Commonwealth Coat of Arms of Australia

Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020

made under the

Health Insurance Act 1973

Compilation No. 12

Compilation date: 1 November 2022

Includes amendments up to: F2022L01099

Registered: 3 November 2022

About this compilation

This compilation

This is a compilation of the Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020 that shows the text of the law as amended and in force on 1 November 2022 (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.

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If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.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

3 Authority

4 Diagnostic imaging services table

Schedule 1—Diagnostic imaging services table

Part 1—Preliminary

Division 1.1—Interpretation

1.1.1 References to diagnostic imaging services

1.1.2 References in this Schedule to items include items determined under section 3C of the Act

1.1.3 Dictionary

Division 1.2—General application provisions

Subdivision A—Capital sensitivity requirements

1.2.1 Restriction on items—services performed on aged equipment

1.2.2 Age of equipment

Subdivision B—Exemptions from capital sensitivity requirements

1.2.4 Meaning of relevant proprietor

1.2.7 Equipment unable to be replaced etc. before end of applicable life age—applying for exemptions

1.2.8 Equipment unable to be replaced etc. before end of applicable life age—granting exemptions

1.2.9 Equipment unable to be replaced etc. before end of applicable life age—applying for extensions of exemption periods

1.2.10 Equipment unable to be replaced etc. before end of applicable life age—extending exemption periods

1.2.11 Reconsideration by Secretary—applying for reconsideration

1.2.12 Reconsideration by Secretary—reconsidering decisions

1.2.13 Review by AAT

1.2.14 Delegation

Subdivision C—Other provisions

1.2.15 Meaning of symbols (R) and (NR)

1.2.16 Who may provide a diagnostic imaging service

1.2.17 Restriction on items—report requirements for Rtype diagnostic imaging services

1.2.18 Bulkbilling incentive

1.2.21 Reduction in fees—multiple services on same day—general

1.2.22 Restriction on items—services provided with autologous injections of blood or blood products

1.2.23 Restriction on items—services provided with harvesting, storage, in vitro processing or injection of nonhaematopoietic stem cells

Part 2—Services and fees

Division 2.1—Group I1: ultrasound

Subdivision A—General

2.1.1 Restriction on items—ultrasound services

2.1.2 Restriction on items—Rtype ultrasound services

Subdivision B—Subgroups 1 to 4 of Group I1

2.1.2A Reduction in fees—multiple services on same day—vascular ultrasounds

2.1.3 Items in Subgroups 1 to 4 of Group I1

Subdivision C—Subgroup 5 of Group I1: obstetric and gynaecological

2.1.4 Obstetric and gynaecological ultrasound services—limits

2.1.5 Obstetric and gynaecological services—referrals and clinical notes

2.1.6 Items in Subgroup 5 of Group I1

Subdivision D—Subgroup 6 of Group I1: musculoskeletal ultrasound

2.1.7 Musculoskeletal ultrasound services—personal attendance

2.1.8 Unilateral item cannot be claimed twice if bilateral item could have been claimed

2.1.9 Musculoskeletal ultrasound services—comparison ultrasonography

2.1.10 Items in Subgroup 6 of Group I1

Subdivision E—Subgroup 7 of Group I1: Transthoracic and stress echocardiograms

2.1.11 Restrictions on items for transthoracic echocardiograms—assessments

2.1.12 Restriction on item 55126—timing

2.1.13 Restriction on items for stress echocardiograms—patients, requests and requirements

2.1.14 Stress echocardiograms—patients

2.1.15 Stress echocardiograms—requirements

2.1.16 Restrictions on items for stress echocardiograms—timing

2.1.17 Reduction in fees—multiple services on same day—transthoracic and stress echocardiograms

2.1.18 Items in Subgroup 7 of Group I1

Division 2.2—Group I2: computed tomography (examination)

Subdivision A—General

2.2.1 CT services—eligible services

2.2.2 Restriction on items—attenuation correction and anatomical correlation

2.2.3 Application of items 56001 and 56007 if axial scan performed for exclusion of acoustic neuroma

2.2.4 CT services—assessment of headache

2.2.5 CT services—number of services

2.2.5A Restriction on item 57360—patients

Subdivision B—Subgroups 1 to 13 of Group I2

2.2.6 Items in Subgroups 1 to 13 of Group I2

Division 2.3—Group I3: diagnostic radiology

Subdivision A—General

2.3.1 Application of items in Subdivision B, D, E or G to services rendered using diagnostic imaging procedures carried out in metropolitan areas and certain inner regional areas

2.3.2 Restriction on items—certain services requested by chiropractors, osteopaths and physiotherapists

2.3.3 Increased fees for certain diagnostic radiology services carried out at residential aged care facilities

Subdivision B—Subgroups 1 to 9 of Group I3

2.3.4 Items in Subgroups 1 to 9 of Group I3

Subdivision C—Subgroup 10 of Group I3: radiographic examination of breasts

2.3.5 Mammography services—eligible services

2.3.6 Items in Subgroup 10 of Group I3

Subdivision D—Subgroups 12 and 13 of Group I3

2.3.7 Items in Subgroups 12 and 13 of Group I3

Subdivision E—Subgroup 15 of Group I3: fluoroscopic examination

2.3.8 Items in Subgroup 15 of Group I3

Subdivision F—Subgroup 16 of Group I3: preparation for radiological procedure

2.3.9 Preparation of patients for radiological procedures

2.3.10 Items in Subgroup 16 of Group I3

Subdivision G—Subgroup 17 of Group I3: interventional techniques

2.3.11 Meaning of angiography suite

2.3.12 Items in Subgroup 17 of Group I3

Division 2.4—Group I4: nuclear medicine imaging

Subdivision A—General

2.4.1 Nuclear scanning services (other than PET nuclear scanning services) and adjunctive services

2.4.1A Restriction on items for stress myocardial perfusion studies—patients, requests and requirements

2.4.1B Stress myocardial perfusion studies—patients

2.4.1C Stress myocardial perfusion studies—requirements

2.4.2 PET nuclear scanning services

2.4.3 PET nuclear scanning services—performance under personal supervision

2.4.4 PET nuclear scanning services—equipment

2.4.5 PET nuclear scanning services—statutory declaration

Subdivision B—Subgroups 1, 2 and 3 of Group I4

2.4.6 Items in Subgroups 1, 2 and 3 of Group I4

Division 2.5—Group I5: magnetic resonance imaging

Subdivision A—General

2.5.1 Application of items to certain MRI and MRA services

2.5.2 MRI and MRA services—request

2.5.3 MRI and MRA services—permissible circumstances for performance

2.5.4 MRI and MRA services—eligible provider

2.5.5 MRI and MRA services—eligible equipment

2.5.6 MRI and MRA services—partial eligible equipment

2.5.7 MRI and MRA services—meaning of scan

2.5.8 Restriction on items—multiple services in certain subgroups on a day

2.5.8A Restriction on items—multiple services in certain subgroups in an attendance

2.5.8B Reduction in fees—multiple services on same day—Subgroups 12 and 13

2.5.9 Restriction on items—related MRI or MRA services

2.5.9A Circumstances for suspecting prostate cancer for item 63541

2.5.9B Restriction on item 63543—timing and purpose

Subdivision B—Subgroups 1 to 19 of Group I5

2.5.10 Items in Subgroups 1 to 19 of Group I5

Subdivision C—Subgroup 20 of Group I5: scans of pelvis and upper abdomen for specified conditions

2.5.11 Restriction on items 63470, 63473, 63740 and 63743

2.5.13 Items in Subgroup 20 of Group I5

Subdivision D—Subgroups 21 and 22 of Group I5

2.5.13A MRI and MRA services—modifying items

2.5.14 Items in Subgroups 21 and 22 of Group I5

Subdivision E—Subgroup 33 of Group I5

2.5.15 Items in Subgroup 33 of Group I5

Subdivision F—Subgroup 34 of Group I5

2.5.16 Items in Subgroup 34 of Group I5

Division 2.6—Group I6: management of bulkbilled services

2.6.1 Application of items 64990, 64991, 64992, 64993, 64994 and 64995

2.6.2 Items in Group I6

Division 2.7—Indexation of fees

2.7.1 Indexation—1 July 2022

Part 3—Dictionary

3.1 Dictionary

Part 4—Application, saving and transitional provisions

Division 1—Health Insurance (Diagnostic Imaging Services Table) Amendment (Equipment Capital Sensitivity) Regulations 2022

4.1 Definitions

4.2 Application of amendments

Endnotes

Endnote 1—About the endnotes

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history

Endnote 5—Editorial changes

1  Name

  This instrument is the Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020.

3  Authority

  This instrument is made under the Health Insurance Act 1973.

4  Diagnostic imaging services table

  For the purposes of section 4AA of the Health Insurance Act 1973, Schedule 1 is prescribed as a table of diagnostic imaging services.

Schedule 1Diagnostic imaging services table

Note: See section 4.

Part 1Preliminary

Division 1.1Interpretation

1.1.1  References to diagnostic imaging services

  A reference to a diagnostic imaging service in an item in Part 2 includes a reference to the undertaking of the diagnostic imaging procedure used for rendering the service.

1.1.2  References in this Schedule to items include items determined under section 3C of the Act

  A reference in this Schedule to an item includes a reference to an item relating to a health service that, under a determination in force under subsection 3C(1) of the Act, is treated as if there were an item in the table that relates to the service.

1.1.3  Dictionary

  The Dictionary in Part 3 of this Schedule defines certain words and expressions that are used in this Schedule, and includes references to certain words and expressions that are defined elsewhere in this Schedule.

Division 1.2General application provisions

Subdivision ACapital sensitivity requirements

1.2.1  Restriction on items—services performed on aged equipment

  Subject to Subdivision B, an item in this Schedule does not apply to a service that is performed on diagnostic imaging equipment if the age of the equipment exceeds the applicable life age of the equipment.

1.2.2  Age of equipment

Working out age of equipment

 (1) The date from which the age of equipment is worked out for the purposes of this instrument is:

 (a) the date the equipment was first installed in Australia; or

 (b) if the equipment was imported as used equipment—the date of manufacture of the oldest component of the equipment.

 (2) The applicable life age:

 (a) for diagnostic imaging equipment that has not been upgraded—is the new effective life age of the equipment; and

 (b) for diagnostic imaging equipment that has been upgraded—is the maximum extended life age of the equipment.

 (3) The new effective life age and maximum extended life age for diagnostic imaging equipment are the periods set out in table 1.2.2 for that type of equipment. The type of equipment is defined by the type of service that is rendered using diagnostic imaging procedures carried out using the equipment:

 

Table 1.2.2—Life ages

Item

Column 1

Type of equipment

Column 2

Definition of type of equipment

Column 3

New effective life age (years)

Column 4

Maximum extended life age (years)

1

Ultrasound equipment

Equipment primarily used in carrying out a diagnostic imaging procedure used in rendering a service to which an item in Group I1 applies

10

15

2

CT equipment

Equipment primarily used in carrying out a diagnostic imaging procedure used in rendering a service to which an item in Group I2 applies

10

15

3

Mammography equipment

Equipment primarily used in carrying out a diagnostic imaging procedure used in rendering a service to which an item in Subgroup 10 of Group I3 applies

10

15

4

Angiography equipment

Equipment primarily used in carrying out a diagnostic imaging procedure used in rendering a service to which an item in Subgroup 13 of Group I3 applies

10

15

5

Other diagnostic radiology equipment

Equipment primarily used in carrying out a diagnostic imaging procedure used in rendering a service to which an item in Subgroups 1 to 9, 12, 14, 15 or 17 of Group I3 applies

15

20

6

Nuclear medicine imaging equipment (other than for PET)

Equipment primarily used in carrying out a diagnostic imaging procedure used in rendering a service to which an item in Group I4 applies (other than items 61523 to 61647)

10

15

7

MRI equipment

Equipment primarily used in carrying out a diagnostic imaging procedure used in rendering a service to which an item in Group I5 applies

10

20

Upgrades

 (4) Diagnostic imaging equipment has been upgraded if:

 (a) an additional reasonable investment has been made within the new effective life age for the equipment that improves the overall performance of the imaging system so that it is equivalent to new equipment supplied in Australia at the time of the improvement; or

 (b) in the case of CT or angiography equipment that was not more than 15 years old on 1 January 2015—an additional reasonable investment has been made before 1 January 2016 that improves the overall performance of the imaging system so that it is equivalent to new equipment supplied in Australia at the time of the improvement; or

 (c) the equipment is currently accredited under The Royal Australian and New Zealand College of Radiologists’ Mammography Quality Assurance Program.

Subdivision BExemptions from capital sensitivity requirements

1.2.4  Meaning of relevant proprietor

  The relevant proprietor for diagnostic imaging equipment is:

 (a) if the equipment is ordinarily located at diagnostic imaging premises—the proprietor of the premises; or

 (b) if the equipment:

 (i) is not ordinarily located at diagnostic imaging premises; and

 (ii) is ordinarily located, when not in use, at a base for mobile diagnostic imaging equipment;

  the proprietor of the base.

1.2.7  Equipment unable to be replaced etc. before end of applicable life age—applying for exemptions

Applying for exemption

 (1) The relevant proprietor for diagnostic imaging equipment may apply to the Secretary for an exemption under clause 1.2.8 in respect of the equipment.

Note: For relevant proprietor, see clause 1.2.4.

 (2) The application must:

 (a) be in writing; and

 (b) be made before the end of the equipment’s applicable life age; and

 (c) set out reasons why the proprietor is unable to replace the equipment (or upgrade the equipment, if it has not already been upgraded) before the end of the equipment’s applicable life age.

Notifying proprietor of receipt of application

 (3) If:

 (a) the Secretary receives an application under subclause (2) of this clause for an exemption in respect of the equipment; and

 (b) the application complies with subclause (2);

the Secretary must notify the relevant proprietor for the equipment in writing that the Secretary has received the application.

Effect of application on capital sensitivity requirements

 (4) Clause 1.2.1 does not apply to a service that is performed on the equipment during the period:

 (a) starting when the Secretary notifies the relevant proprietor under subclause (3) of this clause that the Secretary has received an application in respect of the equipment; and

 (b) ending when the Secretary makes a decision on the application under clause 1.2.8, or the application is withdrawn.

1.2.8  Equipment unable to be replaced etc. before end of applicable life age—granting exemptions

Scope of this clause

 (1) This clause applies if, under subclause 1.2.7(3), the Secretary notifies the relevant proprietor for diagnostic imaging equipment that the Secretary has received an application for an exemption in respect of the equipment.

Granting exemption

 (2) The Secretary must, by notice in writing given to the proprietor:

 (a) subject to subclauses (3) and (4) of this clause, grant the exemption for a specified period; or

 (b) refuse to grant the exemption.

 (3) The Secretary must not grant the exemption unless the Secretary is satisfied that:

 (a) both of the following apply:

 (i) due to circumstances beyond the control of the proprietor, the proprietor is unable to replace the equipment (or upgrade the equipment, if it has not already been upgraded) before the end of its applicable life age;

 (ii) the proprietor will be able to replace the equipment (or upgrade the equipment, if it has not already been upgraded) before the end of the period specified under paragraph (2)(a); or

 (b) both of the following apply:

 (i) the proprietor has taken reasonable steps to replace the equipment (or upgrade the equipment, if it has not already been upgraded) before the end of its applicable life age;

 (ii) the proprietor is unable to replace the equipment (or upgrade the equipment, if it has not already been upgraded) before the end of its applicable life age because of delays or shortages in the supply of equipment.

 (4) The period specified under paragraph (2)(a) must end no later than 3 months after the end of the equipment’s applicable life age.

Note: The period specified under paragraph (2)(a) is the initial exemption period of the exemption: see clause 3.1. The exemption period can be extended under clause 1.2.10.

 (5) The Secretary must make a decision on the application under subclause (2) within 28 days after notifying the proprietor as mentioned in subclause (1).

Effect of exemption or refusal on capital sensitivity requirements

 (6) If the Secretary grants the exemption, clause 1.2.1 does not apply to a service that is performed on the equipment during the exemption period of the exemption (including the exemption period as extended under clause 1.2.10, if applicable).

 (7) If the Secretary refuses to grant the exemption, clause 1.2.1 does not apply to a service that is performed on the equipment during the period:

 (a) starting when the Secretary refuses to grant the exemption; and

 (b) ending:

 (i) when the relevant proprietor for the equipment applies under clause 1.2.11 for reconsideration of the decision to refuse to grant the exemption; or

 (ii) if the relevant proprietor does not apply for such consideration—at the end of the period in which the proprietor could have applied for such reconsideration.

1.2.9  Equipment unable to be replaced etc. before end of applicable life age—applying for extensions of exemption periods

Scope of this clause

 (1) This clause applies if an exemption under clause 1.2.8 in respect of diagnostic imaging equipment is in force.

Applying for extension of exemption period

 (2) The relevant proprietor for the equipment may apply to the Secretary to extend the exemption period of the exemption under clause 1.2.10.

Note: For relevant proprietor, see clause 1.2.4.

 (3) The application must:

 (a) be in writing; and

 (b) be made before the end of the current exemption period of the exemption; and

 (c) set out reasons why the proprietor continues to be unable to replace or upgrade the equipment.

Notifying proprietor of receipt of application

 (4) If:

 (a) the Secretary receives an application under subclause (2) of this clause for an extension of the exemption; and

 (b) the application complies with subclause (3);

the Secretary must notify the relevant proprietor for the equipment in writing that the Secretary has received the application.

Effect of application on capital sensitivity requirements

 (5) Clause 1.2.1 does not apply to a service that is performed on the equipment during the period:

 (a) starting when the Secretary notifies the relevant proprietor under subclause (4) of this clause that the Secretary has received an application in respect of the equipment; and

 (b) ending when the Secretary makes a decision on the application under clause 1.2.10, or the application is withdrawn.

1.2.10  Equipment unable to be replaced etc. before end of applicable life age—extending exemption periods

Scope of this clause

 (1) This clause applies if, under subclause 1.2.9(4), the Secretary notifies the relevant proprietor for diagnostic imaging equipment that the Secretary has received an application for an extension of the exemption period of an exemption in respect of the equipment.

Secretary may extend extension period

 (2) The Secretary must, by notice in writing given to the proprietor:

 (a) subject to subclauses (3) and (4) of this clause, extend the exemption period for a specified period; or

 (b) refuse to extend the exemption period.

 (3) The Secretary must not extend the exemption period unless the Secretary is satisfied that:

 (a) both of the following apply:

 (i) due to circumstances beyond the control of the proprietor, the proprietor is unable to replace the equipment (or upgrade the equipment, if it has not already been upgraded) before the end of the current exemption period of the exemption;

 (ii) the proprietor will be able to replace the equipment (or upgrade the equipment, if it has not already been upgraded) before the end of the exemption period as extended; or

 (b) both of the following apply:

 (i) the proprietor has taken reasonable steps to replace the equipment (or upgrade the equipment, if it has not already been upgraded) before the end of the current exemption period of the exemption;

 (ii) the proprietor is unable to replace the equipment (or upgrade the equipment, if it has not already been upgraded) before the end of the current exemption period of the exemption because of delays or shortages in the supply of equipment.

 (4) The extension must be for no more than 3 months.

 (5) The Secretary must make a decision on the application under subclause (2) within 28 days after notifying the proprietor as mentioned in subclause (1).

Effect of refusal on capital sensitivity requirements

 (6) If the Secretary refuses to extend the exemption period, clause 1.2.1 does not apply to a service that is performed on the equipment during the period:

 (a) starting when the Secretary refuses to extend the exemption period; and

 (b) ending:

 (i) when the relevant proprietor for the equipment applies under clause 1.2.11 for reconsideration of the decision to refuse to extend the exemption period; or

 (ii) if the relevant proprietor does not apply for such consideration—at the end of the period in which the proprietor could have applied for such reconsideration.

Note: Clause 1.2.1 does not apply to a service provided using the equipment during the extended exemption period: see subclause 1.2.8(6).

1.2.11  Reconsideration by Secretary—applying for reconsideration

Scope of this clause

 (1) This clause applies to:

 (a) a decision under clause 1.2.8 to refuse to grant an exemption in respect of diagnostic imaging equipment; or

 (b) a decision under clause 1.2.10 to refuse to extend the exemption period of an exemption in respect of diagnostic imaging equipment.

Applying for reconsideration of decision

 (2) The relevant proprietor for the equipment may apply to the Secretary for reconsideration of the decision under clause 1.2.12.

Note: For relevant proprietor, see clause 1.2.4.

 (3) The application must:

 (a) be in writing; and

 (b) be made within:

 (i) 28 days after the Secretary makes the decision; or

 (ii) if the Secretary is satisfied that special circumstances exist—within such further period (if any) as the Secretary allows; and

 (c) identify the decision for reconsideration; and

 (d) set out the reasons for the application.

 (4) The application may provide new material for the Secretary to consider.

Notifying proprietor of receipt of application

 (5) If:

 (a) the Secretary receives an application under subclause (2) of this clause for reconsideration of the decision; and

 (b) the application complies with subclause (3);

the Secretary must notify the relevant proprietor for the equipment in writing that the Secretary has received the application.

Effect of application on capital sensitivity requirements

 (6) Clause 1.2.1 does not apply to a service that is performed on the equipment during the period:

 (a) starting when the Secretary notifies the relevant proprietor under subclause (5) of this clause that the Secretary has received an application in respect of the equipment; and

 (b) ending when the Secretary makes a decision on the application under clause 1.2.12, or the application is withdrawn.

1.2.12  Reconsideration by Secretary—reconsidering decisions

Scope of this clause

 (1) This clause applies if, under subclause 1.2.11(5), the Secretary notifies the relevant proprietor of diagnostic imaging equipment that the Secretary has received an application for reconsideration of a decision in respect of the equipment.

Reconsidering decisions

 (2) The Secretary must:

 (a) reconsider the decision; and

 (b) by notice in writing given to the proprietor:

 (i) affirm the decision; or

 (ii) set aside the decision and make a decision in substitution for it.

 (3) The Secretary must make a decision on the application under subclause (2) within 28 days after notifying the proprietor as mentioned in subclause (1).

Effect of affirmation of decision on capital sensitivity requirements

 (4) If the Secretary affirms the decision, clause 1.2.1 does not apply to a service that is performed on the equipment during the period:

 (a) starting when the Secretary affirms the decision; and

 (b) ending:

 (i) if an application for review of the decision to affirm is made under clause 1.2.13—when each party to the proceeding has been given a copy of the decision of the Administrative Appeals Tribunal on review; or

 (ii) otherwise—when the time for making such an application for review expires.

Note: For the time for making an application for review, see paragraph 29(1)(d) and subsection 29(2) of the Administrative Appeals Tribunal Act 1975.

1.2.13  Review by AAT

  Applications may be made to the Administrative Appeals Tribunal for review of decisions of the Secretary under clause 1.2.12.

1.2.14  Delegation

  The Secretary may, by written notice, delegate any of the Secretary’s powers under this Subdivision to an SES employee, or acting SES employee, in the Department.

Subdivision COther provisions

1.2.15  Meaning of symbols (R) and (NR)

 (1) A service corresponding to an item including the symbol (R) is an Rtype diagnostic imaging service.

 (2) A service corresponding to an item including the symbol (NR) is an NRtype diagnostic imaging service.

1.2.16  Who may provide a diagnostic imaging service

  Items in this Schedule relating to diagnostic imaging services apply whether the service is provided by:

 (a) a medical practitioner; or

 (b) a person, other than a medical practitioner, who provides the service under the supervision of a medical practitioner in accordance with accepted medical practice.

1.2.17  Restriction on items—report requirements for Rtype diagnostic imaging services

 (1) An item relating to an Rtype diagnostic imaging service (except an item to which subclause (2) applies) applies only if the providing practitioner gives a report of the service performed to the practitioner, participating midwife or participating nurse practitioner who requested the service.

 (2) This subclause applies to:

 (a) items 55054, 55130, 55135, 55848, 57341, 59312, 59314, 60506, 60509 and 61109; and

 (b) items 60918 and 60927.

Note: The items in paragraph (a) relate to services performed in conjunction with a surgical procedure. The items in paragraph (b) relate to services performed in preparation for a radiological procedure.

1.2.18  Bulkbilling incentive

 (1) This clause applies if:

 (a) a service that is mentioned in an item in Divisions 2.1 to 2.5 of this Schedule is provided; and

 (b) the service is not provided in a hospital; and

 (c) the service is bulkbilled.

 (2) The fee for the service is 95% of the fee mentioned in this Schedule for the service.

Note: Under paragraph 10(2)(aa) of the Act and subsection 28(2) of the Health Insurance Regulations 2018, the medicare benefit payable is 100% of the fee for the service.

 (3) This clause does not apply to the service specified in item 61369 or 63549.

1.2.21  Reduction in fees—multiple services on same day—general

 (1) If a medical practitioner renders 2 or more diagnostic imaging services for the same patient on the same day, the fees set out in the items that apply to the services, other than the item with the highest fee, are reduced by $5.

