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SLI 2014 No. 148 Regulations as made
This regulation prescribes a new period of diagnostic imaging services beginning on 1 November 2014 in relation to the payment of Medicare benefits.
Administered by: Health
Made 16 Oct 2014
Registered 17 Oct 2014
Tabled HR 21 Oct 2014
Tabled Senate 28 Oct 2014
Date of repeal 01 Jul 2015
Repealed by Health Insurance (Diagnostic Imaging Services Table) Regulation 2015
Table of contents.

 

Health Insurance (Diagnostic Imaging Services Table) Regulation 2014

 

Select Legislative Instrument No. 148, 2014

I, General the Honourable Sir Peter Cosgrove AK MC (Ret’d), Governor‑General of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, make the following regulation.

Dated 16 October 2014

Peter Cosgrove

Governor‑General

By His Excellency’s Command

Peter Dutton

Minister for Health

 

  

  

  


Contents

1............ Name................................................................................................... 1

2............ Commencement................................................................................... 1

3............ Authority............................................................................................. 1

4............ Schedules............................................................................................ 2

5............ Diagnostic imaging services table....................................................... 2

6............ Dictionary........................................................................................... 2

Schedule 1—Diagnostic imaging services table                              3

Part 1—Preliminary                                                                                                             3

Division 1.1—Interpretation                                                                                     3

1.1.1...... References to diagnostic imaging services.......................................... 3

Division 1.2—General application provisions                                                 4

Subdivision A—Capital sensitivity                                                                        4

1.2.1...... Application of (K) items and (NK) items............................................ 4

1.2.2...... Age of equipment................................................................................ 4

1.2.3...... Exemptions from capital sensitivity..................................................... 6

1.2.4...... Reconsideration of exemption decisions............................................. 9

1.2.5...... Delegation........................................................................................... 9

Subdivision B—Other provisions                                                                         10

1.2.6...... Meaning of symbols (R) and (NR) in the table.................................. 10

1.2.7...... Who may provide a diagnostic imaging service................................ 10

1.2.8...... Report requirements for certain services........................................... 10

1.2.9...... Bulk‑billing incentive........................................................................ 11

1.2.10.... Bulk‑billing—magnetic resonance imaging....................................... 11

1.2.11.... Multiple services—vascular ultrasound............................................ 12

1.2.12.... Multiple services............................................................................... 12

Part 2—Services and fees                                                                                                15

Division 2.1—Group I1: ultrasound                                                                   15

Subdivision A—General                                                                                         15

2.1.1...... Ultrasound services—eligible services.............................................. 15

2.1.2...... Ultrasound services—R‑type eligible services.................................. 15

Subdivision B—Subgroups 1 to 4 of Group I1                                                  16

2.1.3...... Certain items taken to include referred by dental practitioner or referring dental practitioner    16

Subdivision C—Subgroup 5 of Group I1: obstetric and gynaecological   41

2.1.4...... Obstetric and gynaecological ultrasound services—limits................. 41

2.1.5...... Obstetric and gynaecological services—referrals and clinical notes.. 42

2.1.6...... Obstetric and gynaecological services—conditions........................... 42

Subdivision D—Subgroup 6 of Group I1: musculoskeletal ultrasound      68

2.1.7...... Musculoskeletal ultrasound services—personal attendance.............. 68

2.1.8...... Musculoskeletal ultrasound services—comparison ultra‑sonography 68

2.1.9...... Musculoskeletal ultrasound services—equipment............................. 68

Division 2.2—Group I2: computed tomography (examination)          84

2.2.1...... CT services—eligible services.......................................................... 84

2.2.2...... CT services—exclusion of attenuation correction and anatomical correlation           85

2.2.3...... CT services—exclusion of acoustic neuroma.................................... 85

2.2.4...... CT services—assessment of headache.............................................. 85

2.2.5...... CT services—number of services..................................................... 85

2.2.6...... Cone beam computed tomography—items 57362 and 57363........... 85

Division 2.3—Group I3: diagnostic radiology                                              99

Subdivision A—General                                                                                         99

2.3.1...... Who must perform diagnostic imaging procedure............................. 99

Subdivision B—Subgroups 1 to 9 of Group I3                                                  99

Subdivision C—Subgroup 10 of Group I3: radiographic examination of breasts        108

2.3.2...... Mammography services—eligible services..................................... 108

Subdivision D—Subgroups 11 to 14 of Group I3                                           110

Subdivision E—Subgroup 15 of Group I3: fluoroscopic examination    115

Subdivision F—Subgroup 16 of Group I3: preparation for radiological procedure   116

2.3.3...... Preparation of patients for radiological procedures......................... 116

Subdivision G—Subgroup 17 of Group I3: interventional techniques     116

2.3.4...... Meaning of angiography suite........................................................ 116

Division 2.4—Group I4: nuclear medicine imaging                                 118

2.4.1...... Nuclear scanning services—other than PET................................... 118

2.4.2...... PET nuclear scanning services........................................................ 118

2.4.3...... PET nuclear scanning services—performance under personal supervision              119

2.4.4...... PET nuclear scanning services—equipment.................................... 119

2.4.5...... PET nuclear scanning services—statutory declaration.................... 120

Division 2.5—Group I5: magnetic resonance imaging                           133

Subdivision A—General                                                                                       133

2.5.1...... MRI and MRA services—eligible services..................................... 133

2.5.2...... MRI and MRA services—request.................................................. 134

2.5.3...... MRI and MRA services—permissible circumstances for performance 134

2.5.4...... MRI and MRA services—eligible provider.................................... 134

2.5.5...... MRI and MRA services—eligible equipment................................. 134

2.5.6...... MRI and MRA services—partial eligible equipment...................... 135

2.5.7...... MRI and MRA services—meaning of scan.................................... 135

2.5.8...... MRI and MRA services—multiple services................................... 135

2.5.9...... MRI or MRA services—related services that can be claimed in a 12 month period 136

Subdivision B—Subgroups 1 to 19 of Group I5                                             137

Subdivision C—Subgroup 20 of Group I5: scans of pelvis and upper abdomen for specified conditions               149

2.5.10.... MRI services—limit for items 63470, 63473, 63479 and 63481.... 149

2.5.11.... MRI and MRA services—modifying items.................................... 150

Subdivision D—Subgroups 21 and 22 of Group I5                                        151

Subdivision E—Subgroup 33 of Group I5                                                       152

Subdivision F—Subgroup 34 of Group I5                                                       154

Division 2.6—Group I6: management of bulk‑billed services            156

2.6.1...... Application of items 64990 and 64991........................................... 156

Part 3—Dictionary                                                                                                            159

Schedule 2—Repeals                                                                                                        165

Health Insurance (Diagnostic Imaging Services Table) Regulation 2013   165

Schedule 3—Amendments                                                                                            166

Part 1—Technical amendments                                                                            166

Health Insurance Regulations 1975                                                                    166

Part 2—Capital sensitivity for computed tomography and angiography equipment        167

Health Insurance (Diagnostic Imaging Services Table) Regulation 2014   167

Health Insurance (General Medical Services Table) Regulation 2014        173

Health Insurance Regulations 1975                                                                    173

Part 3—Autologous blood injections                                                                176

Health Insurance (Diagnostic Imaging Services Table) Regulation 2014   176

 


1  Name

                   This is the Health Insurance (Diagnostic Imaging Services Table) Regulation 2014.

2  Commencement

                   Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.

 

Commencement information

Column 1

Column 2

Provisions

Commencement

1.  Sections 1 to 4 and anything in this instrument not elsewhere covered by this table

The day after this instrument is registered.

2.  Sections 5 and 6

1 November 2014.

3.  Schedules 1 and 2

1 November 2014.

4.  Schedule 3, Part 1

1 November 2014.

5.  Schedule 3, Parts 2 and 3

1 January 2015.

 

3  Authority

                   This instrument is made under the Health Insurance Act 1973.

4  Schedules

                   Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.

5  Diagnostic imaging services table

                   For subsection 4AA(1) of the Act, Schedule 1 prescribes a table of diagnostic imaging services.

6  Dictionary

                   The Dictionary in Part 3 of Schedule 1 defines certain words and expressions that are used in this instrument, and includes references to certain words and expressions that are defined elsewhere in this instrument.


Schedule 1Diagnostic imaging services table

Note:       See section 5.

Part 1Preliminary

Division 1.1Interpretation

1.1.1  References to diagnostic imaging services

                   A reference to a diagnostic imaging service in an item in Part 2 includes a reference to the undertaking of the diagnostic imaging procedure used for rendering the service.

Division 1.2General application provisions

Subdivision ACapital sensitivity

1.2.1  Application of (K) items and (NK) items

             (1)  Subject to clause 1.2.3, an (NK) item applies to a service that is performed on:

                     (a)  diagnostic imaging equipment:

                              (i)  that has not been upgraded; and

                             (ii)  the age of which exceeds the new effective life age for the equipment; or

                     (b)  diagnostic imaging equipment:

                              (i)  that has been upgraded; and

                             (ii)  the age of which exceeds the maximum extended life age for the equipment.

             (2)  A (K) item does not apply to a service to which an (NK) item applies.

1.2.2  Age of equipment

Age of equipment

             (1)  The date from which the age of equipment is worked out for this instrument is:

                     (a)  the date that the diagnostic imaging equipment was first installed in Australia; or

                     (b)  if the diagnostic imaging equipment was imported as used equipment—the date of manufacture of the oldest component of the equipment.

Life ages

             (2)  The new effective life age and maximum extended life age for equipment are the periods set out in the following table for that type of equipment:

 

Life ages

Item

Column 1

Topic

Column 2

Modality

Column 3

New effective life age (years)

Column 4

Maximum extended life age (years)

1

Ultrasound

Equipment used to perform a service to which an item in Group I1 in Division 2.1 applies

10

15

2

CT

Equipment used to perform a service to which an item in Group I2 in Division 2.2 applies

10

3

Mammography

Equipment used to perform a service to which an item in Group I3 (other than Subgroup 10) in Division 2.3 applies

10

15

4

Angiography

Equipment used to perform a service to which an item in Subgroup 13 of Group I3 in Division 2.3 applies

10

5

Rest of diagnostic radiology

Equipment used to perform a service to which an item in Subgroups 1 to 9, 11, 12, 14, 15 or 17 of Group I3 in Division 2.3 applies

15

20

6

Nuclear medicine (excluding PET)

Equipment used to perform a service to which an item in Group I4 in Division 2.4 applies

10

15

7

MRI

Equipment used to perform a service to which an item in Group I5 in Division 2.5 applies

10

15

Upgrades

             (3)  Diagnostic imaging equipment has been upgraded if:

                     (a)  an additional reasonable investment has been made within the new effective life age for the equipment that improves the overall performance of the imaging system so that it is equivalent to new equipment supplied in Australia at the time of the improvement; or

                     (b)  the equipment is currently accredited under The Royal Australian and New Zealand College of Radiologists’ Mammography Quality Assurance Program.

Note:          Proprietors can obtain further information on what constitutes an upgrade from the Department’s website (http://www.health.gov.au/capitalsensitivity).

1.2.3  Exemptions from capital sensitivity

Outer regional, remote and very remote areas

             (1)  An (NK) item does not apply if:

                     (a)  the diagnostic imaging equipment used to perform the service is ordinarily located at diagnostic imaging premises; and

                     (b)  the diagnostic imaging premises are located in RA2, RA3 or RA4.

Note:       Proprietors can identify what Remoteness Area they fall under at the Department’s DoctorConnect website (http://www.doctorconnect.gov.au). Proprietors should refer to the category names, rather than category numbers as the website uses different category numbers from those specified in this instrument.

             (2)  An (NK) item does not apply if:

                     (a)  the diagnostic imaging equipment used to perform the service is not ordinarily located at diagnostic imaging premises; and

                     (b)  the diagnostic imaging equipment used to perform the service is ordinarily located, when not in use, at a base for mobile diagnostic imaging equipment; and

                     (c)  the base for mobile diagnostic imaging equipment is located in RA2, RA3 or RA4.

Note:       Proprietors can identify what Remoteness Area they fall under at the Department’s DoctorConnect website (http://www.doctorconnect.gov.au). Proprietors should refer to the category names, rather than category numbers as the website uses different category numbers from those specified in this instrument.

Inner regional areas

             (3)  An (NK) item does not apply if:

                     (a)  both of the following subparagraphs apply:

                              (i)  the Department has notified the relevant proprietor of the receipt of a valid application for an exemption under subclause (4);

                             (ii)  the Secretary has not made a decision under subclause (4); or

                     (b)  the Secretary has granted an exemption under subclause (4); or

                     (c)  the Secretary has notified the relevant proprietor that the Secretary has refused to grant an exemption under subclause (4), and:

                              (i)  if the proprietor has not yet applied for reconsideration under clause 1.2.4—the period to apply for reconsideration has not yet expired; or

                             (ii)  if the proprietor has applied for reconsideration under clause 1.2.4—the Secretary has not yet notified the proprietor of the Secretary’s reconsideration decision.

             (4)  The Secretary may grant an exemption in writing in respect of diagnostic imaging equipment if the Secretary is satisfied that the diagnostic imaging equipment:

                     (a)  is operated on a rare and sporadic basis; and

                     (b)  provides crucial patient access to diagnostic imaging services.

             (5)  The Secretary must make a decision under subclause (4) within 28 days of the day on which the Department notifies the relevant proprietor of the receipt of a valid application as mentioned in paragraph (3)(a).

             (6)  A relevant proprietor may only apply for an exemption under subclause (4) if the age of the diagnostic imaging equipment exceeds the maximum extended life age for the diagnostic imaging equipment by less than 3 years, and:

                     (a)  all of the following subparagraphs apply:

                              (i)  the diagnostic imaging equipment is ordinarily located at diagnostic imaging premises;

                             (ii)  the diagnostic imaging premises are located in RA1;

                            (iii)  the diagnostic imaging premises are located in RRMA4 or RRMA5; or

                    (aa)  all of the following subparagraphs apply:

                              (i)  the diagnostic imaging equipment is used to perform a service to which an item in Group I2 in Division 2.2 applies;

                             (ii)  the diagnostic imaging equipment is ordinarily located at diagnostic imaging premises;

                            (iii)  the diagnostic imaging premises are located in RA1;

                            (iv)  the diagnostic imaging premises are not located in RRMA4 or RRMA5;

                             (v)  while the Health Insurance (Diagnostic Imaging Services Table) Regulation 2012 was in force, a service performed using the diagnostic imaging equipment at the diagnostic imaging premises was a service performed in a remote location; or

                     (b)  all of the following subparagraphs apply:

                              (i)  the diagnostic imaging equipment is ordinarily located at a base for mobile diagnostic imaging equipment when not in use;

                             (ii)  the diagnostic imaging equipment is not ordinarily located at diagnostic imaging premises;

                            (iii)  the base for mobile diagnostic imaging equipment is located in RA1;

                            (iv)  the base for mobile diagnostic imaging equipment is located in an area classified as RRMA4 or RRMA5.

Note:       Proprietors can identify what Remoteness Area they fall under at the Department’s DoctorConnect website (http://www.doctorconnect.gov.au). Proprietors should refer to the category names, rather than category numbers as the website uses different category numbers from those specified in this instrument.

             (7)  An application under subclause (6) must be made in writing to the Department.

             (8)  Paragraph (6)(aa) and this subclause are repealed at the end of 30 June 2016.

1.2.4  Reconsideration of exemption decisions

             (1)  If the Secretary refuses to grant an exemption under subclause 1.2.3(4), the proprietor who applied for the exemption may apply to the Secretary for reconsideration of the decision within:

                     (a)  28 days after the date of issue of the notice of the decision to the proprietor; or

                     (b)  if the Secretary is satisfied that special circumstances exist—within such further period (if any) as the Secretary allows.

             (2)  In the application for reconsideration, the proprietor:

                     (a)  must identify the decision for reconsideration and set out the reasons for the application; and

                     (b)  may provide new material for the Secretary to consider.

             (3)  The Secretary must, within 28 days after receipt of an application, reconsider the decision and:

                     (a)  affirm the decision; or

                     (b)  vary the decision; or

                     (c)  set aside the decision and make a decision in substitution for it.

             (4)  The Secretary must notify the proprietor of a reconsideration decision under subclause (3).

1.2.5  Delegation

                   The Secretary may, by written notice, delegate to an APS employee in the Department any of the Secretary’s powers under this Division.

Subdivision BOther provisions

1.2.6  Meaning of symbols (R) and (NR) in the table

             (1)  An item including the symbol (R) is an R‑type diagnostic imaging service.

             (2)  An item including the symbol (NR) is an NR‑type diagnostic imaging service.

1.2.7  Who may provide a diagnostic imaging service

                   Unless the contrary intention appears, items in this table relating to diagnostic imaging services apply whether the service is provided by:

                     (a)  a medical practitioner; or

                     (b)  a person, other than a medical practitioner, who:

                              (i)  is employed by a medical practitioner; or

                             (ii)  provides the service under the supervision of a medical practitioner in accordance with accepted medical practice.

1.2.8  Report requirements for certain services

             (1)  An item in Part 2 (except an item to which subclause (2) applies) applies only if the providing practitioner gives a report of the service performed to the practitioner, participating midwife or participating nurse practitioner who requested the service.

             (2)  This subclause applies to:

                     (a)  items 55026, 55054, 55130, 55131, 55135, 55136, 55848, 55849, 55850, 55851, 57341, 57345, 59312, 59313, 59314, 59315, 60506, 60507, 60509, 60510, 61109 and 61110, being items of services performed in conjunction with a surgical procedure; and

                     (b)  items 60918 and 60927, being items of service performed in preparation for a radiological procedure.

1.2.9  Bulk‑billing incentive

             (1)  This clause applies if:

                     (a)  a service that is mentioned in an item in Divisions 2.1 to 2.4 of this table 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 this table for the service.

             (3)  For paragraph 10(2)(aa) of the Act, the benefit payable is the amount calculated under subclause (2).

Note:          Under subparagraph 6EF(b)(ii) of the Health Insurance Regulations 1975, the medicare benefit payable is 100% of the amount calculated under subclause (2) of this clause.

             (4)  This clause does not apply to the service specified in item 61369 or 61671.

1.2.10  Bulk‑billing—magnetic resonance imaging

             (1)  This clause applies if:

                     (a)  a service that is mentioned in an item in Division 2.5 of this table 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 100% of the fee mentioned in this table for the service.

             (3)  For paragraph 10(2)(aa) of the Act, the benefit payable is the amount calculated under subclause (2).

Note:          Under subparagraph 6EF(b)(ii) of the Health Insurance Regulations 1975, the medicare benefit payable is 100% of the amount calculated under subclause (2) of this clause.

1.2.11  Multiple services—vascular ultrasound

             (1)  If a medical practitioner provides 2 or more vascular ultrasound services for the same patient on the same day, the fees specified for the items that apply to the services are affected as follows:

                     (a)  the second highest fee is reduced by 40%;

                     (b)  any other fee, except the highest, is reduced by 50%.

             (2)  For subclause (1):

                     (a)  if 2 or more applicable fees are equally the highest:

                              (i)  only one of those fees is taken to be the highest fee; and

                             (ii)  the other, or another, highest fee is taken to be the second highest fee; and

                     (b)  if 2 or more fees are equally second highest—any one of those fees may be taken to be the second highest for the purpose of paragraph (1)(b); and

                     (c)  if a reduced fee calculated under subclause (1) is not a multiple of 5 cents—the reduced fee is taken to be the nearest amount that is a multiple of 5 cents.

             (3)  This clause does not apply to the fee specified in item 64990 or 64991.

1.2.12  Multiple services

             (1)  If a medical practitioner renders 2 or more diagnostic imaging services for the same patient on the same day, the fees set out in the items that apply to the services, other than the item with the highest fee, are reduced by $5.

             (2)  If a medical practitioner renders at least one R‑type diagnostic imaging service and at least one consultation service for the same patient on the same day, the highest fee, set out in the items that apply to diagnostic imaging services rendered by the practitioner for that patient on that day, is reduced:

                     (a)  if the fee for the relevant consultation is at least $40—by $35; or

                     (b)  if that fee is less than $40 but more than $15—by $15; or

                     (c)  if that fee is less than $15—by the amount of that fee.

             (3)  For subclause (2), if more than one consultation has occurred, the relevant consultation is the consultation having the highest fee set out in the items that apply to the consultation.

             (4)  If a medical practitioner renders at least one R‑type diagnostic imaging service and at least one non‑consultation service for the same patient on the same day, the highest fee that applies to any diagnostic imaging services performed by the medical practitioner for the same patient on the same day, is reduced by $5.

             (5)  If a medical practitioner renders an R‑type diagnostic imaging service, a consultation and a non‑consultation service for the same patient on the same day, the sum of the reductions under subclauses (2) and (4) must not exceed the highest fee that applies to any diagnostic imaging services rendered by the medical practitioner for the same patient on the same day.

             (6)  Clauses 1.2.11 and 2.5.8 apply, subject to subclauses (7) and (8), in addition to this clause.

             (7)  For clause 1.2.11, if a medical practitioner provides:

                     (a)  2 or more vascular ultrasound services for the same patient on the same day; and

                     (b)  one or more other diagnostic imaging services for that patient on that day;

the amount of the fees payable for the vascular ultrasound services is taken, for this clause, to be an amount payable for one diagnostic imaging service.

             (8)  For clause 2.5.8, if a medical practitioner provides:

                     (a)  2 or more MRI services mentioned in Subgroup 12 or 13 of Division 2.5 in this table for the same patient on the same day; and

                     (b)  one or more other diagnostic imaging services for that patient on that day;

the amount of the fees payable for the MRI services is taken, for this clause, to be an amount payable for one diagnostic imaging service.

             (9)  This clause does not apply to diagnostic imaging services that are rendered in a remote area by a medical practitioner for whom a remote area exemption under section 23DX of the Act is in force for that area.

           (10)  This clause does not apply to the fee specified in item 59103, 59104, 64990 or 64991.

           (11)  In this table:

consultation means a service under an item listed in Divisions 2.1 to 2.14 of the general medical services table.

highest fee means the highest fee specified for an item in the first claim submitted to the Chief Executive Medicare for the services provided.

non‑consultation service means a service under an item listed in the general medical services table other than in Divisions 2.1 to 2.14 of the general medical services table.

Part 2Services and fees

Division 2.1Group I1: ultrasound

Subdivision AGeneral

2.1.1  Ultrasound services—eligible services

                   Items in this Division (except items 55600, 55601, 55603 and 55604) apply to an ultrasound service only if the diagnostic imaging procedure used in rendering the service is performed:

                     (a)  by a medical practitioner; or

                     (b)  by a registered sonographer on behalf of a medical practitioner.

2.1.2  Ultrasound services—R‑type eligible services

             (1)  Items in this Division (except items 55600, 55601, 55603 and 55604) marked with the symbol (R) apply to an ultrasound service (the eligible service) only if the service is performed:

                     (a)  under the professional supervision of a specialist or a consultant physician in the practice of his or her specialty who is available:

                              (i)  to monitor and influence the conduct and diagnostic quality of the examination; and

                             (ii)  if necessary, to attend on the patient personally; or

                     (b)  under the professional supervision of a practitioner who:

                              (i)  is not a specialist or consultant physician; and

                             (ii)  meets the requirement of subclause (2); and

                            (iii)  is available to monitor and influence the conduct and diagnostic quality of the examination and, if necessary, to attend on the patient personally; or

                     (c)  in the circumstance mentioned in subclause (3), and under the professional supervision of a practitioner who is available:

                              (i)  to monitor and influence the conduct and diagnostic quality of the examination; and

                             (ii)  if necessary, to attend on the patient personally; or

                     (d)  if paragraph (a), (b) or (c) cannot be complied with:

                              (i)  in an emergency; or

                             (ii)  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.

             (2)  For subparagraph (1)(b)(ii), the requirement is that, 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 eligible service was rendered, and the rendering of those services entitled payment of medicare benefits.

             (3)  For paragraph (1)(c), the circumstance is that, between 1 September 1997 and 31 August 1999, at least 50 services were rendered in nursing homes or patients’ residences by or on behalf of the practitioner, and the rendering of those services entitled payment of medicare benefits.

Subdivision BSubgroups 1 to 4 of Group I1

2.1.3  Certain items taken to include referred by dental practitioner or referring dental practitioner

                   In items 55005, 55008, 55011, 55028, 55030 and 55032, a reference to a medical practitioner includes a reference to a dental practitioner approved under paragraph (b) of the definition of professional service in subsection 3(1) of the Act.

