Medicare Benefits Schedule - Note IN.0.18

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Category 5 - DIAGNOSTIC IMAGING SERVICES

IN.0.18

Group I5 - Magnetic Resonance Imaging

Itemisation

MRI items in Group I5 are divided into subgroups defined according to the area of the body to be scanned, (ie head, spine, musculoskeletal system, cardiovascular system or body) and the number of occasions in a defined period in which Medicare benefits may be claimed by a patient. Subgroups are divided into individual items, with each item being for a specific clinical indication.

Eligible services

Items in Subgroups 1 to 21 of Group I5 (other than items 63541 to 63544) apply to a MRI or MRA service performed:

  1. on request by a recognised specialist or consultant physician, where the request made in writing identifies the clinical indication for the service;
  2. under the professional supervision of an eligible provider; and
  3. with eligible equipment.

Items 63395 to 63398 and the items in Subgroups 19, 20 and 21 (other than items 63455 and 63461) of Group I5 apply to a MRI service performed:

  1. on request by a recognised specialist or consultant physician, where the request made in writing identifies the clinical indication for the service;
  2. under the professional supervision of an eligible provider; and
  3. with partial eligible equipment.

Items in Subgroup 22 of Group I5 apply to a MRI or MRA service performed:

  1. on request by a medical practitioner, where the request made in writing identifies the clinical indication for the service;
  2. under the professional supervision of an eligible provider; and
  3. with eligible equipment or partial eligible equipment.

Items in Subgroups 33 and 34 of Group I5 apply to a MRI service performed

  1. on request by a medical practitioner other than a specialist or consultant physician, where the request made in writing identifies the clinical indication for the service;
  2. under the professional supervision of an eligible provider; and
  3. with eligible equipment or partial eligible equipment.

Prostate Multiparametric MRI items 63541 to 63544 apply to a service performed:

a.    at the request of a specialist in the speciality of urology, radiation oncology, or medical oncology; and
b.    in a permissible circumstance; and
c.    using:
      (i) eligible equipment; or
      (ii) partial eligible equipment.

Requests

A request must be in writing and identify the clinical indications for the service.

MRI services can only be requested by a recognised specialist medical practitioner or consultant physician for the purpose of the Health Insurance Act 1973. However, there are exceptions to this provision for a limited number of MRI:

  • All dental specialists, prosthodontists, oral and maxillofacial surgeons, oral medicine specialists and oral pathology specialists may request item 63334 - scan of musculoskeletal system for derangement of the temporomandibular joint (s); and
  • Oral and maxillofacial surgeons and oral medicine and oral pathology specialists can also request item 63007 - scan of the head for skull base or orbital tumour; and
  • Items in subgroup 33 and 34 may only be requested by a medical practitioner other than a specialist or a consultant physician.

For cardiac MRI items 63395 to 63398 (scan for diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC)), the request must specify that ARVC is suspected on the basis of diagnostic criteria endorsed by the Cardiac Society of Australia and New Zealand (CSANZ), in force at the time the service is requested.

Permissible circumstances for performance of service

Group I5 items must be performed as follows:

(a) both:

  1. under the professional supervision of an eligible provider who is available to monitor and influence the conduct and diagnostic quality of the examination, including, if necessary, by personal attendance on the patient; and
  2. reported by an eligible provider; or

(b) if paragraph (a) is not complied with:

  1. in an emergency; or
  2. because of medical necessity, in a remote location (refer to DID).

Note: Practitioners do not have to apply for a remote area exemption in these circumstances.

Eligible providers

For items in Group I5 (excluding cardiac MRI items 63395 to 63398), an eligible provider is a specialist in diagnostic radiology who satisfies the Chief Executive Medicare (Department of Human Services) that he or she is a participant of the Royal Australian and New Zealand College of Radiologists' (RANZCR) Quality and Accreditation Program.

For cardiac MRI items 63395 to 63398, an eligible provider is a specialist in diagnostic radiology or a consultant physician, who is recognised by the Conjoint Committee for Certification in Cardiac MRI.  The conjoint committee is comprised of specialists from the Royal Australian and New Zealand College of Radiologists (RANZCR) and the Cardiac Society of Australia and New Zealand (CSANZ).

