Health Insurance (1999-2000 Diagnostic Imaging Services Table) Regulations 1999 (Cth)

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Health Insurance (1999-2000 Diagnostic Imaging Services Table) Regulations 1999

Statutory Rules 1999 No. 255 as amended

made under the

Health Insurance Act 1973

This compilation was prepared on 1 July 2000

taking into account amendments up to SR 2000 No. 147

Prepared by the Office of Legislative Drafting,

Attorney-General’s Department, Canberra

Health Insurance (1999-2000 Diagnostic Imaging Services Table) Regulations 1999

Statutory Rules 1999 No. 255as amended

made under the

Health Insurance Act 1973

Contents

Page

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1Name of Regulations[see Note 1]

 These Regulations are the Health Insurance (1999-2000 Diagnostic Imaging Services Table) Regulations 1999.

2Commencement

 These Regulations commence on 1 November 1999.

3Repeal of Health Insurance (1998-99 Diagnostic Imaging Services Table) Regulations 1998

 The following statutory rules are repealed:

  • •

    1998 No. 302

  • •

    1999 No. 20

  • •

    1999 No. 193

  • •

    1999 No. 219.

4Diagnostic imaging services table

 The table of diagnostic imaging services set out in Schedule 1 is prescribed for the purposes of subsection 4AA (1) of the Health Insurance Act 1973.

Schedule 1Table of diagnostic imaging services

(regulation 4)

Part 1Rules of interpretation

1General

 In this table, unless the contrary intention appears:

Act means the Health Insurance Act 1973.

computed tomography means a service rendered (with or without intravenous contrast):

  • (a)

    using a detector coupled to an X-ray tube that emits a finely collimated X-ray beam as it rotates within a gantry around a patient either in incremental or helical manner; and

  • (b)

    registering a resulting variable amount of X-rays and transforming that information into a cross-sectional image after the application of complex algorithms.

CT means computed tomography.

CT equipment includes the following components:

  • (a)

    a gantry;

  • (b)

    a couch;

  • (c)

    a computer;

  • (d)

    an operator station;

  • (e)

    a generator.

exclusion, in relation to a condition for which a MRI or MRA service is requested, means use of the service as the initial imaging modality for diagnosis of the condition.

MRA means magnetic resonance angiography.

MRI means magnetic resonance imaging.

remote location means a place within Australia that is:

  • (a)

    more than 30 kilometres by road from a hospital that provides a radiology or computed tomography service under the direction of a specialist in the specialty of diagnostic radiology; or

  • (b)

    more than 30 kilometres by road from a free standing radiology or computed tomography facility under the direction of a specialist in the specialty of diagnostic radiology.

sequence, in relation to a scan, means a series of images collected at the same time with similar image parameters (not including a scan designed to establish patient position and subsequently used to plan other scans).

Note Specialist and other words and expressions used in this table are defined in subs 3 (1) of the Act.

2References to items in the general medical services table

 A reference by number to any of items 11240, 11603 to 11612, 30361 and 30488 is a reference to the item so numbered in the general medical services table.

3Meaning of (R) and (NR)

  • (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.

4Meaning of (S)

 An item including the symbol (S) applies only to a service provided by a specialist in the practice of diagnostic radiology.

5Who may provide a diagnostic imaging service

 Unless the contrary intention appears, a diagnostic imaging service in the table is a diagnostic imaging service for the Act, 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.

6Meaning of report in certain items

 In items 55028 to 61109 and 63000 to 63946, report means a report prepared by a medical practitioner.

7Administration of anaesthetics in connection with certain services

 If a general anaesthetic is administered in connection with a service specified in an item that includes the formula:

Anaes. n= n1  B+ n2  T

 in which:

  • (a)

    n is a number; and

  • (b)

    n1 and n2 are other numbers;

 the service that is provided by the medical practitioner who administers the anaesthetic is the service described in item n in the general medical services table.

8Meaning of group of practitioners

 In this table, group of practitioners has the same meaning as in subsection 16A (10) of the Act.

9Meaning of medical practitioner in certain items

(1)

In items 55028, 55030 and 55032, medical practitioner in the phrase referred by a medical practitioner or the referring medical practitioner includes a dental practitioner who is approved by the Minister under paragraph (b) of the definition of professional service in subsection 3 (1) of the Health Insurance Act 1973.

(2)

In items 55050 and 55052, medical practitioner in the phrase referred by a medical practitioner or the referring medical practitioner includes a dental practitioner who is:

  • (a)

    approved by the Minister under paragraph (b) of the definition of professional service in subsection 3 (1) of the Health Insurance Act 1973; or

  • (b)

    a prosthodontist.

9AComputed tomography services — meaning of (K) and (NK)

  • (1)

    In any of items 56001 to 57355, the symbol (K) means:

    • (a)

      for CT equipment that was first installed and used as new equipment at a site in Australia:

      • (i)

        the service was rendered earlier than 10 years after the earliest date on which any component of the equipment was first installed and ready for use; or

      • (ii)

        the service was rendered in a remote location; or

    • (b)

      for CT equipment imported as pre-used equipment:

      • (i)

        the service was rendered earlier than 10 years after the earliest date of manufacture of any component of the equipment; or

      • (ii)

        the service was rendered in a remote location.

  • (2)

    In any of items 56001 to 57355, the symbol (NK) means the service was rendered 10 years or more after:

    • (a)

      for CT equipment that was first installed and used as new equipment in Australia — the earliest date on which any component of the equipment was first installed and ready for use; or

    • (b)

      for CT equipment imported as pre-used equipment — the earliest date of manufacture of any component of the equipment.

  • (3)

    In this rule:

    CT equipment imported as pre-used equipment means equipment that has been used to render CT services before being imported into Australia.

    installed and ready for use, in relation to a component, means ready for immediate income-producing purposes whether or not it is so used.

9BCT services — eligible services

 Items 56001 to 57355 apply only to a computed tomography 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 personally attend on the patient; or

  • (b)

    if paragraph (a) cannot be complied with:

    • (i)

      in an emergency; or

    • (ii)

      because of medical necessity — in a remote location.

9CComputed tomography services — exclusion of acoustic neuroma

 Where axial scans are undertaken for the exclusion of acoustic neuroma, medicare benefits are payable under item 56001 or 56007.

9DComputed tomography — assessment of headache

  • (1)

    If the service described in item 56007 or 56047 is to be used for the assessment of headache of a patient to whom this rule applies, the fee mentioned in the item applies only if:

    • (a)

      a scan without intravenous contrast medium has been undertaken on the patient; and

    • (b)

      the service is required because the result of the scan mentioned in paragraph (a) is abnormal.

  • (2)

    This rule 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.

    10Meaning of Amount under rule 10 in certain items

     In item 59103, Amount under rule 10 means an amount equal to the sum of:

    • (a)

      the fee set out in another item for the radiographic examination in conjunction with which a service referred to in item 59103 is provided; and

    • (b)

      $21.30.

10AAUltrasound services — eligible services

  • (1)

    Items 55028 to 55739 apply only to an ultrasound service (the eligible service) performed for items marked with the symbol (R):

    • (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 personally attend the patient; or

    • (b)

      under the professional supervision of a practitioner who:

      • (i)

        is not a specialist or consultant physician; and

      • (ii)

        meets the requirements of subrule (2); and

      • (iii)

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

    • (c)

      in circumstances mentioned in subrule (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 personally attend the patient; or

    • (d)

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

      • (i)

        in an emergency; or

      • (ii)

        in a remote 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)

    The requirements of this subrule are 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 resulted in the payment of a medicare benefit.

  • (3)

    For paragraph (1) (c), the circumstances are 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 resulted in the payment of medicare benefits.

10ABObstetric and gynaecological ultrasound — limits

 The fees mentioned in items in the item range from 55700 to 55728 in Part 2 of the table are applicable to no more than 3 items of NR-type diagnostic imaging for the same patient in any 1 pregnancy.

10ACClinical indications

  • (1)

    For items where clinical conditions are listed, or where a clinical indication is required for performance of subsequent scans (items 55712, 55715, 55721 or 55725), the referral must identify the relevant clinical indication for the service.

  • (2)

    If the service is self-determined, the clinical condition or indication must be recorded in the medical practitioner's clinical notes.

