Magnetic Resonance Imaging – Specialists

ItemsDescriptionsLimitations
Head
63001tumour of the brain or meningesunlimited
63004inflammation of the brain or meningesunlimited
63007skull base or orbital tumourunlimited
63010stereotactic scan of brain, with Fiducials in place, for planning for stereotactic neurosurgeryunlimited
63040acoustic neuroma3 per year
63043pituitary tumour3 per year
63046toxic or metabolic or ischaemic encephalopathy3 per year
63049demyelinating disease of the brain3 per year
63052congenital malformation of the brain or meninges3 per year
63055venous sinus thrombosis3 per year
63058head trauma3 per year
63061epilepsy3 per year
63064stroke3 per year
63067carotid or vertebral artery dissection3 per year
63070intracranial aneurysm3 per year
63073intracranial arteriovenous malformation3 per year
Head and neck vessels
63101stroke3 per year
Head and cervical spine
63111tumour of the central nervous system or meninges3 per year
63114inflammation of the central nervous system or meninges3 per year
63125demyelinating disease of the central nervous system3 per year
63128congenital malformation of the central nervous system or meninges3 per year
63131syrinx (congenital or acquired)3 per year
Spine - one region or two contiguous regions
63151infectionunlimited
63154tumourunlimited
63161demyelinating disease3 per year
63164congenital malformation of the spinal cord or the cauda equina or the meninges3 per year
63167myelopathy3 per year
63170syrinx (congenital or acquired)3 per year
63173cervical radiculopathy3 per year
63176sciatica3 per year
63179spinal canal stenosis3 per year
63182previous spinal surgery3 per year
63185trauma3 per year
Spine - three contiguous regions or two non-contiguous regions
63201infectionunlimited
63204tumourunlimited
63219demyelinating disease3 per year
63222congenital malformation of the spinal cord or the cauda equina or the meninges3 per year
63225myelopathy3 per year
63228syrinx (congenital or acquired)3 per year
63231cervical radiculopathy3 per year
63234sciatica3 per year
63237spinal canal stenosis3 per year
63240previous spinal surgery3 per year
63243trauma3 per year
Cervical spine and brachial plexus
63271tumour3 per year
63274trauma3 per year
63277cervical radiculopathy3 per year
63280previous surgery3 per year
Musculoskeletal (MSK) System
63301tumour arising in bone or MSK system excludes tumour arising in breast, prostate or rectumunlimited
63304infection arising in bone or MSK system excludes tumour arising in breast, prostate or rectumunlimited
63307osteonecrosisunlimited
63322derangement of hip or its supporting structures*3 per year
63325derangement of shoulder or its supporting structures*3 per year
63328derangement of knee or its supporting structures*3 per year
63331derangement of ankle and/or foot or its supporting structures*3 per year
63334derangement of one or both temporomandibular joints or their supporting structures3 per year
63337derangement of wrist and/or hand or its supporting structures*3 per year
63340derangement of elbow or its supporting structures*3 per year
63361Gaucher disease3 per year
*Limitation is 3 for each side in 12 months
Cardiovascular System
63385congenital disease of the heart or a great vessel2 per year
63388tumour of the heart or a great vessel2 per year
63391abnormality of thoracic aorta2 per year
63395MRI scan of the cardiovascular system for assessment of myocardial structure and function involving:
  1. dedicated right ventricular views; and
  2. 3D volumetric assessment of the right ventricle;and
  3. reporting of end‑diastolic and end‑systolic volumes, ejection fraction and BSA‑indexed values;
if the request for the scan indicates that:
  1. the patient presented with symptoms consistent with arrhythmogenic right ventricular cardiomyopathy (ARVC); or
  2. investigative findings in relation to the patient are consistent with ARVC
1 per year
63397MRI scan of the cardiovascular system for assessment of myocardial structure and function involving:
  1. dedicated right ventricular views; and
  2. 3D volumetric assessment of the right ventricle; and
  3. reporting of end‑diastolic and end‑systolic volumes, ejection fraction and BSA‑indexed values;).
