Health Insurance (Diagnostic Imaging Services Table) Regulations 2002 (Cth)

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Health Insurance (Diagnostic Imaging Services Table) Regulations 2002

Statutory Rules 2002 No. 247 as amended

made under the

Health Insurance Act 1973

This compilation was prepared on 1 June 2003

taking into account amendments up to SR 2003 No. 98

Prepared by the Office of Legislative Drafting,

Attorney-General’s Department, Canberra

Contents

      1Name of Regulations [see Note 1]

These Regulations are the Health Insurance (Diagnostic Imaging Services Table) Regulations 2002.

2Commencement

These Regulations commence on 1 November 2002.

3Health Insurance (Diagnostic Imaging Services Table) Regulations 2001 – repeal

The following Statutory Rules are repealed:

· 2001 No. 293

· 2002 No. 75.

4Definitions

In these Regulations:

Act means the Health Insurance Act 1973.

this table means these Regulations.

5Diagnostic 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 Act.

Schedule 1Table of diagnostic imaging services

(regulation 5)

Part1Prescription of table

1Prescription of table

For section 4AA of the Act, these Regulations prescribe a table of diagnostic imaging services that sets out:

  1. (a)

    in Part 2 — rules for interpretation of the table; and

  2. (b)

    in Part 3:

    1. (i)

      items of diagnostic imaging services; and

    2. (ii)

      the amount of fees applicable for each item.

Part2Rules of interpretation

2General

  1. (1)

    In this table, unless the contrary intention appears:

    (Anaes.) — see the general medical services table.

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

    1. (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

    2. (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:

    1. (a)

      a gantry;

    2. (b)

      a couch;

    3. (c)

      a computer;

    4. (d)

      an operator station;

    5. (e)

      a generator.

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

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

    item means:

    1. (a)

      an item mentioned, by number, in column 1 of:

      1. (i)

        Part 3; or

      2. (ii)

        Part 3 of the pathology services table; or

      3. (iii)

        Part 3 of the general medical services table; and

    2. (b)

      in a reference immediately followed by a number — the item so numbered.

    Example

    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.

    MRA means magnetic resonance angiography.

    MRI means magnetic resonance imaging.

    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).

    providing practitioner, in relation to a service mentioned in an item in Group I1 of Part 3, means the medical practitioner by whom, or under whose supervision or direction, the service was performed.

    registered sonographer means a person whose name is entered on the Register of Sonographers kept by the Commission under regulation 3S of the Health Insurance Commission Regulations 1975.

    remote location means a place within Australia that is more than 30 kilometres by road from:

    1. (a)

      a hospital that provides a radiology or computed tomography service under the direction of a specialist in the specialty of diagnostic radiology; or

    2. (b)

      a free-standing radiology or computed tomography facility under the direction of a specialist in the specialty of diagnostic radiology.

    report means a report prepared by a medical practitioner.

    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 A number of words and expressions used in this table are defined in subsection 3 (1) of the Act. For instance:

    · diagnostic imaging service

    · general medical services table

    · pathology services table

    · specialist.

  2. (2)

    A reference to a Group in the table includes every item in the Group and a reference to a Subgroup in the table includes every item in the Subgroup.

  3. (3)

    A reference to a diagnostic imaging service in an item in Part 3 includes a reference to the undertaking of the diagnostic imaging procedure used for rendering the service.

3Meaning of (R) and (NR) in the table

  1. (1)

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

  2. (2)

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

4Meaning of (S) in the table

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

  1. (a)

    a medical practitioner; or

  2. (b)

    a person, other than a medical practitioner, who:

    1. (i)

      is employed by a medical practitioner; or

    2. (ii)

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

6Report requirements for certain services

  1. (1)

    An item in Part 3 (except an item to which subrule (2) applies) applies only if the providing practitioner gives a report of the service performed to the practitioner who requested the service.

  2. (2)

    This subrule applies to the following items:

    1. (a)

      items 55054, 55130, 55848, 55850, 57341, 57345, 59312, 59314, 60506, 60509 and 61109, being items of services performed in conjunction with a surgical procedure;

    2. (b)

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

    7Meaning of medical practitioner in certain items

    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 Act.

8Meaning of Amount under rule 8 in certain items

In item 59103:

Amount under rule 8 means an amount equal to the sum of:

  1. (a)

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

  2. (b)

    $21.30.

9Ultrasound services — eligible services

Items 55028 to 55854 (except items 55600 and 55603) apply to an ultrasound service only if the service is performed:

  1. (a)

    by a medical practitioner; or

  2. (b)

    by a registered sonographer on behalf of a medical practitioner.

10Ultrasound services — R-type eligible services

  1. (1)

    Items 55028 to 55854 (except items 55600 and 55603), if marked with the symbol (R), apply to an ultrasound service (the eligible service) only if the service is performed:

    1. (a)

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

      1. (i)

        to monitor and influence the conduct and diagnostic quality of the examination; and

      2. (ii)

        if necessary, to personally attend the patient; or

    2. (b)

      under the professional supervision of a practitioner who:

      1. (i)

        is not a specialist or consultant physician; and

      2. (ii)

        meets the requirement of subrule (2); and

      3. (iii)

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

    3. (c)

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

      1. (i)

        to monitor and influence the conduct and diagnostic quality of the examination; and

      2. (ii)

        if necessary, to personally attend the patient; or

    4. (d)

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

      1. (i)

        in an emergency; or

      2. (ii)

        in a location that is not less than 30 kilometres by the most direct road route from another practice where services that comply with paragraph (a) or (b) are available.

  2. (2)

    The requirement of this subrule is that, between 1 September 1997 and 31 August 1999, at least 50 services were rendered by or on behalf of the practitioner at the location where the eligible service was rendered, and the rendering of those services entitled payment of medicare benefits.

  3. (3)

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

    11Angiography services — meaning of (K) and (NK) in items

  4. (1)

    An item that includes the symbol (NK) at the end of the item applies to a service that is performed on equipment that is at least 10 years old.

  5. (2)

    An item that includes the symbol (K) at the end of the item applies to a service that is performed on equipment that is less than 10 years old.

  6. (3)

    The date from which the age of equipment is worked out for this rule is:

    1. (a)

      the date that the equipment was first installed in Australia; or

    2. (b)

      if the equipment was imported as used equipment, the date of manufacture of the oldest component of the equipment.

    12Obstetric and gynaecological ultrasound services — limits

    In respect of NR-type diagnostic imaging services described in any of items 55700 to 55774, the specified fee for no more than 3 services provided to the same patient in any 1 pregnancy applies.

    13Obstetric and gynaecological services — clinical indications

  7. (1)

    For items where clinical conditions are listed, or where a clinical indication is required for performance of subsequent scans (items 55712, 55715, 55721, 55725, 55764, 55766, 55772 and 55774), the referral must identify the relevant clinical indication for the service.

  8. (2)

    If the service is pathologist-determined, the clinical condition or indication must be recorded in the pathology practitioner’s clinical notes.

    14Obstetric and gynaecological services — referral forms

    Items 55700 to 55774 apply to a service in relation to which a referral is provided by a practitioner who has obstetric privileges at a non-metropolitan hospital only if the words ‘non-metropolitan obstetric privileges’ are specified on the referral form.

    15Musculoskeletal ultrasound services — personal attendance

    Items 55800 to 55854 apply to a musculoskeletal ultrasound service only if:

    1. (a)

      the medical practitioner responsible for the conduct and report of the examination personally attends during the performance of the scan and personally examines the patient; or

    2. (b)

      the service is performed, because of medical necessity, in a location that is more than 30 kilometres by the most direct road route from another practice where services that comply with paragraph (a) are available.

