Medical Practitioners:

Head

63001

tumour of the brain or meninges

unlimited

63004

inflammation of the brain or meninges

unlimited

63007

skull base or orbital tumour

unlimited

63010

stereotactic scan of brain, with Fiducials in place, for planning for stereotactic neurosurgery

unlimited

63040

acoustic neuroma

3 per year

63043

pituitary tumour

3 per year

63046

toxic or metabolic or ischaemic encephalopathy

3 per year

63049

demyelinating disease of the brain

3 per year

63052

congenital malformation of the brain or meninges

3 per year

63055

venous sinus thrombosis

3 per year

63058

head trauma

3 per year

63061

epilepsy

3 per year

63064

stroke

3 per year

63067

carotid or vertebral artery dissection

3 per year

63070

intracranial aneurysm

3 per year

63073

intracranial arteriovenous malformation

3 per year

Head and neck vessels

63101

stroke

3 per year

Head and cervical spine

63111

tumour of the central nervous system or meninges

3 per year

63114

inflammation of the central nervous system or meninges

3 per year

63125

demyelinating disease of the central nervous system

3 per year

63128

congenital malformation of the central nervous system or meninges

3 per year

63131

syrinx (congenital or acquired)

3 per year

Spine – one region or two contiguous regions

63151

infection

unlimited

63154

tumour

unlimited

63161

demyelinating disease

3 per year

63164

congenital malformation of the spinal cord or the cauda equina or the meninges

3 per year

63167

myelopathy

3 per year

63170

syrinx (congenital or acquired)

3 per year

63173

cervical radiculopathy

3 per year

63176

sciatica

3 per year

63179

spinal canal stenosis

3 per year

63182

previous spinal surgery

3 per year

63185

trauma

3 per year

Spine – three contiguous regions or two non-contiguous regions

63201

infection

unlimited

63204

tumour

unlimited

63219

demyelinating disease

3 per year

63222

congenital malformation of the spinal cord or the cauda equina or the meninges

3 per year

63225

myelopathy

3 per year

63228

syrinx (congenital or acquired)

3 per year

63231

cervical radiculopathy

3 per year

63234

sciatica

3 per year

63237

spinal canal stenosis

3 per year

63240

previous spinal surgery

3 per year

63243

trauma

3 per year

Cervical spine and brachial plexus

63271

tumour

3 per year

63274

trauma

3 per year

63277

cervical radiculopathy

3 per year

63280

previous surgery

3 per year

Musculoskeletal (MSK) System

63301

tumour arising in bone or MSK system excludes tumour arising in breast, prostate or rectum

unlimited

63304

infection arising in bone or MSK system excludes tumour arising in breast, prostate or rectum

unlimited

63307

osteonecrosis

unlimited

63322

derangement of hip or its supporting structures*

3 per year

63325

derangement of shoulder or its supporting structures*

3 per year

63328

derangement of knee or its supporting structures*

3 per year

63331

derangement of ankle and/or foot or its supporting structures*

3 per year

63334

derangement of one or both temporomandibular joints or their supporting structures

3 per year

63337

derangement of wrist and/or hand or its supporting structures*

3 per year

63340

derangement of elbow or its supporting structures*

3 per year

63361

Gaucher disease

3 per year

Cardiovascular System

63385

congenital disease of the heart or a great vessel

2 per year

63388

tumour of the heart or a great vessel

2 per year

63391

abnormality of thoracic aorta

2 per year

63395

MRI scan of the cardiovascular system for assessment of myocardial structure and function involving:

a.     dedicated right ventricular views; and

b.     3D volumetric assessment of the right ventricle;and

c.     reporting of end‑diastolic and end‑systolic volumes, ejection fraction and BSA‑indexed values;

if the request for the scan indicates that:

1.     the patient presented with symptoms consistent with arrhythmogenic right ventricular cardiomyopathy (ARVC); or

2.     investigative findings in relation to the patient are consistent with ARVC

1 per year

63397

MRI scan of the cardiovascular system for assessment of myocardial structure and function involving:

a.     dedicated right ventricular views; and

b.     3D volumetric assessment of the right ventricle; and

c.     reporting of end‑diastolic and end‑systolic volumes, ejection fraction and BSA‑indexed values;).

if the request for the scan indicates that the patient:

1.     is asymptomatic; and

2.     has one or more first degree relatives diagnosed with confirmed arrhythmogenic right ventricular cardiomyopathy (ARVC)

1 every 3 years

Cardiovascular System MRA

63401

vascular abnormality with a previous anaphylactic reaction to an iodinated contrast medium

3 per year

63404

obstruction of the superior vena cava, inferior vena cava or a major pelvic vein

3 per year

Paediatric (<16yrs) MRA

63416

the vasculature of limbs prior to limb or digit transfer surgery in congenital limb deficiency syndrome

1 per year

Paediatric (<16)

63425

post-inflammatory or post-traumatic physeal fusion

2 per year

63428

Gaucher disease

2 per year

63440

pelvic or abdominal mass

unlimited

63444

mediastinal mass

unlimited

63447

congenital uterine or anorectal abnormality

unlimited

Body Scan

63461

adrenal mass in a patient with malignancy which is otherwise resecetable

1 per year

Body Scan – both breasts

63464

scan of both breast for the detection of cancer where;

a.     a dedicated breast coil is used; and

b.     the request for scan identifies that the woman is asymptomatic and <50 years of age; and

c.     the request for scan identifies either:

I.         that the patient is at high risk of developing breast cancer, due to 1 of the following:

A.   3 or more first or second degree relatives on the same side of the family diagnosed with breast or ovarian cancer;

B.    2 or more first or second degree relatives on the same of the family diagnosed with breast or ovarian cancer, if any of the following applies to at least 1 of the relatives:

§  has been diagnosed with bilateral breast cancer;

§  had onset of breast cancer before the age of 40 years;

§  had onset of ovarian cancer before the age of 50 years;

§  has been diagnosed with breast and ovarian cancer, at the same time or at different times;

§  has Ashkenazi Jewish ancestry;

§  is a male relative who has been diagnosed with breast cancer;

C.    1 first or second degree relative diagnosed with breast cancer at age 45 years or younger, plus another first or second degree relative on the same side of the family with bone or soft tissue sarcoma at age 45 years or younger; or

II.         that genetic testing has identified the presence of a high risk breast cancer gene mutation.

1 per year

Body Scan – both breasts

63467

scan of both breast for the detection of cancer – where;

a.     a dedicated breast coil is used; and

b.     the woman has had an abnormality detected as a result of a service described in item 63464 performed in the previous 12 months

1 per year

Body Scan – one or both breast

63487

MRI — performed under the professional supervision of an eligible provider at an eligible location, if:

a.     the patient is referred by a specialist or a consultant physician; and

b.     a dedicated breast coil is used; and

c.     the request for the scan identifies that:

I.         the patient has been diagnosed with metastatic cancer restricted to the regional lymph nodes; and

II.         clinical examination and conventional imaging have failed to identify the primary cancer (R) (K) (Anaes)

63489

MRI – guided biopsy, performed under the professional supervision of an eligible provider at an eligible location, if:

a.     the patient is referred by a specialist or a consultant physician; and

b.     a dedicated breast coil is used; and

c.     the request for the scan identifies that:

I.         the patient has a suspicious lesion seen on MRI but not on conventional imaging; and

II.         the lesion is not amenable to biopsy guided by conventional imaging; and

d.     a repeat ultrasound scan of the affected breast is performed:

I.         before the guided biopsy is performed; and

II.         as part of the service under this item (R) (K) (Anaes.)

63501

MRI – scan of one or both breasts for the evaluation of implant integrity where:

a.     a dedicated breast coil is used; and

b.     the request for the scan identifies that the patient:

I.         has or is suspected of having a silicone breast implant manufactured by Poly Implant Prosthese (PIP); and

II.         the result of the scan confirms a loss of integrity of the implant (R)

1 per year

63502

MRI – scan of one or both breasts for the evaluation of implant integrity where:

a.     a dedicated breast coil is used; and

b.     the request for the scan identifies that the patient:

i.         has or is suspected of having a silicone breast implant manufactured by Poly Implant Prosthese (PIP); and

ii.         the result of the scan does not demonstrate a loss of integrity of the implant (R)

