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Determinations/Health as made
This Determination ensures that patients in Gippsland and South Eastern NSW continue to have access to Medicare-eligible MRI services for a 20 month transition period following the conclusion of a three year trial of mobile MRI services.
Administered by: Health
Made 28 Oct 2009
Registered 30 Oct 2009
Tabled HR 16 Nov 2009
Tabled Senate 16 Nov 2009
Date of repeal 01 Nov 2012
Repealed by Health Insurance (Gippsland and South Eastern New South Wales Mobile MRI Service and Rockhampton, Bundaberg and Gladstone Mobile MRI Service) Determination 2012

 

 

Health Insurance (Gippsland and South Eastern New South Wales Mobile MRI Service) Determination 2009

__________________________________________________________________

I, ANTONY KINGDON Delegate of the Minister for Health and Ageing, make this Determination in accordance with the powers vested in the Minister under subsection 3C (1) of the Health Insurance Act 1973.

Dated        28 October 2009   



_     Antony Kingdon               ______                        __

DELEGATE OF THE MINISTER FOR HEALTH AND AGEING

 

 

 

 

 

 

 


Contents

 

1.           Name of Determination                                                                             3

2.           Commencement                                                                                      3

3.           Cessation                                                                                               3

4.           Interpretation                                                                                           3

5.           Circumstances where this Determination applies                                        4

5A.          Bulk billing incentive                                                                               6

6.           Treatment of a relevant service                                                                  6

7.           MRI and MRA services – meaning of scan                                                 6

8.           MRI and MRA services – related services that can be claimed in a 12 month period     6

9.           MRI services – limit for items 63472 and 63475                                          7

10.          MRI services – limit for item 63478                                                            7

11.          MRI and MRA services – modifying items                                                  7

12.          Diagnostic imaging services which dental practitioners may request             8

Schedule -     Specified health services                                                              9

 

 


1.                      Name of Determination

This Determination is the Health Insurance (Gippsland and South Eastern New South Wales Mobile MRI Service) Determination 2009.

2.                      Commencement

This Determination commences on 1 November 2009. 

3.                      Cessation

This Determination ceases to have effect at 23:59, 30 June 2011.

4.                      Interpretation

(1)        In this Determination, unless the contrary intention appears:

Act means the Health Insurance Act 1973.

after hours means from 5pm on Mondays, Tuesdays, Wednesdays and Thursdays to 9am on the following day, and from 5pm on Fridays to 9am on Mondays.

Bega means Bega, New South Wales, 2250.

eligible provider means a specialist in diagnostic radiology who has satisfied the Medicare Australia CEO that he or she is a participant in the Royal Australian and New Zealand College of Radiologists’ Quality and Accreditation Program.

funding agreement means the agreement between the Department of Health and Ageing and Regional Imaging Pty Limited [ABN 81 095 630 792] as in force on the day this Determination commences.

item means an item in the Schedule.

MRA means magnetic resonance angiography.

MRI means magnetic resonance imaging.

relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in the Schedule.

Schedule means the Schedule to this Determination.

teleradiology means the electronic transmission of radiological images in digital form from one location to another using a data communication link provided by a third party carrier.

transition period means the period beginning on 1 November 2009 and ending at 23.59, 30 June 2011.

Traralgon means Traralgon, Victoria, 3844.

 

Note          Unless the contrary intention appears, expressions used in this Determination have the same meanings as in the Act—see section 13 of the Legislative Instruments Act 2003.

 

 

(2)        For the avoidance of doubt, in this Determination:

(a)                    a reference to the Act includes a reference to regulations made under the Act; and

(b)                    a reference to the National Health Act 1953 includes a reference to regulations made under that Act; and

(c)                    a reference to any legislation shall be construed as a reference to that legislation as in force from time to time; and

(d)                    a reference to the Health Insurance (Diagnostic Imaging Services Table) Regulations 2009 is a reference to such regulations made pursuant to section 4AA of the Act as are in force from time to time.

