Operators Nikki De Leon and Ian Reynolds demonstrate a new next generation Ingenia Ambition 1.5T MRI machine at Nepean Hospital in Sydney, Monday, March 9, 2020. (AAP Image/Joel Carrett) NO ARCHIVING

Heart MRIs weren’t wiped off the ‘free list’ with Medicare changes

AAP FactCheck July 26, 2021

The Statement

A Facebook post claims heart magnetic resonance imaging (MRI) scans have been removed from the Medicare “free list” following July 1 changes to the Australian government’s Medicare Benefits Schedule.

The post by an Australian account on July 14 shows a screenshot of a Twitter post, which claims:

Twitter post screenshot which claims: “…this dirty rotten LNP (Liberal/National Party) has taken heart MRI’s (sic) off the free list 1 July 2021”.

The Facebook post includes a caption reading: “Someone responded saying an MRI cost them $400”.

Similar posts have been shared by Labor candidates here and here.

The Facebook post
┬áSocial media posts claim heart MRIs have been removed from the Medicare “free list”.┬á

The Analysis

There have been no changes to the Medicare rebate for heart MRIs under the July 1 Medicare Benefits Schedule (MBS) changes, the Department of Health and multiple experts confirmed to AAP FactCheck.

A review into Medicare MRI services recommended no alterations to current services as the majority who received heart MRIs had already been required to cover an excess ‘gap’ payment.

In 2015, the federal government established the Medicare Benefits Schedule Review Taskforce to consider changes to MBS items including consultations, diagnostic tests and operations, all of which may be subsidised by the Australian government as part of Medicare.

On July 1, more than 900 MBS items for rebates were amended as part of the taskforce’s review of more than 5,700 items over five years.

However, the Australian Medical Association (AMA) raised concerns about the rollout of the changes, saying it needed more time to assess and implement them, while the federal opposition used the reforms to accuse the government of cutting Medicare.

The taskforce’s final report on diagnostic committee recommendations in 2018 examined whether some MRI items might be obsolete but concluded that were “clinically valid in spite of the observed low usage”.

“The committee noted that many of the items reviewed had only recently been added to the MBS,” the report said. (page 98)

“The committee agreed that all items reviewed remain appropriate in contemporary clinical practice and therefore did not recommend the deletion of any items.”

A Department of Health document detailing changes to MBS Cardiac Imaging Services does not include any mention of changes to MRI services.

A spokeswoman for the department told AAP FactCheck in an email that the post’s claim is “false”.

“The Australian government did not make any changes to Medicare cardiac MRI services from 1 July 2021,” she said.

Anna Kemp-Casey, a research fellow with the Medicines and Device Surveillance Centre for Research Excellence at the University of South Australia researching PBS and MBS data, said there were some changes in the MBS for cardiac imaging but none of them were MRI-related.

She told AAP FactCheck the MBS changes sought to revise codes that are no longer normal practice into ones more closely aligned with what clinicians need to bill.

“The people who are going to miss out during this changeover, if anyone, are the cardiac surgeons because they’ve been able to concurrently do procedures that take 10 minutes and were able to charge for two of those items, and the government is now saying all of that should count as one,” she said.

In terms of costs, Dr Kemp-Casey said doctors generally can charge what they like for a procedure because they don’t work for the government and there is no cap on what a clinician can charge.

Min Ku, the professional standards manager at the Australian Society of Medical Imaging and Radiation Therapy (ASMIRT), also told AAP FactCheck in an email there had been no changes to the MBS for MRI scans of the cardiovascular system.

She said MRI scans were not “free”, although the MBS provides rebates under certain conditions such as a referral for a specific clinical procedure; a referral by an approved medical practitioner; when the MRI is performed under the supervision of an eligible provider or when it is performed on a Medicare-eligible MRI scanner.

“Heart (cardiac) MRIs have never been included in the Medicare schedule other than for arrhythmogenic right ventricular cardiomyopathy (ARVC) or a family history of ARVC, which was only recently included. The majority of cardiac MRIs are not covered by Medicare and have never been,” Ms Ku said.

“For patients having MRI scans at sites where a fee is charged, the fee depends on many things, including the gap fee charged and the bulk billing policy of that specific site. Different sites will charge or not charge gap fees. Gaps fees will vary from practice to practice.”

Ms Ku said patients whose MRI is eligible for a Medicare rebate and have a Health Care Card or a Pensioner Concession Card will often have their scan bulk billed and they will not be charged a gap fee.

Medical services can bulk bill a service, meaning they accept the Medicare benefit as full payment for the service and don’t require patients to pay excess or ‘gap’ fees.

Two operators demonstrate a Ingenia Ambition 1.5T MRI machine
A demonstration of a next-generation magnetic resonance imaging (MRI) machine in Sydney. 

The Verdict

Heart MRIs have not been taken off the Medicare Benefits Schedule “free list”, the federal Department of Health and experts told AAP FactCheck. These procedures were never free for a majority of patients, and those who qualified for a government rebate often had to pay a gap fee set by individual clinics. The rebates have not changed.

Patients with a Health Concession Card or Pensioner Concession Card can often have their fees bulk billed, depending on individual clinics.

False – Content that has no basis in fact.

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