    16Musculoskeletal ultrasound services — comparison ultra-sonography

    For items 55800 to 55854, the fee applicable for the item includes any views of another part of the patient taken for comparison purposes.

    17Musculoskeletal ultrasound services — equipment

    Items 55800 to 55854 apply only to an ultrasound service performed using an ultrasound system which has available on‑site a transducer capable of operation at at least 7.5 megahertz.

    18Musculoskeletal ultrasound services — multiple scans

    Items 55800 to 55854 apply only once a day for each patient for which a service described in any of those items is provided, regardless of the number of regions scanned in performing the service.

19CT services — meaning of (K) and (NK)

  1. (1)

    In any of items 56001 to 57356, the symbol (K) means:

    1. (a)

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

      1. (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

      2. (ii)

        the service was performed in a remote location; or

    2. (b)

      for CT equipment imported as pre-used equipment:

      1. (i)

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

      2. (ii)

        the service was rendered in a remote location.

  2. (2)

    In any of items 56001 to 57356, the symbol (NK) means the service was rendered 10 years or more after:

    1. (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

    2. (b)

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

  3. (3)

    In this rule:

    CT equipment imported as pre-used equipment means equipment that has been used to perform 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.

20CT services — eligible services

Items 56001 to 57356 apply only to a CT service performed:

  1. (a)

    under the professional supervision of a specialist in the specialty of diagnostic radiology who is available:

    1. (i)

      to monitor and influence the conduct and diagnostic quality of the examination; and

    2. (ii)

      if necessary, to personally attend on the patient; or

  2. (b)

    if paragraph (a) cannot be complied with:

    1. (i)

      in an emergency; or

    2. (ii)

      because of medical necessity, in a remote location.

21CT services — use of Hybrid PET/CT scanner

Items 56001 to 57356 do not apply to a CT service that is performed using a Hybrid Positron Emission Tomography/ Computed Tomography (PET/CT) scanner.

22CT services — exclusion of acoustic neuroma

If an axial scan is performed for the exclusion of acoustic neuroma, item 56001 or 56007 applies instead of any other item in this table that might be taken to apply to the service.

23CT services — assessment of headache

  1. (1)

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

    1. (a)

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

    2. (b)

      the service is required because the result of the scan is abnormal.

  2. (2)

    This rule applies to a patient who:

    1. (a)

      is under 50 years; and

    2. (b)

      is (apart from the headache) otherwise well; and

    3. (c)

      has no localising symptoms or signs; and

    4. (d)

      has no history of malignancy or immunosuppression.

24CT services — number of services

Items 56220 to 56240 and 56619 to 56665 apply once only for a service described in any of those items, regardless of the number of patient attendances required to complete the service.

25Mammography services — eligible services

Items 59300 to 59318 apply only to a mammography service performed:

  1. (a)

    under the professional supervision of a specialist in the specialty of diagnostic radiology who is available:

    1. (i)

      to monitor and influence the conduct and diagnostic quality of the examination; and

    2. (ii)

      if necessary, to personally attend on the patient; or

  2. (b)

    if paragraph (a) cannot be complied with:

    1. (i)

      in an emergency; or

    2. (ii)

      because of medical necessity, in a remote location.

26Preparation of patients for radiological procedures

Items 60918 and 60927 apply only to the preparation of a patient for a radiological procedure for a service to which any of items 59903 to 59974 apply by:

  1. (a)

    injecting opaque or contrast media; or

  2. (b)

    removing fluid and replacing it with air, oxygen or other contrast media; or

  3. (c)

    a similar method.

27Meaning 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.

28Nuclear scanning services

Items 61302 to 61499 apply only if:

  1. (a)

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

  2. (b)

    the service is performed:

    1. (i)

      by a specialist or consultant physician whose name is included in a register, given to the Commission by the Joint Nuclear Medicine Specialist Credentialling and Accreditation Committee of the Royal Australasian College of Physicians and the Royal Australian and New Zealand College of Radiologists, of participants in the Joint Nuclear Medicine Specialist Credentialling Program of the Committee; or

    2. (ii)

      by a person acting on behalf of a specialist or consultant physician mentioned in subparagraph (i); and

  3. (c)

    the final report of the service is compiled by the specialist or consultant physician who performed the preliminary examination of the patient and the estimation and administration of the dosage of radiopharmaceuticals.

29Meaning of Amount under rule 29 in item 61462

In item 61462:

Amount under rule 29 means an amount equal to the sum of:

  1. (a)

    the fee set out in the item in Group I4 in conjunction with which a service mentioned in item 61462 is performed; and

  2. (b)

    $118.15.

30Multiple services — vascular ultrasound

  1. (1)

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

    1. (a)

      the second highest fee is reduced by 40%;

    2. (b)

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

  2. (2)

    For subrule (1):

    1. (a)

      if 2 or more applicable fees are equally the highest, one only of those fees is taken to be the highest fee; and

    2. (b)

      if paragraph (a) applies — the other, or another, highest fee is taken to be the second highest fee; and

    3. (c)

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

    4. (d)

      if a reduced fee calculated under subrule (1) is not a multiple of 5 cents, the reduced fee is taken to be the nearest higher amount that is a multiple of 5 cents.

31Multiple services

  1. (1)

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

  2. (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 diagnostic imaging services rendered by the practitioner for that patient on that day, is reduced:

    1. (a)

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

    2. (b)

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

    3. (c)

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

  3. (3)

    For subrule (2), if more than 1 consultation has occurred, the relevant consultation is the consultation having the highest fee set out in the items that apply to the consultation.

  4. (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 that applies to any diagnostic imaging services performed by the medical practitioner for the same patient on the same day, is reduced by $5.

  5. (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) must not exceed the highest fee that applies to any diagnostic imaging services rendered by the medical practitioner for the same patient on the same day.

  6. (6)

    Rule 30 applies in addition to this rule.

  7. (7)

    However, if a medical practitioner provides:

    1. (a)

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

    2. (b)

      1 or more other diagnostic imaging services for that patient on that day;

    the amount of the fees payable for the vascular ultrasound services is taken, for the purposes of this rule, to be an amount payable for 1 diagnostic imaging service.

  8. (8)

    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.

  1. (9)

    In this rule:

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

    highest fee means the highest fee specified for an item in the first claim submitted to the Commission in relation to the services concerned.

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

32MRI and MRA services — eligible services

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

  1. (a)

    on request, in accordance with rule 33, by a specialist or consultant physician; and

  2. (b)

    in a permissible circumstance, in accordance with rule 34; and

  3. (c)

    with eligible equipment, in accordance with rule 36 or 37.

33MRI and MRA services — requests

Items 63000 to 63946 apply only to a service in respect of which the request:

  1. (a)

    was made in writing; and

  2. (b)

    identified the clinical indications for the service.

34MRI and MRA services — permissible circumstances for performance

For rule 32, a service is performed in a permissible circumstance only if it is performed:

  1. (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

  2. (b)

    if paragraph (a) is not complied with:

    1. (i)

      in an emergency; or

    2. (ii)

      because of medical necessity, in a remote location.

35MRI and MRA services — eligible provider

For rule 34, an eligible provider is a specialist in diagnostic radiology who is an eligible provider within the meaning of rule 30 of Part 2 of Schedule 1 to the Health Insurance (Diagnostic Imaging Services Table) Regulations 2000, as in force on 31 October 2001.

36MRI and MRA services — eligible equipment

For rule 32, equipment is eligible equipment if the equipment is eligible equipment within the meaning of rule 31 of Part 2 of Schedule 1 to the Health Insurance (Diagnostic Imaging Services Table) Regulations 2000, as in force on 31 October 2001.

