Health Insurance (Diagnostic Imaging Services Table) Regulations 2004 (Cth)

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Health Insurance (Diagnostic Imaging Services Table) Regulations 2004

Statutory Rules 2004 No. 307 as amended

made under the

Health Insurance Act 1973

This compilation was prepared on 10 October 2005

taking into account amendments up to SLI 2005 No. 219

Prepared by the Office of Legislative Drafting and Publishing,

Attorney-General’s Department, Canberra

Contents

1Name of Regulations

These Regulations are the Health Insurance (Diagnostic Imaging Services Table) Regulations 2004.

2Commencement

These Regulations commence on 1 November 2004.

3Health Insurance (Diagnostic Imaging Services Table) Regulations 2003 – repeal

The following Statutory Rules are repealed:

· 2003 Nos. 268 and 358

· 2004 Nos. 64, 76, 101, 229 and 266.

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 table1Prescription 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 interpretation2General
  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.

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 Medicare Australia CEO..

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.

  1. (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.

  2. (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.

4Who 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.

5Report 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.

6Meaning 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.

7Meaning of Amount under rule 7 in certain items

In item 59103:

Amount under rule 7 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.

8Ultrasound 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.

9Ultrasound 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.

10Angiography services – meaning of (K) and (NK) in items
  1. (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.

  2. (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.

  3. (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.

11Obstetric 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.

12Obstetric and gynaecological services – clinical indications
  1. (1)

    For items where clinical conditions are listed (items 55700, 55704, 55718, 55723, 55728, 55759 and 55768), or where a clinical indication is required for performance of subsequent scans (items 55712, 55721, 55764 and 55772), the referral must identify the relevant clinical indication for the service.

  2. (2)

    If the service is self-determined (items 55703, 55705, 55715, 55723, 55725, 55762, 55770 and 55774), the clinical condition or indication must be recorded in the medical practitioner’s clinical notes.

13Obstetric and gynaecological services – referral forms

Items 55712, 55721, 55728, 55764 and 55772 apply to a service for which a referral is given by a medical practitioner who has obstetric privileges at a non-metropolitan hospital only if the words ‘non-metropolitan obstetric privileges’ are specified on the referral form.

14Musculoskeletal 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.

15Musculoskeletal 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.

16Musculoskeletal 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.

17Musculoskeletal 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.

18CT 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.

19CT 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.

20CT 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.

21CT 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.

22CT 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.

23CT 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.

24Mammography 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.

25Preparation 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.

26Meaning 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.

27Nuclear 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 Medicare Australia CEO 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.

28Meaning of Amount under rule 28 in item 61462

In item 61462:

Amount under rule 28 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)

    $129.00.

29Multiple 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 the items that apply to the services 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 amount that is a multiple of 5 cents.

  3. (3)

    This rule does not apply to the fee specified in item 64990 or 64991.

30Multiple 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)

    Rules 29 and 38 apply, subject to subrules (7) and (8), in addition to this rule.

  7. (7)

    For rule 29, 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.

  1. (8)

    For rule 38, if a medical practitioner provides:

    1. (a)

      2 or more MRI services described in Subgroup 12 or 13 of Group I5 in this table for the same patient on the same day; and

    1. (b)

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

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

  1. (9)

    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.

  2. (10)

    This rule does not apply to the fee specified in item 64990 or 64991.

  3. (11)

    In this rule:

consultation means a service under an item listed in Groups A1 to A21 of the general medical services table.

highest fee means the highest fee specified for an item in the first claim submitted to the Medicare Australia CEO 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 A21.

31MRI and MRA services – eligible services
  1. (1)

    Subject to subrule (2), items 63001 to 63473 apply only to an MRI or MRA service performed:

    1. (a)

      on request, in accordance with rule 32, by a specialist or consultant physician; and

    2. (b)

      in a permissible circumstance, in accordance with rule 33; and

    3. (c)

      with eligible equipment, in accordance with rule 35 or 36.

  2. (2)

    If a service described in an item mentioned in subrule (1) is performed with eligible equipment described in paragraph 36 (c), the item for the service applies only if the service is bulk-billed in respect of the fee for the service.

  3. (3)

    For subrule (2):

bulk-billed, in relation to a service, means:

  1. (a)

    a medicare benefit is payable to a person in respect of the service; and

  2. (b)

    under an agreement entered into under section 20A of the Act:

    1. (i)

      the person assigns to the eligible provider by whom, or on whose behalf, the service is provided, his or her right to the payment of the medicare benefit; and

    2. (ii)

      the eligible provider accepts the assignment in full payment of his or her fee for the service provided.

32MRI and MRA services – requests

Items 63001 to 63473 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.

33MRI and MRA services – permissible circumstances for performance

For rule 31, 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.

34MRI and MRA services – eligible provider
  1. (1)

    For rule 33, an eligible provider, in relation to an MRI or MRA service performed with equipment to which rule 35 or paragraph 36 (a) applies, 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.

  2. (2)

    For rule 33, an eligible provider, in relation to an MRI or MRA service performed with equipment to which paragraph 36 (b) or (c) applies, is a specialist in diagnostic radiology who has satisfied the Medicare Australia CEO that he or she is a participant in the Royal Australian and New Zealand College of Radiologists’ Quality and Accreditation Program.

