Medicare Benefits Schedule - Note IN.0.19

Search Results for Note IN.0.19

View Related Items

Category 5 - DIAGNOSTIC IMAGING SERVICES

IN.0.19

Bulk Billing Incentive

Out-of-hospital services (except item 61369) attract higher benefits when they are bulk billed by the provider. 

For other than items in Group I5 – Magnetic Resonance Imaging (MRI) - benefits for bulk billed services are payable at 95% of the schedule fee for the item.  For MRI services, benefits for bulk billed services are payable at 100% of the schedule for the item.

Related Items: 55028 55029 55030 55031 55032 55033 55036 55037 55038 55039 55048 55049 55054 55065 55066 55068 55070 55071 55073 55076 55079 55084 55085 55118 55126 55127 55128 55129 55130 55132 55133 55134 55135 55137 55141 55143 55145 55146 55238 55244 55246 55248 55252 55274 55276 55278 55280 55282 55284 55292 55294 55296 55600 55603 55700 55703 55704 55705 55706 55707 55708 55709 55712 55715 55718 55721 55723 55725 55729 55736 55739 55759 55762 55764 55766 55768 55770 55772 55774 55812 55814 55844 55846 55848 55850 55852 55854 55856 55857 55858 55859 55860 55861 55862 55863 55864 55865 55866 55867 55868 55869 55870 55871 55872 55873 55874 55875 55876 55877 55878 55879 55880 55881 55882 55883 55884 55885 55886 55887 55888 55889 55890 55891 55892 55893 55894 55895 56001 56007 56010 56013 56016 56022 56028 56030 56036 56101 56107 56219 56220 56221 56223 56224 56225 56226 56233 56234 56237 56238 56301 56307 56401 56407 56409 56412 56501 56507 56620 56622 56623 56626 56627 56628 56629 56630 56801 56807 57001 57007 57201 57341 57352 57353 57354 57360 57506 57509 57512 57515 57518 57521 57522 57523 57524 57527 57541 57700 57703 57706 57709 57712 57715 57721 57901 57902 57905 57907 57915 57918 57921 57924 57927 57930 57933 57939 57942 57945 57960 57963 57966 57969 58100 58103 58106 58108 58109 58112 58115 58300 58306 58500 58503 58506 58509 58521 58524 58527 58700 58706 58715 58718 58721 58900 58903 58909 58912 58915 58916 58921 58927 58933 58936 58939 59103 59300 59302 59303 59305 59312 59314 59318 59700 59703 59712 59715 59718 59724 59733 59739 59751 59754 59763 59970 60000 60003 60006 60009 60012 60015 60018 60021 60024 60027 60030 60033 60036 60039 60042 60045 60048 60051 60054 60057 60060 60063 60066 60069 60072 60075 60078 60500 60503 60506 60509 60918 60927 61109 61310 61311 61313 61314 61321 61324 61325 61328 61329 61332 61340 61345 61348 61349 61353 61356 61357 61360 61361 61364 61365 61368 61372 61373 61376 61377 61380 61381 61383 61384 61386 61387 61389 61390 61393 61394 61397 61398 61402 61406 61409 61410 61413 61414 61418 61421 61422 61425 61426 61429 61430 61433 61434 61438 61441 61442 61445 61446 61449 61450 61453 61454 61457 61461 61462 61469 61473 61480 61485 61495 61499 61505 61523 61524 61525 61529 61541 61553 61559 61565 61620 61622 61628 61632 61647 61650 63001 63004 63007 63010 63040 63043 63046 63049 63052 63055 63058 63061 63064 63067 63070 63073 63101 63111 63114 63125 63128 63131 63151 63154 63161 63164 63167 63170 63173 63176 63179 63182 63185 63201 63204 63219 63222 63225 63228 63231 63234 63237 63240 63243 63271 63274 63277 63280 63301 63304 63307 63322 63325 63328 63331 63334 63337 63340 63361 63385 63388 63391 63395 63397 63401 63404 63416 63425 63428 63440 63443 63446 63454 63461 63464 63467 63470 63473 63476 63482 63491 63494 63496 63497 63498 63499 63501 63502 63504 63505 63513 63531 63533 63541 63543 63545 63546 63547 63560 64990 64991


Related Items

Category 5 - DIAGNOSTIC IMAGING SERVICES

60500

60500 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

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

(Anaes.)

Fee: $44.45 Benefit: 75% = $33.35 85% = $37.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

60503

60503 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

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

Fee: $30.45 Benefit: 75% = $22.85 85% = $25.90

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

60506

60506 - Additional Information

Item Start Date:
31-Oct-1992
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

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

Fee: $65.30 Benefit: 75% = $49.00 85% = $55.55

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

60509

60509 - Additional Information

Item Start Date:
31-Oct-1992
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

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


Fee: $101.30 Benefit: 75% = $76.00 85% = $86.15

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63385

63385 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

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

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63388

63388 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

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

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63391

63391 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

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

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63395

63395 - Additional Information

Item Start Date:
01-May-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-May-2018

 

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

 

 

 

(Anaes.)

Fee: $855.20 Benefit: 75% = $641.40 85% = $767.30

(See para 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 Updated:
01-May-2020
Schedule Fee Updated:
01-May-2018

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


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

(Anaes.)

Fee: $855.20 Benefit: 75% = $641.40 85% = $767.30

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63461

63461 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

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

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63464

63464 - Additional Information

Item Start Date:
01-Feb-2009
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Feb-2009

MRI—scan of both breasts for the detection of cancer, if a dedicated breast coil is used, the request for the scan identifies that the person is asymptomatic and is younger than 50 years of age, and the request for the scan identifies:


(a) that the patient is at high risk of developing breast cancer, due to one of the following:
(i) 3 or more first or second degree relatives on the same side of the family diagnosed with breast or ovarian cancer;
(ii) 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 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 or is a male relative who has been diagnosed with breast cancer;
(iii) one first or second degree relative diagnosed with breast cancer at age 45 years or younger, and 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
(b) that genetic testing has identified the presence of a high risk breast cancer gene mutation (R) 

(Anaes.)

Fee: $690.00 Benefit: 75% = $517.50 85% = $602.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63467

63467 - Additional Information

Item Start Date:
01-Feb-2009
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Feb-2009

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

(Anaes.)

Fee: $690.00 Benefit: 75% = $517.50 85% = $602.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63531

63531 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2019

MRI—scan of both breasts, if:

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

 

 

(Anaes.)

Fee: $690.00 Benefit: 75% = $517.50 85% = $602.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63533

63533 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2019

MRI—scan of both breasts, if:

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

 

 


 

(Anaes.)

Fee: $690.00 Benefit: 75% = $517.50 85% = $602.10

(See para 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 Updated:
01-Nov-2021
Schedule Fee Updated:
01-Jul-2018

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

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

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

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

(b) using a standardised image acquisition protocol involving:

(i) T2‑weighted imaging; and

(ii) diffusion‑weighted imaging; and

(iii) (unless contraindicated) dynamic contrast enhancement 

(R) 

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

 

(Anaes.)

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

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

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-2018

 

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63547

63547 - Additional Information

Item Start Date:
01-May-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
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
(R) (Contrast)

 

(Anaes.)

Fee: $690.00 Benefit: 75% = $517.50 85% = $602.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63560

63560 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-Jul-2020
Schedule Fee Updated:
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 16 to 49 years with:

(a) inability to extend the knee suggesting the possibility of acute meniscal tear; or
(b) clinical findings suggesting acute anterior cruciate ligament tear (R) (Contrast) 

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56501

56501 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

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

Fee: $394.25 Benefit: 75% = $295.70 85% = $335.15

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56507

56507 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Computed tomography—scan of upper abdomen and pelvis with intravenous contrast medium and with any scans of upper abdomen and pelvis before intravenous contrast injection, when performed, not for the purposes of virtual colonoscopy and not being a service to which item 56807 or 57007 applies (R) (Anaes.)

Fee: $491.65 Benefit: 75% = $368.75 85% = $417.95

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55118

55118 - Additional Information

Item Start Date:
31-Oct-1992
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Jul-2021

Heart, two-dimensional or three-dimensional real time transoesophageal examination of, from at least 2 levels, and in more than one plane at each level, if:

(a) the service includes:

(i) real time colour flow mapping and, if indicated, pulsed wave Doppler examination; and
(ii) recordings on digital media; and

(b) the service is not an intra-operative service; and

(c) not being a service associated with a service to which an item in Subgroup 3 applies.
(R)

(Anaes.)

Fee: $282.15 Benefit: 75% = $211.65 85% = $239.85

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55130

55130 - Additional Information

Item Start Date:
31-Oct-1992
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Jul-2021

Intraoperative two-dimensional or three-dimensional real time transoesophageal echocardiography, if the service:

(a) includes Doppler techniques with colour flow mapping and recordings on digital media; and

(b) is performed during cardiac surgery; and

(c) incorporates sequential assessment of cardiac function before and after the surgical procedure; and

(d) is not associated with a service to which item 55135, or an item in Subgroup 3, applies (R)

(Anaes.)

Fee: $174.10 Benefit: 75% = $130.60 85% = $148.00

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55135

55135 - Additional Information

Item Start Date:
01-May-2004
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Jul-2021

Intraoperative two-dimensional or three-dimensional real time transoesophageal echocardiography, if the service:

(a) is provided on the same day as a service to which item 38477, 38484, 38499, 38516 or 38517 applies; and

(b) includes Doppler techniques with colour flow mapping and recordings on digital media; and

(c) is performed during cardiac valve surgery (replacement or repair); and

(d) incorporates sequential assessment of cardiac function and valve competence before and after the surgical procedure; and

(e) is not associated with a service to which item 55130, or an item in Subgroup 3, applies (R)

(Anaes.)

Fee: $362.15 Benefit: 75% = $271.65 85% = $307.85

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57506

57506 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Hand, wrist, forearm, elbow or humerus (NR)

Fee: $30.45 Benefit: 75% = $22.85 85% = $25.90

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57509

57509 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Hand, wrist, forearm, elbow or humerus (R)

Fee: $40.70 Benefit: 75% = $30.55 85% = $34.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57512

57512 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Hand and wrist, or hand, wrist and forearm, or forearm and elbow, or elbow and humerus (NR)

Fee: $41.45 Benefit: 75% = $31.10 85% = $35.25

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57515

57515 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Hand and wrist, or hand, wrist and forearm, or forearm and elbow, or elbow and humerus (R)

Fee: $55.30 Benefit: 75% = $41.50 85% = $47.05

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57518

57518 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Foot, ankle, leg or femur (NR)

Fee: $33.30 Benefit: 75% = $25.00 85% = $28.35

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57521

57521 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Foot, ankle, leg or femur (R)

Fee: $44.45 Benefit: 75% = $33.35 85% = $37.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57522

57522 - Additional Information

Item Start Date:
01-Nov-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Knee (NR)

Fee: $33.30 Benefit: 75% = $25.00 85% = $28.35

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57523

57523 - Additional Information

Item Start Date:
01-Nov-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Knee (R)

Fee: $44.45 Benefit: 75% = $33.35 85% = $37.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57524

57524 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Foot and ankle, or ankle and leg, or leg and knee, or knee and femur (NR)

Fee: $50.60 Benefit: 75% = $37.95 85% = $43.05

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57527

57527 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Foot and ankle, or ankle and leg, or leg and knee, or knee and femur (R)

Fee: $67.35 Benefit: 75% = $50.55 85% = $57.25

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63322

63322 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

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

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63325

63325 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

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

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63328

63328 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

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

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63331

63331 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

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

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63334

63334 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

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

(Anaes.)

Fee: $336.00 Benefit: 75% = $252.00 85% = $285.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63337

63337 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

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

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63340

63340 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

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

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63513

63513 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2012

MRI—scan of knee for internal joint derangement for a patient under 16 years (R) (Contrast)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56101

56101 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

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) (Anaes.)

Fee: $235.55 Benefit: 75% = $176.70 85% = $200.25

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56107

56107 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

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) before intravenous contrast injection, when undertaken, not being a service associated with a service to which item 56807 applies (R) (Anaes.)

Fee: $348.20 Benefit: 75% = $261.15 85% = $296.00

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56401

56401 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

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

Fee: $256.05 Benefit: 75% = $192.05 85% = $217.65

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56407

56407 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

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

Fee: $368.70 Benefit: 75% = $276.55 85% = $313.40

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56409

56409 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

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

Fee: $256.05 Benefit: 75% = $192.05 85% = $217.65

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56412

56412 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

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

Fee: $368.70 Benefit: 75% = $276.55 85% = $313.40

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57201

57201 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Computed tomography—pelvimetry (R) (Anaes.)

Fee: $158.95 Benefit: 75% = $119.25 85% = $135.15

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57341

57341 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Computed tomography, in conjunction with a surgical procedure using interventional techniques (R) (Anaes.)

Fee: $481.35 Benefit: 75% = $361.05 85% = $409.15

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57352

57352 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2021

Computed tomography—angiography with intravenous contrast medium of any or all, or any part, of:

(a) the arch of the aorta; or

(b) the carotid arteries; or

(c) the vertebral arteries and their branches (head and neck);

including any scans performed before intravenous contrast injection—one or more data acquisitions, including image editing, and maximum intensity projections or 3 dimensional surface shaded display, with hardcopy or digital recording of multiple projections, if:

(d) either:

(i) the service is requested by a specialist or consultant physician; or

(ii) the service is requested by a medical practitioner (other than a specialist or consultant physician) and the request indicates that the patient’s case has been discussed with a specialist or consultant physician; and

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

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

(g) the service is not a study performed to image the coronary arteries (R)

(Anaes.)

