By Dr. Mark Bekhit, Radiologist · Last updated September 2026
Short answer: A knee MRI has a Medicare Schedule fee of $463.80, and outside hospital Medicare pays $394.25, or more if the practice bulk bills. In 2023–24, 84% of patients scanned under the GP knee item paid nothing. The catch is the request. From age 16, a GP can use that item only up to 49, after a recent injury with signs of a meniscal or ACL tear; otherwise you need a specialist’s request or you pay the full private fee. For a child under 16, a GP can request one for a suspected joint problem.
On this page
• How much does a knee MRI cost in Australia?
• Who can request a knee MRI that Medicare pays for?
• Over 50, or no recent injury: your options
• Will your knee MRI be bulk billed?
How much does a knee MRI cost in Australia?
There are three possible prices, and one phone call before you book tells you which one applies. If the practice bulk bills, you pay $0 and Medicare pays the practice 95% of the Schedule fee, which is $440.61 for a knee MRI. If the practice charges its own fee, Medicare still pays $394.25 and you pay the difference, the gap. If your request fits no Medicare item, the practice sets its own fee and Medicare pays nothing.
Medicare has three knee MRI items. They pay the same; what differs is who can sign the request and for whom.
Schedule fees are those on MBS Online as at September 2026, updated 1 July 2026; “Medicare pays” is the 85% out-of-hospital benefit. The last two columns come from the Department of Health’s Medical Costs Finder and count patients scanned at radiology practices outside hospital in 2023–24; the gap is the median among those who were charged, not a quote. If a practice charged exactly the Schedule fee, the gap would be $69.55. The typical gaps are larger because practices set their own fees.
In these figures, where you live mattered more than which knee item you were billed under. Among patients scanned under the GP item, 97% in Western Australia paid nothing, against 53% in the ACT. The Medical Costs Finder publishes no Northern Territory figure for this item.
Who can request a knee MRI that Medicare pays for?
As a rule, only a recognised specialist or consultant physician can request a Medicare MRI, in writing, naming the clinical reason. A specialist can use item 63328 for a knee problem at any age, up to three scans per knee in any 12 months.
GPs get a narrow exception. For an adult, the GP knee item covers one situation: a patient aged 16 to 49 with a recent knee injury, where the knee will not fully straighten, suggesting a torn meniscus, or the examination suggests a torn anterior cruciate ligament (ACL). A 35-year-old with slowly worsening knee pain and no injury does not fit it.
The age-50 rule: since 1 November 2018, GPs cannot request a Medicare knee MRI for patients aged 50 and over. The change came from the MBS Review Taskforce and was meant to cut unnecessary knee MRIs. Specialists can still request one at any age.
If you saw a physiotherapist first, they cannot request a Medicare MRI. Nor can osteopaths, chiropractors, podiatrists or nurse practitioners: the items they can request are X-ray and ultrasound items, with no MRI among them. GP requests are also capped: three GP-requested MRI scans in any rolling 12 months, whatever the body part.
The wording on the form decides the item. For anyone 16 or over, “knee pain” on a GP request is a private scan. The requesting doctor decides the clinical reason, and the radiology practice cannot re-word it for you at the desk.
Over 50, or no recent injury: your options
If you are 50 or over, or your knee has worsened without an injury, the rule can feel arbitrary when your knee hurts. There are four honest routes.
An X-ray first. A GP can request a knee X-ray at any age under item 57523 (Schedule fee $51.15, Medicare pays $43.50), and in 2023–24 93% of patients paid nothing for it; those who paid had a typical gap of $63. For osteoarthritis, tests are not usually needed, and an X-ray is the one your doctor may order. My view as a radiologist: in a knee that has ached for months past 50, a standing X-ray usually shows the wear that explains the pain. An MRI of the same knee commonly finds meniscus and cartilage changes that were expected at that age, and it rarely changes the first plan.
A specialist’s request. A recognised specialist, such as an orthopaedic surgeon or a rheumatologist, can request item 63328 at any age. You need a GP referral for Medicare to help with the specialist visit, and that visit may have its own gap. The MRI then attracts the same $394.25 benefit as the GP item.
The public hospital. With a Medicare card, public hospital care is free as a public patient, given on clinical need; there may be a waiting list.
Pay privately. A practice can scan you on a doctor’s request at its own price, and by law private health insurance cannot cover out-of-hospital imaging. As one dated example, Exact Radiology’s January 2026 price guide lists a Medicare-non-eligible MRI “from $250”. That is one practice’s starting price, not a knee quote.