Eligible Provider declaration

The specialist must give the Department of Human Services a statutory declaration:

  1. stating that he or she is enrolled in the RANZCR Quality and Accreditation Program (except for providers only providing cardiac MRI (items 63395 to 63398));
  2. specifying the location of the MRI equipment;
  3. specifying the kinds of diagnostic imaging equipment offered at the location;
  4. stating the date of installation of the equipment (and the time of installation if this occurred on 12 May 1998); and
  5. if the equipment had not been installed before 7.30pm on 12 May 1998 (Eastern Standard Time), the specialist must also give the Department of Human Services a copy of the contract for the purchase or lease of the equipment.

In addition the Department of Human Services may request further supporting documentation or information. Specialists or consultant physicians are advised to contact the Provider Liaison Section, the Department of Human Services on 132 150 prior to lodging a declaration.

Eligible equipment is equipment which is:

  1. is located at premises of a comprehensive practice; and
  2. is made available to the practice by a person:
    1. who is subject to a deed with the Commonwealth that relates to the equipment; and
    2. for whom the deed has not been terminated; and
  3. is not identified as partial eligible equipment in the deed

Partial eligible equipment is equipment which is:
Equipment that:

  1. is located at premises of a comprehensive practice; and
  2. is made available to the practice by a person:
    1. who is subject to a deed with the Commonwealth that relates to the equipment; and
    2. for whom the deed has not been terminated; and
  3. is identified as partial eligible equipment in the deed

The location of Medicare-eligible MRI machines is available at the Department of Health's website at http://www.health.gov.au

Number of eligible services

Services in subgroups 1, 4, 6, 8, 11 and 18 have no frequency restriction.

For other MRI subgroups frequency restrictions on services are as follows:

 MRI or MRA items   Limitation period  Maximum number of services 
63040 to 63085 12 months 3
63101 and 63104  12 months 3
63125 to 63136 12 months 3
63161 to 63194 12 months 3
63219 to 63265 12 months 3
63271 to 63285 12 months 3
63322 to 63348 12 months 3
63361 and 63364 12 months  2
63385 to 63394 12 months 2
63395 and 63396 12 months 1
63397 and 63398 36 months 1
63401 to 63408 12 months 3
63416 and 63419 12 months 1
63425 to 63433 12 months 2
63455 to 63458 and 63461 to 63467 12 months 1
63545 to 63546 12 months 1
63547 and 63548 patient’s lifetime 1
63482 and 63486 12 months 3
63507 to 63523 and 63551 to 63561 12 months 3

Items 63470 or 63473 in subgroup 20 may be claimed only once in a patient's lifetime.

Items in subgroup 22 (modifying items) may only be ordered in conjunction with an eligible MRI/MRA service.

Items 63501 and 63502 in subgroup 32 may only be claimed once in any 12-month period, and items 63504 and 63505 have no restrictions. 

Example: Item 63271 in subgroup 10 can be claimed by a patient on three occasions in any 12 month period. If the patient had claimed Medicare benefits for the following:

Item Date of Service
63271 10/12/04
63271 18/4/05
63271 16/10/05
63271 11/12/05

The following table provides examples of further dates of service would, and would not, be eligible:

Date of service Claimable? Why?
12/3/05 No Between 10/12/04 and 9/12/05, the patient would have had 4 x 63271 in 12 months - 10/12/04, 12/3/05, 18/4/05 and 16/10/05
4/3/06 No Between 5/3/05 and 4/3/06, the patient would have had 4 x 63271 in 12 months - 18/4/05, 16/10/05, 11/12/05 and 4/3/06
20/4/06 Yes Between 21/4/05 and 20/4/06, the patient would  have had 3x 63271 in 12 months - 16/10/05, 11/12/05 and 20/4/06

The frequency restrictions are therefore considered to be rolling restrictions and not based on calendar or financial years.

In addition, restrictions on the number of services of the kind described in subgroup 12 apply to specific anatomical sites. Where an item description applies to more than one anatomical site the restriction on the number of services applies to each site.

Item 63328, MRI scan for derangement of the knee or its supporting structures, applies to two specific anatomical sites, ie, right knee and left knee. Each anatomical site may be scanned up to 3 times in any 12-month period.

Prostate Multiparametric MRI items 63541 and 63542 are applicable not more than once in a 12 month period.

Prostate Multiparametric MRI items 63543 and 63544 may be claimed:

  1. at the time of diagnosis of prostate cancer; and
  2. 12 months following diagnosis; and
  3. every third year thereafter; or
  4. at any time if there is clinical concern from the specialist requesting the service.

Clinical concern means a clinical decision that the prostate cancer has progressed, and includes prostate specific antigen progression.

Items 63543 and 63544 are not applicable for the purposes of treatment planning or for monitoring after treatment of prostate cancer.