1 per year

63504

MRI – scan of one or both breasts for the evaluation of implant integrity where:

a.     a dedicated breast coil is used; and

b.     the request for the scan identifies that the patient:

i.         has or is suspected of having a silicone breast implant manufactured by Poly Implant Prosthese (PIP); and

ii.         presents with symptoms where implant rupture is suspected; and

iii.         the result of the scan confirms a loss of integrity of the implant (R)

63505

MRI – scan of one or both breasts for the evaluation of implant integrity where:

a.     a dedicated breast coil is used; and

b.     the request for the scan identifies that the patient:

i.         has or is suspected of having a silicone breast implant manufactured by Poly Implant Prosthese (PIP); and

ii.         presents with symptoms where implant rupture is suspected; and

iii.         the result of the scan does not demonstrate a loss of integrity of the implant (R)

63547

MRI scan of both breasts for the detection of cancer, if

a.     a dedicated breast coil is used; and

b.     the request for the scan identifies that:

i.         the patient has a breast implant in situ; and

ii.         anaplastic large cell lymphoma has been diagnosed

1 in a lifetime

Pelvis and Upper Abdomen

63470

Pelvis for the staging of histologically diagnosed cervical cancer at FIGO stages 1B or greater when the request for scan identifies that

i.         a histological diagnosis of carcinoma of the cervix has been made and

ii.         the patient has been diagnosed with cervical cancer at FIGO stage 1B or greater

1 in a lifetime

63473

Pelvis and upper abdomen, in a single examination, for the staging of histologically diagnosed cervical cancer at FIGO stages 1B or greater

1 in a lifetime

63476

Pelvis for the initial staging of rectal cancer where

a.     a phased array body coil is used, and

b.     the request for scan identifies that the indication is for the initial staging of rectal cancer (including cancer of the rectosigmoid and anorectum).

1 in a lifetime

63740

MRI to evaluate small bowel Crohn’s disease. Medicare benefits are only payable for this item if the service is provided to patients:

a.     Evaluation of disease extent at time of initial diagnosis of Crohn’s disease

b.     Evaluation of exacerbation/suspected complications of known Crohn’s disease

c.     Evaluation of known or suspected Crohn’s disease in pregnancy

d.     Assessment of change to therapy in patients with small bowel Crohn’s disease

1 per year

63741

MRI enteroclysis for Crohn’s disease. Medicare benefits are only payable for this item if the service is related to item 63740

63743

MRI for fistulising perianal Crohn’s disease. Medicare benefits are only payable for this item if the service is provided to patients for:

·       Evaluation of pelvic sepsis and fistulas associated with established or suspected Crohn’s disease

·       Assessment of change to therapy of pelvic sepsis and fistulas from Crohn’s disease

Assessment of change to therapy can only be claimed once in a 12 month period.

1 per year

Body – pancreas and biliary tree MRCP

63482

suspected biliary or pancreatic pathology

3 per year

Prostate

63541

MRI of the prostate, where the patient is referred by an urologist, radiation oncologist or medical oncologist; and the request specifies that the clinical criteria below are met; and the patient is suspected of having prostate cancer based on;
1. A digital rectal examination (DRE) which is suspicious for prostate cancer; or
2. Aged < 70 years, at least 2x PSA tests performed within an interval of 1-3 months
> 3.0 ng/ml, and F/T PSA ratio is < 25% or the repeat PSA exceeds 5.5 ng/ml; or
3. Aged < 70 years, whose risk of developing prostate cancer based on family history is at least double the average risk (1st degree relative with prostate cancer or suspected of carrying BRCA 1, BRCA 2 mutation), at least 2 PSA tests performed within an interval of 1-3 months > 2.0 ng/ml, and the F/T PSA ratio is < 25%: or
4. Aged ≥ 70 years , at least 2 PSA tests performed within an interval of 1-3 months
> 5.5 ng/ml and the F/T PSA ratio is < 25%.

1 per year

63543

MRI of the prostate, where the patient is referred by an urologist, radiation oncologist or medical oncologist; and the request specifies that the clinical criteria below are met;

(a) the patient is under active surveillance following a confirmed diagnosis of prostate cancer by biopsy histopathology;
and
(b) the patient is not planning or undergoing treatment for prostate cancer.

NOTE: benefits are payable at the time of diagnosis of prostate cancer, 12 months following diagnosis and then every 3rd year thereafter or at any time, if there is any concern clinically or with PSA progression. This item is not to be used for the purpose of treatment planning or for the monitoring after treatment.

