Brunswick Health
Bulk-billed X-rays, ultrasound and MRI: what to expect
Which scans are usually bulk billed and which are not, why an MRI often is not, when imaging is worth having at all, and how referrals work at Brunswick Health.
The cost of imaging is one of the more common reasons people delay getting a problem looked at, and the answer differs a great deal between scan types.
The short version
| Scan | Usually bulk billed? | Referral from |
|---|---|---|
| Plain X-ray | Usually, at a bulk-billing centre | Chiropractor, physio, podiatrist or GP |
| Ultrasound | Often, at a bulk-billing centre | Chiropractor, physio, podiatrist or GP |
| CT | Sometimes | Usually GP or specialist |
| MRI | Usually not | Medicare rebate generally requires a specialist referral |
X-rays
Standard spinal and limb X-rays are usually bulk billed when performed at a bulk-billing radiology centre. In most cases there is no out-of-pocket cost.
Chiropractors, physiotherapists and podiatrists at Brunswick Health can provide the referral directly, and you take it to a bulk-billing centre.
X-rays show bone well and soft tissue poorly. They are useful for suspected fractures, significant arthritic change and bone abnormalities. They tell you very little about discs, muscles, tendons or ligaments.
Ultrasound
Often bulk billed at a bulk-billing centre. Good for tendons, muscles, bursae and superficial soft tissue, and it has the advantage of being dynamic: the sonographer can watch a tendon move.
Commonly used for shoulder tendon problems, Achilles tendinopathy and plantar fascia assessment.
MRI: why it usually costs
MRI shows soft tissue in detail, discs, nerve roots, cartilage, ligaments, bone marrow oedema, and it is the most expensive of the common scans.
Medicare rebates for MRI are restricted. In most musculoskeletal cases a rebate requires a referral from a specialist rather than from a GP or an allied health practitioner. A limited set of GP-referred MRI items exists, mostly for specific presentations in younger patients.
Without a rebate, an MRI typically costs several hundred dollars. If one is genuinely warranted, the practical path is usually a GP referral to a specialist, who can then refer for a rebated MRI.
If an MRI is recommended at Brunswick Health, you will be told why, what it would change, and roughly what it would cost before you commit to it.
The more important question: is a scan worth having
Imaging is only useful when the result would change what happens next. That sounds obvious and it is frequently ignored, in both directions.
The case against routine scanning. Disc bulges, degenerative change and rotator cuff tears are extremely common in people with no symptoms at all. Roughly a third of people in their twenties have disc degeneration visible on MRI with no back pain, and the proportion rises steadily with age. Scan enough asymptomatic people and you will find something in most of them.
Which creates a real problem: a scan report describing degeneration in someone with ordinary mechanical back pain often finds something incidental, which then gets blamed for the symptoms. There is good evidence that early imaging in uncomplicated low back pain is associated with worse outcomes, more treatment, more intervention, more disability, without better results.
The case for scanning. Suspected fracture. Suspected serious pathology, infection, tumour, inflammatory disease. Progressive neurological deficit. Symptoms that are not following the expected course. Consideration of surgery or injection. In those situations imaging changes the plan, and delaying it is the mistake.
How it works here
If your assessment suggests imaging would change your treatment, your practitioner writes the referral and sends you to an appropriate centre, bulk billing where it is available. The report comes back and is discussed with you in plain language, including what the incidental findings mean and, often, that they do not mean much.
If your assessment does not suggest imaging would change anything, you will be told that too, with the reasoning. That is not a cost-saving measure. It is the better clinical answer, and it avoids the specific harm of being handed a frightening word about your spine that turns out to describe something a third of your age group also has.
When not to wait
Some presentations need imaging urgently rather than after a trial of treatment: significant trauma, suspected fracture, progressive weakness, bladder or bowel changes with back pain, fever with spinal pain, or new back pain in someone with a history of cancer. Those go straight to a GP or an emergency department rather than into a treatment plan.