What does knee arthroscopy and meniscus surgery cost?

If you have private health insurance with cover for knee surgery, most of the cost of an arthroscopy or meniscus repair is met by Medicare, your health fund and your hospital agreement. There is usually a gap, which is the part you pay directly. You will be told exactly what that gap is, in writing, before you decide to go ahead, and it does not change afterwards.

The four separate bills

This surprises most people. Surgery does not produce one account, it produces four, and they come from different places.

• The surgeon's fee, for the operation itself.
• The anaesthetist, who bills separately and sets their own fee.
• The hospital, for theatre time, your stay and any implant or device used.
• Your health fund and Medicare, which between them contribute to the first two and usually most of the third.

Understanding that these are separate matters when you compare surgeons, because a figure quoted by one may include things another has left out.

Why there is a gap at all

This is the part patients are rarely told. The Medicare rebate for surgical procedures was frozen for several years. Indexation was only reintroduced for specialist procedures from 1 July 2019, and it has not caught up with what it costs to provide surgical care. The rebate fell behind. Theatre time, implants, indemnity insurance and staffing did not.

A gap is the difference between what a procedure costs to deliver properly and what Medicare and the funds have chosen to pay towards it.

How I set my fee

Rather than setting a figure at my own discretion, I charge the rate published in the Australian Medical Association's schedule of fees. The AMA is independent of both government and the health funds, and its schedule is its assessment of a reasonable fee for a given procedure. I am a member of the AMA, and I apply the same basis to knee arthroscopy and meniscus surgery as I do to joint replacement.

It means my fee is benchmarked against a published, independent standard rather than set arbitrarily, and that I can explain exactly where it comes from.

What that fee covers

• Every operation is performed by me. No surgeons in training are involved in the care of a private patient.
• Planning for your specific knee, including review of your imaging before the day.
• The implants, sutures and instruments chosen on quality rather than cost.
• Post-operative care through to your maximal recovery, not just the early weeks.
• Timely communication with your GP and your physiotherapist throughout.

You will know the number before you commit

Every patient receives written informed financial consent before a booking is confirmed. It sets out my fee, the expected Medicare and health fund rebates, and the gap you will pay. Nothing is left to be discovered afterwards. If you would like that information before your first appointment, ask and we will send it.

Consultation fees

One point that catches people out: private health insurers do not contribute to the cost of an outpatient consultation. Medicare does, provided you have a current signed referral from a general practitioner, so bring that with you. The rooms will tell you the consultation fee and the rebate when you book.

If you do not have private cover

Self-funded surgery is possible and the full cost can be quoted in advance. It is also worth saying that not every meniscus tear needs an operation. For a degenerative tear in particular, there is good evidence that surgery often adds little, and that conversation is an honest one we will have before anything is booked.

Comparing costs

The federal government's Medical Costs Finder publishes typical fees and out-of-pocket costs by procedure and by state. It is a reasonable independent reference point if you want to see how any surgeon's fee sits against the national picture.

Frequently asked questions