• unexplained seizure
• unexplained headache where significant pathology is suspected
• paranasal sinus pathology which has not responded to conservative therapy.

• significant trauma
• unexplained neck or back pain with associated neurological signs
• unexplained back pain where significant pathology is suspected

Must have x-ray first

• suspected septic arthritis
• suspected slipped capital femoral epiphysis
• suspected perthes disease

Must have x-ray first

• unexplained seizure
• unexplained chronic headache with suspected intracranial pathology

• cervical radiculopathy

• cervical spine trauma

• inability to extend the knee suggesting the possibility of acute meniscal tear or;
• clinical findings suggesting acute anterior cruciate ligament tear

*Patient must be under 50 years of age to qualify for rebate.

• hyperemesis gravidarum;
• diabetes mellitus;
• hypertension;
• toxaemia of pregnancy;
• liver or renal disease;
• autoimmune disease;
• cardiac disease;
• alloimmunisation;
• maternal infection;
• inflammatory bowel disease;
• bowel stoma;
• abdominal wall scarring;
• previous spinal or pelvic trauma or disease;
• drug dependency;
• thrombophilia;
• significant maternal obesity;
• advanced maternal age;
• abdominal pain or mass;
• uncertain dates;
• high risk pregnancy;
• previous post dates delivery;
• previous caesarean section;
• poor obstetric history;
• suspicion of ectopic pregnancy;
• risk of miscarriage;
• diminished symptoms of pregnancy;
• suspected or known cervical incompetence;
• suspected or known uterine abnormality;
• pregnancy after assisted reproduction;
• risk of fetal abnormality.

• hyperemesis gravidarum;
• diabetes mellitus;
• hypertension;
• toxaemia of pregnancy;
• liver or renal disease;
• autoimmune disease;
• cardiac disease;
• alloimmunisation;
• maternal infection;
• inflammatory bowel disease;
• bowel stoma;
• abdominal wall scarring;
• previous spinal or pelvic trauma or disease;
• drug dependency;
• thrombophilia;
• significant maternal obesity;
• advanced maternal age;
• abdominal pain or mass;
• uncertain dates;
• high risk pregnancy;
• previous post dates delivery;
• previous caesarean section;
• poor obstetric history;
• suspicion of ectopic pregnancy;
• risk of miscarriage;
• diminished symptoms of pregnancy;
• suspected or known cervical incompetence;
• suspected or known uterine abnormality;
• pregnancy after assisted reproduction;
• risk of fetal abnormality.

• hyperemesis gravidarum;
• diabetes mellitus;
• hypertension;
• toxaemia of pregnancy;
• liver or renal disease;
• autoimmune disease;
• cardiac disease;
• alloimmunisation;
• maternal infection;
• inflammatory bowel disease;
• bowel stoma;
• abdominal wall scarring;
• previous spinal or pelvic trauma or disease;
• drug dependency;
• thrombophilia;
• significant maternal obesity;
• advanced maternal age;
• abdominal pain or mass;
• uncertain dates;
• high risk pregnancy;
• previous post dates delivery;
• previous caesarean section;
• poor obstetric history;
• suspicion of ectopic pregnancy;
• risk of miscarriage;
• diminished symptoms of pregnancy;
• suspected or known cervical incompetence;
• suspected or known uterine abnormality;
• pregnancy after assisted reproduction;
• risk of fetal abnormality.

• the patient is referred by a medical practitioner; and
• the dating for the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and
• the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
• the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and
• the service is not performed in the same pregnancy as item 55709.

• the patient is referred by a medical practitioner who is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists or who has a Diploma of Obstetrics or has a qualification recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists as being equivalent to a Diploma of Obstetrics or has obstetric privileges at a non-metropolitan hospital; and
• the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and
• the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
• the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and
• further examination is clinically indicated in the same pregnancy to which item 55706 applies.

