Item

Description

Head

63001

tumour of the brain or meninges
(unlimited)

63004

inflammation of the brain or meninges
(unlimited)

63007

skull base or orbital tumour
(unlimited)

63010

stereotactic scan of brain, with Fiducials in place, for planning for stereotactic neurosurgery
(unlimited)

63040

acoustic neuroma
(3 per year)

63043

pituitary tumour
(3 per year)

63046

toxic or metabolic or ischaemic encephalopathy
(3 per year)

63049

demyelinating disease of the brain
(3 per year)

63052

congenital malformation of the brain or meninges
(3 per year)

63055

venous sinus thrombosis
(3 per year)

63058

head trauma
(3 per year)

63061

epilepsy
(3 per year)

63064

stroke
(3 per year)

63067

carotid or vertebral artery dissection
(3 per year)

63070

intracranial aneurysm
(3 per year)

63073

intracranial arteriovenous malformation
(3 per year)

Head and Neck Vessels

63101

stroke
(3 per year)

Head and Cervical Spine

63111

tumour of the central nervous system or meninges
(3 per year)

63114

inflammation of the central nervous system or meninges
(3 per year)

63125

demyelinating disease of the central nervous system
(3 per year)

63128

congenital malformation of the central nervous system or meninges
(3 per year)

63131

syrinx (congenital or acquired)
(3 per year)

Spine – One Region or Two Contiguous Regions

63151

infection
(unlimited)

63154

tumour
(unlimited)

63161

demyelinating disease
(3 per year)

63164

congenital malformation of the spinal cord or the cauda equina or the meninges
(3 per year)

63167

myelopathy
(3 per year)

63170

syrinx (congenital or acquired)
(3 per year)

63173

cervical radiculopathy
(3 per year)

63176

sciatica
(3 per year)

63179

spinal canal stenosis
(3 per year)

63182

previous spinal surgery
(3 per year)

63185

trauma
(3 per year)

Spine – Three Contiguous Regions or Two Non-Contiguous Regions

63201

infection
(unlimited)

63204

tumour
(unlimited)

63219

demyelinating disease
(3 per year)

63222

congenital malformation of the spinal cord or the cauda equina or the meninges
(3 per year)

63225

myelopathy
(3 per year)

63228

syrinx (congenital or acquired)
(3 per year)

63231

cervical radiculopathy
(3 per year)

63234

sciatica
(3 per year)

63237

spinal canal stenosis
(3 per year)

63240

previous spinal surgery
(3 per year)

63243

trauma
(3 per year)

Cervical Spine and Brachial Plexus

63271

tumour
(3 per year)

63274

trauma
(3 per year)

63277

cervical radiculopathy
(3 per year)

63280

previous surgery
(3 per year)

Musculoskeletal (MSK) System

63301

tumour arising in bone or MSK system excludes tumour arising in breast, prostate or rectum
(unlimited)

63304

infection arising in bone or MSK system excludes infection arising in breast, prostate or rectum
(unlimited)

63307

osteonecrosis
(unlimited)

63322

derangement of hip or its supporting structures*
(3 per year)

63325

derangement of shoulder or its supporting structures*
(3 per year)

63328

derangement of knee or its supporting structures*
(3 per year)

63331

derangement of ankle and/or foot or its supporting structures*
(3 per year)

63334

derangement of one or both temporomandibular joints or their supporting structures
(3 per year)

63337

derangement of wrist and/or hand or its supporting structures*
(3 per year)

63340

derangement of elbow or its supporting structures*
(3 per year)

63361

Gaucher disease
(2 per year)

*Limitation is 3 for each side in 12 months

Cardiovascular System

63385

congenital disease of the heart or a great vessel
(2 per year)

63388

tumour of the heart or a great vessel
(2 per year)

63391

abnormality of thoracic aorta
(2 per year)

63395

MRI scan of the cardiovascular system for assessment of myocardial structure and function involving:

• dedicated right ventricular views; and
• 3D volumetric assessment of the right ventricle; and
• reporting of end-diastolic and end-systolic volumes, ejection fraction and BSA-indexed values;

if the request for the scan indicates that:

• the patient presented with symptoms consistent with arrhythmogenic right ventricular cardiomyopathy (ARVC); or
• investigative findings in relation to the patient are consistent with ARVC

(1 per year)

