Medicare Benefits Schedule - Note IN.0.19

To provide an incentive to bulk-bill, for out of hospital services that are bulk billed the schedule fee is reduced by 5% and rebates paid at 100% of this revised fee (except for item 61369, and all items in Group I5 - Magnetic Resonance Imaging).  For items in Group I5 - Magnetic Resonance Imaging, the bulk billing incentive for out of hospital services is 100% of the Schedule Fee listed in the table.

Related Items: 55005 55007 55008 55010 55011 55013 55014 55016 55017 55019 55023 55026 55028 55029 55030 55031 55032 55033 55036 55037 55038 55039 55048 55049 55054 55059 55060 55061 55062 55063 55064 55065 55067 55068 55069 55070 55073 55076 55079 55084 55085 55113 55114 55115 55116 55117 55118 55119 55120 55121 55122 55123 55125 55130 55131 55135 55136 55220 55221 55222 55223 55224 55226 55227 55228 55229 55230 55232 55233 55235 55236 55238 55244 55246 55248 55252 55274 55276 55278 55280 55282 55284 55292 55294 55296 55600 55601 55603 55604 55700 55701 55702 55703 55704 55705 55706 55707 55708 55709 55710 55711 55712 55713 55714 55715 55716 55717 55718 55719 55720 55721 55722 55723 55724 55725 55726 55727 55729 55730 55735 55736 55737 55739 55759 55760 55762 55763 55764 55765 55766 55767 55768 55769 55770 55771 55772 55773 55774 55775 55800 55801 55802 55803 55804 55805 55806 55807 55808 55809 55810 55811 55812 55813 55814 55815 55816 55817 55818 55819 55820 55821 55822 55823 55824 55825 55826 55828 55829 55830 55831 55832 55833 55834 55835 55836 55837 55838 55839 55840 55841 55842 55843 55844 55845 55846 55847 55848 55849 55850 55851 55852 55853 55854 55855 56001 56007 56010 56013 56016 56022 56028 56030 56036 56041 56047 56050 56053 56056 56062 56068 56070 56076 56101 56107 56141 56147 56219 56220 56221 56223 56224 56225 56226 56227 56228 56229 56230 56231 56232 56233 56234 56235 56236 56237 56238 56239 56240 56259 56301 56307 56341 56347 56401 56407 56409 56412 56441 56447 56449 56452 56501 56507 56541 56547 56619 56620 56625 56626 56659 56660 56665 56666 56801 56807 56841 56847 57001 57007 57041 57047 57201 57247 57341 57345 57350 57351 57355 57356 57360 57361 57506 57509 57512 57515 57518 57521 57522 57523 57524 57527 57529 57530 57532 57533 57535 57536 57537 57538 57539 57540 57541 57700 57702 57703 57705 57706 57708 57709 57711 57712 57714 57715 57717 57721 57723 57901 57902 57903 57906 57909 57911 57912 57914 57915 57917 57918 57920 57921 57923 57924 57926 57927 57929 57930 57932 57933 57935 57938 57939 57941 57942 57944 57945 57947 57950 57953 57956 57959 57960 57962 57963 57965 57966 57968 57969 58100 58102 58103 58105 58106 58108 58109 58111 58112 58114 58115 58117 58123 58124 58126 58127 58300 58302 58306 58308 58500 58502 58503 58505 58506 58508 58509 58511 58521 58523 58524 58526 58527 58529 58700 58702 58706 58708 58715 58717 58718 58720 58721 58723 58900 58902 58903 58905 58909 58911 58912 58914 58915 58916 58917 58920 58921 58923 58927 58929 58933 58935 58936 58938 58939 58941 59103 59104 59300 59301 59302 59303 59304 59305 59306 59307 59309 59310 59312 59313 59314 59315 59318 59319 59700 59701 59703 59704 59712 59713 59715 59716 59718 59719 59724 59725 59733 59734 59739 59740 59751 59752 59754 59755 59763 59764 59903 59912 59925 59970 59971 59972 59973 59974 60000 60001 60003 60004 60006 60007 60009 60010 60012 60013 60015 60016 60018 60019 60021 60022 60024 60025 60027 60028 60030 60031 60033 60034 60036 60037 60039 60040 60042 60043 60045 60046 60048 60049 60051 60052 60054 60055 60057 60058 60060 60061 60063 60064 60066 60067 60069 60070 60072 60073 60075 60076 60078 60079 60500 60501 60503 60506 60509 60510 60918 60927 61109 61110 61302 61303 61306 61307 61310 61313 61314 61316 61317 61320 61328 61340 61348 61352 61353 61356 61360 61361 61364 61368 61372 61373 61376 61381 61383 61384 61386 61387 61389 61390 61393 61397 61401 61402 61405 61409 61413 61417 61421 61425 61426 61429 61430 61433 61434 61437 61438 61441 61442 61445 61446 61449 61450 61453 61454 61457 61458 61461 61462 61469 61473 61480 61484 61485 61495 61499 61505 61523 61524 61525 61529 61541 61553 61559 61565 61620 61622 61628 61632 61647 61650 61651 61652 61653 61654 61655 61656 61657 61658 61659 61660 61661 61662 61663 61664 61665 61666 61667 61668 61669 61670 61671 61672 61673 61674 61675 61676 61677 61678 61679 61680 61681 61682 61683 61684 61685 61686 61687 61688 61689 61690 61691 61692 61693 61694 61695 61696 61697 61698 61699 61700 61701 61702 61703 61704 61705 61706 61707 61708 61709 61710 61712 61713 61714 61715 61716 61717 61718 61719 61729 63001 63004 63007 63010 63013 63014 63016 63017 63040 63043 63046 63049 63052 63055 63058 63061 63064 63067 63070 63073 63074 63075 63076 63077 63078 63079 63080 63081 63082 63083 63084 63085 63101 63104 63111 63114 63117 63119 63125 63128 63131 63134 63135 63136 63151 63154 63157 63158 63161 63164 63167 63170 63173 63176 63179 63182 63185 63186 63187 63188 63189 63190 63191 63192 63193 63194 63201 63204 63207 63208 63219 63222 63225 63228 63231 63234 63237 63240 63243 63257 63258 63259 63260 63261 63262 63263 63264 63265 63271 63274 63277 63280 63282 63283 63284 63285 63301 63304 63307 63310 63311 63313 63322 63325 63328 63331 63334 63337 63340 63341 63342 63343 63345 63346 63347 63348 63361 63364 63385 63388 63391 63392 63393 63394 63395 63396 63397 63398 63401 63404 63407 63408 63416 63419 63425 63428 63432 63433 63440 63443 63446 63447 63448 63449 63454 63455 63457 63458 63460 63461 63464 63467 63470 63473 63476 63479 63481 63482 63484 63486 63491 63494 63496 63497 63498 63499 63501 63502 63504 63505 63513 63514 63531 63532 63533 63534 63541 63542 63543 63544 63545 63546 63547 63548 63560 63561 64990 64991

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Bulk bill incentive

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

(Anaes.)

Fee: $43.40 Benefit: 75% = $32.55 85% = $36.90

(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) (NK)

(Anaes.)