Fee: $522.30 Benefit: 75% = $391.75 85% = $444.00

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57353

57353 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2021

Computed tomography—angiography with intravenous contrast medium of any or all, or any part, of:

(a) the ascending and descending aorta; or

(b) the common iliac and abdominal branches including upper limbs (chest, abdomen and upper limbs);

including any scans performed before intravenous contrast injection—one or more data acquisitions, including image editing, and maximum intensity projections or 3 dimensional surface shaded display, with hardcopy or digital recording of multiple projections, if:

(c) either:

(i) the service is requested by a specialist or consultant physician; or

(ii) the service is requested by a medical practitioner (other than a specialist or consultant physician) and the request indicates that the patient’s case has been discussed with a specialist or consultant physician; and

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

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

(f) the service is not a study performed to image the coronary arteries (R)

(Anaes.)

Fee: $522.30 Benefit: 75% = $391.75 85% = $444.00

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57354

57354 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2021

Computed tomography—angiography with intravenous contrast medium of any or all, or any part, of:

(a) the descending aorta; or

(b) the pelvic vessels (aorto‑iliac segment) and lower limbs;

including any scans performed before intravenous contrast injection—one or more data acquisitions, including image editing, and maximum intensity projections or 3 dimensional surface shaded display, with hardcopy or digital recording of multiple projections, if:

(c) either:

(i) the service is requested by a specialist or consultant physician; or

(ii) the service is requested by a medical practitioner (other than a specialist or consultant physician) and the request indicates that the patient’s case has been discussed with a specialist or consultant physician; and

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

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

(f) the service is not a study performed to image the coronary arteries (R)

(Anaes.)

Fee: $522.30 Benefit: 75% = $391.75 85% = $444.00

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57360

57360 - Additional Information

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

Computed tomography of the coronary arteries performed on a minimum of a 64 slice (or equivalent) scanner if:

(a) the request is made by a specialist or consultant physician; and

(b) the patient has stable or acute symptoms consistent with coronary ischaemia; and

(c) the patient is at low to intermediate risk of an acute coronary event, including having no significant cardiac biomarker elevation and no electrocardiogram changes indicating acute ischaemia (R) 

Note:  See explanatory note IN.2.2 for claiming restrictions for this item.

 

(Anaes.)

Fee: $716.90 Benefit: 75% = $537.70 85% = $629.00

(See para IN.0.19, IN.2.2 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61109

61109 - Additional Information

Item Start Date:
31-Oct-1992
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

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 Group applies (R)

Fee: $265.15 Benefit: 75% = $198.90 85% = $225.40

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57901

57901 - Additional Information

Item Start Date:
01-Nov-1998
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Skull, not in association with item 57902 (R)

Fee: $66.05 Benefit: 75% = $49.55 85% = $56.15

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57902

57902 - Additional Information

Item Start Date:
01-Nov-1998
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Cephalometry, not in association with item 57901 (R)

Fee: $66.05 Benefit: 75% = $49.55 85% = $56.15

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57905

57905 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Mastoids or petrous temporal bones (R)

 

Fee: $66.05 Benefit: 75% = $49.55 85% = $56.15

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57907

57907 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Sinuses or facial bones – orbit, maxilla or malar, any or all (R)

 

 

Fee: $48.45 Benefit: 75% = $36.35 85% = $41.20

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57915

57915 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Mandible, not by orthopantomography technique (R)

Fee: $48.30 Benefit: 75% = $36.25 85% = $41.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57918

57918 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Salivary calculus (R)

Fee: $48.30 Benefit: 75% = $36.25 85% = $41.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57921

57921 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Nose (R)

Fee: $48.30 Benefit: 75% = $36.25 85% = $41.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57924

57924 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Eye (R)

Fee: $48.30 Benefit: 75% = $36.25 85% = $41.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57927

57927 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Temporo mandibular joints (R)

Fee: $50.85 Benefit: 75% = $38.15 85% = $43.25

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57930

57930 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Teeth—single area (R)

Fee: $33.70 Benefit: 75% = $25.30 85% = $28.65

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57933

57933 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Teeth - full mouth (R)

Fee: $80.10 Benefit: 75% = $60.10 85% = $68.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57939

57939 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Palato pharyngeal studies with fluoroscopic screening (R)

Fee: $66.05 Benefit: 75% = $49.55 85% = $56.15

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57942

57942 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Palato pharyngeal studies without fluoroscopic screening (R)

Fee: $50.85 Benefit: 75% = $38.15 85% = $43.25

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57945

57945 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

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: $44.45 Benefit: 75% = $33.35 85% = $37.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57960

57960 - Additional Information

Item Start Date:
01-Nov-2002
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Orthopantomography for diagnosis or management (or both) of trauma, infection, tumour or a congenital or surgical condition of the teeth or maxillofacial region (R)

Fee: $48.55 Benefit: 75% = $36.45 85% = $41.30

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57963

57963 - Additional Information

Item Start Date:
01-Nov-2002
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Orthopantomography for diagnosis or management (or both) of any of the following conditions, if the signs and symptoms of the condition is present:
(a) impacted teeth;
(b) caries;
(c) periodontal pathology;
(d) periapical pathology (R)

Fee: $48.55 Benefit: 75% = $36.45 85% = $41.30

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57966

57966 - Additional Information

Item Start Date:
01-Nov-2002
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Orthopantomography for diagnosis or management (or both) of missing or crowded teeth, or developmental anomalies of the teeth or jaws (R)

Fee: $48.55 Benefit: 75% = $36.45 85% = $41.30

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57969

57969 - Additional Information

Item Start Date:
01-Nov-2002
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Orthopantomography for diagnosis or management (or both) of temporo mandibular joint arthroses or dysfunction (R)

Fee: $48.55 Benefit: 75% = $36.45 85% = $41.30

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

58300

58300 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Bone age study (R)

Fee: $41.05 Benefit: 75% = $30.80 85% = $34.90

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

58306

58306 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Skeletal survey (R)

Fee: $91.55 Benefit: 75% = $68.70 85% = $77.85

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

58500

58500 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Chest (lung fields) by direct radiography (NR)

Fee: $36.20 Benefit: 75% = $27.15 85% = $30.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

58503

58503 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Chest (lung fields) by direct radiography (R)

Fee: $48.30 Benefit: 75% = $36.25 85% = $41.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

58506

58506 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Chest (lung fields) by direct radiography with fluoroscopic screening (R)

Fee: $62.20 Benefit: 75% = $46.65 85% = $52.90

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

58509

58509 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Thoracic inlet or trachea (R)

Fee: $40.70 Benefit: 75% = $30.55 85% = $34.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

58521

58521 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Left ribs, right ribs or sternum (R)

Fee: $44.45 Benefit: 75% = $33.35 85% = $37.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

58524

58524 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Left and right ribs, left ribs and sternum, or right ribs and sternum (R)

Fee: $57.85 Benefit: 75% = $43.40 85% = $49.20

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

58527

58527 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Left ribs, right ribs and sternum (R)

Fee: $71.10 Benefit: 75% = $53.35 85% = $60.45

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

59103

59103 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-Nov-2009
Schedule Fee Updated:
01-Jul-2021

Localisation of foreign body, if provided in conjunction with a service described in Subgroups 1 to 12 of Group I3 (R)

Fee: $21.80 Benefit: 75% = $16.35 85% = $18.55

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63401

63401 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

MRA—if the request for the scan specifically identifies the clinical indication for the scan—scan of cardiovascular system for vascular abnormality in a patient with a previous anaphylactic reaction to an iodinated contrast medium (R) (Contrast)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63404

63404 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

MRA—if the request for the scan specifically identifies the clinical indication for the scan—scan of cardiovascular system for obstruction of the superior vena cava, inferior vena cava or a major pelvic vein (R) (Contrast)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63040

63040 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

MRI—scan of head (including MRA, if performed) for acoustic neuroma (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $336.00 Benefit: 75% = $252.00 85% = $285.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63043

63043 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

MRI—scan of head (including MRA, if performed) for pituitary tumour (R) (Anaes.) (Contrast)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63046

63046 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

MRI—scan of head (including MRA, if performed) for toxic or metabolic or ischaemic encephalopathy (R) (Anaes.) (Contrast)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63049

63049 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

MRI—scan of head (including MRA, if performed) for demyelinating disease of the brain (R) (Anaes.) (Contrast)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63052

63052 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

MRI—scan of head (including MRA, if performed) for congenital malformation of the brain or meninges (R) (Anaes.) (Contrast)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63055

63055 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

MRI—scan of head (including MRA, if performed) for venous sinus thrombosis (R) (Anaes.) (Contrast)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63058

63058 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

MRI—scan of head (including MRA, if performed) for head trauma (R) (Anaes.) (Contrast)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63061

63061 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

MRI—scan of head (including MRA, if performed) for epilepsy (R) (Anaes.) (Contrast)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63064

63064 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

MRI—scan of head (including MRA, if performed) for stroke (R) (Anaes.) (Contrast)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63067

63067 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

MRI—scan of head (including MRA, if performed) for carotid or vertebral artery dissection (R) (Anaes.) (Contrast)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63070

63070 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

MRI—scan of head (including MRA, if performed) for intracranial aneurysm (R) (Anaes.) (Contrast)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63073

63073 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

MRI—scan of head (including MRA, if performed) for intracranial arteriovenous malformation (R) (Anaes.) (Contrast)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

64990

64990 - Additional Information

Item Start Date:
01-Feb-2004
Description Updated:
01-Feb-2004
Schedule Fee Updated:
01-Jul-2021

A diagnostic imaging service to which an item in this table (other than this item or item 64991) applies if:

(a)    the service is an unreferred service; and

(b)    the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder;         and

(c)    the person is not an admitted patient of a hospital; and

(d)    the service is bulk-billed in respect of the fees for:

    (i)    this item; and

    (ii)    the other item in this table applying to the service

Fee: $7.20 Benefit: 85% = $6.15

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

64991

64991 - Additional Information

Item Start Date:
01-May-2004
Description Updated:
01-Jan-2020
Schedule Fee Updated:
01-Jul-2021

A diagnostic imaging service to which an item in this table (other than this item or item 64990) applies if:

(a)    the service is an unreferred service; and

(b)    the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder; and

(c)    the person is not an admitted patient of a hospital; and

(d)    the service is bulk-billed in respect of the fees for:

    (i)    this item; and

    (ii)    the other item in this table applying to the service; and

(e)    the service is provided at, or from, a practice location within Modified Monash areas 2 to 7.

    

Fee: $10.90 Benefit: 85% = $9.30

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57001

57001 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Computed tomography—scan of brain and chest with or without scans of upper abdomen without intravenous contrast medium, not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (Anaes.)

Fee: $477.90 Benefit: 75% = $358.45 85% = $406.25

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57007

57007 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Computed tomography—scan of brain and chest with or without scans of upper abdomen with intravenous contrast medium and with any scans of brain and chest and upper abdomen before intravenous contrast injection, when performed, not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (Anaes.)

Fee: $581.45 Benefit: 75% = $436.10 85% = $494.25

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61523

61523 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
22-Dec-2005
Schedule Fee Updated:
01-Oct-2001

Whole body FDG PET study, performed for evaluation of a solitary pulmonary nodule where the lesion is considered unsuitable for transthoracic fine needle aspiration biopsy, or for which an attempt at pathological characterisation has failed.(R)

Fee: $953.00 Benefit: 75% = $714.75 85% = $865.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61524

61524 - Additional Information

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

Whole body FDG PET study, performed for the staging of locally advanced (Stage III) breast cancer, for a patient who is considered suitable for active therapy (R)

 

 

 

(Anaes.)

Fee: $953.00 Benefit: 75% = $714.75 85% = $865.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61525

61525 - Additional Information

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

Whole body FDG PET study, performed for the evaluation of suspected metastatic or suspected locally or regionally recurrent breast carcinoma, for a patient who is considered suitable for active therapy (R)

 

 

 

(Anaes.)