 (2) If a medical practitioner renders at least one Rtype diagnostic imaging service and at least one consultation service for the same patient on the same day, the highest fee, set out in the items that apply to diagnostic imaging services rendered by the practitioner for that patient on that day, is reduced:

 (a) if the fee for the relevant consultation is at least $40—by $35; or

 (b) if that fee is less than $40 but more than $15—by $15; or

 (c) if that fee is less than $15—by the amount of that fee.

 (3) For the purposes of subclause (2), if more than one consultation has occurred, the relevant consultation is the consultation having the highest fee set out in the items that apply to the consultation.

 (4) If a medical practitioner renders at least one Rtype diagnostic imaging service and at least one nonconsultation service for the same patient on the same day, the highest fee that applies to any diagnostic imaging services performed by the medical practitioner for the same patient on the same day, is reduced by $5.

 (5) If a medical practitioner renders an Rtype diagnostic imaging service, a consultation and a nonconsultation service for the same patient on the same day, the sum of the reductions under subclauses (2) and (4) must not exceed the highest fee that applies to any diagnostic imaging services rendered by the medical practitioner for the same patient on the same day.

 (6) Clauses 2.1.2A, 2.1.17 and 2.5.8 apply, subject to subclauses (7), (8) and (8A), in addition to this clause.

 (7) For the purposes of clause 2.1.2A, if a medical practitioner provides:

 (a) 2 or more vascular ultrasound services for the same patient on the same day; and

 (b) one or more other diagnostic imaging services for that patient on that day;

the amount of the fees payable for the vascular ultrasound services is taken, for this clause, to be an amount payable for one diagnostic imaging service.

 (8) For the purposes of clause 2.5.8, if a medical practitioner provides:

 (a) 2 or more MRI services mentioned in Subgroup 12 or 13 of Group I5 for the same patient on the same day; and

 (b) one or more other diagnostic imaging services for that patient on that day;

the amount of the fees payable for the MRI services is taken, for this clause, to be an amount payable for one diagnostic imaging service.

 (8A) For the purposes of clause 2.1.17, if a medical practitioner provides:

 (a) 2 or more echocardiogram services mentioned in subclause 2.1.17(1) for the same patient on the same day; and

 (b) one or more other diagnostic imaging services for that patient on that day;

the amount of the fees payable for the echocardiogram services is taken, for this clause, to be an amount payable for one diagnostic imaging service.

 (9) This clause does not apply to diagnostic imaging services that are rendered in a remote area by a medical practitioner for whom a remote area exemption under section 23DX of the Act is in force for that area.

 (10) This clause does not apply to the fee specified in item 59103, 64990, 64991, 64992, 64993, 64994 or 64995.

 (11) In this Schedule:

consultation means a service under an item listed in Divisions 2.2 to 2.30 of the general medical services table.

highest fee means the highest fee specified for an item in the first claim submitted to the Chief Executive Medicare for the services provided.

nonconsultation service means a service under an item listed in the general medical services table, other than in Divisions 2.2 to 2.30 of the general medical services table.

1.2.22  Restriction on items—services provided with autologous injections of blood or blood products

  An item in this Schedule does not apply to a service mentioned in the item if the service is provided to a patient at the same time as, or in connection with, an injection of blood or a blood product that is autologous.

1.2.23  Restriction on items—services provided with harvesting, storage, in vitro processing or injection of nonhaematopoietic stem cells

  An item in this Schedule does not apply to a service mentioned in the item if the service is provided to a patient at the same time as, or in connection with, the harvesting, storage, in vitro processing or injection of nonhaematopoietic stem cells.

Part 2Services and fees

Division 2.1Group I1: ultrasound

Subdivision AGeneral

2.1.1  Restriction on items—ultrasound services

  Items in this Division (except items 55600 and 55603) apply to an ultrasound service only if the diagnostic imaging procedure used in rendering the service is performed:

 (a) by a medical practitioner; or

 (b) on behalf of a medical practitioner by a person whose name is entered on the Register of Sonographers kept by the Chief Executive Medicare.

Note: Maintaining a register of sonographers is a function of the Chief Executive Medicare under section 32 of the Human Services (Medicare) Regulations 2017.

2.1.2  Restriction on items—Rtype ultrasound services

 (1) Items in this Division (except items 55600 and 55603) marked with the symbol (R) apply to an ultrasound service (the eligible service) only if the service is performed:

 (a) under the supervision of a specialist or a consultant physician in the practice of the specialist’s or consultant physician’s specialty who is available:

 (i) to monitor and influence the conduct and diagnostic quality of the examination; and

 (ii) if necessary, to attend on the patient personally; or

 (b) under the supervision of a practitioner who:

 (i) is not a specialist or consultant physician; and

 (ii) meets the requirement of subclause (2); and

 (iii) is available to monitor and influence the conduct and diagnostic quality of the examination and, if necessary, to attend on the patient personally; or

 (c) in the circumstance mentioned in subclause (3), and under the supervision of a practitioner who is available:

 (i) to monitor and influence the conduct and diagnostic quality of the examination; and

 (ii) if necessary, to attend on the patient personally; or

 (d) if paragraph (a), (b) or (c) cannot be complied with:

 (i) in an emergency; or

 (ii) in a location that is not less than 30 kilometres by the most direct road route from another practice where services that comply with paragraph (a) or (b) are available.

 (2) For the purposes of subparagraph (1)(b)(ii), the requirement is that, between 1 September 1997 and 31 August 1999, at least 50 services were rendered by or on behalf of the practitioner at the location where the eligible service was rendered, and the rendering of those services entitled payment of medicare benefits.

 (3) For the purposes of paragraph (1)(c), the circumstance is that, between 1 September 1997 and 31 August 1999, at least 50 services were rendered in nursing homes or patients’ residences by or on behalf of the practitioner, and the rendering of those services entitled payment of medicare benefits.

Subdivision BSubgroups 1 to 4 of Group I1

2.1.2A  Reduction in fees—multiple services on same day—vascular ultrasounds

 (1) If a medical practitioner provides 2 or more vascular ultrasound services for the same patient on the same day, the fees specified for the items that apply to the services are reduced as follows:

 (a) the second highest fee is reduced by 40%;

 (b) any other fee, except the highest, is reduced by 50%.

 (2) For the purposes of subclause (1):

 (a) if 2 or more applicable fees are equally the highest:

 (i) only one of those fees is taken to be the highest fee; and

 (ii) the other, or another, highest fee is taken to be the second highest fee; and

 (b) if 2 or more fees are equally second highest—any one of those fees may be taken to be the second highest for the purpose of paragraph (1)(b); and

 (c) if a reduced fee calculated under subclause (1) is not a multiple of 5 cents—the reduced fee is taken to be the nearest amount that is a multiple of 5 cents.

 (3) This clause does not apply to the fee specified in item 64990 or 64991.

2.1.3  Items in Subgroups 1 to 4 of Group I1

  This clause sets out items in Subgroups 1 to 4 of Group I1.

Note: The fees in Group I1 are indexed in accordance with clause 2.7.1.

 

Group I1—Ultrasound

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 1—General

55028

Head, ultrasound scan of (R)

110.75

55029

Head, ultrasound scan of (NR)

38.40

55030

Orbital contents, ultrasound scan of (R)

110.75

55031

Orbital contents, ultrasound scan of (NR)

38.40

55032

Neck, one or more structures of, ultrasound scan of (R)

110.75

55033

Neck, one or more structures of, ultrasound scan of (NR)

38.40

55036

Abdomen, ultrasound scan of (including scan of urinary tract when performed), for morphological assessment, if:

(a) the service is not solely a transrectal ultrasonic examination of any of the following:

(i) prostate gland;

(ii) bladder base;

(iii) urethra; and

(b) within 24 hours of the service, a service mentioned in item 55038 is not performed on the same patient by the providing practitioner (R)

112.95

55037

Abdomen, ultrasound scan of (including scan of urinary tract when performed), for morphological assessment, if the service is not solely a transrectal ultrasonic examination of any of the following:

(a) prostate gland;

(b) bladder base;

(c) urethra (NR)

38.40

55038

Urinary tract, ultrasound scan of, if:

(a) the service is not solely a transrectal ultrasonic examination of any of the following:

(i) prostate gland;

(ii) bladder base;

(iii) urethra; and

(b) within 24 hours of the service, a service mentioned in item 55036 or 55065 is not performed on the same patient by the providing practitioner (R)

110.75

55039

Urinary tract, ultrasound scan of, if the service is not solely a transrectal ultrasonic examination of any of the following:

(a) prostate gland;

(b) bladder base;

(c) urethra (NR)

38.40

55048

Scrotum, ultrasound scan of (R)

111.15

55049

Scrotum, ultrasound scan of (NR)

38.40

55054

Ultrasonic crosssectional echography, in conjunction with a surgical procedure (other than a procedure to which item 55848 or 55850 applies) using interventional techniques, not being a service associated with a service to which any other item in this Group applies (R)

110.75

55065

Pelvis, ultrasound scan of, by any or all approaches, if:

(a) the service is not solely a service to which an item (other than item 55736 or 55739) in Subgroup 5 of this Group applies or a transrectal ultrasonic examination of any of the following:

(i) prostate gland;

(ii) bladder base;

(iii) urethra; and

(b) within 24 hours of the service, a service mentioned in item 55038 is not performed on the same patient by the providing practitioner (R)

99.70

55066

Breasts, both, ultrasound scan of, in conjunction with a surgical procedure using interventional techniques, if:

(a) the request for the scan indicates that an ultrasoundguided breast intervention be performed; and

(b) the service is not performed in conjunction with any other item in this Group (R)

221.45

55068

Pelvis, ultrasound scan of, by any or all approaches, if the service is not solely a service to which an item (other than item 55736 or 55739) in Subgroup 5 of this Group applies or a transrectal ultrasonic examination of any of the following:

(a) prostate gland;

(b) bladder base;

(c) urethra (NR)

35.50

55070

Breast, one, ultrasound scan of (R)

99.70

55071

Breast, one, ultrasound scan of, in conjunction with a surgical procedure using interventional techniques, if:

(a) the request for the scan indicates that an ultrasoundguided breast intervention be performed; and

(b) the service is not performed in conjunction with any other item in this group (R)

210.45

55073

Breast, one, ultrasound scan of (NR)

34.55

55076

Breasts, both, ultrasound scan of (including an ultrasound scan for post mastectomy surveillance) (R)

110.75

55079

Breasts, both, ultrasound scan of (including an ultrasound scan for post mastectomy surveillance) (NR)

38.40

55084

Urinary bladder, ultrasound scan of, by any or all approaches, if within 24 hours of the service, a service mentioned in item 11917, 55036, 55038, 55065, 55600 or 55603 is not performed on the same patient by the providing practitioner (R)

99.70

55085

Urinary bladder, ultrasound scan of, by any or all approaches, if within 24 hours of the service, a service mentioned in item 11917, 55037, 55039, 55068, 55600 or 55603 is not performed on the same patient by the providing practitioner (NR)

34.55

Subgroup 2—Cardiac

55118

Heart, twodimensional or threedimensional real time transoesophageal examination of, from at least 2 levels, and in more than one plane at each level, if:

(a) the service includes:

(i) real time colour flow mapping and, if indicated, pulsed wave Doppler examination; and

(ii) recordings on digital media; and

(b) the service is not:

(i) an intraoperative service; or

(ii) a service associated with a service to which an item in Subgroup 3 of this Group applies

(R) (Anaes.)

279.65

55130

Intraoperative twodimensional or threedimensional real time transoesophageal echocardiography, if the service:

(a) includes Doppler techniques with colour flow mapping and recordings on digital media; and

(b) is performed during cardiac surgery; and

(c) incorporates sequential assessment of cardiac function before and after the surgical procedure; and

(d) is not associated with a service to which item 55135, or an item in Subgroup 3, applies (R) (Anaes.)

172.55

55135

Intraoperative twodimensional or threedimensional real time transoesophageal echocardiography, if the service:

(a) is provided on the same day as a service to which item 38477, 38484, 38499, 38516 or 38517 applies; and

(b) includes Doppler techniques with colour flow mapping and recordings on digital media; and

(c) is performed during cardiac valve surgery (replacement or repair); and

(d) incorporates sequential assessment of cardiac function and valve competence before and after the surgical procedure; and

(e) is not associated with a service to which item 55130, or an item in Subgroup 3, applies (R) (Anaes.)

358.90

Subgroup 3—Vascular

55238

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the lower limb or of arteries and bypass grafts in the lower limb, below the inguinal ligament, not being a service associated with any of the following:

(a) a service to which an item in Subgroup 4 applies;

(b) a service to which item 55880, 55881, 55882, 55883, 55884, 55885, 55886, 55887, 55888, 55889, 55890, 55891, 55892, 55893, 55894 or 55895 applies (R)

172.05

55244

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the lower limb, below the inguinal ligament, for acute venous thrombosis, not being a service associated with any of the following:

(a) a service to which item 55246 applies;

(b) a service to which an item in Subgroup 4 applies;

(c) a service to which item 55880, 55881, 55882, 55883, 55884, 55885, 55886, 55887, 55888, 55889, 55890, 55891, 55892, 55893, 55894 or 55895 (R)

172.05

55246

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the lower limb, below the inguinal ligament, for chronic venous disease, not being a service associated with any of the following:

(a) a service to which item 55244 applies;

(b) a service to which an item in Subgroup 4 applies;

(c) a service to which item 55880, 55881, 55882, 55883, 55884, 55885, 55886, 55887, 55888, 55889, 55890, 55891, 55892, 55893, 55894 or 55895 (R)

172.05

55248

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the upper limb or of arteries and bypass grafts in the upper limb, not being a service associated with a service to which an item in Subgroup 4 applies (R)

172.05

55252

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the upper limb, not being a service associated with a service to which an item in Subgroup 4 applies (R)

172.05

55274

Duplex scanning, bilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of extracranial bilateral carotid and vertebral vessels, with or without subclavian and innominate vessels, with or without oculoplethysmography or periorbital Doppler examination, not being a service associated with a service to which an item in Subgroup 4 applies (R)

172.05

55276

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of intraabdominal, aorta and iliac arteries or inferior vena cava and iliac veins or of intraabdominal, aorta and iliac arteries and inferior vena cava and iliac veins, excluding pregnancy related studies, not being a service associated with a service to which an item in Subgroup 4 applies (R)

172.05

55278

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of renal or visceral vessels or of renal and visceral vessels, including aorta, inferior vena cava and iliac vessels as required excluding pregnancy related studies, not being a service associated with a service to which an item in Subgroup 4 applies (R)

172.05

55280

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of intracranial vessels, not being a service associated with a service to which an item in Subgroup 4 applies (R)

172.05

55282

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements:

(a) by spectral analysis of cavernosal artery of the penis following intracavernosal administration of a vasoactive agent; and

(b) performed during the period of pharmacological activity of the injected agent, to confirm a diagnosis of vascular aetiology for impotence; and

(c) if a specialist in diagnostic radiology, nuclear medicine, urology, general surgery (subspecialising in vascular surgery) or a consultant physician in nuclear medicine attends the patient in person at the practice location where the service is performed, immediately before or for a period during the performance of the service; and

(d) if the specialist or consultant physician interprets the results and prepares a report, not being a service associated with a service to which an item in Subgroup 4 applies (R)

172.05

55284

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements:

(a) by spectral analysis of cavernosal tissue of the penis to confirm a diagnosis; and

(b) if indicated, assess the progress and management of:

(i) priapism; or

(ii) fibrosis of any type; or

(iii) fracture of the tunica; or

(iv) arteriovenous malformations; and

(c) if a specialist in diagnostic radiology, nuclear medicine, urology, general surgery (subspecialising in vascular surgery) or a consultant physician in nuclear medicine attends the patient in person at the practice location where the service is performed, immediately before or for a period during the performance of the service; and

(d) if the specialist or consultant physician interprets the results and prepares a report, not being a service associated with a service to which an item in Subgroup 4 applies (R)

172.05

55292

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of surgically created arteriovenous fistula or surgically created arteriovenous access grafts in the upper or lower limbs, not being a service associated with a service to which an item in Subgroup 4 applies (R)

172.05

55294

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or veins, or both, including any associated skin marking, for mapping of bypass conduit before vascular surgery, not being a service associated with any of the following:

(a) a service to which an item in Subgroup 3 or 4 applies;

(b) a service to which item 55880, 55881, 55882, 55883, 55884, 55885, 55886, 55887, 55888, 55889, 55890, 55891, 55892, 55893, 55894 or 55895 applies (R)

172.05

55296

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow spectral analysis and marking of veins in the lower limbs below the inguinal ligament before varicose vein surgery, including any associated skin marking, not being a service associated with any of the following:

(a) a service to which an item in Subgroup 3 or 4 applies;

(b) a service to which item 55880, 55881, 55882, 55883, 55884, 55885, 55886, 55887, 55888, 55889, 55890, 55891, 55892, 55893, 55894 or 55895 applies (R)

112.70

Subgroup 4—Urological

55600

Prostate, bladder base and urethra, ultrasound scan of, if performed:

(a) personally by a medical practitioner (not being the medical practitioner who assessed the patient as specified in paragraph (c)) using one or more transducer probes that can obtain both axial and sagittal scans in 2 planes at right angles; and

(b) after a digital rectal examination of the prostate by that medical practitioner; and

(c) on a patient who has been assessed by:

(i) a specialist in urology, radiation oncology or medical oncology; or

(ii) a consultant physician in medical oncology;

 who has:

(iii) examined the patient in the 60 days before the scan; and

(iv) recommended the scan for the management of the patient’s current prostatic disease (R)

110.75

55603

Prostate, bladder base and urethra, ultrasound scan of, if performed:

(a) personally by a medical practitioner who made the assessment mentioned in paragraph (c) using one or more transducer probes that can obtain both axial and sagittal scans in 2 planes at right angles; and

(b) after a digital rectal examination of the prostate by that medical practitioner; and

(c) on a patient who has been assessed by:

(i) a specialist in urology, radiation oncology or medical oncology; or

(ii) a consultant physician in medical oncology;

 who has:

(iii) examined the patient in the 60 days before the scan; and

(iv) recommended the scan for the management of the patient’s current prostatic disease (R)

110.75

Subdivision CSubgroup 5 of Group I1: obstetric and gynaecological

2.1.4  Obstetric and gynaecological ultrasound services—limits

 (1) For NRtype diagnostic imaging services mentioned in an item in this Subdivision (other than item 55758), the specified fee for no more than 3 services provided to the same patient in any one pregnancy applies.

 (2) For any patient, items 55706, 55707, 55708, 55709, 55718, 55723, 55742, 55743, 55759, 55762, 55768 and 55770 are applicable only once in a pregnancy.

2.1.5  Obstetric and gynaecological services—referrals and clinical notes

 (1) A referral for a service mentioned in item 55700, 55704, 55707, 55712, 55718, 55721, 55740, 55742, 55757, 55759, 55764, 55768 and 55772 must state the relevant condition or clinical indication for the service.

 (2) If a referral for a service mentioned in item 55712, 55721, 55764 or 55772 is given by a medical practitioner who has obstetric privileges at a nonmetropolitan hospital, the referral must also state the words ‘nonmetropolitan obstetric privileges’.

 (3) A medical practitioner’s clinical notes for a service mentioned in item 55703, 55705, 55708, 55715, 55723, 55725, 55741, 55743, 55758, 55762, 55766, 55770 or 55774 must state the relevant condition or clinical indication for the service.

2.1.6  Items in Subgroup 5 of Group I1

  This clause sets out items in Subgroup 5 of Group I1.

Note: The fees in Group I1 are indexed in accordance with clause 2.7.1.

 

Group I1—Ultrasound

Column 1

Item

Column 2

Diagnostic imaging service

Column 3

Fee ($)

Subgroup 5—Obstetric and gynaecological

55700

Pelvis or abdomen, pregnancyrelated or pregnancy complication, ultrasound (the current ultrasound) scan of, by any or all approaches, for determining the gestation, location, viability or number of fetuses, if:

(a) the dating of the pregnancy (as confirmed by the current ultrasound) is less than 12 weeks of gestation; and

(b) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in item 55704, 55705, 55707, 55708, 55740, 55741, 55742 or 55743 (R)

60.90

55703

Pelvis or abdomen, pregnancyrelated or pregnancy complication, ultrasound (the current ultrasound) scan of, by any or all approaches, for determining the gestation, location, viability or number of fetuses, if:

(a) the dating of the pregnancy (as confirmed by the current ultrasound) is less than 12 weeks of gestation; and

(b) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in item 55704, 55705, 55707, 55708, 55740, 55741, 55742 or 55743 (NR)

35.50

55704

Pelvis or abdomen, pregnancyrelated or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, for determining the structure, gestation, location, viability or number of fetuses, if:

(a) the dating of the pregnancy (as confirmed by the current ultrasound) is 12 to 16 weeks of gestation; and

(b) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in another item in this Subgroup (R)

71.05

55705

Pelvis or abdomen, pregnancyrelated or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, for determining the structure, gestation, location, viability or number of fetuses, if:

(a) the dating of the pregnancy (as confirmed by the current ultrasound) is 12 to 16 weeks of gestation; and

(b) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in another item in this Subgroup (NR)

35.50

55706

Pelvis or abdomen, pregnancyrelated or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:

(a) the dating for the pregnancy (as confirmed by the current ultrasound) is 17 to 22 weeks of gestation; and

(b) the current ultrasound:

(i) is not performed in the same pregnancy as item 55709; and

(ii) is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (R)

101.50

55707

Pelvis or abdomen, pregnancyrelated or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, if:

(a) the pregnancy (as confirmed by the current ultrasound) is dated by a fetal crown rump length of 45 to 84 mm; and

(b) nuchal translucency measurement is performed to assess the risk of fetal abnormality; and

(c) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in another item in this Subgroup (R)

71.05

55708

Pelvis or abdomen, pregnancyrelated or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, if:

(a) the pregnancy (as confirmed by the current ultrasound) is dated by a crown rump length of 45 to 84 mm; and

(b) nuchal translucency measurement is performed to assess the risk of fetal abnormality; and

(c) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in another item in this Subgroup (NR)

35.50

55709

Pelvis or abdomen, pregnancyrelated or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:

(a) the dating of the pregnancy (as confirmed by the current ultrasound) is 17 to 22 weeks of gestation; and

(b) the current ultrasound:

(i) is not performed in the same pregnancy as item 55706; and

(ii) is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (NR)

38.55

55712

Pelvis or abdomen, pregnancyrelated or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:

(a) the current ultrasound is requested by a medical practitioner who:

(i) is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; or

(ii) has a Diploma of Obstetrics; or

(iii) has a qualification recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists as being equivalent to a Diploma of Obstetrics; or

(iv) has obstetric privileges at a nonmetropolitan hospital; and

(b) the dating of the pregnancy (as confirmed by the current ultrasound) is 17 to 22 weeks of gestation; and

(c) further examination is clinically indicated after performance, in the same pregnancy, of a scan mentioned in item 55706 or 55709; and

(d) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (R)

116.70

55715

Pelvis or abdomen, pregnancyrelated or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, with measurement of all parameters for dating purposes, performed by or on behalf of a medical practitioner who is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, if:

(a) the dating of the pregnancy (as confirmed by the current ultrasound) is 17 to 22 weeks of gestation; and

(b) further examination is clinically indicated after performance, in the same pregnancy, of a scan mentioned in item 55706 or 55709; and

(c) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (NR)

40.60

55718

Pelvis or abdomen, pregnancyrelated or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, if:

(a) the dating of the pregnancy (as confirmed by the current ultrasound) is after 22 weeks of gestation; and

(b) the current ultrasound:

(i) is not performed in the same pregnancy as item 55723; and

(ii) is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (R)

101.50

55721

Pelvis or abdomen, pregnancyrelated or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, if:

(a) the current ultrasound is requested by a medical practitioner who:

(i) is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; or

(ii) has a Diploma of Obstetrics; or

(iii) has a qualification recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists as being equivalent to a Diploma of Obstetrics; or

(iv) has obstetric privileges at a nonmetropolitan hospital; and

(b) the dating of the pregnancy (as confirmed by current ultrasound) is after 22 weeks of gestation; and

(c) further examination is clinically indicated in the same pregnancy to which item 55718 or 55723 applies; and

(d) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (R)

116.70

55723

Pelvis or abdomen, pregnancyrelated or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, if:

(a) the dating of the pregnancy (as confirmed by the current ultrasound) is after 22 weeks of gestation; and

(b) the current ultrasound:

(i) is not performed in the same pregnancy as item 55718; and

(ii) is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (NR)

38.55

55725

Pelvis or abdomen, pregnancyrelated or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, performed by or on behalf of a medical practitioner who is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, if:

(a) the dating of the pregnancy (as confirmed by the current ultrasound) is after 22 weeks of gestation; and

(b) further examination is clinically indicated in the same pregnancy to which item 55718 or 55723 applies; and

(c) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (NR)

40.60

55729

Duplex scanning, if:

(a) the service involves:

(i) B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of the umbilical artery; and

(ii) measured assessment of amniotic fluid volume after the 24th week of gestation; and

(b) there is reason to suspect intrauterine growth retardation or a significant risk of fetal death;

—examination and report (R)