5.                      Circumstances where this Determination applies

(1)        This Determination applies to a relevant service where the following circumstances apply:

(a)                    in respect of items 63002 to 63483, where the service is performed pursuant to a request that is in accordance with subsection (2); and

(b)                    where the service is performed pursuant to the funding agreement during the transition period; and

(c)                    where the service is performed in a permissible circumstance in accordance with subsection (3), (4), (5), (6), (7) or (8); and

(d)                    where the service is a service of a kind referred to in paragraph 10(2)(a) of the Act – the patient in respect of whom the service is provided is charged a fee that is no more than 75% of the amount specified in the Schedule as the fee applicable to the item that relates to the service; and

(e)                    where the service is not a service to which paragraph (d) applies – the patient in respect of whom the service is provided is charged a fee that is no more than 85% of the amount specified in the Schedule as the fee applicable to the item that relates to the service.

(2)        The request referred to in paragraph (1)(a) must:

(a)                    be made by a practitioner who is a specialist, consultant physician or dental practitioner; and

(b)                    be made in writing; and

(c)                    identify the clinical indications for the service.

 

Note:          Subsection 16B(2) of the Act limits the R-type diagnostic imaging services in respect of which a medicare benefit is payable where the service is requested by a dental practitioner.  See section 12 below.

(3)        For paragraph (1)(c), subject to subsection (4), a relevant service is performed in a permissible circumstance if the service is performed in Bega and it is:

(a)                    performed under the professional supervision of an eligible provider who is available to monitor and influence the conduct and diagnostic quality of the examination via telephone and real-time teleradiology; and

(b)                    reported by an eligible provider; and

(c)                    monitored by a medical practitioner by personal attendance on the patient if the circumstances are such as to require on-site monitoring by a medical practitioner.

(4)        If subsection (3) is not complied with, a relevant service is performed in a permissible circumstance if the service is performed in Bega and it is performed in an emergency.

(5)        For paragraph (1)(c), subject to subsection (6), a relevant service is performed in a permissible circumstance if the service is performed in Traralgon during after hours and it is:

(a)                    performed under the professional supervision of an eligible provider who is available to monitor and influence the conduct and diagnostic quality of the examination via telephone and real-time teleradiology; and

(b)                    reported by an eligible provider; and

(c)                    monitored by a medical practitioner by personal attendance on the patient if the circumstances are such as to require on-site monitoring by a medical practitioner; and

(d)                    not a service to which items 63492 to 63495 are attributable.

(6)        If subsection (5) is not complied with, a relevant service is performed in a permissible circumstance if the service is performed in Traralgon during after hours and it is performed in an emergency.

(7)        For paragraph (1)(c), subject to subsection (8), a relevant service is performed in a permissible circumstance if it is:

(a)                    performed under the professional supervision of an eligible provider who is available to monitor and influence the conduct and diagnostic quality of the examination, including, if necessary, by personal attendance on the patient; and

(b)                    reported by an eligible provider.

(8)        If subsection (7) is not complied with, a relevant service is performed in a permissible circumstance if it is performed:

(a)                    in an emergency; or

(b)                    because of medical necessity, in a remote location.

5A.        Bulk billing incentive

     (1)    This rule applies if:

               (a)         a service that is mentioned in an item in the Schedule is provided; and

               (b)         the service is not provided in a hospital; and

               (c)         the service is bulk billed.

      (2)     The fee for the service is 95% of the fee mentioned in the Schedule for the service.

      (3)     For subsection 10(2) of the Act, the benefit payable is the amount calculated under subrule (2).

                Note  Under  regulation 6EF of the Health Insurance Regulations 1975, the medicare benefit payable is 100% of the amount calculated under subrule (2).

6.                      Treatment of a relevant service

A relevant service shall be treated as if:

(a)                    it were both a professional service and a medical service for the purposes of the provisions of the Act and the National Health Act 1953 that relate to professional and medical services; and

(b)                    there was an item in the diagnostic imaging services table that related to the relevant service and specified in respect of the service a fee in relation to a State, being the fee specified in the Schedule in relation to the State specified; and

(c)                    the item specified in paragraph (b) was part of Group I5 of the diagnostic imaging services table and of the relevant subgroup of Group I5 as is specified in the Schedule.