Fee: $953.00 Benefit: 75% = $714.75 85% = $865.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61529

61529 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
22-Dec-2005
Schedule Fee Updated:
01-Oct-2001

Whole body FDG PET study, performed for the staging of proven non-small cell lung cancer, where curative surgery or radiotherapy is planned (R)

Fee: $953.00 Benefit: 75% = $714.75 85% = $865.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61541

61541 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-Jul-2011
Schedule Fee Updated:
01-Oct-2001

Whole body FDG PET study, following initial therapy, for the evaluation of suspected residual, metastatic or recurrent colorectal carcinoma in patients considered suitable for active therapy (R)

Fee: $953.00 Benefit: 75% = $714.75 85% = $865.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61553

61553 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-Jul-2011
Schedule Fee Updated:
01-Oct-2001

Whole body FDG PET study, following initial therapy, performed for the evaluation of suspected metastatic or recurrent malignant melanoma in patients considered suitable for active therapy (R)

Fee: $999.00 Benefit: 75% = $749.25 85% = $911.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61559

61559 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
22-Dec-2005
Schedule Fee Updated:
01-Oct-2001

FDG PET study of the brain, performed for the evaluation of refractory epilepsy which is being evaluated for surgery (R)

Fee: $918.00 Benefit: 75% = $688.50 85% = $830.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61565

61565 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-Jul-2011
Schedule Fee Updated:
01-Oct-2001

Whole body FDG PET study, following initial therapy, performed for the evaluation of suspected residual, metastatic or recurrent ovarian carcinoma in patients considered suitable for active therapy. (R)

Fee: $953.00 Benefit: 75% = $714.75 85% = $865.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61620

61620 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-Nov-2017
Schedule Fee Updated:
01-Jul-2011

Whole body FDG PET study for the initial staging of newly diagnosed or previously untreated Hodgkin or non-Hodgkin lymphoma (R)

Fee: $953.00 Benefit: 75% = $714.75 85% = $865.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61622

61622 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-Nov-2017
Schedule Fee Updated:
14-Jan-2002

Whole body FDG PET study to assess response to first line therapy either during treatment or within three months of completing definitive first line treatment for Hodgkin or non-Hodgkin lymphoma (R)

Fee: $953.00 Benefit: 75% = $714.75 85% = $865.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61628

61628 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-Nov-2017
Schedule Fee Updated:
14-Jan-2002

Whole body FDG PET study for restaging following confirmation of recurrence of Hodgkin or non-Hodgkin lymphoma (R)

Fee: $953.00 Benefit: 75% = $714.75 85% = $865.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61632

61632 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-Nov-2017
Schedule Fee Updated:
01-Jul-2011

Whole body FDG PET study to assess response to second-line chemotherapy if haemopoietic stem cell transplantation is being considered for Hodgkin or non-Hodgkin lymphoma (R)

Fee: $953.00 Benefit: 75% = $714.75 85% = $865.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61647

61647 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-May-2020

Whole body 68Ga DOTA peptide PET study, if:
(a) a gastro entero pancreatic neuroendocrine tumour is suspected on the basis of biochemical evidence with negative or equivocal conventional imaging; or
(b) both:
(i) a surgically amenable gastro entero pancreatic neuroendocrine tumour has been identified on the basis of conventional techniques; and
(ii) the study is for excluding additional disease sites (R)

Fee: $953.00 Benefit: 75% = $714.75 85% = $865.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55126

55126 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2021

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.1.2

Initial real time transthoracic echocardiographic examination of the heart with real time colour flow mapping from at least 3 acoustic windows, with recordings on digital media, if the service:

(a) is for the investigation of any of the following:

(i) symptoms or signs of cardiac failure;

(ii) suspected or known ventricular hypertrophy or dysfunction;

(iii) pulmonary hypertension;

(iv) valvular, aortic, pericardial, thrombotic or embolic disease;

(v) heart tumour;

(vi) symptoms or signs of congenital heart disease;

(vii) other rare indications; and

(b) is not associated with a service to which:

(i) another item in this Subgroup applies (except items 55137, 55141, 55143, 55145 and 55146); or

(ii) an item in Subgroup 2 applies (except items 55118 and 55130); or

(iii) an item in Subgroup 3 applies

Applicable not more than once in a 24 month period (R)

Fee: $236.25 Benefit: 75% = $177.20 85% = $200.85

(See para IN.0.19, IN.1.3, IR.1.2, IR.1.3 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55127

55127 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2021

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.1.2

Repeat serial real time transthoracic echocardiographic examination of the heart with real time colour flow mapping from at least 3 acoustic windows, with recordings on digital media, if the service:

(a) is for the investigation of known valvular dysfunction; and

(b) is requested by a specialist or consultant physician; and

(c) is not associated with a service to which:

(i) another item in this Subgroup applies (except items 55137, 55141, 55143, 55145 and 55146); or

(ii) an item in Subgroup 2 applies (except items 55118 and 55130); or

(iii) an item in Subgroup 3 applies (R)

 

Fee: $236.25 Benefit: 75% = $177.20 85% = $200.85

(See para IN.0.19, IN.1.4, IR.1.2, IR.1.3 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55128

55128 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2021

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.1.2

Repeat serial real time transthoracic echocardiographic examination of the heart with real time colour flow mapping from at least 3 acoustic windows, with recordings on digital media, if the service:

(a) is for the investigation of known valvular dysfunction; and

(b) is requested by a medical practitioner (other than a specialist or consultant physician) at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(c) is not associated with a service to which:

(i) another item in this Subgroup applies (except items 55137, 55141, 55143, 55145 and 55146); or

(ii) an item in Subgroup 2 applies (except items 55118 and 55130); or

(iii) an item in Subgroup 3 applies (R)



 

Fee: $236.25 Benefit: 75% = $177.20 85% = $200.85

(See para IN.0.19, IN.1.4, IR.1.2, IR.1.3 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55129

55129 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2021

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.1.2

Repeat serial real time transthoracic echocardiographic examination of the heart with real time colour flow mapping from at least 3 acoustic windows, with recordings on digital media, if:

(a) valvular dysfunction is not the primary issue for the patient (although it may be a secondary issue); and

(b) the service is for the investigation of any of the following:

(i) symptoms or signs of cardiac failure;

(ii) suspected or known ventricular hypertrophy or dysfunction;

(iii) pulmonary hypertension;

(iv) aortic, thrombotic, embolic disease or pericardial disease (excluding isolated pericardial effusion or pericarditis);

(v) heart tumour;

(vi) structural heart disease;

(vii) other rare indications; and

(c) the service is requested by a specialist or consultant physician; and

(d) the service is not associated with a service to which:

(i) another item in this Subgroup applies (except items 55137, 55141, 55143, 55145 and 55146); or

(ii) an item in Subgroup 2 applies (except items 55118 and 55130); or

(iii) an item in Subgroup 3 applies (R)

Fee: $236.25 Benefit: 75% = $177.20 85% = $200.85

(See para IN.0.19, IN.1.5, IR.1.2, IR.1.3 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55132

55132 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2021

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.1.2

Serial real time transthoracic echocardiographic examination of the heart with real time colour flow mapping from at least 4 acoustic windows, with recordings on digital media, if the service:

(a) is for the investigation of a patient who:

(i) is under 17 years of age; or

(ii) has complex congenital heart disease; and

(b) is performed by a specialist or consultant physician practising in the speciality of cardiology; and

(c) is not associated with a service to which:

(i) another item in this Subgroup applies (except items 55137, 55141, 55143, 55145 and 55146); or

(ii) an item in Subgroup 2 applies (except items 55118 and 55130); or

(iii) an item in Subgroup 3 applies (R)

 

Fee: $236.25 Benefit: 75% = $177.20 85% = $200.85

(See para IN.0.19, IN.1.6, IR.1.2, IR.1.3 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55133

55133 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2021

Note: the service only applies if the patient meets one or more of the following and the requirements of Note: IR.1.2

Frequent repetition serial real time transthoracic echocardiographic examination of the heart with real time colour flow mapping from at least 3 acoustic windows, with recordings on digital media, if the service:

(a) is for the investigation of a patient who:

(i) has an isolated pericardial effusion or pericarditis; or

(ii) has a normal baseline study, and has commenced medication for non‑cardiac purposes that has cardiotoxic side effects and is a pharmaceutical benefit (within the meaning of Part VII of the National Health Act 1953) for the writing of a prescription for the supply of which under that Part an echocardiogram is required; and

(b) is not associated with a service to which:

(i) another item in this Subgroup applies (except items 55137, 55141, 55143, 55145 and 55146); or

(ii) an item in Subgroup 2 applies (except items 55118 and 55130); or

(iii) an item in Subgroup 3 applies (R)

Fee: $212.65 Benefit: 75% = $159.50 85% = $180.80

(See para IN.0.19, IN.1.7, IR.1.2, IR.1.3 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55134

55134 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2021

Note: the service only applies if the patient meets one or more of the following and the requirements of Note: IR.1.2

Repeat real time transthoracic echocardiographic examination of the heart with real time colour flow mapping from at least 3 acoustic windows, with recordings on digital media, for the investigation of rare cardiac pathologies, if the service:

(a) is requested by a specialist or consultant physician; and

(b) is not associated with a service to which:

(i) another item in this Subgroup applies (except items 55137, 55141, 55143, 55145 and 55146); or

(ii) an item in Subgroup 2 applies (except items 55118 and 55130); or

(iii) an item in Subgroup 3 applies (R)

Fee: $236.25 Benefit: 75% = $177.20 85% = $200.85

(See para IN.0.19, IN.1.8, IR.1.2, IR.1.3 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55137

55137 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Jul-2021

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.1.2

Serial real time transthoracic echocardiographic examination of the heart with real time colour flow mapping from at least 4 acoustic windows, with recordings on digital media, if the service:

(a) is for the investigation of a fetus with suspected or confirmed:

(i) complex congenital heart disease; or

(ii) functional heart disease; or

(iii) fetal cardiac arrhythmia; or

(iv) cardiac structural abnormality requiring confirmation; and

(b) is performed by a specialist or consultant physician practising in the speciality of cardiology with advanced training and expertise in fetal cardiac imaging; and

(c) is not associated with a service to which:

(i) an item in Subgroup 2 applies (except items 55118 and 55130); or

(ii) an item in Subgroup 3 applies (R)

 

 

Fee: $236.25 Benefit: 75% = $177.20 85% = $200.85

(See para IN.0.19, IN.1.9, IR.1.2, IR.1.3 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55141

55141 - Additional Information

Item Start Date:
01-Aug-2020
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2021

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.0.1 and IR.1.2

Exercise stress echocardiography focused study, other than a service associated with a service to which:

(a) item 11704, 11705, 11707, 11714, 11729 or 11730 applies; or

(b) an item in Subgroup 3 applies

Applicable not more than once in a 24 month period (R)


 

 

Fee: $421.20 Benefit: 75% = $315.90 85% = $358.05

(See para IN.0.19, IN.1.10, IR.0.1, IR.1.2, IR.1.3 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55143

55143 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Jul-2021

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.0.1, IR.1.1 and IR.1.2 

Repeat pharmacological or exercise stress echocardiography if:

(a) a service to which item 55141, 55145, 55146, or this item, applies has been performed on the patient in the previous 24 months; and

(b) the patient has symptoms of ischaemia that have evolved and are not adequately controlled with optimal medical therapy; and

(c) the service is requested by a specialist or a consultant physician; and

(d) the service is not associated with a service to which:

(i) item 11704, 11705, 11707, 11714, 11729 or 11730 applies; or

(ii) an item in Subgroup 3 applies

Applicable not more than once in a 12 month period (R)

Fee: $421.20 Benefit: 75% = $315.90 85% = $358.05

(See para IN.0.19, IN.1.10, IR.0.1, IR.1.1, IR.1.2, IR.1.3 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55145

55145 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2021

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.0.1 and IR.1.2

Pharmacological stress echocardiography, other than a service associated with a service to which:

(a) item 11704, 11705, 11707, 11714, 11729 or 11730 applies; or

(b) an item in Subgroup 3 applies

Applicable not more than once in a 24 month period (R)

Note: this item does not apply to a service provided to a patient if, in the previous 24 months, a service associated with a service to which item 55141, 55143 or 55146 applies has been provided to the patient.

 

Fee: $488.20 Benefit: 75% = $366.15 85% = $415.00

(See para IN.0.19, IN.1.10, IR.0.1, IR.1.2, IR.1.3 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

55146

55146 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2021

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.0.1 and IR.1.2

Pharmacological stress echocardiography if:

(a) a service to which item 55141 applies has been performed on the patient in the previous 4 weeks, and the test has failed due to an inadequate heart rate response; and

(b) the service is not associated with a service to which:

(i) item 11704, 11705, 11707, 11714, 11729 or 11730 applies; or

(ii) an item in Subgroup 3 applies

Applicable not more than once in a 24 month period (R)

Note: this item does not apply to a service provided to a patient if, in the previous 24 months, a service associated with a service to which item 55143 or 55145 applies has been provided to the patient.

 

Fee: $488.20 Benefit: 75% = $366.15 85% = $415.00

(See para IN.0.19, IN.1.10, IR.0.1, IR.1.2, IR.1.3 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

58700

58700 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Plain renal only (R)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

58706

58706 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Intravenous pyelography, with or without preliminary plain films and with or without tomography (R)

Fee: $161.70 Benefit: 75% = $121.30 85% = $137.45

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

58715

58715 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Antegrade or retrograde pyelography with or without preliminary plain films and with preparation and contrast injection, one side (R)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

58718

58718 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Retrograde cystography or retrograde urethrography with or without preliminary plain films and with preparation and contrast injection (R) 

(Anaes.)

Fee: $129.15 Benefit: 75% = $96.90 85% = $109.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

58721

58721 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Retrograde micturating cysto urethrography, with preparation and contrast injection (R) 

(Anaes.)

Fee: $141.55 Benefit: 75% = $106.20 85% = $120.35

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

58900

58900 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Plain abdominal only, not being a service associated with a service to which item 58909, 58912 or 58915 applies (NR)

Fee: $36.60 Benefit: 75% = $27.45 85% = $31.15

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

58903

58903 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Plain abdominal only, not being a service associated with a service to which item 58909, 58912 or 58915 applies (R)

Fee: $48.75 Benefit: 75% = $36.60 85% = $41.45

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

58909

58909 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Barium or other opaque meal of one or more of pharynx, oesophagus, stomach or duodenum, with or without preliminary plain films of pharynx, chest or duodenum, not being a service associated with a service to which item 57939, 57942 or 57945 applies (R)

Fee: $92.10 Benefit: 75% = $69.10 85% = $78.30

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

58912

58912 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Barium or other opaque meal of oesophagus, stomach, duodenum and follow through to colon, with or without screening of chest and with or without preliminary plain film (R)

Fee: $112.90 Benefit: 75% = $84.70 85% = $96.00

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

58915

58915 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Barium or other opaque meal, small bowel series only, with or without preliminary plain film (R)

Fee: $80.85 Benefit: 75% = $60.65 85% = $68.75

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

58916

58916 - Additional Information

Item Start Date:
01-Nov-1997
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Small bowel enema, barium or other opaque study of the small bowel, including duodenal intubation, with or without preliminary plain films, not being a service associated with a service to which item 30488 applies (R)

(Anaes.)

