It would be much appreciated if you could take a moment of your time to read the following information as presented in the Medicare Benefits Schedule in relation to the referral of shoulder and knee ultrasounds:

Shoulder Ultrasound – Item No 55808

Benefits are only payable when referred based on the clinical indicators outlined in the item descriptions below. Benefits are not payable when referred for non-specific shoulder pain alone.  The service must be provided for assessment of one or more of the following or suspected conditions:

  • Evaluation of injury to tendon, muscle or muscle/tendon junction; or
  • Rotator cuff tear/calcification/tendinosis (biceps, subscapular, supraspinatus, infraspinatus); or
  • Biceps subluxation; or
  • Capsulitis and bursitis; or
  • Evaluation of a mass including ganglion; or
  • Occult fracture; or
  • Acromioclavicular joint pathology

Knee Ultrasound – Item No 55828

Benefits are only payable when referred based on the clinical indicators outlined in the item descriptions below. Benefits are not payable when referred for non-specific knee pain alone or other knee conditions including meniscal and cruciate ligament tears and assessment of chondral surfaces. The service must be provided for assessment of one or more of the following or suspected conditions:

  • Abnormality of tendons or bursae about the knee; or
  • Meniscal cyst, popliteal fossa cyst, mass or pseudomass; or
  • Nerve entrapment, nerve or nerve sheath tumour; or
  • Injury of collateral ligaments

Therefore when referring your patients for these procedures it is essential that the referral details a relevant clinical indicator. If the referral does not show a relevant clinical indicator, we will endeavour to contact you to obtain a new referral in order that we can perform the procedure.

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