Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020
I, General the Honourable David Hurley AC DSC (Retd), Governor‑General of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, make the following regulations.
David Hurley
Governor‑General
By His Excellency’s Command
Greg Hunt
Minister for Health
Contents
2 Commencement
3 Authority
4 Diagnostic imaging services table
5 Schedule 2
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
1.2.3 Outer regional, remote and very remote areas and Norfolk Island
1.2.4 Meaning of relevant proprietor
1.2.5 Inner regional areas—applying for exemptions
1.2.6 Inner regional areas—granting exemptions
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 R‑type diagnostic imaging services
1.2.18 Bulk‑billing incentive
1.2.19 Bulk‑billing—magnetic resonance imaging
1.2.20 Multiple services—vascular ultrasound
1.2.21 Multiple services
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 non‑haematopoietic 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—R‑type ultrasound services
Subdivision B—Subgroups 1 to 4 of Group I1
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 ultra‑sonography
2.1.10 Items in Subgroup 6 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
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 fee for service rendered using first eligible X‑ray procedure carried out during attendance at residential aged care facility
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
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 and 2 of Group I4
2.4.6 Items in Subgroups 1 and 2 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 MRI and MRA services—multiple services
2.5.9 Restriction on items—related MRI or MRA services
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
2.5.12 MRI and MRA services—modifying items
2.5.13 Items in Subgroup 20 of Group I5
Subdivision D—Subgroups 21 and 22 of Group I5
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 bulk‑billed services
2.6.1 Restriction on items 64990 and 64991
2.6.2 Items in Group I6
Part 3—Dictionary
3.1 Dictionary
Part 4—Application, saving and transitional provisions
Division 1—General provisions
4.1 Definitions
4.2 Transitional provisions—exemptions from capital sensitivity requirements
Schedule 2—Repeals
Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 1) 2020
This instrument is the Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020.
(1) Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.
Commencement information | ||
Column 1 | Column 2 | Column 3 |
Provisions | Commencement | Date/Details |
1. The whole of this instrument | 1 July 2020. | 1 July 2020 |
Note: This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.
(2) Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.
This instrument is made under the Health Insurance Act 1973.
4 Diagnostic imaging services table
For the purposes of subsection 4AA(1) of the Health Insurance Act 1973, Schedule 1 is prescribed as a table of diagnostic imaging services.
Each instrument that is specified in Schedule 2 to this instrument is amended or repealed as set out in the applicable items in that Schedule, and any other item in that Schedule has effect according to its terms.
Schedule 1—Diagnostic imaging services table
Note: See section 4.
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.
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 1.2—General application provisions
Subdivision A—Capital 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.
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 | 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 B—Exemptions from capital sensitivity requirements
1.2.3 Outer regional, remote and very remote areas and Norfolk Island
(1) Clause 1.2.1 does not apply to a service that is performed on diagnostic imaging equipment if:
(a) the equipment is ordinarily located at diagnostic imaging premises; and
(b) the diagnostic imaging premises are located in an area that is:
(i) Outer Regional Australia; or
(ii) Remote Australia; or
(iii) Very Remote Australia; or
(iv) Norfolk Island.
(2) Clause 1.2.1 does not apply to a service that is performed on diagnostic imaging equipment if:
(a) the equipment is not ordinarily located at diagnostic imaging premises; and
(b) the equipment is ordinarily located, when not in use, at a base for mobile diagnostic imaging equipment; and
(c) the base is located in an area that is:
(i) Outer Regional Australia; or
(ii) Remote Australia; or
(iii) Very Remote Australia; or
(iv) Norfolk Island.
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.
1.2.5 Inner regional areas—applying for exemptions
Scope of this clause
(1) This clause applies to diagnostic imaging equipment if:
(a) all of the following subparagraphs apply:
(i) the equipment is ordinarily located at diagnostic imaging premises;
(ii) the diagnostic imaging premises are located in an area that is Inner Regional Australia;
(iii) the diagnostic imaging premises are located in an area that is RRMA4 or RRMA5; or
(b) all of the following subparagraphs apply:
(i) the equipment is not ordinarily located at diagnostic imaging premises;
(ii) the equipment is ordinarily located at a base for mobile diagnostic imaging equipment when not in use;
(iii) the base is located in an area that is Inner Regional Australia;
(iv) the base is located in an area that is RRMA4 or RRMA5.