27.65

55736

Pelvis, ultrasound scan of, in association with saline infusion of the endometrial cavity, by any or all approaches, if a previous transvaginal ultrasound has revealed an abnormality of the uterus or fallopian tube (R)

128.90

55739

Pelvis, ultrasound scan of, in association with saline infusion of the endometrial cavity, by any or all approaches, if a previous transvaginal ultrasound has revealed an abnormality of the uterus or fallopian tube (NR)

57.85

55740

Pelvis or abdomen, pregnancyrelated or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, for determining the structure, gestation, location, viability or number of fetuses, if:

(a) an ultrasound of the same pregnancy confirms a multiple pregnancy; and

(b) the dating of the pregnancy (as confirmed by the current ultrasound) is 12 to 16 weeks of gestation; and

(c) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in another item in this Subgroup (R)

108.30

55741

Pelvis or abdomen, pregnancyrelated or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, for determining the structure, gestation, location, viability or number of fetuses, if:

(a) an ultrasound of the same pregnancy confirms a multiple pregnancy; and

(b) the dating of the pregnancy (as confirmed by the current ultrasound) is 12 to 16 weeks of gestation; and

(c) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in another item in this Subgroup (NR)

54.10

55742

Pelvis or abdomen, pregnancyrelated or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, if:

(a) an ultrasound of the same pregnancy confirms a multiple pregnancy; and

(b) the pregnancy (as confirmed by the current ultrasound) is dated by a fetal crown rump length of 45 to 84 mm; and

(c) nuchal translucency measurement is performed to assess the risk of fetal abnormality; and

(d) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in another item in this Subgroup (R)

108.30

55743

Pelvis or abdomen, pregnancyrelated or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, if:

(a) an ultrasound of the same pregnancy confirms a multiple pregnancy; and

(b) the pregnancy (as confirmed by the current ultrasound) is dated by a fetal crown rump length of 45 to 84 mm; and

(c) nuchal translucency measurement is performed to assess the risk of fetal abnormality; and

(d) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in another item in this Subgroup (NR)

54.10

55757

Pelvis or abdomen, ultrasound (the current ultrasound) scan of, for cervical length assessment for risk of preterm labour, by any or all approaches, if:

(a) the dating of the pregnancy (as confirmed by the current ultrasound) is between 14 and 30 weeks of gestation; and

(b) any of the following apply:

(i) the patient has a history indicating high risk of preterm labour or birth or second trimester fetal loss;

(ii) the patient has symptoms suggestive of threatened preterm labour or second trimester fetal loss;

(iii) the patient’s cervical length is less than 25 mm on an ultrasound before 28 weeks gestation; and

(c) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in another item in this Subgroup (R)

51.55

55758

Pelvis or abdomen, ultrasound (the current ultrasound) scan of, for cervical length assessment for risk of preterm labour, by any or all approaches, if:

(a) the dating of the pregnancy (as confirmed by the current ultrasound) is between 14 and 30 weeks of gestation; and

(b) any of the following apply:

(i) the patient has a history indicating high risk of preterm labour or birth or second trimester fetal loss;

(ii) the patient has symptoms suggestive of threatened preterm labour or second trimester fetal loss;

(iii) the patient’s cervical length is less than 25 mm on an ultrasound before 28 weeks gestation; and

(c) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in another item in this Subgroup (NR)

19.60

55759

Pelvis or abdomen, pregnancyrelated or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:

(a) an ultrasound of the same pregnancy confirms a multiple pregnancy; and

(b) the dating of the pregnancy (as confirmed by the current ultrasound) is 17 to 22 weeks gestation; and

(c) the service mentioned in item 55706, 55709, 55712, 55715 or 55762 is not performed in conjunction with the current ultrasound during the same pregnancy; and

(d) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (R)

152.25

55762

Pelvis or abdomen, pregnancyrelated or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:

(a) an ultrasound of the same pregnancy confirms a multiple pregnancy; and

(b) the dating of the pregnancy (as confirmed by the current ultrasound) is 17 to 22 weeks gestation; and

(c) the service mentioned in item 55706, 55709, 55712, 55715 or 55759 is not performed in conjunction with the current ultrasound during the same pregnancy; and

(d) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (NR)

60.90

55764

Pelvis or abdomen, pregnancyrelated or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:

(a) the service is requested by a medical practitioner who:

(i) is a Member or Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; or

(ii) has a Diploma of Obstetrics; or

(iii) has a qualification recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists as equivalent to a Diploma of Obstetrics; or

(iv) has obstetric privileges at a nonmetropolitan hospital; and

(b) an ultrasound of the same pregnancy confirms a multiple pregnancy; and

(c) the dating of the pregnancy (as confirmed by the current ultrasound) is 17 to 22 weeks gestation; and

(d) further examination is clinically indicated in the same pregnancy in which item 55759 or 55762 has been performed; and

(e) the service mentioned in item 55706, 55709, 55712 or 55715 is not performed in conjunction with the current ultrasound during the same pregnancy; and

(f) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (R))

162.40

55766

Pelvis or abdomen, pregnancyrelated or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, with measurement of all parameters for dating purposes, performed by or on behalf of a medical practitioner, who is a Member or Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, if:

(a) an ultrasound of the same pregnancy confirms a multiple pregnancy; and

(b) the dating of the pregnancy (as confirmed by the current ultrasound) is 17 to 22 weeks of gestation; and

(c) further examination is clinically indicated in the same pregnancy in which item 55759 or 55762 has been performed; and

(d) the service mentioned in item 55706, 55709, 55712 or 55715 is not performed in conjunction with the current ultrasound during the same pregnancy; and

(e) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (NR)

65.95

55768

Pelvis or abdomen, pregnancyrelated or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, if:

(a) dating of the pregnancy (as confirmed by the current ultrasound) is after 22 weeks of gestation; and

(b) an ultrasound confirms a multiple pregnancy; and

(c) the service is not performed in the same pregnancy as item 55770; and

(d) the service mentioned in item 55718, 55721, 55723 or 55725 is not performed in conjunction with the current ultrasound during the same pregnancy; and

(e) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (R)

152.25

55770

Pelvis or abdomen, pregnancyrelated or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, if:

(a) dating of the pregnancy (as confirmed by the current ultrasound) is after 22 weeks of gestation; and

(b) an ultrasound confirms a multiple pregnancy; and

(c) the service is not performed in the same pregnancy as item 55768; and

(d) the service mentioned in item 55718, 55721, 55723 or 55725 is not performed in conjunction with the current ultrasound during the same pregnancy; and

(e) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (NR)

60.90

55772

Pelvis or abdomen, pregnancyrelated or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, if:

(a) dating of the pregnancy as confirmed by the current ultrasound is after 22 weeks of gestation; and

(b) the service is requested by a medical practitioner who:

(i) is a Member or Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; or

(ii) has a Diploma of Obstetrics; or

(iii) has a qualification recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists as equivalent to a Diploma of Obstetrics; or

(iv) has obstetric privileges at a nonmetropolitan hospital; and

(c) further examination is clinically indicated in the same pregnancy to which item 55768 or 55770 has been performed; and

(d) the pregnancy as confirmed by an ultrasound is a multiple pregnancy; and

(e) the service mentioned in item 55718, 55721, 55723 or 55725 is not performed in conjunction with the current ultrasound during the same pregnancy; and

(f) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (R)

162.40

55774

Pelvis or abdomen, pregnancyrelated or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, performed by or on behalf of a medical practitioner who is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, if:

(a) dating of the pregnancy as confirmed by the current ultrasound is after 22 weeks of gestation; and

(b) further examination is clinically indicated in the same pregnancy to which item 55768 or 55770 has been performed; and

(c) the pregnancy as confirmed by an ultrasound is a multiple pregnancy; and

(d) the service mentioned in item 55718, 55721, 55723 or 55725 is not performed in conjunction with the current ultrasound during the same pregnancy; and

(e) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (NR)

65.95

Subdivision DSubgroup 6 of Group I1: musculoskeletal ultrasound

2.1.7  Musculoskeletal ultrasound services—personal attendance

  Items in this Subdivision apply to a musculoskeletal ultrasound service only if:

 (a) the medical practitioner responsible for the conduct and report of the examination personally attends during the performance of the scan and personally examines the patient; or

 (b) the service is performed, because of medical necessity, in a location that is more than 30 kilometres by the most direct road route from another practice where services that comply with paragraph (a) are available.

2.1.8  Unilateral item cannot be claimed twice if bilateral item could have been claimed

  If:

 (a) 2 services (the unilateral services) to which an item listed in column 1 of an item of table 2.1.8 applies are provided in conjunction with each other; and

 (b) a service to which an item in column 2 of the item applies could have been provided instead of the 2 unilateral services;

only one of the unilateral services may be claimed.

 

Table 2.1.8—Unilateral and bilateral services

Item

Column 1

The service in this item cannot be claimed twice …

Column 2

if the service in this item could have been provided …

1

55856

55858

2

55857

55859

3

55860

55862

4

55861

55863

5

55864

55866

6

55865

55867

7

55868

55870

8

55869

55871

9

55872

55874

10

55873

55875

11

55876

55878

12

55877

55879

13

55880

55882

14

55881

55883

15

55884

55886

16

55885

55887

17

55888

55890

18

55889

55891

19

55892

55894

20

55893

55895

2.1.9  Musculoskeletal ultrasound services—comparison ultrasonography

  The fee applicable for items in this Subdivision includes any views of another part of the patient taken for comparison purposes.

2.1.10  Items in Subgroup 6 of Group I1

  This clause sets out items in Subgroup 6 of Group I1.

Note: The fees in Group I1 are indexed in accordance with clause 2.7.1.

 

Group I1—Ultrasound

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 6—Musculoskeletal ultrasound

55812

Chest or abdominal wall, one or more areas, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55070, 55073, 55076 or 55079 (R)

110.75

55814

Chest or abdominal wall, one or more areas, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55070, 55073, 55076 or 55079 (NR)

38.40

55844

Assessment of a mass associated with the skin or subcutaneous structures, not being a part of the musculoskeletal system, one or more areas, ultrasound scan of (R)

88.65

55846

Assessment of a mass associated with the skin or subcutaneous structures, not being a part of the musculoskeletal system, one or more areas, ultrasound scan of (NR)

38.40

55848

Musculoskeletal ultrasound, in conjunction with a surgical procedure using interventional techniques, not being a service associated with a service to which any other item in this group applies, and not performed in conjunction with a service mentioned in item 55054 (R)

138.65

55850

Musculoskeletal ultrasound, in conjunction with a surgical procedure using interventional techniques, inclusive of a diagnostic musculoskeletal ultrasound service, if:

(a) a medical practitioner or nurse practitioner has indicated on a referral for a musculoskeletal ultrasound that an ultrasound guided intervention be performed if clinically indicated; and

(b) the service is not performed in conjunction with a service mentioned in item 55054 or any other item in this Subgroup (R)

183.05

55852

Paediatric spine, spinal cord and overlying subcutaneous tissues, ultrasound scan of (R)

110.75

55854

Paediatric spine, spinal cord and overlying subcutaneous tissues, ultrasound scan of (NR)

38.40

55856

Hand or wrist, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55858 (R)

110.75

55857

Hand or wrist, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55859 (NR)

38.40

55858

Hand or wrist, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55856 (R)

122.90

55859

Hand or wrist, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55857 (NR)

42.65

55860

Forearm or elbow, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55862 (R)

110.75

55861

Forearm or elbow, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55863 (NR)

38.40

55862

Forearm or elbow, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55860 (R)

122.90

55863

Forearm or elbow, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55861 (NR)

42.65

55864

Shoulder or upper arm, or both, left or right, ultrasound scan of, if

(a) the service is used for the assessment of one or more of the following suspected or known conditions:

(i) an injury to a muscle, tendon or muscle/tendon junction;

(ii) rotator cuff tear, calcification or tendinosis (biceps, subscapular, supraspinatus or infraspinatus);

(iii) biceps subluxation;

(iv) capsulitis and bursitis;

(v) a mass, including a ganglion;

(vi) an occult fracture;

(vii) acromioclavicular joint pathology; and

(b) the service is not performed in conjunction with a service mentioned in item 55866 (R)

110.75

55865

Shoulder or upper arm, or both, left or right, ultrasound scan of, if:

(a) the service is used for the assessment of one or more of the following suspected or known conditions:

(i) an injury to a muscle, tendon or muscle/tendon junction;

(ii) rotator cuff tear, calcification or tendinosis (biceps, subscapular, supraspinatus or infraspinatus);

(iii) biceps subluxation;

(iv) capsulitis and bursitis;

(v) a mass, including a ganglion;

(vi) an occult fracture;

(vii) acromioclavicular joint pathology; and

(b) the service is not performed in conjunction with a service mentioned in item 55867 (NR)

38.40

55866

Shoulder or upper arm, or both, left and right, ultrasound scan of, if:

(a) the service is used for the assessment of one or more of the following suspected or known conditions:

(i) an injury to a muscle, tendon or muscle/tendon junction;

(ii) rotator cuff tear, calcification or tendinosis (biceps, subscapular, supraspinatus or infraspinatus);

(iii) biceps subluxation;

(iv) capsulitis and bursitis;

(v) a mass, including a ganglion;

(vi) an occult fracture;

(vii) acromioclavicular joint pathology; and

(b) the service is not performed in conjunction with a service mentioned in item 55864 (R)

122.90

55867

Shoulder or upper arm, or both, left and right, ultrasound scan of, if:

(a) the service is used for the assessment of one or more of the following suspected or known conditions:

(i) an injury to a muscle, tendon or muscle/tendon junction;

(ii) rotator cuff tear, calcification or tendinosis (biceps, subscapular, supraspinatus or infraspinatus);

(iii) biceps subluxation;

(iv) capsulitis and bursitis;

(v) a mass, including a ganglion;

(vi) an occult fracture;

(vii) acromioclavicular joint pathology; and

(c) the service is not performed in conjunction with a service mentioned in item 55865 (NR)

42.65

55868

Hip or groin, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55870 (R)

110.75

55869

Hip or groin, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55871 (NR)

38.40

55870

Hip or groin, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55868 (R)

122.90

55871

Hip or groin, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55869 (NR)

42.65

55872

Paediatric hip examination for dysplasia, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55874 (R)

110.75

55873

Paediatric hip examination for dysplasia, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55875 (NR)

38.40

55874

Paediatric hip examination for dysplasia, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55872 (R)

122.90

55875

Paediatric hip examination for dysplasia, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55873 (NR)

42.65

55876

Buttock or thigh, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55878 (R)

110.75

55877

Buttock or thigh or both, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55879 (NR)

38.40

55878

Buttock or thigh, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55876 (R)

122.90

55879

Buttock or thigh, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55877 (NR)

42.65

55880

Knee, left or right, ultrasound scan of, if:

(a) the service is used for the assessment of one or more of the following suspected or known conditions:

(i) abnormality of tendons or bursae about the knee;

(ii) a meniscal cyst, popliteal fossa cyst, mass or pseudomass;

(iii) a nerve entrapment or a nerve or nerve sheath tumour;

(iv) an injury of collateral ligaments; and

(b) the service is not performed in conjunction with a service mentioned in item 55882 (R)

110.75

55881

Knee, left or right, ultrasound scan of, if:

(a) the service is used for the assessment of one or more of the following suspected or known conditions:

(i) abnormality of tendons or bursae about the knee;

(ii) a meniscal cyst, popliteal fossa cyst, mass or pseudomass;

(iii) a nerve entrapment or a nerve or nerve sheath tumour;

(iv) an injury of collateral ligaments; and

(b) the service is not performed in conjunction with a service mentioned in item 55883 (NR)

38.40

55882

Knee, left and right, ultrasound scan of, if:

(a) the service is used for the assessment of one or more of the following suspected or known conditions:

(i) abnormality of tendons or bursae about the knee;

(ii) a meniscal cyst, popliteal fossa cyst, mass or pseudomass;

(iii) a nerve entrapment or a nerve or nerve sheath tumour;

(iv) an injury of collateral ligaments; and

(b) the service is not performed in conjunction with a service mentioned in item 55880 (R)

122.90

55883

Knee, left and right, ultrasound scan of, if:

(a) the service is used for the assessment of one or more of the following suspected or known conditions:

(i) abnormality of tendons or bursae about the knee;

(ii) a meniscal cyst, popliteal fossa cyst, mass or pseudomass;

(iii) a nerve entrapment or a nerve or nerve sheath tumour;

(iv) an injury of collateral ligaments; and

(b) the service is not performed in conjunction with a service mentioned in item 55881 (NR)

42.65

55884

Lower leg, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55886 (R)

110.75

55885

Lower leg, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55887 (NR)

38.40

55886

Lower leg, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55884 (R)

122.90

55887

Lower leg, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55885 (NR)

42.65

55888

Ankle or hind foot, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55890 (R)

110.75

55889

Ankle or hind foot, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55891 (NR)

38.40

55890

Ankle or hind foot, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55888 (R)

122.90

55891

Ankle or hind foot, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55889 (NR)

42.65

55892

Mid foot or fore foot, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55894 (R)

110.75

55893

Mid foot or fore foot, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55895 (NR)

38.40

55894

Mid foot or fore foot, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55892 (R)

122.90

55895

Mid foot or fore foot, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55893 (NR)

42.65

Subdivision ESubgroup 7 of Group I1: Transthoracic and stress echocardiograms

2.1.11  Restrictions on items for transthoracic echocardiograms—assessments

Items 55126, 55127, 55128, 55129, 55133 and 55134

 (1) Items 55126, 55127, 55128, 55129, 55133 and 55134 apply to a service only if the service includes assessments of each of the following, to the extent possible:

 (a) the left ventricular structure and function, including quantification of systolic function using Mmode, 2dimensional or 3dimensional imaging and diastolic function;

 (b) the right ventricular structure and function, with quantitative assessment;

 (c) the left and right atrial structure, including quantification of atrial sizes;

 (d) the vascular connections of the heart, including the great vessels and systemic venous structures;

 (e) the pericardium and any haemodynamic consequences of pericardial abnormalities;

 (f) all present valves, including structural assessment and measurement of blood flow velocities across the valves using pulsed wave and continuous wave Doppler techniques with quantification of stenosis or regurgitation;

 (g) additional haemodynamic parameters, including the assessment of pulmonary pressures.

Item 55132

 (2) Item 55132 applies to a service only if the service includes assessments of each of the following, to the extent possible:

 (a) the ventricular structure and function, including quantification of systolic function (if the ventricular configuration allows accurate quantification) using at least one of Mmode, 2dimensional or 3dimensional imaging;

 (b) the diastolic function;

 (c) the atrial structure, including quantification of atrial sizes;

 (d) the vascular connections of the heart, including the great vessels and systemic venous structures;

 (e) the pericardium and any haemodynamic consequences of pericardial abnormalities;

 (f) all present valves, including structural assessment and measurement of blood flow velocities across the valves using relevant Doppler techniques with quantification;

 (g) subxiphoid views where recommended for congenital heart lesions;

 (h) additional haemodynamic parameters relevant to the clinical condition under review.

Item 55137

 (3) Item 55137 applies to a service only if the service includes assessments of each of the following, to the extent possible:

 (a) the ventricular structure and function;

 (b) the atrial structure;

 (c) the vascular connections of the heart, including the great vessels and systemic venous structures;

 (d) the pericardium and any haemodynamic consequences of pericardial abnormalities;

 (e) all present valves, including structural assessment and measurement of blood flow velocities across the valves using pulsed wave and continuous wave Doppler techniques with quantification of stenosis or regurgitation.

2.1.12  Restriction on item 55126—timing

  Item 55126 does not apply to a service provided to a patient if, in the previous 24 months, a service associated with a service to which item 55127, 55128, 55129, 55132, 55133 or 55134 applies has been provided to the patient.

2.1.13  Restriction on items for stress echocardiograms—patients, requests and requirements

 (1) Items 55141, 55143, 55145 and 55146 apply to a service performed on a patient only if:

 (a) one or more of subclauses 2.1.14(1), (2) and (3) apply to the patient; and

 (b) the request for the service identifies any symptoms or clinical indications mentioned in those subclauses that apply to the patient; and

 (c) the service is performed in accordance with clause 2.1.15; and

 (d) subclause (2) does not apply to the patient.

 (2) This subclause applies to a patient if:

 (a) stress echocardiography would not provide adequate information about the patient because of:

 (i) the patient’s body habitus, or other physical conditions (including heart rhythm disturbance); or

 (ii) the patient’s inability to exercise to the required extent; or

 (b) the results of a previous imaging service indicate that a stress echocardiogram service would not provide adequate information.

2.1.14  Stress echocardiograms—patients

 (1) This subclause applies to a patient if:

 (a) the patient displays symptoms of typical or atypical angina, including constricting discomfort of one or more of the following:

 (i) the front of the chest;

 (ii) the neck;

 (iii) the shoulders;

 (iv) the jaw;

 (v) the arms; or

 (b) the patient’s symptoms are:

 (i) precipitated by physical exertion; or

 (ii) relieved within 5 minutes or less by rest or glyceryl trinitrate.

 (2) This subclause applies to a patient if:

 (a) the patient has known coronary artery disease; and

 (b) the patient displays one or more symptoms that are suggestive of ischaemia; and

 (c) the symptoms:

 (i) are not adequately controlled with medical therapy; or

 (ii) have evolved since the last functional study undertaken of the patient.

 (3) This subclause applies to a patient if one or more of the following clinical indications apply to the patient:

 (a) assessment of myocardial ischaemia with exercise is required because the patient has congenital heart lesions, has undergone surgery and reversal of ischemia is considered possible;

 (b) the patient does not have a known coronary artery disease but assessment indicates that resting twelvelead electrocardiogram changes are consistent with coronary artery disease or ischaemia;

 (c) coronary artery disease related lesions, of uncertain functional significance, have previously been identified on a computed tomography coronary angiography or invasive coronary angiography;

 (d) an assessment by a specialist or consultant physician indicates that the patient has potential noncoronary artery disease, where a stress echocardiography study is likely to assist the diagnosis;

 (e) an assessment indicates that the patient has undue exertional dyspnoea of uncertain aetiology;

 (f) a preoperative assessment of the patient, who has a functional capacity of less than 4 metabolic equivalents, confirms that surgery is an intermediate to high risk, and the patient also has at least one of the following conditions:

 (i) ischaemic heart disease;

 (ii) previous myocardial infarction;

 (iii) heart failure;

 (iv) stroke;

 (v) transient ischaemic attack;

 (vi) renal dysfunction (serum creatinine greater than 170umol/L or 2 mg/dL or a creatinine clearance of less than 60 mL/min);

 (vii) diabetes mellitus requiring insulin therapy;

 (g) assessment is required before cardiac surgery or catheterbased interventions to:

 (i) increase the cardiac output to assess the severity of aortic stenosis; or

 (ii) determine whether valve regurgitation worsens with exercise or correlates with functional capacity; or

 (iii) correlate functional capacity with the ischaemic threshold;

 (h) either silent myocardial ischaemia is suspected or, due to the patient’s cognitive capacity or expressive language impairment, it is not possible to accurately assess symptom frequency based on medical history.

2.1.15  Stress echocardiograms—requirements

Safety requirements

 (1) A stress echocardiogram service must be performed:

 (a) on premises equipped with resuscitation equipment, including a defibrillator; and

 (b) by a person trained in the matters mentioned in subclause (4) and cardiopulmonary resuscitation who is in continuous personal attendance during the procedure.

 (2) At the time the service is performed, a second person trained in the matters mentioned in subclause (4) and cardiopulmonary resuscitation must be located at the premises, and must be immediately available to respond if required.

 (3) One of the persons mentioned in subclauses (1) and (2) must be a medical practitioner.

 (4) For the purposes of paragraph (1)(b) and subclause (2), the matters are:

 (a) how to safely perform exercise or pharmacological stress monitoring and recording; and

 (b) how to recognise the symptoms and signs of cardiac disease.

Other requirements

 (5) A stress echocardiogram service must include all of the following:

 (a) for an exercise stress echocardiogram:

 (i) twodimensional recordings before exercise (baseline) from at least 2 acoustic windows; and

 (ii) matching recordings at, or immediately after, peak exercise, including at least parasternal short and long axis views, and apical 4chamber and 2chamber views;

 (b) for a pharmacological stress echocardiogram:

 (i) twodimensional recordings before drug infusion (baseline) from at least 2 acoustic windows; and

 (ii) at least 2 matching recordings during drug infusion (with one recording at the time of the peak drug dose), including at least parasternal short and long axis views, and apical 4chamber and 2chamber views;

 (c) recordings on digital media with equipment permitting display of baseline and matching peak images on the same screen;

 (d) resting electrocardiogram and continuous multichannel electrocardiogram monitoring and recording during stress;

 (e) blood pressure monitoring and the recording of other parameters (including heart rate).

2.1.16  Restrictions on items for stress echocardiograms—timing

 (1) Item 55141 does not apply to a service provided to a patient if, in the previous 24 months, a service associated with a service to which item 55143, 55145 or 55146 applies has been provided to the patient.

 (2) Item 55145 does not apply to a service provided to a patient if, in the previous 24 months, a service associated with a service to which item 55141, 55143 or 55146 applies has been provided to the patient.

