Medicare Benefits Schedule - Note IN.0.19

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 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 61311 61313 61314 61321 61324 61325 61328 61329 61332 61340 61345 61348 61349 61353 61356 61357 61360 61361 61364 61365 61368 61372 61373 61376 61377 61380 61381 61383 61384 61386 61387 61389 61390 61393 61394 61397 61398 61402 61406 61409 61410 61413 61414 61418 61421 61422 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 61565 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 64990 64991

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Bulk bill incentive

Fluoroscopy, with general anaesthesia (not being a service associated with a radiographic examination) (R) 

(Anaes.)

Fee: $45.15 Benefit: 75% = $33.90 85% = $38.40

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

Bulk bill incentive

Fluoroscopy, without general anaesthesia (not being a service associated with a radiographic examination) (R) 

Fee: $30.95 Benefit: 75% = $23.25 85% = $26.35

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

Bulk bill incentive

Fluoroscopy using a mobile image intensifier, in conjunction with a surgical procedure lasting less than 1 hour, not being a service associated with a service to which another item in this Group applies (R)

Fee: $66.35 Benefit: 75% = $49.80 85% = $56.40

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

Bulk bill incentive

Fluoroscopy using a mobile image intensifier, in conjunction with a surgical procedure lasting 1 hour or more, not being a service associated with a service to which another item in this Group applies (R)

Fee: $102.90 Benefit: 75% = $77.20 85% = $87.50

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

Bulk bill incentive

MRI—scan of cardiovascular system for congenital disease of the heart or a great vessel (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $455.15 Benefit: 75% = $341.40 85% = $386.90

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

Bulk bill incentive

MRI—scan of cardiovascular system for tumour of the heart or a great vessel (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $455.15 Benefit: 75% = $341.40 85% = $386.90

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

Bulk bill incentive

MRI—scan of cardiovascular system for abnormality of thoracic aorta (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $409.65 Benefit: 75% = $307.25 85% = $348.25

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

Bulk bill incentive

MRI—scan of cardiovascular system for assessment of myocardial structure and function involving:
(a) dedicated right ventricular views; and
(b) 3D volumetric assessment of the right ventricle; and
(c) reporting of end diastolic and end systolic volumes, ejection fraction and BSA indexed values;
if the request for the scan indicates that:
(d) the patient presented with symptoms consistent with arrhythmogenic right ventricular cardiomyopathy (ARVC); or
(e) investigative findings in relation to the patient are consistent with ARVC
(R) (Contrast)

(Anaes.)

Fee: $868.90 Benefit: 75% = $651.70 85% = $781.00

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

Bulk bill incentive

MRI—scan of cardiovascular system for assessment of myocardial structure and function involving:

(a) dedicated right ventricular views; and
(b) 3D volumetric assessment of the right ventricle; and
(c) reporting of end diastolic and end systolic volumes, ejection fraction and BSA indexed values;
if the request for the scan indicates that the patient:
(d) is asymptomatic; and
(e) has one or more first degree relatives diagnosed with confirmed arrhythmogenic right ventricular cardiomyopathy (ARVC)
(R) (Contrast)

(Anaes.)

Fee: $868.90 Benefit: 75% = $651.70 85% = $781.00

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

Bulk bill incentive

MRI—scan of the body for adrenal mass in a patient with a malignancy that is otherwise resectable (R) 

(Anaes.)

Fee: $364.15 Benefit: 75% = $273.15 85% = $309.55

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

Bulk bill incentive

MRI—scan of both breasts for the detection of cancer, if a dedicated breast coil is used, the request for the scan identifies that the person is asymptomatic and is younger than 50 years of age, and the request for the scan identifies:

(a) that the patient is at high risk of developing breast cancer, due to one of the following:
(i) 3 or more first or second degree relatives on the same side of the family diagnosed with breast or ovarian cancer;
(ii) 2 or more first or second degree relatives on the same side of the family diagnosed with breast or ovarian cancer, if any of the relatives has been diagnosed with bilateral breast cancer, had onset of breast cancer before the age of 40 years, had onset of ovarian cancer before the age of 50 years, has been diagnosed with breast and ovarian cancer (at the same time or at different times), has Ashkenazi Jewish ancestry or is a male relative who has been diagnosed with breast cancer;
(iii) one first or second degree relative diagnosed with breast cancer at age 45 years or younger, and another first or second degree relative on the same side of the family with bone or soft tissue sarcoma at age 45 years or younger; or
(b) that genetic testing has identified the presence of a high risk breast cancer gene mutation (R) 

(Anaes.)

Fee: $701.05 Benefit: 75% = $525.80 85% = $613.15

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

Bulk bill incentive

MRI—scan of both breasts for the detection of cancer, if:
(a) a dedicated breast coil is used; and
(b) the person has had an abnormality detected as a result of a service mentioned in item 63464 performed in the previous 12 months (R) 

(Anaes.)

Fee: $701.05 Benefit: 75% = $525.80 85% = $613.15

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

Bulk bill incentive

MRI—scan of both breasts, if:

(a) a dedicated breast coil is used; and
(b) the request for the scan identifies that:
(i) the patient has a breast lesion; and
(ii) the results of conventional imaging are inconclusive for the presence of breast cancer; and
(iii) biopsy has not been possible (R) (Contrast)

(Anaes.)

Fee: $701.05 Benefit: 75% = $525.80 85% = $613.15

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

Bulk bill incentive

MRI—scan of both breasts, if:

(a) a dedicated breast coil is used; and
(b) the request for the scan identifies that:
(i) the patient has been diagnosed with a breast cancer; and
(ii) there is a discrepancy between the clinical assessment and the conventional imaging assessment of the extent of the malignancy; and
(c) the results of breast MRI imaging may alter treatment planning (R) (Contrast)

(Anaes.)

Fee: $701.05 Benefit: 75% = $525.80 85% = $613.15

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

Bulk bill incentive

Multiparametric MRI—scan of the prostate for the detection of cancer, requested by a specialist in the speciality of urology, radiation oncology or medical oncology:

(a) if the request for the scan identifies that the patient is suspected of developing prostate cancer:

(i) on the basis of a digital rectal examination; or

(ii) in the circumstances mentioned in clause 2.5.9A; and

(b) using a standardised image acquisition protocol involving:

(i) T2‑weighted imaging; and

(ii) diffusion‑weighted imaging; and

(iii) (unless contraindicated) dynamic contrast enhancement 

(R) 

Note:  See explanatory note IN.5.1 for the meaning of Clause 2.5.9 in the descriptor for this item and the claiming limitations.

(Anaes.)