    10ADMeaning of non-metropolitan hospital in items in subgroup 5 of Group I1

     In an item in subgroup 5 of Group I1:

    non-metropolitan hospital means a hospital that is located outside the Sydney, Melbourne, Brisbane, Adelaide, Perth, Greater Hobart, Darwin and Canberra major statistical divisions, as defined in the Australian Standard Geographical Classification 1999 published by the Australian Bureau of Statistics (publication number 1216.0 of 1999).

10AMammography services — eligible services

 Items 59300 to 59318 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 personally attend on the patient; or

  • (b)

    if paragraph (a) cannot be complied with:

    • (i)

      in an emergency; or

    • (ii)

      because of medical necessity — in a remote location.

11Preparation of patients for radiological procedures

 Items 60903 to 60927 apply only to the preparation of a patient for a radiological procedure for a service to which items 59900 to 59970 applies 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.

12Meaning of angiography suite in item 61109

 In item 61109, angiography suite means a room that contains only equipment designed for angiography that is able to perform digital subtraction or rapid sequence film angiography.

13Nuclear scanning services

 Items 61302 to 61499 apply to a nuclear scanning service only if:

  • (a)

    the performance of the scan does not involve the use of positron-emission radio-isotopes or a Positron Emission Tomography (PET) scanner; and

  • (b)

    the performance of the scan is undertaken:

    • (i)

      by a specialist or consultant physician; or

    • (ii)

      by a person acting on behalf of a specialist or consultant physician in the presence of the specialist or consultant physician; and

  • (c)

    the compilation of the final report is undertaken by the specialist or consultant physician who undertook the preliminary examination of the patient and the estimation and administration of the dosage.

14Meaning of Amount under rule 14 in item 61462

 In item 61462, Amount under rule 14 means an amount equal to the sum of:

  • (a)

    the fee set out in the item in Group I4 in conjunction with which a service referred to in item 61462 is provided; and

  • (b)

    $113.55.

15Multiple 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 $5.00.

  • (2)

    If a medical practitioner renders at least 1 R-type diagnostic imaging service and at least 1 consultation service for the same patient on the same day — the highest fee, set out in the items that apply to any diagnostic imaging services rendered by the medical practitioner for the same patient on the same day, is reduced by the least of:

    • (a)

      if the fee for the consultation is at least $40.00 — $35.00; or

    • (b)

      if the fee for the consultation is less than $40.00 — $15.00; or

    • (c)

      that fee.

  • (3)

    Subrule (2) only applies to the consultation for which the highest fee is set out in the items that apply to the consultations.

  • (4)

    If a medical practitioner renders at least 1 R-type diagnostic imaging service and at least 1 non-consultation service for the same patient on the same day — the highest fee, set out in the items that apply to any diagnostic imaging services rendered by the medical practitioner for the same patient on the same day, is reduced by $5.00.

  • (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 subrules (2) and (4) is not to exceed the highest fee set out in the items that apply to any diagnostic imaging services rendered by the medical practitioner for the same patient on the same day.

  • (6)

    This rule 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.

  • (7)

    In this rule:

    consultation means a service under an item listed in Groups A1 to A9 of the general medical services table.

    non-consultation servicemeans a service under an item listed in the general medical service table other than in Groups A1 to A9.

  • (8)

    A reference in this rule to a highest feeis a reference to a fee for an item in the first claim processed by the Commission for which subrule (1), (2) or (4) applies.

16MRI and MRA services — eligible services

 Items 63000 to 63946 apply only to a MRI or MRA service performed:

  • (a)

    on request, in accordance with rule 17, by a specialist or consultant physician; and

  • (b)

    in a permissible circumstance, in accordance with rule 18; and

  • (c)

    with eligible equipment, in accordance with rule 20.

17Request for MRI and MRA services — requirements

 A request for any of items 63000 to 63946 must:

  • (a)

    be in writing; and

  • (b)

    identify the clinical indications for the service.

18MRI and MRA services — permissible circumstances for performance

 For rule 16, a service is performed in a permissible circumstance only if it is performed:

  • (a)

    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; or

  • (b)

    if paragraph (a) is not complied with:

    • (i)

      in an emergency; or

    • (ii)

      because of medical necessity — in a remote location.

19MRI and MRA services — eligible provider

  • (1)

    For rule 18, an eligible provider is a specialist in diagnostic radiology who satisfies the Commission that:

    • (a)

      he or she is a participant in the Royal Australasian College of Radiologists’ Quality and Accreditation Program; and

    • (b)

      the equipment he or she proposes to use for providing services of the kind mentioned in Group I5 in the diagnostic imaging services table (the proposed equipment) is eligible equipment for rule 20.

  • (2)

    The Commission must have been given a statutory declaration:

    • (a)

      stating the matters mentioned in paragraphs (1) (a) and (b); and

    • (b)

      specifying the location of the proposed equipment; and

    • (c)

      specifying the kinds of diagnostic imaging procedures offered at that location; and

    • (d)

      if the proposed equipment has been installed at that location and is equipment to which subrule 20 (3) or (4) applies — stating the date that it was installed (the installation date); and

    • (e)

      if paragraph (d) applies, and the installation date was 12 May 1998 — stating the time at which the equipment was installed.

  • (3)

    If paragraph (2) (d) applies, and the equipment was not installed before 7.30 pm on 12 May 1998, Eastern Standard Time, the specialist must have given the Commission, with the statutory declaration, a copy of the contract for the purchase or lease of the equipment.

  • (4)

    The Commission may request a specialist to:

    • (a)

      give the Commission documents to support statements made in the statutory declaration; and

    • (b)

      answer questions put to the specialist by the Commission about those statements.

    Note   The documents may include the contract for purchase or lease of the proposed equipment, if not already given to the Commission under subr (3).

20MRI and MRA services — eligible equipment

  • (1)

    For rule 16, eligible equipment is equipment that complies with this rule.

  • (2)

    The equipment must be located in Australia in a medical practice, or the radiology department of a hospital, that offers a comprehensive range of diagnostic imaging procedures.

  • (3)

    For a medical practice or hospital located in a non-metropolitan area:

    • (a)

      the equipment must have been installed in a medical practice, or hospital, in Australia before 7.30 pm on 12 May 1998, Eastern Standard Time; or

    • (b)

      if the equipment was uninstalled at the time and on the day mentioned in paragraph (a) — it must:

      • (i)

        have been purchased or leased under a contract, in writing (that did not contain an option to cancel) before that time on that day; and

      • (ii)

        on or before 18 October 1999 — be in use for services for which a medicare benefit is claimed; or

    • (c)

      be replacement equipment for equipment mentioned in paragraph (a) or (b).

    Note   Equipment relocated to a new location may continue to comply with subr (3). However, to continue to be eligible equipment, the equipment would have to continue to comply with subr (2).

  • (4)

    For a medical practice or hospital located in a metropolitan area, the equipment must:

    • (a)

      have been installed in a medical practice, or hospital, in Australia before 7.30 pm on 12 May 1998, Eastern Standard Time; or

    • (b)

      if uninstalled at that time on that day — have been purchased or leased under a contract, in writing (that did not contain an option to cancel), before 10 February 1998; or

    • (c)

      be replacement equipment for equipment mentioned in paragraph (a) or (b).

    Note   Equipment relocated to a new location may continue to comply with subr (4). However, to continue to be eligible equipment, the equipment would have to continue to comply with subr (2).

  • (5)

    Equipment mentioned in paragraph (3) (a) or (b) or (4) (a) or (b) ceases to be eligible equipment when replaced by other equipment.

  • (6)

    The Commission must have been given, before 11 October 1999:

    • (a)

      the statutory declaration, under subrule 19 (2), in relation to the equipment; and

    • (b)

      if paragraph (3) (b) or (4) (b) applies, the copy contract mentioned in subrule 19 (3).

  • (7)

    For this rule:

    comprehensive, in relation to a range of diagnostic imaging procedures, means that the range includes x‑ray, ultrasound and computed tomography (CT) procedures.

    medical practice means a practice conducted by a sole practitioner, a practice conducted by a group of practitioners within the meaning of subsection 16A (9) or (10) of the Act or a practice conducted by a medical entrepreneur.

    metropolitan area includes any location within any of the Sydney, Melbourne, Brisbane, Adelaide, Perth, Greater Hobart, Darwin or Canberra major statistical divisions, as defined in the Australian Standard Geographical Classification 1999 published by the Australian Bureau of Statistics (publication number 1216.0 of 1999).