35MRI and MRA services – eligible equipment

For rule 31, 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.

36MRI and MRA services – eligible equipment

For rule 31, eligible equipment is equipment other than equipment to which rule 35 applies, being:

  1. (a)

    equipment:

    1. (i)

      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. (ii)

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

  2. (b)

    equipment:

    1. (i)

      that is registered under the scheme, administered

      by the Department, titled ‘2004 MRI Additional Units Eligibility Scheme’, as in force on 29 November 2004; and

    2. (ii)

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

  3. (c)

    equipment that:

    1. (i)

      is described in columns 3 and 4 of an item in the following table by reference to the manufacturer, scanner model and magnet strength; and

    2. (ii)

      is located in the radiology department of a hospital specified in column 2 of that item.

Item

Location

Manufacturer and scanner model

Magnet strength

1

The Women’s and Children’s Hospital

72 King William Rd

North Adelaide

SA 5006

Philips

Magnet Intera

1.0T

2

The Princess Margaret Hospital for Children

Roberts Rd

Subiaco WA 6008

Siemens

Magnatom Sonata

1.5T

3

The Royal Children’s Hospital

Herston Rd

Herston Qld 4029

Siemens Avanto

1.5T

4

Mater Misericordiae Health Services Brisbane Limited

Raymond Terrace

South Brisbane

Qld 4101

Philips Intera Achieva

3.0T

Note 1 The MRI Additional Units Eligibility Scheme mentioned in subparagraph (a) (i) 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.

Note 2 The 2004 MRI Additional Units Eligibility Scheme mentioned in subparagraph (b) (i) is the scheme of that title published in Gazette No. S 479 on 29 November 2004.

37MRI and MRA services – meaning of scan

In items 63001 to 63473:

scan means a minimum of 3 sequences.

38MRI and MRA services – multiple services rule
  1. (1)

    If an MRI service described in an item in Subgroup 1, 2, 4, 5

    or 14 of Group I5 in this table, and an MRA service described in an item in Subgroup 3 or 15 of that Group, are provided to the same person on the same day, only the fee specified in the item in Subgroup 1, 2, 4, 5 or 14 applies to the services.

  2. (2)

    If a medical practitioner provides 2 or more MRI services described in Subgroup 12 or 13 of Group I5 in this table for the same patient on the same day, the fees specified for the items that apply to the services, other than the item with the highest fee, are reduced by 50%.

  3. (3)

    For subrule (2):

    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 a reduced fee calculated under subrule (2) is not a multiple of 5 cents, the reduced fee is taken to be the nearest amount that is a multiple of 5 cents.

39MRI or MRA services – related services that can be claimed in a 12 month period
  1. (1)

    An MRI or MRA item mentioned in column 2 of the table in subrule (2) does not apply to the service described in that item if the service is provided to a person who, in the 12 months before the service, has been provided with the maximum number of those services mentioned in column 3 of the table for that item.

  2. (2)

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

Item

MRI or MRA items

Maximum number of services

1

63040 to 63073

3

2

63101

3

3

63125 to 63131

3

4

63161 to 63185

3

5

63219 to 63243

3

6

63271 to 63280

3

7

63322 to 63340

3

8

63361

2

9

63385 to 63391

2

10

63401 and 63404

3

11

63416

1

12

63425 and 63428

2

13

63461

1

  1. (3)

    In addition, if 2 or more services of the kind described in an MRI item mentioned in item 7 or 8 of the table in subrule (2) are provided to a person on a single occasion, the fee specified in 1 MRI item only applies to the services.

40MRI services – limit for items 63470 and 63473
  1. (1)

    Item 63470 does not apply to the service described in that item if the person to whom the service is provided has previously been provided with that service or a service described in item 63473.

  2. (2)

    Item 63473 does not apply to the service described in that item if the person to whom the service is provided has previously been provided with that service or a service described in item 63470.

41MRI and MRA services – modifying items
  1. (1)

    Subject to subrules (2), (3) and (4), if item 63491, 63494

    or 63497 applies to an MRI or MRA service, the fee specified in that item applies in addition to the fee specified in the other item in Group I5 of this table that applies to the service.

  2. (2)

    If 2 or more MRI or MRA services described in item 63494 are performed for a person on the same day, the fee specified in that item applies to 1 of those services only.

  3. (3)

    If 2 or more MRI or MRA services described in item 63497 are performed for a person on the same day, the fee specified in that item applies to 1 of those services only.

  4. (4)

    If:

    1. (a)

      1 or more MRI or MRA services described in item 63494; and

    2. (b)

      1 or more MRI or MRA services described in item 63497;

are performed for a person on the same day, the fee specified in item 63494 or item 63497, but not both those items, applies to 1 of those services only.

42Application of items 64990 and 64991
  1. (1)

    If the diagnostic imaging service described in item 64991 is provided to a person, either that item or item 64990, but not both those items, applies to the service.

  2. (2)

    If item 64990 or 64991 applies to a diagnostic imaging service, the fee specified in that item applies in addition to the fee specified in any other item in this table that applies to the service.

