Medicare Information

The Federal Government sets strict guidelines about the examinations that are performed by Hunter Imaging 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...

General Referrals
Bone Mineral Densitometry Criteria
Nuchal Translucency (NT) Criteria
Shoulder and Knee Ultrasound Criteria
Magnetic Resonance Imaging (MRI) Criteria
Allied Health Eligible Criteria

If you have any more queries about the Medicare Benefits Schedule in relation to our examinations then please contact Doctor Direct on 49255451

General Referrals

All examinations performed by Hunter Imaging 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

Hunter Imaging 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 our Doctor Direct line.

Bone Mineral Densitometry (BMD)

Hunter Imaging Group charges a different Medicare Item Number for BMD examinations depending on the patient's clinical history. If the patient does not fit into one of these criteria set by the Medicare Benefits Schedule (MBS) the patient will be charged a private fee and no Medicare rebate will apply.

In addition to the information below Hunter Imaging Group provides specialised tick-box style request pads to our referring physicians. These can be ordered free of charge by calling our Doctor Direct line.

Item Number	Criteria
12323	Performed When... A person aged 70 years or over
12306	Performed When.... 1 or more fractures have occurred after minimal trauma (this can only be used once for each fracture); or Monitoring of osteoporosis proven by previous bone densitometry; Scan at least two years prior with a Z score of -1.50 or lower, or T score of -2.50 or lower.
12312	Performed When... Prolonged & current glucocorticoid therapy (as per dose limits outlined in MBS) Conditions associated with excess glucocorticoid secretion; Male hypogonadism; or Female hypogonadism lasting more that 6 months before age 45
12315	Performed When... Primary hyperparathyroidism Chronic liver disease; Chronic renal disease; Proven malabsoptive disorders (eg. Coeliac or Chron's Disease) Rheumatoid arthritis; or Conditions associated with thyroxine excess
12321	Performed When... If performed 12 months following a significant change in therapy

Nuchal Translucency (NT) Scans

Hunter Imaging Group performs Nuchal Translucency scans in line with the Medicare Benefits Schedule (MBS). For a patient to be eligible for a Medicare rebate they must fit one of the following criteria and the applicable condition must be present and stated on the request form.

The patient is 12-16 weeks of gestation and referred by a medical practitioner, and
One or more of the following conditions are present...

Hyperemesis

Risk of foetal abnormality

Previous post dates delivery

Abdominal wall scarring

Inflammatory bowel disease

Advanced maternal age

Toxaemia of pregnancy

Significant maternal obesity

Previous caesarean section

Suspicion of ectopic pregnancy

Diminished symptoms of pregnancy

Previous pelvis or spinal trauma or disease

Pregnancy after assisted reproduction

Suspected or known uterine disease

Suspected or known cervical incompetence

Diabetes mellitus

Hypertension

Autoimmune disease

Alloimmunisation

Maternal infection

Bowel stoma

Drug dependency

Thrombophilla

Abdominal pain or mass

Liver or renal disease

Poor obstetric history

Risk of miscarriage

High risk pregnancy

Uncertain dates

Cardiac disease

Magnetic Resonance Imaging (MRI)

Hunter Imaging Group operates three Medciare Eligible MRI scanners located at Cardiff, East Maitland and Tamworth.

At all three 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 are a list of the indications for the scans performed by Hunter Imaging Group...

Anatomical Region	Indication
Head	Unlimited referrals... Tumour of the brain or meningies Inflammation of the brain or meningies Skull base or orbital tumour Stereotactic scan of brain Benefits payable for each service on 3 occasions in 12 months... Acoustic neuroma Pituitary tumour Toxic or metabolistic or ischemic encephalopathy Demyelinating disease of the brain Congenital malformation of the brain or meningies Venous sinus thrombosis Head trauma Epilepsy Stroke Carotid or vertebral artery dissection Intracranial aneurysm Intracranial arteriovenous malformation
Head and neck vessels	Benefits payable for each service on 3 occasions in 12 months... MRI/MRA of extra/or intracranial circulation for stroke
Head and cervical spine	Unlimited referrals... Tumour of the CNS of meningies Inflammation of the CNS or meningies Benefits payable for each service on 3 occasions in 12 months Demyelinating disease of the CNS Congenital malformation of the CNS and meningies Syrinx (congenital or acquired)
Spine - one region or two contiguous regions	Unlimited Referrals... Infection Tumour Benefits payable for each service on 3 occasions in 12 months... Demyelinating disease Congenital malformation of the spinal cord or the corda equina or meningies Myelopathy Syrinx (congenital or acquired) Cervical radiculopathy Sciatica Spinal canal stenosis Previous spinal injury Trauma
Spine - three contiguous regions or two non-contiguous regions	Unlimited Referrals... Infection Tumour Benefits payable for each service on 3 occasions in 12 months... Demyelinating disease Congenital malformation of the spinal cord or the corda equina or meningies Myelopathy Syrinx (congenital or acquired) Cervical radiculopathy Sciatica Spinal canal stenosis Previous spinal injury Trauma
Cervical spine and brachial plexus	Benefits payable for each service on 3 occasions in 12 months... Tumour Trauma Cervical radiculopathy Previous surgery
Musculoskeletal system	Unlimited referrals... Tumour arising in bone or musculoskeletal system, this excludes tumours arising in breast, prostate or rectum Infection arising in bone or musculoskeletal system, this excludes tumours arising from the breast, prostate or rectum Ostenocrosis Benefits payable for each service on 3 occasions in 12 months... Derangement of hip or its supporting structures Derangement of shoulder Derangement of knee Derangement of ankle and/or foot Derangement of one or both TMJ's Derangement of hand and/or wrist Derangement of elbow Benefits payable for each service on 2 occasions in 12 month... Gaucher disease
Cardiovascular system	Benefits payable for each service on 2 occasions in 12 months... Congenital disease of the heart or a great vessel Tumour of the heart or a great vessel Abnormality of the thoracic area Benefits payable for each service on 3 occasions in 12 months... MRA for vascular abnormality in a patient with a previous anaphylactic reaction to iodinated contrast medium MRA for obstruction of the superior vena cava, inferior vena cava or a major pelvic vein
Body	Benefits payable for each service on 1 occasion within 12 months... Adrenal mass in a patient with a malignancy which is otherwise resectable
Pelvis and upper abdomen	Benefits payable on 1 occasion only... Pelvis for the staging of histologically diagnosed cervical cancer at FIGO stages 1B or greater Pelvis and upper abdomen, in single examination for the staging of histologically diagnosed cervical cancer at FIGO stages 1B or greater Magnetic resonance cholangiopancreatography (MRCP) for suspected billary or pancreatic pathology
Persons under the age of 16	Benefits payable for each service on 1 occasion in 12 months... MRA for vasculature of limbs prior to limb or digit transfer surgery in congenital limb deficiency syndrome Benefits payable for each service on 2 occasions in 12 months... Post-inflammatory or post-traumatic physeal fusion Gaucher disease Unlimited referrals... Pelvic or abdominal mass Mediastinal mass Congenital uterine or anrectal abnormality

Shoulder and Knee Ultrasounds

Hunter Imaging 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...

Evaluation of injury to tendon, muscle or tendon/muscle junctions 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

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.

Abnormality of tendons or bursa 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 known conditions including...

Meniscal and cruciate ligament tears
Assessment of chondral surfaces

Allied Health Medicare Eligible Services

At Hunter Imaging 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