Medicare Benefits Schedule - Note IN.0.16

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Category 5 - DIAGNOSTIC IMAGING SERVICES

IN.0.16

Group I3 - Diagnostic Radiology

Examination and report  

As for all diagnostic imaging services, the benefits allocated to each item from 57506 to 60509 inclusive cover the total service, i.e. the image, reading and report.  Separate benefits are not payable for individual components of the service, e.g. preliminary reading.  Benefits are not separately payable for associated plain films involved with these items. 

Exposure of more than one film

Where the radiographic examination of a specific area involves the exposure of more than one film, benefits are payable once only, except where special provision is made in the description of the item for the inclusion of all films taken for the purpose of the examination. This means that if an x-ray of the foot is requested, regardless of the number of exposures from different angles, the completed service comprises x-ray of the foot by one or more exposures and the report. The exception to this would be the plain x-ray of the spine items (58100 to 58121) where the item number differs dependent upon the regions of the spine that are examined at the same occasion, ie. 58112 applies where two regions are examined. 

Comparison X-rays  

Where it is necessary for one or more films of the opposite limb to be taken for comparison purposes, benefits are payable for radiographic examination and reporting of one limb only.  Comparison views are considered to be part of the examination requested. 

Images produced using Dual Energy X-ray Absorptiometry (DEXA) equipment

X-ray items of the spine 58100 to 58121 and hip 57712 cannot be claimed when images are produced using Dual Energy X-ray Absorptiometry (DEXA) equipment.  DEXA should be claimed under General Medical Services Table items 12306 to 12322.

Subgroup 1 – Radiographic examination of the extremities

Hand and wrist combination X-ray

An examination of the hand and the wrist on the same side should be claimed as item 57512 (NR) or 57515 (R).  If items 57506 (NR) or 57509 (R) are claimed for multiple non-adjacent areas on the same side, or areas on different sides, the account should include annotation on this e.g. L and R hand, or hand and humerus.

Subgroup 4: Radiographic examination of the spine

Multiple regions

Multiple region items require that the regions of the spine to be studied must be specified on any account issued or patient assignment form completed. 

Item 58112 - spine, two regions 

Where item 58112 is rendered (spine, two regions), the item numbers for the regions of the spine being studied must be specified (i.e. from items 58100, 58103, 58106 and 58109). 

Example: for a radiographic examination of the spine where the cervical and thoracic regions are to be studied, item numbers 58100 and 58103 must be specified on any account issued or patient assignment forms completed. 

Item 58115 - spine, three region 

Where item 58115 is rendered (spine, three regions), the item numbers for the regions of the spine being studied must be specified (items 58100, 58103, 58106 and 58109). 

Example: for a radiographic examination of the spine where the cervical, the thoracic and the lumbosacral regions are to be studied, item numbers 58100, 58103 and 58106 must be specified on any accounts issued or patient assignment forms completed. 

Item 58115 and 58108 - spine, three and four regions – request by medical practitioner 

Three and four region radiographic examinations items 58115 and 58108 only apply when requested by a medical practitioner. 

Items 58120 and 58121 - spine, three and four regions – request by non-medical practitioner 

Items 58120 and 58121 apply to physiotherapists and osteopaths who request a three or four region x-ray.   Benefits are payable for one of these items only per patient per calendar year.

Subgroup 8:  Radiographic examination of alimentary tract and biliary system

Plain abdominal film - items 58900 and 58903

Benefits are not payable for items 58900 and 58903 in association with barium meal examinations or cholecystograms whether provided on the same day or previous day.  Preliminary plain films are covered in each study. 

Subgroup 10:  Radiographic examination of the breasts

Request requirements - items 59300 and 59303

Benefits under items 59300 and 59303 are payable only where the patient has been referred in specific circumstances as indicated in the description of the items.  To facilitate these provisions, the requesting medical practitioner is required to include in the request the clinical indication for the procedure. 

Professional supervision

Mammography services (items 59300 to 59318) are not eligible for a Medicare rebate unless the diagnostic imaging procedure is performed under the professional supervision of a:

-          specialist in the specialty of diagnostic radiology who is available to monitor and influence the conduct and diagnostic quality of the examination, and, if necessary, to personally attend on the patient; or

-          if paragraph (a) cannot be complied with:

-          in an emergency; or

-          because of medical necessity in a remote location.

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

Subgroup 12:  Radiographic examination with opaque or contrast media

Myelogram- item 59724

Benefits are not payable where a myelogram is rendered in association with a CT myelogram (item 56219 – see IN.0.16).  Where it is necessary to render a CT and a myelogram, CT items 56220, 56221 and 56223 would apply.  

Subgroup 13: Angiography

Digital subtraction angiography (DSA) - items 60000-60078

Benefits are payable only where these services are rendered in an angiography suite (a room that contains only equipment designed for angiography that is able to perform digital subtraction or rapid-sequence film angiography). Benefits are not payable when these services are rendered using mobile DSA imaging equipment as these services are covered by item 59970. 

Each item includes all preparation and contrast injections other than for selective catheterisation.  For DSA, benefits are payable for a maximum of one DSA item (from Items 60000 to 60069).  For selective DSA - one DSA item (from 60000 to 60069) and one item covering selective catheterisation (from 60072, 60075 or 60078). 

If a DSA examination covers more than one of the specified regions/combinations, then the region/combination forming the major part of the examination should be selected, with itemisation to cover the total number of film runs obtained.  A run is the injection of contrast, data acquisition, and the generation of a hard copy record. 

Subgroup 16: Preparation for radiological procedure

Preparation items - 60918 and 60927

Items 60918 and 60927 apply only to the preparation of a patient for a radiological procedure for a service to which any of items 59903 to 59970 apply. A report is not required for these services.


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