Facet joint injections in Australia: Medicare, private health and cost
General information only. Not medical, insurance or legal advice. Coverage rules and prices change, so confirm with your insurer or public health service (such as the NHS, HSE or Medicare) before booking, and ask your doctor whether a procedure is right for you.
MBS fees are set by the Australian Government and updated each July. Your doctor can charge more than the schedule fee. Ask for the item numbers and a written estimate (informed financial consent) before treatment.
Medicare
Item 39013 covers injection of one or more facet (zygo-apophyseal) or costo-transverse joints under image guidance. Medicare pays 85% of the schedule fee out of hospital or 75% in hospital; check MBS Online for the current amounts. Imaging can be claimed separately when needed. The MBS explanatory note says consideration should be given to longer-lasting pain management techniques rather than repeated injections that give only short-term relief.
What people pay
Medical Costs Finder reported that for item 39013 out of hospital in 2023–24, 75% of services were bulk-billed. It also lists typical fees.
Private hospital cover
Item 39013 is listed in the “Pain management” clinical category, included in Bronze, Silver and Gold hospital cover.
How coverage works in Australia
As a public patient in a public hospital, you are treated at no charge, but you may wait. For specialist care outside hospital, Medicare pays 85% of the Medicare Benefits Schedule (MBS) fee; as a private patient in hospital it pays 75% and your private hospital cover pays the rest of the schedule fee. Doctors can charge more than the schedule fee, so you may have a “gap” to pay. How coverage works in Australia.
Private hospital cover: waiting periods
Private hospital cover can have waiting periods of up to 12 months for pre-existing conditions and up to 2 months for most other treatment. A condition counts as pre-existing if you had signs or symptoms in the 6 months before you joined or upgraded; a doctor appointed by your insurer decides this.
If you are refused
- Ask your insurer which clinical category and policy rule applies, and get it in writing.
- If you can’t resolve it, the Commonwealth Ombudsman handles private health insurance complaints for free.
- Complaints about a health service go to your state’s health complaints body, such as the Health Care Complaints Commission in NSW or the Health Complaints Commissioner in Victoria.
Frequently asked questions
Does Medicare cover facet joint injections?
Yes, under MBS item 39013, when done under image guidance.
Exercises for back and neck pain
Exercise and staying active are part of most treatment plans, whether or not you have an injection or surgery. These free routines and printable sheets are a good place to start.
- Chronic low back pain routine (4 phases)
- 6-week low back pain recovery programme
- 4-week neck posture reset
A physiotherapist can tailor an exercise plan to you.
Sources
- MBS Online: Item 39013 (facet joint injection)
- Medical Costs Finder: MBS item 39013
- privatehealth.gov.au: MBS items in the Pain management clinical category
- privatehealth.gov.au: Product tiers
- privatehealth.gov.au: Overview of the health system
- privatehealth.gov.au: Out-of-pocket costs
- privatehealth.gov.au: Waiting periods
- Commonwealth Ombudsman: Private health insurance complaints
- Health Care Complaints Commission (NSW)
- Health Complaints Commissioner (Victoria)
Last checked October 2026. Found something out of date? Email hello@protocolarchive.com.
This page explains how coverage usually works, using public Australian Government, insurer, ombudsman and clinic sources listed above. It is general information, not medical, insurance, financial or legal advice, and it does not recommend any treatment, policy or provider. Rules differ by policy and can change, so confirm with your doctor, your insurer or the hospital before you decide. Protocol Archive is independent and is not affiliated with Medicare, the Australian Government or any insurer.