Medicare Benefits Schedule - Item 56555

Search Results for Item 56555

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Category 5 - DIAGNOSTIC IMAGING SERVICES

56555

56555 - Additional Information

Item Start Date:
01-Jul-2018
Description Start Date:
01-Sep-2015
Schedule Fee Start Date:
01-Sep-2015

Group
I2 - Computed Tomography
Subgroup
6 - Upper abdomen and pelvis

Computed tomography-scan of colon for exclusion or diagnosis of colorectal neoplasia in a symptomatic or high risk patient if:

    (a)    one [or more] of the following applies:

        (i)     the patient has had an incomplete colonoscopy in the 3 months before the scan;

        (ii)    there is a high-grade colonic obstruction;

        (iii)    the patient is referred by a specialist or consultant physician who performs colonoscopies [in the practice

            of his or her speciality]; and

    (b)    the service is not a service to which item 56301, 56307, 56401, 56407, 56409, 56412, 56501, 56507, 56801,     

            56807 or 57001 applies; and

    (c)    the service has not been performed on the patient in the 36 months before the scan (R) (NK) (Anaes.)

Bulk bill incentive

Fee: $260.00 Benefit: 75% = $195.00 85% = $221.00

(See para IN.0.12 of explanatory notes to this Category)


Associated Notes

Category 5 - DIAGNOSTIC IMAGING SERVICES

IN.0.12

Group I2 - Computed Tomography (CT)

Capital sensitivity items

A reduced Schedule fee applies to CT services provided on equipment that is 10 years old or older.  This equipment must have been first installed in Australia ten or more years ago, or in the case of imported pre-used equipment, must have been first manufactured ten or more years ago.  A range of items cover services provided on older equipment.  These items are: 

56041, 56047, 56050, 56053, 56056, 56062, 56068, 56070, 56076, 56141, 56147, 56259, 56341, 56347, 56441, 56447, 56449, 56452, 56541, 56547, 56659, 56665, 56841, 56847, 57041, 57047, 57247, 57345, 57355, 57361. 

These items are identified by the addition of the letter '(NK)' at the end of the item.  These items should be used where services are performed on equipment ten years old or older, except where equipment is located in a remote area when items with the letter "K", as described below, will apply. 

Items 56001 to 57356 (which contain the symbol (K) at the end of the item should be used for services which are performed on a date which is less than ten years after the date on which the CT equipment used in performing the service was first installed in Australia.  In the case of imported pre-used CT equipment, the services must have been performed on a date which is less than ten years from the first date of manufacture of the equipment. 

Professional supervision

CT services (items 56001 to 57356) are not eligible for a Medicare rebate unless the service is performed:

(a)              under the professional supervision of a specialist in the specialty of diagnostic radiology who is available:

(i)      to monitor and influence the conduct and diagnostic quality of the examination; and

(ii)     if necessary, to personally attend on the patient; or

(b)              if paragraph (a) cannot be complied with

(i)      in an emergency, or

(ii)     because of medical necessity in a remote area - refer to DID.4.4 for definition of remote area. 

Note:  Practitioners do not have to apply for a remote area exemption in these circumstances. 

Items 57360 and 57361 apply only to a CT service that is:

(a) performed under the professional supervision of a specialist or consultant physician recognised by the Conjoint Committee for the Recognition of Training in CT Coronary Angiography who is available:

(i) to monitor and influence the conduct and diagnostic quality of the examination; and

             (ii) if necessary, to attend on the patient personally; and

(b) reported by a specialist or consultant physician recognised by the Conjoint Committee for the Recognition of Training in CT Coronary Angiography; or

(c) if paragraph (a) and (b) cannot be complied with

(i) in an emergency, or

(ii) because of medical necessity in a remote area - refer to DID.4.4 for definition of remote area.

Use of a hybrid PET/CT or SPECT/CT machine

CT scans rendered on hybrid Positron Emission Tomography (PET)/CT or hybrid Single Photon Emission Computed Tomography (SPECT)/CT units are eligible for a Medicare benefit provided: 

·           the CT scan is not solely used for the purposes of attenuation correction and anatomical correlation of any associated PET or SPECT scan; and

·           the CT scan is rendered under the same conditions as those applying to services rendered on stand-alone CT equipment.  For example, the service would need to be properly requested and performed under the professional supervision of a specialist radiologist, including specialist radiologists with dual nuclear medicine qualifications. 

Scan of more than one area

Items have been provided to cover the common combinations of regions - see Multiple Regions below.  However, where regions are scanned on the one occasion which are not covered by a combination item, for example, item 56220 (scan of the spine) with item 56619 (scan of extremities), both examinations would attract separate benefit. 

Multiple regions

Items have been provided to cover the common combinations of regions.  The items relating to the individual contiguous regions should not be used when scans of multiple regions are performed. 

More than one attendance of the patient to complete a scan

Items 56220 to 56240 and 56619 to 56665 apply once only for a service described in any of those items, regardless of the number of patient attendances required to complete the service.  For example, where a request relates to two or more regions of the spine and one region only is scanned on one occasion with the balance of regions being scanned on a subsequent occasion, benefits are payable for one combination service only upon completion. 

