Medicare Benefits Schedule - Item 55757

Search Results for Item 55757

View Associated Notes

Category 5 - DIAGNOSTIC IMAGING SERVICES

55757

55757 - Additional Information

Item Start Date:
01-Nov-2022
Description Updated:
01-Jan-2024
Schedule Fee Updated:
01-Jul-2024

Group
I1 - Ultrasound
Subgroup
5 - Obstetric And Gynaecological

Pelvis or abdomen, ultrasound (the current ultrasound) scan of, for cervical length assessment for risk of preterm labour, by any or all approaches, if:

(a) the dating of the pregnancy (as confirmed by the current ultrasound) is between 14 and 30 weeks of gestation; and

(b) any of the following apply:

(i) the patient has a history indicating high risk of preterm labour or birth or second trimester fetal loss;

(ii) the patient has symptoms suggestive of threatened preterm labour or second trimester fetal loss;

(iii) the patient’s cervical length is less than 25 mm on an ultrasound before 28 weeks gestation; and

(c) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in another item in this Subgroup (R)

 

Bulk bill incentive

Fee: $55.55 Benefit: 75% = $41.70 85% = $47.25

(See para IN.0.13, IN.0.19 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $31.90


Associated Notes

Category 5 - DIAGNOSTIC IMAGING SERVICES

IN.0.13

Ultrasound

Professional supervision for ultrasound services - R-type eligible services

Ultrasound services (items 55028 to 55895) marked with the symbol (R), except items 55600 and 55603, are not eligible for a Medicare rebate unless the diagnostic imaging procedure is performed under the professional supervision of a:

(a) specialist or a consultant physician in the practice of his or her specialty who is available to monitor and influence the conduct and diagnostic quality of the examination, and if necessary to personally attend the patient; or

(b) practitioner who is not a specialist or consultant physician, and who is available to monitor and influence the conduct and diagnostic quality of the examination and, if necessary, to personally attend the patient, and meets either of the following requirements:

(i) Between 1 September 1997 and 31 August 1999, at least 50 services were rendered by or on behalf of the practitioner at the location where the service was rendered and the rendering of those services entitled the payment of Medicare benefits.

(ii) Between 1 September 1997 and 31 August 1999, at least 50 services were rendered by or on behalf of the practitioner in nursing homes or patients' residences and the rendering of those services entitled payment of Medicare benefits.

If paragraph (a) or (b) cannot be complied with, ultrasound services are eligible for a Medicare rebate:

  • in an emergency; or
  • in a location that is not less than 30 kilometres by the most direct road route from another practice where services that comply with paragraph (a) or (b) are available.

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

The rules regarding items 55600 and 55603 are set out under the heading ‘Subgroup 4: Urological ultrasound – Items 55600 and 55603’.

Sonographer accreditation

Sonographers performing medical ultrasound examinations (either R or NR type items) on behalf of a medical practitioner must be suitably qualified, involved in a relevant and appropriate Continuing Professional Development program and be Registered on the Register of Accredited Sonographers held by Services Australia.

Eligibility for registration

To be eligible for registration on the Register of Accredited Sonographers held by Services Australia, the person must be accredited with the Australian Sonographer Accreditation Registry. For accreditation with the Australian Sonographer Accreditation Registry the person must hold an accredited postgraduate qualification in medical ultrasound or be studying ultrasound.

For further information, please contact Services Australia, Provider Liaison Section, on 132 150 for the cost of a local call or the Australian Sonographer Accreditation Registry through its website at www.asar.com.au

Report requirements  

The sonographer's initial and surname are to be written on the report. They are not required on billing documents or on the copy of the report given to the patient.

Benefits payable

In most instances, a benefit is payable once only for ultrasonic examination at the one attendance, irrespective of the areas involved.

Attendance means that there is a clear separation between one service and the next. For example, where there is a short time between one ultrasound and the next, benefits will be payable for one service only. As a guide, Services Australia will look to a separation of three hours between services and this must be stated on accounts issued for more than one service on the one day. 

