The Federal Government sets strict guidelines about the examinations that are performed by Illawarra Radiology Group and which of these will attract a Medicare Rebate.
See below for criteria about specific examinations and the physicians that can refer for various medical imaging services.
Greater Access for Patients to Medicare Eligible MRI.
In addition to the GP MRI Paediatric items announced in 2012, the Federal Government have extended MRI Medicare eligibility to General Practitioner referred patients who are 16 years or older.
Four new items have been added to theMedicare Benefits Schedule (MBS) for certain regions and clinical conditions. The table below summarises the four new items along with the paediatric items and the clinical conditions required by Medicare.
Table 1: The new General Practitioner Referred MRI Regions and associated clinical criteria
Patients 16 Years or Older
Region | Criteria |
---|---|
Head |
|
Cervical Spine 1 |
|
Cervical Spine 2 |
|
Knee |
|
Patients <16 years
Region | Criteria |
---|---|
Head |
|
Spine |
Following radiographic examination for any of the following:
|
Knee | Following radiographic examination for internal joint derangement. |
Hip |
Following radiographic examination of any of the following:
|
Elbow | Following radiographic examination where a significant fracture or avulsion injury is suspected that will change management. |
Wrist | Following radiographic examination where scaphoid fracture is suspected. |
To view our MRI locations, simply click on Wollongong.
If you any any questions with regard to these changes, please feel free to contact us.
All examinations performed by Illawarra Radiology Group are done so under the Medicare Benefits Schedule (MBS). For a patient to be eligible for a Medicare rebate there are certain criteria that all referrals must display.
- Referrer name
- Referrer provider number
- Referrer contact details
- Examination requested
- All relevant clinical history
Illawarra Radiology Group provides personalised stationary free of charge to assist our referrers in correctly filling out a referral. If you are interested in receiving personalised request forms please contact us.
Illawarra Radiology Group operates 1 Medicare Eligible MRI scanner located at Wollongong.
At all of these locations patients who present for a MRI are scanned in accordance with the Medicare Benefits Schedule (MBS). This means for a patient to be entitled to a Medicare Rebate their request must be from a Specialist Physician and comply with specific indications which must be present and stated on the request form.
Below is a list of the indications for the scans performed by Illawarra Radiology Group:
Anatomical Region | Indication |
---|---|
Breast | Magnetic Resonance Imaging performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician and where;
Scan of both breasts for:
|
Head |
Unlimited referrals:
Benefits payable for each service on 3 occasions in 12 months:
|
Head and neck vessels |
Benefits payable for each service on 3 occasions in 12 months:
|
Head and cervical spine |
Unlimited referrals:
Benefits payable for each service on 3 occasions in 12 months:
|
Spine – one region or two contiguous regions |
Unlimited Referrals:
Benefits payable for each service on 3 occasions in 12 months:
|
Spine – three contiguous regions or two non-contiguous regions |
Unlimited Referrals:
Benefits payable for each service on 3 occasions in 12 months:
|
Cervical spine and brachial plexus |
Benefits payable for each service on 3 occasions in 12 months:
|
Musculoskeletal system |
Unlimited referrals:
Benefits payable for each service on 3 occasions in 12 months:
Benefits payable for each service on 2 occasions in 12 month:
|
Cardiovascular system |
Benefits payable for each service on 2 occasions in 12 months:
Benefits payable for each service on 3 occasions in 12 months:
|
Body |
Benefits payable for each service on 1 occasion within 12 months:
|
Pelvis and upper abdomen |
Benefits payable on 1 occasion only:
|
Persons under the age of 16 |
Benefits payable for each service on 1 occasion in 12 months:
Benefits payable for each service on 2 occasions in 12 months:
Unlimited referrals:
|
Illawarra Radiology Group scans patients that require shoulder and knee ultrasounds in accordance with the Medicare Benefits Schedule (MBS). In May 2003 the Health Insurance Commission issued amendments to the benefits payable for ultrasound of the shoulder and knee.
The amendments outline that Medicare will only rebate these examinations when the request form specifically includes one of the following suspected pathologies…
Shoulder Ultrasound
|
Benefits are payable when referred with suspicion of the following clinical conditions:
Benefits are not payable when referred for non-specific shoulder pain alone. |
Knee Ultrasound | Benefits are payable when referred with suspicion of the following clinical conditions:
Benefits are not payable when referred for non-specific knee pain alone or other known conditions including:
|
At Illawarra Radiology Group we bill patients referred by Allied Health practitioners (Physiotherapists, Chiropractors, Osteopaths and Podiatrists) according to the Medicare Benefits Schedule (MBS).
The MBS states that these referrers’ patients are only entitled to a rebate when referred for the following selected examinations. If a patient presents with a referral for an examination that is not in the list below then they will be charged the private fee.
Physiotherapists, Chiropractors, Osteopaths
- X-ray hip
- X-ray Pelvis
- X-ray cervical spine
- X-ray thoracic spine
- X-ray lumbar spine
- X-ray sacrococcygeal spine
- Long spinal image or multiple spinal regions
Podiatrists
- Ultrasound ankle or hind foot
- Ultrasound mid or fore foot
- Ultrasound lump
- X-ray foot
- X-ray leg
- X-ray knee
- X-ray femur
- Long leg image for leg alignment or leg lengths