Wednesday, 03 September, 2014


Medicare Benefits Schedule - Item 63507

Search Results for Item 63507



View Associated Notes

Category 5 - DIAGNOSTIC IMAGING SERVICES
63507    More information    

referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of head for a patient under 16 years for any of the following:

-    unexplained seizure(s) (R) (Contrast) (Anaes.); or

-    unexplained headache where significant pathology is suspected (R) (Contrast) (Anaes.); or

-    paranasal sinus pathology which has not responded to conservative therapy (R) (Contrast) (Anaes.)

Bulk bill incentive


Fee: $403.20 Benefit: 75% = $302.40 85% = $342.75
(See para DIO of explanatory notes to this Category)
<Previous - Item 63505 Next - Item 63508>

Associated Notes

Category 5 - DIAGNOSTIC IMAGING SERVICES
DIO  Group I5 - Magnetic Resonance Imaging 

Itemisation

MRI items in Group I5, items 63001 to 63561, are divided into subgroups defined according to the area of the body to be scanned, (ie head, spine, musculoskeletal system, cardiovascular system or body) and the number of occasions in a defined period in which Medicare benefits may be claimed by a patient.  Subgroups are divided into individual items, with each item being for a specific clinical indication.

 

Eligible services

Group I5 items 63001 to 63497 apply only to a MRI or MRA service performed:

a)  on request by a recognised specialist or consultant physician, where the request made in writing identifies the clinical indication for the service;

b)  under the professional supervision of an eligible provider; and

c)  with eligible equipment.

 

Group I5 items 63464 to 63476 apply to a MRI service performed:

(a)        on request by a recognised specialist or consultant physician, where the request made in writing identifies the clinical indication for the service;

(b)        under the professional supervision of an eligible provider; and

(c)          with eligible equipment and partial eligible equipment.

 

Group I5 items 63507 to 63561 apply a MRI service performed

a)  on request by a medical practitioner other than a specialist or consultant physician, where the request made in writing identifies the clinical indication for the service;

b)  under the professional supervision of an eligible provider; and

c)  with eligible equipment and partial eligible equipment.

 

Group I5 items 63491 to 63497 to MRI apply to a MRI or MRA service performed

a)  on request by a medical practitioner, where the request made in writing identifies the clinical indication for the service;

b)  under the professional supervision of an eligible provider; and

c)  with eligible equipment and partial eligible equipment.

 

Requests

A request must be in writing and identify the clinical indications for the service.

 

MRI services can only be requested by a recognised specialist medical practitioner or consultant physician for the purpose of the Health Insurance Act 1973.  However, there are exceptions to this provision for a limited number of MRI:

 

-    All dental specialists, prosthodontists, oral and maxillofacial surgeons, oral medicine specialists and oral pathology specialists may request item 63334 - scan of musculoskeletal system for derangement of the temporomandibular joint (s); and

-    Oral and maxillofacial surgeons and oral medicine and oral pathology specialists can also request item 63007 - scan of the head for skull base or orbital tumour; and

-     Items in subgroup 33 and 34 may only be requested by a medical practitioner other than a specialist or a consultant physician.

 

Professional supervision

Group I5 items must be performed as follows:

a)  under the professional supervision of an eligible provider who is available to monitor and influence the conduct and diagnostic quality of the examination, including, if necessary, by personal attendance on the patient; or

b)  if paragraph (a) is not complied with:

i.         in an emergency; or

ii.        because of medical necessity, in a remote location (refer to DID).

 

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

 

Eligible providers

In Group I5, an eligible provider is a specialist in diagnostic radiology who satisfies the Department of Human Services that:

a)  he or she is a participant of the Royal Australian and New Zealand College of Radiologists' (RANZCR) Quality and Accreditation Program; and

b)  the equipment he or she proposes to use for providing services of the kind mentioned in Group I5 is eligible equipment or partial eligible equipment.

