Hermitage St, Geraldton WA 6530
(08) 9964 3757
(08) 9964 4498

Referral Guidelines

For some examinations to be eligible for a Medicare rebate, referrers must indicate specific clinical criteria on the request form. Some of the more commonly-requested examinations that require specific clinical indications are listed below for your convenience.

This information serves as a guide only. A complete copy of the current Medicare Benefits Schedule (MBS) can be downloaded from the MBS online website

Item Description
12306 The confirmation of a presumptive diagnosis of low bone mineral density made on the basis of; 1 or more fractures occurring after minimal trauma; or for the monitoring of low bone mineral density proven by bone densitometry at least 12 months previously. Low bone mineral density is present when the bone mineral density falls more than 1.5 standard deviations below the age matched mean (Z score), or more than 2.5 standard deviations below the young normal mean at the same site and in the same gender (T-score).

1 service only in a period of 24 consecutive months

12312
  • prolonged glucocorticoid therapy;
  • conditions associated with excess glucocorticoid secretion;
  • male hypogonadism; or
  • female hypogonadism lasting more than 6 months before the age of 45.

1 service only in a period of 12 consecutive months

12315 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;
  • proven malabsorptive disorders;
  • rheumatoid arthritis; or
  • conditions associated with thyroxine excess.

1 service only in a period of 24 consecutive months

12321 For the measurement of bone density 12 months following a significant change in therapy (change in class of drugs not just dose changes) for:

  • established low bone mineral density; or
  • the confirmation of a presumptive diagnosis of low bone mineral density made on the basis of 1 or more fractures occurring after minimal trauma.

1 service only in a period of 12 consecutive months

12323 For the measurement of bone mineral density for a person aged 70 years or 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.
DEXA For screening bone mineral density, which is not eligible for a Medicare rebate.
Item Description
63551 Head
Scan of the head for any of the following:

  • unexplained seizure
  • unexplained chronic headache with suspected intracranial pathology
63554 Spine
Scan of the spine for suspected:

  • cervical radiculopathy
63557 Spine
Scan of the spine for suspected:

  • cervical spine trauma
63560 Knee
Scan of the knee following acute knee trauma with:

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

Head

63001 tumour of the brain or meninges
(unlimited)
63004 inflammation of the brain or meninges
(unlimited)
63007 skull base or orbital tumour
(unlimited)
63040 acoustic neuroma
(3 per year)
63043 pituitary tumour
(3 per year)
63046 toxic or metabolic or ischaemic encephalopathy
(3 per year)
63049 demyelinating disease of the brain
(3 per year)
63052 congenital malformation of the brain or meninges
(3 per year)
63055 venous sinus thrombosis
(3 per year)
63058 head trauma
(3 per year)
63061 epilepsy
(3 per year)
63064 stroke
(3 per year)
63067 carotid or vertebral artery dissection
(3 per year)
63070 intracranial aneurysm
(3 per year)
63073 intracranial arteriovenous malformation
(3 per year)

Head and neck vessels

63101 stroke
(3 per year)

Head and cervical spine

63111 tumour of the central nervous system or meninges
(3 per year)
63114 inflammation of the central nervous system or meninges
(3 per year)
63125 demyelinating disease of the central nervous system
(3 per year)
63128 congenital malformation of the central nervous system or meninges
(3 per year)
63131 syrinx (congenital or acquired)
(3 per year)

Spine – one region or two contiguous regions

63151 infection
(unlimited)
63154 tumour
(unlimited)
63161 demyelinating disease
(3 per year)
63164 congenital malformation of the spinal cord or the cauda equina or the meninges
(3 per year)
63167 myelopathy
(3 per year)
63170 syrinx (congenital or acquired)
(3 per year)
63173 cervical radiculopathy
(3 per year)
63176 sciatica
(3 per year)
63179 spinal canal stenosis
(3 per year)
63182 previous spinal surgery
(3 per year)
63185 trauma
(3 per year)

Spine – three contiguous regions or two non-contiguous regions

63201 infection
(unlimited)
63204 tumour
(unlimited)
63219 demyelinating disease
(3 per year)
63222 congenital malformation of the spinal cord or the cauda equina or the meninges
(3 per year)
63225 myelopathy
(3 per year)
63228 syrinx (congenital or acquired)
(3 per year)
63231 cervical radiculopathy
(3 per year)
63234 sciatica
(3 per year)
63237 spinal canal stenosis
(3 per year)
63240 previous spinal surgery
(3 per year)
63243 trauma
(3 per year)

