Changes to MRI Medicare subsidy

The age to be eligible for a subsidised MRI for asymptomatic people with a high risk of developing breast cancer has changed. 

This eligibility has changed from under 50 to under 60 years of age.

The amended item for breast MRI for asymptomatic patients at high risk of developing breast cancer is item 63464.

In addition to the age eligibility criteria, a request for the scan must also identify that the patient is at high risk of developing breast cancer due to one or more of the following:

• genetic testing has identified the presence of a high-risk breast cancer gene mutation in the patient or in a first degree relative of the patient
• one of the patient’s first- or second-degree relatives was diagnosed with breast cancer at age 45 years or younger and another first or second degree relative on the same side of the patient’s family was diagnosed with bone or soft tissue sarcoma at age 45 years or younger
• the patient has a personal history of breast cancer before the age of 50 years
• the patient has a personal history of mantle radiation therapy
• the patient has a lifetime risk estimation greater than 30% or a 10-year absolute risk estimation greater than 5% using a clinically relevant risk evaluation algorithm.

BCNA is aware not everyone qualifies for this subsidy, and that’s why BCNA continues to advocate for greater access to subsided treatment and care.

If breast cancer is found early, there are more treatment options and a better chance for survival. 

GPs and other treating physicians are well placed to determine if their patients are at high risk and meet the Medicare criteria for a subsidised MRI.

For more information on eligibility go to mbsonline.gov.au.