MBS billing rules for multiple ultrasound services - Health professionals

Diagnostic Imaging Multiple Services Rules (DIMSR)

There are service rules that determine how we pay Medicare benefits if you provide multiple ultrasound services in the same attendance. Service rules reduce the schedule fee of the diagnostic imaging service if you provided an imaging service with other services.

There are 3 rules, A, B and C, relating to multiple diagnostic imaging services. More than one rule may apply in a patient episode.

Rule A

This applies to a diagnostic imaging service provided with other imaging items from the Diagnostic Imaging Services Table (DIST).

The schedule fee for the diagnostic imaging service with the highest schedule fee is unchanged. The schedule fee for each additional diagnostic imaging service is reduced by $5.

For example, a patient sees you for neck and abdominal ultrasounds, which we’ll call item A and item B. Item B has the highest schedule fee, therefore: B = $109.10, A = $50.65. This is usually $55.65 but is reduced by $5 due to Rule A.

Rule B

This applies to diagnostic imaging services provided with consultation items.

If you provide a patient with at least one R-type diagnostic imaging service and one consultation service on the same day, we’ll reduce your scheduled fees. The schedule fee for the diagnostic imaging service with the highest schedule fee is reduced based on the consultation item with the highest schedule fee.

When the consultation item schedule fee is more than $40, the diagnostic imaging service with the highest schedule fee is reduced by $35.

When the consultation item schedule fee is $15 to $40, the diagnostic imaging service with the highest schedule fee is reduced by $15.

When the consultation item schedule fee is less than $15, the diagnostic imaging service with the highest schedule fee is reduced by the amount of the consultation item schedule fee.

For example, a patient sees you for an abdominal ultrasound, which we’ll call item A, and a consultation which we’ll call item C. As the consultation item C has a schedule fee of $44.35, the ultrasound item schedule fee is reduced to $20.65, from $55.65.

Read more about multiple services rules in Note IN.0.11 on the MBS online website.

Rule C

This applies to a diagnostic imaging service provided with non-consultation items from the MBS.

Non-consultation items from the MBS are:

category 2 items
category 3 items
category 4 items
cleft and craniofacial services.

For example, a patient sees you for an abdominal ultrasound, which we’ll call item D, and a blood volume estimation, which we’ll call item E. The schedule fee for item D is reduced to $107.95, from $112.95.

Rules B and C

This is where both rules B and C apply.

The sum of the deductions in the schedule fee for the diagnostic imaging service with the highest schedule fee must not exceed the original schedule fee. There cannot be a negative schedule fee.

For example, a patient sees you for:

an abdominal ultrasound, which we’ll call item D
a consultation, which we’ll call item C with schedule fee above $40
a blood volume estimation which we’ll call item E.

Per rule B and C, the total deductions are $40.00. This does not exceed the schedule fee for the diagnostic imaging item, item D, which is at $112.95.

Multiple Vascular Ultrasound Services Rule (MVUSSR)

Vascular ultrasound services have a further multiple services rule that affect the benefit we pay for each service.

The following formula applies to the schedule fee for each vascular ultrasound service:

100% for the item with the greatest schedule fee
plus 60% for the item with the next greatest schedule fee
plus 50% for each other item.

If you perform multiple vascular ultrasound items that have the same fee value, the formula still applies. We take the item with the lower item number to have a higher value when applying the above fee changes.

If other diagnostic imaging items are performed on the same day, Rule A applies. We’ll treat multiple vascular ultrasound items as one combined service for Rule A.

Read more about rules that apply to multiple ultrasound services on the MBS Online website.

Multiple Echocardiogram Services Rule (MESR)

The MESR applies to plain and stress echocardiograms in Category 5, Group I1, Subgroup 7 of the MBS.

If you provide a patient with multiple echocardiogram services on the same day, we’ll reduce your scheduled fees. The reduction to the items you claim will apply as follows:

the item with the highest schedule fee will have no reduction applied
the items with the lower schedule fees will be reduced to 60% of the schedule fee.

This rule applies even if you perform the services at different attendances on the same day.

Read more about safe and best practice cardiac imaging services on the MBS Online website.

Diagnostic Imaging Multiple Services Rules (DIMSR) and MESR both apply

When both MESR and DIMSR apply, the affected echocardiogram items are treated as one combined service.

We calculate Medicare benefits in the following order:

MESR at rates of 100%, 60% and 60%.
DIMSR under rules A, B and C.

Multiple Vascular Ultrasound Services Rule (MVUSSR), MESR and DIMSR all apply

When MESR, MVUSSR and DIMSR all apply, we treat affected items as one combined:

echocardiography service, this is for the total sum of fees for all items where MESR has been applied
vascular ultrasound service, this is for the total sum of fees for all items where MVUSSR has been applied.

The DIMSR rules are calculated using these 2 services and the remaining affected services for:

diagnostic imaging under rules A, B and C
consultation or non-consultation under rules B and C.

Multiple ultrasound services

on this page