Category 5 - Diagnostic Imaging Services - MBS Online

Australian Government
Department of Health




Medicare Benefits Schedule Book
Category 5
Operating from 1 December 2017


















Title: Medicare Benefits Schedule Book
ISBN: 978-1-76007-348-0
Publications Number: 12009 Copyright © 2017 Commonwealth of Australia as represented by the Department of
Health.
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|At the time of printing, the relevant legislation giving |
|authority for the changes included in this edition of the|
|book may still be subject to the approval of Executive |
|Council and the usual Parliamentary scrutiny. This book |
|is not a legal document, and, in cases of discrepancy, |
|the legislation will be the source document for payment |
|of Medicare benefits. |





|The latest Medicare Benefits Schedule information |
|is available from MBS Online at |
|http://www.health.gov.au/mbsonline |

TABLE OF CONTENTS
GENERAL EXPLANATORY NOTES 6
GENERAL EXPLANATORY NOTES 7
CATEGORY 5: DIAGNOSTIC IMAGING SERVICES 33
SUMMARY OF CHANGES FROM 02/11/2017 34
DIAGNOSTIC IMAGING SERVICES NOTES 35
Group I1. Ultrasound 69
Subgroup 1. General 69
Subgroup 2. Cardiac 77
Subgroup 3. Vascular 81
Subgroup 4. Urological 85
Subgroup 5. Obstetric And Gynaecological 87
Subgroup 6. Musculoskeletal 120
Group I2. Computed Tomography 134
Group I3. Diagnostic Radiology 148
Subgroup 1. Radiographic Examination Of Extremities 148
Subgroup 2. Radiographic Examination Of Shoulder Or Pelvis 149
Subgroup 3. Radiographic Examination Of Head 150
Subgroup 4. Radiographic Examination Of Spine 154
Subgroup 5. Bone Age Study And Skeletal Surveys 156
Subgroup 6. Radiographic Examination Of Thoracic Region 156
Subgroup 7. Radiographic Examination Of Urinary Tract 158
Subgroup 8. Radiographic Examination Of Alimentary Tract And Biliary
System 159
Subgroup 9. Radiographic Examination For Localisation Of Foreign Bodies
161
Subgroup 10. Radiographic Examination Of Breasts 161
Subgroup 12. Radiographic Examination With Opaque Or Contrast Media
163
Subgroup 13. Angiography 166
Subgroup 14. Tomography 172
Subgroup 15. Fluoroscopic Examination 172
Subgroup 16. Preparation For Radiological Procedure 173
Subgroup 17. Interventional Techniques 173
Group I4. Nuclear Medicine Imaging 174
Group I5. Magnetic Resonance Imaging 189
Subgroup 1. Scan Of Head - For Specified Conditions 189
Subgroup 2. Scan Of Head - For Specified Conditions 190
Subgroup 3. Scan Of Head And Neck Vessels - For Specified Conditions
192
Subgroup 4. Scan Of Head And Cervical Spine - For Specified Conditions
193
Subgroup 5. Scan Of Head And Cervical Spine - For Specified Conditions
194
Subgroup 6. Scan Of Spine - One Region Or Two Contiguous Regions - For
Specified Conditions 195
Subgroup 7. Scan Of Spine - One Region Or Two Contiguous Regions - For
Specified Conditions 195
Subgroup 8. Scan Of Spine - Three Contiguous Regions Or Two Non-
Contiguous Regions - For Specified Conditions 197
Subgroup 9. Scan Of Spine - Three Contiguous Regions Or Two Non-
Contiguous Regions - For Specified Conditions 198
Subgroup 10. Scan Of Cervical Spine And Brachial Plexus - For Specified
Conditions 200
Subgroup 11. Scan Of Musculoskeletal System - For Specified Conditions
201
Subgroup 12. Scan Of Musculoskeletal System - For Specified Conditions
202
Subgroup 13. Scan Of Musculoskeletal System - For Specified Conditions
204
Subgroup 14. Scan Of Cardiovascular System - For Specified Conditions
205
Subgroup 15. Magnetic Resonance Angiography - Scan Of Cardiovascular
System - For Specified Conditions 206
Subgroup 16. Magnetic Resonance Angiography - For Specified Conditions -
Person Under The Age Of 16 Years 207
Subgroup 17. Magnetic Resonance Imaging - For Specified Conditions -
Person Under The Age Of 16 Years 207
Subgroup 18. Magnetic Resonance Imaging - For Specified Conditions -
Person Under The Age Of 16 Years 208
Subgroup 19. Scan Of Body - For Specified Conditions 209
Subgroup 20. Scan Of Pelvis And Upper Abdomen - For Specified Conditions
214