21MRI and MRA services — meaning of scan

 In items 63000 to 63946:

scan means a minimum of 3 sequences.

22MRI and MRA services — descriptions of purpose of services

 The purposes for which a MRI or MRA service may be claimed (the purpose for each particular service being set out in each of items 63000 to 63946) are:

  • (a)

    the exclusion of a condition; and

  • (b)

    the further investigation of a condition, if the service is used as the secondary imaging modality:

    • (i)

      when the diagnosis is uncertain; or

    • (ii)

      to assess the severity of the condition; and

  • (c)

    the monitoring of a condition, if the service is used following confirmed diagnosis to assess progress of a condition following treatment.

Note   For the meaning of exclusion of a condition, if that is the purpose of requesting a MRI or MRA service, see r 1.

23MRI or MRA services — related services that can be claimed in a 12 month period

(1)

The fee mentioned in an item does not apply if:

  • (a)

    the item is mentioned in subrule (2); and

  • (b)

    the service mentioned in the item 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 subrule (2) for that item.

(2)

For subrule (1), the items and maximum number of services are:

  • (a)

    for items 63000 to 63024, 63050 to 63062, 63100 to 63133, 63150 to 63162, 63300 to 63315, 63350 to 63365, 63400 to 63430, 63450 to 63480, 63500 to 63524, 63550 to 63574, 63600 to 63627, 63650 to 63680, 63700 to 63721, 63750 to 63756, 63870, 63900 to 63909, 63920 and 63930 — 1 service; and

  • (b)

    for items 63200 to 63221, 63250 to 63256, 63745, 63800 to 63806 and 63850 to 63868 — 2 services.

Part 2Service and Fees

Item

Diagnostic imaging service

Fee ($)

Group I1 — Ultrasound

Subgroup 1 — General

55028

Head, ultrasound scan of, performed by, or on behalf of, a medical practitioner where:

(a) the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a service to which an item in Subgroup 2 or 3 of this group applies; and

(b) the referring medical practitioner is not a member of a group of practitioners of which the first mentioned practitioner is a member (R)

99.90

55029

Head, ultrasound scan of, where the patient is not referred by a medical practitioner, not being a service associated with a service to which an item in Subgroup 2 or 3 of this group applies (NR)

34.65

55030

Orbital contents, ultrasound scan of, performed by, or on behalf of, a medical practitioner where:

(a) the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a service to which an item in Subgroup 2 or 3 of this group applies; and

(b) the referring medical practitioner is not a member of a group of practitioners of which the first mentioned practitioner is a member (R)

99.90

55031

Orbital contents, ultrasound scan of, where the patient is not referred by a medical practitioner, not being a service associated with a service to which an item in Subgroup 2 or 3 of this group applies (NR)

34.65

55032

Neck, 1 or more structures of, ultrasound scan of, performed by, or on behalf of, a medical practitioner where:

(a) the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a service to which an item in Subgroup 2 or 3 of this group applies; and

(b) the referring medical practitioner is not a member of a group of practitioners of which the first mentioned practitioner is a member (R)

99.90

55033

Neck, 1 or more structures of, ultrasound scan of, where the patient is not referred by a medical practitioner, not being a service associated with a service to which an item in Subgroup 2 or 3 of this group applies (NR)

34.65

55036

Abdomen, ultrasound scan of, including scan of urinary tract when undertaken, performed by, or on behalf of, a medical practitioner where:

(a) the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a service to which an item in Subgroup 2 or 3 of this group applies; and

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

(c) the service is not performed with item 55038, 55044 or 55731 on the same patient within 24 hours (R)

101.95

55037

Abdomen, ultrasound scan of, including scan of urinary tract when undertaken, where the patient is not referred by a medical practitioner, not being a service associated with a service to which an item in Subgroup 2 or 3 of this group applies (NR)

34.65

55038

Urinary tract, ultrasound scan of, performed by, or on behalf of, a medical practitioner where:

(a) the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a service to which an item in Subgroup 2 or 3 of this group applies; and

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

(c) the service is not performed with item 55036, 55044 or 55731 on the same patient within 24 hours (R)

99.90

55039

Urinary tract, ultrasound scan of, where the patient is not referred by a medical practitioner, not being a service associated with a service to which an item in Subgroup 2 or 3 of this group applies (NR)

34.65

55044

Pelvis, male, ultrasound scan of, by any or all approaches, performed by, or on behalf of, a medical practitioner where:

(a) the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a service to which an item in Subgroup 2 or 3 of this group applies; and

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

(c) the service is not performed with item 55036 or 55038 on the same patient within 24 hours (R)

101.95

55045

Pelvis, male, ultrasound scan of, by any or all approaches, where the patient is not referred by a medical practitioner, not being a service associated with a service to which an item in Subgroup 2 or 3 of this group applies (NR)

34.65

55048

Scrotum, ultrasound scan of, performed by, or on behalf of, a medical practitioner where:

(a) the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a service to which an item in Subgroup 2 or 3 of this group applies; and

(b) the referring medical practitioner is not a member of a group of practitioners of which the first mentioned practitioner is a member (R)

100.30

55049

Scrotum, ultrasound scan of, where the patient is not referred by a medical practitioner, not being a service associated with a service to which an item in Subgroup 2 or 3 of this group applies (NR)

34.65

55050

Musculoskeletal, 1 or more regions, ultrasound scan of, performed by, or on behalf of, a medical practitioner where:

(a) the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a service to which an item in Subgroup 2 or 3 of this group applies; and

(b) the referring medical practitioner is not a member of a group of practitioners of which the first mentioned practitioner is a member (R)

100.30

55051

Musculoskeletal, 1 or more regions, ultrasound scan of, where the patient is not referred by a medical practitioner, not being a service associated with a service to which an item in Subgroup 2 or 3 of this group applies (NR)

34.65

55052

Joint, 1 or more, ultrasound scan of, performed by, or on behalf of, a medical practitioner where:

(a) the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a service to which an item in Subgroup 2 or 3 of this group applies; and

(b) the referring medical practitioner is not a member of a group of practitioners of which the first mentioned practitioner is a member (R)

99.90

55053

Joint, 1 or more, ultrasound scan of, where the patient is not referred by a medical practitioner, not being a service associated with a service to which an item in Subgroup 2 or 3 of this group applies (NR)

34.65

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)

99.90

55058

Measurement of umbilical blood flow using pulsed wave or continuous wave Doppler techniques after the 26th week of gestation where the patient is referred by a medical practitioner for this procedure and where there is reason to suspect intrauterine growth retardation or a significant risk of foetal death, not being a service associated with a service to which an item in this group applies — examination and report (R)

27.25

55070

Breast, one, ultrasound scan of, performed by or on behalf of a medical practitioner, where:

(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 of this group applies; and

(c) the referring medical practitioner is not a member of a group of practitioners of which the first mentioned practitioner is a member (R)

90.00

55073

Breast, one, ultrasound scan of, where:

(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 of this group applies (NR)

31.20

55076

Breasts, both, ultrasound scan of, performed by or on behalf of a medical practitioner where:

(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 of this group applies; and

(c) the referring medical practitioner is not a member of a group of practitioners of which the first mentioned practitioner is a member (R)

99.90

55079

Breasts, both, ultrasound scan of, where:

(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 of this group applies (NR)

34.65

Subgroup 2 — Cardiac

55102

M-Mode and 2 dimensional real time echocardiographic examination of the heart from at least 2 thoracic windows, performed using a mechanical sector scanner or phased array transducer, with measurement of blood flow velocities across the cardiac valves using pulsed wave and continuous wave Doppler techniques, with recordings on video tape, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this group applies (R)

163.90

55105

M-Mode and 2 dimensional real time echocardiographic examination of the heart from at least 2 thoracic windows, performed using a mechanical sector scanner or phased array transducer, with measurement of cardiac dimensions, with recordings on video tape, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this group applies (R)

92.75

55112

M-Mode and 2 dimensional real time echocardiographic examination of the heart from at least 2 thoracic windows, performed using a mechanical sector scanner or phased array transducer, with measurement of blood flow velocities across the cardiac valves using pulsed wave and continuous wave Doppler techniques, and real time colour flow mapping from at least 2 thoracic windows, with recordings on video tape, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this group applies (R)

