— For patients —
Medicare and your echo: the 24-month rule
Medicare allows one bulk-billed initial echocardiogram every two years, regardless of who refers you. If you have a known heart condition, Medicare also covers repeat scans in some circumstances. Here is how it works.
The initial echocardiogram
Medicare’s item for an initial transthoracic echocardiogram covers one scan in any 24-month period. It can be requested by your GP or a specialist. The 24 months applies to you as a patient, not to a particular clinic, so a scan you had somewhere else in the last two years counts.
Repeat scans for a known condition
Medicare has separate items for repeat (serial) echocardiograms when a heart condition is already known, for example:
- monitoring a known valve problem
- monitoring heart failure or another structural heart condition
- fluid around the heart (pericardial effusion) or pericarditis
- starting a medicine that can affect the heart
Most of these repeat scans must be requested by a specialist, such as a cardiologist. In some regional and rural areas, a GP can request a repeat scan for a known valve problem. For fluid around the heart, pericarditis, and medicines that can affect the heart, Medicare allows more frequent scans. Your doctor will know which applies to you.
What this means for you
We bulk-bill every eligible echocardiogram, so there’s no out-of-pocket cost and no gap payment. Eligibility means a valid Medicare card, a referral from a GP or specialist, and a scan that meets the Medicare criteria for the item your referral requests. If you’re not eligible, the scan isn’t bulk-billed and a fee applies.
We check Medicare eligibility before every appointment, so if a fee applies to you we’ll tell you well in advance, not on the day of your scan. If you’ve had an echocardiogram in the last two years, let us know when you book. If you’re unsure whether your referral qualifies, call us on 0410 357 488 and we’ll check for you.