply to therapy services provided to Inpatients.

Fees are for 30 minute sessions unless otherwise stated. For times greater than 30 minutes, fees are charged in 15 minute units.
Hydrotherapy (by a Physiotherapist)
Individual Session 99923 $57.93
Group Session 99922 $34.93
Dietician
Individual Session 99917 $52.96
Driving Assessment
Driving Assessment by Occupational Therapist 99921 $58.42
Driving Instruction By Driving School (30 minutes) 
(charge in 30 minute units) 
99957* $55.55
Occupational Therapy
Individual Session 99920 $52.96
Group Session 99919 $31.84
Worksite / Home Assessment & Report (charge in 30 min units) 99967 $52.96
Physical Education
Individual Session 99958* $52.96
Group Session 99959* $31.84
Physiotherapy
Individual Session 99913 $57.93
Group Session 99914 $34.93
Worksite / Home Assessment & Report
(charge in 30 min units)
99966 $57.93
Podiatry   
Individual Session 99941 $52.96
Psychology
Individual Session 99908 $90.88
Group Session 99907 $54.55
Rehabilitation Assessments & Reports
Initial Assessment and Preparation of Rehabilitation Plan 99904 $592.60
Medical & Like Report / Reviews (Only payable when requested by TAC) 99905* $225.38
Rehabilitation Counselling
Individual Session 99928 $50.43
Group Session 99937 $30.07
Social Work
Individual Session 99940 $52.96
Group Session 99952 $31.84
Special Education / Accredited Teacher
Individual Session 99912* $50.90
Group Session 99936* $30.45
Speech Therapy
Individual Session 99930 $52.96
Group Session 99929 $31.84

^Reimbursements will be made only to hospitals with approved facilities

For private hospital services provided between 1 July 2018 and 30 June 2019
Service DescriptionTAC Item NumberMaximum
Payment
Rate

INPATIENT SERVICES

Advanced Surgical Patients 1 - 14 Days $755.94
15 + Days $581.71
General Surgical Patients 1 - 14 Days $676.93
15 + Days $581.71
Special Medical Patients 1 - 14 Days $676.93
15 + Days $573.37
General Medical Patients 1 - 14 Days $529.10
15 + Days $488.04
Psychiatric Patients 1 - 30 Days $676.93
  31 - 65 Days $573.37
66 + Days $488.04
Rehabilitation Patients 1 - 25 Days $660.55
  26 + Days $504.43
Intensive Care Unit^ 1 - 4 Days $1,846.41
5 + Days Original Patient Classification or High Dependency Unit 
Intensive Care Unit (Metropolitan)^ 1 - 4 Days $2,764.59
5 + Days Original Patient Classification or High Dependency Unit
Coronary Care Unit^ 1 - 4 Days $1,647.58
5 + Days Original Patient Classification or High Dependency Unit 
High Dependency Unit
Hospitals must seek recognition of HDU's from the TAC prior to any payments being considered.
1 - 3 Days $1,145.08
4 + Days Original Patient Classification 
Nursing Home Type Patient
Applies when an Acute Care Certificate is not submitted to TAC for a surgical or medical patient after 35 days hospitalisation or each period up to 31 days thereafter.  
  $187.26
Same Day Patient Bed Fee
Only applicable if a procedure or operation is performed.
  $261.39
Bed Leave / Hospital Leave Fee   75% of the applicable bed fee
Hospital in the Home HIT $379.10
Facility Fee - Emergency Department Patients
A facility fee is only payable to hospitals with an approved Emergency Department.
  $43.77
Theatre Fees   
Band 1A $105.22
  1 $330.72
  2 $469.62
  3 $589.84
  4 $771.20
  5 $1,040.77
  6 $1,299.75
  7 $1,750.63
  8 $2,331.81
  9A $2,546.98
  9 $3,404.34
  10 $4,653.17
  11 $5,085.24
  12 $6,401.72
  13 $7,233.89
  0 (Lithotripsy) $3,119.78
  Electroconvulsive Therapy $236.72
  (Individual approval is required for electroconvulsive therapies)  
Therapy Services Refer Outpatient Services
^Reimbursements will be made only to hospitals with approved facilities

OUTPATIENT SERVICES
These fee and item numbers also apply to therapy services provided to Inpatients.

Fees are for 30 minute sessions unless otherwise stated. For times greater than 30 minutes, fees are charged in 15 minute units.
Hydrotherapy (by a Physiotherapist)
Individual Session 99923 $56.22
Group Session 99922 $33.90
Dietician
Individual Session 99917 $51.39
Driving Assessment
Driving Assessment by Occupational Therapist 99921 $56.69
Driving Instruction By Driving School (30 minutes) 
(charge in 30 minute units) 
99957* $53.91
Occupational Therapy
Individual Session 99920 $51.39
Group Session 99919 $30.90
Worksite / Home Assessment & Report (charge in 30 min units) 99967 $51.39
Physical Education
Individual Session 99958* $51.39
Group Session 99959* $30.90
Physiotherapy
Individual Session 99913 $56.22
Group Session 99914 $33.90
Worksite / Home Assessment & Report
(charge in 30 min units)
99966 $56.22
Podiatry   
Individual Session 99941 $51.39
Psychology
Individual Session 99908 $88.19
Group Session 99907 $52.94
Rehabilitation Assessments & Reports
Initial Assessment and Preparation of Rehabilitation Plan 99904 $575.06
Medical & Like Report / Reviews (Only payable when requested by TAC) 99905* $218.71
Rehabilitation Counselling
Individual Session 99928 $48.94
Group Session 99937 $29.18
Social Work
Individual Session 99940 $51.39
Group Session 99952 $30.90
Special Education / Accredited Teacher
Individual Session 99912* $49.39
Group Session 99936* $29.55
Speech Therapy
Individual Session 99930 $51.39
Group Session 99929 $30.90

^Reimbursements will be made only to hospitals with approved facilities