Fee: $141.85 Benefit: 75% = $106.40 85% = $120.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

58921

58921 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Opaque enema, with or without air contrast study and with or without preliminary plain films (R)

Fee: $138.55 Benefit: 75% = $103.95 85% = $117.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

58927

58927 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Cholegraphy direct, with or without preliminary plain films and with preparation and contrast injection, not being a service associated with a service to which item 30439 applies (R)

Fee: $78.30 Benefit: 75% = $58.75 85% = $66.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

58933

58933 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Cholegraphy, percutaneous transhepatic, with or without preliminary plain films and with preparation and contrast injection (R)

Fee: $210.60 Benefit: 75% = $157.95 85% = $179.05

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

58936

58936 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Cholegraphy, drip infusion, with or without preliminary plain films, with preparation and contrast injection and with or without tomography (R)

Fee: $200.70 Benefit: 75% = $150.55 85% = $170.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

58939

58939 - Additional Information

Item Start Date:
01-Nov-1996
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Defaecogram (R)

Fee: $142.65 Benefit: 75% = $107.00 85% = $121.30

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63271

63271 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

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

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63274

63274 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

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

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63277

63277 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

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

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63280

63280 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

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

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63440

63440 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

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

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63443

63443 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

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

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63446

63446 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

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

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63482

63482 - Additional Information

Item Start Date:
01-Jan-2006
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jan-2006

 

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

 

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63545

63545 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-May-2019

MRI – multiphase scans of liver (including delayed imaging, if performed) with a contrast agent, for characterisation or intervention planning, if:
(a) the patient has:

(i) known colorectal carcinoma; and
(ii) known, suspected, or possible liver metastasis; and
(b) computed tomography, or ultrasound imaging, has identified a mass lesion in patient’s liver.
For any particular patient—applicable not more than once in a 12 month period (R) (Contrast)

 

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63546

63546 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-May-2019

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

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


(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63151

63151 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

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

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63154

63154 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

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

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63161

63161 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

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

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63164

63164 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

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

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63167

63167 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

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

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63170

63170 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

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

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63173

63173 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

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

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63176

63176 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

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

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63179

63179 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

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

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63182

63182 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

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

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63185

63185 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

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

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55700

55700 - Additional Information

Item Start Date:
01-Feb-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

 

Pelvis or abdomen, pregnancy related or pregnancy complication, ultrasound scan of, by any or all approaches, for determining the gestation, location, viability or number of foetuses, if the dating of the pregnancy (as confirmed by ultrasound) is less than 12 weeks of gestation (R)

 

 

 

 

 

 

 

 

Fee: $61.45 Benefit: 75% = $46.10 85% = $52.25

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55703

55703 - Additional Information

Item Start Date:
01-Feb-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

 

Pelvis or abdomen, pregnancy related or pregnancy complication, ultrasound scan of, by any or all approaches, for determining the gestation, location, viability or number of foetuses, if the dating of the pregnancy (as confirmed by ultrasound) is less than 12 weeks of gestation (NR)

 

 

 

 

 

Fee: $35.80 Benefit: 75% = $26.85 85% = $30.45

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55704

55704 - Additional Information

Item Start Date:
01-Feb-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, for determining the structure, gestation, location, viability or number of foetuses, if the dating of the pregnancy (as confirmed by ultrasound) is 12 to 16 weeks of gestation (R)

 

 

 

 

Fee: $71.70 Benefit: 75% = $53.80 85% = $60.95

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55705

55705 - Additional Information

Item Start Date:
01-Feb-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, for determining the structure, gestation, location, viability or number of foetuses, if the dating of the pregnancy (as confirmed by ultrasound) is 12 to 16 weeks of gestation (NR)

Fee: $35.80 Benefit: 75% = $26.85 85% = $30.45

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55706

55706 - Additional Information

Item Start Date:
01-Feb-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:
(a) the dating for the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and
(b) the service is not performed in the same pregnancy as item 55709 (R)

Fee: $102.40 Benefit: 75% = $76.80 85% = $87.05

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55707

55707 - Additional Information

Item Start Date:
01-Nov-2005
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:
(a) the pregnancy (as confirmed by ultrasound) is dated by a fetal crown rump length of 45 to 84 mm; and
(b) nuchal translucency measurement is performed to assess the risk of fetal abnormality; and
(c) the service is not performed with item 55700, 55703, 55704 or 55705 on the same patient within 24 hours (R)

Fee: $71.70 Benefit: 75% = $53.80 85% = $60.95

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55708

55708 - Additional Information

Item Start Date:
01-Nov-2005
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:
(a) the pregnancy (as confirmed by ultrasound) is dated by a crown rump length of 45 to 84 mm; and
(b) nuchal translucency measurement is performed to assess the risk of fetal abnormality; and
(c) the service is not performed with item 55700, 55703, 55704 or 55705, on the same patient within 24 hours (NR)

Fee: $35.80 Benefit: 75% = $26.85 85% = $30.45

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55709

55709 - Additional Information

Item Start Date:
01-Feb-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:
(a) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and
(b the service is not performed in the same pregnancy as item 55706 (NR)

Fee: $38.90 Benefit: 75% = $29.20 85% = $33.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55712

55712 - Additional Information

Item Start Date:
01-Feb-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:
(a) the service is requested by a medical practitioner who:
(i) is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; or
(ii) has a Diploma of Obstetrics; or
(iii) has a qualification recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists as being equivalent to a Diploma of Obstetrics; or
(iv) has obstetric privileges at a non metropolitan hospital; and
(b) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and
(c) further examination is clinically indicated after performance, in the same pregnancy, of a scan mentioned in item 55706 or 55709 (R)

Fee: $117.75 Benefit: 75% = $88.35 85% = $100.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55715

55715 - Additional Information

Item Start Date:
01-Feb-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, performed by or on behalf of a medical practitioner who is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, if:
(a) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and
(b) further examination is clinically indicated after performance, in the same pregnancy, of a scan mentioned in item 55706 or 55709 (NR)

Fee: $40.95 Benefit: 75% = $30.75 85% = $34.85

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55718

55718 - Additional Information

Item Start Date:
01-Feb-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:
(a) the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and
(b) the service is not performed in the same pregnancy as item 55723 (R)

Fee: $102.40 Benefit: 75% = $76.80 85% = $87.05

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55721

55721 - Additional Information

Item Start Date:
01-Feb-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:
(a) the service is requested by a medical practitioner who:
(i) is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; or
(ii) has a Diploma of Obstetrics; or
(iii) has a qualification recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists as being equivalent to a Diploma of Obstetrics; or
(iv) has obstetric privileges at a non metropolitan hospital; and
(b) the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and
(d) further examination is clinically indicated in the same pregnancy to which item 55718 or 55723 applies (R)

Fee: $117.75 Benefit: 75% = $88.35 85% = $100.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55723

55723 - Additional Information

Item Start Date:
01-Feb-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:
(a) the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and
(b) the service is not performed in the same pregnancy as item 55718 (NR)

Fee: $38.90 Benefit: 75% = $29.20 85% = $33.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55725

55725 - Additional Information

Item Start Date:
01-Feb-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, performed by or on behalf of a medical practitioner who is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, if:
(a) the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and
(b) further examination is clinically indicated in the same pregnancy to which item 55718 or 55723 applies (NR)

Fee: $40.95 Benefit: 75% = $30.75 85% = $34.85

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55729

55729 - Additional Information

Item Start Date:
01-Nov-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Duplex scanning, if:
(a) the service involves:
(i) B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of the umbilical artery; and
(ii) measured assessment of amniotic fluid volume after the 24th week of gestation; and
(b) there is reason to suspect intrauterine growth retardation or a significant risk of fetal death;
—examination and report (R)

Fee: $27.90 Benefit: 75% = $20.95 85% = $23.75

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55736

55736 - Additional Information

Item Start Date:
01-Feb-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Pelvis, ultrasound scan of, in association with saline infusion of the endometrial cavity, by any or all approaches, if a previous transvaginal ultrasound has revealed an abnormality of the uterus or fallopian tube (R)

Fee: $130.05 Benefit: 75% = $97.55 85% = $110.55

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55739

55739 - Additional Information

Item Start Date:
01-Feb-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Pelvis, ultrasound scan of, in association with saline infusion of the endometrial cavity, by any or all approaches, if a previous transvaginal ultrasound has revealed an abnormality of the uterus or fallopian tube (NR)

Fee: $58.35 Benefit: 75% = $43.80 85% = $49.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55759

55759 - Additional Information

Item Start Date:
01-Nov-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:
(a) ultrasound of the same pregnancy confirms a multiple pregnancy; and
(b) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks gestation; and
(c) the service mentioned in item 55706, 55709, 55712, 55715 or 55762 is not performed in conjunction with the scan during the same pregnancy (R)

Fee: $153.60 Benefit: 75% = $115.20 85% = $130.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55762

55762 - Additional Information

Item Start Date:
01-Nov-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:

(a) ultrasound of the same pregnancy confirms a multiple pregnancy; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks gestation; and

(c) the service mentioned in item 55706, 55709, 55712, 55715 or 55759 is not performed in conjunction with the scan during the same pregnancy (NR)

Fee: $61.45 Benefit: 75% = $46.10 85% = $52.25

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55764

55764 - Additional Information

Item Start Date:
01-Nov-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:
(a) the service is requested by a medical practitioner who:
(i) is a Member or Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; or
(ii) has a Diploma of Obstetrics; or
(iii) has a qualification recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists as equivalent to a Diploma of Obstetrics; or
(iv) has obstetric privileges at a non metropolitan hospital; and
(b) ultrasound of the same pregnancy confirms a multiple pregnancy; and
(c) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks gestation; and
(d) further examination is clinically indicated in the same pregnancy in which item 55759 or 55762 has been performed; and
(e) the service mentioned in item 55706, 55709, 55712 or 55715 is not performed in conjunction with the scan during the same pregnancy (R)

Fee: $163.85 Benefit: 75% = $122.90 85% = $139.30

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55766

55766 - Additional Information

Item Start Date:
01-Nov-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, performed by or on behalf of a medical practitioner, who is a Member or Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, if:
(a) ultrasound of the same pregnancy confirms a multiple pregnancy; and
(b) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and
(c) further examination is clinically indicated in the same pregnancy in which item 55759 or 55762 has been performed; and
(d) the service mentioned in item 55706, 55709, 55712 or 55715, is not performed in conjunction with the scan during the same pregnancy (NR)

Fee: $66.55 Benefit: 75% = $49.95 85% = $56.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55768

55768 - Additional Information

Item Start Date:
01-Nov-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:
(a) dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and
(b) the ultrasound confirms a multiple pregnancy; and
(c) the service is not performed in the same pregnancy as item 55770; and
(d) the service mentioned in item 55718, 55721, 55723 or 55725 is not performed in conjunction with the scan during the same pregnancy (R)

Fee: $153.60 Benefit: 75% = $115.20 85% = $130.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55770

55770 - Additional Information

Item Start Date:
01-Nov-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:
(a) dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and
(b) the ultrasound confirms a multiple pregnancy; and
(c) the service is not performed in the same pregnancy as item 55768; and
(d) the service mentioned in item 55718, 55721, 55723 or 55725 is not performed in conjunction with the scan during the same pregnancy (NR)

Fee: $61.45 Benefit: 75% = $46.10 85% = $52.25

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55772

55772 - Additional Information

Item Start Date:
01-Nov-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:
(a) dating of the pregnancy as confirmed by ultrasound is after 22 weeks of gestation; and
(b) the service is requested by a medical practitioner who:
(i) is a Member or Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; or
(ii) has a Diploma of Obstetrics; or
(iii) has a qualification recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists as equivalent to a Diploma of Obstetrics; or
(iv) has obstetric privileges at a non metropolitan hospital; and
(c) further examination is clinically indicated in the same pregnancy to which item 55768 or 55770 has been performed; and
(d) the pregnancy as confirmed by ultrasound is a multiple pregnancy; and
(e) the service mentioned in item 55718, 55721, 55723 or 55725 is not performed in conjunction with the scan during the same pregnancy (R)

Fee: $163.85 Benefit: 75% = $122.90 85% = $139.30

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55774

55774 - Additional Information

Item Start Date:
01-Nov-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, performed by or on behalf of a medical practitioner who is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, if:
(a) dating of the pregnancy as confirmed by ultrasound is after 22 weeks of gestation; and
(b) further examination is clinically indicated in the same pregnancy to which item 55768 or 55770 has been performed; and
(c) the pregnancy as confirmed by ultrasound is a multiple pregnancy; and
(d) the service mentioned in item 55718, 55721, 55723 or 55725 is not performed in conjunction with the scan during the same pregnancy (NR)

Fee: $66.55 Benefit: 75% = $49.95 85% = $56.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56301

56301 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Computed tomography—scan of chest, including lungs, mediastinum, chest wall and pleura, with or without scans of the upper abdomen, without intravenous contrast medium, not being a service to which item 56801 or 57001 applies and not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (Anaes.)

Fee: $302.10 Benefit: 75% = $226.60 85% = $256.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56307

56307 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Computed tomography—scan of chest, including lungs, mediastinum, chest wall and pleura, with or without scans of the upper abdomen, with intravenous contrast medium and with any scans of the chest, including lungs, mediastinum, chest wall or pleura and upper abdomen before intravenous contrast injection, when undertaken, not being a service to which item 56807 or 57007 applies and not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56620

56620 - Additional Information

Item Start Date:
01-Nov-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Computed tomography—scan of knee, without intravenous contrast medium, not being a service to which item 56622 or 56629 applies (R) (Anaes.)

Fee: $225.30 Benefit: 75% = $169.00 85% = $191.55

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56622

56622 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Computed tomography—scan of lower limb, left or right or both, one region (other than knee), or more than one region (which may include knee), without intravenous contrast medium, not being a service to which item 56620 applies (R) (Anaes.)

(Anaes.)