Where more than one ultrasound service is rendered on the same occasion and the service relates to a non-contiguous body area, and they are "clinically relevant", (i.e. the service is generally accepted in the medical profession as being necessary for the appropriate treatment or management of the patient to whom it is rendered), benefits greater than the single rate may be payable.  Accounts should be marked "non-contiguous body areas". 

Benefits for two contiguous areas may be payable where it is generally accepted that there are different preparation requirements for the patient and a clear difference in set-up time and scanning. Accounts should be endorsed "contiguous body area with different set-up requirements".

Subgroup 1: General Ultrasound

Abdominal Ultrasound Items 55036 and 55037

Medicare benefits are not payable for ultrasound items 55036 and 55037 unless a morphological assessment of the abdomen has been performed. That is, the items should be used for imaging purposes, not for non-imaging procedures such as transient elastography.

Urinary ultrasound Items 55084 and 55085

When a post-void residual is the only service clinically indicated and/or rendered, it is inappropriate to report a pelvic, urinary or abdominal ultrasound, instead of or in addition to this service (55084 or 55085).Similarly, if a complete pelvic, urinary or abdominal ultrasound is billed, it is inappropriate to bill separately for a post-void residual determination, since payment of this has already been included in the payment for the complete scans.

The report must contain an entry denoting the post-void residual amount and/or bladder capacity as calculated/estimated from the ultrasound device. In addition, the medical record must contain documentation of the indication for the service and the number of times performed to ensure an empty bladder has been reached.

Subgroup 2: Transoesophageal echocardiography

This subgroup now only contains transoesophageal echocardiography - items 55118, 55130 and 55135. Transthoracic and stress echocardiography are now in subgroup 7, the notes for which are covered in notes IN.1.3 to IN.1.10. and IR.0.1 to IR.1.3.

Subgroup 3: Vascular Ultrasound

General

Medicare benefits are only payable for:

  • a maximum of two vascular ultrasound studies in a seven-day period. A vascular ultrasound study may include one or more items. Additionally, where a patient is referred for a bilateral study of both arms or both legs, the account should indicate 'bilateral' or 'left' and 'right' to enable a benefit to be paid.
     
  • clinically relevant services, that is, the service is generally accepted in the medical profession as being necessary for the appropriate treatment or management of the patient to whom it is rendered. Any decision to have a patient return on a different day to complete a multi-area diagnostic imaging service should only be made based on clinical necessity.
     

Deep vein thrombosis (DVT) – Items 55244 and 55246

Medical practitioners referring patients for duplex ultrasound for suspected lower limb DVT (items 55244 and 55246) should read and consider the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCR) 2015 Choosing Wisely recommendations or RANZCR Choosing Wisely recommendations that succeed it.

Examination of peripheral vessels

Vascular ultrasound services can be claimed in conjunction with item 11612 (Exercise study for the evaluation of lower extremity arterial disease).

Subgroup 4: Urological ultrasound - Items 55600 and 55603

Benefits for these items are payable where the service is rendered in the following circumstances:

  • a digital rectal examination of the prostate was personally performed by the medical practitioner who also personally rendered the ultrasound service; and
     
  • the transducer probe or probes used can obtain both axial and sagittal scans in 2 planes at right angles; and
     
  • the patient was assessed prior to the service by a medical practitioner recognised in one or more of the specialties specified, not more than 60 days prior to the ultrasound service. Item 55600 applies where the service is rendered by a medical practitioner who did not assess the patient, whereas item 55603 applies where the service was rendered by a medical practitioner who did assess the patient.
     

Subgroup 5: Obstetric and Gynaecological ultrasound  

NR Services

Except for item 55758, Medicare benefits are not payable for more than three NR-type ultrasound services in Subgroup 5 of Group I1 (ultrasound) that are performed on the same patient in any one pregnancy.

Pre-requisite services

A patient must have previously had either a 55706 or 55709 ultrasound in the same pregnancy to be eligible to claim for either a 55712 or 55715 obstetric service. To be eligible to claim for either a 55721 or 55725 obstetric service, a patient must have previously had either a 55718 or 55723 ultrasound in the same pregnancy. 

Frequency of services

Medicare benefits are only payable once per item per pregnancy for items 55706, 55707, 55708, 55709, 55718, 55723, 55742, 55743, 55759, 55762, 55768 and 55770.