Cervical spine and brachial plexus

63271 tumour
(3 per year)
63274 trauma
(3 per year)
63277 cervical radiculopathy
(3 per year)
63280 previous surgery
(3 per year)

Musculoskeletal (MSK) system

63301 tumour arising in bone or MSK system excludes tumour arising in breast, prostate or rectum
(unlimited)
63304 infection arising in bone or MSK system excludes tumour arising in breast, prostate or rectum
(unlimited)
63307 osteonecrosis
(unlimited)
63322 derangement of hip or its supporting structures*
(3 per year)
63325 derangement of shoulder or its supporting structures*
(3 per year)
63328 derangement of knee or its supporting structures*
(3 per year)
63331 derangement of ankle and/or foot or its supporting structures*
(3 per year)
63334 derangement of one or both temporomandibular joints or their supporting structures
(3 per year)
63337 derangement of wrist and/or hand or its supporting structures*
(3 per year)
63340 derangement of elbow or its supporting structures*
(3 per year)
63361 Gaucher disease
(3 per year)
*Limitation is 3 for each side in 12 months

Cardiovascular system MRA

63404 obstruction of the superior vena cava, inferior vena cava or a major pelvic vein
(3 per year)

Paediatric (<16)

63425 post-inflammatory or post-traumatic physeal fusion
(2 per year)
63428 Gaucher disease
(2 per year)
63440 pelvic or abdominal mass
(unlimited)
63444 mediastinal mass
(unlimited)
Body scan
63461 adrenal mass in a patient with malignancy which is otherwise resecetable
(1 per year)

Body scan – both breasts

63467 scan of both breast for the detection of cancer – where;

  • a dedicated breast coil is used; and
  • 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

63504 MRI – scan of one or both breasts for the evaluation of implant integrity where:

  • a dedicated breast coil is used; and
  • the request for the scan identifies that the patient:
    • has or is suspected of having a silicone breast implant manufactured by Poly Implant Prosthese (PIP); and
    • presents with symptoms where implant rupture is suspected; and
    • the result of the scan confirms a loss of integrity of the implant (R)
63505 MRI – scan of one or both breasts for the evaluation of implant integrity where:

  • a dedicated breast coil is used; and
  • the request for the scan identifies that the patient:
    • has or is suspected of having a silicone breast implant manufactured by Poly Implant Prosthese (PIP); and
    • presents with symptoms where implant rupture is suspected; and
    • the result of the scan does not demonstrate a loss of integrity of the implant (R)

Pelvis and upper abdomen

63470 Pelvis for the staging of histologically diagnosed cervical cancer at FIGO stages 1B or greater when the request for scan identifies that

  • a histological diagnosis of carcinoma of the cervix has been made and
  • the patient has been diagnosed with cervical cancer at FIGO stage 1B or greater

(1 in a lifetime)

63473 Pelvis and upper abdomen, in a single examination, for the staging of histologically diagnosed cervical cancer at FIGO stages 1B or greater

(1 in a lifetime)

63476 Pelvis for the initial staging of rectal cancer where

  • a phased array body coil is used, and
  • 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)

Body – pancreas and biliary tree MRCP

63482 suspected biliary or pancreatic pathology
(3 per year)

Pelvis and upper abdomen – for specified conditions (Crohn’s Disease)

63740 MRI to evaluate small bowel Crohn’s disease. Medicare benefits are only payable for this item if the service is provided to patients:

  • Evaluation of disease extent at time of initial diagnosis of Crohn’s disease
  • Evaluation of exacerbation/suspected complications of known Crohn’s disease
  • Evaluation of known or suspected Crohn’s disease in pregnancy
  • Assessment of change to therapy in patients with small bowel Crohn’s disease

Assessment of change to therapy can only be claimed once in a 12 month period.

63743 MRI 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 pelvis sepsis and fistulas from Crohn’s disease

Assessment of change to therapy can only be claimed once in a 12 month period.

