Specialist Guide To Medicare Rebates
Medicare rebates apply for MRI examinations only when the clinical indications below are present.
Concession card holders are eligible for bulk billing for eligible MRIs.
* To be eligible for a Medicare rebate the patient must have x-ray first.
For Referrers
Specialist Guide to Medicare
Head
63001 – tumour of the brain or meninges
63004 – inflammation of the brain or meaninges
63007 – skull base or orbital tumor
63010 – stereotactic scan of brain, with Fiducials in place, for planning for stereotactic neurosurgery
63040 – acoustic neuroma
63043 – pituitary tumour
63046 – toxic or metabolic or ischaemic encephalopathy
63049 – demyelinating disease of the brain
63052 – congenital malformation of the brain or meninges
63055 – venous sinus thrombosis
63058 – head trauma
63061 – epilepsy
63064 – stroke
63067 – carotid or vertebral artery dissection
63070 – intracranial aneurysm
63073 – intracranial arteriovenous malformation
Head and neck vessels
63101 – stroke
Head and cervical spine
63111 – tumour of the central nervous system or meninges
63114 – inflammation of the central nervous system or meninges
63125 – demyelinating disease of the central nervous system
63128 – congenital malformation of the central nervous system or meninges
63131 – syrinx (congenital or acquired)
Spine – one region or two contiguous regions
63151 – infection
63154 – tumour
63161 – demyelinating disease
63164 – congenital malformation of the spinal cord or the cauda equina or the meninges
63167 – myelopathy
63170 – syrinx (congenital or acquired)
63173 – cervical radiculopathy
63176 – sciatica
63179 – spinal canal stenosis
63182 – previous spinal surgery
63185 – trauma
Spine – three contiguous regions or two non-contiguous regions
63201 – infection
63204 – tumour
63219 – demyelinating disease
63222 – congenital malformation of the spinal cord or the cauda equina or the meninges
63225 – myelopathy
63228 -syrinx (congenital or acquired)
63231 – cervical radiculopathy
63234 – sciatica
63237 – spinal canal stenosis
63240 – previous spinal surgery
63243 – trauma
Cervical spine and brachial plexus
Ultrasound
55712 – Anatomy Scan Specialist referral only (Pregnancy 17-22 weeks only)
Pelvis or abdomen, pregnancy related or pregnancy complication, foetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:
(a) the service is requested by a medical practitioner who:
(i) is a Member or Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; or
(ii) has a Diploma of Obstetrics; or
(iii) has a qualification recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists as equivalent to a Diploma of Obstetrics; or
(iv) has obstetric privileges at a non-metropolitan hospital; and
(b) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and
(c) further examination is clinically indicated after performance, in the same pregnancy, of a scan mentioned in item 55706 or 55709
55721 -Specialist referral only (Pregnancy >22 weeks only)
Pelvis or abdomen, pregnancy related or pregnancy complication, foetal development and anatomy, ultrasound scan of, by any or all approaches, if:
(a) the service is requested by a medical practitioner who:
(i) is a Member or Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; or
(ii) has a Diploma of Obstetrics; or
(iii) has a qualification recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists as equivalent to a Diploma of Obstetrics; or
(iv) has obstetric privileges at a non-metropolitan hospital; and
(b) the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and
(d) further examination is clinically indicated in the same pregnancy to which item 55718 or 55723 applies (R)
55764 – Anatomy scan for multiple pregnancy Specialist referral only (Pregnancy 17-22 weeks only)
Pelvis or abdomen, pregnancy related or pregnancy complication, foetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:
(a) the service is requested by a medical practitioner who:
(i) is a Member or Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; or
(ii) has a Diploma of Obstetrics; or
(iii) has a qualification recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists as equivalent to a Diploma of Obstetrics; or
(iv) has obstetric privileges at a non-metropolitan hospital; and
(b) ultrasound of the same pregnancy confirms a multiple pregnancy; and
(c) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks gestation; and
(d) further examination is clinically indicated in the same pregnancy in which item 55759 or 55762 has been performed; and
(e) the service mentioned in item 55706, 55709, 55712 or 55715 is not performed in conjunction with the scan during the same pregnancy (R)
55772 – Specialist referral only (Pregnancy >22 weeks only)
Pelvis or abdomen, pregnancy related or pregnancy complication, foetal development and anatomy, ultrasound scan of, by any or all approaches, if:
(a) dating of the pregnancy as confirmed by ultrasound is after 22 weeks of gestation; and
(b) the service is requested by a medical practitioner who:
(i) is a Member or Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; or
(ii) has a Diploma of Obstetrics; or
(iii) has a qualification recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists as equivalent to a Diploma of Obstetrics; or
(iv) has obstetric privileges at a non-metropolitan hospital; and
(c) further examination is clinically indicated in the same pregnancy to which item 55768 or 55770 has been performed; and
(d) the pregnancy as confirmed by ultrasound is a multiple pregnancy; and
(e) the service mentioned in item 55718, 55721, 55723 or 55725 is not performed in conjunction with the scan during the same pregnancy
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