if the request for the scan indicates that the patient:
  1. is asymptomatic; and
  2. has one or more first degree relatives diagnosed with confirmed arrhythmogenic right ventricular cardiomyopathy (ARVC)
1 every 3 years
Cardiovascular System MRA
63401vascular abnormality with a previous anaphylactic reaction to an iodinated contrast medium3 per year
63404obstruction of the superior vena cava, inferior vena cava or a major pelvic vein3 per year
Paediatric (<16yrs) MRA
63416the vasculature of limbs prior to limb or digit transfer surgery in congenital limb deficiency syndrome1 per year
Paediatric (<16)
63425post-inflammatory or post-traumatic physeal fusion2 per year
63428Gaucher disease2 per year
63440pelvic or abdominal massunlimited
63444mediastinal massunlimited
63447congenital uterine or anorectal abnormalityunlimited
Body Scan
63461adrenal mass in a patient with malignancy which is otherwise resecetable1 per year
Body Scan - both breasts
63464scan of both breast for the detection of cancer where;
  1. a dedicated breast coil is used; and
  2. the request for scan identifies that the woman is asymptomatic and <50 years of age; and
  3. the request for scan identifies either:
    1. that the patient is at high risk of developing breast cancer, due to 1 of the following:
      1. 3 or more first or second degree relatives on the same side of the family diagnosed with breast or ovarian cancer;
      2. 2 or more first or second degree relatives on the same of the family diagnosed with breast or ovarian cancer, if any of the following applies to at least 1 of the relatives:
        • has been diagnosed with bilateral breast cancer;
        • had onset of breast cancer before the age of 40 years;
        • had onset of ovarian cancer before the age of 50 years;
        • has been diagnosed with breast and ovarian cancer, at the same time or at different times;
        • has Ashkenazi Jewish ancestry;
        • is a male relative who has been diagnosed with breast cancer;
      3. 1 first or second degree relative diagnosed with breast cancer at age 45 years or younger, plus another first or second degree relative on the same side of the family with bone or soft tissue sarcoma at age 45 years or younger; or
    2. that genetic testing has identified the presence of a high risk breast cancer gene mutation.
1 per year
Body Scan - both breasts
63467scan of both breast for the detection of cancer - where;
  1. a dedicated breast coil is used; and
  2. 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
63487MRI — performed under the professional supervision of an eligible provider at an eligible location, if:
  1. the patient is referred by a specialist or a consultant physician; and
  2. a dedicated breast coil is used; and
  3. the request for the scan identifies that:
    1. the patient has been diagnosed with metastatic cancer restricted to the regional lymph nodes; and
    2. clinical examination and conventional imaging have failed to identify the primary cancer (R) (K) (Anaes)
63489MRI - guided biopsy, performed under the professional supervision of an eligible provider at an eligible location, if:
  1. the patient is referred by a specialist or a consultant physician; and
  2. a dedicated breast coil is used; and
  3. the request for the scan identifies that:
    1. the patient has a suspicious lesion seen on MRI but not on conventional imaging; and
    2. the lesion is not amenable to biopsy guided by conventional imaging; and
  4. a repeat ultrasound scan of the affected breast is performed:
    1. before the guided biopsy is performed; and
    2. as part of the service under this item (R) (K) (Anaes.)
