Health Insurance (Gippsland, Rockhampton and Gladstone Mobile MRI Service) Determination 2014 (No. 1)

Link to law: https://www.comlaw.gov.au/Details/F2014L00775

Subscribe to a Global-Regulation Premium Membership Today!

Key Benefits:

Subscribe Now
Health Insurance (Gippsland, Rockhampton and Gladstone Mobile MRI Service) Determination 2014 (No. 1)
 
I, PETER DUTTON, Minister for Health, make this Determination under subsection 3C(1) of the Health Insurance Act 1973.
Dated
 
 
 
 
 
 
 
 
 
 
Hon PETER DUTTON MP
Minister for Health
Contents
 
1.         Name of Determination                                                                                      1
2.         Commencement                                                                                                1
3.         Cessation                                                                                                         1
4.         Interpretation                                                                                                     1
5.         Circumstances where this Determination applies - Gippsland                               2
Mobile MRI Services
5AA.     Circumstances where this Determination applies - Rockhampton                          4     and Gladstone Mobile MRI Services
5A.       Bulk billing incentive                                                                                          6
6.         Treatment of a relevant service                                                                           6
7.         MRI and MRA services – meaning of scan                                                          6
8.         MRI and MRA services – related services that can be claimed
 in a 12 month period                                                                                         7
9.         MRI services – limit for items 63478                                                                   7
10.        MRI and MRA services – modifying items                                                            7   11.  Diagnostic imaging services which dental practitioners may request                8                                                                    
 
Schedule -        Specified health services                                                                     9
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

1.               Name of Determination
This Determination is the Health Insurance (Gippsland, Rockhampton and Gladstone Mobile MRI Service) Determination 2014 (No. 1)
2.               Commencement
This Determination commences on 1 July 2014. 
3.               Cessation
This Determination ceases to have effect at 23:59, 30 June 2015.
4.               Interpretation
(1)   In this Determination, unless the contrary intention appears:
Act means the Health Insurance Act 1973.
after hours means from 5pm on Mondays, Tuesdays, Wednesdays and Thursdays to 9am on the following day, and from 5pm on Fridays to 9am on Mondays.
diagnostic imaging services table means the table prescribed under section 4AA of the Act.
eligible provider means a specialist in diagnostic radiology who has satisfied the Chief Executive Medicare that he or she is a participant in the Royal Australian and New Zealand College of Radiologists’ Quality and Accreditation Program.
item means an item in the Schedule.
MRA means magnetic resonance angiography.
MRI means magnetic resonance imaging.
relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in the Schedule.
RIL funding agreement means the funding agreement between Regional Imaging Pty Ltd [ABN 21 095 630 792] and the Commonwealth of Australia as represented by the Department of Health as in force on 1 July 2014.
Schedule means the Schedule to this Determination.
teleradiology means the electronic transmission of radiological images in digital form from one location to another using a data communication link provided by a third party carrier.
Traralgon means Traralgon, Victoria, 3844.
Note          Unless the contrary intention appears, expressions used in this Determination have the same meanings as in the Act—see section 13 of the Legislative Instruments Act 2003.
(2)   For the avoidance of doubt, in this Determination:
(a)       a reference to the Act includes a reference to regulations made under the Act; and
(b)       a reference to the National Health Act 1953 includes a reference to regulations made under that Act; and
(c)       a reference to any legislation shall be construed as a reference to that legislation as in force from time to time.
5.               Circumstances where this Determination applies – Gippsland Mobile MRI Services
(1)        This Determination applies to a relevant service provided using mobile diagnostic imaging equipment that has as its base for mobile diagnostic imaging the Latrobe Regional Hospital, Princes Highway Traralgon West, Victoria 3844 where the following circumstances apply:
(a)       in respect of items 63002 to 63483, where the service is performed pursuant to a request that is in accordance with subsection (2); and
(b)       in respect of items 63525 to 63530 and items 63584 to 63587, where the service is performed pursuant to a request that is in accordance with subsection (3); and
(c)       where the service is performed pursuant to the RIL funding agreement; and
(d)      where the service is performed in a permissible circumstance in accordance with subsection  (6), (7),  (8) or (9); and
(e)       where the service is a service of a kind referred to in paragraph 10(2)(a) of the Act – the patient in respect of whom the service is provided is charged a fee that is no more than 75% of the amount specified in the Schedule as the fee applicable to the item that relates to the service; and
(f)        where the service is not a service to which paragraph (e) applies – the patient in respect of whom the service is provided is charged a fee that is no more than 85% of the amount specified in the Schedule as the fee applicable to the item that relates to the service.
(2)        The request referred to in paragraph (1)(a) must:
(a)       be made by a practitioner who is a specialist, consultant physician or dental practitioner; and
(b)       be made in writing; and
(c)       identify the clinical indications for the service.
 