Applying for exemption
(2) The relevant proprietor for the equipment may apply to the Secretary for an exemption under clause 1.2.6 in respect of the equipment.
Note: For relevant proprietor, see clause 1.2.4.
(3) The application must:
(a) be in writing; and
(b) be made no later than 3 years after the end of the maximum extended life age of the equipment.
Notifying proprietor of receipt of application
(4) 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 (3);
the Secretary must notify the relevant proprietor for the equipment in writing that the Secretary has received the application.
(5) To avoid doubt, the Secretary is not required to notify the relevant proprietor under subclause (4) if the equipment does not meet the requirements of subclause (1).
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 (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 1.2.6, or the application is withdrawn.
1.2.6 Inner regional areas—granting exemptions
Scope of this clause
(1) This clause applies if, under subclause 1.2.5(4), 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 subclause (3) of this clause, grant the exemption; or
(b) refuse to grant the exemption.
(3) The Secretary must not grant the exemption unless the Secretary is satisfied that the equipment:
(a) is operated on a rare and sporadic basis; and
(b) provides crucial patient access to diagnostic imaging services.
(4) 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 on capital sensitivity requirements
(5) If the Secretary grants the exemption, clause 1.2.1 does not apply to a service that is performed on the equipment while the exemption is in force.
(6) 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.
1.2.7 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) 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; and
(b) 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).
(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.
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.
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) 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; and
(b) 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.
(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 1.2.6 or 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.
Applications may be made to the Administrative Appeals Tribunal for review of decisions of the Secretary under clause 1.2.12.
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 C—Other provisions
1.2.15 Meaning of symbols (R) and (NR)
(1) A service corresponding to an item including the symbol (R) is an R‑type diagnostic imaging service.
(2) A service corresponding to an item including the symbol (NR) is an NR‑type 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 R‑type diagnostic imaging services
(1) An item relating to an R‑type 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) This clause applies if:
(a) a service that is mentioned in an item in Divisions 2.1 to 2.4 of this Schedule is provided; and
(b) the service is not provided in a hospital; and
(c) the service is bulk‑billed.
(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.
1.2.19 Bulk‑billing—magnetic resonance imaging
(1) This clause applies if:
(a) a service that is mentioned in an item in Division 2.5 of this Schedule is provided; and
(b) the service is not provided in a hospital; and
(c) the service is bulk‑billed.
(2) The fee for the service is 100% 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.
1.2.20 Multiple services—vascular ultrasound
(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 affected 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.
(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 R‑type 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 R‑type diagnostic imaging service and at least one non‑consultation 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 R‑type diagnostic imaging service, a consultation and a non‑consultation 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 1.2.20 and 2.5.8 apply, subject to subclauses (7) and (8), in addition to this clause.
(7) For the purposes of clause 1.2.20, 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.
(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 or 64991.
(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.
non‑consultation 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.
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 non‑haematopoietic stem cells.
Division 2.1—Group I1: ultrasound
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—R‑type 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 B—Subgroups 1 to 4 of Group I1
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.
Subdivision C—Subgroup 5 of Group I1: obstetric and gynaecological
2.1.4 Obstetric and gynaecological ultrasound services—limits
(1) For NR‑type diagnostic imaging services mentioned in an item in this Subdivision, 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, 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, 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 non‑metropolitan hospital, the referral must also state the words ‘non‑metropolitan obstetric privileges’.
(3) A medical practitioner’s clinical notes for a service mentioned in item 55703, 55705, 55708, 55715, 55723, 55725, 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.
Subdivision D—Subgroup 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 ultra‑sonography
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.
Division 2.2—Group I2: computed tomography (examination)
2.2.1 CT services—eligible services
(1) Items in this Division (other than item 57360) 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) Item 57360 applies 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.
