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Medicare and billing
information | Fulfilling
Medicare Criteria

At Clarity® we are committed to providing affordable and accessible diagnostic imaging for all our patients.

medicare logoBulk 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 are those which attract a rebate if they satisfy the strict criteria set by the Federal Government in the Medicare Benefits Schedule (MBS).

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.

  1. CT Colonography
  2. Bone Mineral Densitometry (BMD)
  3. MSK Ultrasound – Shoulders and Knees 
  4. Obstetric Ultrasound and Nuchal Translucency 
  5. Allied health requests

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 scanAny TrimesterThird Trimester
risk of fetal abnormalitydiabetes mellitusfetal anatomy /incomplete mid-trimester scan
uncertain dateshypertensionmalpresentation
high risk pregnancymaternal infectioncervical assessment
risk of miscarriageabdominal pain or massprevious complicated delivery
suspicion of ectopic pregnancytoxaemia of pregnancyuterine scar assessment
hyperemesis gravidarumliver or renal diseaseuterine fibroid
suspected or known uterine abnormalityautoimmune diseaseprevious fetal death in utero or neonatal death
poor obstetric historycardiac diseasepremature labour
previous caesarean sectionalloimmunisationprolonged pregnancy
previous post dates deliverydrug dependencytrauma
suspected or known cervical incompetenceprevious spinal or pelvic trauma or diseaseknown or suspected fetal abnormality or fetal cardiac arrhythmia
diminished symptoms of pregnancypregnancy after assisted reproductionclinical suspicion of placental or umbilical cord abnormality
 inflammatory bowel diseaseclinical suspicion of amniotic fluid abnormality
 bowel stomaclinical suspicion of intrauterine growth retardation
 significant maternal obesityantepartum haemorrhage
 advanced maternal agereduced fetal movements
 abdominal wall scarringabnormal cardiotocography
 thrombophiliaclinical suspicion of macrosomia
  suspected fetal death
  fetal infection

Allied Health Referrers

Dentists:

  1. OPG and Lateral Cephalometry 
  2. X-rays

Podiatrists
X-Ray:

  1. Foot
  2. Ankle
  3. Leg
  4. Knee
  5. Femur

Ultrasound:

  1. Ankle 
  2. Foot
  3. Skin/ Lump

Physiotherapists/ Chiropractors and Osteopaths
X-Ray:

  1. Hip
  2. Pelvis
  3. Cervical, thoracic, lumbosacral spine
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