Medicare Referral Guidelines for Shoulder and Knee Ultrasound 2016

SHOULDER ULTRASOUND          ITEM NUMBER 55808

Medicare benefits are payable only if the referral indicates that one or more of the following conditions are suspected

  • 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 mass including ganglion; or
  • occult fracture; or
  • acromioclavicular joint pathology

Benefits are not payable when referred for non-specific pain alone

 

KNEE ULTRASOUND                     ITEM NUMBER 55828

Medicare benefits are payable only if the referral indicates that one or more of the following conditions are suspected

  • 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

Benefits are not payable when referred for non-specific pain alone, for suspected meniscal or cruciate ligament tears or for assessment of chondral surfaces