Paying for diagnostic testing
7-minute read
Key facts
- Diagnostic tests are the tests and scans used to diagnose a medical condition.
- Diagnostic tests include pathology tests and imaging or scans.
- Medicare covers the costs of most pathology tests.
- Medicare also covers some or all the cost of many diagnostic images and scans.
- Always ask your doctor whether Medicare covers the cost of your diagnostic test.
What are diagnostic tests?
Diagnostic tests are:
- pathology tests
- imaging tests or scans
Pathology tests
Pathology tests include:
- blood tests
- urine (wee) tests
- biopsies — when your doctor takes a small piece of tissue from your body for testing
These samples are analysed in a laboratory.
Pathology tests are done to:
- look for evidence of disease
- help diagnose an illness
- predict how long recovery will take
- prepare for treatment
- monitor your condition or treatment
Imaging and scans
Diagnostic imaging and scans include:
Images of your body are taken to help diagnose and monitor your condition.
Other tests
Other tests you might have are:
- an electrocardiogram (ECG) — to measure your heart's electrical activity
- sleep studies
- an audiogram — a type of hearing test
- spirometry — to measure lung function
What are diagnostic tests used for?
Diagnostic testing is used to diagnose and monitor your medical conditions. These tests can be expensive.
Medicare covers the costs of many diagnostic tests. This may depend on whether you are referred by a GP or a specialist.
Why might I need a diagnostic test?
Diagnostic tests should only be done if:
- they are likely to be useful to help diagnose or treat you
- they give accurate results
- the benefits to you are greater than the risks
How can I find out how much my diagnostic test will cost?
Always ask your doctor whether:
- the diagnostic test will be covered by Medicare
- if there will be any costs for you
The Medicare Benefits Schedule (MBS) lists the services paid for by Medicare.
For Medicare to pay, there must be:
- a medical reason for ordering the test
- an approved provider
You can also ask your doctor to select the 'bulk bill' option on the pathology request form.
It's a good idea to talk to your doctor about whether you need the test.
Here are some questions you can ask your doctor:
- Do I really need this test?
- What are the risks?
- Are there simpler — and maybe, safer — options?
- What happens if I don't have the test?
- What are the costs?
Questions to ask your diagnostic test provider
You can also talk about the costs with the provider who is doing the test. Each provider is different.
For example, not all providers bulk bill, and some have different types of billing structures.
Some questions to ask the provider are:
- Are there any out-of-pocket expenses?
- Are there any other costs, over and above the cost of the test?
- Is there a payment plan available?
- How do you support people on a low income or if the cost will cause financial stress?
- How much are travel and parking costs?
You can choose a different provider from the one suggested by your doctor if they offer the test you need.
Does Medicare cover the cost of pathology tests?
Medicare covers the cost of most pathology tests. However, it does not cover the costs of tests for:
- elective cosmetic surgery
- insurance testing
- some genetic tests
If your test is bulk billed, Medicare pays the full cost and you don't have to pay anything.
Usually, the doctor ordering the tests will explain if there will be a cost involved.
Your doctor may give you a form for one pathology provider. However, you can go to another provider if they offer the test you need.
Does Medicare cover the cost of imaging and scans?
Diagnostic imaging providers set their own fees. Before your test you should ask how much you will have to pay.
Some diagnostic imaging providers bulk bill, so you don't have to pay anything. Sometimes you can claim back part of the cost of the image or scan. But you will still be left with an out-of-pocket cost.
If you need diagnostic testing, make sure you understand the costs involved — your doctor can help you with this information.
Your doctor may give you a form for one diagnostic imaging provider. However, you can go to another provider if they offer the test you need.
Will the Medicare Safety net cover any of the costs?
If you need a lot of healthcare including diagnostic tests, you may be eligible for the Medicare Safety Net.
Once you have reached an out-of-pocket threshold, you will get more money back from Medicare for your out-of-pocket expenses.
Will my private health insurance cover the costs of diagnostic testing?
Your private health insurance may pay for diagnostic tests done while you are a patient in hospital. This depends on your private health insurer and the policy that you take out.
But private health insurance does not cover diagnostic tests that are done outside a hospital.
What's the difference between a diagnostic test and a screening test?
Diagnostic tests and screening tests are different.
A screening test cannot diagnose a disease — you need a diagnostic test for that.
Screening tests look for the early stages of a disease such as cancer. They are done before there are any symptoms.
In Australia, common screening tests are:
Resources and support
The Australian Government's Medical Costs Finder Tool helps you find out more about healthcare fees.
You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.