Note:          Subsection 16B(2) of the Act limits the R-type diagnostic imaging services in respect of which a medicare benefit is payable where the service is requested by a dental practitioner.  See section 12 below.
(3)        the request referred to  in paragraph (1)(b) must:
(a)    be at the request of a medical practitioner other than a specialist or consultant physician; and
(b)   be made in writing; and
(c)    identify the clinical indications for the service.
 
(6)        For paragraph (1)(d), subject to subsection (7), a relevant service is performed in a permissible circumstance if the service is performed in Traralgon during after hours and it is:
(a)            performed under the professional supervision of an eligible provider who is available to monitor and influence the conduct and diagnostic quality of the examination via telephone and real-time teleradiology; and
(b)           reported by an eligible provider; and
(c)            monitored by a medical practitioner by personal attendance on the patient if the circumstances are such as to require on-site monitoring by a medical practitioner; and
(d)           not a service to which items 63492 to 63495 are attributable.
(7)        If subsection (6) is not complied with, a relevant service is performed in a permissible circumstance if the service is performed in Traralgon during after hours and it is performed in an emergency.
(8)        For paragraph (1)(d), subject to subsection (9), a relevant service is performed in a permissible circumstance if it is:
(a)      performed 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; and
(b)       reported by an eligible provider.
(9)        If subsection (8) is not complied with, a relevant service is performed in a permissible circumstance if it is performed:
(a)            in an emergency; or
(b)        because of medical necessity, in a remote location
5AA         Circumstances where this Determination applies – Rockhampton and Gladstone Mobile MRI Services
 
(1)   This Determination applies to a relevant service provided using mobile diagnostic imaging equipment that has as its base for mobile diagnostic imaging the Mater Misericordiae Hospital Rockhampton, Ward St Rockhampton, Queensland 4700, where the following circumstances apply:
(a)    in respect of items 63002 to 63483, where the service is performed pursuant to a request that is in accordance with subsection (2); and
(b)   in respect of items 63525 to 63530 and items 63584 to 63587, where the service is performed pursuant to a request that is in accordance with subsection (3); and
(c)    the service is:
(i)        both:
(A)   performed 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; and
(B)    reported by an eligible provider; or
(ii)      performed in emergency; and
(d) the equipment is operated at a location mentioned in the table; and
(e) the equipment used to perform the service is a General Electric Signa Echo Speed with Excite with a magnet strength of 1.5 Tesla and is mounted on a specifically built semi-trailer.
         
(2)   The request referred to in paragraph (1)(a) must:
(a)    be made by a practitioner who is a specialist, consultant physician or dental practitioner; and
(b)   be made in writing;  and
(c)    identify the clinical indications for the service.
 
(3)   The request referred to in paragraph (1)(b) must:
(a)    be at the request of a medical practitioner other than a specialist or consultant physician; and   
(b)   be made in writing; and
(c)    identify the clinical indications for the service.
 
(4)   For paragraph (1)(c), the operation of equipment at a location mentioned in an item in the Table includes the operation of the equipment within the grounds of the location.
 
          Table
Item
Location

1
Mater Misericordiae Hospital Gladstone
50 Rossella St
Gladstone QLD 4680

 
 