 

Group I1—Ultrasound

Item

Description

Fee ($)

Subgroup 1—General

55005

Head, ultrasound scan of, if:

(a) the patient is referred by a medical practitioner; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (R) (NK)

54.55

55007

Head, ultrasound scan of, if:

(a) the patient is not referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (NR) (NK)

18.95

55008

Orbital contents, ultrasound scan of, if:

(a) the patient is referred by a medical practitioner; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (R) (NK)

54.55

55010

Orbital contents, ultrasound scan of, if:

(a) the patient is not referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (NR) (NK)

18.95

55011

Neck, one or more structures of, ultrasound scan of, if:

(a) the patient is referred by a medical practitioner; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (R) (NK)

54.55

55013

Neck, one or more structures of, ultrasound scan of, if:

(a) the patient is not referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (NR) (NK)

18.95

55014

Abdomen, ultrasound scan of (including scan of urinary tract when performed), if:

(a) the patient is referred by a medical practitioner or participating nurse practitioner; and

(b) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner; and

(d) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(e) the service is not solely a transrectal ultrasonic examination of the prostate gland, bladder base and urethra, or any of those organs; and

(f) within 24 hours of the service, a service mentioned in item 55017, 55038, 55065 or 55067 is not performed on the same patient by the providing practitioner (R) (NK)

55.65

55016

Abdomen, ultrasound scan of (including scan of urinary tract when performed), if:

(a) the patient is not referred by a medical practitioner or participating nurse practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(c) the service is not solely a transrectal ultrasonic examination of the prostate gland, bladder base and urethra, or any of those organs (NR) (NK)

18.95

55017

Urinary tract, ultrasound scan of, if:

(a) the patient is referred by a medical practitioner; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) the service is not solely a transrectal ultrasonic examination of the prostate gland, bladder base and urethra, or any of those organs; and

(e) within 24 hours of the service, a service mentioned in item 55014, 55038, 55065 or 55067 is not performed on the same patient by the providing practitioner (R) (NK)

54.55

55019

Urinary tract, ultrasound scan of, if:

(a) the patient is not referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(c) the service is not solely a transrectal ultrasonic examination of the prostate gland, bladder base and urethra, or any of those organs (NR) (NK)

18.95

55023

Scrotum, ultrasound scan of, if:

(a) the patient is referred by a medical practitioner; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (R) (NK)

54.75

55025

Scrotum, ultrasound scan of, if:

(a) the patient is not referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (NR) (NK)

18.95

55026

Ultrasonic cross‑sectional echography, in conjunction with a surgical procedure using interventional techniques, not being a service associated with a service to which any other item in this group applies (R) (NK)

54.55

55028

Head, ultrasound scan of, if:

(a) the patient is referred by a medical practitioner; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (R) (K)

109.10

55029

Head, ultrasound scan of, if:

(a) the patient is not referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (NR) (K)

37.85

55030

Orbital contents, ultrasound scan of, if:

(a) the patient is referred by a medical practitioner; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (R) (K)

109.10

55031

Orbital contents, ultrasound scan of, if:

(a) the patient is not referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (NR) (K)

37.85

55032

Neck, one or more structures of, ultrasound scan of, if:

(a) the patient is referred by a medical practitioner; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (R) (K)

109.10

55033

Neck, one or more structures of, ultrasound scan of, if:

(a) the patient is not referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (NR) (K)

37.85

55036

Abdomen, ultrasound scan of (including scan of urinary tract when performed), if:

(a) the patient is referred by a medical practitioner or participating nurse practitioner for ultrasonic examination; and

(b) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner; and

111.30

 

(d) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(e) the service is not solely a transrectal ultrasonic examination of the prostate gland, bladder base and urethra, or any of those organs; and

(f) within 24 hours of the service, a service mentioned in item 55017, 55038, 55065 or 55067 is not performed on the same patient by the providing practitioner (R) (K)

 

55037

Abdomen, ultrasound scan of (including scan of urinary tract when performed), if:

(a) the patient is not referred by a medical practitioner or participating nurse practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(c) the service is not solely a transrectal ultrasonic examination of the prostate gland, bladder base and urethra, or any of those organs (NR) (K)

37.85

55038

Urinary tract, ultrasound scan of, if:

(a) the patient is referred by a medical practitioner for ultrasonic examination; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) the service is not solely a transrectal ultrasonic examination of the prostate gland, bladder base and urethra, or any of those organs; and

(e) within 24 hours of the service, a service mentioned in item 55017, 55036, 55065 or 55067 is not performed on the same patient by the providing practitioner (R) (K)

109.10

55039

Urinary tract, ultrasound scan of, if:

(a) the patient is not referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(c) the service is not solely a transrectal ultrasonic examination of the prostate gland, bladder base and urethra, or any of those organs (NR) (K)

37.85

55048

Scrotum, ultrasound scan of, if:

(a) the patient is referred by a medical practitioner; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (R) (K)

109.50

55049

Scrotum, ultrasound scan of, if:

(a) the patient is not referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (NR) (K)

37.85

55054

Ultrasonic cross‑sectional echography, in conjunction with a surgical procedure using interventional techniques, not being a service associated with a service to which any other item in this group applies (R) (K)

109.10

55059

Breast, one, ultrasound scan of, if:

(a) the patient is referred by a medical practitioner or participating nurse practitioner; and

(b) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner; and

(d) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (R) (NK)

49.15

55060

Breast, one, ultrasound scan of, if:

(a) the patient is not referred by a medical practitioner or participating nurse practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (NR) (NK)

17.05

55061

Breasts, both, ultrasound scan of, if:

(a) the patient is referred by a medical practitioner or participating nurse practitioner; and

(b) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner; and

(d) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (R) (NK)

54.55

55062

Breasts, both, ultrasound scan of, if:

(a) the patient is not referred by a medical practitioner or participating nurse practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (NR) (NK)

18.95

55063

Urinary bladder, ultrasound scan of, by any or all approaches, if:

(a) the patient is referred by a medical practitioner for ultrasonic examination; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) within 24 hours of the service, a service mentioned in item 11917, 55014, 55017, 55036, 55038, 55065, 55067, 55600, 55601, 55603 or 55604 is not performed on the same patient by the providing practitioner (R) (NK)

49.15

55064

Urinary bladder, ultrasound scan of, by any or all approaches, if:

(a) the patient is not referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(c) within 24 hours of the service, a service mentioned in item 11917, 55016, 55019, 55037, 55039, 55068, 55069, 55600, 55601, 55603 or 55604 is not performed on the same patient by the providing practitioner (NR) (NK)

17.05

55065

Pelvis, ultrasound scan of, by any or all approaches, if:

(a) the patient is referred by a medical practitioner for ultrasonic examination; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) the service is not solely a transrectal ultrasonic examination of the prostate gland, bladder base and urethra, or any of those organs; and

(e) within 24 hours of the service, a service mentioned in item 55014, 55017, 55036 or 55038 is not performed on the same patient by the providing practitioner (R) (K)

98.25

55067

Pelvis, ultrasound scan of, by any or all approaches, if:

(a) the patient is referred by a medical practitioner for ultrasonic examination; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) the service is not solely a transrectal ultrasonic examination of the prostate gland, bladder base and urethra, or any of those organs; and

(e) within 24 hours of the service, a service mentioned in item 55014, 55017, 55036 or 55038 is not performed on the same patient by the providing practitioner (R) (NK)

50.25

55068

Pelvis, ultrasound scan of, by any or all approaches, if:

(a) the patient is not referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(c) the service is not solely a transrectal ultrasonic examination of the prostate gland, bladder base and urethra, or any of those organs (NR) (K)

35.00

55069

Pelvis, ultrasound scan of, by any or all approaches, if:

(a) the patient is not referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(c) the service is not solely a transrectal ultrasonic examination of the prostate gland, bladder base and urethra, or any of those organs (NR) (NK)

17.85

55070

Breast, one, ultrasound scan of, if:

(a) the patient is referred by a medical practitioner or participating nurse practitioner; and

(b) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner; and

(d) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (R) (K)

98.25

55073

Breast, one, ultrasound scan of, if:

(a) the patient is not referred by a medical practitioner or participating nurse practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (NR) (K)

34.05

55076

Breasts, both, ultrasound scan of, if:

(a) the patient is referred by a medical practitioner or participating nurse practitioner; and

(b) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner; and

(d) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (R) (K)

109.10

55079

Breasts, both, ultrasound scan of, if:

(a) the patient is not referred by a medical practitioner or participating nurse practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (NR) (K)

37.85

55084

Urinary bladder, ultrasound scan of, by any or all approaches, if:

(a) the patient is referred by a medical practitioner; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) within 24 hours of the service, a service mentioned in item 11917, 55014, 55017, 55036, 55038, 55065, 55067, 55600, 55601, 55603 or 55604 is not performed on the same patient by the providing practitioner (R) (K)

98.25

55085

Urinary bladder, ultrasound scan of, by any or all approaches, if:

(a) the patient is not referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(c) within 24 hours of the service, a service mentioned in item 11917, 55016, 55019, 55037, 55039, 55068, 55069, 55600, 55601, 55603 or 55604 is not performed on the same patient by the providing practitioner (NR) (K)

34.05

Subgroup 2—Cardiac

55113

M‑mode and two‑dimensional real time echocardiographic examination of the heart from at least 2 acoustic windows for the investigation of symptoms or signs of cardiac failure, or suspected or known ventricular hypertrophy or dysfunction, or chest pain:

(a) with:

(i) measurement of blood flow velocities across the cardiac valves using pulsed wave and continuous wave Doppler techniques; and

230.65

 

(ii) real time colour flow mapping from at least 2 acoustic windows; and

(iii) recordings on video tape or digital media; and

(b) not being a service associated with a service to which an item in Subgroup 1 (except items 55026 and 55054) or 3, or another item in this Subgroup (except items 55118, 55125, 55130 and 55131), applies (R) (K)

 

55114

M‑mode and two‑dimensional real time echocardiographic examination of the heart from at least 2 acoustic windows for the investigation of suspected or known acquired valvular, aortic, pericardial, thrombotic or embolic disease or heart tumour:

(a) with:

(i) measurement of blood flow velocities across the cardiac valves using pulsed wave and continuous wave Doppler techniques; and

(ii) real time colour flow mapping from at least 2 acoustic windows; and

(iii) recordings on video tape or digital media; and

(b) not being a service associated with a service to which an item in Subgroup 1 (except items 55026 and 55054) or 3, or another item in this Subgroup (except items 55118, 55125, 55130 and 55131), applies (R) (K)

230.65

55115

M‑mode and two‑dimensional real time echocardiographic examination of the heart from at least 2 acoustic windows for the investigation of symptoms or signs of congenital heart disease:

(a) with:

(i) measurement of blood flow velocities across the cardiac valves using pulsed wave and continuous wave Doppler techniques; and

(ii) real time colour flow mapping from at least 2 acoustic windows; and

(iii) recordings on video tape or digital media; and

(b) not being a service associated with a service to which an item in Subgroup 1 (except items 55026 and 55054) or 3, or another item in this Subgroup (except items 55118, 55125, 55130 and 55131), applies (R) (K)

230.65

55116

Exercise stress echocardiography performed in conjunction with item 11712:

(a) with:

(i) two‑dimensional recordings before exercise (baseline) from at least 3 acoustic windows; and

(ii) matching recordings from the same windows at, or immediately after, peak exercise; and

(iii) recordings on digital media with equipment permitting display of baseline and matching peak images on the same screen; and

(b) not being a service associated with a service to which an item in Subgroup 1 (except items 55026 and 55054) or 3, or another item in this Subgroup (except items 55118, 55125, 55130 and 55131), applies (R) (K)

261.65

55117

Pharmacological stress echocardiography performed in conjunction with item 11712:

(a) with:

(i) two‑dimensional recordings before drug infusion (baseline) from at least 3 acoustic windows; and

(ii) matching recordings from the same windows at least twice during drug infusion, including a recording at the peak drug dose; and

(iii) recordings on digital media with equipment permitting display of baseline and matching peak images on the same screen; and

(b) not being a service associated with a service to which an item in Subgroup 1 (except items 55026 and 55054) or 3, or another item in this Subgroup (except items 55118, 55125, 55130 and 55131), applies (R) (K)

261.65

55118

Heart, two‑dimensional real time transoesophageal examination of, from at least 2 levels, and in more than one plane at each level:

(a) with:

(i) real time colour flow mapping and, if indicated, pulsed wave Doppler examination; and

(ii) recordings on video tape or digital medium; and

275.50

 

(b) not being an intra‑operative service or a service associated with a service to which an item in Subgroup 1 (except items 55026 and 55054) or 3 applies (R) (K) (Anaes.)

 

55119

M‑mode and two‑dimensional real time echocardiographic examination of the heart from at least 2 acoustic windows for the investigation of symptoms or signs of cardiac failure, or suspected or known ventricular hypertrophy or dysfunction, or chest pain:

(a) with:

(i) measurement of blood flow velocities across the cardiac valves using pulsed wave and continuous wave Doppler techniques; and

(ii) real time colour flow mapping from at least 2 acoustic windows; and

(iii) recordings on video tape or digital media; and

(b) not being a service associated with a service to which an item in Subgroup 1 (except items 55026 and 55054) or 3, or another item in this Subgroup (except items 55118, 55125, 55130 and 55131), applies (R) (NK)

115.35

55120

M‑mode and two‑dimensional real time echocardiographic examination of the heart from at least 2 acoustic windows for the investigation of suspected or known acquired valvular, aortic, pericardial, thrombotic or embolic disease or heart tumour:

(a) with:

(i) measurement of blood flow velocities across the cardiac valves using pulsed wave and continuous wave Doppler techniques; and

(ii) real time colour flow mapping from at least 2 acoustic windows; and

(iii) recordings on video tape or digital media; and

(b) not being a service associated with a service to which an item in Subgroup 1 (except items 55026 and 55054) or 3, or another item in this Subgroup (except items 55118, 55125, 55130 and 55131), applies (R) (NK)

115.35

55121

M‑mode and two‑dimensional real time echocardiographic examination of the heart from at least 2 acoustic windows for the investigation of symptoms or signs of congenital heart disease:

(a) with:

(i) measurement of blood flow velocities across the cardiac valves using pulsed wave and continuous wave Doppler techniques; and

(ii) real time colour flow mapping from at least 2 acoustic windows; and

(iii) recordings on video tape or digital media; and

(b) not being a service associated with a service to which an item in Subgroup 1 (except items 55026 and 55054) or 3, or another item in this Subgroup (except items 55118, 55125, 55130 and 55131), applies (R) (NK)

115.35

55122

Exercise stress echocardiography performed in conjunction with item 11712:

(a) with:

(i) two‑dimensional recordings before exercise (baseline) from at least 3 acoustic windows; and

(ii) matching recordings from the same windows at, or immediately after, peak exercise; and

(iii) recordings on digital media with equipment permitting display of baseline and matching peak images on the same screen; and

(b) not being a service associated with a service to which an item in Subgroup 1 (except items 55026 and 55054) or 3, or another item in this Subgroup (except items 55118, 55125, 55130 and 55131), applies (R) (NK)

130.85

55123

Pharmacological stress echocardiography performed in conjunction with item 11712:

(a) with:

(i) two‑dimensional recordings before drug infusion (baseline) from at least 3 acoustic windows; and

(ii) matching recordings from the same windows at least twice during drug infusion, including a recording at the peak drug dose; and

(iii) recordings on digital media with equipment permitting display of baseline and matching peak images on the same screen; and

(b) not being a service associated with a service to which an item in Subgroup 1 (except items 55026 and 55054) or 3, or another item in this Subgroup (except items 55118, 55125, 55130 and 55131), applies (R) (NK)

130.85

55125

Heart, two‑dimensional real time transoesophageal examination of, from at least 2 levels, and in more than one plane at each level:

(a) with:

(i) real time colour flow mapping and, if indicated, pulsed wave Doppler examination; and

(ii) recordings on video tape or digital medium; and

(b) not being an intra‑operative service or a service associated with a service to which an item in Subgroup 1 (except items 55026 and 55054) or 3 applies (R) (NK) (Anaes.)

137.75

55130

Intra‑operative two‑dimensional real time transoesophageal echocardiography incorporating Doppler techniques with colour flow mapping and recording onto video tape or digital medium, performed during cardiac surgery incorporating sequential assessment of cardiac function before and after the surgical procedure, not being a service associated with a service to which item 55135 or 55136 applies (R) (K) (Anaes.)

170.00

55131

Intra‑operative two‑dimensional real time transoesophageal echocardiography incorporating Doppler techniques with colour flow mapping and recording onto video tape or digital medium, performed during cardiac surgery incorporating sequential assessment of cardiac function before and after the surgical procedure, not being a service associated with a service to which item 55135 or 55136 applies (R) (NK) (Anaes.)

85.00

55135

Intra‑operative two‑dimensional real time transoesophageal echocardiography incorporating Doppler techniques with colour flow mapping and recording onto video tape or digital medium, performed during cardiac valve surgery (replacement or repair) incorporating sequential assessment of cardiac function and valve competence before and after the surgical procedure, not being a service associated with a service to which item 55130 or 55131 applies (R) (K) (Anaes.)

353.60

55136

Intra‑operative two‑dimensional real time transoesophageal echocardiography incorporating Doppler techniques with colour flow mapping and recording onto video tape or digital medium, performed during cardiac valve surgery (replacement or repair) incorporating sequential assessment of cardiac function and valve competence before and after the surgical procedure, not being a service associated with a service to which item 55130 or 55131 applies (R) (NK) (Anaes.)

176.80

Subgroup 3—Vascular

55220

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the lower limb or of arteries and bypass grafts in the lower limb, below the inguinal ligament, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (NK)

84.75

55221

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the lower limb, below the inguinal ligament, for acute venous thrombosis, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (NK)

84.75

55222

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the lower limb, below the inguinal ligament, for chronic venous disease, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (NK)

84.75

55223

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the upper limb or of arteries and bypass grafts in the upper limb, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (NK)

84.75

55224

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the upper limb, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (NK)

84.75

55226

Duplex scanning, bilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of extra‑cranial bilateral carotid and vertebral vessels, with or without subclavian and innominate vessels, with or without oculoplethysmography or peri‑orbital Doppler examination, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (NK)

84.75

55227

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of intra‑abdominal, aorta and iliac arteries or inferior vena cava and iliac veins or of intra‑abdominal, aorta and iliac arteries and inferior vena cava and iliac veins, excluding pregnancy related studies, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (NK)

84.75

55228

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of renal or visceral vessels or of renal and visceral vessels, including aorta, inferior vena cava and iliac vessels as required excluding pregnancy related studies, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (NK)

84.75

55229

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of intra‑cranial vessels, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (NK)

84.75

55230

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements:

(a) by spectral analysis of cavernosal artery of the penis following intracavernosal administration of a vasoactive agent; and

(b) performed during the period of pharmacological activity of the injected agent, to confirm a diagnosis of vascular aetiology for impotence; and

(c) if a specialist in diagnostic radiology, nuclear medicine, urology, general surgery (sub‑specialising in vascular surgery) or a consultant physician in nuclear medicine attends the patient in person at the practice location where the service is performed, immediately before or for a period during the performance of the service; and

(d) if the specialist or consultant physician interprets the results and prepares a report, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (NK)

84.75

55232

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements:

(a) by spectral analysis of cavernosal tissue of the penis to confirm a diagnosis; and

(b) if indicated, assess the progress and management of:

(i) priapism; or

(ii) fibrosis of any type; or

(iii) fracture of the tunica; or

(iv) arteriovenous malformations; and

(c) if a specialist in diagnostic radiology, nuclear medicine, urology, general surgery (sub‑specialising in vascular surgery) or a consultant physician in nuclear medicine attends the patient in person at the practice location where the service is performed, immediately before or for a period during the performance of the service; and

(d) if the specialist or consultant physician interprets the results and prepares a report, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (NK)

84.75

55233

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of surgically created arteriovenous fistula or surgically created arteriovenous access grafts in the upper or lower limbs, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (NK)

84.75

55235

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or veins, or both, including any associated skin marking, for mapping of bypass conduit before vascular surgery, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054), 3 or 4 applies (R) (NK)

84.75

55236

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow spectral analysis and marking of veins in the lower limbs below the inguinal ligament before varicose vein surgery, including any associated skin marking, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054), 3 or 4 applies (R) (NK)

55.55

55238

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the lower limb or of arteries and bypass grafts in the lower limb, below the inguinal ligament, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (K)

169.50

55244

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the lower limb, below the inguinal ligament, for acute venous thrombosis, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (K)

169.50

55246

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the lower limb, below the inguinal ligament, for chronic venous disease, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (K)

169.50

55248

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the upper limb or of arteries and bypass grafts in the upper limb, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (K)

169.50

55252

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the upper limb, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (K)

169.50

55274

Duplex scanning, bilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of extra‑cranial bilateral carotid and vertebral vessels, with or without subclavian and innominate vessels, with or without oculoplethysmography or peri‑orbital Doppler examination, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (K)

169.50

55276

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of intra‑abdominal, aorta and iliac arteries or inferior vena cava and iliac veins or of intra‑abdominal, aorta and iliac arteries and inferior vena cava and iliac veins, excluding pregnancy related studies, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (K)

169.50

55278

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of renal or visceral vessels or of renal and visceral vessels, including aorta, inferior vena cava and iliac vessels as required excluding pregnancy related studies, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (K)

169.50

55280

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of intra‑cranial vessels, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (K)

169.50

55282

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements:

(a) by spectral analysis of cavernosal artery of the penis following intracavernosal administration of a vasoactive agent; and

(b) performed during the period of pharmacological activity of the injected agent, to confirm a diagnosis of vascular aetiology for impotence; and

(c) if a specialist in diagnostic radiology, nuclear medicine, urology, general surgery (sub‑specialising in vascular surgery) or a consultant physician in nuclear medicine attends the patient in person at the practice location where the service is performed, immediately before or for a period during the performance of the service; and

(d) if the specialist or consultant physician interprets the results and prepares a report, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (K)

169.50

55284

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements:

(a) by spectral analysis of cavernosal tissue of the penis to confirm a diagnosis; and

(b) if indicated, assess the progress and management of:

(i) priapism; or

(ii) fibrosis of any type; or

(iii) fracture of the tunica; or

(iv) arteriovenous malformations; and

(c) if a specialist in diagnostic radiology, nuclear medicine, urology, general surgery (sub‑specialising in vascular surgery) or a consultant physician in nuclear medicine attends the patient in person at the practice location where the service is performed, immediately before or for a period during the performance of the service; and

(d) if the specialist or consultant physician interprets the results and prepares a report, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (K)

169.50

55292

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of surgically created arteriovenous fistula or surgically created arteriovenous access grafts in the upper or lower limbs, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (K)

169.50

55294

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or veins, or both, including any associated skin marking, for mapping of bypass conduit before vascular surgery, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054), 3 or 4 applies (R) (K)

169.50

55296

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow spectral analysis and marking of veins in the lower limbs below the inguinal ligament before varicose vein surgery, including any associated skin marking, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054), 3 or 4 applies (R) (K)

111.05

Subgroup 4—Urological

55600

Prostate, bladder base and urethra, l ultrasound scan of, if performed:

(a) personally by a medical practitioner (not being the medical practitioner who assessed the patient as specified in paragraph (c)) using one or more transducer probes that:

(i) have a nominal frequency of 7 to 7.5 MHz or a nominal frequency range that includes frequencies of 7 to 7.5 MHz; and

(ii) can obtain both axial and sagittal scans in 2 planes at right angles; and

(b) after a digital rectal examination of the prostate by that medical practitioner; and

(c) on a patient who has been assessed by a specialist in urology, radiation oncology or medical oncology, a consultant physician in medical oncology, who has:

(i) examined the patient in the 60 days before the scan; and

(ii) recommended the scan for the management of the patient’s current prostatic disease (R) (K)

109.10

55601

Prostate, bladder base and urethra, l ultrasound scan of, if performed:

(a) personally by a medical practitioner (not being the medical practitioner who assessed the patient as specified in paragraph (c)) using one or more transducer probes that:

(i) have a nominal frequency of 7 to 7.5 MHz or a nominal frequency range that includes frequencies of 7 to 7.5 MHz; and

(ii) can obtain both axial and sagittal scans in 2 planes at right angles; and

(b) after a digital rectal examination of the prostate by that medical practitioner; and

(c) on a patient who has been assessed by a specialist in urology, radiation oncology or medical oncology, a consultant physician in medical oncology, who has:

(i) examined the patient in the 60 days before the scan; and

(ii) recommended the scan for the management of the patient’s current prostatic disease (R) (NK)

54.55

55603

Prostate, bladder base and urethra, ultrasound scan of, if performed:

(a) personally by a medical practitioner who made the assessment mentioned in paragraph (c) using one or more transducer probes that:

(i) have a nominal frequency of 7 to 7.5 MHz or a nominal frequency range that includes frequencies of 7 to 7.5 MHz; and

(ii) can obtain both axial and sagittal scans in 2 planes at right angles; and

(b) after a digital rectal examination of the prostate by that medical practitioner; and

(c) on a patient who has been assessed by a specialist in urology, radiation oncology or medical oncology or a consultant physician in medical oncology who has:

(i) examined the patient in the 60 days before the scan; and

(ii) recommended the scan for the management of the patient’s current prostatic disease (R) (K)

109.10

55604

Prostate, bladder base and urethra, ultrasound scan of, if performed:

(a) personally by a medical practitioner who made the assessment mentioned in paragraph (c) using one or more transducer probes that:

(i) have a nominal frequency of 7 to 7.5 MHz or a nominal frequency range that includes frequencies of 7 to 7.5 MHz; and

(ii) can obtain both axial and sagittal scans in 2 planes at right angles; and

(b) after a digital rectal examination of the prostate by that medical practitioner; and

(c) on a patient who has been assessed by a specialist in urology, radiation oncology or medical oncology or a consultant physician in medical oncology who has:

(i) examined the patient in the 60 days before the scan; and

(ii) recommended the scan for the management of the patient’s current prostatic disease (R) (NK)

54.55

Subdivision CSubgroup 5 of Group I1: obstetric and gynaecological

2.1.4  Obstetric and gynaecological ultrasound services—limits

             (1)  For NR‑type diagnostic imaging services mentioned in an item in this Subdivision, the specified fee for no more than 3 services provided to the same patient in any one pregnancy applies.