  3. (3)

    For items 64990 and 64991:

bulk-billed, in relation to a diagnostic imaging service, means:

  1. (a)

    a medicare benefit is payable to a person in respect of the service; and

  2. (b)

    under an agreement entered into under section 20A of the Act:

    1. (i)

      the person assigns to the medical practitioner by whom, or on whose behalf, the service is provided, his or her right to the payment of the medicare benefit; and

    2. (ii)

      the medical practitioner accepts the assignment in full payment of his or her fee for the service provided.

Commonwealth concession card holder means a person who is a concessional beneficiary within the meaning given by subsection 84 (1) of the National Health Act 1953.

unreferred service means a diagnostic imaging service that:

  1. (a)

    is provided to a person by, or on behalf of, a medical practitioner, being a medical practitioner who is not a consultant physician, or specialist, in any speciality (other than a medical practitioner who is, for the purposes of the Act, both a general practitioner and a consultant physician, or specialist, in a particular speciality); and

  2. (b)

    has not been referred to the medical practitioner by another medical practitioner or person with referring rights.

  1. (4)

    For item 64991:

ASGC means the document titled Australian Standard Geographical Classification (ASGC) 2002, published by the Australian Bureau of Statistics, as in force on 1 July 2002.

practice location, in relation to the provision of a diagnostic imaging service, means the place of practice in respect of which the medical practitioner by whom, or on whose behalf, the service is provided, has been allocated a provider number by the Medicare Australia CEO.

regional, rural or remote area means an area classified as RRMAs 3-7 under the Rural, Remote and Metropolitan Areas Classification.

Rural, Remote and Metropolitan Areas Classification has the meaning given by subrule 3 (1) of Part 2 of Schedule 1 to the general medical services table.

SLA means a Statistical Local Area specified in the ASGC.

SSD means a Statistical Subdivision specified in the ASGC.

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)

109.10

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)

37.85

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)

109.10

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)

37.85

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)

109.10

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)

37.85

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

111.30

  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)

37.85

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

109.10

  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)

37.85

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)

111.30

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)

37.85

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)

109.50

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)

37.85

55054

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

109.10

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)

98.25

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)

34.05

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)

109.10

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)

37.85

55084

Urinary bladder, 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 associated with a service to which an item in Subgroup 2 or 3 applies; and

98.25

  1. (d)

    within 24 hours of the service, a service described in item 11917, 55036, 55038, 55044, 55600, 55603 or 55731 is not performed on the same patient by the providing practitioner (R)

55085

Urinary bladder, 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 associated with a service to which an item in Subgroup 2 or 3 applies; and

  3. (c)

    within 24 hours of the service, a service described in item 11917, 55037, 55039, 55045, 55600, 55603 or 55733 is not performed on the same patient by the providing practitioner (NR)

34.05

Subgroup 2 — Cardiac

55113

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

  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)

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

    2. (ii)

      recordings on video tape or digital medium; and

275.50

  1. (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.)

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, not being a service associated with a service to which item 55135 applies (R) (Anaes.)

170.00

55135

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 valve surgery (replacement or repair) incorporating sequential assessment of cardiac function and valve competence before and after the surgical procedure, not being a service associated with a service to which item 55130 applies (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)

169.50

55244

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

169.50

55246

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

169.50

55248

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

169.50

55252

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

169.50

55274

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

169.50

55276

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

169.50

55278

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

169.50

55280

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

169.50

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

169.50

  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

169.50

  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)

169.50

55294

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

169.50

55296

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

111.05

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)

109.10

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

109.10

  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;

  1. (iv)

    toxaemia of pregnancy;

  2. (v)

    liver or renal disease;

  3. (vi)

    autoimmune disease;

  4. (vii)

    cardiac disease;

  5. (viii)

    alloimmunisation;

  6. (ix)

    maternal infection;

  7. (x)

    inflammatory bowel disease;

  8. (xi)

    bowel stoma;

  9. (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 fetal 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;

    6. (vi)

      autoimmune disease;

    7. (vii)

      cardiac disease;

    8. (viii)

      alloimmunisation;

    9. (ix)

      maternal infection;

35.00

  1. (x)

    inflammatory bowel disease;

  2. (xi)

    bowel stoma;

  1. (xii)

    abdominal wall scarring;

  2. (xiii)

    previous spinal or pelvic trauma or disease;

  3. (xiv)

    drug dependency;

  1. (xv)

    thrombophilia;

  2. (xvi)

    significant maternal obesity;

  3. (xvii)

    advanced maternal age;

  4. (xviii)

    abdominal pain or mass;

  1. (xix)

    uncertain dates;

  2. (xx)

    high risk pregnancy;

  3. (xxi)

    previous post dates delivery;

  4. (xxii)

    previous caesarean section;

  5. (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 fetal abnormality (NR)

55704

Pelvis or abdomen, pregnancy-related or pregnancy complication, fetal 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

  4. (d)

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

70.00

  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;

    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 fetal abnormality (R)

55705

Pelvis or abdomen, pregnancy-related or pregnancy complication, fetal 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;

  1. (vii)

    cardiac disease;

  2. (viii)

    alloimmunisation;