2
Mater Misericordiae Hospital Rockhampton
Ward St
Rockhampton QLD 4700

 
5A.        Bulk billing incentive
Paragraph 1.2.10(1)(a) of Part 1 of Schedule 1 of the diagnostic imaging services table shall have effect as if the reference to a “service that is mentioned in an item in Division 2.5 of the table” in that clause included a reference to a service mentioned in an item in the Schedule to this Determination.    
6.               Treatment of a relevant service
A relevant service shall be treated as if:
(a)       it were both a professional service and a medical service for the purposes of the provisions of the Act and the National Health Act 1953 that relate to professional and medical services; and
(b)       there was an item in the diagnostic imaging services table that related to the relevant service and specified in respect of the service a fee in relation to a State, being the fee specified in the Schedule in relation to the State specified; and
(c)       the item specified in paragraph (b) was part of Group I5 of the diagnostic imaging services table and of the relevant subgroup of Group I5 as is specified in the Schedule.
7.               MRI and MRA services – meaning of scan
Clause 2.5.7 of Part 2 of Schedule 1 of the diagnostic imaging services table shall have effect as if the reference to “items 63001 to 63561” also included reference to items 63002 to 63483, items 63525 to 63530 and items 63584 to 63587 specified in the Schedule.
 
8.               MRI and MRA services – related services that can be claimed in a 12 month period
 
Clause 2.5.9 of Part 2 of Schedule 1 of the diagnostic imaging services table shall have effect as if the references to the items mentioned in column 1 of the table below (Existing references) include references to the items mentioned in column 2 of the following table (Additional references).
 

Existing references
Additional references

63040 to 63085
63041 to 63065

63101 and 63104
63102

63125 to 63136
63126 to 63132

63161 to 63194
63163 to 63177

63219 to 63265
63220 to 63244

63271 to 63285
63272 to 63281

63322 to 63348
63323 to 63332

63361 and 63364
63363

63385 to 63394
63386 to 63389

63401 to 63408
63402 and 63405

63416 and 63419
63417

63425 to 63433
63426 and 63429

63455 to 63467
63463, 63466 and 63469

63482 and 63486
63483

63507 to 63561
63525 to 63530 and 63584 to 63587

 
9.               MRI services – limit for item 63478
Item 63478 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 63476 of Part 2 of Schedule 1 of the diagnostic imaging services table.
10.            MRI and MRA services – modifying items
Clause 2.5.11 of Part 2 of Schedule 1 of the diagnostic imaging services table shall have effect as if:
(a)       the reference to item 63491 in that clause was a reference to item 63492; and
(b)       the references to item 63494 in that clause were references to item 63493; and
(c)    the references to item 63497 in that clause were references to item 63495.
11.            Diagnostic imaging services which dental practitioners may request
Regulation 10 of the Health Insurance Regulations 1975 shall have effect as if the paragraphs of that regulation mentioned in column 1 of the table below (Existing references) include references to the items mentioned in column 2 of the table below (Additional references).
 

Existing references
Additional references

paragraph 10(1)(a)
63008, 63329

paragraph 10(1)(b)
63329

paragraph 10(1)(c)
63329

paragraph 10(1)(d)
63008, 63329

Schedule -      Specified health services
 
Item
Health Service
Fee for all States
Relevant subgroup of Group I5

63002
MRI — scan of head (including MRA, if performed) for
tumour of the brain or meninges (R) (Anaes.) (Contrast)
403.20
Subgroup 1 – Scan of head – for specified conditions

63005
MRI — scan of head (including MRA, if performed) for
inflammation of brain or meninges (R) (Anaes.) (Contrast)
403.20
Subgroup 1 – Scan of head – for specified conditions

63008
MRI — scan of head (including MRA, if performed) for
skull base or orbital tumour (R) (Anaes.) (Contrast)
403.20
Subgroup 1 – Scan of head – for specified conditions

63011
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 1 – Scan of head – for specified conditions

63041
MRI — scan of head (including MRA, if performed) for
acoustic neuroma (R) (Anaes.) (Contrast)
336.00
Subgroup 2 – Scan of head – for specified conditions

63042
MRI — scan of head (including MRA, if performed) for
pituitary tumour (R) (Anaes.) (Contrast)
358.40
Subgroup 2 – Scan of head – for specified conditions

63044
MRI — scan of head (including MRA, if performed) for
toxic or metabolic or ischaemic encephalopathy (R)
(Anaes.) (Contrast)
403.20
Subgroup 2 – Scan of head – for specified conditions

63045
MRI — scan of head (including MRA, if performed) for
demyelinating disease of the brain (R) (Anaes.) (Contrast)
403.20
Subgroup 2 – Scan of head – for specified conditions

