Commonwealth Coat of Arms of Australia

 

Health Insurance (Section 3C – Lutetium PSMA Treatment) Amendment Determination 2025

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

Dated 4 June 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  Schedules................................................1

Schedule 1—Amendment 2

Health Insurance (Section 3C – Lutetium PSMA Treatment) Determination 2025 2

 

 

  This instrument is the Health Insurance (Section 3C – Lutetium PSMA Treatment) Amendment Determination 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

Immediately after the commencement of Health Insurance (Section 3C – Lutetium PSMA Treatment) Determination 2025.

1 July 2025

Note:  This table relates only to the provisions of this instrument as originally made.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

  Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.

1  Schedule 1

Repeal the table, substitute:

Category 3 – Therapeutic Procedures

GroupT3 -Therapeutic Nuclear Medicine

Subgroup 2 – Theranostics

Column 1

Item

Column 2

Description

Column 3

Fee ($)

16050

Administration of Lutetium 177 PSMA, followed within 36 hours by whole body Lu-PSMA SPECT, for treatment of a patient with metastatic castrate resistant prostate cancer who is:

  1.      PSMA-positive as determined by PSMA PET (defined as SUVmax >15 at a single site of disease and SUVmax >10 at all sites of measurable disease) after disease progression and
  2.     prior treatment includes at least one taxane chemotherapy and at least one androgen receptor signalling inhibitor.

Applicable once per cycle, up to a maximum of 2 cycles in the initial treatment phase.

8,000.00

16055

Administration of Lutetium 177 PSMA, followed within 36 hours by whole body Lu-PSMA SPECT, for treatment of a patient with metastatic castrate resistant prostate cancer, if:

  1.      a service to which item 16050 applies has been provided; and
  2.     the patient has not developed disease progression while receiving Lutetium 177 PSMA for this condition.

Applicable once per cycle, up to a maximum of 4 cycles in the continuing treatment phase.

8,000.00