Medicare Benefits Schedule - Note IN.0.19

Out-of-hospital services attract higher benefits when they are bulk billed by the provider.

For all diagnostic imaging items (except those in Group 6 – Management of Bulk Billed Services and item 61369) benefits for bulk billed services are payable at 95% of the schedule fee for the item.

Related Items: 55028 55029 55030 55031 55032 55033 55036 55037 55038 55039 55048 55049 55054 55065 55066 55068 55070 55071 55073 55076 55079 55084 55085 55118 55126 55127 55128 55129 55130 55132 55133 55134 55135 55137 55141 55143 55145 55146 55238 55244 55246 55248 55252 55274 55276 55278 55280 55282 55284 55292 55294 55296 55600 55603 55700 55703 55704 55705 55706 55707 55708 55709 55712 55715 55718 55721 55723 55725 55729 55736 55739 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

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Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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

(Anaes.)

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

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

Bulk bill incentive

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

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

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

Bulk bill incentive

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

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

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

Bulk bill incentive

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

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

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

Bulk bill incentive

MRI—scan of 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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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

(Anaes.)

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

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

Bulk bill incentive

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

(Anaes.)

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

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

Bulk bill incentive

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

(Anaes.)

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

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

Bulk bill incentive

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

(Anaes.)

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

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

Bulk bill incentive

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

(Anaes.)

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

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

Bulk bill incentive

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

(Anaes.)

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

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

Bulk bill incentive

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

(Anaes.)

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

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

Bulk bill incentive

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

(Anaes.)

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

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

Bulk bill incentive

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

(Anaes.)

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

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

Bulk bill incentive

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

(Anaes.)

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

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

Bulk bill incentive

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

(Anaes.)

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

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

Bulk bill incentive

MRI—multiphase scans of liver (including delayed imaging, if performed) with a contrast agent, for 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)

Bulk bill incentive

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

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

(Anaes.)

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

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

Bulk bill incentive

MRI—scan of 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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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

(Anaes.)

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

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

Bulk bill incentive

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

(Anaes.)

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

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

Bulk bill incentive

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

(Anaes.)

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

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

Bulk bill incentive

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

(Anaes.)

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

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

Bulk bill incentive

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

(Anaes.)

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

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

Bulk bill incentive

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

(Anaes.)

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

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

Bulk bill incentive

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

(Anaes.)

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

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

Bulk bill incentive

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

(Anaes.)

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

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

Bulk bill incentive

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

(Anaes.)

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

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

Bulk bill incentive

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

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

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

Bulk bill incentive

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

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

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

Bulk bill incentive

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

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

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

Bulk bill incentive

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

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

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

Bulk bill incentive

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

(Anaes.)

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

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

Bulk bill incentive

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

(Anaes.)

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

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

Bulk bill incentive

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

(Anaes.)

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

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

Bulk bill incentive

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

(Anaes.)

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

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

Bulk bill incentive

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

(Anaes.)

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

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

Bulk bill incentive

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

(Anaes.)

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

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

Bulk bill incentive

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

(Anaes.)

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

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

Bulk bill incentive

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

(Anaes.)

Fee: $868.90 Benefit: 75% = $651.70 85% = $775.70

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

Bulk bill incentive

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

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

(Anaes.)

Fee: $868.90 Benefit: 75% = $651.70 85% = $775.70

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

Bulk bill incentive

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

(Anaes.)

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

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

Bulk bill incentive

MRI scan of both breasts for the detection of cancer 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)

Bulk bill incentive

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

(Anaes.)

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

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

Bulk bill incentive

MRI—scan of both breasts, if:

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

(Anaes.)

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

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

Bulk bill incentive

MRI—scan of both breasts, if:

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

(Anaes.)

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

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

Bulk bill incentive

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

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

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

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

(b) using a standardised image acquisition protocol involving:

(i) T2‑weighted imaging; and

(ii) diffusion‑weighted imaging; and

(iii) (unless contraindicated) dynamic contrast enhancement 

(R) 

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

(Anaes.)

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

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

Bulk bill incentive

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

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

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

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

(b) using a standardised image acquisition protocol involving:

(i) T2‑weighted imaging; and

(ii) diffusion‑weighted imaging; and

(iii) (unless contraindicated) dynamic contrast enhancement

(R)

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

(Anaes.)

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

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

Bulk bill incentive

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

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

(Anaes.)

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

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

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

Salivary study (R)

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

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

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

Cystoureterogram (R)

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

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

Bulk bill incentive

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

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)

Bulk bill incentive

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)