Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2004 (No. 4)1
I, PHILIP MICHAEL JEFFERY, Governor-General of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, make the following Regulations under the Health Insurance Act 1973.
Dated 21 July 2004
P. M. JEFFERY
Governor-General
By His Excellency’s Command
TONY ABBOTT
1 Name of Regulations
These Regulations are the Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2004 (No. 4).
2 Commencement
These Regulations commence on 1 August 2004.
3 Amendment of Health Insurance (Diagnostic Imaging Services Table) Regulations 2003
Schedule 1 amends the Health Insurance (Diagnostic Imaging Services Table) Regulations 2003.
Schedule 1 Amendments
(regulation 3)
[1] Schedule 1, Part 2, subrule 2 (1), definition of exclusion
omit
[2] Schedule 1, Part 2, rule 31
substitute
31 MRI and MRA services — eligible services
(1) Subject to subrule (2), items 63001 to 63473 apply only to an MRI or MRA service performed:
(a) on request, in accordance with rule 32, by a specialist or consultant physician; and
(b) in a permissible circumstance, in accordance with rule 33; and
(c) with eligible equipment, in accordance with rule 35 or 36.
(2) If a service described in an item mentioned in subrule (1) is performed with eligible equipment described in paragraph 36 (b), the item for the service applies only if the service is bulk-billed in respect of the fee for the service.
(3) For subrule (2):
bulk-billed, in relation to a service, means:
(a) a medicare benefit is payable to a person in respect of the service; and
(b) under an agreement entered into under section 20A of the Act:
(i) the person assigns to the eligible provider by whom, or on whose behalf, the service is provided, his or her right to the payment of the medicare benefit; and
(ii) the eligible provider accepts the assignment in full payment of his or her fee for the service provided.
[3] Schedule 1, Part 2, rule 32
omit
Items 63000 to 63963
insert
Items 63001 to 63473
[4] Schedule 1, Part 2, rule 36
substitute
36 MRI and MRA services — eligible equipment
For rule 31, eligible equipment is equipment other than equipment to which rule 35 applies, being:
(a) equipment:
(i) that is registered under the scheme, administered by the Department, titled ‘MRI Additional Units Eligibility Scheme’, as in force on 27 June 2001; and
(ii) in relation to which the registration has not been cancelled or otherwise ceased to have effect; or
(b) equipment that:
(i) is described in columns 3 and 4 of an item in the following table by reference to the manufacturer, scanner model and magnet strength; and
(ii) is located in the radiology department of a hospital specified in column 2 of that item.
Note for paragraph (a) The MRI Additional Units Eligibility Scheme is the scheme of that title published in Gazette No. GN 20 on 23 May 2001, as amended by amendments published in Gazette No. S 226 on 27 June 2001.
Item | Location | Manufacturer and scanner model | Magnet strength |
1 | The Women’s and Children’s Hospital | Philips | 1.0T |
2 | The Princess Margaret Hospital for Children | Siemens | 1.5T |
[5] Schedule 1, Part 2, rule 37
omit
In items 63000 to 63963:
insert
In items 63001 to 63473:
[6] Schedule 1, Part 2, rules 38, 39 and 39A
substitute
38 MRI and MRA services — multiple services rule
If an MRI service described in an item in Subgroup 1, 2, 4, 5
or 14 of Group I5 in this table, and an MRA service described in an item in Subgroup 3 or 15 of that Group, are provided to the same person on the same day, only the fee specified in the item in Subgroup 1, 2, 4, 5 or 14 applies to the services.
39 MRI or MRA services — related services that can be claimed in a 12 month period
(1) An MRI or MRA item mentioned in column 2 of the table in subrule (2) does not apply to the service described in that item if the service is provided to a person who, in the 12 months before the service, has been provided with the maximum number of those services mentioned in column 3 of the table for that item.
