Selected Imaging Rebate Criteria
Breast MRI
Breast MRI Rebate Item 63464
Magnetic Resonance Imaging performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician and where
- a dedicated breast coil is used; and
- the request for scan identifies that the woman is less than 50 years of age; and
- the request for scan identifies either:
- that the patient is at high risk of developing breast cancer due to 1 of the following:
- 3 or more first or second degree relatives on the same side of the family diagnosed with breast or ovarian cancer;
- 2 or more first or second degree relatives on the same side of the family diagnosed with breast or ovarian cancer, including any of the following features: bilateral breast cancer; onset of breast cancer before the age of 40 years; onset of ovarian cancer before the age of 50 years; breast and ovarian cancer in one relative; Ashkenazi Jewish ancestry; breast cancer in a male relative;
- 1 first or second degree relative diagnosed with breast cancer at age 45 years or younger, plus another first or second degree relative on the same side of the family with bone or soft tissue sarcoma at age 45 years or younger; or
- that genetic testing has identified the presence of a high risk breast cancer gene mutation.
Note: Benefits are payable on one occasion only in any 12 month period.
Breast MRI Rebate Item 63467
Magnetic Resonance Imaging performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician and where
- a dedicated breast coil is used; and
- the woman has had an abnormality detected as a result of a service described in item 63464 performed in the previous 12 months
Notes: Benefits are payable on one occasion only in any 12 month period. This item is intended for follow-up imaging of abnormalities diagnosed on a scan described by item 63464.