Subdivision B—Subgroups 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.
Division 2.3—Group I3: diagnostic radiology
(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.
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.
(1) This clause applies if:
(a) a person attends a residential aged care facility; and
(b) during the attendance, the person carries out one or more eligible X‑ray procedures on one or more patients who are care recipients in the facility.
(2) The fee for the service that is rendered using the first eligible X‑ray service carried out during the attendance is the amount listed in the item that applies to the service plus $74.75.
Subdivision B—Subgroups 1 to 9 of Group I3
2.3.4 Items in Subgroups 1 to 9 of Group I3
This clause sets out items in Subgroups 1 to 9 of Group I3.
Subdivision C—Subgroup 10 of Group I3: radiographic examination of breasts
2.3.5 Mammography services—eligible services
Items in this Subdivision apply only to a mammography service performed:
(a) under the supervision of a specialist in the specialty of diagnostic radiology who is available:
(i) to monitor and influence the conduct and diagnostic quality of the examination; and
(ii) if necessary, to attend on the patient personally; or
(b) if paragraph (a) cannot be complied with:
(i) in an emergency; or
(ii) because of medical necessity, in a remote location.
2.3.6 Items in Subgroup 10 of Group I3
This clause sets out items in Subgroup 10 of Group I3.
Subdivision D—Subgroups 12 and 13 of Group I3
2.3.7 Items in Subgroups 12 and 13 of Group I3
This clause sets out items in Subgroups 12 and 13 of Group I3.
Group I3—Diagnostic radiography | ||
Column 1 | Column 2 Description | Column 3 Fee ($) |
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 follow‑up 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 | ||
59903 | Angiocardiography, including the service mentioned in item 59970 or 61109, not being a service to which item 59912 or 59925 applies (R) (Anaes.) | 116.25 |
59912 | Selective coronary arteriography, including the service mentioned in item 59970 or 61109, not being a service to which item 59903 or 59925 applies (R) (Anaes.) | 309.80 |
59925 | Selective coronary arteriography and angiocardiography, including a service mentioned in item 59903, 59912, 59970 or 61109 (R) (Anaes.) | 367.90 |
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 E—Subgroup 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.
Group I3—Diagnostic radiography | ||
Column 1 | Column 2 Description | Column 3 Fee ($) |
Subgroup 15—Fluoroscopic examination | ||
60500 | Fluoroscopy, with general anaesthesia (not being a service associated with a radiographic examination) (R) (Anaes.) | 44.05 |
60503 | Fluoroscopy, without general anaesthesia (not being a service associated with a radiographic examination) (R) | 30.20 |
60506 | Fluoroscopy using a mobile image intensifier, in conjunction with a surgical procedure lasting less than 1 hour, not being a service associated with a service to which another item in this Group applies (R) | 64.70 |
60509 | Fluoroscopy using a mobile image intensifier, in conjunction with a surgical procedure lasting 1 hour or more, not being a service associated with a service to which another item in this Group applies (R) | 100.40 |
Subdivision F—Subgroup 16 of Group I3: preparation for radiological procedure
2.3.9 Preparation of patients for radiological procedures
Items in this Subdivision apply only to the preparation of a patient for a radiological procedure for a service to which any of items 59903 to 59970 apply by:
(a) injecting opaque or contrast media; or
(b) removing fluid and replacing it with air, oxygen or other contrast media; or
(c) a similar method.
2.3.10 Items in Subgroup 16 of Group I3
This clause sets out items in Subgroup 16 of Group I3.
Group I3—Diagnostic radiography | ||
Column 1 | Column 2 Description | Column 3 Fee ($) |
Subgroup 16—Preparation for radiological procedure | ||
60918 | Arteriography (peripheral) or phlebography—one vessel, when used in association with a service to which item 59903, 59912, 59925 or 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 59903, 59912, 59925 or 59970 applies, not being a service associated with a service to which any of items 60000 to 60078 apply (NR) (Anaes.) | 38.60 |
Subdivision G—Subgroup 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 rapid‑sequence film angiography.