257.65

55118

Heart, 2 dimensional real time transoesophageal examination of, from at least 2 oesophageal windows:

(a) performed using a mechanical sector scanner or phased array transducer with:

  • (i)

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

  • (ii)

    real time colour flow mapping from at least 2 oesophageal windows; and

  • (iii)

    recordings on video tape; and

(b) not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this group applies (R)

(Anaes. 17708 = 6B + 2T)

257.05

55130

Intra-operative 2 dimensional real time transoesophageal echocardiography incorporating Doppler techniques with colour flow mapping and recording onto video tape, performed during cardiac surgery incorporating sequential assessment of cardiac function before and after the surgical procedure (R)

(Anaes. 17710 = 6B + 4T)

372.20

Subgroup 3 — Vascular

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 item 55054) or 4 of this group applies — 1 examination and report (R)

169.45

55240

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, including a service referred to in item 11603, 11606 or 11609, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this group applies — 1 examination and report (R)

197.00

55242

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, including a service referred to in item 11612, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this group applies — 1 examination and report (R)

218.50

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 item 55054) or 4 of this group applies — 1 examination and report (R)

169.45

55245

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, including a service referred to in item 11603, 11606 or 11609, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this group applies — 1 examination and report (R)

197.00

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 item 55054) or 4 of this group applies — 1 examination and report (R)

169.45

55247

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, including a service referred to in item 11603, 11606 or 11609, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this group applies — 1 examination and report (R)

197.00

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 item 55054) or 4 of this group applies — 1 examination and report (R)

169.45

55250

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, including a service referred to in item 11603, 11606 or 11609, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this group applies — 1 examination and report (R)

197.00

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 item 55054) or 4 of this group applies — 1 examination and report (R)

169.45

55254

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the upper limb, including a service referred to in item 11603, 11606 or 11609, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this group applies — 1 examination and report (R)

197.00

55256

Duplex scanning, bilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the lower limbs or of arteries and bypass grafts in the lower limbs, below the inguinal ligament, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this group applies — 1 examination and report (R)

169.45

55258

Duplex scanning, bilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the lower limbs or of arteries and bypass grafts in the lower limbs, below the inguinal ligament, including a service referred to in item 11603, 11606 or 11609, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this group applies — 1 examination and report (R)

197.00

55260

Duplex scanning, bilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the lower limbs or of arteries and bypass grafts in the lower limbs, below the inguinal ligament, including a service referred to in item 11612, not being a service associated with a service to which an item in Subgroup 1 (with exception of item 55054) or 4 of this group applies — 1 examination and report (R)

218.50

55262

Duplex scanning, bilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the lower limbs, 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 item 55054) or 4 of this group applies — 1 examination and report (R)

169.45

55263

Duplex scanning, bilateral, 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, including a service referred to in item 11603, 11606 or 11609, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this group applies — 1 examination and report (R)

197.00

55264

Duplex scanning, bilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the lower limbs, 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 item 55054) or 4 of this group applies — 1 examination and report (R)

169.45

55265

Duplex scanning, bilateral, 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, including a service referred to in item 11603, 11606 or 11609, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this group applies — 1 examination and report (R)

197.00

55266

Duplex scanning, bilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the upper limbs or of arteries and bypass grafts in the upper limbs, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this group applies — 1 examination and report (R)

169.45

55268

Duplex scanning, bilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the upper limbs, including a service referred to in item 11603, 11606 or 11609, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this group applies — 1 examination and report (R)

197.00

55270

Duplex scanning, bilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the upper limbs, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this group applies — 1 examination and report (R)

169.45

55272

Duplex scanning, bilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the upper limbs, including a service referred to in item 11603, 11606 or 11609, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this group applies — 1 examination and report (R)

197.00

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 item 55054) or 4 of this group applies — 1 examination and report (R)

169.45

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, for an examination of not less than 45 minutes duration, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this group applies — 1 examination and report (R)

169.45

55277

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of intra-abdominal, aorta and iliac arteries and inferior vena cava and iliac veins, excluding pregnancy related studies, for an examination of between 25 and 45 minutes duration, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this group applies — 1 examination and report (R)

109.40

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, for an examination of not less than 45 minutes duration, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this group applies — 1 examination and report (R)

169.45

55279

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, for an examination of between 25 and 45 minutes duration, not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054) or 4 of this group applies — 1 examination and report (R)

109.40

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 item 55054) or 4 of this group applies — 1 examination and report (R)

169.45

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 vasular aetiology for impotence; and

(c) where 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 rendered, immediately prior to or for a period during the rendering of the service; and

169.45

(d) where that 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 item 55054) or 4 of this group applies — examination and report (R)

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) where 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) where 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 rendered, immediately prior to or for a period during the rendering of the service; and

(d) where that 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 item 55054) or 4 of this group applies — 1 examination and report (R)

169.45

55288

Two examinations of the kind referred to in items 55238 to 55280 except for an examination of the kind referred to in the items shown in the following blocks, where only one examination can be provided from the items in any one block:

block (a) items 55238, 55240, 55242, 55256, 55258 and 55260;

block (b) items 55244, 55245, 55246, 55247, 55262, 55263, 55264 and 55265;

block (c) items 55248, 55250, 55266 and 55268;

block (d) items 55252, 55254, 55270 and 55272;

block (e) items 55276, 55277, 55278 and 55279;

not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054), or 4 of this group applies — examination and report (R)

298.65

55290

Three examinations of the kind referred to in items 55238 to 55280 except for an examination of the kind referred to in the items shown in the following blocks, where only one examination can be provided from the items in any one block:

block (a) items 55238, 55240, 55242, 55256, 55258 and 55260;

block (b) items 55244, 55245, 55246, 55247, 55262, 55263, 55264 and 55265;

block (c) items 55248, 55250, 55266 and 55268;

block (d) items 55252, 55254, 55270 and 55272;

block (e) items 55276, 55277, 55278 and 55279;

not being a service associated with a service to which an item in Subgroup 1 (with the exception of item 55054), or 4 this group applies — examination and report (R)

298.65

Subgroup 4 — Urological

55600

Prostate, bladder base and urethra, transrectal ultrasound scan of, where performed:

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

  • (i)

    has a nominal frequency of 7 to 7.5 megahertz or a nominal frequency range which includes frequencies of 7 to 7.5 megahertz; and

  • (ii)

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

(b) following 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 prior to the scan; and

  • (ii)

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

99.90

55603

Prostate, bladder base and urethra, transrectal ultrasound scan of, where performed:

(a) personally by a medical practitioner who undertook the assessment referred to in paragraph (c) using a transducer probe that:

  • (i)

    has a nominal frequency of 7 to 7.5 megahertz or a nominal frequency

    range which includes frequencies of 7 to 7.5 megahertz; and

  • (ii)

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

(b) following 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 prior to the scan; and

  • (ii)

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

99.90

Subgroup 5 — Obstetric and gynaecological

55700

Pelvis or abdomen, pregnancy related or pregnancy complication, ultrasound scan of, by any or all approaches, performed by or on behalf of a medical practitioner, where:

(a) the patient is referred by a medical practitioner; 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 of this group applies; and

(d) the referring practitioner is not a member of a group of practitioners of which the first mentioned practitioner is a member; and

(e) one or more of the following conditions are present:

(i) hyperemesis gravidarum;

(ii) diabetes mellitus;

(iii) hypertension;

(iv) toxaemia of pregnancy;

(v) liver or renal disease;

(vi) autoimmune disease;

(vii) cardiac disease;

(viii) alloimmunisation;

(ix) maternal infection;

(x) inflammatory bowel disease;

(xi) bowel stoma;

(xii) abdominal wall scarring;

(xiii) previous spinal or pelvic trauma or disease;

(xiv) drug dependency;

(xv) thrombophilia;

(xvi) gross maternal obesity;

(xvii) advanced maternal age;

(xviii) abdominal pain or mass;

(xix) uncertain dates;

(xx) high risk pregnancy;

(xxi) previous post dates delivery;

(xxii) previous caesarean section;

(xxiii) poor obstetric history;

(xxiv) suspicion of ectopic pregnancy;

(xxv) risk of miscarriage;

(xxvi) diminished symptoms of pregnancy;

(xxvii) suspected or known cervical incompetence;

(xxviii) suspected or known uterine abnormality;

