Medicare Benefits Schedule - Note IN.0.19

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Category 5 - DIAGNOSTIC IMAGING SERVICES

IN.0.19

Bulk Billing Incentive

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 55740 55741 55742 55743 55757 55758 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 61313 61314 61321 61324 61325 61328 61329 61340 61345 61348 61349 61353 61356 61357 61360 61361 61364 61368 61372 61373 61376 61381 61383 61384 61386 61387 61389 61390 61393 61394 61397 61398 61402 61406 61409 61410 61413 61414 61421 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 61563 61564 61565 61612 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 63563 64990 64991


Related Items

Category 5 - DIAGNOSTIC IMAGING SERVICES

59700

59700 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Discography, each disc, with or without preliminary plain films and with preparation and contrast injection (R) (Anaes.)

(Anaes.)

Fee: $100.50 Benefit: 75% = $75.40 85% = $85.45

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

59703

59703 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Dacryocystography, one side, with or without preliminary plain film and with preparation and contrast injection (R)

Fee: $79.00 Benefit: 75% = $59.25 85% = $67.15

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

59712

59712 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Hysterosalpingography, with or without preliminary plain films and with preparation and contrast injection (R)(Anaes.)

(Anaes.)

Fee: $118.30 Benefit: 75% = $88.75 85% = $100.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

59715

59715 - Additional Information

Item Start Date:
01-Nov-1997
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Bronchography, one side, with or without preliminary plain films and with preparation and contrast injection, on a person under 16 years of age (R) (Anaes.)

(Anaes.)

Fee: $149.35 Benefit: 75% = $112.05 85% = $126.95

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

59718

59718 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Phlebography, one side, with or without preliminary plain films and with preparation and contrast injection (R) (Anaes.)

(Anaes.)

Fee: $140.10 Benefit: 75% = $105.10 85% = $119.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

59724

59724 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Myelography, one or more regions, with or without preliminary plain films and with preparation and contrast injection, not being a service associated with a service to which item 56219 applies (R)(Anaes.)

(Anaes.)

Fee: $235.60 Benefit: 75% = $176.70 85% = $200.30

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

59733

59733 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Sialography, one side, with preparation and contrast injection, not being a service associated with a service to which item 57918 applies (R)

Fee: $112.05 Benefit: 75% = $84.05 85% = $95.25

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

59739

59739 - Additional Information

Item Start Date:
01-Nov-1997
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Sinogram or fistulogram, one or more regions, with or without preliminary plain films and with preparation and contrast injection (R)

Fee: $76.70 Benefit: 75% = $57.55 85% = $65.20

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

59751

59751 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Arthrography, each joint, excluding the facet (zygapophyseal) joints of the spine, single or double contrast study, with or without preliminary plain films and with preparation and contrast injection (R)

Fee: $144.80 Benefit: 75% = $108.60 85% = $123.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

59754

59754 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Lymphangiography, one or both sides, with preliminary plain films and follow-up radiography and with preparation and contrast injection (R)

Fee: $228.25 Benefit: 75% = $171.20 85% = $194.05

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

59763

59763 - Additional Information

Item Start Date:
01-Nov-1996
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Air insufflation during video—fluoroscopic imaging including associated consultation (R)

Fee: $139.30 Benefit: 75% = $104.50 85% = $118.45

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

60500

60500 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

60503

60503 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

60506

60506 - Additional Information

Item Start Date:
31-Oct-1992
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

60509

60509 - Additional Information

Item Start Date:
31-Oct-1992
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63001

63001 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

MRI—scan of head (including MRA, if performed) for tumour 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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63004

63004 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

MRI—scan of head (including MRA, if performed) for inflammation of 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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63007

63007 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

MRI—scan of head (including MRA, if performed) for skull base or orbital tumour (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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63010

63010 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

MRI—scan of head (including MRA, if performed) for stereotactic scan of brain, with fiducials in place, for the sole purpose of allowing planning for stereotactic neurosurgery (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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63322

63322 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63325

63325 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63328

63328 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63331

63331 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63334

63334 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63337

63337 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63340

63340 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63440

63440 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63443

63443 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63446

63446 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63482

63482 - Additional Information

Item Start Date:
01-Jan-2006
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

 

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63545

63545 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-Nov-2022
Schedule Fee Updated:
01-Jul-2022

MRI—multiphase scans of liver (including delayed imaging, if performed) with a contrast agent, for staging where surgical resection or interventional techniques are under consideration to treat any liver metastases detected, if:

(a) the patient has a confirmed extra‑hepatic primary malignancy (other than hepatocellular carcinoma), with no persistent extra‑hepatic disease; and

(b) computed tomography of the patient’s liver is negative or inconclusive for metastatic disease; and

(c) the identification of liver metastases would change the patient’s treatment planning

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63546

63546 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63125

63125 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

MRI—scan of head and cervical spine (including MRA, if performed) for demyelinating disease of the central nervous system (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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63128

63128 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

MRI—scan of head and cervical spine (including MRA, if performed) for congenital malformation of the central nervous system or meninges (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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63131

63131 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

MRI—scan of head and cervical spine (including MRA, if performed) for syrinx (congenital or acquired) (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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63161

63161 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63164

63164 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63167

63167 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63170

63170 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63173

63173 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63176

63176 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63179

63179 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63182

63182 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63185

63185 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

56401

56401 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

56407

56407 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

56409

56409 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

56412

56412 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63271

63271 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63274

63274 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63277

63277 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63280

63280 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63385

63385 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63388

63388 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63391

63391 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63395

63395 - Additional Information

Item Start Date:
01-May-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

 

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% = $775.70

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63397

63397 - Additional Information

Item Start Date:
01-May-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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% = $775.70

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63461

63461 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63464

63464 - Additional Information

Item Start Date:
01-Feb-2009
Description Updated:
01-Nov-2022
Schedule Fee Updated:
01-Jul-2022

MRI scan of both breasts for the detection of cancer in a patient, if:

(a) a dedicated breast coil is used; and

(b) the request for the scan identifies that the patient is asymptomatic and is younger than 60 years of age; and

(c) the request for the scan identifies that the patient is at high risk of developing breast cancer due to one or more of the following:

(i) genetic testing has identified the presence of a high risk breast cancer gene mutation in the patient or in a first degree relative of the patient;

(ii) both:

(A) one of the patient’s first or second degree relatives was diagnosed with breast cancer at age 45 years or younger; and

(B) another first or second degree relative on the same side of the patient’s family was diagnosed with bone or soft tissue sarcoma at age 45 years or younger;

(iii) the patient has a personal history of breast cancer before the age of 50 years;

(iv) the patient has a personal history of mantle radiation therapy;

(v) the patient has a lifetime risk estimation greater than 30% or a 10 year absolute risk estimation greater than 5% using a clinically relevant risk evaluation algorithm; and

(d) the service is not performed in conjunction with item 55076 or 55079

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

(Anaes.)

Fee: $701.05 Benefit: 75% = $525.80 85% = $607.85

(See para IN.0.18, IN.0.19 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63467

63467 - Additional Information

Item Start Date:
01-Feb-2009
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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% = $607.85

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63531

63531 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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% = $607.85

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63533

63533 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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% = $607.85

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63541

63541 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-Nov-2021
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63543

63543 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-Nov-2021
Schedule Fee Updated:
01-Jul-2022

 

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63547

63547 - Additional Information

Item Start Date:
01-May-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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% = $607.85

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63491

63491 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

NOTE: Benefits in Subgroup 22 are only payable for modifying items where claimed simultaneously with MRI services. Modifiers for sedation and anaesthesia may not be claimed for the same service.

 

MRI or MRA service to which an item in this Group (other than an item in this Subgroup) applies if:


(a) the service is performed on a person in accordance with clause 2.5.1; and
(b) the item for the service includes in its description ‘(Contrast)’; and
(c) the service is performed using a contrast agent

Fee: $45.50 Benefit: 75% = $34.15 85% = $38.70

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63494

63494 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

MRI or MRA service to which an item in this Group (other than an item in this Subgroup) applies if:


(a) the service is performed on a person in accordance with clause 2.5.1; and
(b) the service is performed using intravenous or intra muscular sedation

Fee: $45.50 Benefit: 75% = $34.15 85% = $38.70

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63496

63496 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

NOTE: Benefits in Subgroup 22 are only payable for modifying items where claimed simultaneously with MRI services. Modifiers for sedation and anaesthesia may not be claimed for the same service. 

MRI service to which item 63545 or 63546 applies if:


(a) the service is performed on a person under the supervision of an eligible provider; and
(b) the service is performed using an hepatobiliary specific contrast agent

Fee: $254.00 Benefit: 75% = $190.50 85% = $215.90

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63497

63497 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

MRI or MRA service to which an item in this Group (other than an item in this Subgroup) applies if:


(a) the service is performed on a person in accordance with clause 2.5.1; and
(b) the service is performed under anaesthetic in the presence of a medical practitioner who is qualified to perform an anaesthetic

Fee: $159.30 Benefit: 75% = $119.50 85% = $135.45

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63498

63498 - Additional Information

Item Start Date:
12-Mar-2012
Description Updated:
12-Mar-2012
Schedule Fee Updated:
01-Jul-2022

MRI service to which item 63501, 63502, 63504 or 63505 applies if:

(a) the service is performed in accordance with the determination; and

(b) the service is performed on a person using intravenous or intra muscular sedation

Fee: $45.50 Benefit: 75% = $34.15 85% = $38.70

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63499

63499 - Additional Information

Item Start Date:
12-Mar-2012
Description Updated:
12-Mar-2012
Schedule Fee Updated:
01-Jul-2022

MRI service to which item 63501, 63502, 63504 or 63505 applies if:

(a) the service is performed in accordance with the determination; and

(b) the service is performed on a person under anaesthetic in the presence of a medical practitioner who is qualified to perform an anaesthetic.

