__________________________________________________________________
I, ANTONY KINGDON Delegate of the Minister for Health and Ageing, make this Determination in accordance with the powers vested in the Minister under subsection 3C (1) of the Health Insurance Act 1973.
Dated 23rd June 2009
DELEGATE OF THE MINISTER FOR HEALTH AND AGEING
1. Name of Determination
2. Commencement and Revocation
3. Cessation
4. Interpretation`
5. Circumstances where this Determination applies
6. Treatment of a relevant service
7. MRI and MRA services – meaning of scan
8. MRI and MRA services – related services that can be claimed in a 12 month period
9. MRI services – limit for items 63472 and 63475
10. MRI services – limit for item 63478
11. MRI and MRA services – modifying items
12. Diagnostic imaging services which dental practitioners may request
Schedule - Specified health services
This Determination is the Health Insurance (Gippsland and South Eastern New South Wales Mobile MRI Trial) Determination 2009 (No. 3) .
(1) This Determination is to commence on 1 July 2009.
(2) This Determination revokes the Health Insurance (Gippsland and South Eastern New South Wales Mobile MRI Trial) Determination 2009 (No. 2) made on 28 April 2009.
This Determination will cease to have effect at the end of 31 October 2009.
(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.
Bega means Bega, New South Wales, 2250.
eligible provider means 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.
establishment period means the Establishment Period as defined in the funding agreement.
funding agreement means the deed of agreement between the Department of Health and Ageing and Regional Imaging Pty Limited [ABN 81 095 630 792] as in force on the day this Determination commences.
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.
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
Trial means the trial of a Medicare benefits eligible mobile MRI service for the Gippsland region of Victoria and the South Eastern region of New South Wales, pursuant to the funding agreement.
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; and
(d) a reference to the Health Insurance (Diagnostic Imaging Services Table) Regulations 2008 is a reference to such regulations made pursuant to section 4AA of the Act as are in force from time to time.
(1) This Determination applies to a relevant service 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) where the service is performed pursuant to the funding agreement during the establishment period or as part of the Trial; and
(c) where the service is performed in a permissible circumstance in accordance with subsection (3), (3A), (4), (5) or (6); and
(d) 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
(e) where the service is not a service to which paragraph (d) 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 11 below.
(3) For paragraph (1)(c), subject to subsection (4), a relevant service is performed in a permissible circumstance if the service is performed in Bega 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.
(3A) For paragraph (1)(c), subject to subsection (4), 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;
(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.
(4) If subsection (3) or (3A) is not complied with, a relevant service is performed in a permissible circumstance if the service is performed in Bega or Traralgon during after hours (whichever is the case) and it is performed in an emergency.
(5) For paragraph (1)(c), subject to subsection (6), 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.
(6) If subsection (5) 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.
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 were 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) were part of Group I5 of the diagnostic imaging services table and of the relevant subgroup of Group I5 as is specified in the Schedule.
Rule 37 of Part 2 of Schedule 1 of the Health Insurance (Diagnostic Imaging Services Table) Regulations 2008 shall have effect as if the reference to “items 63001 to 63482” in that rule was a reference to “items 63002 to 63483” of the Schedule.
Rule 39 of Part 2 of Schedule 1 of the Health Insurance (Diagnostic Imaging Services Table) Regulations 2008 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 63073 | 63041 to 63065 |
63101 | 63102 |
63125 to 63131 | 63126 to 63132 |
63161 to 63185 | 63163 to 63177 |
63219 to 63243 | 63220 to 63244 |
63271 to 63280 | 63272 to 63281 |
63322 to 63340 | 63323 to 63332 |
63361 | 63363 |
63385 to 63391 | 63386 to 63389 |
63401 and 63404 | 63402 and 63405 |
63416 | 63417 |
63425 and 63428 | 63426 and 63429 |
63461, 63464 and 63467 | 63463, 63466 and 63469 |
63482 | 63483 |
Rule 40 of Part 2 of Schedule 1 of the Health Insurance (Diagnostic Imaging Services Table) Regulations 2008 shall have effect as if:
(a) the reference to item 63473 in subrule 40(1) was a reference to “item 63472, 63473 or 63475”;
(b) the reference to item 63470 in subrule 40(2) was a reference to “item 63470, 63472 or 63475”;
(c) there is an additional subrule 40(3) as follows “Item 63472 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 items 63470, 63473 or 63475”; and
(d) there is an additional subrule 40(4) as follows “Item 63475 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, 63472 or 63473”.
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 3 of Schedule 1 of the Health Insurance (Diagnostic Imaging Services Table) Regulations 2008.
Rule 41 of Part 2 of Schedule 1 of the Health Insurance (Diagnostic Imaging Services Table) Regulations 2008 shall have effect as if:
(a) the reference to item 63491 in that rule was a reference to item 63492; and
(b) the references to item 63494 in that rule were references to item 63493; and
(c) the references to item 63497 in that rule were references to item 63495.
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) paragraph 10(1)(d) | 63329 63008, 63329 |
Schedule - Specified health services
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 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, including any of the following features;
(A) bilateral breast cancer: (B) onset of breast cancer before the age of 40 years; (C) onset of ovarian cancer before the age of 50 years; (D) breast and ovarian cancer in 1 relative; (E) Ashkenazi Jewish ancestry; (F) breast cancer in a male relative; or
(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 |
Note Section 3C (7) of the Act deems an internal Territory to form part of the State of New South Wales.
