By Dr. Mark Bekhit, Radiologist · Last updated September 2026
The quick answer
Short answer: Most adult MRI scans need a specialist request for a Medicare rebate. A GP can request four Medicare MRI items for people aged 16 and over, plus six items for children under 16. The referral reason and the clinic’s Medicare status must also match. Ask the clinic to check your exact referral before you book. Medicare does not set the clinic fee.
On this page
The three Medicare checks
A Medicare rebate is possible only when all three checks below pass.
1
The scan matches
Your body part, age and referral reason match an MBS item.
2
The requester matches
The item permits a request from your GP or specialist.
3
The clinic matches
The MRI service uses Medicare-eligible equipment.
Most adult MRI items need a specialist or consultant physician request. A GP request for an adult shoulder, lower-back or pelvic MRI usually does not qualify. The clinic may still offer the scan at its full private price. Our shoulder MRI cost guide compares that price with the shoulder ultrasound a GP can request.
Which MRI scans can a GP request?
A GP can request ten specific MRI items. Four apply from age 16. Six apply to children under 16. The rebate figures below are current as at July 2026. They are Medicare benefits, not clinic prices. If you have no referral yet, or your physio suggested the scan, see who can request an MRI that Medicare pays for.
For what a head MRI then costs, item by item and state by state, see the brain MRI cost guide.
People aged 16 and over
Head · 63551
Unexplained seizures, or persistent unexplained headache when serious disease inside the skull is suspected
Medicare benefit: $394.25
Knee, ages 16–49 · 63560
A recent injury with signs of a meniscal tear or ACL tear
Medicare benefit: $394.25
Knee limit: the GP-requested knee item stops at age 50. Medicare also limits it to three scans per patient each year. Our knee MRI cost guide covers the routes from 50.
Children under 16
Head · 63507
Unexplained seizure, or unexplained headache when serious disease is suspected, or sinus disease that has not improved with treatment
Medicare benefit: $394.25
Spine · 63510
After an X-ray: significant injury, or unexplained pain with concerning signs
Medicare benefit: $438.05
Hip · 63516
After an X-ray: suspected serious infection or specific childhood hip disease
Medicare benefit: $394.25
Elbow · 63519
After an X-ray: suspected fracture or tendon-pull injury that could change treatment
Medicare benefit: $394.25
Four children’s items need an X-ray first. The clinic will check this from the referral and earlier imaging.
What does Medicare pay?
Medicare eligibility decides whether a benefit can be paid. It does not set the clinic’s price.
Eligible and bulk billed
You pay $0
Eligible and privately billed
You pay the clinic fee minus the Medicare benefit.
Use the MRI cost guide for price examples, or the heart MRI cost guide for the six Medicare heart MRI items. The bulk-billing guide explains the billing choice. You can also take your referral to another clinic that offers the scan.
How do you find and compare a clinic?
Search MRI clinics in Sydney, Melbourne, Brisbane or Perth. Then ask each clinic to check the exact referral.
Two clinics can give different answers. They can match the referral to different MBS items. Their equipment status can differ. Their prices and bulk-billing choices can also differ.
What changed in the Medicare rules?
Changes since July 2025 made more MRI equipment eligible at licensed practices. A July 2026 update also changed some claim rules. A planned July 2027 change would remove the Commonwealth equipment-licence requirement, subject to legislation.
These equipment changes do not remove the rules for the scan, referral reason or requester. The booking team still needs to check your referral.
What should you ask when you book?
Booking script: “Can you check whether this exact MRI is Medicare-rebatable at your clinic? If it is, will you bulk bill it? If not, what is my final gap?”
- Have the referral in front of you.
- State the body part and reason written on it.
- Ask for the total fee, Medicare benefit and final gap.
- Ask about contrast, preparation and MRI safety checks.
- Mention claustrophobia or implanted devices when you book.
Sources and methodology
Sources and methodology
The item numbers, requester rules, benefits and equipment changes were checked against MBS Online and Australian Government guidance in September 2026.
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.
Leave a Reply