Medicare Benefits Schedule - Note AN.2.1

Consultations rendered by specialist radiologists

Medicare benefits are not payable for items 52, 53, 54, 57, 151, 104 and 105 when claimed by a specialist radiologist in association with any of the following diagnostic imaging items:

(a) an item in Subgroup 6 of Group I1;
(b) an item in any of Subgroups 1 to 7 of Group I3;
(c) items 58900 and 58903 in Subgroup 8 of Group I3; and
(d) item 59103 in Subgroup 9 of Group I3.

Consultations rendered in association with magnetic resonance imaging (MRI) services - Group I5

Medicare benefits are not payable for items 52, 53, 54, 57, 151, 104 and 105 in association with MRI services unless the providing practitioner determines that the consultation is necessary for the treatment or management of the patient's condition. 

The restrictions above apply when these services are performed by the same practitioner, on the same patient, on the same day.

Related Items: 52 53 54 57 104 105 151

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Professional attendance at consulting rooms or hospital by a specialist in the practice of the specialist's specialty after referral of the patient to the specialist-each attendance, other than a second or subsequent attendance, in a single course of treatment, other than a service to which item 106, 109 or 16401 applies

Fee: $98.95 Benefit: 75% = $74.25 85% = $84.15

(See para AN.0.7, AN.0.25, AN.2.1, AN.40.1, TN.1.4 of explanatory notes to this Category)

Professional attendance by a specialist in the practice of the specialist's specialty following referral of the patient to the specialist-an attendance after the first in a single course of treatment, if that attendance is at consulting rooms or hospital, other than a service to which item 16404 applies

Fee: $49.75 Benefit: 75% = $37.35 85% = $42.30

(See para AN.0.7, AN.0.25, AN.0.70, AN.2.1, AN.3.1, AN.40.1, TN.1.4 of explanatory notes to this Category)

Professional attendance at consulting rooms of not more than 5 minutes in duration (other than a service to which any other item applies)-each attendance, by:

(a) a medical practitioner (who is not a general practitioner); or

(b) a Group A1 disqualified general practitioner, as defined in the dictionary of the General Medical Services Table (GMST).

Fee: $11.00 Benefit: 100% = $11.00

(See para AN.0.9, AN.2.1, AN.7.2, MN.1.3, MN.1.4, MN.1.5, MN.1.6, MN.1.7, MN.1.8 of explanatory notes to this Category)

Professional attendance at consulting rooms of more than 5 minutes in duration but not more than 25 minutes (other than a service to which any other item applies)-each attendance, by:

(a) a medical practitioner (who is not a general practitioner); or

(b) a Group A1 disqualified general practitioner, as defined in the dictionary of the General Medical Services Table (GMST).

Fee: $21.00 Benefit: 100% = $21.00

(See para AN.0.9, AN.2.1, AN.7.2, MN.1.3, MN.1.4, MN.1.5, MN.1.6, MN.1.7, MN.1.8 of explanatory notes to this Category)

Professional attendance at consulting rooms of more than 25 minutes in duration but not more than 45 minutes (other than a service to which any other item applies)-each attendance, by:

(a) a medical practitioner (who is not a general practitioner); or

(b) a Group A1 disqualified general practitioner, as defined in the dictionary of the General Medical Services Table (GMST).

Fee: $38.00 Benefit: 100% = $38.00

(See para AN.0.9, AN.2.1, AN.7.2, MN.1.3, MN.1.4, MN.1.5, MN.1.6, MN.1.7, MN.1.8 of explanatory notes to this Category)

Professional attendance at consulting rooms lasting more than 45 minutes, but not more than 60 minutes (other than a service to which any other item applies) by:
(a) a medical practitioner who is not a general practitioner; or
(b) a Group A1 disqualified general practitioner

Fee: $61.00 Benefit: 100% = $61.00

(See para AN.0.9, AN.2.1, AN.7.2, MN.1.3, MN.1.4, MN.1.5, MN.1.6, MN.1.7, MN.1.8 of explanatory notes to this Category)

Professional attendance at consulting rooms lasting more than 60 minutes (other than a service to which any other item applies) by:
(a) a medical practitioner who is not a general practitioner; or
(b) a Group A1 disqualified general practitioner

Fee: $98.40 Benefit: 100% = $98.40

(See para AN.0.9, AN.2.1, AN.7.2, MN.1.3, MN.1.4, MN.1.5, MN.1.6, MN.1.7, MN.1.8 of explanatory notes to this Category)