Medicare Guidelines

A partial Medicare rebate applies when any of the following features are present and stated on the request form.

• Hyperemesis gravidarum
• Risk of fetal abnormality
• Previous post dates delivery
• Abdominal wall scaring
• Inflammatory bowel disease
• Advanced maternal age
• Toxaemia of pregnancy
• Significant maternal obesity
• Previous caesarean section
• Suspicion of ectopic pregnancy
• Previous spinal or pelvic trauma or disease
• Pregnancy after assisted reproduction
• Suspected or known uterine abnormality
• Suspected or known cervical incompetence
• Diabetes mellitus
• Hypertension
• Autoimmune disease
• Alloimmunisation
• Maternal infection
• Bowel stoma
• Drug dependency
• Thrombophilia
• Abdominal pain or mass
• Liver or renal disease
• Risk of miscarriage
• High risk pregnancy
• Uncertain dates
• Cardiac disease
• Poor obstetric history
• Diminished symptoms of pregnancy

Medicare has rules that apply to rebates for shoulder and knee Ultrasound examinations. Medicare will only provide a rebate when the request form specifically includes one of the following suspected pathologies:

Shoulder/Upper Arm, one or both
• Evaluation of injury to tendon, muscle or tendon/muscle junction including tears,
calcification or tendinosis
• Rotator cuff tear/calcification/tendinosis of biceps, subscapular supraspinatus or
infraspinatus
• Biceps subluxation
• Capsulitis and bursitis
• Evaluation of mass, including ganglion
• Occult fracture
• Acromioclavicular joint pathology

Benefits are not payable when referred for non-specific shoulder pain alone

Knee, one or both
• Abnormality of tendons or bursae about the knee
• Meniscal cyst, popliteal fossa cyst, mass or pseudomass
• Nerve entrapment, nerve or nerve sheath tumor
• Injury of collateral ligaments
Benefits are not payable when referred for non-specific knee pain alone or other
knee conditions including:
• Meniscal or cruciate ligament tears

Medicare has set strict rules that apply to rebates for patients referred by Physiotherapists, Chiropractors and Osteopaths. Your patient may be eligible for a Medicare rebate for the following radiographic requests with corresponding item numbers.57712 X-ray of the hip joint

57712 X-ray of the hip joint

57715 X-ray of the pelvic girdle

58100 X-ray of the cervical spine
58103 X-ray of the thoracic spine
58106 X-ray of the lumbosacral spine
58109 X-ray of the sacrum / coccyx
58112 X-ray of two regions of the spine
58120 X-ray of four regions of the spine
• cervical, thoracic, lumbosacral, sacrococcygeal
58121 X-ray of three regions of the spine
• cervical, thoracic, lumbosacral

Medicare has set strict rules that apply to rebates for patients referred by Chiropractors. Your patient may be eligible for a Medicare rebate for the following radiographic requests with corresponding item numbers.

57712 X-ray of the hip joint
57715 X-ray of the pelvic girdle
58100 X-ray of the cervical spine
58103 X-ray of the thoracic spine
58106 X-ray of the lumbosacral spine
58109 X-ray of the sacrum / coccyx
58112 X-ray of two regions of the spine

Medicare has set strict rules that apply to rebates for patients referred by Podiatrists. Your patient may be eligible for a Medicare rebate for the following radiographic and ultrasound requests with corresponding item numbers.

57521 X-ray of the foot, ankle, femur, leg or knee
57527 X-ray of the foot and ankle
X-ray of the ankle and leg
X-ray of the knee and leg
X-ray of the knee and femur
55836 Ultrasound of the ankle or hind foot
55840 Ultrasound of the mid or forefoot
55844 Ultrasound to assess a mass of the skin or subcutaneous tissues and not
associated with the musculoskeletal system