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  1. #1
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    Default Please help with medicare rebates for ultrasound!

    Hi Ladies!

    So I had an ultrasound at 17 weeks for fetal well being after I had a complicated CVS in week 12. Just checking on the amniotic fluid etc. I was referred by my GP and went to my local medical imaging, which they bulk billed.

    So at my 19-20 week Morphology/anomaly scan (I went to Sydney ultrasound for women), they charged $375. I assumed I'd get must of that back because I have already reached the safety net threshold. Anyway, I went into medicare today and they said I can't get anything/much back because I've already had a morphology scan. To which I replied I hadn't. She said to contact the other place and get them to reverse it. So I called the original place, and they refused to change it, despite the fact it wasn't a morphology scan. They said you are only entitled to one scan between 17-22 weeks.

    I read on an old forum you can have one from a GP referral and one from your OB (which mine were). Can anyone shed any light on this for me? Wish someone had told me before I shelled out $375 at SUFW.

    Btw, my GP definitely wrote 'well being after CVS' on the 17 week one.

    Thanks ladies!

  2. #2
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    Unfortunately, I think the radiology place is correct. I work in radiology and there is only that one item number that can be used for the weeks of 17-22. That is a huge fee though, I thought $195 was bad!

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    Unfortunately I think being charged is correct. Was always told you can only have 1 scan between that time bulk billed. $375 seems fairly high though I always thought around the $180-$200 was the 'normal' price.

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    HearMeRoar  (01-05-2014)

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    Hmm I think it has something to do with in 2010 Medicare put a cap on how many pregnancy ultrasounds they would pay out for under particular item numbers. It sounds to me like the place that you went to at 17wks used the morphology scan item number on the medicare form rather than a different item number. So when the other place lodged a morphology scan it says you've already have it. The 17wk scan place I think should have used a different scan code.

    http://www.health.gov.au/internet/mb...and_Obstetrics

    That might help a little.
    Last edited by ICanDream; 01-05-2014 at 21:37.

  6. #5
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    Thanks ladies,

    I just looked at that schedule 'Icandream'. There seems to be different numbers that can be used for GP's and Obstetricians? 55706 and 55712? The original fits under the premise that there was some sort of concern or complication. So if this is the case, who should I contact - the first imaging place or medicare?
    And yes, SUFW is so expensive. It didnt bother me at the time because I assumed I'd get most of it back!
    If it works out that I can't get them to change it, could I do this? Ask the original place if I can pay them ($95) instead of them bulk billing me? I'd be much better off if I could get the medicare rebate back from the expensive scan and pay the other.
    wtyk?

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    I would speak to your GP about what he requested on the 17wk check up and tell him what has happened. I would also ring the first scanning place and speak to them again - I don't think Medicare will help, it is up to the place to put the right code in.

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    Porky  (02-05-2014)

  9. #7
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    I think there might be some rule that says you can only have either 55706 or 55712? Or maybe the OB code only applies where the OB does your scan in practice or refers you to a specialist centre.

    I used to work in radiology, in my experience I have never seen Medicare approve two morph scans, in any circumstance... Sorry!!

    Just so you know, if they want you to have another scan at all during the pregnancy, Medicare will only rebate for 1 scan between 22-26 weeks and 1 after that, regardless of what the dr puts on the referral form. Just a heads up so you don't get put in this crummy situation again!

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    Porky  (02-05-2014)

  11. #8
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    Thanks for all your help yesterday.
    SUFw ended up changing the item number to 55712 which is the Ob referral number. I still only got back $165 though and that's with safety net!

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    Anyone know why I would not get any rebate on 12 week scan? I paid about 180 and they made me sign saying I wouldn't get rebate. I had to continue as I needed scan for Down syndrome testing ect.. I did have a dating scan at 10 weeks at same place and got a rebate then. ( of course went to diff place for 20 wk scan and was bulk billed). Also hoping I get bulk billed again as I need scan at 32 weeks! Thanks!

  13. #10
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    12 week scan isn't always bulk billed, but you should have gotten some rebate... Maybe they only charged you the gap amount to save you having to go to Medicare?

    If the scan wasn't medicare debatable and you hadn't already had a nuchal scan done, then maybe try weren't accredited to do them? That's the only reason I can think of, assuming you hadn't already used up your right to a nuchal by having an earlier scan? Maybe they billed your dating as a nuchal incorrectly?


 

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