Fee: $21.70 Benefit: 75% = $16.30 85% = $18.45

(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: $29.75 Benefit: 75% = $22.35 85% = $25.30

(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 Table applies (R)

Fee: $63.75 Benefit: 75% = $47.85 85% = $54.20

(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 Table applies (R)

Fee: $98.90 Benefit: 75% = $74.20 85% = $84.10

(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 Table applies (R) (NK)

Fee: $49.45 Benefit: 75% = $37.10 85% = $42.05

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

Bulk bill incentive

NOTE: Benefits are payable for each service included by Subgroup 14 on two occasions only in any 12 month period

MAGNETIC RESONANCE IMAGING (including Magnetic Resonance Angiography if performed), performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of cardiovascular system for:

- congenital disease of the heart or a great vessel (R) (Contrast)

(Anaes.)

Fee: $448.00 Benefit: 75% = $336.00 85% = $380.80

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

Bulk bill incentive

- tumour of the heart or a great vessel (R) (Contrast)

(Anaes.)

Fee: $448.00 Benefit: 75% = $336.00 85% = $380.80

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

Bulk bill incentive

- abnormality of thoracic aorta (R) (Contrast)

(Anaes.)

Fee: $403.20 Benefit: 75% = $302.40 85% = $342.75

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

Bulk bill incentive

NOTE: Benefits are payable for each service included by Subgroup 14 on two occasions only in any 12 month period

MAGNETIC RESONANCE IMAGING (including Magnetic Resonance Angiography if performed), performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of cardiovascular system for:

- congenital disease of the heart or a great vessel (R) (NK) (Contrast)

(Anaes.)

Fee: $224.00 Benefit: 75% = $168.00 85% = $190.40

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

Bulk bill incentive

- tumour of the heart or a great vessel (R) (NK) (Contrast)

(Anaes.)

Fee: $224.00 Benefit: 75% = $168.00 85% = $190.40

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

Bulk bill incentive

- abnormality of thoracic aorta (R) (NK) (Contrast)

(Anaes.)

Fee: $201.60 Benefit: 75% = $151.20 85% = $171.40

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

Bulk bill incentive

MRI scan of the cardiovascular system, performed by a person who is:

(a) a specialist in diagnostic radiology or a consultant physician; and

(b) recognised by the Conjoint Committee for Certification in Cardiac MRI

for the 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

NOTE: benefits are payable once in 12 months

(R) (K) (Contrast)

(Anaes.)

Fee: $855.20 Benefit: 75% = $641.40 85% = $770.50

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

Bulk bill incentive

MRI scan of the cardiovascular system, performed by a person who is:

(a) a specialist in diagnostic radiology or a consultant physician; and

(b) recognised by the Conjoint Committee for Certification in Cardiac MRI

for the 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

NOTE: benefits are payable once in 12 months

(R) (NK) (Contrast)

(Anaes.)

Fee: $427.60 Benefit: 75% = $320.70 85% = $363.50

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

Bulk bill incentive

MRI scan of the cardiovascular system, performed by a person who is:

(a) a specialist in diagnostic radiology or a consultant physician; and

(b) recognised by the Conjoint Committee for Certification in Cardiac MRI
 

for the 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)

 NOTE: benefits are payable once in 36 months

(R) (K) (Contrast)

(Anaes.)

Fee: $855.20 Benefit: 75% = $641.40 85% = $770.50

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

Bulk bill incentive

MRI scan of the cardiovascular system, performed by a person who is:

(a) a specialist in diagnostic radiology or a consultant physician; and

(b) recognised by the Conjoint Committee for Certification in Cardiac MRI
 

for the 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)

NOTE: benefits are payable once in 36 months

(R) (NK) (Contrast)

(Anaes.)

Fee: $427.60 Benefit: 75% = $320.70 85% = $363.50

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

Bulk bill incentive

MAGNETIC RESONANCE IMAGING scan of the pelvis or abdomen, where:

(a) the patient is referred by a specialist obstetrician; and
(b) the patient is pregnant at 18 weeks gestation or greater; and
(c) a fetal central nervous system (CNS) abnormality is suspected; and
(d) an ultrasound provided by, or on behalf of, or at the request of, a specialist who is practising in the specialty of obstetrics, has been performed and diagnosis is indeterminate or requires further examination. 

(R) (K) (Contrast)

(Anaes.)

Fee: $1,200.00 Benefit: 75% = $900.00 85% = $1,115.30

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

Bulk bill incentive

NOTE: Benefits are payable for each service included by Subgroup 19 on one occasion only in any 12 month period

MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of body for:

- adrenal mass in a patient with malignancy which is otherwise resectable (R) (NK)

(Anaes.)

Fee: $179.20 Benefit: 75% = $134.40 85% = $152.35

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

Bulk bill incentive

MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician and where:  

(a)     a dedicated breast coil is used; and

(b)     the request for scan identifies that the person is asymptomatic and is less than 50 years of age; and

(c)     the request for scan identifies either:

    (i)     that the patient is at high risk of developing breast cancer, due to 1 of the following:

    (A) 3 or more first or second degree relatives on the same side of the family diagnosed with breast or ovarian cancer;

    (B) 2 or more first or second degree relatives on the same side of the family diagnosed with breast or ovarian cancer,  if any of the following applies to at least 1 of the relatives:                                                              

        - has been diagnosed with bilateral breast cancer;

        - had onset of breast cancer before the age of 40 years;

        - had onset of ovarian cancer before the age of 50 years;

        - has been diagnosed with breast and ovarian cancer, at the same time or at different times;

        - has Ashkenazi Jewish ancestry;

        - is a male relative who has been diagnosed with breast cancer;

    (C) 1 first or second degree relative diagnosed with breast cancer at age 45 years or younger, plus another first or second degree relative on the same side of the family with bone or soft tissue sarcoma at age 45 years or younger; or

    (ii)    that genetic testing has identified the presence of a high risk breast cancer gene mutation.

Scan of both breasts for:

- detection of cancer (R)

NOTE: Benefits are payable on one occasion only in any 12 month period

(NK)

(Anaes.)

Fee: $345.00 Benefit: 75% = $258.75 85% = $293.25

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

Bulk bill incentive

MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician and where:

(a)     a dedicated breast coil is used; and

(b)   the person has had an abnormality detected as a result of a service described in item 63464 or 63457 performed in the previous 12 months

Scan of both breasts for:

- detection of cancer (R)

NOTE 1:    Benefits are payable on one occasion only in any 12 month period

NOTE 2:    This item is intended for follow-up imaging of abnormalities diagnosed on a scan described by item 63464 or 63457

(NK)

(Anaes.)

Fee: $345.00 Benefit: 75% = $258.75 85% = $293.25

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

Bulk bill incentive

MAGNETIC RESONANCE IMAGING scan of the pelvis or abdomen, where:

(a) the patient is referred by a specialist obstetrician; and
(b) the patient is pregnant at 18 weeks gestation or greater; and
(c) a fetal central nervous system (CNS) abnormality is suspected; and
(d) an ultrasound provided by, or on behalf of, or at the request of, a specialist who is practising in the specialty of obstetrics, has been performed and diagnosis is indeterminate or requires further examination. 

(R) (NK) (Contrast)

(Anaes.)

Fee: $600.00 Benefit: 75% = $450.00 85% = $515.30

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

Bulk bill incentive

NOTE: Benefits are payable for each service included by Subgroup 19 on one occasion only in any 12 month period

MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of body for:

- adrenal mass in a patient with malignancy which is otherwise resecetable (R)

(Anaes.)