(2) For subrule (1), the items and maximum number of services are:
Item | MRI or MRA items | Maximum number of services |
1 | 63040 to 63073 | 3 |
2 | 63101 | 3 |
3 | 63125 to 63131 | 3 |
4 | 63161 to 63185 | 3 |
5 | 63219 to 63243 | 3 |
6 | 63271 to 63280 | 3 |
7 | 63322 to 63340 | 3 |
8 | 63361 | 2 |
9 | 63385 to 63391 | 2 |
10 | 63401 and 63404 | 3 |
11 | 63416 | 1 |
12 | 63425 and 63428 | 2 |
13 | 63461 | 1 |
(3) In addition, if 2 or more services of the kind described in an MRI item mentioned in item 7 or 8 of the table in subrule (2) are provided to a person on a single occasion, the fee specified in 1 MRI item only applies to the services.
40 MRI services — limit for items 63470 and 63473
(1) Item 63470 does not apply to the service described in that item if the person to whom the service is provided has previously been provided with that service or a service described in item 63473.
(2) Item 63473 does not apply to the service described in that item if the person to whom the service is provided has previously been provided with that service or a service described in item 63470.
41 MRI and MRA services — modifying items
(1) Subject to subrules (2), (3) and (4), if item 63491, 63494
or 63497 applies to an MRI or MRA service, the fee specified in that item applies in addition to the fee specified in the other item in Group I5 of this table that applies to the service.
(2) If 2 or more MRI or MRA services described in item 63494 are performed for a person on the same day, the fee specified in that item applies to 1 of those services only.
(3) If 2 or more MRI or MRA services described in item 63497 are performed for a person on the same day, the fee specified in that item applies to 1 of those services only.
(4) If:
(a) 1 or more MRI or MRA services described in item 63494; and
(b) 1 or more MRI or MRA services described in item 63497;
are performed for a person on the same day, the fee specified in item 63494 or item 63497, but not both those items, applies to 1 of those services only.
[7] Schedule 1, Part 2, rule 77, heading
substitute
42 Application of items 64990 and 64991
[8] Schedule 1, Part 3, Group I5
substitute
Group I5 — Magnetic resonance imaging | |||
Subgroup 1 — Scan of head — for specified conditions | |||
63001 | MRI — scan of head (including MRA, if performed) for tumour of the brain or meninges (R) (Anaes.) (Contrast) | 403.20 | |
63004 | MRI — scan of head (including MRA, if performed) for inflammation of brain or meninges (R) (Anaes.) (Contrast) | 403.20 | |
63007 | MRI — scan of head (including MRA, if performed) for skull base or orbital tumour (R) (Anaes.) (Contrast) | 403.20 | |
63010 | MRI — scan of head (including MRA, if performed) for stereotactic scan of brain, with fiducials in place, for the sole purpose of allowing planning for stereotactic neurosurgery (R) (Anaes.) (Contrast) |
336.00 | |
Subgroup 2 — Scan of head— for specified conditions | |||
63040 | MRI — scan of head (including MRA, if performed) for acoustic neuroma (R) (Anaes.) (Contrast) | 336.00 | |
63043 | MRI — scan of head (including MRA, if performed) for pituitary tumour (R) (Anaes.) (Contrast) | 358.40 | |
63046 | MRI — scan of head (including MRA, if performed) for toxic or metabolic or ischaemic encephalopathy (R) (Anaes.) (Contrast) | 403.20 | |
63049 | MRI — scan of head (including MRA, if performed) for demyelinating disease of the brain (R) (Anaes.) (Contrast) | 403.20 | |
63052 | MRI — scan of head (including MRA, if performed) for congenital malformation of the brain or meninges (R) (Anaes.) (Contrast) | 403.20 | |
63055 | MRI — scan of head (including MRA, if performed) for venous sinus thrombosis (R) (Anaes.) (Contrast) | 403.20 | |
63058 | MRI — scan of head (including MRA, if performed) for head trauma (R) (Anaes.) (Contrast) | 403.20 | |
63061 | MRI — scan of head (including MRA, if performed) for epilepsy (R) (Anaes.) (Contrast) | 403.20 | |
