Appendix A                     Full list of items: Recommendations list

Table A: MRI of the knee

Item

Item Description

Recommendation

Page reference

63328

NOTE: Benefits are payable for each service included by Subgroup 12 on three occasions only in any 12 month period

MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician – scan of musculoskeletal system for:

­ derangement of knee or its supporting structures (R) 

No change

18

63343

NOTE: Benefits are payable for each service included by Subgroup 12 on three occasions only in any 12 month period

MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician – scan of musculoskeletal system for:

– derangement of knee or its supporting structures (R) (NK)

No change

18

63513

SUBGROUP 33- MAGNETIC RESONANCE IMAGING – FOR SPECIFIED CONDITIONS – PERSON UNDER THE AGE OF 16YRS

referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of knee for a patient under 16 years following radiographic examination for internal joint derangement (R) (Contrast) (Anaes.)

Change

18

63514

SUBGROUP 33- MAGNETIC RESONANCE IMAGING – FOR SPECIFIED CONDITIONS – PERSON UNDER THE AGE OF 16YRS

referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of knee for a patient under 16 years following radiographic examination for internal joint derangement (R) (NK) (Contrast) (Anaes.)             

Change

18

63560

SUBGROUP 34 – MAGNETIC RESONANCE IMAGING – FOR SPECIFIED CONDITIONS

referral 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.)

Change

19


63561

SUBGROUP 34 – MAGNETIC RESONANCE IMAGING – FOR SPECIFIED CONDITIONS

referral 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.)

Change

19

 

Table B: Ultrasound of the knee

Common MBS item descriptor

Note: Benefits are only payable when referred based on the clinical indicators outlined in the item descriptions. Benefits are not payable when referred for non-specific knee pain alone or other knee condition including:

– meniscal and cruciate ligament tears

– assessment of chondral surface

KNEE, 1 or both sides, ultrasound scan of, where:

(a)  the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and

(b)  the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member,

and 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.

Item

Specifier

Recommendation

Page reference

55828

R

Change

25

55829

R NK

Change

25

55830

NR

Change

25

55831

NR NK

Change

25

 


Table C: X-ray of the knee

Common MBS item descriptor

FOOT, ANKLE, LEG, KNEE OR FEMUR

Item

Specifier

Recommendation

Page reference

57518

NR

Change

27

57521

R

Change

27

57535

NR NK

Change

27

57536

R NK

Change

27

Common MBS item descriptor

FOOT AND ANKLE, OR ANKLE AND LEG, OR LEG AND KNEE, OR KNEE AND FEMUR

Item

Specifier

Recommendation

Page reference

57524

NR

Change

27

57527

R

Change

27

57538

NR NK

Change

27

57539

R NK

Change

27

 

Table D: CT of the knee

Common MBS item descriptor

COMPUTED TOMOGRAPHY - scan of extremities, 1 or more regions without intravenous contrast medium, payable once only whether 1 or more attendances are required to complete the service (Anaes.)

Item

Specifier

Recommendation

Page reference

56619

R K

Change

29

56659

R NK

Change

29

Common MBS item descriptor

COMPUTED TOMOGRAPHY – scan of extremities, 1 or more regions with intravenous contrast medium and with any scans of extremities prior to intravenous contrast injection, when undertaken; only 1 benefit is payable whether 1 or more attendances are required to complete the service (Anaes.)

Item

Specifier

Recommendation

Page reference

56625

R K

Change

29

56665

R NK

Change

29