Robotic knee surgery is becoming more widely available in Australia’s private health system, and it is important to explore the financial side of it. From Medicare rebates to robotic fees, insurance gaps, and hospital charges, the total cost of surgery can be difficult to estimate without expert guidance. This page breaks it all down, truthfully and clearly, so you can budget for robotic-assisted knee replacement without unexpected out-of-pocket bills or hidden fees.
Whether you’re comparing public vs private options, trying to understand what private health insurance actually covers, or wondering if robotic technology adds extra costs, this guide will help you get the full picture. Let’s dive into the real cost of robotic knee replacement in Australia, so you can plan ahead with clarity.
Public vs Private: Where Can You Access Robotic Knee Surgery?
In Australia, most robotic knee replacements are performed in private hospitals. Although robotic systems like the Mako or VELYS are present in a small number of public facilities, they’re not routinely available to every public patient. Access is typically limited to those involved in clinical research programs or patients being treated at specific high-volume centres where robotic platforms have been integrated into standard care.
This limited availability means that even if you qualify for knee replacement under the public system, there’s no guarantee that robotic technology will be used. Unlike traditional methods, you can’t generally request robotic-assisted surgery as a public patient. It depends entirely on hospital resources and surgeon preferences.
For those seeking faster wait times or access to advanced tools like robotic systems, the private system is often the only reliable pathway. However, this shift into private care carries a wide range of associated costs that are not always obvious at first glance.
Tip: If you’re on a public waitlist, ask your orthopaedic team directly whether robotic technology is used at that hospital, and if not, whether a private referral might be appropriate for your preferences and timeline.
Northern Beaches Hospital (NBH) offers robotic-assisted total knee replacement for most eligible private health patients. All hospitals that Dr Negus operates at offer robotic-assisted surgery.
Does Medicare Cover Robotic Knee Surgery?
Medicare covers standard knee replacement surgery through specific MBS (Medical Benefits Schedule) item numbers. However, robotic assistance itself is not separately listed or rebated.
This means that:
- Your Medicare rebate is based on the core procedure, such as total knee arthroplasty (e.g. Item 49518), regardless of whether it’s performed robotically.
- Any additional costs associated with robotic technology, such as software fees, system usage charges, or advanced imaging requirements, are not reimbursed by Medicare and are typically paid out-of-pocket.
- Medicare rebates only cover part of the surgeon’s fee, leaving the rest as a gap unless bulk billing arrangements exist (rare in private orthopaedic surgery).
It’s important to note that Medicare also does not cover private hospital fees, which can be significant, particularly for joint replacement procedures involving theatre time, overnight stays, and consumables.
If you are uninsured and considering private surgery, you will be responsible for all non-rebated costs in full, including hospital and robotic platform charges. Always request a full quote upfront.
What Do Private Health Funds Cover (and Don’t Cover)?
Private health insurance for robotic knee surgery can reduce overall costs, but many patients are surprised to find that not everything is covered, and the fine print matters. Here’s a breakdown of how cover typically works:
✅ Often Covered:
- The core procedure (e.g. total knee replacement), when your policy includes joint replacement.
- A portion of the surgeon’s and anaesthetist’s fees, up to the scheduled MBS rebate amount.
- Hospital costs, including room fees, theatre use, and nursing care, if you’re in a contracted facility.
- Implants (prosthetic knee components) are listed on the Prostheses List, which most insurers cover in full under hospital cover.
❌ Often Not Covered:
- In Dr Negus’s practice, robotic technology is included in the standard surgical fee at no additional cost. However, this may not be the case in all practices across Australia, so it’s important to ask directly.
- Non-contracted hospital fees, if your hospital or surgeon is outside your fund’s network. This can lead to large gap payments.
- Outpatient services, such as post-op physio or pre-surgical imaging, may only be partially covered through extras (if at all).
Even among “Gold” level hospital policies, there can be differences in how robotic surgery is handled. Some funds may classify robotic-assisted procedures as “non-essential” enhancements, meaning you’ll bear the full cost of that component, even though the rest of the surgery is covered.
Always confirm the MBS item number with your knee orthopaedic surgeon and contact your fund to check exactly how much is covered, how much isn’t, and whether any excess or co-payments apply.
Typical Fees: Surgeon, Hospital and Robotic Technology
Robotic-assisted knee replacement cost depends on your location, surgeon, hospital, and whether the robotic technology fee is included or billed separately. Below is a more detailed breakdown of typical costs seen in private practice settings across Australia:
| Cost Component | Typical Fee Range (AUD) | Details |
|---|---|---|
| Surgeon’s Fee | $3,000 – $8,000 | No robotic fee. AMA fees start at ~$4,700. Dr Negus’ typical fee is ~$4,800. Private health no-gap options start from ~$2,500. |
| Anaesthetist Fee | $1,000 – $2,500 | Often billed separately, with limited Medicare or fund coverage |
| Assistant Surgeon | $400 – $800 | Sometimes included with the surgeon’s bill or billed independently |
| Hospital Fees | $3,000 – $10,000+ | Includes theatre, overnight stay, nursing; higher for multi-night recovery |
| Robotic Platform Fee | $0 in this practice | In Dr Jonathan Negus’s practice, there is no extra charge for robotic assistance, and no “technology fee” is billed separately. However, in other clinics, particularly outside NSW, this fee may be added as a standalone charge. |
| Prosthetic Implant | Covered (in most cases) | Should be on the Prostheses List and fully covered by the health fund |
Keep in mind that these are estimates only. A full quote depends on your location, the robotic system used, the complexity of your surgery, and your insurance level. Some clinics use all-inclusive packages, while others itemise each service independently.