7.                      MRI and MRA services – meaning of scan

Rule 37 of Part 2 of Schedule 1 of the Health Insurance (Diagnostic Imaging Services Table) Regulations 2009 shall have effect as if the reference to “items 63001 to 63482” in that rule was a reference to “items 63002 to 63483” of the Schedule.

8.                      MRI and MRA services – related services that can be claimed in a 12 month period

Rule 39 of Part 2 of Schedule 1 of the Health Insurance (Diagnostic Imaging Services Table) Regulations 2009 shall have effect as if the references to the items mentioned in column 1 of the table below (Existing references) include references to the items mentioned in column 2 of the following table (Additional references).


 

Existing references

Additional references

63040 to 63073

63041 to 63065

63101

63102

63125 to 63131

63126 to 63132

63161 to 63185

63163 to 63177

63219 to 63243

63220 to 63244

63271 to 63280

63272 to 63281

63322 to 63340

63323 to 63332

63361

63363

63385 to 63391

63386 to 63389

63401 and 63404

63402 and 63405

63416

63417

63425 and 63428

63426 and 63429

63461, 63464 and 63467

63463, 63466 and 63469

63482

63483

9.                      MRI services – limit for items 63472 and 63475

Rule 40 of Part 2 of Schedule 1 of the Health Insurance (Diagnostic Imaging Services Table) Regulations 2009 shall have effect as if:

(a)                    the reference to item 63473 in subrule 40(1) was a reference to “item 63472, 63473 or 63475”;

(b)                    the reference to item 63470 in subrule 40(2) was a reference to “item 63470, 63472 or 63475”;

(c)                    there is an additional subrule 40(3) as follows “Item 63472 does not apply to the service described in that item if the person to whom the service is provided has previously been provided with that service or a service described in items 63470, 63473 or 63475”; and

(d)                    there is an additional subrule 40(4) as follows “Item 63475 does not apply to the service described in that item if the person to whom the service is provided has previously been provided with that service or a service described in item 63470, 63472 or 63473”.

10.                  MRI services – limit for item 63478

Item 63478 does not apply to the service described in that item if the person to whom the service is provided has previously been provided with that service or a service described in item 63476 of Part 3 of Schedule 1 of  the Health Insurance (Diagnostic Imaging Services Table) Regulations 2009.

11.                  MRI and MRA services – modifying items

Rule 41 of Part 2 of Schedule 1 of the Health Insurance (Diagnostic Imaging Services Table) Regulations 2009 shall have effect as if:

(a)                    the reference to item 63491 in that rule was a reference to item 63492; and

(b)                    the references to item 63494 in that rule were references to item 63493; and

(c)                    the references to item 63497 in that rule were references to item 63495.

12.                  Diagnostic imaging services which dental practitioners may request

Regulation 10 of the Health Insurance Regulations 1975 shall have effect as if the paragraphs of that regulation mentioned in column 1 of the table below (Existing references) include references to the items mentioned in column 2 of the table below (Additional references).

 

Existing references

Additional references

paragraph 10(1)(a)

63008, 63329

paragraph 10(1)(b)

63329

paragraph 10(1)(c)

63329

paragraph 10(1)(d)

63008, 63329

Schedule -        Specified health services

 

Item

Health Service

Fee for all States

Relevant subgroup of Group I5

63002

MRI — scan of head (including MRA, if performed) for

tumour of the brain or meninges (R) (Anaes.) (Contrast)

403.20

Subgroup 1 – Scan of head – for specified conditions

63005

MRI — scan of head (including MRA, if performed) for

inflammation of brain or meninges (R) (Anaes.) (Contrast)

403.20

Subgroup 1 – Scan of head – for specified conditions

63008

MRI — scan of head (including MRA, if performed) for

skull base or orbital tumour (R) (Anaes.) (Contrast)