  3. (ix)

    maternal infection;

  4. (x)

    inflammatory bowel disease;

  5. (xi)

    bowel stoma;

  6. (xii)

    abdominal wall scarring;

  7. (xiii)

    previous spinal or pelvic trauma or disease;

  8. (xiv)

    drug dependency;

  9. (xv)

    thrombophilia;

  1. (xvi)

    significant maternal obesity;

  2. (xvii)

    advanced maternal age;

  3. (xviii)

    abdominal pain or mass;

  4. (xix)

    uncertain dates;

  5. (xx)

    high risk pregnancy;

  6. (xxi)

    previous post dates delivery;

  7. (xxii)

    previous caesarean section;

  8. (xxiii)

    poor obstetric history;

  9. (xxiv)

    suspicion of ectopic pregnancy;

  10. (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 fetal abnormality (NR)

55706

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

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

  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, fetal 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 fetal abnormality or fetal cardiac arrhythmia;

  1. (ii)

    fetal 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 fetal 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 fetal movements;

  2. (xv)

    suspected fetal death;

  3. (xvi)

    abnormal cardiotocography;

  4. (xvii)

    prolonged pregnancy;

  5. (xviii)

    premature labour;

  6. (xix)

    fetal 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, fetal 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

    3. (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

115.00

  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, fetal 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 fetal abnormality or fetal cardiac arrhythmia;

    2. (ii)

      fetal 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 fetal 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 fetal movements;

  3. (xv)

    suspected fetal death;

  4. (xvi)

    abnormal cardiotocography;

  5. (xvii)

    prolonged pregnancy;

  6. (xviii)

    premature labour;

  1. (xix)

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

  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, fetal 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

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of the umbilical artery, and measured assessment of amniotic fluid volume after the 24th 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 fetal 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, fetal 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, fetal 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, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:

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

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

(ii) has a Diploma of Obstetrics; or

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

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

  1. (iv)

    has obstetric privileges at a non-metropolitan hospital; and

  1. (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, fetal development and anatomy, ultrasound scan of, by any or all approaches, performed by or on behalf of a medical practitioner who is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, where:

  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)

109.10

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)

37.85

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)

109.10

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)

37.85

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

109.10

  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)

37.85

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)

109.10

55814

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

564.00

60003

Digital subtraction angiography, examination of head and neck with or without arch aortography — 4 to 6 data acquisition runs (R) (Anaes.)

827.10

60006

Digital subtraction angiography, examination of head and neck with or without arch aortography — 7 to 9 data acquisition runs (R) (Anaes.)

1 176.10

60009

Digital subtraction angiography, examination of head and neck with or without arch aortography — 10 or more data acquisition runs (R) (Anaes.)

1 376.30

60012

Digital subtraction angiography, examination of thorax — 1 to 3 data acquisition runs (R) (Anaes.)

564.00

60015

Digital subtraction angiography, examination of thorax — 4 to 6 data acquisition runs (R) (Anaes.)

827.10

60018

Digital subtraction angiography, examination of thorax — 7 to 9 data acquisition runs (R) (Anaes.)

1 176.10

60021

Digital subtraction angiography, examination of thorax — 10 or more data acquisition runs (R) (Anaes.)

1 376.30

60024

Digital subtraction angiography, examination of abdomen — 1 to 3 data acquisition runs (R) (Anaes.)

564.00

60027

Digital subtraction angiography, examination of abdomen — 4 to 6 data acquisition runs (R) (Anaes.)

827.10

60030

Digital subtraction angiography, examination of abdomen — 7 to 9 data acquisition runs (R) (Anaes.)

1 176.10

60033

Digital subtraction angiography, examination of abdomen — 10 or more data acquisition runs (R) (Anaes.)

1 376.30

60036

Digital subtraction angiography, examination of upper limb or limbs — 1 to 3 data acquisition runs (R) (Anaes.)

564.00

60039

Digital subtraction angiography, examination of upper limb or limbs — 4 to 6 data acquisition runs (R) (Anaes.)

827.10

60042

Digital subtraction angiography, examination of upper limb or limbs — 7 to 9 data acquisition runs (R) (Anaes.)

1 176.10

60045

Digital subtraction angiography, examination of upper limb or limbs — 10 or more data acquisition runs (R) (Anaes.)

1 376.30

60048

Digital subtraction angiography, examination of lower limb or limbs — 1 to 3 data acquisition runs (R) (Anaes.)

564.00

60051

Digital subtraction angiography, examination of lower limb or limbs — 4 to 6 data acquisition runs (R) (Anaes.)

827.10

60054

Digital subtraction angiography, examination of lower limb or limbs — 7 to 9 data acquisition runs (R) (Anaes.)

1 176.10

60057

Digital subtraction angiography, examination of lower limb or limbs — 10 or more data acquisition runs (R) (Anaes.)

1 376.30

60060

Digital subtraction angiography, examination of aorta and lower limb or limbs — 1 to 3 data acquisition runs (R) (Anaes.)

564.00

60063

Digital subtraction angiography, examination of aorta and lower limb or limbs — 4 to 6 data acquisition runs (R) (Anaes.)