Related Items: 63395 63396 63397 63398 63454 63460 63496 63507 63508 63510 63511 63513 63514 63516 63517 63519 63520 63522 63523 63541 63542 63543 63544 63545 63546 63547 63548 63551 63552 63554 63555 63557 63558 63560 63561


Related Items

Category 5 - DIAGNOSTIC IMAGING SERVICES

63395

63395 - Additional Information

Item Start Date:
01-May-2018
Description Start Date:
10-Aug-2018
Schedule Fee Start Date:
01-May-2018

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% = $771.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63396

63396 - Additional Information

Item Start Date:
01-May-2018
Description Start Date:
10-Aug-2018
Schedule Fee Start Date:
01-May-2018

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63397

63397 - Additional Information

Item Start Date:
01-May-2018
Description Start Date:
10-Aug-2018
Schedule Fee Start Date:
01-May-2018

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% = $771.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63398

63398 - Additional Information

Item Start Date:
01-May-2018
Description Start Date:
10-Aug-2018
Schedule Fee Start Date:
01-May-2018

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63454

63454 - Additional Information

Item Start Date:
01-May-2019
Description Start Date:
01-May-2019
Schedule Fee Start Date:
01-May-2019

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 diagnosis is indeterminate; and
(d) further examination is clinically indicated in the same pregnancy to which item 55712 or 55715 or 55719 or 55720 or 55721 or 55724 or 55725 or 55727 applies. 

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

(Anaes.)

Fee: $1,200.00 Benefit: 75% = $900.00 85% = $1,116.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63460

63460 - Additional Information

Item Start Date:
01-May-2019
Description Start Date:
01-May-2019
Schedule Fee Start Date:
01-May-2019

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 diagnosis is indeterminate; and
(d) further examination is clinically indicated in the same pregnancy to which item 55712 or 55715 or 55719 or 55720 or 55721 or 55724 or 55725 or 55727 applies.

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

 

(Anaes.)

Fee: $600.00 Benefit: 75% = $450.00 85% = $516.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63541

63541 - Additional Information

Item Start Date:
01-Jul-2018
Description Start Date:
01-Jul-2018
Schedule Fee Start Date:
01-Jul-2018

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63542

63542 - Additional Information

Item Start Date:
01-Jul-2018
Description Start Date:
01-Jul-2018
Schedule Fee Start Date:
01-Jul-2018

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63543

63543 - Additional Information

Item Start Date:
01-Jul-2018
Description Start Date:
01-Jul-2018
Schedule Fee Start Date:
01-Jul-2018

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63544

63544 - Additional Information

Item Start Date:
01-Jul-2018
Description Start Date:
01-Jul-2018
Schedule Fee Start Date:
01-Jul-2018

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63547

63547 - Additional Information

Item Start Date:
01-May-2018
Description Start Date:
01-May-2018
Schedule Fee Start Date:
01-May-2018

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% = $606.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63548

63548 - Additional Information

Item Start Date:
01-May-2018
Description Start Date:
01-May-2018
Schedule Fee Start Date:
01-May-2018

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)

Category 5 - DIAGNOSTIC IMAGING SERVICES

63545

63545 - Additional Information

Item Start Date:
01-May-2019
Description Start Date:
01-May-2019
Schedule Fee Start Date:
01-May-2019

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

MAGNETIC RESONANCE IMAGING with a contrast agent – multiphase scans of the liver (including delayed imaging, when performed) - performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or consultant physician - for characterisation or intervention planning, in a patient with:

  1. known colorectal carcinoma; and
  2. known, suspected, or possible liver metastasis; and
  3. previous computed tomography or ultrasound imaging has identified a mass lesion in the liver.

For use with HEPATOBILIARY-SPECIFIC CONTRAST AGENT (item 63496). If a patient has known or suspected clinical indication/s considered by a specialist or consultant physician to indicate the need for imaging with an extracellular contrast agent, the modifying MRI item 63491 can be used with this item.

Fee: $550   Benefit: 75% = $412.50  85% = $467.50 (R) (K) (Anaes.)

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

(Anaes.)

Fee: $550.00 Benefit: 75% = $412.50 85% = $467.50

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

Item will expire on 01-Jan-9999

Category 5 - DIAGNOSTIC IMAGING SERVICES

63546

63546 - Additional Information

Item Start Date:
01-May-2019
Description Start Date:
01-May-2019
Schedule Fee Start Date:
01-May-2019

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

MAGNETIC RESONANCE IMAGING with a contrast agent – multiphase scans of the liver (including delayed imaging, when performed) - performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or consultant physician – for diagnosis or staging, in a patient with known or suspected hepatocellular carcinoma, and:

  1. chronic liver disease, that has been confirmed by a specialist or consultant physician; and
  2. liver function identified as Child-Pugh class A or B; and
  3. an identified hepatic lesion over 10 mm in diameter.

