Referral guidelines

MRI – specialists

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)
63010 stereotactic scan of brain, with Fiducials in place, for planning for stereotactic neurosurgery
(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 infection 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
(2 per year)
  *Limitation is 3 for each side in 12 months
  Cardiovascular system
63385 congenital disease of the heart or a great vessel
(2 per year)
63388 tumour of the heart or a great vessel
(2 per year)
63391 abnormality of thoracic aorta
(2 per year)
63395

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)

63397

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)

  Cardiovascular system MRA
63401 vascular abnormality with a previous anaphylactic reaction to an iodinated contrast medium
(3 per year)
63404 obstruction of the superior vena cava, inferior vena cava or a major pelvic vein
(3 per year)
  Paediatric (<16yrs) MRA
63416 the vasculature of limbs prior to limb or digit transfer surgery in congenital limb deficiency syndrome
(1 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)
63443 mediastinal mass
(unlimited)
63447 pelvic or abdominal mass
(unlimited)
63449 congenital uterine or anorectal abnormality
(unlimited)
  Body scan
63461 adrenal mass in a patient with malignancy which is otherwise resecetable
(1 per year)
  Body scan - both breasts
63531

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

63533

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

63464 scan of both breast for the detection of cancer where;
  • a dedicated breast coil is used; and
  • the request for scan identifies that the woman is asymptomatic and <50 years of age; and
  • the request for scan identifies either:
    • that the patient is at high risk of developing breast cancer, due to 1 of the following:
      • 3 or more first or second degree relatives on the same side of the family diagnosed with breast or ovarian cancer;
      • 2 or more first or second degree relatives on the same of the family diagnosed with breast or ovarian cancer, if any of the following applies to at least 1 of the relatives:
        • has been diagnosed with bilateral breast cancer;
        • had onset of breast cancer before the age of 40 years;
        • had onset of ovarian cancer before the age of 50 years;
        • has been diagnosed with breast and ovarian cancer, at the same time or at different times;
        • has Ashkenazi Jewish ancestry;
        • is a male relative who has been diagnosed with breast cancer;
      • 1 first or second degree relative diagnosed with breast cancer at age 45 years or younger, plus another first or second degree relative on the same side of the family with bone or soft tissue sarcoma at age 45 years or younger; or
    • that genetic testing has identified the presence of a high risk breast cancer gene mutation.

(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
63501 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
    • the result of the scan confirms a loss of integrity of the implant (R)

(1 per year)

63502 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
    • the result of the scan does not demonstrate a loss of integrity of the implant (R)

(1 per year)

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)
63547

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

NOTE: benefits are payable once in a patient's lifetime (R) (K) (Contrast) (Anaes.)
63487

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)

63489 

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.) 

  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:

(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

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.
  Prostate
63541

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:

  1. A digital rectal examination (DRE) which is suspicious for prostate cancer; or
  2. In a person less than 70 years, at least two prostate specific antigen (PSA_ tests performed within an interval of 1-3 months are greater than 3.0 ng/ml, and the free/total PSA ratio is less than 25% or the repeat PSA exceeds 5.5 ng/ml; or
  3. In a person aged less than 70 years, whose risk of developing prostate cancer based on a family history is at least double the average risk, at least two PSA tests performed within an interval of 1-3 month, are greater than 2.0 ng/ml, and the free/total PSA ratio is less than 25%; or
  4. In a person aged 70 years or older, at least two PSA tests performed within an interval of 1-3 months are greater than 5.5 ng/ml and the free/total PSA ratio is less than 25%.

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

63543

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.

  Liver
63545 Patients with colorectal carcinoma with known, suspected or possible liver metastases for the purpose of characterisation or intervention planning where the patient has had a mass lesion detected on previous CT scanning or ultrasound
63546

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

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