Again, who can refer?

Please check all referrals as we are getting many rejected claims from Medicare because staff are accepting referrals for scans that certain Allied Health or Practioners are unable to refer for.

Claims that have been rejected in the last week:

• Nurse Practitioners referring for Dopplers
• Dentists referring for CT Facial Bones

Remember, you must adhere to the rules below. 

Information as at July 2020

Who may request a diagnostic imaging service?

The following practitioners may request a diagnostic imaging service: Medical practitioners, specialists and consultant physicians. Specialists and consultant physicians can request any diagnostic imaging service (some exceptions apply, for example, obstetric ultrasound item 55712 where the requester needs to have obstetric qualifications). Other medical practitioners can request any service and specific MRI Services – including on behalf of the treating practitioner, for example, by a resident medical officer at a hospital on behalf of the patient's treating practitioner.

Dental practitioners

All dental practitioners may request the following items:

57509, 57515, 57521, 57523, 57527, 57901 to 57969, 58100, 58300, 58503, 58903, 59733, 59739, 59751, 60500 and 60503.

Oral and maxillofacial surgeons, prosthodontists, approved dental practitioners, dental specialists (periodontists, endodontists, pedeodontists, orthodontists) and specialists in oral medicine and oral pathology are also able to request the following items: Oral and maxillofacial surgeons (without medical specialist registration i.e. approved dental practitioners)

55028, 55030, 55032, 56001 to 56220, 56224, 56301 to 56507, 56801 to 57007, 57341, 57362, 57703, 57709, 57712, 57715, 58103 to 58115, 58306, 58506, 58521 to 58527, 58909, 59103, 59703, 60000 to 60009, 60506, 60509, 61109, 61372, 61421, 61425, 61429, 61430, 61433, 61434, 61446, 61449, 61450, 61453, 61454, 61457, 61462, 63007 and 63334.

Note: Approved dental practitioners are dentists who were approved by the Medical Benefits (Dental Practitioners) Advisory Committee to provide oral and maxillofacial MRI services and request certain diagnostic imaging services. This committee no longer exists. Practices should contact Services Australia to determine their eligibility for providing and requesting these services. Oral and maxillofacial surgeons (with medical specialist registration)

Oral and maxillofacial surgeons who also have a medical qualification and are registered as medical specialist can request any item in the Diagnostic Imaging Services Table, subject to their scope of practice and any clauses or requirements relevant to the individual item.

Prosthodontists

55028, 56013, 56016, 56022, 56028, 57362, 58306, 61421, 61425, 61429, 61430, 61433, 61434, 61446, 61449, 61450, 61453, 61454, 61457, 61462 and 63334.

Dental specialists (periodontists, endodontists, pedeodontists, orthodontists).

56022, 57362, 58306, 61421, 61454, 61457 and 63334. Specialists in oral medicine and/or oral pathology 55028, 55030, 55032, 56001, 56007, 56010, 56013, 56016, 56022, 56028, 56101, 56107, 56301, 56307, 56401, 56407, 57341, 57362, 58306, 58506, 58909, 59103, 59703, 60000 to 60009, 60506, 60509, 61109, 61372, 61421, 61425, 61429, 61430, 61433, 61434, 61446, 61449, 61450, 61453, 61454, 61457, 61462, 63007 and 63334.

Chiropractors

57712, 57715, 58100 to 58106, 58109 and 58112.

Physiotherapists and Osteopaths

57712, 57715, 58100 to 58106, 58109, 58112, 58120 and 58121.

Podiatrists

55844, 55888, 55889, 55890, 55891, 55892, 55893, 55894, 55895, 57521, 57523 and 57527.

Participating Nurse Practitioners

 55036, 55066, 55070, 55071, 55076, 55600, 55768, 55812, 55844, 55848, 55850, 55852, 55856, 55857, 55858, 55859, 55860, 55861, 55862, 55863, 55864, 55865, 55866, 55867, 55868, 55869, 55870, 55871, 55872, 55873, 55874, 55875, 55876, 55877, 55878, 55879, 55880, 55881, 55882, 55883, 55884, 55885, 55886, 55887, 55888, 55889, 55890, 55891, 55892, 55893, 55894, 55895, 57509, 57515, 57521, 57523, 57527, 57703, 57709, 57712, 57715, 57721, 58503 to 58527.

Participating Midwives

57712, 57715, 57901, 57902, 57907, 57915, 57921, 58100 to 58115, 58521, 58524, 58527, 58700 and 59103.

Request to specified provider not required It is not necessary that a written request for a diagnostic imaging service be addressed to a particular provider or that, if the request is addressed to a particular provider, the service must be rendered by that provider.

Request forms containing relevant information about a diagnostic imaging provider supplied, or made available to, a requesting practitioner by a diagnostic imaging provider must include a statement that informs the patient that the request may be taken to a diagnostic imaging provider of the patient's choice. Request for more than one service and limit on time to render services The requesting practitioner may use a single request to order a number of diagnostic imaging services. However, all services provided under this request must be rendered within seven days after the rendering of the first service.