Medicare Rebates for PGT Testing

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Medicare Rebate for Pre-implantation Genetic Testing – FAQs

From 1 November 2021, patients will be able to claim a Medicare rebate for several new items for Pre-implantation Genetic Testing (PGT).

It is Important to note that patients will need to meet the Medicare Criteria to be eligible for the rebate. (see below for Medicare Criteria)

What PGT tests are covered?

PGT-M (monogenic) for couples at risk of passing on recessive, autosomal dominant, or mitochondrial disorders
PGT-SR (structural rearrangements) for carriers of chromosomal rearrangements
PGT for sex selection for couples at risk of passing on X-linked disorders

The rebate will contribute to the costs of both PGT-M Evaluation (as required for PGT-M and some PGT-SR) and the testing of embryo biopsies themselves.

What PGT tests are NOT covered?

Screening tests in patients without a known genetic risk (eg. reproductive carrier screening)
PGT-A for aneuploidy screening of embryos, in couples without a known risk of a chromosomal disorder

When does the rebate start?

The rebate commences from the 1^st of November. For eligible patients to qualify:

Test request forms must be dated on or after 01/11/2021
Blood specimen collections must be performed on or after 01/11/2021
Embryo biopsies must be collected on or after 01/11/2021
Meet the Medicare Criteria as listed below.

How will patients be billed?

The female partner will be invoiced (for PGT-M evaluation). Further invoicing will follow from Virtus Diagnostics for embryo biopsy testing fees. They will need to pay Virtus Diagnostics testing fees, and will then need to contact Medicare to be reimbursed 85% of the relevant item (depending on the number of embryo biopsies tested).

Please contact our accounts department on 1800 090 325 if you have any questions on the new rebates and charges.

Any questions concerning Pre-Implantation Genetic Testing we encourage you to speak to your IVF Specialists.

To contact one of our laboratories phone us on 1800 837 284

Medicare Criteria

As per Health Insurance Legislation Amendment (2021 Measures No. 2) Regulations 2021 - F2021L01281

Clause 2.7.3A

Items 73384 to 73387 (relating to pre‑implantation genetic testing)—patient eligibility

A patient is eligible for a service described in any of items 73384 to 73387 only if:

the patient or the patient’s reproductive partner:

(i) has an identified gene variant which places the patient at risk of having a pregnancy affected by a Mendelian or mitochondrial disorder; or

(ii) is at risk of an autosomal dominant disorder which places the patient at risk of having a child who develops the autosomal dominant disorder; or

(iii) has a chromosome re‑arrangement or copy number variant which places the patient at risk of having a pregnancy affected by a chromosome disorder; and

there is no curative treatment for the disorder and there is severe limitation of quality of life despite contemporary management of the disorder; and
the patient has previously had a consultation, with a specialist or consultant physician practising as a clinical geneticist, that included a discussion about the disorder.

73384

Genetic analysis, for a patient who is eligible for this service under clause 2.7.3A, of samples from the patient and (if relevant) the patient’s reproductive partner, for the purpose of providing an assay for pre‑implantation genetic testing, requested by a specialist or consultant physician

Applicable not more than once per patient episode per disorder (of a kind described in clause 2.7.3A) per reproductive relationship

Fee: $2400 with rebate $1642.80

73385

Genetic analysis, for a patient who is eligible for this service under clause 2.7.3A, of embryonic tissue from a sample from one embryo, if the analysis is:

for the purpose of providing a pre‑implantation genetic test; and
requested by a specialist or consultant physician; and
performed in the assisted reproductive treatment cycle in which the embryo was produced

Applicable not more than once per embryo

Virtus fee =

PGT-M $900 with rebate $541.80 (1 embryo)
PGT-SR/SS $800 with rebate $541.80 (1 embryo)

73386

Genetic analysis, for a patient who is eligible for this service under clause 2.7.3A, of embryonic tissue from samples from 2 embryos, if the analysis is:

for the purpose of providing a pre‑implantation genetic test; and
requested by a specialist or consultant physician; and
performed in the assisted reproductive treatment cycle in which the embryos were produced

Applicable not more than once per assisted reproductive treatment cycle, and not more than once for the 2 embryos tested

Virtus fee =

PGT-M $1800 with rebate $1176.80 (2 embryo)
PGT-SR/SS $1600 with rebate $1176.80 (2 embryo)

73387

Genetic analysis, for a patient who is eligible for this service under clause 2.7.3A, of embryonic tissue from samples from 3 or more embryos, if the analysis is:

for the purpose of providing a pre‑implantation genetic test; and
requested by a specialist or consultant physician; and
performed in the assisted reproductive treatment cycle in which the embryos were produced

Applicable not more than once per assisted reproductive treatment cycle for the 3 or more embryos tested

Virtus fee =

PGT-M $2700 with rebate $1811.80 (3 embryo)
PGT-SR/SS $2400 with rebate $1811.80 (3 embryo)

$1811.80 = maximum medicare rebate