Health Insurance (Diagnostic Imaging Services Table) Regulation 2013 (Cth)
made under the
This is a compilation of the
This compilation was prepared on 1 July 2014.
The notes at the end of this compilation
(the
The effect of uncommenced amendments is not reflected in the text of the compiled law but the text of the amendments is included in the endnotes.
If the operation of a provision or amendment is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.
If a provision of the compiled law is affected by a modification that is in force, details are included in the endnotes.
If a provision of the compiled law has expired or otherwise ceased to have effect in accordance with a provision of the law, details are included in the endnotes.
Contents
This regulation is the
Health Insurance (Diagnostic Imaging Services Table) Regulation 2013 .
This regulation is made under 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Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.
For subsection 4AA(1) of the Act, this regulation prescribes a table of diagnostic imaging services set out in Schedule 1.
The Dictionary in Part 3 of Schedule 1 defines certain words and expressions that are used in this regulation, and includes references to certain words and expressions that are defined elsewhere in this regulation.
(1) An application made under subsection 6(7) of the Determination, that was not decided before the commencement of this section, is taken to have been made under subclause 1.2.3(6) of Schedule 1.
(2) To avoid doubt, the Department is taken to have notified the relevant proprietor of the receipt of that application if the Department has notified the proprietor as mentioned in paragraph 6(4)(a) of the Determination.
(3) An exemption under subsection 6(5) of the Determination, that is in force just before the commencement of this section, is taken to be an exemption under subclause 1.2.3(4) of Schedule 1.
(4) A refusal by the Secretary to grant an exemption under subsection 6(5) of the Determination is taken to have been a refusal to grant an exemption under subclause 1.2.3(4) of Schedule 1, if, just before the commencement of this section:
(a) the proprietor had not yet applied for reconsideration under section 8 of the Determination and the period to apply for reconsideration had not yet expired; or
(b) the proprietor had applied for reconsideration under section 8 and the Secretary had not yet notified the proprietor of the Secretary’s reconsideration decision.
(5) To avoid doubt, the Secretary is taken to have notified the relevant proprietor of a refusal to make an exemption under subclause 1.2.3(4) of Schedule 1 if the Secretary notifies the relevant proprietor of a refusal to grant an exemption under subsection 6(5) of the Determination.
(6) An application made under section 8 of the Determination is taken to be an application made under clause 1.2.4 of Schedule 1, if:
(a) the application was made before the commencement of this section; and
(b) the Secretary did not notify the proprietor of the reconsideration decision before that commencement.
(7) A delegation made under section 9 of the Determination that was in force just before the commencement of this section continues in force after the commencement, despite the repeal of the Determination.
(8) In this section:
Determination means theHealth Insurance (Diagnostic Imaging Capital Sensitivity) Determination 2011 .
Note: See section 5.
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) Subject to clause 1.2.3, an (NK) item applies to a service that is performed on:
(a) diagnostic imaging equipment:
(i) that has not been upgraded; and
(ii) the age of which exceeds the new effective life age for the equipment; or
(b) diagnostic imaging equipment:
(i) that has been upgraded; and
(ii) the age of which exceeds the maximum extended life age for the equipment.
(2) A (K) item does not apply to a service to which an (NK) item applies.
Age of equipment
(1) The date from which the age of equipment is worked out for this regulation is:
(a) the date that the diagnostic imaging equipment was first installed in Australia; or
(b) if the diagnostic imaging equipment was imported as used equipment—the date of manufacture of the oldest component of the equipment.
Life ages
(2) The
new effective life age andmaximum extended life age for equipment are the periods set out in the following table for that type of equipment:
1 | Ultrasound | Equipment used to perform a service to which an item in Group I1 in Division 2.1 applies | 10 | 15 |
2 | CT | Equipment used to perform a service to which an item in Group I2 in Division 2.2 applies | 10 | ‑ |
3 | Mammography | Equipment used to perform a service to which an item in Group I3 (other than Subgroup 10) in Division 2.3 applies | 10 | 15 |
4 | Angiography | Equipment used to perform a service to which an item in Subgroup 13 of Group I3 in Division 2.3 applies | 10 | ‑ |
5 | Rest of diagnostic radiology | Equipment used to perform a service to which an item in Subgroups 1 to 9, 11, 12, 14, 15 or 17 of Group I3 in Division 2.3 applies | 15 | 20 |
6 | Nuclear medicine (excluding PET) | Equipment used to perform a service to which an item in Group I4 in Division 2.4 applies | 10 | 15 |
7 | MRI | Equipment used to perform a service to which an item in Group I5 in Division 2.5 applies | 10 | 15 |
Upgrades
(3) 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) the equipment is currently accredited under The Royal Australian and New Zealand College of Radiologists’ Mammography Quality Assurance Program.
Note: Proprietors can obtain further information on what constitutes an upgrade from the Department’s website ( from capital sensitivity
Outer regional, remote and very remote areas
(1) An (NK) item does not apply if:
(a) the diagnostic imaging equipment used to perform the service is ordinarily located at diagnostic imaging premises; and
(b) the diagnostic imaging premises are located in RA2, RA3 or RA4.
Note: Proprietors can identify what Remoteness Area they fall under at the Department’s DoctorConnect website ( Proprietors should refer to the category names, rather than category numbers as the website uses different category numbers from those specified in this regulation.