37MRI and MRA services — eligible equipment

For rule 32, eligible equipment is equipment other than equipment to which rule 36 applies:

  1. (a)

    that is registered under the scheme, administered by the Department, titled ‘MRI Additional Units Eligibility Scheme’, as in force on 27 June 2001; and

  2. (b)

    in relation to which the registration has not been cancelled or otherwise ceased to have effect.

Note The MRI Additional Units Eligibility Scheme is the scheme of that title published in Gazette No. GN 20 on 23 May 2001, as amended by amendments published in Gazette No. S 226 on 27 June 2001.

38MRI and MRA services — meaning of scan

In items 63000 to 63946:

scan means a minimum of 3 sequences.

39MRI and MRA services — descriptions of purpose of services

The description of a service mentioned in any of items 63000 to 63946 means, as applicable:

  1. (a)

    the exclusion of a condition; or

  2. (b)

    the further investigation of a condition, using the service as the secondary imaging modality:

    1. (i)

      when the diagnosis is uncertain; or

    2. (ii)

      to assess the severity of the condition; or

  3. (c)

    the monitoring of a condition, using the service following confirmed diagnosis to assess progress of a condition following treatment.

Note For exclusion of a condition, see subrule 2 (1).

40MRI or MRA services — related services that can be claimed in a 12 month period

(1)

An item mentioned in subrule (2) does not apply to the service mentioned in the item if the service is provided to a person who, in the 12 months before the service, has been provided with the maximum number of those services mentioned in subrule (2) for that item.

(2)

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

  1. (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, 63750 to 63756, 63870, 63900 to 63909, 63920 and 63930 — 1 service; and

  2. (b)

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

  3. (c)

    for items 63600 to 63721 — 1 service for a specific anatomical site; and

  4. (d)

    for item 63745 — 2 services for a specific anatomical site.

(3)

In addition, if 2 or more services of the kind described in an item mentioned in paragraph (2) (c) or (d) are provided to a person on a single occasion, only 1 service applies.

Part3Services and fees 

Item

Diagnostic imaging service

Fee ($)

Group I1 — Ultrasound

Subgroup 1 — General

55028

Head, ultrasound scan of, if:

  1. (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 applies; and

  2. (b)

    the referring medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R)

99.90

55029

Head, ultrasound scan of, if 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 applies (NR)

34.65

55030

Orbital contents, ultrasound scan of, if:

  1. (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 applies; and

  2. (b)

    the referring medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R)

99.90

55031

Orbital contents, ultrasound scan of, if 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 applies (NR)

34.65

55032

Neck, 1 or more structures of, ultrasound scan of, if:

  1. (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 applies; and

  2. (b)

    the referring medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R)

99.90

55033

Neck, 1 or more structures of, ultrasound scan of, if 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 applies (NR)

34.65

55036

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

  1. (a)

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

  2. (b)

    the referring medical practitioner is not a member of a group of practitioners of which the practitioner is a member; and

  3. (c)

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

101.95

  1. (d)

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

  2. (e)

    within 24 hours of the service, a service described in item 55038, 55044 or 55731 is not performed on the same patient by the providing practitioner (R)

55037

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

  1. (a)

    the patient is not referred by a medical practitioner; and

  2. (b)

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

  3. (c)

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

34.65

55038

Urinary tract, ultrasound scan of, if:

  1. (a)

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

  2. (b)

    the referring medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

  3. (c)

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

99.90

  1. (d)

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

  2. (e)

    within 24 hours of the service, a service described in item 55036, 55044 or 55731 is not performed on the same patient by the providing practitioner (R)

55039

Urinary tract, ultrasound scan of, if:

  1. (a)

    the patient is not referred by a medical practitioner; and

  2. (b)

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

  3. (c)

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

34.65

55044

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

  1. (a)

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

  2. (b)

    the referring medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

  3. (c)

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

  4. (d)

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

  5. (e)

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

101.95

55045

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

  1. (a)

    the patient is not referred by a medical practitioner; and

  2. (b)

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

  3. (c)

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

34.65

55048

Scrotum, ultrasound scan of, if:

  1. (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 applies; and

  2. (b)

    the referring medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R)

100.30

55049

Scrotum, ultrasound scan of, if 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 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

55070

Breast, one, ultrasound scan of, if:

  1. (a)

    the patient is referred by a medical practitioner; and

  2. (b)

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

  3. (c)

    the referring medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R)

90.00

55073

Breast, one, ultrasound scan of, if:

  1. (a)

    the patient is not referred by a medical practitioner; and

  2. (b)

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

31.20

55076

Breasts, both, ultrasound scan of, if:

  1. (a)

    the patient is referred by a medical practitioner; and

  2. (b)

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

  3. (c)

    the referring medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R)

99.90

55079

Breasts, both, ultrasound scan of, if:

  1. (a)

    the patient is not referred by a medical practitioner; and

  2. (b)

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

34.65

Subgroup 2 — Cardiac

55113

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

  1. (a)

    with:

    1. (i)

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

230.65

  1. (ii)

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

  2. (iii)

    recordings on video tape or digital media; and

(b)

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

55114

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

  1. (a)

    with:

    1. (i)

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

230.65

  1. (ii)

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

  2. (iii)

    recordings on video tape or digital media; and

(b)

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

55115

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

  1. (a)

    with:

    1. (i)

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

    2. (ii)

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

    3. (iii)

      recordings on video tape or digital media; and

  2. (b)

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

230.65

55116

Exercise stress echocardiography performed in conjunction with item 11712:

  1. (a)

    with:

    1. (i)

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

    2. (ii)

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

    3. (iii)

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

  2. (b)

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

256.50

55117

Pharmacological stress echocardiography performed in conjunction with item 11712:

  1. (a)

    with:

    1. (i)

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

    2. (ii)

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

256.50

  1. (iii)

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

(b)

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

55118

Heart, two-dimensional real time transoesophageal examination of, from at least 2 levels, and in more than 1 plane at each level:

  1. (a)

    with:

    1. (i)

      pulsed wave Doppler examination; and

    2. (ii)

      real time colour flow mapping; and

    3. (iii)

      recordings on video tape or digital media; and

  2. (b)

    not being an intra-operative service or a service associated with a service to which an item in Subgroup 1 (except item 55054) or 3 applies (R) (Anaes.)

275.50

55130

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

353.60

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 applies (R)

155.25

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 applies (R)

155.25

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 applies (R)

155.25

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 applies (R)

155.25

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 applies (R)

155.25

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 applies (R)

155.25

55276

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

155.25

55278

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

155.25

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 applies (R)

155.25

55282

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

  1. (a)

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

  2. (b)

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

155.25

  1. (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 performed, immediately before or for a period during the performance of the service; and

  2. (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 applies (R)

55284

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

  1. (a)

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

155.25

  1. (b)

    where indicated, assess the progress and management of:

    1. (i)

      priapism; or

    2. (ii)

      fibrosis of any type; or

    3. (iii)

      fracture of the tunica; or

    4. (iv)

      arteriovenous malformations; and

  2. (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 performed, immediately before or for a period during the performance of the service; and

  1. (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 applies (R)

55292

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

155.25

55294

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

155.25

55296

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

101.70

Subgroup 4 — Urological

55600

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

  1. (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:

    1. (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

    2. (ii)

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

  2. (b)

    following a digital rectal examination of the prostate by that medical practitioner; and

  3. (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:

    1. (i)

      examined the patient in the 60 days before the scan; and

    2. (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:

  1. (a)

    personally by a medical practitioner who made the assessment mentioned in paragraph (c) using a transducer probe that:

    1. (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

    2. (ii)

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

  2. (b)

    following a digital rectal examination of the prostate by that medical practitioner; and

99.90

  1. (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:

    1. (i)

      examined the patient in the 60 days before the scan; and

    2. (ii)

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

Subgroup 5 — Obstetric and gynaecological

55700

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

  1. (a)

    the patient is referred by a medical practitioner; and

  2. (b)

