Paying for diagnostic testing

Diagnostic tests help medical and other health practitioners assess, diagnose and monitor illnesses and injuries. Diagnostic tests include:

• pathology tests
• imaging tests or scans
• other diagnostic services

Pathology tests

Pathology tests include:

• blood tests
• urine (wee) tests
• stool (poo) 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
• prepare for treatment
• monitor your condition or treatment

Imaging and scans

Diagnostic imaging and scans include:

• x-rays
• computed tomography (CT scans)
• magnetic resonance imaging (MRI scans)
• positron emission tomography (PET scans)
• ultrasound scans

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

Diagnostic testing is used to diagnose and monitor medical conditions. These tests can be expensive.

Medicare covers the cost of many diagnostic tests. This may depend on whether you are referred by a GP or a specialist.

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

Always ask your doctor whether:

• the diagnostic test will be covered by Medicare
• there will be any costs for you

You can also use the Australian Government's Medical Costs Finder tool (Opens in new tab) to find and understand costs for some services.

For Medicare to pay, there must be:

• a medical reason for ordering the test
• an approved provider

You can 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.

Here are some questions you can ask the provider:

• 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 will travel and parking cost?

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 cost 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.

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.

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.

Your private health insurance may cover some of the costs of diagnostic testing but this depends on your level of hospital cover. Some people with private health insurance may receive a rebate from their health fund that can cover all or part of their out-of-pocket costs for private hospital services.

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:

• breast cancer screening
• lung cancer screening
• bowel cancer screening
• cervical screening tests

For more information or support the following organisations and services can help:

• The Australian Government has further information about pathology (Opens in new tab) and diagnostic imaging (Opens in new tab) in Australia. They also provide an Understanding Medicare Provider Handbook (Opens in new tab) and information on out of pocket costs (Opens in new tab).
• Pathology Tests Explained provides simple information about pathology tests your doctor may have requested.

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 you 24 hours a day, 7 days a week.

Languages other than English

• The Translating and Interpreting Service (TIS National) (Opens in new tab) is an interpreting service for people who do not speak English.
• Services Australia has information about payments and services (Opens in new tab) in languages other than English.

Information for Aboriginal and/or Torres Strait Islander peoples

• The Australian Government provides annual health checks (Opens in new tab) for Aboriginal and/or Torres Strait Islander peoples.
• Services Australia has further support and information to complete and claim payment (Opens in new tab) for Indigenous health assessments and follow-up services for Aboriginal and/or Torres Strait Islander peoples. They also provide information in Aboriginal and/or Torres Strait Islander languages (Opens in new tab), and a guide to Medicare for Indigenous health services (Opens in new tab).