Fee: $358.40 Benefit: 75% = $268.80 85% = $304.65

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

Bulk bill incentive

MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician and where:  

(a)     a dedicated breast coil is used; and

(b)     the request for scan identifies that the person is asymptomatic and is less than 50 years of age; and

(c)     the request for scan identifies either:

    (i)     that the patient is at high risk of developing breast cancer, due to 1 of the following:

    (A) 3 or more first or second degree relatives on the same side of the family diagnosed with breast or ovarian cancer;

    (B) 2 or more first or second degree relatives on the same side of the family diagnosed with breast or ovarian cancer,  if any of the following applies to at least 1 of the relatives:                                                              

        - has been diagnosed with bilateral breast cancer;

        - had onset of breast cancer before the age of 40 years;

        - had onset of ovarian cancer before the age of 50 years;

        - has been diagnosed with breast and ovarian cancer, at the same time or at different times;

        - has Ashkenazi Jewish ancestry;

        - is a male relative who has been diagnosed with breast cancer;

    (C) 1 first or second degree relative diagnosed with breast cancer at age 45 years or younger, plus another first or second degree relative on the same side of the family with bone or soft tissue sarcoma at age 45 years or younger; or

    (ii)    that genetic testing has identified the presence of a high risk breast cancer gene mutation.

Scan of both breasts for:

- detection of cancer (R)

NOTE: Benefits are payable on one occasion only in any 12 month period

(Anaes.)

Fee: $690.00 Benefit: 75% = $517.50 85% = $605.30

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

Bulk bill incentive

MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician and where:

(a)     a dedicated breast coil is used; and

(b)   the person has had an abnormality detected as a result of a service described in item 63464 performed in the previous 12 months

Scan of both breasts for:

- detection of cancer (R)

NOTE 1:    Benefits are payable on one occasion only in any 12 month period

NOTE 2:    This item is intended for follow-up imaging of abnormalities diagnosed on a scan described by item     63464

(Anaes.)

Fee: $690.00 Benefit: 75% = $517.50 85% = $605.30

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

Bulk bill incentive

MRI – scan of both breasts, performed under the supervision of a specialist in diagnostic radiology who is a participant of the Royal Australian and New Zealand College of Radiologists' (RANZCR) Quality and Accreditation Program at an eligible location, if:

1. a dedicated breast coil is used; and
2. the service has been requested by a specialist or consultant physician; and
3. the request for the scan identifies that:
   1. the patient has a breast lesion; and
   2. the results of conventional imaging are inconclusive for the presence of breast cancer; and
   3. biopsy has not been possible.

NOTE: This service can be provided on both full and partial MRI eligible equipment. There are no frequency restrictions for this item.

(R) (K) (Anaes.) (Contrast)

Fee: $690.00 Benefit: 75% = $517.50 85% = $605.30

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

Bulk bill incentive

MRI – scan of both breasts, performed under the supervision of a specialist in diagnostic radiology who is a participant of the Royal Australian and New Zealand College of Radiologists' (RANZCR) Quality and Accreditation Program at an eligible location, if:

1. a dedicated breast coil is used; and
2. the service has been requested by a specialist or consultant physician; and
3. the request for the scan identifies that:
   1. the patient has a breast lesion; and
   2. the results of conventional imaging are inconclusive for the presence of breast cancer; and
   3. biopsy has not been possible.

NOTE: This service can be provided on both full and partial MRI eligible equipment. There are no frequency restrictions for this item.

(R) (NK) (Anaes.) (Contrast)

Fee: $345.00 Benefit: 75% = $258.75 85% = $293.25

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

Bulk bill incentive

MRI – scan of both breasts, performed under the supervision of a specialist in diagnostic radiology who is a participant of the Royal Australian and New Zealand College of Radiologists' (RANZCR) Quality and Accreditation Program at an eligible location, if:

1. a dedicated breast coil is used; and
2. the service has been requested by a specialist or consultant physician; and
3. the request for the scan identifies that:
   1. the patient has been diagnosed with a breast cancer; and
   2. there is a discrepancy between the clinical assessment and the conventional imaging assessment of the extent of the malignancy; and
4. the results of breast MRI imaging may alter treatment planning. 

NOTE: This service can be provided on both full and partial MRI eligible equipment. There are no frequency restrictions for this item.

(R) (K) (Anaes.) (Contrast)

Fee: $690.00 Benefit: 75% = $517.50 85% = $605.30

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

Bulk bill incentive

MRI – scan of both breasts, performed under the supervision of a specialist in diagnostic radiology who is a participant of the Royal Australian and New Zealand College of Radiologists' (RANZCR) Quality and Accreditation Program at an eligible location, if:

1. a dedicated breast coil is used; and
2. the service has been requested by a specialist or consultant physician; and
3. the request for the scan identifies that:
   1. the patient has been diagnosed with a breast cancer;and
   2. there is a discrepancy between the clinical assessment and the conventional imaging assessment of the extent of the malignancy; and
4. the results of breast MRI imaging may alter treatment planning. 

NOTE: This service can be provided on both full and partial MRI eligible equipment. There are no frequency restrictions for this item.

(R) (NK) (Anaes.) (Contrast)

Fee: $345.00 Benefit: 75% = $258.75 85% = $293.25

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

Bulk bill incentive

Multiparametric Magnetic Resonance Imaging scan of the prostate for the detection of cancer, if the patient is referred by an urologist, radiation oncologist, or medical oncologist and the request for the scan identifies:

that the patient is suspected of  developing prostate cancer, due to one of the following:
(i) a digital rectal examination which is suspicious for prostate cancer; or
(ii) in a person under 70 years, at least two prostate specific antigen (PSA) tests performed within an interval of 1- 3 months are greater than 3.0 ng/ml, and the free/total PSA ratio is less than 25% or the repeat PSA exceeds 5.5 ng/ml; or
(iii) in a person under 70 years, whose risk of developing prostate cancer based on relevant family history is at least double the average risk, at least two PSA tests performed within an interval of 1- 3 months are greater than 2.0 ng/ml, and the free/total PSA  ratio is less than 25%; or
(iv) in a person 70 years or older, at least two PSA tests performed within an interval of 1- 3 months are greater than 5.5ng/ml and the free/total PSA ratio is less than 25%.
using a standardised image acquisition protocol involving T2 Weighted Imaging, Diffusion Weighted Imaging, and Dynamic Contrast Enhancement (unless contraindicated)
 (R) (K) 

Note: Benefits are payable on one occasion only in any 12 month period.

Relevant family history is a first degree relative with prostate cancer, or suspected of carrying a BRCA 1 or BRCA 2 mutation.

(Anaes.)

Fee: $450.00 Benefit: 75% = $337.50 85% = $382.50

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

Bulk bill incentive

Multiparametric Magnetic Resonance Imaging scan of the prostate for the detection of cancer, if the patient is referred by an urologist, radiation oncologist, or medical oncologist and the request for the scan identifies:

that the patient is suspected of  developing prostate cancer, due to one of the following:
(i) a digital rectal examination which is suspicious for prostate cancer; or
(ii) in a person under 70 years, at least two prostate specific antigen (PSA) tests performed within an interval of 1- 3 months are greater than 3.0 ng/ml, and the free/total PSA ratio is less than 25% or the repeat PSA exceeds 5.5 ng/ml; or
(iii) in a person under 70 years, whose risk of developing prostate cancer based on relevant family history is at least double the average risk, at least two PSA tests performed within an interval of 1- 3 months are greater than 2.0 ng/ml, and the free/total PSA  ratio is less than 25%; or
(iv) in a person 70 years or older, at least two PSA tests performed within an interval of 1- 3 months are greater than 5.5ng/ml and the free/total PSA ratio is less than 25%.
using a standardised image acquisition protocol involving T2 Weighted Imaging, Diffusion Weighted Imaging, and Dynamic Contrast Enhancement (unless contraindicated)
 (R) (NK) 

Note: Benefits are payable on one occasion only in any 12 month period.

