The Government has set complex rules that apply to Medicare rebates for a number of procedures that North Shore Radiology & Nuclear Medicine perform.

Medicare Rebates are available for the following:-

Bone Mineral Densitometry

Clinical indicators which are eligible for a Medicare rebate.

MBS Item Number

_____________________

Clinical Indicator

12306

Charged for confirmation of a presumptive diagnosis of low bone mineral density made on the basis of:

  • 1 or more fractures occurring after minimal trauma;
  • For the monitoring of osteoporosis proven by bone densitometry at least 12 months previously

12312

Charged for the diagnosis and monitoring of bone loss associated with 1 or more of the following conditions:

  • Prolonged glucocorticoid therapy;
  • Conditions associated with excess glucocorticoid secretion;
  • Male hypogonadism;
  • Female hypogonadism lasting more than 6 months before age 45

12315

Charged for the diagnosis and monitoring of bone loss associated with 1 or more of the following conditions:

  • Primary hyperparathyroidism;
  • Chronic liver disease
  • Chronic renal disease (excluding kidney stones)
  • Proven malabsorptive disorders
  • Rheumatoid arthritis;
  • Conditions associated with thyroxine excess.

12321

Charged for the measurement of bone density 12 months following significant change in therapy for established low bone density or confirmation of a presumptive diagnosis of low bone mineral density made on the basis of 1 or more fractures occurring after minimal trauma

12323

Charged for the diagnosis and monitoring of bone loss in ALL patients aged 70 years and over. This number takes precedence over any other bone density number and should therefore be used in all patients over 70 years of age because there is no time restriction on this service. 

Dental Requests

MBS Item Number

_____________________

Clinical Indicator

57960

Orthopantomography (OPG) for diagnosis and/or management of trauma, infection, tumours, congenital conditions or surgical conditions of the teeth or maxillofacial region ®

57963

OPG, for diagnosis and/or management of impacted teeth, caries, periodontal or peripical pathology where signs or symptoms of those conditions are evident ®

57966

OPG, for diagnosis and/or management of missing or crowded teeth, or developmental anomalies of the teeth or jaws ®

57969

OPG, for diagnosis and/or management of temporomandibular joint arthroses or dysfunction ®

57902

Cephalometry, not in association with item 57901 ®

57927

TMJs  (Temporomandibular joints)

58300

Bone Age Study

Medicare eligible item numbers for CT & MRI for oral & maxillofacial surgeons, prosthodontists, dental specialists (periodontists, endodontists, pedodontists, orthodontists) and specialists in oral medicine and oral pathology.

MBS Item Number

_____________________

Descriptor

56022

Computer Tomography Scan of facial bones, para nasal sinuses

63007

MRI skull base or orbital tumour

63334

MRI derangement of one or both temporomandibular joints

Mammography

Requesting doctors must include relevant clinical indications / history for all mammography procedures, otherwise patients are not eligible for a Medicare rebate.

MBS Item Number

_____________________

Clinical Indicator
59300
  • the past occurrence of breast malignancy in the patient or in a member of the patient's family (blood relative) OR
  • symptoms or indications of malignancy found on an examination of the patient by a medical practitioner. 
59303 1 breast

Physiotherapists, Chiropractors & Osteopaths

Physiotherapists, Chiropractors and Osteopaths may request diagnostic imaging, however only certain x-ray items are entitled to a Medicare rebate:

MBS Item Number

_____________________

Descriptor
57712 Hip joint
57715 Pelvis
58100 Spine - Cervical
58103 Spine - Thoracic
58106 Spine - Lumbo-sacral
58109 Spine - Sacrococcygeal
58112 Spine - Two Regions
58210

4 region spine - cervical, thoracic, lumbo-sacral and sacrococcygeal  (ONLY ONE SERVICE within the same calendar year)

58121 3 region spine - cervical, thoracic, lumbo-sacral and sacrococcygeal  (ONLY ONE SERVICE within the same calendar year)

Podiatrists

Item Number

_____________________

Descriptor
55836  Ultrasound Anke or Hind Foot
55840 Ultrasound Mid Foot or Fore Foot
55844 Ultrasound Assessment of a Mass
57521 Foot, ankle, leg, knee or femur
57527  Foot & ankle or ankle & leg, or leg & knee or knee & femur

CT Coronary Angiogram

In order to attract a Medicare rebate, the patient must fit into one of three categories and be referred by a specialist.

MBS Item Number

_____________________

Clinical Indicator
57360
  • the patient has stable symptoms consistent with coronary ischaemia, is at low to intermediate risk of coronary artery disease and would have been considered for coronary angiography; or
  • the patient requires exclusion of coronary artery anomaly or fistula; or
  • the patient will be undergoing non-coronary cardiac surgery.

CT Colonoscopy

Colonoscopy is rebated if one or more of the following applies

MBS Item Number

_____________________

Clinical Indicator
56553
  • The patient has had an incomplete colonoscopy in the 3 months before the scan (date stated on request)
  • There is a known high grade obstruction that will not allow passage of the scope
  • The patient is referred by a specialist or consultant physician who performs colonoscopies  AND 
  • Items 56552 56554 and 56553 have not been billed in the 36 months before this procedure

Ultrasound

Many Ultrasounds have restrictions allowing for only one per visit.  We usually try to split these up over consecutive days. Other restrictions include:

MBS Item Number

_____________________

Clinical Indicator
55808 Shoulder/Upper arm ultrasound to be eligible for a Medicare rebate, the request MUST state that the service is for the assessment of a specific or suspected condition. Benefits are not payable when referred for non-specific shoulder pain. 
55828

Knee ultrasound to be eligible for a Medicare rebate, the request MUST state that the service is for the assessment of a specific or suspected condition.

Benefits are not payable when referred for:-

  • non-specific knee pain
  • Meniscal and cruciate ligament tears OR
  • Assessment of chondral surfaces