Spinal cord stimulation 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 | What it covers |
|---|---|
| 39130 | Percutaneous epidural lead placement (per lead) |
| 39134 | Neurostimulator (generator) placement |
Schedule fees for these items range from about A$410 to A$810; check MBS Online for the current amounts.
The MBS explanatory note expects a comprehensive pain management approach with a multidisciplinary team before implantation.
Private hospital cover
Implanting a pain device falls under “Pain management with device”, which is only guaranteed in Gold hospital cover. Lower tiers may include it as an optional extra, so check your policy. Hospital and device costs can be large, so get a written estimate.
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
Do I need Gold cover for a spinal cord stimulator?
“Pain management with device” is only a minimum requirement of Gold hospital cover. Some lower-tier policies may include it, so check yours.
Living well with long-term 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 pain and fibromyalgia routine (4 phases)
- Body scan relaxation (guided audio)
- Seated tai chi for beginners
A physiotherapist can tailor an exercise plan to you.
Sources
- MBS Online: Item 39130 (spinal cord stimulator leads) and explanatory note TN.8.244
- MBS Online: Item 39134 (neurostimulator placement)
- privatehealth.gov.au: Clinical categories
- privatehealth.gov.au: Product tiers
- privatehealth.gov.au: MBS items in the Pain management with device clinical category
- 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.