For use with HEPATOBILIARY-SPECIFIC CONTRAST AGENT (item 63496). If a patient has known or suspected clinical indication/s considered by a specialist or consultant physician to indicate the need for imaging with an extracellular contrast agent, the modifying MRI item 63491 can be used with this item.

Fee: $550 Benefit: 75% = $412.50 85% = $467.50 (R) (K) (Anaes.)

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

(Anaes.)

Fee: $550.00 Benefit: 75% = $412.50 85% = $467.50

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63551

63551 - Additional Information

Item Start Date:
01-Nov-2013
Description Start Date:
01-Nov-2013
Schedule Fee Start Date:
01-Nov-2013

referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of head for a patient  16 years or older for any of the following:


- unexplained seizure(s) (R) (Contrast) (Anaes.)

- unexplained chronic headache with suspected intracranial pathology (R) (Contrast) (Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63552

63552 - Additional Information

Item Start Date:
01-Nov-2013
Description Start Date:
01-Nov-2013
Schedule Fee Start Date:
01-Nov-2013

referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of head for a patient  16 years or older for any of the following:


- unexplained seizure(s) (R) (NK) (Contrast) (Anaes.)

- unexplained chronic headache with suspected intracranial pathology (R) (NK) (Contrast) (Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63554

63554 - Additional Information

Item Start Date:
01-Nov-2013
Description Start Date:
01-Nov-2013
Schedule Fee Start Date:
01-Nov-2013

referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of spine for a patient 16 years or older for suspected:


- cervical radiculopathy (R) (Contrast) (Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63555

63555 - Additional Information

Item Start Date:
01-Nov-2013
Description Start Date:
01-Nov-2013
Schedule Fee Start Date:
01-Nov-2013

referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of spine for a patient 16 years or older for suspected:


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

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63557

63557 - Additional Information

Item Start Date:
01-Nov-2013
Description Start Date:
01-Nov-2013
Schedule Fee Start Date:
01-Nov-2013

referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of spine for a patient 16 years or older for suspected:


- cervical spine trauma (R) (Contrast) (Anaes.)

Fee: $492.80 Benefit: 75% = $369.60 85% = $418.90

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63558

63558 - Additional Information

Item Start Date:
01-Nov-2013
Description Start Date:
01-Nov-2013
Schedule Fee Start Date:
01-Nov-2013


referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of spine for a patient 16 years or older for suspected:


- cervical spine trauma (R) (NK) (Contrast) (Anaes.)

Fee: $246.40 Benefit: 75% = $184.80 85% = $209.45

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63560

63560 - Additional Information

Item Start Date:
01-Nov-2013
Description Start Date:
01-Nov-2018
Schedule Fee Start Date:
01-Nov-2013

MRI - scan of knee following acute knee trauma, after referral by a medical practitioner (other than a specialist or consultant physician), for a patient aged 16 to 49 years with:

  • inability to extend the knee suggesting the possibility of acute meniscal tear; or
  • clinical findings suggesting acute anterior cruciate ligament tear.

(R) (K) (Contrast) (Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63561

63561 - Additional Information

Item Start Date:
01-Nov-2013
Description Start Date:
01-Nov-2018
Schedule Fee Start Date:
01-Nov-2013

MRI - scan of knee following acute knee trauma, after referral by a medical practitioner (other than a specialist or consultant physician), for a patient aged 16 to 49 years with:

  • inability to extend the knee suggesting the possibility of acute meniscal tear; or
  • clinical findings suggesting acute anterior cruciate ligament tear.

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

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63496

63496 - Additional Information

Item Start Date:
01-May-2019
Description Start Date:
01-May-2019
Schedule Fee Start Date:
01-May-2019

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. 

Modifying item for use with MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the service requested by a specialist or by a consultant and the scan performed involves the use of HEPATOBILIARY SPECIFIC contrast agent, as clinically indicated for eligible MRI items 64545 and 64546.

