Must be at least 24 months since any previous BMD if performed for:

• 1 or more fractures occurring after minimal trauma (this can only be used once for each fracture); or
• Monitoring of osteoporosis proven by previous BMD at least 2 years prior with Z score of -1.50 or lower, or a T score of -2.50 or lower

Must be at least 12 months since any previous BMD if performed for:

• Prolonged & current glucocorticoid therapy (as per dose limits outlined in the MBS);
• Conditions associated with excess glucocorticoid secretion;
• Male hypogonadism;
• Female hypogonadism lasting more than 6 months before the age of 45.

Must be 24 months since any previous BMD if performed for:

• Primary hyperparathyroidism;
• Chronic liver disease;
• Chronic renal disease;
• Proven malabsorptive disorders (e.g. Coeliac or Crohn’s disease);
• Rheumatoid arthritis; or
• Conditions associated with thyroxine excess. 

Must be either:

The first time the patient is having BMD OR at least five years since any previous BMD if performed for:

• A person aged 70 years or over and not had a scan before
• A person aged 70 years or over and found to have no to mild osteopaenia (T-score 0 to 1.5) on previous scan

Must be at least 12 months since any previous BMD if performed for:

• 12 months following a significant change in therapy

Must be at least 24 months since any previous BMD if performed for:

• A person aged 70 years or over found to have moderate to marked osteopaenia (T-score -1.5 to -2.5) on previous scan

CT angiography with intravenous contrast medium of any or all, or any part of:

• The pulmonary arteries and their branches;

For the exclusion of pulmonary embolism this item can be requested by a medical practitioner (other than a specialist or consultant physician)

CT angiography with intravenous contrast medium of any or all, or any part of:

• The arch of the aorta; OR
• The carotid arteries; OR
• The vertebral arteries and their branches (head and neck)

Only claimable once in a 12 month period.

CT angiography with intravenous contrast medium of any or all, or any part of:

• The ascending and descending aorta; OR
• The common iliac and abdominal branches including upper limbs (chest, abdomen and upper limbs)

Only claimable once in a 12 month period.

CT angiography with intravenous contrast medium of any or all, or any part of:

• The descending aorta: OR
• The pelvic vessels (aorto iliac segment) and lower limbs;

Only claimable once in a 12 month period.

*Claimable once every 2 years

Can be referred by GP or specialists/specialist consultants

• Cannot be claimed within 24 months of any resting echo item.
• Can be ordered for any suspected heart condition.

Can be referred by specialists/specialist consultants

• For serial assessment of previously diagnosed valvular disease.

Can be referred by GPs in Modified Monash areas 3-7*

*Modified Monash areas 3-7 relate to remote to very remote locations.

Can be referred by specialists/specialist consultants

• For serial assessment of heart failure or other non-valvular heart disease.

Can be referred by GP or specialists/specialist consultants

• Repeat echocardiograms in patients with isolated pericardial effusion OR who has commenced medication for non-cardiac purposes that have cardio toxic side effects, and if the patient has a normal baseline study which requires echocardiograms to comply with requirements of PBS.

Can be referred by specialists/specialist consultants

• Repeat echocardiogram in patients not covered by other rare indications.

Medicare will initially be guided by the details as stipulated by the requesting practitioner, regardless of what the patient does or does not state.

A rebate is available for a diagnostic mammogram, if there is a reason to suspect the presence of malignancy because of:

• Previous breast cancer
• Significant family history of breast or ovarian cancer
• Symptoms or indications of breast disease found on examination of the patient by a medical practitioner (indicate area on a diagram),

for example, (but not limited to):

• Focal pain/tenderness
• Lump in breast
• Discharge
• Thickening
• Nipple retraction or change
• Skin changes/dimpling

A mammogram without the necessary, eligible clinical indications present on the request form is considered screening and there is no Medicare rebate.

Medicare will initially be guided by the details as stipulated by the requesting practitioner, regardless of what the patient does or does not state.

A rebate is available for a diagnostic mammogram, if there is a reason to suspect the presence of malignancy because of:

• Previous breast cancer
• Significant family history of breast or ovarian cancer
• Symptoms or indications of breast disease found on examination of the patient by a medical practitioner (indicate area on a diagram),

for example, (but not limited to):

• Focal pain/tenderness
• Lump in breast
• Discharge
• Thickening
• Nipple retraction or change
• Skin changes/dimpling

A mammogram without the necessary, eligible clinical indications present on the request form is considered screening and there is no Medicare rebate.

Can be referred by GPs and specialists/specialist consultants

• Claimable once every 2 years
• Has any of the following criteria:
  • Patient has body habitus (obesity) OR
  • Inability to undergo Stress Echo OR
  • Unable to exercise OR
  • Clinical indication as per “STRESS” Clinical Indication Criteria outlined below.