If your knee is badly swollen or has changed shape, is hot and red with a fever, or the pain follows a major injury, go to an emergency department rather than shopping for a scan.
Will your knee MRI be bulk billed?
Usually. The Department’s Medicare quarterly statistics, published 10 August 2026, count every MRI service Medicare paid for, not only knees. Between April and June 2026, 80.8% of MRI services were bulk billed. When a practice did charge outside hospital, the average gap was $200.43. These are per-service figures and an average, so they do not line up exactly with the per-patient, middle-value (median) gaps above.
In the ACT, fewer than half of MRI services were bulk billed. The machine matters too: not every MRI machine is Medicare-eligible yet, and all of them will be from 1 July 2027. On a machine that is not eligible, there is no Medicare benefit.
Where to book, and what to ask
Your request can go to any practice you choose, even if it is printed on one group’s form. Start with the MRI clinics near you in Sydney, Melbourne, Brisbane, Perth, Adelaide, Canberra or Hobart. If you are taking the X-ray-first route, try X-ray clinics in Sydney, X-ray clinics in Melbourne or X-ray clinics in Brisbane.
Two examples from our directory, checked on 26 September 2026, not a ranking: Queensland X-Ray at the Mater Hospital, South Brisbane, whose own site lists knee MRI, and Melbourne Radiology Clinic, East Melbourne, whose own site sets out the GP knee item and its age limit. Neither listing shows today’s billing.
Ask the clinic when you book
✓ “Do you bulk bill the item on my request, and if not, what is the fee and the Medicare benefit?”
✓ “Is the MRI I will be booked on Medicare-eligible?”
✓ “Can I have the estimate in writing?” A written estimate should list the item numbers and your out-of-pocket cost.
✓ Bring any earlier knee X-rays or scans. The radiologist reads the new images better with the old ones beside them.
If the enclosed space worries you, read our guide to wide-bore and open MRI before you book. For MRI prices across the whole body, see the MRI cost guide; for brain scans, the brain MRI cost guide; for the back and neck, the spine CT and MRI cost guide; for the foot and ankle, the foot and ankle MRI cost guide; and for the full list of GP MRI items, which MRI scans Medicare covers.
Common questions
Can I get a knee MRI without a referral?
Not with any Medicare help. You need a referral from your doctor for an MRI. Medicare pays only when the practice has the written request before the scan and the request fits a knee item. A request that fits no item is scanned at the practice’s own price.
Can my physio refer me for a knee MRI?
Not one that Medicare pays for, and a physiotherapist cannot request a Medicare knee X-ray either. Your GP can request the X-ray at any age and the MRI if you are 16 to 49 with the injury signs described above. Ask your physio to send their examination findings to your GP. If they suspect an ACL tear, that is exactly what the GP item asks the request to record.
Does private health insurance cover a knee MRI?
Not at a radiology practice. By law, extras and hospital cover cannot pay for out-of-hospital imaging. Medicare is the only help, and only when the request fits a Medicare item. A health fund only comes into it if the MRI is done while you are admitted to hospital as a private patient.
How we know: sources and method
Item wording, Schedule fees and benefits come from the Medicare Benefits Schedule, read on 26 September 2026 (every fee quoted was updated on 1 July 2026). The age-50 rule is from the MBS knee imaging factsheet, and the requester and frequency rules from notes IN.0.18, IN.0.6 and IN.0.2, and machine eligibility from note IN.0.18 and the Department’s MRI locations page. What patients paid per item is the Department of Health’s Medical Costs Finder, filtered to diagnostic radiology, out of hospital, 2023–24, counted per patient; the same filter as our other cost guides, including the X-ray cost guide. The state bulk-billing rates are the Department’s June-quarter 2025–26 Medicare statistics, counted per service across all MRI. Where I give a view on X-ray versus MRI for an older knee, that is my judgement as a radiologist; your own doctor’s advice comes first. For how bulk billing works across all scans, see our bulk-billing guide.
This article is general information, not personal medical advice. Discuss your individual report and next steps with the healthcare professional responsible for your care.
Author: Dr. Mark Bekhit
Dr Mark Bekhit (MBChB, FRANZCR) is a musculoskeletal radiologist practising in Brisbane and an AHPRA-registered specialist in diagnostic radiology (MED0002920947). He spends as much time building software as reading scans: he founded Imaging Finder (Australia) and Radiology Clinics NZ to make imaging easier to find, and builds radiology dictation and pain-tracking tools with one aim — better patient outcomes and a smoother reporting workflow. Outside the reading room he's usually training, bringing the same performance mindset to imaging.
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