Robotic technology fees are not standardised across Australia, so two hospitals may charge very different amounts for the same procedure, depending on licensing, agreements, and equipment ownership. For eligible Medibank Private and HCF patients linked to MQ, a no gap scheme applies.
Hidden Costs to Plan For
Beyond the core surgery, several non-surgical costs can add to your total bill, especially if you don’t have extras cover or aren’t eligible for bulk billing. These often-overlooked fees include:
- Diagnostic imaging, such as CT scans (for MAKO) or standard X-rays/MRIs. VELYS is imageless and creates a 3D model from the patient’s own anatomy during surgery.
- Rehabilitation programs, especially if your surgeon recommends tailored private physiotherapy or hydrotherapy. Public outpatient rehab may be available, but there could be waitlists.
- Assistive equipment, like crutches, compression devices, or raised toilet seats, which are usually out-of-pocket expenses.
- Follow-up consults, which are typically required at multiple intervals post-surgery (e.g. 2 weeks, 6 weeks, 3 months). These may attract private fees if not done in a public clinic.
For patients travelling from regional areas to access robotic surgery in metropolitan centres, there may also be accommodation and transport costs to factor in.
Don’t assume everything is included in the surgical quote. Ask your care team to walk you through the full timeline, from scans to rehab, to identify any additional expenses.
How to Request an Itemised Estimate
A detailed quote is essential for financial planning. Without it, patients often underestimate total costs or discover late-stage expenses they weren’t prepared for. To get a full itemised estimate:
- Start with the surgeon’s team. Request a written quote with all anticipated MBS item numbers, such as item number 49518 (Medicare code for total knee replacement), 49519 for bilateral knee, and ask about any expected gap fees.
- Ask if robotic technology is included. Some providers fold this into the base fee, while others list it separately.
- Get quotes from other providers. Anaesthetists and assistant surgeons often operate independently and will invoice you separately.
- Contact your health fund. Use the item numbers provided to check exact rebates, including hospital eligibility, excess amounts, and any waiting period issues.
- Clarify hospital charges. Request a written estimate for accommodation, theatre time, and any extra equipment, such as robotic use or disposable surgical tools.
A complete quote package will allow you to calculate the total cost accurately. Ideally, do this before booking your surgery so you can make informed choices about where and how to proceed.
Example: Sample Cost Breakdown for a Private Patient
Let’s walk through a realistic example of robotic knee replacement costs for a privately insured patient in a metropolitan private hospital.
| Item | Cost (AUD) | Covered By | Approximate Out of Pocket Fee |
|---|---|---|---|
| Surgeon’s Fee | $5,000 | $1,372.15 Medicare + partial fund rebate | $3,000 |
| Robotic Assistance Fee | $1,500 | Not covered | |
| Anaesthetist’s Fee | $1,800 | Fund rebate + Medicare | $1,000 |
| Assistant Surgeon’s Fee | $600 | Medicare rebate only | $400 |
| Hospital Stay (3 nights) | $7,000 | Covered under hospital cover | Just excess – Usually $500 |
| Prosthesis (TGA-approved) | $0 | Fully covered | |
| Imaging (MRI + X-ray) | All done by the time we book | Partially bulk billed | |
| Post-op Physio (8 private sessions) | $1,000 | Out-of-pocket or extras cover | |
| Total: $4,900 |
Estimated Out-of-Pocket fees depend on your fund, surgeon, and recovery needs. In Dr Negus’s practice, robotic assistance is included at no extra cost.
This example doesn’t include travel, accommodation, or any unexpected complications. For self-funded patients or those with exclusions on their policy, out-of-pocket costs may exceed $25,000.
Planning Ahead: Smarter Ways to Budget for Robotic Knee Surgery
Getting robotic knee surgery isn’t just about the procedure. It’s also about preparing financially so you’re not caught off guard when the bills roll in. Here are five practical ways to stay in control of your costs and avoid last-minute surprises:
- Ask early and ask clearly. Once you’ve been referred for surgery, reach out to your surgeon’s office and private health fund as soon as possible. Don’t wait until you’re handed a surgery date. Confirm what’s covered, what isn’t, and whether robotic assistance is part of the plan or charged separately.
- Break down the quote, line by line. If a quote looks vague or bundled, it’s okay to ask for more details. Request individual figures for the surgeon, anaesthetist, hospital, prosthesis, and any robotic platform fees. This helps you spot any gaps or exclusions that could affect your bottom line.
