Health Insurance (Diagnostic Imaging Services Table) Regulations 2009 (Cth)
made under the
This compilation was prepared on 1 July 2010
taking into account amendments up to SLI 2010 No. 65
Prepared by the Office of Legislative Drafting and Publishing,
Attorney‑General’s Department, Canberra
These Regulations are the
Health Insurance (Diagnostic Imaging Services Table) Regulations 2009 .
These Regulations commence on 1 November 2009.
The
Health Insurance (Diagnostic Imaging Services Table) Regulations 2008 are repealed.
In these Regulations:
Act means theHealth Insurance Act 1973 .
this table means these Regulations.
The table of diagnostic imaging services set out in Schedule 1 is prescribed for subsection 4AA (1) of the Act.
(regulation 5)
For section 4AA of the Act, these Regulations prescribe a table of diagnostic imaging services that sets out:
(a) in Part 2 — rules for interpretation of the table; and
(b) in Part 3:
(i) items of diagnostic imaging services; and
(ii) the fee applicable for each item.
(1) In this table, unless the contrary intention appears:
accredited site means a site accredited by ANZAPNM as a site for advanced training in PET.
(Anaes.) — see the general medical services table.
ANZAPNM means the Australian and New Zealand Association of Physicians in Nuclear Medicine (ABN 99 665 425 983).
bulk‑billed , 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, his or her right to the payment of the medicare benefit; and
(ii) the eligible provider accepts the assignment in full payment of his or her fee for the service provided.
comprehensive facility means a building or part of a building, or more than 1 building if public access betweenthe buildings is by a covered pedestrian walkway, 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) neurology;
(f) radiation oncology;
(g) surgical oncology;
(h) x-ray.
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.
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.
CT equipment includes the following components:
(a) a gantry;
(b) a couch;
(c) a computer;
(d) an operator station;
(e) a generator.
FDG means18 F-fluorodeoxyglucose.
GEJ means gastro-oesophageal junction.
group of practitioners has the same meaning as in subsection 16A (10) of the Act.
item means:
(a) an item mentioned, by number, in column 1 of:
(i) Part 3; or
(ii) Part 3 of the pathology services table; or
(iii) Part 3 of 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.
MRA means magnetic resonance angiography.
MRI means magnetic resonance imaging.
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 Australian Standard Geographical Classification 1999 published by the Australian Bureau of Statistics (publication number 1216.0 of 1999).
PET means positron emission tomography.
providing practitioner , for a service mentioned in an item in Group I1 of Part 3, means the medical practitioner by whom, or under whose supervision or direction, the service was performed.
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).
registered sonographer means a person whose name is entered on the Register of Sonographers kept by the Medicare Australia CEO.
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.
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).
Note A number ofwords and expressions used in this table are defined in subsection 3 (1) of the Act, including:· diagnostic imaging service
· general medical services table
· pathology services table
· specialist.
(2) A reference to a Group in the table includes every item in the Group and a reference to a Subgroup in the table includes every item in the Subgroup.
(3) A reference to a diagnostic imaging service in an item in Part 3 includes a reference to the undertaking of the diagnostic imaging procedure used for rendering the service.
(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.
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) An item in Part 3 (except an item to which subrule (2) applies) applies only if the providing practitioner gives a report of the service performed to the practitioner who requested the service.
(2) This subrule applies to the following items:
(a) items 55054, 55130, 55135, 55848, 55850, 57341, 57345, 59312, 59314, 60506, 60509 and 61109, being items of services performed in conjunction with a surgical procedure;
(b) items 60918 and 60927, being items of service performed in preparation for a radiological procedure.
6 Meaning of medical practitioner in certain items In items 55028, 55030 and 55032,
medical practitioner in the phrasereferred by a medical practitioner orthe referring medical practitioner includes a dental practitioner who is approved by the Minister under paragraph (b) of the definition ofprofessional service in subsection 3 (1) of the Act.
Items 55028 to 55854 (except items 55600 and 55603) apply to an ultrasound service only if the service is performed:
(a) by a medical practitioner; or
(b) by a registered sonographer on behalf of a medical practitioner.
(1) Items 55028 to 55854 (except items 55600 and 55603), if 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 subrule (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 subrule (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.
10 Angiography services — meaning of (K) and (NK) in items
(1) An item that includes the symbol
(NK) at the end of the item applies to a service that is performed on equipment that is at least 10 years old.(2) An item that includes the symbol
(K) at the end of the item applies to a service that is performed on equipment that is less than 10 years old.(3) The date from which the age of equipment is worked out for this rule is:
(a) the date that 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.
11 Obstetric and gynaecological ultrasound services — limits
(1) For NR‑type diagnostic imaging services described in any of items 55700 to 55774, the specified fee for no more than 3 services provided to the same patient in any 1 pregnancy applies.
(2) For any patient, items 55706, 55707, 55708, 55709, 55718, 55723, 55759, 55762, 55768 and 55770 are applicable not more than once in a pregnancy.
12 Obstetric and gynaecological services — clinical indications
(1) For items in which clinical conditions are listed (items 55700, 55704, 55707, 55718, 55759 and 55768), or for which a clinical indication is required for performance of subsequent scans (items 55712, 55721, 55764 and 55772), the referral must identify the relevant clinical indication for the service.
(2) If the service is self‑determined (items 55703, 55705, 55708, 55715, 55723, 55725, 55762, 55766, 55770 and 55774), the clinical condition or indication must be recorded in the medical practitioner’s clinical notes.
13 Obstetric and gynaecological services — referral forms Items 55712, 55721, 55764 and 55772 apply to a service for which a referral is given by a medical practitioner who has obstetric privileges at a non‑metropolitan hospital only if the words ‘non‑metropolitan obstetric privileges’ are specified on the referral form.