2.3.12 Items in Subgroup 17 of Group I3
This clause sets out items in Subgroup 17 of Group I3.
Group I3—Diagnostic radiography | ||
Column 1 | 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 2.4—Group I4: nuclear medicine imaging
2.4.1 Nuclear scanning services—other than PET
Items 61302 to 61505 and 61650 to 61647 apply only if:
(a) the performance of the service does not involve the use of positron‑emission radio‑isotopes 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.
2.4.2 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 B—Subgroups 1 and 2 of Group I4
2.4.6 Items in Subgroups 1 and 2 of Group I4
This clause sets out items in Subgroup 17 of Group I3.
Group I4—Nuclear medicine imaging | ||
Column 1 | Column 2 Description | Column 3 Fee ($) |
Subgroup 1—Nuclear medicine—non PET | ||
61302 | Single stress or rest myocardial perfusion study—planar imaging (R) | 448.85 |
61303 | Single stress or rest myocardial perfusion study—with single photon emission tomography and with planar imaging when performed (R) | 565.30 |
61306 | Combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion—planar imaging (R) | 709.70 |
61307 | Combined stress and rest, stress and re‑injection or rest and redistribution myocardial perfusion study, including delayed imaging or re‑injection protocol on a subsequent occasion—with single photon emission tomography and with planar imaging when performed (R) | 834.90 |
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 |
61328 | Lung perfusion study (R) | 227.65 |
61340 | Lung ventilation study using aerosol, technegas or xenon gas (R) | 253.00 |
61348 | Lung perfusion study and lung ventilation study using aerosol, technegas or xenon gas (R) | 443.35 |
61353 | Liver and spleen study (colloid) (R) | 386.60 |
61356 | Red blood cell spleen or liver study (R) | 392.80 |
61360 | Hepatobiliary study, including morphine administration or pre‑treatment 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 | Indium‑labelled octreotide study (including single photon emission tomography when undertaken), if: (a) a gastro‑entero‑pancreatic endocrine tumour is suspected on the basis of biochemical evidence with negative or equivocal conventional imaging; or (b) both: (i) a surgically amenable gastro‑entero‑pancreatic 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 | Gastro‑oesophageal 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 pre‑procedural 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 |
61397 | Cystoureterogram (R) | 246.85 |
61402 | Cerebral perfusion study, with single photon emission tomography and with planar imaging when performed (R) | 605.05 |
61409 | Cerebro‑spinal fluid transport study, with imaging on 2 or more separate occasions (R) | 873.50 |
61413 | Cerebro‑spinal fluid shunt patency study (R) | 225.95 |
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 (infra‑arterial) or Le Veen shunt study (R) | 253.00 |
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 items 61302 to 61647; if no separate diagnostic CT report is issued (R) | 100.00 |
61650 | LeukoScan study of the long bones and feet for suspected osteomyelitis, if: (a) the patient does not have access to ex‑vivo 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 non‑small 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 |
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 gastro‑oesophageal junction carcinoma, in a patient considered suitable for active therapy (R) | 953.00 |
61598 | Whole body FDG PET study performed for the staging of biopsy‑proven, newly‑diagnosed 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 |
61620 | Whole body FDG PET study for the initial staging of newly diagnosed or previously untreated Hodgkin or non‑Hodgkin 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 non‑Hodgkin lymphoma (R) | 953.00 |
61628 | Whole body FDG PET study for restaging following confirmation of recurrence of Hodgkin or non‑Hodgkin lymphoma (R) | 953.00 |
61632 | Whole body FDG PET study to assess response to second‑line chemotherapy if haemopoietic stem cell transplantation is being considered for Hodgkin or non‑Hodgkin lymphoma (R) | 953.00 |
61640 | Whole body FDG PET study for initial staging of a patient with biopsy‑proven 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 68Ga‑DOTA‑peptide PET study, if: (a) a gastro‑entero‑pancreatic neuroendocrine tumour is suspected on the basis of biochemical evidence with negative or equivocal conventional imaging; or (b) both: (i) a surgically amenable gastro‑entero‑pancreatic neuroendocrine tumour has been identified on the basis of conventional techniques; and (ii) the study is for excluding additional disease sites (R) | 953.00 |
Division 2.5—Group I5: magnetic resonance imaging
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 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 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:
(i) eligible equipment mentioned in clause 2.5.5; or
(ii) 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:
(i) eligible equipment mentioned in clause 2.5.5; or
(ii) 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 located at the premises of a comprehensive practice; and
(b) it is made available to the practice by a person who is subject to a current deed with the Commonwealth that relates to the equipment; and
(c) 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 located at the premises of a comprehensive practice; and
(b) it is made available to the practice by a person who is subject to a current deed with the Commonwealth that relates to the equipment; and
(c) it is identified as partial eligible equipment in the deed.