Relevant family history is a first degree relative with prostate cancer, or suspected of carrying a BRCA 1 or BRCA 2 mutation.

(Anaes.)

Fee: $225.00 Benefit: 75% = $168.75 85% = $191.25

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

Bulk bill incentive

Multiparametric Magnetic Resonance Imaging scan of the prostate for the assessment of cancer, if the patient is referred by an urologist, radiation oncologist, or medical oncologist and:

 the request for the scan identifies: 
(i) the patient is under active surveillance following a confirmed diagnosis of prostate cancer by biopsy histopathology; and
(ii) the patient is not planning or undergoing treatment for prostate cancer.
using a standardised image acquisition protocol involving T2 Weighted Imaging, Diffusion Weighted Imaging, and Dynamic Contrast Enhancement (unless contraindicated)
(R) (K)

Note: Benefits are payable at the time of diagnosis of prostate cancer, 12 months following diagnosis and then every 3rd year thereafter or at any time, if there is a clinical concern, including PSA progression.  This item is not to be used for the purposes of treatment planning or for monitoring after treatment.

(Anaes.)

Fee: $450.00 Benefit: 75% = $337.50 85% = $382.50

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

Bulk bill incentive

Multiparametric Magnetic Resonance Imaging scan of the prostate for the assessment of cancer, if the patient is referred by an urologist, radiation oncologist, or medical oncologist and:

 the request for the scan identifies: 
(i) the patient is under active surveillance following a confirmed diagnosis of prostate cancer by biopsy histopathology; and
(ii) the patient is not planning or undergoing treatment for prostate cancer.
using a standardised image acquisition protocol involving T2 Weighted Imaging, Diffusion Weighted Imaging, and Dynamic Contrast Enhancement (unless contraindicated)
(R) (NK)

Note: Benefits are payable at the time of diagnosis of prostate cancer, 12 months following diagnosis and then every 3rd year thereafter or at any time, if there is a clinical concern, including PSA progression.  This item is not to be used for the purposes of treatment planning or for monitoring after treatment

(Anaes.)

Fee: $225.00 Benefit: 75% = $168.75 85% = $191.25

(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 request for the scan identifies that:    

 (i) the patient has a breast implant in situ; and    

 (ii) anaplastic large cell lymphoma has been diagnosed 

NOTE: benefits are payable once in a patient's lifetime

(R) (K) (Contrast)

(Anaes.)

Fee: $690.00 Benefit: 75% = $517.50 85% = $605.30

(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 request for the scan identifies that:    

 (i) the patient has a breast implant in situ; and    

 (ii) anaplastic large cell lymphoma has been diagnosed 

NOTE: benefits are payable once in a patient's lifetime

(R) (NK) (Contrast)

(Anaes.)

Fee: $345.00 Benefit: 75% = $258.75 85% = $293.25

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

Bulk bill incentive

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

Fee: $385.00 Benefit: 75% = $288.75 85% = $327.25

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

Bulk bill incentive

COMPUTED TOMOGRAPHY - scan of upper abdomen and pelvis with intravenous contrast medium and with any scans of upper abdomen and pelvis prior to intravenous contrast injection, when undertaken, not for the purposes of virtual colonoscopy, not being a service to which item 56807 or 57007 applies (R) (K) (Anaes.)

Fee: $480.05 Benefit: 75% = $360.05 85% = $408.05

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

Bulk bill incentive

COMPUTED TOMOGRAPHY - scan of upper abdomen and pelvis without intravenous contrast medium, not for the purposes of virtual colonoscopy, not being a service to which item 56841 or 57041 applies (R) (NK) (Anaes.)

Fee: $193.15 Benefit: 75% = $144.90 85% = $164.20

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

Bulk bill incentive

COMPUTED TOMOGRAPHY - scan of upper abdomen and pelvis with intravenous contrast medium, and with any scans of upper abdomen and pelvis prior to intravenous contrast injection, when undertaken, not for the purposes of virtual colonoscopy, not being a service to which item 56847 or 57047 applies (R) (NK) (Anaes.)

Fee: $243.75 Benefit: 75% = $182.85 85% = $207.20

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

Bulk bill incentive

M-MODE and 2 DIMENSIONAL REAL TIME ECHOCARDIOGRAPHIC EXAMINATION of the heart from at least 2 acoustic windows, with measurement of blood flow velocities across the cardiac valves using pulsed wave and continuous wave Doppler techniques, and real time colour flow mapping from at least 2 acoustic windows, with recordings on video tape or digital medium, not being a service associated with a service to which an item in Subgroups 1 (with the exception of item 55054) or 3, or another item in this Subgroup (with the exception of items 55118 and 55130), applies, for the investigation of symptoms or signs of cardiac failure, or suspected or known ventricular hypertrophy or dysfunction, or chest pain (R)

Fee: $230.65 Benefit: 75% = $173.00 85% = $196.10

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

Bulk bill incentive

M-MODE and 2 DIMENSIONAL REAL TIME ECHOCARDIOGRAPHIC EXAMINATION of the heart from at least 2 acoustic windows, with measurement of blood flow velocities across the cardiac valves using pulsed wave and continuous wave Doppler techniques, and real time colour flow mapping from at least 2 acoustic windows, with recordings on video tape or digital medium, not being a service associated with a service to which an item in Subgroups 1 (with the exception of item 55054) or 3, or another item in this Subgroup (with the exception of items 55118 and 55130), applies, for the investigation of suspected or known acquired valvular, aortic, pericardial, thrombotic, or embolic disease, or heart tumour (R)

Fee: $230.65 Benefit: 75% = $173.00 85% = $196.10

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

Bulk bill incentive

M-MODE and 2 DIMENSIONAL REAL TIME ECHOCARDIOGRAPHIC EXAMINATION of the heart from at least 2 acoustic windows, with measurement of blood flow velocities across the cardiac valves using pulsed wave and continuous wave Doppler techniques, and real time colour flow mapping from at least 2 acoustic windows, with recordings on video tape or digital medium, not being a service associated with a service to which an item in Subgroups 1 (with the exception of item 55054) or 3, or another item in this Subgroup (with the exception of items 55118 and 55130), applies, for the investigation of symptoms or signs of congenital heart disease (R)

Fee: $230.65 Benefit: 75% = $173.00 85% = $196.10

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

Bulk bill incentive

EXERCISE STRESS ECHOCARDIOGRAPHY performed in conjunction with item 11712, with two-dimensional recordings before exercise (baseline) from at least three acoustic windows and matching recordings from the same windows at, or immediately after, peak exercise, not being a service associated with a service to which an item in Subgroups 1 (with the exception of item 55054) or 3, or another item in this Subgroup applies (with the exception of items 55118 and 55130). Recordings must be made on digital media with equipment permitting display of baseline and matching peak images on the same screen (R)

Fee: $261.65 Benefit: 75% = $196.25 85% = $222.45

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

Bulk bill incentive

PHARMACOLOGICAL STRESS ECHOCARDIOGRAPHY performed in conjunction with item 11712, with two-dimensional recordings before drug infusion (baseline) from at least three acoustic windows and matching recordings from the same windows at least twice during drug infusion, including a recording at the peak drug dose not being a service associated with a service to which an item in Subgroups 1 (with the exception of item 55054) or 3, or another item in this Subgroup, applies (with the exception of items 55118 and 55130). Recordings must be made on digital media with equipment permitting display of baseline and matching peak images on the same screen (R)

Fee: $261.65 Benefit: 75% = $196.25 85% = $222.45

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

Bulk bill incentive

HEART, 2 DIMENSIONAL REAL TIME TRANSOESOPHAGEAL EXAMINATION of, from at least two levels, and in more than one plane at each level:

(a)    with:

    (i)    real time colour flow mapping and, if indicated, pulsed wave Doppler examination; and

    (ii)    recordings on video tape or digital medium; and

(b)    not being an intra-operative service or a service associated with a service to which an item

in Subgroups 1 (with the exception of item 55054) or 3, applies (R)

(Anaes.)

