Commonwealth Coat of Arms of Australia

 

Health Insurance (Section 3C General Medical Services – Proton-Photon Comparison Plan) Determination (No.2) 2025

I, Mary Warner, delegate for the Minister of Health and Ageing, make the following Determination

Dated 15 May 2025

Mary Warner

Assistant Secretary
Diagnostic Imaging and Pathology Branch
Medicare Benefits and Digital Health Division
Health Resourcing Group
Department of Health, Disability and Ageing

 

 

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

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

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

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

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

6  Indexation................................................2

7  Schedules................................................2

Schedule 1—Relevant services 3

Schedule 2—Repeals 4

Health Insurance (Section 3C General Medical Services – Proton-Photon Comparison Plan) Determination 2025              4

 

 

  This instrument is the Health Insurance (Section 3C General Medical Services – Proton-Photon Comparison Plan) Determination (No.2) 2025.

  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.

This instrument is taken to have commenced on 1 July 2024.

1 July 2024

Note:  This table relates only to the provisions of this instrument as originally made.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.

  1.     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 subsection 3C(1) of the Health Insurance Act 1973.

 (1) In this instrument:

Act means the Health Insurance Act 1973.

bulk-billed has the same meaning given by clause 7.1.1 of the general medical services table.

radiation oncologist has the same meaning given by clause 5.3.2 of the general medical services table.

Schedule means a Schedule to this instrument.

Note: A number of expressions used in this instrument are defined in definitions section of the Act, including the following:

(a) general medical services table;

(b) item;

(c) professional service;

(d) clinically relevant service.

 

 (2) Unless the contrary intention appears, a reference in this instrument to a provision of the Act or the National Health Act 1953 or regulations made under the Act or under the National Health Act 1953 as applied, adopted or incorporated in relation to specifying a matter is a reference to those provisions as in force from time to time and any other reference to provisions of an Act or regulations is a reference to those provisions as in force from time to time.

  For subsection 3C(1) of the Act, a relevant service, provided in accordance with this instrument and as a clinically relevant service, is to be treated, for the relevant provisions, as if:

  1.           it were both a professional service and a general medical service; and
  2.           there were an item in the general medical services table that:
  1.            related to the service; and
  2.          specified for the service a fee in relation to each State, being the fee specified in the Schedule in relation to the service.

 (1) At the start of 1 July 2025 (the indexation time), each amount covered by subsection (2) is replaced by the amount worked out using the following formula:

 1.024 multiplied by the amount immediately before the indexation time

Note:             The indexed fees could in 2025 be viewed on the Department of Health and Aged Care’s MBS Online website (https://www.mbsonline.gov.au).

 (2) The amounts covered by this subsection are the fee for each item in a Schedule of this Determination.

 (3) An amount worked out under subsection (1) is to be rounded up or down to the nearest 5 cents (rounding down if the amount is an exact multiple of 2.5 cents).

  Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.


 

Group T2—Radiation Oncology

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 15—Proton Beam Therapy

15990

Proton beam dosimetry, and proton-photon comparative plan reporting, to assess eligibility for proton beam therapy via the Medical Treatment Overseas Program if:

  1.      proton planning is required to calculate dose to single or multiple-target structures and requires a dose-volume histogram to complete the planning process; and
  2.     the proton planning process optimises the differential between target dose, organs at risk, and normal tissue dose, based on review and assessment by a radiation oncologist; and
  3.      all relevant gross tumour volumes, clinical target volumes and organs at risk are rendered as volumes and nominated with planning dose objectives; and
  4.     organs at risk are nominated as planning dose constraints; and
  5.      dose calculations and dose-volume histograms are generated in an inverse planned process, using a specialised calculation algorithm, with prescription and plan details approved and recorded with the plan; and
  6.      a three-dimensional or four-dimensional image volume dataset is used for the relevant region to be planned and verified; and
  7.     the final proton dosimetry plan is:
  1.         validated by both the appropriately qualified radiation therapist and medical physicist, using robust quality assurance processes; and
  2.         approved by the radiation oncologist, ensuring the plan is clinically realistic and assessed to be robust to expected uncertainties encountered in proton beam therapy; and
  1.     a proton-photon comparative plan report is generated; and
  2.       the service is bulk-billed

 

7,356.25

 

 

1.  The whole of this instrument

Repeal the instrument.