63064 | MRI — scan of head (including MRA, if performed) for stroke (R) (Anaes.) (Contrast) | 403.20 | |
63067 | MRI — scan of head (including MRA, if performed) for carotid or vertebral artery dissection (R) (Anaes.) (Contrast) | 403.20 | |
63070 | MRI — scan of head (including MRA, if performed) for intracranial aneurysm (R) (Anaes.) (Contrast) | 403.20 | |
63073 | MRI — scan of head (including MRA, if performed) for intracranial arteriovenous malformation (R) (Anaes.) (Contrast) | 403.20 | |
Subgroup 3 — Scan of head and neck vessels — for specified conditions | |||
63101 | MRI and MRA of extracranial or intracranial circulation (or both) — scan of head and neck vessels for stroke (R) (Anaes.) (Contrast) | 492.80 | |
Subgroup 4 — Scan of head and cervical spine — for specified conditions | |||
63111 | MRI — scan of head and cervical spine (including MRA, if performed) for tumour of the central nervous system or meninges (R) (Anaes.) (Contrast) | 492.80 | |
63114 | MRI — scan of head and cervical spine (including MRA, if performed) for inflammation of the central nervous system or meninges (R) (Anaes.) (Contrast) | 492.80 | |
Subgroup 5 — Scan of head and cervical spine — for specified conditions | |||
63125 | MRI — scan of head and cervical spine (including MRA, if performed) for demyelinating disease of the central nervous system (R) (Anaes.) (Contrast) | 492.80 | |
63128 | MRI — scan of head and cervical spine (including MRA, if performed) for congenital malformation of the central nervous system or meninges (R) (Anaes.) (Contrast) | 492.80 | |
63131 | MRI — scan of head and cervical spine (including MRA, if performed) for syrinx (congenital or acquired) (R) (Anaes.) (Contrast) | 492.80 | |
Subgroup 6 — Scan of spine — 1 region or 2 contiguous regions — for specified conditions | |||
63151 | MRI — scan of 1 region or 2 contiguous regions of the spine for infection (R) (Anaes.) (Contrast) | 358.40 | |
63154 | MRI — scan of 1 region or 2 contiguous regions of the spine for tumour (R) (Anaes.) (Contrast) | 358.40 | |
Subgroup 7 — Scan of spine — 1 region or 2 contiguous regions — for specified conditions | |||
63161 | MRI — scan of 1 region or 2 contiguous regions of the spine for demyelinating disease (R) (Anaes.) (Contrast) | 358.40 | |
63164 | MRI — scan of 1 region or 2 contiguous regions of the spine for congenital malformation of the spinal cord or the cauda equina or the meninges (R) (Anaes.) (Contrast) | 358.40 | |
63167 | MRI — scan of 1 region or 2 contiguous regions of the spine for myelopathy (R) (Anaes.) (Contrast) | 358.40 | |
63170 | MRI — scan of 1 region or 2 contiguous regions of the spine for syrinx (congenital or acquired) (R) (Anaes.) (Contrast) | 358.40 | |
63173 | MRI — scan of 1 region or 2 contiguous regions of the spine for cervical radiculopathy (R) (Anaes.) (Contrast) | 358.40 | |
63176 | MRI — scan of 1 region or 2 contiguous regions of the spine for sciatica (R) (Anaes.) (Contrast) | 358.40 | |
63179 | MRI — scan of 1 region or 2 contiguous regions of the spine for spinal canal stenosis (R) (Anaes.) (Contrast) | 358.40 | |
63182 | MRI — scan of 1 region or 2 contiguous regions of the spine for previous spinal surgery (R) (Anaes.) (Contrast) | 358.40 | |
63185 | MRI — scan of 1 region or 2 contiguous regions of the spine for trauma (R) (Anaes.) | 358.40 | |
Subgroup 8 — Scan of spine — 3 contiguous or 2 non-contiguous regions — for specified conditions | |||
63201 | MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for infection (R) (Anaes.) (Contrast) | 448.00 | |
63204 | MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for tumour (R) (Anaes.) (Contrast) | 448.00 | |
Subgroup 9 — Scan of spine — 3 contiguous or 2 non-contiguous regions — for specified conditions | |||
63219 | MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for demyelinating disease (R) (Anaes.) (Contrast) | 448.00 | |
