NEW MEDICARE ITEMS - MRI SERVICES FOR PATIENTS WITH PIP IMPLANTS
From 12 March 2012, four 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.
The item numbers, item descriptors and schedule fee are shown in the table below.
There are some important differences between the requirements for these new items and 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 PIP branded implant when referring their patients for these Medicare rebated MRI services, and indicate whether the patient has presented with symptoms of a 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.
New modifying Items
Two new modifying items have been created for use (where applicable) with the new MRI items, where there is a need for sedation or anaesthetic.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.
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.For further information visit the Department of Health and Ageing website at: www.health.gov.au
Item descriptors – MRI of the breast to evaluate PIP breast implant
| Item | Service |
 | Subgroup 32 – Magnetic resonance imaging – PIP breast implant |
| 63501 | MRI – scan of one or both breasts for the evaluation of implant integrity where: (a) a dedicated breast coil is used; and (b) the request for the scan identifies that the patient: (i) has or is suspected of having a silicone breast implant manufactured by Poly Implant Prosthese (PIP); and (ii) the result of the scan confirms a loss of integrity of the implant (R) Note: Benefits are payable on one occasion only in any 12 Month Period Fee: $500.00 Benefit: 75% = $375.00 85%= $426.30 |
| 63502 | MRI – scan of one or both breasts for the evaluation of implant integrity where: (a) a dedicated breast coil is used; and (b) the request for the scan identifies that the patient: (i) has or is suspected of having a silicone breast implant manufactured by Poly Implant Prosthese (PIP); and (ii) the result of the scan does not demonstrate a loss of integrity of the implant (R) Note: Benefits are payable on one occasion only in any 12 Month Period Fee: $500.00 Benefit: 75% = $375.00 85%= $426.30 |
| 63504 | MRI – scan of one or both breasts for the evaluation of implant integrity where: (a) a dedicated breast coil is used; and (b) the request for the scan identifies that the patient: (i) has or is suspected of having a silicone breast implant manufactured by Poly Implant Prosthese (PIP); and (ii) presents with symptoms where implant rupture is suspected; and (iii) the result of the scan confirms a loss of integrity of the implant (R) Fee: $500.00 Benefit: 75% = $375.00 85%= $426.30 |
| 63505 | MRI – scan of one or both breasts for the evaluation of implant integrity where: (a) a dedicated breast coil is used; and (b) the request for the scan identifies that the patient: (i) has or is suspected of having a silicone breast implant manufactured by Poly Implant Prosthese (PIP); and (ii) presents with symptoms where implant rupture is suspected; and (iii) the result of the scan does not demonstrate a loss of integrity of the implant (R) Fee: $500.00 Benefit: 75% = $375.00 85%= $426.30 |
| Subgroup 22 – Modifying items |
| 63498 | MRI service to which item 63501, 63502, 63504 or 63505 applies if: (a) the service is performed in accordance with the determination; and (b) the service is performed on a person using intravenous or intra muscular sedation Fee: $44.80 Benefit: 75% = $33.60 85%= $38.10 |
| 63499 | MRI service to which item 63501, 63502, 63504 or 63505 applies if: (a) the service is performed in accordance with the determination; and (b) the service is performed on a person under anaesthetic in the presence of a medical practitioner who is qualified to perform an anaesthetic. Fee: $156.80 Benefit: 75% = $117.60 85%= $133.30 |
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The May 2013 Medicare Benefits Schedule
The March 2013 Medicare Benefits Schedule
The January 2013 Medicare Benefits Schedule
The December 2012 Medicare Benefits Schedule
The November 2012 Medicare Benefits Schedule
The July 2012 Medicare Benefits Schedule - incorporating 1 August 2012 amendment