Medicare Benefits Schedule - Note IN.3.1

Overview

MBS items 60506 and 60509 pertain to the use of fluoroscopy with a mobile image intensifier during surgical procedures.

Appropriate Usage

Duration of Fluoroscopy:

• Item 60506 should be used when the fluoroscopy service lasts less than one hour.
• Item 60509 should be used when the fluoroscopy service lasts one hour or more.
• The duration refers specifically to the time the fluoroscopy is in use, not the total duration of the surgical operation.
   

Service Association:

• Both items should not be claimed in conjunction with other services within the same Diagnostic Radiology group. This ensures that the fluoroscopy service is billed appropriately and avoids duplication of claims.

Eligible Providers:

• These items can be claimed by medical practitioners, provided they meet the necessary requirements for performing fluoroscopy during surgical procedures.
   

Hospital Treatment:

• These procedures must be performed or provided in a hospital, as a part of hospital treatment. Only the 75% benefit is applicable for these items, meaning that the patient will receive 75% of the scheduled fee as the benefit. This requirement ensures that the procedures are performed in a controlled and regulated hospital environment, which is essential for patient safety and accurate billing.
   

Consistency across Surgical Procedures:

• A surgical operation can involve one or more surgical procedures. It is important to note that where more than one surgical procedure is involved, not all surgical procedures may be relevant for the fluoroscopy. However, the requirement that these procedures must be part of hospital treatment and that only the 75% benefit is applicable should be consistent across all procedures used as part of the surgical operation. This ensures uniformity in billing and compliance with MBS guidelines.
   

Timing Clarifications

• Fluoroscopy Procedure: The timing for the fluoroscopy procedure refers to the actual duration of the fluoroscopy service. For item 60506, this duration should be less than one hour, while for item 60509, it should be one hour or more.
   
• Surgical Operation: This encompasses the entire duration of the surgery from start to finish. A surgical operation can involve one or more surgical procedures. The total duration of the surgical operation is not directly relevant to the selection of MBS items 60506 or 60509, which are based solely on the duration of the fluoroscopy service.

Related Items: 60506 60509

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Bulk bill incentive

Fluoroscopy, using a mobile image intensifier, that: 

(a)  lasts less than 1 hour; and

(b)  is in conjunction with a surgical procedure;

not being a service associated with a service to which another item in this Group applies (R) (H)

Fee: $73.20 Benefit: 75% = $54.90

(See para IN.3.1 of explanatory notes to this Category)

Bulk bill incentive

Fluoroscopy, using a mobile image intensifier, that:

(a) lasts 1 hour or more; and

(b) is in conjunction with a surgical procedure;

not being a service associated with a service to which another item in this Group applies (R) (H)

Fee: $113.55 Benefit: 75% = $85.20

(See para IN.3.1 of explanatory notes to this Category)