Common Case Studies

Common Case Studies

Dr Smith is a GP working in a metro area in NSW. He purchases an ultrasound machine with the view to use it on his own patients in his rooms. He has decided to become accredited under the Diagnostic Imaging Accreditation Scheme [DIAS] so that he has the option to bulk bill patients [and receive a rebate] or charge his patients privately, but still allowing them to have access to a rebate from Medicare. He anticipates using the machine to assist with joint injections, early pregnancy scans, small lumps and bumps and gynaecological procedures. He plans to use the NR [non referred] item numbers available to him as a GP in the General, O&G and MSK Medicare benefits table. He understands that the scheduled fee for these items are approximately $30 each.

Dr Jones is a GP working in a remote area in WA. He is over 30km from the nearest facility providing an ultrasound service. He has decided to purchase an ultrasound machine to use on his patients so they do not have to travel unnecessarily for scanning. Dr Jones understands that he has the ability to obtain an exemption in relation to accessing R item numbers. This will allow him to use some R [referred] items without the need for a referral. To access this exemption Dr Jones needs to be a member of either ACRRM or RACGP and also complete some a Medicare form. R item numbers often have a much higher scheduled fee. Dr Jones would often use his machine for early pregnancy viability and guidance for joint injections. Some MSK injections that are done in conjunction with ultrasound guidance have a rebate of over $100.

Dr White is an Obstetrician/Gynaecologist working in Melbourne. She has purchased an ultrasound machine with the view to scan her antenatal and gynaecological patients. Dr White routinely uses the NR items available to her in the O&G section of the MBS table as she self determines the need for imaging in her rooms. If she receives a specific referral for imaging she knows she can bill an R item number, which often has a much higher scheduled fee. If Dr White did use any R item numbers after receiving a referral, she would need to provide a report [letter] back to the referrer. There is a maximum of 3 NR items allowable per pregnancy. Most NR item numbers have a scheduled fee of approximately $30 each. Some R item numbers have a rebate of $70 and above.