(2) An (NK) item does not apply if:
(a) the diagnostic imaging equipment used to perform the service is not ordinarily located at diagnostic imaging premises; and
(b) the diagnostic imaging equipment used to perform the service is ordinarily located, when not in use, at a base for mobile diagnostic imaging equipment; and
(c) the base for mobile diagnostic imaging equipment is located in RA2, RA3 or RA4.
Note: Proprietors can identify what Remoteness Area they fall under at the Department’s DoctorConnect website ( Proprietors should refer to the category names, rather than category numbers as the website uses different category numbers from those specified in this regulation.
Inner regional areas
(3) An (NK) item does not apply if:
(a) both of the following subparagraphs apply:
(i) the Department has notified the relevant proprietor of the receipt of a valid application for an exemption under subclause (4);
(ii) the Secretary has not made a decision under subclause (4); or
(b) the Secretary has granted an exemption under subclause (4); or
(c) the Secretary has notified the relevant proprietor that the Secretary has refused to grant an exemption under subclause (4), and:
(i) if the proprietor has not yet applied for reconsideration under clause 1.2.4—the period to apply for reconsideration has not yet expired; or
(ii) if the proprietor has applied for reconsideration under clause 1.2.4—the Secretary has not yet notified the proprietor of the Secretary’s reconsideration decision.
(4) The Secretary may grant an exemption in writing in respect of diagnostic imaging equipment if the Secretary is satisfied that the diagnostic imaging equipment:
(a) is operated on a rare and sporadic basis; and
(b) provides crucial patient access to diagnostic imaging services.
(5) The Secretary must make a decision under subclause (4) within 28 days of the day on which the Department notifies the relevant proprietor of the receipt of a valid application as mentioned in paragraph (3)(a).
(6) A relevant proprietor may only apply for an exemption under subclause (4) if the age of the diagnostic imaging equipment exceeds the maximum extended life age for the diagnostic imaging equipment by less than 3 years, and:
(a) all of the following subparagraphs apply:
(i) the diagnostic imaging equipment is ordinarily located at diagnostic imaging premises;
(ii) the diagnostic imaging premises are located in RA1;
(iii) the diagnostic imaging premises are located in RRMA4 or RRMA5; or
(aa) all of the following subparagraphs apply:
(i) the diagnostic imaging equipment is used to perform a service to which an item in Group I2 in Division 2.2 applies;
(ii) the diagnostic imaging equipment is ordinarily located at diagnostic imaging premises;
(iii) the diagnostic imaging premises are located in RA1;
(iv) the diagnostic imaging premises are not located in RRMA4 or RRMA5;
(v) while the
Health Insurance (Diagnostic Imaging Services Table) Regulation 2012 was in force, a service performed using the diagnostic imaging equipment at the diagnostic imaging premises was a service performed in a remote location; or(b) all of the following subparagraphs apply:
(i) the diagnostic imaging equipment is ordinarily located at a base for mobile diagnostic imaging equipment when not in use;
(ii) the diagnostic imaging equipment is not ordinarily located at diagnostic imaging premises;
(iii) the base for mobile diagnostic imaging equipment is located in RA1;
(iv) the base for mobile diagnostic imaging equipment is located in an area classified as RRMA4 or RRMA5.
Note: Proprietors can identify what Remoteness Area they fall under at the Department’s DoctorConnect website ( Proprietors should refer to the category names, rather than category numbers as the website uses different category numbers from those specified in this regulation.
(7) An application under subclause (6) must be made in writing to the Department.
(8) Paragraph (6)(aa) and this subclause expire at the end of 30 June 2016 as if they had been repealed by another regulation.
1.2.4 Reconsideration of exemption decisions
(1) If the Secretary refuses to grant an exemption under subclause 1.2.3(4), the proprietor who applied for the exemption may apply to the Secretary for reconsideration of the decision within:
(a) 28 days after the date of issue of the notice of the decision to the proprietor; or
(b) if the Secretary is satisfied that special circumstances exist—within such further period (if any) as the Secretary allows.
(2) In the application for reconsideration, the proprietor:
(a) must identify the decision for reconsideration and set out the reasons for the application; and
(b) may provide new material for the Secretary to consider.
(3) The Secretary must, within 28 days after receipt of an application, reconsider the decision and:
(a) affirm the decision; or
(b) vary the decision; or
(c) set aside the decision and make a decision in substitution for it.
(4) The Secretary must notify the proprietor of a reconsideration decision under subclause (3).
1.2.5 Delegation The Secretary may, by written notice, delegate to an APS employee in the Department any of the Secretary’s powers under this Division.
Subdivision B Other provisions 1.2.6 Meaning of symbols (R) and (NR) in the table
(1) An item including the symbol
(R) is an R‑type diagnostic imaging service.(2) An item including the symbol
(NR) is an NR‑type diagnostic imaging service.1.2.7 Who may provide a diagnostic imaging service Unless the contrary intention appears, items in this table 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:
(i) is employed by a medical practitioner; or
(ii) provides the service under the supervision of a medical practitioner in accordance with accepted medical practice.
1.2.8 Report requirements for certain services
(1) An item in Part 2 (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 55026, 55054, 55130, 55131, 55135, 55136, 55848, 55849, 55850, 55851, 57341, 57345, 59312, 59313, 59314, 59315, 60506, 60507, 60509, 60510, 61109 and 61110, being items of services performed in conjunction with a surgical procedure; and
(b) items 60918 and 60927, being items of service performed in preparation for a radiological procedure.
