Medicare Benefits Schedule - Note IN.5.1

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Category 5 - DIAGNOSTIC IMAGING SERVICES

IN.5.1

Item 63541 - meaning of clause 2.5.9

Clause 2.5.9 mentioned in item 63541 is a clause in Schedule 1 of the DIST.  The clause covers the patient categories to which the items apply. 

In summary, the clause means that before the item applies: 

  • for a person 70 years or older, at least two PSA tests performed within an interval of 1- 3 months have a PSA concentration of greater than 5.5 µg/L and the free/total PSA ratio is less than 25%.
  • for a person under 70 years, at least two prostate specific antigen (PSA) tests performed within an interval of 1- 3 months have PSA concentration of greater than 3.0 ng/ml, and the free/total PSA ratio is less than 25%, or the repeat PSA exceeds 5.5 µg/L; or
  • for a person under 70 years with a relevant family history, at least two PSA tests performed within an interval of 1- 3 months have a PSA concentration greater than 2.0 ng/ml, and the free/total PSA  ratio is less than 25%, or the repeat PSA exceeds 5.5 µg/L. Relevant family history is a first degree relative with or has had prostate cancer, or suspected of carrying a BRCA 1 or BRCA 2 mutation.

Benefits for this item are payable once only in a 12 month period.

Related Items: 63541


Related Items

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)


Legend

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