Who is eligible for Medicare funded testing in Australia?
Genetic testing is funded under Medicare (bulk billed) if certain criteria are met. The criteria are listed under item numbers that can be found on the MBS Online website. For example, all individuals with triple negative breast cancer are now eligible for bulk billed testing.
Triple negative breast cancer is associated with a 10% or higher likelihood of a BRCA1 or BRCA2 pathogenic mutation. That is, individuals who have been diagnosed with triple negative meet the criteria for testing outlined in Medicare item number 73296.
The information about the 10% likelihood comes from guidelines and risk calculators. Risk calculators include the Manchester score or more sophisticated models such as CanRisk used by Genetic Oncologists. Guidelines must be Australian based such as the Australian National eviQ guidelines on cancer genetic testing.
To be bulk billed, the test must be ordered by a specialist, such as a Genetic Oncologist , or consultant physician, not a GP or genetic counsellor
As Medicare will only pay once, a full panel should be chosen (eg a panel of at least 10 breast and/or ovarian cancer risk genes, not just BRCA1 and BRCA2).
For a simple list of when Medicare will pay for genetic testing, listed by cancer type, follow the links below.
Breast cancer and Medicare funded testing in Australia
Ovarian cancer and Medicare funded testing in Australia
Prostate cancer and Medicare funded testing in Australia
Uterine cancer and Medicare funded testing in Australia
Hereditary Cancer Syndromes and Medicare funded testing in Australia
If a pathogenic (disease causing) mutation has been found in a blood relative, your "predictive" testing is usually Medicare funded. This is true even if the mutation was detected in a cousin and your parent and/or your aunt/uncle has not had testing.
Under the eviQ guidelines, public clinics may offer funded testing for clinically important genes that do not yet have a Medicare item number. An example would be the MEN1 gene associated with Multiple Endocrine Neoplasia syndrome Type 1. See eviQ’s page on genetic testing for heritable pathogenic variants for an up-to-date, complete list.
If you are not eligible for a Medicare funded (bulk billed) test, you can still pay for your own testing. It usually costs between $450 and $600 for a group (panel) of genes.