60.00

(xxix) pregnancy after assisted reproduction;

(xxx) risk of fetal abnormality (R)

55703

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

(a) the patient is not referred by a medical practitioner; 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 of this group applies; and

(d) one or more of the following conditions are present:

(i) hyperemesis gravidarum;

(ii) diabetes mellitus;

(iii) hypertension;

(iv) toxaemia of pregnancy;

(v) liver or renal disease;

(vi) autoimmune disease;

(vii) cardiac disease;

(viii) alloimmunisation;

(ix) maternal infection;

(x) inflammatory bowel disease;

(xi) bowel stoma;

(xii) abdominal wall scarring;

(xiii) previous spinal or pelvic trauma or disease;

(xiv) drug dependency;

(xv) thrombophilia;

(xvi) gross maternal obesity;

(xvii) advanced maternal age;

(xviii) abdominal pain or mass;

(xix) uncertain dates;

(xx) high risk pregnancy;

(xxi) previous post dates delivery;

(xxii) previous caesarean section;

(xxiii) poor obstetric history;

(xxiv) suspicion of ectopic pregnancy;

(xxv) risk of miscarriage;

(xxvi) diminished symptoms of pregnancy;

(xxvii) suspected or known cervical incompetence;

(xxviii) suspected or known uterine abnormality;

(xxix) pregnancy after assisted reproduction;

(xxx) risk of fetal abnormality (NR)

35.00

55704

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, where:

(a) the patient is referred by a medical practitioner; 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 of this group applies; and

(d) the referring practitioner is not a member of a group of practitioners of which the first mentioned practitioner is a member; and

(e) one or more of the following conditions are present:

(i) hyperemesis gravidarum;

(ii) diabetes mellitus;

(iii) hypertension;

(iv) toxaemia of pregnancy;

(v) liver or renal disease;

(vi) autoimmune disease;

(vii) cardiac disease;

(viii) alloimmunisation;

(ix) maternal infection;

(x) inflammatory bowel disease;

(xi) bowel stoma;

(xii) abdominal wall scarring;

(xiii) previous spinal or pelvic trauma or disease;

(xiv) drug dependency;

(xv) thrombophilia;

(xvi) gross maternal obesity;

(xvii) advanced maternal age;

(xviii) abdominal pain or mass;

(xix) uncertain dates;

(xx) high risk pregnancy;

(xxi) previous post dates delivery;

(xxii) previous caesarean section;

(xxiii) poor obstetric history;

(xxiv) suspicion of ectopic pregnancy;

(xxv) risk of miscarriage;

(xxvi) diminished symptoms of pregnancy;

(xxvii) suspected or known cervical incompetence;

(xxviii) suspected or known uterine abnormality;

(xxix) pregnancy after assisted reproduction;

(xxx) risk of fetal abnormality (R)

70.00

55705

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

(a) the patient is not referred by a medical practitioner; 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 of this group applies; and

(d) one or more of the following conditions are present:

(i) hyperemesis gravidarum;

(ii) diabetes mellitus;

(iii) hypertension;

(iv) toxaemia of pregnancy;

(v) liver or renal disease;

(vi) autoimmune disease;

(vii) cardiac disease;

(viii) alloimmunisation;

(ix) maternal infection;

(x) inflammatory bowel disease;

(xi) bowel stoma;

(xii) abdominal wall scarring;

(xiii) previous spinal or pelvic trauma or disease;

(xiv) drug dependency;

(xv) thrombophilia;

(xvi) gross maternal obesity;

(xvii) advanced maternal age;

(xviii) abdominal pain or mass;

(xix) uncertain dates;

(xx) high risk pregnancy;

(xxi) previous post dates delivery;

(xxii) previous caesarean section;

(xxiii) poor obstetric history;

(xxiv) suspicion of ectopic pregnancy;

(xxv) risk of miscarriage;

(xxvi) diminished symptoms of pregnancy;

(xxvii) suspected or known cervical incompetence;

(xxviii) suspected or known uterine abnormality;

(xxix) pregnancy after assisted reproduction;

(xxx) risk of fetal abnormality (NR)

35.00

55706

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan (not exceeding 1 service in any 1 pregnancy) of, by any or all approaches, with measurement of all parameters for dating purposes, performed by or on behalf of a medical practitioner, where:

(a) the patient is referred by a medical practitioner; 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 of this group applies; and

100.00

(d) the referring practitioner is not a member of a group of practitioners of which the first mentioned practitioner is a member; and

(e) the service is not performed in the same pregnancy as item 55709 (R)

55709

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan (not exceeding 1 service in any 1 pregnancy) of, by any or all approaches, with measurement of all parameters for dating purposes, where:

(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 of this group applies; and

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

38.00

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, performed by or on behalf of a medical practitioner, where:

(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 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 of this group applies; and

(d) the referring practitioner is not a member of a group of practitioners of which the first mentioned practitioner is a member; and

115.00

(e) further examination is clinically indicated in the same pregnancy to which item 55706 or 55709 applies (R)

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, where:

(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 of this group applies; and

(d) further examination is clinically indicated in the same pregnancy to which item 55706 or 55709 applies (NR)

40.00

55718

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan (not exceeding 1 service in any 1 pregnancy) of, by any or all approaches, performed by or on behalf of a medical practitioner, where:

(a) the patient is 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 of this group applies; and

100.00

(d) the referring practitioner is not a member of a group of practitioners of which the first mentioned practitioner is a member; and

(e) the service is not performed in the same pregnancy as item 55723; and

(f) one or more of the following conditions are present:

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

(ii) fetal anatomy (late booking or incomplete mid-trimester scan);

(iii) malpresentation;

(iv) cervical assessment;

(v) clinical suspicion of amniotic fluid abnormality;

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

(vii) previous complicated delivery;

(viii) uterine scar assessment;

(ix) uterine fibroid;

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

(xi) antepartum haemorrhage;

(xii) clinical suspicion of intrauterine growth retardation;

(xiii) clinical suspicion of macrosomia;

(xiv) reduced fetal movements;

(xv) suspected fetal death;

(xvi) abnormal cardiotocography;

(xvii) prolonged pregnancy;

(xviii) premature labour;

(xix) multiple pregnancy;

(xx) fetal infection;

(xxi) pregnancy after assisted reproduction;

(xxii) trauma;

(xxiii) diabetes mellitus;

(xxiv) hypertension;

(xxv) toxaemia of pregnancy;

(xxvi) liver or renal disease;

(xxvii) autoimmune disease;

(xxviii) cardiac disease;

(xxix) alloimmunisation;

(xxx) maternal infection;

(xxxi) inflammatory bowel disease;

(xxxii) bowel stoma;

(xxxiii) abdominal wall scarring;

(xxxiv) previous spinal or pelvic trauma or disease;

(xxxv) drug dependency;

(xxxvi) thrombophilia;

(xxxvii) gross maternal obesity;

(xxxviii) advanced maternal age;

(xxxix) abdominal pain or mass (R)

55721

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, where:

(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 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 of this group applies; and

115.00

(d) the referring practitioner is not a member of a group of practitioners of which the first mentioned practitioner is a member; and

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

55723

Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan (not exceeding 1 service in any 1 pregnancy) of, by any or all approaches, where:

(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 of this group applies; and

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

(e) one or more of the following conditions are present:

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

(ii) fetal anatomy (late booking or incomplete mid-trimester scan);

(iii) malpresentation;

(iv) cervical assessment;

(v) clinical suspicion of amniotic fluid abnormality;

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

(vii) previous complicated delivery;

(viii) uterine scar assessment;

(ix) uterine fibroid;

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

(xi) antepartum haemorrhage;

(xii) clinical suspicion of intrauterine growth retardation;

(xiii) clinical suspicion of macrosomia;

(xiv) reduced fetal movements;

(xv) suspected fetal death;

(xvi) abnormal cardiotocography;

(xvii) prolonged pregnancy;

(xviii) premature labour;

(xix) multiple pregnancy;

(xx) fetal infection;

(xxi) pregnancy after assisted reproduction;

(xxii) trauma;

(xxiii) diabetes mellitus;

(xxiv) hypertension;

(xxv) toxaemia of pregnancy;

(xxvi) liver or renal disease;

(xxvii) autoimmune disease;

(xxviii) cardiac disease;

(xxix) alloimmunisation;

(xxx) maternal infection;