 (3) Item 55146 does not apply to a service provided to a patient if, in the previous 24 months, a service associated with a service to which item 55143 or 55145 applies has been provided to the patient.

2.1.17  Reduction in fees—multiple services on same day—transthoracic and stress echocardiograms

 (1) If a medical practitioner provides 2 or more echocardiogram services mentioned in items 55126, 55127, 55128, 55129, 55132, 55133, 55134, 55137, 55141, 55143, 55145 or 55146 for the same patient on the same day, any fees specified for the items that apply to the services, except the highest fee, are reduced by 40%.

 (2) For the purposes of subclause (1):

 (a) if 2 or more applicable fees are equally the highest—only one of those fees is taken to be the highest fee; and

 (b) if a reduced fee calculated under subclause (1) is not a multiple of 5 cents—the reduced fee is taken to be the nearest amount that is a multiple of 5 cents.

2.1.18  Items in Subgroup 7 of Group I1

  This clause sets out items in Subgroup 7 of Group I1.

Note: The fees in Group I1 are indexed in accordance with clause 2.7.1.

 

Group I1—Ultrasound

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 7—Transthoracic and stress echocardiograms

55126

Initial real time transthoracic echocardiographic examination of the heart with real time colour flow mapping from at least 3 acoustic windows, with recordings on digital media, if the service:

(a) is for the investigation of any of the following:

(i) symptoms or signs of cardiac failure;

(ii) suspected or known ventricular hypertrophy or dysfunction;

(iii) pulmonary hypertension;

(iv) valvular, aortic, pericardial, thrombotic or embolic disease;

(v) heart tumour;

(vi) symptoms or signs of congenital heart disease;

(vii) other rare indications; and

(b) is not associated with a service to which:

(i) another item in this Subgroup applies (except items 55137, 55141, 55143, 55145 and 55146); or

(ii) an item in Subgroup 2 applies (except items 55118 and 55130); or

(iii) an item in Subgroup 3 applies

Applicable not more than once in a 24 month period (R)

234.15

55127

Repeat serial real time transthoracic echocardiographic examination of the heart with real time colour flow mapping from at least 3 acoustic windows, with recordings on digital media, if the service:

(a) is for the investigation of known valvular dysfunction; and

(b) is requested by a specialist or consultant physician; and

(c) is not associated with a service to which:

(i) another item in this Subgroup applies (except items 55137, 55141, 55143, 55145 and 55146); or

(ii) an item in Subgroup 2 applies (except items 55118 and 55130); or

(iii) an item in Subgroup 3 applies (R)

234.15

55128

Repeat serial real time transthoracic echocardiographic examination of the heart with real time colour flow mapping from at least 3 acoustic windows, with recordings on digital media, if the service:

(a) is for the investigation of known valvular dysfunction; and

(b) is requested by a medical practitioner (other than a specialist or consultant physician) at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(c) is not associated with a service to which:

(i) another item in this Subgroup applies (except items 55137, 55141, 55143, 55145 and 55146); or

(ii) an item in Subgroup 2 applies (except items 55118 and 55130); or

(iii) an item in Subgroup 3 applies (R)

234.15

55129

Repeat serial real time transthoracic echocardiographic examination of the heart with real time colour flow mapping from at least 3 acoustic windows, with recordings on digital media, if:

(a) valvular dysfunction is not the primary issue for the patient (although it may be a secondary issue); and

(b) the service is for the investigation of any of the following:

(i) symptoms or signs of cardiac failure;

(ii) suspected or known ventricular hypertrophy or dysfunction;

(iii) pulmonary hypertension;

(iv) aortic, thrombotic, embolic disease or pericardial disease (excluding isolated pericardial effusion or pericarditis);

(v) heart tumour;

(vi) structural heart disease;

(vii) other rare indications; and

(c) the service is requested by a specialist or consultant physician; and

(d) the service is not associated with a service to which:

(i) another item in this Subgroup applies (except items 55137, 55141, 55143, 55145 and 55146); or

(ii) an item in Subgroup 2 applies (except items 55118 and 55130); or

(iii) an item in Subgroup 3 applies (R)

234.15

55132

Serial real time transthoracic echocardiographic examination of the heart with real time colour flow mapping from at least 4 acoustic windows, with recordings on digital media, if the service:

(a) is for the investigation of a patient who:

(i) is under 17 years of age; or

(ii) has complex congenital heart disease; and

(b) is performed by a specialist or consultant physician practising in the speciality of cardiology; and

(c) is not associated with a service to which:

(i) another item in this Subgroup applies (except items 55137, 55141, 55143, 55145 and 55146); or

(ii) an item in Subgroup 2 applies (except items 55118 and 55130); or

(iii) an item in Subgroup 3 applies (R)

234.15

55133

Frequent repetition serial real time transthoracic echocardiographic examination of the heart with real time colour flow mapping from at least 3 acoustic windows, with recordings on digital media, if the service:

(a) is for the investigation of a patient who:

(i) has an isolated pericardial effusion or pericarditis; or

(ii) has a normal baseline study, and has commenced medication for noncardiac purposes that has cardiotoxic side effects and is a pharmaceutical benefit (within the meaning of Part VII of the National Health Act 1953) for the writing of a prescription for the supply of which under that Part an echocardiogram is required; and

(b) is not associated with a service to which:

(i) another item in this Subgroup applies (except items 55137, 55141, 55143, 55145 and 55146); or

(ii) an item in Subgroup 2 applies (except items 55118 and 55130); or

(iii) an item in Subgroup 3 applies (R)

210.75

55134

Repeat real time transthoracic echocardiographic examination of the heart with real time colour flow mapping from at least 3 acoustic windows, with recordings on digital media, for the investigation of rare cardiac pathologies, if the service:

(a) is requested by a specialist or consultant physician; and

(b) is not associated with a service to which:

(i) another item in this Subgroup applies (except items 55137, 55141, 55143, 55145 and 55146); or

(ii) an item in Subgroup 2 applies (except items 55118 and 55130); or

(iii) an item in Subgroup 3 applies (R)

234.15

55137

Serial real time transthoracic echocardiographic examination of the heart with real time colour flow mapping from at least 4 acoustic windows, with recordings on digital media, if the service:

(a) is for the investigation of a fetus with suspected or confirmed:

(i) complex congenital heart disease; or

(ii) functional heart disease; or

(iii) fetal cardiac arrhythmia; or

(iv) cardiac structural abnormality requiring confirmation; and

(b) is performed by a specialist or consultant physician practising in the speciality of cardiology with advanced training and expertise in fetal cardiac imaging; and

(c) is not associated with a service to which:

(i) an item in Subgroup 2 applies (except items 55118 and 55130); or

(ii) an item in Subgroup 3 applies (R)

234.15

55141

Exercise stress echocardiography focused study, other than a service associated with a service to which:

(a) item 11704, 11705, 11707, 11714, 11729 or 11730 applies; or

(b) an item in Subgroup 3 applies

Applicable not more than once in a 24 month period (R)

417.45

55143

Repeat pharmacological or exercise stress echocardiography if:

(a) a service to which item 55141, 55145 or 55146, or this item, applies has been performed on the patient in the previous 24 months; and

(b) the patient has symptoms of ischaemia that have evolved and are not adequately controlled with optimal medical therapy; and

(c) the service is requested by a specialist or a consultant physician; and

(d) the service is not associated with a service to which:

(i) item 11704, 11705, 11707, 11714, 11729 or 11730 applies; or

(ii) an item in Subgroup 3 applies

Applicable not more than once in a 12 month period (R)

417.45

55145

Pharmacological stress echocardiography, other than a service associated with a service to which:

(a) item 11704, 11705, 11707, 11714, 11729 or 11730 applies; or

(b) an item in Subgroup 3 applies

Applicable not more than once in a 24 month period (R)

483.85

55146

Pharmacological stress echocardiography if:

(a) a service to which item 55141 applies has been performed on the patient in the previous 4 weeks, and the test has failed due to an inadequate heart rate response; and

(b) the service is not associated with a service to which:

(i) item 11704, 11705, 11707, 11714, 11729 or 11730 applies; or

(ii) an item in Subgroup 3 applies

Applicable not more than once in a 24 month period (R)

483.85

Division 2.2Group I2: computed tomography (examination)

Subdivision AGeneral

2.2.1  CT services—eligible services

 (1) Items in this Division (other than items 57360 and 57364) apply to a CT service that is:

 (a) performed under the supervision of a specialist in the specialty of diagnostic radiology who is available:

 (i) to monitor and influence the conduct and diagnostic quality of the examination; and

 (ii) if necessary, to attend on the patient personally; and

 (b) reported by a specialist in the specialty of diagnostic radiology.

 (2) Items 57360 and 57364 apply to a CT service that is:

 (a) performed under the supervision of a specialist or consultant physician who is recognised by the Conjoint Committee for the Recognition of Training in CT Coronary Angiography and available:

 (i) to monitor and influence the conduct and diagnostic quality of the examination; and

 (ii) if necessary, to attend on the patient personally; and

 (b) reported by a specialist or consultant physician who is recognised by the Conjoint Committee for the Recognition of Training in CT Coronary Angiography.

 (3) However, items in this Division apply to a CT service that does not comply with the requirements mentioned in subclause (1) or (2) if the service is performed:

 (a) in an emergency; or

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

2.2.2  Restriction on items—attenuation correction and anatomical correlation

  Items in this Division do not apply to a CT service that is performed for the purpose of attenuation correction or anatomical correlation of another diagnostic imaging procedure.

2.2.3  Application of items 56001 and 56007 if axial scan performed for exclusion of acoustic neuroma

  If an axial scan is performed for the exclusion of acoustic neuroma, item 56001 or 56007 applies instead of any other item in this Schedule that might be taken to apply to the service.

2.2.4  CT services—assessment of headache

 (1) If the service mentioned in item 56007 or 56036 is used for the assessment of a headache of a patient to whom this clause applies, the fee mentioned in the item applies only if:

 (a) a scan without intravenous contrast medium has been performed on the patient; and

 (b) the service is required because the result of the scan is abnormal.

 (2) This clause applies to a patient who:

 (a) is under 50 years; and

 (b) is (apart from the headache) otherwise well; and

 (c) has no localising symptoms or signs; and

 (d) has no history of malignancy or immunosuppression.

2.2.5  CT services—number of services

  Items 56220 to 56238 and 56620 to 56630 apply once only for a service mentioned in any of those items, regardless of the number of patient attendances required to complete the service.

2.2.5A  Restriction on item 57360—patients

  Item 57360 does not apply to a service provided to a patient if:

 (a) in the previous 5 years, a service to which item 57360 or 57364 applies has been provided to the patient; and

 (b) no obstructive coronary artery disease was detected as part of that service;

unless the patient is:

 (c) eligible, under clause 5.10.17A of the general medical services table, for a service to which item 38244 or 38247 applies; or

 (d) eligible, under clause 5.10.17B of the general medical services table, for a service to which item 38248 or 38249 applies.

Subdivision BSubgroups 1 to 13 of Group I2

2.2.6  Items in Subgroups 1 to 13 of Group I2

  This clause sets out items in Subgroups 1 to 13 of Group I2.

Note: The fees in Group I2 are indexed in accordance with clause 2.7.1.

 

Group I2—Computed tomography—examination

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 1—Head

56001

Computed tomography—scan of brain without intravenous contrast medium, not being a service to which item 57001 applies (R) (Anaes.)

198.00

56007

Computed tomography—scan of brain with intravenous contrast medium and with any scans of the brain before intravenous contrast injection, when performed, not being a service to which item 57007 applies (R) (Anaes.)

253.75

56010

Computed tomography—scan of pituitary fossa with or without intravenous contrast medium and with or without brain scan when performed (R) (Anaes.)

255.90

56013

Computed tomography—scan of orbits with or without intravenous contrast medium and with or without brain scan when performed (R) (Anaes.)

253.75

56016

Computed tomography—scan of petrous bones in axial and coronal planes in 1 mm or 2 mm sections, with or without intravenous contrast medium, with or without scan of brain (R) (Anaes.)

294.35

56022

Computed tomography—scan of facial bones, para nasal sinuses or both without intravenous contrast medium (R) (Anaes.)

228.35

56028

Computed tomography—scan of facial bones, para nasal sinuses or both with intravenous contrast medium and with any scans of the facial bones, para nasal sinuses or both before intravenous contrast injection, when performed (R) (Anaes.)

341.85

56030

Computed tomography—scan of facial bones, para nasal sinuses or both, with scan of brain, without intravenous contrast medium (R) (Anaes.)

228.35

56036

Computed tomography—scan of facial bones, para nasal sinuses or both, with scan of brain, with intravenous contrast medium, if:

(a) a scan without intravenous contrast medium has been performed; and

(b) the service is required because the result of the scan mentioned in paragraph (a) is abnormal (R) (Anaes.)

341.85

Subgroup 2—Neck

56101

Computed tomography—scan of soft tissues of neck, including larynx, pharynx, upper oesophagus and salivary glands (not associated with cervical spine) without intravenous contrast medium, not being a service to which item 56801 applies (R) (Anaes.)

233.45

56107

Computed tomography—scan of soft tissues of neck, including larynx, pharynx, upper oesophagus and salivary glands (not associated with cervical spine)—with intravenous contrast medium and with any scans of soft tissues of neck, including larynx, pharynx, upper oesophagus and salivary glands (not associated with cervical spine) before intravenous contrast injection, when undertaken, not being a service associated with a service to which item 56807 applies (R) (Anaes.)

345.10

Subgroup 3—Spine

56219

Computed tomography—scan of spine, one or more regions with intrathecal contrast medium, including the preparation for intrathecal injection of contrast medium and any associated plain Xrays, not being a service to which item 59724 or 59275 applies (R) (Anaes.)

331.10

56220

Computed tomography—scan of spine, cervical region, without intravenous contrast medium (R) (Anaes.)

243.60

56221

Computed tomography—scan of spine, thoracic region, without intravenous contrast medium (R) (Anaes.)

243.60

56223

Computed tomography—scan of spine, lumbosacral region, without intravenous contrast medium (R) (Anaes.)

243.60

56224

Computed tomography—scan of spine, cervical region, with intravenous contrast medium and with any scans of the cervical region of the spine before intravenous contrast injection when undertaken (R) (Anaes.)

356.65

56225

Computed tomography—scan of spine, thoracic region, with intravenous contrast medium and with any scans of the thoracic region of the spine before intravenous contrast injection when undertaken (R) (Anaes.)

356.65

56226

Computed tomography—scan of spine, lumbosacral region, with intravenous contrast medium and with any scans of the lumbosacral region of the spine prior to intravenous contrast injection when undertaken (R) (Anaes.)

356.65

56233

Computed tomography—scan of spine, 2 examinations of the kind referred to in items 56220, 56221 and 56223, without intravenous contrast medium (R) (Anaes.)

243.60

56234

Computed tomography—scan of spine, 2 examinations of the kind referred to in items 56224, 56225 and 56226, with intravenous contrast medium and with any scans of these regions of the spine before intravenous contrast injection when undertaken (R) (Anaes.)

356.65

56237

Computed tomography—scan of spine, 3 regions cervical, thoracic and lumbosacral, without intravenous contrast medium (R) (Anaes.)

243.60

56238

Computed tomography—scan of spine, 3 regions, cervical, thoracic and lumbosacral, with intravenous contrast medium and with any scans of these regions of the spine before intravenous contrast injection when undertaken (R) (Anaes.)

356.65

Subgroup 4—Chest and upper abdomen

56301

Computed tomography—scan of chest, including lungs, mediastinum, chest wall and pleura, with or without scans of the upper abdomen, without intravenous contrast medium, not being a service to which item 56801 or 57001 applies and not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (Anaes.)

299.40

56307

Computed tomography—scan of chest, including lungs, mediastinum, chest wall and pleura, with or without scans of the upper abdomen, with intravenous contrast medium and with any scans of the chest, including lungs, mediastinum, chest wall or pleura and upper abdomen before intravenous contrast injection, when undertaken, not being a service to which item 56807 or 57007 applies and not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (Anaes.)

406.00

Subgroup 5—Upper abdomen only

56401

Computed tomography—scan of upper abdomen only (diaphragm to iliac crest) without intravenous contrast medium, not being a service to which item 56301, 56501, 56801 or 57001 applies (R) (Anaes.)

253.75

56407

Computed tomography—scan of upper abdomen only (diaphragm to iliac crest), with intravenous contrast medium, and with any scans of upper abdomen (diaphragm to iliac crest) before intravenous contrast injection, when undertaken, not being a service to which item 56307, 56507, 56807 or 57007 applies (R) (Anaes.)

365.40

56409

Computed tomography—scan of pelvis only (iliac crest to pubic symphysis) without intravenous contrast medium not being a service associated with a service to which item 56401 applies (R) (Anaes.)

253.75

56412

Computed tomography—scan of pelvis only (iliac crest to pubic symphysis), with intravenous contrast medium and with any scans of pelvis (iliac crest to pubic symphysis) before intravenous contrast injection, when undertaken, not being a service to which item 56407 applies (R) (Anaes.)

365.40

Subgroup 6—Upper abdomen and pelvis

56501

Computed tomography—scan of upper abdomen and pelvis without intravenous contrast medium, not for the purposes of virtual colonoscopy and not being a service to which item 56801 or 57001 applies(R) (Anaes.)

390.75

56507

Computed tomography—scan of upper abdomen and pelvis with intravenous contrast medium and with any scans of upper abdomen and pelvis before intravenous contrast injection, when performed, not for the purposes of virtual colonoscopy and not being a service to which item 56807 or 57007 applies (R) (Anaes.)

487.25

56553

Computed tomography—scan of colon for exclusion or diagnosis of colorectal neoplasia in a symptomatic or high risk patient if:

(a) one or more of the following applies:

(i) the patient has had an incomplete colonoscopy in the 3 months before the scan;

(ii) there is a highgrade colonic obstruction;

(iii) the service is requested by a specialist or consultant physician who performs colonoscopies in the practice of the specialist’s or consultant physician’s speciality; and

(b) the service is not a service to which item 56301, 56307, 56401, 56407, 56409, 56412, 56501, 56507, 56801, 56807 or 57001 applies (R) (Anaes.)

527.80

Subgroup 7—Extremities

56620

Computed tomography—scan of knee, without intravenous contrast medium, not being a service to which item 56622 or 56629 applies (R) (Anaes.)

223.30

56622

Computed tomography—scan of lower limb, left or right or both, one region (other than knee), or more than one region (which may include knee), without intravenous contrast medium, not being a service to which item 56620 applies (R) (Anaes.)

223.30

56623

Computed tomography—scan of lower limb, left or right or both, one region (other than knee), or more than one region (which may include knee), with intravenous contrast medium and with any scans of the lower limb before intravenous contrast injection, when performed, not being a service to which item 56626 applies (R) (Anaes.)

339.65

56626

Computed tomography—scan of knee, with intravenous contrast medium and with any scans of the knee before intravenous contrast injection, when performed, not being a service to which to which item 56623 or 56630 applies (R) (Anaes.)

339.65

56627

Computed tomography—scan of upper limb, left or right or both, any one region, or more than one region, without intravenous contrast medium (R) (Anaes.)

223.30

56628

Computed tomography—scan of upper limb, left or right or both, any one region, or more than one region, with intravenous contrast medium and with any scans of the upper limb before intravenous contrast injection, when performed (R) (Anaes.)

339.65

56629

Computed tomography—scan of upper limb and lower limb, left or right or both, any one region (other than knee), or more than one region (which may include knee) without intravenous contrast medium not being a service to which item 56620 applies (R) (Anaes.)

223.30

56630

Computed tomography—scan of upper limb and lower limb, left or right or both, any one region (other than knee), or more than one region (which may include knee) with intravenous contrast medium with any scans of the limbs before intravenous contrast injection, when performed, not being a service to which item 56626 applies (R) (Anaes.)

339.65

Subgroup 8—Chest, abdomen, pelvis and neck

56801

Computed tomography—scan of chest, abdomen and pelvis with or without scans of soft tissues of neck without intravenous contrast medium, not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (Anaes.)

473.55

56807

Computed tomography—scan of chest, abdomen and pelvis with or without scans of soft tissues of neck with intravenous contrast medium and with any scans of chest, abdomen and pelvis with or without scans of soft tissue of neck before intravenous contrast injection, when performed, not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (Anaes.)

568.40

Subgroup 9—Brain, chest and upper abdomen

57001

Computed tomography—scan of brain and chest with or without scans of upper abdomen without intravenous contrast medium, not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (Anaes.)

473.65

57007

Computed tomography—scan of brain and chest with or without scans of upper abdomen with intravenous contrast medium and with any scans of brain and chest and upper abdomen before intravenous contrast injection, when performed, not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (Anaes.)

576.25

Subgroup 10—Pelvimetry

57201

Computed tomography—pelvimetry (R) (Anaes.)

157.55

Subgroup 11—Interventional techniques

57341

Computed tomography, in conjunction with a surgical procedure using interventional techniques (R) (Anaes.)

477.05

Subgroup 12—Angiography

57352

Computed tomography—angiography with intravenous contrast medium of any or all, or any part, of:

(a) the arch of the aorta; or

(b) the carotid arteries; or

(c) the vertebral arteries and their branches (head and neck);

including any scans performed before intravenous contrast injection—one or more data acquisitions, including image editing, and maximum intensity projections or 3 dimensional surface shaded display, with hardcopy or digital recording of multiple projections, if:

(d) either:

(i) the service is requested by a specialist or consultant physician; or

(ii) the service is requested by a medical practitioner (other than a specialist or consultant physician) and the request indicates that the patient’s case has been discussed with a specialist or consultant physician; and

(e) the service is not a service to which another item in this group applies; and

(f) the service is performed for the exclusion of arterial stenosis, occlusion, aneurysm or embolism; and

(g) the service is not a study performed to image the coronary arteries (R) (Anaes.)

517.65

57353

Computed tomography—angiography with intravenous contrast medium of any or all, or any part, of:

(a) the ascending and descending aorta; or

(b) the common iliac and abdominal branches including upper limbs (chest, abdomen and upper limbs);

including any scans performed before intravenous contrast injection—one or more data acquisitions, including image editing, and maximum intensity projections or 3 dimensional surface shaded display, with hardcopy or digital recording of multiple projections, if:

(c) either:

(i) the service is requested by a specialist or consultant physician; or

(ii) the service is requested by a medical practitioner (other than a specialist or consultant physician) and the request indicates that the patient’s case has been discussed with a specialist or consultant physician; and

(d) the service is not a service to which another item in this group applies; and

(e) the service is performed for the exclusion of arterial stenosis, occlusion, aneurysm or embolism; and

(f) the service is not a study performed to image the coronary arteries (R) (Anaes.)

517.65

57354

Computed tomography—angiography with intravenous contrast medium of any or all, or any part, of:

(a) the descending aorta; or

(b) the pelvic vessels (aortoiliac segment) and lower limbs;

including any scans performed before intravenous contrast injection—one or more data acquisitions, including image editing, and maximum intensity projections or 3 dimensional surface shaded display, with hardcopy or digital recording of multiple projections, if:

(c) either:

(i) the service is requested by a specialist or consultant physician; or

(ii) the service is requested by a medical practitioner (other than a specialist or consultant physician) and the request indicates that the patient’s case has been discussed with a specialist or consultant physician; and

(d) the service is not a service to which another item in this group applies; and

(e) the service is performed for the exclusion of arterial stenosis, occlusion, aneurysm or embolism; and

(f) the service is not a study performed to image the coronary arteries (R) (Anaes.)

517.65

57357

Computed tomography—angiography with intravenous contrast medium of any or all, or any part, of the pulmonary arteries and their branches, including any scans performed before intravenous contrast injection—one or more data acquisitions, including image editing, and maximum intensity projections or 3 dimensional surface shaded display, with hardcopy or digital recording of multiple projections, if:

(a) the service is:

(i) performed for the exclusion of pulmonary arterial stenosis, occlusion, aneurysm or embolism and is requested by a specialist or consultant physician; or

(ii) performed for the exclusion of pulmonary arterial stenosis, occlusion or aneurysm, is requested by a medical practitioner (other than a specialist or consultant physician) and the request indicates that the patient’s case has been discussed with a specialist or consultant physician; or

(iii) performed for the exclusion of pulmonary embolism and is requested by a medical practitioner (other than a specialist or consultant physician); and

(b) the service is not:

(i) a service to which another item in this group applies; or

(ii) a study performed to image the coronary arteries (R) (Anaes)

517.65

57360

Computed tomography of the coronary arteries performed on a minimum of a 64 slice (or equivalent) scanner if:

(a) the request is made by a specialist or consultant physician; and

(b) the patient has stable or acute symptoms consistent with coronary ischaemia; and

(c) the patient is at low to intermediate risk of an acute coronary event, including having no significant cardiac biomarker elevation and no electrocardiogram changes indicating acute ischaemia (R) (Anaes.)

