Medicare Benefits Schedule - Note IN.5.2

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Category 5 - DIAGNOSTIC IMAGING SERVICES

IN.5.2

Item 63543 - claiming restrictions

A period of at least 12 months needs to have elapsed before benefits for a second service under 63543 are payable. Benefits are then only payable after a period of three years has elapsed from the date of the second scan and at least each three years thereafter. 

Item 63543 is also applicable to a service described in that item if the clinical need for the service is stated in the request and documented in the record of the service.

Benefits are not payable where the service is provided for the purposes of treatment planning or monitoring after treatment for prostate cancer.

Related Items: 63543


Related Items

Category 5 - DIAGNOSTIC IMAGING SERVICES

63543

63543 - Additional Information

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

 

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

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

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

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

(b) using a standardised image acquisition protocol involving:

(i) T2‑weighted imaging; and

(ii) diffusion‑weighted imaging; and

(iii) (unless contraindicated) dynamic contrast enhancement

(R)

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

 

(Anaes.)

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

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


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  • Assist - Addition/Deletion of (Assist.)
  • Amend - Amended Description
  • Anaes - Anaesthetic Values Amended
  • Emsn - EMSN Change
  • Fee - Fee Amended
  • Renum - Item Number Change (renumbered)
  • New - New Item
  • NewMin - New Item (previous Ministerial Determination)
  • Qfe - QFE Change