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Ultrasound criteria


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#1 bluecupcakes

Posted 08 February 2013 - 01:05 PM

I'm just over 12 weeks pregnant and I went to the doctor yesterday to get a referral to book into hospital.  While I was there she gave me a blood test form and also an ultrasound one.  I questioned the ultrasound one as I have never had an ultrasound this early before, she said yes I had to have it but was unclear why.
I called today to book in and the lady asked why I was having it and I just said because my doctor has told me to.  She said unless I meet a certain criteria I will have to pay full cost as Medicare don't cover ultrasounds if you just want to look at your baby.  I asked what he criteria was and she said it was very extensive but you were only eligible if you were at high risk of problems or have had previous pregnancy losses among other things.
So I'm thinking I won't be eligible meaning it will cost around $200 for nothing really.  This was a unplanned pregnancy so not budgeted for, with my other children's starting school and kinder expenses just been paid I can't really afford extra expenses at the moment.
So my question is does anyone know what the criteria is and what you need to do to meet it?  I have looked at the Medicare site but to no answers there!

#2 Beltie

Posted 08 February 2013 - 01:11 PM

I think this is current:


For a patient to be eligible for a Medicare rebate they must fit one of the following criteria and the applicable condition must be present and stated on the request form.

The patient is 12-16 weeks of gestation and referred by a medical practitioner, and
One or more of the following conditions are present...
Hyperemesis
Risk of foetal abnormality
Previous post dates delivery
Abdominal wall scarring
Inflammatory bowel disease
Advanced maternal age
Toxaemia of pregnancy
Significant maternal obesity
Previous caesarean section
Suspicion of ectopic pregnancy
Diminished symptoms of pregnancy
Previous pelvis or spinal trauma or disease
Pregnancy after assisted reproduction
Suspected or known uterine disease
Suspected or known cervical incompetence
Diabetes mellitus
Hypertension
Autoimmune disease
Alloimmunisation
Maternal infection
Bowel stoma
Drug dependency
Thrombophilla
Abdominal pain or mass
Liver or renal disease
Poor obstetric history
Risk of miscarriage
High risk pregnancy
Uncertain dates
Cardiac disease

#3 bluecupcakes

Posted 08 February 2013 - 01:29 PM

Thanks, I actually do fit several of those criteria but don't know what the doctor has put on the form as I can't understand it!


#4 Let_it_Rain

Posted 08 February 2013 - 01:51 PM

I am pretty sure most places charge a gap for the 12 week scan, so try and confirm what the out of pocket will be.

I think from memory the rebate is something like $60-80 and there is sometimes costs for the blood test as well.

#5 Walkers

Posted 08 February 2013 - 02:00 PM

I had the scan last week - cost $200 & got $59 back

#6 Tesseract

Posted 08 February 2013 - 02:07 PM

The 12 week scan is usually for Down Syndrome screening, isn't it? The doctor should have explained things better.

#7 Justaduck

Posted 08 February 2013 - 02:08 PM

Wow didn't realise so many things covered it. I've had a c-sec with DD so would fit those, but she was high risk for DS (but chromosomally normal) so hopefully that is enough to cover it.

I paid $199 and got nothing back

#8 TotesFeral

Posted 08 February 2013 - 02:16 PM

Is the doctor getting you to do the Downs Syndrome screening ultrasound or just a standard one?
With DD I had one at 7 weeks, 12 weeks and then 19 weeks.
With DS I had one at 7 weeks, declined the 12 week one as didn't want it done and then 19 weeks. But for everyone I know it is standard for the doctor to refer them to have the 12 week scan done

It cost me $120 with DD and I got about half of that back off medicare.

#9 bluecupcakes

Posted 08 February 2013 - 02:35 PM

Well under the clinical details part of the form it has,

G4 P3
2MP 12 nov 2012
POG  12 week (there is a symbol between POG and 12 but I can't do it on here)

Anyone have any idea what that means...

I'm happy to pay a Medicare gap of course just not happy to pay $200 for something if its really not necessary.  I don't think I will get into see a doctor before my appointment so really don't know what to do!


#10 purple_daisy

Posted 08 February 2013 - 02:52 PM

I think that means

Gestation #4, Pregnancy #3 (I think that means one previous loss?)
I think it might have meant to say LMP as in your last period was on 12 Nov 2012.

Not sure about the POG. Mine said something like P US 12 week meaning pelvic ultrasound 12 weeks.

My GP said the 12 week is now almost considered routine because they check lots of things like your risks for down sydrome and the other trisonomy conditions and can just check the baby is forming properly, location of placenta etc. We were charged about 200 but got 65 back from medicare. I fit several of those points above but unless your doc specifies it on the form I think most ultrasound places go ahead and charge the full rate.

We wouldn't have done anything even if we came back with high chances of down syndrome or the other conditions but we did it because we would at least want plenty of time to prepare ourselves if that had happened, and it was very comforting seeing that the heart, umbilical cord, placenta etc were all performing well and the baby was measuring correctly.