710.50

57364

Computed tomography of the coronary arteries performed on a minimum of a 64 slice (or equivalent) scanner, if:

(a) the service is requested by a specialist or consultant physician; and

(b) at least one of the following apply to the patient:

(i) the patient has stable symptoms and newly recognised left ventricular systolic dysfunction of unknown aetiology;

(ii) the patient requires exclusion of coronary artery anomaly or fistula;

(iii) the patient will be undergoing noncoronary cardiac surgery;

(iv) the patient meets the criteria to be eligible for a service to which item 38247, 38249 or 38252 applies, but as an alternative to selective coronary angiography will require an assessment of the patency of one or more bypass grafts

(R) (Anaes)

710.50

Subgroup 13—Cone beam computed tomography

57362

Cone beam computed tomography—dental and temporomandibular joint imaging (without contrast medium) for diagnosis and management of any of the following:

(a) mandibular and dentoalveolar fractures;

(b) dental implant planning;

(c) orthodontics;

(d) endodontic conditions;

(e) periodontal conditions;

(f) temporomandibular joint conditions

Applicable once per patient per day, not being for a service to which any of items 57960 to 57969 apply, and not being a service associated with another service in Group I2 (R) (Anaes.)

114.85

Division 2.3Group I3: diagnostic radiology

Subdivision AGeneral

2.3.1  Application of items in Subdivision B, D, E or G to services rendered using diagnostic imaging procedures carried out in metropolitan areas and certain inner regional areas

 (1) This clause applies to a service described in an item in Subdivision B, D, E or G if the diagnostic imaging procedure used to render the service is carried out in an area other than area that is:

 (a) both:

 (i) Inner Regional Australia; and

 (ii) RRMA4 or RRMA5; or

 (b) Outer Regional Australia; or

 (c) Remote Australia; or

 (d) Very Remote Australia; or

 (e) Norfolk Island.

 (2) The item applies to the service only if the procedure is carried out as permitted by subclause (3) or (4).

 (3) For the purposes of subclause (2), the procedure used to render a service described in an item in Subdivision B, D, E or G may be carried out:

 (a) by a medical practitioner; or

 (b) by a person who is registered as a medical radiation practitioner under a law of a State or Territory, if the person carries out the procedure under the supervision of a medical practitioner in accordance with accepted medical practice.

 (4) For the purposes of subclause (2), the procedure used to render a service described in an item in Subgroup 3 of Group I3 may also be carried out by a dental practitioner if the dental practitioner carries out the procedure under the supervision of a medical practitioner in accordance with accepted medical practice.

2.3.2  Restriction on items—certain services requested by chiropractors, osteopaths and physiotherapists

  For any particular patient, if the service mentioned in any of the following items is requested more than once on the same day by the same chiropractor, physiotherapist, or osteopath, the item applies to the service only once on that day:

 (a) items 58100 to 58106;

 (b) items 58109 and 58112.

2.3.3  Increased fees for certain diagnostic radiology services carried out at residential aged care facilities

 (1) This clause applies to a service to which item 57509, 57515, 57521, 57527, 57703, 57709, 57712, 57715, 58503, 58521, 58524, 58527 or 58903 applies.

 (2) If:

 (a) a providing practitioner renders a service to a care recipient of a residential aged care facility during an attendance at the facility; and

 (b) subclause (3) does not apply in relation to that attendance; and

 (c) the service was requested during a personal attendance on the care recipient at the facility by the requesting practitioner; and

 (d) subclause (4) applies to the service;

the fee for the service is the amount listed in the item that applies to the service plus $74.75.

 (3) If:

 (a) a providing practitioner renders 2 or more services to one or more care recipients of a residential aged care facility during an attendance at the facility; and

 (b) the services were requested during personal attendances on the care recipients by one or more requesting practitioners at the facility; and

 (c) subclause (4) applies to at least one of the services;

the fee for the first service carried out during the attendance by the providing practitioner is the amount listed in the item that applies to the service plus $74.75.

 (4) This subclause applies to a service if the service is requested because a care recipient of a residential aged care facility:

 (a) for a service to which item 57509, 57515, 57521, 57527, 57703, 57709, 57712, 57715, 58521, 58524 or 58527 applies—has had a fall; and

 (b) for a service to which item 58503 applies—is suspected of having pneumonia or heart failure; and

 (c) for a service to which item 58903 applies—is suspected of having an acute abdomen or bowel obstruction.

Subdivision BSubgroups 1 to 9 of Group I3

2.3.4  Items in Subgroups 1 to 9 of Group I3

  This clause sets out items in Subgroups 1 to 9 of Group I3.

Note: The fees in Group I3 are indexed in accordance with clause 2.7.1.

 

Group I3—Diagnostic radiology

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 1—Radiographic examination of extremities

57506

Hand, wrist, forearm, elbow or humerus (NR)

30.20

57509

Hand, wrist, forearm, elbow or humerus (R)

40.35

57512

Hand and wrist, or hand, wrist and forearm, or forearm and elbow, or elbow and humerus (NR)

41.10

57515

Hand and wrist, or hand, wrist and forearm, or forearm and elbow, or elbow and humerus (R)

54.80

57518

Foot, ankle, leg or femur (NR)

33.00

57521

Foot, ankle, leg or femur (R)

44.05

57522

Knee (NR)

33.00

57523

Knee (R)

44.05

57524

Foot and ankle, or ankle and leg, or leg and knee, or knee and femur (NR)

50.15

57527

Foot and ankle, or ankle and leg, or leg and knee, or knee and femur (R)

66.75

Subgroup 2—Radiographic examination of shoulder or pelvis

57700

Shoulder or scapula (NR)

41.10

57703

Shoulder or scapula (R)

54.80

57706

Clavicle (NR)

33.00

57709

Clavicle (R)

44.05

57712

Hip joint (R)

47.85

57715

Pelvic girdle (R)

61.80

57721

Femur, internal fixation of neck or intertrochanteric (pertrochanteric) fracture (R)

100.75

Subgroup 3—Radiographic examination of head

57901

Skull, not in association with item 57902 (R)

65.45

57902

Cephalometry, not in association with item 57901 (R)

65.45

57905

Mastoids or petrous temporal bones (R)

65.45

57907

Sinuses, or facial bones—orbit, maxilla or malar, any or all (R)

48.00

57915

Mandible, not by orthopantomography technique (R)

47.85

57918

Salivary calculus (R)

47.85

57921

Nose (R)

47.85

57924

Eye (R)

47.85

57927

Temporomandibular joints (R)

50.40

57930

Teeth—single area (R)

33.40

57933

Teeth—full mouth (R)

79.40

57939

Palatopharyngeal studies with fluoroscopic screening (R)

65.45

57942

Palatopharyngeal studies without fluoroscopic screening (R)

50.40

57945

Larynx, lateral airways and soft tissues of the neck, not being a service associated with a service to which item 57939 or 57942 applies (R)

44.05

57960

Orthopantomography for diagnosis or management (or both) of trauma, infection, tumour or a congenital or surgical condition of the teeth or maxillofacial region (R)

48.10

57963

Orthopantomography for diagnosis or management (or both) of any of the following conditions, if the signs and symptoms of the condition is present:

(a) impacted teeth;

(b) caries;

(c) periodontal pathology;

(d) periapical pathology (R)

48.10

57966

Orthopantomography for diagnosis or management (or both) of missing or crowded teeth, or developmental anomalies of the teeth or jaws (R)

48.10

57969

Orthopantomography for diagnosis or management (or both) of temporomandibular joint arthroses or dysfunction (R)

48.10

Subgroup 4—Radiographic examination of spine

58100

Spine—cervical (R)

68.15

58103

Spine—thoracic (R)

55.95

58106

Spine—lumbosacral (R)

78.15

58108

Spine—4 regions, cervical, thoracic, lumbosacral and sacrococcygeal (R)

111.65

58109

Spine—sacrococcygeal (R)

47.70

58112

Spine—2 examinations of the kind mentioned in items 58100, 58103, 58106 and 58109 (R)

98.70

58115

Spine—3 examinations of the kind mentioned in items 58100, 58103, 58106 and 58109 (R)

111.65

58120

Spine—4 regions, cervical, thoracic, lumbosacral and sacrococcygeal, if the service to which item 58120 or 58121 applies has not been performed on the same patient within the same calendar year (R)

111.65

58121

Spine—3 examinations of the kind mentioned in items 58100, 58103, 58106 and 58109, if the service to which item 58120 or 58121 applies has not been performed on the same patient within the same calendar year (R)

111.65

Subgroup 5—Bone age study and skeletal survey

58300

Bone age study (R)

40.70

58306

Skeletal survey (R)

90.75

Subgroup 6—Radiographic examination of thoracic region

58500

Chest (lung fields) by direct radiography (NR)

35.90

58503

Chest (lung fields) by direct radiography (R)

47.85

58506

Chest (lung fields) by direct radiography with fluoroscopic screening (R)

61.65

58509

Thoracic inlet or trachea (R)

40.35

58521

Left ribs, right ribs or sternum (R)

44.05

58524

Left and right ribs, left ribs and sternum, or right ribs and sternum (R)

57.35

58527

Left ribs, right ribs and sternum (R)

70.45

Subgroup 7—Radiographic examination of urinary tract

58700

Plain renal only (R)

46.75

58706

Intravenous pyelography, with or without preliminary plain films and with or without tomography (R)

160.25

58715

Antegrade or retrograde pyelography with or without preliminary plain films and with preparation and contrast injection, one side (R)

153.80

58718

Retrograde cystography or retrograde urethrography with or without preliminary plain films and with preparation and contrast injection (R) (Anaes.)

128.00

58721

Retrograde micturating cystourethrography, with preparation and contrast injection (R) (Anaes.)

140.30

Subgroup 8—Radiographic examination of alimentary tract and biliary system

58900

Plain abdominal only, not being a service associated with a service to which item 58909, 58912 or 58915 applies (NR)

36.25

58903

Plain abdominal only, not being a service associated with a service to which item 58909, 58912 or 58915 applies (R)

48.30

58909

Barium or other opaque meal of one or more of pharynx, oesophagus, stomach or duodenum, with or without preliminary plain films of pharynx, chest or duodenum, not being a service associated with a service to which item 57939, 57942 or 57945 applies (R)

91.30

58912

Barium or other opaque meal of oesophagus, stomach, duodenum and follow through to colon, with or without screening of chest and with or without preliminary plain film (R)

111.90

58915

Barium or other opaque meal, small bowel series only, with or without preliminary plain film (R)

80.15

58916

Small bowel enema, barium or other opaque study of the small bowel, including duodenal intubation, with or without preliminary plain films, not being a service associated with a service to which item 30488 applies (R) (Anaes.)

140.60

58921

Opaque enema, with or without air contrast study and with or without preliminary plain films (R)

137.30

58927

Cholegraphy direct, with or without preliminary plain films and with preparation and contrast injection, not being a service associated with a service to which item 30439 applies (R)

77.60

58933

Cholegraphy, percutaneous transhepatic, with or without preliminary plain films and with preparation and contrast injection (R)

208.70

58936

Cholegraphy, drip infusion, with or without preliminary plain films, with preparation and contrast injection and with or without tomography (R)

198.90

58939

Defaecogram (R)

141.40

Subgroup 9—Radiographic examination for localisation of foreign bodies

59103

Localisation of foreign body, if provided in conjunction with a service mentioned in Subgroups 1 to 12 of Group I3 (R)

21.60

Subdivision CSubgroup 10 of Group I3: radiographic examination of breasts

2.3.5  Mammography services—eligible services

  Items in this Subdivision apply only to a mammography service performed:

 (a) under the supervision of a specialist in the specialty of diagnostic radiology who is available:

 (i) to monitor and influence the conduct and diagnostic quality of the examination; and

 (ii) if necessary, to attend on the patient personally; or

 (b) if paragraph (a) cannot be complied with:

 (i) in an emergency; or

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

2.3.6  Items in Subgroup 10 of Group I3

  This clause sets out items in Subgroup 10 of Group I3.

Note: The fees in Group I3 are indexed in accordance with clause 2.7.1.

 

Group I3—Diagnostic radiography

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 10—Radiographic examination of breasts

59300

Mammography 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 (R)

90.85

59303

Mammography of one breast if:

(a) the service is specifically requested for a unilateral mammogram; and

(b) there is reason to suspect the presence of malignancy because of:

(i) the past occurrence of breast malignancy in the patient; or

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

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

54.75

59312

Radiographic examination of both breasts, in conjunction with a surgical procedure on each breast, using interventional techniques (R)

88.30

59314

Radiographic examination of one breast, in conjunction with a surgical procedure using interventional techniques (R)

53.30

59318

Radiographic examination of excised breast tissue to confirm satisfactory excision of one or more lesions in one breast or both following preoperative localisation in conjunction with a service under item 31536 (R)

47.75

Subdivision DSubgroups 12 and 13 of Group I3

2.3.7  Items in Subgroups 12 and 13 of Group I3

  This clause sets out items in Subgroups 12 and 13 of Group I3.

Note: The fees in Group I3 are indexed in accordance with clause 2.7.1.

 

Group I3—Diagnostic radiography

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 12—Radiographic examination with opaque or contrast media

59700

Discography, each disc, with or without preliminary plain films and with preparation and contrast injection (R) (Anaes.)

98.00

59703

Dacryocystography, one side, with or without preliminary plain film and with preparation and contrast injection (R)

77.05

59712

Hysterosalpingography, with or without preliminary plain films and with preparation and contrast injection (R)(Anaes.)

115.40

59715

Bronchography, one side, with or without preliminary plain films and with preparation and contrast injection, on a person under 16 years of age (R) (Anaes.)

145.70

59718

Phlebography, one side, with or without preliminary plain films and with preparation and contrast injection (R) (Anaes.)

136.65

59724

Myelography, one or more regions, with or without preliminary plain films and with preparation and contrast injection, not being a service associated with a service to which item 56219 applies (R)(Anaes.)

229.85

59733

Sialography, one side, with preparation and contrast injection, not being a service associated with a service to which item 57918 applies (R)

109.30

59739

Sinogram or fistulogram, one or more regions, with or without preliminary plain films and with preparation and contrast injection (R))

74.85

59751

Arthrography, each joint, excluding the facet (zygapophyseal) joints of the spine, single or double contrast study, with or without preliminary plain films and with preparation and contrast injection (R)

141.25

59754

Lymphangiography, one or both sides, with preliminary plain films and followup radiography and with preparation and contrast injection (R)

222.65

59763

Air insufflation during video—fluoroscopic imaging including associated consultation (R)

135.90

Subgroup 13—Angiography

59970

Angiography or digital subtraction angiography, or both, with fluoroscopy and image acquisition, using a mobile image intensifier, including any preliminary plain films, preparation and contrast injection—one or more regions (R) (Anaes.)

170.80

60000

Digital subtraction angiography, examination of head and neck with or without arch aortography—1 to 3 data acquisition runs (R) (Anaes.)

572.45

60003

Digital subtraction angiography, examination of head and neck with or without arch aortography—4 to 6 data acquisition runs (R) (Anaes.)

839.50

60006

Digital subtraction angiography, examination of head and neck with or without arch aortography—7 to 9 data acquisition runs (R) (Anaes.)

1,193.75

60009

Digital subtraction angiography, examination of head and neck with or without arch aortography—10 or more data acquisition runs (R) (Anaes.)

1,396.95

60012

Digital subtraction angiography, examination of thorax—1 to 3 data acquisition runs (R) (Anaes.)

572.45

60015

Digital subtraction angiography, examination of thorax—4 to 6 data acquisition runs (R) (Anaes.)

839.50

60018

Digital subtraction angiography, examination of thorax—7 to 9 data acquisition runs (R) (Anaes.)

1,193.75

60021

Digital subtraction angiography, examination of thorax—10 or more data acquisition runs (R) (Anaes.)

1,396.95

60024

Digital subtraction angiography, examination of abdomen—1 to 3 data acquisition runs (R) (Anaes.)

572.45

60027

Digital subtraction angiography, examination of abdomen—4 to 6 data acquisition runs (R) (Anaes.)

839.50

60030

Digital subtraction angiography, examination of abdomen—7 to 9 data acquisition runs (R) (Anaes.)

1,193.75

60033

Digital subtraction angiography, examination of abdomen—10 or more data acquisition runs (R) (Anaes.)

1,396.95

60036

Digital subtraction angiography, examination of upper limb or limbs—1 to 3 data acquisition runs (R) (Anaes.)

572.45

60039

Digital subtraction angiography, examination of upper limb or limbs—4 to 6 data acquisition runs (R) (Anaes.)

839.50

60042

Digital subtraction angiography, examination of upper limb or limbs—7 to 9 data acquisition runs (R) (Anaes.)

1,193.75

60045

Digital subtraction angiography, examination of upper limb or limbs—10 or more data acquisition runs (R) (Anaes.)

1,396.95

60048

Digital subtraction angiography, examination of lower limb or limbs—1 to 3 data acquisition runs (R) (Anaes.)

572.45

60051

Digital subtraction angiography, examination of lower limb or limbs—4 to 6 data acquisition runs (R) (Anaes.)

839.50

60054

Digital subtraction angiography, examination of lower limb or limbs—7 to 9 data acquisition runs (R) (Anaes.)

1,193.75

60057

Digital subtraction angiography, examination of lower limb or limbs—10 or more data acquisition runs (R) (Anaes.)

1,396.95

60060

Digital subtraction angiography, examination of aorta and lower limb or limbs—1 to 3 data acquisition runs (R) (Anaes.)

572.45

60063

Digital subtraction angiography, examination of aorta and lower limb or limbs—4 to 6 data acquisition runs (R) (Anaes.)

839.50

60066

Digital subtraction angiography, examination of aorta and lower limb or limbs—7 to 9 data acquisition runs (R) (Anaes.)

1,193.75

60069

Digital subtraction angiography, examination of aorta and lower limb or limbs—10 or more data acquisition runs (R) (Anaes.)

1,396.95

60072

Selective arteriography or selective venography by digital subtraction angiography technique—one vessel (NR) (Anaes.)

48.80

60075

Selective arteriography or selective venography by digital subtraction angiography technique—2 vessels (NR) (Anaes.)

97.55

60078

Selective arteriography or selective venography by digital subtraction angiography technique—3 or more vessels (NR) (Anaes.)

146.40

Subdivision ESubgroup 15 of Group I3: fluoroscopic examination

2.3.8  Items in Subgroup 15 of Group I3

  This clause sets out items in Subgroup 15 of Group I3.

Note: The fees in Group I3 are indexed in accordance with clause 2.7.1.

 

Group I3—Diagnostic radiography

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 15—Fluoroscopic examination

60500

Fluoroscopy, with general anaesthesia (not being a service associated with a radiographic examination) (R) (Anaes.)

44.05

60503

Fluoroscopy, without general anaesthesia (not being a service associated with a radiographic examination) (R)

30.20

60506

Fluoroscopy using a mobile image intensifier, in conjunction with a surgical procedure lasting less than 1 hour, not being a service associated with a service to which another item in this Group applies (R)

64.70

60509

Fluoroscopy using a mobile image intensifier, in conjunction with a surgical procedure lasting 1 hour or more, not being a service associated with a service to which another item in this Group applies (R)

100.40

Subdivision FSubgroup 16 of Group I3: preparation for radiological procedure

2.3.9  Preparation of patients for radiological procedures

  Items in this Subdivision apply only to the preparation of a patient for a radiological procedure for a service to which item 59970 applies by:

 (a) injecting opaque or contrast media; or

 (b) removing fluid and replacing it with air, oxygen or other contrast media; or

 (c) a similar method.

2.3.10  Items in Subgroup 16 of Group I3

  This clause sets out items in Subgroup 16 of Group I3.

Note: The fees in Group I3 are indexed in accordance with clause 2.7.1.

 

Group I3—Diagnostic radiography

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 16—Preparation for radiological procedure

60918

Arteriography (peripheral) or phlebography—one vessel, when used in association with a service to which item 59970 applies, not being a service associated with a service to which any of items 60000 to 60078 apply (NR) (Anaes.)

47.85

60927

Selective arteriogram or phlebogram, when used in association with a service to which item 59970 applies, not being a service associated with a service to which any of items 60000 to 60078 apply (NR) (Anaes.)

38.60

Subdivision GSubgroup 17 of Group I3: interventional techniques

2.3.11  Meaning of angiography suite

  In this Schedule:

angiography suite means a room that contains only equipment designed for angiography that is able to perform digital subtraction or rapidsequence film angiography.

2.3.12  Items in Subgroup 17 of Group I3

  This clause sets out items in Subgroup 17 of Group I3.

Note: The fees in Group I3 are indexed in accordance with clause 2.7.1.

 

Group I3—Diagnostic radiography

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 17—Interventional techniques

61109

Fluoroscopy in an angiography suite with image intensification, in conjunction with a surgical procedure using interventional techniques, not being a service associated with a service to which another item in this Group applies (R)

262.80

Division 2.4Group I4: nuclear medicine imaging

Subdivision AGeneral

2.4.1  Nuclear scanning services (other than PET nuclear scanning services) and adjunctive services

  An item in Subgroup 1 or 3 of Group I4 applies only if:

 (a) the performance of the service does not involve the use of positronemission radioisotopes or a PET scanner; and

 (b) the service is performed:

 (i) by a specialist or consultant physician whose name is included in a register, given to the Chief Executive Medicare by the JNMCAC, of participants in the Joint Nuclear Medicine Specialist Credentialling Program of the JNMCAC; or

 (ii) by a person acting on behalf of a specialist or consultant physician mentioned in subparagraph (i); and

 (c) the final report of the service is compiled by the specialist or consultant physician who performed the preliminary examination of the patient and the estimation and administration of the dosage of radiopharmaceuticals.

2.4.1A  Restriction on items for stress myocardial perfusion studies—patients, requests and requirements

  Items 61324, 61329, 61345, 61349, 61357, 61394, 61398, 61406, 61410 and 61414 apply to a service performed on a patient only if:

 (a) one or more of subclauses 2.4.1B(1), (2) and (3) apply to the patient; and

 (b) the request for the service identifies any symptoms or clinical indications mentioned in those subclauses that apply to the patient; and

 (c) the service is performed in accordance with clause 2.4.1C.

2.4.1B  Stress myocardial perfusion studies—patients

  (1) This subclause applies to a patient if:

 (a) the patient displays symptoms of typical or atypical angina, including constricting discomfort of one or more of the following:

 (i) the front of the chest;

 (ii) the neck;

 (iii) the shoulders;

 (iv) the jaw;

 (v) the arms; or

 (b) the patient’s symptoms are:

 (i) precipitated by physical exertion; or

 (ii) relieved within 5 minutes or less by rest or glyceryl trinitrate.

 (2) This subclause applies to a patient if:

 (a) the patient has known coronary artery disease; and

 (b) the patient displays one or more symptoms that are suggestive of ischaemia; and

 (c) the symptoms:

 (i) are not adequately controlled with medical therapy; or

 (ii) have evolved since the last functional study undertaken of the patient.

 (3) This subclause applies to a patient if one or more of the following clinical indications apply to the patient:

 (a) the patient does not have a known coronary artery disease but assessment indicates that resting twelvelead electrocardiogram changes are consistent with coronary artery disease or ischaemia;

 (b) coronary artery disease related lesions, of uncertain functional significance, have previously been identified on a computed tomography coronary angiography or invasive coronary angiography;

 (c) an assessment by a specialist or consultant physician indicates that the patient has possible painless myocardial ischaemia, where a stress myocardial perfusion study is likely to assist the diagnosis;

 (d) an assessment indicates that the patient has undue exertional dyspnoea of uncertain aetiology;

 (e) a preoperative assessment of the patient, who has a functional capacity of less than 4 metabolic equivalents, confirms that surgery is an intermediate to high risk, and the patient also has at least one of the following conditions:

 (i) ischaemic heart disease;

 (ii) previous myocardial infarction;

 (iii) heart failure;

 (iv) stroke;

 (v) transient ischaemic attack;

 (vi) renal dysfunction (serum creatinine greater than 170umol/L or 2 mg/dL or a creatinine clearance of less than 60 mL/min);

 (vii) diabetes mellitus requiring insulin therapy;

 (f) assessment, including quantification, is required before either percutaneous coronary intervention or coronary bypass surgery to quantify the extent and severity of myocardial ischaemia, and to ensure the criteria for intervention are met;

 (g) assessment is required of relative amounts of ischaemic viable myocardium and nonviable (infarcted) myocardium because the patient has a previous myocardial infarction;

 (h) assessment of myocardial ischaemia with exercise is required because the patient has congenital heart lesions, has undergone surgery and ischemia is considered possible;

 (i) the patient is under 17 years old, with coronary anomalies, and assessment of myocardial perfusion is required before and after cardiac surgery:

 (i) for congenital heart disease; or

 (ii) where there is a probable or confirmed coronary artery abnormality;

 (j) myocardial perfusion abnormality is suspected but, due to the patient’s cognitive capacity or expressive language impairment, it is not possible to accurately assess symptom frequency based on medical history.

2.4.1C  Stress myocardial perfusion studies—requirements

 (1) A stress myocardial perfusion study must be performed:

 (a) on premises equipped with resuscitation equipment, including a defibrillator; and

 (b) by a person trained in cardiopulmonary resuscitation who is in continuous personal attendance during the procedure.

 (2) At the time the service is performed, a second person trained in the matters mentioned in subclause (4) and cardiopulmonary resuscitation must be located at the premises while the exercise test is performed, and must be immediately available to respond if required.

