Medicare Benefits Schedule - Item 61564

Search Results for Item 61564

View Associated Notes

Category 5 - DIAGNOSTIC IMAGING SERVICES

61564

61564 - Additional Information

Item Start Date:
01-Jul-2022
Description Updated:
01-Jul-2022
Schedule Fee Updated:
01-Jul-2022

Group
I4 - Nuclear Medicine Imaging
Subgroup
2 - PET

Whole body prostate-specific membrane antigen PET study performed for
the restaging of recurrent prostate adenocarcinoma, for a patient who:
(a) has undergone prior locoregional therapy; and
(b) is considered suitable for further locoregional therapy to determine
appropriate therapeutic pathways and timing of treatment initiation

Applicable twice per lifetime (R)

Bulk bill incentive

Fee: $1,300.00 Benefit: 75% = $975.00 85% = $1,206.80

(See para IN.0.17, IN.0.19 of explanatory notes to this Category)


Associated Notes

Category 5 - DIAGNOSTIC IMAGING SERVICES

IN.0.17

Group I4 - Nuclear Medicine Imaging

Nuclear medicine imaging services other than PET

Benefits for a nuclear scanning service (other than PET) are only payable when the service is performed:

  • by a credentialed specialist or consultant physician, or by a person acting on behalf of the specialist; and
  • the final report of the service is compiled by the specialist or consultant physician who performed the preliminary examination of the patient and the estimation and administration of the dosage.

Additional benefits will only be attracted for specialist physician or consultant physician attendance under Category 1 of the Schedule where there is also a referral letter from the patient’s treating medical practitioner for a full medical examination of the patient. The referral letter needs to be distinct from the request for the nuclear medicine scan.

Credentialling for nuclear medicine imaging services

Payment of Medicare rebates for nuclear medicine imaging services is limited to specialists or consultant physicians who are credentialled by the Joint Nuclear Medicine Credentialling and Accreditation Committee (JNMCAC) of the Royal Australian College of Physicians (RACP) and the Royal Australian and New Zealand College of Radiologists (RANZCR).

The scheme was developed by the profession in consultation with Government to ensure that specialists in nuclear medicine are appropriately trained and licensed, provide appropriate personal supervision of procedures and are involved in ongoing continuing medical education.

For information regarding the Scheme and for application forms, please go to RANZCR’s website at www.ranzcr.com or RACP’s website at www.racp.edu.au.

Radiopharmaceuticals

The schedule fees for nuclear medicine imaging services incorporate the costs of radiopharmaceuticals.

Myocardial perfusion studies - various items

See notes IN.1.10 to IN.4.3 and IR.0.1 to IR.4.2.

Pulmonary Embolism (PE) – items 61328, 61340 and 61348

Medical practitioners requesting imaging for suspected PE should read and consider the RANZCR 2015 Choosing Wisely recommendations, or such clinical RANZCR Choosing Wisely recommendations that succeed it.

Hepatobiliary study (pre-treatment) - item 61360

Item 61360 - the standard hepatobiliary item - also includes allowance of the pre-procedural cholagogue administration for preparatory emptying of the gall bladder and also morphine augmentation.

Hepatobiliary study (infusion) - item 61361

Item 61361 applies specifically to a standard hepatobiliary study to which has been added an infusion of cholagogue following which acquisition is continued and quantification of gallbladder ejection fraction and/or common bile duct activity time curves are performed.

Whole body studies - items 61426-61438

"Whole body" studies must include the trunk, head and upper and lower limbs down to the elbow and knee joints respectively, whether acquired as multiple overlapping camera views or whole body sweeps (runs) with additional camera views as required. Any study that does not fulfil these criteria is a localised study.

Repeat studies - item 61462

Item 61462 covers repeat planar (whole body or localised) and/or SPECT imaging performed on a separate occasion using the same administration of radiopharmaceutical. The repeat planar and SPECT imaging when performed on a separate occasion using the same administration of radiopharmaceutical should be itemised as item 61462 and the original item and date of service should be indicated for reference purposes.

This item does not apply to bone scans, adrenal studies or gastro-oesophageal reflux studies, myocardial perfusion studies, colonic transit or CFS transport studies, where allowance for performance of the delayed study is incorporated into the baseline benefit fee.

Thyroid study - item 61473

Item 61473 incorporates the measurement of thyroid uptake on a gamma camera using a proven technique, where clinically indicated.

