Referrers

 

We automatically bulk bill any health care card holder or pensioner and will always acknowledge every individual request for bulk billing.


Printable Referral Forms

RE-ORDER REQUEST PADS

 


As our practices are fully digital and integrated, your patients’ reports are available on paper, fax and electronic transfer. If you would like to receive reports via electronic transfer please contact our clinical liaison officer Diane Cook. This is a complimentary service for our referrers.

VIEW IMAGES ONLINE

 


Medicare Indications

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

Physiotherapists and Chiropractors

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

  • examination of the hip joint
  • examination of the pelvic girdle
  • examination of the cervical spine
  • examination of the thoracic spine
  • examination of the lumbosacral spine
  • examination of the sacrococcygeal region
  • examination of two regions of the spine
  • examination of three regions of the spine (limited to 1 per patient per calendar year)
  • examination of the four regions of the spine (limited to 1 per patient per calendar year)

Shoulder Ultrasound

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.

Knee Ultrasound

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.

Digital Mammography

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 in a member of the patient’s family (blood relative).

OR

  • symptoms or indications of malignancy found on an examination of the patient by a medical practitioner.

Bone Mineral Densitometry

Unfortunately, not all patients are eligible for a Medicare rebate for bone mineral densitometry.

1. Item number 12306 is charged for confirmation of a presumptive diagnosis of low bone mineral density made on the basis of:

  • 1 or more fractures occurring after minimal trauma
  • For the monitoring of osteoporosis proven by bone densitometry at least 12 months previously.

2. Item number 12312 is charged for the diagnosis and monitoring of bone loss associated with 1 or more of the following conditions:

  • Prolonged glucocorticoid therapy
  • Conditions associated with excess glucocorticoid secretion
  • Male hypogonadism
  • Female hypogonadism lasting more than 6 months before age 45.

3. Item number 12315 is charged for the diagnosis and monitoring of bone loss associated with 1 or more of the following conditions:

  • Primary hyperparathyroidism
  • Chronic liver disease
  • Chronic renal disease (excluding kidney stones)
  • Proven malabsorptive disorders
  • Rheumatoid arthritis
  • Conditions associated with thyroxine excess.

4. Item number 12321 is charged for the measurement of bone density 12 months following significant change in therapy for established low bone density or confirmation of a presumptive diagnosis of low bone mineral density made on the basis of:

  • 1 or more fractures occurring after minimal trauma.

5. Item number 12323 is charged for the diagnosis and monitoring of bone loss in ALL patients aged 70 years and over. This number takes precedence over any other bone density number and should therefore be used in all patients over 70 years of age because there is no time restriction on this service.

Magnetic Resonance Imaging for Specific Conditions

 

Magnetic Resonance Imaging for Specific Conditions – Adults (aged 16 years or older)

Item Number Region Conditions
63551 Head/Brain Referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of head for any of the following:

  • unexplained seizure(s)
  • unexplained chronic headache with suspected intracranial pathology
63554 Spine Referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of spine for suspected:

  • cervical radiculopathy
63557 Spine Referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of the spine for suspected:

  • cervical spine trauma
63560 Knee Referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of the knee following acute knee trauma with:

  • inability to extend the knee suggesting the possibility of acute meniscal tear
  • clinical findings suggesting acute anterior cruciate ligament tear

Magnetic Resonance Imaging for Specific Conditions – Paediatrics (aged under 16 years)

Item Number Region Conditions
63507 Head/Brain Referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of head for any of the following:

  • unexplained seizure(s)
  • unexplained headache where significant pathology is suspected
  • paranasal sinus pathology which has not responded to conservative therapy
63510 Spine Referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of spine following radiographic examination for any or the following:

  • significant trauma
  • unexplained neck or back pain with associated neurological signs
  • unexplained back pain where significant pathology is suspected
63513 Knee Referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of knee following radiographic examination for internal joint derangement.
63516 Hip Referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of hip following radiographic examination for any of the following:

  • suspected septic arthritis
  • suspected slipped capital femoral epiphysis
  • suspected Perthes disease
63519 Elbow Referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of elbow following radiographic examination where a significant fracture or avulsion injury is suspected that will change management.
63522 Wrist Referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of wrist following radiographic examination where scaphoid fracture is suspected.

 

Magnetic Resonance Imaging for Specific Conditions – Abdo/Pelvis

63740 Abdo/Pelvis Referral by a specialist

MRI – scan to evaluate small bowel Crohn’s disease if the service is provided to a patient for:

(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; or

(d) Assessment of change to therapy in a patient with small bowel Crohn’s disease.

This item applies only once in a 12 month period where the service is provided for assessment of change to therapy in a patient with small bowel Crohn’s disease.

63743 Abdo/Pelvis Referral by a specialist

MRI – scan for fistulising perianal Crohn’s disease if the service is provided to a patient for:

(a)   Evaluation of pelvic sepsis and fistulas associated with established or suspected Crohn’s disease; or

(b)   Assessment of change to therapy of pelvis sepsis and fistulas from Crohn’s disease.

This item applies only once in a 12 month period where the service is provided for assessment of change to therapy of pelvis sepsis and fistulas from Crohn’s disease.

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


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