 (3) One of the persons mentioned in subclauses (1) and (2) must be a medical practitioner.

 (4) For the purposes of subclause (2), the matters are:

 (a) how to safely perform exercise or pharmacological stress monitoring and recording; and

 (b) how to recognise the symptoms and signs of cardiac disease.

2.4.2  PET nuclear scanning services

 (1) Items 61523 to 61647 apply only if the service is performed on a person:

 (a) at the written request of a specialist or consultant physician (the requesting practitioner) if:

 (i) the person is the requesting practitioner’s patient; and

 (ii) the requesting practitioner decides that the service is necessary; and

 (b) in a comprehensive facility; and

 (c) in accordance with clauses 2.4.3 and 2.4.4.

 (2) Also, the items apply only if the owner or operator of the equipment used to perform the service is not in breach of clause 2.4.5.

2.4.3  PET nuclear scanning services—performance under personal supervision

 (1) For the purposes of clause 2.4.2, the service must be performed on a person by or under the personal supervision of:

 (a) a credentialled specialist other than the requesting practitioner; or

 (b) a medical practitioner other than the requesting practitioner if the medical practitioner:

 (i) is a Fellow of the RACP or RANZCR; and

 (ii) has reported 400 or more studies forming part of PET services for which a medicare benefit was payable; and

 (iii) is authorised under State or Territory law to prescribe and administer to humans the PET radiopharmaceuticals that are to be administered to the person; and

 (iv) met the requirements of subparagraphs (i), (ii) and (iii) before 1 November 2011.

 (2) In this clause:

requesting practitioner has the same meaning as in paragraph 2.4.2(1)(a).

2.4.4  PET nuclear scanning services—equipment

  For the purposes of clause 2.4.2, the service must be performed on a person using equipment that meets the requirements set out in Requirements for PET Accreditation (Instrumentation & Radiation Safety) 3rd Edition (2017), issued by the Australian and New Zealand Society of Nuclear Medicine Inc, as existing on 1 July 2020.

Note: The Requirements for PET Accreditation (Instrumentation & Radiation Safety) 3rd Edition (2017) could in 2020 be viewed on the website of the Society (https://www.anzsnm.org.au).

2.4.5  PET nuclear scanning services—statutory declaration

 (1) The owner or operator mentioned in subclause 2.4.2(2) must have given a statutory declaration to the Chief Executive Medicare that includes the following information:

 (a) whether the owner or operator is a credentialed specialist or a medical practitioner who satisfies the requirements mentioned in subparagraphs 2.4.3(1)(b)(i) to (iv);

 (b) whether the place where the owner or operator provides the service in a comprehensive facility;

 (c) whether the equipment meets the requirements mentioned in clause 2.4.4;

 (d) the facility’s address;

 (e) the provider number for the facility given by the Chief Executive Medicare;

 (f) the location specific practice number for the facility given by the Minister;

 (g) the models, serial numbers and manufacturers of the equipment.

 (2) If the matters declared in the statutory declaration change, the owner or operator must give the Chief Executive Medicare written notice of the change as soon as the owner or operator knows about the change.

Subdivision BSubgroups 1, 2 and 3 of Group I4

2.4.6  Items in Subgroups 1, 2 and 3 of Group I4

  This clause sets out items in Subgroups 1, 2 and 3 of Group I4.

 

Group I4—Nuclear medicine imaging

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 1—Nuclear medicine—non PET

61310

Myocardial infarct avid study (R)

367.30

61313

Gated cardiac blood pool study, (equilibrium) (R)

303.35

61314

Gated cardiac blood pool study, with or without intervention, and first pass blood flow or cardiac shunt study (R)

420.00

61321

Single rest myocardial perfusion study for the assessment of the extent and severity of viable and nonviable myocardium, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has left ventricular systolic dysfunction and probable or confirmed coronary artery disease; and

(b) the service uses a single rest technetium99m (Tc99m) protocol; and

(c) the service is requested by a specialist or a consultant physician; and

(d) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61325, 61329, 61332, 61345, 61380, 61398, 61406 or 61422 applies; and

(e) if the patient is 17 years or older—a service to which this item, or item 61325, 61329, 61332, 61345, 61380, 61398, 61406 or 61422, applies has not been provided to the patient in the previous 24 months (R)

329.00

61324

Single stress myocardial perfusion study, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) at least one of the following applies:

(i) the patient has body habitus or other physical conditions (including heart rhythm disturbance) to the extent that a stress echocardiography would not provide adequate information;

(ii) the patient is unable to exercise to the extent required for a stress echocardiography to provide adequate information;

(iii) the patient has had a failed stress echocardiography provided in a service to which item 55141, 55143, 55145 or 55146 applies; and

(c) the service includes resting ECG, continuous ECG monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(d) the service is requested by a specialist or consultant physician; and

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61325, 61329, 61332, 61377, 61345, 61357, 61380, 61394, 61398, 61406, 61414 or 61422 applies; and

(f) if the patient is 17 years or older—a service to which this item, or item 61311, 61329, 61332, 61345, 61357, 61377, 61380, 61394, 61398, 61406 or 61414, applies has not been provided to the patient in the previous 24 months (R)

653.05

61325

Single rest myocardial perfusion study for the assessment of the extent and severity of viable and nonviable myocardium, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has left ventricular systolic dysfunction and probable or confirmed coronary artery disease; and

(b) the service uses:

(i) an initial rest study followed by a redistribution study on the same day; and

(ii) a thallous chloride201 (Tl201) protocol; and

(c) the service is requested by a specialist or a consultant physician; and

(d) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61321, 61329, 61332, 61345, 61380, 61398, 61406 or 61422 applies; and

(e) if the patient is 17 years or older:

(i) a service to which item 61321, 61329, 61332, 61345, 61380, 61398, 61406 or 61442, applies has not been provided to the patient in the previous 24 months; and

(ii) the service is applicable only twice each 24 months (R)

329.00

61328

Lung perfusion study (R)

227.65

61329

Combined stress and rest, stress and reinjection or rest and redistribution myocardial perfusion study, including delayed imaging or reinjection protocol on a subsequent occasion, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) at least one of the following applies:

(i) the patient has body habitus or other physical conditions (including heart rhythm disturbance) to the extent that a stress echocardiography would not provide adequate information;

(ii) the patient is unable to exercise to the extent required for a stress echocardiography to provide adequate information;

(iii) the patient has had a failed stress echocardiography provided in a service to which item 55141, 55143, 55145 or 55146 applies; and

(c) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(d) the service is requested by a medical practitioner (other than a specialist or consultant physician); and

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61332, 61345, 61357, 61377, 61380, 61394, 61398, 61406, 61414 or 61422 applies; and

(f) if the patient is 17 years or older—a service to which this item, or item 61311, 61321, 61324, 61325, 61332, 61345, 61357, 61380, 61394, 61398, 61406, 61414 or 61422, applies has not been provided to the patient in the previous 24 months (R)

982.05

61340

Lung ventilation study using aerosol, technegas or xenon gas (R)

253.00

61345

Combined stress and rest, stress and reinjection or rest and redistribution myocardial perfusion study, including delayed imaging or reinjection protocol on a subsequent occasion, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) at least one of the following applies:

(i) the patient has body habitus or other physical conditions (including heart rhythm disturbance) to the extent that a stress echocardiography would not provide adequate information;

(ii) the patient is unable to exercise to the extent required for a stress echocardiography to provide adequate information;

(iii) the patient has had a failed stress echocardiography provided in a service to which item 55141, 55143, 55145 or 55146 applies; and

(c) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(d) the service is requested by a specialist or consultant physician; and

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61332, 61357, 61377, 61380, 61394, 61398, 61406, 61414 or 61422 applies; and

(f) if the patient is 17 years or older—a service to which this item, or item 61311, 61321, 61324, 61325, 61329, 61332, 61357, 61377, 61380, 61394, 61398, 61406, 61414 or 61422, applies has not been provided to the patient in the previous 24 months (R)

982.05

61348

Lung perfusion study and lung ventilation study using aerosol, technegas or xenon gas (R)

443.35

61349

Repeat combined stress and rest, stress and reinjection or rest and redistribution myocardial perfusion study, including delayed imaging or reinjection protocol on a subsequent occasion, with single photon emission tomography, with or without planar imaging, if:

(a) both:

(i) a service has been provided to the patient in the previous 24 months to which this item, or item 61311, 61324, 61329, 61332, 61337, 61345, 61357, 61365, 61380, 61394, 61398, 61406, 61410, 61414 or 61418, applies; and

(ii) the patient has subsequently undergone a revascularisation procedure; and

(b) the patient has one or more symptoms of cardiac ischaemia that have evolved and are not adequately controlled with optimal medical therapy; and

(c) at least one of the following applies:

(i) the patient has body habitus or other physical conditions (including heart rhythm disturbance) to the extent that a stress echocardiography would not provide adequate information;

(ii) the patient is unable to exercise to the extent required for a stress echocardiography to provide adequate information;

(iii) the patient has had a failed stress echocardiography provided in a service to which item 55141, 55143, 55145 or 55146 applies; and

(d) the service is requested by a specialist or a consultant physician; and

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61365, 61410 or 61418 applies; and

(f) if the patient is 17 years or older—a service to which this item, or item 61365, 61410 or 61418, applies has not been provided to the patient in the previous 12 months

Applicable not more than once in 12 months (R)

982.05

61353

Liver and spleen study (colloid) (R)

386.60

61356

Red blood cell spleen or liver study (R)

392.80

61357

Single stress myocardial perfusion study, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) at least one of the following applies:

(i) the patient has body habitus or other physical conditions (including heart rhythm disturbance) to the extent that a stress echocardiography would not provide adequate information;

(ii) the patient is unable to exercise to the extent required for a stress echocardiography to provide adequate information;

(iii) the patient has had a failed stress echocardiography provided in a service to which items 55141, 55143, 55145 or 55146 applies; and

(c) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(d) the service is requested by a medical practitioner (other than a specialist or consultant physician); and

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61332, 61345, 61377, 61380, 61394, 61398, 61406, 61414 or 61422 applies; and

(f) if the patient is 17 years or older—a service to which this item, or item 61311, 61324, 61329, 61332, 61345, 61377, 61380, 61394, 61398, 61406, or 61414, applies has not been provided to the patient in the previous 24 months (R)

653.05

61360

Hepatobiliary study, including morphine administration or pretreatment with a cholagogue when performed (R)

403.35

61361

Hepatobiliary study with formal quantification following baseline imaging, using a cholagogue (R)

461.40

61364

Bowel haemorrhage study (R)

496.95

61368

Meckel’s diverticulum study (R)

223.10

61369

Indiumlabelled octreotide study (including single photon emission tomography when undertaken), if:

(a) a gastroenteropancreatic endocrine tumour is suspected on the basis of biochemical evidence with negative or equivocal conventional imaging; or

(b) both:

(i) a surgically amenable gastroenteropancreatic endocrine tumour has been identified on the basis of conventional techniques; and

(ii) the study is to exclude additional disease sites (R)

2,015.75

61372

Salivary study (R)

223.10

61373

Gastrooesophageal reflux study, including delayed imaging on a separate occasion when performed (R)

489.70

61376

Oesophageal clearance study (R)

143.35

61381

Gastric emptying study, using single tracer (R)

574.35

61383

Combined solid and liquid gastric emptying study using dual isotope technique or the same isotope on separate days (R)

624.95

61384

Radionuclide colonic transit study (R)

687.70

61386

Renal study, including perfusion and renogram images and computer analysis or cortical study with planar imaging (R)

332.50

61387

Renal cortical study, with single photon emission tomography and planar quantification (R)

430.75

61389

Single renal study with preprocedural administration of a diuretic or angiotensin converting enzyme (ACE) inhibitor (R)

370.55

61390

Renal study with diuretic administration after a baseline study (R)

409.95

61393

Combined examination involving a renal study following angiotensin converting enzyme (ACE) inhibitor provocation and a baseline study, in either order and related to a single referral episode (R)

605.50

61394

Single stress myocardial perfusion study, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) the service is provided at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(c) a stress echocardiography service is not available in the Modified Monash area where the service is provided; and

(d) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(e) the service is requested by a specialist or consultant physician; and

(f) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61332, 61345, 61357, 61377, 61380, 61398, 61406, 61414 or 61422 applies; and

(g) if the patient is 17 years or older—a service to which this item, or item 61311, 61324, 61329, 61332, 61345, 61357, 61377, 61380, 61398, 61406 or 61414, applies has not been provided to the patient in the previous 24 months (R)

653.05

61397

Cystoureterogram (R)

246.85

61398

Combined stress and rest, stress and reinjection or rest and redistribution myocardial perfusion study, including delayed imaging or reinjection protocol on a subsequent occasion, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) the service is provided at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(c) a stress echocardiography service is not available in the Modified Monash area where the services is provided; and

(d) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(e) the service is requested by a medical practitioner (other than a specialist or consultant physician); and

(f) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61332, 61345, 61357, 61377, 61380, 61394, 61406, 61414 or 61422 applies; and

(g) if the patient is 17 years or older—a service to which this item, or item 61311, 61321, 61324, 61325, 61329, 61332, 61345, 61357, 61377, 61380, 61394, 61406, 61414 or 61422, applies has not been provided to the patient in the previous 24 months (R)

982.05

61402

Cerebral perfusion study, with single photon emission tomography and with planar imaging when performed (R)

605.05

61406

Combined stress and rest, stress and reinjection or rest and redistribution myocardial perfusion study, including delayed imaging or reinjection protocol on a subsequent occasion, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) the service is provided at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(c) a stress echocardiography service is not available in the Modified Monash area where the service is provided; and

(d) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(e) the service is requested by a specialist or consultant physician; and

(f) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61332, 61377, 61345, 61357, 61380, 61394, 61398, 61414 or 61422 applies; and

(g) if the patient is 17 years or older—a service to which this item, or item 61311, 61321, 61324, 61325, 61329, 61332, 61345, 61357, 61377, 61380, 61394, 61398, 61414 or 61422, applies has not been provided to the patient in the previous 24 months (R)

982.05

61409

Cerebrospinal fluid transport study, with imaging on 2 or more separate occasions (R)

873.50

61410

Repeat combined stress and rest, stress and reinjection or rest and redistribution myocardial perfusion study, including delayed imaging or reinjection protocol on a subsequent occasion, with single photon emission tomography, with or without planar imaging, if:

(a) both:

(i) a service has been provided to the patient in the previous 24 months to which this item, or item 61311, 61324, 61329, 61332, 61345, 61349, 61357, 61365, 61377, 61380, 61394, 61398, 61406, 61414 or 61418, applies; and

(ii) the patient has subsequently undergone a revascularisation procedure; and

(b) the patient has one or more symptoms of cardiac ischaemia that have evolved and are not adequately controlled with optimal medical therapy; and

(c) the service is provided at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(d) a stress echocardiography service is not available in the Modified Monash area where the service is provided; and

(e) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730 or 61418 applies; and

(f) if the patient is 17 years or older—a service to which item 61349, 61365 or 61418 applies has not been provided to the patient in the previous 12 months

Applicable not more than once in 12 months (R)

982.05

61413

Cerebrospinal fluid shunt patency study (R)

225.95

61414

Single stress myocardial perfusion study, with single photon emission tomography, with or without planar imaging, if:

(a) the patient has symptoms of cardiac ischaemia; and

(b) the service is provided at, or from, a practice located in a Modified Monash 3, 4, 5, 6 or 7 area; and

(c) a stress echocardiography service is not available in the Modified Monash area where the service is provided; and

(d) the service includes resting electrocardiograph, continuous electrocardiograph monitoring during exercise (with recording), blood pressure monitoring and the recording of other parameters (including heart rate); and

(e) the service is requested by a medical practitioner (other than a specialist or consultant physician); and

(f) the service is not associated with a service to which item 11704, 11705, 11707, 11714, 11729, 11730, 61311, 61321, 61324, 61325, 61329, 61332, 61345, 61357, 61377, 61380, 61394, 61398, 61406 or 61422 applies; and

(g) if the patient is 17 years or older—a service to which this item, or item 61311, 61324, 61329, 61332, 61345, 61357, 61377, 61380, 61398 or 61406, applies has not been provided to the patient in the previous 24 months (R)

653.05

61421

Bone study—whole body, with, when undertaken, blood flow, blood pool and delayed imaging on a separate occasion (R)

479.80

61425

Bone study—whole body and single photon emission tomography, with, when undertaken, blood flow, blood pool and delayed imaging on a separate occasion (R)

600.70

61426

Whole body study using iodine (R)

554.80

61429

Whole body study using gallium (R)

543.00

61430

Whole body study using gallium, with single photon emission tomography (R)

659.45

61433

Whole body study using cells labelled with technetium (R)

496.95

61434

Whole body study using cells labelled with technetium, with single photon emission tomography (R)

615.40

61438

Whole body study using thallium (R)

672.95

61441

Bone marrow study—whole body using technetium labelled bone marrow agents (R)

489.70

61442

Whole body study, using gallium—with single photon emission tomography of 2 or more body regions acquired separately (R)

752.35

61445

Bone marrow study—localised using technetium labelled agent (R)

286.80

61446

Regional scintigraphic study using an approved bone scanning agent, including, when undertaken, blood flow imaging, blood pool imaging and repeat imaging on a separate occasion (R)

333.55

61449

Regional scintigraphic study and single photon emission tomography, using an approved bone scanning agent, including, when undertaken, blood flow imaging, blood pool imaging and repeat imaging on a separate occasion (R)

456.20

61450

Localised study using gallium (R)

397.55

61453

Localised study using gallium, with single photon emission tomography (R)

514.70

61454

Localised study using cells labelled with technetium (R)

348.10

61457

Localised study using cells labelled with technetium, with single photon emission tomography (R)

470.45

61461

Localised study using thallium (R)

527.85

61462

Repeat planar and single photon emission tomography imaging, or repeat planar imaging or single photon emission tomography imaging on an occasion subsequent to the performance of item 61364, 61426, 61429, 61430, 61442, 61450, 61453, 61469 or 61485, if there is no additional administration of radiopharmaceutical and if the previous radionuclide scan was abnormal or equivocal (R)

129.00

61469

Lymphoscintigraphy (R)

348.10

61473

Thyroid study (R)

175.40

61480

Parathyroid study (R)

386.85

61485

Adrenal study, with single photon emission tomography (R)

999.20

61495

Tear duct study (R)

223.10

61499

Particle perfusion study (infraarterial) or Le Veen shunt study (R)

253.00

61650

LeukoScan study of the long bones and feet for suspected osteomyelitis, if:

(a) the patient does not have access to exvivo white blood cell scanning; and

(b) the patient is not being investigated for other sites of infection (R)

878.70

Subgroup 2—PET

61523

Whole body FDG PET study, performed for evaluation of a solitary pulmonary nodule, if:

(a) the nodule is considered unsuitable for transthoracic fine needle aspiration biopsy; or

(b) an attempt at pathological characterisation has failed (R)

953.00

61524

Whole body FDG PET study, performed for the staging of locally advanced (Stage III) breast cancer, for a patient who is considered suitable for active therapy (R)

953.00

61525

Whole body FDG PET study, performed for the evaluation of suspected metastatic or suspected locally or regionally recurrent breast carcinoma, for a patient who is considered suitable for active therapy (R)

953.00

61529

Whole body FDG PET study, performed for the staging of proven nonsmall cell lung cancer, if curative surgery or radiotherapy is planned (R)

953.00

61538

FDG PET study of the brain for evaluation of suspected residual or recurrent malignant brain tumour based on anatomical imaging findings, after definitive therapy (or during ongoing chemotherapy) in patients who are considered suitable for further active therapy (R)

901.00

61541

Whole body FDG PET study, following initial therapy, performed for the evaluation of suspected residual, metastatic or recurrent colorectal carcinoma in a patient considered suitable for active therapy (R)

953.00

61553

Whole body FDG PET study, following initial therapy, performed for the evaluation of suspected metastatic or recurrent malignant melanoma in a patient considered suitable for active therapy (R)

999.00

61559

FDG PET study of the brain, performed for the evaluation of refractory epilepsy, that is being evaluated for surgery (R)

918.00

61560

FDG PET study of the brain, performed for the diagnosis of Alzheimer’s disease, if:

(a) clinical evaluation of the patient by a specialist, or in consultation with a specialist, is equivocal; and

(b) the service includes a quantitative comparison of the results of the study with the results of an FDG PET study of a normal brain from a reference database; and

(c) a service to which this item applies has not been performed on the patient in the previous 12 months; and

(d) a service to which item 61402 applies has not been performed on the patient in the previous 12 months for the diagnosis or management of Alzheimer’s disease

Applicable not more than 3 times per lifetime (R)

605.05

61563

Whole body prostatespecific membrane antigen PET study performed for the initial staging of intermediate to highrisk prostate adenocarcinoma, for a previously untreated patient who is considered suitable for locoregional therapy with curative intent

Applicable once per lifetime (R)

1,300.00

61564

Whole body prostatespecific membrane antigen PET study performed for the restaging of recurrent prostate adenocarcinoma, for a patient who:

(a) has undergone prior locoregional therapy; and

(b) is considered suitable for further locoregional therapy to determine appropriate therapeutic pathways and timing of treatment initiation

Applicable twice per lifetime (R)

1,300.00

61565

Whole body FDG PET study, following initial therapy, performed for the evaluation of suspected residual, metastatic or recurrent ovarian carcinoma in a patient considered suitable for active therapy (R)

953.00

61571

Whole body FDG PET study for the further primary staging of patients with histologically proven carcinoma of the uterine cervix, at FIGO stage IB2 or greater by conventional staging, prior to planned radical radiation therapy or combined modality therapy with curative intent (R)

953.00

61575

Whole body FDG PET study for the further staging of patients with confirmed local recurrence of carcinoma of the uterine cervix considered suitable for salvage pelvic chemoradiotherapy or pelvic exenteration with curative intent (R)

953.00

61577

Whole body FDG PET study, performed for the staging of proven oesophageal or gastrooesophageal junction carcinoma, in a patient considered suitable for active therapy (R)

953.00

61598

Whole body FDG PET study performed for the staging of biopsyproven, newlydiagnosed or recurrent head and neck cancer (R)

953.00

61604

Whole body FDG PET study performed for the evaluation of a patient with suspected residual head and neck cancer after definitive treatment, and who is suitable for active therapy (R)

953.00

61610

Whole body FDG PET study performed for the evaluation of metastatic squamous cell carcinoma of unknown primary site involving cervical nodes (R)

953.00

61612

Whole body FDG PET study for the initial staging of eligible cancer types, for a patient who is considered suitable for active therapy, if:

(a) the eligible cancer type is:

(i) a rare or uncommon cancer (less than 12 cases per 100,000 persons per year); and

(ii) a typically FDGavid cancer; and

(b) there is at least a 10% likelihood that the PET study result will inform a significant change in management for the patient

Applicable once per cancer diagnosis (R)

953.00

61620

Whole body FDG PET study for the initial staging of newly diagnosed or previously untreated Hodgkin or nonHodgkin lymphoma (R)

953.00

61622

Whole body FDG PET study to assess response to first line therapy either during treatment or within 3 months of completing definitive first line treatment for Hodgkin or nonHodgkin lymphoma (R)

953.00

61628

Whole body FDG PET study for restaging following confirmation of recurrence of Hodgkin or nonHodgkin lymphoma (R)

953.00

61632

Whole body FDG PET study to assess response to secondline chemotherapy if haemopoietic stem cell transplantation is being considered for Hodgkin or nonHodgkin lymphoma (R)

953.00

61640

Whole body FDG PET study for initial staging of a patient with biopsyproven bone or soft tissue sarcoma (excluding gastrointestinal stromal tumour) considered by conventional staging to be potentially curable (R)

999.00

61646

Whole body FDG PET study for the evaluation of patients with suspected residual or recurrent sarcoma (excluding gastrointestinal stromal tumour) after the initial course of definitive therapy to determine suitability for subsequent therapy with curative intent (R)

999.00

61647

Whole body 68GaDOTApeptide PET study, if:

(a) a gastroenteropancreatic neuroendocrine tumour is suspected on the basis of biochemical evidence with negative or equivocal conventional imaging; or

(b) both:

(i) a surgically amenable gastroenteropancreatic neuroendocrine tumour has been identified on the basis of conventional techniques; and

(ii) the study is for excluding additional disease sites (R)

953.00

Subgroup 3—Adjunctive services

61505

CT scan:

(a) performed at the same time as, and covering the same body area as, single photon emission tomography or positron emission tomography; and

(b) performed for the purpose of anatomic localisation or attenuation correction; and

(c) performed in association with a service to which an item in Subgroup 1 or 2 of Group I4 applies;

if no separate diagnostic CT report is issued (R)

100.00

Division 2.5Group I5: magnetic resonance imaging

Subdivision AGeneral

2.5.1  Application of items to certain MRI and MRA services

 (1) The items in Subgroups 1 to 21 apply to an MRI or MRA service performed:

 (a) at the request of a specialist or consultant physician in accordance with clause 2.5.2; and

 (b) in a permissible circumstance mentioned in clause 2.5.3; and

 (c) using equipment that is:

 (i) located at the premises of a comprehensive practice; and

 (ii) if the equipment is located in a Modified Monash 1 area—eligible equipment mentioned in clause 2.5.5.

