What does ACL reconstruction cost in Adelaide?

Cost is one of the first things patients want to know about and one of the last things most surgical websites will tell them. This page sets out how the cost of ACL reconstruction is actually built up in the Australian private system, what each party contributes, and what you can do to get a precise figure for your own operation before you commit to anything.

The four separate bills

ACL reconstruction does not produce one invoice. It produces several, from different providers, rebated separately.

• The surgeon’s fee, for the operation itself and the associated post-operative care.
• The anaesthetist’s fee, billed independently by the anaesthetist.
• The hospital, covering theatre time, the ward stay, and the implants and fixation devices used.
• Imaging and allied health, including the MRI that established the diagnosis, any post-operative imaging, and your physiotherapy, which is generally the largest ongoing cost after the operation.

Physiotherapy is the item patients most often forget to budget for. ACL rehabilitation runs for nine to twelve months, and while some of it can be done independently, the supervised component is substantial.

Who pays what

Medicare

ACL reconstruction is covered by Medicare item 49542. The wording of that item is worth knowing, because it explains something patients often query on their invoice: the item includes graft harvest, donor site repair, meniscal repair, collateral ligament repair, extra-articular tenodesis and other associated intra-articular surgery. In other words, a single Medicare item covers the ligament reconstruction and most of the additional work done at the same operation. You will not see separate rebates for each part.

A valid GP referral is required for a Medicare rebate on your consultations. Without one, you receive no Medicare contribution at all.

Your health fund

With hospital cover at the appropriate level, your fund contributes to the hospital admission, the theatre, the implants and the anaesthetist, and makes a contribution toward the surgical fee. Your policy excess applies to the admission. Waiting periods apply if the policy is new or was recently upgraded, so it is worth checking before you book, because ACL injuries are usually sudden and the cover has to already be in place.

You

The out-of-pocket amount is the difference between the fees charged and what Medicare and your fund pay back. Dr Mooney’s surgical fees are based on the rates recommended by the Australian Medical Association, which assesses the real cost of running a safe private practice. The gap varies by procedure and by fund.

If you do not have private cover

Two options exist. The public system provides ACL reconstruction at no cost, but with a waiting list, and for a young person wanting to return to sport the wait itself has consequences, both for the knee and for the season. Alternatively, some patients elect to self-fund the procedure privately. If that is your situation, say so at the first consultation and the rooms will prepare a total figure covering the surgical, anaesthetic and hospital components together.

How to get a real number for your operation

General figures published online, including on this page, are a starting point only. They cannot tell you what your operation will cost, because that depends on your fund, your policy, your excess, and what needs to be done inside your knee.

Two things give you a precise answer:

• The written financial consent. Once your procedure is booked, Dr Mooney’s team issues a document setting out the full surgical fee, the expected Medicare and health fund rebates, and your estimated out-of-pocket cost, in writing, before anything proceeds. Nothing is a surprise on the day.
• The Australian Government’s Medical Costs Finder. A free public tool that publishes typical fees and typical out-of-pocket costs for specialist procedures, including knee reconstruction, by location. It is worth looking at before any consultation, with any surgeon.

You can also call your health fund with the Medicare item number, 49542, and ask what they will pay toward it under your specific policy. Funds will give you that figure over the phone.

Questions worth asking any surgeon

• What is your surgical fee, and what is my expected out-of-pocket after rebates?
• Will I get that in writing before I commit?
• What will the anaesthetist and the hospital charge, and are there likely gaps there?
• Are post-operative reviews included, or billed separately?
• What should I budget for physiotherapy over the next twelve months?

A practice that cannot answer those questions clearly is worth a second thought.

Consultation fees

Dr Mooney’s current consultation fees, including the Aged Pension rate and the fee for second opinion consultations, are published in full on the fees page. A Medicare rebate applies where a valid GP referral is held.