Fee: $225.30 Benefit: 75% = $169.00 85% = $191.55

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56623

56623 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Computed tomography—scan of lower limb, left or right or both, one region (other than knee), or more than one region (which may include knee), with intravenous contrast medium and with any scans of the lower limb before intravenous contrast injection, when performed, not being a service to which item 56626 applies (R) (Anaes.)

(Anaes.)

Fee: $342.70 Benefit: 75% = $257.05 85% = $291.30

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56626

56626 - Additional Information

Item Start Date:
01-Nov-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Computed tomography—scan of knee, with intravenous contrast medium and with any scans of the knee before intravenous contrast injection, when performed, not being a service to which items 56623 or 56630 apply (R) (Anaes.)

Fee: $342.70 Benefit: 75% = $257.05 85% = $291.30

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56627

56627 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Computed tomography—scan of upper limb, left or right or both, any one region, or more than one region, without intravenous contrast medium (R) (Anaes.)

(Anaes.)

Fee: $225.30 Benefit: 75% = $169.00 85% = $191.55

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56628

56628 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Computed tomography—scan of upper limb, left or right or both, any one region, or more than one region, with intravenous contrast medium and with any scans of the upper limb before intravenous contrast injection, when performed (R) (Anaes.)

(Anaes.)

Fee: $342.70 Benefit: 75% = $257.05 85% = $291.30

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56629

56629 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Computed tomography—scan of upper limb and lower limb, left or right or both, any one region (other than knee), or more than one region (which may include knee) without intravenous contrast medium not being a service to which item 56620 applies (R) (Anaes.)

(Anaes.)

Fee: $225.30 Benefit: 75% = $169.00 85% = $191.55

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56630

56630 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Computed tomography—scan of upper limb and lower limb, left or right or both, any one region (other than knee), or more than one region (which may include knee) with intravenous contrast medium with any scans of the limbs before intravenous contrast injection, when performed, not being a service to which item 56626 applies (R)

(Anaes.)

Fee: $342.70 Benefit: 75% = $257.05 85% = $291.30

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

59700

59700 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Discography, each disc, with or without preliminary plain films and with preparation and contrast injection (R) (Anaes.)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

59703

59703 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Dacryocystography, one side, with or without preliminary plain film and with preparation and contrast injection (R)

Fee: $77.75 Benefit: 75% = $58.35 85% = $66.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

59712

59712 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Hysterosalpingography, with or without preliminary plain films and with preparation and contrast injection (R)(Anaes.)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

59715

59715 - Additional Information

Item Start Date:
01-Nov-1997
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Bronchography, one side, with or without preliminary plain films and with preparation and contrast injection, on a person under 16 years of age (R) (Anaes.)

(Anaes.)

Fee: $147.00 Benefit: 75% = $110.25 85% = $124.95

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

59718

59718 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Phlebography, one side, with or without preliminary plain films and with preparation and contrast injection (R) (Anaes.)

(Anaes.)

Fee: $137.90 Benefit: 75% = $103.45 85% = $117.25

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

59724

59724 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Myelography, one or more regions, with or without preliminary plain films and with preparation and contrast injection, not being a service associated with a service to which item 56219 applies (R)(Anaes.)

(Anaes.)

Fee: $231.90 Benefit: 75% = $173.95 85% = $197.15

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

59733

59733 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Sialography, one side, with preparation and contrast injection, not being a service associated with a service to which item 57918 applies (R)

Fee: $110.30 Benefit: 75% = $82.75 85% = $93.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

59739

59739 - Additional Information

Item Start Date:
01-Nov-1997
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Sinogram or fistulogram, one or more regions, with or without preliminary plain films and with preparation and contrast injection (R)

Fee: $75.50 Benefit: 75% = $56.65 85% = $64.20

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

59751

59751 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Arthrography, each joint, excluding the facet (zygapophyseal) joints of the spine, single or double contrast study, with or without preliminary plain films and with preparation and contrast injection (R)

Fee: $142.50 Benefit: 75% = $106.90 85% = $121.15

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

59754

59754 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Lymphangiography, one or both sides, with preliminary plain films and follow-up radiography and with preparation and contrast injection (R)

Fee: $224.65 Benefit: 75% = $168.50 85% = $191.00

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

59763

59763 - Additional Information

Item Start Date:
01-Nov-1996
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Air insufflation during video—fluoroscopic imaging including associated consultation (R)

Fee: $137.10 Benefit: 75% = $102.85 85% = $116.55

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

60918

60918 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Jul-2021

Arteriography (peripheral) or phlebography—one vessel, when used in association with a service to which item 59970 applies, not being a service associated with a service to which any of items 60000 to 60078 apply (NR)

(Anaes.)

Fee: $48.30 Benefit: 75% = $36.25 85% = $41.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

60927

60927 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Jul-2021

Selective arteriogram or phlebogram, when used in association with a service to which item 59970 applies, not being a service associated with a service to which any of items 60000 to 60078 apply (NR) 

(Anaes.)

Fee: $38.95 Benefit: 75% = $29.25 85% = $33.15

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57700

57700 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Shoulder or scapula (NR)

Fee: $41.45 Benefit: 75% = $31.10 85% = $35.25

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57703

57703 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Shoulder or scapula (R)

Fee: $55.30 Benefit: 75% = $41.50 85% = $47.05

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57706

57706 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Clavicle (NR)

Fee: $33.30 Benefit: 75% = $25.00 85% = $28.35

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57709

57709 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Clavicle (R)

Fee: $44.45 Benefit: 75% = $33.35 85% = $37.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57712

57712 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Hip joint (R)

Fee: $48.30 Benefit: 75% = $36.25 85% = $41.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57715

57715 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Pelvic girdle (R)

Fee: $62.35 Benefit: 75% = $46.80 85% = $53.00

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

57721

57721 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Femur, internal fixation of neck or intertrochanteric (pertrochanteric) fracture (R)

Fee: $101.65 Benefit: 75% = $76.25 85% = $86.45

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

58100

58100 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Spine—cervical (R)

Fee: $68.75 Benefit: 75% = $51.60 85% = $58.45

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

58103

58103 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Spine—thoracic (R)

Fee: $56.45 Benefit: 75% = $42.35 85% = $48.00

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

58106

58106 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Spine—lumbosacral (R)

Fee: $78.85 Benefit: 75% = $59.15 85% = $67.05

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

58108

58108 - Additional Information

Item Start Date:
01-Nov-2001
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Spine—4 regions, cervical, thoracic, lumbosacral and sacrococcygeal (R)

Fee: $112.65 Benefit: 75% = $84.50 85% = $95.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

58109

58109 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Spine—sacrococcygeal (R)

Fee: $48.15 Benefit: 75% = $36.15 85% = $40.95

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

58112

58112 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

NOTE:  An account issued or a patient assignment form must show the item numbers of the examinations performed under this item

 

Spine—2 examinations of the kind mentioned in items 58100, 58103, 58106 and 58109 (R)

Fee: $99.60 Benefit: 75% = $74.70 85% = $84.70

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

58115

58115 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

NOTE:  An account issued or a patient assignment form must show the item numbers of the examinations performed under this item

 

Spine—3 examinations of the kind mentioned in items 58100, 58103, 58106 and 58109 (R)

Fee: $112.65 Benefit: 75% = $84.50 85% = $95.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63001

63001 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

MRI—scan of head (including MRA, if performed) for tumour of the brain or meninges (R) (Anaes.) (Contrast)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63004

63004 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

MRI—scan of head (including MRA, if performed) for inflammation of brain or meninges (R) (Anaes.) (Contrast)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63007

63007 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

MRI—scan of head (including MRA, if performed) for skull base or orbital tumour (R) (Anaes.) (Contrast)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63010

63010 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

MRI—scan of head (including MRA, if performed) for stereotactic scan of brain, with fiducials in place, for the sole purpose of allowing planning for stereotactic neurosurgery (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $336.00 Benefit: 75% = $252.00 85% = $285.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63125

63125 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

MRI—scan of head and cervical spine (including MRA, if performed) for demyelinating disease of the central nervous system (R) (Anaes.) (Contrast)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63128

63128 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

MRI—scan of head and cervical spine (including MRA, if performed) for congenital malformation of the central nervous system or meninges (R) (Anaes.) (Contrast)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63131

63131 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

MRI—scan of head and cervical spine (including MRA, if performed) for syrinx (congenital or acquired) (R) (Anaes.) (Contrast)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56001

56001 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Computed tomography—scan of brain without intravenous contrast medium, not being a service to which item 57001 applies (R) (Anaes.)

Fee: $199.80 Benefit: 75% = $149.85 85% = $169.85

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56007

56007 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Computed tomography—scan of brain with intravenous contrast medium and with any scans of the brain before intravenous contrast injection, when performed, not being a service to which item 57007 applies (R) (Anaes.)

Fee: $256.05 Benefit: 75% = $192.05 85% = $217.65

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56010

56010 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Computed tomography—scan of pituitary fossa with or without intravenous contrast medium and with or without brain scan when performed (R) (Anaes.)

Fee: $258.20 Benefit: 75% = $193.65 85% = $219.50

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56013

56013 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

COMPUTED TOMOGRAPHY - scan of orbits with or without intravenous contrast medium and with or without brain scan when undertaken (R) (Anaes.)

Fee: $256.05 Benefit: 75% = $192.05 85% = $217.65

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56016

56016 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Computed tomography—scan of petrous bones in axial and coronal planes in 1 mm or 2 mm sections, with or without intravenous contrast medium, with or without scan of brain (R) (Anaes.)

Fee: $297.00 Benefit: 75% = $222.75 85% = $252.45

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56022

56022 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Computed tomography—scan of facial bones, para nasal sinuses or both without intravenous contrast medium (R) (Anaes.)

Fee: $230.40 Benefit: 75% = $172.80 85% = $195.85

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56028

56028 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Computed tomography—scan of facial bones, para nasal sinuses or both with intravenous contrast medium and with any scans of the facial bones, para nasal sinuses or both before intravenous contrast injection, when performed (R) (Anaes.)

Fee: $344.95 Benefit: 75% = $258.75 85% = $293.25

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56030

56030 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Computed tomography—scan of facial bones, para nasal sinuses or both, with scan of brain, without intravenous contrast medium (R) (Anaes.)

Fee: $230.40 Benefit: 75% = $172.80 85% = $195.85

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

56036

56036 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Computed tomography—scan of facial bones, para nasal sinuses or both, with scan of brain, with intravenous contrast medium, if:
(a) a scan without intravenous contrast medium has been performed; and
(b) the service is required because the result of the scan mentioned in paragraph (a) is abnormal (R) (Anaes.)

Fee: $344.95 Benefit: 75% = $258.75 85% = $293.25

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55028

55028 - Additional Information

Item Start Date:
01-Jul-1993
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Head, ultrasound scan of (R)

Fee: $111.75 Benefit: 75% = $83.85 85% = $95.00

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55029

55029 - Additional Information

Item Start Date:
01-Jul-1993
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Head, ultrasound scan of (NR)

Fee: $38.75 Benefit: 75% = $29.10 85% = $32.95

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55030

55030 - Additional Information

Item Start Date:
01-Jul-1993
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Orbital contents, ultrasound scan of (R)

Fee: $111.75 Benefit: 75% = $83.85 85% = $95.00

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55031

55031 - Additional Information

Item Start Date:
01-Jul-1993
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Orbital contents, ultrasound scan of (NR)

Fee: $38.75 Benefit: 75% = $29.10 85% = $32.95

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55032

55032 - Additional Information

Item Start Date:
01-Jul-1993
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Neck, one or more structures of, ultrasound scan of (R)

Fee: $111.75 Benefit: 75% = $83.85 85% = $95.00

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55033

55033 - Additional Information

Item Start Date:
01-Jul-1993
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Neck, one or more structures of, ultrasound scan of (NR)

Fee: $38.75 Benefit: 75% = $29.10 85% = $32.95

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55036

55036 - Additional Information

Item Start Date:
01-Jul-1993
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Abdomen, ultrasound scan of (including scan of urinary tract when performed), for morphological assessment, if:
(a) the service is not solely a transrectal ultrasonic examination of any of the following:
(i) prostate gland;
(ii) bladder base;
(iii) urethra; and
(b) within 24 hours of the service, a service mentioned in item 55038 is not performed on the same patient by the providing practitioner (R)

Fee: $113.95 Benefit: 75% = $85.50 85% = $96.90

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55037

55037 - Additional Information

Item Start Date:
01-Jul-1993
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Abdomen, ultrasound scan of (including scan of urinary tract when performed), for morphological assessment, if the service is not solely a transrectal ultrasonic examination of any of the following:
(i) prostate gland;
(ii) bladder base;
(iii) urethra (NR)

Fee: $38.75 Benefit: 75% = $29.10 85% = $32.95

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55038

55038 - Additional Information

Item Start Date:
01-Jul-1993
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Urinary tract, ultrasound scan of, if:

(a) the service is not solely a transrectal ultrasonic examination of any of the following:

(i) prostate gland;

(ii) bladder base;

(iii) urethra; and

(b) within 24 hours of the service, a service mentioned in item 55036 or 55065 is not performed on the same patient by the providing practitioner (R)

Fee: $111.75 Benefit: 75% = $83.85 85% = $95.00

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55039

55039 - Additional Information

Item Start Date:
01-Jul-1993
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Urinary tract, ultrasound scan of, if the service is not solely a transrectal ultrasonic examination of any of the following:

(a) prostate gland;

(b) bladder base;

(c) urethra (NR)

Fee: $38.75 Benefit: 75% = $29.10 85% = $32.95

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55048

55048 - Additional Information

Item Start Date:
01-Jul-1993
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Scrotum, ultrasound scan of (R)