2.5.7 MRI and MRA services—meaning of scan
In items 63001 to 63560 and 63740 to 63743:
scan means a minimum of 3 sequences.
2.5.8 MRI and MRA services—multiple services
(1) If an MRI service mentioned in an item in Subgroup 1, 2, 4, 5 or 14 of Group I5, and an MRA service mentioned in an item in Subgroup 3 or 15 of Group I5, are provided to the same person on the same day, only the fee specified in the item in Subgroup 1, 2, 4, 5 or 14 applies to the services.
(2) If a medical practitioner provides 2 or more MRI services mentioned in Subgroup 12 or 13 of Group I5 for the same patient 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%.
(3) For the purposes of subclause (2):
(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 (2) 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 | 63454 to 63467 | 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 |
Subdivision B—Subgroups 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.
Group I5—Magnetic resonance imaging | ||
Column 1 | 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 non‑contiguous regions—for infection or tumour | ||
63201 | MRI—scan of 3 contiguous or 2 non‑contiguous regions of the spine for infection (R) (Anaes.) (Contrast) | 448.00 |
63204 | MRI—scan of 3 contiguous or 2 non‑contiguous regions of the spine for tumour (R) (Anaes.) (Contrast) | 448.00 |
Subgroup 9—Scan of spine—3 contiguous or 2 non‑contiguous regions—for other conditions | ||
63219 | MRI—scan of 3 contiguous or 2 non‑contiguous regions of the spine for demyelinating disease (R) (Anaes.) (Contrast) | 448.00 |
63222 | MRI—scan of 3 contiguous or 2 non‑contiguous 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 non‑contiguous regions of the spine for myelopathy (R) (Anaes.) (Contrast) | 448.00 |
63228 | MRI—scan of 3 contiguous or 2 non‑contiguous regions of the spine for syrinx (congenital or acquired) (R) (Anaes.) (Contrast) | 448.00 |
63231 | MRI—scan of 3 contiguous or 2 non‑contiguous regions of the spine for cervical radiculopathy (R) (Anaes.) (Contrast) | 448.00 |
63234 | MRI—scan of 3 contiguous or 2 non‑contiguous regions of the spine for sciatica (R) (Anaes.) (Contrast) | 448.00 |
63237 | MRI—scan of 3 contiguous or 2 non‑contiguous regions of the spine for spinal canal stenosis (R) (Anaes.) (Contrast) | 448.00 |
63240 | MRI—scan of 3 contiguous or 2 non‑contiguous regions of the spine for previous spinal surgery (R) (Anaes.) (Contrast) | 448.00 |
63243 | MRI—scan of 3 contiguous or 2 non‑contiguous 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 end‑diastolic and end‑systolic volumes, ejection fraction and BSA‑indexed 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 end‑diastolic and end‑systolic volumes, ejection fraction and BSA‑indexed 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 post‑inflammatory or post‑traumatic 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 | ||
63454 | MRI—scan of the pelvis or abdomen, if: (a) the pregnancy is at, or after, 18 weeks gestation; and (b) fetal central nervous system abnormality is suspected; and (c) an ultrasound has been performed and is provided by, or on behalf of, or at the request of, a specialist who is practising in the specialty of obstetrics; and (d) the diagnosis is indeterminate or requires further examination; and (e) the service is requested by a specialist practising in the specialty of obstetrics (R) (Anaes.) (Contrast) | 1,200.00 |
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, if a dedicated breast coil is used, the request for the scan identifies that the person is asymptomatic and is younger than 50 years of age, and the request for the scan identifies: (a) that the patient is at high risk of developing breast cancer, due to one of the following: (i) 3 or more first or second degree relatives on the same side of the family diagnosed with breast or ovarian cancer; (ii) 2 or more first or second degree relatives on the same side of the family diagnosed with breast or ovarian cancer, if any of the relatives has been diagnosed with bilateral breast cancer, had onset of breast cancer before the age of 40 years, had onset of ovarian cancer before the age of 50 years, has been diagnosed with breast and ovarian cancer (at the same time or at different times), has