Subgroup 21. Scan Of Body - For Specified Conditions 217
Subgroup 22. Modifying Items 218
Subgroup 32. Magnetic Resonance Imaging - Pip Breast Implant 219
Subgroup 33. Magnetic Resonance Imaging - For Specified Conditions -
Person Under The Age Of 16yrs 220
Subgroup 34. Magnetic Resonance Imaging - For Specified Conditions
222
Group I6. Management Of Bulk-Billed Services 224
INDEX 227 GENERAL EXPLANATORY NOTES
GENERAL EXPLANATORY NOTES GN.1.1 The Medicare Benefits Schedule - Introduction
Schedules of Services
Each professional service contained in the Schedule has been allocated a
unique item number. Located with the item number and description for each
service is the Schedule fee and Medicare benefit, together with a reference
to an explanatory note relating to the item (if applicable).
If the service attracts an anaesthetic, the word (Anaes.) appears following
the description. Where an operation qualifies for the payment of benefits
for an assistant, the relevant items are identified by the inclusion of the
word (Assist.) in the item description. Medicare benefits are not payable
for surgical assistance associated with procedures which have not been so
identified.
In some cases two levels of fees are applied to the same service in General
Medical Services, with each level of fee being allocated a separate item
number. The item identified by the letter "S" applies in the case where
the procedure has been rendered by a recognised specialist in the practice
of his or her specialty and the patient has been referred. The item
identified by the letter "G" applies in any other circumstance.
Higher rates of benefits are also provided for consultations by a
recognised consultant physician where the patient has been referred by
another medical practitioner or an approved dental practitioner (oral
surgeons).
Differential fees and benefits also apply to services listed in Category 5
(Diagnostic Imaging Services). The conditions relating to these services
are set out in Category 5.
Explanatory Notes
Explanatory notes relating to the Medicare benefit arrangements and notes
that have general application to services are located at the beginning of
the schedule, while notes relating to specific items are located at the
beginning of each Category. While there may be a reference following the
description of an item to specific notes relating to that item, there may
also be general notes relating to each Group of items.
GN.1.2 Medicare - an outline
The Medicare Program ('Medicare') provides access to medical and hospital
services for all Australian residents and certain categories of visitors to
Australia. The Department of Human Services administers Medicare and the
payment of Medicare benefits. The major elements of Medicare are contained
in the Health Insurance Act 1973, as amended, and include the following:
a. Free treatment for public patients in public hospitals.
b. The payment of 'benefits', or rebates, for professional services
listed in the Medicare Benefits Schedule (MBS). In general, the
Medicare benefit is 85% of the Schedule fee, otherwise the benefits
are
i. 100% of the Schedule fee for services provided by a general
practitioner to non-referred, non-admitted patients;
ii. 100% of the Schedule fee for services provided on behalf of a
general practitioner by a practice nurse or Aboriginal and
Torres Strait Islander health practitioner;
iii. 75% of the Schedule fee for professional services rendered to a
patient as part of an episode of hospital treatment (other than
public patients);
iv. 75% of the Schedule fee for professional services rendered as
part of a privately insured episode of hospital-substitute
treatment.
Medicare benefits are claimable only for 'clinically relevant' services
rendered by an appropriate health practitioner. A 'clinically relevant'
service is one which is generally accepted by the relevant profession as
necessary for the appropriate treatment of the patient.
When a service is not clinically relevant, the fee and payment arrangements
are a private matter between the practitioner and the patient.