Fee: $457.20 Benefit: 75% = $342.90 85% = $388.65

(See para IN.0.19, IN.5.1 of explanatory notes to this Category)

Bulk bill incentive

Multiparametric MRI—scan of the prostate for the assessment of cancer, requested by a specialist in the speciality of urology, radiation oncology or medical oncology:

(a) if the request for the scan identifies that the patient:

(i) is under active surveillance following a confirmed diagnosis of prostate cancer by biopsy histopathology; and

(ii) is not undergoing, or planning to undergo, treatment for prostate cancer; and

(b) using a standardised image acquisition protocol involving:

(i) T2‑weighted imaging; and

(ii) diffusion‑weighted imaging; and

(iii) (unless contraindicated) dynamic contrast enhancement

(R)

Note: See explanatory note IN.5.2 for claiming restrictions for this item.

(Anaes.)

Fee: $457.20 Benefit: 75% = $342.90 85% = $388.65

(See para IN.0.19, IN.5.2 of explanatory notes to this Category)

Bulk bill incentive

MRI—scan of both breasts for the detection of cancer, if:

(a) a dedicated breast coil is used; and
(b) the request for the scan identifies that:
(i) the patient has a breast implant in situ; and
(ii) anaplastic large cell lymphoma has been diagnosed
(R) (Contrast)

(Anaes.)

Fee: $701.05 Benefit: 75% = $525.80 85% = $613.15

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

Bulk bill incentive

MRI - scan of knee following acute knee trauma, after referral by a medical practitioner (other than a specialist or consultant physician), for a patient 16 to 49 years with:

(a) inability to extend the knee suggesting the possibility of acute meniscal tear; or
(b) clinical findings suggesting acute anterior cruciate ligament tear (R) (Contrast) 

(Anaes.)

Fee: $409.65 Benefit: 75% = $307.25 85% = $348.25

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

Bulk bill incentive

Computed tomography—scan of upper abdomen and pelvis without intravenous contrast medium, not for the purposes of virtual colonoscopy and not being a service to which item 56801 or 57001 applies(R) (Anaes.)

Fee: $400.55 Benefit: 75% = $300.45 85% = $340.50

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

Bulk bill incentive

Computed tomography—scan of upper abdomen and pelvis with intravenous contrast medium and with any scans of upper abdomen and pelvis before intravenous contrast injection, when performed, not for the purposes of virtual colonoscopy and not being a service to which item 56807 or 57007 applies (R) (Anaes.)

Fee: $499.50 Benefit: 75% = $374.65 85% = $424.60

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

Bulk bill incentive

Heart, two-dimensional or three-dimensional real time transoesophageal examination of, from at least 2 levels, and in more than one plane at each level, if:

(a) the service includes:

(i) real time colour flow mapping and, if indicated, pulsed wave Doppler examination; and
(ii) recordings on digital media; and

(b) the service is not an intra-operative service; and

(c) not being a service associated with a service to which an item in Subgroup 3 applies.
(R)

(Anaes.)

Fee: $286.65 Benefit: 75% = $215.00 85% = $243.70

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

Bulk bill incentive

Intraoperative two-dimensional or three-dimensional real time transoesophageal echocardiography, if the service:

(a) includes Doppler techniques with colour flow mapping and recordings on digital media; and

(b) is performed during cardiac surgery; and

(c) incorporates sequential assessment of cardiac function before and after the surgical procedure; and

(d) is not associated with a service to which item 55135, or an item in Subgroup 3, applies (R)

(Anaes.)

Fee: $176.90 Benefit: 75% = $132.70 85% = $150.40

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

Bulk bill incentive

Intraoperative two-dimensional or three-dimensional real time transoesophageal echocardiography, if the service:

(a) is provided on the same day as a service to which item 38477, 38484, 38499, 38516 or 38517 applies; and

(b) includes Doppler techniques with colour flow mapping and recordings on digital media; and

(c) is performed during cardiac valve surgery (replacement or repair); and

(d) incorporates sequential assessment of cardiac function and valve competence before and after the surgical procedure; and

(e) is not associated with a service to which item 55130, or an item in Subgroup 3, applies (R)

(Anaes.)

Fee: $367.95 Benefit: 75% = $276.00 85% = $312.80

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

Bulk bill incentive

Hand, wrist, forearm, elbow or humerus (NR)

Fee: $30.95 Benefit: 75% = $23.25 85% = $26.35

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

Bulk bill incentive

Hand, wrist, forearm, elbow or humerus (R)

Fee: $41.35 Benefit: 75% = $31.05 85% = $35.15

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

Bulk bill incentive

Hand and wrist, or hand, wrist and forearm, or forearm and elbow, or elbow and humerus (NR)

Fee: $42.10 Benefit: 75% = $31.60 85% = $35.80

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

Bulk bill incentive

Hand and wrist, or hand, wrist and forearm, or forearm and elbow, or elbow and humerus (R)

Fee: $56.20 Benefit: 75% = $42.15 85% = $47.80

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

Bulk bill incentive

Foot, ankle, leg or femur (NR)

Fee: $33.85 Benefit: 75% = $25.40 85% = $28.80

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

Bulk bill incentive

Foot, ankle, leg or femur (R)

Fee: $45.15 Benefit: 75% = $33.90 85% = $38.40

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

Bulk bill incentive

Knee (NR)

Fee: $33.85 Benefit: 75% = $25.40 85% = $28.80

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

Bulk bill incentive

Knee (R)

Fee: $45.15 Benefit: 75% = $33.90 85% = $38.40

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

Bulk bill incentive

Foot and ankle, or ankle and leg, or leg and knee, or knee and femur (NR)

Fee: $51.40 Benefit: 75% = $38.55 85% = $43.70

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

Bulk bill incentive

Foot and ankle, or ankle and leg, or leg and knee, or knee and femur (R)

Fee: $68.45 Benefit: 75% = $51.35 85% = $58.20

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

Bulk bill incentive

MRI—scan of musculoskeletal system for derangement of hip or its supporting structures (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $409.65 Benefit: 75% = $307.25 85% = $348.25

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

Bulk bill incentive

MRI—scan of musculoskeletal system for derangement of shoulder or its supporting structures (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $409.65 Benefit: 75% = $307.25 85% = $348.25

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

Bulk bill incentive

MRI—scan of musculoskeletal system for derangement of knee or its supporting structures (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $409.65 Benefit: 75% = $307.25 85% = $348.25

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

Bulk bill incentive

MRI—scan of musculoskeletal system for derangement of ankle or foot (or both) or its supporting structures (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $409.65 Benefit: 75% = $307.25 85% = $348.25

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

Bulk bill incentive

MRI—scan of musculoskeletal system for derangement of one or both temporomandibular joints or their supporting structures (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $341.40 Benefit: 75% = $256.05 85% = $290.20

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

Bulk bill incentive

MRI—scan of musculoskeletal system for derangement of wrist or hand (or both) or its supporting structures (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $455.15 Benefit: 75% = $341.40 85% = $386.90

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

Bulk bill incentive

MRI—scan of musculoskeletal system for derangement of elbow or its supporting structures (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $409.65 Benefit: 75% = $307.25 85% = $348.25

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

Bulk bill incentive

MRI—scan of knee for internal joint derangement for a patient under 16 years (R) (Contrast)

(Anaes.)

