Medicare Rebates for Breast Imaging

Plain‑English guidance on when Medicare helps cover 3D mammogram, ultrasound or MRI

Close-up of assorted paper currency with a green healthcare or medicare card in the center. Understand Medicare rebates for breast imaging and your personalised Breast Screening Journey.

Why rebates matter

Medicare rebates for breast imaging can help reduce the cost of certain scans such as 3D mammograms, breast ultrasound and breast MRI depending on the test, your risk category and clinical indications. This page explains when Medicare rebates apply and how out-of-pocket costs may arise. Personalised screening often uses different tests at different intervals. We’ll help you understand what’s covered and what out‑of‑pocket costs to expect.

Medicare item numbers that may apply

  • 3D Mammogram (Tomosynthesis): Mammography remains the cornerstone of breast cancer screening. The national program still provides only 2D mammography, but most private centres have offered 3D mammography for years. It delivers clearer images, particularly for dense breasts. More recently, contrast‑enhanced mammography (CEM) has been added to our toolkit, providing even greater accuracy. Medicare item 59302 covers screening mammography if there is a significant family history of breast or ovarian cancer — our risk calculator evaluates this in detail. Currently there is no item for CEM, so a small out‑of‑pocket fee usually applies if contrast is added during a 3D mammogram.

  • Breast Ultrasound: Best used as a targeted test for new breast symptoms or to investigate an abnormality seen on mammogram or MRI. As a screening test, bilateral ultrasound is limited because it is operator‑dependent. Nonetheless, it is often recommended for women with dense breasts as an adjunct to mammography, particularly during the first screening round if MRI is not available. Medicare item 55076 can apply for bilateral breast ultrasound in this context.

  • Breast MRI: Medicare item 63464 allows screening breast MRI for women under 60 classified as high risk. Notably, the Medicare definition of high‑risk is not the same as Cancer Australia’s (>3× population risk). For rebates, eligibility generally means a lifetime risk >30% or a 10‑year risk >5% using a validated tool, such as ours. In practice, this means some women classified as moderate risk by Cancer Australia may still qualify for a rebate — saving around $700 in out‑of‑pocket costs.

  • Important to know: A Medicare rebate reduces the fee; a gap will remain depending on the imaging modality. Medicare rules and item descriptors change from time to time. We will check current requirements at your appointment and adjust your plan if needed.

How MCBC helps to get Medicare rebate for breast imaging

  • We confirm your modelled risk (IBIS) and whether Medicare criteria are met.

  • We issue a compliant request with the clinical details imaging centres need.

  • We coordinate your imaging with a network of carefully selected radiology providers across Melbourne, chosen for their expertise in breast imaging.

Check your Medicare eligibility for MRI screening

Frequently asked questions

  • Medicare item number 59302 applies to screening 3D mammography for women assessed as having an increased risk of breast cancer, including those in the moderate and high-risk categories. There is currently no Medicare rebate for contrast-enhanced mammography, and patients should expect additional out-of-pocket costs if contrast is required.

  • Medicare item number 63464 provides a rebate for screening breast MRI in women under 60 who meet specific high-risk criteria, including a lifetime risk above 30% or a 10-year risk above 5%. A specialist referral is required, which MCBC can facilitate as part of your care, avoiding the need for an additional specialist consultation.

  • Possibly. Even when a Medicare rebate applies, imaging providers may charge a gap fee depending on the type of test, technology used, and individual billing practices. MCBC will advise you of any expected out-of-pocket costs before your appointment.

  • Yes. Medicare-rebated breast imaging requires a referral from a GP or specialist that meets the relevant MBS criteria. MCBC can facilitate this referral as part of your care, avoiding the need for an additional GP or specialist visit.

  • MCBC helps by:

    • Assessing individual breast cancer risk

    • Clarifying which imaging tests may be appropriate

    • Guiding referrals that align with MBS requirements

    • Helping patients understand potential rebates and out-of-pocket costs