Medicare partially covers PGS/PGD Genetic Testing. A rebate applies to the specialist and procedure fees when billed under the correct MBS item numbers, but you'll typically still have an out-of-pocket gap. The exact amount depends on your provider, their fee structure, and whether you hold private health insurance.
Clinical Eligibility:PGS/PGD Genetic Testing may attract a Medicare rebate when performed for a documented medical necessity. Eligibility is assessed on a case-by-case basis by your treating specialist. Procedures performed purely for cosmetic or elective reasons without clinical indication are unlikely to be covered.
Specific MBS item numbers vary by clinical circumstances. Ask your specialist which MBS items apply to your procedure, or search mbsonline.gov.au.
Procedure Overview
Use this pgs/pgd genetic testing context to pressure-test the practical budget before you commit: what is often bundled, what is commonly separate, and which Medicare or MBS questions are worth clearing up early.
Planning FAQ
Ask for a written breakdown that separates the specialist fee from anaesthetic, facility, pathology, devices, medication, and follow-up costs. That makes it easier to compare like-for-like quotes instead of only comparing the headline number.
Ask whether any MBS items apply to your circumstances, what clinical criteria need to be met, and whether the expected rebate changes the final out-of-pocket cost meaningfully.
Before booking, confirm transport arrangements, expected downtime, medication or dressing needs, and how follow-up will work. If you have work, school-run, or caregiving constraints, raise them before you lock in the date so the quote and recovery plan line up.
Cost and Cover Context
PGS/PGD Genetic Testing can be rebate-eligible only in some medical circumstances. Before comparing providers, ask whether your situation is expected to meet MBS criteria, which item numbers might apply, and how that changes the private gap.
A GP referral is required before you can see a specialist for PGS/PGD Genetic Testing and access any Medicare rebate. Referrals to specialists are valid for 12 months (3 months for non-specific referrals).
Private health insurance can reduce out-of-pocket costs for PGS/PGD Genetic Testing when performed in a private hospital setting. Your level of cover (Gold, Silver, Bronze) determines which clinical categories are included. Check waiting periods. Most new policies have a 12-month waiting period for obstetric and major dental procedures.
Get a referral from your GP. This is required for most specialist consultations and procedures.
At your specialist appointment, ask which MBS item numbers will be billed and confirm the expected out-of-pocket cost.
After treatment, your provider may submit the claim directly to Medicare (bulk billing), or you pay and claim yourself.
To self-claim: log in to myGov, go to Medicare, and select 'Make a claim'. Upload your receipt.
If you have private hospital cover, submit a separate claim to your health fund for any eligible hospital or extras costs.
PGS/PGD Genetic Testing is partially covered by Medicare when billed under the appropriate MBS item numbers. You may still have an out-of-pocket gap depending on what your provider charges above the schedule fee.
Yes. In most cases you'll need a referral from your GP to see a specialist who can perform PGS/PGD Genetic Testing. The referral is also required for Medicare claims to be processed correctly.
Private health insurance can reduce out-of-pocket costs for PGS/PGD Genetic Testing if the procedure is performed in a private hospital and your policy includes the relevant clinical category. Check your extras cover and waiting periods before booking.
Ask your specialist for the specific MBS item numbers they plan to use, then check the Medicare Benefits Schedule to find the schedule fee and rebate. The gap is the difference between your provider's fee and the Medicare benefit.
The Medicare gap is the amount you pay after the Medicare rebate is applied. If your provider charges above the schedule fee, the gap is the difference between their fee and what Medicare pays. Providers using the known gap scheme agree to cap gaps at disclosed amounts.
Get the Medicare Coverage Guide
Our plain-english PDF guide on how to understand MBS items and specialist fees.
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