Fee: $159.30 Benefit: 75% = $119.50 85% = $135.45

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63111

63111 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

MRI—scan of head and cervical spine (including MRA, if performed) for tumour of the central nervous system or meninges (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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63114

63114 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

MRI—scan of head and cervical spine (including MRA, if performed) for inflammation of the central nervous system or meninges (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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55812

55812 - Additional Information

Item Start Date:
01-Nov-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Chest or abdominal wall, one or more areas, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55070, 55073, 55076 or 55079 (R)

Fee: $113.55 Benefit: 75% = $85.20 85% = $96.55

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55814

55814 - Additional Information

Item Start Date:
01-Nov-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Chest or abdominal wall, one or more areas, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55070, 55073, 55076 or 55079 (NR)

Fee: $39.35 Benefit: 75% = $29.55 85% = $33.45

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55844

55844 - Additional Information

Item Start Date:
01-Nov-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Assessment of a mass associated with the skin or subcutaneous structures, not being a part of the musculoskeletal system, one or more areas, ultrasound scan of (R)

Fee: $90.90 Benefit: 75% = $68.20 85% = $77.30

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55846

55846 - Additional Information

Item Start Date:
01-Nov-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Assessment of a mass associated with the skin or subcutaneous structures, not being a part of the musculoskeletal system, one or more areas, ultrasound scan of (NR)

Fee: $39.35 Benefit: 75% = $29.55 85% = $33.45

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55848

55848 - Additional Information

Item Start Date:
01-Nov-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Musculoskeletal ultrasound, in conjunction with a surgical procedure using interventional techniques, not being a service associated with a service to which any other item in this group applies, and not performed in conjunction with a service mentioned in item 55054 (R)

Fee: $142.15 Benefit: 75% = $106.65 85% = $120.85

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55850

55850 - Additional Information

Item Start Date:
01-Nov-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Musculoskeletal ultrasound, in conjunction with a surgical procedure using interventional techniques, inclusive of a diagnostic musculoskeletal ultrasound service, if:
(a) the medical practitioner or nurse practitioner has indicated on a request for a musculoskeletal ultrasound that an ultrasound guided intervention be performed if clinically indicated; and
(b) the service is not performed in conjunction with a service mentioned in item 55054 or any other item in this Subgroup (R)

Fee: $187.65 Benefit: 75% = $140.75 85% = $159.55

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55852

55852 - Additional Information

Item Start Date:
01-May-2001
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Paediatric spine, spinal cord and overlying subcutaneous tissues, ultrasound scan of (R)

Fee: $113.55 Benefit: 75% = $85.20 85% = $96.55

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55854

55854 - Additional Information

Item Start Date:
01-May-2001
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Paediatric spine, spinal cord and overlying subcutaneous tissues, ultrasound scan of (NR)

Fee: $39.35 Benefit: 75% = $29.55 85% = $33.45

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55856

55856 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Hand or wrist or both, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55858 (R)

Fee: $113.55 Benefit: 75% = $85.20 85% = $96.55

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55857

55857 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Hand or wrist, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with item 55859 (NR)

Fee: $39.35 Benefit: 75% = $29.55 85% = $33.45

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55858

55858 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Hand or wrist, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55856 (R)

Fee: $126.00 Benefit: 75% = $94.50 85% = $107.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55859

55859 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Hand or wrist, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55857 (NR)



Fee: $43.75 Benefit: 75% = $32.85 85% = $37.20

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55860

55860 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Forearm or elbow, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55862 (R)

Fee: $113.55 Benefit: 75% = $85.20 85% = $96.55

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55861

55861 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Forearm or elbow, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55863 (NR)

Fee: $39.35 Benefit: 75% = $29.55 85% = $33.45

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55862

55862 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Forearm or elbow, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55860 (R)

Fee: $126.00 Benefit: 75% = $94.50 85% = $107.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55863

55863 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Forearm or elbow, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with item 55861 (NR)


Fee: $43.75 Benefit: 75% = $32.85 85% = $37.20

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55864

55864 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Shoulder or upper arm, or both, left or right, ultrasound scan of, if:
(a) the service is used for the assessment of one or more of the following suspected or known conditions:
(i) an injury to a muscle, tendon or muscle/tendon junction;
(ii) rotator cuff tear, calcification or tendinosis (biceps, subscapular, supraspinatus or infraspinatus);
(iii) biceps subluxation;
(iv) capsulitis and bursitis;
(v) a mass, including a ganglion;
(vi) an occult fracture;
(vii) acromioclavicular joint pathology; and
(b) the service is not performed in conjunction with a service mentioned in item 55866 (R)

Fee: $113.55 Benefit: 75% = $85.20 85% = $96.55

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55865

55865 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Shoulder or upper arm, or both, left or right, ultrasound scan of, if:
(a) the service is used for the assessment of one or more of the following suspected or known conditions:
(i) an injury to a muscle, tendon or muscle/tendon junction;
(ii) rotator cuff tear, calcification or tendinosis (biceps, subscapular, supraspinatus or infraspinatus);
(iii) biceps subluxation;
(iv) capsulitis and bursitis;
(v) a mass, including a ganglion;
(vi) an occult fracture;
(vii) acromioclavicular joint pathology; and
(b) the service is not performed in conjunction with a service mentioned in item 55867 (NR)

Fee: $39.35 Benefit: 75% = $29.55 85% = $33.45

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55866

55866 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Shoulder or upper arm, or both, left and right, ultrasound scan of, if:
(a) the service is used for the assessment of one or more of the following suspected or known conditions:
(i) an injury to a muscle, tendon or muscle/tendon junction;
(ii) rotator cuff tear, calcification or tendinosis (biceps, subscapular, supraspinatus or infraspinatus);
(iii) biceps subluxation;
(iv) capsulitis and bursitis;
(v) a mass, including a ganglion;
(vi) an occult fracture;
(vii) acromioclavicular joint pathology; and
(b) the service is not performed in conjunction with a service mentioned in item 55864 (R)

Fee: $126.00 Benefit: 75% = $94.50 85% = $107.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55867

55867 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Shoulder or upper arm, or both, left and right, ultrasound scan of, if:
(a) the service is used for the assessment of one or more of the following suspected or known conditions:
(i) an injury to a muscle, tendon or muscle/tendon junction;
(ii) rotator cuff tear, calcification or tendinosis (biceps, subscapular, supraspinatus or infraspinatus);
(iii) biceps subluxation;
(iv) capsulitis and bursitis;
(v) a mass, including a ganglion;
(vi) an occult fracture;
(vii) acromioclavicular joint pathology; and
(b) the service is not performed in conjunction with a service mentioned in item 55865 (NR)






Fee: $43.75 Benefit: 75% = $32.85 85% = $37.20

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55868

55868 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Hip or groin, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55870 (R)

Fee: $113.55 Benefit: 75% = $85.20 85% = $96.55

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55869

55869 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Hip or groin, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55871 (NR)

Fee: $39.35 Benefit: 75% = $29.55 85% = $33.45

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55870

55870 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Hip or groin, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55868 (R)

Fee: $126.00 Benefit: 75% = $94.50 85% = $107.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55871

55871 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Hip or groin, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55869 (NR)

Fee: $43.75 Benefit: 75% = $32.85 85% = $37.20

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55872

55872 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Paediatric hip examination for dysplasia, left or right, ultrasound scan of, if the service is not performed in conjunction with item 55874 (R)

Fee: $113.55 Benefit: 75% = $85.20 85% = $96.55

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55873

55873 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Paediatric hip examination for dysplasia, left or right, ultrasound scan of, if the service is not performed in conjunction with item 55875 (NR)

Fee: $39.35 Benefit: 75% = $29.55 85% = $33.45

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55874

55874 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Paediatric hip examination for dysplasia, left and right, ultrasound scan of, if the service is not performed in conjunction with item 55872 (R)

Fee: $126.00 Benefit: 75% = $94.50 85% = $107.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55875

55875 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Paediatric hip examination for dysplasia, left and right, ultrasound scan of, if the service is not performed in conjunction with item 55873 (NR)

Fee: $43.75 Benefit: 75% = $32.85 85% = $37.20

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55876

55876 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Buttock or thigh, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with item 55878 (R)

Fee: $113.55 Benefit: 75% = $85.20 85% = $96.55

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55877

55877 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022


Buttock or thigh or both, left or right, ultrasound scan of, if the service is not performed in conjunction with item 55879 (NR)

Fee: $39.35 Benefit: 75% = $29.55 85% = $33.45

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55878

55878 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Buttock or thigh, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with item 55876 (R)

Fee: $126.00 Benefit: 75% = $94.50 85% = $107.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55879

55879 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022


Buttock or thigh, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with item 55877 (NR)

Fee: $43.75 Benefit: 75% = $32.85 85% = $37.20

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55880

55880 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Knee, left or right, ultrasound scan of, if:
(a) the service is used for the assessment of one or more of the following suspected or known conditions:
(i) abnormality of tendons or bursae about the knee;
(ii) a meniscal cyst, popliteal fossa cyst, mass or pseudomass;
(iii) a nerve entrapment or a nerve or nerve sheath tumour;
(iv) an injury of collateral ligaments; and
(b) the service is not performed in conjunction with item 55882 (R)

Fee: $113.55 Benefit: 75% = $85.20 85% = $96.55

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55881

55881 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Knee, left or right, ultrasound scan of, if:
(a) the service is used for the assessment of one or more of the following suspected or known conditions:
(i) abnormality of tendons or bursae about the knee;
(ii) a meniscal cyst, popliteal fossa cyst, mass or pseudomass;
(iii) a nerve entrapment or a nerve or nerve sheath tumour;
(iv) an injury of collateral ligaments; and
(b) the service is not performed in conjunction with item 55883 (NR)