Fee: $409.65 Benefit: 75% = $307.25 85% = $348.25

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

Bulk bill incentive

Computed tomography—scan of soft tissues of neck, including larynx, pharynx, upper oesophagus and salivary glands (not associated with cervical spine) without intravenous contrast medium, not being a service to which item 56801 applies (R) (Anaes.)

Fee: $239.30 Benefit: 75% = $179.50 85% = $203.45

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

Bulk bill incentive

Computed tomography—scan of soft tissues of neck, including larynx, pharynx, upper oesophagus and salivary glands (not associated with cervical spine)—with intravenous contrast medium and with any scans of soft tissues of neck, including larynx, pharynx, upper oesophagus and salivary glands (not associated with cervical spine) before intravenous contrast injection, when undertaken, not being a service associated with a service to which item 56807 applies (R) (Anaes.)

Fee: $353.75 Benefit: 75% = $265.35 85% = $300.70

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

Bulk bill incentive

Computed tomography—scan of upper abdomen only (diaphragm to iliac crest) without intravenous contrast medium, not being a service to which item 56301, 56501, 56801 or 57001 applies (R) (Anaes.)

Fee: $260.15 Benefit: 75% = $195.15 85% = $221.15

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

Bulk bill incentive

Computed tomography—scan of upper abdomen only (diaphragm to iliac crest), with intravenous contrast medium, and with any scans of upper abdomen (diaphragm to iliac crest) before intravenous contrast injection, when undertaken, not being a service to which item 56307, 56507, 56807 or 57007 applies (R) (Anaes.)

Fee: $374.60 Benefit: 75% = $280.95 85% = $318.45

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

Bulk bill incentive

Computed tomography—scan of pelvis only (iliac crest to pubic symphysis) without intravenous contrast medium not being a service associated with a service to which item 56401 applies (R) (Anaes.)

Fee: $260.15 Benefit: 75% = $195.15 85% = $221.15

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

Bulk bill incentive

Computed tomography—scan of pelvis only (iliac crest to pubic symphysis), with intravenous contrast medium and with any scans of pelvis (iliac crest to pubic symphysis) before intravenous contrast injection, when undertaken, not being a service to which item 56407 applies (R) (Anaes.)

Fee: $374.60 Benefit: 75% = $280.95 85% = $318.45

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

Bulk bill incentive

Computed tomography—pelvimetry (R) (Anaes.)

Fee: $161.50 Benefit: 75% = $121.15 85% = $137.30

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

Bulk bill incentive

Computed tomography, in conjunction with a surgical procedure using interventional techniques (R) (Anaes.)

Fee: $489.05 Benefit: 75% = $366.80 85% = $415.70

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

Bulk bill incentive

Computed tomography—angiography with intravenous contrast medium of any or all, or any part, of:

(a) the arch of the aorta; or

(b) the carotid arteries; or

(c) the vertebral arteries and their branches (head and neck);

including any scans performed before intravenous contrast injection—one or more data acquisitions, including image editing, and maximum intensity projections or 3 dimensional surface shaded display, with hardcopy or digital recording of multiple projections, if:

(d) either:

(i) the service is requested by a specialist or consultant physician; or

(ii) the service is requested by a medical practitioner (other than a specialist or consultant physician) and the request indicates that the patient’s case has been discussed with a specialist or consultant physician; and

(e) the service is not a service to which another item in this group applies; and

(f) the service is performed for the exclusion of arterial stenosis, occlusion, aneurysm or embolism; and

(g) the service is not a study performed to image the coronary arteries (R)

(Anaes.)

Fee: $530.65 Benefit: 75% = $398.00 85% = $451.10

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

Bulk bill incentive

Computed tomography—angiography with intravenous contrast medium of any or all, or any part, of:

(a) the ascending and descending aorta; or

(b) the common iliac and abdominal branches including upper limbs (chest, abdomen and upper limbs);

including any scans performed before intravenous contrast injection—one or more data acquisitions, including image editing, and maximum intensity projections or 3 dimensional surface shaded display, with hardcopy or digital recording of multiple projections, if:

(c) either:

(i) the service is requested by a specialist or consultant physician; or

(ii) the service is requested by a medical practitioner (other than a specialist or consultant physician) and the request indicates that the patient’s case has been discussed with a specialist or consultant physician; and

(d) the service is not a service to which another item in this group applies; and

(e) the service is performed for the exclusion of arterial stenosis, occlusion, aneurysm or embolism; and

(f) the service is not a study performed to image the coronary arteries (R)

(Anaes.)

Fee: $530.65 Benefit: 75% = $398.00 85% = $451.10

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

Bulk bill incentive

Computed tomography—angiography with intravenous contrast medium of any or all, or any part, of:

(a) the descending aorta; or

(b) the pelvic vessels (aorto‑iliac segment) and lower limbs;

including any scans performed before intravenous contrast injection—one or more data acquisitions, including image editing, and maximum intensity projections or 3 dimensional surface shaded display, with hardcopy or digital recording of multiple projections, if:

(c) either:

(i) the service is requested by a specialist or consultant physician; or

(ii) the service is requested by a medical practitioner (other than a specialist or consultant physician) and the request indicates that the patient’s case has been discussed with a specialist or consultant physician; and

(d) the service is not a service to which another item in this group applies; and

(e) the service is performed for the exclusion of arterial stenosis, occlusion, aneurysm or embolism; and

(f) the service is not a study performed to image the coronary arteries (R)

(Anaes.)

Fee: $530.65 Benefit: 75% = $398.00 85% = $451.10

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

Bulk bill incentive

Computed tomography of the coronary arteries performed on a minimum of a 64 slice (or equivalent) scanner if:

(a) the request is made by a specialist or consultant physician; and

(b) the patient has stable or acute symptoms consistent with coronary ischaemia; and

(c) the patient is at low to intermediate risk of an acute coronary event, including having no significant cardiac biomarker elevation and no electrocardiogram changes indicating acute ischaemia (R) 

Note:  See explanatory note IN.2.2 for claiming restrictions for this item.

(Anaes.)