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

  3. (c)

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

  4. (d)

    the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

60.00

  1. (e)

    one or more of the following conditions are present:

    1. (i)

      hyperemesis gravidarum;

    2. (ii)

      diabetes mellitus;

    3. (iii)

      hypertension;

    4. (iv)

      toxaemia of pregnancy;

    5. (v)

      liver or renal disease;

    6. (vi)

      autoimmune disease;

    7. (vii)

      cardiac disease;

    8. (viii)

      alloimmunisation;

    9. (ix)

      maternal infection;

    10. (x)

      inflammatory bowel disease;

    11. (xi)

      bowel stoma;

    12. (xii)

      abdominal wall scarring;

  1. (xiii)

    previous spinal or pelvic trauma or disease;

  2. (xiv)

    drug dependency;

  1. (xv)

    thrombophilia;

  2. (xvi)

    significant maternal obesity;

  3. (xvii)

    advanced maternal age;

  4. (xviii)

    abdominal pain or mass;

  5. (xix)

    uncertain dates;

  6. (xx)

    high risk pregnancy;

  7. (xxi)

    previous post dates delivery;

  8. (xxii)

    previous caesarean section;

  9. (xxiii)

    poor obstetric history;

  10. (xxiv)

    suspicion of ectopic pregnancy;

  11. (xxv)

    risk of miscarriage;

  12. (xxvi)

    diminished symptoms of pregnancy;

  13. (xxvii)

    suspected or known cervical incompetence;

(xxviii)

suspected or known uterine abnormality;

  1. (xxix)

    pregnancy after assisted reproduction;

  2. (xxx)

    risk of foetal abnormality (R)

55703

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

  1. (a)

    the patient is not referred by a medical practitioner; and

  2. (b)

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

  3. (c)

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

  4. (d)

    one or more of the following conditions are present:

    1. (i)

      hyperemesis gravidarum;

    2. (ii)

      diabetes mellitus;

    3. (iii)

      hypertension;

    4. (iv)

      toxaemia of pregnancy;

    5. (v)

      liver or renal disease;

35.00

  1. (vi)

    autoimmune disease;

  1. (vii)

    cardiac disease;

  2. (viii)

    alloimmunisation;

  3. (ix)

    maternal infection;

  4. (x)

    inflammatory bowel disease;

  5. (xi)

    bowel stoma;

  1. (xii)

    abdominal wall scarring;

  2. (xiii)

    previous spinal or pelvic trauma or disease;

  3. (xiv)

    drug dependency;

  4. (xv)

    thrombophilia;

  5. (xvi)

    significant maternal obesity;

  6. (xvii)

    advanced maternal age;

  7. (xviii)

    abdominal pain or mass;

  8. (xix)

    uncertain dates;

  9. (xx)

    high risk pregnancy;

  10. (xxi)

    previous post dates delivery;

  11. (xxii)

    previous caesarean section;

  12. (xxiii)

    poor obstetric history;

  13. (xxiv)

    suspicion of ectopic pregnancy;

  14. (xxv)

    risk of miscarriage;

  15. (xxvi)

    diminished symptoms of pregnancy;

  16. (xxvii)

    suspected or known cervical incompetence;

(xxviii)

suspected or known uterine abnormality;

  1. (xxix)

    pregnancy after assisted reproduction;

  2. (xxx)

    risk of foetal abnormality (NR)

55704

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

  1. (a)

    the patient is referred by a medical practitioner; and

  2. (b)

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

  3. (c)

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

70.00

  1. (d)

    the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

  2. (e)

    one or more of the following conditions are present:

    1. (i)

      hyperemesis gravidarum;

    2. (ii)

      diabetes mellitus;

    3. (iii)

      hypertension;

    4. (iv)

      toxaemia of pregnancy;

    5. (v)

      liver or renal disease;

    6. (vi)

      autoimmune disease;

    7. (vii)

      cardiac disease;

    8. (viii)

      alloimmunisation;

    9. (ix)

      maternal infection;

    10. (x)

      inflammatory bowel disease;

    11. (xi)

      bowel stoma;

    12. (xii)

      abdominal wall scarring;

    13. (xiii)

      previous spinal or pelvic trauma or disease;

    14. (xiv)

      drug dependency;

    15. (xv)

      thrombophilia;

    16. (xvi)

      significant maternal obesity;

  1. (xvii)

    advanced maternal age;

  2. (xviii)

    abdominal pain or mass;

  3. (xix)

    uncertain dates;

  4. (xx)

    high risk pregnancy;

  5. (xxi)

    previous post dates delivery;

  6. (xxii)

    previous caesarean section;

  7. (xxiii)

    poor obstetric history;

  1. (xxiv)

    suspicion of ectopic pregnancy;

  2. (xxv)

    risk of miscarriage;

  3. (xxvi)

    diminished symptoms of pregnancy;

  4. (xxvii)

    suspected or known cervical incompetence;

(xxviii)

suspected or known uterine abnormality;

  1. (xxix)

    pregnancy after assisted reproduction;

  2. (xxx)

    risk of foetal abnormality (R)

55705

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

  1. (a)

    the patient is not referred by a medical practitioner; and

  2. (b)

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

  3. (c)

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

35.00

  1. (d)

    one or more of the following conditions are present:

    1. (i)

      hyperemesis gravidarum;

    2. (ii)

      diabetes mellitus;

    3. (iii)

      hypertension;

    4. (iv)

      toxaemia of pregnancy;

    5. (v)

      liver or renal disease;

    6. (vi)

      autoimmune disease;

    7. (vii)

      cardiac disease;

    8. (viii)

      alloimmunisation;

    9. (ix)

      maternal infection;

    10. (x)

      inflammatory bowel disease;

    11. (xi)

      bowel stoma;

    12. (xii)

      abdominal wall scarring;

    13. (xiii)

      previous spinal or pelvic trauma or disease;

    14. (xiv)

      drug dependency;

    15. (xv)

      thrombophilia;

    16. (xvi)

      significant maternal obesity;

    17. (xvii)

      advanced maternal age;

    18. (xviii)

      abdominal pain or mass;

    19. (xix)

      uncertain dates;

    20. (xx)

      high risk pregnancy;

    21. (xxi)

      previous post dates delivery;

    22. (xxii)

      previous caesarean section;

    23. (xxiii)

      poor obstetric history;

    24. (xxiv)

      suspicion of ectopic pregnancy;

    25. (xxv)

      risk of miscarriage;

  1. (xxvi)

    diminished symptoms of pregnancy;

  2. (xxvii)

    suspected or known cervical incompetence;

(xxviii)

suspected or known uterine abnormality;

  1. (xxix)

    pregnancy after assisted reproduction;

  2. (xxx)

    risk of foetal abnormality (NR)

55706

Pelvis or abdomen, pregnancy-related or pregnancy complication, foetal 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:

  1. (a)

    the patient is referred by a medical practitioner; and

  2. (b)

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

  3. (c)

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

100.00

  1. (d)

    the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

  2. (e)

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

55709

Pelvis or abdomen, pregnancy-related or pregnancy complication, foetal 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:

  1. (a)

    the patient is not referred by a medical practitioner; and

  2. (b)

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

  3. (c)

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

  4. (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, foetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, where:

  1. (a)

    the patient is referred by a medical practitioner who:

    1. (i)

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

    2. (ii)

      has a Diploma of Obstetrics; or

115.00

  1. (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

  2. (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

  1. (c)

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

  1. (d)

    the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

  1. (e)

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

55715

Pelvis or abdomen, pregnancy-related or pregnancy complication, foetal 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:

  1. (a)

    the patient is not referred by a medical practitioner; and

40.00

  1. (b)

