Medicare and billing
information | Fulfilling
Medicare Criteria
At Clarity® we are committed to providing affordable and accessible diagnostic imaging for all our patients.
Bulk billing is available for Medicare eligible* x-rays and CT examinations, as well as for pension and healthcare card holders. A small out-of-pocket fee may apply to some other services in order to bridge the gap between the Medicare rebate and the actual cost of providing quality services with up-to-date technology and highly skilled professionals. Any cost for services will be outlined at the time of booking your appointment. Please contact our reception staff if you have any questions.
Medicare Eligible Services- Referrer Information
Various procedures require specific indications or criteria in order to attract a Medicare rebate. Please see a summary below as a guide or refer to the MBS. If you have any further questions about the eligibility of a request please contact our reception staff.
CT Colonography
Only available for exclusion of colorectal neoplasia in symptomatic or high-risk patients if:
i) the patient has had an incomplete colonoscopy in the prior 3 months (date of incomplete colonoscopy must be provided on the referral form)
ii) the patient is contraindicated for colonoscopy due to high grade obstruction
iii) the patient is referred by a specialist or consultant physician who performs colonoscopies
This service is only rebatable once in a 36-month period.
Bone Mineral Densitometry (BMD)
BMD by qCT (Quantitative CT) is available for those patients who are over 70 years old and satisfy one of the following:
i) Has NOT had previous bone densitometry within the last 5 years
OR
ii) The t-score for the patient’s bone mineral density is -1.5 or more. Rebatable once only in a 5 year period
OR
iii) The t-score for the patient’s bone mineral density is less than -1.5 but more than -2.5. Rebatable once only in a 2-year period.
MSK Ultrasound
Shoulder
Medicare benefits are NOT payable when referred for non-specific shoulder pain alone.
In order for your patient to be eligible for a Medicare rebate or bulk billing the HIC requires that a shoulder ultrasound be performed 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, subscapularis, supraspinatus, infraspinatus); or
- biceps subluxation; or
- capsulitis and bursitis; or
- evaluation of mass including ganglion; or
- occult fracture; or
- acromioclavicular joint pathology
Please ensure the referral indicates the relevant clinical indications/ conditions.
Knee
Medicare 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 surfaces
In order for your patient to be eligible for a Medicare rebate or bulk billing the HIC requires that a knee ultrasound be performed 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
Please ensure the referral indicates the relevant clinical indications/ conditions.
Obstetric Ultrasound
Medicare eligible clinical indications are listed in the table below, one of these indications must be recorded on the referral.
In addition, Medicare eligible services are restricted on repeat examinations after 17 weeks gestational age. As a general rule after the 12 week scan a General Practitioner can only refer for one examination at 19-20 weeks and then one scan at greater than 23 weeks, with one of the clinical indications listed below.
Subsequent scans in the second and third trimester will only attract a Medicare rebate where the referring medical practitioner is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (FRANZCOG).
| Medicare Eligible – Obstetric Indications | ||
| First Trimester / NT scan | Any Trimester | Third Trimester |
| risk of fetal abnormality | diabetes mellitus | fetal anatomy /incomplete mid-trimester scan |
| uncertain dates | hypertension | malpresentation |
| high risk pregnancy | maternal infection | cervical assessment |
| risk of miscarriage | abdominal pain or mass | previous complicated delivery |
| suspicion of ectopic pregnancy | toxaemia of pregnancy | uterine scar assessment |
| hyperemesis gravidarum | liver or renal disease | uterine fibroid |
| suspected or known uterine abnormality | autoimmune disease | previous fetal death in utero or neonatal death |
| poor obstetric history | cardiac disease | premature labour |
| previous caesarean section | alloimmunisation | prolonged pregnancy |
| previous post dates delivery | drug dependency | trauma |
| suspected or known cervical incompetence | previous spinal or pelvic trauma or disease | known or suspected fetal abnormality or fetal cardiac arrhythmia |
| diminished symptoms of pregnancy | pregnancy after assisted reproduction | clinical suspicion of placental or umbilical cord abnormality |
| inflammatory bowel disease | clinical suspicion of amniotic fluid abnormality | |
| bowel stoma | clinical suspicion of intrauterine growth retardation | |
| significant maternal obesity | antepartum haemorrhage | |
| advanced maternal age | reduced fetal movements | |
| abdominal wall scarring | abnormal cardiotocography | |
| thrombophilia | clinical suspicion of macrosomia | |
| suspected fetal death | ||
| fetal infection | ||
Allied Health Referrers
Dentists:
- OPG and Lateral Cephalometry
- X-rays
Podiatrists
X-Ray:
- Foot
- Ankle
- Leg
- Knee
- Femur
Ultrasound:
- Ankle
- Foot
- Skin/ Lump
Physiotherapists/ Chiropractors and Osteopaths
X-Ray:
- Hip
- Pelvis
- Cervical, thoracic, lumbosacral spine