1.2.9 Bulk‑billing incentive
(1) This clause applies if:
(a) a service that is mentioned in an item in Divisions 2.1 to 2.4 of this table 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 table for the service.
(3) For paragraph 10(2)(aa) of the Act, the benefit payable is the amount calculated under subclause (2).
Note: Under subparagraph 6EF(b)(ii) of the
Health Insurance Regulations 1975 , the medicare benefit payable is 100% of the amount calculated under subclause (2) of this clause.(4) This clause does not apply to the service specified in item 61369 or 61671.
1.2.10 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 table 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 table for the service.
(3) For paragraph 10(2)(aa) of the Act, the benefit payable is the amount calculated under subclause (2).
Note: Under subparagraph 6EF(b)(ii) of the
Health Insurance Regulations 1975 , the medicare benefit payable is 100% of the amount calculated under subclause (2) of this clause.1.2.11 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 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.
1.2.12 Multiple services
(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 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 1.2.11 and 2.5.8 apply, subject to subclauses (7) and (8), in addition to this clause.
(7) For clause 1.2.11, 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 clause 2.5.8, if a medical practitioner provides:
(a) 2 or more MRI services mentioned in Subgroup 12 or 13 of Division 2.5 in this table 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, 59104, 64990 or 64991.
(11) In this table:
consultation means a service under an item listed in Divisions 2.1 to 2.14 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 2.1 to 2.14 of the general medical services table.Part 2 Services and fees
Items in this Division (except items 55600, 55601, 55603 and 55604) 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) by a registered sonographer on behalf of a medical practitioner.
(1) Items in this Division (except items 55600, 55601, 55603 and 55604) marked with the symbol
(R) apply to an ultrasound service (theeligible service ) only if the service is performed:
(a) under the professional supervision of a specialist or a consultant physician in the practice of his or her 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 professional 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 professional 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 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 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.
In items 55005, 55008, 55011, 55028, 55030 and 55032, a reference to a medical practitioner includes a reference to a dental practitioner approved under paragraph (b) of the definition of
professional service in subsection 3(1) of the Act.
55005 | Head, ultrasound scan of, if:
| 54.55 |
55007 | Head, ultrasound scan of, if:
| 18.95 |
55008 | Orbital contents, ultrasound scan of, if:
| 54.55 |
55010 | Orbital contents, ultrasound scan of, if:
| 18.95 |
55011 | Neck, one or more structures of, ultrasound scan of, if:
| 54.55 |
55013 | Neck, one or more structures of, ultrasound scan of, if:
| 18.95 |
55014 | Abdomen, ultrasound scan of (including scan of urinary tract when performed), if:
| 55.65 |
55016 | Abdomen, ultrasound scan of (including scan of urinary tract when performed), if:
| 18.95 |
55017 | Urinary tract, ultrasound scan of, if:
| 54.55 |
55019 | Urinary tract, ultrasound scan of, if:
| 18.95 |
55023 | Scrotum, ultrasound scan of, if:
| 54.75 |
55025 | Scrotum, ultrasound scan of, if:
| 18.95 |
55026 | Ultrasonic cross‑sectional echography, in conjunction with a surgical procedure using interventional techniques, not being a service associated with a service to which any other item in this group applies (R) (NK) | 54.55 |
55028 | Head, ultrasound scan of, if:
| 109.10 |
55029 | Head, ultrasound scan of, if:
| 37.85 |
55030 | Orbital contents, ultrasound scan of, if:
| 109.10 |
55031 | Orbital contents, ultrasound scan of, if:
| 37.85 |
55032 | Neck, one or more structures of, ultrasound scan of, if:
| 109.10 |
55033 | Neck, one or more structures of, ultrasound scan of, if:
| 37.85 |
55036 | Abdomen, ultrasound scan of (including scan of urinary tract when performed), if:
| 111.30 |
| ||
55037 | Abdomen, ultrasound scan of (including scan of urinary tract when performed), if:
| 37.85 |
55038 | Urinary tract, ultrasound scan of, if:
| 109.10 |
55039 | Urinary tract, ultrasound scan of, if:
| 37.85 |
55048 | Scrotum, ultrasound scan of, if:
| 109.50 |
55049 | Scrotum, ultrasound scan of, if:
| 37.85 |
55054 | Ultrasonic cross‑sectional echography, in conjunction with a surgical procedure using interventional techniques, not being a service associated with a service to which any other item in this group applies (R) (K) | 109.10 |
55059 | Breast, one, ultrasound scan of, if:
| 49.15 |
55060 | Breast, one, ultrasound scan of, if:
| 17.05 |
55061 | Breasts, both, ultrasound scan of, if:
| 54.55 |
55062 | Breasts, both, ultrasound scan of, if:
| 18.95 |
55063 | Urinary bladder, ultrasound scan of, by any or all approaches, if:
| 49.15 |
55064 | Urinary bladder, ultrasound scan of, by any or all approaches, if:
| 17.05 |
| ||
55065 | Pelvis, ultrasound scan of, by any or all approaches, if:
| 98.25 |
55067 | Pelvis, ultrasound scan of, by any or all approaches, if:
| 50.25 |
55068 | Pelvis, ultrasound scan of, by any or all approaches, if:
| 35.00 |
55069 | Pelvis, ultrasound scan of, by any or all approaches, if:
| 17.85 |
55070 | Breast, one, ultrasound scan of, if:
| 98.25 |
55073 | Breast, one, ultrasound scan of, if:
| 34.05 |
55076 | Breasts, both, ultrasound scan of, if:
| 109.10 |
55079 | Breasts, both, ultrasound scan of, if:
| 37.85 |
55084 | Urinary bladder, ultrasound scan of, by any or all approaches, if:
| 98.25 |
55085 | Urinary bladder, ultrasound scan of, by any or all approaches, if:
| |
| 34.05 | |
55113 | M‑mode and two‑dimensional real time echocardiographic examination of the heart from at least 2 acoustic windows for the investigation of symptoms or signs of cardiac failure, or suspected or known ventricular hypertrophy or dysfunction, or chest pain: (a) with:
| 230.65 |
| ||
55114 | M‑mode and two‑dimensional real time echocardiographic examination of the heart from at least 2 acoustic windows for the investigation of suspected or known acquired valvular, aortic, pericardial, thrombotic or embolic disease or heart tumour: (a) with:
| 230.65 |
55115 | M‑mode and two‑dimensional real time echocardiographic examination of the heart from at least 2 acoustic windows for the investigation of symptoms or signs of congenital heart disease: (a) with:
| 230.65 |
55116 | Exercise stress echocardiography performed in conjunction with item 11712: (a) with:
| 261.65 |
55117 | Pharmacological stress echocardiography performed in conjunction with item 11712: (a) with:
| 261.65 |
55118 | Heart, two‑dimensional real time transoesophageal examination of, from at least 2 levels, and in more than one plane at each level: (a) with:
| 275.50 |
| ||
55119 | M‑mode and two‑dimensional real time echocardiographic examination of the heart from at least 2 acoustic windows for the investigation of symptoms or signs of cardiac failure, or suspected or known ventricular hypertrophy or dysfunction, or chest pain: (a) with:
| 115.35 |
55120 | M‑mode and two‑dimensional real time echocardiographic examination of the heart from at least 2 acoustic windows for the investigation of suspected or known acquired valvular, aortic, pericardial, thrombotic or embolic disease or heart tumour: (a) with:
| 115.35 |
55121 | M‑mode and two‑dimensional real time echocardiographic examination of the heart from at least 2 acoustic windows for the investigation of symptoms or signs of congenital heart disease: (a) with:
| 115.35 |
55122 | Exercise stress echocardiography performed in conjunction with item 11712: (a) with:
| 130.85 |
55123 | Pharmacological stress echocardiography performed in conjunction with item 11712: (a) with:
| 130.85 |
55125 | Heart, two‑dimensional real time transoesophageal examination of, from at least 2 levels, and in more than one plane at each level: (a) with:
| 137.75 |
55130 | Intra‑operative two‑dimensional real time transoesophageal echocardiography incorporating Doppler techniques with colour flow mapping and recording onto video tape or digital medium, performed during cardiac surgery incorporating sequential assessment of cardiac function before and after the surgical procedure, not being a service associated with a service to which item 55135 or 55136 applies (R) (K) (Anaes.) | 170.00 |
55131 | Intra‑operative two‑dimensional real time transoesophageal echocardiography incorporating Doppler techniques with colour flow mapping and recording onto video tape or digital medium, performed during cardiac surgery incorporating sequential assessment of cardiac function before and after the surgical procedure, not being a service associated with a service to which item 55135 or 55136 applies (R) (NK) (Anaes.) | 85.00 |
55135 | Intra‑operative two‑dimensional real time transoesophageal echocardiography incorporating Doppler techniques with colour flow mapping and recording onto video tape or digital medium, performed during cardiac valve surgery (replacement or repair) incorporating sequential assessment of cardiac function and valve competence before and after the surgical procedure, not being a service associated with a service to which item 55130 or 55131 applies (R) (K) (Anaes.) | 353.60 |
55136 | Intra‑operative two‑dimensional real time transoesophageal echocardiography incorporating Doppler techniques with colour flow mapping and recording onto video tape or digital medium, performed during cardiac valve surgery (replacement or repair) incorporating sequential assessment of cardiac function and valve competence before and after the surgical procedure, not being a service associated with a service to which item 55130 or 55131 applies (R) (NK) (Anaes.) | 176.80 |
55220 | Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the lower limb or of arteries and bypass grafts in the lower limb, below the inguinal ligament, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (NK) | 84.75 |
55221 | Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the lower limb, below the inguinal ligament, for acute venous thrombosis, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (NK) | 84.75 |
55222 | Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the lower limb, below the inguinal ligament, for chronic venous disease, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (NK) | 84.75 |
55223 | Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the upper limb or of arteries and bypass grafts in the upper limb, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (NK) | 84.75 |
55224 | Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the upper limb, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (NK) | 84.75 |
55226 | Duplex scanning, bilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of extra‑cranial bilateral carotid and vertebral vessels, with or without subclavian and innominate vessels, with or without oculoplethysmography or peri‑orbital Doppler examination, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (NK) | 84.75 |
55227 | Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of intra‑abdominal, aorta and iliac arteries or inferior vena cava and iliac veins or of intra‑abdominal, aorta and iliac arteries and inferior vena cava and iliac veins, excluding pregnancy related studies, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (NK) | 84.75 |
55228 | Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of renal or visceral vessels or of renal and visceral vessels, including aorta, inferior vena cava and iliac vessels as required excluding pregnancy related studies, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (NK) | 84.75 |
55229 | Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of intra‑cranial vessels, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (NK) | 84.75 |
55230 | Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements:
| 84.75 |
55232 | Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements:
| 84.75 |