Fee: $112.15 Benefit: 75% = $84.15 85% = $95.35

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55049

55049 - Additional Information

Item Start Date:
01-Jul-1993
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Scrotum, ultrasound scan of (NR)

Fee: $38.75 Benefit: 75% = $29.10 85% = $32.95

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55054

55054 - Additional Information

Item Start Date:
01-Jul-1993
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Ultrasonic cross-sectional echography, in conjunction with a surgical procedure (other than a procedure to which item 55848 or 55850 applies) using interventional techniques, not being a service associated with a service to which any other item in this Group applies (R)

Fee: $111.75 Benefit: 75% = $83.85 85% = $95.00

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55065

55065 - Additional Information

Item Start Date:
01-Jul-2014
Description Updated:
01-Nov-2021
Schedule Fee Updated:
01-Jul-2021

Pelvis, ultrasound scan of, by any or all approaches, if:
(a) the service is not solely a service to which an item (other than item 55736 or 55739) in Subgroup 5 of this Group applies or a transrectal ultrasonic examination of any of the following:

  1. prostate gland;
  2. bladder base;
  3. urethra; and

(b) within 24 hours of the service, a service mentioned in item 55038 is not performed on the same patient by the providing practitioner (R)

Fee: $100.60 Benefit: 75% = $75.45 85% = $85.55

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55066

55066 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Breasts, both, ultrasound scan, in conjunction with a surgical procedure using interventional techniques, if:
(a) the request for the scan indicates that an ultrasound guided breast intervention be performed; and
(b) the service is not performed in conjunction with any other item in this Group (R)

Fee: $223.45 Benefit: 75% = $167.60 85% = $189.95

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55068

55068 - Additional Information

Item Start Date:
01-Jul-2014
Description Updated:
01-Nov-2021
Schedule Fee Updated:
01-Jul-2021

Pelvis, ultrasound scan of, by any or all approaches, if the service is not solely a service to which an item (other than item 55736 or 55739) in Subgroup 5 of this Group applies or a transrectal ultrasonic examination of any of the following:
(i) prostate gland;
(ii) bladder base;
(iii) urethra (NR)

Fee: $35.80 Benefit: 75% = $26.85 85% = $30.45

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55070

55070 - Additional Information

Item Start Date:
01-Feb-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Breast, one, ultrasound scan of (R)

Fee: $100.60 Benefit: 75% = $75.45 85% = $85.55

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55071

55071 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Breast, one, ultrasound scan, in conjunction with a surgical procedure using interventional techniques, if:
(a) the request for the scan indicates that an ultrasound guided breast intervention be performed; and
(b) the service is not performed in conjunction with any other item in this group (R)

Fee: $212.35 Benefit: 75% = $159.30 85% = $180.50

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55073

55073 - Additional Information

Item Start Date:
01-Feb-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Breast, one, ultrasound scan of (NR)

Fee: $34.85 Benefit: 75% = $26.15 85% = $29.65

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55076

55076 - Additional Information

Item Start Date:
01-Feb-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Breasts, both, ultrasound scan of, including an ultrasound scan for post mastectomy surveillance (R)

Fee: $111.75 Benefit: 75% = $83.85 85% = $95.00

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55079

55079 - Additional Information

Item Start Date:
01-Feb-2000
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Breasts, both, ultrasound scan of, including an ultrasound scan for post mastectomy surveillance (NR)

Fee: $38.75 Benefit: 75% = $29.10 85% = $32.95

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55084

55084 - Additional Information

Item Start Date:
01-May-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Urinary bladder, ultrasound scan of, by any or all approaches, if within 24 hours of the service, a service mentioned in item 11917, 55036, 55038, 55065, 55600 or 55603 is not performed on the same patient by the providing practitioner (R)

Fee: $100.60 Benefit: 75% = $75.45 85% = $85.55

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55085

55085 - Additional Information

Item Start Date:
01-May-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Urinary bladder, ultrasound scan of, by any or all approaches, if within 24 hours of the service, a service mentioned in item 11917, 55037, 55039, 55068, 55600 or 55603 is not performed on the same patient by the providing practitioner (NR)

Fee: $34.85 Benefit: 75% = $26.15 85% = $29.65

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55600

55600 - Additional Information

Item Start Date:
01-Nov-1998
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Prostate, bladder base and urethra, ultrasound scan of, if performed:
(a) personally by a medical practitioner (not being the medical practitioner who assessed the patient as specified in paragraph (c)) using one or more transducer probes that can obtain both axial and sagittal scans in 2 planes at right angles; and
(b) after a digital rectal examination of the prostate by that medical practitioner; and
(c) on a patient who has been assessed by:
(i) a specialist in urology, radiation oncology or medical oncology; or
(ii) a consultant physician in medical oncology;
who has:
(iii) examined the patient in the 60 days before the scan; and
(iv) recommended the scan for the management of the patient’s current prostatic disease
(R)

Fee: $111.75 Benefit: 75% = $83.85 85% = $95.00

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55603

55603 - Additional Information

Item Start Date:
01-Nov-1998
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Prostate, bladder base and urethra, ultrasound scan of, if performed:
(a) personally by a medical practitioner who made the assessment mentioned in paragraph (c) using one or more transducer probes that can obtain both axial and sagittal scans in 2 planes at right angles; and
(b) after a digital rectal examination of the prostate by that medical practitioner; and
(c) on a patient who has been assessed by:
(i) a specialist in urology, radiation oncology or medical oncology; or
(ii) a consultant physician in medical oncology;
who has:
(iii) examined the patient in the 60 days before the scan; and
(iv) recommended the scan for the management of the patient’s current prostatic disease
(R)

Fee: $111.75 Benefit: 75% = $83.85 85% = $95.00

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63219

63219 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

MRI—scan of 3 contiguous or 2 non contiguous regions of the spine for demyelinating disease (R) (Anaes.) (Contrast)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63222

63222 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

MRI—scan of 3 contiguous or 2 non contiguous regions of the spine for congenital malformation of the spinal cord or the cauda equina or the meninges (R) (Anaes.) (Contrast)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63225

63225 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

MRI—scan of 3 contiguous or 2 non contiguous regions of the spine for myelopathy (R) (Anaes.) (Contrast)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63228

63228 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

MRI—scan of 3 contiguous or 2 non contiguous regions of the spine for syrinx (congenital or acquired) (R) (Anaes.) (Contrast)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63231

63231 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

MRI—scan of 3 contiguous or 2 non contiguous regions of the spine for cervical radiculopathy (R) (Anaes.) (Contrast)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63234

63234 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

MRI—scan of 3 contiguous or 2 non contiguous regions of the spine for sciatica (R) (Anaes.) (Contrast)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63237

63237 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

MRI—scan of 3 contiguous or 2 non contiguous regions of the spine for spinal canal stenosis (R) (Anaes.) (Contrast)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63240

63240 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

MRI—scan of 3 contiguous or 2 non contiguous regions of the spine for previous spinal surgery (R) (Anaes.) (Contrast)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63243

63243 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

MRI—scan of 3 contiguous or 2 non contiguous regions of the spine for trauma (R) (Anaes.)

(Anaes.)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61310

61310 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Myocardial infarct avid study (R)

Fee: $367.30 Benefit: 75% = $275.50 85% = $312.25

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61311

61311 - Additional Information

Item Start Date:
14-Sep-2019
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Dec-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Single stress myocardial perfusion study, with PET if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) at least one of the following applies:

  1. the patient has body habitus or other physical conditions (including heart rhythm disturbance) to the extent that a stress echocardiography would not provide adequate information;
  2. the patient is unable to exercise to the extent required for a stress echocardiography to provide adequate information;
  3. the patient has had a failed stress echocardiography provided in a service to which item 55141, 55143, 55145 or 55146 applies; and

(c) the service includes resting ECG, continuous ECG monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(d) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61321, 61324, 61325, 61329, 61332, 61345, 61357, 61377, 61394, 61398, 61380, 61406, 61414 or 61422 applies

Applicable not more than once in 24 months (R)    

Item 61311 was available from 1 December 2020 until 28 February 2021, during a national shortage of technetium. See the Health Insurance (Section 3C Diagnostic Imaging - Nuclear Medicine Services) Determination 2019 on the Federal Register of Legislation for further information.

Fee: $653.05 Benefit: 75% = $489.80 85% = $565.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61313

61313 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Gated cardiac blood pool study, (equilibrium) (R)

Fee: $303.35 Benefit: 75% = $227.55 85% = $257.85

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61314

61314 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Gated cardiac blood pool study, with or without intervention, and first pass blood flow or cardiac shunt study (R)

Fee: $420.00 Benefit: 75% = $315.00 85% = $357.00

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61321

61321 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Aug-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.2

Single rest myocardial perfusion study for the assessment of the extent and severity of viable and non‑viable myocardium, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has left ventricular systolic dysfunction and probable or confirmed coronary artery disease; and

(b) the service uses a single rest technetium‑99m (Tc‑99m) protocol; and

(c) the service is requested by a specialist or a consultant physician; and

(d) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61325, 61329, 61332, 61345, 61380, 61398, 61406 or 61422 applies; and

(e) if the patient is 17 years or older—a service to which this item, or item 61325, 61329, 61332, 61345, 61380, 61398, 61406 or 61422, applies has not been provided to the patient in the previous 24 months (R)

 

 

Fee: $329.00 Benefit: 75% = $246.75 85% = $279.65

(See para IN.0.19, IN.4.1, IR.4.1, IR.4.2 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61324

61324 - Additional Information

Item Start Date:
01-Aug-2020
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Aug-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Single stress myocardial perfusion study, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) at least one of the following applies:

(i) the patient has body habitus or other physical conditions (including heart rhythm disturbance) to the extent that a stress echocardiography would not provide adequate information;

(ii) the patient is unable to exercise to the extent required for a stress echocardiography to provide adequate information;

(iii) the patient has had a failed stress echocardiography provided in a service to which item 55141, 55143, 55145 or 55146 applies; and

(c) the service includes resting ECG, continuous ECG monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(d) the service is requested by a specialist or consultant physician; and

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61325, 61329, 61332, 61377, 61345, 61357, 61380, 61394, 61398, 61406, 61414 or 61422 applies; and

(f) if the patient is 17 years or older—a service to which this item, or item 61311, 61329, 61332, 61345, 61357, 61377, 61380, 61394, 61398, 61406 or 61414, applies has not been provided to the patient in the previous 24 months (R)

 

Fee: $653.05 Benefit: 75% = $489.80 85% = $565.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61325

61325 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Aug-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.2

Single rest myocardial perfusion study for the assessment of the extent and severity of viable and non‑viable myocardium, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has left ventricular systolic dysfunction and probable or confirmed coronary artery disease; and

(b) the service uses:

(i) an initial rest study followed by a redistribution study on the same day; and

(ii) a thallous chloride‑201 (Tl‑201) protocol; and

(c) the service is requested by a specialist or a consultant physician; and

(d) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61321, 61329, 61332, 61345, 61380, 61398, 61406 or 61422 applies; and

(e) if the patient is 17 years or older:

(i) a service to which item 61321, 61329, 61332, 61345, 61380, 61398, 61406 or 61442, applies has not been provided to the patient in the previous 24 months; and

(ii) the service is applicable only twice each 24 months (R)

 

 

Fee: $329.00 Benefit: 75% = $246.75 85% = $279.65

(See para IN.0.19, IN.4.2, IR.4.2 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61328

61328 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Lung perfusion study (R)

Fee: $227.65 Benefit: 75% = $170.75 85% = $193.55

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61329

61329 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Aug-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) at least one of the following applies:

(i) the patient has body habitus or other physical conditions (including heart rhythm disturbance) to the extent that a stress echocardiography would not provide adequate information;

(ii) the patient is unable to exercise to the extent required for a stress echocardiography to provide adequate information;

(iii) the patient has had a failed stress echocardiography provided in a service to which item 55141, 55143, 55145 or 55146 applies; and

(c) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(d) the service is requested by a medical practitioner (other than a specialist or consultant physician); and

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61332, 61345, 61357, 61377, 61380, 61394, 61398, 61406, 61414 or 61422 applies; and

(f) if the patient is 17 years or older—a service to which this item, or item 61311, 61321, 61324, 61325, 61332, 61345, 61357, 61380, 61394, 61398, 61406, 61414 or 61422, applies has not been provided to the patient in the previous 24 months (R)

 

 

Fee: $982.05 Benefit: 75% = $736.55 85% = $894.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61332

61332 - Additional Information

Item Start Date:
14-Sep-2019
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Dec-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion, with PET, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) at least one of the following applies:

  1. the patient has body habitus or other physical conditions (including heart rhythm disturbance) to the extent that a stress echocardiography would not provide adequate information;
  2. the patient is unable to exercise to the extent required for a stress echocardiography to provide adequate information;
  3. the patient has had a failed stress echocardiography provided in a service to which item 55141, 55143, 55145 or 55146 applies; and

(c) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(d) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61345, 61357, 61377, 61380, 61394, 61398, 61406, 61414 or 61422 applies

Applicable not more than once in 24 months (R)

Item 61332 was available from 1 December 2020 until 28 February 2021, during a national shortage of technetium. See the Health Insurance (Section 3C Diagnostic Imaging - Nuclear Medicine Services) Determination 2019 on the Federal Register of Legislation for further information.