Fee: $275.50 Benefit: 75% = $206.65 85% = $234.20

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

Bulk bill incentive

M-MODE and 2 DIMENSIONAL REAL TIME ECHOCARDIOGRAPHIC EXAMINATION of the heart from at least 2 acoustic windows, with measurement of blood flow velocities across the cardiac valves using pulsed wave and continuous wave Doppler techniques, and real time colour flow mapping from at least 2 acoustic windows, with recordings on video tape or digital medium, not being a service associated with a service to which an item in Subgroups 1 (with the exception of items 55026 and 55054) or 3, or another item in this Subgroup (with the exception of items 55118, 55125, 55130 and 55131), applies, for the investigation of symptoms or signs of cardiac failure, or suspected or known ventricular hypertrophy or dysfunction, or chest pain (R) (NK)

Fee: $115.35 Benefit: 75% = $86.55 85% = $98.05

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

Bulk bill incentive

M-MODE and 2 DIMENSIONAL REAL TIME ECHOCARDIOGRAPHIC EXAMINATION of the heart from at least 2 acoustic windows, with measurement of blood flow velocities across the cardiac valves using pulsed wave and continuous wave Doppler techniques, and real time colour flow mapping from at least 2 acoustic windows, with recordings on video tape or digital medium, not being a service associated with a service to which an item in Subgroups 1 (with the exception of items 55026 and 55054) or 3, or another item in this Subgroup (with the exception of items 55118, 55125, 55130 and 55131), applies, for the investigation of suspected or known acquired valvular, aortic, pericardial, thrombotic, or embolic disease, or heart tumour (R) (NK)

Fee: $115.35 Benefit: 75% = $86.55 85% = $98.05

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

Bulk bill incentive

M-MODE and 2 DIMENSIONAL REAL TIME ECHOCARDIOGRAPHIC EXAMINATION of the heart from at least 2 acoustic windows, with measurement of blood flow velocities across the cardiac valves using pulsed wave and continuous wave Doppler techniques, and real time colour flow mapping from at least 2 acoustic windows, with recordings on video tape or digital medium, not being a service associated with a service to which an item in Subgroups 1 (with the exception of items 55026 and 55054) or 3, or another item in this Subgroup (with the exception of items 55118, 55125, 55130 and 55131), applies, for the investigation of symptoms or signs of congenital heart disease (R) (NK)

Fee: $115.35 Benefit: 75% = $86.55 85% = $98.05

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

Bulk bill incentive

EXERCISE STRESS ECHOCARDIOGRAPHY performed in conjunction with item 11712, with two-dimensional recordings before exercise (baseline) from at least three acoustic windows and matching recordings from the same windows at, or immediately after, peak exercise, not being a service associated with a service to which an item in Subgroups 1 (with the exception of items 55026 and 55054) or 3, or another item in this Subgroup applies (with the exception of items 55118, 55125, 55130 and 55131). Recordings must be made on digital media with equipment permitting display of baseline and matching peak images on the same screen (R) (NK)

Fee: $130.85 Benefit: 75% = $98.15 85% = $111.25

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

Bulk bill incentive

PHARMACOLOGICAL STRESS ECHOCARDIOGRAPHY performed in conjunction with item 11712, with two-dimensional recordings before drug infusion (baseline) from at least three acoustic windows and matching recordings from the same windows at least twice during drug infusion, including a recording at the peak drug dose not being a service associated with a service to which an item in Subgroups 1 (with the exception of items 55026 and 55054) or 3, or another item in this Subgroup, applies (with the exception of items 55118, 55125, 55130 and 55131). Recordings must be made on digital media with equipment permitting display of baseline and matching peak images on the same screen (R) (NK)

Fee: $130.85 Benefit: 75% = $98.15 85% = $111.25

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

Bulk bill incentive

HEART, 2 DIMENSIONAL REAL TIME TRANSOESOPHAGEAL EXAMINATION of, from at least two levels, and in more than one plane at each level:

(a)    with:

    (i)    real time colour flow mapping and, if indicated, pulsed wave Doppler examination; and

    (ii)    recordings on video tape or digital medium; and

(b)    not being an intra-operative service or a service associated with a service to which an item

in Subgroups 1 (with the exception of items 55026 and 55054) or 3, applies (R) (NK)

(Anaes.)

Fee: $137.75 Benefit: 75% = $103.35 85% = $117.10

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

Bulk bill incentive

INTRA-OPERATIVE 2 DIMENSIONAL REAL TIME TRANSOESOPHAGEAL ECHOCARDIOGRAPHY incorporating Doppler techniques with colour flow mapping and recording onto video tape or digital medium, performed during cardiac surgery incorporating sequential assessment of cardiac function before and after the surgical procedure - not associated with item 55135 (R)

(Anaes.)

Fee: $170.00 Benefit: 75% = $127.50 85% = $144.50

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

Bulk bill incentive

INTRA-OPERATIVE 2 DIMENSIONAL REAL TIME TRANSOESOPHAGEAL ECHOCARDIOGRAPHY incorporating Doppler techniques with colour flow mapping and recording onto video tape or digital medium, performed during cardiac surgery incorporating sequential assessment of cardiac function before and after the surgical procedure - not associated with items 55135 and 55136 (R) (NK)

(Anaes.)

Fee: $85.00 Benefit: 75% = $63.75 85% = $72.25

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

Bulk bill incentive

INTRA-OPERATIVE 2 DIMENSIONAL REAL TIME TRANSOESOPHAGEAL ECHOCARDIOGRAPHY incorporating Doppler techniques with colour flow mapping and recording onto video tape or digital medium, performed during cardiac valve surgery (repair or replacement) incorporating sequential assessment of cardiac function and valve competence before and after the surgical procedure - not associated with item 55130 (R)

(Anaes.)

Fee: $353.60 Benefit: 75% = $265.20 85% = $300.60

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

Bulk bill incentive

INTRA-OPERATIVE 2 DIMENSIONAL REAL TIME TRANSOESOPHAGEAL ECHOCARDIOGRAPHY incorporating Doppler techniques with colour flow mapping and recording onto video tape or digital medium, performed during cardiac valve surgery (repair or replacement) incorporating sequential assessment of cardiac function and valve competence before and after the surgical procedure - not associated with items 55130 and 55131 (R) (NK)

(Anaes.)

