Pathology, imaging and other diagnostic services is an Australia's health topic

Pathology, diagnostic imaging and other diagnostic services assist medical and other health practitioners to describe, diagnose and monitor a patient’s illness or injury. Patients may receive such services in hospital, but for services provided in non‑hospital settings, these services are typically requested for patients by a medical practitioner. Simple basic pathology tests, non-requested type imaging services and many other diagnosis services, do not require a referral to attract a Medicare benefit.

Pathology services include a wide range of tests on patient samples, such as blood or body tissue.

Diagnostic imaging services include radiography (X-ray), ultrasound, computed tomography (CT scan), nuclear medicine and magnetic resonance imaging (MRI). These services are performed by qualified technical staff in conjunction with registered medical practitioners who are often specialists in diagnostic radiology.

As well as pathology and diagnostic imaging, there are a wide variety of other diagnostic services performed by, or under the direct supervision of, a medical practitioner (often a specialist). These services include electrocardiography (ECG), sleep studies, bone densitometry, audiograms and spirometry. 

While many diagnostic services are rendered in hospital, not all of these are subsidised through the Medicare Benefits Schedule (MBS). Common examples of non-MBS subsidised services include services: 

  • provided by hospital doctors to public patients, as these services receive a separate Commonwealth subsidy through the National Health Reform Agreement
  • provided under the Department of Veterans' Affairs National Treatment Account 
  • covered by third party or workers' compensation.

Private health insurance rebates 

Some people choose to pay for private health insurance and as such may receive a rebate from their health fund to cover all or some of out-of-pocket costs for private services in hospital, depending on their level of hospital cover.

This page does not include information on rebates from private health insurers because private health rebates are not captured in MBS claims data.

This page focuses on pathology, imaging and other diagnostic services subsidised through the MBS, and based on the financial year of service rendered between 2012–13 and 2022–23.

How many Medicare-subsidised pathology, imaging and other diagnostic services were provided?

Overall, in 2022–23, 17.4 million (67%) Australians accessed 196.9 million Medicare-subsidised pathology services, imaging scans and a range of diagnostic services. Most (91% or 178.6 million) Medicare-subsidised services included in this grouping were provided in non-hospital settings.

The most common Medicare-subsidised services in this group were pathology (59% of all people had at least one service) and diagnostic imaging services (39% of people had at least one service) (Table 1). Pathology services are generally split into pathology tests and patient episode initiation items (the collection and transport of specimens) associated with the tests, so are reported separately in the table below. As tests are the most relevant number to measure the provision of healthcare services to the Australian community, this report presents the number of tests as the preferred measure to represent the volume of pathology services hereafter. Furthermore, the cost of patient episode initiation items is included in the pathology tests to reflect the full cost of the tests.

Table 1: Use of Medicare-subsidised pathology, imaging and other diagnostic services, 2022–23

Type of service

Number of patients (million)(a)

Proportion of people receiving a service (%)(b)

Number of services (million)

Number of services per patient (average)

Pathology – total

15.3

58.8

160.1

10.5

Pathology – tests(c)

15.3

58.8

113.9

7.4

Pathology – patient episode initiation(d)

15.2

58.5

46.3

3.0

Diagnostic imaging(e)

10.2

39.4

29.7

2.9

Other diagnostic services(f)

4.0

15.4

7.1

1.8

Total

17.4

66.7

196.9

11.3

(a) This is the number of unique patients, with patients being only counted once in the total, even if they have had services across different categories.

(b) The proportion of people receiving a service is calculated by dividing the total patients by the Australian Estimated Resident Population as at 30 June 2022.

(c) Pathology tests include tests of patient samples, such as blood, urine, stools or body tissues. One sample may result in multiple tests and therefore multiple pathology items. Some pathology items cover multiple tests. Each time a Medicare benefit is paid for a pathology item, it is counted as one test in Medicare benefit statistics. It is not feasible to report statistics on the components of individual items. 

Medicare benefits are only payable for the 3 most expensive tests ordered by a general practitioner outside hospital for the same patient on the same day. Tests after the 3 most expensive tests do not appear in Medicare benefits statistics. There are some exceptions to this pathology coning rule.

(d) Patient episode initiation items are for the collection and transport of specimens – not for the pathology tests themselves.

(e) Diagnostic imaging services include X-rays, CT scans, ultrasound scans, MRI scans and nuclear medicine scans.

(f) Other diagnostic services include diagnostic procedures and investigations, such as electrocardiography, allergy testing, audiograms, bone densitometry and sleep studies.

