Paying for knee replacement in Australia
Total knee replacement. Four routes can pay for it: a public hospital, the Medicare benefit, private hospital cover and paying the provider yourself. The table sets out what each route covers, the wait and the price, with the source of every figure and the date it was read. Where a route publishes nothing, or this site has not read it, the cell says so.
How each route pays for knee replacement
| Route | What it covers | Wait | Price | Source |
|---|---|---|---|---|
| Public hospitalAs a public patient, under Medicare | Treatment by a doctor the hospital appoints; you cannot choose your doctor, and you may be placed on a public hospital waiting list | 255 daysmedian from listing to admission, public hospitals, Australia, 2024-25; 23.2% waited more than 365 days | No charge as a public patient in a public hospitalMedicare covers treatment as a public patient by a doctor the hospital appoints |
|
| Medicare benefitPrivate patient: doctors’ fees | Medicare benefit for a privately admitted hospital patient (75% of the schedule fee) | Not applicableMedicare pays a benefit; it does not set a wait | Benefit set per MBS item: item 49518Total knee replacement. Figures not reproduced here until the MBS reuse terms are confirmed |
|
| Private hospital coverInsurance as a mechanism; no insurer or policy named | In-hospital medical services in APRA's "Orthopaedic surgical operations" groupAll insurers combined, Australia. Each specialty is an MBS item range as APRA groups it, not a single procedure. | Not trackedNo private-hospital wait is published | 46.9% billed under a no-gap agreement78,043 services in the quarter; average gap A$887.02 per service. Doctors' bills only; not hospital charges |
|
| Self-pay: Maryvale Private HospitalMorwell, VIC. The one hospital self-pay page read so far | Total knee replacementFixed package (contents not itemised on the page) | Not trackedNo self-pay wait has been read | from A$27,000Full fixed package (contents not itemised on the page) |
|
- Public hospital waits are AIHW's: Public hospitals only. Time from being added to the surgical waiting list to admission; excludes the wait to see a specialist. No private or self-pay wait is published.
- Medicare does not cover private-patient hospital costs such as theatre fees and accommodation (privatehealth.gov.au: Medicare, read 26 October 2026).
- In-hospital medical services paid for by private health insurers, all insurers combined. Not hospital charges, and not a self-pay price. The share under a no-gap agreement counts only services billed under an insurer's no-gap agreement; it is not APRA's headline no-gap share. Source: Australian Prudential Regulation Authority (APRA), Quarterly Private Health Insurance Statistics, licensed under CC BY 3.0 AU. APRA does not endorse TreatCompare or its use of the data.
- Figures from different routes are not added together. A Medicare benefit, an insurer's payment and a hospital's self-pay price each describe a different part of the bill.
Public hospital wait by state and territory
AIHW's own state rows for 2024-25, in a fixed order. Where AIHW prints no row or withholds the figure, the cell says "Not published".
| State or territory | Median wait | Waited over 365 days | Surgeries |
|---|---|---|---|
| NSW | 340 days | 31.3% | 7,172 |
| VIC | 133 days | 14.9% | 3,839 |
| QLD | 266 days | 21.5% | 2,712 |
| SA | 147 days | 14.7% | 1,322 |
| WA | 155 days | 18.8% | 2,087 |
| TAS | 161 days | 6.8% | 559 |
| ACT | 388 days | 53% | 202 |
| NT | Not published (NP) | Not published (NP) | 94 |
Source: AIHW MyHospitals: elective surgery, 2024-25, read 26 October 2026.
The Medicare items for knee replacement
Medicare pays a benefit per MBS item, and each item has its own. They are listed one by one and never added together: which items a doctor bills depends on the treatment given, and the schedule fee is what the benefit is calculated from, not what a doctor charges. Each item links to its page on MBS Online, where its fee and benefits are published. The figures are not reproduced here until the MBS reuse terms are confirmed.
Item 49518: Total knee replacement
Source: MBS Online, release 20261101, read 26 October 2026. Item labels are TreatCompare's plain-English wording; the MBS descriptor on MBS Online is the authority.
More on knee replacement in Australia
Sources
- APRA quarterly private health insurance statistics: medical services, Jun 2026. Read 26 October 2026. Source: Australian Prudential Regulation Authority (APRA), Quarterly Private Health Insurance Statistics, licensed under CC BY 3.0 AU. APRA does not endorse TreatCompare or its use of the data.
- MBS Online, release 20261101. Read 26 October 2026. Medicare Benefits Schedule items, per item.
- AIHW MyHospitals: elective surgery, 2024-25. Read 26 October 2026. Based on Australian Institute of Health and Welfare material, licensed under CC BY 4.0. TreatCompare is independent of AIHW, and AIHW does not endorse this site. Public hospitals only. Time from being added to the surgical waiting list to admission; excludes the wait to see a specialist.
- privatehealth.gov.au: Medicare. Read 26 October 2026.
- MBS Online item 49518. Read 26 October 2026.
- Maryvale Private Hospital: self-pay surgery. Read 26 October 2026.