Health Insurance (Section 3C General Medical Services – Mechanical Thrombectomy) Determination 2017
I, MICHAEL RYAN, delegate of the Minister for Health, make this Determination under subsection 3C(1) of the Health Insurance Act 1973.
MICHAEL RYAN
Acting Assistant Secretary
MBS Policy and Specialist Services Branch
Medical Benefits Division
Department of Health
5. Treatment of relevant services
6. Application of provisions of the general medical services table
Schedule 1 – relevant services
This Determination is the Health Insurance (Section 3C General Medical Services – Mechanical Thrombectomy) Determination 2017.
This Determination is commences on 1 November 2017.
This Determination is made under subsection 3C(1) of the Health Insurance Act 1973.
(1) In this Determination:
Act means the Health Insurance Act 1973.
eligible stroke centre means a facility that:
(a) has a designated stroke unit;
(b) is equipped and has staff available or on call so that it is capable of providing the following to a patient on a 24-hour basis:
(i) the services of a specialist or consultant physician who has the training required under paragraph (b) of item 35414;
(ii) diagnostic imaging services using advanced imaging techniques, which must include computed tomography, computed tomography angiography, digital subtraction angiography, magnetic resonance imaging, and magnetic resonance angiography; and
(iii) care from a team of health practitioners which includes a stroke physician, a neurologist, a neurosurgeon, a radiologist, an anaesthetist, an intensive care unit specialist, a medical imaging technologist, and a nurse;
(c) has dedicated endovascular angiography facilities; and
(d) has written procedures for assessing and treating patients who have, or may have, experienced a stroke.
Note: A health practitioner may fulfil the role of more than one of the types of health practitioner specified in paragraph (b)(iii). For example, a neurologist may also be a stroke physician.
relevant provisions means 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 Determination.
Note: The following terms are defined in subsection 3(1) of the Act:
(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.
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 medical service; and
(b) there were an item in the general medical 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.
(1) Clause 1.2.1 of the general medical services table shall have effect as if item 35414 were specified in Part 2 of the general medical services table.
(2) Clause 1.2.4 of the general medical services table shall have effect as if item 35414 were also specified in subclause 1.2.4(1).
(3) Clause 1.2.5 of the general medical services table shall have effect as if item 35414 were also specified in subclause 1.2.5(1).
(4) Clause 2.44.2 of the general medical services table shall have effect as if item 35414 were specified in Group T8 of the general medical services table.
Group T8 – Surgical operations | ||
Subgroup 3 - Vascular | ||
Subheading 13 – Interventional Radiology Procedures | ||
Item | Service | Fee ($) |
35414 | Mechanical thrombectomy, in a patient with a diagnosis of acute ischaemic stroke caused by occlusion of a large vessel of the anterior cerebral circulation, including intra-operative imaging and aftercare, if: (a) the diagnosis is confirmed by an appropriate imaging modality such as computed tomography, magnetic resonance imaging or angiography; and (b) the service is performed by a specialist or consultant physician with appropriate training that is recognised by the Conjoint Committee for Recognition of Training in Interventional Neuroradiology; and (c) the service is provided in an eligible stroke centre. For any particular patient - applicable once per presentation by the patient at an eligible stroke centre, regardless of the number of times mechanical thrombectomy is attempted during that presentation (H) (Anaes.) (Assist.) | 3,500.00 |
