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Determinations/Health as amended, taking into account amendments up to Health Insurance (Section 3C Diagnostic Imaging Services –Liver and Obstetric MRI Services) Amendment Determination 2019
Administered by: Health
Registered 07 Aug 2019
Start Date 01 Aug 2019

Commonwealth Coat of Arms of Australia

Health Insurance (Section 3C Diagnostic Imaging Services – Liver and Obstetric MRI Services) Determination 2019

made under subsection 3C(1) of the

Health Insurance Act 1973

Compilation No. 1

Compilation date:                           1 August 2019

Includes amendments up to:         F2019L01014

Registered:                                      7 August 2019

 

About this compilation

This compilation

This is a compilation of the Health Insurance (Section 3C Diagnostic Imaging Services – Liver and Obstetric MRI Services) Determination 2019 that shows the text of the law as amended and in force on 1 August 2019 (the compilation date).

The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.

Uncommenced amendments

The effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Legislation Register (www.legislation.gov.au). The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the series page on the Legislation Register for the compiled law.

Application, saving and transitional provisions for provisions and amendments

If the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.

Editorial changes

For more information about any editorial changes made in this compilation, see the endnotes.

Modifications

If the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the series page on the Legislation Register for the compiled law.

Self-repealing provisions

If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.

  

  

  

 


Contents

 

1.               Name  1

2.               Commencement 1

3.               Authority  1

4.               Definitions  1

5.               Treatment of relevant services  2

6.               Bulk-billing—magnetic resonance imaging  3

7.               Application of items 63454 and 63460  3

8.               Application of items 63545 and 63546  3

9.               Application of contrast 4

Schedule 1 – relevant services  5

Part 1 – MRI obstetric services for suspected fetal central nervous system abnormality  5

Part 2 – MRI services for colorectal or hepatocellular carcinomas  6

Part 3 – Hepatobiliary-specific contrast agent services  7

Endnotes  8

Endnote 1—About the endnotes                                                                              8

Endnote 2—Abbreviation key                                                                                 9

Endnote 3—Legislation history  10

Endnote 4—Amendment history  11

 


1.                   Name

This Determination is the Health Insurance (Section 3C Diagnostic Imaging Services – Liver and Obstetric MRI Services) Determination 2019.

2.                   Commencement

(1)        Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.

 

Commencement information

Column 1

Column 2

Column 3

Provisions

Commencement

Date/Details

1.  The whole of this instrument

1 May 2019

 

Note:          This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.

(2)        Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.

3.                   Authority

This Determination is made under subsection 3C(1) of the Health Insurance Act 1973.

4.                   Definitions

(1)        In this Determination:

Act means the Health Insurance Act 1973.

eligible equipment has the meaning given by clause 2.5.5 of the diagnostic imaging services table.

eligible provider has the meaning given by clause 2.5.4 (item 1) of the diagnostic imaging services table.

(K) has the meaning given by subclause 1.2.1(2) of the diagnostic imaging services table.

(NK) has the meaning given by subclause 1.2.1(1) of the diagnostic imaging services table.

partial eligible equipment has the meaning given by clause 2.5.6 of the diagnostic imaging services table.

relevant provisions means all provisions, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under that Act, relating to medical services, professional services or items.

relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in the Schedule.

remote location has the meaning given by the same term in Part 3 of the diagnostic imaging services table.

scan means a minimum of 3 sequences.

sequence, for a scan, means a series of images collected at the same time with similar image parameters (not including a scan designed to establish patient position and subsequently used to plan other scans).

Schedule means the Schedule to this Determination.

Note:     The following terms are defined in subsection 3(1) of the Act:

·         clinically relevant service

·         consultant physician

·         diagnostic imaging services table

·         general medical services table

·         item

·         professional service

·         specialist

Note: For the effect of the term (Anaes.) used in items in this table, see subclause 2.44.5(2) of the general medical services table.

(2)        Unless the contrary intention appears, a reference in this Determination to a provision of the Act or the National Health Act 1953 or regulations made under the Act or under the National Health Act 1953 as applied, adopted or incorporated in relation to specifying a matter is a reference to those provisions as in force from time to time and any other reference to provisions of an Act or regulations is a reference to those provisions as in force from time to time.

5.                   Treatment of relevant services

For subsection 3C(1) of the Act a relevant service, provided in accordance with this Determination and as a clinically relevant service, is to be treated, for the relevant provisions, as if:

(a)                    it were both a professional service and a diagnostic imaging service; and

(b)                   there were an item in the diagnostic imaging services table that:

(i)                      related to the service; and

(ii)                    specified for the service a fee in relation to each State, being the fee specified in the Schedule in relation to the service.