Fee: $39.35 Benefit: 75% = $29.55 85% = $33.45

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55882

55882 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Knee, left and right, ultrasound scan of, if:
(a) the service is used for the assessment of one or more of the following suspected or known conditions:
(i) abnormality of tendons or bursae about the knee;
(ii) a meniscal cyst, popliteal fossa cyst, mass or pseudomass;
(iii) a nerve entrapment or a nerve or nerve sheath tumour;
(iv) an injury of collateral ligaments; and
(b) the service is not performed in conjunction with a service mentioned in item 55880 (R)

Fee: $126.00 Benefit: 75% = $94.50 85% = $107.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55883

55883 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Knee, left and right, ultrasound scan of, if:
(a) the service is used for the assessment of one or more of the following suspected or known conditions:
(i) abnormality of tendons or bursae about the knee;
(ii) a meniscal cyst, popliteal fossa cyst, mass or pseudomass;
(iii) a nerve entrapment or a nerve or nerve sheath tumour;
(iv) an injury of collateral ligaments; and
(b) the service is not performed in conjunction with item 55881 (NR)

Fee: $43.75 Benefit: 75% = $32.85 85% = $37.20

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55884

55884 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Lower leg, left or right, ultrasound scan of, if the service is not performed in conjunction with item 55886 (R)

Fee: $113.55 Benefit: 75% = $85.20 85% = $96.55

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55885

55885 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Lower leg, left or right, ultrasound scan of, if the service is not performed in conjunction with item 55887 (NR)

Fee: $39.35 Benefit: 75% = $29.55 85% = $33.45

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55886

55886 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Lower leg, left and right, ultrasound scan of, if the service is not performed in conjunction with item 55884 (R)

Fee: $126.00 Benefit: 75% = $94.50 85% = $107.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55887

55887 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Lower leg, left and right, ultrasound scan of, if the service is not performed in conjunction with item 55885 (NR) 

Fee: $43.75 Benefit: 75% = $32.85 85% = $37.20

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55888

55888 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Ankle or hind foot, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with item 55890 (R)

Fee: $113.55 Benefit: 75% = $85.20 85% = $96.55

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55889

55889 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Ankle or hind foot, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with item 55891 (NR)

Fee: $39.35 Benefit: 75% = $29.55 85% = $33.45

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55890

55890 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Ankle or hind foot, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with item 55888 (R)

Fee: $126.00 Benefit: 75% = $94.50 85% = $107.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55891

55891 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Ankle or hind foot, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with item 55889 (NR)

Fee: $43.75 Benefit: 75% = $32.85 85% = $37.20

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55892

55892 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Mid foot or fore foot, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with item 55894 (R)

Fee: $113.55 Benefit: 75% = $85.20 85% = $96.55

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55893

55893 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Mid foot or fore foot, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with item 55895 (NR)

Fee: $39.35 Benefit: 75% = $29.55 85% = $33.45

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55894

55894 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Mid foot or fore foot, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with item 55892 (R)

Fee: $126.00 Benefit: 75% = $94.50 85% = $107.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55895

55895 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Mid foot or fore foot, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with item 55893 (NR)

Fee: $43.75 Benefit: 75% = $32.85 85% = $37.20

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56620

56620 - Additional Information

Item Start Date:
01-Nov-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Computed tomography—scan of knee, without intravenous contrast medium, not being a service to which item 56622 or 56629 applies (R) (Anaes.)

Fee: $228.90 Benefit: 75% = $171.70 85% = $194.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56622

56622 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Computed tomography—scan of lower limb, left or right or both, one region (other than knee), or more than one region (which may include knee), without intravenous contrast medium, not being a service to which item 56620 applies (R) (Anaes.)

(Anaes.)

Fee: $228.90 Benefit: 75% = $171.70 85% = $194.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56623

56623 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Computed tomography—scan of lower limb, left or right or both, one region (other than knee), or more than one region (which may include knee), with intravenous contrast medium and with any scans of the lower limb before intravenous contrast injection, when performed, not being a service to which item 56626 applies (R) (Anaes.)

(Anaes.)

Fee: $348.20 Benefit: 75% = $261.15 85% = $296.00

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56626

56626 - Additional Information

Item Start Date:
01-Nov-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Computed tomography—scan of knee, with intravenous contrast medium and with any scans of the knee before intravenous contrast injection, when performed, not being a service to which items 56623 or 56630 apply (R) (Anaes.)

Fee: $348.20 Benefit: 75% = $261.15 85% = $296.00

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56627

56627 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Computed tomography—scan of upper limb, left or right or both, any one region, or more than one region, without intravenous contrast medium (R) (Anaes.)

(Anaes.)

Fee: $228.90 Benefit: 75% = $171.70 85% = $194.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56628

56628 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Computed tomography—scan of upper limb, left or right or both, any one region, or more than one region, with intravenous contrast medium and with any scans of the upper limb before intravenous contrast injection, when performed (R) (Anaes.)

(Anaes.)

Fee: $348.20 Benefit: 75% = $261.15 85% = $296.00

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56629

56629 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Computed tomography—scan of upper limb and lower limb, left or right or both, any one region (other than knee), or more than one region (which may include knee) without intravenous contrast medium not being a service to which item 56620 applies (R) (Anaes.)

(Anaes.)

Fee: $228.90 Benefit: 75% = $171.70 85% = $194.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56630

56630 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Computed tomography—scan of upper limb and lower limb, left or right or both, any one region (other than knee), or more than one region (which may include knee) with intravenous contrast medium with any scans of the limbs before intravenous contrast injection, when performed, not being a service to which item 56626 applies (R)

(Anaes.)

Fee: $348.20 Benefit: 75% = $261.15 85% = $296.00

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61310

61310 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Myocardial infarct avid study (R)

Fee: $367.30 Benefit: 75% = $275.50 85% = $312.25

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61313

61313 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Gated cardiac blood pool study, (equilibrium) (R)

Fee: $303.35 Benefit: 75% = $227.55 85% = $257.85

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61314

61314 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Gated cardiac blood pool study, with or without intervention, and first pass blood flow or cardiac shunt study (R)

Fee: $420.00 Benefit: 75% = $315.00 85% = $357.00

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61321

61321 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Aug-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.2

Single rest myocardial perfusion study for the assessment of the extent and severity of viable and non‑viable myocardium, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has left ventricular systolic dysfunction and probable or confirmed coronary artery disease; and

(b) the service uses a single rest technetium‑99m (Tc‑99m) protocol; 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 item 11704, 11705, 11707, 11714, 11729, 11730, 61325, 61329, 61332, 61345, 61380, 61398, 61406 or 61422 applies; and

(e) if the patient is 17 years or older—a service to which this item, or item 61325, 61329, 61332, 61345, 61380, 61398, 61406 or 61422, applies has not been provided to the patient in the previous 24 months (R)

 

 

Fee: $329.00 Benefit: 75% = $246.75 85% = $279.65

(See para IN.0.19, IN.4.1, IR.4.1, IR.4.2 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61324

61324 - Additional Information

Item Start Date:
01-Aug-2020
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Aug-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Single stress myocardial perfusion study, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) at least one of the following applies:

(i) the patient has body habitus or other physical conditions (including heart rhythm disturbance) to the extent that a stress echocardiography would not provide adequate information;

(ii) the patient is unable to exercise to the extent required for a stress echocardiography to provide adequate information;

(iii) the patient has had a failed stress echocardiography provided in a service to which item 55141, 55143, 55145 or 55146 applies; and

(c) the service includes resting ECG, continuous ECG monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

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

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61325, 61329, 61332, 61377, 61345, 61357, 61380, 61394, 61398, 61406, 61414 or 61422 applies; and

(f) if the patient is 17 years or older—a service to which this item, or item 61311, 61329, 61332, 61345, 61357, 61377, 61380, 61394, 61398, 61406 or 61414, applies has not been provided to the patient in the previous 24 months (R)

 

Fee: $653.05 Benefit: 75% = $489.80 85% = $559.85

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61325

61325 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Aug-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.2

Single rest myocardial perfusion study for the assessment of the extent and severity of viable and non‑viable myocardium, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has left ventricular systolic dysfunction and probable or confirmed coronary artery disease; and

(b) the service uses:

(i) an initial rest study followed by a redistribution study on the same day; and

(ii) a thallous chloride‑201 (Tl‑201) protocol; 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 item 11704, 11705, 11707, 11714, 11729, 11730, 61321, 61329, 61332, 61345, 61380, 61398, 61406 or 61422 applies; and

(e) if the patient is 17 years or older:

(i) a service to which item 61321, 61329, 61332, 61345, 61380, 61398, 61406 or 61442, applies has not been provided to the patient in the previous 24 months; and

(ii) the service is applicable only twice each 24 months (R)

 

 

Fee: $329.00 Benefit: 75% = $246.75 85% = $279.65

(See para IN.0.19, IN.4.2, IR.4.2 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61328

61328 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Lung perfusion study (R)

Fee: $227.65 Benefit: 75% = $170.75 85% = $193.55

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61329

61329 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Aug-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) at least one of the following applies:

(i) the patient has body habitus or other physical conditions (including heart rhythm disturbance) to the extent that a stress echocardiography would not provide adequate information;

(ii) the patient is unable to exercise to the extent required for a stress echocardiography to provide adequate information;

(iii) the patient has had a failed stress echocardiography provided in a service to which item 55141, 55143, 55145 or 55146 applies; and

(c) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(d) the service is requested by a medical practitioner (other than a specialist or consultant physician); and

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61332, 61345, 61357, 61377, 61380, 61394, 61398, 61406, 61414 or 61422 applies; and