             (2)  For any patient, items 55706, 55707, 55708, 55709, 55713, 55714, 55716, 55717, 55718, 55722, 55723, 55726, 55759, 55760, 55762, 55763, 55768, 55769, 55770 and 55771 are applicable only once in a pregnancy.

2.1.5  Obstetric and gynaecological services—referrals and clinical notes

             (1)  A referral for a service mentioned in item 55700, 55701, 55704, 55707, 55710, 55712, 55714, 55718, 55719, 55721, 55722, 55724, 55759, 55760, 55764, 55765, 55768, 55769, 55772 or 55773 must state the relevant condition or clinical indication for the service.

             (2)  If a referral for a service mentioned in item 55712, 55719, 55721, 55724, 55764, 55765, 55772 or 55773 is given by a medical practitioner who has obstetric privileges at a non‑metropolitan hospital, the referral must also state the words ‘non‑metropolitan obstetric privileges’.

             (3)  A medical practitioner’s clinical notes for a service mentioned in item 55702, 55703, 55705, 55708, 55711, 55715, 55716, 55720, 55723, 55725, 55726, 55727, 55762, 55763, 55766, 55767, 55770, 55771, 55774 or 55775 must state the relevant condition or clinical indication for the service.

2.1.6  Obstetric and gynaecological services—conditions

             (1)  The conditions for items 55700, 55701, 55702, 55703, 55704, 55705, 55707, 55708, 55710, 55711, 55714 and 55716, are as follows:

                     (a)  hyperemesis gravidarum;

                     (b)  diabetes mellitus;

                     (c)  hypertension;

                     (d)  toxaemia of pregnancy;

                     (e)  liver or renal disease;

                      (f)  autoimmune disease;

                     (g)  cardiac disease;

                     (h)  alloimmunisation;

                      (i)  maternal infection;

                      (j)  inflammatory bowel disease;

                     (k)  bowel stoma;

                      (l)  abdominal wall scarring;

                    (m)  previous spinal or pelvic trauma or disease;

                     (n)  drug dependency;

                     (o)  thrombophilia;

                     (p)  significant maternal obesity;

                     (q)  advanced maternal age;

                      (r)  abdominal pain or mass;

                      (s)  uncertain dates;

                      (t)  high risk pregnancy;

                     (u)  previous post dates delivery;

                     (v)  previous caesarean section;

                    (w)  poor obstetric history;

                     (x)  suspicion of ectopic pregnancy;

                     (y)  risk of miscarriage;

                     (z)  diminished symptoms of pregnancy;

                    (za)  suspected or known cervical incompetence;

                   (zb)  suspected or known uterine abnormality;

                    (zc)  pregnancy after assisted reproduction;

                   (zd)  risk of fetal abnormality.

             (2)  The conditions for items 55718, 55722, 55723 and 55726, are as follows:

                     (a)  known or suspected fetal abnormality or fetal cardiac arrhythmia;

                     (b)  fetal anatomy (late booking or incomplete mid‑trimester scan);

                     (c)  malpresentation;

                     (d)  cervical assessment;

                     (e)  clinical suspicion of amniotic fluid abnormality;

                      (f)  clinical suspicion of placental or umbilical cord abnormality;

                     (g)  previous complicated delivery;

                     (h)  uterine scar assessment;

                      (i)  uterine fibroid;

                      (j)  previous fetal death in utero or neonatal death;

                     (k)  antepartum haemorrhage;

                      (l)  clinical suspicion of intrauterine growth retardation;

                    (m)  clinical suspicion of macrosomia;

                     (n)  reduced fetal movements;

                     (o)  suspected fetal death;

                     (p)  abnormal cardiotocography;

                     (q)  prolonged pregnancy;

                      (r)  premature labour;

                      (s)  fetal infection;

                      (t)  pregnancy after assisted reproduction;

                     (u)  trauma;

                     (v)  diabetes mellitus;

                    (w)  hypertension;

                     (x)  toxaemia of pregnancy;

                     (y)  liver or renal disease;

                     (z)  autoimmune disease;

                    (za)  cardiac disease;

                   (zb)  alloimmunisation;

                    (zc)  maternal infection;

                   (zd)  inflammatory bowel disease;

                    (ze)  bowel stoma;

                    (zf)  abdominal wall scarring;

                    (zg)  previous spinal or pelvic trauma or disease;

                   (zh)  drug dependency;

                    (zi)  thrombophilia;

                    (zj)  gross maternal obesity;

                   (zk)  advanced maternal age;

                    (zl)  abdominal pain or mass.

 

Group I1—Ultrasound

Item

Diagnostic imaging service

Fee ($)

Subgroup 5—Obstetric and gynaecological

55700

Pelvis or abdomen, pregnancy‑related or pregnancy complication, ultrasound scan of, by any or all approaches, if:

(a) the patient is referred by a medical practitioner or participating midwife; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is less than 12 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(e) if the patient is referred by a participating midwife—the midwife does not have a business or financial arrangement with the providing practitioner; and

(f) one or more of the conditions mentioned in subclause 2.1.6(1) are present (R) (K)

60.00

55701

Pelvis or abdomen, pregnancy‑related or pregnancy complication, ultrasound scan of, by any or all approaches, if:

(a) the patient is referred by a medical practitioner or participating midwife; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is less than 12 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(e) if the patient is referred by a participating midwife—the midwife does not have a business or financial arrangement with the providing practitioner; and

(f) one or more of the conditions mentioned in subclause 2.1.6(1) are present (R) (NK)

30.00

55702

Pelvis or abdomen, pregnancy‑related or pregnancy complication, ultrasound scan of, by any or all approaches, if:

(a) the patient is not referred by a medical practitioner or participating midwife; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is less than 12 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) one or more of the conditions mentioned in subclause 2.1.6(1) are present (NR) (NK)

17.50

55703

Pelvis or abdomen, pregnancy‑related or pregnancy complication, ultrasound scan of, by any or all approaches, if:

(a) the patient is not referred by a medical practitioner or participating midwife; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is less than 12 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) one or more of the conditions mentioned in subclause 2.1.6(1) are present (NR) (K)

35.00

55704

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) the patient is referred by a medical practitioner or participating midwife; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is 12 to 16 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(e) if the patient is referred by a participating midwife—the midwife does not have a business or financial arrangement with the providing practitioner; and

(f) one or more of the conditions mentioned in subclause 2.1.6(1) are present (R) (K)

70.00

55705

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) the patient is not referred by a medical practitioner or participating midwife; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is 12 to 16 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) one or more of the conditions mentioned in subclause 2.1.6(1) are present (NR) (K)

35.00

55706

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:

(a) the patient is referred by a medical practitioner or participating midwife; and

(b) the dating for the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(e) if the patient is referred by a participating midwife—the midwife does not have a business or financial arrangement with the providing practitioner; and

(f) the service is not performed in the same pregnancy as item 55709 or 55717 (R) (K)

100.00

55707

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) the patient is referred by a medical practitioner or participating midwife; and

(b) the pregnancy (as confirmed by ultrasound) is dated by a fetal crown rump length of 45 to 84 mm; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(e) if the patient is referred by a participating midwife—the midwife does not have a business or financial arrangement with the providing practitioner; and

(f) nuchal translucency measurement is performed to assess the risk of fetal abnormality; and

(g) the service is not performed with item 55700, 55701, 55702, 55703, 55704, 55705, 55710 or 55711 on the same patient within 24 hours; and

(h) one or more of the conditions mentioned in subclause 2.1.6(1) are present (NR) (K)

70.00

55708

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) the patient is not referred by a medical practitioner or participating midwife; and

(b) the pregnancy (as confirmed by ultrasound) is dated by a crown rump length of 45 to 84 mm; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) nuchal translucency measurement is performed to assess the risk of fetal abnormality; and

(e) the service is not performed with item 55700, 55701, 55702, 55703, 55704, 55705, 55710 or 55711 on the same patient within 24 hours; and

(f) one or more of the conditions mentioned in subclause 2.1.6(1) are present (NR) (K)

35.00

55709

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:

(a) the patient is not referred by a medical practitioner; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) the service is not performed in the same pregnancy as item 55706 or 55713 (NR) (K)

38.00

55710

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) the patient is referred by a medical practitioner or participating midwife; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is 12 to 16 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(e) if the patient is referred by a participating midwife—the midwife does not have a business or financial arrangement with the providing practitioner; and

(f) one or more of the conditions mentioned in subclause 2.1.6(1) are present (R) (NK)

35.00

55711

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) the patient is not referred by a medical practitioner or participating midwife; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is 12 to 16 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) one or more of the conditions mentioned in subclause 2.1.6(1) are present (NR) (NK)

17.50

55712

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:

(a) the patient is referred by a medical practitioner who:

(i) is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; or

(ii) has a Diploma of Obstetrics; or

(iii) 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

(iv) has obstetric privileges at a non‑metropolitan hospital; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and

(d) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(e) further examination is clinically indicated after performance, in the same pregnancy, of a scan mentioned in item 55706, 55709, 55713 or 55717 (R) (K)

115.00

55713

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:

(a) the patient is referred by a medical practitioner or participating midwife; and

(b) the dating for the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(e) if the patient is referred by a participating midwife—the midwife does not have a business or financial arrangement with the providing practitioner; and

(f) the service is not performed in the same pregnancy as item 55709 or 55717 (R) (NK)

50.00

55714

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) the patient is referred by a medical practitioner or participating midwife; and

(b) the pregnancy (as confirmed by ultrasound) is dated by a fetal crown rump length of 45 to 84 mm; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(e) if the patient is referred by a participating midwife—the midwife does not have a business or financial arrangement with the providing practitioner; and

(f) nuchal translucency measurement is performed to assess the risk of fetal abnormality; and

(g) the service is not performed with item 55700, 55701, 55702, 55703, 55704, 55705, 55710 or 55711 on the same patient within 24 hours; and

(h) one or more of the conditions mentioned in subclause 2.1.6(1) are present (NR) (NK)

35.00

55715

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, performed by or on behalf of a medical practitioner who is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, if:

(a) the patient is not referred by a medical practitioner; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) further examination is clinically indicated after performance, in the same pregnancy, of a scan mentioned in item 55706, 55709, 55713 or 55717 (NR) (K)

40.00

55716

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) the patient is not referred by a medical practitioner or participating midwife; and

(b) the pregnancy (as confirmed by ultrasound) is dated by a crown rump length of 45 to 84 mm; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) nuchal translucency measurement is performed to assess the risk of fetal abnormality; and

(e) the service is not performed with item 55700, 55701, 55702, 55703, 55704, 55705, 55710 or 55711on the same patient within 24 hours; and

(f) one or more of the conditions mentioned in subclause 2.1.6(1) are present (NR) (NK)

17.50

55717

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:

(a) the patient is not referred by a medical practitioner; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) the service is not performed in the same pregnancy as item 55706 or 55713 (NR) (NK)

19.00

55718

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) the patient is referred by a medical practitioner or participating midwife; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(e) if the patient is referred by a participating midwife—the midwife does not have a business or financial arrangement with the providing practitioner; and

(f) the service is not performed in the same pregnancy as item 55723 or 55726; and

(g) one or more of the conditions mentioned in subclause 2.1.6(2) are present (R) (K)

100.00

55719

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:

(a) the patient is referred by a medical practitioner who:

(i) is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; or

(ii) has a Diploma of Obstetrics; or

(iii) 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

(iv) has obstetric privileges at a non‑metropolitan hospital; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and

(d) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(e) further examination is clinically indicated after performance, in the same pregnancy, of a scan mentioned in item 55706, 55709, 55713 or 55717 (R) (NK)

57.50

55720

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, performed by or on behalf of a medical practitioner who is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, if:

(a) the patient is not referred by a medical practitioner; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) further examination is clinically indicated after performance, in the same pregnancy, of a scan mentioned in item 55706, 55709, 55713 or 55717 (NR) (NK)

20.00

55721

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) the patient is referred by a medical practitioner who:

(i) is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; or

(ii) has a Diploma of Obstetrics; or

(iii) 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

(iv) has obstetric privileges at a non‑metropolitan hospital; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and

(d) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(e) further examination is clinically indicated in the same pregnancy to which item 55718, 55722, 55723 or 55726 applies (R) (K)

115.00

55722

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) the patient is referred by a medical practitioner or participating midwife; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(e) if the patient is referred by a participating midwife—the midwife does not have a business or financial arrangement with the providing practitioner; and

(f) the service is not performed in the same pregnancy as item 55723 or 55726; and

(g) one or more of the conditions mentioned in subclause 2.1.6(2) are present (R) (NK)

50.00

55723

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) the patient is not referred by a medical practitioner; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) the service is not performed in the same pregnancy as item 55718 or 55722; and

(e) one or more of the conditions mentioned in subclause 2.1.6(2) are present (NR) (K)

38.00

55724

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) the patient is referred by a medical practitioner who:

(i) is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; or

(ii) has a Diploma of Obstetrics; or

(iii) 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

(iv) has obstetric privileges at a non‑metropolitan hospital; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and

(d) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(e) further examination is clinically indicated in the same pregnancy to which item 55718, 55722, 55723 or 55726 applies (R) (NK)

57.50

55725

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, performed by or on behalf of a medical practitioner who is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, if:

(a) the patient is not referred by a medical practitioner; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) further examination is clinically indicated in the same pregnancy to which item 55718, 55722, 55723 or 55726 applies (NR) (K)

40.00

55726

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) the patient is not referred by a medical practitioner; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) the service is not performed in the same pregnancy as item 55718 or 55722; and

(e) one or more of the conditions mentioned in subclause 2.1.6(2) are present (NR) (NK)

19.00

55727

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, performed by or on behalf of a medical practitioner who is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, if:

(a) the patient is not referred by a medical practitioner; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) further examination is clinically indicated in the same pregnancy to which item 55718, 55722, 55723 or 55726 applies (NR) (NK)

30.00

55729

Duplex scanning, if:

(a) the service involves:

(i) B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of the umbilical artery; and

(ii) measured assessment of amniotic fluid volume after the 24th week of gestation; and

(b) the patient is referred by a medical practitioner for this procedure; and

(c) there is reason to suspect intrauterine growth retardation or a significant risk of fetal death; and

(d) the service is not associated with a service to which an item in this group applies;

—examination and report (R) (K)

27.25

55730

Duplex scanning, if:

(a) the service involves:

(i) B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of the umbilical artery; and

(ii) measured assessment of amniotic fluid volume after the 24th week of gestation; and

(b) the patient is referred by a medical practitioner for this procedure; and

(c) there is reason to suspect intrauterine growth retardation or a significant risk of fetal death; and

(d) the service is not associated with a service to which an item in this group applies;

—examination and report (R) (NK)

13.65

55735

Pelvis, ultrasound scan of, in association with saline infusion of the endometrial cavity, by any or all approaches, if:

(a) the patient is referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(c) the medical practitioner is not a member of a group of medical practitioners of which the providing practitioner is a member; and

(d) a previous transvaginal ultrasound has revealed an abnormality of the uterus or fallopian tube (R) (NK)

63.50

55736

Pelvis, ultrasound scan of, in association with saline infusion of the endometrial cavity, by any or all approaches, if:

(a) the patient is referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(c) the medical practitioner is not a member of a group of medical practitioners of which the providing practitioner is a member; and

(d) a previous transvaginal ultrasound has revealed an abnormality of the uterus or fallopian tube (R) (K)

127.00

55737

Pelvis, ultrasound scan of, in association with saline infusion of the endometrial cavity, by any or all approaches, if:

(a) the patient is not referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(c) a previous transvaginal ultrasound has revealed an abnormality of the uterus or fallopian tube (NR) (NK)

28.50

55739

Pelvis, ultrasound scan of, in association with saline infusion of the endometrial cavity, by any or all approaches, if:

(a) the patient is not referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(c) a previous transvaginal ultrasound has revealed an abnormality of the uterus or fallopian tube (NR) (K)

57.00

55759

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:

(a) the patient is referred by a medical practitioner; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) ultrasound of the same pregnancy confirms a multiple pregnancy; and

(d) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks gestation; and

(e) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(f) the service mentioned in item 55706, 55709, 55712, 55713, 55715, 55717, 55719, 55720, 55762 or 55763 is not performed in conjunction with the scan during the same pregnancy (R) (K)

150.00

55760

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:

(a) the patient is referred by a medical practitioner; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) ultrasound of the same pregnancy confirms a multiple pregnancy; and

(d) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks gestation; and

(e) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(f) the service mentioned in item 55706, 55709, 55712, 55713, 55715, 55717, 55719, 55720, 55762 or 55763 is not performed in conjunction with the scan during the same pregnancy (R) (NK)

75.00

55762

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:

(a) the patient is not referred by a medical practitioner; and

(b) ultrasound of the same pregnancy confirms a multiple pregnancy; and

(c) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks gestation; and

(d) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(e) the service mentioned in item 55706, 55709, 55712, 55713, 55715, 55717, 55719, 55720, 55759 or 55760 is not performed in conjunction with the scan during the same pregnancy (NR) (K)

60.00

55763

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:

(a) the patient is not referred by a medical practitioner; and

(b) ultrasound of the same pregnancy confirms a multiple pregnancy; and

(c) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks gestation; and

(d) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(e) the service mentioned in item 55706, 55709, 55712, 55713, 55715, 55717, 55719, 55720, 55759 or 55760 is not performed in conjunction with the scan during the same pregnancy (NR) (NK)

30.00

55764

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:

(a) the patient is referred by a medical practitioner who:

(i) is a Member or Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; or

(ii) has a Diploma of Obstetrics; or

(iii) has a qualification recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists as equivalent to a Diploma of Obstetrics; or

(iv) has obstetric privileges at a non‑metropolitan hospital; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) ultrasound of the same pregnancy confirms a multiple pregnancy; and

(d) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks gestation; and

(e) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(f) further examination is clinically indicated in the same pregnancy in which item 55759, 55760, 55762 or 55763 has been performed; and

(g) the service mentioned in item 55706, 55709, 55712, 55713, 55715, 55717, 55719 or 55720 is not performed in conjunction with the scan during the same pregnancy (R) (K)

160.00

55765

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:

(a) the patient is referred by a medical practitioner who:

(i) is a Member or Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; or

(ii) has a Diploma of Obstetrics; or

(iii) has a qualification recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists as equivalent to a Diploma of Obstetrics; or

(iv) has obstetric privileges at a non‑metropolitan hospital; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) ultrasound of the same pregnancy confirms a multiple pregnancy; and

(d) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks gestation; and

(e) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(f) further examination is clinically indicated in the same pregnancy in which item 55759, 55760, 55762 or 55763 has been performed; and

(g) the service mentioned in item 55706, 55709, 55712, 55713, 55715, 55717, 55719 or 55720 is not performed in conjunction with the scan during the same pregnancy (R) (NK)

80.00

55766

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, performed by or on behalf of a medical practitioner, who is a Member or Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, if:

(a) the patient is not referred by a medical practitioner; and

(b) ultrasound of the same pregnancy confirms a multiple pregnancy; and

(c) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and

(d) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(e) further examination is clinically indicated in the same pregnancy in which item 55759, 55760, 55762 or 55763 has been performed; and

(f) the service mentioned in item 55706, 55709, 55712, 55713, 55715, 55717, 55719 or 55720 is not performed in conjunction with the scan during the same pregnancy (NR) (K)

65.00

55767

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, performed by or on behalf of a medical practitioner, who is a Member or Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, if:

(a) the patient is not referred by a medical practitioner; and

(b) ultrasound of the same pregnancy confirms a multiple pregnancy; and

(c) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and

(d) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(e) further examination is clinically indicated in the same pregnancy in which item 55759, 55760, 55762 or 55763 has been performed; and

(f) the service mentioned in item 55706, 55709, 55712, 55713, 55715, 55717, 55719 or 55720 is not performed in conjunction with the scan during the same pregnancy (NR) (NK)

32.50

55768

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and

(b) the ultrasound confirms a multiple pregnancy; and

(c) the patient is referred by a medical practitioner; and

(d) the service is not performed in the same pregnancy as item 55770 or 55771; and

(e) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(f) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(g) the service mentioned in item 55718, 55721, 55722, 55723, 55724, 55725, 55726 or 55727 is not performed in conjunction with the scan during the same pregnancy (R) (K)

150.00

55769

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and

(b) the ultrasound confirms a multiple pregnancy; and

(c) the patient is referred by a medical practitioner; and

(d) the service is not performed in the same pregnancy as item 55770 or 55771; and

(e) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(f) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(g) the service mentioned in item 55718, 55721, 55722, 55723, 55724, 55725, 55726 or 55727 is not performed in conjunction with the scan during the same pregnancy (R) (NK)

75.00

55770

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and

(b) the ultrasound confirms a multiple pregnancy; and

(c) the patient is not referred by a medical practitioner; and

(d) the service is not performed in the same pregnancy as item 55768 or 55769; and

(e) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(f) the service mentioned in item 55718, 55721, 55722, 55723, 55724, 55725, 55726 or 55727 is not performed in conjunction with the scan during the same pregnancy (NR) (K)

60.00

55771

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and

(b) the ultrasound confirms a multiple pregnancy; and

(c) the patient is not referred by a medical practitioner; and

(d) the service is not performed in the same pregnancy as item 55768 or 55769; and

(e) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(f) the service mentioned in item 55718, 55721, 55722, 55723, 55724, 55725, 55726 or 55727 is not performed in conjunction with the scan during the same pregnancy (NR) (NK)

30.00

55772

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) dating of the pregnancy as confirmed by ultrasound is after 22 weeks of gestation; and

(b) the patient is referred by a medical practitioner who:

(i) is a Member or Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; or

(ii) has a Diploma of Obstetrics; or

(iii) has a qualification recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists as equivalent to a Diploma of Obstetrics; or

(iv) has obstetric privileges at a non‑metropolitan hospital; and

(c) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(d) further examination is clinically indicated in the same pregnancy to which item 55768, 55769, 55770 or 55771 has been performed; and

(e) the pregnancy as confirmed by ultrasound is a multiple pregnancy; and

(f) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(g) the service mentioned in item 55718, 55721, 55722, 55723, 55724, 55725, 55726 or 55727 is not performed in conjunction with the scan during the same pregnancy (R) (K)

160.00

55773

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) dating of the pregnancy as confirmed by ultrasound is after 22 weeks of gestation; and

(b) the patient is referred by a medical practitioner who:

(i) is a Member or Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; or

(ii) has a Diploma of Obstetrics; or

(iii) has a qualification recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists as equivalent to a Diploma of Obstetrics; or

(iv) has obstetric privileges at a non‑metropolitan hospital; and

(c) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(d) further examination is clinically indicated in the same pregnancy to which item 55768, 55769, 55770 or 55771 has been performed; and

(e) the pregnancy as confirmed by ultrasound is a multiple pregnancy; and

(f) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(g) the service mentioned in item 55718, 55721, 55722, 55723, 55724, 55725, 55726 or 55727 is not performed in conjunction with the scan during the same pregnancy (R) (NK)

80.00

55774

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, performed by or on behalf of a medical practitioner who is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, if:

(a) dating of the pregnancy as confirmed by ultrasound is after 22 weeks of gestation; and

(b) the patient is not referred by a medical practitioner; and

(c) further examination is clinically indicated in the same pregnancy to which item 55768, 55769, 55770 or 55771 has been performed; and

(d) the pregnancy as confirmed by ultrasound is a multiple pregnancy; and

(e) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(f) the service mentioned in item 55718, 55721, 55722, 55723, 55724, 55725, 55726 or 55727 is not performed in conjunction with the scan during the same pregnancy (NR) (K)

65.00

55775

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, performed by or on behalf of a medical practitioner who is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, if:

(a) dating of the pregnancy as confirmed by ultrasound is after 22 weeks of gestation; and

(b) the patient is not referred by a medical practitioner; and

(c) further examination is clinically indicated in the same pregnancy to which item 55768, 55769, 55770 or 55771 has been performed; and

(d) the pregnancy as confirmed by ultrasound is a multiple pregnancy; and

(e) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(f) the service mentioned in item 55718, 55721, 55722, 55723, 55724, 55725, 55726 or 55727 is not performed in conjunction with the scan during the same pregnancy (NR) (NK)

32.50

Subdivision DSubgroup 6 of Group I1: musculoskeletal ultrasound

2.1.7  Musculoskeletal ultrasound services—personal attendance

                   Items in this Subdivision apply to a musculoskeletal ultrasound service only if:

                     (a)  the medical practitioner responsible for the conduct and report of the examination personally attends during the performance of the scan and personally examines the patient; or

                     (b)  the service is performed, because of medical necessity, in a location that is more than 30 kilometres by the most direct road route from another practice where services that comply with paragraph (a) are available.

