Ultrasound services

Make sure you read the relevant item descriptions, fact sheets and explanatory notes on the MBS Online website.

Types of ultrasound services

There are several types of ultrasound services you can claim or bill with different requirements.

Requested services

You can bill or claim for requested (R-type) ultrasound services if:

• an eligible health professional sends you a request in writing
• you get the request in writing before providing the service.

Rendering practitioners need to check the patient to decide if the requested services are appropriate.

Read more about requests for R-type diagnostic imaging services on the MBS Online website.

Read about requests for diagnostic imaging services versus referrals for other services under Medicare on the MBS Online website.

Professional supervision for R-type ultrasound services

Ultrasound services marked with the symbol ‘R’ are only eligible for a Medicare benefit if they’re performed under professional supervision. This rule doesn’t apply to items 55600 and 55603.

Supervision can be from either:

• a specialist in the practice of their specialty
• a consultant physician in the practice of their specialty.

A practitioner who isn’t a specialist or consultant physician can supervise ultrasound services if they meet the requirements in Note IN.0.13 on the MBS Online website.

Practitioners can also claim Medicare benefits for ultrasound services either in:

• an emergency
• a location that is further than 30 kilometres by the most direct road route from another practice.

Non-requested services

Some R-type services have similar Non-Requested (NR-type) items in the MBS. You can bill or claim them if the requirement for the requests doesn’t meet specific circumstances.

Read more about requests for diagnostic imaging services in Note IN.0.6 on the MBS Online website.

Read more about notation requirements in Note IN.0.8 on the MBS Online website.

Personal attendance

The practitioner supervising ultrasound services should examine the patient face-to-face when medically necessary.

The patient should have a short waiting time and not have to re-book.

Musculoskeletal ultrasound items

We only pay Medicare benefits for a musculoskeletal ultrasound service if the responsible practitioner:

• attends during the performance of the service
• examines the patient face-to-face.

This requirement doesn’t apply to services they’ve performed because of medical necessity in a remote location. A remote area is more than 30 kilometres, by the most direct road route, from another practice.

Find out more in the Diagnostic Imaging Services Table (DIST) on the MBS online website.

Multiple musculoskeletal ultrasound scans

We’ll pay Medicare benefits for more than one musculoskeletal ultrasound service that a practitioner performs on the same day. These services are subject to Rule A of the general diagnostic imaging multiple services rules.

If a practitioner performs a bilateral ultrasound as per the items description, they can only bill the relevant item once. This also applies if the item description states either:

• one or both sides
• left and right.

Practitioners should avoid asking patients to make a second appointment if multiple scans are required.

Ultrasound reporting requirements

For Medicare purposes, the rendering practitioner is the practitioner who provides the report.

Unless an ultrasound item is designed for use in surgery, a report of the requested service must be provided to the requesting health professional.

Ultrasound services where Medicare benefits aren’t payable

We don’t pay Medicare benefits for ultrasound services if the service both:

• isn’t reasonably needed for managing the patient’s medical condition
• doesn’t meet the MBS item description.

For example, for ultrasound item F, the item description states it’s only when a scan is ordered for:

• abnormality of tendons or bursae about the knee
• meniscal cyst, popliteal fossa cyst, mass or pseudomass
• nerve entrapment, nerve or nerve sheath tumour, or injury of collateral ligaments.

Practitioners can’t claim this item for any reason other than those listed in the item description.

If they do claim the item for non-specific knee pain, it wouldn’t meet the MBS item description. It also wouldn’t be reasonably required to treat the patient’s condition, so isn’t eligible for a Medicare benefit.

Practitioners located outside Australia

We won’t pay Medicare benefits for ultrasound services if a practitioner located outside of Australia reported on them.

Practitioners must complete all elements of the service, including preparation of the report in Australia.

Sonographers

Sonographers performing medical ultrasound examinations, either R- or NR-type items, on behalf of a practitioner must be:

• suitably qualified
• involved in a relevant and appropriate Continuing Professional Development program
• registered on the Register of Accredited Sonographers.

Reporting requirements

The name of the sonographer must be included in the report.

The patient copy of the report doesn’t need to include the name of the sonographer.