55233 | Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of surgically created arteriovenous fistula or surgically created arteriovenous access grafts in the upper or lower limbs, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (NK) | 84.75 |
55235 | Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or veins, or both, including any associated skin marking, for mapping of bypass conduit before vascular surgery, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054), 3 or 4 applies (R) (NK) | 84.75 |
55236 | Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow spectral analysis and marking of veins in the lower limbs below the inguinal ligament before varicose vein surgery, including any associated skin marking, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054), 3 or 4 applies (R) (NK) | 55.55 |
55238 | Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the lower limb or of arteries and bypass grafts in the lower limb, below the inguinal ligament, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (K) | 169.50 |
55244 | Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the lower limb, below the inguinal ligament, for acute venous thrombosis, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (K) | 169.50 |
55246 | Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the lower limb, below the inguinal ligament, for chronic venous disease, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (K) | 169.50 |
55248 | Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the upper limb or of arteries and bypass grafts in the upper limb, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (K) | 169.50 |
55252 | Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the upper limb, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (K) | 169.50 |
55274 | Duplex scanning, bilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of extra‑cranial bilateral carotid and vertebral vessels, with or without subclavian and innominate vessels, with or without oculoplethysmography or peri‑orbital Doppler examination, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (K) | 169.50 |
55276 | Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of intra‑abdominal, aorta and iliac arteries or inferior vena cava and iliac veins or of intra‑abdominal, aorta and iliac arteries and inferior vena cava and iliac veins, excluding pregnancy related studies, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (K) | 169.50 |
55278 | Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of renal or visceral vessels or of renal and visceral vessels, including aorta, inferior vena cava and iliac vessels as required excluding pregnancy related studies, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (K) | |
169.50 | ||
55280 | Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of intra‑cranial vessels, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (K) | 169.50 |
55282 | Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements:
| 169.50 |
55284 | Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements:
| 169.50 |
55292 | Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of surgically created arteriovenous fistula or surgically created arteriovenous access grafts in the upper or lower limbs, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054) or 4 applies (R) (K) | 169.50 |
55294 | Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or veins, or both, including any associated skin marking, for mapping of bypass conduit before vascular surgery, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054), 3 or 4 applies (R) (K) | 169.50 |
55296 | Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow spectral analysis and marking of veins in the lower limbs below the inguinal ligament before varicose vein surgery, including any associated skin marking, not being a service associated with a service to which an item in Subgroup 1 (with the exception of items 55026 and 55054), 3 or 4 applies (R) (K) | 111.05 |
55600 | Prostate, bladder base and urethra, l ultrasound scan of, if performed:
| 109.10 |
55601 | Prostate, bladder base and urethra, l ultrasound scan of, if performed:
| 54.55 |
55603 | Prostate, bladder base and urethra, ultrasound scan of, if performed:
| 109.10 |
55604 | Prostate, bladder base and urethra, ultrasound scan of, if performed:
| 54.55 |
(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, 55713, 55714, 55716, 55717, 55718, 55722, 55723, 55726, 55759, 55760, 55762, 55763, 55768, 55769, 55770 and 55771 are applicable only once in a pregnancy.
(1) A referral for a service mentioned in item 55700, 55701, 55704, 55707, 55710, 55712, 55714, 55718, 55719, 55721, 55722, 55724, 55759, 55760, 55764, 55765, 55768, 55769, 55772 or 55773 must state the relevant condition or clinical indication for the service.
(2) If a referral for a service mentioned in item 55712, 55719, 55721, 55724, 55764, 55765, 55772 or 55773 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 55702, 55703, 55705, 55708, 55711, 55715, 55716, 55720, 55723, 55725, 55726, 55727, 55762, 55763, 55766, 55767, 55770, 55771, 55774 or 55775 must state the relevant condition or clinical indication for the service.
(1) The conditions for items 55700, 55701, 55702, 55703, 55704, 55705, 55707, 55708, 55710, 55711, 55714 and 55716, are as follows:
(a) hyperemesis gravidarum;
(b) diabetes mellitus;
(c) hypertension;
(d) toxaemia of pregnancy;
(e) liver or renal disease;
(f) autoimmune disease;
(g) cardiac disease;
(h) alloimmunisation;
(i) maternal infection;
(j) inflammatory bowel disease;
(k) bowel stoma;
(l) abdominal wall scarring;
(m) previous spinal or pelvic trauma or disease;
(n) drug dependency;
(o) thrombophilia;
(p) significant maternal obesity;
(q) advanced maternal age;
(r) abdominal pain or mass;
(s) uncertain dates;
(t) high risk pregnancy;
(u) previous post dates delivery;
(v) previous caesarean section;
(w) poor obstetric history;
(x) suspicion of ectopic pregnancy;
(y) risk of miscarriage;
(z) diminished symptoms of pregnancy;
(za) suspected or known cervical incompetence;
(zb) suspected or known uterine abnormality;
(zc) pregnancy after assisted reproduction;
(zd) risk of fetal abnormality.