- Check if your hospital is fully covered. Private hospital knee surgery fees can vary, and not all facilities are covered by every fund’s agreement. If you choose a facility that’s out-of-network, you could be hit with higher accommodation fees or unexpected theatre costs, even if you have top-level cover.
- Factor in the extras most people forget. Things like travel, home recovery equipment, pre-op imaging, and physio can add hundreds (or thousands) to your total. A good rule of thumb? Add a 10–20% buffer to whatever your initial quote says, just in case.
- Put it in writing. Verbal conversations are useful, but written quotes and confirmation emails give you something solid to refer back to. They also help prevent misunderstandings, especially if you’re coordinating between multiple providers.
Final note: While robotic-assisted surgery may offer advanced precision, the financial side deserves just as much attention. Clear communication, detailed quotes, and a realistic budget will help you feel more confident and in control throughout the process. If you’re unsure where to start, speak with your GP or orthopaedic specialist; they can help you navigate your options.
Benefits of Robotic Assistance
Robotic-assisted knee surgery combines the expertise of the surgeon with advanced computer-guided technology. Systems like Mako and Velys are designed to support — not replace — the surgeon, offering real-time data and high-resolution imaging to improve the planning and execution of each procedure.
The key benefits include:
- Improved surgical precision and consistency: Robotic platforms allow for millimetre-level adjustments during bone preparation and implant placement. This level of accuracy helps surgeons follow the surgical plan with greater consistency, even in complex anatomies.
- Potential for better joint alignment and long-term outcomes: Optimal implant positioning is a critical factor in the long-term success of knee replacements. Robotic assistance can support more accurate alignment and soft tissue balancing, which may reduce the risk of premature wear or revision in some patient groups.
- Reduced soft tissue trauma: By allowing surgeons to tailor the procedure to the individual patient’s anatomy, robotic systems may help minimise unnecessary bone cuts or ligament tension. This can lead to less soft tissue disruption, which may contribute to faster functional recovery and improved early mobility.
- Enhanced surgical planning with 3D mapping: Both Mako and Velys systems use pre-operative imaging (such as CT scans or X-rays) to create a personalised, three-dimensional model of the patient’s knee. This allows for more detailed planning and intraoperative adjustments, with the aim of delivering more predictable results.
Robotic systems like Mako or Velys assist surgeons with millimetre-level precision and real-time feedback during surgery. This can improve implant positioning and soft tissue balance—factors linked to better outcomes and reduced revision rates in some studies.
While robotic assistance is not suitable or necessary for every patient, it is an evolving tool that may enhance the accuracy and personalisation of knee replacement surgery. As always, the choice of surgical approach should be discussed in detail with your orthopaedic surgeon, taking into account your individual condition, goals, and overall health.
Disclaimer: This content is intended for informational purposes and does not replace professional medical advice, diagnosis, or treatment. Always consult a registered health practitioner before beginning any treatment or making decisions about your healthcare. You can verify registration at AHPRA’s public register. Individual outcomes may vary depending on personal health circumstances and the nature of the injury.
Frequently Asked Questions on Robotic Knee Surgery Costs in Australia
1. Is there an extra charge for the robotic technology itself?
No. In Dr Jonathan Negus’s practice, there is no extra charge for robotic assistance. Whether your surgery uses MAKO or VELYS, the fee remains the same as for traditional knee replacement. However, this may not be standard in other NSW or interstate practices, so it’s always worth confirming.
2. What MBS item number applies to robotic knee replacement, and does it affect my rebate?
Robotic-assisted knee replacements still fall under the same MBS item numbers as standard procedures (e.g. Item 49518 for total knee replacement). There is no separate Medicare item for robotic assistance. This means your Medicare rebate is calculated as if it were a traditional procedure, and the use of robotic technology has no effect on the Medicare rebate amount.
3. Can I claim any part of the robotic fee through private extras cover?
Generally, no. Robotic fees are classified as hospital or surgical technology costs, and extras cover usually applies to non-hospital services such as dental, physio, and optical. However, some extras policies may help cover related expenses like post-operative physiotherapy or mobility aids, so it’s worth checking with your health fund for any relevant benefits.
4. Are robotic knee surgery costs the same at every private hospital?
No, costs can vary significantly between hospitals, even within the same city. Some hospitals own their robotic systems and charge a flat usage fee, while others lease the equipment or pass on manufacturer charges to the patient. The final price can also depend on whether your surgeon operates in a contracted hospital under your health fund.
In Dr Negus’s hospitals, there are no separate robotic fees. However, this may differ in other hospitals or states, so it’s important to request a facility-specific quote.
5. What should I do if I’m quoted robotic fees I wasn’t expecting?
If a robotic assistance fee appears on your quote and you weren’t made aware of it, ask for clarification in writing. You can also request whether the same surgeon offers the procedure without robotic assistance, which may reduce the fee. If budget considerations are a concern, your GP or orthopaedic specialist can help you explore both robotic-assisted and traditional approaches — each with its own merits depending on individual needs and circumstances.
