Medicare Benefits Schedule - Note AN.2.1

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Category 1 - PROFESSIONAL ATTENDANCES

AN.2.1

Limitation of items - certain attendances by diagnostic imaging providers

 

Consultations rendered by specialist radiologists

Medicare benefits are not payable for items 52, 53, 54, 57, 104 and 105 when claimed by a specialist radiologist in association with any of the following diagnostic imaging items:

(a) an item in Subgroup 6 of Group I1;
(b) an item in any of Subgroups 1 to 7 of Group I3;
(c) items 58900 and 58903 in Subgroup 8 of Group I3; and
(d) item 59103 in Subgroup 9 of Group I3.

Consultations rendered in association with magnetic resonance imaging (MRI) services - Group I5

Medicare benefits are not payable for items 52, 53, 54, 57, 104 and 105 in association with MRI services unless the providing practitioner determines that the consultation is necessary for the treatment or management of the patient's condition. 

The restrictions above apply when these services are performed by the same practitioner, on the same patient, on the same day.

 

Related Items: 52 53 54 57 104 105


Related Items

Category 1 - PROFESSIONAL ATTENDANCES

104

104 - Additional Information

Item Start Date:
01-Nov-1990
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Jul-2021

Professional attendance at consulting rooms or hospital by a specialist in the practice of the specialist's specialty after referral of the patient to the specialist-each attendance, other than a second or subsequent attendance, in a single course of treatment, other than a service to which item 106, 109 or 16401 applies

Fee: $90.35 Benefit: 75% = $67.80 85% = $76.80

(See para AN.0.7, AN.2.1, AN.40.1, TN.1.4 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

105

105 - Additional Information

Item Start Date:
01-Nov-1990
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Jul-2021

Professional attendance by a specialist in the practice of the specialist's specialty following referral of the patient to the specialist-an attendance after the first in a single course of treatment, if that attendance is at consulting rooms or hospital, other than a service to which item 16404 applies

Fee: $45.40 Benefit: 75% = $34.05 85% = $38.60

(See para AN.0.7, AN.0.70, AN.2.1, AN.40.1, TN.1.4 of explanatory notes to this Category)


Consultation At Consulting Rooms

Professional attendance at consulting rooms

Category 1 - PROFESSIONAL ATTENDANCES

52

52 - Additional Information

Item Start Date:
01-Dec-1989
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Dec-1991

 

Professional attendance at consulting rooms of not more than 5 minutes in duration (other than a service to which any other item applies)-each attendance, by:

(a) a medical practitioner (who is not a general practitioner); or

(b) a Group A1 disqualified general practitioner, as defined in the dictionary of the General Medical Services Table (GMST).

Fee: $11.00 Benefit: 100% = $11.00

(See para AN.2.1 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

53

53 - Additional Information

Item Start Date:
01-Dec-1989
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Dec-1991

Professional attendance at consulting rooms of more than 5 minutes in duration but not more than 25 minutes (other than a service to which any other item applies)-each attendance, by:

(a) a medical practitioner (who is not a general practitioner); or

(b) a Group A1 disqualified general practitioner, as defined in the dictionary of the General Medical Services Table (GMST).

Fee: $21.00 Benefit: 100% = $21.00

(See para AN.2.1 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

54

54 - Additional Information

Item Start Date:
01-Dec-1989
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Dec-1991

Professional attendance at consulting rooms of more than 25 minutes in duration but not more than 45 minutes (other than a service to which any other item applies)-each attendance, by:

(a) a medical practitioner (who is not a general practitioner); or

(b) a Group A1 disqualified general practitioner, as defined in the dictionary of the General Medical Services Table (GMST).

Fee: $38.00 Benefit: 100% = $38.00

(See para AN.2.1 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

57

57 - Additional Information

Item Start Date:
01-Dec-1989
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Dec-1991

Professional attendance at consulting rooms of more than 45 minutes in duration (other than a service to which any other item applies)-each attendance, by:

(a) a medical practitioner (who is not a general practitioner); or

(b) a Group A1 disqualified general practitioner, as defined in the dictionary of the General Medical Services Table (GMST).

Fee: $61.00 Benefit: 100% = $61.00

(See para AN.2.1 of explanatory notes to this Category)


Legend

  • 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