(xxxi) inflammatory bowel disease;

(xxxii) bowel stoma;

(xxxiii) abdominal wall scarring;

(xxxiv) previous spinal or pelvic trauma or disease;

(xxxv) drug dependency;

(xxxvi) thrombophilia;

(xxxvii) gross maternal obesity;

(xxxviii) advanced maternal age;

(xxxix) abdominal pain or mass (NR)

38.00

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, where:

(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 of this group applies; and

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

40.00

55728

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, where:

(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 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 of this group applies; and

100.00

(d) the referring practitioner is not a member of a group of practitioners of which the first mentioned practitioner is a member; and

(e) it can be demonstrated that a clinical condition other than a condition mentioned in paragraph (f) of item 55718 or paragraph (e) of item 55723 is present (R)

55731

Pelvis, female, ultrasound scan of, by any or all approaches, performed by or on behalf of a medical practitioner, where:

(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 of this group applies; and

(c) the referring practitioner is not a member of a group of practitioners of which the first mentioned practitioner is a member; and

(d) the service is not performed with item 55036 or 55038 on the same patient within 24 hours (R)

98.00

55733

Pelvis, female, ultrasound scan of, by any or all approaches, where:

(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 of this group applies (NR)

35.00

55736

Pelvis, female, ultrasound scan of, in association with saline infusion of the endometrial cavity, by any or all approaches, performed by or on behalf of a medical practitioner, where:

(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 of this group applies; and

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

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

127.00

55739

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

(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 of this group applies; and

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

57.00

Group I2 — Computed Tomography — Examination and Report

56001

Computed tomography — scan of brain without intravenous contrast medium, not being a service to which item 57001 applies (R) (K)

195.00

56007

Computed tomography — scan of brain with intravenous contrast medium and with any scans of the brain prior to intravenous contrast injection, when undertaken, not being a service to which item 57007 applies (R) (K)

250.00

56010

Computed tomography — scan of pituitary fossa with or without intravenous contrast medium and with or without brain scan when undertaken (R) (K)

252.10

56013

Computed tomography — scan of orbits with or without intravenous contrast medium and with or without brain scan when undertaken (R) (K)

250.00

56016

Computed tomography — scan of petrous bones in axial and coronal planes in 1 mm or 2 mm sections, with or without contrast medium, with or without scan of brain (R) (K)

290.00

56022

Computed tomography — scan of facial bones, para nasal sinuses or both without intravenous contrast medium (R) (K)

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 prior to intravenous contrast injection, when undertaken (R) (K)

336.80

56030

Computed tomography — scan of facial bones, paranasal sinuses or both, with scan of brain, without intravenous contrast medium (R) (K)

300.00

56036

Computed tomography — scan of facial bones, paranasal sinuses or both, with scan of brain, with intravenous contrast medium, where:

(a) a scan without intravenous contrast medium has been undertaken; and

(b) the service is required because the result of the scan mentioned in paragraph (a) is abnormal (R) (K)

375.00

56041

Computed tomography — scan of brain without intravenous contrast medium, not being a service to which item 57041 applies (R) (NK)

98.75

56047

Computed tomography — scan of brain with intravenous contrast medium and with any scans of the brain prior to intravenous contrast injection, when undertaken, not being a service to which item 57047 applies (R) (NK)

126.10

56050

Computed tomography — scan of pituitary fossa with or without intravenous contrast medium and with or without brain scan when undertaken (R) (NK)

128.15

56053

Computed tomography — scan of orbits with or without intravenous contrast medium and with or without brain scan when undertaken (R) (NK)

128.15

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)

155.40

56062

Computed tomography — scan of facial bones, para nasal sinuses or both without intravenous contrast medium (R) (NK)

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 prior to intravenous contrast injection, when undertaken (R) (NK)

168.40

56070

Computed tomography — scan of facial bones, paranasal sinuses or both, with scan of brain, without intravenous contrast medium (R) (NK)

150.00

56076

Computed tomography — scan of facial bones, paranasal sinuses or both, with scan of brain, with intravenous contrast medium, where:

(a) a scan without intravenous contrast medium has been undertaken; and

(b) the service is required because the result of the scan mentioned in paragraph (a) is abnormal (R) (NK)

187.50

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)

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) prior to intravenous contrast injection, when undertaken, not being a service associated with a service to which item 56807 applies (R) (K)

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)

116.40

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) prior to intravenous contrast injection, when undertaken, not being a service associated with a service to which item 56847 applies (R) (NK)

171.60

56210

Computed tomography — scan of spine, 1 or more regions, without intravenous contrast medium, payable once only whether 1 or more attendances are required to complete the service (R) (K)

240.00

56216

Computed tomography — scan of spine, 1 or more regions, with intravenous contrast medium and with any scans of the spine prior to intravenous contrast injection when undertaken; only 1 benefit is payable whether 1 or more attendances are required to complete the service (R) (K)

351.35

56219

Computed tomography — scan of spine, 1 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 applies (R) (K)

326.20

56250

Computed tomography — scan of spine, 1 or more regions, without intravenous contrast medium, payable once only whether 1 or more attendances are required to complete the service (R) (NK)

122.50

56256

Computed tomography — scan of spine, 1 or more regions, with intravenous contrast medium and with any scans of the spine prior to intravenous contrast injection when undertaken; only 1 benefit is payable whether 1 or more attendances are required to complete the service (R) (NK)

177.50

56259

Computed tomography — scan of spine, 1 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 applies (R) (NK)

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 (R) (K)

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 prior to 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 (R) (K)

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 (R) (NK)

149.50

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 prior to 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 (R) (NK)

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)

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) prior to intravenous contrast injection, when undertaken, not being a service to which item 56307, 56507, 56807 or 57007 applies (R) (K)

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)

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) prior to intravenous contrast injection, when undertaken, not being a service to which item 56407 applies (R) (K)

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)

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) prior to intravenous contrast injection, when undertaken, not being a service to which item 56347, 56547, 56847 or 57047 applies (R) (NK)

181.45

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)

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) prior to intravenous contrast injection, when undertaken, not being a service to which item 56447 applies (R) (NK)

181.45

56501

Computed tomography — scan of upper abdomen and pelvis without intravenous contrast medium, not being a service to which item 56801 or 57001 applies (R) (K)

385.00

56507

Computed tomography — scan of upper abdomen and pelvis with intravenous contrast medium and with any scans of upper abdomen and pelvis prior to intravenous contrast injection, when undertaken, not being a service to which item 56807 or 57007 applies (R) (K)

475.00

63353

MRI — scan of 3 contiguous regions or 2 non‑contiguous regions of the spine (with or without intravenous contrast) for the exclusion of tumour (R)

475.00

63356

MRI — scan of 3 contiguous regions or 2 non‑contiguous regions of the spine (with or without intravenous contrast) for the exclusion of demyelinating disease (R)

475.00

63359

MRI — scan of 3 contiguous regions or 2 non‑contiguous regions of the spine (with or without intravenous contrast) for the exclusion of congenital malformation of the spinal cord or the cauda equina or the meninges (R)

475.00

63362

MRI — scan of 3 contiguous regions or 2 non‑contiguous regions of the spine (with or without intravenous contrast) for the exclusion of myelopathy (R)

475.00

63365

MRI — scan of 3 contiguous regions or 2 non‑contiguous regions of the spine (with or without intravenous contrast) for the exclusion of syrinx — congenital or acquired (R)

475.00

Subgroup 11 — Scan of spine — 1 region or 2 contiguous regions — for further investigation of specified conditions

63400

MRI — scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for further investigation of infection (R)

475.00

63403

MRI — scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for further investigation of tumour (R)

475.00

63406

MRI — scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for further investigation of demyelinating disease (R)

475.00

63409

MRI — scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for further investigation of congenital malformation of the spinal cord or the cauda equina or the meninges (R)

475.00

63412

MRI — scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for further investigation of myelopathy (R)

475.00

63415

MRI — scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for further investigation of syrinx — congenital or acquired (R)

475.00

63418

MRI — scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for further investigation of cervical radiculopathy (R)

475.00

63421

MRI — scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for further investigation of sciatica (R)

475.00

63424

MRI — scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for further investigation of spinal canal stenosis (R)

 475.00

63427

MRI — scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for further investigation of previous spinal surgery (R)