63222 | MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for congenital malformation of the spinal cord or the cauda equina or the meninges (R) (Anaes.) (Contrast) | 448.00 | |
63225 | MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for myelopathy (R) (Anaes.) (Contrast) | 448.00 | |
63228 | MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for syrinx (congenital or acquired) (R) (Anaes.) (Contrast) | 448.00 | |
63231 | MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for cervical radiculopathy (R) (Anaes.) (Contrast) | 448.00 | |
63234 | MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for sciatica (R) (Anaes.) (Contrast) | 448.00 | |
63237 | MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for spinal canal stenosis (R) (Anaes.) (Contrast) | 448.00 | |
63240 | MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for previous spinal surgery (R) (Anaes.) (Contrast) | 448.00 | |
63243 | MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for trauma (R) (Anaes.) | 448.00 | |
Subgroup 10 — Scan of cervical spine and brachial plexus — for specified conditions | |||
63271 | MRI — Scan of cervical spine and brachial plexus for tumour (R) (Anaes.) (Contrast) | 492.80 | |
63274 | MRI — Scan of cervical spine and brachial plexus for trauma (R) (Anaes.) (Contrast) | 492.80 | |
63277 | MRI — Scan of cervical spine and brachial plexus for cervical radiculopathy (R) (Anaes.) (Contrast) | 492.80 | |
63280 | MRI — Scan of cervical spine and brachial plexus for previous surgery (R) (Anaes.) (Contrast) | 492.80 | |
Subgroup 11 — Scan of musculoskeletal system — for specified conditions | |||
63301 | MRI — scan of musculoskeletal system for tumour arising in bone or musculoskeletal system, excluding tumours arising in breast, prostate or rectum (R) (Anaes.) (Contrast) | 380.80 | |
63304 | MRI — scan of musculoskeletal system for infection arising in bone or musculoskeletal system, excluding infection arising in breast, prostate or rectum (R) (Anaes.) (Contrast) | 380.80 | |
63307 | MRI — scan of musculoskeletal system for osteonecrosis (R) (Anaes.) (Contrast) | 380.80 | |
Subgroup 12 — Scan of musculoskeletal system — for specified conditions | |||
63322 | MRI — scan of musculoskeletal system for derangement of hip or its supporting structures (R) (Anaes.) (Contrast) | 403.20 | |
63325 | MRI — scan of musculoskeletal system for derangement of shoulder or its supporting structures (R) (Anaes.) (Contrast) | 403.20 | |
63328 | MRI — scan of musculoskeletal system for derangement of knee or its supporting structures (R) (Anaes.) (Contrast) | 403.20 | |
63331 | MRI — scan of musculoskeletal system for derangement of ankle or foot (or both) or its supporting structures (R) (Anaes.) (Contrast) | 403.20 | |
63334 | MRI — scan of musculoskeletal system for derangement of 1 or both temporomandibular joints or their supporting structures (R) (Anaes.) (Contrast) | 336.00 | |
63337 | MRI — scan of musculoskeletal system for derangement of wrist or hand (or both) or its supporting structures (R) (Anaes.) (Contrast) | 448.00 | |
63340 | MRI — scan of musculoskeletal system for derangement of elbow or its supporting structures (R) (Anaes.) (Contrast) | 403.20 | |
Subgroup 13 — Scan of musculoskeletal system — for specified conditions | |||
63361 | MRI — scan of musculoskeletal system for Gaucher disease (R) (Anaes.) | 403.20 | |
Subgroup 14 — Scan of cardiovascular system — for specified conditions | |||
63385 | MRI — scan of cardiovascular system for congenital disease of the heart or a great vessel (R) (Anaes.) (Contrast) | 448.00 | |
63388 | MRI — scan of cardiovascular system for tumour of the heart or a great vessel (R) (Anaes.) (Contrast) | 448.00 | |
63391 | MRI — scan of cardiovascular system for abnormality of thoracic aorta (R) (Anaes.) (Contrast) | 403.20 | |
Subgroup 15 — Magnetic resonance angiography — scan of cardiovascular system — for specified conditions | |||
