MSK Shoulder and Knee Ultrasounds

Ultrasounds have become the modiality of choice to examine joints. Shoulder and Knee ultrasounds are only covered under the Medicare Benefit Schedule if the referring practitioner includes specific details on the request form based on the clinical indicators outlined in the item descriptions (Items 55808 and 55828). This means, benefits are not payable when referred for non-specific pain or soreness.

Medicare Benefit Schedule:

Item Number: 55808

Note: Benefits are only payable when referred based on the clinical indicators outlined in the item descriptions. Benefits are not payable when referred for non-specific shoulder pain alone.

SHOULDER OR UPPER ARM, 1 or both sides, ultrasound scan of, where:
(a) the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and

(b) the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member, and where the service is provided, for the assessment of one or more of the following conditions or suspected conditions:

• evaluation of injury to tendon, muscle or muscle/tendon junction;
• rotator cuff tear/calcification/tendinosis (biceps, subscapular, suspraspinatus, infraspinatus);
• biceps subluxation;
• capsulitis and bursitis;
• evaluation of mass including ganglion;
• occult fracture;
• acromioclavicular joint pathology.

Item Number: 55828

Note: Benefits are only payable when referred based on the clinical indicators outlined in the item descriptions. Benefits are not payable when referred for non-specific knee pain alone or other knee condition including:

• meniscal and cruciate ligament tears
• assessment of chondral surfaces

KNEE, 1 or both sides, ultrasound scan of, where:
(a) the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and

(b) the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member, and where the service is provided for the assessment of one or more of the following conditions or suspected conditions:

• abnormality of tendons or bursae about the knee;
• meniscal cyst, popliteal fossa cyst, mass or pseudomass;
• nerve entrapment, nerve or nerve sheath tumour;
• injury of collateral ligaments.