63397

MRI scan of the cardiovascular system for assessment of myocardial structure and function involving:

• dedicated right ventricular views; and
• 3D volumetric assessment of the right ventricle; and
• reporting of end-diastolic and end-systolic volumes, ejection fraction and BSA-indexed values;

if the request for the scan indicates that the patient:

• is asymptomatic; and
• has one or more first degree relatives diagnosed with confirmed arrhythmogenic right ventricular cardiomyopathy (ARVC)

(Once per 36 months)

63399

Cardiac MRI post covid vaccine

Cardiovascular System MRA

63401

vascular abnormality with a previous anaphylactic reaction to an iodinated contrast medium
(3 per year)

63404

obstruction of the superior vena cava, inferior vena cava or a major pelvic vein
(3 per year)

Paediatric (<16yrs) MRA

63416

the vasculature of limbs prior to limb or digit transfer surgery in congenital limb deficiency syndrome
(1 per year)

Paediatric (<16)

63425

post-inflammatory or post-traumatic physeal fusion
(2 per year)

63428

Gaucher disease
(2 per year)

63440

pelvic or abdominal mass
(unlimited)

63443

mediastinal mass
(unlimited)

63447

pelvic or abdominal mass
(unlimited)

63449

congenital uterine or anorectal abnormality
(unlimited)

Body Scan

63461

adrenal mass in a patient with malignancy which is otherwise resecetable
(1 per year)

Body Scan – Both Breasts

63531

MRI of both breasts where the patient has a breast lesion, the results of conventional imaging examinations are inconclusive for the presence of breast cancer, and biopsy has not been possible

63533

MRI of both breasts where the patient has been diagnosed with breast cancer, discrepancy exists between clinical assessment and conventional imaging assessment, and the results of breast MRI may alter treatment planning

63464

MRI scan of both breasts for the detection of cancer in a patient, if:

• (a) a dedicated breast coil is used; and
• (b) the request for scan identifies that the patient is asymptomatic and is younger than ; and
• (c) the request for the scan identifies that the patient is at high risk of developing breast cancer due to one or more of the following:
  • (i) genetic testing has identified the presence of a high risk breast cancer gene mutation in the patient or in a first degree relative of the patient;
  • (ii) both:
    • (A) one of the patient’s first or second degree relatives was diagnosed with breast cancer at age 45 years or younger; and
    • (B) another first or second degree relative on the same side of the patient’s family was diagnosed with bone or soft tissue sarcoma at age 45 years or younger;
  • (iii) the patient has a personal history of breast cancer before the age of 50 years;
  • (iv) the patient has a personal history of mantle radiation therapy;
  • (v) the patient has a lifetime risk estimation greater than 30% or a 10 year absolute risk estimation greater than 5% using a clinically relevant risk evaluation algorithm; and
• (d) the service is not performed in conjunction with item 55076 or 55079

Applicable not more than once in a 12 month period (R) (Contrast)

Body Scan – Both Breasts

63467

scan of both breast for the detection of cancer – where;

• a dedicated breast coil is used; and
• the woman has had an abnormality detected as a result of a service described in item 63464 performed in the previous 12 months

(1 per year)

Body scan – One or Both Breast

63501

MRI – scan of one or both breasts for the evaluation of implant integrity where:

• a dedicated breast coil is used; and
• the request for the scan identifies that the patient:
  • has or is suspected of having a silicone breast implant manufactured by Poly Implant Prosthese (PIP); and
  • the result of the scan confirms a loss of integrity of the implant (R)

(1 per year)

63502

MRI – scan of one or both breasts for the evaluation of implant integrity where:

• a dedicated breast coil is used; and
• the request for the scan identifies that the patient:
  • has or is suspected of having a silicone breast implant manufactured by Poly Implant Prosthese (PIP); and
  • the result of the scan does not demonstrate a loss of integrity of the implant (R)

(1 per year)

63504

MRI – scan of one or both breasts for the evaluation of implant integrity where:

• a dedicated breast coil is used; and
• the request for the scan identifies that the patient:
  • has or is suspected of having a silicone breast implant manufactured by Poly Implant Prosthese (PIP); and
  • presents with symptoms where implant rupture is suspected; and
  • the result of the scan confirms a loss of integrity of the implant (R)

63505

MRI – scan of one or both breasts for the evaluation of implant integrity where:

• a dedicated breast coil is used; and
• the request for the scan identifies that the patient:
  • has or is suspected of having a silicone breast implant manufactured by Poly Implant Prosthese (PIP); and
  • presents with symptoms where implant rupture is suspected; and
  • the result of the scan does not demonstrate a loss of integrity of the implant (R)

63547

MRI scan of both breasts for the detection of cancer, if

(a) a dedicated breast coil is used; and

(b) the request for the scan identifies that: (i)the patient has a breast implant in situ; and (ii) anaplastic large cell lymphoma has been diagnosed

NOTE: benefits are payable once in a patient’s lifetime (R) (K) (Contrast) (Anaes.)