Ashkenazi Jewish ancestry or is a male relative who has been diagnosed with breast cancer; (iii) one first or second degree relative diagnosed with breast cancer at age 45 years or younger, and another first or second degree relative on the same side of the family with bone or soft tissue sarcoma at age 45 years or younger; or (b) that genetic testing has identified the presence of a high risk breast cancer gene mutation (R) (Anaes.) | 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—guided biopsy, if: (a) the request for the scan identifies that the patient has a suspicious lesion seen on MRI but not on conventional imaging; and (b) an ultrasound scan of the affected breast, performed immediately before the biopsy, confirms that the lesion is not amenable to biopsy guided by conventional imaging; and (c) a dedicated breast coil is used (R) (Anaes.) | 1,440.00 |
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 |
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 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
(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.
2.5.12 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.
2.5.13 Items in Subgroup 20 of Group I5
This clause sets out items in Subgroup 20 of Group I5.
Subdivision D—Subgroups 21 and 22 of Group I5
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: Subgroups 23 to 32 of Group I5 are set out in a determination made under subsection 3C(1) of the Act.
Subdivision E—Subgroup 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.
Subdivision F—Subgroup 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.
Division 2.6—Group I6: management of bulk‑billed services
2.6.1 Restriction on items 64990 and 64991
(1) If the diagnostic imaging service mentioned in item 64991 is provided to a person, either that item or item 64990, but not both those items, applies to the service.
(2) If item 64990 or 64991 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.
This clause sets out items in Group I6.
Group I6—Management of bulk‑billed services | ||
Column 1 | 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) 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 bulk‑billed for the fees for: (i) this item; and (ii) the other item in this Schedule applying to the service | 14.30 |
64991 | A diagnostic imaging service to which an item in this Schedule (other than this item or item 64990) 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 bulk‑billed 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: (i) a Modified Monash 2 area; or (ii) a Modified Monash 3 area; or (iii) a Modified Monash 4 area; or (iv) a Modified Monash 5 area; or (v) a Modified Monash 6 area; or (vi) a Modified Monash 7 area | 21.60 |
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.
bulk‑billed: a diagnostic imaging service is bulk‑billed 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) X‑ray.
comprehensive practice means a medical practice, or a radiology department of a hospital, that provides X‑ray, 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 X‑ray tube that emits a finely collimated X‑ray 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 X‑ray beam, which are transformed into a cross‑sectional image after the application of complex algorithms.
cone beam computed tomography means a service performed on a rotating gantry to which an X‑ray source and a 2‑dimensional flat panel detector are fixed that produces multiple sequential planar projection images in a single revolution around the patient, which are reconstructed into a 3‑dimensional 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.
eligible X‑ray procedure means a diagnostic imaging procedure used in rendering a service to which item 57509, 57515, 57521, 57527, 57703, 57709, 57712, 57715, 58503, 58521, 58524, 58527 or 58903 applies.
exemption period of an exemption under clause 1.2.5B means the period mentioned in paragraph 1.2.8(2)(a) (as extended under clause 1.2.10 if applicable).
FDG means 18F‑fluorodeoxyglucose.
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 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).
non‑consultation service has the meaning given by clause 1.2.21.
non‑metropolitan 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.
