Paying for diagnostic testing
What is diagnostic testing?
Tests and scans used to diagnose a medical condition can be expensive. If you need diagnostic testing, make sure you first understand the costs involved – your doctor can help you with this information. Many diagnostic tests are covered by Medicare but not all, and this may also depend on whether you are referred by a specialist, a GP, or an allied health professional.
Diagnostic tests and scans are used to diagnose a medical condition.
Pathology tests: During a pathology test, samples of blood, urine or tissue are taken and then analysed in a laboratory. Pathology tests are used to look for evidence of disease, diagnose an illness, predict how long recovery will take, prepare for treatment, or to monitor your condition or medication.
Imaging and scans: Images of the inside of a person’s body are taken to help diagnose and monitor a condition. Diagnostic imaging and scans include:
Other tests you might have include eye tests and hearing tests.
Diagnostic tests are not the same as screening tests. Screening tests look for the early stages of a disease such as cancer, before there are any symptoms. In Australia, common screening tests include breast screening, bowel screening and cervical screening.
A screening test cannot diagnose disease – you would need a diagnostic test for that.
Does Medicare cover diagnostic tests?
Medicare covers the cost of most pathology tests. Many are bulk billed — that means that Medicare pays the full cost so you don't have to pay anything. Some pathology tests are done by private providers and you may need to pay some or all of the cost. Usually the doctor ordering the tests will explain if there will be an out-of-pocket cost involved.
Medicare also covers some or all of the cost of many diagnostic images and scans. Each provider sets their own fee. Some 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.
The services paid for by Medicare are listed on the Medicare Benefits Schedule (MBS). For Medicare to pay, there must be a medical reason for ordering the test and the laboratory or imaging provider must be approved by Medicare.
Some diagnostic tests are not covered by Medicare. For example, there may be a Medicare rebate for some MRIs with a GP referral for certain areas of the body (such as the brain or knee), or for other areas if they are requested by a specialist rather than a GP.
Medicare does not cover the costs of some tests done for cosmetic surgery, insurance testing, and several genetic tests. There are also limits on the number of times you can receive a Medicare rebate for some tests.
Your private health insurance may pay for diagnostic tests done while you are a patient in hospital. But private health insurance does not cover diagnostic tests that are done outside a hospital and that are listed on the MBS.
How can I find out how much it will cost?
Always ask your doctor whether the diagnostic test will be covered by Medicare, and whether there will be out-of-pocket costs for you. You can search for the test on MBS Online to see whether it is covered by Medicare.
You can ask the doctor who orders the test to select the 'bulk bill' option on the pathology request form. You can also ask whether there is a public or private option for the test, and what the difference will be.
You can 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. You are entitled to choose a different provider from the one recommended by your doctor so long as they can do the test you need.
Some questions to ask the provider are:
- Will there be any out-of-pocket expenses to you?
- Is there a payment plan available?
- Do they have a way to support you if you are on a low income or if the cost will cause you financial stress?
- Will there be any additional costs, over and above the cost of the test?
- How much will travel and parking cost?
If you or someone in your family needs a lot of tests, you may be eligible for the Medicare Safety Net. This means you can get a higher rebate from Medicare for diagnostic tests and other medical services after you have reached an out-of-pocket threshold.
Is my diagnostic test appropriate?
It is a good idea to talk to your doctor about whether you need the test. Diagnostic tests should only be ordered if they are likely to be useful to diagnose or treat you, if they are likely to give accurate results, and if the benefits to you are greater than any risks.
Always ask your doctor these questions about diagnostic tests:
- 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?
For more information, visit Choosing Wisely Australia.
Learn more here about the development and quality assurance of healthdirect content.
Last reviewed: August 2021