63487

MRI—performed under the professional supervision of an eligible provider at an eligible location, if:

(a) the patient is referred by a specialist or a consultant physician; and
(b) a dedicated breast coil is used; and
(c) the request for the scan identifies that:
(i) the patient has been diagnosed with metastatic cancer restricted to the regional lymph nodes; and
(ii) clinical examination and conventional imaging have failed to identify the primary cancer (R) (K) (Anaes)

63489

MRI-guided biopsy, performed under the professional supervision of an eligible provider at an eligible location, if:

(a) the patient is referred by a specialist or a consultant physician; and
(b) a dedicated breast coil is used; and
(c) the request for the scan identifies that:
(i) the patient has a suspicious lesion seen on MRI but not on conventional imaging; and
(ii) the lesion is not amenable to biopsy guided by conventional imaging; and
(d) a repeat ultrasound scan of the affected breast is performed:
(i) before the guided biopsy is performed; and
(ii) as part of the service under this item (R) (K) (Anaes.)

Pelvis and Upper Abdomen

63470

Pelvis for the staging of histologically diagnosed cervical cancer at FIGO stages 1B or greater when the request for scan identifies that

• a histological diagnosis of carcinoma of the cervix has been made and
• the patient has been diagnosed with cervical cancer at FIGO stage 1B or greater

(1 in a lifetime)

63473

Pelvis and upper abdomen, in a single examination, for the staging of histologically diagnosed cervical cancer at FIGO stages 1B or greater

(1 in a lifetime)

63476

Pelvis for the initial staging of rectal cancer where

(a) a high resolution T2 technique is used; and

(b) the request for the scan identifies that the indication is for:

(i) the initial staging of rectal cancer (including cancer of the rectosigmoid and anorectum); or

(ii) the initial assessment of response to chemotherapy or chemoradiotherapy; or

(III) the assessment of possible recurrent tumour after complete response to neoadjuvant therapy, within an active surveillance program; or

(iv) the assessment of recurrent disease prior to treatment planning

63563

MRI scan of the pelvis or abdomen, if the request for the scan identifies that the investigation is for:

(a) sub-fertility that requires one or more of the following:

(i) an investigation of suspected Mullerian duct anomaly seen in pelvic ultrasound or hysterosalpingogram;

(ii) an assessment of uterine mass identified on pelvic ultrasound before consideration of surgery;

(iii) an investigation of recurrent implantation failure in IVF (2 or more embryo transfer cycles without viable pregnancy); or

(b) surgical planning of a patient with known or suspected deep endometriosis involving the bowel, bladder or ureter (or any combination of the bowel, bladder or ureter), where the results of pelvic ultrasound are inconclusive

Applicable not more than once in a 2 year period (R) (Contrast)

63549

MRI scan of the pelvis or abdomen, for a patient with a multiple pregnancy, if:

(a) the multiple pregnancy is at, or after, 18 weeks gestation; and

(b) fetal abnormality is suspected; and

(c) an ultrasound has been performed and is provided by, or on behalf of, or at the request of, a specialist who is practising in the specialty of obstetrics; and

(d) the diagnosis of fetal abnormality as a result of the ultrasound is indeterminate or requires further examination; and

(e) the MRI service is requested by a specialist practising in the specialty of obstetrics (R) (Contrast)

Body – Pancreas and Biliary Tree MRCP

63482

suspected biliary or pancreatic pathology
(3 per year)

Pelvis and Upper Abdomen – for Specified Conditions (Crohn’s Disease)

63740

MRI to evaluate small bowel Crohn’s disease. Medicare benefits are only payable for this item if the service is provided to patients:

(a) Evaluation of disease extent at time of initial diagnosis of Crohn’s disease
(b) Evaluation of exacerbation/suspected complications of known Crohn’s disease
(c) Evaluation of known or suspected Crohn’s disease in pregnancy
(d) Assessment of change to therapy in patients with small bowel Crohn’s disease

Assessment of change to therapy can only be claimed once in a 12 month period.