Fee: $728.35 Benefit: 75% = $546.30 85% = $640.45

(See para IN.0.19, IN.2.2 of explanatory notes to this Category)

Bulk bill incentive

Fluoroscopy in an angiography suite with image intensification, in conjunction with a surgical procedure using interventional techniques, not being a service associated with a service to which another item in this Group applies (R)

Fee: $269.40 Benefit: 75% = $202.05 85% = $229.00

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

Bulk bill incentive

Skull, not in association with item 57902 (R)

Fee: $67.10 Benefit: 75% = $50.35 85% = $57.05

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

Bulk bill incentive

Cephalometry, not in association with item 57901 (R)

Fee: $67.10 Benefit: 75% = $50.35 85% = $57.05

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

Bulk bill incentive

Mastoids or petrous temporal bones (R)

Fee: $67.10 Benefit: 75% = $50.35 85% = $57.05

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

Bulk bill incentive

Sinuses or facial bones – orbit, maxilla or malar, any or all (R)

Fee: $49.25 Benefit: 75% = $36.95 85% = $41.90

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

Bulk bill incentive

Mandible, not by orthopantomography technique (R)

Fee: $49.05 Benefit: 75% = $36.80 85% = $41.70

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

Bulk bill incentive

Salivary calculus (R)

Fee: $49.05 Benefit: 75% = $36.80 85% = $41.70

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

Bulk bill incentive

Nose (R)

Fee: $49.05 Benefit: 75% = $36.80 85% = $41.70

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

Bulk bill incentive

Eye (R)

Fee: $49.05 Benefit: 75% = $36.80 85% = $41.70

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

Bulk bill incentive

Temporo mandibular joints (R)

Fee: $51.65 Benefit: 75% = $38.75 85% = $43.95

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

Bulk bill incentive

Teeth—single area (R)

Fee: $34.25 Benefit: 75% = $25.70 85% = $29.15

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

Bulk bill incentive

Teeth - full mouth (R)

Fee: $81.40 Benefit: 75% = $61.05 85% = $69.20

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

Bulk bill incentive

Palato pharyngeal studies with fluoroscopic screening (R)

Fee: $67.10 Benefit: 75% = $50.35 85% = $57.05

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

Bulk bill incentive

Palato pharyngeal studies without fluoroscopic screening (R)

Fee: $51.65 Benefit: 75% = $38.75 85% = $43.95

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

Bulk bill incentive

Larynx, lateral airways and soft tissues of the neck, not being a service associated with a service to which item 57939 or 57942 applies (R)

Fee: $45.15 Benefit: 75% = $33.90 85% = $38.40

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

Bulk bill incentive

Orthopantomography for diagnosis or management (or both) of trauma, infection, tumour or a congenital or surgical condition of the teeth or maxillofacial region (R)

Fee: $49.35 Benefit: 75% = $37.05 85% = $41.95

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

Bulk bill incentive

Orthopantomography for diagnosis or management (or both) of any of the following conditions, if the signs and symptoms of the condition is present:
(a) impacted teeth;
(b) caries;
(c) periodontal pathology;
(d) periapical pathology (R)

Fee: $49.35 Benefit: 75% = $37.05 85% = $41.95

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

Bulk bill incentive

Orthopantomography for diagnosis or management (or both) of missing or crowded teeth, or developmental anomalies of the teeth or jaws (R)

Fee: $49.35 Benefit: 75% = $37.05 85% = $41.95

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

Bulk bill incentive

Orthopantomography for diagnosis or management (or both) of temporo mandibular joint arthroses or dysfunction (R)

Fee: $49.35 Benefit: 75% = $37.05 85% = $41.95

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

Bulk bill incentive

Bone age study (R)

Fee: $41.70 Benefit: 75% = $31.30 85% = $35.45

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

Bulk bill incentive

Skeletal survey (R)

Fee: $93.00 Benefit: 75% = $69.75 85% = $79.05

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

Bulk bill incentive

Chest (lung fields) by direct radiography (NR)

Fee: $36.80 Benefit: 75% = $27.60 85% = $31.30

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

Bulk bill incentive

Chest (lung fields) by direct radiography (R)

Fee: $49.05 Benefit: 75% = $36.80 85% = $41.70

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

Bulk bill incentive

Chest (lung fields) by direct radiography with fluoroscopic screening (R)

Fee: $63.20 Benefit: 75% = $47.40 85% = $53.75

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

Bulk bill incentive

Thoracic inlet or trachea (R)

Fee: $41.35 Benefit: 75% = $31.05 85% = $35.15

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

Bulk bill incentive

Left ribs, right ribs or sternum (R)

Fee: $45.15 Benefit: 75% = $33.90 85% = $38.40

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

Bulk bill incentive

Left and right ribs, left ribs and sternum, or right ribs and sternum (R)

Fee: $58.80 Benefit: 75% = $44.10 85% = $50.00

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

Bulk bill incentive

Left ribs, right ribs and sternum (R)

Fee: $72.25 Benefit: 75% = $54.20 85% = $61.45

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

Bulk bill incentive

Localisation of foreign body, if provided in conjunction with a service described in Subgroups 1 to 12 of Group I3 (R)

Fee: $22.15 Benefit: 75% = $16.65 85% = $18.85

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

Bulk bill incentive

MRA—if the request for the scan specifically identifies the clinical indication for the scan—scan of cardiovascular system for vascular abnormality in a patient with a previous anaphylactic reaction to an iodinated contrast medium (R) (Contrast)

(Anaes.)

Fee: $409.65 Benefit: 75% = $307.25 85% = $348.25

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

Bulk bill incentive

MRA—if the request for the scan specifically identifies the clinical indication for the scan—scan of cardiovascular system for obstruction of the superior vena cava, inferior vena cava or a major pelvic vein (R) (Contrast)

(Anaes.)

Fee: $409.65 Benefit: 75% = $307.25 85% = $348.25

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

Bulk bill incentive

MRI—scan of head (including MRA, if performed) for acoustic neuroma (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $341.40 Benefit: 75% = $256.05 85% = $290.20

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

Bulk bill incentive

MRI—scan of head (including MRA, if performed) for pituitary tumour (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $364.15 Benefit: 75% = $273.15 85% = $309.55

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

Bulk bill incentive

MRI—scan of head (including MRA, if performed) for toxic or metabolic or ischaemic encephalopathy (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $409.65 Benefit: 75% = $307.25 85% = $348.25

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

Bulk bill incentive

MRI—scan of head (including MRA, if performed) for demyelinating disease of the brain (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $409.65 Benefit: 75% = $307.25 85% = $348.25

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

Bulk bill incentive

MRI—scan of head (including MRA, if performed) for congenital malformation of the brain or meninges (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $409.65 Benefit: 75% = $307.25 85% = $348.25

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

Bulk bill incentive

MRI—scan of head (including MRA, if performed) for venous sinus thrombosis (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $409.65 Benefit: 75% = $307.25 85% = $348.25

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

Bulk bill incentive

MRI—scan of head (including MRA, if performed) for head trauma (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $409.65 Benefit: 75% = $307.25 85% = $348.25

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

Bulk bill incentive

MRI—scan of head (including MRA, if performed) for epilepsy (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $409.65 Benefit: 75% = $307.25 85% = $348.25

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

Bulk bill incentive

MRI—scan of head (including MRA, if performed) for stroke (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $409.65 Benefit: 75% = $307.25 85% = $348.25

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

Bulk bill incentive

MRI—scan of head (including MRA, if performed) for carotid or vertebral artery dissection (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $409.65 Benefit: 75% = $307.25 85% = $348.25

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

Bulk bill incentive

MRI—scan of head (including MRA, if performed) for intracranial aneurysm (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $409.65 Benefit: 75% = $307.25 85% = $348.25