2.1.8  Musculoskeletal ultrasound services—comparison ultra‑sonography

                   The fee applicable for items in this Subdivision includes any views of another part of the patient taken for comparison purposes.

2.1.9  Musculoskeletal ultrasound services—equipment

                   Items in this Subdivision apply only to an ultrasound service performed using an ultrasound system that has available on‑site a transducer capable of operation at a frequency of at least 7.5 MHz.

 

Group I1—Ultrasound

Item

Description

Fee ($)

Subgroup 6—Musculoskeletal ultrasound

55800

Hand or wrist, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is referred by a medical practitioner or participating nurse practitioner; and

(c) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(d) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner (R) (K)

109.10

55801

Hand or wrist, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is referred by a medical practitioner or participating nurse practitioner; and

(c) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(d) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner (R) (NK)

54.55

55802

Hand or wrist, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is not referred by a medical practitioner or participating nurse practitioner (NR) (K)

37.85

55803

Hand or wrist, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is not referred by a medical practitioner or participating nurse practitioner (NR) (NK)

18.95

55804

Forearm or elbow, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is referred by a medical practitioner or participating nurse practitioner; and

(c) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(d) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner (R) (K)

109.10

55805

Forearm or elbow, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is referred by a medical practitioner or participating nurse practitioner; and

(c) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(d) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner (R) (NK)

54.55

55806

Forearm or elbow, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is not referred by a medical practitioner or participating nurse practitioner (NR) (K)

37.85

55807

Forearm or elbow, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is not referred by a medical practitioner or participating nurse practitioner (NR) (NK)

18.95

55808

Shoulder or upper arm, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is referred by a medical practitioner or participating nurse practitioner; and

(c) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(d) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner; and

(e) the service is used for the assessment of one or more of the following suspected or known conditions:

(i) an injury to a muscle, tendon or muscle/tendon junction;

(ii) rotator cuff tear, calcification or tendinosis (biceps, subscapular, supraspinatus, infraspinatus);

(iii) biceps subluxation;

(iv) capsulitis and bursitis;

(v) a mass, including a ganglion;

(vi) an occult fracture;

(vii) acromioclavicular joint pathology (R) (K)

109.10

55809

Shoulder or upper arm, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is referred by a medical practitioner or participating nurse practitioner; and

(c) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(d) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner; and

(e) the service is used for the assessment of one or more of the following suspected or known conditions:

(i) an injury to a muscle, tendon or muscle/tendon junction;

(ii) rotator cuff tear, calcification or tendinosis (biceps, subscapular, supraspinatus, infraspinatus);

(iii) biceps subluxation;

(iv) capsulitis and bursitis;

(v) a mass, including a ganglion;

(vi) an occult fracture;

(vii) acromioclavicular joint pathology (R) (NK)

54.55

 

55810

Shoulder or upper arm, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is not referred by a medical practitioner or participating nurse practitioner; and

(c) the service is used for the assessment of one or more of the following suspected or known conditions:

(i) an injury to a muscle, tendon or muscle/tendon junction;

(ii) rotator cuff tear, calcification or tendinosis (biceps, subscapular, supraspinatus, infraspinatus);

(iii) biceps subluxation;

(iv) capsulitis and bursitis;

(v) a mass, including a ganglion;

(vi) an occult fracture;

(vii) acromioclavicular joint pathology (NR) (K)

37.85

55811

Shoulder or upper arm, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is not referred by a medical practitioner or participating nurse practitioner; and

(c) the service is used for the assessment of one or more of the following suspected or known conditions:

(i) an injury to a muscle, tendon or muscle/tendon junction;

(ii) rotator cuff tear, calcification or tendinosis (biceps, subscapular, supraspinatus, infraspinatus);

(iii) biceps subluxation;

(iv) capsulitis and bursitis;

(v) a mass, including a ganglion;

(vi) an occult fracture;

(vii) acromioclavicular joint pathology (NR) (NK)

18.95

55812

Chest or abdominal wall, one or more areas, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is referred by a medical practitioner or participating nurse practitioner; and

(c) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(d) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner (R) (K)

109.10

55813

Chest or abdominal wall, one or more areas, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is referred by a medical practitioner or participating nurse practitioner; and

(c) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(d) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner (R) (NK)

54.55

55814

Chest or abdominal wall, one or more areas, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is not referred by a medical practitioner or participating nurse practitioner (NR) (K)

37.85

55815

Chest or abdominal wall, one or more areas, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is not referred by a medical practitioner or participating nurse practitioner (NR) (NK)

18.95

55816

Hip or groin, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is referred by a medical practitioner or participating nurse practitioner; and

(c) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(d) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner (R) (K)

109.10

55817

Hip or groin, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is referred by a medical practitioner or participating nurse practitioner; and

(c) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(d) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner (R) (NK)

54.55

55818

Hip or groin, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is not referred by a medical practitioner or participating nurse practitioner (NR) (K)

37.85

55819

Hip or groin, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is not referred by a medical practitioner or participating nurse practitioner (NR) (NK)

18.95

55820

Paediatric hip examination for dysplasia, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is referred by a medical practitioner or participating nurse practitioner; and

(c) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(d) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner (R) (K)

109.10

55821

Paediatric hip examination for dysplasia, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is referred by a medical practitioner or participating nurse practitioner; and

(c) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(d) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner (R) (NK)

54.55

55822

Paediatric hip examination for dysplasia one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is not referred by a medical practitioner or participating nurse practitioner (NR) (K)

37.85

55823

Paediatric hip examination for dysplasia one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is not referred by a medical practitioner or participating nurse practitioner (NR) (NK)

18.95

55824

Buttock or thigh, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is referred by a medical practitioner or participating nurse practitioner; and

(c) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(d) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner (R) (K)

109.10

55825

Buttock or thigh, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is referred by a medical practitioner or participating nurse practitioner; and

(c) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(d) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner (R) (NK)

54.55

55826

Buttock or thigh, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is not referred by a medical practitioner or participating nurse practitioner (NR) (K)

37.85

55827

Buttock or thigh, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is not referred by a medical practitioner or participating nurse practitioner (NR) (NK)

18.95

55828

Knee, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is referred by a medical practitioner or participating nurse practitioner; and

(c) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(d) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner; and

(e) the service is used for the assessment of one or more of the following suspected or known conditions:

(i) abnormality of tendons or bursae about the knee;

(ii) a meniscal cyst, popliteal fossa cyst, mass or pseudomass;

(iii) a nerve entrapment or a nerve or nerve sheath tumour;

(iv) an injury of collateral ligaments (R) (K)

109.10

55829

Knee, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is referred by a medical practitioner or participating nurse practitioner; and

(c) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(d) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner; and

(e) the service is used for the assessment of one or more of the following suspected or known conditions:

(i) abnormality of tendons or bursae about the knee;

(ii) a meniscal cyst, popliteal fossa cyst, mass or pseudomass;

(iii) a nerve entrapment or a nerve or nerve sheath tumour;

(iv) an injury of collateral ligaments (R) (NK)

54.55

55830

Knee, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is not referred by a medical practitioner or participating nurse practitioner; and

(c) the service is used for the assessment of one or more of the following suspected or known conditions:

(i) abnormality of tendons or bursae about the knee;

(ii) a meniscal cyst, popliteal fossa cyst, mass or pseudomass;

(iii) a nerve entrapment or a nerve or nerve sheath tumour;

(iv) an injury of collateral ligaments (NR) (K)

37.85

55831

Knee, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is not referred by a medical practitioner or participating nurse practitioner; and

(c) the service is used for the assessment of one or more of the following suspected or known conditions:

(i) abnormality of tendons or bursae about the knee;

(ii) a meniscal cyst, popliteal fossa cyst, mass or pseudomass;

(iii) a nerve entrapment or a nerve or nerve sheath tumour;

(iv) an injury of collateral ligaments (NR) (NK)

18.95

55832

Lower leg, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is referred by a medical practitioner or participating nurse practitioner; and

(c) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(d) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner (R) (K)

109.10

55833

Lower leg, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is referred by a medical practitioner or participating nurse practitioner; and

(c) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(d) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner (R) (NK)

54.55

55834

Lower leg, one or both sides, ultrasound scan of, performed by or on behalf of a medical practitioner, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is not referred by a medical practitioner or participating nurse practitioner (NR) (K)

37.85

55835

Lower leg, one or both sides, ultrasound scan of, performed by or on behalf of a medical practitioner, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is not referred by a medical practitioner or participating nurse practitioner (NR) (NK)

18.95

55836

Ankle or hind foot, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is referred by a medical practitioner, participating nurse practitioner or podiatrist; and

(c) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(d) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner (R) (K)

109.10

55837

Ankle or hind foot, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is referred by a medical practitioner, participating nurse practitioner or podiatrist; and

(c) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(d) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner (R) (NK)

54.55

55838

Ankle or hind foot, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is not referred by a medical practitioner or participating nurse practitioner (NR) (K)

37.85

55839

Ankle or hind foot, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is not referred by a medical practitioner or participating nurse practitioner (NR) (NK)

18.95

55840

Mid foot or fore foot, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is referred by a medical practitioner, participating nurse practitioner or podiatrist; and

(c) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(d) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner (R) (K)

109.10

55841

Mid foot or fore foot, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is referred by a medical practitioner, participating nurse practitioner or podiatrist; and

(c) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(d) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner (R) (NK)

54.55

55842

Mid foot or fore foot, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is not referred by a medical practitioner or participating nurse practitioner (NR) (K)

37.85

55843

Mid foot or fore foot, one or both sides, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is not referred by a medical practitioner or participating nurse practitioner (NR) (NK)

18.95

55844

Assessment of a mass associated with the skin or subcutaneous structures, not being a part of the musculoskeletal system, one or more areas, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is referred by a medical practitioner, participating nurse practitioner or podiatrist; and

(c) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(d) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner (R) (K)

87.35

55845

Assessment of a mass associated with the skin or subcutaneous structures, not being a part of the musculoskeletal system, one or more areas, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is referred by a medical practitioner, participating nurse practitioner or podiatrist; and

(c) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(d) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner (R) (NK)

43.70

55846

Assessment of a mass associated with the skin or subcutaneous structures, not being a part of the musculoskeletal system, one or more areas, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is not referred by a medical practitioner or participating nurse practitioner (NR) (K)

37.85

55847

Assessment of a mass associated with the skin or subcutaneous structures, not being a part of the musculoskeletal system, one or more areas, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is not referred by a medical practitioner or participating nurse practitioner (NR) (NK)

18.95

55848

Musculoskeletal cross‑sectional echography, in conjunction with a surgical procedure using interventional techniques, not being a service associated with a service to which any other item in this group applies, and not performed in conjunction with item 55026 or 55054 (R) (K)

109.10

55849

Musculoskeletal cross‑sectional echography, in conjunction with a surgical procedure using interventional techniques, not being a service associated with a service to which any other item in this group applies, and not performed in conjunction with item 55026 or 55054 (R) (NK)

54.55

55850

Musculoskeletal cross‑sectional echography, in conjunction with a surgical procedure using interventional techniques, inclusive of a diagnostic musculoskeletal ultrasound service, if:

(a) the patient is referred by a medical practitioner or participating nurse practitioner; and

(b) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial relationship with the providing practitioner; and

(d) the medical practitioner or nurse practitioner has indicated on a referral for a musculoskeletal ultrasound that an ultrasound guided intervention be performed if clinically indicated; and

(e) the service is not performed in conjunction with item 55026, 55054 or 55800 to 55849 (R) (K)

152.85

55851

Musculoskeletal cross‑sectional echography, in conjunction with a surgical procedure using interventional techniques, inclusive of a diagnostic musculoskeletal ultrasound service, if:

(a) the patient is referred by a medical practitioner or participating nurse practitioner; and

(b) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial relationship with the providing practitioner; and

(d) the medical practitioner or nurse practitioner has indicated on a referral for a musculoskeletal ultrasound that an ultrasound guided intervention be performed if clinically indicated; and

(e) the service is not performed in conjunction with item 55026, 55054 or 55800 to 55849 (R) (NK)

76.45

55852

Paediatric spine, spinal cord and overlying subcutaneous tissues, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is referred by a medical practitioner or participating nurse practitioner; and

(c) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(d) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner (R) (K)

109.10

55853

Paediatric spine, spinal cord and overlying subcutaneous tissues, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is referred by a medical practitioner or participating nurse practitioner; and

(c) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(d) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner (R) (NK)

54.55

55854

Paediatric spine, spinal cord and overlying subcutaneous tissues, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is not referred by a medical practitioner or participating nurse practitioner (NR) (K)

37.85

55855

Paediatric spine, spinal cord and overlying subcutaneous tissues, ultrasound scan of, if:

(a) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(b) the patient is not referred by a medical practitioner or participating nurse practitioner (NR) (NK)

18.95

Division 2.2Group I2: computed tomography (examination)

2.2.1  CT services—eligible services

             (1)  Items in this Division (other than items 57360 and 57361) apply to a CT service that is:

                     (a)  performed under the professional supervision of a specialist in the specialty of diagnostic radiology who is available:

                              (i)  to monitor and influence the conduct and diagnostic quality of the examination; and

                             (ii)  if necessary, to attend on the patient personally; and

                     (b)  reported by a specialist in the specialty of diagnostic radiology.

             (2)  Items 57360 and 57361 apply to a CT service that is:

                     (a)  performed under the professional supervision of a specialist or consultant physician who is recognised by the Conjoint Committee for the Recognition of Training in CT Coronary Angiography and available:

                              (i)  to monitor and influence the conduct and diagnostic quality of the examination; and

                             (ii)  if necessary, to attend on the patient personally; and

                     (b)  reported by a specialist or consultant physician who is recognised by the Conjoint Committee for the Recognition of Training in CT Coronary Angiography.

             (3)  However, items in this Division apply to a CT service that does not comply with the requirements mentioned in subclause (1) or (2) if the service is performed:

                     (a)  in an emergency; or

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

2.2.2  CT services—exclusion of attenuation correction and anatomical correlation

                   Items in this Division do not apply to a CT service that is performed for the purpose of attenuation correction or anatomical correlation of another diagnostic imaging procedure.

2.2.3  CT services—exclusion of acoustic neuroma

                   If an axial scan is performed for the exclusion of acoustic neuroma, item 56001 or 56007 applies instead of any other item in this table that might be taken to apply to the service.

2.2.4  CT services—assessment of headache

             (1)  If the service mentioned in item 56007 or 56047 is used for the assessment of a headache of a patient to whom this clause applies, the fee mentioned in the item applies only if:

                     (a)  a scan without intravenous contrast medium has been performed on the patient; and

                     (b)  the service is required because the result of the scan is abnormal.

             (2)  This clause applies to a patient who:

                     (a)  is under 50 years; and

                     (b)  is (apart from the headache) otherwise well; and

                     (c)  has no localising symptoms or signs; and

                     (d)  has no history of malignancy or immunosuppression.

2.2.5  CT services—number of services

                   Items 56220 to 56240 and 56619 to 56665 apply once only for a service mentioned in any of those items, regardless of the number of patient attendances required to complete the service.

2.2.6  Cone beam computed tomography—items 57362 and 57363

                   Item 57362 or 57363 applies to a service described in the item only if:

                     (a)  the service is performed with diagnostic imaging equipment that is not used to perform any other diagnostic imaging service; and

                     (b)  the equipment is located in a practice accredited under a diagnostic imaging accreditation scheme; and

                     (c)  the service is requested by a dental specialist.

 

Group I2—Computed tomography—examination

Item

Description

Fee ($)

56001

Computed tomography—scan of brain without intravenous contrast medium, not being a service to which item 57001 applies (R) (K) (Anaes.)

195.05

56007

Computed tomography—scan of brain with intravenous contrast medium and with any scans of the brain before intravenous contrast injection, when performed, not being a service to which item 57007 applies (R) (K) (Anaes.)

250.00

56010

Computed tomography—scan of pituitary fossa with or without intravenous contrast medium and with or without brain scan when performed (R) (K) (Anaes.)

252.10

56013

Computed tomography—scan of orbits with or without intravenous contrast medium and with or without brain scan when performed (R) (K) (Anaes.)

250.00

56016

Computed tomography—scan of petrous bones in axial and coronal planes in 1 mm or 2 mm sections, with or without intravenous contrast medium, with or without scan of brain (R) (K) (Anaes.)

290.00

56022

Computed tomography—scan of facial bones, para nasal sinuses or both without intravenous contrast medium (R) (K) (Anaes.)

225.00

56028

Computed tomography—scan of facial bones, para nasal sinuses or both with intravenous contrast medium and with any scans of the facial bones, para nasal sinuses or both before intravenous contrast injection, when performed (R) (K) (Anaes.)

336.80

56030

Computed tomography—scan of facial bones, para nasal sinuses or both, with scan of brain, without intravenous contrast medium (R) (K) (Anaes.)

225.00

56036

Computed tomography—scan of facial bones, para nasal sinuses or both, with scan of brain, with intravenous contrast medium, if:

(a) a scan without intravenous contrast medium has been performed; and

(b) the service is required because the result of the scan mentioned in paragraph (a) is abnormal (R) (K) (Anaes.)

336.80

56041

Computed tomography—scan of brain without intravenous contrast medium, not being a service to which item 57041 applies (R) (NK) (Anaes.)

98.75

56047

Computed tomography—scan of brain with intravenous contrast medium and with any scans of the brain before intravenous contrast injection, when performed, not being a service to which item 57047 applies (R) (NK) (Anaes.)

126.10

56050

Computed tomography—scan of pituitary fossa with or without intravenous contrast medium and with or without brain scan when performed (R) (NK) (Anaes.)

128.20

56053

Computed tomography—scan of orbits with or without intravenous contrast medium and with or without brain scan when performed (R) (NK) (Anaes.)

128.20

56056

Computed tomography—scan of petrous bones in axial and coronal planes in 1 mm or 2 mm sections, with or without intravenous contrast medium, with or without scan of brain (R) (NK) (Anaes.)

155.45

56062

Computed tomography—scan of facial bones, para nasal sinuses or both without intravenous contrast medium (R) (NK) (Anaes.)

113.15

56068

Computed tomography—scan of facial bones, para nasal sinuses or both with intravenous contrast medium and with any scans of the facial bones, para nasal sinuses or both before intravenous contrast injection, when performed (R) (NK) (Anaes.)

168.40

56070

Computed tomography—scan of facial bones, para nasal sinuses or both, with scan of brain, without intravenous contrast medium (R) (NK) (Anaes.)

113.15

56076

Computed tomography—scan of facial bones, para nasal sinuses or both, with scan of brain, with intravenous contrast medium, if:

(a) a scan without intravenous contrast medium has been performed; and

(b) the service is required because the result of the scan mentioned in paragraph (a) is abnormal (R) (NK) (Anaes.)

168.40

56101

Computed tomography—scan of soft tissues of neck, including larynx, pharynx, upper oesophagus and salivary glands (not associated with cervical spine) without intravenous contrast medium, not being a service to which item 56801 applies (R) (K) (Anaes.)

230.00

56107

Computed tomography—scan of soft tissues of neck, including larynx, pharynx, upper oesophagus and salivary glands (not associated with cervical spine)—with intravenous contrast medium and with any scans of soft tissues of neck, including larynx, pharynx, upper oesophagus and salivary glands (not associated with cervical spine) before intravenous contrast injection, when undertaken, not being a service associated with a service to which item 56807 applies (R) (K) (Anaes.)

340.00

56141

Computed tomography—scan of soft tissues of neck, including larynx, pharynx, upper oesophagus and salivary glands (not associated with cervical spine) without intravenous contrast medium, not being a service to which item 56841 applies (R) (NK) (Anaes.)

116.45

56147

Computed tomography—scan of soft tissues of neck, including larynx, pharynx, upper oesophagus and salivary glands (not associated with cervical spine)—with intravenous contrast medium and with any scans of soft tissues of neck, including larynx, pharynx, upper oesophagus and salivary glands (not associated with cervical spine) before intravenous contrast injection, when performed, not being a service associated with a service to which item 56847 applies (R) (NK) (Anaes.)

171.60

56219

Computed tomography—scan of spine, one or more regions with intrathecal contrast medium, including the preparation for intrathecal injection of contrast medium and any associated plain X‑rays, not being a service to which item 59724 or 59275 applies (R) (K) (Anaes.)

326.20

56220

Computed tomography—scan of spine, cervical region, without intravenous contrast medium (R) (K) (Anaes.)

240.00

56221

Computed tomography—scan of spine, thoracic region, without intravenous contrast medium (R) (K) (Anaes.)

240.00

56223

Computed tomography—scan of spine, lumbosacral region, without intravenous contrast medium (R) (K) (Anaes.)

240.00

56224

Computed tomography—scan of spine, cervical region, with intravenous contrast medium and with any scans of the cervical region of the spine before intravenous contrast injection when undertaken (R) (K) (Anaes.)

351.40

56225

Computed tomography—scan of spine, thoracic region, with intravenous contrast medium and with any scans of the thoracic region of the spine before intravenous contrast injection when undertaken (R) (K) (Anaes.)

351.40

56226

Computed tomography—scan of spine, lumbosacral region, with intravenous contrast medium and with any scans of the lumbosacral region of the spine prior to intravenous contrast injection when undertaken (R) (K) (Anaes.)

351.40

56227

Computed tomography—scan of spine, cervical region, without intravenous contrast medium (R) (NK) (Anaes.)

122.50

56228

Computed tomography—scan of spine, thoracic region, without intravenous contrast medium (R) (NK) (Anaes.)

122.50

56229

Computed tomography—scan of spine, lumbosacral region, without intravenous contrast medium (R) (NK) (Anaes.)

122.50

56230

Computed tomography—scan of spine, cervical region, with intravenous contrast medium and with any scans to the cervical region of the spine before intravenous contrast injection when undertaken (R) (NK) (Anaes.)

177.45

56231

Computed tomography—scan of spine, thoracic region, with intravenous contrast medium and with any scans to the cervical region of the spine before intravenous contrast injection when undertaken (R) (NK) (Anaes.)

177.45

56232

Computed tomography—scan of spine, lumbosacral region, with intravenous contrast medium and with any scans to the lumbosacral region of the spine before intravenous contrast injection when undertaken (R) (NK) (Anaes.)

177.45

56233

Computed tomography—scan of spine, 2 examinations of the kind referred to in items 56220, 56221 and 56223, without intravenous contrast medium (R) (K) (Anaes.)

240.00

56234

Computed tomography—scan of spine, 2 examinations of the kind referred to in items 56224, 56225 and 56226, with intravenous contrast medium and with any scans of these regions of the spine before intravenous contrast injection when undertaken (R) (K) (Anaes.)

351.40

56235

Computed tomography—scan of spine, 2 examinations of the kind referred to in items 56227, 56228 and 56229, without intravenous contrast medium (R) (NK) (Anaes.)

122.45

56236

Computed tomography—scan of spine, 2 examinations of the kind referred to in items 56230, 56231 and 56232, with intravenous contrast medium and with any scans of these regions of the spine before intravenous contrast injection when undertaken (R) (NK) (Anaes.)

177.45

56237

Computed tomography—scan of spine, 3 regions cervical, thoracic and lumbosacral, without intravenous contrast medium (R) (K) (Anaes.)

240.00

56238

Computed tomography—scan of spine, 3 regions, cervical, thoracic and lumbosacral, with intravenous contrast medium and with any scans of these regions of the spine before intravenous contrast injection when undertaken (R) (K) (Anaes.)

351.40

56239

Computed tomography—scan of spine, 3 regions, cervical, thoracic and lumbosacral, without intravenous contrast medium (R) (NK) (Anaes.)

122.45

56240

Computed tomography—scan of spine, 3 regions, cervical, thoracic and lumbosacral, with intravenous contrast medium and with any scans of these regions of the spine before intravenous contrast injection when undertaken (R) (NK) (Anaes.)

177.45

56259

Computed tomography—scan of spine, one or more regions with intrathecal contrast medium, including the preparation for intrathecal injection of contrast medium and any associated plain X‑rays, not being a service to which item 59724 or 59275 applies (R) (NK) (Anaes.)

164.80

56301

Computed tomography—scan of chest, including lungs, mediastinum, chest wall and pleura, with or without scans of the upper abdomen, without intravenous contrast medium, not being a service to which item 56801 or 57001 applies and not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (K) (Anaes.)