Fee: $176.80 Benefit: 75% = $132.60 85% = $150.30

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

Bulk bill incentive

HAND, WRIST, FOREARM, ELBOW OR HUMERUS (NR)

Fee: $29.75 Benefit: 75% = $22.35 85% = $25.30

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

Bulk bill incentive

HAND, WRIST, FOREARM, ELBOW OR HUMERUS (R)

Fee: $39.75 Benefit: 75% = $29.85 85% = $33.80

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

Bulk bill incentive

HAND AND WRIST OR HAND, WRIST AND FOREARM OR FOREARM AND ELBOW OR ELBOW AND HUMERUS (NR)

Fee: $40.50 Benefit: 75% = $30.40 85% = $34.45

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

Bulk bill incentive

HAND AND WRIST OR HAND, WRIST AND FOREARM OR FOREARM AND ELBOW OR ELBOW AND HUMERUS (R)

Fee: $54.00 Benefit: 75% = $40.50 85% = $45.90

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

Bulk bill incentive

FOOT, ANKLE, LEG, OR FEMUR (NR)(K)

Fee: $32.50 Benefit: 75% = $24.40 85% = $27.65

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

Bulk bill incentive

FOOT, ANKLE, LEG, OR FEMUR (R)(K)

Fee: $43.40 Benefit: 75% = $32.55 85% = $36.90

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

Bulk bill incentive

Knee (NR)(K)

Fee: $32.50 Benefit: 75% = $24.40 85% = $27.65

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

Bulk bill incentive

Knee (R)(K)

Fee: $43.40 Benefit: 75% = $32.55 85% = $36.90

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

Bulk bill incentive

FOOT AND ANKLE, OR ANKLE AND LEG, OR LEG AND KNEE, OR KNEE AND FEMUR (NR)

Fee: $49.40 Benefit: 75% = $37.05 85% = $42.00

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

Bulk bill incentive

FOOT AND ANKLE, OR ANKLE AND LEG, OR LEG AND KNEE, OR KNEE AND FEMUR (R)

Fee: $65.75 Benefit: 75% = $49.35 85% = $55.90

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

Bulk bill incentive

HAND, WRIST, FOREARM, ELBOW OR HUMERUS (NR) (NK)

Fee: $14.90 Benefit: 75% = $11.20 85% = $12.70

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

Bulk bill incentive

HAND, WRIST, FOREARM, ELBOW OR HUMERUS (R) (NK)

Fee: $19.90 Benefit: 75% = $14.95 85% = $16.95

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

Bulk bill incentive

HAND AND WRIST OR HAND, WRIST AND FOREARM OR FOREARM AND ELBOW OR ELBOW AND HUMERUS (NR) (NK)

Fee: $20.25 Benefit: 75% = $15.20 85% = $17.25

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

Bulk bill incentive

HAND AND WRIST OR HAND, WRIST AND FOREARM OR FOREARM AND ELBOW OR ELBOW AND HUMERUS (R) (NK)

Fee: $27.00 Benefit: 75% = $20.25 85% = $22.95

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

Bulk bill incentive

FOOT, ANKLE, LEG, OR FEMUR (NR) (NK)

Fee: $16.25 Benefit: 75% = $12.20 85% = $13.85

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

Bulk bill incentive

FOOT, ANKLE, LEG, OR FEMUR (R) (NK)

Fee: $21.70 Benefit: 75% = $16.30 85% = $18.45

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

Bulk bill incentive

Knee (NR)(NK)

Fee: $16.25 Benefit: 75% = $12.20 85% = $13.85

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

Bulk bill incentive

FOOT AND ANKLE, OR ANKLE AND LEG, OR LEG AND KNEE, OR KNEE AND FEMUR (NR) (NK)

Fee: $24.70 Benefit: 75% = $18.55 85% = $21.00

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

Bulk bill incentive

FOOT AND ANKLE, OR ANKLE AND LEG, OR LEG AND KNEE, OR KNEE AND FEMUR (R) (NK)

Fee: $32.90 Benefit: 75% = $24.70 85% = $28.00

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

Bulk bill incentive

Knee (R)(NK)

Fee: $21.70 Benefit: 75% = $16.30 85% = $18.45

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

Bulk bill incentive

NOTE: Benefits are payable for each service included by Subgroup 17 on two occasions only in any 12 month period, for previously diagnosed conditions

MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of person under the age of 16 for:

- post-inflammatory or post-traumatic physeal fusion (R)

(Anaes.)

Fee: $403.20 Benefit: 75% = $302.40 85% = $342.75

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

Bulk bill incentive

- Gaucher disease (R)

(Anaes.)

Fee: $403.20 Benefit: 75% = $302.40 85% = $342.75

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

Bulk bill incentive

NOTE: Benefits are payable for each service included by Subgroup 17 on two occasions only in any 12 month period, for previously diagnosed conditions

MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of person under the age of 16 for:

- post-inflammatory or post-traumatic physeal fusion (R) (NK)

(Anaes.)

Fee: $201.60 Benefit: 75% = $151.20 85% = $171.40

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

Bulk bill incentive

- Gaucher disease (R) (NK)

(Anaes.)

Fee: $201.60 Benefit: 75% = $151.20 85% = $171.40

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

Bulk bill incentive

NOTE: Benefits are payable for each service included by Subgroup 9 on three occasions only in any 12 month period

MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of three contiguous regions or two non  contiguous regions of the spine for:

- demyelinating disease (R) (Contrast)

(Anaes.)

Fee: $448.00 Benefit: 75% = $336.00 85% = $380.80

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

Bulk bill incentive

- congenital malformation of the spinal cord or the cauda equina or the meninges (R) (Contrast)

(Anaes.)

Fee: $448.00 Benefit: 75% = $336.00 85% = $380.80

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

Bulk bill incentive

- myelopathy (R) (Contrast)

(Anaes.)

Fee: $448.00 Benefit: 75% = $336.00 85% = $380.80

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

Bulk bill incentive

- syrinx (congenital or acquired ) (R) (Contrast)

(Anaes.)

Fee: $448.00 Benefit: 75% = $336.00 85% = $380.80

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

Bulk bill incentive

- cervical radiculopathy (R) (Contrast)

(Anaes.)

Fee: $448.00 Benefit: 75% = $336.00 85% = $380.80

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

Bulk bill incentive

- sciatica (R) (Contrast)

(Anaes.)

Fee: $448.00 Benefit: 75% = $336.00 85% = $380.80

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

Bulk bill incentive

- spinal canal stenosis (R) (Contrast)

(Anaes.)

Fee: $448.00 Benefit: 75% = $336.00 85% = $380.80

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

Bulk bill incentive

- previous spinal surgery (R) (Contrast)

(Anaes.)

Fee: $448.00 Benefit: 75% = $336.00 85% = $380.80

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

Bulk bill incentive

- trauma (R)

(Anaes.)

Fee: $448.00 Benefit: 75% = $336.00 85% = $380.80

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

Bulk bill incentive

NOTE: Benefits are payable for each service included by Subgroup 9 on three occasions only in any 12 month period

MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of three contiguous regions or two non  contiguous regions of the spine for:

- demyelinating disease (R) (NK) (Contrast)

(Anaes.)

Fee: $224.00 Benefit: 75% = $168.00 85% = $190.40

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

Bulk bill incentive

- congenital malformation of the spinal cord or the cauda equina or the meninges (R) (NK) (Contrast)

(Anaes.)

Fee: $224.00 Benefit: 75% = $168.00 85% = $190.40

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

Bulk bill incentive

- myelopathy (R) (NK) (Contrast)

(Anaes.)

Fee: $224.00 Benefit: 75% = $168.00 85% = $190.40

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

Bulk bill incentive

- syrinx (congenital or acquired ) (R) (NK) (Contrast)

(Anaes.)

Fee: $224.00 Benefit: 75% = $168.00 85% = $190.40

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

Bulk bill incentive

- cervical radiculopathy (R) (NK) (Contrast)

(Anaes.)

Fee: $224.00 Benefit: 75% = $168.00 85% = $190.40

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

Bulk bill incentive

- sciatica (R) (NK) (Contrast)

(Anaes.)

