Breast Magnetic Resonance Imaging (MRI) Questions and Answers.
This document provides answers to possible questions about the Medicare rebate for breast MRI scans.
Australian Government funding has been provided from 1 February 2009 for Medicare rebates for breast Magnetic Resonance Imaging (MRI) scans of women less than 50 years of age, with no signs or symptoms of breast cancer, but who are at high risk of breast cancer due to family history or genetic mutation.
Q1. How did this rebate come about?In order for an MRI service to receive a Medicare rebate, the scan must be an MRI service listed on the Medicare Benefits Schedule (MBS).
In order for a new medical service to be listed on the MBS, an application must be made to the Medical Services Advisory Committee (MSAC) for assessment. MSAC is an independent scientific committee which provides advice to the Minister for Health and Ageing on the strength of new evidence relating to the safety, clinical effectiveness and cost effectiveness to Government of new medical technologies and procedures. A rigorous assessment of evidence is thus the basis of decision making when funding is sought for a new service under Medicare.
Such a process through MSAC led to the Medicare rebate for breast MRI scans.
The purpose of the MSAC process is to ensure that Australians have access to medical services that are of demonstrated value in terms of safety and effectiveness, and that those services represent value for money to Australians, both as patients and taxpayers.
Q2. Who is eligible for this Medicare rebate?Women less than 50 years of age, with no signs or symptoms of breast cancer, but who are at high risk of breast cancer based on the criteria outlined under question 3 below, are eligible for a Medicare rebate for annual breast MRI scans.
Q3. How do I know if I am at high risk due to a family history or genetic mutation?If there is history of breast cancer in your close relatives, you may have increased risk of developing breast cancer. Please discuss your family history with your general practitioner or specialist medical practitioner.
For this Medicare rebate, women at high risk due to family history or genetic mutation have been defined as having one of the following:
- Three or more first or second degree relatives, on the same side of the family, who have been diagnosed with breast or ovarian cancer;
- Two or more first or second degree relatives, on the same side of the family, who have been diagnosed with breast or ovarian cancer; Two or more first or second degree relatives, on the same side of the family, who have been diagnosed with breast or ovarian cancer, if any of the following applies to at least one of the relatives:
- has been diagnosed with bilateral cancer;
- had onset of breast cancer before 40 years of age;
- had onset of ovarian cancer before 50 years of age;
- has been diagnosed with breast and ovarian cancer, at the same time or at different times;
- has Ashkenazi Jewish ancestry;
- is a male relative who has been diagnosed with breast cancer;
Q4. Who are my first and second degree relatives?First degree relatives are blood relatives from your immediate family, such as your parents, siblings and children. Second degree relatives are blood relatives from your extended family, such as your aunts, uncles, nieces, nephews, and grandparents from both sides of your parents’ families.
Q5. Why have the items been restricted to women less than 50 years of age?Existing evidence shows that a mammogram performs less well in women under 50 years of age due to the density of their breast tissue and an MRI scan may produce better results. Mammograms have proven to perform well for women from 50 years of age whose breast density has reduced with age.
Q6. Is there a minimum age for eligibility for these rebates?There is no minimum age in order to be eligible for Medicare rebates for these breast MRI scan items. The necessity for MRI scans in all circumstances should be determined on a case by case basis with your medical practitioner.
Q7. Do I still need a mammogram?For women of all ages who are at high risk of developing breast cancer, an individual surveillance program should be developed in consultation with your medical practitioner. This may include whether you should have a mammogram or any other additional tests. You should discuss the options available and associated costs with your medical practitioner.
Q8. What support is available to women who are not eligible for the breast MRI rebate but have a history or diagnosis of breast cancer?The Australian Government provides Medicare rebates for a range of medical tests other than MRI for women who are not eligible for the breast MRI rebate but have a history or diagnosis of breast cancer, such as diagnostic mammograms, ultrasound and guided biopsies.
The role of MRI in the follow-up of women with a history of breast cancer is evolving. At this stage, published guidelines such as those produced by the National Health and Medical Research Council recommend that the follow-up of breast cancer include regular clinical examination and annual mammograms.
Q9. If I am eligible for the breast MRI rebate but then have a sign or symptom of breast cancer, am I still eligible?Some women who otherwise meet the eligibility requirements for the breast MRI rebate may at some future point be found to have a sign or symptom of breast cancer (possibly as a result of their annual MRI scan). Some of these women may be diagnosed subsequently with breast cancer, and receive treatment for that breast cancer:
- Once a woman has a sign or symptom of breast cancer, she is no longer eligible for the breast MRI rebate;
- If the sign or symptom is investigated and found to not be breast cancer, the woman then has no signs or symptoms of breast cancer and returns to being eligible for the breast MRI rebate (until of course she reaches age 50 or if she becomes symptomatic again in the future);
- Alternatively, if that sign or symptom is investigated and results in a diagnosis of breast cancer, the woman is no longer eligible for the breast MRI rebate. The woman returns to being eligible for the breast MRI rebate following successful treatment of the breast cancer (until of course she reaches age 50 or if she becomes symptomatic again in the future).
Q10. What does the breast MRI scan involve?MRI uses strong magnetic fields to generate images that can help diagnose illnesses. It is especially effective on soft tissue. Unlike some other diagnostic imaging tools such as X-rays and Computed Tomography (CT) scans, MRI does not use ionising radiation.
A breast MRI scan is performed using an MRI machine fitted with a dedicated breast coil. If you want to know more about what is involved, discuss this with your MRI provider prior to undergoing your MRI scan.
Q11. Who can request and perform the breast MRI scan?To be eligible for a Medicare rebate, breast MRI scans must be requested by your specialist medical practitioner. The involvement of your specialist medical practitioner is important because the ongoing management of young women at high risk of developing breast cancer is complex, and involves counselling, physical examination and the correlation of imaging results from a mammogram, ultrasound and MRI.
To be able to claim the rebate your breast MRI scan must be performed under the professional supervision of a Medicare-eligible provider on a Medicare-eligible MRI unit.
A “Medicare-eligible provider” is a specialist in diagnostic radiology who is a participant in the Royal Australian and New Zealand College of Radiologists’ Quality and Accreditation Program.
Q12. How can I find a Medicare-eligible MRI unit?For a list of current Medicare-eligible MRI units, please call the Department of Health and Ageing MRI Hotline on (02) 6289 9100 or email MRI inbox. Medicare-eligible scans conducted on these MRI units attract a Medicare rebate.
Q13. What will I be charged for the breast MRI scan?In the MBS, the schedule fee for a breast MRI scan is $690.00.
However, medical practitioners are free to set their own fees for their services which can be above or below the MBS schedule fee. You should discuss the costs for any services and the likely Medicare rebate with your medical practitioners, including the MRI provider, prior to undergoing your MRI scan.
Q14. Is breast MRI safe?Breast MRI is a safe procedure and unlike some other diagnostic imaging tools, MRI does not use ionising radiation.
Certain metallic implants, notably some cardiac pacemakers, intracranial aneurysm clips, breast tissue expanders and cochlear implants can put patients at risk from the high magnetic fields associated with MRI. It may not be appropriate for patients with such implants to have an MRI scan. The MRI provider will ask you about these issues before your MRI scan.
Q15. How many breast MRI scans can I have?Eligible women can receive the Medicare rebate for a breast MRI scan once in any 12 month period.
If you are concerned about family history as a risk factor for breast cancer, you should discuss this with your doctor.