63743

MRI for fistulising perianal Crohn’s disease. Medicare benefits are only payable for this item if the service is provided to patients for:

• Evaluation of pelvic sepsis and fistulas associated with established or suspected Crohn’s disease
• Assessment of change to therapy of pelvis sepsis and fistulas from Crohn’s disease

Assessment of change to therapy can only be claimed once in a 12 month period.

Prostate

63541

Diagnosis

Multiparametric Magnetic Resonance Imaging (mpMRI) using a standardised image acquisition protocol involving T2 weighted imaging, Diffusion Weighted Imaging, and Dynamic Contrast Enhancement (unless contraindicated); and
performed under the professional supervision of an eligible provider at an eligible location; and the patient is referred by an urologist, radiation oncologist, or medical oncologist; and
the request specifies that the clinical criteria below are met; and the patient is suspected of having prostate cancer based on:

• for a person 70 years or older, at least two PSA tests performed within an interval of 1- 3 months have a PSA concentration of greater than 5.5 μg/L and the free/total PSA ratio is less than 25%.
• for a person under 70 years, at least two prostate specific antigen (PSA) tests performed within an interval of 1- 3 months have PSA concentration of greater than 3.0 ng/ml, and the free/total PSA ratio is less than 25%, or the repeat PSA exceeds 5.5 μg/L; or
• for a person under 70 years with a relevant family history, at least two PSA tests performed within an interval of 1- 3 months have a PSA concentration greater than 2.0 ng/ml, and the free/total PSA ratio is less than 25%, or the repeat PSA exceeds 5.5 μg/L. Relevant family history is a first degree relative with or has had prostate cancer, or suspected of carrying a BRCA 1 or BRCA 2 mutation. Benefits for this item are payable once only in a 12 month period.

Scan of the prostate for:
– detection of cancer (R)

Note: benefits are payable on one occasion only in any 12 month period.

Relevant family history is first degree relative with prostate cancer or suspected of carrying a BRCA

1. BRCA 2 mutation

63543

Active Surveillance

Multiparametric Magnetic Resonance Imaging (mpMRI) using a standardised image acquisition protocol involving T2 weighted imaging, Diffusion Weighted Imaging, and Dynamic Contrast Enhancement (unless contraindicated); and
performed under the professional supervision of an eligible provider at an eligible location; and the patient is referred by an urologist, radiation oncologist, or medical oncologist; and
the request specifies that the clinical criteria below are met;

a) the patient is under active surveillance following a confirmed diagnosis of prostate cancer by the biopsy histopathology; and
b) The patient is not planning or undergoing treatment for prostate cancer

Scan of the prostate for:
– detection of cancer (R)

Note: benefits are payable at the time of diagnosis of prostate cancer, 12 months following diagnosis and then every 3rd year thereafter or at any time, if there is any concern clinically or with PSA progression. This item is not to be used for the purposes of treatment planning or for monitoring after treatment.

Liver

63545

MRI—multiphase scans of liver (including delayed imaging, if performed) with a contrast agent, for staging where surgical resection or interventional techniques are under consideration to treat any liver metastases detected, if:

(a) The patient has a confirmed extra-hepatic primary malignancy (other than hepatocellular carcinoma), with no persistent extra-hepatic disease; and

(b) computed tomography of the patient’s liver is negative or inconclusive for metastatic disease; and

(c) the identification of liver metastases would change the patient’s treatment planning

Applicable not more than once in a 12 month period (R) (Contrast)

63546

Patients with known or suspected hepatocellular carcinoma for the purposes of diagnosis or staging where the patient:

• has pre-existing chronic liver disease, confirmed by a specialist; and
• has an identified hepatic lesion over 10mm in diameter and
• has been assessed as having a Child-Pugh class A or B liver function

Whole-Body

63564

MRI – whole body scan for the early detection of cancer:

a) requested by a specialist or consultant physician in consultation with a clinical geneticist in a familial cancer or genetic clinic; and

b) the request identifies that the patient has a high risk of developing cancer malignancy

due to heritable TP53 – related cancer (hTP53rc) syndrome

(R)