Fee: $224.00 Benefit: 75% = $168.00 85% = $190.40

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

Bulk bill incentive

- spinal canal stenosis (R) (NK) (Contrast)

(Anaes.)

Fee: $224.00 Benefit: 75% = $168.00 85% = $190.40

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

Bulk bill incentive

- previous spinal surgery (R) (NK) (Contrast)

(Anaes.)

Fee: $224.00 Benefit: 75% = $168.00 85% = $190.40

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

Bulk bill incentive

- trauma (R) (NK)

(Anaes.)

Fee: $224.00 Benefit: 75% = $168.00 85% = $190.40

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

Bulk bill incentive

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

Fee: $230.00 Benefit: 75% = $172.50 85% = $195.50

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

Bulk bill incentive

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

Fee: $340.00 Benefit: 75% = $255.00 85% = $289.00

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

Bulk bill incentive

COMPUTED TOMOGRAPHY - scan of soft tissues of neck, including larynx, pharynx, upper oesophagus and salivary glands (not associated with cervical spine) without intravenous contrast medium, not being a service to which item 56841 applies (R) (NK) (Anaes.)

Fee: $116.45 Benefit: 75% = $87.35 85% = $99.00

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

Bulk bill incentive

COMPUTED TOMOGRAPHY - scan of soft tissues of neck, including larynx, pharynx, upper oesophagus and salivary glands (not associated with cervical spine) - with intravenous contrast medium and with any scans of soft tissues of neck including larynx, pharynx, upper oesophagus and salivary glands (not associated with cervical spine) prior to intravenous contrast injection, when undertaken, not being a service associated with a service to which item 56847 applies (R) (NK) (Anaes.)

Fee: $171.60 Benefit: 75% = $128.70 85% = $145.90

(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) (K) (Anaes.)

Fee: $250.00 Benefit: 75% = $187.50 85% = $212.50

(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) prior to intravenous contrast injection, when undertaken, not being a service to which item 56307, 56507, 56807 or 57007 applies (R) (K) (Anaes.)

Fee: $360.00 Benefit: 75% = $270.00 85% = $306.00

(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) (K) (Anaes.)

Fee: $250.00 Benefit: 75% = $187.50 85% = $212.50

(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) prior to intravenous contrast injection, when undertaken, not being a service to which item 56407 applies (R) (K) (Anaes.)

Fee: $360.00 Benefit: 75% = $270.00 85% = $306.00

(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 56341, 56541, 56841 or 57041 applies (R) (NK) (Anaes.)

Fee: $126.80 Benefit: 75% = $95.10 85% = $107.80

(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) prior to intravenous contrast injection, when undertaken, not being a service to which item 56347, 56547, 56847 or 57047 applies (R) (NK) (Anaes.)

Fee: $181.50 Benefit: 75% = $136.15 85% = $154.30

(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 to which item 56441 applies (R) (NK) (Anaes.)

Fee: $126.80 Benefit: 75% = $95.10 85% = $107.80

(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) prior to intravenous contrast injection, when undertaken, not being a service to which item 56447 applies (R) (NK) (Anaes.)

Fee: $181.50 Benefit: 75% = $136.15 85% = $154.30

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

Bulk bill incentive

COMPUTED TOMOGRAPHY - PELVIMETRY (R) (K) (Anaes.)

Fee: $155.20 Benefit: 75% = $116.40 85% = $131.95

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

Bulk bill incentive

COMPUTED TOMOGRAPHY - PELVIMETRY (R) (NK) (Anaes.)

Fee: $77.55 Benefit: 75% = $58.20 85% = $65.95

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

Bulk bill incentive

COMPUTED TOMOGRAPHY, in conjunction with a surgical procedure using interventional techniques, not being a service associated with a service to which another item in this table applies (R) (K) (Anaes.)

Fee: $470.00 Benefit: 75% = $352.50 85% = $399.50

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

Bulk bill incentive

COMPUTED TOMOGRAPHY, in conjunction with a surgical procedure using interventional techniques, not being a service associated with a service to which another item in this table applies (R) (NK) (Anaes.)

Fee: $241.60 Benefit: 75% = $181.20 85% = $205.40

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

Bulk bill incentive

COMPUTED TOMOGRAPHY - spiral angiography with intravenous contrast medium, including any scans performed before intravenous contrast injection - 1 or more spiral data acquisitions, including image editing, and maximum intensity projections or 3 dimensional surface shaded display, with hardcopy recording of multiple projections, where: 

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

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

(c)    the service has not been performed on the same patient within the previous 12 months; and 

(d)    the service is not a study performed to image the coronary arteries (R) (K) (Anaes.)

Fee: $510.00 Benefit: 75% = $382.50 85% = $433.50

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

Bulk bill incentive

COMPUTED TOMOGRAPHY - spiral angiography with intravenous contrast medium, including any scans performed before intravenous contrast injection - 1 or more spiral data acquisitions, including image editing, and maximum intensity projections or 3 dimensional surface shaded display, with hardcopy recording of multiple projections, where:

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

(b)    the service is performed for the exclusion of acute or recurrent pulmonary embolism; acute symptomatic arterial occlusion; post operative complication of arterial surgery; acute ruptured aneurysm; or acute dissection of the aorta, carotid or vertebral artery; and

(c)    the services to which 57350 or 57355 apply have been performed on the same patient within the previous 12 months; and

(d)    the service is not a study performed to image the coronary arteries (R) (K) (Anaes.)

Fee: $510.00 Benefit: 75% = $382.50 85% = $433.50

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

Bulk bill incentive

COMPUTED TOMOGRAPHY - spiral angiography with intravenous contrast medium, including any scans performed before intravenous contrast injection - 1 or more spiral data acquisitions, including image editing, and maximum intensity projections or 3 dimensional surface shaded display, with hardcopy recording of multiple projections, where:

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

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

(c)    the service has not been performed on the same patient within the previous 12 months; and

(d)    the service is not a study performed to image the coronary arteries (R) (NK) (Anaes.)

Fee: $264.15 Benefit: 75% = $198.15 85% = $224.55

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

Bulk bill incentive

COMPUTED TOMOGRAPHY - spiral angiography with intravenous contrast medium, including any scans performed before intravenous contrast injection - 1 or more spiral data acquisitions, including image editing, and maximum intensity projections or 3 dimensional surface shaded display, with hardcopy recording of multiple projections, where:

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

b)    the service is performed for the exclusion of acute or recurrent pulmonary embolism; acute symptomatic arterial

    occlusion; post operative complication of arterial surgery; or acute ruptured aneurysm; acute dissection of the aorta,

    carotid or vertebral artery; and

(c)    the services to which 57350 or 57355 apply have been performed on the same patient within the previous 12 months; and

(d)    the service is not a study performed to image the coronary arteries (R) (NK) (Anaes.)

Fee: $264.15 Benefit: 75% = $198.15 85% = $224.55

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

Bulk bill incentive

COMPUTED TOMOGRAPHY OF THE CORONARY ARTERIES performed on a minimum of a 64 slice (or equivalent) scanner, where the request is made by a specialist or consultant physician, and:

a)    the patient has stable symptoms consistent with coronary ischaemia, is at low to intermediate risk of coronary artery disease and would have been considered for coronary angiography; or

b)    the patient requires exclusion of coronary artery anomaly or fistula; or

c)    the patient will be undergoing non-coronary cardiac surgery (R) (K)

(Anaes.)