63401 | MRA — if the request for the scan specifically identifies the clinical indication for the scan — scan of cardiovascular system for vascular abnormality in a patient with a previous anaphylactic reaction to an iodinated contrast medium (R) (Anaes.) (Contrast) | 403.20 | |
63404 | MRA — if the request for the scan specifically identifies the clinical indication for the scan — scan of cardiovascular system for obstruction of the superior vena cava, inferior vena cava or a major pelvic vein (R) (Anaes.) (Contrast) | 403.20 | |
Subgroup 16 — Magnetic resonance angiography — for specified conditions — person under the age of 16 years | |||
63416 | MRA — scan of person under the age of 16 for the vasculature of limbs prior to limb or digit transfer surgery in congenital limb deficiency syndrome (R) (Anaes.) (Contrast) | 403.20 | |
Subgroup 17 — Magnetic resonance imaging — for specified conditions — person under the age of 16 years | |||
63425 | MRI — scan of person under the age of 16 for post-inflammatory or post-traumatic physeal fusion (R) (Anaes.) | 403.20 | |
63428 | MRI — scan of person under the age of 16 for Gaucher disease (R) (Anaes.) | 403.20 | |
Subgroup 18 — Magnetic resonance imaging — for specified conditions — person under the age of 16 years | |||
63440 | MRI — scan of person under the age of 16 for pelvic or abdominal mass (R) (Anaes.) (Contrast) | 403.20 | |
63443 | MRI — scan of person under the age of 16 for mediastinal mass (R) (Anaes.) (Contrast) | 403.20 | |
63446 | MRI — scan of person under the age of 16 for congenital uterine or anorectal abnormality (R) (Anaes.) (Contrast) | 403.20 | |
Subgroup 19 — Scan of body — for specified conditions | |||
63461 | MRI — scan of the body for adrenal mass in a patient with a malignancy that is otherwise resectable (R) (Anaes.) | 358.40 | |
Subgroup 20 — Scan of pelvis and upper abdomen — for specified conditions | |||
63470 | MRI — if: (a) the patient is referred by a specialist or by a consultant physician; and (b) the request for scan identifies that: (i) a histological diagnosis of carcinoma of the cervix has been made; and (ii) the patient has been diagnosed with cervical cancer at FIGO stage 1B or greater — scan of pelvis for the staging of histologically diagnosed cervical cancer at FIGO stages 1B or greater (R) (Anaes.) (Contrast) | 403.20 | |
63473 | MRI — if: (a) the patient is referred by a specialist or by a consultant physician; and (b) the request for scan identifies that: (i) a histological diagnosis of carcinoma of the cervix has been made; and (ii) the patient has been diagnosed with cervical cancer at FIGO stage 1B or greater — scan of pelvis and upper abdomen, in a single examination, for the staging of histologically diagnosed cervical cancer at FIGO stages 1B or greater (R) (Anaes.) (Contrast) | 627.20 | |
Subgroup 21 — Modifying items | |||
63491 | MRI or MRA service to which an item in this Group (other than an item in this Subgroup) applies if: (a) the service is performed in accordance with rule 31; and (b) the item for the service includes in its description ‘(Contrast)’; and (c) the service is performed using a contrast agent | 44.80 | |
63494 | MRI or MRA service to which an item in this Group (other than an item in this Subgroup) applies if: (a) the service is performed in accordance with rule 31; and (b) the service is performed on a person using intravenous or intra muscular sedation | 44.80 | |
63497 | MRI or MRA service to which an item in this Group (other than an item in this Subgroup) applies if: (a) the service is performed in accordance with rule 31; and (b) the service is performed on a person under anaesthetic in the presence of a medical practitioner who is qualified to perform an anaesthetic | 156.80 | |
Notes
1. These Regulations amend Statutory Rules 2003 No. 268, as amended by 2003 No. 358; 2004 Nos. 64, 76 and 101.
2. Notified in the Commonwealth of Australia Gazette on 28 July 2004.