Medicare Benefits Schedule - Note IN.1.11

This item (55080) covers the use of ultrasound scans for the assessment, management or planning, of a patient suspected of or diagnosed with a complex gynaecological condition which includes, but is not limited to, a range of complex gynaecological conditions such as endometriosis, adenomyosis, pelvic congestion syndrome, chronic pelvic inflammatory disease, and pelvic floor dysfunction.

The requesting practitioner must have identified that the patient is suspected of having, or is known to have a complex gynaecological condition. The requesting practitioner can be a medical practitioner (GP, specialist or consultant physician), nurse practitioner, or midwife.

The service is classified as a complex investigation due to the detailed imaging and thorough evaluation required to accurately diagnose and assess for each condition. A minimum expected scanning time of 30 minutes ensures that sufficient time is allocated for a comprehensive patient assessment and examination of the pelvic structures.

The scan must include detailed imaging and documentation of any identified pathology. Particular attention should be given to conditions such as severe endometriosis, which may necessitate a thorough evaluation of the pelvic structures.

The ultrasound scan may be performed using any or all approaches, including transabdominal and transvaginal techniques. This flexibility allows the practitioner to choose the most appropriate method(s) based on the patient's specific condition and clinical presentation.

It is recommended that the service be performed by a qualified practitioner with expertise in advanced pelvic ultrasound techniques to ensure comprehensive assessment and accurate diagnosis.

To avoid duplication of services, this item cannot be billed if a service mentioned in item 55038, 55065, 55700, 55704, 55736, or 55739 is performed on the same patient within 24 hours. This ensures that each service is distinct and necessary, preventing unnecessary repetition of diagnostic procedures.

Related Items: 55080

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Bulk bill incentive

Pelvis, ultrasound scan of, by any or all approaches (including transvaginal), if:

(a) the patient is known to have, or the requesting practitioner suspects, a complex gynaecological condition; and

(b) the service is considered a complex investigation requiring a minimum of 30 minutes scanning time; and

(c) within 24 hours of the service, a service mentioned in item 55038, 55065, 55700, 55704, 55736, or 55739 is not performed on the same patient. (R)

Fee: $255.00 Benefit: 75% = $191.25 85% = $216.75

(See para IN.0.13, IN.0.19, IN.1.11 of explanatory notes to this Category)