Medicare Guidelines – Allied

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All examinations performed by North Coast Radiology are done so in observance of the Medicare Benefits Schedule. The Medicare Benefits Schedule provides criteria which determine if rebates offered by Medicare can be accessed by patients.

 

For a patient to be eligible for a Medicare rebate there are certain criteria that all referrals must display.

– Referrer name, provider number, contact details and signature of the referrer
– Examination requested
– All relevant clinical history

 

Click on the tab with Modality you want Medicare rule information about. If you are a GP click here for Medicare information.

 

For detailed MBS information about a CMBS item click here for the search screen.

Chiropractors

Chiropractors

ItemDescriptionLimitations
57712x-ray - hip joint
57715x-ray - pelvic girdle
58100x-ray - cervical spine
58103x-ray - thoracic spine
58106x-ray - lumbosacral spine
58109x-ray - sacrococcygeal spine
58112x-ray - 2 Region Spine
58500x-ray - chest
57706x-ray - clavicle
57518x-ray - foot, ankle, leg, knee or femur
57524x-ray - foot and ankle, ankle and leg, leg and knee or knee and femur
57506x-ray - hand, wrist, forearm, elbow and humerus
57512x-ray - hand and wrist, hand wrist and forearm, forearm and elbow or elbow and humerus
57700x-ray - shoulder or scapula

Dental Practioners

Dental Practioners (all)

ItemDescriptionLimitations
57901x-ray skull
57902x-ray - cephalometry
57903x-ray sinuses
57918x-ray - salivary calculus
57906x-ray - mastoids
57921x-ray - nose
57909x-ray - petrous temporal bones
57912x-ray - facial bones
57915x-ray - mandible

Midwives

Midwives

ItemDescriptionLimitations
55700Pelvis or abdomen, pregnancy related or pregnancy complication, ultrasound scan of, by any or all approaches, for determining the gestation, location, viability or number of foetuses, if the dating of the pregnancy (as confirmed by ultrasound) is less than 12 weeks of gestation.Pregnancy < 12 weeks only
55707Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if: (a) the pregnancy (as confirmed by ultrasound) is dated by a fetal crown rump length of 45 to 84 mm; and (b) nuchal translucency measurement is performed to assess the risk of fetal abnormality; and (c) the service is not performed with item 55700, 55703, 55704 or 55705 on the same patient within 24 hours (R)Pregnancy nuchal translucency only
55704Pelvis or abdomen, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, for determining the structure, gestation, location, viability or number of foetuses, if the dating of the pregnancy (as confirmed by ultrasound) is 12 to 16 weeks of gestation.Pregnancy 12 -16 weeks only
55706PELVIS 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. the patient is referred by a medical practitioner; and
  2. the dating for the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and
  3. the service is not performed in the same pregnancy as item 55709
Pregnancy 17 -22 weeks only and only 1 per pregnancy
55718PELVIS or ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, where:
     
  1. the patient is referred by a medical practitioner; and
  2. the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and
  3. the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
  4. the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and
  5. the service is not performed in the same pregnancy as item 55723; and
  6. one or more of the following conditions are present:
       
    1. known or suspected fetal abnormality or fetal cardiac arrhythmia;
    2. fetal anatomy (late booking or incomplete mid-trimester scan);
    3. malpresentation;
    4. cervical assessment;
    5. clinical suspicion of amniotic fluid abnormality;
    6. clinical suspicion of placental or umbilical cord abnormality;
    7. previous complicated delivery;
    8. uterine scar assessment;
    9. uterine fibroid;
    10. previous fetal death in utero or neonatal death;
    11. antepartum haemorrhage;
    12. clinical suspicion of intrauterine growth retardation;
    13. clinical suspicion of macrosomia;
    14. reduced fetal movements;
    15. suspected fetal death;
    16. abnormal cardiotocography;
    17. prolonged pregnancy;
    18. premature labour;
    19. fetal infection;
    20. pregnancy after assisted reproduction;
    21. trauma;
    22. diabetes mellitus;
    23. hypertension;
    24. toxaemia of pregnancy;
    25. liver or renal disease;
    26. autoimmune disease;
    27. cardiac disease;
    28. alloimmunisation;
    29. maternal infection;
    30. inflammatory bowel disease;
    31. bowel stoma;
    32. abdominal wall scarring;
    33. previous spinal or pelvic trauma or disease;
    34. drug dependency;
    35. thrombophilia;
    36. significant maternal obesity;
    37. advanced maternal age;
    38. abdominal pain or mass
Pregnancy >22 weeks only and only 1 per pregnancy

Nurse Practitioners

Nurse Practitioners

ItemDescriptionLimitations
57509x-ray - hand, wrist, forearm, elbow or humerus
57515x-ray - hand and wrist, hand wrist and forearm, forearm and elbow and elbow and humerus
57521x-ray - foot, ankle, leg, knee or femur - cannot refer for combination lower extremity
58503x-ray - chest
58506x-ray - chest with fluoroscopic screening
58509x-ray - thoracic inlet or trachea
58521x-ray - left ribs, right ribs or sternum
58524x-ray - left and right ribs, left ribs and sternum, or right ribs and sternum
58527x-ray - left ribs, right ribs and sternum
55036ultrasound - abdomen and urinary tract
55070ultrasound - breast 1 side only
55076ultrasound - breast both sides

Physiotherapists & Osteopaths

Physiotherapists & Osteopaths

ItemDescriptionLimitations
57712x-ray - hip joint
57715x-ray - pelvic girdle
58100x-ray - cervical spine
58103x-ray - thoracic spine
58106x-ray - lumbosacral spine
58109x-ray - sacrococcygeal spine
58112x-ray - spine; two examinations of the kind referred to in items 58100, 58103, 58106 and 58109
58120*x-ray - spine, four regions, cervical, thoracic, lumbosacral and sacrococcygeal*Items 58120 or 58121(not both) limitation is one per calendar year
58121*x-ray - spine, three examinations of the kind mentioned in items 58100, 58103, 58106 and 58109*Items 58120 or 58121(not both) limitation is one per calendar year
58500x-ray - chest
57706x-ray - clavicle
57518x-ray - foot, ankle, leg, knee or femur
57524x-ray - foot and ankle, ankle and leg, leg and knee or knee and femur
57506x-ray - hand, wrist, forearm, elbow and humerus
57512x-ray - hand and wrist, hand wrist and forearm, forearm and elbow or elbow and humerus
57700x-ray - shoulder or scapula

Podiatrists

Podiatrists

ItemDescriptionLimitations
55888ultrasound - ankle or hind foot
55892ultrasound - mid foot or fore foot
55844ultrasound - assessment of a mass associated with the skin or subcutaneous structures; not being part of MSK system
57521x-ray - foot, ankle, lower & upper leg, knee, femur, heel
57527x-ray - foot/ankle, knee/femur, ankle/leg, leg/knee