295.00

56307

Computed tomography—scan of chest, including lungs, mediastinum, chest wall and pleura, with or without scans of the upper abdomen, with intravenous contrast medium and with any scans of the chest, including lungs, mediastinum, chest wall or pleura and upper abdomen before intravenous contrast injection, when undertaken, not being a service to which item 56807 or 57007 applies and not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (K) (Anaes.)

400.00

56341

Computed tomography—scan of chest, including lungs, mediastinum, chest wall and pleura, with or without scans of the upper abdomen, without intravenous contrast medium, not being a service to which item 56841 or 57041 applies and not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (NK) (Anaes.)

149.45

56347

Computed tomography—scan of chest, including lungs, mediastinum, chest wall and pleura, with or without scans of the upper abdomen, with intravenous contrast medium and with any scans of the chest, including lungs, mediastinum, chest wall or pleura and upper abdomen before intravenous contrast injection, when undertaken, not being a service to which item 56847 or 57047 applies and not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (NK) (Anaes.)

202.00

56401

Computed tomography—scan of upper abdomen only (diaphragm to iliac crest) without intravenous contrast medium, not being a service to which item 56301, 56501, 56801 or 57001 applies (R) (K) (Anaes.)

250.00

56407

Computed tomography—scan of upper abdomen only (diaphragm to iliac crest), with intravenous contrast medium, and with any scans of upper abdomen (diaphragm to iliac crest) before intravenous contrast injection, when undertaken, not being a service to which item 56307, 56507, 56807 or 57007 applies (R) (K) (Anaes.)

360.00

56409

Computed tomography—scan of pelvis only (iliac crest to pubic symphysis) without intravenous contrast medium not being a service associated with a service to which item 56401 applies (R) (K) (Anaes.)

250.00

56412

Computed tomography—scan of pelvis only (iliac crest to pubic symphysis), with intravenous contrast medium and with any scans of pelvis (iliac crest to pubic symphysis) before intravenous contrast injection, when undertaken, not being a service to which item 56407 applies (R) (K) (Anaes.)

360.00

56441

Computed tomography—scan of upper abdomen only (diaphragm to iliac crest) without intravenous contrast medium, not being a service to which item 56341, 56541, 56841 or 57041 applies (R) (NK) (Anaes.)

126.80

56447

Computed tomography—scan of upper abdomen only (diaphragm to iliac crest), with intravenous contrast medium, and with any scans of upper abdomen (diaphragm to iliac crest) before intravenous contrast injection, when performed, not being a service to which item 56347, 56547, 56847 or 57047 applies (R) (NK) (Anaes.)

181.50

56449

Computed tomography—scan of pelvis only (iliac crest to pubic symphysis) without intravenous contrast medium not being a service associated with a service to which item 56441 applies (R) (NK) (Anaes.)

126.80

56452

Computed tomography—scan of pelvis only (iliac crest to pubic symphysis), with intravenous contrast medium and with any scans of pelvis (iliac crest to pubic symphysis) before intravenous contrast injection, when undertaken, not being a service to which item 56447 applies (R) (NK) (Anaes.)

181.50

56501

Computed tomography—scan of upper abdomen and pelvis without intravenous contrast medium, not for the purposes of virtual colonoscopy and not being a service to which item 56801 or 57001 applies (R) (K) (Anaes.)

385.00

56507

Computed tomography—scan of upper abdomen and pelvis with intravenous contrast medium and with any scans of upper abdomen and pelvis before intravenous contrast injection, when performed, not for the purposes of virtual colonoscopy and not being a service to which item 56807 or 57007 applies (R) (K) (Anaes.)

480.05

56541

Computed tomography—scan of upper abdomen and pelvis without intravenous contrast medium, not for the purposes of virtual colonoscopy and not being a service to which item 56841 or 57041 applies (R) (NK) (Anaes.)

193.15

56547

Computed tomography—scan of upper abdomen and pelvis with intravenous contrast medium and with any scans of upper abdomen and pelvis before intravenous contrast injection, when performed, not for the purposes of virtual colonoscopy and not being a service to which item 56847 or 57047 applies (R) (NK) (Anaes.)

243.75

56552

Computed tomography—scan of colon for exclusion of colorectal neoplasia in symptomatic or high risk patients if:

(a) the patient has had an incomplete colonoscopy in the 3 months before the scan; and

(b) the date of incomplete colonoscopy is set out on the request for scan; and

(c) the service is not a service to which item 56301, 56307, 56401, 56407, 56409, 56412, 56501, 56507, 56801, 56807 or 57001 applies (R) (K) (Anaes.)

600.00

56554

Computed tomography—scan of colon for exclusion of colorectal neoplasia in symptomatic or high risk patients if:

(a) the request for scan states that one of the following contraindications to colonoscopy is present:

(i) suspected perforation of the colon;

(ii) complete or high‑grade obstruction that will not allow passage of the scope; and

(b) the service must not be a service to which item 56301, 56307, 56401, 56407, 56409, 56412, 56501, 56507, 56801, 56807 or 57001 applies (R) (K) (Anaes.)

600.00

56619

Computed tomography—scan of extremities, one or more regions without intravenous contrast medium (R) (K) (Anaes.)

220.00

56625

Computed tomography—scan of extremities, one or more regions with intravenous contrast medium and with any scans of extremities before intravenous contrast injection, when performed (R) (K) (Anaes.)

334.65

56659

Computed tomography—scan of extremities, one or more regions without intravenous contrast medium (R) (NK) (Anaes.)

112.10

56665

Computed tomography—scan of extremities, one or more regions with intravenous contrast medium and with any scans of extremities before intravenous contrast injection, when performed (R) (NK) (Anaes.)

167.40

56801

Computed tomography—scan of chest, abdomen and pelvis with or without scans of soft tissues of neck without intravenous contrast medium, not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (K) (Anaes.)

466.55

56807

Computed tomography—scan of chest, abdomen and pelvis with or without scans of soft tissues of neck with intravenous contrast medium and with any scans of chest, abdomen and pelvis with or without scans of soft tissue of neck before intravenous contrast injection, when performed, not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (K) (Anaes.)

560.00

56841

Computed tomography—scan of chest, abdomen and pelvis with or without scans of soft tissues of neck without intravenous contrast medium, not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (NK) (Anaes.)

233.35

56847

Computed tomography—scan of chest, abdomen and pelvis with or without scans of soft tissues of neck with intravenous contrast medium and with any scans of chest, abdomen and pelvis with or without scans of soft tissue of neck before intravenous contrast injection, when performed, not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (NK) (Anaes.)

283.85

57001

Computed tomography—scan of brain and chest with or without scans of upper abdomen without intravenous contrast medium, not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (K) (Anaes.)

466.65

57007

Computed tomography—scan of brain and chest with or without scans of upper abdomen with intravenous contrast medium and with any scans of brain and chest and upper abdomen before intravenous contrast injection, when performed, not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (K) (Anaes.)

567.75

57041

Computed tomography—scan of brain and chest with or without scans of upper abdomen without intravenous contrast medium, not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (NK) (Anaes.)

233.40

57047

Computed tomography—scan of brain and chest with or without scans of upper abdomen with intravenous contrast medium and with any scans of brain and chest and upper abdomen before intravenous contrast injection, when performed, not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (NK) (Anaes.)

283.90

57201

Computed tomography—pelvimetry (R) (K) (Anaes.)

155.20

57247

Computed tomography—pelvimetry (R) (NK) (Anaes.)

77.55

57341

Computed tomography, in conjunction with a surgical procedure using interventional techniques, not being a service associated with a service to which another item in this table applies (R) (K) (Anaes.)

470.00

57345

Computed tomography, in conjunction with a surgical procedure using interventional techniques, not being a service associated with a service to which another item in this table applies (R) (NK) (Anaes.)

241.60

57350

Computed tomography—spiral angiography with intravenous contrast medium including any scans performed before intravenous contrast injection—one or more spiral data acquisitions, including image editing, and maximum intensity projections or 3 dimensional surface shaded display, with hardcopy recording of multiple projections, if:

(a) the service is not a service to which another item in this group applies; and

(b) the service is performed for the exclusion of arterial stenosis, occlusion, aneurysm or embolism; and

(c) the service has not been performed on the same patient within the previous 12 months; and

(d) the service is not a study performed to image the coronary arteries (R) (K) (Anaes.)

510.00

57351

Computed tomography—spiral angiography with intravenous contrast medium, including any scans performed before intravenous contrast injection—one or more spiral data acquisitions, including image editing, and maximum intensity projections or 3 dimensional surface shaded display, with hardcopy recording of multiple projections, if:

(a) the service is not a service to which another item in this group applies; and

(b) the service is performed for the exclusion of acute or recurrent pulmonary embolism, acute symptomatic arterial occlusion, post‑operative complication of arterial surgery, acute ruptured aneurysm, or acute dissection of the aorta, carotid or vertebral artery; and

(c) a service to which item 57350 or 57355 applies has been performed on the same patient within the previous 12 months; and

(d) the service is not a study performed to image the coronary arteries (R) (K) (Anaes.)

510.00

57355

Computed tomography—spiral angiography with intravenous contrast medium including any scans performed before intravenous contrast injection—one or more spiral data acquisitions, including image editing, and maximum intensity projections or 3 dimensional surface shaded display, with hardcopy recording of multiple projections, if:

(a) the service is not a service to which another item in this group applies; and

(b) the service is performed for the exclusion of arterial stenosis, occlusion, aneurysm or embolism; and

(c) the service has not been performed on the same patient within the previous 12 months; and

(d) the service is not a study performed to image the coronary arteries (R) (NK) (Anaes.)

264.15

57356

Computed tomography—spiral angiography with intravenous contrast medium, including any scans performed before intravenous contrast injection—one or more spiral data acquisitions, including image editing, and maximum intensity projections or 3 dimensional surface shaded display, with hardcopy recording of multiple projections, if:

(a) the service is not a service to which another item in this group applies; and

(b) the service is performed for the exclusion of acute or recurrent pulmonary embolism, acute symptomatic arterial occlusion, post‑operative complication of arterial surgery, acute ruptured aneurysm, or acute dissection of the aorta, carotid or vertebral artery; and

(c) the service to which item 57350 or 57355 applies has been performed on the same patient within the previous 12 months; and

(d) the service is not a study performed to image the coronary arteries (R) (NK) (Anaes.)

264.15

57360

Computed tomography of the coronary arteries performed on a minimum of a 64 slice (or equivalent) scanner if:

(a) the request is made by a specialist or consultant physician; and

(b) one of the following subparagraphs applies to the patient:

(i) the patient has stable symptoms consistent with coronary ischaemia, is at low to intermediate risk of coronary artery disease and would have been considered for coronary angiography;

(ii) the patient requires exclusion of coronary artery anomaly or fistula;

(iii) the patient will be undergoing non‑coronary cardiac surgery (R) (K) (Anaes.)

700.00

57361

Computed tomography of the coronary arteries performed on a minimum of a 64 slice (or equivalent) scanner if:

(a) the request is made by a specialist or consultant physician; and

(b) one of the following applies to the patient:

(i) the patient has stable symptoms consistent with coronary ischaemia, is at low to intermediate risk of coronary artery disease and would have been considered for coronary angiography;

(ii) the patient requires exclusion of coronary artery anomaly or fistula;

(iii) the patient will be undergoing non‑coronary cardiac surgery (R) (NK) (Anaes.)

350.00

57362

Cone beam computed tomography—dental and temporo‑mandibular joint imaging (without contrast medium) for diagnosis and management of any of the following:

(a) mandibular and dento‑alveolar fractures;

(b) dental implant planning;

(c) orthodontics;

(d) endodontic conditions;

(e) periodontal conditions;

(f) temporo‑mandibular joint conditions

Payable once per patient per day, not being for a service to which any of items 57959 to 57969 apply, and not being a service associated with another service in Group I2 (R) (K) (Anaes.)

113.15

57363

Cone beam computed tomography—dental and temporo‑mandibular joint imaging (without contrast medium) for diagnosis and management of any of the following:

(a) mandibular and dento‑alveolar fractures;

(b) dental implant planning;

(c) orthodontics;

(d) endodontic conditions;

(e) periodontal conditions;

(f) temporo‑mandibular joint conditions

Payable once per patient per day, not being for a service to which any of items 57959 to 57969 apply, and not being a service associated with services in Group I2 (R) (NK) (Anaes.)

56.60

Division 2.3Group I3: diagnostic radiology

Subdivision AGeneral

2.3.1  Who must perform diagnostic imaging procedure

             (1)  For a service mentioned in an item in Subdivision B, D, E or G of this Division, a diagnostic imaging procedure must be performed by:

                     (a)  a medical practitioner; or

                     (b)  a person registered as a medical radiation practitioner under a law of a State or Territory who:

                              (i)  is employed by a medical practitioner; or

                             (ii)  provides the service under the supervision of a medical practitioner in accordance with accepted medical practice.

             (2)  However, for a service mentioned in items 57901 to 57969, a diagnostic imaging procedure may also be performed by a dental practitioner who:

                     (a)  may request the service because of the operation of subsection 16B(2) of the Act; and

                     (b)  either:

                              (i)  is employed by a medical practitioner; or

                             (ii)  provides the service under the supervision of a medical practitioner in accordance with accepted medical practice.

             (3)  Subclauses (1) and (2) do not apply if the procedure is performed:

                     (a)  in RA2, RA3 or RA4; or

                     (b)  in:

                              (i)  RA1; and

                             (ii)  RRMA4 or RRMA5.

Subdivision BSubgroups 1 to 9 of Group I3

 

Group I3—Diagnostic radiology

Item

Description

Fee ($)

Subgroup 1—Radiographic examination of extremities

57506

Hand, wrist, forearm, elbow or humerus (NR) (K)

29.75

57509

Hand, wrist, forearm, elbow or humerus (R) (K)

39.75

57512

Hand and wrist, or hand, wrist and forearm, or forearm and elbow, or elbow and humerus (NR) (K)

40.50

57515

Hand and wrist, or hand, wrist and forearm, or forearm and elbow, or elbow and humerus (R) (K)

54.00

57518

Foot, ankle, leg, knee or femur (NR) (K)

32.50

57521

Foot, ankle, leg, knee or femur (R) (K)

43.40

57524

Foot and ankle, or ankle and leg, or leg and knee, or knee and femur (NR) (K)

49.40

57527

Foot and ankle, or ankle and leg, or leg and knee, or knee and femur (R) (K)

65.75

57529

Hand, wrist, forearm, elbow or humerus (NR) (NK)

14.90

57530

Hand, wrist, forearm, elbow or humerus (R) (NK)

19.90

57532

Hand and wrist, or hand, wrist and forearm, or forearm and elbow, or elbow and humerus (NR) (NK)

20.25

57533

Hand and wrist, or hand, wrist and forearm, or forearm and elbow, or elbow and humerus (R) (NK)

27.00

57535

Foot, ankle, leg, knee or femur (NR) (NK)

16.25

57536

Foot, ankle, leg, knee or femur (R) (NK)

21.70

57538

Foot and ankle, or ankle and leg, or leg and knee, or knee and femur (NR) (NK)

24.70

57539

Foot and ankle, or ankle and leg, or leg and knee, or knee and femur (R) (NK)

32.90

Subgroup 2—Radiographic examination of shoulder or pelvis

57700

Shoulder or scapula (NR) (K)

40.50

57702

Shoulder or scapula (NR) (NK)

20.25

57703

Shoulder or scapula (R) (K)

54.00

57705

Shoulder or scapula (R) (NK)

27.00

57706

Clavicle (NR) (K)

32.50

57708

Clavicle (NR) (NK)

16.25

57709

Clavicle (R) (K)

43.40

57711

Clavicle (R) (NK)

21.70

57712

Hip joint (R) (K)

47.15

57714

Hip joint (R) (NK)

23.60

57715

Pelvic girdle (R) (K)

60.90

57717

Pelvic girdle (R) (NK)

30.45

57721

Femur, internal fixation of neck or intertrochanteric (pertrochanteric) fracture (R) (K)

99.25

57723

Femur, internal fixation of neck or intertrochanteric (pertrochanteric) fracture (R) (NK)

49.65

Subgroup 3—Radiographic examination of head

57901

Skull, not in association with item 57902 or 57914 (R) (K)

64.50

57902

Cephalometry, not in association with item 57901 or 57911 (R) (K)

64.50

57903

Sinuses (R) (K)

47.30

57906

Mastoids (R) (K)

64.50

57909

Petrous temporal bones (R) (K)

64.50

57911

Skull, not in association with item 57902 or 57914 (R) (NK)

32.25

57912

Facial bones—orbit, maxilla or malar, any or all (R) (K)

47.15

57914

Cephalometry, not in association with item 57901 or 57911 (R) (NK)

32.25

57915

Mandible, not by orthopantomography technique (R) (K)

47.15

57917

Sinuses (R) (NK)

23.65

57918

Salivary calculus (R) (K)

47.15

57920

Mastoids (R) (NK)

32.25

57921

Nose (R) (K)

47.15

57923

Petrous temporal bones (R) (NK)

32.25

57924

Eye (R) (K)

47.15

57926

Facial bones—orbit, maxilla or malar, any or all (R) (NK)

23.60

57927

Temporo‑mandibular joints (R) (K)

49.65

57929

Mandible, not by orthopantomography technique (R) (NK)

23.60

57930

Teeth—single area (R) (K)

32.90

57932

Salivary calculus (R) (NK)

23.60

57933

Teeth—full mouth (R) (K)

78.25

57935

Nose (R) (NK)

23.60

57938

Eye (R) (NK)

23.60

57939

Palato‑pharyngeal studies with fluoroscopic screening (R) (K)

64.50

57941

Temporo‑mandibular joints (R) (NK)

24.85

57942

Palato‑pharyngeal studies without fluoroscopic screening (R) (K)

49.65

57944

Teeth—single area (R) (NK)

16.45

57945

Larynx, lateral airways and soft tissues of the neck, not being a service associated with a service to which item 57939, 57942, 57950 or 57953 applies (R) (K)

43.40

57947

Teeth—full mouth (R) (NK)

39.15

57950

Palato‑pharyngeal studies with fluoroscopic screening (R) (NK)

32.25

57953

Palato‑pharyngeal studies without fluoroscopic screening (R) (NK)

24.85

57956

Larynx, lateral airways and soft tissues of the neck, not being a service associated with a service to which item 57939, 57942, 57950 or 57953 applies (R) (NK)

21.70

57959

Orthopantomography for diagnosis or management (or both) of trauma, infection, tumour or a congenital or surgical condition of the teeth or maxillofacial region (R) (NK)

23.70

57960

Orthopantomography for diagnosis or management (or both) of trauma, infection, tumour or a congenital or surgical condition of the teeth or maxillofacial region (R) (K)

47.40

57962

Orthopantomography for diagnosis or management (or both) of any of the following conditions, if the signs and symptoms of the condition is present:

(a) impacted teeth;

(b) caries;

(c) periodontal pathology;

(d) periapical pathology (R) (NK)

23.70

57963

Orthopantomography for diagnosis or management (or both) of any of the following conditions, if the signs and symptoms of the condition is present:

(a) impacted teeth;

(b) caries;

(c) periodontal pathology;

(d) periapical pathology (R) (K)

47.40

57965

Orthopantomography for diagnosis or management (or both) of missing or crowded teeth, or developmental anomalies of the teeth or jaws (R) (NK)

23.70

57966

Orthopantomography for diagnosis or management (or both) of missing or crowded teeth, or developmental anomalies of the teeth or jaws (R) (K)

47.40

57968

Orthopantomography for diagnosis or management (or both) of temporo‑mandibular joint arthroses or dysfunction (R) (NK)

23.70

57969

Orthopantomography for diagnosis or management (or both) of temporo‑mandibular joint arthroses or dysfunction (R) (K)

47.40

Subgroup 4—Radiographic examination of spine

58100

Spine—cervical (R) (K)

67.15

58102

Spine—cervical (R) (NK)

33.60

58103

Spine—thoracic (R) (K)

55.10

58105

Spine—thoracic (R) (NK)

27.55

58106

Spine—lumbosacral (R) (K)

77.00

58108

Spine—4 regions, cervical, thoracic, lumbosacral and sacrococcygeal (R) (K)

110.00

58109

Spine—sacrococcygeal (R) (K)

47.00

58111

Spine—lumbosacral (R) (NK)

38.50

58112

Spine—2 examinations of the kind mentioned in items 58100, 58102, 58103, 58105, 58106, 58109, 58111 and 58117 (R) (K)

97.25

58114

Spine—4 regions, cervical, thoracic, lumbosacral and sacrococcygeal (R) (NK)

55.00

58115

Spine—3 examinations of the kind mentioned in items 58100, 58102, 58103, 58105, 58106, 58109, 58111 and 58117 (R) (K)

110.00

58117

Spine—sacrococcygeal (R) (NK)

23.50

58120

Spine—4 regions, cervical, thoracic, lumbosacral and sacrococcygeal, if the service to which item 58120, 58121, 58126 or 58127 applies has not been performed on the same patient within the same calendar year (R) (K)

110.00

58121

Spine—3 examinations of the kind mentioned in items 58100, 58102, 58103, 58105, 58106, 58109, 58111 and 58117, if the service to which item 58120, 58121, 58126 or 58127 applies has not been performed on the same patient within the same calendar year (R) (K)

110.00

58123

Spine—2 examinations of the kind mentioned in items 58100, 58102, 58103, 58105, 58106, 58109, 58111 and 58117 (R) (NK)

48.65

58124

Spine—3 examinations of the kind mentioned in items 58100, 58102, 58103, 58105, 58106, 58109, 58111 and 58117 (R) (NK)

55.00

58126

Spine—4 regions, cervical, thoracic, lumbosacral and sacrococcygeal, if the service to which item 58120, 58121, 58126 or 58127 applies has not been performed on the same patient within the same calendar year (R) (NK)

55.00

58127

Spine—3 examinations of the kind mentioned in items 58100, 58102, 58103, 58105, 58106, 58109, 58111 and 58117, if the service to which item 58120, 58121, 58126 or 58127 applies has not been performed on the same patient within the same calendar year (R) (NK)

55.00

Subgroup 5—Bone age study and skeletal survey

58300

Bone age study (R) (K)

40.10

58302

Bone age study (R) (NK)

20.05

58306

Skeletal survey (R) (K)

89.40

58308

Skeletal survey (R) (NK)

44.70

Subgroup 6—Radiographic examination of thoracic region

58500

Chest (lung fields) by direct radiography (NR) (K)

35.35

58502

Chest (lung fields) by direct radiography (NR) (NK)

17.70

58503

Chest (lung fields) by direct radiography (R) (K)

47.15

58505

Chest (lung fields) by direct radiography (R) (NK)

23.60

58506

Chest (lung fields) by direct radiography with fluoroscopic screening (R) (K)

60.75

58508

Chest (lung fields) by direct radiography with fluoroscopic screening (R) (NK) (K)

30.40

58509

Thoracic inlet or trachea (R) (K)

39.75

58511

Thoracic inlet or trachea (R) (NK)

19.90

58521

Left ribs, right ribs or sternum (R) (K)

43.40

58523

Left ribs, right ribs or sternum (R) (NK)

21.70

58524

Left and right ribs, left ribs and sternum, or right ribs and sternum (R) (K)

56.50

58526

Left and right ribs, left ribs and sternum, or right ribs and sternum (R) (NK)

28.25

58527

Left ribs, right ribs and sternum (R) (K)

69.40

58529

Left ribs, right ribs and sternum (R) (NK)

34.70

Subgroup 7—Radiographic examination of urinary tract

58700

Plain renal only (R) (K)

46.05

58702

Plain renal only (R) (NK)

23.05

58706

Intravenous pyelography, with or without preliminary plain films and with or without tomography (R) (K)

157.90

58708

Intravenous pyelography, with or without preliminary plain films and with or without tomography (R) (NK)

78.95

58715

Antegrade or retrograde pyelography with or without preliminary plain films and with preparation and contrast injection, one side (R) (K)

151.55

58717

Antegrade or retrograde pyelography with or without preliminary plain films and with preparation and contrast injection, one side (R) (NK)

75.80

58718

Retrograde cystography or retrograde urethrography with or without preliminary plain films and with preparation and contrast injection (R) (K) (Anaes.)

126.10

58720

Retrograde cystography or retrograde urethrography with or without preliminary plain films and with preparation and contrast injection (R) (NK) (Anaes.)

63.05

58721

Retrograde micturating cysto‑urethrography, with preparation and contrast injection (R) (K) (Anaes.)

138.25

58723

Retrograde micturating cysto‑urethrography, with preparation and contrast injection (R) (NK) (Anaes.)

