Who can request MRI scans

The majority of MRI scans listed on the MBS are only eligible for a Medicare rebate if they are requested by a specialist.  This is because, usually, the types of conditions for which MRI scans are needed should be managed by a specialist. 

There are a small set of MRI items under Medicare that can be requested by a GP, which were established based on expert advice on the clinical appropriateness of the items in the general practice setting.  These items are intended to improve patient access to timely MRI services and reduce patient exposure to unnecessary radiation (associated with some types of diagnostic imaging such as CT (computed tomography) scans).

Difference between full and partial Medicare eligibility

Full Medicare-eligible MRI units are able to perform all MRI services listed on the MBS with a Medicare rebate for the patient.

Partial Medicare-eligible MRI units are currently able to perform a limited number of MRI items listed on the MBS.  These items (listed below) include:

• GP requested items for children under the age of 16 years;
• GP requested items for patients 16 years and over;
• a range of cancer staging services such as MRI of the breast; prostate; and pelvis - for cervical and rectal cancer;
• breast MRI items where conventional imaging has been inconclusive or inconsistent with clinical assessment;
• MRI of the pancreas and biliary tree for suspected pathologies;
• cardiomyopathy MRI items;
• approved Crohn’s disease MRI items; and
• items to evaluate Poly Implant Prothèse (PIP) breast implant integrity.

Any future MRI items listed on the MBS will be able to be provided on partially eligible MRI units.

MBS items eligible on partially eligible machines

The following two tables contain a summary of items that can be provided on MRI units with either partial (or full) Medicare eligibility.  A full description of these items including the specific clinical indications for each item, can be found on the MBS online website, by clicking on the relevant MBS item number in the tables.

Table 1: General Practitioner requested MRI items

MBS Item	Descriptor Summary	Requestor	Provider
63507	MRI of the head – under 16 years	GP	MRI Specialist
63510	MRI of the spine – under 16 years	GP	MRI Specialist
63513	MRI of the knee – under 16 years	GP	MRI Specialist
63516	MRI of the hip – under 16 years	GP	MRI Specialist
63519	MRI of the elbow – under 16 years	GP	MRI Specialist
63522	MRI of the wrist – under 16 years	GP	MRI Specialist
63551	MRI of the head – 16 years and over	GP	MRI Specialist
63554	MRI of the spine (cervical radiculopathy)	GP	MRI Specialist
63557	MRI of the spine (cervical spine trauma)	GP	MRI Specialist
63560	MRI of the knee - 16 to 49 years	GP	MRI Specialist

Note: An MRI Specialist is a person who is a specialist in diagnostic radiology and a participant in RANZCRs’ Quality and Accreditation Program.

Table 2: Specialist requested MBS items

MBS Item	Descriptor Summary	Requestor	Provider
63464	MRI of both breasts for asymptomatic patients less than 50 years	Specialist	MRI Specialist
63467	MRI of both breasts within 12months of abnormality detected in service 63464	Specialist	MRI Specialist
63470	MRI of the pelvis (cervical cancer)	Specialist	MRI Specialist
63473	MRI of the pelvis and abdomen (cervical cancer)	Specialist	MRI Specialist
63476	MRI of the pelvis (rectal cancer)	Specialist	MRI Specialist
63482	MRI of the pancreas and biliary tree	Specialist	MRI Specialist
63487	MRI of the breast/s (occult breast cancer)	Specialist	MRI Specialist
63489	MRI guided breast biopsy	Specialist	MRI Specialist
63740	MRI of the pelvis and upper abdomen (Crohn’s disease)	Specialist	MRI Specialist
63741	MRI enteroclysis for Crohn’s disease)	Specialist	MRI Specialist
63743	MRI pelvis (fistulising Crohn’s disease)	Specialist	MRI Specialist
63395	MRI of the heart (suspected ARVC )	Specialist	MRI Specialist
63397	MRI of the heart (family history of ARVC)	Specialist	MRI Specialist
63547	MRI of the breast (BIA-ALCL)	Specialist	MRI Specialist
63491	MRI modifying item – contrast agent	Specialist	MRI Specialist
63494	MRI modifying item – sedation	Specialist	MRI Specialist
63497	MRI modifying item – anaesthetic	Specialist	MRI Specialist
63531	MRI of both breasts to detect breast cancer where conventional imaging is inconclusive.	Specialist	MRI Specialist
63533	MRI of both breasts following breast cancer diagnosis, where there is a discrepancy between clinical assessment and conventional imaging.	Specialist	MRI Specialist
63541	Multiparametric MRI of the prostate for the detection of cancer (suspected cancer)	Specialist	MRI Specialist
63543	Multiparametric MRI of the prostate for the detection of cancer (confirmed diagnosis)	Specialist	MRI Specialist
63545	MRI of the liver for patients with colorectal carcinoma with known, suspected or possible liver metastases for characterisation or intervention planning	Specialist	MRI Specialist
63546	MRI of the liver for patients with known or suspected hepatocellular carcinoma for diagnosis or staging	Specialist	MRI Specialist
63496	Hepatobiliary specific contrast agent - for use with 63545 and 63546	Specialist	MRI Specialist
63454	MRI of pelvis or abdomen, for suspected fetal CNS abnormality (gestation of 18 weeks or after)	Specialist	MRI Specialist

Notes: An MRI Specialist is a person who is a specialist in diagnostic radiology and a participant in RANZCRs’ Quality and Accreditation Program. For items 63395 to 63398 an MRI specialist is a specialist in diagnostic radiology or a consultant physician, and is recognised by the Conjoint Committee for Certification in Cardiac MRI.

A specialist requestor is a medical specialist or consultant physician (other than a specialist radiologist) who determined that the service was necessary and whose patient the person was, consistent with requirements of the specific items. For items 63541 and 65543 a specialist requestor must be a urologist, radiation oncologist or medical oncologist. For item 63454 a specialist requestor is a specialist practicing in the speciality of obstetrics.

Items relating to breast implants manufactured by Poly Implant Prothèse (PIP)

The summary of items in table 3 were established following the TGA recall of silicone-filled breast implants manufactured by the French company Poly Implant Prothèse (PIP) in 2012. These MRI items are to evaluate the integrity of the PIP implants and detect implant rupture in patients presenting with symptoms. These items are eligible for a Medicare rebate when provided on any DIAS-accredited MRI unit, with or without Medicare eligibility.

Table 3: Breast MRI items associated with PIP implants

MBS Item	Descriptor Summary	Requestor	Provider
63501	MRI of the Breast for evaluation of PIP/suspected PIP implant integrity, where results show loss of integrity	Any Medical Practitioner	MRI Specialist
63502	MRI of the Breast MRI of the Breast for evaluation of PIP/suspected PIP implant integrity, where result doesn’t show loss of integrity	Any Medical Practitioner	MRI Specialist
63504	MRI of the Breast for evaluation of PIP/suspected PIP implant integrity, where rupture is suspected, and results show a loss of integrity	Any Medical Practitioner	MRI Specialist
63505	MRI of the Breast for evaluation of PIP/suspected PIP implant integrity, where rupture is suspected, and result doesn’t show a loss of integrity	Any Medical Practitioner	MRI Specialist
63498	PIP Modifying item - sedation	Any Medical Practitioner	MRI Specialist
63499	PIP Modifying item - anaesthetic	Any Medical Practitioner	MRI Specialist

Note: An MRI Specialist is a person who is a specialist in diagnostic radiology and a participant in RANZCRs’ Quality and Accreditation Program.