(f) if the patient is 17 years or older—a service to which this item, or item 61311, 61321, 61324, 61325, 61332, 61345, 61357, 61380, 61394, 61398, 61406, 61414 or 61422, applies has not been provided to the patient in the previous 24 months (R)

 

 

Fee: $982.05 Benefit: 75% = $736.55 85% = $888.85

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61340

61340 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Lung ventilation study using aerosol, technegas or xenon gas (R)

Fee: $253.00 Benefit: 75% = $189.75 85% = $215.05

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61345

61345 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Aug-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) at least one of the following applies:

(i) the patient has body habitus or other physical conditions (including heart rhythm disturbance) to the extent that a stress echocardiography would not provide adequate information;

(ii) the patient is unable to exercise to the extent required for a stress echocardiography to provide adequate information;

(iii) the patient has had a failed stress echocardiography provided in a service to which item 55141, 55143, 55145 or 55146 applies; and

(c) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

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

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61332, 61357, 61377, 61380, 61394, 61398, 61406, 61414 or 61422 applies (R); and

(f) if the patient is 17 years or older—a service to which this item, or item 61311, 61321, 61324, 61325, 61329, 61332, 61357, 61377, 61380, 61394, 61398, 61406, 61414 or 61422, applies has not been provided to the patient in the previous 24 months (R)

 

 

 

Fee: $982.05 Benefit: 75% = $736.55 85% = $888.85

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61348

61348 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Lung perfusion study and lung ventilation study using aerosol, technegas or xenon gas (R)

Fee: $443.35 Benefit: 75% = $332.55 85% = $376.85

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61349

61349 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Aug-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Repeat combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion, with single photon emission tomography, with or without planar imaging, if:

(a) both:

(i) a service has been provided to the patient in the previous 24 months to which this item, or item 61311, 61324, 61329, 61332, 61337, 61345, 61357, 61365, 61380, 61394, 61398, 61406, 61410, 61414 or 61418, applies; and

(ii) the patient has subsequently undergone a revascularisation procedure; and

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

(c) at least one of the following applies:

(i) the patient has body habitus or other physical conditions (including heart rhythm disturbance) to the extent that a stress echocardiography would not provide adequate information;

(ii) the patient is unable to exercise to the extent required for a stress echocardiography to provide adequate information;

(iii) the patient has had a failed stress echocardiography provided in a service to which item 55141, 55143, 55145 or 55146 applies; and

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

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61365, 61410 or 61418 applies; and

(f) if the patient is 17 years or older—a service to which this item, or item 61365, 61410 or 61418, applies has not been provided to the patient in the previous 12 months (R)

 

Fee: $982.05 Benefit: 75% = $736.55 85% = $888.85

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61353

61353 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Liver and spleen study (colloid) (R)

Fee: $386.60 Benefit: 75% = $289.95 85% = $328.65

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61356

61356 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Red blood cell spleen or liver study (R)

Fee: $392.80 Benefit: 75% = $294.60 85% = $333.90

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61357

61357 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Aug-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Single stress myocardial perfusion study, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) at least one of the following applies:

(i) the patient has body habitus or other physical conditions (including heart rhythm disturbance) to the extent that a stress echocardiography would not provide adequate information;

(ii) the patient is unable to exercise to the extent required for a stress echocardiography to provide adequate information;

(iii) the patient has had a failed stress echocardiography provided in a service to which items 55141, 55143, 55145 or 55146 applies; and

(c) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(d) the service is requested by a medical practitioner (other than a specialist or consultant physician); and

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61332, 61345, 61377, 61380, 61394, 61398, 61406, 61414 or 61422 applies; and

(f) if the patient is 17 years or older—a service to which this item, or item 61311, 61324, 61329, 61332, 61345, 61377, 61380, 61394, 61398, 61406, or 61414, applies has not been provided to the patient in the previous 24 months (R)

 

 

 

Fee: $653.05 Benefit: 75% = $489.80 85% = $559.85

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61360

61360 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Hepatobiliary study, including morphine administration or pre-treatment with a cholagogue when performed (R)

Fee: $403.35 Benefit: 75% = $302.55 85% = $342.85

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61361

61361 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Hepatobiliary study with formal quantification following baseline imaging, using a cholagogue (R)

Fee: $461.40 Benefit: 75% = $346.05 85% = $392.20

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61364

61364 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Bowel haemorrhage study (R)

Fee: $496.95 Benefit: 75% = $372.75 85% = $422.45

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61368

61368 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Meckel’s diverticulum study (R)

Fee: $223.10 Benefit: 75% = $167.35 85% = $189.65

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61372

61372 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Salivary study (R)

Fee: $223.10 Benefit: 75% = $167.35 85% = $189.65

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61373

61373 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Gastro-oesophageal reflux study, including delayed imaging on a separate occasion when performed (R)

Fee: $489.70 Benefit: 75% = $367.30 85% = $416.25

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61376

61376 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Oesophageal clearance study (R)

Fee: $143.35 Benefit: 75% = $107.55 85% = $121.85

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61381

61381 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Gastric emptying study, using single tracer (R)

Fee: $574.35 Benefit: 75% = $430.80 85% = $488.20

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61383

61383 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Combined solid and liquid gastric emptying study using dual isotope technique or the same isotope on separate days (R)

Fee: $624.95 Benefit: 75% = $468.75 85% = $531.75

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61384

61384 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Radionuclide colonic transit study (R)

Fee: $687.70 Benefit: 75% = $515.80 85% = $594.50

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61386

61386 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Renal study, including perfusion and renogram images and computer analysis or cortical study with planar imaging (R)

Fee: $332.50 Benefit: 75% = $249.40 85% = $282.65

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61387

61387 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Renal cortical study, with single photon emission tomography and planar quantification (R)

Fee: $430.75 Benefit: 75% = $323.10 85% = $366.15

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61389

61389 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Single renal study with pre-procedural administration of a diuretic or angiotensin converting enzyme (ACE) inhibitor (R)

Fee: $370.55 Benefit: 75% = $277.95 85% = $315.00

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61390

61390 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Renal study with diuretic administration after a baseline study (R)

Fee: $409.95 Benefit: 75% = $307.50 85% = $348.50

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61393

61393 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Combined examination involving a renal study following angiotensin converting enzyme (ACE) inhibitor provocation and a baseline study, in either order and related to a single referral episode (R)

Fee: $605.50 Benefit: 75% = $454.15 85% = $514.70

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61394

61394 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
15-Sep-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Single stress myocardial perfusion study, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) the service is provided at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(c) a stress echocardiography service is not available in the Modified Monash area where the service is provided; and

(d) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

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

(f) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61332, 61345, 61357, 61377, 61380, 61398, 61406, 61414 or 61422 applies; and

(g) if the patient is 17 years or older—a service to which this item, or item 61311, 61324, 61329, 61332, 61345, 61357, 61377, 61380, 61398, 61406 or 61414, applies has not been provided to the patient in the previous 24 months (R)

 

 

Fee: $653.05 Benefit: 75% = $489.80 85% = $559.85

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61397

61397 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Cystoureterogram (R)

Fee: $246.85 Benefit: 75% = $185.15 85% = $209.85

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61398

61398 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
15-Sep-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) the service is provided at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(c) a stress echocardiography service is not available in the Modified Monash area where the services is provided; and

(d) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(e) the service is requested by a medical practitioner (other than a specialist or consultant physician); and

(f) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61332, 61345, 61357, 61377, 61380, 61394, 61406, 61414 or 61422 applies; and

(g) if the patient is 17 years or older—a service to which this item, or item 61311, 61321, 61324, 61325, 61329, 61332, 61345, 61357, 61377, 61380, 61394, 61406, 61414 or 61422, applies has not been provided to the patient in the previous 24 months (R)

 

 

Fee: $982.05 Benefit: 75% = $736.55 85% = $888.85

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61402

61402 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Cerebral perfusion study, with single photon emission tomography and with planar imaging when performed (R)

Fee: $605.05 Benefit: 75% = $453.80 85% = $514.30

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61406

61406 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
15-Sep-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) the service is provided at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(c) a stress echocardiography service is not available in the Modified Monash area where the service is provided; and

(d) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

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

(f) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61332, 61377, 61345, 61357, 61380, 61394, 61398, 61414 or 61422 applies; and

(g) if the patient is 17 years or older—a service to which this item, or item 61311, 61321, 61324, 61325, 61329, 61332, 61345, 61357, 61377, 61380, 61394, 61398, 61414 or 61422, applies has not been provided to the patient in the previous 24 months (R)

 

 

Fee: $982.05 Benefit: 75% = $736.55 85% = $888.85

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61409

61409 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Cerebro spinal fluid transport study, with imaging on 2 or more separate occasions (R)

Fee: $873.50 Benefit: 75% = $655.15 85% = $780.30

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61410

61410 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
15-Sep-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Repeat combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion, with single photon emission tomography, with or without planar imaging, if:

(a) both:

(i) a service has been provided to the patient in the previous 24 months to which this item, or item 61311, 61324, 61329, 61332, 61345, 61349, 61357, 61365, 61377, 61380, 61394, 61398, 61406, 61414 or 61418, applies; and

(ii) the patient has subsequently undergone a revascularisation procedure; and

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

(c) the service is provided at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(d) a stress echocardiography service is not available in the Modified Monash area where the service is provided; and

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730 or 61418 applies; and

(f) if the patient is 17 years or older—a service to which item 61349, 61365 or 61418 applies has not been provided to the patient in the previous 12 months

 

 

Fee: $982.05 Benefit: 75% = $736.55 85% = $888.85

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61413

61413 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Cerebro spinal fluid shunt patency study (R)

Fee: $225.95 Benefit: 75% = $169.50 85% = $192.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61414