Item Description
59300 Bilateral breast

Where there is a reason to suspect the presence of malignancy because of:

  • the past occurrence of breast malignancy in the patient or members of the patient’s family (blood relative); or
  • symptoms or indications of malignancy found on an examination of the patient by a medical practitioner

Symptoms or indications of malignancy include: localised mass, localised lumps, localised pain, localised tenderness.

For previous history of malignancy in patient or family member please provide relevant history.

The following criteria will NOT attract a Medicare rebate: screening, cyst, generalised tenderness or pain, previous benign lump, lumpy breasts, non-specific follow up, or no clinical indication.

It is helpful to include any relevant clinical information such as past history of breast surgery, breast reduction or augmentation and specific information relating to the area of interest, including the side, size and location within the breast.

59303 Unilateral breast

Where there is reason to suspect the presence of malignancy because of:

  • the past occurrence of breast malignancy in the patient or members of the patient’s family; or
  • symptoms or indications of malignancy found on an examination of the patient by a medical practitioner.

Symptoms or indications of malignancy include: localised mass, localised lumps, localised pain, localised tenderness.

For previous history of malignancy in patient or family member please provide relevant history.

The following criteria will NOT attract a Medicare rebate: screening, cyst, generalised tenderness or pain, previous benign lump, lumpy breasts, non-specific follow up, or no clinical indication.

It is helpful to include any relevant clinical information such as past history of breast surgery, breast reduction or augmentation and specific information relating to the area of interest, including the side, size and location within the breast.

Item Description
57960 Orthopantomography, for diagnosis and/or management of trauma, infection, tumours, congenital conditions or surgical conditions of the teeth or maxillofacial region.
57963 Orthopantomography, for diagnosis and/or management of impacted teeth, caries, periodontal or peripical pathology where signs or symptoms of those conditions are evident.
57966 Orthopantomography, for diagnosis and/or management of missing or crowded teeth, or developmental anomalies of the teeth or jaws.
57969 Orthopantomography, for diagnosis and/or management of temporomandibular joint arthroses or dysfunction.
Item Description
55700 Pregnancy < 12 weeks

The pregnancy is dated at less than 12 weeks gestation and one or more of the following conditions are present:

  • hyperemesis gravidarum;
  • diabetes mellitus;
  • hypertension;
  • toxaemia of pregnancy;
  • liver or renal disease;
  • autoimmune disease;
  • cardiac disease;
  • alloimmunisation;
  • maternal infection;
  • inflammatory bowel disease;
  • bowel stoma;
  • abdominal wall scarring;
  • previous spinal or pelvic trauma or disease;
  • drug dependency;
  • thrombophilia;
  • significant maternal obesity;
  • advanced maternal age;
  • abdominal pain or mass;
  • uncertain dates;
  • high risk pregnancy;
  • previous post dates delivery;
  • previous caesarean section;
  • poor obstetric history;
  • suspicion of ectopic pregnancy;
  • risk of miscarriage;
  • diminished symptoms of pregnancy;
  • suspected or known cervical incompetence;
  • suspected or known uterine abnormality;
  • pregnancy after assisted reproduction;
  • risk of fetal abnormality.
55707 Pregnancy nuchal translucency

The pregnancy (as confirmed by ultrasound) is dated by a crown rump length of 45 to 84mm; and nuchal translucency measurement is performed to assess the risk of fetal abnormality; and one or more of the following conditions are present:

  • hyperemesis gravidarum;
  • diabetes mellitus;
  • hypertension;
  • toxaemia of pregnancy;
  • liver or renal disease;
  • autoimmune disease;
  • cardiac disease;
  • alloimmunisation;
  • maternal infection;
  • inflammatory bowel disease;
  • bowel stoma;
  • abdominal wall scarring;
  • previous spinal or pelvic trauma or disease;
  • drug dependency;
  • thrombophilia;
  • significant maternal obesity;
  • advanced maternal age;
  • abdominal pain or mass;
  • uncertain dates;
  • high risk pregnancy;
  • previous post dates delivery;
  • previous caesarean section;
  • poor obstetric history;
  • suspicion of ectopic pregnancy;
  • risk of miscarriage;
  • diminished symptoms of pregnancy;
  • suspected or known cervical incompetence;
  • suspected or known uterine abnormality;
  • pregnancy after assisted reproduction;
  • risk of fetal abnormality.
55704 Pregnancy 12-16 weeks

