Medicare Guideline are listed below for your convenience.
A partial Medicare rebate applies when any of the following features are present and stated on the request form.
- Hyperemesis gravidarum
- Risk of fetal abnormality
- Previous post dates delivery
- Abdominal wall scaring
- Inflammatory bowel disease
- Advanced maternal age
- Toxaemia of pregnancy
- Significant maternal obesity
- Previous caesarean section
- Suspicion of ectopic pregnancy
- Previous spinal or pelvic trauma or disease
- Pregnancy after assisted reproduction
- Suspected or known uterine abnormality
- Suspected or known cervical incompetence
- Diabetes mellitus
- Hypertension
- Autoimmune disease
- Alloimmunisation
- Maternal infection
- Bowel stoma
- Drug dependency
- Thrombophilia
- Abdominal pain or mass
- Liver or renal disease
- Risk of miscarriage
- High risk pregnancy
- Uncertain dates
- Cardiac disease
- Poor obstetric history
- Diminished symptoms of pregnancy
Medicare has rules that apply to rebates for shoulder and knee Ultrasound examinations. Medicare will only provide a rebate when the request form specifically includes one of the following suspected pathologies:
Shoulder/Upper Arm, one or both
- 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
- Abnormality of tendons or bursae about the knee
- Meniscal cyst, popliteal fossa cyst, mass or pseudomass
- Nerve entrapment, nerve or nerve sheath tumor
- Injury of collateral ligaments
- Meniscal or cruciate ligament tears
- 57712 X-ray of the hip joint
- 57715 X-ray of the pelvic girdle
- 58100 X-ray of the cervical spine
- 58103 X-ray of the thoracic spine
- 58106 X-ray of the lumbosacral spine
- 58109 X-ray of the sacrum / coccyx
- 58112 X-ray of two regions of the spine
- 58120 X-ray of four regions of the spine
– cervical, thoracic, lumbosacral, sacrococcygeal - 58121 X-ray of three regions of the spine
– cervical, thoracic, lumbosacral
Medicare has set strict rules that apply to rebates for patients referred by Chiropractors. Your patient may be eligible for a Medicare rebate for the following radiographic requests with corresponding item numbers.
- 57712 X-ray of the hip joint
- 57715 X-ray of the pelvic girdle
- 58100 X-ray of the cervical spine
- 58103 X-ray of the thoracic spine
- 58106 X-ray of the lumbosacral spine
- 58109 X-ray of the sacrum / coccyx
- 58112 X-ray of two regions of the spine
Medicare has set strict rules that apply to rebates for patients referred by Podiatrists. Your patient may be eligible for a Medicare rebate for the following radiographic and ultrasound requests with corresponding item numbers.
- 57521 X-ray of the foot, ankle, femur, leg or knee
- 57527 X-ray of the foot and ankle
- X-ray of the ankle and leg
- X-ray of the knee and leg
- X-ray of the knee and femur
- 55836 Ultrasound of the ankle or hind foot
- 55840 Ultrasound of the mid or forefoot
- 55844 Ultrasound to assess a mass of the skin or subcutaneous tissues and not associated with the musculoskeletal system