827.10

60066

Digital subtraction angiography, examination of aorta and lower limb or limbs — 7 to 9 data acquisition runs (R) (Anaes.)

1 176.10

60069

Digital subtraction angiography, examination of aorta and lower limb or limbs — 10 or more data acquisition runs (R) (Anaes.)

1 376.30

60072

Selective arteriography or selective venography by digital subtraction angiography technique — 1 vessel (NR) (Anaes.)

48.10

60075

Selective arteriography or selective venography by digital subtraction angiography technique — 2 vessels (NR) (Anaes.)

96.10

60078

Selective arteriography or selective venography by digital subtraction angiography technique — 3 or more vessels (NR) (Anaes.)

144.25

Subgroup 14 — Tomography

60100

Tomography of any region (R) (Anaes.)

60.75

Subgroup 15 — Fluoroscopic examination

60500

Fluoroscopy, with general anaesthesia (not being a service associated with a radiographic examination) (R) (Anaes.)

43.40

60503

Fluoroscopy, without general anaesthesia (not being a service associated with a radiographic examination) (R)

29.75

60506

Fluoroscopy using a mobile image intensifier, in conjunction with a surgical procedure lasting less than 1 hour, not being a service associated with a service to which another item in this table applies (R)

63.75

60509

Fluoroscopy using a mobile image intensifier, in conjunction with a surgical procedure lasting 1 hour or more, not being a service associated with a service to which another item in this table applies (R)

98.90

Subgroup 16 — Preparation for radiological procedure

60918

Arteriography (peripheral) or phlebography —1 vessel, when used in association with a service to which item 59903, 59912, 59925, 59970, 59971, 59972, 59973 or 59974 applies, not being a service associated with a service to which any of items 60000 to 60078 apply (NR) (Anaes.)

47.15

60927

Selective arteriogram or phlebogram, when used in association with a service to which item 59903, 59912, 59925, 59970, 59971, 59972, 59973 or 59974 applies, not being a service associated with a service to which any of items 60000 to 60078 apply (NR) (Anaes.)

38.05

Subgroup 17 — Interventional techniques

61109

Fluoroscopy in an angiography suite with image intensification, in conjunction with a surgical procedure using interventional techniques, not being a service associated with a service to which another item in this table applies (R)

258.90

Group I4 — Nuclearmedicineimaging

61302

Single stress or rest myocardial perfusion study — planar imaging (R)

444.40

61303

Single stress or rest myocardial perfusion study — with single photon emission tomography and with planar imaging when performed (R)

559.70

61306

Combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re-injection protocol on a subsequent occasion — planar imaging (R)

702.65

61307

Combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re-injection protocol on a subsequent occasion — with single photon emission tomography and with planar imaging when performed (R)

826.65

61310

Myocardial infarct-avid-study, with planar imaging and single photon emission tomography, or planar imaging or single photon emission tomography (R)

363.65

61313

Gated cardiac blood pool study, (equilibrium), with planar imaging and single photon emission tomography, or planar imaging or single photon emission tomography (R)

300.35

61314

Gated cardiac blood pool study, and first pass blood flow or cardiac shunt study, with planar imaging and single photon emission tomography, or planar imaging, or single photon emission tomography (R)

415.85

61316

Gated cardiac blood pool study, with intervention, with planar imaging and single photon emission tomography, or planar imaging, or single photon emission tomography (R)

377.40

61317

Gated cardiac blood pool study, with intervention and first pass blood flow study or cardiac shunt study, with planar imaging and single photon emission tomography or planar imaging, or single photon emission tomography (R)

487.50

61320

Cardiac first pass blood flow study or cardiac shunt study, not being a service to which another item in this group applies (R)

226.65

61328

Lung perfusion study, with planar imaging and single photon emission tomography or planar imaging, or single photon emission tomography (R)

225.40

61340

Lung ventilation study using aerosol, technegas or xenon gas, with planar imaging and single photon emission tomography or planar imaging or single photon emission tomography (R)

250.50

61348

Lung perfusion study and lung ventilation study using aerosol, technegas or xenon gas, with planar imaging and single photon emission tomography, or planar imaging, or single photon emission tomography (R)

438.95

61352

Liver and spleen study (colloid) — planar imaging (R)

256.80

61353

Liver and spleen study (colloid), with single photon emission tomography and with planar imaging when performed (R)

382.75

61356

Red blood cell spleen or liver study, including single photon emission tomography when performed (R)

388.90

61360

Hepatobiliary study, including morphine administration or pre-treatment with cholecystokinin (CCK) when performed (R)

399.35

61361

Hepatobiliary study with formal quantification following baseline imaging, using an infusion of cholecystokinin (CCK) (R)

456.85

61364

Bowel haemorrhage study (R)

492.05

61368

Meckel’s diverticulum study (R)

220.90

61372

Salivary study (R)

220.90

61373

Gastro-oesophageal reflux study, including delayed imaging on a separate occasion when performed (R)

484.85

61376

Oesophageal clearance study (R)

141.95

61381

Gastric emptying study, using single tracer (R)

568.65

61383

Combined solid and liquid gastric emptying study using dual isotope technique or the same isotope on separate days (R)

618.75

61384

Radionuclide colonic transit study (R)