403.20

Subgroup 1 – Scan of head – for specified conditions

63011

MRI — scan of head (including MRA, if performed) for

stereotactic scan of brain, with fiducials in place, for the

sole purpose of allowing planning for stereotactic

neurosurgery (R) (Anaes.) (Contrast)

336.00

Subgroup 1 – Scan of head – for specified conditions

63041

MRI — scan of head (including MRA, if performed) for

acoustic neuroma (R) (Anaes.) (Contrast)

336.00

Subgroup 2 – Scan of head – for specified conditions

63042

MRI — scan of head (including MRA, if performed) for

pituitary tumour (R) (Anaes.) (Contrast)

358.40

Subgroup 2 – Scan of head – for specified conditions

63044

MRI — scan of head (including MRA, if performed) for

toxic or metabolic or ischaemic encephalopathy (R)

(Anaes.) (Contrast)

403.20

Subgroup 2 – Scan of head – for specified conditions

63045

MRI — scan of head (including MRA, if performed) for

demyelinating disease of the brain (R) (Anaes.) (Contrast)

403.20

Subgroup 2 – Scan of head – for specified conditions

63047

MRI — scan of head (including MRA, if performed) for

congenital malformation of the brain or meninges (R)

(Anaes.) (Contrast)

403.20

Subgroup 2 – Scan of head – for specified conditions

63048

MRI — scan of head (including MRA, if performed) for

venous sinus thrombosis (R) (Anaes.) (Contrast)

403.20

Subgroup 2 – Scan of head – for specified conditions

63051

MRI — scan of head (including MRA, if performed) for

head trauma (R) (Anaes.) (Contrast)

403.20

Subgroup 2 – Scan of head – for specified conditions

63054

MRI — scan of head (including MRA, if performed) for

epilepsy (R) (Anaes.) (Contrast)

403.20

Subgroup 2 – Scan of head – for specified conditions

63057

MRI — scan of head (including MRA, if performed) for

stroke (R) (Anaes.) (Contrast)

403.20

Subgroup 2 – Scan of head – for specified conditions

63060

MRI — scan of head (including MRA, if performed) for

carotid or vertebral artery dissection (R) (Anaes.)

(Contrast)

403.20

Subgroup 2 – Scan of head – for specified conditions

63063

MRI — scan of head (including MRA, if performed) for

intracranial aneurysm (R) (Anaes.) (Contrast)

403.20

Subgroup 2 – Scan of head – for specified conditions


63065

MRI — scan of head (including MRA, if performed) for

intracranial arteriovenous malformation (R) (Anaes.)

(Contrast)

403.20

Subgroup 2 – Scan of head – for specified conditions

63102

MRI and MRA of extracranial or intracranial circulation

(or both) — scan of head and neck vessels for stroke (R) (Anaes.) (Contrast)

492.80

Subgroup 3 – Scan of head and neck vessels – for specified conditions

63113

MRI — scan of head and cervical spine (including MRA, if performed) for tumour of the central nervous system or meninges (R) (Anaes.) (Contrast)

492.80

Subgroup 4 – Scan of head and cervical spine – for specified conditions

63116

MRI — scan of head and cervical spine (including MRA, if performed) for inflammation of the central nervous system or meninges (R) (Anaes.) (Contrast)

492.80

Subgroup 4 – Scan of head and cervical spine – for specified conditions

63126

MRI — scan of head and cervical spine (including MRA, if performed) for demyelinating disease of the central nervous system (R) (Anaes.) (Contrast)

492.80

Subgroup 5 – Scan of head and cervical spine – for specified conditions

63129

MRI — scan of head and cervical spine (including MRA, if performed) for congenital malformation of the central nervous system or meninges (R) (Anaes.) (Contrast)

492.80

Subgroup 5 – Scan of head and cervical spine – for specified conditions

63132

MRI — scan of head and cervical spine (including MRA, if performed) for syrinx (congenital or acquired) (R) (Anaes.) (Contrast)

492.80

Subgroup 5 – Scan of head and cervical spine – for specified conditions

63152

MRI — scan of 1 region or 2 contiguous regions of the

spine for infection (R) (Anaes.) (Contrast)