6.                   Bulk-billing—magnetic resonance imaging

Clause 1.2.10 of the diagnostic imaging services table shall have effect as if an item in Schedule 1 of this Determination were specified in paragraph 1.2.10(1)(a) of the diagnostic imaging services table.

7.                   Application of items 63454 and 63460

(1)               For any particular patient, items 63454 and 63460 apply to a service performed:

(a)                    in a permissible circumstance; and

(b)                   using:

(i)                      eligible equipment; or

(ii)                    partial eligible equipment.

(2)               For any particular patient, a request for items 63454 and 63460 must be:

(a)                    made in writing; and

(b)                   identify the clinical indications for the service.

(3)               For the purposes of paragraph 7(1)(a), a service is performed in a permissible circumstance only if it is:

(a)                    both:

(i)                      performed under the supervision of an eligible provider who is available to monitor and influence the conduct and diagnostic quality of the examination, including, if necessary, by personal attendance on the patient; and

(ii)                    reported by an eligible provider; or

(b)                    performed in an emergency; or

(c)                    performed because of medical necessity, in a remote location.

8.                   Application of items 63545 and 63546

(1)               For any particular patient, items 63545 and 63546 apply to a service performed:

(a)                   at the request of a specialist or consultant physician in accordance with subsection 8(2); and

(b)                   in a permissible circumstance; and

(c)                   using:

(i)                     eligible equipment; or

(ii)                   partial eligible equipment.

(2)               For any particular patient, a request for items 63545 and 63546 must be:

(a)                    made in writing; and

(b)                   identify the clinical indications for the service.

(3)               For the purposes of paragraph 8(1)(b), a service is performed in a permissible circumstance only if it is:

(a)                    both:

(i)                      performed under the supervision of an eligible provider who is available to monitor and influence the conduct and diagnostic quality of the examination, including, if necessary, by personal attendance on the patient; and

(ii)                    reported by an eligible provider; or

(b)                    performed in an emergency; or

(c)                    performed because of medical necessity, in a remote location.

9.                   Application of contrast

(1)             An item in the Determination including the symbol (Contrast) applies in addition to:

(a)                    Item 63491 of the diagnostic imaging services table, if the service to which items 63454 or 63460 applies is performed using a contrast agent; or

(b)                    Item 63496 of the Determination, if the service to which items 63545 or 63546 applies is performed using a hepatobiliary-specific contrast agent; or

(c)                    Item 63491 of the diagnostic imaging services table, if the service to which items 63545 or 63546 applies is:

(i)                      performed using an extracellular contrast agent; and

(ii)                    the requesting practitioner indicates the need for imaging with an extracellular contrast agent.


Schedule 1 – relevant services

Part 1 – MRI obstetric services for suspected fetal central nervous system abnormality

 

Group I5 – Magnetic Resonance Imaging

Subgroup 19 – Scan of Body – for specified conditions

Item

Service

                Fee ($)

63454

MRI – scan of the pelvis or abdomen, if:

(a)     the pregnancy is on, or after, 18 weeks gestation; and

(b)     fetal central nervous system abnormality is suspected; and

(c)     an ultrasound has been performed and is provided by, or on behalf of, or at the request of, a specialist who is practising in the specialty of obstetrics, and diagnosis is indeterminate or requires further examination; and

(d)     the service is requested by a specialist practising in the specialty of obstetrics.

 (R) (K) (Anaes.) (Contrast)

1200.00

63460

MRI – scan of the pelvis or abdomen, if:

(a)     the pregnancy is on, or after, 18 weeks gestation; and

(b)     fetal central nervous system abnormality is suspected; and

(c)     an ultrasound has been performed and is provided by, or on behalf of, or at the request of, a specialist who is practising in the specialty of obstetrics, and diagnosis is indeterminate or requires further examination; and

(d)     the service is requested by a specialist practising in the specialty of obstetrics.

 (R) (NK) (Anaes.) (Contrast)

600.00

 

Part 2 – MRI services for colorectal or hepatocellular carcinomas

 

Group I5 – Magnetic Resonance Imaging

Subgroup 21 – Scan of Body – for specified conditions

Item

Service

Fee ($)

63545

MRI – multiphase scans of the liver (including delayed imaging, if performed) with a contrast agent, for characterisation or intervention planning, in a patient with:

(a)       known colorectal carcinoma; and

(b)       known, suspected, or possible liver metastasis; and

(c)       computed tomography or ultrasound imaging have identified a mass lesion in the liver.

