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Determinations/Health as amended, taking into account amendments up to Health Insurance Legislation Amendment (Section 3C General Medical and Diagnostic Imaging Services – Medicare Indexation) Determination 2020
This determination provides a legal basis for the payment of Medicare benefits for two new items 53902 and 53905 for three dimensional breast tomosynthesis (3DBT) services.
Administered by: Health
Registered 24 Aug 2020
Start Date 01 Jul 2020
End Date 30 Jun 2021
Table of contents.

Commonwealth Coat of Arms of Australia

Health Insurance (Section 3C Diagnostic Imaging Services – 3D Breast Tomosynthesis) Determination 2018

made under subsection 3C(1) of the

Health Insurance Act 1973

Compilation No. 2

Compilation date:                              1 July 2020

Includes amendments up to:            F2020L00748

Registered:                                         24 August 2020

About this compilation

This compilation

This is a compilation of the Health Insurance (Section 3C Diagnostic Imaging Services – 3D Breast Tomosynthesis) Determination 2018 that shows the text of the law as amended and in force on 1 July 2020 (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

3............ Authority....................................................................................................................... 1

4............ Definitions..................................................................................................................... 1

5............ Treatment of relevant services....................................................................................... 1

6............ Application of a provision of the diagnostic imaging services table.............................. 2

Schedule—Relevant services                                                                                                                      3

Endnotes                                                                                                                                                                 4

Endnote 1—About the endnotes                                                                                                        4

Endnote 2—Abbreviation key                                                                                                            5

Endnote 3—Legislation history                                                                                                         6

Endnote 4—Amendment history                                                                                                       7

 

 


1  Name

                   This instrument is the Health Insurance (Section 3C Diagnostic Imaging Services – 3D Breast Tomosynthesis) Determination 2018.

3  Authority

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

4  Definitions

             (1)  In this instrument:

Act means the Health Insurance Act 1973.

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

Schedule means the Schedule to this instrument.

Note:          A number of expressions used in this instrument are defined in subsection 3(1) of the Act, including the following:

(a)      clinically relevant service;

(b)      diagnostic imaging services table;

(c)      item;

(d)      professional service;

(e)      specialist.

             (2)  Unless the contrary intention appears, a reference in this instrument 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

             (1)  For subsection 3C(1) of the Act a relevant service, provided in accordance with this instrument 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  Application of a provision of the diagnostic imaging services table

             (1)  Clause 2.3.5 of the diagnostic imaging services table shall have effect as if the items contained in the Schedule were also specified in the clause.


 

Schedule—Relevant services

 

 Category 5 – Diagnostic Imaging Services

Group I3 – Diagnostic Radiology

Subgroup 10 – Radiographic Examination of Breasts 

Item

Service

Fee ($)

59302

Three dimensional tomosynthesis of both breasts, if there is reason to suspect the presence of malignancy because of:

a)      the past occurrence of breast malignancy in the patient; or

b)significant history of breast or ovarian malignancy in the patient’s family; or

c)      symptoms or indications of breast disease found on examination of the patient by a medical practitioner

Not being a service to which item 59300 applies (R)

205.05

59305

Three dimensional tomosynthesis of one breast, if there is reason to suspect the presence of malignancy because of:

a)      the past occurrence of breast malignancy in the patient; or

b)significant history of breast or ovarian malignancy in the patient’s family; or

c)      symptoms or indications of breast disease found on examination of the patient by a medical practitioner

Not being a service to which item 59303 applies (R)

115.70

 


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 – 3D Breast Tomosynthesis) Determination 2018

2 Oct 2018 (F2018L01387)

1 Nov 2018 (s 2(1) item 1)

 

Health Insurance Legislation Amendment (Section 3C – Medical and Diagnostic Imaging Services) Determination 2020

29 Apr 2020 (F2020L00518)

1 May 2020 (s 2(1) item 1)

Health Insurance Legislation Amendment (Section 3C General Medical and Diagnostic Imaging Services – Medicare Indexation) Determination 2020

18 June 2020 (F2020L00748)

Sch 1 (items 12, 13): 1 July 2020 (s 2(1) item 1)

 

Endnote 4—Amendment history

 

Provision affected

How affected

s 2.............................................

rep LA s 48D

s 6.............................................

am F2020L00518

Schedule

 

Schedule...................................

am F2020L00518

 

ed C1

 

am F2020L00748