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

Bulk bill incentive

MRI—scan of head (including MRA, if performed) for intracranial arteriovenous malformation (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $409.65 Benefit: 75% = $307.25 85% = $348.25

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

Bulk bill incentive

A diagnostic imaging service to which an item in this table (other than this item or item 64991, 64992, 64993, 64994 or 64995) applies if:

(a)    the service is an unreferred service; and

(b)    the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder;         and

(c)    the person is not an admitted patient of a hospital; and

(d)    the service is bulk-billed in respect of the fees for:

    (i)    this item; and

    (ii)    the other item in this table applying to the service

Fee: $7.30 Benefit: 85% = $6.25

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

Bulk bill incentive

A diagnostic imaging service to which an item in this table (other than this item or item 64990, 64992, 64993, 64994 or 64995) applies if:

(a)    the service is an unreferred service; and

(b)    the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder; and

(c)    the person is not an admitted patient of a hospital; and

(d)    the service is bulk-billed in respect of the fees for:

    (i)    this item; and

    (ii)    the other item in this table applying to the service; and

(e) the service is provided at, or from, a practice location in a Modified Monash 2 area

Fee: $11.05 Benefit: 85% = $9.40

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

Bulk bill incentive

Computed tomography—scan of brain and chest with or without scans of upper abdomen without intravenous contrast medium, not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (Anaes.)

Fee: $485.55 Benefit: 75% = $364.20 85% = $412.75

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

Bulk bill incentive

Computed tomography—scan of brain and chest with or without scans of upper abdomen with intravenous contrast medium and with any scans of brain and chest and upper abdomen before intravenous contrast injection, when performed, not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (Anaes.)

Fee: $590.75 Benefit: 75% = $443.10 85% = $502.85

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

Bulk bill incentive

Whole body FDG PET study, performed for evaluation of a solitary pulmonary nodule where the lesion is considered unsuitable for transthoracic fine needle aspiration biopsy, or for which an attempt at pathological characterisation has failed.(R)

Fee: $953.00 Benefit: 75% = $714.75 85% = $865.10

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

Bulk bill incentive

Whole body FDG PET study, performed for the staging of locally advanced (Stage III) breast cancer, for a patient who is considered suitable for active therapy (R)

(Anaes.)

Fee: $953.00 Benefit: 75% = $714.75 85% = $865.10

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

Bulk bill incentive

Whole body FDG PET study, performed for the evaluation of suspected metastatic or suspected locally or regionally recurrent breast carcinoma, for a patient who is considered suitable for active therapy (R)

(Anaes.)

Fee: $953.00 Benefit: 75% = $714.75 85% = $865.10

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

Bulk bill incentive

Whole body FDG PET study, performed for the staging of proven non-small cell lung cancer, where curative surgery or radiotherapy is planned (R)

Fee: $953.00 Benefit: 75% = $714.75 85% = $865.10

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

Bulk bill incentive

Whole body FDG PET study, following initial therapy, for the evaluation of suspected residual, metastatic or recurrent colorectal carcinoma in patients considered suitable for active therapy (R)

Fee: $953.00 Benefit: 75% = $714.75 85% = $865.10

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

Bulk bill incentive

Whole body FDG PET study, following initial therapy, performed for the evaluation of suspected metastatic or recurrent malignant melanoma in patients considered suitable for active therapy (R)

Fee: $999.00 Benefit: 75% = $749.25 85% = $911.10

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

Bulk bill incentive

FDG PET study of the brain, performed for the evaluation of refractory epilepsy which is being evaluated for surgery (R)

Fee: $918.00 Benefit: 75% = $688.50 85% = $830.10

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

Bulk bill incentive

Whole body FDG PET study, following initial therapy, performed for the evaluation of suspected residual, metastatic or recurrent ovarian carcinoma in patients considered suitable for active therapy. (R)

Fee: $953.00 Benefit: 75% = $714.75 85% = $865.10

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

Bulk bill incentive

Whole body FDG PET study for the initial staging of newly diagnosed or previously untreated Hodgkin or non-Hodgkin lymphoma (R)

Fee: $953.00 Benefit: 75% = $714.75 85% = $865.10

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

Bulk bill incentive

Whole body FDG PET study to assess response to first line therapy either during treatment or within three months of completing definitive first line treatment for Hodgkin or non-Hodgkin lymphoma (R)

Fee: $953.00 Benefit: 75% = $714.75 85% = $865.10

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

Bulk bill incentive

Whole body FDG PET study for restaging following confirmation of recurrence of Hodgkin or non-Hodgkin lymphoma (R)

Fee: $953.00 Benefit: 75% = $714.75 85% = $865.10

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

Bulk bill incentive

Whole body FDG PET study to assess response to second-line chemotherapy if haemopoietic stem cell transplantation is being considered for Hodgkin or non-Hodgkin lymphoma (R)

Fee: $953.00 Benefit: 75% = $714.75 85% = $865.10

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

Bulk bill incentive

Whole body ⁶⁸Ga DOTA peptide PET study, if:
(a) a gastro entero pancreatic neuroendocrine tumour is suspected on the basis of biochemical evidence with negative or equivocal conventional imaging; or
(b) both:
(i) a surgically amenable gastro entero pancreatic neuroendocrine tumour has been identified on the basis of conventional techniques; and
(ii) the study is for excluding additional disease sites (R)

Fee: $953.00 Benefit: 75% = $714.75 85% = $865.10

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

Bulk bill incentive

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.1.2

Initial real time transthoracic echocardiographic examination of the heart with real time colour flow mapping from at least 3 acoustic windows, with recordings on digital media, if the service:

(a) is for the investigation of any of the following:

(i) symptoms or signs of cardiac failure;

(ii) suspected or known ventricular hypertrophy or dysfunction;

(iii) pulmonary hypertension;

(iv) valvular, aortic, pericardial, thrombotic or embolic disease;

(v) heart tumour;

(vi) symptoms or signs of congenital heart disease;

(vii) other rare indications; and

(b) is not associated with a service to which:

(i) another item in this Subgroup applies (except items 55137, 55141, 55143, 55145 and 55146); or

(ii) an item in Subgroup 2 applies (except items 55118 and 55130); or

(iii) an item in Subgroup 3 applies

Applicable not more than once in a 24 month period (R)

Fee: $240.05 Benefit: 75% = $180.05 85% = $204.05

(See para IN.0.19, IN.1.3, IR.1.2, IR.1.3 of explanatory notes to this Category)

Bulk bill incentive

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.1.2

Repeat serial real time transthoracic echocardiographic examination of the heart with real time colour flow mapping from at least 3 acoustic windows, with recordings on digital media, if the service:

(a) is for the investigation of known valvular dysfunction; and

(b) is requested by a specialist or consultant physician; and

(c) is not associated with a service to which:

(i) another item in this Subgroup applies (except items 55137, 55141, 55143, 55145 and 55146); or

(ii) an item in Subgroup 2 applies (except items 55118 and 55130); or

(iii) an item in Subgroup 3 applies (R)