 

Eligible Provider declaration

The specialist must give the Department of Human Services a statutory declaration:

a)  stating that he or she is enrolled in the RANZCR Quality and Accreditation Program;

b)  specifying the location of the MRI equipment;

c)  specifying the kinds of diagnostic imaging equipment offered at the location;

d)  stating the date of installation of the equipment (and the time of installation if this occurred on 12 May 1998); and

e)  if the equipment had not been installed before 7.30pm on 12 May 1998 (Eastern Standard Time), the specialist must also give the Department of Human Services a copy of the contract for the purchase or lease of the equipment.

 

In addition the Department of Human Services may request further supporting documentation or information.  Specialists or consultant physicians are advised to contact the Provider Liaison Section, the Department of Human Services on 132 150 prior to lodging a declaration.

 

Eligible equipment is equipment which is:

a)  is located at premises of a comprehensive practice; and

b)  is made available to the practice by a person:

i.         who is subject to a deed with the Commonwealth that relates to the equipment; and

ii.        for whom the deed has not been terminated; and

c)  is not identified as partial eligible equipment in the deed

 

Partial eligible equipment is equipment which is:

Equipment that:

a)  is located at premises of a comprehensive practice; and

b)  is made available to the practice by a person:

i.         who is subject to a deed with the Commonwealth that relates to the equipment; and

ii.        for whom the deed has not been terminated; and

c)  is identified as partial eligible equipment in the deed

 

The location of Medicare-eligible MRI machines is available at the Department of Health and Ageing's website at http://www.health.gov.au

 

Number of eligible services

-    Items have been placed in subgroups according to frequency restrictions for Medicare eligibility as follows:

-    Services in subgroups 1, 4, 6, 8, 11 and 18 have no frequency restriction.

-    Services in subgroups 16 and 19 may be claimed on one occasion in any 12-month period.

-    Services in subgroups 13, 14 and 17 may be claimed on two occasions in any 12-month period.

-    Services in subgroups 2, 3, 5, 7, 9, 10, 12, 15, 21 33 and 34 may be claimed on three occasions only in any 12-month period.

-    Items 63470 or 63473 in Subgroup 20 may be claimed only once in a patient's lifetime.

-    Items 63476 in Subgroup 20 may be claimed only once in a patient's lifetime.

-    Items in subgroup 22 may only be ordered in conjunction with an eligible MRI/MRA service.

-    Items in subgroup 32 for item 63501 and 63502 may be claimed only one in a patient's lifetime, and 63504 and 63505 have no restrictions.

 

Example : Item 63271 in subgroup 10 can be claimed by a patient on three occasions in any 12 month period. If the patient had claimed Medicare benefits for the following:

 

Item   

Date of service

63271

10/12/04

63271

18/4/05

63271

16/10/05

63271

11/12/05

 

The following table provides examples of further dates of service would, and would not, be eligible:

 

Date of service

Claimable?

Why?

12/3/05

No

Between 10/12/04 and 9/12/05, the patient would have had 4 x 63271 in 12 months - 10/12/04, 12/3/05, 18/4/05 and 16/10/05

 

4/3/06

No

Between 5/3/05 and 4/3/06, the patient would have had 4 x 63271 in 12 months - 18/4/05, 16/10/05, 11/12/05 and 4/3/06

 

20/4/06

Yes

Between 21/4/05 and 20/4/06, the patient would  have had 3x 63271 in 12 months - 16/10/05, 11/12/05 and 20/4/06

 

 

                                                               

The frequency restrictions are therefore considered to be rolling restrictions and not based on calendar or financial years.

 

In addition, restrictions on the number of services of the kind described in subgroup 12 apply to specific anatomical sites.  Where an item description applies to more than one anatomical site the restriction on the number of services applies to each site.

-   Item 63328, MRI scan for derangement of the knee or its supporting structures, applies to two specific anatomical sites, ie, right knee and left knee.  Each anatomical site may be scanned up to 3 times in any 12-month period.

Related Items: 63507, 63508, 63510, 63511, 63514, 63516, 63517, 63519, 63520, 63522, 63523, 63551, 63552, 63554, 63555, 63557, 63558, 63560, 63561

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