Positron Emission Tomography (PET) - items 61523 to 61647

General

PET services must be:

  • performed by or under the personal supervision of:
    • specialist or consultant physician credentialled under the Joint Nuclear Medicine Specialist Credentialling Program for the Recognition of the Credentials of Nuclear Medicine Specialists for Positron Emission Tomography overseen by the Joint Nuclear Medicine Credentialling and Accreditation Committee of the RACP and RANZCR; or
    • practitioner who is a Fellow of either the RACP or RANZCR, and who, prior to 1 November 2011, reported 400 or more studies forming part of PET services for which a Medicare benefit was payable, and who holds a current license from the relevant State radiation licensing body to prescribe and administer the intended PET radiopharmaceuticals to humans;

  • provided in a comprehensive facility that can provide a full range of diagnostic imaging services (including PET, CT, X-Ray and diagnostic ultrasound) and cancer treatment services (including chemotherapy, radiation oncology and surgical oncology) at the one site;

  • provided using equipment that meets the Requirements for PET Accreditation (Instrumentation & Radiation Safety) 3rd Edition (2017) issued by the Australian and New Zealand Society of Nuclear Medicine Inc;

  • only provided following a request from a specialist or consultant physician; and

  • all PET providers must complete a specific PET provider Statutory Declaration prior to being eligible to claim Medicare rebates. Statutory declarations can be obtained directly from Services Australia.
     

Whole body FDG PET

In patients with Hodgkin and non- Hodgkin lymphoma (excluding indolent non- Hodgkin lymphoma), whole body FDG PET studies should not be used for surveillance nor for assessment of patients with suspected (as opposed to confirmed) disease recurrence.

PET for Alzheimer's disease

For item 61560:

  • the study must include a quantitative comparison of the results with the results obtained from a PET study in a reference library of a normal brain.
  • benefits are not payable for the item if the patient has a previous PET scan for Alzheimer’s disease claimed in the previous 12 months.

  • benefits are not payable for the item if a cerebral perfusion study (item 61402) for the diagnosis or management of Alzheimer’s disease has been claimed in the previous 12 months.

  • benefits are only payable for a maximum of three services in the patient’s lifetime.
     

Prostate-specific membrane antigen (PSMA) PET study for Prostate Cancer

Item 61563 - Whole body PSMA PET study for the initial staging of the patient

  • The requesting specialist or consultant physician is to record in the clinical notes and the imaging request that the patient:
    • has intermediate to high-risk prostate adenocarcinoma, as defined below;
    • has previously been untreated; and
    • is considered suitable for locoregional therapy with curative intent.
  • Patients with intermediate risk prostate adenocarcinoma can be defined as having at least one of the following risk factors in the absence of any high-risk features: PSA of 10-20 ng/ml, or Gleason score of 7 or International Society of Urological Pathology (ISUP) grade group 2 or 3, or Stage T2b.

  • Patients with high-risk prostate adenocarcinoma can be defined as having at least one of the following risk factors: PSA >20 ng/ml, or Gleason score >7 or ISUP grade group 4 or 5, or Stage T2c or ≥T3.

  • Benefits are only payable for a maximum of one service in the patient’s lifetime. 

Item 61564 - Whole body PSMA PET study for the restaging of the patient

  • The requesting specialist or consultant physician is to record in the clinical notes and the imaging request that the patient has undergone prior locoregional therapy for prostatic adenocarcinoma and is considered potentially suitable for further locoregional therapy for recurrent disease.

  • This item can be claimed by patients with:
    • a prostate specific antigen (PSA) increase of 2ng/ml above the nadir after radiation therapy; or
    • failure of PSA levels to fall to undetectable levels; or
    • rising serum PSA after a radical prostatectomy.

  • Benefits are only payable for a maximum of two services in the patient’s lifetime.
     

Whole body PSMA PET study items 61563 and 61564 are not to be used for surveillance nor for assessment of patients with suspected (as opposed to confirmed) prostate adenocarcinoma or disease recurrence.

Claiming of diagnostic Computed Tomography (CT) with PET scans

Diagnostic CT items should not be co-claimed with a whole body PET scan unless the service is clinically relevant and appropriately requested. Under the Health Insurance (Diagnostic Imaging Services Table) Regulations, diagnostic CT items cannot be claimed with a PET item where the purpose of the CT is for attenuation correction or anatomical correlation. CT attenuation item 61505 is the correct item to be claimed in these circumstances.

Substitute PET items for use in radiopharmaceutical supply disruptions

Items 61333, 61336 and 61341 can be used if items 61348, 61402, 61421 or 61425 have been requested and:

1.     the requested service is not available due to a supply disruption of technetium-99m; and

2.     the patient's clinical condition requires the service to be performed before the resumption of normal isotope supply is anticipated; and

3.     the report of the service performed includes a justification for the substitute service and the unavailability of the original item.

Item 61612 – FDG PET study of the initial staging of eligible cancer types

For item 61612, the requesting specialist or consultant physician is to record in the clinical notes and the imaging request that the patient has a rare or uncommon cancer that meets the eligibility criteria as stated in the item descriptor. Benefits are only payable once per cancer diagnosis.
 