63047
MRI — scan of head (including MRA, if performed) for
congenital malformation of the brain or meninges (R)
(Anaes.) (Contrast)
403.20
Subgroup 2 – Scan of head – for specified conditions

63048
MRI — scan of head (including MRA, if performed) for
venous sinus thrombosis (R) (Anaes.) (Contrast)
403.20
Subgroup 2 – Scan of head – for specified conditions

63051
MRI — scan of head (including MRA, if performed) for
head trauma (R) (Anaes.) (Contrast)
403.20
Subgroup 2 – Scan of head – for specified conditions

63054
MRI — scan of head (including MRA, if performed) for
epilepsy (R) (Anaes.) (Contrast)
403.20
Subgroup 2 – Scan of head – for specified conditions

63057
MRI — scan of head (including MRA, if performed) for
stroke (R) (Anaes.) (Contrast)
403.20
Subgroup 2 – Scan of head – for specified conditions

63060
MRI — scan of head (including MRA, if performed) for
carotid or vertebral artery dissection (R) (Anaes.)
(Contrast)
403.20
Subgroup 2 – Scan of head – for specified conditions

63063
MRI — scan of head (including MRA, if performed) for
intracranial aneurysm (R) (Anaes.) (Contrast)
403.20
Subgroup 2 – Scan of head – for specified conditions

63065
MRI — scan of head (including MRA, if performed) for
intracranial arteriovenous malformation (R) (Anaes.)
(Contrast)
403.20
Subgroup 2 – Scan of head – for specified conditions

63102
MRI and MRA of extracranial or intracranial circulation
(or both) — scan of head and neck vessels for stroke (R) (Anaes.) (Contrast)
492.80
Subgroup 3 – Scan of head and neck vessels – for specified conditions

63113
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
Subgroup 4 – Scan of head and cervical spine – for specified conditions

63116
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 4 – Scan of head and cervical spine – for specified conditions

63126
MRI — scan of head and cervical spine (including MRA, if performed) for demyelinating disease of the central nervous system (R) (Anaes.) (Contrast)
492.80
Subgroup 5 – Scan of head and cervical spine – for specified conditions

63129
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
Subgroup 5 – Scan of head and cervical spine – for specified conditions

63132
MRI — scan of head and cervical spine (including MRA, if performed) for syrinx (congenital or acquired) (R) (Anaes.) (Contrast)
492.80
Subgroup 5 – Scan of head and cervical spine – for specified conditions

63152
MRI — scan of 1 region or 2 contiguous regions of the
spine for infection (R) (Anaes.) (Contrast)
358.40
Subgroup 6 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions

63155
MRI — scan of 1 region or 2 contiguous regions of the
spine for tumour (R) (Anaes.) (Contrast)
358.40
Subgroup 6 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions

63163
MRI — scan of 1 region or 2 contiguous regions of the
spine for demyelinating disease (R) (Anaes.) (Contrast)
358.40
Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions

63165
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
Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions

63168
MRI — scan of 1 region or 2 contiguous regions of the
spine for myelopathy (R) (Anaes.) (Contrast)
358.40
Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions

63169
MRI — scan of 1 region or 2 contiguous regions of the
spine for syrinx (congenital or acquired) (R) (Anaes.)
(Contrast)
358.40
Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions

63171
MRI — scan of 1 region or 2 contiguous regions of the
spine for cervical radiculopathy (R) (Anaes.) (Contrast)
358.40
Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions

63172
MRI — scan of 1 region or 2 contiguous regions of the
spine for sciatica (R) (Anaes.) (Contrast)
358.40
Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions

63174
MRI — scan of 1 region or 2 contiguous regions of the
spine for spinal canal stenosis (R) (Anaes.) (Contrast)
358.40
Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions

63175
MRI — scan of 1 region or 2 contiguous regions of the
spine for previous spinal surgery (R) (Anaes.) (Contrast)
358.40
Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions

63177
MRI — scan of 1 region or 2 contiguous regions of the
spine for trauma (R) (Anaes.)
358.40
Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions

63202
MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for infection (R) (Anaes.) (Contrast)
448.00
Subgroup 8 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions

63205
MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for tumour (R) (Anaes.) (Contrast)
448.00
Subgroup 8 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions

63220
MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for demyelinating disease (R) (Anaes.) (Contrast)
448.00
Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions

63223
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
Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions

63224
MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for myelopathy (R) (Anaes.) (Contrast)
448.00
Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions

63226
MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for syrinx (congenital or acquired) (R) (Anaes.) (Contrast)
448.00
Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions

63227
MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for cervical radiculopathy (R) (Anaes.) (Contrast)
448.00
Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions

63229
MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for sciatica (R) (Anaes.) (Contrast)
448.00
Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions

63230
MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for spinal canal stenosis (R) (Anaes.) (Contrast)
448.00
Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions

63232
MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for previous spinal surgery (R) (Anaes.) (Contrast)
448.00
Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions

63244
MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for trauma (R) (Anaes.)
448.00
Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions

63272
MRI — Scan of cervical spine and brachial plexus for
tumour (R) (Anaes.) (Contrast)
492.80
Subgroup 10 – Scan of cervical spine and brachial plexus – for specified conditions

63275
MRI — Scan of cervical spine and brachial plexus for
trauma (R) (Anaes.) (Contrast)
492.80
Subgroup 10 – Scan of cervical spine and brachial plexus – for specified conditions

63278
MRI — Scan of cervical spine and brachial plexus for
cervical radiculopathy (R) (Anaes.) (Contrast)
492.80
Subgroup 10 – Scan of cervical spine and brachial plexus – for specified conditions

63281
MRI — Scan of cervical spine and brachial plexus for
previous surgery (R) (Anaes.) (Contrast)
492.80
Subgroup 10 – Scan of cervical spine and brachial plexus – for specified conditions

63302
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
Subgroup 11 – Scan of musculoskeletal system – for specified conditions

63305
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
Subgroup 11 – Scan of musculoskeletal system – for specified conditions

63308
MRI — scan of musculoskeletal system for osteonecrosis (R) (Anaes.) (Contrast)
380.80
Subgroup 11 – Scan of musculoskeletal system – for specified conditions

63323
MRI — scan of musculoskeletal system for derangement of hip or its supporting structures (R) (Anaes.) (Contrast)
403.20
Subgroup 12 – Scan of musculoskeletal system – for specified conditions

63324
MRI — scan of musculoskeletal system for derangement of shoulder or its supporting structures (R) (Anaes.) (Contrast)
403.20
Subgroup 12 – Scan of musculoskeletal system – for specified conditions

63326
MRI — scan of musculoskeletal system for derangement of knee or its supporting structures (R) (Anaes.) (Contrast)
403.20
Subgroup 12 – Scan of musculoskeletal system – for specified conditions

63327
MRI — scan of musculoskeletal system for derangement of ankle or foot (or both) or its supporting structures (R) (Anaes.) (Contrast)
403.20
Subgroup 12 – Scan of musculoskeletal system – for specified conditions

63329
MRI — scan of musculoskeletal system for derangement of 1 or both temporomandibular joints or their supporting structures (R) (Anaes.) (Contrast)
336.00
Subgroup 12 – Scan of musculoskeletal system – for specified conditions

63330
MRI — scan of musculoskeletal system for derangement of wrist or hand (or both) or its supporting structures (R) (Anaes.) (Contrast)
448.00
Subgroup 12 – Scan of musculoskeletal system – for specified conditions

63332
MRI — scan of musculoskeletal system for derangement of elbow or its supporting structures (R) (Anaes.) (Contrast)
403.20
Subgroup 12 – Scan of musculoskeletal system – for specified conditions

63363
MRI — scan of musculoskeletal system for Gaucher
disease (R) (Anaes.)
403.20
Subgroup 13 – Scan of musculoskeletal system – for specified conditions

63386
MRI — scan of cardiovascular system for congenital
disease of the heart or a great vessel (R) (Anaes.)
(Contrast)
448.00
Subgroup 14 – Scan of cardiovascular system – for specified conditions

63387
MRI — scan of cardiovascular system for tumour of the
heart or a great vessel (R) (Anaes.) (Contrast)
448.00
Subgroup 14 – Scan of cardiovascular system – for specified conditions

63389
MRI — scan of cardiovascular system for abnormality of thoracic aorta (R) (Anaes.) (Contrast)
403.20
Subgroup 14 – Scan of cardiovascular system – for specified conditions

63402
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
Subgroup 15 – Magnetic resonance angiography – scan of cardiovascular system – for specified conditions