Pre contrast scans

Pre contrast scans are included in an item of service with contrast medium only when the pre-contrast scans are of the same region. 

Head

Exclusion of acoustic neuroma

If an axial scan is performed for the exclusion of acoustic neuroma, Medicare benefits are payable under item 56001 or 56007. 

Assessment of headache

If the service described in item 56007 or 56047 is used for the assessment of headache of a patient, the fee mentioned in the item applies only if:

(a)        a scan without intravenous contrast medium has been undertaken on the patient; and

(b)        the service is required because the result of the scan is abnormal. 

This rule applies to a patient who:

(i)         is under 50 years; and

(ii)        is (apart from the headache) otherwise well; and

(iii)       has no localising symptoms or signs; and

(iv)       has no history of malignancy or immunosuppression. 

Spine

CT items exist which separate the examination of the spine into the cervical, thoracic and lumbosacral regions. These items are 56220 to 56240 inclusive.  They include items for CT scans of two regions of the spine (56233, 56234, 56235 and 56236) and for all three regions of the spine (56237, 56238, 56239 and 56240).  Restrictions apply to the following items: 

(a)        item 56233 is used where two examinations of the kind referred to in items 56220, 56221 and 56223 are performed.  The item numbers of the examination which are performed must be shown on any accounts issued or patient assignment forms completed.

(b)        item 56234 is used where two examinations of the kind referred to in items 56224, 56225 and 56226 are performed.  The item numbers of the examination which are performed must be shown on any accounts issued or patient assignment forms completed.

(c)        item 56235 is used where two examinations of the kind referred to in items 56227, 56228 and 56229 are performed.  The item numbers of the examination which are performed must be shown on any accounts issued or patient assignment forms completed

(d)        item 56236 is used where two examinations of the kind referred to in items 56230, 56231 and 56232 are performed.  The item numbers of the examination which are performed must be shown on any accounts issued or patient assignment forms completed 

Example: for a CT examination of the spine where the cervical and thoracic regions are to be studied (item 56233), item numbers 56220 and 56221 must be specified. 

With intrathecal contrast medium (Item 56219)

The item incorporates the cost of contrast medium for intrathecal injection and associated x-rays.  Benefits are not payable for this item when rendered in association with myelograms (Item 59724).  Where a myelogram is rendered under item 59724 and a CT is necessary, the relevant item would be scan of spine without intravenous contrast (Item 56220, 56221 or 56223). 

Upper abdomen and pelvis

Items 56501, 56507, 56541 and 56547 are not eligible for Medicare Benefits if performed for the purpose of performing a virtual colonoscopy (otherwise known as CT colonography and CT colography).  CT  Colonography is covered by items 56553 and 56555. 

Computed Tomography of the Colon (Items 56553 and 56555)

In items 56553 and 56555 the terms 'high risk' and 'incomplete colonoscopy' are defined as follows: 

High Risk

Asymptomatic people fit into this category if they have:

- three or more first-degree or a combination of first-degree and second-degree relatives on the same side of the family diagnosed with bowel cancer (suspected hereditary non-polyposis colorectal cancer or NPCC), or

- two or more first-degree or second-degree relatives on the same side of the family diagnosed with bowel cancer, including any of the following high-risk features:

- multiple bowel cancers in the one person

- bowel cancer before the age of 50 years

- at least one relative with cancer of the endometrium, ovary, stomach, small bowel, ureter, biliary tract or brain

- at least one first-degree relative with a large number of adenomas throughout the large bowel (suspected familial adenomatis polyposis or FAP), or

- somebody in the family in whom the presence of a high-risk mutation in the adenomatis polyposis coli (APC) gene or one of the mismatch repair (MMR) genes has been identified. 

Source: NHMRC 2005 Clinical Practice Guidelines for the Prevention, Early Detection and Management of Colorectal Cancer - Category 3 - those at potentially high risk. 

Incomplete Colonoscopy

For audit purposes, an incomplete colonoscopy is defined as one that is not completed for technical or medical reasons and must have been performed in the preceding 3 months. 

Spiral angiography

Items 57350 and 57355 and items 57351 and 57356

CT spiral angiography items 57351 and 57356 apply under certain circumstances specified in the items including where a service to which items 57350 or 57355 have been performed on the same patient within the previous 12 months, whereas items 57350 and 57355 apply under the circumstances specified in the items and where the service has not been performed on the same patient within the previous 12 months. 

Computed tomography of the coronary arteries (Items 57360 and 57361)

Payment of Medicare rebates for items 57360 and 57361 is limited to specialists or consultant physicians who have fulfilled the training and credentialing requirements developed by the Conjoint Committee for the Recognition of Training in CT Coronary Angiography (CTCA). The descriptors for CT spiral angiography items 57350, 57351, 57355 and 57356 and CT chest items 56301, 56307, 56341, 56347, 56801, 56807, 56841, 56847, 57001, 57007, 57041 and 57047 clarify that they are not to be used to image the coronary arteries.

Related Items: 56553 56555 57360 57361


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