61414 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
15-Sep-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Single stress myocardial perfusion study, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) the service is provided at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(c) a stress echocardiography service is not available in the Modified Monash area where the service is provided; and

(d) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(e) the service is requested by a medical practitioner (other than a specialist or consultant physician); and

(f) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61332, 61345, 61357, 61377, 61380, 61394, 61398, 61406 or 61422 applies; and

(g) if the patient is 17 years or older—a service to which this item, or item 61311, 61324, 61329, 61332, 61345, 61357, 61377, 61380, 61398 or 61406, applies has not been provided to the patient in the previous 24 months (R)

 

 

Fee: $653.05 Benefit: 75% = $489.80 85% = $559.85

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61421

61421 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Bone study—whole body, with, when undertaken, blood flow, blood pool and delayed imaging on a separate occasion (R)

Fee: $479.80 Benefit: 75% = $359.85 85% = $407.85

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61425

61425 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Bone study—whole body and single photon emission tomography, with, when undertaken, blood flow, blood pool and delayed imaging on a separate occasion (R)

Fee: $600.70 Benefit: 75% = $450.55 85% = $510.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61426

61426 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Whole body study using iodine (R)

Fee: $554.80 Benefit: 75% = $416.10 85% = $471.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61429

61429 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Whole body study using gallium (R)

Fee: $543.00 Benefit: 75% = $407.25 85% = $461.55

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61430

61430 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Whole body study using gallium, with single photon emission tomography (R)



Fee: $659.45 Benefit: 75% = $494.60 85% = $566.25

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61433

61433 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Whole body study using cells labelled with technetium (R)

Fee: $496.95 Benefit: 75% = $372.75 85% = $422.45

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61434

61434 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Whole body study using cells labelled with technetium, with single photon emission tomography (R)

Fee: $615.40 Benefit: 75% = $461.55 85% = $523.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61438

61438 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Whole body study using thallium (R)

Fee: $672.95 Benefit: 75% = $504.75 85% = $579.75

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61441

61441 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Bone marrow study—whole body using technetium labelled bone marrow agents (R)

Fee: $489.70 Benefit: 75% = $367.30 85% = $416.25

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61442

61442 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Whole body study, using gallium—with single photon emission tomography of 2 or more body regions acquired separately (R)

Fee: $752.35 Benefit: 75% = $564.30 85% = $659.15

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61445

61445 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Bone marrow study—localised using technetium labelled agent (R)

Fee: $286.80 Benefit: 75% = $215.10 85% = $243.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61446

61446 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Regional scintigraphic study, using an approved bone scanning agent, including when undertaken, blood flow imaging, blood pool imaging and repeat imaging on a separate occasion (R)

Fee: $333.55 Benefit: 75% = $250.20 85% = $283.55

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61449

61449 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Regional scintigraphic study, using an approved bone scanning agent and single photon emission tomography, including when undertaken, blood flow imaging, blood pool imaging and repeat imaging on a separate occasion (R)

Fee: $456.20 Benefit: 75% = $342.15 85% = $387.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61450

61450 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Localised study using gallium (R)

Fee: $397.55 Benefit: 75% = $298.20 85% = $337.95

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61453

61453 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Localised study using gallium, with single photon emission tomography (R)

Fee: $514.70 Benefit: 75% = $386.05 85% = $437.50

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61454

61454 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Localised study using cells labelled with technetium (R)

Fee: $348.10 Benefit: 75% = $261.10 85% = $295.90

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61457

61457 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Localised study using cells labelled with technetium, with single photon emission tomography (R)

Fee: $470.45 Benefit: 75% = $352.85 85% = $399.90

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61461

61461 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Localised study using thallium (R)

Fee: $527.85 Benefit: 75% = $395.90 85% = $448.70

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61462

61462 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-May-2007

Repeat planar and single photon emission tomography imaging, or repeat planar imaging or single photon emission tomography imaging on an occasion subsequent to the performance of item 61364, 61426, 61429, 61430, 61442, 61450, 61453, 61469 or 61485, if there is no additional administration of radiopharmaceutical and if the previous radionuclide scan was abnormal or equivocal (R)

 

 

 

 

Fee: $129.00 Benefit: 75% = $96.75 85% = $109.65

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61469

61469 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Lymphoscintigraphy (R)

Fee: $348.10 Benefit: 75% = $261.10 85% = $295.90

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61473

61473 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Thyroid study (R)

Fee: $175.40 Benefit: 75% = $131.55 85% = $149.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61480

61480 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Parathyroid study (R)

Fee: $386.85 Benefit: 75% = $290.15 85% = $328.85

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61485

61485 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Adrenal study, with single photon emission tomography (R)

Fee: $999.20 Benefit: 75% = $749.40 85% = $906.00

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61495

61495 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Tear duct study (R)

Fee: $223.10 Benefit: 75% = $167.35 85% = $189.65

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61499

61499 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Particle perfusion study (infra arterial) or Le Veen shunt study (R)

Fee: $253.00 Benefit: 75% = $189.75 85% = $215.05

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61650

61650 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

LeukoScan study of the long bones and feet for suspected osteomyelitis, if:
(a) the patient does not have access to ex vivo white blood cell scanning; and
(b) the patient is not being investigated for other sites of infection (R)

 

Fee: $878.70 Benefit: 75% = $659.05 85% = $785.50

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55126

55126 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55127

55127 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55128

55128 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55129

55129 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55132

55132 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55133

55133 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55134

55134 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55137

55137 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55141

55141 - Additional Information

Item Start Date:
01-Aug-2020
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55143

55143 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55145

55145 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55146

55146 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61505

61505 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-May-2007

CT scan performed at the same time and covering the same body area as single photon emission tomography or positron emission tomography for the purpose of anatomic localisation or attenuation correction if no separate diagnostic CT report is issued and performed in association with a service to which an item in Subgroup 1 or 2 of Group I4 applies (R)

Fee: $100.00 Benefit: 75% = $75.00 85% = $85.00

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55238

55238 - Additional Information

Item Start Date:
01-Nov-1997
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the lower limb or of arteries and bypass grafts in the lower limb, below the inguinal ligament, not being a service associated with any of the following:
(a) a service to which an item in Subgroup 4 applies;
(b) a service to which item 55880, 55881, 55882, 55883, 55884, 55885, 55886, 55887, 55888, 55889, 55890, 55891, 55892, 55893, 55894 or 55895 applies (R)

Fee: $176.40 Benefit: 75% = $132.30 85% = $149.95

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55244

55244 - Additional Information

Item Start Date:
01-Nov-1997
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the lower limb, below the inguinal ligament, for acute venous thrombosis, not being a service associated with any of the following:
(a) a service to which item 55246 applies;
(b) a service to which an item in Subgroup 4 applies;
(c) a service to which item 55880, 55881, 55882, 55883, 55884, 55885, 55886, 55887, 55888, 55889, 55890, 55891, 55892, 55893, 55894 or 55895 applies (R)

Fee: $176.40 Benefit: 75% = $132.30 85% = $149.95

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55246

55246 - Additional Information

Item Start Date:
01-Nov-1997
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the lower limb, below the inguinal ligament, for chronic venous disease, not being a service associated with any of the following:
(a) a service to which item 55244 applies;
(b) a service to which an item in Subgroup 4 applies;
(c) a service to which item 55880, 55881, 55882, 55883, 55884, 55885, 55886, 55887, 55888, 55889, 55890, 55891, 55892, 55893, 55894 or 55895 applies (R)

Fee: $176.40 Benefit: 75% = $132.30 85% = $149.95

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55248

55248 - Additional Information

Item Start Date:
01-Nov-1997
Description Updated:
01-Nov-2020
Schedule Fee Updated:
01-Jul-2022

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the upper limb or of arteries and bypass grafts in the upper limb, not being a service associated with a service to which an item in Subgroup 4 applies (R) 

Fee: $176.40 Benefit: 75% = $132.30 85% = $149.95

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55252

55252 - Additional Information

Item Start Date:
01-Nov-1997
Description Updated:
01-Nov-2020
Schedule Fee Updated:
01-Jul-2022

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the upper limb, not being a service associated with a service to which an item in Subgroup 4 applies (R).

Fee: $176.40 Benefit: 75% = $132.30 85% = $149.95

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55274

55274 - Additional Information

Item Start Date:
01-Nov-1997
Description Updated:
01-Nov-2020
Schedule Fee Updated:
01-Jul-2022

Duplex scanning, bilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of extra cranial bilateral carotid and vertebral vessels, with or without subclavian and innominate vessels, with or without oculoplethysmography or peri orbital Doppler examination, not being a service associated with a service to which an item in Subgroup 4 applies (R).

