New Medicare Benefits for PSMA PET/CT scans

New Diagnostic Imaging Medicare Benefits Schedule (MBS) items 61563 and 61564.

PSMA PET/CT

Last updated: 16 May 2022

  • From 1 July 2022, two new items will be introduced for prostate-specific membrane antigen (PSMA) positron emission tomography (PET) study for patients with prostate cancer.
  • These items will allow for a PSMA PET study for the initial staging of intermediate to high-risk patients with prostate cancer and for the restaging of patients with recurrent prostate cancer.
  • These items will assist patients with prostate cancer to receive the most appropriate treatment pathway.

What are the changes?
In the 2021-22 Budget the Government announced that from 1 July 2022 two new PSMA PET scans for patients with prostate cancer will commence:

Item 61563

  • Whole body PSMA PET study performed for the initial staging of intermediate to high-risk prostate adenocarcinoma, for a previously untreated patient who is considered suitable for locoregional therapy with curative intent.
  • Medicare benefits are payable for a maximum of one service in the patient’s lifetime.

Item 61564

  • Whole body PSMA PET study performed for the restaging of recurrent prostate adenocarcinoma, for a patient who has undergone prior locoregional therapy and is considered suitable for further locoregional therapy to determine appropriate therapeutic pathways and timing of treatment initiation.
  • This item can be claimed by patients with a prostate specific antigen (PSA) increase of 2ng/ml above the nadir after radiation therapy; or failure of PSA levels to fall to undetectable levels; or rising PSA serum after a radical prostatectomy.
  • Medicare benefits are payable for a maximum of two services in the patient’s lifetime. Whole body PSMA PET study items 61563 and 61564 are not to be used for surveillance nor for assessment of patients with suspected (as opposed to confirmed) prostate adenocarcinoma or disease recurrence.