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Diagnostic Imaging

Medicare-Eligible MRI service for Poly Implant Protheses (PIP) breast implants

This website contains information for patients, treating doctors and diagnostic imaging providers regarding the introduction of these new items.

Medicare-Eligible MRI service for PIP breast implants

From 12 March 2012, new MRI items will be available for the evaluation of the integrity of breast implants known or suspected to have been manufactured by Poly Implant Protheses (PIP), a French company.

Information for Patients

Do you have a PIP breast implant?

If you have a PIP implant or are unsure about the brand of your implant you are strongly encouraged to seek advice from your medical practitioner to seek a clinical assessment. This assessment may include a referral for an MRI scan.

Yes, I have (or think I have) a PIP breast implant, what next?

As of Monday, 12 March 2012 you will have access to one Medicare rebated MRI scan within the next 12 months, to evaluate the integrity of your implant. If you develop symptoms of implant rupture you will also be able to receive a Medicare rebate for MRI, regardless of whether or not you have previously had a normal MRI.

If you are referred for an MRI, you will require a referral from your specialist or GP, that states you have or are suspected of having a PIP branded implant. If you have symptoms of a rupture, your GP or Specialist must also note this on your referral.

Where can I have my MRI scan?

You can have your MRI scan on any MRI machine that has a dedicated breast coil and is accredited to provide Diagnostic Imaging Services. A list of Diagnostic Imaging Practices that provide breast MRI services is available below. This list will be updated regularly as other DI practices/locations are identified.

List of Diagnostic Imaging Practices that provide breast MRI services. (PDF 31 KB)

When making an appointment to have your MRI scan you should check if the provider has a dedicated breast coil, as not all MRI providers have dedicated breast coils. Your MRI scan must also be provided by a specialist radiologist.

MRI providers will be able to provide you with detailed information regarding the scan and what the use of a breast coil involves.

It is important to note that you can currently take a request form for a diagnostic imaging service to any accredited diagnostic imaging provider. Patients are not compelled to take the request for the service to the provider stated on the referral form and both private imaging practices and many public hospitals provide diagnostic imaging Medicare services. You may also wish to discuss your concerns with your Specialist or GP at the time the diagnostic imaging request is made.

Can my MRI scan be bulk billed or do I have to pay?

Medicare rebates apply to the new PIP MRI items. The schedule fee for the PIP MRI services has been set at $500 per item.

The Government encourages bulk billing, but it is at the provider’s discretion whether or not to bulk bill. There are bulk billing incentives for diagnostic imaging services, including these new MRI services. Medical practitioners, including radiologists, are free to set their own value on the services they provide. While the Government is responsible for setting the schedule fee on which Medicare benefits are based, there is nothing to prevent radiologists or any other medical practitioner setting fees that exceed those in the schedule. In these circumstances, you may be required to pay the gap between the fee charged and the Medicare rebate.

Breast Implant Information Line - 1800 217 257

The Australian Government has set up a free-call help line for individuals concerned about breast implants. The help line can be called 24 hours a day.

If you are a diagnostic imaging provider and have questions regarding the new items, please contact the MRI hotline on (02) 6289 9100 during normal business hours or via email to MRI@health.gov.au

Information for Diagnostic Imaging Providers

The item numbers, item descriptors and schedule fee for the Medicare rebateable PIP MRI items are available on the MBSonline website.

There are some important differences between the requirements for these new items, compared to existing Medicare rebated MRI items.

Referral to PIP MRI services

These items will be accessed by referral from a specialist or consultant physician, as is the case for other MRI services. However, these items will also be able to be accessed by referral from a GP.

For a number of reasons patients may not have access to a specialist therefore GP referral will help to ensure that affected patients have timely access to MRI services, and allow patients with normal results to be managed in the primary care setting.

Both Specialists and General Practitioners will need to identify that their patient is known or suspected of having a PIP branded implant when referring their patients for these Medicare rebated MRI services, and if the patient has presented with symptoms of an implant rupture.

Access to MRI Services

The requirements for these items are different from existing MRI services.
Items 63501, 63502, 63504 and 63505 may be provided on Medicare-eligible and Medicare-ineligible MRI units (providing they use a dedicated breast coil), as long as the service is provided within an imaging practice which is accredited under the Diagnostic Imaging Accreditation Scheme.
Items 63501, 63502, 63504 and 63505 must be provided by a specialist radiologist.

Item number selection and scan results

To assist in gathering data about the rate of actual ruptures of PIP implants, radiologists and imaging practices are asked to claim an item number that indicates whether or not the MRI scan shows loss of integrity of the implant. This will provide data to assist in appropriate future support and management of these patients.

New modifying Items

Two new modifying items have been created for use (where applicable) with the new MRI items.

These items can only be claimed in association with items 63501, 63502, 63504 or 63505.

Items 63498 and 63499 must be provided in the presence of a medical practitioner who is qualified to perform an anaesthetic.

Media release from The Hon Tanya Plibersek MP, Minister for Health

Women with PIP breast implants to receive subsidised MRI scans