Cone beam computed tomography (CBCT) Medicare items fact sheet

About cone beam computed tomography (CBCT) Medicare items - their indications, usage and how to comply.

Page last updated: 02 June 2015

From 1 November 2014, cone beam computed tomography (CBCT) dental items 56025 and 56026 have been replaced with items 57362 and 57363

What are the indications, fees and benefits associated with the new items?


Group I2 – Computed Tomography
MBS item numbers Health service Fee
57362

Cone beam computed tomography – dental and temporo-mandibular joint imaging (without contrast medium) for diagnosis and management of any of the following:
  1. mandibular and dento-alveolar fractures;
  2. dental implant planning;
  3. orthodontics;
  4. endodontic conditions;
  5. periodontal conditions;
  6. temporo-mandibular joint conditions.
Payable once per patient per day, not being for a service to which any of items 57959 to 57969  apply, and not being a service associated with another service in Group I2 (R) (K) (Anaes.)
$113.15
57363 Cone beam computed tomography – dental and temporo-mandibular joint imaging (without contrast medium) for diagnosis and management of any of the following:
  1. mandibular and dento-alveolar fractures;
  2. dental implant planning;
  3. orthodontics;
  4. endodontic conditions;
  5. periodontal conditions;
  6. temporo-mandibular joint conditions.
Payable once per patient per day, not being for a service to which any of items MBS items 57959 to 57969 apply, and not being a service associated with another service in Group I2 (R) (NK) (Anaes.)
$ 56.60


What are the restrictions under the new items, and why have they been applied?

As recommended by the Medical Services Advisory Committee (MSAC), the new items will be accompanied by a range of restrictions to encourage the judicious use of CBCT in order to optimise the safety and quality of services.

Multiple claiming during the same attendance

Claims for more than one CBCT per day are not permitted; claiming for two-dimensional imaging in the same attendance (items 57959 to 57969) and with CT in the same attendance (items 56001 to 57361) are also excluded.

Why? Data showed that there was a high level of claiming of CBCT items with other panoramic radiography services and additional CBCT scan/s during a single episode of care. Given safety concerns at the increased radiation exposure to patients, and the lack of a demonstrated clinical justification, MSAC recommended that claiming of multiple services should be precluded.

CBCT scans can be requested by Medicare-eligible medical practitioners and specialist dentists

General dentists can no longer request CBCT services under Medicare.

Why? MSAC concluded that CBCT should have the same restrictions that apply for CT items and should therefore be restricted to dental specialists. Medical practitioners can request any CT service.
Services must be performed on dedicated CBCT units

Services performed on hybrid units are excluded under the new arrangements.

Why? MSAC noted that multiple scans are often required when CBCT services are performed on equipment with a fixed or narrow field of view, which is a common limitation of hybrid CBCT units. Given concerns at over-servicing and exposure of patients to unnecessary levels of radiation, MSAC recommended that hybrid CBCT units be excluded under the new arrangements.
    Services must be delivered in practices accredited under the Diagnostic Imaging Accreditation Scheme

    CBCT services under Medicare can no longer be performed in practices that are not Diagnostic Imaging Accreditation Scheme (DIAS) accredited.

    Why? Given the range of safety and quality issues associated with CBCT services MSAC recommended that claims for CBCT should be restricted to DIAS-accredited practices, noting that DIAS is the primary quality assurance scheme in diagnostic imaging.

    The Diagnostic Imaging Accreditation Scheme (DIAS)

    DIAS is a mandatory scheme, established via a 2007 amendment to the Health Insurance Act 1973, that links accreditation to the payment of Medicare benefits for diagnostic imaging services. DIAS commenced operations in 2008, and is a key mechanism in Australia for ensuring minimum safety and quality standards in diagnostic imaging practices.

    Further information about DIAS, and how practices can become accredited, is available at the Diagnostic Imaging Accreditation Scheme page on this website.

    Compliance with the restrictions

    Compliance with the new restrictions will be managed by the Department of Human Services. Claims must be in compliance with the restrictions in order to receive reimbursement under Medicare.