Fee: $240.05 Benefit: 75% = $180.05 85% = $204.05

(See para IN.0.19, IN.1.4, IR.1.2, IR.1.3 of explanatory notes to this Category)

Bulk bill incentive

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.1.2

Repeat serial real time transthoracic echocardiographic examination of the heart with real time colour flow mapping from at least 3 acoustic windows, with recordings on digital media, if the service:

(a) is for the investigation of known valvular dysfunction; and

(b) is requested by a medical practitioner (other than a specialist or consultant physician) at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(c) is not associated with a service to which:

(i) another item in this Subgroup applies (except items 55137, 55141, 55143, 55145 and 55146); or

(ii) an item in Subgroup 2 applies (except items 55118 and 55130); or

(iii) an item in Subgroup 3 applies (R)

Fee: $240.05 Benefit: 75% = $180.05 85% = $204.05

(See para IN.0.19, IN.1.4, IR.1.2, IR.1.3 of explanatory notes to this Category)

Bulk bill incentive

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.1.2

Repeat serial real time transthoracic echocardiographic examination of the heart with real time colour flow mapping from at least 3 acoustic windows, with recordings on digital media, if:

(a) valvular dysfunction is not the primary issue for the patient (although it may be a secondary issue); and

(b) the service is for the investigation of any of the following:

(i) symptoms or signs of cardiac failure;

(ii) suspected or known ventricular hypertrophy or dysfunction;

(iii) pulmonary hypertension;

(iv) aortic, thrombotic, embolic disease or pericardial disease (excluding isolated pericardial effusion or pericarditis);

(v) heart tumour;

(vi) structural heart disease;

(vii) other rare indications; and

(c) the service is requested by a specialist or consultant physician; and

(d) the service is not associated with a service to which:

(i) another item in this Subgroup applies (except items 55137, 55141, 55143, 55145 and 55146); or

(ii) an item in Subgroup 2 applies (except items 55118 and 55130); or

(iii) an item in Subgroup 3 applies (R)

Fee: $240.05 Benefit: 75% = $180.05 85% = $204.05

(See para IN.0.19, IN.1.5, IR.1.2, IR.1.3 of explanatory notes to this Category)

Bulk bill incentive

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.1.2

Serial real time transthoracic echocardiographic examination of the heart with real time colour flow mapping from at least 4 acoustic windows, with recordings on digital media, if the service:

(a) is for the investigation of a patient who:

(i) is under 17 years of age; or

(ii) has complex congenital heart disease; and

(b) is performed by a specialist or consultant physician practising in the speciality of cardiology; and

(c) is not associated with a service to which:

(i) another item in this Subgroup applies (except items 55137, 55141, 55143, 55145 and 55146); or

(ii) an item in Subgroup 2 applies (except items 55118 and 55130); or

(iii) an item in Subgroup 3 applies (R)

Fee: $240.05 Benefit: 75% = $180.05 85% = $204.05

(See para IN.0.19, IN.1.6, IR.1.2, IR.1.3 of explanatory notes to this Category)

Bulk bill incentive

Note: the service only applies if the patient meets one or more of the following and the requirements of Note: IR.1.2

Frequent repetition serial real time transthoracic echocardiographic examination of the heart with real time colour flow mapping from at least 3 acoustic windows, with recordings on digital media, if the service:

(a) is for the investigation of a patient who:

(i) has an isolated pericardial effusion or pericarditis; or

(ii) has a normal baseline study, and has commenced medication for non‑cardiac purposes that has cardiotoxic side effects and is a pharmaceutical benefit (within the meaning of Part VII of the National Health Act 1953) for the writing of a prescription for the supply of which under that Part an echocardiogram is required; and

(b) is not associated with a service to which:

(i) another item in this Subgroup applies (except items 55137, 55141, 55143, 55145 and 55146); or

(ii) an item in Subgroup 2 applies (except items 55118 and 55130); or

(iii) an item in Subgroup 3 applies (R)

Fee: $216.05 Benefit: 75% = $162.05 85% = $183.65

(See para IN.0.19, IN.1.7, IR.1.2, IR.1.3 of explanatory notes to this Category)

Bulk bill incentive

Note: the service only applies if the patient meets one or more of the following and the requirements of Note: IR.1.2

Repeat real time transthoracic echocardiographic examination of the heart with real time colour flow mapping from at least 3 acoustic windows, with recordings on digital media, for the investigation of rare cardiac pathologies, if the service:

(a) is requested by a specialist or consultant physician; and

(b) is not associated with a service to which:

(i) another item in this Subgroup applies (except items 55137, 55141, 55143, 55145 and 55146); or

(ii) an item in Subgroup 2 applies (except items 55118 and 55130); or

(iii) an item in Subgroup 3 applies (R)

Fee: $240.05 Benefit: 75% = $180.05 85% = $204.05

(See para IN.0.19, IN.1.8, IR.1.2, IR.1.3 of explanatory notes to this Category)

Bulk bill incentive

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.1.2

Serial real time transthoracic echocardiographic examination of the heart with real time colour flow mapping from at least 4 acoustic windows, with recordings on digital media, if the service:

(a) is for the investigation of a fetus with suspected or confirmed:

(i) complex congenital heart disease; or

(ii) functional heart disease; or

(iii) fetal cardiac arrhythmia; or

(iv) cardiac structural abnormality requiring confirmation; and

(b) is performed by a specialist or consultant physician practising in the speciality of cardiology with advanced training and expertise in fetal cardiac imaging; and

(c) is not associated with a service to which:

(i) an item in Subgroup 2 applies (except items 55118 and 55130); or

(ii) an item in Subgroup 3 applies (R)

Fee: $240.05 Benefit: 75% = $180.05 85% = $204.05

(See para IN.0.19, IN.1.9, IR.1.2, IR.1.3 of explanatory notes to this Category)

Bulk bill incentive

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.0.1 and IR.1.2

Exercise stress echocardiography focused study, other than a service associated with a service to which:

(a) item 11704, 11705, 11707, 11714, 11729 or 11730 applies; or

(b) an item in Subgroup 3 applies

Applicable not more than once in a 24 month period (R)

Fee: $427.95 Benefit: 75% = $321.00 85% = $363.80

(See para IN.0.19, IN.1.10, IR.0.1, IR.1.2, IR.1.3 of explanatory notes to this Category)

Bulk bill incentive

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.0.1, IR.1.1 and IR.1.2 

Repeat pharmacological or exercise stress echocardiography if:

(a) a service to which item 55141, 55145, 55146, or this item, applies has been performed on the patient in the previous 24 months; and

(b) the patient has symptoms of ischaemia that have evolved and are not adequately controlled with optimal medical therapy; and

(c) the service is requested by a specialist or a consultant physician; and

(d) the service is not associated with a service to which:

(i) item 11704, 11705, 11707, 11714, 11729 or 11730 applies; or

(ii) an item in Subgroup 3 applies

Applicable not more than once in a 12 month period (R)

Fee: $427.95 Benefit: 75% = $321.00 85% = $363.80

(See para IN.0.19, IN.1.10, IR.0.1, IR.1.1, IR.1.2, IR.1.3 of explanatory notes to this Category)

Bulk bill incentive

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.0.1 and IR.1.2

Pharmacological stress echocardiography, other than a service associated with a service to which:

(a) item 11704, 11705, 11707, 11714, 11729 or 11730 applies; or

(b) an item in Subgroup 3 applies

Applicable not more than once in a 24 month period (R)

Note: this item does not apply to a service provided to a patient if, in the previous 24 months, a service associated with a service to which item 55141, 55143 or 55146 applies has been provided to the patient.