PELVIS or ABDOMEN dating of the pregnancy (by ultrasound) is 12 – 16 weeks and one or more of the following conditions are present:

  • hyperemesis gravidarum;
  • diabetes mellitus;
  • hypertension;
  • toxaemia of pregnancy;
  • liver or renal disease;
  • autoimmune disease;
  • cardiac disease;
  • alloimmunisation;
  • maternal infection;
  • inflammatory bowel disease;
  • bowel stoma;
  • abdominal wall scarring;
  • previous spinal or pelvic trauma or disease;
  • drug dependency;
  • thrombophilia;
  • significant maternal obesity;
  • advanced maternal age;
  • abdominal pain or mass;
  • uncertain dates;
  • high risk pregnancy;
  • previous post dates delivery;
  • previous caesarean section;
  • poor obstetric history;
  • suspicion of ectopic pregnancy;
  • risk of miscarriage;
  • diminished symptoms of pregnancy;
  • suspected or known cervical incompetence;
  • suspected or known uterine abnormality;
  • pregnancy after assisted reproduction;
  • risk of fetal abnormality.
55706 Pregnancy 17-22 weeks
(1 per pregnancy)
PELVIS or ABDOMEN pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, where

  • the patient is referred by a medical practitioner; and
  • the dating for the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and
  • the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
  • the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and
  • the service is not performed in the same pregnancy as item 55709.
55712
Referrer restrictions apply
(see item)
Pregnancy 17-22 weeks

PELVIS or ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, where:

  • the patient is referred by a medical practitioner who is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists or who has a Diploma of Obstetrics or has a qualification recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists as being equivalent to a Diploma of Obstetrics or has obstetric privileges at a non-metropolitan hospital; and
  • the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and
  • the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
  • the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and
  • further examination is clinically indicated in the same pregnancy to which item 55706 applies.
55718 Pregnancy >22 weeks
(1 per pregnancy)
PELVIS or ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, where:

  • the patient is referred by a medical practitioner; and
  • the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and
  • the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
  • the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and
  • the service is not performed in the same pregnancy as item 55723; and
  • one or more of the following conditions are present:
    • known or suspected fetal abnormality or fetal cardiac arrhythmia;
    • fetal anatomy (late booking or incomplete mid-trimester scan);
    • malpresentation;
    • cervical assessment;
    • clinical suspicion of amniotic fluid abnormality;
    • clinical suspicion of placental or umbilical cord abnormality;
    • previous complicated delivery;
    • uterine scar assessment;
    • uterine fibroid;
    • previous fetal death in utero or neonatal death;
    • antepartum haemorrhage;
    • clinical suspicion of intrauterine growth retardation;
    • clinical suspicion of macrosomia;
    • reduced fetal movements;
    • suspected fetal death;
    • abnormal cardiotocography;
    • prolonged pregnancy;
    • premature labour;
    • fetal infection;
    • pregnancy after assisted reproduction;
    • trauma;
    • diabetes mellitus;
    • hypertension;
    • toxaemia of pregnancy;
    • liver or renal disease;
    • autoimmune disease;
    • cardiac disease;
    • alloimmunisation;
    • maternal infection;
    • inflammatory bowel disease;
    • bowel stoma;
    • abdominal wall scarring;
    • previous spinal or pelvic trauma or disease;
    • drug dependency;
    • thrombophilia;
    • significant maternal obesity;
    • advanced maternal age;
    • abdominal pain or mass.
55721
Referrer restrictions apply
(see item)
Pregnancy >22 weeks

PELVIS or ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of by any or all approaches, where:

  • the patient is referred by a medical practitioner who is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists or who has a Diploma of Obstetrics or has qualifications recognised by the Royal Australian and New Zealand College of Obstericians and Gynaecologists as being equivalent to a Diploma of obstetrics or has obstetric privileges at a non-metropolitan hospital; and
  • the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and
  • the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
  • the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and
  • further examination is clinically indicated in the same pregnancy to which item 55718 applies.
55759 Multiple Pregnancy 17-22 weeks only
(1 per pregnancy)
PELVIS or ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, where:

  • the patient is referred by a medical practitioner; and
  • ultrasound of the same pregnancy confirms a multiple pregnancy; and
  • the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks gestation; and
  • the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
  • the referring practitioner is not a member of a group of practitioners to which the providing practitioner is a member; and
  • the service is not performed in conjunction with item 55706 or 55712 during the same pregnancy.
55764
Referrer restrictions apply
(see item)
Multiple Pregnancy 17-22 weeks

PELVIS or ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, where:

the patient is referred by a medical practitioner who is a Member or Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists or who has a Diploma of Obstetrics or has a qualification recognised by the Royal Australian and New Zealand College of Obstericians and Gynaecologists as equivalent to a Diploma of obstetrics or has obstetric privileges at a non-metropolitan hospital; and

  • ultrasound of the same pregnancy confirms a multiple pregnancy; and
  • the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks gestation; and
  • the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
  • the referring practitioner is not a member of a group of practitioners to which the providing practitioner is a member; and
  • further examination is clinically indicated in the same pregnancy to which item 55759 has been performed; and
  • not performed in conjunction with item 55706 or 55712 during the same pregnancy.
55768 Multiple Pregnancy >22 weeks
(1 per pregnancy)
PELVIS or ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, where:

  • dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and
  • the ultrasound confirms a multiple pregnancy; and
  • the patient is referred by a medical practitioner; and
  • the service is not performed in the same pregnancy as item 55770; and
  • the service is not associated with a service to which an item in Subgroups 2 or 3 of this group applies; and
  • the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and
  • the service is not performed in conjunction with item 55718 or 55721 during the same pregnancy.
55772 Referrer restrictions apply
(see item)
Multiple Pregnancy >22 weeks

PELVIS or ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, where:

  • dating of the pregnancy as confirmed by ultrasound is after 22 weeks of gestation; and
  • the patient is referred by a medical practitioner who is a Member or Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists or who has a Diploma of Obstetrics or has a qualification recognised by the Royal Australian and New Zealand College of Obstericians and Gynaecologists as equivalent to a Diploma of obstetrics or has obstetric privileges at a non-metropolitan hospital; and
  • further examination is clinically indicated in the same pregnancy to which item 55768 or 55770 has been performed; and
  • the pregnancy as confirmed by ultrasound is a multiple pregnancy; and
  • the service is not associated with a service to which an item in Subgroups 2 or 3 of this group applies; and
  • the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and
  • the service is not performed in conjunction with item 55718 or 55721 during the same pregnancy.
Item Description
55808 Shoulder or upper arm

Where the service is provided, for the assessment of one or more of the following conditions or suspected conditions:

  • evaluation of injury to tendon, muscle or muscle/tendon junction; or
  • rotator cuff tear/calcification/tendinosis (biceps, subscapular, suspraspinatus, infraspinatus); or
  • biceps subluxation; or
  • capsulitis and bursitis; or
  • evaluation of mass including ganglion; or
  • occult fracture; or
  • acromioclavicular joint pathology.

Benefits are not payable when referred for non-specific pain alone.

55828 Knee

Where the service is provided for the assessment of one or more of the following conditions or suspected conditions:

  • abnormality of tendons or bursae about the knee; or
  • meniscal cyst, popliteal fossa cyst, mass or pseudomass; or
  • nerve entrapment, nerve or nerve sheath tumour; or
  • injury of collateral ligaments.

Benefits are not payable when referred for non-specific pain alone and including meniscal or cruciate ligament tears and assessment of chondral surfaces.

Chiropractors, physiotherapists and osteopaths

The following items are Medicare eligible for chiropractors, physiotherapists and osteopaths. X-ray of the:

Item Description 
57712 hips
57715 pelvis
58100 cervical spine
58103 thoracic spine
58106 lumbar spine
58109 sacrum and coccyx
58112 two region spine
58121* three region spine
58120* four region spine

*benefit allowable for only one of the items, per patient, per calendar year.

Podiatrist

The following items are Medicare eligible for podiatrists:

Item Description
55836 ultrasound ankle or hind foot
55840 ultrasound mid foot or fore foot
55844 ultrasound mass – skin or subcutaneous structures
57521 x-ray ankle, foot, lower leg (below the knee)
57527 x-ray left 2 or more regions (below the knee)
F