Referrers

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RE-ORDER REQUEST PADS

Medicare has strict criteria for payment of benefits for the following examinations based on the clinical indications.

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

Spinal x-ray Three region (58121, 58127)
The requesting rights for these items will be restricted to medical practitioners, physiotherapists and
osteopaths. Chiropractors will no longer be able to request these items.

Under the recommendations only requesting rights are to be amended. In all other regards the
items, including fees, remain unchanged.

Spinal x-ray Four region (58120, 58126)
The requesting rights for these items will be restricted to medical practitioners, physiotherapists and
osteopaths. Chiropractors will no longer be able to request these items.

Under the recommendations only requesting rights are to be amended. In all other regards the
items, including fees, remain unchanged.

Spinal x-ray One region (58100, 58102, 58103, 58105, 58106, 58109, 58111, 58117)
These items will be amended to restrict allied health practitioners from requesting more than one of
these items for the same patient on the same day.

Only requesting rights are to be amended. In all other regards the items, including medical
practitioner access and MBS recommended fees, remain unchanged.

Spinal x-ray Two region (58112, 58123)
These items will be amended to restrict allied health practitioners from requesting more than one of
these items for the same patient on the same day.

Only requesting rights are to be amended. In all other regards the items, including medical
practitioner access and MBS recommended fees, remain unchanged.

Medicare will only provide a rebate if the referral specifically includes one of the following suspected pathologies. Benefits are payable when referred with suspicion of the following clinical conditions:

• evaluation of injury to tendon, muscle or tendon/muscle junction including tears, calcification or tendinosis
• rotator cuff tear/calcification/tendinosis of biceps, subscapular, supraspinatus or infraspinatus
• biceps subluxation
• capsulitis and bursitis
• evaluation of mass, including ganglion
• occult fracture
• acromioclavicular joint pathology.

Medicare will only provide a rebate if the referral specifically includes one of the following suspected pathologies. Benefits are payable when referred with suspicion of the following clinical conditions:

• abnormality of tendons or bursae about the knee
• meniscal cyst, popliteal fossa cyst, mass or pseudomass
• nerve entrapment, nerve or nerve sheath tumour.

Benefits are not payable when referred for non-specific knee pain alone or other knee conditions including:

• meniscal and cruciate ligament tears
• assessment of chondral surfaces.

59300, 59303

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

For patients to be eligible for a Medicare rebate, you must include your reasons to suspect malignancy in the breasts because of:

• the past occurrence of breast malignancy in the patient;

OR

• significant history of breast or ovarian malignancy in the patient’s family;

OR

• symptoms or indications of breast disease found on examination of the patient by a medical practitioner

59302, 59305

Three dimensional tomosynthesis of both breasts, not being a service associated with item 59300 or 59301,

For patients to be eligible for a Medicare rebate, you must include your reasons to suspect malignancy in the breasts because of:

• the past occurrence of breast malignancy in the patient;

OR

• significant history of breast or ovarian malignancy in the patient’s family;

OR

• symptoms or indications of breast disease found on examination of the patient by a medical practitioner

12306

Bone densitometry, using dual energy X-ray absorptiometry, involving the measurement of 2 or
more sites (including interpretation and reporting), for:
(a) confirmation of a presumptive diagnosis of low bone mineral density made on the basis of one or
more fractures occurring after minimal trauma; or
(b) monitoring of low bone mineral density proven by bone densitometry at least 12 months
previously;
other than a service associated with a service to which item 12312, 12315 or 12321 applies
For any particular patient, once only in a 24 month period

12312

Bone densitometry, using dual energy X-ray absorptiometry, involving the measurement of 2 or
more sites (including interpretation and reporting) for diagnosis and monitoring of bone loss
associated with one or more of the following:
(a) prolonged glucocorticoid therapy; ( ‘Prolonged glucocorticoid therapy’ is defined as the
commencement of a dosage of inhaled glucocorticoid equivalent to or greater than 800 micrograms
beclomethasone dipropionate or budesonide per day; or 2540)
(b) any condition associated with excess glucocorticoid secretion; (a supraphysiological
glucocorticoid dosage equivalent to or greater than 7.5 mg prednisolone in an adult taken orally per
day; for a period anticipated to last for at least 4 months. Glucocorticoid therapy must be
contemporaneous with the current scan. Patients no longer on steroids would not qualify for
benefits).
(c) male hypogonadism; (Male hypogonadism is defined as serum testosterone levels below the age
matched normal range).
(d) female hypogonadism lasting more than 6 months before the age of 45; (Female hypogonadism
is defined as serum oestrogen levels below the age matched normal range).
other than a service associated with a service to which item 12306, 12315 or 12321 applies
For any particular patient, once only in a 12 month period

12315

Bone densitometry, using dual energy X-ray absorptiometry, involving the measurement of 2 or
more sites (including interpretation and reporting) for diagnosis and monitoring of bone loss
associated with one or more of the following conditions:
(a) primary hyperparathyroidism;
(b) chronic liver disease;
(c) chronic renal disease;
(d) any proven malabsorptive disorder; (A malabsorptive disorder is defined as one or more of the
following:
(1) malabsorption of fat, defined as faecal fat estimated at greater than 18 gm per 72 hours on a
normal fat diet; or
(2) bowel disease with presumptive vitamin D malabsorption as indicated by a sub-normal
circulating 25-hydroxyvitamin D level; or
(3) histologically proven Coeliac disease).
(e) rheumatoid arthritis;
(f) any condition associated with thyroxine excess;
other than a service associated with a service to which item 12306, 12312 or 12321 applies
For any particular patient, once only in a 24 month period

12320

Bone densitometry, using dual energy X-ray absorptiometry or quantitative computed tomography,
involving the measurement of 2 or more sites (including interpretation and reporting) for
measurement of bone mineral density, if:
(a) the patient is 70 years of age or over; and
(b) either:
(i) the patient has not previously had bone densitometry; or
(ii) the t-score for the patient’s bone mineral density is -1.5 or more;
other than a service associated with a service to which item 12306, 12312, 12315, 12321 or 12322
applies
For any particular patient, once only in a 5 year period

12321

Bone densitometry, using dual energy X-ray absorptiometry, involving the measurement of 2 or
more sites at least 12 months after a significant change in therapy (including interpretation and
reporting), for:
(a) established low bone mineral density; or
(b) confirming a presumptive diagnosis of low bone mineral density made on the basis of one or
more fractures occurring after minimal trauma;
other than a service associated with a service to which item 12306, 12312 or 12315 applies

For any particular patient, once only in a 12 month period

12322

Bone densitometry, using dual energy X-ray absorptiometry or quantitative computed tomography,
involving the measurement of 2 or more sites (including interpretation and reporting) for
measurement of bone mineral density, if:
(a) the patient is 70 years of age or over; and
(b) the t-score for the patient’s bone mineral density is less than -1.5 but more than -2.5;
other than a service associated with a service to which item 12306, 12312, 12315, 12320 or 12321
applies
For any particular patient, once only in a 2 year period

For more information see the Medicare benefits schedule www.mbsonline.gov.au

• The Royal Australian and New Zealand College of Radiologists
• The Department of Health – Privacy & Personal Information
• Royal Australian College of GPs
• The Fetal Medicine Foundation
• Radiology information
• Musculoskeletal MRI
• Diagnostic Imaging Pathways
• Medicare