358.40

Subgroup 6 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions

63155

MRI — scan of 1 region or 2 contiguous regions of the

spine for tumour (R) (Anaes.) (Contrast)

358.40

Subgroup 6 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions

63163

MRI — scan of 1 region or 2 contiguous regions of the

spine for demyelinating disease (R) (Anaes.) (Contrast)

358.40

Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions

63165

MRI — scan of 1 region or 2 contiguous regions of the

spine for congenital malformation of the spinal cord or the cauda equina or the meninges (R) (Anaes.) (Contrast)

358.40

Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions

63168

MRI — scan of 1 region or 2 contiguous regions of the

spine for myelopathy (R) (Anaes.) (Contrast)

358.40

Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions

63169

MRI — scan of 1 region or 2 contiguous regions of the

spine for syrinx (congenital or acquired) (R) (Anaes.)

(Contrast)

358.40

Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions

63171

MRI — scan of 1 region or 2 contiguous regions of the

spine for cervical radiculopathy (R) (Anaes.) (Contrast)

358.40

Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions

63172

MRI — scan of 1 region or 2 contiguous regions of the

spine for sciatica (R) (Anaes.) (Contrast)

358.40

Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions

63174

MRI — scan of 1 region or 2 contiguous regions of the

spine for spinal canal stenosis (R) (Anaes.) (Contrast)

358.40

Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions

63175

MRI — scan of 1 region or 2 contiguous regions of the

spine for previous spinal surgery (R) (Anaes.) (Contrast)

358.40

Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions

63177

MRI — scan of 1 region or 2 contiguous regions of the

spine for trauma (R) (Anaes.)

358.40

Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions

63202

MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for infection (R) (Anaes.) (Contrast)

448.00

Subgroup 8 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions

63205

MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for tumour (R) (Anaes.) (Contrast)

448.00

Subgroup 8 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions

63220

MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for demyelinating disease (R) (Anaes.) (Contrast)

448.00

Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions

63223

MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for congenital malformation of the spinal cord or the cauda equina or the meninges (R) (Anaes.) (Contrast)

448.00

Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions

63224

MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for myelopathy (R) (Anaes.) (Contrast)

448.00

Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions


63226

MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for syrinx (congenital or acquired) (R) (Anaes.) (Contrast)

448.00

Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions

63227

MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for cervical radiculopathy (R) (Anaes.) (Contrast)

448.00

Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions

63229

MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for sciatica (R) (Anaes.) (Contrast)

448.00

Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions

63230

MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for spinal canal stenosis (R) (Anaes.) (Contrast)

448.00

Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions

63232

MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for previous spinal surgery (R) (Anaes.) (Contrast)

448.00

Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions

63244

MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for trauma (R) (Anaes.)

448.00

Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions

63272

MRI — Scan of cervical spine and brachial plexus for

tumour (R) (Anaes.) (Contrast)

492.80

Subgroup 10 – Scan of cervical spine and brachial plexus – for specified conditions

63275

MRI — Scan of cervical spine and brachial plexus for

trauma (R) (Anaes.) (Contrast)

492.80

Subgroup 10 – Scan of cervical spine and brachial plexus – for specified conditions

63278

MRI — Scan of cervical spine and brachial plexus for

cervical radiculopathy (R) (Anaes.) (Contrast)

492.80

Subgroup 10 – Scan of cervical spine and brachial plexus – for specified conditions

63281

MRI — Scan of cervical spine and brachial plexus for

previous surgery (R) (Anaes.) (Contrast)

492.80

Subgroup 10 – Scan of cervical spine and brachial plexus – for specified conditions

63302

MRI — scan of musculoskeletal system for tumour arising in bone or musculoskeletal system, excluding tumours arising in breast, prostate or rectum (R) (Anaes.) (Contrast)

380.80

Subgroup 11 – Scan of musculoskeletal system – for specified conditions


63305

MRI — scan of musculoskeletal system for infection

arising in bone or musculoskeletal system, excluding

infection arising in breast, prostate or rectum (R) (Anaes.) (Contrast)