475.00

63430

MRI — scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for further investigation of trauma (R)

475.00

Subgroup 12 — Scan of spine — 3 contiguous or 2 non‑contiguous regions — for further investigation of specified conditions

63450

MRI — scan of 3 contiguous regions or 2 non‑contiguous regions of the spine (with or without intravenous contrast) for further investigation of infection (R)

475.00

63453

MRI — scan of 3 contiguous regions or 2 non‑contiguous regions of the spine (with or without intravenous contrast) for further investigation of tumour (R)

475.00

63456

MRI — scan of 3 contiguous regions or 2 non‑contiguous regions of the spine (with or without intravenous contrast) for further investigation of demyelinating disease (R)

475.00

63459

MRI — scan of 3 contiguous regions or 2 non‑contiguous regions of the spine (with or without intravenous contrast) for the further investigation of congenital malformation of the spinal cord or the cauda equina or the meninges (R)

475.00

63462

MRI — scan of 3 contiguous regions or 2 non‑contiguous regions of the spine (with or without intravenous contrast) for further investigation of myelopathy (R)

475.00

63465

MRI — scan of 3 contiguous regions or 2 non‑contiguous regions of the spine (with or without intravenous contrast) for further investigation of syrinx — congenital or acquired (R)

475.00

63468

MRI — scan of 3 contiguous regions or 2 non‑contiguous regions of the spine (with or without intravenous contrast) for the further investigation cervical radiculopathy (R)

475.00

63471

MRI — scan of 3 contiguous regions or 2 non‑contiguous regions of the spine (with or without intravenous contrast) for the further investigation of sciatica (R)

475.00

63474

MRI — scan of 3 contiguous regions or 2 non‑contiguous regions of the spine (with or without intravenous contrast) for the further investigation of spinal canal stenosis (R)

475.00

63477

MRI — scan of 3 contiguous regions or 2 non‑contiguous regions of the spine (with or without intravenous contrast) for the further investigation of previous spinal surgery (R)

475.00

63480

MRI — scan of 3 contiguous regions or 2 non‑contiguous regions of the spine (with or without intravenous contrast) for the further investigation of trauma (R)

475.00

Subgroup 13 — Scan of spine — 1 region or 2 contiguous regions — for monitoring of specified conditions

63500

MRI — scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for monitoring of demyelinating disease (R)

475.00

63503

MRI — scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for monitoring of congenital malformation of the spinal cord or the cauda equina or the meninges (R)

475.00

63506

MRI — scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for monitoring of myelopathy (R)

475.00

63509

MRI — scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for monitoring of syrinx — congenital or acquired (R)

475.00

63512

MRI — scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for monitoring of cervical radiculopathy (R)

475.00

63515

MRI — scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for monitoring of sciatica (R)

475.00

63518

MRI — scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for monitoring of spinal canal stenosis (R)

475.00

63521

MRI — scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for monitoring of previous spinal surgery (R)

475.00

63524

MRI — scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for monitoring of trauma (R)

475.00

Subgroup 14 — Scan of spine — 3 contiguous or 2 non‑contiguous regions — for monitoring of specified conditions

63550

MRI — scan of 3 contiguous regions or 2 non‑contiguous regions of the spine (with or without intravenous contrast) for monitoring of demyelinating disease (R)

475.00

63553

MRI — scan of 3 contiguous regions or 2 non‑contiguous regions of the spine (with or without intravenous contrast) for the monitoring of congenital malformation of the spinal cord or the cauda equina or the meninges (R)

475.00

63556

MRI — scan of 3 contiguous regions or 2 non‑contiguous regions of the spine (with or without intravenous contrast) for the monitoring of myelopathy (R)

475.00

63559

MRI — scan of 3 contiguous regions or 2 non‑contiguous regions of the spine (with or without intravenous contrast) for the monitoring of syrinx — congenital or acquired (R)

475.00

63562

MRI — scan of up to 3 contiguous regions or 2 non‑contiguous regions of the spine (with or without intravenous contrast) for monitoring of cervical radiculopathy (R)

475.00

63565

MRI — scan of up to 3 contiguous regions or 2 non‑contiguous regions of the spine (with or without intravenous contrast) for monitoring of sciatica (R)

475.00

63568

MRI — scan of up to 3 contiguous regions or 2 non‑contiguous regions of the spine (with or without intravenous contrast) for monitoring of spinal canal stenosis (R)

475.00

63571

MRI — scan of up to 3 contiguous regions or 2 non‑contiguous regions of the spine (with or without intravenous contrast) for monitoring of previous spinal surgery (R)

475.00

63574

MRI — scan of 3 contiguous regions or 2 non‑contiguous regions of the spine (with or without intravenous contrast) for monitoring of trauma (R)

475.00

Subgroup 15 — Scan of spine — 1 region or 2 contiguous regions — for monitoring of specified conditions

63580

MRI — scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for monitoring of infection (R)

475.00

63583

MRI — scan of 1 region or 2 contiguous regions of the spine (with or without intravenous contrast) for monitoring of tumour (R)

475.00

Subgroup 16 — Scan of spine — 3 contiguous or 2 non‑contiguous regions — for monitoring of specified conditions

63590

MRI — scan of 3 contiguous regions or 2 non‑contiguous regions of the spine (with or without intravenous contrast) for monitoring of infection (R)

475.00

63593

MRI — scan of 3 contiguous regions or 2 non‑contiguous regions of the spine (with or without intravenous contrast) for monitoring of tumour (R)

475.00

Subgroup 17 — Scan of musculoskeletal system — for the exclusion of specified conditions

63600

MRI — scan of musculoskeletal system (with or without intravenous contrast) for the exclusion of tumour arising in bone or other connective tissue (R)

475.00

63603

MRI — scan of musculoskeletal system (with or without intravenous contrast) for the exclusion of infection arising in bone or other connective tissue (R)

475.00

63606

MRI — scan of musculoskeletal system (with or without intravenous contrast) for the exclusion of osteonecrosis (R)

475.00

63609

MRI — scan of musculoskeletal system (with or without intravenous contrast) for the exclusion of derangement of hip or its supporting structures (R)

475.00

63612

MRI — scan of musculoskeletal system (with or without intravenous contrast) for the exclusion of derangement of shoulder or its supporting structures (R)

475.00

63615

MRI — scan of musculoskeletal system (with or without intravenous contrast) for the exclusion of derangement of knee or its supporting structures (R)

475.00

63618

MRI — scan of musculoskeletal system (with or without intravenous contrast) for the exclusion of derangement of ankle or its supporting structures (R)

475.00

63621

MRI — scan of musculoskeletal system (with or without intravenous contrast) for the exclusion of derangement of temporomandibular joint or its supporting structures (R)

475.00

63624

MRI — scan of musculoskeletal system (with or without intravenous contrast) for the exclusion of derangement of wrist or its supporting structures (R)

475.00

63627

MRI — scan of musculoskeletal system (with or without intravenous contrast) for the exclusion of derangement of elbow or its supporting structures (R)

475.00

Subgroup 18 — Scan of musculoskeletal system — for further investigation of specified conditions

63650

MRI — scan of musculoskeletal system (with or without intravenous contrast) for further investigation of tumour arising in bone or other connective tissue (R)

 475.00

63653

MRI — scan of musculoskeletal system (with or without intravenous contrast) for further investigation of infection arising in bone or other connective tissue (R)

475.00

63656

MRI — scan of musculoskeletal system (with or without intravenous contrast) for further investigation of osteonecrosis (R)

475.00

63659

MRI — scan of musculoskeletal system (with or without intravenous contrast) for further investigation of derangement of hip or its supporting structures (R)

 475.00

63662

MRI — scan of musculoskeletal system (with or without intravenous contrast) for further investigation of derangement of shoulder or its supporting structures (R)

475.00

63665

MRI — scan of musculoskeletal system (with or without intravenous contrast) for further investigation of derangement of knee or its supporting structures (R)

475.00

63668

MRI — scan of musculoskeletal system (with or without intravenous contrast) for further investigation of derangement of ankle or its supporting structures (R)

475.00

63671

MRI — scan of musculoskeletal system (with or without intravenous contrast) for further investigation of derangement of temporomandibular joint or its supporting structures (R)

475.00

63674

MRI — scan of musculoskeletal system (with or without intravenous contrast) for further investigation of derangement of wrist or its supporting structures (R)

