Medicare Benefits Schedule - Note IN.0.15

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Category 5 - DIAGNOSTIC IMAGING SERVICES

IN.0.15

Group I2 - Computed Tomography (CT)

Professional supervision  

CT services (items 56001 to 57362) are not eligible for a Medicare rebate unless the service is performed, for an eligible person:

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

·         to monitor and influence the conduct and diagnostic quality of the examination; and

·         if necessary, to personally attend the patient;

 (b) reported by a specialist in diagnostic radiology (who may or may not be the supervising specialist); or

 (c)    if the above criteria cannot be complied with

·         in an emergency, or

·         because of medical necessity in a remote location. 

 The definition of a remote location is one that is more than 30 kilometres by road from: 

 (a)   a hospital which provides a radiology service under the direction of a specialist in the specialty of diagnostic radiology; or

 (b)  a free-standing radiology facility under the direction of a specialist in the specialty of diagnostic radiology. 

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

Restriction on items—attenuation correction and anatomical correlation

Items in this Division do not apply to a CT service that is performed for the purpose of attenuation correction or anatomical correlation of another diagnostic imaging procedure.

Use of PET/CT or SPECT/CT machines  

CT scans rendered on Positron Emission Tomography (PET)/CT or Single Photon Emission Computed Tomography (SPECT)/CT units are eligible for a Medicare benefit provided the CT scan is rendered under the same conditions as those applying to services rendered on stand-alone CT equipment.

Scan of more than one area/region

Where multiple regions are scanned on one occasion and a combination item exists that covers those regions, the combination item must be claimed. Items covering individual contiguous regions must not be used when scans of multiple regions are performed and a combination item exists that covers those regions.

More than one attendance of the patient to complete a scan

Items 56219 to 56238 (CT of the spine) and 56620 to 56630 (CT of the extremities) apply once only for a service described in any of those items, regardless of the number of patient attendances (ie patient visits) required to complete the service.  For example, where a request relates to two or more regions of the spine and only one region is scanned on one occasion with the balance of regions being scanned on a subsequent occasion, benefits are payable for one service only. 

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. 

Inclusive of intrathecal contrast medium – item 56219

The fee for item 56219 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 myelogram 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 (items 56220, 56221 or 56223). 

Computed tomography of the 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 item 56007 or 56036 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:

·         is under 50 years; and

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

·         has no localising symptoms or signs; and

·         has no history of malignancy or immunosuppression.  

Computed tomography of the spine

Multiple regions

CT items exist which separate the examination of the spine into the cervical, thoracic and lumbosacral regions.

These items are 56220 to 56238 inclusive.  They include items for CT scans of two regions of the spine (56233 and 56234) and for all three regions of the spine (56237 and 56238).  Restrictions apply to the following items: 

·         item 56233 should be claimed 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.

 ·         item 56234 should be claimed 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.

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. 

Computed tomography of the upper abdomen and pelvis

Items 56501 and 56507 are not eligible for benefits if performed for the purpose of performing a virtual colonoscopy (otherwise known as CT colonography and CT colography).  Item 56553 is to be used for a CT colonography. 

Computed tomography of the colon

In item 56553, the terms 'high risk' and 'incomplete colonoscopy' are defined as follows: 

High Risk

Asymptomatic people fit into this category if they have any of the following:

·         at least three first-degree relatives diagnosed with colorectal cancer at any age

·         at least three first-degree or second-degree relatives with colorectal cancer with at least one diagnosed before age 55 years.

Relative risk for category 3 is 7–10 times average risk. For the majority of people in this category, the risk of colorectal cancer is 7 times higher than average.
 
Source:  Cancer Council Australia – Short Form Summary of NHMRC Approved Recommendations - January 2018 - Clinical practice guidelines for the prevention, early detection and management of colorectal cancer – category 3 – those at high risk (page 12) .
 

Incomplete Colonoscopy

An incomplete colonoscopy is defined as one that is not completed for technical or medical reasons.

Computed tomography angiography

If items 57352, 57353, 57354 or 57357 are requested by a medical practitioner (other than a specialist or consultant physician) the patient’s case must be discussed with a specialist or consultant physician (not the radiologist likely to perform the service) and noted as such on the request.

Item 57357 (angiography of the pulmonary arteries and their branches) may be requested by a medical practitioner (other than a specialist or consultant physician), without the patient’s case being discussed with a specialist or consultant physician if the service is performed for the exclusion of pulmonary embolism as stated on the request.

Computed Tomography Coronary Angiography (CTCA) for coronary artery disease

Items 57360 and 57364 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:

·         to monitor and influence the conduct and diagnostic quality of the examination; and

·         if necessary, to personally attend the patient; and

(b)    reported by a specialist or consultant physician (who may or may not be the supervising specialist) recognised by the Conjoint Committee for the Recognition of Training in CT Coronary Angiography; or

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

·         in an emergency, or

·         because of medical necessity in a remote location. 
 

The definition of a remote location is one that is more than 30 kilometres by road from: 

(a)   a hospital which provides a radiology service under the direction of a specialist in the specialty of diagnostic radiology; or

(b)  a free-standing radiology facility under the direction of a specialist in the specialty of diagnostic radiology. 

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

 

 


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