Fee: $176.40 Benefit: 75% = $132.30 85% = $149.95

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55276

55276 - Additional Information

Item Start Date:
01-Nov-1997
Description Updated:
01-Nov-2020
Schedule Fee Updated:
01-Jul-2022

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of intra‑abdominal, aorta and iliac arteries or inferior vena cava and iliac veins or of intra‑abdominal, aorta and iliac arteries and inferior vena cava and iliac veins, excluding pregnancy related studies, not being a service associated with a service to which an item in Subgroup 4 applies (R)

 

Fee: $176.40 Benefit: 75% = $132.30 85% = $149.95

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55278

55278 - Additional Information

Item Start Date:
01-Nov-1997
Description Updated:
01-Nov-2020
Schedule Fee Updated:
01-Jul-2022

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of renal or visceral vessels or of renal and visceral vessels, including aorta, inferior vena cava and iliac vessels as required excluding pregnancy related studies, not being a service associated with a service to which an item in Subgroup 4 applies (R)

Fee: $176.40 Benefit: 75% = $132.30 85% = $149.95

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55280

55280 - Additional Information

Item Start Date:
01-Nov-1997
Description Updated:
01-Nov-2020
Schedule Fee Updated:
01-Jul-2022

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of intra cranial vessels, not being a service associated with a service to which an item in Subgroup 4 applies (R)

Fee: $176.40 Benefit: 75% = $132.30 85% = $149.95

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55282

55282 - Additional Information

Item Start Date:
01-Nov-1997
Description Updated:
01-Nov-2020
Schedule Fee Updated:
01-Jul-2022

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements:
(a) by spectral analysis of cavernosal artery of the penis following intracavernosal administration of a vasoactive agent; and
(b) performed during the period of pharmacological activity of the injected agent, to confirm a diagnosis of vascular aetiology for impotence; and
(c) if a specialist in diagnostic radiology, nuclear medicine, urology, general surgery (sub specialising in vascular surgery) or a consultant physician in nuclear medicine attends the patient in person at the practice location where the service is performed, immediately before or for a period during the performance of the service; and
(d) if the specialist or consultant physician interprets the results and prepares a report, not being a service associated with a service to which an item in Subgroup 4 applies (R)

Fee: $176.40 Benefit: 75% = $132.30 85% = $149.95

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55284

55284 - Additional Information

Item Start Date:
01-Nov-1997
Description Updated:
01-Nov-2020
Schedule Fee Updated:
01-Jul-2022

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements:
(a) by spectral analysis of cavernosal tissue of the penis to confirm a diagnosis; and
(b) if indicated, assess the progress and management of:
(i) priapism; or
(ii) fibrosis of any type; or
(iii) fracture of the tunica; or
(iv) arteriovenous malformations; and
(c) if a specialist in diagnostic radiology, nuclear medicine, urology, general surgery (sub specialising in vascular surgery) or a consultant physician in nuclear medicine attends the patient in person at the practice location where the service is performed, immediately before or for a period during the performance of the service; and
(d) if the specialist or consultant physician interprets the results and prepares a report, not being a service associated with a service to which an item in Subgroup 4 applies (R)

Fee: $176.40 Benefit: 75% = $132.30 85% = $149.95

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55292

55292 - Additional Information

Item Start Date:
01-Nov-2001
Description Updated:
01-Nov-2020
Schedule Fee Updated:
01-Jul-2022

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of surgically created arteriovenous fistula or surgically created arteriovenous access grafts in the upper or lower limbs, not being a service associated with 
a service to which an item in Subgroup 4 applies (R)

Fee: $176.40 Benefit: 75% = $132.30 85% = $149.95

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55294

55294 - Additional Information

Item Start Date:
01-Nov-2001
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or veins, or both, including any associated skin marking, for mapping of bypass conduit before vascular surgery, not being a service associated with any of the following:
(a) a service to which an item in Subgroup 3 or 4 applies;
(b) a service to which item 55880, 55881, 55882, 55883, 55884, 55885, 55886, 55887, 55888, 55889, 55890, 55891, 55892, 55893, 55894 or 55895 applies (R)

Fee: $176.40 Benefit: 75% = $132.30 85% = $149.95

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55296

55296 - Additional Information

Item Start Date:
01-Nov-2001
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow spectral analysis and marking of veins in the lower limbs below the inguinal ligament before varicose vein surgery, including any associated skin marking, not being a service associated with any of the following:
(a) a service to which an item in Subgroup 3 or 4 applies;
(b) a service to which item 55880, 55881, 55882, 55883, 55884, 55885, 55886, 55887, 55888, 55889, 55890, 55891, 55892, 55893, 55894 or 55895 applies (R)

Fee: $115.50 Benefit: 75% = $86.65 85% = $98.20

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57506

57506 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

57509

57509 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

57512

57512 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

57515

57515 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

57518

57518 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

57521

57521 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

57522

57522 - Additional Information

Item Start Date:
01-Nov-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Knee (NR)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57523

57523 - Additional Information

Item Start Date:
01-Nov-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Knee (R)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57524

57524 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

57527

57527 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

59300

59300 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Mammography of both breasts if there is reason to suspect the presence of malignancy because of:
(a) the past occurrence of breast malignancy in the patient; or
(b) significant history of breast or ovarian malignancy in the patient’s family; or
(c) symptoms or indications of breast disease found on examination of the patient by a medical practitioner (R)

 

(Note: These items are intended for use in the investigation of a clinical abnormality of the breast/s and NOT for individual, group or opportunistic screening of asymptomatic patients)

 

 

 

 

Fee: $93.10 Benefit: 75% = $69.85 85% = $79.15

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

59302

59302 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Three dimensional tomosynthesis of both breasts, if there is reason to suspect the presence of malignancy because of:

a)      the past occurrence of breast malignancy in the patient; or

b)      significant history of breast or ovarian malignancy in the patient’s family; or

c)      symptoms or indications of breast disease found on examination of the patient by a medical practitioner

Not being a service to which item 59300 applies (R)



Fee: $210.20 Benefit: 75% = $157.65 85% = $178.70

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

59303

59303 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Mammography of one breast if:

(a) the service is specifically requested for a unilateral mammogram; and
(b) there is reason to suspect the presence of malignancy because of:
(i) the past occurrence of breast malignancy in the patient; or
(ii) significant history of breast or ovarian malignancy in the patient’s family; or
(iii) symptoms or indications of breast disease found on examination of the patient by a medical practitioner (R)

Fee: $56.15 Benefit: 75% = $42.15 85% = $47.75

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

59305

59305 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Three dimensional tomosynthesis of one breast, if there is reason to suspect the presence of malignancy because of:

a)      the past occurrence of breast malignancy in the patient; or

b)      significant history of breast or ovarian malignancy in the patient’s family; or

c)      symptoms or indications of breast disease found on examination of the patient by a medical practitioner

Not being a service to which item 59303 applies (R)

Fee: $118.60 Benefit: 75% = $88.95 85% = $100.85

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

59312

59312 - Additional Information

Item Start Date:
01-Nov-1997
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Radiographic examination of both breasts, in conjunction with a surgical procedure on each breast, using interventional techniques (R)

Fee: $90.55 Benefit: 75% = $67.95 85% = $77.00

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

59314

59314 - Additional Information

Item Start Date:
01-Nov-1997
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Radiographic examination of one breast, in conjunction with a surgical procedure using interventional techniques (R)

Fee: $54.65 Benefit: 75% = $41.00 85% = $46.50

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

59318

59318 - Additional Information

Item Start Date:
01-Nov-1997
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Radiographic examination of excised breast tissue to confirm satisfactory excision of one or more lesions in one breast or both following pre-operative localisation in conjunction with a service under item 31536 (R)

Fee: $48.95 Benefit: 75% = $36.75 85% = $41.65

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57700

57700 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Shoulder or scapula (NR)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57703

57703 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Shoulder or scapula (R)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57706

57706 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Clavicle (NR)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57709

57709 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Clavicle (R)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57712

57712 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Hip joint (R)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57715

57715 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Pelvic girdle (R)

Fee: $63.35 Benefit: 75% = $47.55 85% = $53.85

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57721

57721 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Femur, internal fixation of neck or intertrochanteric (pertrochanteric) fracture (R)

Fee: $103.30 Benefit: 75% = $77.50 85% = $87.85

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63101

63101 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

MRI and MRA of extracranial or intracranial circulation (or both)—scan of head and neck vessels for stroke (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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63219

63219 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

MRI—scan of 3 contiguous or 2 non contiguous regions of the spine for demyelinating disease (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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63222

63222 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

MRI—scan of 3 contiguous or 2 non contiguous regions of the spine for congenital malformation of the spinal cord or the cauda equina or the meninges (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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63225

63225 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

MRI—scan of 3 contiguous or 2 non contiguous regions of the spine for myelopathy (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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63228

63228 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

MRI—scan of 3 contiguous or 2 non contiguous regions of the spine for syrinx (congenital or acquired) (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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63231

63231 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

MRI—scan of 3 contiguous or 2 non contiguous regions of the spine for cervical radiculopathy (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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63234

63234 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

MRI—scan of 3 contiguous or 2 non contiguous regions of the spine for sciatica (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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63237

63237 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

MRI—scan of 3 contiguous or 2 non contiguous regions of the spine for spinal canal stenosis (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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63240

63240 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

MRI—scan of 3 contiguous or 2 non contiguous regions of the spine for previous spinal surgery (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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63243

63243 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

MRI—scan of 3 contiguous or 2 non contiguous regions of the spine for trauma (R) (Anaes.)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63513

63513 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

56101

56101 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

56107

56107 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

57201

57201 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

58500

58500 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

58503

58503 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

58506

58506 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

58509

58509 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

58521

58521 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

58524

58524 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

58527

58527 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63361

63361 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

MRI—scan of musculoskeletal system for Gaucher disease (R) (Anaes.)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63454

63454 - Additional Information

Item Start Date:
01-Jul-2021
Description Updated:
01-Nov-2022
Schedule Fee Updated:
01-Jul-2022

MRI scan of the pelvis or abdomen, for a patient who is pregnant, if:

(a) the pregnancy is at, or after, 18 weeks gestation; and

(b) fetal abnormality is suspected; and

(c) an ultrasound has been performed and is provided by, or on behalf of, or at the request of, a specialist who is practising in the specialty of obstetrics; and

(d) the diagnosis of fetal abnormality as a result of the ultrasound is indeterminate or requires further examination; and

(e) the MRI service is requested by a specialist practising in the specialty of obstetrics (R) (Contrast)

(Anaes.)