69.15

Subgroup 8—Radiographic examination of alimentary tract and biliary system

58900

Plain abdominal only, not being a service associated with a service to which item 58909, 58911, 58912, 58914, 58915, 58917, 58924 or 58926 applies (NR) (K)

35.70

58902

Plain abdominal only, not being a service associated with a service to which item 58909, 58911, 58912, 58914, 58915, 58917, 58924 or 58926 applies (NR) (NK)

17.85

58903

Plain abdominal only, not being a service associated with a service to which item 58909, 58911, 58912, 58914, 58915, 58917, 58924 or 58926 applies (R) (K)

47.60

58905

Plain abdominal only, not being a service associated with a service to which item 58909, 58911,58912, 58914, 58915, 58917, 58924 or 58926 applies (R) (NK)

23.80

58909

Barium or other opaque meal of one or more of pharynx, oesophagus, stomach or duodenum, with or without preliminary plain films of pharynx, chest or duodenum, not being a service associated with a service to which item 57939, 57942, 57945, 57950, 57953 or 57956 applies (R) (K)

89.95

58911

Barium or other opaque meal of one or more of pharynx, oesophagus, stomach or duodenum, with or without preliminary plain films of pharynx, chest or duodenum, not being a service associated with a service to which item 57939, 57942, 57945, 57950, 57953 or 57956 applies (R) (NK)

45.00

58912

Barium or other opaque meal of oesophagus, stomach, duodenum and follow through to colon, with or without screening of chest and with or without preliminary plain film (R) (K)

110.25

58914

Barium or other opaque meal of oesophagus, stomach, duodenum and follow through to colon, with or without screening of chest and with or without preliminary plain film (R) (NK)

55.15

58915

Barium or other opaque meal, small bowel series only, with or without preliminary plain film (R) (K)

78.95

58916

Small bowel enema, barium or other opaque study of the small bowel, including duodenal intubation, with or without preliminary plain films, not being a service associated with a service to which item 30488 applies (R) (K) (Anaes.)

138.50

58917

Barium or other opaque meal, small bowel series only, with or without preliminary plain film (R) (NK)

39.50

58920

Small bowel enema, barium or other opaque study of the small bowel, including duodenal intubation, with or without preliminary plain films, not being a service associated with a service to which item 30488 applies (R) (NK) (Anaes.)

69.25

58921

Opaque enema, with or without air contrast study and with or without preliminary plain films (R) (K)

135.25

58923

Opaque enema, with or without air contrast study and with or without preliminary plain films (R) (NK)

67.65

58924

Graham’s test (cholecystography), with preliminary plain films and with or without tomography (R) (K)

84.05

58926

Graham’s test (cholecystography), with preliminary plain films and with or without tomography (R) (NK)

42.05

58927

Cholegraphy direct, with or without preliminary plain films and with preparation and contrast injection, not being a service associated with a service to which item 30439 applies (R) (K)

76.45

58929

Cholegraphy direct, with or without preliminary plain films and with preparation and contrast injection, not being a service associated with a service to which item 30439 applies (R) (NK)

38.25

58933

Cholegraphy, percutaneous transhepatic, with or without preliminary plain films and with preparation and contrast injection (R) (K)

205.60

58935

Cholegraphy, percutaneous transhepatic, with or without preliminary plain films and with preparation and contrast injection (R) (NK)

102.80

58936

Cholegraphy, drip infusion, with or without preliminary plain films, with preparation and contrast injection and with or without tomography (R) (K)

195.95

58938

Cholegraphy, drip infusion, with or without preliminary plain films, with preparation and contrast injection and with or without tomography (R) (NK)

98.00

58939

Defaecogram (R) (K)

139.30

58941

Defaecogram (R) (NK)

69.65

Subgroup 9—Radiographic examination for localisation of foreign bodies

59103

Localisation of foreign body, if provided in conjunction with a service mentioned in Subgroups 1 to 12 of Group I3 (R) (K)

21.30

59104

Localisation of foreign body, if provided in conjunction with a service mentioned in Subgroups 1 to 12 of Group I3 (R) (NK)

10.65

Subdivision CSubgroup 10 of Group I3: radiographic examination of breasts

2.3.2  Mammography services—eligible services

                   Items in this Subdivision apply only to a mammography service performed:

                     (a)  under the professional supervision of a specialist in the specialty of diagnostic radiology who is available:

                              (i)  to monitor and influence the conduct and diagnostic quality of the examination; and

                             (ii)  if necessary, to attend on the patient personally; or

                     (b)  if paragraph (a) cannot be complied with:

                              (i)  in an emergency; or

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

 

Group I3—Diagnostic radiography

Item

Description

Fee ($)

Subgroup 10—Radiographic examination of breasts

59300

Mammography of both breasts if there is reason to suspect the presence of malignancy because of:

(a) the past occurrence of breast malignancy in the patient or members of the patient’s family; or

(b) symptoms or indications of malignancy found on examination of the patient by a medical practitioner (R) (K)

89.50

59301

Mammography of both breasts if there is reason to suspect the presence of malignancy because of:

(a) the past occurrence of breast malignancy in the patient or members of the patient’s family; or

(b) symptoms or indications of malignancy found on examination of the patient by a medical practitioner (R) (NK)

44.75

59303

Mammography of one breast if:

(a) the patient is referred with a specific request for a unilateral mammogram; and

(b) there is reason to suspect the presence of malignancy because of:

(i) the past occurrence of breast malignancy in the patient or members of the patient’s family; or

(ii) symptoms or indications of malignancy found on examination of the patient by a medical practitioner (R) (K)

53.95

59304

Mammography of one breast if:

(a) the patient is referred with a specific request for a unilateral mammogram; and

(b) there is reason to suspect the presence of malignancy because of:

(i) the past occurrence of breast malignancy in the patient or members of the patient’s family; or

(ii) symptoms or indications of malignancy found on examination of the patient by a medical practitioner (R) (NK)

27.00

59306

Mammary ductogram (galactography)—one breast (R) (K)

100.30

59307

Mammary ductogram (galactography)—one breast (R) (NK)

50.15

59309

Mammary ductogram (galactography)—2 breasts (R) (K)

200.60

59310

Mammary ductogram (galactography)—2 breasts (R) (NK)

100.30

59312

Radiographic examination of both breasts, in conjunction with a surgical procedure on each breast, using interventional techniques (R) (K)

87.00

59313

Radiographic examination of both breasts, in conjunction with a surgical procedure on each breast, using interventional techniques (R) (NK)

43.50

59314

Radiographic examination of one breast, in conjunction with a surgical procedure using interventional techniques (R) (K)

52.50

59315

Radiographic examination of one breast, in conjunction with a surgical procedure using interventional techniques (R) (NK)

26.25

59318

Radiographic examination of excised breast tissue to confirm satisfactory excision of one or more lesions in one breast or both following pre‑operative localisation in conjunction with a service under item 31536 (R) (K)

47.05

59319

Radiographic examination of excised breast tissue to confirm satisfactory excision of one or more lesions in one breast or both following pre‑operative localisation in conjunction with a service under item 31536 (R) (NK)

23.55

Subdivision DSubgroups 11 to 14 of Group I3

 

Group I3—Diagnostic radiography

Item

Description

Fee ($)

Subgroup 11—Radiographic examination in connection with pregnancy

59503

Pelvimetry, not being a service associated with a service to which item 57201 applies (R) (K)

89.40

59504

Pelvimetry, not being a service associated with a service to which item 57201 or 57247 applies (R) (NK)

44.70

Subgroup 12—Radiographic examination with opaque or contrast media

59700

Discography, each disc, with or without preliminary plain films and with preparation and contrast injection (R) (K) (Anaes.)

96.55

59701

Discography, each disc, with or without preliminary plain films and with preparation and contrast injection (R) (NK) (Anaes.)

48.30

59703

Dacryocystography, one side, with or without preliminary plain film and with preparation and contrast injection (R) (K)

75.90

59704

Dacryocystography, one side, with or without preliminary plain film and with preparation and contrast injection (R) (NK)

37.95

59712

Hysterosalpingography, with or without preliminary plain films and with preparation and contrast injection (R) (K) (Anaes.)

113.70

59713

Hysterosalpingography, with or without preliminary plain films and with preparation and contrast injection (R) (NK) (Anaes.)

56.85

59715

Bronchography, one side, with or without preliminary plain films and with preparation and contrast injection (R) (K) (Anaes.)

143.55

59716

Bronchography, one side, with or without preliminary plain films and with preparation and contrast injection (R) (NK) (Anaes.)

71.80

59718

Phlebography, one side, with or without preliminary plain films and with preparation and contrast injection (R) (K) (Anaes.)

134.65

59719

Phlebography, one side, with or without preliminary plain films and with preparation and contrast injection (R) (NK) (Anaes.)

67.35

59724

Myelography, one or more regions, with or without preliminary plain films and with preparation and contrast injection, not being a service associated with a service to which item 56219 applies (R) (K) (Anaes.)

226.45

59725

Myelography, one or more regions, with or without preliminary plain films and with preparation and contrast injection, not being a service associated with a service to which item 56219 or 56259 applies (R) (NK) (Anaes.)

113.25

59733

Sialography, one side, with preparation and contrast injection, not being a service associated with a service to which item 57918 or 57932 applies (R) (K)

107.70

59734

Sialography, one side, with preparation and contrast injection, not being a service associated with a service to which item 57918 or 57932 applies (R) (NK)

53.85

59736

Vasoepididymography, one side (R) (K)

62.00

59737

Vasoepididymography, one side (R) (NK)

31.00

59739

Sinogram or fistulogram, one or more regions, with or without preliminary plain films and with preparation and contrast injection (R) (K)

73.75

59740

Sinogram or fistulogram, one or more regions, with or without preliminary plain films and with preparation and contrast injection (R) (NK)

36.90

59751

Arthrography, each joint, excluding the facet (zygapophyseal) joints of the spine, single or double contrast study, with or without preliminary plain films and with preparation and contrast injection (R) (K)

139.15

59752

Arthrography, each joint, excluding the facet (zygapophyseal) joints of the spine, single or double contrast study, with or without preliminary plain films and with preparation and contrast injection (R) (NK)

69.60

59754

Lymphangiography, one or both sides, with preliminary plain films and follow‑up radiography and with preparation and contrast injection (R) (K)

219.35

59755

Lymphangiography, one or both sides, with preliminary plain films and follow‑up radiography and with preparation and contrast injection (R) (NK)

109.70

59760

Peritoneogram (herniography) with or without contrast medium including preparation—performed on a person over 14 years of age (R) (K)

115.15

59761

Peritoneogram (herniography) with or without contrast medium including preparation—performed on a person over 14 years of age (R) (NK)

57.60

59763

Air insufflation during video—fluoroscopic imaging including associated consultation (R) (K)

133.90

59764

Air insufflation during video—fluoroscopic imaging including associated consultation (R) (NK)

66.95

Subgroup 13—Angiography

59903

Angiocardiography, including the service mentioned in item 59970, 59974, 61109 or 61110, not being a service to which item 59912 or 59925 applies (R) (K) (Anaes.)

114.55

59912

Selective coronary arteriography, including the service mentioned in item 59970, 59974, 61109 or 61110, not being a service to which item 59903 or 59925 applies (R) (K) (Anaes.)

305.20

59925

Selective coronary arteriography and angiocardiography, including a service mentioned in item 59903, 59912, 59970, 59974, 61109 or 61110 (R) (K) (Anaes.)

362.45

59970

Angiography or digital subtraction angiography, or both, with fluoroscopy and image acquisition, using a mobile image intensifier, including any preliminary plain films, preparation and contrast injection—one or more regions (R) (K) (Anaes.)

168.30

59971

Angiocardiography, including the service mentioned in item 59970, 59974, 61109 or 61110, not being a service to which item 59972 or 59973 applies (R) (NK) (Anaes.)

57.30

59972

Selective coronary arteriography, including the service mentioned in item 59970, 59974, 61109 or 61110, not being a service to which item 59971 or 59973 applies (R) (NK) (Anaes.)

152.60

59973

Selective coronary arteriography and angiocardiography, including a service mentioned in item 59970, 59971, 59972, 59974, 61109 or 61110 (R) (NK) (Anaes.)

181.25

59974

Angiography or digital subtraction angiography, or both, with fluoroscopy and image acquisition using a mobile image intensifier, including any preliminary plain films, preparation and contrast injection—one or more regions (R) (NK) (Anaes.)

84.20

60000

Digital subtraction angiography, examination of head and neck with or without arch aortography—1 to 3 data acquisition runs (R) (Anaes.)

564.00

60003

Digital subtraction angiography, examination of head and neck with or without arch aortography—4 to 6 data acquisition runs (R) (Anaes.)

827.10

60006

Digital subtraction angiography, examination of head and neck with or without arch aortography—7 to 9 data acquisition runs (R) (Anaes.)

1 176.10

60009

Digital subtraction angiography, examination of head and neck with or without arch aortography—10 or more data acquisition runs (R) (Anaes.)

1 376.30

60012

Digital subtraction angiography, examination of thorax—1 to 3 data acquisition runs (R) (Anaes.)

564.00

60015

Digital subtraction angiography, examination of thorax—4 to 6 data acquisition runs (R) (Anaes.)

827.10

60018

Digital subtraction angiography, examination of thorax—7 to 9 data acquisition runs (R) (Anaes.)

1 176.10

60021

Digital subtraction angiography, examination of thorax—10 or more data acquisition runs (R) (Anaes.)

1 376.30

60024

Digital subtraction angiography, examination of abdomen—1 to 3 data acquisition runs (R) (Anaes.)

564.00

60027

Digital subtraction angiography, examination of abdomen—4 to 6 data acquisition runs (R) (Anaes.)

827.10

60030

Digital subtraction angiography, examination of abdomen—7 to 9 data acquisition runs (R) (Anaes.)

1 176.10

60033

Digital subtraction angiography, examination of abdomen—10 or more data acquisition runs (R) (Anaes.)

1 376.30

60036

Digital subtraction angiography, examination of upper limb or limbs—1 to 3 data acquisition runs (R) (Anaes.)

564.00

60039

Digital subtraction angiography, examination of upper limb or limbs—4 to 6 data acquisition runs (R) (Anaes.)

827.10

60042

Digital subtraction angiography, examination of upper limb or limbs—7 to 9 data acquisition runs (R) (Anaes.)

1 176.10

60045

Digital subtraction angiography, examination of upper limb or limbs—10 or more data acquisition runs (R) (Anaes.)

1 376.30

60048

Digital subtraction angiography, examination of lower limb or limbs—1 to 3 data acquisition runs (R) (Anaes.)

564.00

60051

Digital subtraction angiography, examination of lower limb or limbs—4 to 6 data acquisition runs (R) (Anaes.)

827.10

60054

Digital subtraction angiography, examination of lower limb or limbs—7 to 9 data acquisition runs (R) (Anaes.)

1 176.10

60057

Digital subtraction angiography, examination of lower limb or limbs—10 or more data acquisition runs (R) (Anaes.)

1 376.30

60060

Digital subtraction angiography, examination of aorta and lower limb or limbs—1 to 3 data acquisition runs (R) (Anaes.)

564.00

60063

Digital subtraction angiography, examination of aorta and lower limb or limbs—4 to 6 data acquisition runs (R) (Anaes.)

827.10

60066

Digital subtraction angiography, examination of aorta and lower limb or limbs—7 to 9 data acquisition runs (R) (Anaes.)

1 176.10

60069

Digital subtraction angiography, examination of aorta and lower limb or limbs—10 or more data acquisition runs (R) (Anaes.)

1 376.30

60072

Selective arteriography or selective venography by digital subtraction angiography technique—one vessel (NR) (Anaes.)

48.10

60075

Selective arteriography or selective venography by digital subtraction angiography technique—2 vessels (NR) (Anaes.)

96.10

60078

Selective arteriography or selective venography by digital subtraction angiography technique—3 or more vessels (NR) (Anaes.)

144.25

Subgroup 14—Tomography

60100

Tomography of any region (R) (K) (Anaes.)

60.75

60101

Tomography of any region (R) (NK) (Anaes.)

30.40

Subdivision ESubgroup 15 of Group I3: fluoroscopic examination

 

Group I3—Diagnostic radiography

Item

Description

Fee ($)

Subgroup 15—Fluoroscopic examination

60500

Fluoroscopy, with general anaesthesia (not being a service associated with a radiographic examination) (R) (K) (Anaes.)

43.40

60501

Fluoroscopy, with general anaesthesia (not being a service associated with a radiographic examination) (R) (NK) (Anaes.)

21.70

60503

Fluoroscopy, without general anaesthesia (not being a service associated with a radiographic examination) (R) (K)

29.75

60504

Fluoroscopy, without general anaesthesia (not being a service associated with a radiographic examination) (R) (NK)

14.90

60506

Fluoroscopy using a mobile image intensifier, in conjunction with a surgical procedure lasting less than 1 hour, not being a service associated with a service to which another item in this table applies (R) (K)

63.75

60507

Fluoroscopy using a mobile image intensifier, in conjunction with a surgical procedure lasting less than 1 hour, not being a service associated with a service to which another item in this table applies (R) (NK)

31.90

60509

Fluoroscopy using a mobile image intensifier, in conjunction with a surgical procedure lasting 1 hour or more, not being a service associated with a service to which another item in this table applies (R) (K)

98.90

60510

Fluoroscopy using a mobile image intensifier, in conjunction with a surgical procedure lasting 1 hour or more, not being a service associated with a service to which another item in this table applies (R) (NK)

49.45

Subdivision FSubgroup 16 of Group I3: preparation for radiological procedure

2.3.3  Preparation of patients for radiological procedures

                   Items in this Subdivision apply only to the preparation of a patient for a radiological procedure for a service to which any of items 59903 to 59974 apply by:

                     (a)  injecting opaque or contrast media; or

                     (b)  removing fluid and replacing it with air, oxygen or other contrast media; or

                     (c)  a similar method.

 

Group I3—Diagnostic radiography

Item

Description

Fee ($)

Subgroup 16—Preparation for radiological procedure

60918

Arteriography (peripheral) or phlebography—one vessel, when used in association with a service to which item 59903, 59912, 59925, 59970, 59971, 59972, 59973 or 59974 applies, not being a service associated with a service to which any of items 60000 to 60078 apply (NR) (Anaes.)

47.15

60927

Selective arteriogram or phlebogram, when used in association with a service to which item 59903, 59912, 59925, 59970, 59971, 59972, 59973 or 59974 applies, not being a service associated with a service to which any of items 60000 to 60078 apply (NR) (Anaes.)

38.05

Subdivision GSubgroup 17 of Group I3: interventional techniques

2.3.4  Meaning of angiography suite

                   In this table:

angiography suite means a room that contains only equipment designed for angiography that is able to perform digital subtraction or rapid‑sequence film angiography.

 

Group I3—Diagnostic radiography

Item

Description

Fee ($)

Subgroup 17—Interventional techniques

61109

Fluoroscopy in an angiography suite with image intensification, in conjunction with a surgical procedure using interventional techniques, not being a service associated with a service to which another item in this table applies (R) (K)

258.90

61110

Fluoroscopy in an angiography suite with image intensification, in conjunction with a surgical procedure using interventional techniques, not being a service associated with a service to which another item in this table applies (R) (NK)

129.45

Division 2.4Group I4: nuclear medicine imaging

2.4.1  Nuclear scanning services—other than PET

                   Items 61302 to 61505, 61650 to 61719 and 61729 apply only if:

                     (a)  the performance of the service does not involve the use of positron‑emission radio‑isotopes or a PET scanner; and

                     (b)  the service is performed:

                              (i)  by a specialist or consultant physician whose name is included in a register, given to the Chief Executive Medicare by the JNMCAC, of participants in the Joint Nuclear Medicine Specialist Credentialling Program of the JNMCAC; or

                             (ii)  by a person acting on behalf of a specialist or consultant physician mentioned in subparagraph (i); and

                     (c)  the final report of the service is compiled by the specialist or consultant physician who performed the preliminary examination of the patient and the estimation and administration of the dosage of radiopharmaceuticals.

2.4.2  PET nuclear scanning services

             (1)  Items 61523 to 61646 apply only if the service is performed on a person:

                     (a)  at the written request of a specialist or consultant physician (the requesting practitioner) if:

                              (i)  the person is the requesting practitioner’s patient; and

                             (ii)  the requesting practitioner decides that the service is necessary; and

                     (b)  in a comprehensive facility; and

                     (c)  in accordance with clauses 2.4.3 and 2.4.4.

             (2)  Also, the items apply only if the owner or operator of the equipment used to perform the service is not in breach of clause 2.4.5.

2.4.3  PET nuclear scanning services—performance under personal supervision

             (1)  For clause 2.4.2, the service must be performed on a person by or under the personal supervision of:

                     (a)  a credentialled specialist other than the requesting practitioner; or

                     (b)  a medical practitioner other than the requesting practitioner if the medical practitioner:

                              (i)  is a Fellow of the RACP or RANZCR; and

                             (ii)  has reported 400 or more studies forming part of PET services for which a medicare benefit was payable; and

                            (iii)  is authorised under State or Territory law to prescribe and administer to humans the PET radiopharmaceuticals that are to be administered to the person; and

                            (iv)  met the requirements of subparagraphs (i), (ii) and (iii) before 1 November 2011.

             (2)  In this clause:

requesting practitioner has the same meaning as in paragraph 2.4.2(1)(a).

2.4.4  PET nuclear scanning services—equipment

                   For clause 2.4.2, the service must be performed on a person using equipment that meets the following requirements:

                     (a)  the Requirements for PET Accreditation (Instrumentation & Radiation Safety) 2nd Edition (2012), issued by the Australian and New Zealand Society of Nuclear Medicine Inc;

                     (b)  the NEMA Standards Publication NU 2‑2007, Performance Measurements of Positron Emission Tomographs, published by the National Electrical Manufacturers Association (USA).

2.4.5  PET nuclear scanning services—statutory declaration

             (1)  The owner or operator mentioned in subclause 2.4.2(2) must have given a statutory declaration to the Chief Executive Medicare that includes the following information:

                     (a)  whether the owner or operator is a credentialed specialist or a medical practitioner who satisfies the requirements mentioned in subparagraphs 2.4.3(1)(b)(i) to (iv);

                     (b)  whether the place where the owner or operator provides the service in a comprehensive facility;

                     (c)  whether the equipment meets the requirements mentioned in clause 2.4.4;

                     (d)  the facility’s address;

                     (e)  the provider number for the facility given by the Chief Executive Medicare;

                      (f)  the location specific practice number for the facility given by the Minister;

                     (g)  the models, serial numbers and manufacturers of the equipment.

             (2)  If the matters declared in the statutory declaration change, the owner or operator must give the Chief Executive Medicare written notice of the change as soon as the owner or operator knows about the change.

