2 Sept 1998
 

MRI CMB CODES

These pages present the CMB codes in a format which is easier to comprehend than the original documentation.  Comments are open to interpretation and units making use of this material should read the original Medicare Benefits Schedule and associated explanatory notes.
Head Spine 1 region or 2 contiguous regions Magnetic Resonance Angiography
Head & Cervical Spine Spine 3 contiguous or 2 non-contiguous regions Body MRI For Persons under the age of 16 years
Musculo-Skeletal Cardiovascular System Body MRI


Notes

EXCLUSION  MRI is the initial imaging modality 
FURTHER INVESTIGATION (F.I..)  MRI is a subsequent imaging modality
MONITORING  Diagnosis confirmed and treatment has occurred
 

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HEAD

Plain numbers One code per 12 months (subgroups 1,3, )
Bold Numbers Two codes per 12 months (subgroup 5)
Underlined Numbers  Unrestricted eligibility (subgroup 7)
 
Condition  Exclusion F.I..  Monitoring
Tumour of brain or meningies  63000 63100  63270 
Skull base or orbital tumour 63003 63103  63273
Acoustic neuroma 63006  63106  63200
Pituitary Tumour 63009 63109  63203
Inflammation of Brain or Meninges 63012 63112  63276 
Toxic or Ischaemic Encephalopathy 63015 63115 63221
Demyelinating disease of brain 63018 63118  63206
Congenital Malformation of brain or meninges  63021  63121** 63209 ** 
Head trauma N.A. 63124 63212
Epilepsy N.A. 63127 63215
Stroke N.A. 63130 63218
Venous sinus thrombosis 63024 63133 *** 63279 ***
* Use code 63850 if MRA is done
** If MRA is done code 63859 can be used to credit extra services
*** If MRA is done code 63859 can be used to credit extra services

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HEAD & CERVICAL SPINE

Plain numbers   One code per 12 months (subgroups 2,4 )
Bold Numbers   Two codes per 12 months (subgroup 6)
Underlined Numbers   Unrestricted eligibility (subgroup 8)
 
Condition  Exclusion. F.I.. Monitoring
Tumour of CNS or meninges 63050  63150 63290
Inflammation of CNS or meninges  63053 63153 63293
Demyelination disease of CNS 63056 63156 63250
Congenital Malformation of CNS or meninges 63059 63159 63253
Syrinx (congenital or acquired) 63062 63162 63256

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SPINE One region or Two contiguous regions

Plain numbers   One code per 12 months (subgroups 9,11,13)
Underlined Numbers    Unrestricted eligibility (subgroup 15)
 
Condition Exclusion F.I.. Monitoring
Infection 63300 63400 63580
Tumour 63303 63403 63583
Demyelinating disease 63306 63406 63500
Congenital malformation Cord, Cauda Equina, Meninges 63309 63409 63503
Myelopathy 63312 63412 63506
Syrinx 63315 63415 63509
Cervical Radiculopathy N.A. 63418 63512
Sciatica N.A 63421 63515
Spinal canal stenosis N.A. 63424 63518
Previous spinal surgery N.A. 63427 63521
Trauma N.A. 63430 63524

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SPINE 3 contiguous regions or 2 non contiguous regions

Plain numbers    One code per 12 months (subgroups 10,12,14 )
Underlined Numbers    Unrestricted eligibility (subgroup 16)
 
Condition  Exclusion F.I.. Monitoring
Infection  63350  63450 63590
Tumour 63353 63453 63593
Demyelinating disease 63356 63456 63550
Congenital malformation Cord, Cauda Equina, Meninges 63359 63459 63553
Myelopathy 63362 63462 63556
Syrinx 63365 63465 63559
Cervical Radiculopathy N.A. 63468 63562
Sciatica  N.A 63471 63565
Spinal canal stenosis N.A.  63474 63568
Previous spinal surgery N.A.  63477 63571
Trauma N.A. 63480 63574

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MUSCULO-SKELETAL 

Plain numbers One code per 12 months (subgroups 18,19 )
Underlined Numbers Unrestricted eligibility (subgroup 20)
Bold Numbers Two codes per 12 months (subgroup 21)
 
Condition Exclusion F.I.. Monitoring 
Tumour of Bone or connective tissue 63600 63650 63739 
Infection of bone or connective tissue  63603 63653 63742
Osteonecrosis 63606 63656 63736 
Derangement Hip or support structures 63609 63659 63700
Derangement Shoulder or support structures 63612  63662 63703
Derangement Knee or support structures 63615 63665 63706
Derangement Ankle or support structures 63618 63668 63709
Derangement TMJ or support structures 63621 63671 63712
Derangement Wrist or support structures 63624 63674 63715
Derangement Elbow or support structures  63627 63677 63718
Post inflammatory/ post trauma physeal fusion in a person under 16 years of age N.A. 63680 63721
Investigation or monitoring of Gaucher disease (musculo-skeletal) N.A. N.A. 63745

  
CARDIOVASCULAR SYSTEM

 
Plain numbers One code per 12 months (subgroups 22 )
Bold Numbers Two codes per 12 months (subgroup 23)
 
 
Condition Exclusion F.I.. Monitoring
Congenital disease of heart or great vessel N.A. 63750 63800
Tumour of heart or great vessel  N.A. 63753 63803
Abnormality of thoracic Aorta  N.A. 63756 63806

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MAGNETIC RESONANCE ANGIOGRAPHY

 
Plain numbers One code per 12 months (subgroup 25 )
Bold Numbers Two codes per 12 months (subgroup 24)
Underlined Numbers Unrestricted eligibility (subgroup 26)
 
Condition Exclusion F.I.. Monitoring
Stroke 63850 63850 N.A. 
Carotid of Vertebral artery dissection 63853 63880 N.A. 
Intra-cranial Aneurysm 63856 63856 N.A. 
Intra-cranial Arterio-venous malformation 63859 63859 N.A.
Venous sinus thrombosis 63862 63883 N.A.
Vascular abnormality in patient with previous anaphylactic reaction to iodinated contrast 63865  63865 N.A.
Obstruction of SVC or IVC or a major pelvic vein 63868 63868 N.A. 
Peripheral MRA prior to DSA in Congenital Limb Deficiency Syndrome, for a patient under the age of 16 years  N.A 63870  N.A. 

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BODY MRI FOR PERSONS UNDER THE AGE OF 16 YEARS
 

Plain numbers One code per 12 months (subgroup 27 )
Underlined Numbers Unrestricted eligibility (subgroup 30)
 
Condition Exclusion F.I.. Monitoring
Pelvic or Abdominal mass N.A.  63900 63943
Mediastinal mass N.A. 63903 63940
Congenital Uterine or Ano-rectal abnormality N.A.  63906 63930
Gaucher disease N.A. 63909 64946

BODY MRI

Plain numbers  One code per 12 months (subgroup 29 )
 
Condition Exclusion F.I.. Monitoring 
Adrenal mass in a patient with a malignancy which is otherwise resectable N.A. 63920 N.A. 
 

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