(2) The conditions for items 55718, 55722, 55723 and 55726, are as follows:
(a) known or suspected fetal abnormality or fetal cardiac arrhythmia;
(b) fetal anatomy (late booking or incomplete mid‑trimester scan);
(c) malpresentation;
(d) cervical assessment;
(e) clinical suspicion of amniotic fluid abnormality;
(f) clinical suspicion of placental or umbilical cord abnormality;
(g) previous complicated delivery;
(h) uterine scar assessment;
(i) uterine fibroid;
(j) previous fetal death in utero or neonatal death;
(k) antepartum haemorrhage;
(l) clinical suspicion of intrauterine growth retardation;
(m) clinical suspicion of macrosomia;
(n) reduced fetal movements;
(o) suspected fetal death;
(p) abnormal cardiotocography;
(q) prolonged pregnancy;
(r) premature labour;
(s) fetal infection;
(t) pregnancy after assisted reproduction;
(u) trauma;
(v) diabetes mellitus;
(w) hypertension;
(x) toxaemia of pregnancy;
(y) liver or renal disease;
(z) autoimmune disease;
(za) cardiac disease;
(zb) alloimmunisation;
(zc) maternal infection;
(zd) inflammatory bowel disease;
(ze) bowel stoma;
(zf) abdominal wall scarring;
(zg) previous spinal or pelvic trauma or disease;
(zh) drug dependency;
(zi) thrombophilia;
(zj) gross maternal obesity;
(zk) advanced maternal age;
(zl) abdominal pain or mass.
55700 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, ultrasound scan of, by any or all approaches, if:
| 60.00 |
55701 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, ultrasound scan of, by any or all approaches, if:
| 30.00 |
55702 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, ultrasound scan of, by any or all approaches, if:
| 17.50 |
55703 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, ultrasound scan of, by any or all approaches, if:
| 35.00 |
55704 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:
| 70.00 |
55705 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:
| 35.00 |
55706 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:
| 100.00 |
55707 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:
| 70.00 |
55708 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:
| 35.00 |
55709 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:
| 38.00 |
55710 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:
| 35.00 |
55711 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:
| 17.50 |
55712 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:
| |
201.60 |
63482 | MRI—scan of pancreas and biliary tree for suspected biliary or pancreatic pathology (R) (K) (Anaes.) | 403.20 |
63486 | MRI—scan of pancreas and biliary tree for suspected biliary or pancreatic pathology (R) (NK) (Anaes.) | 201.60 |
63491 | MRI or MRA service to which an item in this Group (other than an item in this Subgroup) applies if:
| 44.80 |
63494 | MRI or MRA service to which an item in this Group (other than an item in this Subgroup) applies if:
| 44.80 |
63497 | MRI or MRA service to which an item in this Group (other than an item in this Subgroup) applies if:
| 156.80 |
Note: Subgroups 23 to 32 of this table are set out in a determination made under subsection 3C(1) of the Act.
63507 | MRI—scan of head for a patient under 16 years if the service is for: (a) an unexplained seizure; or
| 403.20 |
63508 | MRI—scan of head for a patient under 16 years if the service is for: (a) an unexplained seizure; or
| 201.60 |
63510 | MRI—scan of spine following radiographic examination for a patient under 16 years if the service is for: (a) significant trauma; or
| 448.00 |
63511 | MRI—scan of spine following radiographic examination for a patient under 16 years if the service is for: (a) significant trauma; or
| 224.00 |
63513 | MRI—scan of knee following radiographic examination for internal joint derangement for a patient under 16 years (R) (K) (Anaes.) (Contrast) | 403.20 |
63514 | MRI—scan of knee following radiographic examination for internal joint derangement for a patient under 16 years (R) (NK) (Anaes.) (Contrast) | 201.60 |
63516 | MRI—scan of hip following radiographic examination for a patient under 16 years if any of the following is suspected: (a) septic arthritis; (b) slipped capital femoral epiphysis; (c) Perthes disease (R) (K) (Anaes.) (Contrast) | 403.20 |
63517 | MRI—scan of hip following radiographic examination for a patient under 16 years if any of the following is suspected: (a) septic arthritis; (b) slipped capital femoral epiphysis; (c) Perthes disease (R) (NK) (Anaes.) (Contrast) | 201.60 |
63519 | MRI—scan of elbow following radiographic examination for a patient under 16 years if a significant fracture or avulsion injury, which would change the way in which the patient is managed, is suspected (R) (K) (Anaes.) (Contrast) | 403.20 |
63520 | MRI—scan of elbow following radiographic examination for a patient under 16 years if a significant fracture or avulsion injury, which would change the way in which the patient is managed, is suspected (R) (NK) (Anaes.) (Contrast) | 201.60 |
63522 | MRI—scan of wrist following radiographic examination for a patient under 16 years if a scaphoid fracture is suspected (R) (K) (Anaes.) (Contrast) | 448.00 |
63523 | MRI—scan of wrist following radiographic examination for a patient under 16 years if a scaphoid fracture is suspected (R) (NK) (Anaes.) (Contrast) | 224.00 |
63551 | Scan of head for a patient 16 years or older, after referral by a medical practitioner (other than a specialist or consultant physician), for any of the following: (a) unexplained seizure(s);
| 403.20 |
63552 | Scan of head for a patient 16 years or older, after referral by a medical practitioner (other than a specialist or consultant physician), for any of the following: (a) unexplained seizure(s);
| 201.60 |
63554 | Scan of spine for a patient 16 years or older, after referral by a medical practitioner (other than a specialist or consultant physician), for suspected cervical radiculopathy (R) (K) (Contrast) (Anaes.) | 358.40 |
63555 | Scan of spine for a patient 16 years or older, after referral by a medical practitioner (other than a specialist or consultant physician), for suspected cervical radiculopathy (R) (NK) (Contrast) (Anaes.) | 179.20 |
63557 | Scan of spine for a patient 16 years or older, after referral by a medical practitioner (other than a specialist or consultant physician), for suspected cervical spinal trauma (R) (K) (Contrast) (Anaes.) | 492.80 |
63558 | Scan of spine for a patient 16 years or older, after referral by a medical practitioner (other than a specialist or consultant physician), for suspected cervical spinal trauma (R) (NK) (Contrast) (Anaes.) | 246.40 |
63560 | Scan of knee following acute knee trauma, after referral by a medical practitioner (other than a specialist or consultant physician), for a patient 16 years or older with:
| 403.20 |
63561 | Scan of knee following acute knee trauma, after referral by a medical practitioner (other than a specialist or consultant physician), for a patient 16 years or older with:
| 201.60 |
(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 table that applies to the service.