Fee: $982.05 Benefit: 75% = $736.55 85% = $894.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61340

61340 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Lung ventilation study using aerosol, technegas or xenon gas (R)

Fee: $253.00 Benefit: 75% = $189.75 85% = $215.05

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61345

61345 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Aug-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) at least one of the following applies:

(i) the patient has body habitus or other physical conditions (including heart rhythm disturbance) to the extent that a stress echocardiography would not provide adequate information;

(ii) the patient is unable to exercise to the extent required for a stress echocardiography to provide adequate information;

(iii) the patient has had a failed stress echocardiography provided in a service to which item 55141, 55143, 55145 or 55146 applies; and

(c) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(d) the service is requested by a specialist or consultant physician; and

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61332, 61357, 61377, 61380, 61394, 61398, 61406, 61414 or 61422 applies (R); and

(f) if the patient is 17 years or older—a service to which this item, or item 61311, 61321, 61324, 61325, 61329, 61332, 61357, 61377, 61380, 61394, 61398, 61406, 61414 or 61422, applies has not been provided to the patient in the previous 24 months (R)

 

 

 

Fee: $982.05 Benefit: 75% = $736.55 85% = $894.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61348

61348 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Lung perfusion study and lung ventilation study using aerosol, technegas or xenon gas (R)

Fee: $443.35 Benefit: 75% = $332.55 85% = $376.85

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61349

61349 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Aug-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Repeat combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion, with single photon emission tomography, with or without planar imaging, if:

(a) both:

(i) a service has been provided to the patient in the previous 24 months to which this item, or item 61311, 61324, 61329, 61332, 61337, 61345, 61357, 61365, 61380, 61394, 61398, 61406, 61410, 61414 or 61418, applies; and

(ii) the patient has subsequently undergone a revascularisation procedure; and

(b) the patient has one or more symptoms of cardiac ischaemia that have evolved and are not adequately controlled with optimal medical therapy; and

(c) at least one of the following applies:

(i) the patient has body habitus or other physical conditions (including heart rhythm disturbance) to the extent that a stress echocardiography would not provide adequate information;

(ii) the patient is unable to exercise to the extent required for a stress echocardiography to provide adequate information;

(iii) the patient has had a failed stress echocardiography provided in a service to which item 55141, 55143, 55145 or 55146 applies; and

(d) the service is requested by a specialist or a consultant physician; and

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61365, 61410 or 61418 applies; and

(f) if the patient is 17 years or older—a service to which this item, or item 61365, 61410 or 61418, applies has not been provided to the patient in the previous 12 months (R)

 

Fee: $982.05 Benefit: 75% = $736.55 85% = $894.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61353

61353 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Liver and spleen study (colloid) (R)

Fee: $386.60 Benefit: 75% = $289.95 85% = $328.65

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61356

61356 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Red blood cell spleen or liver study (R)

Fee: $392.80 Benefit: 75% = $294.60 85% = $333.90

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61357

61357 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Aug-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Single stress myocardial perfusion study, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) at least one of the following applies:

(i) the patient has body habitus or other physical conditions (including heart rhythm disturbance) to the extent that a stress echocardiography would not provide adequate information;

(ii) the patient is unable to exercise to the extent required for a stress echocardiography to provide adequate information;

(iii) the patient has had a failed stress echocardiography provided in a service to which items 55141, 55143, 55145 or 55146 applies; and

(c) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(d) the service is requested by a medical practitioner (other than a specialist or consultant physician); and

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61332, 61345, 61377, 61380, 61394, 61398, 61406, 61414 or 61422 applies; and

(f) if the patient is 17 years or older—a service to which this item, or item 61311, 61324, 61329, 61332, 61345, 61377, 61380, 61394, 61398, 61406, or 61414, applies has not been provided to the patient in the previous 24 months (R)

 

 

 

Fee: $653.05 Benefit: 75% = $489.80 85% = $565.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61360

61360 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Hepatobiliary study, including morphine administration or pre-treatment with a cholagogue when performed (R)

Fee: $403.35 Benefit: 75% = $302.55 85% = $342.85

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61361

61361 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Hepatobiliary study with formal quantification following baseline imaging, using a cholagogue (R)

Fee: $461.40 Benefit: 75% = $346.05 85% = $392.20

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61364

61364 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Bowel haemorrhage study (R)

Fee: $496.95 Benefit: 75% = $372.75 85% = $422.45

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61365

61365 - Additional Information

Item Start Date:
01-Dec-2020
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Dec-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Repeat combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion, with PET, if:

(a) in the previous 24 months, the patient has had a service performed to which item 61311, 61324, 61329, 61332, 61345, 61357, 61377, 61380, 61394, 61398, 61406 or 61414 applies and has subsequently undergone a revascularisation procedure; and

(b) the patient has one or more symptoms of cardiac ischaemia that have evolved and are not adequately controlled with optimal medical therapy; and

(c) at least one of the following applies:

  1. the patient has body habitus or other physical conditions (including heart rhythm disturbance) to the extent that a stress echocardiography would not provide adequate information;
  2. the patient is unable to exercise to the extent required for a stress echocardiography to provide adequate information;
  3. the patient has had a failed stress echocardiography provided in a service to which item 55141, 55143, 55145 or 55146 applies; and

(d) the service is requested by a specialist or a consultant physician; and

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61349, 61410 or 61418 applies

Applicable not more than once in 12 months (R)

Item 61365 was available from 1 December 2020 until 28 February 2021, during a national shortage of technetium. See the Health Insurance (Section 3C Diagnostic Imaging - Nuclear Medicine Services) Determination 2019 on the Federal Register of Legislation for further information.

Fee: $982.05 Benefit: 75% = $736.55 85% = $894.15

(See para IN.0.19, IN.4.3 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61368

61368 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Meckel’s diverticulum study (R)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61372

61372 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Salivary study (R)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61373

61373 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Gastro-oesophageal reflux study, including delayed imaging on a separate occasion when performed (R)

Fee: $489.70 Benefit: 75% = $367.30 85% = $416.25

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61376

61376 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Oesophageal clearance study (R)

Fee: $143.35 Benefit: 75% = $107.55 85% = $121.85

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61377

61377 - Additional Information

Item Start Date:
01-Dec-2020
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Dec-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Single stress myocardial perfusion study, with PET, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) the service is provided at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(c) a stress echocardiography service is not available in the Modified Monash area where the service is provided; and

(d) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61332, 61345, 61357, 61380, 61394, 61398, 61406, 61414 or 61422 applies

Applicable not more than once in 24 months (R)

Item 61377 was available from 1 December 2020 until 28 February 2021, during a national shortage of technetium. See the Health Insurance (Section 3C Diagnostic Imaging - Nuclear Medicine Services) Determination 2019 on the Federal Register of Legislation for further information.

Fee: $653.05 Benefit: 75% = $489.80 85% = $565.15

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61380

61380 - Additional Information

Item Start Date:
01-Dec-2020
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Dec-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion, with PET, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) the service is provided at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(c) a stress echocardiography service is not available in the Modified Monash area where the services is provided; and

(d) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61332, 61345, 61357, 61377, 61394, 61398, 61406, 61414 or 61422 applies

Applicable not more than once in 24 months (R)

Item 61380 was available from 1 December 2020 until 28 February 2021, during a national shortage of technetium. See the Health Insurance (Section 3C Diagnostic Imaging - Nuclear Medicine Services) Determination 2019 on the Federal Register of Legislation for further information.

Fee: $982.05 Benefit: 75% = $736.55 85% = $894.15

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61381

61381 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Gastric emptying study, using single tracer (R)

Fee: $574.35 Benefit: 75% = $430.80 85% = $488.20

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61383

61383 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Combined solid and liquid gastric emptying study using dual isotope technique or the same isotope on separate days (R)

Fee: $624.95 Benefit: 75% = $468.75 85% = $537.05

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61384

61384 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Radionuclide colonic transit study (R)

Fee: $687.70 Benefit: 75% = $515.80 85% = $599.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61386

61386 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Renal study, including perfusion and renogram images and computer analysis or cortical study with planar imaging (R)

Fee: $332.50 Benefit: 75% = $249.40 85% = $282.65

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61387

61387 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Renal cortical study, with single photon emission tomography and planar quantification (R)

Fee: $430.75 Benefit: 75% = $323.10 85% = $366.15

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61389

61389 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Single renal study with pre-procedural administration of a diuretic or angiotensin converting enzyme (ACE) inhibitor (R)

Fee: $370.55 Benefit: 75% = $277.95 85% = $315.00

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61390

61390 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Renal study with diuretic administration after a baseline study (R)

Fee: $409.95 Benefit: 75% = $307.50 85% = $348.50

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61393

61393 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Combined examination involving a renal study following angiotensin converting enzyme (ACE) inhibitor provocation and a baseline study, in either order and related to a single referral episode (R)

Fee: $605.50 Benefit: 75% = $454.15 85% = $517.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61394

61394 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
15-Sep-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Single stress myocardial perfusion study, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) the service is provided at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(c) a stress echocardiography service is not available in the Modified Monash area where the service is provided; and

(d) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(e) the service is requested by a specialist or consultant physician; and

(f) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61332, 61345, 61357, 61377, 61380, 61398, 61406, 61414 or 61422 applies; and

(g) if the patient is 17 years or older—a service to which this item, or item 61311, 61324, 61329, 61332, 61345, 61357, 61377, 61380, 61398, 61406 or 61414, applies has not been provided to the patient in the previous 24 months (R)

 

 

Fee: $653.05 Benefit: 75% = $489.80 85% = $565.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61397

61397 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Cystoureterogram (R)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61398

61398 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
15-Sep-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) the service is provided at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(c) a stress echocardiography service is not available in the Modified Monash area where the services is provided; and

(d) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(e) the service is requested by a medical practitioner (other than a specialist or consultant physician); and

(f) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61332, 61345, 61357, 61377, 61380, 61394, 61406, 61414 or 61422 applies; and

(g) if the patient is 17 years or older—a service to which this item, or item 61311, 61321, 61324, 61325, 61329, 61332, 61345, 61357, 61377, 61380, 61394, 61406, 61414 or 61422, applies has not been provided to the patient in the previous 24 months (R)

 

 

Fee: $982.05 Benefit: 75% = $736.55 85% = $894.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61402

61402 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Cerebral perfusion study, with single photon emission tomography and with planar imaging when performed (R)

Fee: $605.05 Benefit: 75% = $453.80 85% = $517.15

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61406

61406 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
15-Sep-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) the service is provided at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(c) a stress echocardiography service is not available in the Modified Monash area where the service is provided; and

(d) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(e) the service is requested by a specialist or consultant physician; and

(f) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61332, 61377, 61345, 61357, 61380, 61394, 61398, 61414 or 61422 applies; and

(g) if the patient is 17 years or older—a service to which this item, or item 61311, 61321, 61324, 61325, 61329, 61332, 61345, 61357, 61377, 61380, 61394, 61398, 61414 or 61422, applies has not been provided to the patient in the previous 24 months (R)

 

 

Fee: $982.05 Benefit: 75% = $736.55 85% = $894.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61409

61409 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Cerebro spinal fluid transport study, with imaging on 2 or more separate occasions (R)

Fee: $873.50 Benefit: 75% = $655.15 85% = $785.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61410

61410 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
15-Sep-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Repeat combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion, with single photon emission tomography, with or without planar imaging, if:

(a) both:

(i) a service has been provided to the patient in the previous 24 months to which this item, or item 61311, 61324, 61329, 61332, 61345, 61349, 61357, 61365, 61377, 61380, 61394, 61398, 61406, 61414 or 61418, applies; and

(ii) the patient has subsequently undergone a revascularisation procedure; and

(b) the patient has one or more symptoms of cardiac ischaemia that have evolved and are not adequately controlled with optimal medical therapy; and

(c) the service is provided at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(d) a stress echocardiography service is not available in the Modified Monash area where the service is provided; and

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730 or 61418 applies; and

(f) if the patient is 17 years or older—a service to which item 61349, 61365 or 61418 applies has not been provided to the patient in the previous 12 months

 

 

Fee: $982.05 Benefit: 75% = $736.55 85% = $894.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61413

61413 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Cerebro spinal fluid shunt patency study (R)

Fee: $225.95 Benefit: 75% = $169.50 85% = $192.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61414

61414 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
15-Sep-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Single stress myocardial perfusion study, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) the service is provided at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(c) a stress echocardiography service is not available in the Modified Monash area where the service is provided; and

(d) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(e) the service is requested by a medical practitioner (other than a specialist or consultant physician); and

(f) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61332, 61345, 61357, 61377, 61380, 61394, 61398, 61406 or 61422 applies; and

(g) if the patient is 17 years or older—a service to which this item, or item 61311, 61324, 61329, 61332, 61345, 61357, 61377, 61380, 61398 or 61406, applies has not been provided to the patient in the previous 24 months (R)

 

 

Fee: $653.05 Benefit: 75% = $489.80 85% = $565.15

(See para IN.0.19, IN.4.3, IR.4.1 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61418

61418 - Additional Information

Item Start Date:
01-Dec-2020
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Dec-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.1

Repeat combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion, with PET, if:

(a) in the previous 24 months, the patient has had a service performed to which item 61311, 61324, 61329, 61332, 61345, 61357, 61377, 61380, 61394, 61398, 61406 or 61414 applies, and has subsequently undergone a revascularisation procedure; and

(b) the patient has one or more symptoms of cardiac ischaemia that have evolved and are not adequately controlled with optimal medical therapy; and

(c) the service is provided at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(d) a stress echocardiography service is not available in the Modified Monash area where the service is provided; and

(e) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(f) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61349, 61365 or 61410 applies

Applicable not more than once in 12 months (R)

Item 61418 was available from 1 December 2020 until 28 February 2021, during a national shortage of technetium. See the Health Insurance (Section 3C Diagnostic Imaging - Nuclear Medicine Services) Determination 2019 on the Federal Register of Legislation for further information.