380.80

Subgroup 11 – Scan of musculoskeletal system – for specified conditions

63308

MRI — scan of musculoskeletal system for osteonecrosis (R) (Anaes.) (Contrast)

380.80

Subgroup 11 – Scan of musculoskeletal system – for specified conditions

63323

MRI — scan of musculoskeletal system for derangement of hip or its supporting structures (R) (Anaes.) (Contrast)

403.20

Subgroup 12 – Scan of musculoskeletal system – for specified conditions

63324

MRI — scan of musculoskeletal system for derangement of shoulder or its supporting structures (R) (Anaes.) (Contrast)

403.20

Subgroup 12 – Scan of musculoskeletal system – for specified conditions

63326

MRI — scan of musculoskeletal system for derangement of knee or its supporting structures (R) (Anaes.) (Contrast)

403.20

Subgroup 12 – Scan of musculoskeletal system – for specified conditions

63327

MRI — scan of musculoskeletal system for derangement of ankle or foot (or both) or its supporting structures (R) (Anaes.) (Contrast)

403.20

Subgroup 12 – Scan of musculoskeletal system – for specified conditions

63329

MRI — scan of musculoskeletal system for derangement of 1 or both temporomandibular joints or their supporting structures (R) (Anaes.) (Contrast)

336.00

Subgroup 12 – Scan of musculoskeletal system – for specified conditions

63330

MRI — scan of musculoskeletal system for derangement of wrist or hand (or both) or its supporting structures (R) (Anaes.) (Contrast)

448.00

Subgroup 12 – Scan of musculoskeletal system – for specified conditions

63332

MRI — scan of musculoskeletal system for derangement of elbow or its supporting structures (R) (Anaes.) (Contrast)

403.20

Subgroup 12 – Scan of musculoskeletal system – for specified conditions

63363

MRI — scan of musculoskeletal system for Gaucher

disease (R) (Anaes.)

403.20

Subgroup 13 – Scan of musculoskeletal system – for specified conditions

63386

MRI — scan of cardiovascular system for congenital

disease of the heart or a great vessel (R) (Anaes.)

(Contrast)

448.00

Subgroup 14 – Scan of cardiovascular system – for specified conditions

63387

MRI — scan of cardiovascular system for tumour of the

heart or a great vessel (R) (Anaes.) (Contrast)

448.00

Subgroup 14 – Scan of cardiovascular system – for specified conditions

63389

MRI — scan of cardiovascular system for abnormality of thoracic aorta (R) (Anaes.) (Contrast)

403.20

Subgroup 14 – Scan of cardiovascular system – for specified conditions

63402

MRA — if the request for the scan specifically identifies the clinical indication for the scan — scan of

cardiovascular system for vascular abnormality in a patient with a previous anaphylactic reaction to an iodinated contrast medium (R) (Anaes.) (Contrast)

403.20

Subgroup 15 – Magnetic resonance angiography – scan of cardiovascular system – for specified conditions

63405

MRA — if the request for the scan specifically identifies the clinical indication for the scan — scan of

cardiovascular system for obstruction of the superior vena cava, inferior vena cava or a major pelvic vein (R)

(Anaes.) (Contrast)

403.20

Subgroup 15 – Magnetic resonance angiography – scan of cardiovascular system – for specified conditions

63417

MRA — scan of person under the age of 16 for the

vasculature of limbs prior to limb or digit transfer surgery in congenital limb deficiency syndrome (R) (Anaes.) (Contrast)

403.20

Subgroup 16 – Magnetic resonance angiography – for specified conditions – person under the age of 16 years

63426

MRI — scan of person under the age of 16 for

post-inflammatory or post-traumatic physeal fusion (R)

(Anaes.)

403.20

Subgroup 17 – Magnetic resonance imaging – for specified conditions – person under the age of 16 years

63429

MRI — scan of person under the age of 16 for Gaucher

disease (R) (Anaes.)

