What a scan really costs in Australia: Medicare, the gap and bulk billing

Few things about medical imaging confuse Australians more than the cost. You get a referral for an MRI, ring two clinics, and one quotes “bulk billed, nothing to pay” while the other says “$450.” Same scan, same city. What’s going on? Here’s how it actually works — and how to make sure you pay as little as possible.

The one fact that explains everything: clinics set their own fees

Medicare doesn’t set the price of your scan. Diagnostic imaging providers set their own fees, and you should ask what they are before your appointment.^[1] Medicare’s role is separate: it pays a fixed rebate for scans that are eligible (there’s a valid medical reason, an approved provider, and the right referral).^[1]

So there are really two numbers in play:

• The clinic’s fee (set by the clinic), and
• The Medicare rebate (set by the government).

Everything else — bulk billing, the gap, your out-of-pocket cost — comes from how those two numbers line up.

Bulk billing vs the gap, in plain English

The gap is simply the clinic’s fee minus the Medicare rebate.^[1] Whether a clinic bulk bills is its own commercial decision — it’s not the same as whether the scan is Medicare-eligible.^[5] That’s why two clinics with identical Medicare eligibility can quote wildly different prices.

One reason gaps have grown over the years: the Medicare rebate for many imaging items hasn’t kept pace with inflation, so clinics that don’t bulk bill pass the difference on to you.

X-ray, CT, ultrasound, MRI: the eligibility quirks

Most X-rays, CT scans and ultrasounds are rebatable on a GP referral when there’s a genuine clinical reason, and many are widely bulk billed.^[1]

MRI is the tricky one. Whether Medicare pays can depend on who referred you and why — some MRI items are only rebated when a specialist requests them, while others qualify on a GP referral if specific clinical conditions are met.^[2] This is the most common reason people get surprised by an MRI bill. Your referring doctor knows which item applies to your situation; it’s worth asking them directly, “Is this MRI Medicare-rebatable for me?”

Ways to pay less (that many people miss)

• Ring around. With referral in hand, call a few clinics and ask the magic question: “Will this be bulk billed, and if not, what’s my out-of-pocket cost?” You’re allowed to choose a different provider from the one your doctor suggested.^[1]
• Concession and pension cards. Pensioners and healthcare/concession card holders are often bulk billed or charged a reduced rate for eligible imaging — always mention your card.^[1]
• The Medicare Safety Net. If you have a lot of out-of-pocket medical costs in a calendar year, once you pass a threshold Medicare starts paying a higher proportion of the gap on out-of-hospital services. Costs count toward it automatically, but check your family is registered.^[1]
• Compare before you commit. The government’s free Medical Costs Finder helps you understand typical costs for many services.^[3]
• Ask about payment plans. Some clinics offer them, or reduced fees for financial hardship — it never hurts to ask.^[1]

What about private health insurance?

For scans done as an outpatient (the usual case — you walk in, have the scan, go home), private health insurance generally does not help, because Medicare is the funder for out-of-hospital imaging. Private cover mainly comes into play for imaging done as part of an admitted hospital stay, depending on your level of hospital cover.^[1] So for a standard MRI or CT at a community radiology clinic, it’s Medicare and the gap that matter — not your health fund.

The questions to actually ask

Borrowing from healthdirect’s excellent checklist, here’s what to ask your doctor:^[1]

• Do I really need this scan, and what happens if I don’t have it?
• Is it Medicare-rebatable for me (especially for MRI)?
• Are there simpler or cheaper alternatives?

And what to ask the clinic:^[1]

• Will it be bulk billed?
• If not, what’s my out-of-pocket cost — and are there any extra fees?
• Is there a payment plan or concession rate?

Why the price shouldn’t be your only guide

Cost matters, but so does getting the right scan, done well, and read by a radiologist. A modern scanner, an accredited practice, and a quality report are worth more than saving $50. Use cost to choose between comparable, accredited clinics — not to talk yourself out of a scan you genuinely need. If money is the barrier, tell your GP; there are almost always bulk-billing options for people who need them.

Frequently asked questions

Why was my friend’s MRI free but mine cost $400?

Because clinics set their own fees and decide whether to bulk bill, and because MRI Medicare eligibility can depend on who referred you. Same scan, different clinic (or different referral), different price.^[2]

Does Medicare cover CT scans?

Yes — Medicare covers a wide range of CT scans when they’re clinically justified and referred by a GP or specialist. Whether you pay a gap depends on the clinic’s billing.^[1]

Can I claim part of the cost back if I’m not bulk billed?

Often yes — if the scan is Medicare-eligible you can claim the rebate back, leaving you with just the gap. The clinic or Services Australia can tell you how to claim.^[1]

How do I find a bulk-billing radiology clinic near me?

Ring local practices and ask directly, or check clinic websites — many state their billing policy. Concession card holders should always mention it, as bulk billing is more commonly offered.^[1]