63405
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 15 – Magnetic resonance angiography – scan of cardiovascular system – for specified conditions

63417
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 16 – Magnetic resonance angiography – for specified conditions – person under the age of 16 years

63426
MRI — scan of person under the age of 16 for
post-inflammatory or post-traumatic physeal fusion (R)
(Anaes.)
403.20
Subgroup 17 – Magnetic resonance imaging – for specified conditions – person under the age of 16 years

63429
MRI — scan of person under the age of 16 for Gaucher
disease (R) (Anaes.)
403.20
Subgroup 17 – Magnetic resonance imaging – for specified conditions – person under the age of 16 years

63441
MRI — scan of person under the age of 16 for pelvic or
abdominal mass (R) (Anaes.) (Contrast)
403.20
Subgroup 18 – Magnetic resonance imaging – for specified conditions – person under the age of 16 years

63442
MRI — scan of person under the age of 16 for mediastinal mass (R) (Anaes.) (Contrast)
403.20
Subgroup 18 – Magnetic resonance imaging – for specified conditions – person under the age of 16 years

63444
MRI — scan of person under the age of 16 for congenital uterine or anorectal abnormality (R) (Anaes.) (Contrast)
403.20
Subgroup 18 – Magnetic resonance imaging – for specified conditions – person under the age of 16 years

63463
MRI — scan of the body for adrenal mass in a patient with a malignancy that is otherwise resectable (R) (Anaes.)
358.40
Subgroup 19 – Scan of body – for specified conditions

63466
MRI – scan of both breasts for the detection of cancer, if a dedicated breast coil is used, the request for the scan identifies that the woman is asymptomatic and is less than 50 years of age, and the request for the scan identifies:
 
(a)     that the patient is at high risk of      developing breast cancer due to 1 of the following:
 
(i)        3 or more first or second degree relatives on the same side of the family diagnosed with breast or ovarian cancer;
 
(ii)       2 or more first or second degree relatives on the same side of the family diagnosed with breast or ovarian cancer, if any of the following applies to at least 1 of the relatives:  
                                                         
(A)    has been diagnosed with bilateral breast cancer:
(B)    had onset of breast cancer before the age of 40 years;
(C)    had onset of ovarian cancer     before the age of 50 years;
(D)    has been diagnosed with breast and ovarian cancer, at the same time or at different times;
(E)    has Ashkenazi Jewish ancestry;
(F)    is a male relative who has had breast cancer;
 
(iii)     1 first or second degree relative diagnosed with breast  cancer at age 45 years or younger plus another first or second degree relative on the same side of the family with bone or soft tissue sarcoma at age 45 years or younger; or
 
(b)    that genetic testing has identified the  presence of a high risk breast cancer gene mutation.
 
 (R) (Anaes)
690.00
Subgroup 19 – Scan of body – for specified conditions

63469
MRI – scan of both breasts for the detection of cancer, if:
(a)    a dedicated breast coil is used: and
(b)    the woman has had an abnormality detected as a result of a service described in item 63464 or 63466 performed in the previous 12 months
 (R) (Anaes)
 
690.00
Subgroup 19 – Scan of body – for specified conditions

63472
MRI — scan of the pelvis for the staging of histologically diagnosed cervical cancer at FIGO stages 1B or greater, if the request for scan identifies that:
(a)    a histological diagnosis of carcinoma of the cervix         has been made; and
  (b)    the patient has been diagnosed with cervical
  cancer at FIGO stage 1B or greater.
(R) (Anaes.) (Contrast)
403.20
Subgroup 20 – Scan of pelvis and upper abdomen – for specified conditions

63475
MRI — scan of the pelvis and upper abdomen, in a single examination, for the staging of histologically diagnosed cervical cancer at FIGO stage 1B or greater, if the request for scan identifies that:
(a)    a histological diagnosis of carcinoma of the cervix  has been made; and
                  (b)    the patient has been diagnosed with cervical cancer at FIGO stage 1B or greater.
(R)  (Anaes.) (Contrast)
627.20
Subgroup 20 – Scan of pelvis and upper abdomen – for specified conditions

