What are the new services?
As of 1 May 2018, Medicare rebates have been available for four new items covering cardiac MRI scans for patients with suspected arrthymogenic right ventricular cardiomyopathy (ARVC) (items 63395 K & 63396 NK) and asymptomatic patients with a family history of ARVC in a first-degree relative (items 63397 K & 63398 NK).
The MBS fee for K items 63395 and 63397 is $855.20. For the NK equivalents, 63396 and 63398, the MBS fee is $427.60. All items include the use of contrast.
Who can provide these services?
These services may be provided by a person who is:
- (a) a specialist in diagnostic radiology or a consultant physician; and
(b) recognised by the Conjoint Committee for Certification in Cardiac MRI.
Who can request these items?
Specialists and consultant physicians are eligible to request these items. General practitioners are not eligible to request these items.
What are the patient eligibility requirements?
These items are only for scans of patients with specified indications. The request form must list the relevant clinical indications.
For MBS items 63395 and 63396 (NK):
- (a) the patient must present with symptoms consistent with ARVC; or
(b) investigative findings in relation to the patient are consistent with ARVC.
For MBS items 63397 and 63398 (NK) the patient:
- (a) must be asymptomatic; and
(b) have one or more first degree relatives diagnosed with confirmed ARVC.
Medicare benefits for MBS items 63395 (K) and 63396 (NK) are payable once per patient in a 12 month period.
Benefits for MBS items 63397 (K) and 63398 (NK) are payable once per patient in a 36 month period.
Where can the procedure take place to be eligible for a Medicare rebate?
A Medicare benefit will only be payable if the service is performed on an eligible MRI unit with either full or partial Medicare eligibility. A complete list of (full and partial) Medicare eligible units is searchable by state and territory and available on this site at MRI unit locations.
- · Cardiac Society of Australia and New Zealand
· The Royal Australian and New Zealand College of Radiologists
See the Medical Services Advisory Committee’s website for more information about the committee’s recommendation to list the service.
Details on these new cardiac MRI items can be viewed at MBS online.