63501MRI - scan of one or both breasts for the evaluation of implant integrity where:
  1. a dedicated breast coil is used; and
  2. the request for the scan identifies that the patient:
    1. has or is suspected of having a silicone breast implant manufactured by Poly Implant Prosthese (PIP); and
    2. the result of the scan confirms a loss of integrity of the implant (R)
1 per year
63502MRI - scan of one or both breasts for the evaluation of implant integrity where:
  1. a dedicated breast coil is used; and
  2. the request for the scan identifies that the patient:
    1. has or is suspected of having a silicone breast implant manufactured by Poly Implant Prosthese (PIP); and
    2. the result of the scan does not demonstrate a loss of integrity of the implant (R)
1 per year
63504MRI - scan of one or both breasts for the evaluation of implant integrity where:
  1. a dedicated breast coil is used; and
  2. the request for the scan identifies that the patient:
    1. has or is suspected of having a silicone breast implant manufactured by Poly Implant Prosthese (PIP); and
    2. presents with symptoms where implant rupture is suspected; and
    3. the result of the scan confirms a loss of integrity of the implant (R)
63505MRI - scan of one or both breasts for the evaluation of implant integrity where:
  1. a dedicated breast coil is used; and
  2. the request for the scan identifies that the patient:
    1. has or is suspected of having a silicone breast implant manufactured by Poly Implant Prosthese (PIP); and
    2. presents with symptoms where implant rupture is suspected; and
    3. the result of the scan does not demonstrate a loss of integrity of the implant (R)
63531MRI - scan 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
63533MRI - scan 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 the breast MRI may alter treatment planning.
63547MRI scan of both breasts for the detection of cancer, if
  1. a dedicated breast coil is used; and
  2. the request for the scan identifies that:
    1. the patient has a breast implant in situ; and
    2. anaplastic large cell lymphoma has been diagnosed
1 in a lifetime
Pelvis and Upper Abdomen
63470Pelvis for the staging of histologically diagnosed cervical cancer at FIGO stages 1B or greater when the request for scan identifies that
  1. a histological diagnosis of carcinoma of the cervix has been made and
  2. the patient has been diagnosed with cervical cancer at FIGO stage 1B or greater
1 in a lifetime
63473Pelvis and upper abdomen, in a single examination, for the staging of histologically diagnosed cervical cancer at FIGO stages 1B or greater1 in a lifetime
63476Pelvis for the initial staging of rectal cancer where
  1. a phased array body coil is used, and
  2. the request for scan identifies that the indication is for the initial staging of rectal cancer (including cancer of the rectosigmoid and anorectum).
1 in a lifetime
63740MRI to evaluate small bowel Crohn’s disease. Medicare benefits are only payable for this item if the service is provided to patients:
  1. Evaluation of disease extent at time of initial diagnosis of Crohn’s disease
  2. Evaluation of exacerbation/suspected complications of known Crohn’s disease
  3. Evaluation of known or suspected Crohn’s disease in pregnancy
  4. Assessment of change to therapy in patients with small bowel Crohn’s disease
1 per year
63741MRI enteroclysis for Crohn’s disease. Medicare benefits are only payable for this item if the service is related to item 63740
63743MRI 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 pelvic sepsis and fistulas from Crohn’s disease
Assessment of change to therapy can only be claimed once in a 12 month period.		1 per year
Body - pancreas and biliary tree MRCP
63482suspected biliary or pancreatic pathology3 per year
Prostate
63541MRI of the prostate, where 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;
1. A digital rectal examination (DRE) which is suspicious for prostate cancer; or
2. Aged < 70 years, at least 2x PSA tests performed within an interval of 1-3 months
> 3.0 ng/ml, and F/T PSA ratio is < 25% or the repeat PSA exceeds 5.5 ng/ml; or
3. Aged < 70 years, whose risk of developing prostate cancer based on family history is at least double the average risk (1st degree relative with prostate cancer or suspected of carrying BRCA 1, BRCA 2 mutation), at least 2 PSA tests performed within an interval of 1-3 months > 2.0 ng/ml, and the F/T PSA ratio is < 25%: or
4. Aged ≥ 70 years , at least 2 PSA tests performed within an interval of 1-3 months
> 5.5 ng/ml and the F/T PSA ratio is < 25%.
1 per year
63543MRI of the prostate, where 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 biopsy histopathology;
and
(b) the patient is not planning or undergoing treatment for prostate cancer.

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 purpose of treatment planning or for the monitoring after treatment.