475.00

63677

MRI — scan of musculoskeletal system (with or without intravenous contrast) for further investigation of derangement of elbow or its supporting structures (R)

475.00

63680

MRI — scan of musculoskeletal system (with or without intravenous contrast) for further investigation of post inflammatory or post traumatic physeal fusion in a person under 16 years of age (R)

475.00

Subgroup 19 — Scan of musculoskeletal system — for monitoring of specified conditions

63700

MRI — scan of musculoskeletal system (with or without intravenous contrast) for monitoring of derangement of hip or its supporting structures (R)

475.00

63703

MRI — scan of musculoskeletal system (with or without intravenous contrast) for monitoring of derangement of shoulder or its supporting structures (R)

475.00

63706

MRI — scan of musculoskeletal system (with or without intravenous contrast) for monitoring of derangement of knee or its supporting structures (R)

475.00

63709

MRI — scan of musculoskeletal system (with or without intravenous contrast) for monitoring of derangement of ankle or its supporting structures (R)

475.00

63712

MRI — scan of musculoskeletal system (with or without intravenous contrast) for monitoring of derangement of temporomandibular joint or its supporting structures (R)

475.00

63715

MRI — scan of musculoskeletal system (with or without intravenous contrast) for monitoring of derangement of wrist or its supporting structures (R)

475.00

63718

MRI — scan of musculoskeletal system (with or without intravenous contrast) for monitoring of derangement of elbow or its supporting structures (R)

475.00

63721

MRI — scan of musculoskeletal system (with or without intravenous contrast) for monitoring of post inflammatory or post traumatic physeal fusion in a person under 16 years of age (R)

475.00

Subgroup 20 — Scan of musculoskeletal system — for monitoring of specified conditions

63736

MRI — scan of musculoskeletal system (with or without intravenous contrast) for monitoring of osteonecrosis (R)

475.00

63739

MRI — scan of musculoskeletal system (with or without intravenous contrast) for monitoring of tumour arising in bone or other connective tissue (R)

475.00

63742

MRI — scan of musculoskeletal system (with or without intravenous contrast) for monitoring of infection arising in bone or other connective tissue (R)

475.00

Subgroup 21 — Scan of musculoskeletal system — for further investigation or monitoring of specified conditions

63745

MRI — scan of the musculoskeletal system (with or without intravenous contrast) for further investigation or monitoring of Gaucher disease (R)

475.00

Subgroup 22 — Scan of cardiovascular system — for further investigation of specified conditions

63750

MRI — scan of the cardiovascular system (with or without intravenous contrast and including MRA, if performed) for further investigation of congenital disease of the heart or a great vessel (R)

475.00

63753

MRI — scan of the cardiovascular system (with or without intravenous contrast and including MRA, if performed) for further investigation of tumour of the heart or a great vessel (R)

475.00

63756

MRI — scan of the cardiovascular system

 (with or without intravenous contrast and including MRA, if performed) for further investigation of abnormality of thoracic aorta (R)

475.00

Subgroup 23 — Scan of cardiovascular system — for monitoring of specified conditions

63800

MRI — scan of the cardiovascular system (with or without intravenous contrast and including MRA, if performed) for monitoring of congenital disease of the heart or a great vessel (R)

475.00

63803

MRI — scan of the cardiovascular system

 (with or without intravenous contrast and including MRA, if performed) for monitoring of tumour of the heart or a great vessel (R)

475.00

63806

MRI — scan of the cardiovascular system (with or without intravenous contrast and including MRA if performed) for monitoring of abnormality of the thoracic aorta (R)

475.00

Subgroup 24 — Magnetic resonance angiography — scan of cardiovascular system — for the exclusion of or further investigation of specified conditions

63850

MRA — scan of the cardiovascular system (with or without intravenous contrast) for exclusion, or further investigation of stroke (R)

475.00

63853

MRA — scan of the cardiovascular system (with or without intravenous contrast) for exclusion, or further investigation of carotid or vertebral artery dissection (R)

475.00

63856

MRA — scan of the cardiovascular system (with or without intravenous contrast) for exclusion, or further investigation of intracranial aneurysm (R)

475.00

63859

MRA — scan of the cardiovascular system (with or without intravenous contrast) for exclusion, or further investigation of intracranial arteriovenous malformation (R)

475.00

63862

MRA — scan of the cardiovascular system (with or without intravenous contrast) for exclusion, or further investigation of venous sinus thrombosis (R)

475.00

63865

MRA — scan of the cardiovascular system (with or without intravenous contrast) for exclusion, or further investigation, of vascular abnormality in a patient with a previous anaphylactic reaction to an iodinated contrast medium (R)

475.00

63868

MRA — scan of the cardiovascular system (with or without intravenous contrast) for exclusion, or further investigation of obstruction of the superior vena cava, inferior vena cava or a major pelvic vein (R)

475.00

Subgroup 25 — Magnetic resonance angiography — scan of cardiovascular system — for further investigation of specified conditions — person under the age of 16 years

63870

MRA — scan of the cardiovascular system in a person under the age of 16 years (with or without intravenous contrast) for further investigation of the vasculature of limbs prior to limb or digit transfer surgery in congenital limb deficiency syndrome (R)

475.00

Subgroup 26 — Magnetic resonance angiography — scan of cardiovascular system — for monitoring of specified conditions

63880

MRA — scan of the cardiovascular system (with or without intravenous contrast) for monitoring of carotid or vertebral artery dissection (R)

475.00

63883

MRA — scan of the cardiovascular system (with or without intravenous contrast) for monitoring of venous sinus thrombosis (R)

475.00

Subgroup 27 — Scan of body — for further investigation of specified conditions — person under the age of 16 years

63900

MRI — scan of the body in a person under the age of 16 years (with or without intravenous contrast) for further investigation of pelvic or abdominal mass (R)

475.00

63903

MRI — scan of the body in a person under the age of 16 years (with or without intravenous contrast) for further investigation of mediastinal mass (R)

475.00

63906

MRI — scan of the body in a person under the age of 16 years (with or without intravenous contrast) for further investigation of congenital uterine or anorectal abnormality (R)

475.00

63909

MRI — scan of the body in a person under the age of 16 years (with or without intravenous contrast) for further investigation of Gaucher disease (R)

475.00

Subgroup 28 — Scan of body — for further investigation of specified conditions

63920

MRI — scan of the body (with or without intravenous contrast) for further investigation of adrenal mass in a patient with a malignancy which is otherwise resectable (R)

475.00

Subgroup 29 — Scan of body — for monitoring of specified conditions — person under the age of 16 years

63930

MRI — scan of the body (with or without intravenous contrast) for monitoring of congenital uterine or anorectal abnormality in a person under the age of 16 years (R)

475.00

Subgroup 30 — Scan of body — for monitoring of specified conditions — person under the age of 16 years

63940

MRI — scan of the body of a person under the age of 16 years (with or without intravenous contrast) for monitoring of mediastinal mass (R)

475.00

63943

MRI — scan of the body of a person under the age of 16 years (with or without intravenous contrast) for monitoring of pelvic or abdominal mass (R)

475.00

63946

MRI — scan of the body of a person under the age of 16 years (with or without intravenous contrast) for monitoring of Gaucher disease (R)

475.00

Notes to the Health Insurance (1999-2000 Diagnostic Imaging Services Table) Regulations 1999

Note 1

The Health Insurance (1999-2000 Diagnostic Imaging Services Table) Regulations 1999 (in force under the Health Insurance Act 1973) as shown in this compilation comprise Statutory Rules 1999 No. 255 amended as indicated in the Tables below.

Table of Statutory Rules

Year and

number

Date of notification

in Gazette

Date of

commencement

Application, saving or

transitional provisions

1999 No. 255

27 Oct 1999

1 Nov 1999

1999 No. 345

22 Dec 1999

Rr. 1-3 and Schedule 1:

1 Nov 1999

Remainder: 1 Feb 2000

—

2000 No. 59

28 Apr 2000

1 May 2000

—

2000 No. 147

28 June 2000

1 July 2000

—

Table of Amendments

    ad. = added or inserted

     am. = amended rep. = repealed rs. = repealed and substituted

Provision affected

How affected

Schedule 1.............................

am. 1999 No. 345; 2000 Nos. 59 and 147

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