(3) For item 64991, this subclause applies to a geographical area included in any of the following SSD spatial units:
(a) Beaudesert Shire Part A;
(b) Belconnen;
(c) Darwin City;
(d) Eastern Outer Melbourne;
(e) East Metropolitan Perth;
(f) Frankston City;
(g) Gosford‑Wyong;
(h) Greater Geelong City Part A;
(i) Gungahlin‑Hall;
(j) Ipswich City (Part in BSD);
(k) Litchfield Shire;
(l) Melton‑Wyndham;
(m) Mornington Peninsula Shire;
(n) Newcastle;
(o) North Canberra;
(p) Palmerston‑East Arm;
(q) Pine Rivers Shire;
(r) Queanbeyan;
(s) South Canberra;
(t) South Eastern Outer Melbourne;
(u) Southern Adelaide;
(v) South West Metropolitan Perth;
(w) Thuringowa City Part A;
(x) Townsville City Part A;
(y) Tuggeranong;
(z) Weston Creek–Stromlo;
(za) Woden Valley;
(zb) Yarra Ranges Shire Part A.
(4) In this table:
Commonwealth concession card holder means a person who is a concessional beneficiary within the meaning given by subsection 84(1) of theNational 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.
regional, rural or remote area means an area classified as RRMAs 3‑7 under the Rural, Remote and Metropolitan Areas Classification.
SLA means a Statistical Local Area specified in the ASGC.
SSD means a Statistical Subdivision specified in the ASGC.
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.
64990 | A diagnostic imaging service to which an item in this table (other than this item or item 64991) applies if: (a) the service is an unreferred service; and
(d) the service is bulk‑billed for the fees for:
| 7.05 |
64991 | A diagnostic imaging service to which an item in this table (other than this item or item 64990) applies if: (a) the service is an unreferred service; and
(d) the service is bulk‑billed for the fees for:
| 10.65 |
Note: All references in the Dictionary to a provision are references to a provision in this Schedule of this regulation unless otherwise indicated.
In this regulation:
Act means theHealth Insurance Act 1973 .
(Anaes.) has the meaning given by clause 2.43.5 of Schedule 1 to the general medical services table.
angiography suite has the meaning given by clause 2.3.4.
ASGC means the document titledAustralian Standard Geographical Classification (ASGC) (ABS catalogue number 1216.0), published by the Australian Statistician in July 2010.Note: In 2013, the AGSC was accessible at for a service, means:
(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 eligible provider by whom, or on whose behalf, the service is provided, the person’s right to the payment of the medicare benefit; and
(ii) the eligible provider accepts the assignment in full payment of the eligible provider’s fee for the service provided.
Commonwealth concession card holder has the meaning given by clause 2.6.1.
comprehensive facility means a building or part of a building, or more than one building, 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 means a service performed (with or without intravenous contrast):
(a) using a detector 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) registering a resulting variable amount of X‑rays and transforming that information into a cross‑sectional image after the application of complex algorithms.
consultation has the meaning given by clause 1.2.12.
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 means computed tomography.
eligible equipment , for an MRI or MRA service, has the meaning given by clause 2.5.5.
eligible provider , for an MRI or MRA service, has the meaning given by clause 2.5.4.
FDG means18 F‑fluorodeoxyglucose.
GEJ means gastro‑oesophageal junction.
Group , for a Group in the table, means every item in the Group.
group of practitioners has the same meaning as in subsection 16A(10) of the Act.
highest fee has the meaning given by clause 1.2.12.
item means:
(a) an item mentioned, by number, in column 1 of a table in:
(i) Schedule 1; or
(ii) Schedule 1 to the pathology services table; or
(iii) Schedule 1 to the general medical services table; and
(b) in a reference immediately followed by a number—the item so numbered.
Example: A reference by number to any of items 11240, 11603 to 11612, 30361 and 30488 is a reference to the item so numbered in the general medical services table.
