Limitation of items - certain attendances by diagnostic imaging providers
Explanatory note · departmental guidance
Consultations rendered by specialist radiologists
Medicare benefits are not payable for items 52, 53, 54, 57, 151, 104 and 105 when claimed by a specialist radiologist in association with any of the following diagnostic imaging items:
(a) an item in Subgroup 6 of Group I1;
(b) an item in any of Subgroups 1 to 7 of Group I3;
(c) items 58900 and 58903 in Subgroup 8 of Group I3; and
(d) item 59103 in Subgroup 9 of Group I3.
Consultations rendered in association with magnetic resonance imaging (MRI) services - Group I5
Medicare benefits are not payable for items 52, 53, 54, 57, 151, 104 and 105 in association with MRI services unless the providing practitioner determines that the consultation is necessary for the treatment or management of the patient's condition.
The restrictions above apply when these services are performed by the same practitioner, on the same patient, on the same day.