Medicare bulk-billing tripling: what it did to direct-billing GP economics

The bulk-billing incentive is a Commonwealth loading that tops up the MBS rebate when a practice bulk-bills a patient (i.e. accepts the MBS rebate as full payment, with no out-of-pocket charge). Before 1 November 2025, the incentive was paid only when the bulk-billed patient was a child under 16 or a Commonwealth concession-card holder. The dollar amount was also smaller.

From 1 November 2025, two things changed at once. First, the incentive applies to every bulk-billed patient for standard GP consultation items, not just children and concession holders. Second, the dollar value was tripled. Together, the change delivers a roughly $18 per standard consultation uplift to the practice for every bulk-billed patient. For a practice seeing 120 patients per day across its clinical team, that is a material gross revenue lift.

The tripling is not a rebate increase for private-fee billing. Practices that mix-bill (private fee plus Medicare rebate) do not collect the incentive unless they move that patient stream to bulk-bill.

For a standard Level B GP consultation (MBS item 23), the patient-facing economics look like this:

• Before 1 November 2025, non-concession adult bulk-billed: rebate around $42, no incentive, practice collects $42.
• After 1 November 2025, non-concession adult bulk-billed: rebate around $42 plus incentive around $18, practice collects around $60.
• Children and concession holders: the practice was already collecting rebate plus (smaller) incentive; the new settings roughly doubled the incentive portion for this cohort.

Level C and Level D consults move proportionally. A direct-billing GP with a higher Level C ratio (longer consults, chronic-disease management, mental-health plans) sees a larger absolute uplift.

A 6-hour session at a bulk-billing practice averaging 30 Level B equivalents:

• Pre-November 2025 gross: around $1,260 (30 x $42).
• Post-November 2025 gross: around $1,800 (30 x $60).
• Per-session uplift: around $540 on gross billings before service fee.

That is the gross figure. Whether it flows to your bank depends on the service fee arrangement with the practice, which, in turn, depends on the state payroll-tax position.

The Thomas and Naaz doctrinemeans a medical centre with contractor GPs can owe payroll tax on the GP's share of patient billings wherever the relevant-contract provisions apply. Several states have since layered GP-specific relief on top, structured differently and mostly tied to bulk-billing: Victoria, NSW, Queensland, South Australia, and the ACT. States with no GP-specific scheme leave the exposure with the practice. When the Medicare incentive moved up by around 43% on gross, three practice responses emerged:

• Practices still pricing in payroll tax (states with no GP-specific relief scheme such as WA, NT, and TAS, plus any practice outside the relief conditions, for example non-bulk-billing or specialist work): service fees raised from the pre-Thomas-and-Naaz 30% to 35% level up to 40% to 50%. The stated reason is the payroll tax bill the practice pays on the contractor's share. A locum on a 45% service fee sees roughly $1,800 gross less $810 service fee equals $990 net, compared to a pre-November $1,260 less 32% equals $857 net. The uplift is real but absorbed by the fee increase.
• Victoria: the 1 July 2025 GP exemption applies to GP wages to the extent they relate to bulk-billed (fully funded) items, so the relief is proportional to the practice's bulk-billing share. Service fees in VIC stayed near 30% to 35% in most bulk-billing arrangements. A VIC locum on 32% sees $1,800 less $576 equals $1,224 net, compared to a pre-November $1,260 less 32% equals $857 net. The uplift flows through almost in full.
• NSW, QLD, SA, ACT: each added its own GP relief (a NSW rebate from 4 September 2024, a permanent QLD exemption from 1 December 2024, an SA bulk-billing exemption from 1 July 2024, and an ACT exemption from 1 July 2025), mostly conditional on bulk-billing. Where a practice genuinely bulk-bills and qualifies, the payroll-tax driver on the service fee is reduced and fees should reflect that; verify the practice's position before assuming the higher fee is justified.

Sessional tags every workplace with its state and exemption status on the invoice view, and the direct-billing breakdown shows gross, service fee, net, and effective hourly rate per shift.

Agency GP rates in late 2025 and early 2026 did move, but not in proportion to the gross billings shift at the host practice. The reason is structural: the agency contracts a fixed day-rate with the host practice, keeps its own margin, and pays the contractor GP. When the incentive change lifted the host practice's gross by around 40%, the agency was positioned to negotiate a higher day-rate only on renewal, and then only if the host practice was willing to split the windfall.

In practice, metro agency GP day-rates moved up by $100 to $200 between October 2025 and April 2026 (roughly 6% to 12% depending on catchment). Regional and rural agency rates moved more, because the underlying practice incentive loadings interact with rural workforce incentives to compound the gross change. If your work is predominantly agency, the Medicare tripling was not a moment of windfall; it was a slow rate-negotiation cycle you can track in the earnings dashboard.

Two places in the app put the November 2025 shift in numbers:

• Shift-level direct-billing card: enter your consult mix (Level A, B, C, D counts) and Sessional computes gross under current MBS rates, applies the service fee, shows the net and the effective hourly. Toggle to old-settings gross for comparison.
• Earnings dashboard: year-over-year comparison with a settings-aware filter. You can see whether an earnings change is Medicare, a service-fee re-negotiation, a caseload change, or a consult-mix shift.

See also the agency vs direct billing comparison for the end-to-end take-home frame, and BAS preparation for how GST-free medical services apply regardless of which side of the tripling you are on.

• Is the service fee percentage stated as pre-tripling or post-tripling? If you joined the practice before November 2025 on a 32% fee, and the contract has since rolled to 45%, the Medicare uplift has already been absorbed by the practice.
• Is the service fee ex-GST or GST-inclusive? A 45% GST-inclusive fee is a different net to you than 45% ex-GST.
• If the practice is in Victoria, is there any service fee increase since 1 July 2025? If yes, the practice may be over-charging against its actual exemption position.
• If the practice is in NSW, QLD, or WA, does the contract state the payroll tax assumption used to derive the service fee? Clarity here makes future renegotiations easier.
• Is GST being applied correctly on the service fee line? Service fees charged by the practice to the doctor attract GST; the doctor claims an input tax credit if GST-registered. Sessional's direct billing card handles the mechanics.

See the tripling land in your earnings, not just the press release. Sessional shows gross billings, service fee, and net take-home on every direct-billing shift. Toggle between old and new Medicare settings to see exactly what changed in your portfolio.

Start free

See pricing