Paediatrician billings & income calculator
Model a consultant paediatrician's private income the way an outpatient clinic really runs — build your week of clinic, telehealth and hospital days, set how many patients each session sees and your new-to-review mix, then charge a private gap above the MBS rebate. A share of new referrals become complex-needs plans (item 132) or neurodevelopmental assessments (item 135); reviews mostly bill the item 116 workhorse; bulk-billed visits earn only the rebate; no-shows earn nothing. Take off your overhead and see the after-tax take-home. Every figure is an editable, indicative default.
Interactive Australian consultant paediatrician income planner: build a Monday-to-Sunday clinic week of clinic, telehealth and hospital days; set patients per session and your new-to-review mix; new referrals bill the initial attendance item 110 (or the complex-needs plan 132 / once-per-lifetime neurodevelopmental assessment 135) and reviews bill the item 116 workhorse (with occasional 133 plan-reviews); set your private gap fee above the 85% out-of-hospital rebate; bulk-billed visits and no-shows are handled; take off a service-fee or solo overhead; and see the practice split and after-tax take-home.
Public / hospital sessional & salaried work (optional)
Item rebates (editable — MBS benefit = 85% of schedule fee out of hospital, post-1-July-2026, verify on MBS Online)
How private paediatric billing works — the 60-second version
Referral + attendance items. A paediatrician is a consultant physician and needs a referral. A new referred patient bills item 110 ($183.35 fee, $155.85 benefit); every subsequent review bills item 116 ($91.70 fee, $77.95 benefit) — item 116 is the workhorse of a paediatric clinic. A brief problem-focused visit can bill the minor item 119 ($52.25 fee, $44.45 benefit).
Complex-needs & neuro plans replace, not stack. For a child with two or more morbidities, a ≥45-minute initial complex-needs plan bills item 132 ($320.55 fee, $272.50 benefit) — once per 12 months — with reviews on item 133 ($160.50 fee, $136.45 benefit), a maximum of twice per 12 months. A neurodevelopmental assessment for autism/ADHD in an under-25 (≥45 min) bills item 135, once per lifetime. Each of these replaces the standard 110/116/119 for that visit — they never stack on top of it.
The rebate is 85%, the gap is yours. Out of hospital in private rooms the Medicare benefit is 85% of the schedule fee. You set a fee above that; the family pays it and claims the benefit back, so you bank the whole fee. Bulk-billing means accepting the 85% benefit as full payment — no gap. Many paediatricians bulk-bill a large share, especially reviews and disadvantaged families.
Steady-state reviews are 116, not 133. Because 132 is once a year and 133 caps at two reviews a year, an ongoing review reverts to item 116. This tool bills the great majority of reviews at 116 and treats the plan items as the occasional exception — billing every review as 133 would badly overstate income.
No-shows & overhead. A DNA earns nothing and its fee isn't Medicare-rebatable, so the DNA rate removes those slots. Off the private billings comes overhead — a group service fee (~30-40%) or solo rooms/staff cost — before tax. Public sessional or salaried work is added net.
Can a paediatrician bill a complex-needs plan (item 132) and a standard attendance on the same day?
No. Items 132, 133 and 135 are complete-attendance items in their own right — the plan or neurodevelopmental item replaces the standard attendance (110, 116 or 119) for that visit, it does not stack on top of it. This tool always substitutes one item per visit, never both, so it never double-counts a day.
Why doesn't the calculator bill every review at item 133 instead of item 116?
Because item 132 can be claimed only once per patient every 12 months and item 133 a maximum of twice per patient every 12 months, a steady-state review is billed at item 116 (schedule fee $91.70, 85% benefit $77.95), not the higher plan-review item. Defaulting every review to 133 would badly overstate income, so the tool bills the great majority of reviews at 116 and treats plan items as the occasional exception they are.
Is the Medicare rebate the full schedule fee or 85%?
For attendances in private rooms out of hospital, the Medicare benefit is 85% of the schedule fee, not the full fee. So item 110 pays a $155.85 benefit on its $183.35 schedule fee, and item 116 pays $77.95 on $91.70. Your private gap is the fee you charge minus that 85% benefit; a bulk-billed visit earns only the 85% benefit with no gap.
How are no-shows and neurodevelopmental assessments handled?
No-show (DNA) slots earn nothing — a missed appointment is not a Medicare-rebatable service, and any private no-show fee is not claimable — so the DNA-rate slider removes that share of slots from billable income. Item 135, the neurodevelopmental assessment for autism or ADHD, is claimable only once in a patient's lifetime, so it is modelled as a one-off for a fraction of new patients rather than a recurring item.
Methodology, sources & public-hospital comparison
Method. Each booked slot minus the no-show rate is a billable visit. Visits split into new and review by your mix; a share of new visits are complex/neuro and bill item 132 or (once-per-lifetime, so a fraction) item 135 instead of item 110; the rest bill 110. Reviews bill item 116 — the plan-review item 133 is capped at two per patient per year so it is a minor share, and steady-state reviews revert to 116. Each visit earns the 85% benefit plus, if not bulk-billed, your private gap (charged fee − 85% benefit). Overhead is a service-fee percentage (or fixed solo cost) on clinic billings; tax uses the 2026-27 resident rates plus the 2% Medicare levy, with an optional 2026-27 HELP repayment.
Public-hospital comparison (indicative). A salaried staff-specialist paediatrician package is roughly $232k-$313k effective depending on state, seniority and allowances; a sessional VMO earns roughly $840-$1,250 per ~4-hour session. Private clinic income above overhead can exceed this but carries the practice risk, no leave loading and no employer super — compare on total value, not headline billings.
Sources. Item numbers, schedule fees and 85% benefits from MBS Online (post-1-July-2026 indexation) and frequency/eligibility rules from the MBS explanatory notes; tax and HELP thresholds from the ATO. All figures are editable and indicative only — confirm current items and fees before relying on them.