680.90

61386

Renal study, including perfusion and renogram images and computer analysis or cortical study with planar imaging (R)

329.20

61387

Renal cortical study, with single photon emission tomography and planar quantification (R)

426.50

61389

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

366.90

61390

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

405.90

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)

599.50

61397

Cystoureterogram (R)

244.40

61401

Testicular study (R)

160.70

61402

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

599.05

61405

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

342.55

61409

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

864.85

61413

Cerebro-spinal fluid shunt patency study (R)

223.70

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)

117.65

61421

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

475.05

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)

594.75

61426

Whole body study using iodine (R)

549.30

61429

Whole body study using gallium (R)

537.60

61430

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

652.90

61433

Whole body study using cells labelled with technetium (R)

492.05

61434

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

609.30

61437

Whole body study using thallium (R)

537.40

61438

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

666.30

61441

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

484.85

61442

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

744.90

61445

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

283.95

61446

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

330.25

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)

451.70

61450

Localised study using gallium (R)

393.60

61453

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

509.60

61454

Localised study using cells labelled with technetium (R)

344.65

61457

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

465.80

61458

Localised study using thallium (R)

393.00

61461

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

522.60

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 28

61465

Venography (R)

262.85

61469

Lymphoscintigraphy (R)

344.65

61473

Thyroid study including uptake measurement when performed (R)

173.65

61480

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

383.00

61484

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

872.15

61485

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

989.30

61495

Tear duct study (R)

220.90

61499

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

250.50

Group I5 — Magnetic resonance imaging

Subgroup 1 — Scan of head — for specified conditions

63001

MRI — scan of head (including MRA, if performed) for tumour of the brain or meninges (R) (Anaes.) (Contrast)

403.20

63004

MRI — scan of head (including MRA, if performed) for inflammation of brain or meninges (R) (Anaes.) (Contrast)

403.20

63007

MRI — scan of head (including MRA, if performed) for skull base or orbital tumour (R) (Anaes.) (Contrast)

403.20

63010

MRI — scan of head (including MRA, if performed) for stereotactic scan of brain, with fiducials in place, for the sole purpose of allowing planning for stereotactic neurosurgery (R) (Anaes.) (Contrast)

336.00

Subgroup 2 — Scan of head — for specified conditions

63040

MRI — scan of head (including MRA, if performed) for acoustic neuroma (R) (Anaes.) (Contrast)

336.00

63043

MRI — scan of head (including MRA, if performed) for pituitary tumour (R) (Anaes.) (Contrast)

358.40

63046

MRI — scan of head (including MRA, if performed) for toxic or metabolic or ischaemic encephalopathy (R) (Anaes.) (Contrast)

403.20

63049

MRI — scan of head (including MRA, if performed) for demyelinating disease of the brain (R) (Anaes.) (Contrast)

403.20

63052

MRI — scan of head (including MRA, if performed) for congenital malformation of the brain or meninges (R) (Anaes.) (Contrast)

403.20

63055

MRI — scan of head (including MRA, if performed) for venous sinus thrombosis (R) (Anaes.) (Contrast)

403.20

63058

MRI — scan of head (including MRA, if performed) for head trauma (R) (Anaes.) (Contrast)

403.20

63061

MRI — scan of head (including MRA, if performed) for epilepsy (R) (Anaes.) (Contrast)

403.20

63064

MRI — scan of head (including MRA, if performed) for stroke (R) (Anaes.) (Contrast)

403.20

63067

MRI — scan of head (including MRA, if performed) for carotid or vertebral artery dissection (R) (Anaes.) (Contrast)

403.20

63070

MRI — scan of head (including MRA, if performed) for intracranial aneurysm (R) (Anaes.) (Contrast)

403.20

63073

MRI — scan of head (including MRA, if performed) for intracranial arteriovenous malformation (R) (Anaes.) (Contrast)

403.20

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

63101

MRI and MRA of extracranial or intracranial circulation (or both) — scan of head and neck vessels for stroke (R) (Anaes.) (Contrast)

492.80

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

63111

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

492.80

63114

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

492.80

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

63125

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

492.80

63128

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

492.80

63131

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

492.80

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

63151

MRI — scan of 1 region or 2 contiguous regions of the spine for infection (R) (Anaes.) (Contrast)

358.40

63154

MRI — scan of 1 region or 2 contiguous regions of the spine for tumour (R) (Anaes.) (Contrast)

358.40

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

63161

MRI — scan of 1 region or 2 contiguous regions of the spine for demyelinating disease (R) (Anaes.) (Contrast)

358.40

63164

MRI — scan of 1 region or 2 contiguous regions of the spine for congenital malformation of the spinal cord or the cauda equina or the meninges (R) (Anaes.) (Contrast)

358.40

63167

MRI — scan of 1 region or 2 contiguous regions of the spine for myelopathy (R) (Anaes.) (Contrast)

358.40

63170

MRI — scan of 1 region or 2 contiguous regions of the spine for syrinx (congenital or acquired) (R) (Anaes.) (Contrast)

358.40

63173

MRI — scan of 1 region or 2 contiguous regions of the spine for cervical radiculopathy (R) (Anaes.) (Contrast)

358.40

63176

MRI — scan of 1 region or 2 contiguous regions of the spine for sciatica (R) (Anaes.) (Contrast)

358.40

63179

MRI — scan of 1 region or 2 contiguous regions of the spine for spinal canal stenosis (R) (Anaes.) (Contrast)

358.40

63182

MRI — scan of 1 region or 2 contiguous regions of the spine for previous spinal surgery (R) (Anaes.) (Contrast)

358.40

63185

MRI — scan of 1 region or 2 contiguous regions of the spine for trauma (R) (Anaes.)