Dating of pregnancy

When dating a pregnancy for the purpose of items 55700 to 55774, a patient is:

  • "less than 12 weeks of gestation" means up to 11 weeks and 6 days of pregnancy; 
  • "12 to 16 weeks of gestation" means from 12 weeks 0 days of pregnancy up to 16 weeks plus 6 days of pregnancy (inclusive);
  • "17 to 22 weeks of gestation" means from 17 weeks 0 days of pregnancy up to 22 weeks plus 6 days of pregnancy (inclusive);
  • "after 22 weeks of gestation" means from 23 weeks 0 days of pregnancy onwards;
  • "after 24 weeks of gestation" means from 25 weeks 0 days of pregnancy onwards;

  • "between 14 and 30 weeks of gestation” means from 14 weeks 0 days of pregnancy to 30 weeks plus 6 days of pregnancy (inclusive); and
  • “before 28 weeks gestation” means up to 27 weeks plus 6 days of pregnancy (inclusive).

Singleton pregnancies

Obstetric ultrasound items 55700 to 55725 (except for items 55736 and 55739 which are performed pre-pregnancy) cover scanning of a patient who is experiencing a singleton pregnancy, with the items including requested and non-requested services. Item 55729 covers both single and multiple pregnancies.

Except for items 55700 (R) and 55703 (NR) all singleton items restrict the claiming of cervical length items 55757 and 55758 within 24 hours. Items 55700 and 55703 advise that the ultrasound service cannot be performed on the same patient within 24 hours of a service mentioned in item 55704, 55705, 55707, 55708, 55740, 55741, 55742 or 55743. This accords with clinical practice guidelines which do not recommend repeat scanning at intervals less than 24 hours.

For all other singleton items, the ultrasound cannot be performed on the same patient within 24 hours of a service mentioned in another item in Subgroup 5 of Group I1. The most appropriate item to be claimed should be chosen based on clinical need, with each ultrasound scan representing a completed medical service.

Nuchal Translucency Testing

A nuchal translucency measurement ultrasound is performed to assess the patient’s risk of fetal abnormality when the pregnancy is dated by a crown rump length of 45 to 84mm. If a nuchal translucency measurement is performed for a singleton pregnancy, items 55707 (R) or 55708 (NR) should be claimed. If a nuchal translucency measurement is performed for a multiple pregnancy, items 55742 (R) or 55743 (NR) should be claimed.

The nuchal translucency measurement ultrasound service should not be performed on the same patient within 24 hours of a service mentioned in another item in Subgroup 5 of Group I1. If nuchal translucency measurement for risk of foetal abnormality is performed (items 55707, 55708, 55742 or 55743) within 24 hours of any other additional items in Subgroup 5 of Group I1, only one fee is payable. It is the treating practitioner’s responsibility to consider the clinical circumstances of any services rendered and to determine the appropriate MBS item(s) to claim, if any.

The RANZCR provides a credentialling program for providers of nuchal translucency scans.

Cervical length items 55757 and 55758

Items 55757 (R) and 55758 (NR) are to assess the cervical length of the patient to determine risk of preterm labour and can be claimed for any pregnancy. These items cannot be co-claimed within 24 hours of another item in Subgroup 5 of Group I1. There are no clinical grounds for repeat scanning within 24 hours.

Multiple pregnancies

Obstetric ultrasound items 55740 to 55774 (except for items 55757 and 55758) cover scanning of a patient who is experiencing a multiple pregnancy. Based on the recommendations of the profession, the items apply only to patients where a multiple pregnancy has been confirmed by ultrasound. The items include identical restrictions and provisions as the second and third trimester items (55706-55725) and include items for requested and non-requested services. Due to the ongoing risks and complications associated with multiple pregnancies regardless of pregnancy outcomes, any pregnancy identified as multiple at the commencement of the second trimester (13+0 weeks) should continue to utilise the multiple pregnancy items for the duration of that pregnancy.

