10 most expensive surgeries in Australia

What's the most expensive surgery in Australia?

Based on data from Medical Costs Finder, heart valve replacement is among the most expensive surgeries tracked in Australia. Organ transplants are also extremely expensive, with the total cost from donor to donation often north of $100,000.

Australia's 10 most expensive surgeries

Below is the list of some of the most expensive surgeries in Australia. The data we've used comes from Medical Costs Finder, a government database tracking how much Aussies pay for surgery after their private health insurance kicks in.

Using that data has a couple of important notes to keep in mind:

• Some expensive surgeries aren't included, like organ transplants, because the database isn't completely exhaustive.
• The prices are a combination of the surgery and hospital costs, both of which are medians. Your specific price would be different.
• These prices are based on private hospital treatment. If you're eligible for Medicare, public hospital treatment is free, though waiting times are higher.

1. Heart valve replacement: $58,000

This is a major surgery where your damaged heart valve is removed and replaced with a mechanical or biological one. It's a serious procedure, but it can significantly improve your quality of life by restoring normal blood flow through your heart.

Specialists' Fees: $15,000
Hospital fees: $43,000
Median out-of-pocket costs: $470

Costs vary depending on the hospital, specialist and your health cover, but it's typically one of the higher-cost cardiac procedures.

Instead of replacing the entire valve, this procedure aims to fix the existing one. Techniques may involve repairing damaged leaflets, removing obstructions or reinforcing weakened structures. Valve repair is often preferred when possible, as it preserves your natural valve function.

Specialists' Fees: $16,000
Hospital fees: $38,000
Median out-of-pocket costs: $460

Costs vary based on the complexity of the repair, where it's done and your level of cover.

This surgery creates new pathways for blood to flow around blocked coronary arteries. Healthy blood vessels, often taken from your leg or chest, are grafted onto the heart to bypass the blocked areas, improving blood supply to the heart muscle.

Specialists' Fees: $15,000
Hospital fees: $35,000
Median out-of-pocket costs: $470

Specialists' Fees: $16,000Hospital fees: $36,000Typical out-of-pocket costs: $510

This involves replacing both hip joints simultaneously. It's a complex procedure typically performed in patients with severe arthritis in both hips. Recovery requires significant rehabilitation, but it can dramatically reduce pain and improve mobility.

Specialists' Fees: $9,500
Hospital fees: $35,000
Median out-of-pocket costs: $4,100

Specialists' Fees: $10,000Hospital fees: $33,000Median out-of-pocket costs: $5,500

This is a sophisticated electronic device surgically implanted to help people with severe to profound hearing loss hear. It consists of an external sound processor and an internal implant that stimulates the auditory nerve, allowing the brain to interpret sounds.

Specialists' Fees: $5,200
Hospital fees: $32,000
Median out-of-pocket costs: $500

Costs vary based on the device, provider and your cover.

These procedures involve placing, removing, or adjusting electrodes within the body, often in the heart or brain. They are used to treat various conditions, such as abnormal heart rhythms (pacemakers) or movement disorders (deep brain stimulation).

Specialists' Fees: $4,300
Hospital fees: $28,000
Median out-of-pocket costs: $40

Specialists' Fees: $4,600Hospital fees: $27,000Typical out-of-pocket costs: $80 (for patients who incurred one)

These are major lung surgeries. Pneumonectomy involves removing an entire lung, while lobectomy removes a specific lobe (section) of the lung. These procedures are typically performed to treat lung cancer or other severe lung diseases.

Specialists' Fees: $8,500
Hospital fees: $17,000
Median out-of-pocket costs: $510

Costs depend on the procedure, length of stay and the hospital you're treated in.

This surgery replaces a damaged hip joint with an artificial one. It's a common procedure for people with severe hip arthritis, significantly reducing pain and improving mobility and quality of life.

Specialists' Fees: $5,000
Hospital fees: $20,000
Median out-of-pocket costs: $690

Costs can vary depending on the prosthesis used, the hospital and your insurer's arrangements.

Similar to hip replacement, this procedure replaces the damaged ball-and-socket joint of the shoulder with an artificial one. It's often performed to treat severe arthritis, rotator cuff tears, or other shoulder conditions that cause significant pain and disability.