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

  2. (c)

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

  1. (d)

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

55718

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

  1. (a)

    the patient is referred by a medical practitioner; and

  2. (b)

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

  3. (c)

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

100.00

  1. (d)

    the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

  2. (e)

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

  3. (f)

    one or more of the following conditions are present:

    1. (i)

      known or suspected foetal abnormality or foetal cardiac arrhythmia;

  1. (ii)

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

  2. (iii)

    malpresentation;

  3. (iv)

    cervical assessment;

  4. (v)

    clinical suspicion of amniotic fluid abnormality;

  1. (vi)

    clinical suspicion of placental or umbilical cord abnormality;

  2. (vii)

    previous complicated delivery;

  3. (viii)

    uterine scar assessment;

  4. (ix)

    uterine fibroid;

  1. (x)

    previous foetal death in utero or neonatal death;

  2. (xi)

    antepartum haemorrhage;

  3. (xii)

    clinical suspicion of intrauterine growth retardation;

  4. (xiii)

    clinical suspicion of macrosomia;

  1. (xiv)

    reduced foetal movements;

  2. (xv)

    suspected foetal death;

  3. (xvi)

    abnormal cardiotocography;

  4. (xvii)

    prolonged pregnancy;

  5. (xviii)

    premature labour;

  6. (xix)

    foetal infection;

  7. (xx)

    pregnancy after assisted reproduction;

  8. (xxi)

    trauma;

  9. (xxii)

    diabetes mellitus;

  10. (xxiii)

    hypertension;

  11. (xxiv)

    toxaemia of pregnancy;

  12. (xxv)

    liver or renal disease;

  1. (xxvi)

    autoimmune disease;

  2. (xxvii)

    cardiac disease;

(xxviii)

alloimmunisation;

  1. (xxix)

    maternal infection;

  2. (xxx)

    inflammatory bowel disease;

  1. (xxxi)

    bowel stoma;

  2. (xxxii)

    abdominal wall scarring;

  3. (xxxiii)

    previous spinal or pelvic trauma or disease;

(xxxiv)

drug dependency;

  1. (xxxv)

    thrombophilia;

(xxxvi)

gross maternal obesity;

(xxxvii)

advanced maternal age;

(xxxviii)

abdominal pain or mass (R)

55721

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

  1. (a)

    the patient is referred by a medical practitioner who:

    1. (i)

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

115.00

  1. (ii)

    has a Diploma of Obstetrics; or

  1. (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

  1. (iv)

    has obstetric privileges at a non-metropolitan hospital; and

  1. (b)

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

  2. (c)

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

  1. (d)

    the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

  2. (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, foetal development and anatomy, ultrasound scan of (not exceeding 1 service in any 1 pregnancy), by any or all approaches, where:

  1. (a)

    the patient is not referred by a medical practitioner; and

  2. (b)

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

  3. (c)

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

  4. (d)

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

38.00

  1. (e)

    one or more of the following conditions are present:

    1. (i)

      known or suspected foetal abnormality or foetal cardiac arrhythmia;

    2. (ii)

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

    3. (iii)

      malpresentation;

    4. (iv)

      cervical assessment;

  1. (v)

    clinical suspicion of amniotic fluid abnormality;

  2. (vi)

    clinical suspicion of placental or umbilical cord abnormality;

  3. (vii)

    previous complicated delivery;

  4. (viii)

    uterine scar assessment;

  5. (ix)

    uterine fibroid;

  1. (x)

    previous foetal death in utero or neonatal death;

  2. (xi)

    antepartum haemorrhage;

  3. (xii)

    clinical suspicion of intrauterine growth retardation;

  1. (xiii)

    clinical suspicion of macrosomia;

  2. (xiv)

    reduced foetal movements;

  3. (xv)

    suspected foetal death;

  4. (xvi)

    abnormal cardiotocography;

  5. (xvii)

    prolonged pregnancy;

  6. (xviii)

    premature labour;

  1. (xix)

    foetal infection;

  2. (xx)

    pregnancy after assisted reproduction;

  3. (xxi)

    trauma;

  4. (xxii)

    diabetes mellitus;

  5. (xxiii)

    hypertension;

  6. (xxiv)

    toxaemia of pregnancy;

  7. (xxv)

    liver or renal disease;

  1. (xxvi)

    autoimmune disease;

  2. (xxvii)

    cardiac disease;

(xxviii)

alloimmunisation;

  1. (xxix)

    maternal infection;

  2. (xxx)

    inflammatory bowel disease;

  3. (xxxi)

    bowel stoma;

  4. (xxxii)

    abdominal wall scarring;

  1. (xxxiii)

    previous spinal or pelvic trauma or disease;

(xxxiv)

drug dependency;

  1. (xxxv)

    thrombophilia;

(xxxvi)

gross maternal obesity;

(xxxvii)

advanced maternal age;

(xxxviii)

abdominal pain or mass (NR)

55725

Pelvis or abdomen, pregnancy-related or pregnancy complication, foetal 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:

  1. (a)

    the patient is not referred by a medical practitioner; and

  2. (b)

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

40.00

  1. (c)

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

  2. (d)

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

55728

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

  1. (a)

    the patient is referred by a medical practitioner who:

    1. (i)

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

    2. (ii)

      has a Diploma of Obstetrics; or

100.00

  1. (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

  2. (iv)

    has obstetric privileges at a non-metropolitan hospital; and

  1. (b)

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

  2. (c)

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

  1. (d)

    the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

  1. (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)

55729

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

55731

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

  1. (a)

    the patient is referred by a medical practitioner; and

  2. (b)

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

98.00

  1. (c)

    the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

  2. (d)

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

55733

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

  1. (a)

    the patient is not referred by a medical practitioner; and

  2. (b)

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

35.00

55736

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

  1. (a)

    the patient is referred by a medical practitioner; and

  2. (b)

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

127.00

  1. (c)

    the referring medical practitioner is not a member of a group of medical practitioners of which the providing practitioner is a member; and

  1. (d)

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

55739

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

  1. (a)

    the patient is not referred by a medical practitioner; and

  2. (b)

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

  3. (c)

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

57.00

55759

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

  1. (a)

    the patient is referred by a medical practitioner; and

  2. (b)

    ultrasound of the same pregnancy confirms a multiple pregnancy; and

150.00

  1. (c)

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

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

  1. (e)

    the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

    (f) the service described in item 55706, 55709, 55712, 55715 or 55762 is not performed in conjunction with the scan during the same pregnancy (R)

55762

Pelvis or abdomen, pregnancy-related or pregnancy complication, foetal development and anatomy, ultrasound scan of (not exceeding 1 service in any 1 pregnancy), 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) ultrasound of the same pregnancy confirms a multiple pregnancy; and

60.00

  1. (c)

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

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

  1. (e)

    the service described in item 55706, 55709, 55712, 55715 or 55759 is not performed in conjunction with the scan during the same pregnancy (NR)

55764

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

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

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

(ii) has a Diploma of Obstetrics; or

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

160.00

  1. (iv)

    has obstetric privileges at a non-metropolitan hospital; and

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

  1. (c)

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

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

  1. (e)

    the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

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

  1. (g)

    the service described in item 55706, 55709, 55712 or 55715 is not performed in conjunction with the scan during the same pregnancy (R)

55766

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

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

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

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

65.00

  1. (d)

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

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

  1. (f)

    the service described in item 55706, 55709, 55712 or 55715 is not performed in conjunction with the scan during the same pregnancy (NR)

55768

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

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

(b) the ultrasound confirms a multiple pregnancy; and

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

150.00

  1. (d)

    the service is not performed in the same pregnancy as item 55770; and

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

  1. (f)

    the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

  1. (g)

    the service described in item 55718, 55721, 55723, 55725 or 55728 is not performed in conjunction with the scan during the same pregnancy (R)