Source: AIHW analysis of MBS data maintained by the Australian Government Department of Health and Aged Care; National, state and territory population, ABS 2023.

Trends in services

Overall, there was an increase in the proportion of people who had a Medicare-subsidised diagnostic service over the 10 years between 2012–13 and 2022–23. Over this period, the proportion of the population who had a pathology test increased from 53% to 59%, and the proportion who had diagnostic imaging services increased from 36% to 39%. In 2022–23, the number of patients receiving a pathology test reverted to a number more consistent with the long-term trend, compared with 2020–21 and 2021–22 when 62% and 70% of the Australian population received a pathology test, respectively. Much of this previous increase in 2020–21 and 2021–22 was due to the large number of patients receiving a polymerase chain reaction (PCR) test for COVID-19. For more information, see COVID-19 and What types of pathology tests do people use?

The number of diagnostic services per 100 people increased between 2012–13 and 2022–23, from 366 to 438 pathology tests and from 94 to 114 diagnostic imaging services. After adjusting for differences in the age structure of the population, this increase was still observed (348 to 397 pathology tests, and 90 to 104 diagnostic imaging services). Figure 1 shows further details on the volume of pathology tests and diagnostic imaging services.

Figure 1: Pathology, imaging and other diagnostic services, 2012–13 to 2022–23

Between 2012–13 and 2022–23, the number of Medicare-subsidised diagnostic services and the percentage of population receiving a service has increased for other diagnostic services (5.9 million to 7.1 million services, 13.5% to 15.1%). 

Patient characteristics

In 2022–23, older people were more likely to receive at least one Medicare-subsidised diagnostic service with 97% of people aged 65 and over having at least one service, compared with 2 in 3 (67%) people aged 16–64 and 2 in 5 (40%) people aged 15 and under (Figure 2).

Females were more likely than males to have had one or more Medicare-subsidised diagnostic services (73% compared with 60%). This can mainly be explained by a lower number of males aged 16–64 receiving one or more Medicare-subsidised diagnostic services.

Similar proportions of people living in Major cities, Inner regional and Outer regional areas received these diagnostic services, compared with Remote and Very remote areas, where lower percentages of people received them. In Outer regional, Major cities and Inner regional areas, 65%–70% of people received a service, compared with 57% of people living in Remote areas and 50% of people living in Very remote areas. This effect was broadly present across age groups, with Remote and Very remote areas having a consistently lower percentage.

The proportion of people receiving a diagnostic service varied across socioeconomic disadvantage areas. A smaller proportion of residents in areas of most disadvantage received a service when compared to areas of least disadvantage. Only 58% of residents living in areas of most disadvantage received at least one service, whereas for areas of least disadvantage, 76% of residents received at least one service.

The age-standardised rates of people receiving diagnostic services across different geographic regions were consistent with the proportion of people residing in those areas receiving the services. In Major cities there were 708 age-standardised diagnostic services rendered per 100 people compared to 471 age-standardised diagnostic services rendered per 100 people residing in Very remote areas. Similarly, there was an age-standardised rate of 814 services per 100 people residing in areas of least disadvantage, which can be compared to an age-standardised rate of 579 services per 100 people residing in areas of most disadvantage.

Figure 2: Pathology, imaging and other diagnostic services by age, sex, remoteness area and socioeconomic area, 2012–13 to 2022–23 

Access to Medicare-subsidised diagnostic services in more remote areas changed slightly. Between 2012–13 and 2022–23, 54%–60% of people in Remote areas received a diagnostic service while it was 45%–53% of people in Very remote areas.

Access to diagnostic services in lower socioeconomic areas remained stable, apart from 2 COVID-19 years in 2020–21 and 2021–22. Excluding these 2 years, 55%–58% of people in the lowest socioeconomic areas received a diagnostic service which was almost identical to the second lowest socioeconomic areas (56%–59%). 

Spending

In 2022–23, $9.8 billion was spent on Medicare-subsidised pathology, imaging and other diagnostic services. This comprised:

  • $8.7 billion in Medicare benefits paid by the Australian Government
  • $1.1 billion in out-of-pocket costs paid by private patients.

The breakdown of the $1.1 billion in out-of-pocket costs by clinical setting consisted of:

  • $688.1 million paid by patients in non-hospital settings
  • $410.5 million paid by patients in hospital settings.