(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 free‑standing 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 63560 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 4—Application, saving and transitional provisions
In this Division:
old table means Schedule 1 to the Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 1) 2020 as in force immediately before 1 July 2020.
4.2 Transitional provisions—exemptions from capital sensitivity requirements
Applications for exemptions
(1) If:
(a) a valid application was made under subclause 1.2.5(2) of the old table before 1 July 2020; and
(b) the Department did not notify the relevant proprietor of receipt of the valid application as mentioned in subclause 1.2.5(4) of the old table before 1 July 2020;
subclauses 1.2.5(4) and (5) of this Schedule apply in relation to the application as if it were an application made under subclause 1.2.5(2) of this Schedule.
Notifications of receipt of valid applications
(2) If:
(a) the Department notified the relevant proprietor of receipt of a valid application as mentioned in subclause 1.2.5(4) of the old table before 1 July 2020; and
(b) the Secretary did not make a decision on the application under subclause 1.2.6(2) of the old table before 1 July 2020;
subclause 1.2.5(6) and clause 1.2.6 of this Schedule apply in relation to the notification as if it were a notification given under subclause 1.2.5(4) of this Schedule.
Exemptions
(3) An exemption:
(a) granted under subclause 1.2.6(2) of the old table; and
(b) in force immediately before 1 July 2020;
has effect, from 1 July 2020, as if it had been granted under clause 1.2.6 of this Schedule.
Refusals to grant exemptions
(4) If:
(a) the Secretary refused to grant an exemption under subclause 1.2.6(2) of the old table before 1 July 2020; and
(b) the proprietor who applied for the exemption did not apply under clause 1.2.11 of the old table for reconsideration of the decision before 1 July 2020; and
(c) the period to apply for such reconsideration did not end before 1 July 2020;
subclause 1.2.6(6) and clause 1.2.11 of this Schedule apply in relation to the decision to refuse to grant the exemption as if it were a decision under paragraph 1.2.6(2)(b) of this Schedule to refuse to grant an exemption.
Applications for reconsideration of refusals
(5) If:
(a) the Secretary refused to grant an exemption under subclause 1.2.6(2) of the old table in respect of diagnostic imaging equipment; and
(b) the proprietor who applied for the exemption applied under clause 1.2.11 of the old table for reconsideration of the decision before 1 July 2020; and
(c) the Secretary did not make a decision under clause 1.2.12 of the old table on the application for reconsideration before 1 July 2020;
for the purposes of subclause 1.2.11(6) and clause 1.2.12 of this Schedule, the Secretary is taken to have notified the proprietor under subclause 1.2.11(5) of this Schedule, when the Secretary received the application for reconsideration, that the Secretary had received an application for reconsideration of a decision under clause 1.2.6 of this Schedule to refuse to grant an exemption in respect of the equipment.
Affirmations of refusals
(6) If:
(a) the Secretary affirmed a decision under subparagraph 1.2.12(2)(b)(i) of the old table before 1 July 2020; and
(b) application was not made for review of the decision to affirm under clause 1.2.13 of the old table before 1 July 2020; and
(c) the time for making such an application for review did not end before 1 July 2020;
subclause 1.2.12(4) and clause 1.2.13 of this Schedule apply in relation to the decision as if it were a decision under subparagraph 1.2.12(2)(b)(i) of this Schedule to affirm a decision under paragraph 1.2.6(2)(b) of this Schedule.
Applications for AAT review
(7) If:
(a) an application was made under clause 1.2.13 of the old table for review of a decision before 1 July 2020; and
(b) immediately before 1 July 2020, each party to the proceeding had not been given a copy of the decision of the Administrative Appeals Tribunal on review;
the application is taken, from 1 July 2020, to be an application made under clause 1.2.13 of this Schedule for review of a decision under subparagraph 1.2.12(2)(b)(i) of this Schedule to affirm a decision under paragraph 1.2.6(2)(b) of this Schedule.
Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 1) 2020
1 The whole of the instrument
Repeal the instrument.