 (2) Items 63395 to 63397 and the items in Subgroups 19, 20 and 21 (other than item 63461) also apply to an MRI service performed:

 (a) at the request of a specialist or consultant physician in accordance with clause 2.5.2; and

 (b) in a permissible circumstance mentioned in clause 2.5.3; and

 (c) using equipment that is:

 (i) located at the premises of a comprehensive practice; and

 (ii) if the equipment is located in a Modified Monash 1 area—partial eligible equipment mentioned in clause 2.5.6.

 (3) The items in Subgroup 22 apply to an MRI or MRA service performed:

 (a) at the request of a medical practitioner in accordance with clause 2.5.2; and

 (b) in a permissible circumstance mentioned in clause 2.5.3; and

 (c) using equipment that is:

 (i) located at the premises of a comprehensive practice; and

 (ii) if the equipment is located in a Modified Monash 1 area—eligible equipment mentioned in clause 2.5.5 or partial eligible equipment mentioned in clause 2.5.6.

 (4) The items in Subgroups 33 and 34 apply to an MRI service performed:

 (a) at the request of a medical practitioner other than a specialist or consultant physician in accordance with clause 2.5.2; and

 (b) in a permissible circumstance mentioned in clause 2.5.3; and

 (c) using equipment that is:

 (i) located at the premises of a comprehensive practice; and

 (ii) if the equipment is located in a Modified Monash 1 area—eligible equipment mentioned in clause 2.5.5 or partial eligible equipment mentioned in clause 2.5.6.

2.5.2  MRI and MRA services—request

  For the purposes of clause 2.5.1, a request must:

 (a) be made in writing; and

 (b) identify the clinical indications for the service.

2.5.3  MRI and MRA services—permissible circumstances for performance

  For the purposes of clause 2.5.1, 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.

2.5.4  MRI and MRA services—eligible provider

  A person mentioned in column 2 of an item of table 2.5.4 is an eligible provider for an MRI or MRA service mentioned in column 1 of the item.

 

Table 2.5.4—Eligible providers

Item

Column 1

MRI or MRA service

Column 2

Person

1

A service to which none of items 63395 to 63397 apply

A person who:

(a) is a specialist in diagnostic radiology; and

(b) satisfies the Chief Executive Medicare that the specialist is a participant in the Royal Australian and New Zealand College of Radiologists’ Quality and Accreditation Program

2

A service to which any of items 63395 to 63397 apply

A person who is:

(a) a specialist in diagnostic radiology or a consultant physician; and

(b) recognised by the Conjoint Committee for Certification in Cardiac MRI

2.5.5  MRI and MRA services—eligible equipment

  For the purposes of clause 2.5.1, equipment is eligible equipment if:

 (a) it is made available to the comprehensive practice at which it is located by a person who is subject to a current deed with the Commonwealth that relates to the equipment; and

 (b) it is not identified as partial eligible equipment in the deed.

2.5.6  MRI and MRA services—partial eligible equipment

  For the purposes of clause 2.5.1, equipment is partial eligible equipment if:

 (a) it is made available to the comprehensive practice at which it is located by a person who is subject to a current deed with the Commonwealth that relates to the equipment; and

 (b) it is identified as partial eligible equipment in the deed.

2.5.7  MRI and MRA services—meaning of scan

  In items 63001 to 63563 and 63740 to 63743:

scan means a minimum of 3 sequences.

2.5.8  Restriction on items—multiple services in certain subgroups on a day

  If an MRI service described in an item in Subgroup 1, 2, 4, 5 or 14 of Group I5, and an MRA service described in an item in Subgroup 3 or 15 of Group I5, are provided to the same patient on the same day, the item in Subgroup 3 or 15 of Group I5 does not apply to the MRA service.

2.5.8A  Restriction on items—multiple services in certain subgroups in an attendance

Multiple services in subgroups 1 to 5

 (1) If more than one service described in an item in Subgroup 1, 2, 3, 4 or 5 of Group I5 is provided to a patient in a single attendance, only the following items apply to the services:

 (a) the item that describes the service with the highest fee;

 (b) each item that describes a service to which subclause (4) applies (if any).

Multiple services in subgroups 6 to 10

 (2) If more than one service described in an item in Subgroup 6, 7, 8, 9 or 10 of Group I5 is provided to a patient in a single attendance, only the following items apply to the services:

 (a) the item that describes the service with the highest fee;

 (b) each item that describes a service to which subclause (4) applies (if any).

Multiple services with same highest fee

 (3) For the purposes of paragraphs (1)(a) and (2)(a), if 2 or more applicable fees are equally the highest, only one of those fees is taken to be the highest fee.

Services with documented clinical need

 (4) For the purposes of paragraphs (1)(b) and (2)(b), this subclause applies to a service provided to a person in an attendance if the clinical need for the service is:

 (a) stated in the request for the service; and

 (b) appropriately documented in the record of the service.

2.5.8B  Reduction in fees—multiple services on same day—Subgroups 12 and 13

 (1) If a medical practitioner provides 2 or more MRI services described in Subgroup 12 or 13 of Group I5 for the same person on the same day, the fees specified for the items that apply to the services, other than the item with the highest fee, are reduced by 50%.

 (2) For the purposes of subclause (1):

 (a) if 2 or more applicable fees are equally the highest, only one of those fees is taken to be the highest fee; and

 (b) if a reduced fee calculated under subclause (1) is not a multiple of 5 cents, the reduced fee is taken to be the nearest amount that is a multiple of 5 cents.

2.5.9  Restriction on items—related MRI or MRA services

  An MRI or MRA item does not apply to a service provided to a person if:

 (a) the MRI or MRA item is specified in column 1 of an item (the table item) of table 2.5.9; and

 (b) during the period (the limitation period):

 (i) specified in column 2 of the table item; and

 (ii) ending immediately before the service is provided;

  the person was provided with one or more services (the earlier services) to which any of the MRI or MRA items mentioned in the table item applied; and

 (c) the number of earlier services provided to the person in the limitation period was equal to the maximum number specified in column 3 of the table item.

 

Table 2.5.9—Related services

Item

Column 1

MRI or MRA items

Column 2

Limitation period

Column 3

Maximum number of services

1

63040 to 63073

12 months

3

2

63101

12 months

3

3

63125 to 63131

12 months

3

4

63161 to 63185

12 months

3

5

63219 to 63243

12 months

3

6

63271 to 63280

12 months

3

7

63322 to 63340

12 months

3

8

63361

12 months

2

9

63385 to 63391

12 months

2

10

63395

12 months

1

11

63397

36 months

1

12

63401 to 63404

12 months

3

13

63416

12 months

1

14

63425 to 63428

12 months

2

15

63461 to 63467

12 months

1

15A

63541

12 months

1

16

63547

patient’s lifetime

1

17

63482

12 months

3

18

63507 to 63522 and 63551 to 63560

12 months

3

2.5.9A  Circumstances for suspecting prostate cancer for item 63541

 (1) For the purposes of subparagraph (a)(ii) of item 63541, the circumstances for suspecting a patient of developing prostate cancer are that:

 (a) 2 PSA quantitation tests have been performed for the patient, with an interval between the tests of at least 1 month but not more than 3 months; and

 (b) subclause (2), (3), (4), (5) or (6) applies to the patient.

Patients at least 70 years of age

 (2) This subclause applies to a patient if:

 (a) the patient is at least 70 years of age; and

 (b) both PSA quantitation tests showed a PSA concentration of greater than 5.5 µg/L; and

 (c) a free/total PSA ratio test performed for the patient at least 1 month but not more than 3 months after the first PSA quantitation test showed a free/total PSA ratio of less than 25%.

Patients under 70 years of age without increased risk due to family history

 (3) This subclause applies to a patient if:

 (a) the patient is under 70 years of age; and

 (b) both PSA quantitation tests showed a PSA concentration of greater than 3 µg/L; and

 (c) a free/total PSA ratio test performed for the patient at least 1 month but not more than 3 months after the first PSA quantitation test showed a free/total PSA ratio of less than 25%.

 (4) This subclause applies to a patient if:

 (a) the patient is under 70 years of age; and

 (b) the first PSA quantitation test showed a PSA concentration of greater than 3 µg/L; and

 (c) the second PSA quantitation test showed a PSA concentration of greater than 5.5 µg/L.

Patients under 70 years of age with increased risk due to family history

 (5) This subclause applies to a patient if:

 (a) the patient is under 70 years of age; and

 (b) both PSA quantitation tests showed a PSA concentration of greater than 2 µg/L; and

 (c) a free/total PSA ratio test performed for the patient at least 1 month but not more than 3 months after the first PSA quantitation test showed a free/total PSA ratio of less than 25%; and

 (d) the patient has a firstdegree biological relative:

 (i) who has, or has had, prostate cancer; or

 (ii) who is suspected of carrying a BRCA 1 or BRCA 2 mutation.

 (6) This subclause applies to a patient if:

 (a) the patient is under 70 years of age; and

 (b) the first PSA quantitation test showed a PSA concentration of greater than 2 µg/L; and

 (c) the second PSA quantitation test showed a PSA concentration of greater than 5.5 µg/L; and

 (d) the patient has a firstdegree biological relative:

 (i) who has, or has had, prostate cancer; or

 (ii) who is suspected of carrying a BRCA 1 or BRCA 2 mutation.

2.5.9B  Restriction on item 63543—timing and purpose

 (1) Subject to subclauses (2) and (3), item 63543 is applicable to a service described in that item for a patient with a diagnosis of prostate cancer if it is:

 (a) the first service provided after the date of the diagnosis; or

 (b) the first service provided after 12 months after the date of the service mentioned in paragraph (a); or

 (c) the first service provided after 3 years after the date of a service to which item 63543 applied under paragraph (b) or this paragraph.

 (2) Subject to subclause (3), item 63543 is also applicable to a service described in that item if the clinical need for the service is:

 (a) stated in the request for the service; and

 (b) appropriately documented in the record of the service.

 (3) Item 63543 is not applicable to a service provided for the purposes of:

 (a) treatment planning; or

 (b) monitoring after treatment of prostate cancer.

Subdivision BSubgroups 1 to 19 of Group I5

2.5.10  Items in Subgroups 1 to 19 of Group I5

  This clause sets out items in Subgroups 1 to 19 of Group I5.

Note: The fees in Group I5 are indexed in accordance with clause 2.7.1.

 

Group I5—Magnetic resonance imaging

Column 1

Item

Column 2

Description

Column 3

Fee ($)

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—one region or 2 contiguous regions—for infection or tumour

63151

MRI—scan of one region or 2 contiguous regions of the spine for infection (R) (Anaes.) (Contrast)

358.40

63154

MRI—scan of one region or 2 contiguous regions of the spine for tumour (R) (Anaes.) (Contrast)

358.40

Subgroup 7—Scan of spine—one region or 2 contiguous regions—for other conditions

63161

MRI—scan of one region or 2 contiguous regions of the spine for demyelinating disease (R) (Anaes.) (Contrast)

358.40

63164

MRI—scan of one 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 one region or 2 contiguous regions of the spine for myelopathy (R) (Anaes.) (Contrast)

358.40

63170

MRI—scan of one region or 2 contiguous regions of the spine for syrinx (congenital or acquired) (R) (Anaes.) (Contrast)

358.40

63173

MRI—scan of one region or 2 contiguous regions of the spine for cervical radiculopathy (R) (Anaes.) (Contrast)

358.40

63176

MRI—scan of one region or 2 contiguous regions of the spine for sciatica (R) (Anaes.) (Contrast)

358.40

63179

MRI—scan of one region or 2 contiguous regions of the spine for spinal canal stenosis (R) (Anaes.) (Contrast)

358.40

63182

MRI—scan of one region or 2 contiguous regions of the spine for previous spinal surgery (R) (Anaes.) (Contrast)

358.40

63185

MRI—scan of one region or 2 contiguous regions of the spine for trauma (R) (Anaes.)

358.40

Subgroup 8—Scan of spine—3 contiguous or 2 noncontiguous regions—for infection or tumour

63201

MRI—scan of 3 contiguous or 2 noncontiguous regions of the spine for infection (R) (Anaes.) (Contrast)

448.00

63204

MRI—scan of 3 contiguous or 2 noncontiguous regions of the spine for tumour (R) (Anaes.) (Contrast)

448.00

Subgroup 9—Scan of spine—3 contiguous or 2 noncontiguous regions—for other conditions

63219

MRI—scan of 3 contiguous or 2 noncontiguous regions of the spine for demyelinating disease (R) (Anaes.) (Contrast)

448.00

63222

MRI—scan of 3 contiguous or 2 noncontiguous 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 noncontiguous regions of the spine for myelopathy (R) (Anaes.) (Contrast)

448.00

63228

MRI—scan of 3 contiguous or 2 noncontiguous regions of the spine for syrinx (congenital or acquired) (R) (Anaes.) (Contrast)

448.00

63231

MRI—scan of 3 contiguous or 2 noncontiguous regions of the spine for cervical radiculopathy (R) (Anaes.) (Contrast)

448.00

63234

MRI—scan of 3 contiguous or 2 noncontiguous regions of the spine for sciatica (R) (Anaes.) (Contrast)

448.00

63237

MRI—scan of 3 contiguous or 2 noncontiguous regions of the spine for spinal canal stenosis (R) (Anaes.) (Contrast)

448.00

63240

MRI—scan of 3 contiguous or 2 noncontiguous regions of the spine for previous spinal surgery (R) (Anaes.) (Contrast)

448.00

63243

MRI—scan of 3 contiguous or 2 noncontiguous 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 tumour, infection or osteonecrosis

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 joint derangement

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 one 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 Gaucher disease

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

63395

MRI—scan of cardiovascular system for assessment of myocardial structure and function involving:

(a) dedicated right ventricular views; and

(b) 3D volumetric assessment of the right ventricle; and

(c) reporting of enddiastolic and endsystolic volumes, ejection fraction and BSAindexed values;

if the request for the scan indicates that:

(d) the patient presented with symptoms consistent with arrhythmogenic right ventricular cardiomyopathy (ARVC); or

(e) investigative findings in relation to the patient are consistent with ARVC

(R) (Anaes.) (Contrast)

855.20

63397

MRI—scan of cardiovascular system for assessment of myocardial structure and function involving:

(a) dedicated right ventricular views; and

(b) 3D volumetric assessment of the right ventricle; and

(c) reporting of enddiastolic and endsystolic volumes, ejection fraction and BSAindexed values;

if the request for the scan indicates that the patient:

(d) is asymptomatic; and

(e) has one or more first degree relatives diagnosed with confirmed arrhythmogenic right ventricular cardiomyopathy (ARVC)

(R) (Anaes.) (Contrast)

855.20

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—person under the age of 16 years—for physeal fusion or Gaucher disease

63425

MRI—scan of person under the age of 16 for postinflammatory or posttraumatic 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—person under the age of 16 years—for other conditions

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

63464

MRI—scan of both breasts for the detection of cancer in a patient, if:

(a) a dedicated breast coil is used; and

(b) the request for the scan identifies that the patient is asymptomatic and is younger than 60 years of age; and

(c) the request for the scan identifies that the patient is at high risk of developing breast cancer due to one or more of the following:

(i) genetic testing has identified the presence of a high risk breast cancer gene mutation in the patient or in a first degree relative of the patient;

(ii) both:

(A) one of the patient’s first or second degree relatives was diagnosed with breast cancer at age 45 years or younger; and

(B) another first or second degree relative on the same side of the patient’s family was diagnosed with bone or soft tissue sarcoma at age 45 years or younger;

(iii) the patient has a personal history of breast cancer before the age of 50 years;

(iv) the patient has a personal history of mantle radiation therapy;

(v) the patient has a lifetime risk estimation greater than 30% or a 10 year absolute risk estimation greater than 5% using a clinically relevant risk evaluation algorithm; and

(d) the service is not performed in conjunction with item 55076 or 55079

Applicable not more than once in a 12 month period (R) (Anaes.) (Contrast)

690.00

63467

MRI—scan of both breasts for the detection of cancer, if:

(a) a dedicated breast coil is used; and

(b) the person has had an abnormality detected as a result of a service mentioned in item 63464 performed in the previous 12 months (R) (Anaes.)

690.00

63487

MRI—scan of both breasts, if:

(a) a dedicated breast coil is used; and

(b) the request for the scan identifies that:

(i) the patient has been diagnosed with metastatic cancer restricted to the regional lymph nodes; and

(ii) clinical examination and conventional imaging have failed to identify the primary cancer (R) (Anaes.)

690.00

63489

MRI—scan of one breast, performed in conjunction with a biopsy procedure on that breast and an ultrasound scan of that breast, if:

(a) the request for the MRI scan identifies that the patient has a suspicious lesion seen on MRI but not on conventional imaging; and

(b) the ultrasound scan is performed immediately before the MRI scan and confirms that the lesion is not amenable to biopsy guided by conventional imaging; and

(c) a dedicated breast coil is used (R) (Anaes.)

1,008.00

63531

MRI—scan of both breasts, if:

(a) a dedicated breast coil is used; and

(b) the request for the scan identifies that:

(i) the patient has a breast lesion; and

(ii) the results of conventional imaging are inconclusive for the presence of breast cancer; and

(iii) biopsy has not been possible (R) (Anaes.) (Contrast)

690.00

63533

MRI—scan of both breasts, if:

(a) a dedicated breast coil is used; and

(b) the request for the scan identifies that:

(i) the patient has been diagnosed with a breast cancer; and

(ii) there is a discrepancy between the clinical assessment and the conventional imaging assessment of the extent of the malignancy; and

(c) the results of breast MRI imaging may alter treatment planning (R) (Anaes.) (Contrast)

690.00

63541

Multiparametric MRI—scan of the prostate for the detection of cancer, requested by a specialist in the speciality of urology, radiation oncology or medical oncology:

(a) if the request for the scan identifies that the patient is suspected of developing prostate cancer:

(i) on the basis of a digital rectal examination; or

(ii) in the circumstances mentioned in clause 2.5.9A; and

(b) using a standardised image acquisition protocol involving:

(i) T2weighted imaging; and

(ii) diffusionweighted imaging; and

(iii) (unless contraindicated) dynamic contrast enhancement

(R) (Anaes)

450.00

63543

Multiparametric MRI—scan of the prostate for the assessment of cancer, requested by a specialist in the speciality of urology, radiation oncology or medical oncology:

(a) if the request for the scan identifies that the patient:

(i) is under active surveillance following a confirmed diagnosis of prostate cancer by biopsy histopathology; and

(ii) is not undergoing, or planning to undergo, treatment for prostate cancer; and

(b) using a standardised image acquisition protocol involving:

(i) T2weighted imaging; and

(ii) diffusionweighted imaging; and

(iii) (unless contraindicated) dynamic contrast enhancement

(R) (Anaes)

450.00

63547

MRI—scan of both breasts for the detection of cancer, if:

(a) a dedicated breast coil is used; and

(b) the request for the scan identifies that:

(i) the patient has a breast implant in situ; and

(ii) anaplastic large cell lymphoma has been diagnosed

(R) (Anaes.) (Contrast)

690.00

Subdivision CSubgroup 20 of Group I5: scans of pelvis and upper abdomen for specified conditions

2.5.11  Restriction on items 63470, 63473, 63740 and 63743

 (1) Item 63470 does not apply to the service mentioned in that item if the person to whom the service is provided has previously been provided with that service or a service mentioned in item 63473.

 (2) Item 63473 does not apply to the service mentioned in that item if the person to whom the service is provided has previously been provided with that service or a service mentioned in item 63470.

 (3) For any patient, if the service mentioned in item 63740 is provided for assessment of change to therapy in a patient with small bowel Crohn’s disease, the item applies to that service only once in a 12 month period.

 (4) For any patient, if the service mentioned in item 63743 is provided for assessment of change to therapy of pelvis sepsis and fistulas from Crohn’s disease, the item applies to that service only once in a 12 month period.

2.5.13  Items in Subgroup 20 of Group I5

  This clause sets out items in Subgroup 20 of Group I5.

Note: The fees in Group I5 are indexed in accordance with clause 2.7.1.

 

Group I5—Magnetic resonance imaging

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 20—Scan of pelvis and upper abdomen—for specified conditions

63454

MRI—scan of the pelvis or abdomen, for a patient who is pregnant, if:

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

(b) fetal 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

(d) the diagnosis of fetal abnormality as a result of the ultrasound is indeterminate or requires further examination; and

(e) the MRI service is requested by a specialist practising in the specialty of obstetrics

(R) (Anaes.) (Contrast)

1,200.00

63470

MRI—scan of the pelvis for the staging of histologically diagnosed cervical cancer at FIGO stage 1B or greater, if the request for scan identifies that:

(a) a histological diagnosis of carcinoma of the cervix has been made; and

(b) the patient has been diagnosed with cervical cancer at FIGO stage 1B or greater (R) (Anaes.) (Contrast)

403.20

63473

MRI—scan of the pelvis and upper abdomen, in a single examination, for the staging of histologically diagnosed cervical cancer at FIGO stage 1B or greater, if the request for the scan identifies that:

(a) a histological diagnosis of carcinoma of the cervix has been made; and

(b) the patient has been diagnosed with cervical cancer at FIGO stage 1B or greater (R) (Anaes.) (Contrast)

627.20

63476

MRI—scan of the pelvis for the initial staging of rectal cancer, if:

(a) a phased array body coil is used; and

(b) the request for the scan identifies that the indication is for the initial staging of rectal cancer (including cancer of the rectosigmoid and anorectum) (R) (Anaes.) (Contrast)

403.20

63549

MRI—scan of the pelvis or abdomen, for a patient with a multiple pregnancy, if:

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

(b) fetal 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

(d) the diagnosis of fetal abnormality as a result of the ultrasound is indeterminate or requires further examination; and

(e) the MRI service is requested by a specialist practising in the specialty of obstetrics (R) (Anaes.) (Contrast)

1,828.80

63563

MRI—scan of the pelvis or abdomen, if the request for the scan identifies that the investigation is for:

(a) subfertility that requires one or more of the following:

(i) an investigation of suspected Mullerian duct anomaly seen in pelvic ultrasound or hysterosalpingogram;

(ii) an assessment of uterine mass identified on pelvic ultrasound before consideration of surgery;

(iii) an investigation of recurrent implantation failure in IVF (2 or more embryo transfer cycles without viable pregnancy); or

(b) surgical planning of a patient with known or suspected deep endometriosis involving the bowel, bladder or ureter (or any combination of the bowel, bladder or ureter), where the results of pelvic ultrasound are inconclusive

Applicable not more than once in a 2 year period (R) (Anaes.) (Contrast)

409.65

63740

MRI—scan to evaluate small bowel Crohn’s disease if the service is provided to a patient for:

(a) evaluation of disease extent at time of initial diagnosis of Crohn’s disease; or

(b) evaluation of exacerbation, or suspected complications, of known Crohn’s disease; or

(c) evaluation of known or suspected Crohn’s disease in pregnancy; or

(d) assessment of change to therapy in a patient with small bowel Crohn’s disease (R) (Contrast)

457.20

63741

MRI—scan with enteroclysis for Crohn’s disease if the service is related to item 63740 (R)

265.25

63743

MRI—scan for fistulising perianal Crohn’s disease if the service is provided to a patient for:

(a) evaluation of pelvic sepsis and fistulas associated with established or suspected Crohn’s disease; or

(b) assessment of change to therapy of pelvis sepsis and fistulas from Crohn’s disease (R) (Contrast)

403.20

Subdivision DSubgroups 21 and 22 of Group I5

2.5.13A  MRI and MRA services—modifying items

 (1) Subject to subclauses (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 that applies to the service.

 (2) If 2 or more MRI or MRA services mentioned in item 63494 are performed for a person on the same day, the fee specified in that item applies to one of those services only.

 (3) If 2 or more MRI or MRA services mentioned in item 63497 are performed for a person on the same day, the fee specified in that item applies to one of those services only.

 (4) If:

 (a) one or more MRI or MRA services mentioned in item 63494; and

 (b) one or more MRI or MRA services mentioned in item 63497;

are performed for a person on the same day, the fee specified in item 63494 or 63497, but not both those items, applies to one of those services only.

2.5.14  Items in Subgroups 21 and 22 of Group I5

  This clause sets out items in Subgroups 21 and 22 of Group I5.

Note: The fees in Group I5 are indexed in accordance with clause 2.7.1.

 

Group I5—Magnetic resonance imaging

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 21—Scan of body—for suspected hepatobiliary or pancreatic pathology

63482

MRI—scan of pancreas and biliary tree for suspected biliary or pancreatic pathology (R) (Anaes.)