• the patient is referred by a medical practitioner; and
• the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and
• the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
• the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and
• the service is not performed in the same pregnancy as item 55723; and
• one or more of the following conditions are present:
  • known or suspected fetal abnormality or fetal cardiac arrhythmia;
  • fetal anatomy (late booking or incomplete mid-trimester scan);
  • malpresentation;
  • cervical assessment;
  • clinical suspicion of amniotic fluid abnormality;
  • clinical suspicion of placental or umbilical cord abnormality;
  • previous complicated delivery;
  • uterine scar assessment;
  • uterine fibroid;
  • previous fetal death in utero or neonatal death;
  • antepartum haemorrhage;
  • clinical suspicion of intrauterine growth retardation;
  • clinical suspicion of macrosomia;
  • reduced fetal movements;
  • suspected fetal death;
  • abnormal cardiotocography;
  • prolonged pregnancy;
  • premature labour;
  • fetal infection;
  • pregnancy after assisted reproduction;
  • trauma;
  • diabetes mellitus;
  • hypertension;
  • toxaemia of pregnancy;
  • liver or renal disease;
  • autoimmune disease;
  • cardiac disease;
  • alloimmunisation;
  • maternal infection;
  • inflammatory bowel disease;
  • bowel stoma;
  • abdominal wall scarring;
  • previous spinal or pelvic trauma or disease;
  • drug dependency;
  • thrombophilia;
  • significant maternal obesity;
  • advanced maternal age;
  • abdominal pain or mass.

• the patient is referred by a medical practitioner who is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists or who has a Diploma of Obstetrics or has qualifications recognised by the Royal Australian and New Zealand College of Obstericians and Gynaecologists as being equivalent to a Diploma of obstetrics or has obstetric privileges at a non-metropolitan hospital; and
• the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and
• the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
• the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and
• further examination is clinically indicated in the same pregnancy to which item 55718 applies.

• the patient is referred by a medical practitioner; and
• ultrasound of the same pregnancy confirms a multiple pregnancy; and
• the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks gestation; and
• the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
• the referring practitioner is not a member of a group of practitioners to which the providing practitioner is a member; and
• the service is not performed in conjunction with item 55706 or 55712 during the same pregnancy.

• the patient is referred by a medical practitioner who is a Member or Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists or who has a Diploma of Obstetrics or has a qualification recognised by the Royal Australian and New Zealand College of Obstericians and Gynaecologists as equivalent to a Diploma of obstetrics or has obstetric privileges at a non-metropolitan hospital; and
• ultrasound of the same pregnancy confirms a multiple pregnancy; and
• the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks gestation; and
• the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
• the referring practitioner is not a member of a group of practitioners to which the providing practitioner is a member; and
• further examination is clinically indicated in the same pregnancy to which item 55759 has been performed; and
• not performed in conjunction with item 55706 or 55712 during the same pregnancy.

• dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and
• the ultrasound confirms a multiple pregnancy; and
• the patient is referred by a medical practitioner; and
• the service is not performed in the same pregnancy as item 55770; and
• the service is not associated with a service to which an item in Subgroups 2 or 3 of this group applies; and
• the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and
• the service is not performed in conjunction with item 55718 or 55721 during the same pregnancy.

• dating of the pregnancy as confirmed by ultrasound is after 22 weeks of gestation; and
• the patient is referred by a medical practitioner who is a Member or Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists or who has a Diploma of Obstetrics or has a qualification recognised by the Royal Australian and New Zealand College of Obstericians and Gynaecologists as equivalent to a Diploma of obstetrics or has obstetric privileges at a non-metropolitan hospital; and
• further examination is clinically indicated in the same pregnancy to which item 55768 or 55770 has been performed; and
• the pregnancy as confirmed by ultrasound is a multiple pregnancy; and
• the service is not associated with a service to which an item in Subgroups 2 or 3 of this group applies; and
• the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and
• the service is not performed in conjunction with item 55718 or 55721 during the same pregnancy.

• evaluation of injury to tendon, muscle or muscle/tendon junction; or
• rotator cuff tear/calcification/tendinosis (biceps, subscapular, suspraspinatus, infraspinatus); or
• biceps subluxation; or
• capsulitis and bursitis; or
• evaluation of mass including ganglion; or
• occult fracture; or
• acromioclavicular joint pathology.

Benefits are not payable when referred for non-specific pain alone.

• abnormality of tendons or bursae about the knee; or
• meniscal cyst, popliteal fossa cyst, mass or pseudomass; or
• nerve entrapment, nerve or nerve sheath tumour; or
• injury of collateral ligaments.

Benefits are not payable when referred for non-specific pain alone and including meniscal or cruciate ligament tears and assessment of chondral surfaces.