#11 epl0822

Posted 08 February 2013 - 03:03 PM

My GP referred me for so many ultrasound scans, I thought I was supposed to get one if I sneezed. I wasn't aware there were specific criteria.

#12 elizabethany

Posted 08 February 2013 - 03:08 PM

My GP just wrot 12 week OB scan, and medicare covered it.  I fit about 6 of those criterea, but none of them were on the refferal.

#13 bluecupcakes

Posted 08 February 2013 - 03:12 PM

Your right Purple_Daisy I have been googling and that is what G4P3 means however now I'm even more confused because it is my 4th pregnancy but I have never had a loss so not sure what she is on about there.

From what I can find I think the POG means a dating scan I don't know why she is sending me for that as I know exactly when my LMP was as I allways write it on the calendar!  

I think I might go see another doctor this one is really confusing me!

I never knew there was a criteria for ultrasounds until today either, but like I said have never had an early one before.  My 20 week ones were arranged and done at the hospital it is public and didn't cost me a cent.

Edited by bluecupcakes, 08 February 2013 - 03:14 PM.


#14 Fossy

Posted 08 February 2013 - 03:26 PM

G4P3 is gravida 4 para 3, meaning this is your 4th pregnancy, resulting in 3 live births, your current pregnancy hasn't been born so isn't counted yet.



#15 Beltie

Posted 08 February 2013 - 04:20 PM

The criterion I cut-and-pasted above are for Medicare rebates. They are the conditions for which the government agrees to subsidise an ultrasound around 12 weeks. The individual ultrasound companies can decide how much they charge for the scan so you may end up paying a gap.

This list is not the list of people who SHOULD have the scan. That decision, particularly for the 12ish week scan, is usually made after discussion with your O+G/GP/antenatal team and depends on many individual factors and preferences.

OP, could you leave a message for the referring GP to give you a call to explain why this scan is being requested?

#16 againagain

Posted 08 February 2013 - 07:54 PM

The problem is that you have a referral to the wrong place I think. You seem to have a referral to a private place that will charge you a gap unless you have a health-care card or similar. You need a referral to a public clinic. This is what happens near me anyway, I could be wrong!

Around here if you don't want to pay anything you need to book well in advance and have the ultrasounds done at the hospital clinic. If we go to MIA or the likes you need to pay an amount and then get a rebate from Medicare.

#17 Love_Evie

Posted 08 February 2013 - 08:04 PM

12 week US are standard arnt they? It's not just to look at the baby it's to check the development of the baby.
I had one done previously at a public hospital and it was free. I have also had them done at private clinics which was approx $220 out of pocket and $85 back from Medicare.
Are you delivering at a public hospital? If so they should refer you to their own radiology department and it shouldn't cost you.
Not sure on your circumstances but this was a major teaching hospital in Melbourne, not sure on rural or other states.
Problem is with public is that you need to book really far in advance and often can't choose your date/time. If you ring them and plead your case they might be able to do something though.


#18 Soontobegran

Posted 08 February 2013 - 09:23 PM

QUOTE (bluecupcakes @ 08/02/2013, 04:12 PM) <{POST_SNAPBACK}>
Your right Purple_Daisy I have been googling and that is what G4P3 means however now I'm even more confused because it is my 4th pregnancy but I have never had a loss so not sure what she is on about there.

From what I can find I think the POG means a dating scan I don't know why she is sending me for that as I know exactly when my LMP was as I allways write it on the calendar!  

I think I might go see another doctor this one is really confusing me!

I never knew there was a criteria for ultrasounds until today either, but like I said have never had an early one before.  My 20 week ones were arranged and done at the hospital it is public and didn't cost me a cent.


As Fossey has said G4 P3 is correct for 4 pregnacies and 3 live babies so far.
POG is 'proof of gestation' and is useful sometimes for those who do not ovulate regularly on or about the 14th day  and the 2MP would be doctor's scibble for LNMP:)

You do not have to have this U/S some people choose no to, it is the morph scan at around 20 weeks that is definitely recommended these days.
I do know that all my daughters have been out of pocket around $200 for the NT scan at 12 weeks.

#19 bluecupcakes

Posted 08 February 2013 - 09:56 PM

Thanks for all the replies.  In my past 3 pregnancys I have been offered an early ultrasound I have just chose to not have them.  This gp just seemed to be really pushing it.  She was not my normal gp so I think I will just have my bloods done then try to get in to see my usual doctor.

I will be going to Box Hill hospital, with my others I had my 20 week ultrasounds there.  I only went to the doctor to get a referral to the hospital but she wouldn't give it to me she said I have to get the other stuff done first.

#20 Wildence

Posted 08 February 2013 - 11:47 PM

OP, how old are you? some GPs recommend to do 12 week scan if you are over 35 due to higher DS risk.

I believe 12 week scans are important. as for the POG, that's probably just to confirm the due date.

#21 bluecupcakes

Posted 08 February 2013 - 11:56 PM

Im 34. I have regular 28 day cycles and even know the day I would have conceived so not much need for a dating scan.




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