55770

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

  1. (a)

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

  2. (b)

    the patient is not referred by a medical practitioner; and

  3. (c)

    the service is not performed in the same pregnancy as item 55768; and

60.00

  1. (d)

    the pregnancy as confirmed by ultrasound is a multiple pregnancy; and

  2. (e)

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

  1. (f)

    the service described in item 55718, 55721, 55723, 55725 or 55728 is not performed in conjunction with the scan during the same pregnancy (NR)

55772

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

  1. (a)

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

  2. (b)

    the patient is referred by a medical practitioner who:

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

    (ii) has a Diploma of Obstetrics; or

160.00

  1. (iii)

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

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

(c) further examination is clinically indicated in the same pregnancy to which item 55768 or 55770 has been performed; and

  1. (d)

    the pregnancy as confirmed by ultrasound is a multiple pregnancy; and

  2. (e)

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

  1. (f)

    the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

  2. (g)

    the service described in item 55718, 55721, 55723, 55725 or 55728 is not performed in conjunction with the scan during the same pregnancy (R)

55774

Pelvis or abdomen, pregnancy-related or pregnancy complication, foetal 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:

  1. (a)

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

65.00

  1. (b)

    the patient is not referred by a medical practitioner; and

    (c) further examination is clinically indicated in the same pregnancy to which item 55768 or 55770 has been performed; and

  1. (d)

    the pregnancy as confirmed by ultrasound is a multiple pregnancy; and

  2. (e)

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

  3. (f)

    the service described in item 55718, 55721, 55723, 55725 or 55728 is not performed in conjunction with the scan during the same pregnancy (NR)

Subgroup 6 — Musculoskeletal Ultrasound

55800

Hand or wrist, 1 or both sides, ultrasound scan of, where:

  1. (a)

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

  2. (b)

    the patient is referred by a medical practitioner; and

  3. (c)

    the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R)

99.90

55802

Hand or wrist, 1 or both sides, ultrasound scan of, where:

  1. (a)

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

  2. (b)

    the patient is not referred by a medical practitioner (NR)

34.65

55804

Forearm or elbow, 1 or both sides, ultrasound scan of, where:

  1. (a)

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

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

  2. (c)

    the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R)

99.90

55806

Forearm or elbow, 1 or both sides, ultrasound scan of, where:

  1. (a)

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

  2. (b)

    the patient is not referred by a medical practitioner (NR)

34.65

55808

Shoulder or upper arm, 1 or both sides, ultrasound scan of, if:

  1. (a)

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

  2. (b)

    the patient is referred by a medical practitioner; and

  3. (c)

    the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

99.90

 
  1. (d)

    the service is used for the assessment of 1 or more of the following suspected or known conditions:

    1. (i)

      an injury to a muscle, tendon or muscle/tendon junction;

    (ii) rotator cuff tear, calcification or tendinosis (biceps, subscapular, supraspinatus, infraspinatus);

    (iii) biceps subluxation;

    (iv) capsulitis and bursitis;

    (v) a mass, including a ganglion;

    (vi) an occult fracture;

    (vii) acromioclavicular joint pathology (R)

55810

Shoulder or upper arm, 1 or both sides, ultrasound scan of, if:

  1. (a)

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

  2. (b)

    the patient is not referred by a medical practitioner; and

  3. (c)

    the service is used for the assessment of 1 or more of the following suspected or known conditions:

    1. (i)

      an injury to a muscle, tendon or muscle/tendon junction;

    (ii) rotator cuff tear, calcification or tendinosis (biceps, subscapular, supraspinatus, infraspinatus);

    (iii) biceps subluxation;

    (iv) capsulitis and bursitis;

    (v) a mass, including a ganglion;

    (vi) an occult fracture;

    (vii) acromioclavicular joint pathology (NR)

34.65

55812

Chest or abdominal wall, 1 or more areas, ultrasound scan of, where:

  1. (a)

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

  2. (b)

    the patient is referred by a medical practitioner; and

  3. (c)

    the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R)

99.90

55814

Chest or abdominal wall, 1 or more areas, ultrasound scan of, where:

  1. (a)

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

  2. (b)

    the patient is not referred by a medical practitioner (NR)

34.65

55816

Hip or groin, 1 or both sides, ultrasound scan of, where:

  1. (a)

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

  2. (b)

    the patient is referred by a medical practitioner; and

  3. (c)

    the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R)

99.90

55818

Hip or groin, 1 or both sides, ultrasound scan of, where:

  1. (a)

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

  2. (b)

    the patient is not referred by a medical practitioner (NR)

34.65

55820

Paediatric hip examination for dysplasia, 1 or both sides, ultrasound scan of, where:

  1. (a)

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

  2. (b)

    the patient is referred by a medical practitioner; and

  3. (c)

    the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R)

99.90

55822

Paediatric hip examination for dysplasia 1 or both sides, ultrasound scan of, where:

  1. (a)

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

  2. (b)

    the patient is not referred by a medical practitioner (NR)

34.65

55824

Buttock or thigh, 1 or both sides, ultrasound scan of, where:

  1. (a)

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

  2. (b)

    the patient is referred by a medical practitioner; and

  3. (c)

    the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R)

99.90

55826

Buttock or thigh, 1 or both sides, ultrasound scan of, where:

  1. (a)

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

  2. (b)

    the patient is not referred by a medical practitioner (NR)

34.65

55828

Knee, 1 or both sides, ultrasound scan of, if:

  1. (a)

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

  2. (b)

    the patient is referred by a medical practitioner; and

  3. (c)

    the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

  4. (d)

    the service is used for the assessment of 1 or more of the following suspected or known conditions:

    1. (i)

      abnormality of tendons or bursae about the knee;

    (ii) a meniscal cyst, popliteal fossa cyst, mass or pseudomass;

    (iii) a nerve entrapment or a nerve or nerve sheath tumour;

    (iv) an injury of collateral ligaments (R)

99.90

55830

Knee, 1 or both sides, ultrasound scan of, if:

  1. (a)

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

  2. (b)

    the patient is not referred by a medical practitioner; and

  3. (c)

    the service is used for the assessment of 1 or more of the following suspected or known conditions:

    1. (i)

      abnormality of tendons or bursae about the knee;

    (ii) a meniscal cyst, popliteal fossa cyst, mass or pseudomass;

    (iii) a nerve entrapment or a nerve or nerve sheath tumour;

    (iv) an injury of collateral ligaments (NR)

34.65

55832

Lower leg, 1 or both sides, ultrasound scan of, where:

  1. (a)

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

  2. (b)

    the patient is referred by a medical practitioner; and

99.90

  1. (c)

    the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R)

55834

Lower leg, 1 or both sides, ultrasound scan of, performed by or on behalf of a medical practitioner, where:

  1. (a)

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

  2. (b)

    the patient is not referred by a medical practitioner (NR)

34.65

55836

Ankle or hind foot, 1 or both sides, ultrasound scan of, where:

  1. (a)

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

  2. (b)

    the patient is referred by a medical practitioner; and

  3. (c)

    the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R)

99.90

55838

Ankle or hind foot, 1 or both sides, ultrasound scan of, where:

  1. (a)

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

  2. (b)

    the patient is not referred by a medical practitioner (NR)

34.65

55840

Mid foot or fore foot, 1 or both sides, ultrasound scan of, where:

  1. (a)

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

  2. (b)

    the patient is referred by a medical practitioner; and

  3. (c)

    the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R)

99.90

55842

Mid foot or fore foot, 1 or both sides, ultrasound scan of, where:

  1. (a)

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

  2. (b)

    the patient is not referred by a medical practitioner (NR)