 

Group I4—Nuclear medicine imaging

Item

Description

Fee ($)

61302

Single stress or rest myocardial perfusion study—planar imaging (R) (K)

448.85

61303

Single stress or rest myocardial perfusion study—with single photon emission tomography and with planar imaging when performed (R) (K)

565.30

61306

Combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion—planar imaging (R) (K)

709.70

61307

Combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion—with single photon emission tomography and with planar imaging when performed (R) (K)

834.90

61310

Myocardial infarct‑avid‑study, with planar imaging and single photon emission tomography, or planar imaging or single photon emission tomography (R) (K)

367.30

61313

Gated cardiac blood pool study, (equilibrium), with planar imaging and single photon emission tomography, or planar imaging or single photon emission tomography (R) (K)

303.35

61314

Gated cardiac blood pool study, and first pass blood flow or cardiac shunt study, with planar imaging and single photon emission tomography, or planar imaging, or single photon emission tomography (R) (K)

420.00

61316

Gated cardiac blood pool study, with intervention, with planar imaging and single photon emission tomography, or planar imaging, or single photon emission tomography (R) (K)

381.15

61317

Gated cardiac blood pool study, with intervention and first pass blood flow study or cardiac shunt study, with planar imaging and single photon emission tomography or planar imaging, or single photon emission tomography (R) (K)

492.40

61320

Cardiac first pass blood flow study or cardiac shunt study, not being a service to which another item in this group applies (R) (K)

228.90

61328

Lung perfusion study, with planar imaging and single photon emission tomography or planar imaging, or single photon emission tomography (R) (K)

227.65

61340

Lung ventilation study using aerosol, technegas or xenon gas, with planar imaging and single photon emission tomography or planar imaging or single photon emission tomography (R) (K)

253.00

61348

Lung perfusion study and lung ventilation study using aerosol, technegas or xenon gas, with planar imaging and single photon emission tomography, or planar imaging, or single photon emission tomography (R) (K)

443.35

61352

Liver and spleen study (colloid)—planar imaging (R) (K)

259.35

61353

Liver and spleen study (colloid), with single photon emission tomography and with planar imaging when performed (R) (K)

386.60

61356

Red blood cell spleen or liver study, including single photon emission tomography when performed (R) (K)

392.80

61360

Hepatobiliary study, including morphine administration or pre‑treatment with a cholagogue when performed (R) (K)

403.35

61361

Hepatobiliary study with formal quantification following baseline imaging, using a cholagogue (R) (K)

461.40

61364

Bowel haemorrhage study (R) (K)

496.95

61368

Meckel’s diverticulum study (R) (K)

223.10

61369

Indium‑labelled octreotide study, including single photon emission tomography when undertaken, if:

(a) a gastro‑entero‑pancreatic endocrine tumour is suspected, based on biochemical evidence, with negative or equivocal conventional imaging; or

(b) a surgically amenable gastro‑entero‑pancreatic endocrine tumour has been identified based on conventional techniques, to exclude additional disease sites (R) (K)

2 015.75

61372

Salivary study (R) (K)

223.10

61373

Gastro‑oesophageal reflux study, including delayed imaging on a separate occasion when performed (R) (K)

489.70

61376

Oesophageal clearance study (R) (K)

143.35

61381

Gastric emptying study, using single tracer (R) (K)

574.35

61383

Combined solid and liquid gastric emptying study using dual isotope technique or the same isotope on separate days (R) (K)

624.95

61384

Radionuclide colonic transit study (R) (K)

687.70

61386

Renal study, including perfusion and renogram images and computer analysis or cortical study with planar imaging (R) (K)

332.50

61387

Renal cortical study, with single photon emission tomography and planar quantification (R) (K)

430.75

61389

Single renal study with pre‑procedural administration of a diuretic or angiotensin converting enzyme (ACE) inhibitor (R) (K)

370.55

61390

Renal study with diuretic administration after a baseline study (R) (K)

409.95

61393

Combined examination involving a renal study following angiotensin converting enzyme (ACE) inhibitor provocation and a baseline study, in either order and related to a single referral episode (R) (K)

605.50

61397

Cystoureterogram (R) (K)

246.85

61401

Testicular study (R) (K)

162.30

61402

Cerebral perfusion study, with single photon emission tomography and with planar imaging when performed (R) (K)

605.05

61405

Brain study with blood brain barrier agent, with planar imaging and single photon emission tomography, or planar imaging, or single photon emission tomography (R) (K)

346.00

61409

Cerebro‑spinal fluid transport study, with imaging on 2 or more separate occasions (R) (K)

873.50

61413

Cerebro‑spinal fluid shunt patency study (R) (K)

225.95

61417

Dynamic blood flow study or regional blood volume quantitative study, not being a service associated with a service to which another item in this group applies (R) (K)

118.85

61421

Bone study—whole body, with, when undertaken, blood flow, blood pool and delayed imaging on a separate occasion (R) (K)

479.80

61425

Bone study—whole body and single photon emission tomography, with, when undertaken, blood flow, blood pool and delayed imaging on a separate occasion (R) (K)

600.70

61426

Whole body study using iodine (R) (K)

554.80

61429

Whole body study using gallium (R) (K)

543.00

61430

Whole body study using gallium, with single photon emission tomography (R) (K)

659.45

61433

Whole body study using cells labelled with technetium (R) (K)

496.95

61434

Whole body study using cells labelled with technetium, with single photon emission tomography (R) (K)

615.40

61437

Whole body study using thallium (R) (K)

542.75

61438

Whole body study using thallium, with single photon emission tomography (R) (K)

672.95

61441

Bone marrow study—whole body using technetium labelled bone marrow agents (R) (K)

489.70

61442

Whole body study, using gallium—with single photon emission tomography of 2 or more body regions acquired separately (R) (K)

752.35

61445

Bone marrow study—localised using technetium labelled agent (R) (K)

286.80

61446

Localised bone or joint study, including when undertaken, blood flow, blood pool and repeat imaging on a separate occasion (R) (K)

333.55

61449

Localised bone or joint study and single photon emission tomography, including when undertaken, blood flow, blood pool and imaging on a separate occasion (R) (K)

456.20

61450

Localised study using gallium (R) (K)

397.55

61453

Localised study using gallium, with single photon emission tomography (R) (K)

514.70

61454

Localised study using cells labelled with technetium (R) (K)

348.10

61457

Localised study using cells labelled with technetium, with single photon emission tomography (R) (K)

470.45

61458

Localised study using thallium (R) (K)

396.95

61461

Localised study using thallium, with single photon emission tomography (R) (K)

527.85

61462

Repeat planar and single photon emission tomography imaging, or repeat planar imaging or single photon emission tomography imaging on an occasion subsequent to the performance of item 61364, 61426, 61429, 61430, 61442, 61450, 61453, 61469, 61484, 61485, 61669, 61692, 61693, 61694, 61700, 61704, 61705, 61712, 61715 or 61716, if there is no additional administration of radiopharmaceutical and if the previous radionuclide scan was abnormal or equivocal (R) (K)

129.00

61465

Venography (R) (K)

265.50

61469

Lymphoscintigraphy (R) (K)

348.10

61473

Thyroid study including uptake measurement when performed (R) (K)

175.40

61480

Parathyroid study, planar imaging and single photon emission tomography when performed (R) (K)

386.85

61484

Adrenal study (R) (K)

880.85

61485

Adrenal study, with single photon emission tomography (R) (K)

999.20

61495

Tear duct study (R) (K)

223.10

61499

Particle perfusion study (infra‑arterial) or Le Veen shunt study (R) (K)

253.00

61505

CT scan performed at the same time and covering the same body area as single photon emission tomography for the purpose of anatomic localisation or attenuation correction if no separate diagnostic CT report is issued and only in association with items 61302 to 61729 (R) (K)

100.00

61523

Whole body FDG PET study, performed for evaluation of a solitary pulmonary nodule, if:

(a) the nodule is considered unsuitable for transthoracic fine needle aspiration biopsy; or

(b) an attempt at pathological characterisation has failed (R)

953.00

61529

Whole body FDG PET study, performed for the staging of proven non‑small cell lung cancer, if curative surgery or radiotherapy is planned (R)

953.00

61538

FDG PET study of the brain for evaluation of suspected residual or recurrent malignant brain tumour based on anatomical imaging findings, after definitive therapy (or during ongoing chemotherapy) in patients who are considered suitable for further active therapy (R)

901.00

61541

Whole body FDG PET study, following initial therapy, performed for the evaluation of suspected residual, metastatic or recurrent colorectal carcinoma in a patient considered suitable for active therapy (R)

953.00

61553

Whole body FDG PET study, following initial therapy, performed for the evaluation of suspected metastatic or recurrent malignant melanoma in a patient considered suitable for active therapy (R)

999.00

61559

FDG PET study of the brain, performed for the evaluation of refractory epilepsy, that is being evaluated for surgery (R)

918.00

61565

Whole body FDG PET study, following initial therapy, performed for the evaluation of suspected residual, metastatic or recurrent ovarian carcinoma in a patient considered suitable for active therapy (R)

953.00

61571

Whole body FDG PET study for the further primary staging of patients with histologically proven carcinoma of the uterine cervix, at FIGO stage IB2 or greater by conventional staging, prior to planned radical radiation therapy or combined modality therapy with curative intent (R)

953.00

61575

Whole body FDG PET study for the further staging of patients with confirmed local recurrence of carcinoma of the uterine cervix considered suitable for salvage pelvic chemoradiotherapy or pelvic exenteration with curative intent (R)

953.00

61577

Whole body FDG PET study, performed for the staging of proven oesophageal or GEJ carcinoma, in a patient considered suitable for active therapy (R)

953.00

61598

Whole body FDG PET study performed for the staging of biopsy‑proven, newly‑diagnosed or recurrent head and neck cancer (R)

953.00

61604

Whole body FDG PET study performed for the evaluation of a patient with suspected residual head and neck cancer after definitive treatment, and who is suitable for active therapy (R)

953.00

61610

Whole body FDG PET study performed for the evaluation of metastatic squamous cell carcinoma of unknown primary site involving cervical nodes (R)

953.00

61616

Whole body FDG PET study for the initial staging of indolent non‑Hodgkin’s lymphoma if:

(a) clinical, pathological and imaging findings indicated that the stage is I or IIA; and

(b) the proposed management is definitive radiotherapy with curative intent (R)

953.00

61620

Whole body FDG PET study for the initial staging of newly diagnosed or previously untreated Hodgkin’s or non‑Hodgkin’s lymphoma (excluding indolent non‑Hodgkin’s lymphoma) (R)

953.00

61622

Whole body FDG PET study to assess response to first line therapy either during treatment or within 3 months of completing definitive first line treatment for Hodgkin’s or non‑Hodgkin’s lymphoma (excluding indolent non‑Hodgkin’s lymphoma) (R)

953.00

61628

Whole body FDG PET study for restaging following confirmation of recurrence of Hodgkin’s or non‑Hodgkin’s lymphoma (excluding indolent non‑Hodgkin’s lymphoma) (R)

953.00

61632

Whole body FDG PET study to assess response to second‑line chemotherapy if stem cell transplantation is being considered for Hodgkin’s or non‑Hodgkin’s lymphoma (excluding indolent non‑Hodgkin’s lymphoma) (R)

953.00

61640

Whole body FDG PET study for initial staging of a patient with biopsy‑proven bone or soft tissue sarcoma (excluding gastrointestinal stromal tumour) considered by conventional staging to be potentially curable (R)

999.00

61646

Whole body FDG PET study for the evaluation of patients with suspected residual or recurrent sarcoma (excluding gastrointestinal stromal tumour) after the initial course of definitive therapy to determine suitability for subsequent therapy with curative intent (R)

999.00

61650

LeukoScan study of the long bones and feet for suspected osteomyelitis, if patient does not have access to ex‑vivo white blood cell scanning (R) (K)

Note:          LeukoScan is only indicated for diagnostic imaging in a patient suspected of infection of the long bones and feet, including those with diabetic ulcers. The descriptor does not cover a patient who is being investigated for other sites of infection.

878.70

61651

Single stress or rest myocardial perfusion study—planar imaging (R) (NK)

224.45

61652

Single stress or rest myocardial perfusion study—with single photon emission tomography and with planar imaging when performed (R) (NK)

282.65

61653

Combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion—planar imaging (R) (NK)

354.85

61654

Combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion—with single photon emission tomography and with planar imaging when performed (R) (NK) (K)

417.45

61655

Myocardial infarct‑avid‑study, with planar imaging and single photon emission tomography, or planar imaging or single photon emission tomography (R) (NK)

183.65

61656

Gated cardiac blood pool study, (equilibrium), with planar imaging and single photon emission tomography, or planar imaging or single photon emission tomography (R) (NK)

151.70

61657

Gated cardiac blood pool study, and first pass blood flow or cardiac shunt study, with planar imaging and single photon emission tomography, or planar imaging, or single photon emission tomography (R) (NK)

210.00

61658

Gated cardiac blood pool study, with intervention, with planar imaging and single photon emission tomography, or planar imaging, or single photon emission tomography (R) (NK)

190.60

61659

Gated cardiac blood pool study, with intervention and first pass blood flow study or cardiac shunt study, with planar imaging and single photon emission tomography or planar imaging, or single photon emission tomography (R) (NK)

246.20

61660

Cardiac first pass blood flow study or cardiac shunt study, not being a service to which another item in this group applies (R) (NK)

114.45

61661

Lung perfusion study, with planar imaging and single photon emission tomography or planar imaging, or single photon emission tomography (R) (NK)

113.85

61662

Lung ventilation study using aerosol, technegas or xenon gas, with planar imaging and single photon emission tomography or planar imaging or single photon emission tomography (R) (NK)

126.50

61663

Lung perfusion study and lung ventilation study using aerosol, technegas or xenon gas, with planar imaging and single photon emission tomography, or planar imaging, or single photon emission tomography (R) (NK)

221.70

61664

Liver and spleen study (colloid)—planar imaging (R) (NK)

129.70

61665

Liver and spleen study (colloid), with single photon emission tomography and with planar imaging when performed (R) (NK)

193.30

61666

Red blood cell spleen or liver study, including single photon emission tomography when performed (R) (NK)

196.40

61667

Hepatobiliary study, including morphine administration or pre‑treatment with a cholagogue when performed (R) (NK)

201.70

61668

Hepatobiliary study with formal quantification following baseline imaging, using a cholagogue (R) (NK)

230.70

61669

Bowel haemorrhage study (R) (NK)

248.50

61670

Meckel’s diverticulum study (R) (NK)

111.55

61671

Indium‑labelled octreotide study, including single photon emission tomography when undertaken, if:

(a) a gastro‑entero‑pancreatic endocrine tumour is suspected, based on biochemical evidence, with negative or equivocal conventional imaging; or

(b) a surgically amenable gastro‑entero‑pancreatic endocrine tumour has been identified based on conventional techniques, to exclude additional disease sites (R) (NK)

1 007.90

61672

Salivary study (R) (NK)

111.55

61673

Gastro‑oesophageal reflux study, including delayed imaging on a separate occasion when performed (R) (NK)

244.85

61674

Oesophageal clearance study (R) (NK)

71.70

61675

Gastric emptying study, using single tracer (R) (NK)

287.20

61676

Combined solid and liquid gastric emptying study using dual isotope technique or the same isotope on separate days (R) (NK)

312.50

61677

Radionuclide colonic transit study (R) (NK)

343.85

61678

Renal study, including perfusion and renogram images and computer analysis or cortical study with planar imaging (R) (NK)

166.25

61679

Renal cortical study, with single photon emission tomography and planar quantification (R) (NK)

215.40

61680

Single renal study with pre‑procedural administration of a diuretic or angiotensin converting enzyme (ACE) inhibitor (R) (NK)

185.30

61681

Renal study with diuretic administration after a baseline study (R) (NK)

205.00

61682

Combined examination involving a renal study following angiotensin converting enzyme (ACE) inhibitor provocation and a baseline study, in either order and related to a single referral episode (R) (NK)

302.75

61683

Cystoureterogram (R) (NK)

123.45

61684

Testicular study (R) (NK)

81.15

61685

Cerebral perfusion study, with single photon emission tomography and with planar imaging when performed (R) (NK)

302.55

61686

Brain study with blood brain barrier agent, with planar imaging and single photon emission tomography, or planar imaging, or single photon emission tomography (R) (NK)

173.00

61687

Cerebro‑spinal fluid transport study, with imaging on 2 or more separate occasions (R) (NK)

436.75

61688

Cerebro‑spinal fluid shunt patency study (R) (NK)

113.00

61689

Dynamic blood flow study or regional blood volume quantitative study, not being a service associated with a service to which another item in this group applies (R) (NK)

59.45

61690

Bone study—whole body, with, when undertaken, blood flow, blood pool and delayed imaging on a separate occasion (R) (NK)

239.90

61691

Bone study—whole body and single photon emission tomography, with, when undertaken, blood flow, blood pool and delayed imaging on a separate occasion (R) (NK)

300.35

61692

Whole body study using iodine (R) (NK)

277.40

61693

Whole body study using gallium (R) (NK)

271.50

61694

Whole body study using gallium, with single photon emission tomography (R) (NK)

329.75

61695

Whole body study using cells labelled with technetium (R) (NK)

248.50

61696

Whole body study using cells labelled with technetium, with single photon emission tomography (R) (NK)

307.70

61697

Whole body study using thallium (R) (NK)

271.40

61698

Whole body study using thallium, with single photon emission tomography (R) (NK)

336.50

61699

Bone marrow study—whole body using technetium labelled bone marrow agents (R) (NK)

244.85

61700

Whole body study, using gallium—with single photon emission tomography of 2 or more body regions acquired separately (R) (NK)

376.20

61701

Bone marrow study—localised using technetium labelled agent (R) (NK)

143.40

61702

Localised bone or joint study, including when undertaken, blood flow, blood pool and repeat imaging on a separate occasion (R) (NK)

166.80

61703

Localised bone or joint study and single photon emission tomography, including when undertaken, blood flow, blood pool and imaging on a separate occasion (R) (NK)

228.10

61704

Localised study using gallium (R) (NK)

198.80

61705

Localised study using gallium, with single photon emission tomography (R) (NK)

257.35

61706

Localised study using cells labelled with technetium (R) (NK)

174.05

61707

Localised study using cells labelled with technetium, with single photon emission tomography (R) (NK)

235.25

61708

Localised study using thallium (R) (NK)

198.50

61709

Localised study using thallium, with single photon emission tomography (R) (NK)

263.95

61710

Repeat planar and single photon emission tomography imaging, or repeat planar imaging or single photon emission tomography imaging on an occasion subsequent to the performance of item 61364, 61426, 61429, 61430, 61442, 61450, 61453, 61469, 61484, 61485, 61669, 61692, 61693, 61694, 61700, 61704, 61705, 61712, 61715 or 61716, if there is no additional administration of radiopharmaceutical and if the previous radionuclide scan was abnormal or equivocal (R) (NK)

64.50

61711

Venography (R) (NK)

132.75

61712

Lymphoscintigraphy (R) (NK)

174.05

61713

Thyroid study including uptake measurement when performed (R) (NK)

87.70

61714

Parathyroid study, planar imaging and single photon emission tomography when performed (R) (NK)

193.45

61715

Adrenal study (R) (NK)

440.45

61716

Adrenal study, with single photon emission tomography (R) (NK)

499.60

61717

Tear duct study (R) (NK)

111.55

61718

Particle perfusion study (infra‑arterial) or Le Veen shunt study (R) (NK)

126.50

61719

CT scan performed at the same time and covering the same body area as single photon emission tomography for the purpose of anatomic localisation or attenuation correction if no separate diagnostic CT report is issued and only in association with items 61302 to 61729 (R) (NK)

50.00

61729

LeukoScan study of the long bones and feet for suspected osteomyelitis, if patient does not have access to ex‑vivo white blood cell scanning (R) (NK)

Note:          LeukoScan is only indicated for diagnostic imaging in a patient suspected of infection of the long bones and feet, including those with diabetic ulcers. The descriptor does not cover a patient who is being investigated for other sites of infection.

439.35

Division 2.5Group I5: magnetic resonance imaging

Subdivision AGeneral

2.5.1  MRI and MRA services—eligible services

             (1)  Items 63001 to 63486 apply to an MRI or MRA service performed:

                     (a)  at the request of a specialist or consultant physician in accordance with clause 2.5.2; and

                     (b)  in a permissible circumstance mentioned in clause 2.5.3; and

                     (c)  using eligible equipment mentioned in clause 2.5.5.

             (2)  Items 63457, 63458, 63464 to 63484 also apply to an MRI service performed:

                     (a)  at the request of a specialist or consultant physician in accordance with clause 2.5.2; and

                     (b)  in a permissible circumstance mentioned in clause 2.5.3; and

                     (c)  using partial eligible equipment mentioned in clause 2.5.6.

             (3)  Items 63491 to 63497 apply to an MRI or MRA service performed:

                     (a)  at the request of a medical practitioner in accordance with clause 2.5.2; and

                     (b)  in a permissible circumstance mentioned in clause 2.5.3; and

                     (c)  using:

                              (i)  eligible equipment mentioned in clause 2.5.5; or

                             (ii)  partial eligible equipment mentioned in clause 2.5.6.

             (4)  Items 63507 to 63561 apply to an MRI service performed:

                     (a)  at the request of a medical practitioner other than a specialist or consultant physician in accordance with clause 2.5.2; and

                     (b)  in a permissible circumstance mentioned in clause 2.5.3; and

                     (c)  using:

                              (i)  eligible equipment mentioned in clause 2.5.5; or

                             (ii)  partial eligible equipment mentioned in clause 2.5.6.

2.5.2  MRI and MRA services—request

                   For clause 2.5.1, a request must:

                     (a)  be made in writing; and

                     (b)  identify the clinical indications for the service.

2.5.3  MRI and MRA services—permissible circumstances for performance

                   A service is performed in a permissible circumstance only if it is:

                     (a)  for clause 2.5.1:

                              (i)  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

                             (ii)  reported by an eligible provider; or

                     (b)  for clause 2.5.1:

                              (i)  performed in an emergency; or

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

2.5.4  MRI and MRA services—eligible provider

                   The table sets out eligible providers for an MRI or MRA service.

 

Eligible providers

Item

Person

1

A specialist in diagnostic radiology who satisfies the Chief Executive Medicare that the specialist is a participant in the Royal Australian and New Zealand College of Radiologists’ Quality and Accreditation Program

2.5.5  MRI and MRA services—eligible equipment

                   The table sets out eligible equipment for an MRI or MRA service.

 

Eligible equipment

Item

Equipment

1

Equipment that:

(a) is located at the premises of a comprehensive practice; and

(b) is made available to the practice by a person:

(i) who is subject to a deed with the Commonwealth that relates to the equipment; and

(ii) for whom the deed has not been terminated; and

(c) is not identified as partial eligible equipment in the deed

2.5.6  MRI and MRA services—partial eligible equipment

                   The table sets out partial eligible equipment for an MRI or MRA service.

 

Partial eligible equipment

Item

Equipment

1

Equipment that:

(a) is located at the premises of a comprehensive practice; and

(b) is made available to the practice by a person:

(i) who is subject to a deed with the Commonwealth that relates to the equipment; and

(ii) for whom the deed has not been terminated; and

(c) is identified as partial eligible equipment in the deed

2.5.7  MRI and MRA services—meaning of scan

                   In items 63001 to 63561:

scan means a minimum of 3 sequences.

2.5.8  MRI and MRA services—multiple services

             (1)  If an MRI service mentioned in an item in Subgroup 1, 2, 4, 5 or 14 of Group I5 in the table in Subdivision B, and an MRA service mentioned in an item in Subgroup 3 or 15 of that table, are provided to the same person on the same day, only the fee specified in the item in Subgroup 1, 2, 4, 5 or 14 applies to the services.

             (2)  If a medical practitioner provides 2 or more MRI services mentioned in Subgroup 12 or 13 of Group I5 in the table in Subdivision B for the same patient on the same day, the fees specified for the items that apply to the services, other than the item with the highest fee, are reduced by 50%.

             (3)  For subclause (2):

                     (a)  if 2 or more applicable fees are equally the highest, only one of those fees is taken to be the highest fee; and

                     (b)  if a reduced fee calculated under subclause (2) is not a multiple of 5 cents, the reduced fee is taken to be the nearest amount that is a multiple of 5 cents.

2.5.9  MRI or MRA services—related services that can be claimed in a 12 month period

                   An MRI or MRA item mentioned in column 1 of the table does not apply to the service mentioned in that item if the service is provided to a person who, in the 12 months before the service, has been provided with the maximum number of those services mentioned in column 2 of the table for that item.

