Occipital nerve blocks in Australia: Medicare 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 18242 covers injection of an anaesthetic agent into the greater occipital nerve. Medicare pays 85% of the schedule fee out of hospital; check MBS Online for the current amount, and ask which item number will be billed.
What people pay
Medical Costs Finder reported that for item 18242 in 2023–24, 57% of services were bulk-billed. It also lists typical fees and out-of-pocket costs.
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
Is an occipital nerve block bulk-billed?
Often. In 2023–24, 57% of item 18242 services were bulk-billed.
Exercises for neck-related headache
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.
- Neck-related (cervicogenic) headache routine
- 4-week neck posture reset
- Acupressure for tension headaches
A physiotherapist can tailor an exercise plan to you.
Sources
- MBS Online: Item 18242 (greater occipital nerve injection)
- Medical Costs Finder: MBS item 18242
- 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.