Many Ultrasound examinations have specific Federal Government Pre-requisites in place to enable you to claim a medicare rebate for that examination. When you book your appointment you will be advised if a rebate is applicable for your examination.
Having said that some categories of examinations commonly asked about. Here is an overview.
Pregnancy Scans and Nuchal Translucency Scans
0 – 12 Weeks – Due to the need to know dates, all patients are eligible to a scan during this period and receive a medicare rebate.
12 – 16 Weeks – For a scan during this time, there needs to be a medical reason such as query dates, bleeding or diminished symptoms of pregnancy. See the detailed List below for more examples.
17 Weeks + – Everyone is entitled to one Morphology scan. If more than one scan is required in between 17 and 22 weeks, the referral must be referred by an Obstetrics & Gynaecology specialist or a GP with a Diploma in Obstetrics & Gynaecology and also requires a clinical reason such as those listed below.
22 Weeks + – Requires a clinical reason such as those listed below. If more than one scan is required after 22 weeks, the referral must be referred by an Obstetrics & Gynaecology specialist or a GP with a Diploma in Obstetrics & Gynaecology and also requires a clinical reason such as those listed below.
Valid clinical reasons which should be documented on the referral for Pregnancy and Nuchal Translucency Scans where clinical reasons are required:
Hyperemesis gravidarum, diabetes mellitus, hypertension, toxaemia of pregnancy, liver or renal disease, autoimmune disease, cardiac disease, alloimmunisation, maternal infection, inflammatory bowel disease, bowel stoma, abdominal wall scarring, previous spinal or pelvic trauma or disease, drug dependency, thrombophilia, significant maternal obesity, advanced maternal age, abdominal pain or mass, uncertain dates, high risk pregnancy, previous post dates delivery, previous caesarean section, poor obstetric history, suspicion of ectopic pregnancy, risk of miscarriage, diminished symptoms of pregnancy, suspected or known cervical incompetence, suspected or known uterine abnormality, pregnancy after assisted reproduction, risk of foetal abnormality.
Musculoskeletal Ultrasound
Please refer to the downloads section for a specific run down on medicare requirements for Shoulders and Knees as ‘pain’ as a reason does not meet medicare requirements
For all other joints, pain is a medicare eligible reason to use to qualify for a rebate.
Other Ultrasounds
For all other Ultrasounds, combining another examination with a Doppler cannot be done on the same day