With the exception of items 55740 (R) and 55741 (NR), the multiple pregnancy items cannot be co-claimed within 24 hours of cervical length items 55757 (R) or 55758 (NR). Items 55740 and 55741 cannot be co-claimed within 24 hours of another item in Subgroup 5 of Group I1. There are no clinical grounds for repeat scanning within 24 hours.

Obstetric and gynaecological services—Requests and clinical notes

For R-type obstetric and gynaecological ultrasound services, the request form must state the relevant condition or clinical indication for the service.

For NR type obstetric and gynaecological ultrasound services, the clinical notes of the services must state the relevant condition or clinical indication for the service.

Obstetric ultrasound and non-metropolitan providers (items 55712, 55721, 55764 and 55772)

In addition to the requirement that the request form and clinical notes must state the relevant condition or clinical indication for the service, where a practitioner has obstetric privileges at a non-metropolitan hospital and requests items 55712, 55721, 55764 and 55772, the practitioner must confirm his/her eligibility by stating 'non-metropolitan obstetric privileges' on the request form.

In relation to items 55712, 55721, 55764 and 55772, a non-metropolitan area includes any location outside of the Sydney, Melbourne, Brisbane, Adelaide, Perth, Greater Hobart, Darwin or Canberra major statistical divisions, as defined in the Australian Standard Geographical Classification 2010 published by the Australian Bureau of Statistics.

Subgroup 6:  Musculoskeletal (MSK)

Multiple Musculoskeletal Ultrasound Scans

Generally, Medicare benefits are payable for more than one musculoskeletal ultrasound scan performed on the same day, however the scans are subject to Rule A of the general diagnostic imaging multiple services rules. 

It is not permitted to split a bilateral scan.  Where bilateral ultrasound scans are performed, the relevant item should be itemised once only on accounts and receipts or Medicare bulk billing forms.  For example, if both shoulders are scanned, item 55866 or 55867, as the case may be, should be claimed once only.  This is because the item descriptor for these items covers both sides.  A patient should not be asked to make a second appointment in order to attract a benefit for multiple scans. 

Shoulder and knee (items 55864 to 55867 and 55880 to 55883)

Benefits for shoulder and knee ultrasound items are only payable when the request is based on the clinical indicators outlined in the item descriptions.  Benefits are not payable when referred for non-specific shoulder or knee pain alone or other specific conditions such as meniscal and cruciate ligament tears and assessment of chondral surfaces.

Items in association with a surgical procedure (55848 and 55850)

Item 55848 is a musculoskeletal (MSK) ultrasound service for use in association with a surgical procedure, such as a joint injection. 

Item 55850 is a musculoskeletal ultrasound service for use in association with a surgical procedure, such as a joint injection, which is inclusive of a diagnostic ultrasound.  This item cannot be claimed if diagnostic ultrasound was not conducted during the examination.

Subgroup 7 - Transthoracic and stress echocardiography 

The notes for these items are shown in notes IN.1.3 to IN.1.10. and IR.0.1 to IR.1.3.

Related Items: 55700 55703 55704 55705 55740 55741 55742 55743 55757 55758

Category 5 - DIAGNOSTIC IMAGING SERVICES

IN.0.19

Bulk Billing Incentive

Out-of-hospital services attract higher benefits when they are bulk billed by the provider.

For all diagnostic imaging items (except those in Group 6 – Management of Bulk Billed Services and items 61369, 61466, 61485) benefits for bulk billed services are payable at 95% of the schedule fee 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 55740 55741 55742 55743 55757 55758 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 56553 56620 56622 56623 56626 56627 56628 56629 56630 56801 56807 57001 57007 57201 57341 57352 57353 57354 57357 57360 57362 57364 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 61313 61314 61321 61324 61325 61328 61329 61340 61345 61348 61349 61353 61356 61357 61360 61361 61364 61368 61372 61373 61376 61381 61383 61384 61386 61387 61389 61390 61393 61394 61397 61398 61402 61406 61409 61410 61413 61414 61421 61425 61426 61429 61430 61433 61434 61438 61441 61442 61445 61446 61449 61450 61453 61454 61457 61461 61462 61469 61473 61480 61495 61499 61505 61523 61524 61525 61529 61541 61553 61559 61563 61564 61565 61612 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 63549 63560 63563 64990 64991


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