Fee: $496.00 Benefit: 75% = $372.00 85% = $421.60

(See para IN.0.19, IN.1.10, IR.0.1, IR.1.2, IR.1.3 of explanatory notes to this Category)

Bulk bill incentive

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.0.1 and IR.1.2

Pharmacological stress echocardiography if:

(a) a service to which item 55141 applies has been performed on the patient in the previous 4 weeks, and the test has failed due to an inadequate heart rate response; and

(b) the service is not associated with a service to which:

(i) item 11704, 11705, 11707, 11714, 11729 or 11730 applies; or

(ii) an item in Subgroup 3 applies

Applicable not more than once in a 24 month period (R)

Note: this item does not apply to a service provided to a patient if, in the previous 24 months, a service associated with a service to which item 55143 or 55145 applies has been provided to the patient.

Fee: $496.00 Benefit: 75% = $372.00 85% = $421.60

(See para IN.0.19, IN.1.10, IR.0.1, IR.1.2, IR.1.3 of explanatory notes to this Category)

Bulk bill incentive

Plain renal only (R)

Fee: $47.90 Benefit: 75% = $35.95 85% = $40.75

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

Bulk bill incentive

Intravenous pyelography, with or without preliminary plain films and with or without tomography (R)

Fee: $164.30 Benefit: 75% = $123.25 85% = $139.70

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

Bulk bill incentive

Antegrade or retrograde pyelography with or without preliminary plain films and with preparation and contrast injection, one side (R)

Fee: $157.70 Benefit: 75% = $118.30 85% = $134.05

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

Bulk bill incentive

Retrograde cystography or retrograde urethrography with or without preliminary plain films and with preparation and contrast injection (R) 

(Anaes.)

Fee: $131.20 Benefit: 75% = $98.40 85% = $111.55

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

Bulk bill incentive

Retrograde micturating cysto urethrography, with preparation and contrast injection (R) 

(Anaes.)

Fee: $143.80 Benefit: 75% = $107.85 85% = $122.25

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

Bulk bill incentive

Plain abdominal only, not being a service associated with a service to which item 58909, 58912 or 58915 applies (NR)

Fee: $37.20 Benefit: 75% = $27.90 85% = $31.65

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

Bulk bill incentive

Plain abdominal only, not being a service associated with a service to which item 58909, 58912 or 58915 applies (R)

Fee: $49.55 Benefit: 75% = $37.20 85% = $42.15

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

Bulk bill incentive

Barium or other opaque meal of one or more of pharynx, oesophagus, stomach or duodenum, with or without preliminary plain films of pharynx, chest or duodenum, not being a service associated with a service to which item 57939, 57942 or 57945 applies (R)

Fee: $93.55 Benefit: 75% = $70.20 85% = $79.55

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

Bulk bill incentive

Barium or other opaque meal of oesophagus, stomach, duodenum and follow through to colon, with or without screening of chest and with or without preliminary plain film (R)

Fee: $114.70 Benefit: 75% = $86.05 85% = $97.50

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

Bulk bill incentive

Barium or other opaque meal, small bowel series only, with or without preliminary plain film (R)

Fee: $82.15 Benefit: 75% = $61.65 85% = $69.85

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

Bulk bill incentive

Small bowel enema, barium or other opaque study of the small bowel, including duodenal intubation, with or without preliminary plain films, not being a service associated with a service to which item 30488 applies (R)

(Anaes.)

Fee: $144.10 Benefit: 75% = $108.10 85% = $122.50

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

Bulk bill incentive

Opaque enema, with or without air contrast study and with or without preliminary plain films (R)

Fee: $140.75 Benefit: 75% = $105.60 85% = $119.65

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

Bulk bill incentive

Cholegraphy direct, with or without preliminary plain films and with preparation and contrast injection, not being a service associated with a service to which item 30439 applies (R)

Fee: $79.55 Benefit: 75% = $59.70 85% = $67.65

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

Bulk bill incentive

Cholegraphy, percutaneous transhepatic, with or without preliminary plain films and with preparation and contrast injection (R)

Fee: $213.95 Benefit: 75% = $160.50 85% = $181.90

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

Bulk bill incentive

Cholegraphy, drip infusion, with or without preliminary plain films, with preparation and contrast injection and with or without tomography (R)

Fee: $203.90 Benefit: 75% = $152.95 85% = $173.35

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

Bulk bill incentive

Defaecogram (R)

Fee: $144.95 Benefit: 75% = $108.75 85% = $123.25

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

Bulk bill incentive

MRI—scan of cervical spine and brachial plexus for tumour (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $500.70 Benefit: 75% = $375.55 85% = $425.60

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

Bulk bill incentive

MRI—scan of cervical spine and brachial plexus for trauma (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $500.70 Benefit: 75% = $375.55 85% = $425.60

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

Bulk bill incentive

MRI—scan of cervical spine and brachial plexus for cervical radiculopathy (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $500.70 Benefit: 75% = $375.55 85% = $425.60

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

Bulk bill incentive

MRI—scan of cervical spine and brachial plexus for previous surgery (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $500.70 Benefit: 75% = $375.55 85% = $425.60

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

Bulk bill incentive

MRI—scan of person under the age of 16 for pelvic or abdominal mass (R) (Contrast)

(Anaes.)

Fee: $409.65 Benefit: 75% = $307.25 85% = $348.25

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

Bulk bill incentive

MRI—scan of person under the age of 16 for mediastinal mass (R) (Contrast)

(Anaes.)

Fee: $409.65 Benefit: 75% = $307.25 85% = $348.25

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

Bulk bill incentive

MRI—scan of person under the age of 16 for congenital uterine or anorectal abnormality (R) (Contrast)

(Anaes.)

Fee: $409.65 Benefit: 75% = $307.25 85% = $348.25

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

Bulk bill incentive

MRI—scan of pancreas and biliary tree for suspected biliary or pancreatic pathology (R) 

(Anaes.)

Fee: $409.65 Benefit: 75% = $307.25 85% = $348.25

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

Bulk bill incentive

MRI – multiphase scans of liver (including delayed imaging, if performed) with a contrast agent, for characterisation or intervention planning, if:
(a) the patient has:

(i) known colorectal carcinoma; and
(ii) known, suspected, or possible liver metastasis; and
(b) computed tomography, or ultrasound imaging, has identified a mass lesion in patient’s liver.
For any particular patient—applicable not more than once in a 12 month period (R) (Contrast)

(Anaes.)