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63507

63507 - Additional Information

Item Start Date:
01-Nov-2012
Description Start Date:
01-Oct-2013
Schedule Fee Start Date:
01-Nov-2012

referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of head for a patient under 16 years for any of the following:

-    unexplained seizure(s) (R) (Contrast) (Anaes.); or

-    unexplained headache where significant pathology is suspected (R) (Contrast) (Anaes.); or

-    paranasal sinus pathology which has not responded to conservative therapy (R) (Contrast) (Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63508

63508 - Additional Information

Item Start Date:
01-Nov-2012
Description Start Date:
01-Oct-2013
Schedule Fee Start Date:
01-Nov-2012

referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of head for a patient under 16 years for any of the following:

-    unexplained seizure(s) (R) (NK) (Contrast) (Anaes.); or

-    unexplained headache where significant pathology is suspected (R) (NK) (Contrast) (Anaes.); or

-    paranasal sinus pathology which has not responded to conservative therapy (R) (NK) (Contrast) (Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63510

63510 - Additional Information

Item Start Date:
01-Nov-2012
Description Start Date:
01-Oct-2013
Schedule Fee Start Date:
01-Nov-2012

referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of spine for a patient under 16 years following radiographic examination for:

-    significant trauma (R) (Contrast) (Anaes.); or

-    unexplained neck or back pain with associated neurological signs (R) (Contrast) (Anaes.); or

-    unexplained back pain where significant pathology is suspected (R) (Contrast) (Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63511

63511 - Additional Information

Item Start Date:
01-Nov-2012
Description Start Date:
01-Oct-2013
Schedule Fee Start Date:
01-Nov-2012

referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of spine for a patient under 16 years following radiographic examination for:

-    significant trauma (R) (NK) (Contrast) (Anaes.); or

-    unexplained neck or back pain with associated neurological signs (R) (NK) (Contrast) (Anaes.); or

-    unexplained back pain where significant pathology is suspected (R) (NK) (Contrast) (Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63513

63513 - Additional Information

Item Start Date:
01-Nov-2012
Description Start Date:
01-Nov-2018
Schedule Fee Start Date:
01-Nov-2012

MRI - referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of knee for a patient aged under 16 years for internal joint derangement (R) (K) (Contrast) (Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63514

63514 - Additional Information

Item Start Date:
01-Nov-2012
Description Start Date:
01-Nov-2018
Schedule Fee Start Date:
01-Nov-2012

MRI - referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of knee for a patient aged under 16 years for internal joint derangement (R) (NK) (Contrast) (Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63516

63516 - Additional Information

Item Start Date:
01-Nov-2012
Description Start Date:
01-Oct-2013
Schedule Fee Start Date:
01-Nov-2012

referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of hip for a patient under 16 years following radiographic examination for:

-    suspected septic arthritis (R) (Contrast) (Anaes.); or

-    suspected slipped capital femoral epiphysis (R) (Contrast) (Anaes.); or

-    suspected Perthes disease (R) (Contrast) (Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63517

63517 - Additional Information

Item Start Date:
01-Nov-2012
Description Start Date:
01-Oct-2013
Schedule Fee Start Date:
01-Nov-2012

referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of hip for a patient under 16 years following radiographic examination for:

-    suspected septic arthritis (R) (NK) (Contrast) (Anaes.); or

-    suspected slipped capital femoral epiphysis (R) (NK) (Contrast) (Anaes.); or

-    suspected Perthes disease (R) (NK) (Contrast) (Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63519

63519 - Additional Information

Item Start Date:
01-Nov-2012
Description Start Date:
01-Oct-2013
Schedule Fee Start Date:
01-Nov-2012

referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of elbow for a patient under 16 years following radiographic examination where a significant fracture or avulsion injury is suspected that will change management (R) (Contrast) (Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63520

63520 - Additional Information

Item Start Date:
01-Nov-2012
Description Start Date:
01-Oct-2013
Schedule Fee Start Date:
01-Nov-2012

referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of elbow for a patient under 16 years following radiographic examination where a significant fracture or avulsion injury is suspected that will change management (R) (NK) (Contrast) (Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63522

63522 - Additional Information

Item Start Date:
01-Nov-2012
Description Start Date:
01-Oct-2013
Schedule Fee Start Date:
01-Nov-2012

referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of wrist for a patient under 16 years following radiographic examination where scaphoid fracture is suspected (R) (Contrast) (Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63523

63523 - Additional Information

Item Start Date:
01-Nov-2012
Description Start Date:
01-Oct-2013
Schedule Fee Start Date:
01-Nov-2012

referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of wrist for a patient under 16 years following radiographic examination where scaphoid fracture is suspected (R) (NK) (Contrast) (Anaes.)

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

(See para IN.0.18 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