Fee: $700.00 Benefit: 75% = $525.00 85% = $615.30

(See para IN.0.12, IN.0.19 of explanatory notes to this Category)

Bulk bill incentive

COMPUTED TOMOGRAPHY OF THE CORONARY ARTERIES performed on a minimum of a 64 slice (or equivalent) scanner, where the request is made by a specialist or consultant physician, and:

a)    the patient has stable symptoms consistent with coronary ischaemia, is at low to intermediate risk of coronary artery disease and would have been considered for coronary angiography; or

b)    the patient requires exclusion of coronary artery anomaly or fistula; or

c)    the patient will be undergoing non-coronary cardiac surgery (R) (NK)

(Anaes.)

Fee: $350.00 Benefit: 75% = $262.50 85% = $297.50

(See para IN.0.12, IN.0.19 of explanatory notes to this Category)

Bulk bill incentive

FLUOROSCOPY in an ANGIOGRAPHY SUITE with image intensification, in conjunction with a surgical procedure, using interventional techniques, not being a service associated with a service to which another item in this Table applies (R)

Fee: $258.90 Benefit: 75% = $194.20 85% = $220.10

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

Bulk bill incentive

FLUOROSCOPY in an ANGIOGRAPHY SUITE with image intensification, in conjunction with a surgical procedure, using interventional techniques, not being a service associated with a service to which another item in this Table applies (R) (NK)

Fee: $129.45 Benefit: 75% = $97.10 85% = $110.05

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

Bulk bill incentive

SKULL, not in association with item 57902 (R)

Fee: $64.50 Benefit: 75% = $48.40 85% = $54.85

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

Bulk bill incentive

CEPHALOMETRY, not in association with item 57901 (R)

Fee: $64.50 Benefit: 75% = $48.40 85% = $54.85

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

Bulk bill incentive

SINUSES (R)

Fee: $47.30 Benefit: 75% = $35.50 85% = $40.25

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

Bulk bill incentive

MASTOIDS (R)

Fee: $64.50 Benefit: 75% = $48.40 85% = $54.85

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

Bulk bill incentive

PETROUS TEMPORAL BONES (R)

Fee: $64.50 Benefit: 75% = $48.40 85% = $54.85

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

Bulk bill incentive

SKULL, not in association with item 57902 or 57914 (R) (NK)

Fee: $32.25 Benefit: 75% = $24.20 85% = $27.45

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

Bulk bill incentive

FACIAL BONES  orbit, maxilla or malar, any or all (R)

Fee: $47.15 Benefit: 75% = $35.40 85% = $40.10

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

Bulk bill incentive

CEPHALOMETRY, not in association with item 57901 or 57911 (R) (NK)

Fee: $32.25 Benefit: 75% = $24.20 85% = $27.45

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

Bulk bill incentive

MANDIBLE, not by orthopantomography technique (R)

Fee: $47.15 Benefit: 75% = $35.40 85% = $40.10

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

Bulk bill incentive

SINUSES (R) (NK)

Fee: $23.65 Benefit: 75% = $17.75 85% = $20.15

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

Bulk bill incentive

SALIVARY CALCULUS (R)

Fee: $47.15 Benefit: 75% = $35.40 85% = $40.10

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

Bulk bill incentive

MASTOIDS (R) (NK)

Fee: $32.25 Benefit: 75% = $24.20 85% = $27.45

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

Bulk bill incentive

NOSE (R)

Fee: $47.15 Benefit: 75% = $35.40 85% = $40.10

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

Bulk bill incentive

PETROUS TEMPORAL BONES (R) (NK)

Fee: $32.25 Benefit: 75% = $24.20 85% = $27.45

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

Bulk bill incentive

EYE (R)

Fee: $47.15 Benefit: 75% = $35.40 85% = $40.10

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

Bulk bill incentive

FACIAL BONES  orbit, maxilla or malar, any or all (R) (NK)

Fee: $23.60 Benefit: 75% = $17.70 85% = $20.10

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

Bulk bill incentive

TEMPOROMANDIBULAR JOINTS (R)

Fee: $49.65 Benefit: 75% = $37.25 85% = $42.25

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

Bulk bill incentive

MANDIBLE, not by orthopantomography technique (R) (NK)

Fee: $23.60 Benefit: 75% = $17.70 85% = $20.10

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

Bulk bill incentive

TEETH  SINGLE AREA (R)

Fee: $32.90 Benefit: 75% = $24.70 85% = $28.00

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

Bulk bill incentive

SALIVARY CALCULUS (R) (NK)

Fee: $23.60 Benefit: 75% = $17.70 85% = $20.10

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

Bulk bill incentive

TEETH  FULL MOUTH (R)

Fee: $78.25 Benefit: 75% = $58.70 85% = $66.55

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

Bulk bill incentive

NOSE (R) (NK)

Fee: $23.60 Benefit: 75% = $17.70 85% = $20.10

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

Bulk bill incentive

EYE (R) (NK)

Fee: $23.60 Benefit: 75% = $17.70 85% = $20.10

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

Bulk bill incentive

PALATOPHARYNGEAL STUDIES with fluoroscopic screening (R)

Fee: $64.50 Benefit: 75% = $48.40 85% = $54.85

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

Bulk bill incentive

TEMPOROMANDIBULAR JOINTS (R) (NK)

Fee: $24.85 Benefit: 75% = $18.65 85% = $21.15

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

Bulk bill incentive

PALATOPHARYNGEAL STUDIES without fluoroscopic screening (R)

Fee: $49.65 Benefit: 75% = $37.25 85% = $42.25

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

Bulk bill incentive

TEETH  SINGLE AREA (R) (NK)

Fee: $16.45 Benefit: 75% = $12.35 85% = $14.00

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

Bulk bill incentive

LARYNX, LATERAL AIRWAYS AND SOFT TISSUES OF THE NECK, not being a service associated with a service to which item 57939 or 57942 applies (R)

Fee: $43.40 Benefit: 75% = $32.55 85% = $36.90

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

Bulk bill incentive

TEETH  FULL MOUTH (R) (NK)

Fee: $39.15 Benefit: 75% = $29.40 85% = $33.30

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

Bulk bill incentive

PALATOPHARYNGEAL STUDIES with fluoroscopic screening (R) (NK)

Fee: $32.25 Benefit: 75% = $24.20 85% = $27.45

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

Bulk bill incentive

PALATOPHARYNGEAL STUDIES without fluoroscopic screening (R) (NK)

Fee: $24.85 Benefit: 75% = $18.65 85% = $21.15

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

Bulk bill incentive

LARYNX, LATERAL AIRWAYS AND SOFT TISSUES OF THE NECK, not being a service associated with a service to which item 57939, 57942, 57950 or 57953 applies (R) (NK)

Fee: $21.70 Benefit: 75% = $16.30 85% = $18.45

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

Bulk bill incentive

Orthopantomography, for diagnosis and/or management of trauma, infection, tumours, congenital conditions or surgical conditions of the teeth or maxillofacial region (R) (NK)

Fee: $23.70 Benefit: 75% = $17.80 85% = $20.15

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

Bulk bill incentive

Orthopantomography, for diagnosis and/or management of trauma, infection, tumours, congenital conditions or surgical conditions of the teeth or maxillofacial region (R)

Fee: $47.40 Benefit: 75% = $35.55 85% = $40.30

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

Bulk bill incentive

Orthopantomography, for diagnosis and/or management of impacted teeth, caries, periodontal or peripical pathology where signs or symptoms of those conditions are evident (R) (NK)

Fee: $23.70 Benefit: 75% = $17.80 85% = $20.15

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