A transparent, fact-based overview of General and Upper GI surgical fees, the $500 Known Gap scheme, MBS item code guides, and structured bariatric clinical care funnels across our Melbourne clinic network.
Informed Financial Consent & Fee Transparency
Northern Surgical Care practices complete financial transparency in strict accordance with the **Australian Health Practitioner Regulation Agency (AHPRA)** medical advertising guidelines. We believe that accessing expert General and Upper GI surgical care should be straightforward, predictable, and entirely free from hidden administrative elements. All out-of-pocket medical costs are provided to you explicitly in writing following your initial specialist consultation.
Insured vs. Uninsured Surgical Pathways: Understanding the Difference
When preparing for a surgical procedure in the private healthcare system, your financial pathway is determined by whether you hold active private health insurance cover at the time of your admission.
Insured Patients (Private Health Insurance)
If you have active private health insurance (with a tier matching your specific procedure), your health fund and Medicare combine to absorb the vast majority of your core physical infrastructure expenses.
- Covered by Fund: Operating theatre room hire, overnight private ward accommodation bed days, intensive nursing care, and approved surgical implants or prostheses.
- Patient Responsibility: Your specific health fund policy excess (paid directly to the hospital upon checking in) plus any out-of-pocket medical gaps assigned by the surgeon or anaesthetist.
Uninsured Patients (Self-Funded Pathway)
If you do not hold private health insurance, you can still access immediate, fast-tracked treatment on our private surgical lists. However, you assume absolute responsibility for the entire hospital invoice.
- Patient Responsibility: 100% of the private hospital facility fees (theatre minutes, bed days, single-use consumables), which are quoted and charged directly by the hospital prior to admission.
- Professional Fees: The separate professional medical fees for the primary surgeon, surgical assistant, and independent anaesthetist. A small portion of these professional fees remains rebateable via Medicare.
The Known Gap Scheme for General & Upper GI Surgery
To directly address the cost barrier of private medicine for local catchments in Epping, Werribee, and surrounding expansion hubs, Dr Ashok Gunawardene actively participates in the **Known Gap Scheme** with the vast majority of Australian private health funds.
For eligible, insured patients undergoing essential General or Upper GI procedures, the Known Gap arrangement ensures that your out-of-pocket surgical fee is strictly capped at **$500**. This model provides absolute financial predictability, protecting you from un-capped or unexpected invoice surprises post-operatively.
What the $500 Known Gap Surgeon’s Fee Includes:
- Performance of your keyhole or open general surgery procedure by fully accredited Consultant Surgeon Dr Ashok Gunawardene.
- All in-hospital post-operative management, diagnostic oversight, and rounds during your private admission stay.
- Routine out-of-hospital post-operative follow-up review consultations at our specialist rooms during your primary recovery phase.
Common General & Upper GI Procedures: MBS Item Fee Schedule
The table below provides a clear, compliant breakdown of the common Medicare Benefit Schedule (MBS) item codes managed within our General and Upper GI surgical divisions for **insured patients** navigating our primary private operating tracks:
| Core Procedure Profile | Primary MBS Codes | Surgeon Out-of-Pocket Gap |
|---|---|---|
| Laparoscopic Cholecystectomy Keyhole gallbladder removal with routine intraoperative cholangiogram (IOC). |
30445, 30439 | Capped at $500 (Under Known Gap Scheme) |
| Laparoscopic Fundoplication & Hiatus Hernia Repair Anatomical reduction of diaphragmatic hernia and tailored partial wrap (Dor/Toupet). |
30527, 31466 | Capped at $500 (Under Known Gap Scheme) |
| Laparoscopic Inguinal / Femoral Hernia Repair Keyhole groin hernia correction utilizing advanced tension-free anatomical mesh placement. |
30609, 30614 | Capped at $500 (Under Known Gap Scheme) |
| Laparoscopic Ventral / Umbilical / Incisional Hernia Abdominal wall structural reinforcement with tailored structural mesh support structures. |
30617, 30621, 30653 | Capped at $500 (Under Known Gap Scheme) |
| Diagnostic Gastroscopy / Colonoscopy High-resolution internal visualisation screens, tissue biopsy collection, or polyp removal. |
32076, 32222 Framework | $250-$500 (Subject to fund rules) |
*Disclaimer Note: The $500 cap applies explicitly to Dr Ashok Gunawardene’s direct professional surgical fee component under fund rules. It excludes external third-party independent expenses, such as your hospital accommodation excesses, diagnostic pathology laboratories, external radiology tracking, or independent anaesthetist procedural invoices.
Out-of-Hospital Specialist Consulting Structures
Our consulting fee structure remains entirely uniform across all outpatient growth-corridor clinics, including our suites in **Epping, Wallan, Point Cook, and Werribee**:
- Standard Private Consultation
Initial Evaluation & Case Mapping: $250 | Subsequent Review Session: $150
*Rebate Parameters: Presenting a current, valid General Practitioner referral enables an immediate Medicare Rebate of approximately $86 for the initial staging session and $42 for subsequent reviews. - Concession & Pensioner Support Framework
Initial Evaluation & Staging: $225
*Reduced billing tiers are explicitly maintained to ensure accessible specialist access for local community members holding a validated Australian Age Pension or Disability Support Pension card. - Direct Access / Non-Referral Clinical Path
Surgical Staging & Safety Audit: $250
*Includes an expedited specialist assessment and initial dietetic screening onboarding. Because no active referral is lodged at check-in, this initial exploratory tract does not attract a Medicare Rebate under Australian law. If surgical metrics are confirmed, a report is sent to your GP to coordinate formal referral paths before scheduling treatment.
Initiate Your Personal Assessment
Our central reception desk is equipped to process medical referrals rapidly and deliver an itemised written quote tailored precisely to your private health fund level.
For Patients
Schedule your general or upper GI consultation at our nearest consulting suite. Please secure a current GP referral before checking in.
For General Practitioners
Secure medical referrals, acute hospital triage datasets, and clinical histories can be dispatched directly into our electronic networks:
HealthLink EDI Identifier: nsrgiclc
Secure Practice Fax: 03 7073 2000
Central Intake Email: info@northernsurgicalcare.com.au