About $3.8 billion was spent on Medicare-subsidised pathology tests, and $5.3 billion on diagnostic imaging services. The remaining $0.7 billion was for other diagnostic services.

In 2022–23, 172 million (87%) of these diagnostic services were bulk-billed (indicating that patients did not incur costs for these services). Pathology tests contributed a large proportion of this figure. For those who did incur out-of-pocket costs, diagnostic imaging had the highest average cost per patient for all imaging services received in 2022–23:

  • $207 per patient in non-hospital settings (an average of $123 per service)
  • $271 per patient in hospital settings (an average of $86 per service).

It may seem counterintuitive that the average out-of-pocket cost paid by patients (on a per patient basis) for services in hospital settings is higher than that for services occurring in non-hospital settings, when the average out-of-pocket cost on a per service basis is lower for services occurring in hospital settings. This is because of the different mix of diagnostic imaging items being rendered in hospital settings as opposed to non-hospital settings, the amount of diagnostic imaging services being rendered to each patient and the different pricing models employed between hospital and non-hospital settings.

An example of an item rendered in hospital and non-hospital settings: MBS item 58503 (chest x-ray)

Item 58503 (chest x-ray) accounts for 23% of all diagnostic imaging services in hospital settings, but only 5% of services in non-hospital settings. However, for item 58503 rendered in hospital which incurred out-of-pocket costs, the average out-of-pocket cost is $25 per service, which sits in contrast to $67 in out-of-pocket costs per service for services in non-hospital settings. On average for this item, there were 2.3 services per patient which incurred out-of-pocket costs in hospital settings, compared to only 1.1 services per patient which incurred out-of-pocket costs in non-hospital settings. This demonstrates the different propensity for items to be rendered to patients at different prices in hospital and non-hospital settings.

In contrast, pathology had the lowest average out-of-pocket cost per patient for all tests incurring a cost in the year:

  • $76 per patient in non-hospital settings (an average of $23 per test)
  • $167 per patient in hospital settings (an average of $20 per test).

Similar to diagnostic imaging services, pathology tests have a higher average out-of-pocket cost paid by patients for tests in hospital settings than that for tests occurring in non-hospital settings, with the opposite being true for the average out-of-pocket cost per test. The reasons for this are similar to the reasons for diagnostic imaging services, with the addition of the pathology coning rule (see note (c) of Table 1) not applying to pathology tests rendered in hospital settings. The absence of episode coning means that Medicare benefits will be paid (and associated out-of-pocket costs captured) for a greater number of lesser expensive tests, which will also have the effect of driving average out-of-pocket costs on a per test basis lower for tests rendered in hospital settings.

Trends in spending

In the 10 years between 2012–13 and 2022–23, spending on Medicare-subsidised pathology, imaging and other diagnostic services increased, with spikes in 2020–21 and 2021–22 attributed to the COVID-19 pandemic:

  • Medicare benefits paid by the Australian Government increased in real terms (after adjusting for inflation), from $6.5 billion in 2012–13 to $8.7 billion in 2022–23 (Figure 3). Per patient, this was an increase in real terms from $458 to $501 over the same period.
  • Patient out-of-pocket costs in non-hospital settings increased in real terms, from $506.5 million in 2012–13 to $688.1 million in 2022–23. On a per patient basis, there was an increase in real terms from $164 to $186 in this period.
  • Patient out-of-pocket costs in hospital settings increased in real terms from $384.3 million in 2012–13 to $410.5 million in 2022–23. On a per patient basis, there was a decrease in real terms from $303 per patient to $269 during this period. The reason for the increase in total out-of-pocket costs paid and the decrease of these costs on a per patient basis is due to the volume of patients increasing at a faster rate (20.5% increase) than the out-of-pocket costs (6.8% increase), resulting in a decrease in the average out-of-pocket cost on a per patient basis.

For pathology tests, the number of patients who had an out-of-pocket cost remained static at about 1.5 million between 2012–13 and 2022–23. Over the same period, the average cost per patient (for those who had out-of-pocket costs) decreased in real terms, from $81 to $76 per patient in non-hospital settings, and from $183 to $167 per patient in hospital settings.

However, for diagnostic imaging services, the number of patients who had an out-of-pocket cost increased from 2.4 million in 2012–13 to 3.1 million in 2022–23 (this represented an increase of 10.8% to 11.9% of the population). The average cost per patient (for those who had an out-of-pocket cost) increased in real terms from $183 to $207 per patient in non-hospital settings but decreased from $288 to $271 per patient in hospital settings.