Fee: $558.80 Benefit: 75% = $419.10 85% = $475.00

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

Bulk bill incentive

MRI – multiphase scans of the liver (including delayed imaging, if performed) with a contrast agent, for diagnosis or staging, if:

(a) the patient has:
(i) known or suspected hepatocellular carcinoma; and
(ii) chronic liver disease that has been confirmed by a specialist or consultant physician; and
(b) the patient’s liver function has been identified as Child Pugh class A or B; and
(c) the patient has an identified hepatic lesion over 10 mm in diameter.
For any particular patient—applicable not more than once in a 12 month period (R) (Contrast)

(Anaes.)

Fee: $558.80 Benefit: 75% = $419.10 85% = $475.00

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

Bulk bill incentive

MRI—scan of one region or 2 contiguous regions of the spine for infection (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $364.15 Benefit: 75% = $273.15 85% = $309.55

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

Bulk bill incentive

MRI—scan of one region or 2 contiguous regions of the spine for tumour (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $364.15 Benefit: 75% = $273.15 85% = $309.55

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

Bulk bill incentive

MRI—scan of one region or 2 contiguous regions of the spine for demyelinating disease (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $364.15 Benefit: 75% = $273.15 85% = $309.55

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

Bulk bill incentive

MRI—scan of one region or 2 contiguous regions of the spine for congenital malformation of the spinal cord or the cauda equina or the meninges (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $364.15 Benefit: 75% = $273.15 85% = $309.55

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

Bulk bill incentive

MRI—scan of one region or 2 contiguous regions of the spine for myelopathy (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $364.15 Benefit: 75% = $273.15 85% = $309.55

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

Bulk bill incentive

MRI—scan of one region or 2 contiguous regions of the spine for syrinx (congenital or acquired) (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $364.15 Benefit: 75% = $273.15 85% = $309.55

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

Bulk bill incentive

MRI—scan of one region or 2 contiguous regions of the spine for cervical radiculopathy (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $364.15 Benefit: 75% = $273.15 85% = $309.55

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

Bulk bill incentive

MRI—scan of one region or 2 contiguous regions of the spine for sciatica (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $364.15 Benefit: 75% = $273.15 85% = $309.55

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

Bulk bill incentive

MRI—scan of one region or 2 contiguous regions of the spine for spinal canal stenosis (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $364.15 Benefit: 75% = $273.15 85% = $309.55

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

Bulk bill incentive

MRI—scan of one region or 2 contiguous regions of the spine for previous spinal surgery (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $364.15 Benefit: 75% = $273.15 85% = $309.55

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

Bulk bill incentive

MRI—scan of one region or 2 contiguous regions of the spine for trauma (R) (Anaes.)

(Anaes.)

Fee: $364.15 Benefit: 75% = $273.15 85% = $309.55

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

Bulk bill incentive

Pelvis or abdomen, pregnancy related or pregnancy complication, ultrasound scan of, by any or all approaches, for determining the gestation, location, viability or number of foetuses, if the dating of the pregnancy (as confirmed by ultrasound) is less than 12 weeks of gestation (R)

Fee: $62.45 Benefit: 75% = $46.85 85% = $53.10

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

Bulk bill incentive

Pelvis or abdomen, pregnancy related or pregnancy complication, ultrasound scan of, by any or all approaches, for determining the gestation, location, viability or number of foetuses, if the dating of the pregnancy (as confirmed by ultrasound) is less than 12 weeks of gestation (NR)

Fee: $36.35 Benefit: 75% = $27.30 85% = $30.90

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

Bulk bill incentive

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, for determining the structure, gestation, location, viability or number of foetuses, if the dating of the pregnancy (as confirmed by ultrasound) is 12 to 16 weeks of gestation (R)

Fee: $72.85 Benefit: 75% = $54.65 85% = $61.95

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

Bulk bill incentive

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, for determining the structure, gestation, location, viability or number of foetuses, if the dating of the pregnancy (as confirmed by ultrasound) is 12 to 16 weeks of gestation (NR)

Fee: $36.35 Benefit: 75% = $27.30 85% = $30.90

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

Bulk bill incentive

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:
(a) the dating for the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and
(b) the service is not performed in the same pregnancy as item 55709 (R)

Fee: $104.05 Benefit: 75% = $78.05 85% = $88.45

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

Bulk bill incentive

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:
(a) the pregnancy (as confirmed by ultrasound) is dated by a fetal crown rump length of 45 to 84 mm; and
(b) nuchal translucency measurement is performed to assess the risk of fetal abnormality; and
(c) the service is not performed with item 55700, 55703, 55704 or 55705 on the same patient within 24 hours (R)

Fee: $72.85 Benefit: 75% = $54.65 85% = $61.95

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

Bulk bill incentive

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:
(a) the pregnancy (as confirmed by ultrasound) is dated by a crown rump length of 45 to 84 mm; and
(b) nuchal translucency measurement is performed to assess the risk of fetal abnormality; and
(c) the service is not performed with item 55700, 55703, 55704 or 55705, on the same patient within 24 hours (NR)

Fee: $36.35 Benefit: 75% = $27.30 85% = $30.90

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

Bulk bill incentive

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:
(a) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and
(b the service is not performed in the same pregnancy as item 55706 (NR)

Fee: $39.50 Benefit: 75% = $29.65 85% = $33.60

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

Bulk bill incentive

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:
(a) the service is requested by a medical practitioner who:
(i) is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; or
(ii) has a Diploma of Obstetrics; or
(iii) has a qualification recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists as being equivalent to a Diploma of Obstetrics; or
(iv) has obstetric privileges at a non metropolitan hospital; and
(b) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and
(c) further examination is clinically indicated after performance, in the same pregnancy, of a scan mentioned in item 55706 or 55709 (R)

Fee: $119.65 Benefit: 75% = $89.75 85% = $101.75

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

Bulk bill incentive

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, performed by or on behalf of a medical practitioner who is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, if:
(a) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and
(b) further examination is clinically indicated after performance, in the same pregnancy, of a scan mentioned in item 55706 or 55709 (NR)

Fee: $41.60 Benefit: 75% = $31.20 85% = $35.40

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

Bulk bill incentive

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:
(a) the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and
(b) the service is not performed in the same pregnancy as item 55723 (R)

Fee: $104.05 Benefit: 75% = $78.05 85% = $88.45

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

Bulk bill incentive

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:
(a) the service is requested by a medical practitioner who:
(i) is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; or
(ii) has a Diploma of Obstetrics; or
(iii) has a qualification recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists as being equivalent to a Diploma of Obstetrics; or
(iv) has obstetric privileges at a non metropolitan hospital; and
(b) the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and
(d) further examination is clinically indicated in the same pregnancy to which item 55718 or 55723 applies (R)