Extended Medicare Safety Net (EMSN) benefit caps

Extended Medicare Safety Net (EMSN) benefit caps apply to more than 500 Medicare Benefit Schedule (MBS) items.

Page last updated: 21 October 2015

Extended Medicare Safety Net (EMSN) benefit caps are applied to Medicare Benefit Schedule (MBS) services including assisted reproductive technology (ART) services, some surgical procedures and all consultations.

Once a patient reaches the EMSN threshold, the benefit for a capped item is calculated at 80% of the patient’s out-of-pocket cost. If the:

  • out-of-pocket cost is greater than the EMSN benefit cap, the patient will receive the EMSN benefit cap (that is, the lesser of the two) amounts
  • calculated benefit is less than the EMSN benefit cap, the patient receives 80% of the out-of-pocket costs for the claim.
EMSN benefit caps apply to the MBS item groups listed below. For detailed information on specific items, see MBS Online.