For any particular patient—applicable not more than once in a 12 month period (R) (K) (Anaes.) (Contrast)

550.00

63546

MRI – multiphase scans of the liver (including delayed imaging, if performed) with a contrast agent, for diagnosis or staging, in a patient with known or suspected hepatocellular carcinoma, and:

(a)       chronic liver disease, that has been confirmed by a specialist or consultant physician; and

(b)       liver function identified as Child-Pugh class A or B; and

(c)       an identified hepatic lesion over 10 mm in diameter.

For any particular patient—applicable not more than once in a 12 month period (R) (K) (Anaes.) (Contrast)

550.00

 

Part 3 – Hepatobiliary-specific contrast agent services

 

Group I5 – Magnetic Resonance Imaging

Subgroup 22 – Modifying items

Item

Service

Fee

63496

MRI service to which an item in 63545 or 63546 applies if:

a)       the service is performed under the supervision of an eligible provider; and

b)       the service is performed on a person using a hepatobiliary-specific contrast agent.

250.00

 


Endnotes

Endnote 1—About the endnotes

The endnotes provide information about this compilation and the compiled law.

The following endnotes are included in every compilation:

Endnote 1—About the endnotes

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history

Abbreviation key—Endnote 2

The abbreviation key sets out abbreviations that may be used in the endnotes.

Legislation history and amendment history—Endnotes 3 and 4

Amending laws are annotated in the legislation history and amendment history.

The legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.

The amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.

Editorial changes

The Legislation Act 2003 authorises First Parliamentary Counsel to make editorial and presentational changes to a compiled law in preparing a compilation of the law for registration. The changes must not change the effect of the law. Editorial changes take effect from the compilation registration date.

If the compilation includes editorial changes, the endnotes include a brief outline of the changes in general terms. Full details of any changes can be obtained from the Office of Parliamentary Counsel.

Misdescribed amendments

A misdescribed amendment is an amendment that does not accurately describe the amendment to be made. If, despite the misdescription, the amendment can be given effect as intended, the amendment is incorporated into the compiled law and the abbreviation “(md)” added to the details of the amendment included in the amendment history.

If a misdescribed amendment cannot be given effect as intended, the abbreviation “(md not incorp)” is added to the details of the amendment included in the amendment history.

Endnote 2—Abbreviation key

 

ad = added or inserted

o = order(s)

am = amended

Ord = Ordinance

amdt = amendment

orig = original

c = clause(s)

par = paragraph(s)/subparagraph(s)

C[x] = Compilation No. x

    /sub‑subparagraph(s)

Ch = Chapter(s)

pres = present

def = definition(s)

prev = previous

Dict = Dictionary

(prev…) = previously

disallowed = disallowed by Parliament

Pt = Part(s)

Div = Division(s)

r = regulation(s)/rule(s)

ed = editorial change

reloc = relocated

exp = expires/expired or ceases/ceased to have

renum = renumbered

    effect

rep = repealed

F = Federal Register of Legislation

rs = repealed and substituted

gaz = gazette

s = section(s)/subsection(s)

LA = Legislation Act 2003

Sch = Schedule(s)

LIA = Legislative Instruments Act 2003

Sdiv = Subdivision(s)

(md) = misdescribed amendment can be given

SLI = Select Legislative Instrument

    effect

SR = Statutory Rules

(md not incorp) = misdescribed amendment

Sub‑Ch = Sub‑Chapter(s)

    cannot be given effect

SubPt = Subpart(s)

mod = modified/modification

underlining = whole or part not

No. = Number(s)

    commenced or to be commenced

 

Endnote 3—Legislation history

 

Name

Registration

Commencement

Application, saving and transitional provisions

Health Insurance (Section 3C Diagnostic Imaging Services – Liver and Obstetric MRI Services) Determination 2019

29 Mar 2019 (F2019L00480)

1 May 2019 (s 2(1) item 1)

 

Health Insurance (Section 3C Diagnostic Imaging Services –Liver and Obstetric MRI Services) Amendment Determination 2019

29 July 2019 (F2019L01014)

1 Aug 2019 (s 2(1) item 1)

 

Endnote 4—Amendment history

 

Provision affected

How affected

Schedule 1

 

Part 1

 

Group I5 Table.........................

am F2019L01014