Figure 3: Spending on pathology, imaging and other diagnostic services, constant prices, 2012–13 to 2022–23

Between 2012–13 and 2022–23, Medicare benefits paid was stable for other diagnostic services ($0.5 billion or $0.6 billion each year). Fees charged by providers was also stable ($0.6 billion to $0.8 billion each year). Medicare covered about 80% of provider fees.

What types of pathology tests do people use?

The overall growth in pathology tests was steady between 2012–13 and 2022–23, apart from the large growth as a result of the COVID-19 pandemic in 2020–21 and 2021–22. Among all pathology groups, microbiology group received the largest impact from the pandemic.

Pathology groups 

MBS pathology tests are categorised into 9 pathology groups:

Haematology: focuses on diseases which affect the blood such as anaemia, leukaemia, and clotting or bleeding disorders.

Chemical: uses chemical tests to detect abnormalities associated with diseases, for example, diagnosis of a heart attack, high cholesterol or diabetes.

Microbiology: focuses on diseases caused by bacteria, viruses, fungi and parasites, for example, influenza, pneumonia, meningitis and COVID-19.

Immunology: focuses on allergies and auto-immune diseases, for example, testing for allergy antibodies, or monitoring the level of T-lymphocytes which disappear after HIV infection.

Tissue pathology: focuses on the tissue diagnosis of disease, largely for detection and diagnosis of cancer.

Cytology: focuses on the diagnosis of disease by examining single cells and small clusters of cells, mainly for diagnosis and prevention of cancer, for example, testing for human papillomavirus which causes most cervical cancer.

Genetics: focuses on the examination of genetic abnormalities, for example, prenatal diagnosis of Down’s syndrome and predictive testing for cancer.

Infertility and pregnancy tests: involve diagnosis of infertility and pregnancy.

Simple basic pathology tests: are non-referred pathology services for simple basic tests performed by a medical practitioner or by a participating nurse practitioner.

Microbiology group

The microbiology group experienced a sharp increase in 2020–21 and 2021–22 and had a subsequent steep decline in 2022–23, which was likely due to a number of factors, including the reduction of mandatory COVID-19 testing, increased availability of rapid antigen tests and rising vaccination rates. Since March 2020, new Medicare items were introduced within the microbiology group to provide funding for COVID-19 PCR testing by accredited public and private pathology laboratories (rapid antigen tests were not funded under Medicare, nor were the mass testing conducted at Government-run testing sites during the pandemic).

Figure 4 demonstrates between 2012–13 and 2019–20, the number of microbiology tests gradually rose from 12.5 to 18.1 million tests. In 2019–20, there were only a small number of COVID-19 PCR tests rendered to patients. This was likely because during the early stage of the COVID-19 pandemic, COVID-19 testing was limited to only certain groups of patients (for example, those returning from overseas, and healthcare workers).

Over the following 2 years, COVID-19 PCR testing became more readily available and the volume of COVID-19 testing grew rapidly. In 2021–22 this accounted for nearly 63% of all microbiology tests rendered (and 82% of all microbiology benefits paid). However, 2022–23 saw the decline in the number of COVID-19 tests funded through Medicare to only 18% of the volume of all microbiology tests.

For more information, see COVID-19.

Figure 4: Pathology tests by group, 2012–13 to 2022–23

The number of Medicare-subsidised tests for simple basic pathology tests gently increased from 0.6 million services in 2012–13 to 0.7 million services in 2017–18, then fell to 0.4 million services in 2022–23.

Cytology group

Another observable change in pathology tests rendered is the cytology group, which includes cervical screening items. The cytology group saw a 40% decrease in the volume of tests rendered between 2018–19 and 2021–22. New cervical screening items were introduced in December 2017, which only needed to be rendered once every 5 years to symptomless patients and replaced the existing 2 yearly Pap test. The large decrease in cytology tests could be attributed to the decreased frequency in cervical screening required by the new items. Medicare benefits paid for cytology tests followed a similar pattern.

Genetics group

The genetics group experienced a large increase in the average out-of-pocket costs per patient between 2020–21 and 2022–23 for tests rendered out of hospital only. In 2020–21, the average out-of-pocket cost per patient for tests in this group was $56 and by 2022–23 it had risen to $192, which represents a 242% increase. This increase was driven by the introduction of items 73387 and 73384 in November 2021, and relate to the genetic analysis of embryonic tissue (item 73387) and for the purpose of providing an assay for pre-implantation genetic testing (item 73384). For more information on pre-implantation genetic testing items, see MBS online.