34.65

55844

Assessment of a mass associated with the skin or subcutaneous structures, not being a part of the musculoskeletal system, 1 or more areas, ultrasound scan of, where:

  1. (a)

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

  2. (b)

    the patient is referred by a medical practitioner; and

80.00

  1. (c)

    the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R)

55846

Assessment of a mass associated with the skin or subcutaneous structures, not being a part of the musculoskeletal system, 1 or more areas, ultrasound scan of, where:

  1. (a)

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

  2. (b)

    the patient is not referred by a medical practitioner (NR)

34.65

55848

Musculoskeletal cross-sectional echography, in conjunction with a surgical procedure using interventional techniques, not being a service associated with a service to which any other item in this group applies, and not performed in conjunction with item 55054 (R)

99.90

55850

Musculoskeletal cross-sectional echography, in conjunction with a surgical procedure using interventional techniques, inclusive of a diagnostic musculoskeletal ultrasound service, where:

  1. (a)

    the referring practitioner has indicated on a referral for a musculoskeletal ultrasound that an ultrasound guided intervention be performed if clinically indicated; and

  2. (b)

    the service is not performed in conjunction with items 55054, or 55800 to 55848; and

  3. (c)

    the patient is referred by a medical practitioner; and

  4. (d)

    the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R)

140.00

55852

Paediatric spine, spinal cord and overlying subcutaneous tissues, ultrasound scan of, where:

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

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

(c) the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R)

99.90

55854

Paediatric spine, spinal cord and overlying subcutaneous tissues, ultrasound scan of, where:

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

(b) the patient is not referred by a medical practitioner (NR)

34.65

Group I2 — Computed tomography — Examination

56001

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

185.25

56007

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

237.50

56010

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

61389

Single renal study with pre-procedural administration of a diuretic or angiotensin converting enzyme (ACE) inhibitor (R)

336.05

61390

Renal study with diuretic administration following a baseline study (R)

371.80

61393

Combined examination involving a renal study following angiotensin converting enzyme (ACE) inhibitor provocation and a baseline study, in either order and related to a single referral episode (R)

549.10

61397

Cystoureterogram (R)

223.85

61401

Testicular study (R)

147.15

61402

Cerebral perfusion study, with single photon emission tomography and with planar imaging when performed (R)

548.70

61405

Brain study with blood brain barrier agent, with planar imaging and single photon emission tomography, or planar imaging, or single photon emission tomography (R)

313.75

61409

Cerebro-spinal fluid transport study, with imaging on 2 or more separate occasions (R)

792.10

61413

Cerebro-spinal fluid shunt patency study (R)

204.90

61417

Dynamic blood flow study or regional blood volume quantitative study, not being a service associated with a service to which another item in this group applies (R)

107.75

61421

Bone study — whole body, with, when undertaken, blood flow, blood pool and delayed imaging on a separate occasion (R)

435.10

61425

Bone study — whole body and single photon emission tomography, with, when undertaken, blood flow, blood pool and delayed imaging on a separate occasion (R)

544.75

61426

Whole body study using iodine (R)

503.10

61429

Whole body study using gallium (R)

492.40

61430

Whole body study using gallium, with single photon emission tomography (R)

598.00

61433

Whole body study using cells labelled with technetium (R)

450.65

61434

Whole body study using cells labelled with technetium, with single photon emission tomography (R)

558.05

61437

Whole body study using thallium (R)

492.20

61438

Whole body study using thallium, with single photon emission tomography (R)

610.30

61441

Bone marrow study — whole body using technetium labelled bone marrow agents (R)

444.10

61442

Whole body study, using gallium — with single photon emission tomography of 2 or more body regions acquired separately (R)

682.25

61445

Bone marrow study — localised using technetium labelled agent (R)

260.10

61446

Localised bone or joint study, including when undertaken, blood flow, blood pool and repeat imaging on a separate occasion (R)

302.50

61449

Localised bone or joint study and single photon emission tomography, including when undertaken, blood flow, blood pool and imaging on a separate occasion (R)

413.75

61450

Localised study using gallium (R)

360.50

61453

Localised study using gallium, with single photon emission tomography (R)

466.75

61454

Localised study using cells labelled with technetium (R)

315.65

61457

Localised study using cells labelled with technetium, with single photon emission tomography (R)

426.65

61458

Localised study using thallium (R)

359.95

61461

Localised study using thallium, with single photon emission tomography (R)

478.70

61462

Repeat planar and single photon emission tomography imaging, or repeat planar imaging or single photon emission tomography imaging on an occasion subsequent to the performance of item 61364, 61426, 61429, 61430, 61442, 61450, 61453 or 61469, where there is no additional administration of radiopharmaceutical and where the previous radionuclide scan was abnormal or equivocal (R)

Amount under rule 29

61465

Venography (R)

240.75

61469

Lymphoscintigraphy (R)

315.65

61473

Thyroid study including uptake measurement when performed (R)

159.05

61480

Parathyroid study, planar imaging and single photon emission tomography when performed (R)

350.80

61484

Adrenal study, with imaging on 2 or more separate occasions (R)

798.80

61485

Adrenal study, with imaging on 2 or more occasions and renal localisation and single photon emission tomography when performed (R)

906.15

61495

Tear duct study (R)

202.30

61499

Particle perfusion study (infra-arterial) or Le Veen shunt study (R)

229.45

Group I5 — Magnetic resonance imaging

Subgroup 1 — Scan of head — for the exclusion of specified conditions

63000

MRI — scan of head (with or without intravenous contrast and including MRA, if performed) for the exclusion of tumour of the brain or meninges (R) (Anaes.)

475.00

63003

MRI — scan of head (with or without intravenous contrast and including MRA, if performed) for the exclusion of skull base or orbital tumour (R) (Anaes.)

475.00

63006

MRI — scan of head (with or without intravenous contrast and including MRA, if performed) for the exclusion of acoustic neuroma (R) (Anaes.)

475.00

63009

MRI — scan of head (with or without intravenous contrast and including MRA, if performed) for the exclusion of pituitary tumour (R) (Anaes.)

475.00

63012

MRI — scan of head (with or without intravenous contrast and including MRA, if performed) for the exclusion of inflammation of brain or meninges (R) (Anaes.)

475.00

63015

MRI — scan of head (with or without intravenous contrast and including MRA, if performed) for the exclusion of toxic or metabolic or ischaemic encephalopathy (R) (Anaes.)

475.00

63018

MRI — scan of head (with or without intravenous contrast and including MRA, if performed) for the exclusion of demyelinating disease of the brain (R) (Anaes.)

475.00

63021

MRI — scan of head (with or without intravenous contrast and including MRA, if performed) for the exclusion of congenital malformation of brain or meninges (R) (Anaes.)

475.00

63024

MRI — scan of head (with or without intravenous contrast and including MRA, if performed) for the exclusion of venous sinus thrombosis (R) (Anaes.)

475.00

Subgroup 2 — Scan of head and cervical spine — for the exclusion of specified conditions

63050

MRI — scan of head and cervical spine (with or without intravenous contrast and including MRA, if performed) for the exclusion of tumour of the central nervous system or meninges (R) (Anaes.)

475.00

63053

MRI — scan of head and cervical spine (with or without intravenous contrast and including MRA, if performed) for the exclusion of inflammation of the central nervous system or meninges (R) (Anaes.)

475.00

63056

MRI — scan of head and cervical spine (with or without intravenous contrast and including MRA, if performed) for the exclusion of demyelinating disease of the central nervous system (R) (Anaes.)

475.00

63059

MRI — scan of head and cervical spine (with or without intravenous contrast and including MRA, if performed) for the exclusion of congenital malformation of the central nervous system or meninges (R) (Anaes.)

