Federal Register of Legislation - Australian Government

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Determinations/Health as made
This instrument introduces new Medicare Benefits Schedule item 63564, which is for a whole body magnetic resonance imaging scan to enable the detection of cancer in patients with germline pathogenic TP53 variants.
Administered by: Health and Aged Care
Registered 17 Nov 2022
Tabling HistoryDate
Tabled HR21-Nov-2022
Tabled Senate22-Nov-2022
Table of contents.

Commonwealth Coat of Arms of Australia

 

Health Insurance (Section 3C Diagnostic Imaging Services – Whole Body Magnetic Resonance Imaging Scan) Determination 2022

I, Travis Haslam, delegate of the Minister for Health and Aged Care, make the following determination.

Dated     15 November 2022

 

 

 

 

Travis Haslam

Acting First Assistant Secretary

Medical Benefits Division

Health Resourcing Group

Department of Health and Aged Care

 

 

 

 

 

  

  


Contents

1.  Name ...................................................................................................................................... 1

2.  Commencement....................................................................................................................... 1

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

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

5.  Treatment of relevant services................................................................................................. 2

6.  Application of provisions of the general medical services table............................................... 2

Schedule 1 – relevant services                                                                                      3

 


1.  Name

              This instrument is the Health Insurance (Section 3C Diagnostic Imaging Services – Whole Body Magnetic Resonance Imaging Scan) Determination 2022.

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 March 2023

 

                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 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.

MRI means magnetic resonance imaging.

(R) has the meaning given by clause 1.2.15(1) of the diagnostic imaging services table.

relevant provisions mean all provisions, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under the National Health Act 1953, 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 a Schedule.

Schedule means a Schedule to this instrument.

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

·         clinically relevant service;

·         diagnostic imaging services table;

·         item;

·         professional service.

 (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

 

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 provisions of the diagnostic imaging services table

(1)   Clause 1.2.17 of the diagnostic imaging services table shall have effect as if the items in Schedule 1 of this instrument were specified for the purpose of that clause.

 

7. Limitation of items

(1)   A service described under item 63564 applies only if the same patient has not received a service to which the same item applies within the preceding 12 months.

 

Schedule – relevant services

 

Group I5 – Magnetic Resonance Imaging

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 19 – Scan of Body – For Specified Conditions

63564

MRI – whole body scan for the early detection of cancer:

a)       requested by a specialist or consultant physician in consultation with a clinical geneticist in a familial cancer or genetic clinic; and

b)       the request identifies that the patient has a high risk of developing cancer malignancy

due to heritable TP53 - related cancer (hTP53rc) syndrome

(R) (Anaes.)

1,500.00