Improving access to Magnetic Resonance Imaging (MRI) Services for patients 16 years of age and older- Fact Sheet

A fact sheet to inform the public and the profession of improving access to Magnetic Resonance Imaging (MRI) services

Page last updated: 26 July 2017

Fact Sheet - Improving Access to Magnetic Resonance Imaging (MRI) Services (Word 71 KB)
Fact Sheet - Improving Access to Magnetic Resonance Imaging (MRI) Services (PDF 137 KB)

Improving access to Magnetic Resonance Imaging (MRI) services

The Australian Government believes all Australians should have access to an affordable, quality health care system regardless of whether they live in the city or in regional areas. This includes ensuring patients have continued access to affordable and convenient diagnostic imaging services such as Medicare-eligible MRI services.

Improving access to Medicare-eligible MRI items:

As of 1 November 2013, GP requesting rights for a small set of clinically appropriate MRI indications will be extended to all patients 16 years of age and older.

Extending MRI requesting rights to GPs is aimed at increasing access to MRI services for patients managed by GPs who would otherwise be required to be referred to a specialist or consultant physician in order to have access to a Medicare funded MRI scan. The availability of these items should also help to reduce patient exposure to unnecessary radiation associated with other types of diagnostic imaging like computed tomography (CT) scans.

Four GP MRI requested items for patients 16 years of age and older were developed with the assistance of an Expert Working Group which was established to provide advice to the department on the appropriate indications for the proposed new items. These items and explanatory notes can be found on the MBS Online website.

The four new GP requested MRI items for patients 16 years of age and older are for the following indications: scan of the head for certain indications, scan of the cervical spine for radiculopathy and trauma, and scan of the knee for specific clinical indications. These services can be provided on full and partial Medicare eligible units. There are currently 337 Medicare eligible MRI units nationally.

The Department of Health funded the Royal College of General Practitioners (RACGP) and the Royal Australian and New Zealand Collage of Radiologists (RANZCR) to produce guidance material to support and assist GP's when requesting MRI GP requested items for patients 16 years and over. This guidance material can be found on the Royal College of General Practitioners (RACGP) website.

The Medicare Benefits Schedule (MBS) item numbers are:

Magnetic Resonance Imaging – Group I5

Subgroup 34 – Magnetic Resonance Imaging - For Specified Conditions
63551referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of head for a patient 16 years or older for any of the following:
      - unexplained seizure(s) (R) (Contrast) (Anaes.)
      - unexplained chronic headache with suspected intracranial pathology (R) (Contrast) (Anaes.)
Fee: $403.20 Benefit: 75% = $302.40 85% = $342.75
63552referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of head for a patient 16 years or older for any of the following:
      - unexplained seizure(s) (R) (NK) (Contrast) (Anaes.)
      - unexplained chronic headache with suspected intracranial pathology (R) (NK) (Contrast) (Anaes.)
Fee: $201.60 Benefit: 75% = $151.20 85% = $171.40
63554referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of spine for a patient 16 years or older for suspected:
      - cervical radiculopathy (R) (Contrast) (Anaes.)
Fee: $358.40 Benefit: 75% = $268.80 85% = $304.65
63555referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of spine for a patient 16 years or older for suspected:
      - cervical radiculopathy (R) (NK) (Contrast) (Anaes.)
Fee: $179.20 Benefit: 75% = $134.40 85% = $152.35
63557referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of spine for a patient 16 years or older for suspected:
      - cervical spine trauma (R) (Contrast) (Anaes.)
Fee: $492.80 Benefit: 75% = $369.60 85% = $418.90
63558referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of spine for a patient 16 years or older for suspected:
      - cervical spine trauma (R) (NK) (Contrast) (Anaes.)
Fee: $246.40 Benefit: 75% = $ 184.80 85% = $209.45
63560referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of knee following acute knee trauma for a patient 16 years or older with:
      - inability to extend the knee suggesting the possibility of acute meniscal tear (R) (Contrast) (Anaes.); or
      - clinical findings suggesting acute anterior cruciate ligament tear. (R) (Contrast) (Anaes.)
Fee: $403.20 Benefit: 75% = $302.40 85% = $342.75
63561referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of knee following acute knee trauma for a patient 16 years or older with:
      - inability to extend the knee suggesting the possibility of acute meniscal tear (R) (NK) (Contrast) (Anaes.); or
      - clinical findings suggesting acute anterior cruciate ligament tear. (R) (NK) (Contrast) (Anaes.)
Fee: $201.60 Benefit: 75% = $151.20 85% = $171.40
These items can only be provided on either a full or partial Medicare-eligible MRI unit. The complete list of Medicare-eligible MRI units is available on the Department of Health website.

Frequently Asked Questions -

Where can I find the details of the Medicare MRI items?

Details of the item descriptors and explanatory notes can be found at mbsonline.gov.au

Which MRI units can provide these four new Medicare rebated GP requested items?

Both partial and full Medicare-eligible MRI units can provide these services.

Can these items also be requested by a specialist?

No, these items are restricted to request only by medical practitioners excluding specialist or consultant physician. If requested by a specialist or consultant physician a Medicare rebate will not apply. Specialist and consultant physicians can currently request equivalent Medicare-eligible MRI services.

Are patients under the age of 16 years eligible for these items?

No, the patient must be aged of 16 years or older on the day the service is performed, not on the day the service is requested.

If a request is dated pre 1 November 2013 is it eligible?

Yes. GP requests dated prior to 1 November 2013 will be Medicare-eligible as long as the service is performed from 1 November 2013.

Overview of Medicare-eligible MRI items for MRI Providers

The following list provides a breakdown of which MBS MRI items can be provided on full or partial Medicare-eligible MRI units.
Item Range
Status
Description
Requester
Access
63001
To
63482
Existing items
MRI items
Specialist; or
Consultant physician
Full Medicare-eligible
63507
To
63523
Existing items (introduced 1 November 2012)
MRI items for patients under the age of 16
Medical practitioners other than specialist or consultant physiciansFull Medicare-eligible; and
Partial Medicare-eligible
63464
To
63476
Existing items
Existing Cancer staging & breast screening items
Specialist; or
Consultant physician
Full Medicare-eligible; and
Partial Medicare-eligible
63491
To
63497
Existing items
MRI modifying items
All medical practitionersFull Medicare-eligible; and
Partial Medicare-eligible
63501
63502
63504
63505
Existing items (Interim listed items)
Interim listed PIP breast MRI
All medical practitionersAny MRI unit (eligible or ineligible) that have:
Practice Accreditation under the Diagnostic Imaging Accreditation Scheme (DIAS); and
Operates a dedicated breast coil.
63551
To
63561
New Items
1 November 2013
MRI items for all patients 16 years of age and older
Medical practitioners other than specialist or consultant physiciansFull Medicare-eligible; and
Partial Medicare-eligible