Pregnancy Scans are subject to Medicare Eligibility Criteria to qualify for a Medicare rebate:
0 – 12 Weeks: Patients are eligible to receive a Medicare rebate for a ultrasound during this period if they meet the any of the clinical criteria listed below. This includes their dating scan.
12 – 16 Weeks: If a dating scan has already been completed, there needs to be a clinical reason from the criteria below for the patient to receive a Medicare Rebate.
17 – 22 Weeks: All patients are entitled to one Medicare rebatable Morphology Ultrasound. This is performed around 20 weeks to maximise visualisation of fetal anatomy. If more that one ultrasound is required between 17 and 22 weeks, the referral must be referred by an Obstetrics and Gynaecology specialist or a GP with a Diploma in Obstetrics and Gynaecology with a clinical reason from the criteria below to be Medicare rebatable.
22 Weeks plus: All patients are entitled to one Ultrasound if criteria listed below is met. If more than one scan is required after 22 weeks, the referral must be referred by an Obstetrics & Gynaecology specialist or a GP with a Diploma in Obstetrics & Gynaecology with a clinical reason from the criteria listed below to be Medicare rebatable.
Royal Australian and New Zealand College of Obstetricians and Gynaecologists Prenatal Assessment of Fetal Structural Conditions guidelines available here: Prenatal-assessment-of-fetal-structural-conditions(C-Obs-60)-Amended-May-2018_1-8.
Hyperemesis gravidarum, diabetes mellitus, hypertension, toxaemia of pregnancy, liver or renal disease, autoimmune disease, cardiac disease, alloimmunisation, maternal infection, inflammatory bowel disease, bowel stoma, abdominal wall scarring, previous spinal or pelvic trauma or disease, drug dependency, thrombophilia, significant maternal obesity, advanced maternal age, abdominal pain or mass, uncertain dates, high risk pregnancy, previous post dates delivery, previous caesarean section, poor obstetric history, suspicion of ectopic pregnancy, risk of miscarriage, diminished symptoms of pregnancy, suspected or known cervical incompetence, suspected or known uterine abnormality, pregnancy after assisted reproduction, risk of foetal abnormality.