MRI for high risk women

Updated Medicare information for funding of MRI scans for women under 50 at high risk of breast cancer

The Department of Health and Ageing has advised that an amendment has been made to Medicare item 63464 for the use of Magnetic Resonance Imaging (MRI) in the surveillance and diagnosis of women under 50 years of age at high risk of developing breast cancer, and who have no signs or symptoms of the disease.

The amendment has clarified any ambiguity surrounding the eligibility criteria for the Medicare Benefit.

The MRI scan must be performed under the professional supervision of an eligible provider at an eligible location, where the patient is referred by a specialist or consultant physician.

The amended Item Descriptor is as follows:

63464  MRI – scan of both breasts for the detection of cancer, if a dedicated breast coil is used, the request for scan identifies that the woman is asymptomatic and is less than 50 years of age, and the request for the scan identifies:

a) that the patient is at high risk of developing breast cancer, due to one of the following:

(i)  Three or more first or second degree relatives on the same side of the family diagnosed with breast or ovarian cancer;

(ii) Two or more first or second degree relatives on the same side of the family diagnosed with breast or ovarian cancer, if any of the following applies to at least one of the relatives:

(A) has been diagnosed with bilateral breast cancer;

(B) had onset of breast cancer before the age of 40 years;

(C) had onset of ovarian cancer before the age of 50 years;

(D) has been diagnosed with breast and ovarian cancer at the same or at different times;

(E) has Ashkenazi Jewish ancestry;

(F) is a male who has been diagnosed with breast cancer;

(iii) One first or second degree relative diagnosed with breast cancer at age 45 years or younger, plus another first or second degree relative on the same side of the family with bone or soft tissue sarcoma at age 45 years or younger; or

b) that genetic testing has identified the presence of a high risk breast cancer gene mutation.