 

Related services

Item

Column 1

MRI or MRA items

Column 2

Maximum number of services

1

63040 to 63085

3

2

63101 and 63104

3

3

63125 to 63136

3

4

63161 to 63194

3

5

63219 to 63265

3

6

63271 to 63285

3

7

63322 to 63348

3

8

63361 and 63364

2

9

63385 to 63394

2

10

63401 to 63408

3

11

63416 and 63419

1

12

63425 to 63433

2

13

63455 to 63467

1

14

63482 and 63486

3

15

63507 to 63561

3

Subdivision BSubgroups 1 to 19 of Group I5

 

Group I5—Magnetic resonance imaging

Item

Description

Fee ($)

Subgroup 1—Scan of head—for specified conditions

63001

MRI—scan of head (including MRA, if performed) for tumour of the brain or meninges (R) (K) (Anaes.) (Contrast)

403.20

63004

MRI—scan of head (including MRA, if performed) for inflammation of brain or meninges (R) (K) (Anaes.) (Contrast)

403.20

63007

MRI—scan of head (including MRA, if performed) for skull base or orbital tumour (R) (K) (Anaes.) (Contrast)

403.20

63010

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) (K) (Anaes.) (Contrast)

336.00

63013

MRI—scan of head (including MRA, if performed) for tumour of the brain or meninges (R) (NK) (Anaes.) (Contrast)

201.60

63014

MRI—scan of head (including MRA, if performed) for inflammation of brain or meninges (R) (NK) (Anaes.) (Contrast)

201.60

63016

MRI—scan of head (including MRA, if performed) for skull base or orbital tumour (R) (NK) (Anaes.) (Contrast)

201.60

63017

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) (NK) (Anaes.) (Contrast)

168.00

Subgroup 2—Scan of head—for specified conditions

63040

MRI—scan of head (including MRA, if performed) for acoustic neuroma (R) (Anaes.) (K) (Contrast)

336.00

63043

MRI—scan of head (including MRA, if performed) for pituitary tumour (R) (K) (Anaes.) (Contrast)

358.40

63046

MRI—scan of head (including MRA, if performed) for toxic or metabolic or ischaemic encephalopathy (R) (K) (Anaes.) (Contrast)

403.20

63049

MRI—scan of head (including MRA, if performed) for demyelinating disease of the brain (R) (K) (Anaes.) (Contrast)

403.20

63052

MRI—scan of head (including MRA, if performed) for congenital malformation of the brain or meninges (R) (K) (Anaes.) (Contrast)

403.20

63055

MRI—scan of head (including MRA, if performed) for venous sinus thrombosis (R) (K) (Anaes.) (Contrast)

403.20

63058

MRI—scan of head (including MRA, if performed) for head trauma (R) (K) (Anaes.) (Contrast)

403.20

63061

MRI—scan of head (including MRA, if performed) for epilepsy (R) (K) (Anaes.) (Contrast)

403.20

63064

MRI—scan of head (including MRA, if performed) for stroke (R) (K) (Anaes.) (Contrast)

403.20

63067

MRI—scan of head (including MRA, if performed) for carotid or vertebral artery dissection (R) (K) (Anaes.) (Contrast)

403.20

63070

MRI—scan of head (including MRA, if performed) for intracranial aneurysm (R) (K) (Anaes.) (Contrast)

403.20

63073

MRI—scan of head (including MRA, if performed) for intracranial arteriovenous malformation (R) (K) (Anaes.) (Contrast)

403.20

63074

MRI—scan of head (including MRA, if performed) for acoustic neuroma (R) (NK) (Anaes.) (Contrast)

168.00

63075

MRI—scan of head (including MRA, if performed) for pituitary tumour (R) (K) (NK) (Anaes.) (Contrast)

179.20

63076

MRI—scan of head (including MRA, if performed) for toxic or metabolic or ischaemic encephalopathy (R) (NK) (Anaes.) (Contrast)

201.60

63077

MRI—scan of head (including MRA, if performed) for demyelinating disease of the brain (R) (NK) (Anaes.) (Contrast)

201.60

63078

MRI—scan of head (including MRA, if performed) for congenital malformation of the brain or meninges (R) (NK) (Anaes.) (Contrast)

201.60

63079

MRI—scan of head (including MRA, if performed) for venous sinus thrombosis (R) (NK) (Anaes.) (Contrast)

201.60

63080

MRI—scan of head (including MRA, if performed) for head trauma (R) (NK) (Anaes.) (Contrast)

201.60

63081

MRI—scan of head (including MRA, if performed) for epilepsy (R) (NK) (Anaes.) (Contrast)

201.60

63082

MRI—scan of head (including MRA, if performed) for stroke (R) (NK) (Anaes.) (Contrast)

201.60

63083

MRI—scan of head (including MRA, if performed) for carotid or vertebral artery dissection (R) (NK) (Anaes.) (Contrast)

201.60

63084

MRI—scan of head (including MRA, if performed) for intracranial aneurysm (R) (NK) (Anaes.) (Contrast)

201.60

63085

MRI—scan of head (including MRA, if performed) for intracranial arteriovenous malformation (R) (NK) (Anaes.) (Contrast)

201.60

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

63101

MRI and MRA of extracranial or intracranial circulation (or both)—scan of head and neck vessels for stroke (R) (K) (Anaes.) (Contrast)

492.80

63104

MRI and MRA of extracranial or intracranial circulation (or both)—scan of head and neck vessels for stroke (R) (NK) (Anaes.) (Contrast)

246.40

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

63111

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

492.80

63114

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

492.80

63117

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

246.40

63119

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

246.40

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

63125

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

492.80

63128

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

492.80

63131

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

492.80

63134

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

246.40

63135

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

246.40

63136

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

246.40

Subgroup 6—Scan of spine—one region or 2 contiguous regions—for specified conditions

63151

MRI—scan of one region or 2 contiguous regions of the spine for infection (R) (K) (Anaes.) (Contrast)

358.40

63154

MRI—scan of one region or 2 contiguous regions of the spine for tumour (R) (K) (Anaes.) (Contrast)

358.40

63157

MRI—scan of one region or 2 contiguous regions of the spine for infection (R) (NK) (Anaes.) (Contrast)

179.20

63158

MRI—scan of one region or 2 contiguous regions of the spine for tumour (R) (NK) (Anaes.) (Contrast)

179.20

Subgroup 7—Scan of spine—one region or 2 contiguous regions—for specified conditions

63161

MRI—scan of one region or 2 contiguous regions of the spine for demyelinating disease (R) (K) (Anaes.) (Contrast)

358.40

63164

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

358.40

63167

MRI—scan of one region or 2 contiguous regions of the spine for myelopathy (R) (K) (Anaes.) (Contrast)

358.40

63170

MRI—scan of one region or 2 contiguous regions of the spine for syrinx (congenital or acquired) (R) (K) (Anaes.) (Contrast)

358.40

63173

MRI—scan of one region or 2 contiguous regions of the spine for cervical radiculopathy (R) (K) (Anaes.) (Contrast)

358.40

63176

MRI—scan of one region or 2 contiguous regions of the spine for sciatica (R) (K) (Anaes.) (Contrast)

358.40

63179

MRI—scan of one region or 2 contiguous regions of the spine for spinal canal stenosis (R) (K) (Anaes.) (Contrast)

358.40

63182

MRI—scan of one region or 2 contiguous regions of the spine for previous spinal surgery (R) (K) (Anaes.) (Contrast)

358.40

63185

MRI—scan of one region or 2 contiguous regions of the spine for trauma (R) (K) (Anaes.)

358.40

63186

MRI—scan of one region or 2 contiguous regions of the spine for demyelinating disease (R) (NK) (Anaes.) (Contrast)

179.20

63187

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

179.20

63188

MRI—scan of one region or 2 contiguous regions of the spine for myelopathy (R) (NK) (Anaes.) (Contrast)

179.20

63189

MRI—scan of one region or 2 contiguous regions of the spine for syrinx (congenital or acquired) (R) (NK) (Anaes.) (Contrast)

179.20

63190

MRI—scan of one region or 2 contiguous regions of the spine for cervical radiculopathy (R) (NK) (Anaes.) (Contrast)

179.20

63191

MRI—scan of one region or 2 contiguous regions of the spine for sciatica (R) (NK) (Anaes.) (Contrast)

179.20

63192

MRI—scan of one region or 2 contiguous regions of the spine for spinal canal stenosis (R) (NK) (Anaes.) (Contrast)

179.20

63193

MRI—scan of one region or 2 contiguous regions of the spine for previous spinal surgery (R) (NK) (Anaes.) (Contrast)

179.20

63194

MRI—scan of one region or 2 contiguous regions of the spine for trauma (R) (NK) (Anaes.)

179.20

Subgroup 8—Scan of spine—3 contiguous or 2 non‑contiguous regions—for specified conditions

63201

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

448.00

63204

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

448.00

63207

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

224.00

63208

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

224.00

Subgroup 9—Scan of spine—3 contiguous or 2 non‑contiguous regions—for specified conditions

63219

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

448.00

63222

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) (K) (Anaes.) (Contrast)

448.00

63225

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

448.00

63228

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

448.00

63231

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

448.00

63234

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

448.00

63237

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

448.00

63240

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

448.00

63243

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

448.00

63257

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

224.00

63258

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) (NK) (Anaes.) (Contrast)

224.00

63259

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

224.00

63260

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

224.00

63261

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

224.00

63262

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

224.00

63263

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

224.00

63264

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

224.00

63265

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

224.00

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

63271

MRI—scan of cervical spine and brachial plexus for tumour (R) (K) (Anaes.) (Contrast)

492.80

63274

MRI—scan of cervical spine and brachial plexus for trauma (R) (K) (Anaes.) (Contrast)

492.80

63277

MRI—scan of cervical spine and brachial plexus for cervical radiculopathy (R) (K) (Anaes.) (Contrast)

492.80

63280

MRI—scan of cervical spine and brachial plexus for previous surgery (R) (K) (Anaes.) (Contrast)

492.80

63282

MRI—scan of cervical spine and brachial plexus for tumour (R) (NK) (Anaes.) (Contrast)

246.40

63283

MRI—scan of cervical spine and brachial plexus for trauma (R) (NK) (Anaes.) (Contrast)

246.40

63284

MRI—scan of cervical spine and brachial plexus for cervical radiculopathy (R) (NK) (Anaes.) (Contrast)

246.40

63285

MRI—scan of cervical spine and brachial plexus for previous surgery (R) (NK) (Anaes.) (Contrast)

246.40

Subgroup 11—Scan of musculoskeletal system—for specified conditions

63301

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

380.80

63304

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

380.80

63307

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

380.80

63310

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

190.40

63311

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

190.40

63313

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

190.40

Subgroup 12—Scan of musculoskeletal system—for specified conditions

63322

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

403.20

63325

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

403.20

63328

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

403.20

63331

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

403.20

63334

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

336.00

63337

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

448.00

63340

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

403.20

63341

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

201.60

63342

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

201.60

63343

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

201.60

63345

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

201.60

63346

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

168.00

63347

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

224.00

63348

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

201.60

Subgroup 13—Scan of musculoskeletal system—for specified conditions

63361

MRI—scan of musculoskeletal system for Gaucher disease (R) (K) (Anaes.)

403.20

63364

MRI—scan of musculoskeletal system for Gaucher disease (R) (NK) (Anaes.)

201.60

Subgroup 14—Scan of cardiovascular system—for specified conditions

63385

MRI—scan of cardiovascular system for congenital disease of the heart or a great vessel (R) (K) (Anaes.) (Contrast)

448.00

63388

MRI—scan of cardiovascular system for tumour of the heart or a great vessel (R) (Anaes.) (K) (Contrast)

448.00

63391

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

403.20

63392

MRI—scan of cardiovascular system for congenital disease of the heart or a great vessel (R) (NK) (Anaes.) (Contrast)

224.00

63393

MRI—scan of cardiovascular system for tumour of the heart or a great vessel (R) (NK) (Anaes.) (Contrast)

224.00

63394

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

201.60

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

63401

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) (K) (Anaes.) (Contrast)

403.20

63404

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) (K) (Anaes.) (Contrast)

403.20

63407

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) (NK) (Anaes.) (Contrast)

201.60

63408

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) (NK) (Anaes.) (Contrast)

201.60

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

63416

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) (K) (Anaes.) (Contrast)

403.20

63419

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) (NK) (Anaes.) (Contrast)

201.60

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

63425

MRI—scan of person under the age of 16 for post‑inflammatory or post‑traumatic physeal fusion (R) (K) (Anaes.)

403.20

63428

MRI—scan of person under the age of 16 for Gaucher disease (R) (K) (Anaes.)

403.20

63432

MRI—scan of person under the age of 16 for post‑inflammatory or post‑traumatic physeal fusion (R) (NK) (Anaes.)

201.60

63433

MRI—scan of person under the age of 16 for Gaucher disease (R) (NK) (Anaes.)

201.60

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

63440

MRI—scan of person under the age of 16 for pelvic or abdominal mass (R) (K) (Anaes.) (Contrast)

403.20

63443

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

403.20

63446

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

403.20

63447

MRI—scan of person under the age of 16 for pelvic or abdominal mass (R) (NK) (Anaes.) (Contrast)

201.60

63448

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

201.60

63449

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

201.60

Subgroup 19—Scan of body—for specified conditions

63455

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

179.20

63457

MRI—scan of both breasts for the detection of cancer, if a dedicated breast coil is used, the request for scan identifies that the person is asymptomatic and is younger 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 one 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 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 or is a male relative who has been diagnosed with breast cancer;

(iii) one first or second degree relative diagnosed with breast cancer at age 45 years or younger, and 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.) (NK)

345.00

63458

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

(a) a dedicated breast coil is used; and

(b) the person has had an abnormality detected as a result of a service mentioned in item 63457 or 63464 performed in the previous 12 months (R) (NK) (Anaes.)

345.00

63461

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

358.40

63464

MRI—scan of both breasts for the detection of cancer, if a dedicated breast coil is used, the request for scan identifies that the person is asymptomatic and is younger 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 one 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 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 or is a male relative who has been diagnosed with breast cancer;

(iii) one first or second degree relative diagnosed with breast cancer at age 45 years or younger, and 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) (K) (Anaes.)

690.00

63467

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

(a) a dedicated breast coil is used; and

(b) the person has had an abnormality detected as a result of a service mentioned in item 63457 or 63464 performed in the previous 12 months (R) (K) (Anaes.)

690.00

Subdivision CSubgroup 20 of Group I5: scans of pelvis and upper abdomen for specified conditions

2.5.10  MRI services—limit for items 63470, 63473, 63479 and 63481

             (1)  Item 63470 or 63479 does not apply to the service mentioned in that item if the person to whom the service is provided has previously been provided with that service or a service mentioned in item 63473 or 63481.

             (2)  Item 63473 or 63481 does not apply to the service mentioned in that item if the person to whom the service is provided has previously been provided with that service or a service mentioned in item 63470 or 63479.

2.5.11  MRI and MRA services—modifying items

             (1)  Subject to subclauses (2), (3) and (4), if item 63491, 63494 or 63497 applies to an MRI or MRA service, the fee specified in that item applies in addition to the fee specified in the other item in Group I5 of this table that applies to the service.

             (2)  If 2 or more MRI or MRA services mentioned in item 63494 are performed for a person on the same day, the fee specified in that item applies to one of those services only.

             (3)  If 2 or more MRI or MRA services mentioned in item 63497 are performed for a person on the same day, the fee specified in that item applies to one of those services only.

             (4)  If:

                     (a)  one or more MRI or MRA services mentioned in item 63494; and

                     (b)  one or more MRI or MRA services mentioned in item 63497;

are performed for a person on the same day, the fee specified in item 63494 or item 63497, but not both those items, applies to one of those services only.

 

Group I5—Magnetic resonance imaging

Item

Description

Fee ($)

Subgroup 20—Scans of pelvis and upper abdomen—for specified conditions

63470

MRI—scan of the pelvis 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) (K) (Anaes.) (Contrast)

403.20

63473

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) (K) (Anaes.) (Contrast)

627.20

63476

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) (K) (Anaes.) (Contrast)

403.20

63479

MRI—scan of the pelvis 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) (NK) (Anaes.) (Contrast)

201.60

63481

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) (NK) (Anaes.) (Contrast)

313.60

63484

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) (NK) (Anaes.) (Contrast)

201.60

Subdivision DSubgroups 21 and 22 of Group I5

 

Group I5—Magnetic resonance imaging

Item

Description

Fee ($)

Subgroup 21—Scan of body—for specified conditions

63482

MRI—scan of pancreas and biliary tree for suspected biliary or pancreatic pathology (R) (K) (Anaes.)

403.20

63486

MRI—scan of pancreas and biliary tree for suspected biliary or pancreatic pathology (R) (NK) (Anaes.)

201.60

Subgroup 22—Modifying items

63491

MRI or MRA service to which an item in this Group (other than an item in this Subgroup) applies if:

(a) the service is performed in accordance with clause 2.5.1; and

(b) the item for the service includes in its description ‘(Contrast)’; and

(c) the service is performed using a contrast agent

44.80

63494

MRI or MRA service to which an item in this Group (other than an item in this Subgroup) applies if:

(a) the service is performed in accordance with clause 2.5.1; and

(b) the service is performed on a person using intravenous or intra muscular sedation

44.80

63497

MRI or MRA service to which an item in this Group (other than an item in this Subgroup) applies if:

(a) the service is performed in accordance with clause 2.5.1; and

(b) 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

Note:          Subgroups 23 to 32 of this table are set out in a determination made under subsection 3C(1) of the Act.

Subdivision ESubgroup 33 of Group I5

 

Group I5—Magnetic resonance imaging

Item

Description

Fee ($)

Subgroup 33—Scan of body—for specified conditions

63507

MRI—scan of head for a patient under 16 years if the service is for:

(a) an unexplained seizure; or

(b) an unexplained headache if significant pathology is suspected; or

(c) paranasal sinus pathology that has not responded to conservative therapy (R) (K) (Anaes.) (Contrast)

403.20

63508

MRI—scan of head for a patient under 16 years if the service is for:

(a) an unexplained seizure; or

(b) an unexplained headache if significant pathology is suspected; or

(c) paranasal sinus pathology that has not responded to conservative therapy (R) (NK) (Anaes.) (Contrast)

201.60

63510

MRI—scan of spine following radiographic examination for a patient under 16 years if the service is for:

(a) significant trauma; or

(b) unexplained neck or back pain with associated neurological signs; or

(c) unexplained back pain if significant pathology is suspected (R) (Anaes.) (K) (Contrast)

448.00

63511

MRI—scan of spine following radiographic examination for a patient under 16 years if the service is for:

(a) significant trauma; or

(b) unexplained neck or back pain with associated neurological signs; or

(c) unexplained back pain if significant pathology is suspected (R) (NK) (Anaes.) (Contrast)

224.00

63513

MRI—scan of knee following radiographic examination for internal joint derangement for a patient under 16 years (R) (K) (Anaes.) (Contrast)

403.20

63514

MRI—scan of knee following radiographic examination for internal joint derangement for a patient under 16 years (R) (NK) (Anaes.) (Contrast)

201.60

63516

MRI—scan of hip following radiographic examination for a patient under 16 years if any of the following is suspected:

(a) septic arthritis;

(b) slipped capital femoral epiphysis;

(c) Perthes disease (R) (K) (Anaes.) (Contrast)

403.20

63517

MRI—scan of hip following radiographic examination for a patient under 16 years if any of the following is suspected:

(a) septic arthritis;

(b) slipped capital femoral epiphysis;

(c) Perthes disease (R) (NK) (Anaes.) (Contrast)

201.60

63519

MRI—scan of elbow following radiographic examination for a patient under 16 years if a significant fracture or avulsion injury, which would change the way in which the patient is managed, is suspected (R) (K) (Anaes.) (Contrast)

403.20

63520

MRI—scan of elbow following radiographic examination for a patient under 16 years if a significant fracture or avulsion injury, which would change the way in which the patient is managed, is suspected (R) (NK) (Anaes.) (Contrast)

201.60

63522

MRI—scan of wrist following radiographic examination for a patient under 16 years if a scaphoid fracture is suspected (R) (K) (Anaes.) (Contrast)

448.00

63523

MRI—scan of wrist following radiographic examination for a patient under 16 years if a scaphoid fracture is suspected (R) (NK) (Anaes.) (Contrast)

224.00

Subdivision FSubgroup 34 of Group I5

 

Group I5—Magnetic resonance imaging

Item

Description

Fee ($)

Subgroup 34—Magnetic resonance imaging—for specified conditions

63551

Scan of head for a patient 16 years or older, after referral by a medical practitioner (other than a specialist or consultant physician), for any of the following:

(a) unexplained seizure(s);

(b) unexplained chronic headache with suspected intracranial pathology (R) (K) (Contrast) (Anaes.)

403.20

63552

Scan of head for a patient 16 years or older, after referral by a medical practitioner (other than a specialist or consultant physician), for any of the following:

(a) unexplained seizure(s);

(b) unexplained chronic headache with suspected intracranial pathology (R) (NK) (Contrast) (Anaes.)

201.60

63554

Scan of spine for a patient 16 years or older, after referral by a medical practitioner (other than a specialist or consultant physician), for suspected cervical radiculopathy (R) (K) (Contrast) (Anaes.)

358.40

63555

Scan of spine for a patient 16 years or older, after referral by a medical practitioner (other than a specialist or consultant physician), for suspected cervical radiculopathy (R) (NK) (Contrast) (Anaes.)

179.20

63557

Scan of spine for a patient 16 years or older, after referral by a medical practitioner (other than a specialist or consultant physician), for suspected cervical spinal trauma (R) (K) (Contrast) (Anaes.)

492.80

63558

Scan of spine for a patient 16 years or older, after referral by a medical practitioner (other than a specialist or consultant physician), for suspected cervical spinal trauma (R) (NK) (Contrast) (Anaes.)

246.40

63560

Scan of knee following acute knee trauma, after referral by a medical practitioner (other than a specialist or consultant physician), for a patient 16 years or older with:

(a) inability to extend the knee suggesting the possibility of acute meniscal tear; or

(b) clinical findings suggesting acute anterior cruciate ligament tear (R) (K) (Contrast) (Anaes.)

403.20

63561

Scan of knee following acute knee trauma, after referral by a medical practitioner (other than a specialist or consultant physician), for a patient 16 years or older with:

(a) inability to extend the knee suggesting the possibility of acute meniscal tear; or

(b) clinical findings suggesting acute anterior cruciate ligament tear (R) (NK) (Contrast) (Anaes.)

201.60

Division 2.6Group I6: management of bulk‑billed services

2.6.1  Application of items 64990 and 64991

             (1)  If the diagnostic imaging service mentioned in item 64991 is provided to a person, either that item or item 64990, but not both those items, applies to the service.

             (2)  If item 64990 or 64991 applies to a diagnostic imaging service, the fee specified in that item applies in addition to the fee specified in any other item in this table that applies to the service.

             (3)  For item 64991, this subclause applies to a geographical area included in any of the following SSD spatial units:

                     (a)  Beaudesert Shire Part A;

                     (b)  Belconnen;

                     (c)  Darwin City;

                     (d)  Eastern Outer Melbourne;

                     (e)  East Metropolitan Perth;

                      (f)  Frankston City;

                     (g)  Gosford‑Wyong;

                     (h)  Greater Geelong City Part A;

                      (i)  Gungahlin‑Hall;

                      (j)  Ipswich City (Part in BSD);

                     (k)  Litchfield Shire;

                      (l)  Melton‑Wyndham;

                    (m)  Mornington Peninsula Shire;

                     (n)  Newcastle;

                     (o)  North Canberra;

                     (p)  Palmerston‑East Arm;

                     (q)  Pine Rivers Shire;

                      (r)  Queanbeyan;

                      (s)  South Canberra;

                      (t)  South Eastern Outer Melbourne;

                     (u)  Southern Adelaide;

                     (v)  South West Metropolitan Perth;

                    (w)  Thuringowa City Part A;

                     (x)  Townsville City Part A;

                     (y)  Tuggeranong;

                     (z)  Weston Creek–Stromlo;

                    (za)  Woden Valley;

                   (zb)  Yarra Ranges Shire Part A.

             (4)  In this table:

Commonwealth concession card holder means a person who is a concessional beneficiary within the meaning given by subsection 84(1) of the National Health Act 1953.

practice location, for the provision of a diagnostic imaging service, means the place of practice for which the medical practitioner by whom, or on whose behalf, the service is provided, has been allocated a provider number by the Chief Executive Medicare.

regional, rural or remote area means an area classified as RRMAs 3‑7 under the Rural, Remote and Metropolitan Areas Classification.

SLA means a Statistical Local Area specified in the ASGC.

SSD means a Statistical Subdivision specified in the ASGC.

unreferred service means a diagnostic imaging service that:

                     (a)  is provided to a person by, or on behalf of, a medical practitioner, being a medical practitioner who is not a consultant physician, or specialist, in any speciality (other than a medical practitioner who is, for the Act, both a general practitioner and a consultant physician, or specialist, in a particular speciality); and

                     (b)  has not been referred to the medical practitioner by another medical practitioner or person with referring rights.

 

Group I6—Management of bulk‑billed services

Item

Description

Fee ($)

64990

A diagnostic imaging service to which an item in this table (other than this item or item 64991) applies if:

(a) the service is an unreferred service; and

(b) the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder; and

(c) the person is not an admitted patient of a hospital; and

(d) the service is bulk‑billed for the fees for:

(i) this item; and

(ii) the other item in this table applying to the service

7.05

64991

A diagnostic imaging service to which an item in this table (other than this item or item 64990) applies if:

(a) the service is an unreferred service; and

(b) the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder; and

(c) the person is not an admitted patient of a hospital; and

(d) the service is bulk‑billed for the fees for:

(i) this item; and

(ii) the other item in this table applying to the service; and

(e) the service is provided at, or from, a practice location in:

(i) a regional, rural or remote area; or

(ii) Tasmania; or

(iii) a geographical area to which subclause 2.6.1(3) applies; or

(iv) the geographical area included in the SLA spatial unit of Palm Island (AC)

10.65

Part 3Dictionary

Note:       All references in the Dictionary to a provision are references to a provision in this Schedule of this instrument unless otherwise indicated.

  

                   In this instrument:

Act means the Health Insurance Act 1973.

(Anaes.) has the meaning given by clause 2.43.5 of Schedule 1 to the general medical services table.

angiography suite has the meaning given by clause 2.3.4.

ASGC means the document titled Australian Standard Geographical Classification (ASGC) (ABS catalogue number 1216.0), published by the Australian Statistician in July 2010.

Note:          The ASGC could in 2014 be viewed on the Australian Bureau of Statistics website (http://www.abs.gov.au).

bulk‑billed, for a service, means the following:

                     (a)  a medicare benefit is payable to a person in relation to the service;

                     (b)  under an agreement entered into under section 20A of the Act:

                              (i)  the person assigns to the eligible provider by whom, or on whose behalf, the service is provided, the person’s right to the payment of the medicare benefit; and

                             (ii)  the eligible provider accepts the assignment in full payment of the eligible provider’s fee for the service provided.

Commonwealth concession card holder has the meaning given by clause 2.6.1.

comprehensive facility means a building or part of a building, or more than one building, where all of the following services are performed (whether or not other services are also performed):

                     (a)  PET;

                     (b)  computed tomography;

                     (c)  diagnostic ultrasound;

                     (d)  medical oncology;

                     (e)  radiation oncology;

                      (f)  surgical oncology;

                     (g)  X‑ray.

comprehensive practice means a medical practice, or a radiology department of a hospital, that provides X‑ray, ultrasound and computed tomography services (whether or not it provides other services).

computed tomography means a service performed (with or without intravenous contrast) using a detector:

                     (a)  that is coupled to an X‑ray tube tha