The good news is that Medicare rebates have nothing to do with your health fund or the practice you choose to attend. In most cases, the rebate or out of pocket charge comes down to the clinical indication that’s written (or ticked) on your referral by your GP or specialist.
Let’s look at how this works and why it matters.
What Medicare looks at
In Australia, Medicare uses a detailed set of rules called the Medicare Benefits Schedule. These rules guide when diagnostic imaging services are bulk billed.
For knee and shoulder imaging, Medicare doesn’t only look at the body part being scanned, but also considers:
- Your age
- Your symptoms
- The suspected diagnosis
- Whether the problem is acute or chronic, and
- The clinical question your doctor wants answered
This information must be provided on your referral because Medicare can only assess what is documented.
Why wording on referrals matters
Medicare rebates have been set up by the government after thorough consultation with clinicians to ensure appropriate patient access to services. As well as considering patient safety and managing unnecessary exposure to radiation.
As a service provider, Central Queensland Radiology must follow the rules as laid out by Medicare for each scan.
These examples show how Medicare applies its rules in everyday situations:
Example 1: X-rays
Your GP has referred you for an X-ray because you’ve been experiencing shoulder pain for some time. Your X-ray can be bulk billed whether your pain is acute or chronic, regardless of how detailed the clinical notes are.
Example 2: Ultrasound
Your ultrasound of your shoulder may be eligible for a rebate if your GP referral mentions a specific concern like bursitis, rotator cuff tendinosis or evaluation of a mass and this is noted (or ticked) on the referral form. There are no age restrictions on shoulder ultrasounds.
If your referral only mentions shoulder pain, or notes that the pain is chronic, your imaging doesn’t qualify for the rebate, even though your pain is very real!
Example 3: MRI with GP Referral
An MRI of the knee may be eligible for a rebate after an acute injury and your GP referral mentions specific concerns like a suspected meniscal or cruciate ligament tear, and you’re 16 to 49 years of age.
If your referral only mentions knee pain, the pain is noted as chronic, or you’re over 50 years old, your MRI scan doesn’t qualify for the rebate.
Example 4: MRI with Specialist Referral
You have a specialist referral for a knee MRI. Your specialist has included their specific concerns on the referral which means the scan will qualify for bulk billing (even if you’re over 50 years old).
Example 5: CT scan
Your GP or specialist has referred you for a CT scan. This can be bulk billed with any of the clinical details that are provided, including chronic pain.
If your specialist has requested a CT scan prior to surgery, they may also request that a specific protocol (like Mako or Medacta) for planning the surgery is used. These specialised CT protocols may only be available at selected imaging clinics and won’t affect your Medicare rebate.
Prioritising your health
Hearing that there’s an out-of-pocket cost can be disappointing. However, most patients tell us that having the scan was one of the best decisions they made for their health, because it gave them clarity and direction.
Knee and shoulder scans can:
- Provide a clear diagnosis
- Help your doctor choose the most effective treatment
- Prevent unnecessary treatments or procedures
- Rule out serious conditions
- Provide peace of mind
Living with uncertainty and ongoing pain can affect work, exercise and quality of life. Having clarity about your knee or shoulder condition helps you move forward with confidence, whether that means targeted treatment, rehabilitation physiotherapy or the reassurance that nothing serious is going on.
Will my knee and shoulder scans be covered by Medicare at Central Queensland Radiology
The Bookings Team at Central Queensland Radiology will advise you if your knee or shoulder scan will be bulk billed or if there’s an out-of-pocket cost when to make your appointment. They will be guided by what is written on your referral by your GP or specialist.
When you come in for your scans our team will explain what you can expect, answer your questions and support you during your procedure.
Our radiologists and staff will work closely with your GP or specialist to ensure you receive the right scan for your needs.
Where can I get a knee and shoulder scan?
If knee or shoulder pain is limiting your daily life, clarity matters. Speak to your GP about your symptoms and whether imaging is appropriate for you.
If you have a referral, Central Queensland Radiology is ready to help you take the next step with clear information, compassionate care and high-quality imaging. We have clinics located across Central Queensland so you can choose a location that’s convenient for you. We accept all referrals, regardless of the template they’re printed on.
