Multiple ultrasound services

You may perform multiple ultrasound services on the same occasion in some circumstances. Several rules may apply when calculating Medicare benefits for providing multiple services.

Read more about multiple services rules on the MBS Online website.

Diagnostic Imaging Multiple Services Rule (DIMSR) A, B and C

There are service rules that determine how we pay Medicare benefits if multiple ultrasound services are provided on the same day to the same patient by the same medical practitioner. These service rules reduce the Schedule fee of the diagnostic imaging service if you provided an imaging service with other services.

After calculating the Schedule fee, we determine the Medicare benefit as a percentage of that fee. Medicare pays 75% of the Schedule fee for in-hospital services or 85% of the Schedule fee for out-of-hospital services.

There are 3 rules, A, B and C, and more than one rule may apply in a patient episode.

DIMSR A

This applies to a diagnostic imaging service provided with other imaging services from the Diagnostic Imaging Services Table (DIST), by the same medical practitioner.

If a patient has multiple diagnostic imaging services on the same day, both of the following applies:

• 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 has a neck and abdominal ultrasound. The neck ultrasound, with the highest Schedule fee, has no reduction. The abdominal ultrasound Schedule fee is reduced by $5.

Specific breast ultrasound and imaging items are exempt to the $5 Schedule fee reduction part of DIMSR A.

DIMSR B

This applies to diagnostic imaging services provided with consultations by the same medical practitioner.

We reduce the Schedule fee of the diagnostic imaging service with the highest Schedule fee if on the same day, a patient has at least both:

• one requested (R-type) diagnostic imaging service
• one consultation service.

When the Schedule fee of the consultation item is:

• more than $40, the diagnostic imaging service is reduced by $35
• $15 to $40, the diagnostic imaging service is reduced by $15
• less than $15, the diagnostic imaging service is reduced by the Schedule fee amount of the consultation item.

The reduction is based on the consultation item with the highest Schedule fee.

For example, a patient has an ultrasound and a consultation with a Schedule fee over $40. Because the consultation Schedule fee is more than $40, the ultrasound Schedule fee is reduced by $35.

DIMSR C

This applies to a diagnostic imaging service provided with non-consultation MBS services by the same medical practitioner.

We reduce the Schedule fee for the diagnostic imaging service with the highest Schedule fee by $5, if on the same day, a patient has at least both:

• one R-type diagnostic imaging service
• one non-consultation service.

Non-consultation items are in MBS Categories 2, 3, 4 and 7.

For example, a patient has an ultrasound and a blood volume estimation. The Schedule fee for the ultrasound is reduced by $5.

DIMSR B and C

This is where both DIMSR B and C apply.

The total reduction applied to the diagnostic imaging service with the highest Schedule fee must not be more than its original Schedule fee.

The Schedule fee cannot be less than zero.

For example, a patient has all of the following:

• an abdominal ultrasound with a Schedule fee of $112.95
• a consultation with a Schedule fee over $40
• a blood volume estimation.

Under DIMSR B and C, the combined reduction is $40. This amount is less than the Schedule fee for the diagnostic imaging item.

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:

• the item with the highest Schedule fee is unchanged
• plus 60% for the item with the next highest Schedule fee
• plus 50% for each other item.

If the Schedule fee for some of the items are the same, the one with the lowest item number is taken to have the higher Schedule fee.

If other diagnostic imaging items are performed on the same day, DIMSR A applies. We treat multiple vascular ultrasound items as one service under DIMSR 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 transthoracic and stress echocardiograms in MBS Category 5, Group I1, Subgroup 7.

If a patient has multiple echocardiogram services on the same day, the following formula applies to the Schedule fees for each service:

• 100% for the item with the highest Schedule fee
• plus 60% for the items with the next highest Schedule fee.

If the Schedule fee for some of the items are the same, the one with the lowest item number is taken to have the higher Schedule fee.

This rule applies even if the services are performed at different times on the same day.

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

Situations where more than one service rule applies at the same time

DIMSR and MESR both apply

When MESR and DIMSR both apply, the echocardiogram items are treated as a single service.

We calculate adjustments to the Schedule fees in this order:

1. MESR
2. DIMSR A, B and C.

MVUSSR, MESR and DIMSR all apply

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

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

We then apply DIMSR using these combined services along with any remaining services for:

• diagnostic imaging under DIMSR A
• consultation and non-consultation services under DIMSR B and C.