Fee: $1,219.20 Benefit: 75% = $914.40 85% = $1,126.00

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63470

63470 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

MRI—scan of the pelvis for the staging of histologically diagnosed cervical cancer at FIGO stage 1B or greater, if the request for scan identifies that:

(a) a histological diagnosis of carcinoma of the cervix has been made; and
(b) the patient has been diagnosed with cervical cancer at FIGO stage 1B or greater (R) (Contrast)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63473

63473 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

MRI—scan of the pelvis and upper abdomen, in a single examination, for the staging of histologically diagnosed cervical cancer at FIGO stage 1B or greater, if the request for the scan identifies that:


(a) a histological diagnosis of carcinoma of the cervix has been made; and
(b) the patient has been diagnosed with cervical cancer at FIGO stage 1B or greater (R) (Contrast)

(Anaes.)

Fee: $637.25 Benefit: 75% = $477.95 85% = $544.05

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63476

63476 - Additional Information

Item Start Date:
01-Jul-2009
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

MRI—scan of the pelvis for the initial staging of rectal cancer, if:

(a) a phased array body coil is used; and
(b) the request for the scan identifies that the indication is for the initial staging of rectal cancer (including cancer of the rectosigmoid and anorectum) (R) (Contrast)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63563

63563 - Additional Information

Item Start Date:
01-Nov-2022
Description Updated:
01-Nov-2022
Schedule Fee Updated:
01-Nov-2022

MRI scan of the pelvis or abdomen, if the request for the scan identifies that the investigation is for:

(a) sub‑fertility that requires one or more of the following:

(i) an investigation of suspected Mullerian duct anomaly seen in pelvic ultrasound or hysterosalpingogram;

(ii) an assessment of uterine mass identified on pelvic ultrasound before consideration of surgery;

(iii) an investigation of recurrent implantation failure in IVF (2 or more embryo transfer cycles without viable pregnancy); or

(b) surgical planning of a patient with known or suspected deep endometriosis involving the bowel, bladder or ureter (or any combination of the bowel, bladder or ureter), where the results of pelvic ultrasound are inconclusive

Applicable not more than once in a 2 year period (R) (Contrast)

(Anaes.)

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

(See para IN.0.18, IN.0.19 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63201

63201 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

MRI—scan of 3 contiguous or 2 non contiguous regions of the spine for infection (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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63204

63204 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

MRI—scan of 3 contiguous or 2 non contiguous regions of the spine for tumour (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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

56219

56219 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Computed tomography—scan of spine, one or more regions with intrathecal contrast medium, including the preparation for intrathecal injection of contrast medium and any associated plain X rays, not being a service to which item 59724 or 59275 applies (R) (Anaes.)

Fee: $339.45 Benefit: 75% = $254.60 85% = $288.55

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56220

56220 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Computed tomography—scan of spine, cervical region, without intravenous contrast medium (R) (Anaes.)

Fee: $249.75 Benefit: 75% = $187.35 85% = $212.30

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56221

56221 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Computed tomography—scan of spine, thoracic region, without intravenous contrast medium (R) (Anaes.)

Fee: $249.75 Benefit: 75% = $187.35 85% = $212.30

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56223

56223 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Computed tomography—scan of spine, lumbosacral region, without intravenous contrast medium (R) (Anaes.)

Fee: $249.75 Benefit: 75% = $187.35 85% = $212.30

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56224

56224 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Computed tomography—scan of spine, cervical region, with intravenous contrast medium and with any scans of the cervical region of the spine before intravenous contrast injection when undertaken (R) (Anaes.)

Fee: $365.60 Benefit: 75% = $274.20 85% = $310.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56225

56225 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Computed tomography—scan of spine, thoracic region, with intravenous contrast medium and with any scans of the thoracic region of the spine before intravenous contrast injection when undertaken (R) (Anaes.)

Fee: $365.60 Benefit: 75% = $274.20 85% = $310.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56226

56226 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Computed tomography—scan of spine, lumbosacral region, with intravenous contrast medium and with any scans of the lumbosacral region of the spine prior to intravenous contrast injection when undertaken (R) (Anaes.)

Fee: $365.60 Benefit: 75% = $274.20 85% = $310.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56233

56233 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

NOTE:  An account issued or a patient assignment form must show the item numbers of the examinations performed under this item

 

Computed tomography—scan of spine, 2 examinations of the kind referred to in items 56220, 56221 and 56223, without intravenous contrast medium (R) (Anaes.)

Fee: $249.75 Benefit: 75% = $187.35 85% = $212.30

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56234

56234 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

NOTE:  An account issued or a patient assignment form must show the item numbers of the examinations performed under this item

 

Computed tomography—scan of spine, 2 examinations of the kind referred to in items 56224, 56225 and 56226, with intravenous contrast medium and with any scans of these regions of the spine before intravenous contrast injection when undertaken (R) (Anaes.)

Fee: $365.60 Benefit: 75% = $274.20 85% = $310.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56237

56237 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Computed tomography—scan of spine, 3 regions cervical, thoracic and lumbosacral, without intravenous contrast medium (R) (Anaes.)

Fee: $249.75 Benefit: 75% = $187.35 85% = $212.30

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56238

56238 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Computed tomography—scan of spine, 3 regions, cervical, thoracic and lumbosacral, with intravenous contrast medium and with any scans of these regions of the spine before intravenous contrast injection when undertaken (R) (Anaes.)

Fee: $365.60 Benefit: 75% = $274.20 85% = $310.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56301

56301 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Computed tomography—scan of chest, including lungs, mediastinum, chest wall and pleura, with or without scans of the upper abdomen, without intravenous contrast medium, not being a service to which item 56801 or 57001 applies and not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (Anaes.)

Fee: $306.95 Benefit: 75% = $230.25 85% = $260.95

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56307

56307 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Computed tomography—scan of chest, including lungs, mediastinum, chest wall and pleura, with or without scans of the upper abdomen, with intravenous contrast medium and with any scans of the chest, including lungs, mediastinum, chest wall or pleura and upper abdomen before intravenous contrast injection, when undertaken, not being a service to which item 56807 or 57007 applies and not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (Anaes.)

Fee: $416.20 Benefit: 75% = $312.15 85% = $353.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56801

56801 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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

Fee: $485.45 Benefit: 75% = $364.10 85% = $412.65

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56807

56807 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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

Fee: $582.70 Benefit: 75% = $437.05 85% = $495.30

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

58300

58300 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

58306

58306 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Skeletal survey (R)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

59103

59103 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-Nov-2009
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63425

63425 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

 

MRI—scan of person under the age of 16 for post inflammatory or post traumatic physeal fusion (R) 

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63428

63428 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

MRI—scan of person under the age of 16 for Gaucher disease (R) 

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63151

63151 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63154

63154 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

64990

64990 - Additional Information

Item Start Date:
01-Feb-2004
Description Updated:
01-Jan-2022
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

64991

64991 - Additional Information

Item Start Date:
01-May-2004
Description Updated:
01-Jan-2022
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

57001

57001 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

57007

57007 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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% = $502.15

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57352

57352 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

57353

57353 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

57354

57354 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

57360

57360 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-Nov-2021
Schedule Fee Updated:
01-Jul-2022

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% = $635.15

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61523

61523 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
22-Dec-2005
Schedule Fee Updated:
01-Oct-2001

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% = $859.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61524

61524 - Additional Information

Item Start Date:
01-Nov-2019
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Nov-2019

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% = $859.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61525

61525 - Additional Information

Item Start Date:
01-Nov-2019
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Nov-2019

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% = $859.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61529

61529 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
22-Dec-2005
Schedule Fee Updated:
01-Oct-2001

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% = $859.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61541

61541 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-Jul-2011
Schedule Fee Updated:
01-Oct-2001

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% = $859.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61553

61553 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-Jul-2011
Schedule Fee Updated:
01-Oct-2001

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% = $905.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61559

61559 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
22-Dec-2005
Schedule Fee Updated:
01-Oct-2001

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% = $824.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61563

61563 - Additional Information

Item Start Date:
01-Jul-2022
Description Updated:
01-Jul-2022
Schedule Fee Updated:
01-Jul-2022

Whole body prostate-specific membrane antigen PET study performed for
the initial staging of intermediate to high-risk prostate adenocarcinoma, for a
previously untreated patient who is considered suitable for locoregional
therapy with curative intent

Applicable once per lifetime (R)

Fee: $1,300.00 Benefit: 75% = $975.00 85% = $1,206.80

(See para IN.0.17, IN.0.19 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61564

61564 - Additional Information

Item Start Date:
01-Jul-2022
Description Updated:
01-Jul-2022
Schedule Fee Updated:
01-Jul-2022

Whole body prostate-specific membrane antigen PET study performed for
the restaging of recurrent prostate adenocarcinoma, for a patient who:
(a) has undergone prior locoregional therapy; and
(b) is considered suitable for further locoregional therapy to determine
appropriate therapeutic pathways and timing of treatment initiation

Applicable twice per lifetime (R)

Fee: $1,300.00 Benefit: 75% = $975.00 85% = $1,206.80

(See para IN.0.17, IN.0.19 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61565

61565 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-Jul-2011
Schedule Fee Updated:
01-Oct-2001

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% = $859.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61612

61612 - Additional Information

Item Start Date:
01-Nov-2022
Description Updated:
01-Nov-2022
Schedule Fee Updated:
01-Nov-2022

Whole body FDG PET study for the initial staging of eligible cancer types, for a patient who is considered suitable for active therapy, if:

(a) the eligible cancer type is:

(i) a rare or uncommon cancer (less than 12 cases per 100,000 persons per year); and

(ii) a typically FDG‑avid cancer; and

(b) there is at least a 10% likelihood that the PET study result will inform a significant change in management for the patient

Applicable once per cancer diagnosis (R)

Fee: $953.00 Benefit: 75% = $714.75 85% = $859.80

(See para IN.0.17, IN.0.19 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61620

61620 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-Nov-2017
Schedule Fee Updated:
01-Jul-2011

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% = $859.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61622

61622 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-Nov-2017
Schedule Fee Updated:
14-Jan-2002