403.20

63545

MRI—multiphase scans of liver (including delayed imaging, if performed) with a contrast agent, for staging where surgical resection or interventional techniques are under consideration to treat any liver metastases detected, if:

(a) the patient has a confirmed extrahepatic primary malignancy (other than hepatocellular carcinoma), with no persistent extrahepatic disease; and

(b) computed tomography of the patient’s liver is negative or inconclusive for metastatic disease; and

(c) the identification of liver metastases would change the patient’s treatment planning

Applicable not more than once in a 12 month period (R) (Anaes.) (Contrast)

550.00

63546

MRI—multiphase scans of the liver (including delayed imaging, if performed) with a contrast agent, for diagnosis or staging, if:

(a) the patient has:

(i) known or suspected hepatocellular carcinoma; and

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

(b) the patient’s liver function has been identified as ChildPugh class A or B; and

(c) the patient has an identified hepatic lesion over 10 mm in diameter

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

550.00

Subgroup 22—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 clause 2.5.1; 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 clause 2.5.1; and

(b) the service is performed using intravenous or intra muscular sedation

44.80

63496

MRI service to which item 63545 or 63546 applies if:

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

(b)the service is performed using an hepatobiliaryspecific contrast agent

250.00

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 clause 2.5.1; and

(b) the service is performed under anaesthetic in the presence of a medical practitioner who is qualified to perform an anaesthetic

156.80

Note: Subgroups 23 to 32 of Group I5 are set out in a determination made under subsection 3C(1) of the Act.

Subdivision ESubgroup 33 of Group I5

2.5.15  Items in Subgroup 33 of Group I5

  This clause sets out items in Subgroup 33 of Group I5.

Note: The fees in Group I5 are indexed in accordance with clause 2.7.1.

 

Group I5—Magnetic resonance imaging

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 33—Scan of body—person under the age of 16 years—general practice requests

63507

MRI—scan of head for a patient under 16 years if the service is for:

(a) an unexplained seizure; or

(b) an unexplained headache if significant pathology is suspected; or

(c) paranasal sinus pathology that has not responded to conservative therapy (R) (Anaes.) (Contrast)

403.20

63510

MRI—scan of spine following radiographic examination for a patient under 16 years if the service is for:

(a) significant trauma; or

(b) unexplained neck or back pain with associated neurological signs; or

(c) unexplained back pain if significant pathology is suspected (R) (Anaes.) (Contrast)

448.00

63513

MRI—scan of knee for internal joint derangement for a patient under 16 years (R) (Anaes.) (Contrast)

403.20

63516

MRI—scan of hip following radiographic examination for a patient under 16 years if any of the following is suspected:

(a) septic arthritis;

(b) slipped capital femoral epiphysis;

(c) Perthes disease (R) (Anaes.) (Contrast)

403.20

63519

MRI—scan of elbow following radiographic examination for a patient under 16 years if a significant fracture or avulsion injury, which would change the way in which the patient is managed, is suspected (R) (Anaes.) (Contrast)

403.20

63522

MRI—scan of wrist following radiographic examination for a patient under 16 years if a scaphoid fracture is suspected (R) (Anaes.) (Contrast)

448.00

Subdivision FSubgroup 34 of Group I5

2.5.16  Items in Subgroup 34 of Group I5

  This clause sets out items in Subgroup 34 of Group I5.

Note: The fees in Group I5 are indexed in accordance with clause 2.7.1.

 

Group I5—Magnetic resonance imaging

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 34—Scan of body—person over the age of 16 years—general practice requests

63551

Scan of head for a patient 16 years or older, after a request by a medical practitioner (other than a specialist or consultant physician), for any of the following:

(a) unexplained seizure(s);

(b) unexplained chronic headache with suspected intracranial pathology (R) (Contrast) (Anaes.)

403.20

63554

Scan of spine for a patient 16 years or older, after referral by a medical practitioner (other than a specialist or consultant physician), for suspected cervical radiculopathy (R) (Contrast) (Anaes.)

358.40

63557

Scan of spine for a patient 16 years or older, after referral by a medical practitioner (other than a specialist or consultant physician), for suspected cervical spinal trauma (R) (Contrast) (Anaes.)

492.80

63560

Scan of knee following acute knee trauma, after referral by a medical practitioner (other than a specialist or consultant physician), for a patient 16 to 49 years with:

(a) inability to extend the knee suggesting the possibility of acute meniscal tear; or

(b) clinical findings suggesting acute anterior cruciate ligament tear (R) (Contrast) (Anaes.)

403.20

Division 2.6Group I6: management of bulkbilled services

2.6.1  Application of items 64990, 64991, 64992, 64993, 64994 and 64995

 (2) If item 64990, 64991, 64992, 64993, 64994 or 64995 applies to a diagnostic imaging service, the fee specified in that item applies in addition to the fee specified in any other item in this Schedule that applies to the service.

 (3) In this Schedule:

Commonwealth concession card holder has the same meaning as concessional beneficiary has for the purposes of Part VII of the National Health Act 1953.

practice location, for the provision of a diagnostic imaging service, means the place of practice for which the medical practitioner by whom, or on whose behalf, the service is provided, has been allocated a provider number by the Chief Executive Medicare.

unreferred service means a diagnostic imaging service that:

 (a) is provided to a person by, or on behalf of, a medical practitioner, being a medical practitioner who is not a consultant physician, or specialist, in any speciality (other than a medical practitioner who is, for the Act, both a general practitioner and a consultant physician, or specialist, in a particular speciality); and

 (b) has not been referred to the medical practitioner by another medical practitioner or person with referring rights.

2.6.2  Items in Group I6

  This clause sets out items in Group I6.

Note: The fees in Group I6 are indexed in accordance with clause 2.7.1.

 

Group I6—Management of bulkbilled services

Column 1

Item

Column 2

Description

Column 3

Fee ($)

64990

A diagnostic imaging service to which an item in this Schedule (other than this item or item 64991, 64992, 64993, 64994 or 64995) applies if:

(a) the service is an unreferred service; and

(b) the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder; and

(c) the person is not an admitted patient of a hospital; and

(d) the service is bulkbilled for the fees for:

(i) this item; and

(ii) the other item in this Schedule applying to the service

7.15

64991

A diagnostic imaging service to which an item in this Schedule (other than this item or item 64990, 64992, 64993, 64994 or 64995) applies if:

(a) the service is an unreferred service; and

(b) the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder; and

(c) the person is not an admitted patient of a hospital; and

(d) the service is bulkbilled for the fees for:

(i) this item; and

(ii) the other item in this Schedule applying to the service; and

(e) the service is provided at, or from, a practice location in a Modified Monash 2 area

10.80

64992

A diagnostic imaging service to which an item in this Schedule (other than this item or item 64990, 64991, 64993, 64994 or 64995) applies if:

(a) the service is an unreferred service; and

(b) the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder; and

(c) the person is not an admitted patient of a hospital; and

(d) the service is bulkbilled in relation to the fees for:

(i) this item; and

(ii) the other item in this Schedule applying to the service; and

(e) the service is provided at, or from, a practice location in:

(i) a Modified Monash 3 area; or

(ii) a Modified Monash 4 area

11.55

64993

A diagnostic imaging service to which an item in this Schedule (other than this item or item 64990, 64991, 64992, 64994 or 64995) applies if:

(a) the service is an unreferred service; and

(b) the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder; and

(c) the person is not an admitted patient of a hospital; and

(d) the service is bulkbilled in relation to the fees for:

(i) this item; and

(ii) the other item in this Schedule applying to the service; and

(e) the service is provided at, or from, a practice location in a Modified Monash 5 area

12.25

64994

A diagnostic imaging service to which an item in this Schedule (other than this item or item 64990, 64991, 64992, 64993 or 64995) applies if:

(a) the service is an unreferred service; and

(b) the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder; and

(c) the person is not an admitted patient of a hospital; and

(d) the service is bulkbilled in relation to the fees for:

(i) this item; and

(ii) the other item in this Schedule applying to the service; and

(e) the service is provided at, or from, a practice location in a Modified Monash 6 area

13.00

64995

A diagnostic imaging service to which an item in this Schedule (other than this item or item 64990, 64991, 64992, 64993 or 64994) applies if:

(a) the service is an unreferred service; and

(b) the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder; and

(c) the person is not an admitted patient of a hospital; and

(d) the service is bulkbilled in relation to the fees for:

(i) this item; and

(ii) the other item in this Schedule applying to the service; and

(e) the service is provided at, or from, a practice location in a Modified Monash 7 area

14.25

Division 2.7Indexation of fees

2.7.1  Indexation—1 July 2022

 (1) On 1 July 2022 (the indexation day), each amount covered by subclause (2) is replaced by the amount worked out using the following formula:

Start formula 1.016 times the amount immediately before the indexation day end formula

Note: The indexed fees could in 2022 be viewed on the Department of Health’s MBS Online website (http://www.health.gov.au).

 (2) The amounts covered by this subclause are the following:

 (a) the fee for each item in the following:

 (i) Group I1 (ultrasound services);

 (ii) Group I2 (computer tomography services);

 (iii) Group I3 (diagnostic radiology services);

 (iv) Group I5 (magnetic resonance imaging services);

 (v) Group I6 (bulkbilled services);

 (b) the amount mentioned in each of subclauses 2.3.3(2) and (3) (increased fee for certain diagnostic radiology services carried out at residential aged care facilities).

 (3) An amount worked out under subclause (1) is to be rounded up or down to the nearest 5 cents (rounding down if the amount is an exact multiple of 2.5 cents).

Part 3Dictionary

 

3.1  Dictionary

Note 1: All references in this clause to a provision are references to a provision in this Schedule, unless otherwise indicated.

Note 2: A number of expressions used in this Schedule are defined in subsection 3(1) of the Act, including the following:

(a) diagnostic imaging service;

(b) general medical services table;

(c) practitioner;

(d) Secretary;

(e) specialist.

Note 3: For the effect of the term (Anaes.) used in items in this Schedule, see subclause 5.9.4(1) of the general medical services table.

  In this Schedule:

Act means the Health Insurance Act 1973.

angiography suite has the meaning given by clause 2.3.11.

applicable life age has the meaning given by subclause 1.2.2(2).

ASGC 2006 means the July 2006 edition of Statistical Geography Volume 1 Australian Standard Geographical Classification (ASGC) (ABS catalogue number 1216.0), published by the Australian Statistician, as existing on 1 July 2020.

ASGC 2010 means the July 2010 edition of the Australian Standard Geographical Classification (ASGC) (ABS catalogue number 1216.0), published by the Australian Statistician, as existing on 1 July 2020.

bulkbilled: a diagnostic imaging service is bulkbilled if:

 (a) a medicare benefit is payable to a person in relation to the service; and

 (b) under an agreement entered into under section 20A of the Act:

 (i) the person assigns to the medical practitioner by whom, or on whose behalf, the service is provided, the person’s right to the payment of the medicare benefit; and

 (ii) the medical practitioner accepts the assignment in full payment of the medical practitioner’s fee for the service provided.

care recipient has the meaning given by the general medical services table.

Commonwealth concession card holder has the meaning given by clause 2.6.1.

comprehensive facility means a facility where all of the following services are performed (whether or not other services are also performed):

 (a) PET;

 (b) computed tomography;

 (c) diagnostic ultrasound;

 (d) medical oncology;

 (e) radiation oncology;

 (f) surgical oncology;

 (g) Xray.

comprehensive practice means a medical practice, or a radiology department of a hospital, that provides Xray, ultrasound and computed tomography services (whether or not it provides other services).

computed tomography or CT means a service performed (with or without intravenous contrast) using a detector:

 (a) that is coupled to an Xray tube that emits a finely collimated Xray beam as it rotates within a gantry around a patient either in incremental or helical manner; and

 (b) that receives a series of data profiles depicting the degree of absorption of the Xray beam, which are transformed into a crosssectional image after the application of complex algorithms.

cone beam computed tomography means a service performed on a rotating gantry to which an Xray source and a 2dimensional flat panel detector are fixed that produces multiple sequential planar projection images in a single revolution around the patient, which are reconstructed into a 3dimensional image.

consultation has the meaning given by clause 1.2.21.

credentialled specialist means a specialist or consultant physician credentialled under the Joint Nuclear Medicine Specialist Credentialling Program for the Recognition of the Credentials of Nuclear Medicine Specialists for Positron Emission Tomography overseen by the JNMCAC.

CT: see computed tomography.

eligible provider, for an MRI or MRA service, has the meaning given by clause 2.5.4.

exemption period of an exemption means the period mentioned in paragraph 1.2.8(2)(a) (as extended under clause 1.2.10 if applicable).

FDG means 18Ffluorodeoxyglucose.

highest fee has the meaning given by clause 1.2.21.

Inner Regional Australia means a Remoteness Area classified as Inner Regional Australia under the ASGC 2006.

JNMCAC means the Joint Nuclear Medicine Credentialling and Accreditation Committee of the RACP and RANZCR.

maximum extended life age has the meaning given by subclause 1.2.2(3).

Modified Monash 1 area means an area that is not a Modified Monash 2 to 7 area.

Modified Monash 2 area has the meaning given by the general medical services table.

Modified Monash 3 area has the meaning given by the general medical services table.

Modified Monash 4 area has the meaning given by the general medical services table.

Modified Monash 5 area has the meaning given by the general medical services table.

Modified Monash 6 area has the meaning given by the general medical services table.

Modified Monash 7 area has the meaning given by the general medical services table.

MRA means magnetic resonance angiography.

MRI means magnetic resonance imaging.

new effective life age has the meaning given by subclause 1.2.2(3).

nonconsultation service has the meaning given by clause 1.2.21.

nonmetropolitan hospital means a hospital that is located outside the Sydney, Melbourne, Brisbane, Adelaide, Perth, Greater Hobart, Darwin and Canberra statistical divisions, as defined in the ASGC 2010.

(NR) has the meaning given by clause 1.2.15.

Outer Regional Australia means a Remoteness Area classified as Outer Regional Australia under the ASGC 2006.

PET means positron emission tomography.

practice location has the meaning given by clause 2.6.1.

providing practitioner has the same meaning as in subsection 16B(1) of the Act.

PSA is short for prostate specific antigen.

(R) has the meaning given by clause 1.2.15.

RACP means The Royal Australasian College of Physicians (ABN 90 270 343 237).

RANZCR means The Royal Australian and New Zealand College of Radiologists (ABN 37 000 029 863).

relevant proprietor has the meaning given by clause 1.2.4.

Remote Australia means a Remoteness Area classified as Remote Australia under the ASGC 2006.

remote location means a place within Australia that is more than 30 kilometres by road from:

 (a) a hospital that provides a radiology or computed tomography service under the direction of a specialist in the specialty of diagnostic radiology; or

 (b) a freestanding radiology or computed tomography facility under the direction of a specialist in the specialty of diagnostic radiology.

report means a report prepared by a medical practitioner.

residential aged care facility has the meaning given by the general medical services table.

RRMA4 means a small rural centre as classified by the Rural, Remote and Metropolitan Areas Classification.

RRMA5 means a rural centre with an urban centre population of less than 10,000 persons as classified by the Rural, Remote and Metropolitan Areas Classification.

Rural, Remote and Metropolitan Areas Classification has the meaning given by the general medical services table.

scan, for items 63001 to 63563 and 63740 to 63743, has the meaning given by clause 2.5.7.

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

unreferred service has the meaning given by clause 2.6.1.

upgraded has the meaning given by subclause 1.2.2(4).

Very Remote Australia means a Remoteness Area classified as Very Remote Australia under the ASGC 2006.

Part 4Application, saving and transitional provisions

Division 1Health Insurance (Diagnostic Imaging Services Table) Amendment (Equipment Capital Sensitivity) Regulations 2022

4.1  Definitions

  In this Division:

amending instrument means the Health Insurance (Diagnostic Imaging Services Table) Amendment (Equipment Capital Sensitivity) Regulations 2022.

commencement day means the day the amending instrument commences.

4.2  Application of amendments

  The amendments of clauses 1.2.8 and 1.2.10 of this instrument made by the amending instrument apply in relation to a decision on an application made by the Secretary on or after the commencement day, regardless of when the application was made.

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 how an amendment is to be made. If, despite the misdescription, the amendment can be given effect as intended, then the misdescribed amendment can be incorporated through an editorial change made under section 15V of the Legislation Act 2003.

If a misdescribed amendment cannot be given effect as intended, the amendment is not incorporated and “(md not incorp)” is added to 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

/subsubparagraph(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

SubCh = SubChapter(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 (Diagnostic Imaging Services Table) Regulations (No. 2) 2020

15 June 2020 (F2020L00713)

1 July 2020 (s 2(1) item 1)

 

Health Insurance Legislation Amendment (2020 Measures No. 1) Regulations 2020

6 July 2020 (F2020L00882)

Sch 1 (items 1–4): 1 Aug 2020 (s 2(1) item 1)

Health Insurance Legislation Amendment (Bulkbilling Incentive (No. 2)) Regulations 2020

23 Sept 2020 (F2020L01203)

Sch 1 (items 1, 2): 1 Oct 2020 (s 2(1) item 1)

Health Insurance Legislation Amendment (2020 Measures No. 2) Regulations 2020

20 Oct 2020 (F2020L01330)

Sch 1 (items 150–152): 1 Nov 2020 (s 2(1) item 1)

Health Legislation Amendment (Administration) Regulations 2020

14 Dec 2020 (F2020L01602)

Sch 1 (item 1): 15 Dec 2020 (s 2(1) item 1)

Health Insurance Legislation Amendment (2020 Measures No. 3) Regulations 2020

14 Dec 2020 (F2020L01608)

Sch 1 (items 10–24, 67, 69–80): 1 Mar 2021 (s 2(1) items 2, 4)

Health Insurance Legislation Amendment (2021 Measures No. 1) Regulations 2021

2 June 2021 (F2021L00681)

Sch 1 (items 1–5, 8–33, 40–42, 96–100): 1 July 2021 (s 2(1) items 2–4)

Health Insurance Legislation Amendment (2021 Measures No. 2) Regulations 2021

17 Sept 2021 (F2021L01281)

Sch 2: 1 Nov 2021 (s 2(1) item 1)

Health Insurance Legislation Amendment (Rural Bulk‑billing Incentive) Regulations 2021

9 Dec 2021 (F2021L01748)

Sch 1 (items 1–8): 1 Jan 2022 (s 2(1) item 1)

Health Insurance (Diagnostic Imaging Services Table) Amendment (Equipment Capital Sensitivity) Regulations 2021

9 Dec 2021 (F2021L01749)

1 May 2022 (s 2(1) item 1)

Health Insurance Legislation Amendment (2021 Measures No. 3) Regulations 2021

17 Dec 2021 (F2021L01814)

Sch 1 (items 1–5): 1 Jan 2022 (s 2(1) item 1)

Health Insurance Legislation Amendment (2022 Measures No. 1) Regulations 2022

22 Mar 2022 (F2022L00367)

Sch 1 (items 1–3, 38, 39, 44–48): 1 July 2022 (s 2(1) items 2, 3)

Health Insurance Legislation Amendment (2022 Measures No. 3) Regulations 2022

22 Aug 2022 (F2022L01099)

Sch 2: 1 Nov 2022 (s 2(1) item 2)

Health Insurance (Diagnostic Imaging Services Table) Amendment (Equipment Capital Sensitivity) Regulations 2022

16 Sept 2022 (F2022L01220)

17 Sept 2022 (s 2(1) item 1)

 

Endnote 4—Amendment history

 

Provision affected

How affected

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

rep LA s 48D

s 4.....................

am F2020L01602

s 5.....................

rep LA s 48C

Schedule 1

 

Part 1

 

Division 1.2

 

Subdivision B

 

c 1.2.3...................

rep F2021L01749

c 1.2.5...................

rep F2021L01749

c 1.2.6...................

rep F2021L01749

c 1.2.8...................

am F2022L01220

c 1.2.10..................

am F2022L01220

c 1.2.11..................

am F2021L01749

Subdivision C

 

c 1.2.18..................

am F2022L00367; F2022L01099

c 1.2.19..................

rep F2022L00367

c 1.2.20..................

rep F2021L01281

 

am F2021L01748 (amdt never applied (Sch 1 item 1))

c 1.2.21..................

am F2020L01608; F2021L01281; F2021L01748

 

ed C8

Part 2

 

Division 2.1

 

Subdivision B

 

c 2.1.2A.................

ad F2021L01281

c 2.1.3...................

am F2021L00681; F2021L01814

Group I1 Table.............

am F2020L00882; F2020L01330; F2020L01608; F2021L00681; F2021L01281

Subdivision C

 

c 2.1.4...................

am F2022L01099

c 2.1.5...................

am F2022L01099

c 2.1.6...................

am F2021L00681; F2021L01814

Group I1 Table.............

am F2022L01099

 

ed C12

Subdivision D

 

c 2.1.10..................

am F2021L00681; F2021L01814

Subdivision E

 

Subdivision E..............

ad F2020L01608

c 2.1.11..................

ad F2020L01608

c 2.1.12..................

ad F2020L01608

c 2.1.13..................

ad F2020L01608

c 2.1.14..................

ad F2020L01608

c 2.1.15..................

ad F2020L01608

c 2.1.16..................

ad F2020L01608

c 2.1.17..................

ad F2020L01608

 

am F2021L01281

c 2.1.18..................

ad F2020L01608

 

am F2022L00367

Group I1 Table.............

am F2021L00681

Division 2.2

 

Subdivision A

 

c 2.2.1...................

am F2021L00681

c 2.2.5A.................

ad F2021L01281

Subdivision B

 

c 2.2.6...................

am F2021L00681; F2021L01814

Group I2 Table.............

am F2020L01608; F2021L00681; F2021L01281

Division 2.3

 

Subdivision A

 

c 2.3.3...................

rs F2020L01608

Subdivision B

 

c 2.3.4...................

am F2021L00681; F2021L01814

Subdivision C

 

c 2.3.6...................

am F2021L00681; F2021L01814

Subdivision D

 

c 2.3.7...................

am F2021L00681; F2021L01814

Group I3 Table.............

am F2021L00681

Subdivision E

 

c 2.3.8...................

am F2021L00681; F2021L01814

Subdivision F

 

c 2.3.9...................

am F2021L00681

c 2.3.10..................

am F2021L00681; F2021L01814

Group I3 Table.............

am F2021L00681

Subdivision G

 

c 2.3.12..................

am F2021L00681; F2021L01814

Division 2.4

 

Subdivision A

 

c 2.4.1...................

am F2020L00882; F2020L01608

c 2.4.1A.................

ad F2020L01608

c 2.4.1B.................

ad F2020L01608

c 2.4.1C.................

ad F2020L01608

c 2.4.1D.................

ad F2020L01608

 

rep F2021L00681

Subdivision B

 

Subdivision B heading........

am F2020L01608

c 2.4.6...................

am F2020L01608

Group I4 Table.............

am F2020L00882; F2020L01608; F2021L00681

 

ed C6

 

am F2021L01281; F2021L01814; F2022L00367; F2022L01099

Division 2.5

 

Subdivision A

 

c 2.5.1...................

am F2022L01099

c 2.5.5...................

am F2022L01099

c 2.5.6...................

am F2022L01099

c 2.5.7...................

am F2022L01099

c 2.5.8...................

rs F2021L01281

c 2.5.8A.................

ad F2021L01281

c 2.5.8B.................

ad F2021L01281

c 2.5.9...................

am F2021L00681; F2021L01281; F2022L01099

c 2.5.9A.................

ad F2021L01281

 

am F2022L00367

c 2.5.9B.................

ad F2021L01281

 

ed C7

Subdivision B

 

c 2.5.10..................

am F2022L00367

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

am F2021L00681; F2021L01281; F2022L01099

Subdivision C

 

c 2.5.12..................

rep F2022L01099

c 2.5.13..................

am F2022L00367

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

am F2021L00681; F2022L01099

Subdivision D

 

c 2.5.13A.................

ad F2022L01099

c 2.5.14..................

am F2022L00367

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

am F2022L01099

Subdivision E

 

c 2.5.15..................

am F2022L00367

Subdivision F

 

c 2.5.16..................

am F2022L00367

Division 2.6

 

c 2.6.1...................

am F2021L01748

c 2.6.2...................

am F2021L00681; F2021L01814

Group I6 table.............

am F2020L01203; F2021L01748

Division 2.7

 

Division 2.7...............

ad F2021L00681

c 2.7.1...................

ad F2021L00681

 

ed C6

 

am F2022L00367

Part 3

 

c 3.1....................

am F2020L01608; F2021L01281; F2021L01749; F2022L01099

Part 4

 

Part 4...................

rep F2021L01749

 

ad F2022L01220

Division 1

 

c 4.1....................

rep F2021L01749

 

ad F2022L01220

c 4.2....................

rep F2021L01749

 

ad F2022L01220

Schedule 2................

rep LA s 48C

 

Endnote 5—Editorial changes

In preparing this compilation for registration, the following kinds of editorial change(s) were made under the Legislation Act 2003.

Schedule 1 (item 55712, column 2, paragraph (a))

Kind of editorial change

Removal of redundant text

Details of editorial change

Schedule 2 item 27 of the Health Insurance Legislation Amendment (2022 Measures No. 3) Regulations 2022 instructs to omit “service” and substitute “the current ultrasound” in column 2 of paragraph (a) of item 55712 of Schedule 1.

This amendment results in two consecutive occurrences of the word “the”.

This compilation was editorially changed to omit “the the” and substitute “the” in column 2 of paragraph (a) of item 55712 of Schedule 1 to remove the redundant text.