63478
 MRI — scan of the pelvis for the initial staging of rectal cancer, if:
 (a)    a phased array body coil is used; and
 (b)    the request for scan identifies that the indication is for the initial staging of rectal cancer (including cancer of the rectosigmoid and anorectum). 
(R) (Anaes.) (Contrast)
403.20
Subgroup 20 – Scan of pelvis and upper abdomen – for specified conditions

63483
MRI — scan of pancreas and biliary tree for suspected
biliary or pancreatic pathology (R) (Anaes.)
403.20
Subgroup 21 – Scan of body – for specified conditions

63492
MRI or MRA service to which an item in this Group
(other than an item in this Subgroup) applies if:
(a) the item for the service includes in its description
‘(Contrast)’; and
(b) the service is performed using a contrast agent
44.80
Subgroup 22 – Modifying items

63493
MRI or MRA service to which an item in this Group
(other than an item in this Subgroup) applies if
the service is performed on a person using
intravenous or intra muscular sedation
44.80
Subgroup 22 – Modifying items

63495
MRI or MRA service to which an item in this Group
(other than an item in this Subgroup) applies if
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
Subgroup 22 – Modifying items

63525
MRI—scan of head for a patient under 16 years if the service is for:
(a) an unexplained seizure (R) (Anaes.) (Contrast); or
(b) an unexplained headache if significant pathology is suspected (R) (Anaes.) (Contrast); or
(c) paranasal sinus pathology that has not responded to conservative therapy (R) (Anaes.) (Contrast)
403.20
Subgroup 33 – Scan of body -  for specified conditions

63526
 
MRI—scan of spine following radiographic examination for a patient under 16 years if the service is for:
(a) significant trauma (R) (Anaes.) (Contrast); or
(b) unexplained neck or back pain with associated neurological signs (R) (Anaes.) (Contrast); or
(c) unexplained back pain if significant pathology is suspected (R) (Anaes.) (Contrast)
448.00
Subgroup 33 – Scan of body -  for specified conditions

63527
 
MRI—scan of knee following radiographic examination for internal joint derangement for a patient under 16 years (R) (Anaes.) (Contrast)
 
403.20
 
Subgroup 33 – Scan of body -  for  specified conditions

63528
 
MRI—scan of hip following radiographic examination for a patient under 16 years if any of the following is suspected:
(a) septic arthritis (R) (Anaes.) (Contrast);
(b) slipped capital femoral epiphysis (R) (Anaes.) (Contrast);
(c) Perthes disease (R) (Anaes.) (Contrast)
403.20
 
Subgroup 33 – Scan of body -  for specified conditions

63529
 
MRI—scan of elbow following radiographic examination for a patient under 16 years if a significant fracture or avulsion injury, which would change the way in which the patient is managed, is suspected (R) (Anaes.) (Contrast)
403.20
Subgroup 33 – Scan of body -  for specified conditions

63530
MRI—scan of wrist following radiographic examination for a patient under 16 years if a scaphoid fracture is suspected (R) (Anaes.) (Contrast)
 
448.00
Subgroup 33 – Scan of body-  for specified conditions

63584
Scan of head for a patient 16 years or older, after referral by a medical practitioner (other than a specialist or consultant physician), for any of the following:
(a) unexplained seizure(s);
(b) unexplained chronic headache with suspected intracranial pathology (R) (Contrast) (Anaes.)
 
 
403.20
Subgroup 34 – Scan of body-  for specified conditions

63585
Scan of spine for a patient 16 years or older, after referral by a medical practitioner (other than a specialist or consultant physician), for suspected cervical radiculopathy (R) (Contrast) (Anaes.)
358.40
Subgroup 34 – Scan of body-  for specified conditions

63586
Scan of spine for a patient 16 years or older, after referral by a medical practitioner (other than a specialist or consultant physician), for suspected cervical spinal trauma (R) (Contrast) (Anaes.)
492.80
Subgroup 34 – Scan of body-  for specified conditions

63587
Scan of knee following acute knee trauma, after referral by a medical practitioner (other than a specialist or consultant physician), for a patient 16 years or older with:
(a) inability to extend the knee suggesting the possibility of acute meniscal tear; or
(b) clinical findings suggesting acute anterior cruciate ligament tear (R) (Contrast) (Anaes.)
403.20
Subgroup 34 – Scan of body-  for specified conditions

 
Note          Section 3C (7) of the Act deems an internal Territory to form part of the State of New South Wales