Fee: $982.05 Benefit: 75% = $736.55 85% = $894.15

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61421

61421 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Bone study—whole body, with, when undertaken, blood flow, blood pool and delayed imaging on a separate occasion (R)

Fee: $479.80 Benefit: 75% = $359.85 85% = $407.85

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61422

61422 - Additional Information

Item Start Date:
01-Dec-2020
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Dec-2020

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.4.2

Single rest myocardial perfusion study for the assessment of the extent and severity of viable and non‑viable myocardium, with PET, if:

(a) the patient has left ventricular systolic dysfunction and probable or confirmed coronary artery disease; and

(b) technetium is not available and the service uses an equivalent protocol to the single rest technetium‑99m (Tc‑99m) protocol; and

(c) the service is requested by a specialist or a consultant physician; and

(d) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61332, 61345, 61357, 61377, 61380, 61394, 61398, 61406 or 61414 applies

Applicable not more than once in 24 months (R)

Item 61422 was available from 1 December 2020 until 28 February 2021, during a national shortage of technetium. See the Health Insurance (Section 3C Diagnostic Imaging - Nuclear Medicine Services) Determination 2019 on the Federal Register of Legislation for further information.

Fee: $329.00 Benefit: 75% = $246.75 85% = $279.65

(See para IN.0.19, IN.4.1, IR.4.2 of explanatory notes to this Category)

Category 5 - DIAGNOSTIC IMAGING SERVICES

61425

61425 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Bone study—whole body and single photon emission tomography, with, when undertaken, blood flow, blood pool and delayed imaging on a separate occasion (R)

Fee: $600.70 Benefit: 75% = $450.55 85% = $512.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61426

61426 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Whole body study using iodine (R)

Fee: $554.80 Benefit: 75% = $416.10 85% = $471.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61429

61429 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Whole body study using gallium (R)

Fee: $543.00 Benefit: 75% = $407.25 85% = $461.55

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61430

61430 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Whole body study using gallium, with single photon emission tomography (R)



Fee: $659.45 Benefit: 75% = $494.60 85% = $571.55

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61433

61433 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Whole body study using cells labelled with technetium (R)

Fee: $496.95 Benefit: 75% = $372.75 85% = $422.45

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61434

61434 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Whole body study using cells labelled with technetium, with single photon emission tomography (R)

Fee: $615.40 Benefit: 75% = $461.55 85% = $527.50

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61438

61438 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Whole body study using thallium (R)

Fee: $672.95 Benefit: 75% = $504.75 85% = $585.05

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61441

61441 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Bone marrow study—whole body using technetium labelled bone marrow agents (R)

Fee: $489.70 Benefit: 75% = $367.30 85% = $416.25

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61442

61442 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Whole body study, using gallium—with single photon emission tomography of 2 or more body regions acquired separately (R)

Fee: $752.35 Benefit: 75% = $564.30 85% = $664.45

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61445

61445 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Bone marrow study—localised using technetium labelled agent (R)

Fee: $286.80 Benefit: 75% = $215.10 85% = $243.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61446

61446 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Regional scintigraphic study, using an approved bone scanning agent, including when undertaken, blood flow imaging, blood pool imaging and repeat imaging on a separate occasion (R)

Fee: $333.55 Benefit: 75% = $250.20 85% = $283.55

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61449

61449 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Regional scintigraphic study, using an approved bone scanning agent and single photon emission tomography, including when undertaken, blood flow imaging, blood pool imaging and repeat imaging on a separate occasion (R)

Fee: $456.20 Benefit: 75% = $342.15 85% = $387.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61450

61450 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Localised study using gallium (R)

Fee: $397.55 Benefit: 75% = $298.20 85% = $337.95

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61453

61453 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Localised study using gallium, with single photon emission tomography (R)

Fee: $514.70 Benefit: 75% = $386.05 85% = $437.50

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61454

61454 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Localised study using cells labelled with technetium (R)

Fee: $348.10 Benefit: 75% = $261.10 85% = $295.90

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61457

61457 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Localised study using cells labelled with technetium, with single photon emission tomography (R)

Fee: $470.45 Benefit: 75% = $352.85 85% = $399.90

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61461

61461 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Localised study using thallium (R)

Fee: $527.85 Benefit: 75% = $395.90 85% = $448.70

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61462

61462 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-May-2007

Repeat planar and single photon emission tomography imaging, or repeat planar imaging or single photon emission tomography imaging on an occasion subsequent to the performance of item 61364, 61426, 61429, 61430, 61442, 61450, 61453, 61469 or 61485, if there is no additional administration of radiopharmaceutical and if the previous radionuclide scan was abnormal or equivocal (R)

 

 

 

 

Fee: $129.00 Benefit: 75% = $96.75 85% = $109.65

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61469

61469 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Lymphoscintigraphy (R)

Fee: $348.10 Benefit: 75% = $261.10 85% = $295.90

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61473

61473 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Thyroid study (R)

Fee: $175.40 Benefit: 75% = $131.55 85% = $149.10

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61480

61480 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Parathyroid study (R)

Fee: $386.85 Benefit: 75% = $290.15 85% = $328.85

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61485

61485 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Adrenal study, with single photon emission tomography (R)

Fee: $999.20 Benefit: 75% = $749.40 85% = $911.30

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61495

61495 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Tear duct study (R)

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

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61499

61499 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

Particle perfusion study (infra arterial) or Le Veen shunt study (R)

Fee: $253.00 Benefit: 75% = $189.75 85% = $215.05

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61650

61650 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Nov-2006

LeukoScan study of the long bones and feet for suspected osteomyelitis, if:
(a) the patient does not have access to ex vivo white blood cell scanning; and
(b) the patient is not being investigated for other sites of infection (R)

 

Fee: $878.70 Benefit: 75% = $659.05 85% = $790.80

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

61505

61505 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-May-2007

CT scan performed at the same time and covering the same body area as single photon emission tomography or positron emission tomography for the purpose of anatomic localisation or attenuation correction if no separate diagnostic CT report is issued and performed in association with a service to which an item in Subgroup 1 or 2 of Group I4 applies (R)

Fee: $100.00 Benefit: 75% = $75.00 85% = $85.00

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55238

55238 - Additional Information

Item Start Date:
01-Nov-1997
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the lower limb or of arteries and bypass grafts in the lower limb, below the inguinal ligament, not being a service associated with any of the following:
(a) a service to which an item in Subgroup 4 applies;
(b) a service to which item 55880, 55881, 55882, 55883, 55884, 55885, 55886, 55887, 55888, 55889, 55890, 55891, 55892, 55893, 55894 or 55895 applies (R)

Fee: $173.60 Benefit: 75% = $130.20 85% = $147.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55244

55244 - Additional Information

Item Start Date:
01-Nov-1997
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the lower limb, below the inguinal ligament, for acute venous thrombosis, not being a service associated with any of the following:
(a) a service to which item 55246 applies;
(b) a service to which an item in Subgroup 4 applies;
(c) a service to which item 55880, 55881, 55882, 55883, 55884, 55885, 55886, 55887, 55888, 55889, 55890, 55891, 55892, 55893, 55894 or 55895 applies (R)

Fee: $173.60 Benefit: 75% = $130.20 85% = $147.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55246

55246 - Additional Information

Item Start Date:
01-Nov-1997
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the lower limb, below the inguinal ligament, for chronic venous disease, not being a service associated with any of the following:
(a) a service to which item 55244 applies;
(b) a service to which an item in Subgroup 4 applies;
(c) a service to which item 55880, 55881, 55882, 55883, 55884, 55885, 55886, 55887, 55888, 55889, 55890, 55891, 55892, 55893, 55894 or 55895 applies (R)

Fee: $173.60 Benefit: 75% = $130.20 85% = $147.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55248

55248 - Additional Information

Item Start Date:
01-Nov-1997
Description Updated:
01-Nov-2020
Schedule Fee Updated:
01-Jul-2021

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the upper limb or of arteries and bypass grafts in the upper limb, not being a service associated with a service to which an item in Subgroup 4 applies (R) 

Fee: $173.60 Benefit: 75% = $130.20 85% = $147.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55252

55252 - Additional Information

Item Start Date:
01-Nov-1997
Description Updated:
01-Nov-2020
Schedule Fee Updated:
01-Jul-2021

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the upper limb, not being a service associated with a service to which an item in Subgroup 4 applies (R).

Fee: $173.60 Benefit: 75% = $130.20 85% = $147.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55274

55274 - Additional Information

Item Start Date:
01-Nov-1997
Description Updated:
01-Nov-2020
Schedule Fee Updated:
01-Jul-2021

Duplex scanning, bilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of extra cranial bilateral carotid and vertebral vessels, with or without subclavian and innominate vessels, with or without oculoplethysmography or peri orbital Doppler examination, not being a service associated with a service to which an item in Subgroup 4 applies (R).

Fee: $173.60 Benefit: 75% = $130.20 85% = $147.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55276

55276 - Additional Information

Item Start Date:
01-Nov-1997
Description Updated:
01-Nov-2020
Schedule Fee Updated:
01-Jul-2021

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of intra‑abdominal, aorta and iliac arteries or inferior vena cava and iliac veins or of intra‑abdominal, aorta and iliac arteries and inferior vena cava and iliac veins, excluding pregnancy related studies, not being a service associated with a service to which an item in Subgroup 4 applies (R)

 

Fee: $173.60 Benefit: 75% = $130.20 85% = $147.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55278

55278 - Additional Information

Item Start Date:
01-Nov-1997
Description Updated:
01-Nov-2020
Schedule Fee Updated:
01-Jul-2021

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of renal or visceral vessels or of renal and visceral vessels, including aorta, inferior vena cava and iliac vessels as required excluding pregnancy related studies, not being a service associated with a service to which an item in Subgroup 4 applies (R)

Fee: $173.60 Benefit: 75% = $130.20 85% = $147.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55280

55280 - Additional Information

Item Start Date:
01-Nov-1997
Description Updated:
01-Nov-2020
Schedule Fee Updated:
01-Jul-2021

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of intra cranial vessels, not being a service associated with a service to which an item in Subgroup 4 applies (R)

Fee: $173.60 Benefit: 75% = $130.20 85% = $147.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55282

55282 - Additional Information

Item Start Date:
01-Nov-1997
Description Updated:
01-Nov-2020
Schedule Fee Updated:
01-Jul-2021

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements:
(a) by spectral analysis of cavernosal artery of the penis following intracavernosal administration of a vasoactive agent; and
(b) performed during the period of pharmacological activity of the injected agent, to confirm a diagnosis of vascular aetiology for impotence; and
(c) if a specialist in diagnostic radiology, nuclear medicine, urology, general surgery (sub specialising in vascular surgery) or a consultant physician in nuclear medicine attends the patient in person at the practice location where the service is performed, immediately before or for a period during the performance of the service; and
(d) if the specialist or consultant physician interprets the results and prepares a report, not being a service associated with a service to which an item in Subgroup 4 applies (R)

Fee: $173.60 Benefit: 75% = $130.20 85% = $147.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55284

55284 - Additional Information

Item Start Date:
01-Nov-1997
Description Updated:
01-Nov-2020
Schedule Fee Updated:
01-Jul-2021

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements:
(a) by spectral analysis of cavernosal tissue of the penis to confirm a diagnosis; and
(b) if indicated, assess the progress and management of:
(i) priapism; or
(ii) fibrosis of any type; or
(iii) fracture of the tunica; or
(iv) arteriovenous malformations; and
(c) if a specialist in diagnostic radiology, nuclear medicine, urology, general surgery (sub specialising in vascular surgery) or a consultant physician in nuclear medicine attends the patient in person at the practice location where the service is performed, immediately before or for a period during the performance of the service; and
(d) if the specialist or consultant physician interprets the results and prepares a report, not being a service associated with a service to which an item in Subgroup 4 applies (R)

Fee: $173.60 Benefit: 75% = $130.20 85% = $147.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55292

55292 - Additional Information

Item Start Date:
01-Nov-2001
Description Updated:
01-Nov-2020
Schedule Fee Updated:
01-Jul-2021

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of surgically created arteriovenous fistula or surgically created arteriovenous access grafts in the upper or lower limbs, not being a service associated with 
a service to which an item in Subgroup 4 applies (R)

Fee: $173.60 Benefit: 75% = $130.20 85% = $147.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55294

55294 - Additional Information

Item Start Date:
01-Nov-2001
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or veins, or both, including any associated skin marking, for mapping of bypass conduit before vascular surgery, not being a service associated with any of the following:
(a) a service to which an item in Subgroup 3 or 4 applies;
(b) a service to which item 55880, 55881, 55882, 55883, 55884, 55885, 55886, 55887, 55888, 55889, 55890, 55891, 55892, 55893, 55894 or 55895 applies (R)

Fee: $173.60 Benefit: 75% = $130.20 85% = $147.60

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

55296

55296 - Additional Information

Item Start Date:
01-Nov-2001
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow spectral analysis and marking of veins in the lower limbs below the inguinal ligament before varicose vein surgery, including any associated skin marking, not being a service associated with any of the following:
(a) a service to which an item in Subgroup 3 or 4 applies;
(b) a service to which item 55880, 55881, 55882, 55883, 55884, 55885, 55886, 55887, 55888, 55889, 55890, 55891, 55892, 55893, 55894 or 55895 applies (R)

Fee: $113.70 Benefit: 75% = $85.30 85% = $96.65

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63301

63301 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004

MRI—scan of musculoskeletal system for tumour arising in bone or musculoskeletal system, excluding tumours arising in breast, prostate or rectum (R) (Anaes.) (Contrast)

(Anaes.)

Fee: $380.80 Benefit: 75% = $285.60 85% = $323.70

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

Category 5 - DIAGNOSTIC IMAGING SERVICES

63304

63304 - Additional Information

Item Start Date:
01-Aug-2004
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Aug-2004