475.00

63062

MRI — scan of head and cervical spine (with or without intravenous contrast and including MRA, if performed) for the exclusion of syrinx — congenital or acquired (R) (Anaes.)

475.00

Subgroup 3 — Scan of head — for further investigation of specified conditions

63100

MRI — scan of head (with or without intravenous contrast and including MRA, if performed) for further investigation of tumour of the brain or meninges (R) (Anaes.)

475.00

63103

MRI — scan of head (with or without intravenous contrast and including MRA, if performed) for further investigation of skull base or orbital tumour (R) (Anaes.)

475.00

63106

MRI — scan of head (with or without intravenous contrast and including MRA, if performed) for further investigation of acoustic neuroma (R) (Anaes.)

475.00

63109

MRI — scan of head (with or without intravenous contrast and including MRA, if performed) for further investigation of pituitary tumour (R) (Anaes.)

475.00

63112

MRI — scan of head (with or without intravenous contrast and including MRA, if performed) for further investigation of inflammation of the brain or meninges (R) (Anaes.)

475.00

63115

MRI — scan of head (with or without intravenous contrast and including MRA, if performed) for further investigation of toxic or metabolic or ischaemic encephalopathy (R) (Anaes.)

475.00

63118

MRI — scan of head (with or without intravenous contrast and including MRA, if performed) for further investigation of demyelinating disease of the brain (R) (Anaes.)

475.00

63121

MRI — scan of head (with or without intravenous contrast and including MRA, if performed) for further investigation of congenital malformation of the brain or meninges (R) (Anaes.)

475.00

63124

MRI — scan of head (with or without intravenous contrast and including MRA, if performed) for further investigation of head trauma (R) (Anaes.)

475.00

63127

MRI — scan of head (with or without intravenous contrast and including MRA, if performed) for further investigation of epilepsy (R) (Anaes.)

475.00

63130

MRI — scan of head (with or without intravenous contrast and including MRA, if performed) for further investigation of stroke (R) (Anaes.)

475.00

63133

MRI — scan of head (with or without intravenous contrast and including MRA, if performed) for further investigation of venous sinus thrombosis (R) (Anaes.)

475.00

Subgroup 4 — Scan of head and cervical spine — for further investigation of specified conditions

63150

MRI — scan of head and cervical spine (with or without intravenous contrast and including MRA, if performed) for further investigation of tumour of the central nervous system or meninges (R) (Anaes.)

475.00

63153

MRI — scan of head and cervical spine (with or without intravenous contrast and including MRA, if performed) for further investigation of inflammation of the central nervous system or meninges (R) (Anaes.)

475.00

63156

MRI — scan of head and cervical spine (with or without intravenous contrast and including MRA, if performed) for further investigation of demyelinating disease of the central nervous system (R) (Anaes.)

475.00

63159

MRI — scan of head and cervical spine (with or without intravenous contrast and including MRA, if performed) for further investigation of congenital malformation of the central nervous system or meninges (R) (Anaes.)

475.00

63162

MRI — scan of head and cervical spine (with or without intravenous contrast and including MRA, if performed) for further investigation of syrinx — congenital or acquired (R) (Anaes.)

475.00

Subgroup 5 — Scan of head — for monitoring of specified conditions

63200

MRI — scan of head (with or without intravenous contrast and including MRA, if performed) for monitoring of acoustic neuroma (R) (Anaes.)

475.00

63203

MRI — scan of head (with or without intravenous contrast and including MRA, if performed) for monitoring of pituitary tumour (R) (Anaes.)

475.00

63206

MRI — scan of head (with or without intravenous contrast and including MRA, if performed) for monitoring of demyelinating disease of the brain (R) (Anaes.)

475.00

63209

MRI — scan of head (with or without intravenous contrast and including MRA, if performed) for monitoring of congenital malformation of brain or meninges (R) (Anaes.)

475.00

63212

MRI — scan of head (with or without intravenous contrast, and including MRA, if performed) for monitoring of head trauma (R) (Anaes.)

475.00

63215

MRI — scan of head (with or without intravenous contrast and including MRA, if performed) for monitoring of epilepsy (R) (Anaes.)

475.00

63218

MRI — scan of head (with or without intravenous contrast and including MRA, if performed) for monitoring of stroke (R) (Anaes.)

475.00

63221

MRI — scan of head (with or without intravenous contrast and including MRA, if performed) for monitoring of toxic or metabolic or ischaemic encephalopathy (R) (Anaes.)

475.00

Subgroup 6 — Scan of head and cervical spine — for monitoring of specified conditions

63250

MRI — scan of head and cervical spine (with or without intravenous contrast and including MRA, if performed) for monitoring of demyelinating disease of the central nervous system (R) (Anaes.)

475.00

63253

MRI — scan of head and cervical spine (with or without intravenous contrast and including MRA, if performed) for monitoring of congenital malformation of the central nervous system or meninges (R) (Anaes.)

475.00

63256

MRI — scan of head and cervical spine (with or without intravenous contrast and including MRA, if performed) for monitoring of syrinx — congenital or acquired (R) (Anaes.)

475.00

Subgroup 7 — Scan of head — for monitoring of specified conditions

63270

MRI — scan of head (with or without intravenous contrast and including MRA, if performed) for monitoring of tumour of the brain or meninges (R) (Anaes.)

475.00

63273

MRI — scan of head (with or without intravenous contrast and including MRA, if performed) for monitoring of skull base or orbital tumour (R) (Anaes.)

475.00

63276

MRI — scan of head (with or without intravenous contrast and including MRA, if performed) for monitoring of inflammation of brain or meninges (R) (Anaes.)

475.00

63279

MRI — scan of head (with or without intravenous contrast and including MRA, if performed) for monitoring of venous sinus thrombosis (R) (Anaes.)

475.00

Subgroup 8 — Scan of head and cervical spine — for monitoring of specified conditions

63290

MRI — scan of head and cervical spine (with or without intravenous contrast and including MRA, if performed) for monitoring of tumour of the central nervous system or meninges (R) (Anaes.)

475.00

63293

MRI — scan of head and cervical spine (with or without intravenous contrast and including MRA, if performed) for monitoring of inflammation of the central nervous system or meninges (R) (Anaes.)

475.00

Subgroup 9 — Scan of spine — 1 region or 2 contiguous regions — for the exclusion of a specified condition

63300

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

475.00

63303

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

475.00

63306

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

475.00

63309

MRI — scan of 1 region or 2 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) (Anaes.)

475.00

63312

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

475.00

63315

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

475.00

Subgroup 10 — Scan of spine — 3 contiguous or 2 non‑contiguous regions — for the exclusion of specified conditions

63350

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

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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 of cervical radiculopathy (R) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

475.00

63606

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

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

475.00

63656

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

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

475.00

63703

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

475.00

63706

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

475.00

63709

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

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) (Anaes.)

475.00

63715

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

475.00

63718

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

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

475.00

63856

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

475.00

63859

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

475.00

63862

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

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) (Anaes.)

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) (Anaes.)

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 before limb or digit transfer surgery in congenital limb deficiency syndrome (R) (Anaes.)

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) (Anaes.)

475.00

63883

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

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

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) (Anaes.)

475.00

Notes to the Health Insurance (Diagnostic Imaging Services Table) Regulations 2002

Note 1

The Health Insurance (Diagnostic Imaging Services Table) Regulations 2002 (in force under the Health Insurance Act 1973) as shown in this compilation comprise Statutory Rules 2002 No. 247 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

2002 No. 247

24 Oct 2002

1 Nov 2002

2003 No. 68

28 Apr 2003

1 May 2003

—

2003 No. 98

29 May 2003

1 June 2003

—

Table of Amendments

    ad. = added or inserted

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

Provision affected

How affected

Schedule 1

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

am. 2003 Nos. 68 and 98

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