JNMCAC means the Joint Nuclear Medicine Credentialling and Accreditation Committee of the RACP and RANZCR.
(K) item means an item that includes the symbol (K) at the end of the item.
maximum extended life age has the meaning given by clause 1.2.2.
MRA means magnetic resonance angiography.
MRI means magnetic resonance imaging.
new effective life age has the meaning given by clause 1.2.2.
(NK) item means an item that includes the symbol (NK) at the end of the item.
non‑consultation service has the meaning given by clause 1.2.12.
non‑metropolitan hospital means a hospital that is located outside the Sydney, Melbourne, Brisbane, Adelaide, Perth, Greater Hobart, Darwin and Canberra major statistical divisions, as defined in the ASGC.
(NR) has the meaning given by clause 1.2.6.
partial eligible equipment has the meaning given by clause 2.5.6.
PET means positron emission tomography.
practice location has the meaning given by clause 2.6.1.
professional service has the meaning given by subsection 3(1) of the Act.
providing practitioner , for a service mentioned in an item in Group I1 of Part 2, means the medical practitioner by whom, or under whose supervision or direction, the service was performed.
(R) has the meaning given by clause 1.2.6.
RA1 means an inner regional area as classified by the ASGC.
RA2 means an outer regional area as classified by the ASGC.
RA3 means a remote area as classified by the ASGC.
RA4 means a very remote area as classified by the ASGC.
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).
regional, rural or remote area has the meaning given by clause 2.6.1.
registered sonographer means a person whose name is entered on the Register of Sonographers kept by the Chief Executive Medicare.
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.
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 63567, 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 a scan designed to establish patient position and subsequently used to plan other scans).
SLA has the meaning given by clause 2.6.1.
SSD has the meaning given by clause 2.6.1.
Subgroup for a Subgroup in the table, means every item in the Subgroup.
unreferred service has the meaning given by clause 2.6.1.
upgraded has the meaning given by subclause 1.2.2(3).Note: Several other words and expressions used in this regulation have a meaning given by subsection 3(1) of the Act, for example, the following:
(a) diagnostic imaging service;
(b) general medical services table;
(c) participating midwife;
(d) participating nurse practitioner;
(e) pathology services table;
(f) practitioner;
(g) specialist.
Endnotes Endnote 1 About the endnotes The endnotes provide details of the history of this legislation and its provisions. The following endnotes are included in each compilation:
Endnote 1—About the endnotes
Endnote 2—Abbreviation key
Endnote 3—Legislation history
Endnote 4—Amendment history
Endnote 5—Uncommenced amendments
Endnote 6—Modifications
Endnote 7—Misdescribed amendments
Endnote 8—Miscellaneous
If there is no information under a particular endnote, the word “none” will appear in square brackets after the endnote heading.
Abbreviation key—Endnote 2 The abbreviation key in this endnote sets out abbreviations that may be used in the endnotes.
Legislation history and amendment history—Endnotes 3 and 4 Amending laws are annotated in the legislation history and amendment history.
The legislation history in endnote 3 provides information about each law that has amended the compiled law. The information includes commencement information for amending laws and details of application, saving or transitional provisions that are not included in this compilation.
The amendment history in endnote 4 provides information about amendments at the provision level. It also includes information about any provisions that have expired or otherwise ceased to have effect in accordance with a provision of the compiled law.
Uncommenced amendments—Endnote 5 The effect of uncommenced amendments is not reflected in the text of the compiled law but the text of the amendments is included in endnote 5.
Modifications—Endnote 6 If the compiled law is affected by a modification that is in force, details of the modification are included in endnote 6.
Misdescribed amendments—Endnote 7 An amendment is a misdescribed amendment if the effect of the amendment cannot be incorporated into the text of the compilation. Any misdescribed amendment is included in endnote 7.
Miscellaneous—Endnote 8 Endnote 8 includes any additional information that may be helpful for a reader of the compilation.
Endnote 2 Abbreviation key
ad = added or inserted
pres = present
am = amended
prev = previous
c = clause(s)
(prev) = previously
Ch = Chapter(s)
Pt = Part(s)
def = definition(s)
r = regulation(s)/rule(s)
Dict = Dictionary
Reg = Regulation/Regulations
disallowed = disallowed by Parliament
reloc = relocated
Div = Division(s)
renum = renumbered
exp = expired or ceased to have effect
rep = repealed
hdg = heading(s)
rs = repealed and substituted
LI = Legislative Instrument
s = section(s)
LIA =
Legislative Instruments Act 2003 Sch = Schedule(s)
mod = modified/modification
Sdiv = Subdivision(s)
No = Number(s)
SLI = Select Legislative Instrument
o = order(s)
SR = Statutory Rules
Ord = Ordinance
Sub‑Ch = Sub‑Chapter(s)
orig = original
SubPt = Subpart(s)
par = paragraph(s)/subparagraph(s)
|
247, 2013 | 26 Nov 2013 ( | 27 Nov 2013 | |
250, 2013 | 26 Nov 2013 ( | Sch 2 (items 1, 2): 1 Jan 2014 | — |
79, 2014 | 16 June 2014 ( | 1 July 2014 | — |
s 2......................................... | rep LIA s 48D | |
Sch 1..................................... | am No 250, 2013; No 79, 2014 | |
Sch 2..................................... | rep LIA s 48C | |
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