358.40

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

63201

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

448.00

63204

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

448.00

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

63219

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

448.00

63222

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

448.00

63225

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

448.00

63228

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

448.00

63231

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

448.00

63234

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

448.00

63237

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

448.00

63240

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

448.00

63243

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

448.00

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

63271

MRI — Scan of cervical spine and brachial plexus for tumour (R) (Anaes.) (Contrast)

492.80

63274

MRI — Scan of cervical spine and brachial plexus for trauma (R) (Anaes.) (Contrast)

492.80

63277

MRI — Scan of cervical spine and brachial plexus for cervical radiculopathy (R) (Anaes.) (Contrast)

492.80

63280

MRI — Scan of cervical spine and brachial plexus for previous surgery (R) (Anaes.) (Contrast)

492.80

Subgroup 11 — Scan of musculoskeletal system — for specified conditions

63301

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

380.80

63304

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

380.80

63307

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

380.80

Subgroup 12 — Scan of musculoskeletal system — for specified conditions

63322

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

403.20

63325

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

403.20

63328

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

403.20

63331

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

403.20

63334

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

336.00

63337

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

448.00

63340

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

403.20

Subgroup 13 — Scan of musculoskeletal system — for specified conditions

63361

MRI — scan of musculoskeletal system for Gaucher disease (R) (Anaes.)

403.20

Subgroup 14 — Scan of cardiovascular system — for specified conditions

63385

MRI — scan of cardiovascular system for congenital disease of the heart or a great vessel (R) (Anaes.) (Contrast)

448.00

63388

MRI — scan of cardiovascular system for tumour of the heart or a great vessel (R) (Anaes.) (Contrast)

448.00

63391

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

403.20

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

63401

MRA — if the request for the scan specifically identifies the clinical indication for the scan — scan of cardiovascular system for vascular abnormality in a patient with a previous anaphylactic reaction to an iodinated contrast medium (R) (Anaes.) (Contrast)

403.20

63404

MRA — if the request for the scan specifically identifies the clinical indication for the scan — scan of cardiovascular system for obstruction of the superior vena cava, inferior vena cava or a major pelvic vein (R) (Anaes.) (Contrast)

403.20

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

63416

MRA — scan of person under the age of 16 for the vasculature of limbs prior to limb or digit transfer surgery in congenital limb deficiency syndrome (R) (Anaes.) (Contrast)

403.20

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

63425

MRI — scan of person under the age of 16 for post‑inflammatory or post-traumatic physeal fusion (R) (Anaes.)

403.20

63428

MRI — scan of person under the age of 16 for Gaucher disease (R) (Anaes.)

403.20

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

63440

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

403.20

63443

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

403.20

63446

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

403.20

Subgroup 19 — Scan of body — for specified conditions

63461

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

358.40

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

63470

MRI — if:

  1. (a)

    the patient is referred by a specialist or by a consultant physician; and

  2. (b)

    the request for scan identifies that:

    1. (i)

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

    2. (ii)

      the patient has been diagnosed with cervical cancer at FIGO stage 1B or greater —

scan of pelvis for the staging of histologically diagnosed cervical cancer at FIGO stages 1B or greater (R) (Anaes.) (Contrast)

403.20

63473

MRI — if:

  1. (a)

    the patient is referred by a specialist or by a consultant physician; and

  2. (b)

    the request for scan identifies that:

    1. (i)

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

    2. (ii)

      the patient has been diagnosed with cervical cancer at FIGO stage 1B or greater —

scan of pelvis and upper abdomen, in a single examination, for the staging of histologically diagnosed cervical cancer at FIGO stages 1B or greater (R) (Anaes.) (Contrast)

627.20

Subgroup 21 — Modifying items

63491

MRI or MRA service to which an item in this Group (other than an item in this Subgroup) applies if:

  1. (a)

    the service is performed in accordance with rule 31; and

  2. (b)

    the item for the service includes in its description ‘(Contrast)’; and

  3. (c)

    the service is performed using a contrast agent

44.80

63494

MRI or MRA service to which an item in this Group (other than an item in this Subgroup) applies if:

  1. (a)

    the service is performed in accordance with rule 31; and

  2. (b)

    the service is performed on a person using intravenous or intra muscular sedation

44.80

63497

MRI or MRA service to which an item in this Group (other than an item in this Subgroup) applies if:

  1. (a)

    the service is performed in accordance with rule 31; and

  2. (b)

    the service is performed on a person under anaesthetic in the presence of a medical practitioner who is qualified to perform an anaesthetic

156.80

Group I6 — Management of bulk-billed services

64990

A diagnostic imaging service to which an item in this table (other than this item or item 64991) applies if:

  1. (a)

    the service is an unreferred service; and

  2. (b)

    the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder; and

  3. (c)

    the person is not an admitted patient of a hospital or day‑hospital facility; and

  4. (d)

    the service is bulk-billed in respect of the fees for:

    1. (i)

      this item; and

    2. (ii)

      the other item in this table applying to the service

5.85

64991

A diagnostic imaging service to which an item in this table (other than this item or item 64990) applies if:

  1. (a)

    the service is an unreferred service; and

  2. (b)

    the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder; and

  3. (c)

    the person is not an admitted patient of a hospital or day‑hospital facility; and

  4. (d)

    the service is bulk-billed in respect of the fees for:

    1. (i)

      this item; and

    2. (ii)

      the other item in this table applying to the service; and

  5. (e)

    the service is provided at, or from, a practice location in:

    1. (i)

      a regional, rural or remote area; or

    2. (ii)

      Tasmania; or

    3. (iii)

      a geographical area included in any of the following SSD spatial units:

      1. (A)

        Beaudesert Shire Part A

      2. (B)

        Belconnen

      3. (C)

        Darwin City

      4. (D)

        Eastern Outer Melbourne

      5. (E)

        East Metropolitan

      6. (F)

        Frankston City

      7. (G)

        Gosford-Wyong

      8. (H)

        Greater Geelong City Part A

      9. (I)

        Gungahlin-Hall

      10. (J)

        Ipswich City (Part in BSD)

      11. (K)

        Litchfield Shire

      12. (L)

        Melton-Wyndham

      13. (M)

        Mornington Peninsula Shire

      14. (N)

        Newcastle

      15. (O)

        North Canberra

      16. (P)

        Palmerston-East Arm

      17. (Q)

        Pine Rivers Shire

      18. (R)

        Queanbeyan

      19. (S)

        South Canberra

      20. (T)

        South Eastern Outer Melbourne

      21. (U)

        Southern Adelaide

      22. (V)

        South West Metropolitan

      23. (W)

        Thuringowa City Part A

      24. (X)

        Townsville City Part A

      25. (Y)

        Tuggeranong

      26. (Z)

        Weston Creek-Stromlo

      27. (ZA)

        Woden Valley

      28. (ZB)

        Yarra Ranges Shire Part A; or

8.80

  1. (iv)

    the geographical area included in the SLA spatial unit of Palm Island (AC)

Notes to the Health Insurance (Diagnostic Imaging Services Table) Regulations 2004

Note 1

The Health Insurance (Diagnostic Imaging Services Table) Regulations 2004 (in force under the Health Insurance Act 1973) as shown in this compilation comprise Statutory Rules 2004 No. 307 amended as indicated in the Tables below.

Under the Legislative Instruments Act 2003, which came into force on 1 January 2005, it is a requirement for all non-exempt legislative instruments to be registered on the Federal Register of Legislative Instruments. From 1 January 2005 the Statutory Rules series ceased to exist and was replaced with Select Legislative Instruments (SLI series). Numbering conventions remain the same, ie Year and Number.

Table of Instruments

Year and

number

Date of notification

in Gazette or FRLI registration

Date of

commencement

Application, saving or

transitional provisions

2004 No. 307

29 Oct 2004

1 Nov 2004

2004 No. 384

23 Dec 2004

1 Jan 2005

—

2005 No. 65

27 Apr 2005 (see F2005L00935)

1 May 2005

—

2005 No. 178

8 Aug 2005 (see F2005L02031)

9 Aug 2005

—

2005 No. 207 (a)

19 Sept 2005 (see F2005L02673)

1 Oct 2005

—

2005 No. 219

7 Oct 2005 (see F2005L03034)

8 Oct 2005

—

(a) Select Legislative Instrument 2005 No. 207 is made under the Civil Aviation Act 1988, the Commonwealth Authorities and Companies Act 1997, the Customs Administration Act 1985, the Family Law Act 1975, the Financial Management and Accountability Act 1997, the Financial Transaction Reports Act 1988, the Freedom of Information Act 1982, the Health Insurance Act 1973, the Health Insurance Commission Act 1973, the Income Tax Assessment Act 1997, the Lands Acquisition Act 1989, the Maternity Leave (Commonwealth Employees) Act 1973, the Medical Indemnity Act 2002, the National Health Act 1953, the Ombudsman Act 1976, the Privacy Act 1988, the Proceeds of Crime Act 1987, the Public Works Committee Act 1969 and the Superannuation (Productivity Benefit) Act 1988.

Table of Amendments

    ad. = added or inserted

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

Provision affected

How affected

Schedule 1

Part 2

R. 2.........................................

am. 2005 No. 207

R. 27.......................................

am. 2005 No. 207

R. 30.......................................

am. 2005 No. 207

R. 31.......................................

am. 2004 No. 384

R. 34.......................................

rs. 2004 No. 384

am. 2005 No. 207

R. 36.......................................

rs. 2004 No. 384

am. 2005 Nos. 178 and 219

R. 42.......................................

am. 2005 No. 207

Part 3

Part 3......................................

am. 2005 No. 65

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