Changes to Medicare Funded Knee Imaging Services

Page last updated: 30 October 2018

Knee Imaging - Factsheet (PDF 170 KB)
Knee Imaging - Factsheet (DOC 489 KB)

The Australian Government is introducing changes to Medicare-funded knee imaging, to ensure that these services are aligned with best practice. These changes follow recommendations from the Medicare Benefits Schedule (MBS) Review Taskforce.

What are the changes?

From 1 November 2018, new restrictions will be introduced to limit the ability of general practitioners (GPs) to request knee MRIs for patients 50 years and over (MBS items 63560 & 63561). Specialists will still be able to request knee MRIs for any patient, regardless of the patient’s age. These changes will reduce unnecessary MRIs and help ensure patients are receiving the right test, at the right place, at the right time.

The current requirement of a mandatory X-ray before an MRI in patients aged less than 16 years of age will be removed, to avoid unnecessary doses of radiation (MBS items 63513 & 63514).

In addition, new items are being introduced to support the ongoing monitoring of computed tomography (CT) and X-ray of the knee. This will help future reviews assess whether these services are being used appropriately.

What does this mean for relevant health professionals?

GPs will not be able to request more than three knee MRIs per patient per annum for patients aged 16-49 and will not be able to refer patients aged 50 years and over for knee MRIs. There will be no change to specialists requesting MRIs for any age group. Providers will need to use new item numbers for knee X-rays and knee CTs.

Why are the changes being made?

The changes were recommended by the MBS Review Taskforce following an extensive period of consultation. The Taskforce is conducting a clinician-led review, and makes recommendations to the Government on how the MBS can be modernised to improve patient safety, support equity of access and reduce waste. Changes to knee imaging services are being introduced to ensure MBS funded knee imaging services are being provided appropriately.

What do I tell patients?

Patients will benefit from receiving recognised best practice knee imaging services. Patients will not undergo unnecessary knee MRIs or exposure to radiation.

Where can I find more information?

Detailed information on the changes can be found on the MBS Online website and by calling the Department of Human Services on 132 150.

New items:

56620

New item

COMPUTED TOMOGRAPHY - scan of knee, without intravenous contrast medium. Payable once only whether one or more attendances are required to complete the service, not being a service to which any of items 56619, 56625, 56659 or 56665 apply (R) (K) (Anaes.)

(See para IN.0.19 of explanatory notes to this Category)

Fee: $220.00 Benefit: 75% = $165.00 85% = $187.00

56626

New item

COMPUTED TOMOGRAPHY - scan of the knee, with intravenous contrast medium and with any scans of the knee prior to intravenous contrast injection, when undertaken. Payable once only whether one or more attendances are required to complete the service, not being a service to which any of items 56619, 56625, 56659 or 56665 apply (R) (K) (Anaes.).

(See para IN.0.19 of explanatory notes to this Category)

Fee: $334.65 Benefit: 75% = $251.00 85% = $284.50

56660

New item

COMPUTED TOMOGRAPHY - scan of the knee, without intravenous contrast medium, Payable once only whether one or more attendances are required to complete the service, not being a service to which any of items 56619, 56625, 56659 or 56665 apply (R) (NK) (Anaes.)

(See para IN.0.19 of explanatory notes to this Category)

Fee: $112.10 Benefit: 75% = $84.10 85% = $95.30

56666

New item

COMPUTED TOMOGRAPHY - scan of knee, with intravenous contrast medium, and with any scans of the knee prior to intravenous contrast injection, when performed. Payable once only whether one or more attendances are required to complete the service, not being a service to which any of items 56619, 56625, 56659 or 56665 apply (R) (NK) (Anaes.)

(See para IN.0.19 of explanatory notes to this Category)

Fee: $167.40 Benefit: 75% = $125.55 85% = $142.30

57522

New item

Knee (NR)(K)

(See para IN.0.19 of explanatory notes to this Category)

Fee: $32.50 Benefit: 75% = $24.40 85% = $27.65

57523

New item

Knee (R)(K)

(See para IN.0.19 of explanatory notes to this Category)

Fee: $43.40 Benefit: 75% = $32.55 85% = $36.90

57537

New item

Knee (NR)(NK)

(See para IN.0.19 of explanatory notes to this Category)

Fee: $16.25 Benefit: 75% = $12.20 85% = $13.85

57540

New item

Knee (R)(NK)

(See para IN.0.19 of explanatory notes to this Category)

Fee: $21.70 Benefit: 75% = $16.30 85% = $18.45