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% = $859.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61628

61628 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-Nov-2017
Schedule Fee Updated:
14-Jan-2002

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% = $859.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61632

61632 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-Nov-2017
Schedule Fee Updated:
01-Jul-2011

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% = $859.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61647

61647 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-May-2020

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% = $859.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55600

55600 - Additional Information

Item Start Date:
01-Nov-1998
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Prostate, bladder base and urethra, ultrasound scan of, if performed:
(a) personally by a medical practitioner (not being the medical practitioner who assessed the patient as specified in paragraph (c)) using one or more transducer probes that can obtain both axial and sagittal scans in 2 planes at right angles; and
(b) after a digital rectal examination of the prostate by that medical practitioner; and
(c) on a patient who has been assessed by:
(i) a specialist in urology, radiation oncology or medical oncology; or
(ii) a consultant physician in medical oncology;
who has:
(iii) examined the patient in the 60 days before the scan; and
(iv) recommended the scan for the management of the patient’s current prostatic disease
(R)

Fee: $113.55 Benefit: 75% = $85.20 85% = $96.55

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55603

55603 - Additional Information

Item Start Date:
01-Nov-1998
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Prostate, bladder base and urethra, ultrasound scan of, if performed:
(a) personally by a medical practitioner who made the assessment mentioned in paragraph (c) using one or more transducer probes that can obtain both axial and sagittal scans in 2 planes at right angles; and
(b) after a digital rectal examination of the prostate by that medical practitioner; and
(c) on a patient who has been assessed by:
(i) a specialist in urology, radiation oncology or medical oncology; or
(ii) a consultant physician in medical oncology;
who has:
(iii) examined the patient in the 60 days before the scan; and
(iv) recommended the scan for the management of the patient’s current prostatic disease
(R)

Fee: $113.55 Benefit: 75% = $85.20 85% = $96.55

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61109

61109 - Additional Information

Item Start Date:
31-Oct-1992
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

58700

58700 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

58706

58706 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

58715

58715 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

58718

58718 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

58721

58721 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63301

63301 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

MRI—scan of musculoskeletal system for tumour arising in bone or musculoskeletal system, excluding tumours arising in breast, prostate or rectum (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $386.90 Benefit: 75% = $290.20 85% = $328.90

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63304

63304 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

MRI—scan of musculoskeletal system for infection arising in bone or musculoskeletal system, excluding infection arising in breast, prostate or rectum (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $386.90 Benefit: 75% = $290.20 85% = $328.90

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63307

63307 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

MRI—scan of musculoskeletal system for osteonecrosis (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $386.90 Benefit: 75% = $290.20 85% = $328.90

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63401

63401 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63404

63404 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63416

63416 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

MRA—scan of person under the age of 16 for the vasculature of limbs prior to limb or digit transfer surgery in congenital limb deficiency syndrome (R) (Contrast)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63040

63040 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63043

63043 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63046

63046 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63049

63049 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63052

63052 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63055

63055 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63058

63058 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63061

63061 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63064

63064 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63067

63067 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63070

63070 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63073

63073 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55700

55700 - Additional Information

Item Start Date:
01-Feb-2000
Description Updated:
01-Nov-2022
Schedule Fee Updated:
01-Jul-2022

Pelvis or abdomen, pregnancy‑related or pregnancy complication, ultrasound (the current ultrasound) scan of, by any or all approaches, for determining the gestation, location, viability or number of fetuses, if:

(a) the dating of the pregnancy (as confirmed by the current ultrasound) is less than 12 weeks of gestation; and

(b) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in item 55704, 55705, 55707, 55708, 55740, 55741, 55742 or 55743 (R) 

 

 

 

 

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

(See para IN.0.13, IN.0.19 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55703

55703 - Additional Information

Item Start Date:
01-Feb-2000
Description Updated:
01-Nov-2022
Schedule Fee Updated:
01-Jul-2022

Pelvis or abdomen, pregnancy‑related or pregnancy complication, ultrasound (the current ultrasound) scan of, by any or all approaches, for determining the gestation, location, viability or number of fetuses, if:

(a) the dating of the pregnancy (as confirmed by the current ultrasound) is less than 12 weeks of gestation; and

(b) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in item 55704, 55705, 55707, 55708, 55740, 55741, 55742 or 55743 (NR)

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

(See para IN.0.13, IN.0.19 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55704

55704 - Additional Information

Item Start Date:
01-Feb-2000
Description Updated:
01-Nov-2022
Schedule Fee Updated:
01-Jul-2022

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, for determining the structure, gestation, location, viability or number of fetuses, if:

(a) the dating of the pregnancy (as confirmed by the current ultrasound) is 12 to 16 weeks of gestation; and

(b) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in another item in this Subgroup (R)

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

(See para IN.0.13, IN.0.19 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55705

55705 - Additional Information

Item Start Date:
01-Feb-2000
Description Updated:
01-Nov-2022
Schedule Fee Updated:
01-Jul-2022

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, for determining the structure, gestation, location, viability or number of fetuses, if:

(a) the dating of the pregnancy (as confirmed by the current ultrasound) is 12 to 16 weeks of gestation; and

(b) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in another item in this Subgroup (NR)

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

(See para IN.0.13, IN.0.19 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55706

55706 - Additional Information

Item Start Date:
01-Feb-2000
Description Updated:
01-Nov-2022
Schedule Fee Updated:
01-Jul-2022

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound (the current 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 the current ultrasound) is 17 to 22 weeks of gestation; and

(b) the current ultrasound:

(i) is not performed in the same pregnancy as item 55709; and

(ii) is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (R)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55707

55707 - Additional Information

Item Start Date:
01-Nov-2005
Description Updated:
01-Nov-2022
Schedule Fee Updated:
01-Jul-2022

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, if:
(a) the pregnancy (as confirmed by the current 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 current ultrasound is not performed on the same patient within 24 hours of a service mentioned in another item in this Subgroup (R)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55708

55708 - Additional Information

Item Start Date:
01-Nov-2005
Description Updated:
01-Nov-2022
Schedule Fee Updated:
01-Jul-2022

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, if:
(a) the pregnancy (as confirmed by the current 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 current ultrasound is not performed on the same patient within 24 hours of a service mentioned in another item in this Subgroup (NR)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55709

55709 - Additional Information

Item Start Date:
01-Feb-2000
Description Updated:
01-Nov-2022
Schedule Fee Updated:
01-Jul-2022

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound (the current 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 the current ultrasound) is 17 to 22 weeks of gestation; and

(b) the current ultrasound:

(i) is not performed in the same pregnancy as item 55706; and

(ii) is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (NR)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55712

55712 - Additional Information

Item Start Date:
01-Feb-2000
Description Updated:
01-Nov-2022
Schedule Fee Updated:
01-Jul-2022

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:

(a) the current ultrasound 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 the current 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; and

(d) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (R)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55715

55715 - Additional Information

Item Start Date:
01-Feb-2000
Description Updated:
01-Nov-2022
Schedule Fee Updated:
01-Jul-2022

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound (the current 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 the current 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; and

(c) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (NR)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55718

55718 - Additional Information

Item Start Date:
01-Feb-2000
Description Updated:
01-Nov-2022
Schedule Fee Updated:
01-Jul-2022

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, if:

(a) the dating of the pregnancy (as confirmed by the current ultrasound) is after 22 weeks of gestation; and

(b) the current ultrasound:

(i) is not performed in the same pregnancy as item 55723; and

(ii) is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (R)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55721

55721 - Additional Information

Item Start Date:
01-Feb-2000
Description Updated:
01-Nov-2022
Schedule Fee Updated:
01-Jul-2022

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, if:

(a) the current ultrasound 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 the current ultrasound) is after 22 weeks of gestation; and

(c) further examination is clinically indicated in the same pregnancy to which item 55718 or 55723 applies; and

(d) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (R)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55723

55723 - Additional Information

Item Start Date:
01-Feb-2000
Description Updated:
01-Nov-2022
Schedule Fee Updated:
01-Jul-2022

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, if:

(a) the dating of the pregnancy (as confirmed by the current ultrasound) is after 22 weeks of gestation; and

(b) the current ultrasound:

(i) is not performed in the same pregnancy as item 55718; and

(ii) is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (NR)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55725

55725 - Additional Information

Item Start Date:
01-Feb-2000
Description Updated:
01-Nov-2022
Schedule Fee Updated:
01-Jul-2022

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, 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 the current ultrasound) is after 22 weeks of gestation; and

(b) further examination is clinically indicated in the same pregnancy to which item 55718 or 55723 applies; and

(c) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (NR)

 

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55729

55729 - Additional Information

Item Start Date:
01-Nov-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Duplex scanning, if:
(a) the service involves:
(i) B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of the umbilical artery; and
(ii) measured assessment of amniotic fluid volume after the 24th week of gestation; and
(b) there is reason to suspect intrauterine growth retardation or a significant risk of fetal death;
—examination and report (R)

Fee: $28.35 Benefit: 75% = $21.30 85% = $24.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55736

55736 - Additional Information

Item Start Date:
01-Feb-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Pelvis, ultrasound scan of, in association with saline infusion of the endometrial cavity, by any or all approaches, if a previous transvaginal ultrasound has revealed an abnormality of the uterus or fallopian tube (R)

Fee: $132.15 Benefit: 75% = $99.15 85% = $112.35

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55739

55739 - Additional Information

Item Start Date:
01-Feb-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2022

Pelvis, ultrasound scan of, in association with saline infusion of the endometrial cavity, by any or all approaches, if a previous transvaginal ultrasound has revealed an abnormality of the uterus or fallopian tube (NR)

Fee: $59.30 Benefit: 75% = $44.50 85% = $50.45

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

Category 5 - DIAGNOSTIC IMAGING SERVICES