Specialists' Fees: $5,300
Hospital fees: $19,000
Median out-of-pocket costs: $700

Costs vary depending on the type of replacement and your insurer's agreements.

This involves replacing the damaged knee joint with an artificial one. It's a common procedure for people with severe knee arthritis, significantly reducing pain, improving mobility, and allowing for a more active lifestyle.

Costs vary depending on the hospital, surgeon and whether you have gap arrangements in place.

Does Medicare pay all surgery costs?

Medicare is Australia's public health care system and will pay the costs for all elective, semi-elective and urgent/emergency surgeries that you need as a public patient in a public hospital. If you're eligible for Medicare, you can be treated for free in a public hospital when you're treated as a public patient. There are only a limited number of essential services that aren't covered by Medicare.

When you go in for surgery, Medicare will fully cover:

• Operating theatre fees in public hospitals
• Medically-necessary surgeries (for example, removing a tumour)
• Necessary surgical consultations

What Medicare won't cover

Medicare won't cover everything, including surgery in a private hospital. In this case, you'll need to hold private health insurance to receive some cover for your surgery.

Also, if you're admitted as a private patient to a public hospital, Medicare will only partially cover your treatment. The rest must be paid by you or your health fund. This is why it's commonly suggested that you only present to a public hospital as a public patient.

Public hospital surgery waiting lists

The other downside of free treatment in a public hospital is the waiting times for elective surgery. These are long - often getting into months or years. Private treatment generally gets you in for surgery in a matter of weeks.

How does private health insurance pay for surgery?

Assuming your treatment is covered on your policy, private health insurance will help you pay for the cost of surgery in a private hospital, but it may not cover everything. More specifically, Medicare will pay a little bit, then private health insurance will pay a decent amount of the rest. Anything left over is called a 'gap payment', also called out-of-pocket expense.

The way the gap is calculated varies between health fund and hospital. Your health fund should pay all your accommodation costs, but the surgeon's fees may not be totally covered. If the surgeon and/or hospital is part of your health fund's preferred provider network then you'll likely pay less. The best bet is to call your health fund before your surgery and ask them for a statement of what they'll cover.

Benefits of private treatment

Despite the cost of premiums and potential out-of-pocket costs, there are a few advantages to getting surgery in the private system. These benefits include:

• The choice of your own surgeon
• Avoiding lengthy public surgery waiting lists
• Flexibility on when you're admitted to the hospital
• Access to a private room

Frequently asked questions

• What's the most expensive surgery in Australia?

  Based on Medical Costs Finder data, heart valve replacement is the most expensive surgery in Australia, at a median of around $58,000. Organ transplants cost more again - often north of $100,000 from donor to donation - but they sit outside that dataset, so they aren't part of our ranked list.

• Does Medicare pay for surgery in Australia?

  Medicare will cover the cost of medically necessary surgeries for public patients in public hospitals. As a private patient in hospital, Medicare pays 75% of the Medicare Benefits Schedule fee, and your health fund pays at least the other 25% if the service is covered on your policy. Doctors can charge more than the Schedule fee, and anything above it is your out-of-pocket cost.

• What won't health insurance policies cover me for?

  Health insurance policies won't cover any non-medically necessary procedures, such as cosmetic surgery.

Written by

Tim Bennett

Insurance expert

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A seasoned journalist with over 10 years of experience in news, politics and finance reporting, Tim has previously held roles at the ABC, SBS and Fairfax Media. Tim’s expert insights have been quoted in The Australian, The Daily Telegraph, The Courier Mail and more. He regularly appears on TV and radio, and has been interviewed on 7 News, Sunrise, SBS News, ABC Local, 3AW and 5AA. Tim is passionate about simplifying complex insurance topics for Australian consumers. He holds a Bachelor of Arts (Politics) from Macquarie University and a Tier 1 General Insurance (General Advice) certification, which meets the requirements of ASIC Regulatory Guide 146 (RG146). If you’re interested in a media interview with Tim, please reach out to our PR team at aupr@finder.com. See full bio

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