Medicare Rebates Explained

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 rebate for your personalised Breast Screening Journey.

Why rebates matter

Personalised screening often uses different tests at different intervals. Medicare may contribute to some scans depending on your age, risk level, clinical findings and current rules. We’ll help you understand what’s covered and what out‑of‑pocket costs to expect.

At a glance

  • 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 mammographyfor 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, especially at the first 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 who are at 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

  • 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 MRI ELIGIBILITY