Medicare rebates now available for magnetic resonance imaging (MRI) of the prostate
What are the new services?
From 1 July 2018, Medicare rebates will be available for MRI prostate scans for both the diagnosis of prostate cancer and for men on active surveillance (diagnosis proven following a biopsy).
Who can request these items?
Urologists, radiation oncologists and medical oncologists are eligible to request these items. General practitioners are not eligible to request these items.
What are the patient eligibility requirements?
The following criteria needs to be met to qualify for the rebate.
1. The scan must be requested by a urologist, radiation-oncologist or medical oncologist.
2. The patient must be suspected of having prostate cancer based on:
a. a digital rectal examination (DRE) which is suspicious for prostate cancer; or
b. in a person <70yo, at least two PSA blood tests are >3ng/ml, and the free/total PSA ratio is <25% or the repeat PSA >5.5ng/ml; or
c. in a person <70yo, whose risk of developing prostate cancer based on family history is at least double the average risk, and least two PSA tests are >2.0 ng/ml, and the free/total PSA ratio is <25%; or
d. in a person >70yo, at least two PSA tests are >5.5ng/ml and the free/total PSA ratio is <25%.
3. The patient has known prostate cancer and:
a. is on active surveillance and is not planning or undergoing treatment for prostate cancer.