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RACGP backs plan to expand rebated MRIs
With access to MRIs ‘a critical issue’, a review has set out proposals to significantly increase the clinical indications allowing GPs to request rebated services.
Proposals to increase patient access for rebated MRIs have been backed by the RACGP.
GPs would be able to request rebated magnetic resonance imaging (MRI) services for a raft of additional clinical reasons under proposals being considered by health officials.
In its recent review of MRI services, the Department of Health, Disability and Ageing (DoHDA) proposed an initial phase of changes allowing GPs to refer patients for MBS-funded:
- lumbar spine MRIs
- thoracolumbar spine MRIs
- foot, ankle, hip and shoulder MRIs
- MRIs for suspected stress or insufficiency fractures.
The proposals have been backed by the RACGP
in recent feedback sent to DoHDA, with the college noting that access is a ‘critical issue’ in rural and remote areas.
‘Limited access to non-GP specialists means patients often wait months (sometimes years) for an MRI that their GP cannot currently order,’ the feedback states.
‘This delays diagnosis and treatment, prolongs pain, and leads to avoidable deterioration.
‘Enabling GPs to request MRIs directly would significantly improve timely access to imaging, fast-track management, and ensure only those who truly need specialist care are referred on.’
Currently GP-referred MRIs eligible for Medicare rebates are restricted to a relatively narrow set of clinical indications and anatomical regions.
A later, second phase of the plan could pave the way for GPs to refer patients for rebated musculoskeletal MRI scans covering a broader range of conditions, including joint injuries, spinal radiculopathy and soft tissue pathologies.
Professor Mark Morgan, Chair of RACGP Expert Committee – Quality Care, said the review reflects the college’s advocacy to increase GPs’ scope of practice without unnecessary restrictions.
‘Eligibility for MRI funding should be based on clinical need, and the RACGP has pushed strongly for Medicare rules to reflect clinical need,’ he told
newsGP.
‘Current Medicare rules about how and when an MRI can be requested make little sense.
‘Medicare requirements that state an MRI will only be funded if the request comes from a non-GP specialist creates a situation when only the wealthy, living near an urban centre, can access timely imaging.’
In its feedback to DoHDA, the RACGP also called for a multiparametric magnetic resonance (mpMRI) of the prostate to be added. Currently this can only be requested by urologists, radiation oncologists and medical oncologists.
‘The RACGP recommends mpMRI requesting for GPs be addressed and included in Phase 1, to align with current best practice guidelines for investigation of raised PSA,’ the submission states.
The review also proposes limiting the number of possible GP-referred rebated lumbar, thoracolumbar, foot, ankle, hip, and shoulder MRIs to twice a year per patient, a limitation queried by the RACGP.
‘Where there is clinical suspicion of new serious pathology, best imaged by MRI, then it makes no sense to limit the frequency of MRI to some arbitrary number of scans per year,’ Professor Morgan said.
‘The passage of the Earth around the Sun does not determine clinical need.’
A third phase of possible reform may allow GPs and other health professionals to request MRI scans to monitor conditions that have already been diagnosed by a specialist such as multiple sclerosis, sarcoma and other musculoskeletal tumours, and prostate cancer.
The DoHDA review is also weighing up expanded MRI requesting rights for nurse practitioners and physiotherapists in the second phase of changes, with the college offering qualified support.
‘While the RACGP supports in principle, the expansion of MRI services particularly where GPs or specialists are unavailable, safeguards need to be in place to reduce duplication and avoid the provision of low-value MRIs,’ the college feedback states.
‘The RACGP has concerns that the limited training and experience of some nurse practitioners and physiotherapists may lead to low-value MRI requests.
‘It may, however, be appropriate to allow limited access to ordering an MRI by nurse practitioners and physiotherapists where they form part of a formal multidisciplinary care team with a GP.’
The college also emphasises the importance of including relevant clinical details both in requests for scans, and in radiologists’ reports once the scan has taken place.
The DoHDA review marks the latest in a series of significant shifts to MRI access.
Recent licensing reforms have expanded the availability of Medicare-eligible MRI services and prompted an increase in GP referrals, with a rise of 44% over the past two financial years in regional and rural areas.
A significant shift in requesting rights
took place in November 2013, when GPs were given the green light to refer patients for rebated MRIs for three anatomical regions covering six clinical indications.
These included MRIs for the head for unexplained seizure, and chronic headache with suspected intracranial pathology; cervical spine for cervical radiculopathy, and cervical spine trauma; and the knee for acute anterior cruciate ligament and acute meniscal tear.
With consultation for the latest review now closed, DoHDA officials are due to provide advice to the Federal Government in early 2026.
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