Fees and Charges

Average costs for services provided to Medicare ineligible patients

Health services are required to set their own fees for patients who are not covered by Medicare,
including overseas patients. Fees for ineligible patients should be set to achieve full cost recovery.
When charging fees, hospitals should be aware that some overseas patients are entitled to financial
assistance (e.g. because of Reciprocal Health Care Agreements).
Fees will vary between hospitals, and may be determined on a DRG or bed day basis. Fees raised on a
DRG basis are calculated using the DRG cost weight and the private WIES rate. These are published in
the Victorian health policy and funding guidelines.
The following table provides a guide to average costs per day/per encounter for services provided to
Medicare ineligible patients. Please note that this is a guideline only, and that fees charged to
Medicare ineligible patients are to be determined by individual health services.

Patient Classification Estimated average costs for 2016-17 Estimated range for 2016-17
(the department expects that
costs for 50% of patients will fall within this range)
Accomodation Charges - Fee per day
Same Day
-Single Room $403 $121 - $522
-Shared Ward $418 $168 - $558
-Single Room $821 $625 - $1,008
-Shared Ward $735 $580 - $838
Intensive Care Unit (ICU)
-1 to 4 Days $4,273 $2,726 - $5,028
-5+ days $3,979 $2,675 - $5,026
Coronary Care Unit (CCU)
-1 to 4 Days $1,546 $1,103 - $1,636
-5+ Days $1,288 $1,110 - $1,326
Special Care Nursing $923 $747 - $1,040
Emergency Department $570 $222 - $680
Hospital in the Home $338 $272 - $394
Outpatients - Fee per Encounter
-Medical $329 $132 - $328
-Allied Health $171 $68 - $184
Postnatal Care - hourly rate* $92.24 N/A


Except where indicated, estimated average costs are based on costs for 2014-15 reported to the
Victorian Cost Data Collection, and an allowance has been made for indexation, capital and
depreciation to estimate bed day and encounter costs for 2016-17. Note that a number of costs are
excluded, and health services should ensure that they also charge for the following items in addition
to any fee determined on either a DRG or bed day basis:

(cccxxi) Medical costs billed separately by the treating medical practitioner
(cccxxii)Diagnostics, which should be charged at 100% of the Medicare Benefits Schedule rate
(cccxxiii) Prostheses, in line with the Commonwealth’s schedule rate
(cccxxiv) Drugs, which should be charged at cost (only when a bed day fee applies – fees
determined on a DRG basis already include costs for drugs)
(cccxxv)Theatre fees, with charges based on the TAC Schedule of Fees for Private Hospital
Services (Non Arrangement): http://www.tac.vic.gov.au/providers/fees-and-policies/feeschedule/

* Fee for Postnatal Care is based on Community Health Nursing hourly rates, as an average cost
cannot be calculated with the available data.