STRESS Clinical Indication Criteria

1.  if the patient displays one or more of the following symptoms of typical or atypical angina:
   
   1. constricting discomfort in the:
      1. front of the chest; or
      2. neck; or
      3. shoulders; or
      4. jaw; or
      5. arms; or
   2. the patient’s symptoms are precipitated by physical exertion; or
   3. the patient’s symptoms are relieved by rest or glyceryl trinitrate within 5 minutes or less; or
2.  if the patient has known coronary artery disease, and displays one or more symptoms that are suggestive of ischaemia:
   1. 1. which are not adequately controlled with medical therapy; or
      2. which have evolved since the last functional study; or
3. if the patient qualifies for one or more of the following indications:
   1. 1. assessment indicates that resting 12 lead electrocardiogram changes are consistent with coronary artery disease or ischaemia, in a patient that is without known coronary artery disease; or
      2. coronary artery disease related lesions, of uncertain functional significance, which have previously been identified on computed tomography coronary angiography or invasive coronary angiography; or
      3. an assessment by a specialist or consultant physician indicates that the patient has possible painless myocardial ischaemia, which includes undue exertional dyspnoea of uncertain aetiology; or
      4. a pre-operative assessment of a patient with functional capacity of less than 4 metabolic equivalents, confirming that surgery is intermediate to high risk, and the patient has at least one of following conditions:
         1. ischaemic heart disease or previous myocardial infarction; or
         2. heart failure; or
         3. stroke or transient ischaemic attack; or
         4. renal dysfunction (serum creatinine greater than 70umol/L or 2 mg/dL or a creatinine clearance of less than 60 mL/min); or
         5. diabetes mellitus requiring insulin therapy: or
      5. quantification of extent and severity of myocardial ischaemia, before either percutaneous coronary intervention or coronary bypass surgery, to ensure the criteria for intervention are met; or
      6. assessment of relative amounts of ischaemic viable myocardium and non-viable (infarcted) myocardium, in patients with previous myocardial infarction; or
      7. assessment of myocardial ischaemia with exercise is required, if a patient with congenital heart lesions has undergone surgery and ischemia is considered possible; or
      8. assessment of myocardial perfusion in a person who is under 17 years old with coronary anomalies, before and after cardiac surgery for congenital heart disease, or where there is a probable or confirmed coronary artery abnormality; or
      9. for patients where myocardial perfusion abnormality is suspected but due to the patient’s cognitive capacity or expressive language impairment, it is not possible to accurately assess symptom frequency based on medical history.

Can only be referred by specialists or specialist consultants

• Only claimable once in a 12-month period
• Previous stress / rest MPS in the last 12 months, AND
• Undergone revascularisation procedure, AND
• Has any of the following criteria:
  • Patient has body habitus (obesity) OR
  • Inability to have Stress Echo OR
  • Unable to exercise OR
  • Clinical indications as per “STRESS” Clinical Indication Criteria outlined below.

STRESS Clinical Indication Criteria

1.  if the patient displays one or more of the following symptoms of typical or atypical angina:
   
   1. constricting discomfort in the:
      1. front of the chest; or
      2. neck; or
      3. shoulders; or
      4. jaw; or
      5. arms; or
   2. the patient’s symptoms are precipitated by physical exertion; or
   3. the patient’s symptoms are relieved by rest or glyceryl trinitrate within 5 minutes or less; or
2.  if the patient has known coronary artery disease, and displays one or more symptoms that are suggestive of ischaemia:
   1. 1. which are not adequately controlled with medical therapy; or
      2. which have evolved since the last functional study; or
3. if the patient qualifies for one or more of the following indications:
   1. 1. assessment indicates that resting 12 lead electrocardiogram changes are consistent with coronary artery disease or ischaemia, in a patient that is without known coronary artery disease; or
      2. coronary artery disease related lesions, of uncertain functional significance, which have previously been identified on computed tomography coronary angiography or invasive coronary angiography; or
      3. an assessment by a specialist or consultant physician indicates that the patient has possible painless myocardial ischaemia, which includes undue exertional dyspnoea of uncertain aetiology; or
      4. a pre-operative assessment of a patient with functional capacity of less than 4 metabolic equivalents, confirming that surgery is intermediate to high risk, and the patient has at least one of following conditions:
         1. ischaemic heart disease or previous myocardial infarction; or
         2. heart failure; or
         3. stroke or transient ischaemic attack; or
         4. renal dysfunction (serum creatinine greater than 70umol/L or 2 mg/dL or a creatinine clearance of less than 60 mL/min); or
         5. diabetes mellitus requiring insulin therapy: or
      5. quantification of extent and severity of myocardial ischaemia, before either percutaneous coronary intervention or coronary bypass surgery, to ensure the criteria for intervention are met; or
      6. assessment of relative amounts of ischaemic viable myocardium and non-viable (infarcted) myocardium, in patients with previous myocardial infarction; or
      7. assessment of myocardial ischaemia with exercise is required, if a patient with congenital heart lesions has undergone surgery and ischemia is considered possible; or
      8. assessment of myocardial perfusion in a person who is under 17 years old with coronary anomalies, before and after cardiac surgery for congenital heart disease, or where there is a probable or confirmed coronary artery abnormality; or
      9. for patients where myocardial perfusion abnormality is suspected but due to the patient’s cognitive capacity or expressive language impairment, it is not possible to accurately assess symptom frequency based on medical history.

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/ calcifications/ tendinosis or 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.

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
• Injury of collateral ligament

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

The following items are Medicare eligible for physiotherapists and osteopaths.

*Claimable once per calendar year

Non Rebateable Items

Lime Radiology welcomes non Medicare-eligible musculoskeletal ultrasound scans from physiotherapists and osteopaths where the areas being imaged are of clinical interest.

The following items are Medicare eligible for chiropractors.

The following items are Medicare eligible for podiatrists.