The following are considered rare or uncommon cancer types:

  • anal cancer
  • bladder cancer
  • brain and other central nervous system (cancer of the)
  • brain cancer
  • gallbladder and extrahepatic bile ducts (cancer of the)
  • gastrointestinal stromal tumours (GIST)
  • Kaposi sarcoma
  • liver cancer
  • Merkel cell cancer
  • mesothelioma
  • multiple myeloma
  • ovarian cancer (incidence only)
  • ovarian cancer and serous carcinomas of the fallopian tube
  • pancreatic cancer
  • penile cancer
  • peritoneal cancer
  • placenta cancer
  • small cell lung cancer
  • small intestine (cancer of the)
  • stomach cancer
  • testicular cancer
  • thyroid cancer
  • unknown primary site (cancer of)
  • uterine cancer
  • vaginal cancer
  • vulvar cancer.


 

Related Items: 61333 61336 61341 61563 61564 61612

Category 5 - DIAGNOSTIC IMAGING SERVICES

IN.0.19

Bulk Billing Incentive

Out-of-hospital services attract higher benefits when they are bulk billed by the provider.

For all diagnostic imaging items (except those in Group 6 – Management of Bulk Billed Services and item 61369) benefits for bulk billed services are payable at 95% of the schedule fee for the item.

Related Items: 55028 55029 55030 55031 55032 55033 55036 55037 55038 55039 55048 55049 55054 55065 55066 55068 55070 55071 55073 55076 55079 55084 55085 55118 55126 55127 55128 55129 55130 55132 55133 55134 55135 55137 55141 55143 55145 55146 55238 55244 55246 55248 55252 55274 55276 55278 55280 55282 55284 55292 55294 55296 55600 55603 55700 55703 55704 55705 55706 55707 55708 55709 55712 55715 55718 55721 55723 55725 55729 55736 55739 55740 55741 55742 55743 55757 55758 55759 55762 55764 55766 55768 55770 55772 55774 55812 55814 55844 55846 55848 55850 55852 55854 55856 55857 55858 55859 55860 55861 55862 55863 55864 55865 55866 55867 55868 55869 55870 55871 55872 55873 55874 55875 55876 55877 55878 55879 55880 55881 55882 55883 55884 55885 55886 55887 55888 55889 55890 55891 55892 55893 55894 55895 56001 56007 56010 56013 56016 56022 56028 56030 56036 56101 56107 56219 56220 56221 56223 56224 56225 56226 56233 56234 56237 56238 56301 56307 56401 56407 56409 56412 56501 56507 56620 56622 56623 56626 56627 56628 56629 56630 56801 56807 57001 57007 57201 57341 57352 57353 57354 57360 57506 57509 57512 57515 57518 57521 57522 57523 57524 57527 57541 57700 57703 57706 57709 57712 57715 57721 57901 57902 57905 57907 57915 57918 57921 57924 57927 57930 57933 57939 57942 57945 57960 57963 57966 57969 58100 58103 58106 58108 58109 58112 58115 58300 58306 58500 58503 58506 58509 58521 58524 58527 58700 58706 58715 58718 58721 58900 58903 58909 58912 58915 58916 58921 58927 58933 58936 58939 59103 59300 59302 59303 59305 59312 59314 59318 59700 59703 59712 59715 59718 59724 59733 59739 59751 59754 59763 59970 60000 60003 60006 60009 60012 60015 60018 60021 60024 60027 60030 60033 60036 60039 60042 60045 60048 60051 60054 60057 60060 60063 60066 60069 60072 60075 60078 60500 60503 60506 60509 60918 60927 61109 61310 61313 61314 61321 61324 61325 61328 61329 61340 61345 61348 61349 61353 61356 61357 61360 61361 61364 61368 61372 61373 61376 61381 61383 61384 61386 61387 61389 61390 61393 61394 61397 61398 61402 61406 61409 61410 61413 61414 61421 61425 61426 61429 61430 61433 61434 61438 61441 61442 61445 61446 61449 61450 61453 61454 61457 61461 61462 61469 61473 61480 61485 61495 61499 61505 61523 61524 61525 61529 61541 61553 61559 61563 61564 61565 61612 61620 61622 61628 61632 61647 61650 63001 63004 63007 63010 63040 63043 63046 63049 63052 63055 63058 63061 63064 63067 63070 63073 63101 63111 63114 63125 63128 63131 63151 63154 63161 63164 63167 63170 63173 63176 63179 63182 63185 63201 63204 63219 63222 63225 63228 63231 63234 63237 63240 63243 63271 63274 63277 63280 63301 63304 63307 63322 63325 63328 63331 63334 63337 63340 63361 63385 63388 63391 63395 63397 63401 63404 63416 63425 63428 63440 63443 63446 63454 63461 63464 63467 63470 63473 63476 63482 63491 63494 63496 63497 63498 63499 63501 63502 63504 63505 63513 63531 63533 63541 63543 63545 63546 63547 63560 63563 64990 64991


Legend

  • Assist - Addition/Deletion of (Assist.)
  • Amend - Amended Description
  • Anaes - Anaesthetic Values Amended
  • Emsn - EMSN Change
  • Fee - Fee Amended
  • Renum - Item Number Change (renumbered)
  • New - New Item
  • NewMin - New Item (previous Ministerial Determination)
  • Qfe - QFE Change