403.20

Subgroup 17 – Magnetic resonance imaging – for specified conditions – person under the age of 16 years

63441

MRI — scan of person under the age of 16 for pelvic or

abdominal mass (R) (Anaes.) (Contrast)

403.20

Subgroup 18 – Magnetic resonance imaging – for specified conditions – person under the age of 16 years

63442

MRI — scan of person under the age of 16 for mediastinal mass (R) (Anaes.) (Contrast)

403.20

Subgroup 18 – Magnetic resonance imaging – for specified conditions – person under the age of 16 years

63444

MRI — scan of person under the age of 16 for congenital uterine or anorectal abnormality (R) (Anaes.) (Contrast)

403.20

Subgroup 18 – Magnetic resonance imaging – for specified conditions – person under the age of 16 years

63463

MRI — scan of the body for adrenal mass in a patient with a malignancy that is otherwise resectable (R) (Anaes.)

358.40

Subgroup 19 – Scan of body – for specified conditions

63466

MRI – scan of both breasts for the detection of cancer, if a dedicated breast coil is used, the request for the scan identifies that the woman is asymptomatic and is less than 50 years of age, and the request for the scan identifies:

 

(a)     that the patient is at high risk of      developing breast cancer due to 1 of the following:

 

(i)         3 or more first or second degree relatives on the same side of the family diagnosed with breast or ovarian cancer;

 

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

                                                         

            (A)    has been diagnosed with bilateral breast cancer:

    (B)    had onset of breast cancer before the age of 40 years;

    (C)    had onset of ovarian cancer     before the age of 50 years;

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

(E)    has Ashkenazi Jewish ancestry;

(F)    is a male relative who has had breast cancer;

 

(iii)        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

 

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

 

 (R) (Anaes)

690.00

Subgroup 19 – Scan of body – for specified conditions

63469

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

(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 or 63466 performed in the previous 12 months

 (R) (Anaes)

 

690.00

Subgroup 19 – Scan of body – for specified conditions

63472

MRI — scan of the pelvis for the staging of histologically diagnosed cervical cancer at FIGO stages 1B or greater, if the request for scan identifies that:

(a)    a histological diagnosis of carcinoma of the cervix         has been made; and

  (b)    the patient has been diagnosed with cervical

  cancer at FIGO stage 1B or greater.

(R) (Anaes.) (Contrast)

403.20

Subgroup 20 – Scan of pelvis and upper abdomen – for specified conditions

63475

MRI — scan of the pelvis and upper abdomen, in a single examination, for the staging of histologically diagnosed cervical cancer at FIGO stage 1B or greater, if the request for scan identifies that:

(a)    a histological diagnosis of carcinoma of the cervix  has been made; and

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

(R)  (Anaes.) (Contrast)

627.20

Subgroup 20 – Scan of pelvis and upper abdomen – for specified conditions

63478

 MRI — scan of the pelvis for the initial staging of rectal cancer, if:

 (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). 

(R) (Anaes.) (Contrast)

403.20

Subgroup 20 – Scan of pelvis and upper abdomen – for specified conditions

63483

MRI — scan of pancreas and biliary tree for suspected

biliary or pancreatic pathology (R) (Anaes.)

403.20

Subgroup 21 – Scan of body – for specified conditions

63492

MRI or MRA service to which an item in this Group

(other than an item in this Subgroup) applies if:

(a) the item for the service includes in its description

‘(Contrast)’; and

(b) the service is performed using a contrast agent

44.80

Subgroup 22 – Modifying items

63493

MRI or MRA service to which an item in this Group

(other than an item in this Subgroup) applies if

the service is performed on a person using

intravenous or intra muscular sedation

44.80

Subgroup 22 – Modifying items

63495

MRI or MRA service to which an item in this Group

(other than an item in this Subgroup) applies if

the service is performed on a person under

anaesthetic in the presence of a medical practitioner

who is qualified to perform an anaesthetic

156.80

Subgroup 22 – Modifying items

 

Note          Section 3C (7) of the Act deems an internal Territory to form part of the State of New South Wales.