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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 - Additional Information
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: $476.00 Benefit: 75% = $357.00 85% = $404.60
(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