MRI – specialists

MRI scan of the cardiovascular system for assessment of myocardial structure and function involving:

• dedicated right ventricular views; and
• 3D volumetric assessment of the right ventricle; and
• reporting of end‑diastolic and end‑systolic volumes, ejection fraction and BSA‑indexed values;

if the request for the scan indicates that:

• the patient presented with symptoms consistent with arrhythmogenic right ventricular cardiomyopathy (ARVC); or
• investigative findings in relation to the patient are consistent with ARVC

(1 per year)

MRI scan of the cardiovascular system for assessment of myocardial structure and function involving:

• dedicated right ventricular views; and
• 3D volumetric assessment of the right ventricle; and
• reporting of end‑diastolic and end‑systolic volumes, ejection fraction and BSA‑indexed values;

if the request for the scan indicates that the patient:

• is asymptomatic; and
• has one or more first degree relatives diagnosed with confirmed arrhythmogenic right ventricular cardiomyopathy (ARVC)

(Once per 36 months)

MRI of both breasts where the patient has a breast lesion, the results of conventional imaging examinations are inconclusive for the presence of breast cancer, and biopsy has not been possible

MRI of both breasts where the patient has been diagnosed with breast cancer, discrepancy exists between clinical assessment and conventional imaging assessment, and the results of breast MRI may alter treatment planning

• 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)

• 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
  • the result of the scan confirms a loss of integrity of the implant (R)

(1 per year)

• 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
  • the result of the scan does not demonstrate a loss of integrity of the implant (R)

(1 per year)

• 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)

• 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)

MRI scan of both breasts for the detection of cancer, if

(a) a dedicated breast coil is used; and

(b) the request for the scan identifies that: (i)the patient has a breast implant in situ; and (ii) anaplastic large cell lymphoma has been diagnosed

MRI—performed under the professional supervision of an eligible provider at an eligible location, if:

(a) the patient is referred by a specialist or a consultant physician; and
(b) a dedicated breast coil is used; and
(c) the request for the scan identifies that:
(i) the patient has been diagnosed with metastatic cancer restricted to the regional lymph nodes; and
(ii) clinical examination and conventional imaging have failed to identify the primary cancer (R) (K) (Anaes)

MRI-guided biopsy, performed under the professional supervision of an eligible provider at an eligible location, if:

(a) the patient is referred by a specialist or a consultant physician; and
(b) a dedicated breast coil is used; and
(c) the request for the scan identifies that:
(i) the patient has a suspicious lesion seen on MRI but not on conventional imaging; and
(ii) the lesion is not amenable to biopsy guided by conventional imaging; and
(d) a repeat ultrasound scan of the affected breast is performed:
(i) before the guided biopsy is performed; and
(ii) as part of the service under this item (R) (K) (Anaes.)

• 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)

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)

• 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)

(a) sub‑fertility that requires one or more of the following:

(i) an investigation of suspected Mullerian duct anomaly seen in pelvic ultrasound or hysterosalpingogram;

(ii) an assessment of uterine mass identified on pelvic ultrasound before consideration of surgery;

(iii) an investigation of recurrent implantation failure in IVF (2 or more embryo transfer cycles without viable pregnancy); or

(b) surgical planning of a patient with known or suspected deep endometriosis involving the bowel, bladder or ureter (or any combination of the bowel, bladder or ureter), where the results of pelvic ultrasound are inconclusive

Applicable not more than once in a 2 year period (R) (Contrast)

suspected biliary or pancreatic pathology
(3 per year)

Pelvis and upper abdomen - for specified conditions (Crohn's Disease)

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

(a) Evaluation of disease extent at time of initial diagnosis of Crohn’s disease
(b) Evaluation of exacerbation/suspected complications of known Crohn’s disease
(c) Evaluation of known or suspected Crohn’s disease in pregnancy
(d) Assessment of change to therapy in patients with small bowel Crohn’s disease

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

Diagnosis

Multiparametric Magnetic Resonance Imaging (mpMRI) using a standardised image acquisition protocol involving T2 weighted imaging, Diffusion Weighted Imaging, and Dynamic Contrast Enhancement (unless contraindicated); and
performed under the professional supervision of an eligible provider at an eligible location; and the patient is referred by an urologist, radiation oncologist, or medical oncologist; and
the request specifies that the clinical criteria below are met; and the patient is suspected of having prostate cancer based on:

• for a person 70 years or older, at least two PSA tests performed within an interval of 1- 3 months have a PSA concentration of greater than 5.5 μg/L and the free/total PSA ratio is less than 25%.
• for a person under 70 years, at least two prostate specific antigen (PSA) tests performed within an interval of 1- 3 months have PSA concentration of greater than 3.0 ng/ml, and the free/total PSA ratio is less than 25%, or the repeat PSA exceeds 5.5 μg/L; or
• for a person under 70 years with a relevant family history, at least two PSA tests performed within an interval of 1- 3 months have a PSA concentration greater than 2.0 ng/ml, and the free/total PSA ratio is less than 25%, or the repeat PSA exceeds 5.5 μg/L. Relevant family history is a first degree relative with or has had prostate cancer, or suspected of carrying a BRCA 1 or BRCA 2 mutation. Benefits for this item are payable once only in a 12 month period.

Scan of the prostate for:
- detection of cancer (R)

Note: benefits are payable on one occasion only in any 12 month period.

Relevant family history is first degree relative with prostate cancer or suspected of carrying a BRCA

1. BRCA 2 mutation

Active Surveillance

Multiparametric Magnetic Resonance Imaging (mpMRI) using a standardised image acquisition protocol involving T2 weighted imaging, Diffusion Weighted Imaging, and Dynamic Contrast Enhancement (unless contraindicated); and
performed under the professional supervision of an eligible provider at an eligible location; and the patient is referred by an urologist, radiation oncologist, or medical oncologist; and
the request specifies that the clinical criteria below are met;

a) the patient is under active surveillance following a confirmed diagnosis of prostate cancer by the biopsy histopathology; and
b) The patient is not planning or undergoing treatment for prostate cancer

Scan of the prostate for:
- detection of cancer (R)

Note: benefits are payable at the time of diagnosis of prostate cancer, 12 months following diagnosis and then every 3rd year thereafter or at any time, if there is any concern clinically or with PSA progression. This item is not to be used for the purposes of treatment planning or for monitoring after treatment.

Patients with known or suspected hepatocellular carcinoma for the purposes of diagnosis or staging where the patient:

• has pre-existing chronic liver disease, confirmed by a specialist; and
• has an identified hepatic lesion over 10mm in diameter and
• has been assessed as having a Child-Pugh class A or B liver function

Whole-body