Infertility and pregnancy tests group

The infertility and pregnancy tests group also experienced a noticeable increase in the total out-of-pocket costs and average out-of-pocket costs per patient between 2019–20 and 2022–23 for tests rendered out of hospital. The existing item predominantly driving the increase in out-of-pocket costs was item 73523 (semen examination). The average out-of-pocket cost per patient for this item increased from $98 in 2019–20 to $134 in 2022–23 (a 36% increase). Furthermore, the total out-of-pocket costs paid by patients for this item has also increased, from $749,000 in 2019–20 to $1.4 million in 2022–23 (an 87% increase).

What types of diagnostic imaging services do people use?

Between 2012–13 and 2022–23, all diagnostic imaging groups experienced an increase in the number of services rendered, although different groups saw the service volumes increase at different rates. In 2018–19 ultrasound services (which had a 52% increase in service volumes over the 10-year period) overtook diagnostic radiology services as the group with the highest number of services rendered (see Figure 5).

Diagnostic imaging groups 

MBS diagnostic imaging services are categorised into 5 imaging groups:

Ultrasound: uses high-frequency sound waves to produce moving images of the body's internal structures. It is often used to monitor a pregnant woman and her unborn baby; and to help diagnose unexplained pain, swelling and infection.

Computed tomography (CT): uses multiple X-rays to create detailed images of internal organs, bones, soft tissue and blood vessels. It is often used to detect many different cancers; and to reveal internal injuries and bleeding.

Diagnostic radiography (or X-ray): uses a very small dose of ionising radiation to produce images of the body's internal structures. X-rays are often used to help diagnose fractured bones; look for injury or infection and to locate foreign objects in soft tissue.

Nuclear medicine imaging: uses small amounts of radioactive material, a special camera and a computer to create images inside the body. It helps diagnose many types of cancers, heart disease, gastrointestinal, endocrine, neurological disorders and other conditions. It may detect disease in its earliest stages. Positron emission tomography (PET) is a type of nuclear medicine imaging.

Magnetic resonance imaging (MRI): uses a powerful magnetic field, radio waves and a computer to produce detailed images of the body's internal structures. It is used to evaluate a variety of conditions, including tumours and diseases of the liver, heart, and bowel.

Magnetic resonance imaging (MRI) services experienced the largest increase in the volume of services rendered on a percentage basis. Services volumes increased 120% from 0.6 million to 1.4 million over the 10-year period. This was likely due to an increase of the availability of MRI scanners, as well as the listing of additional Medicare items to provide rebates for MRI services requested by general practitioners in November 2013.

Computed tomography (CT) services also experienced a rather large percentage increase (76% from 2.5 million to 4.5 million) in service volumes over the period. The large increase occurred in 2020–21 (due to new items listed on the MBS in May 2020, in particular, item 56622 for scan of lower limb was a driver for the rise) and 2022–23.

While nuclear medicine imaging services experienced a comparatively smaller rise in service volumes (44% from 0.6 million to 0.9 million between 2012–13 and 2022–23), its subgroup – positron emission tomography (PET) services – did experience a large increase in both services and benefits over the 10-year period. Services volumes increased 350% (from 45,000 to 203,000), and Medicare benefits increased 292% (from $48 million to $189 million) with respect to PET services. Factors likely driving this increase in recent years are the addition of extra PET items to the MBS from 2017–18 onwards, and the availability of more PET scanners.

Although the service volumes of CT, MRI and nuclear medicine imaging were much lower than ultrasound and diagnostic radiology, these high technology forms of imaging are more expensive services. The average out-of-pocket costs per patient for these 3 groups were higher than ultrasound and diagnostic radiology. However, MRI showed a trend of a progressive reduction in average out-of-pocket costs in real terms across both hospital and non-hospital settings. Overall, MRI dropped from $255 per patient in 2018–19 to $219 in 2022–23.

Figure 5: Diagnostic imaging services by group, 2012–13 to 2022–23

The out-of-pocket costs paid by patients for non-hospital ultrasound services had a mild growth in real terms from $271.0 million to $333.3 million over 6 years from 2012–13 to 2018–19, but a sharper rise from $316.8 million to $424.3 million over 3 years from 2019–20 to 2022–23. However, the average out-of-pocket cost per patient increased slightly from $168 to $188 over the entire period.

Where do I go for more information?

For more information on pathology and imaging, see: 

For more on this topic, visit Diagnostic services.