14 Musculoskeletal ultrasound services — personal attendance Items 55800 to 55854 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.
15 Musculoskeletal ultrasound services — comparison ultra‑sonography For items 55800 to 55854, the fee applicable for the item includes any views of another part of the patient taken for comparison purposes.
16 Musculoskeletal ultrasound services — equipment Items 55800 to 55854 apply only to an ultrasound service performed using an ultrasound system that has available on‑site a transducer capable of operation at a frequency of at least 7.5 MHz.
(1) In any of items 56001 to 57356, the symbol
(K) means:
(a) for CT equipment that was first installed and used as new equipment at a site in Australia:
(i) the service was rendered earlier than 10 years after the earliest date on which any component of the equipment was first installed and ready for use; or
(ii) the service was performed in a remote location; or
(b) for CT equipment imported as pre‑used equipment:
(i) the service was rendered earlier than 10 years after the earliest date of manufacture of any component of the equipment; or
(ii) the service was rendered in a remote location.
(2) In any of items 56001 to 57356, the symbol
(NK) means the service was rendered 10 years or more after:
(a) for CT equipment that was first installed and used as new equipment in Australia — the earliest date on which any component of the equipment was first installed and ready for use; or
(b) for CT equipment imported as pre‑used equipment — the earliest date of manufacture of any component of the equipment.
(3) In this rule:
CT equipment imported as pre‑used equipment means equipment that has been used to perform CT services before being imported into Australia.
installed and ready for use , for a component, means ready for immediate income‑producing purposes, whether or not it is so used.
(1) Subject to subrule (2), items 56001 to 57356 apply only to a CT service that is:
(a) performed under the professional supervision of a specialist in the specialty of diagnostic radiology who is available:
(i) to monitor and influence the conduct and diagnostic quality of the examination; and
(ii) if necessary, to attend on the patient personally; and
(b) reported by a specialist in the specialty of diagnostic radiology.
(2) Items 56001 to 57360 apply to a CT service that fails to comply with subrule (1) if the service is performed:
(a) in an emergency; or
(b) because of medical necessity, in a remote location.
20 CT services — exclusion of attenuation correction and anatomical correlation Items 56001 to 57356 do not apply to a CT service that is performed for the purpose of attenuation correction or anatomical correlation of another diagnostic imaging procedure.
If an axial scan is performed for the exclusion of acoustic neuroma, item 56001 or 56007 applies instead of any other item in this table that might be taken to apply to the service.
(1) If the service described in item 56007 or 56047 is used for the assessment of a headache of a patient to whom this rule 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 rule 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.
Items 56220 to 56240 and 56619 to 56665 apply once only for a service described in any of those items, regardless of the number of patient attendances required to complete the service.
Items 59300 to 59318 apply only to a mammography service performed:
(a) under the professional 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.
25 Preparation of patients for radiological procedures Items 60918 and 60927 apply only to the preparation of a patient for a radiological procedure for a service to which any of items 59903 to 59974 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.
In item 61109:
angiography suite means a room that contains only equipment designed for angiography that is able to perform digital subtraction or rapid‑sequence film angiography.
Items 61302 to 61505 and item 61650 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 Medicare Australia CEO 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.
(1) Items 61523 to 61613 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) at an accredited site in a comprehensive facility; and
(c) in accordance with rules 27B and 27C.
(2) Also, the items apply only if the owner or operator of the equipment used to perform the service is not in breach of rule 27D.
27B PET nuclear scanning services — performance under personal supervision
(1) For rule 27A, 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.
(2) In this rule:
requesting practitioner has the same meaning as in paragraph 27A (1) (a).
For rule 27A, the service must be performed on a person using equipment that meets the following requirements:
(a) the
Requirements for PET Accreditation (Instrumentation & Radiation Safety) dated 4 May 2007 issued by the Australian and New Zealand Society of Nuclear Medicine Inc;
(b) the NEMA Standards Publication NU 2-2007,
Performance Measurements of Positron Emission Tomographs , published by the National Electrical Manufacturers Association (USA).
27D PET nuclear scanning services — statutory declaration
(1) The owner or operator mentioned in subrule 27A (2) must have given a statutory declaration to the Medicare Australia CEO that includes the following information:
(a) whether the owner or operator is a credentialled specialist or a medical practitioner who satisfies the requirements mentioned in subparagraphs 27B (1) (b) (i) to (iii);
(b) whether the place where the owner or operator provides the service is an accredited site in a comprehensive facility;
(c) whether the equipment meets the requirements mentioned in rule 27C;
(d) the facility’s address;
(e) the provider number for the facility given by the Medicare Australia CEO;
(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 Medicare Australia CEO written notice of the change as soon as the owner or operator knows about the change.
(1) This rule applies if:
(a) a service that is mentioned in an item in Groups I1 to I5 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 subsection 10 (2) of the Act, the benefit payable is the amount calculated under subrule (2).
Note Under regulation 6EF of theHealth Insurance Regulations 1975 , the medicare benefit payable is 100% of the amount calculated under subrule (2).
(4) This rule does not apply to the service specified in item 61369.
Note Item 61369 is taken to be an item in the table — see theHealth Insurance (Indium‑labelled Octreotide Study) Determination HS/09/2006 .
(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 subrule (1):
(a) if 2 or more applicable fees are equally the highest, one only of those fees is taken to be the highest fee; and
(b) if paragraph (a) applies — the other, or another, highest fee is taken to be the second highest fee; and
(c) if 2 or more fees are equally second highest, any 1 of those fees may be taken to be the second highest for the purpose of paragraph (1) (b); and
(d) if a reduced fee calculated under subrule (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 rule 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 1 R‑type diagnostic imaging service and at least 1 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 subrule (2), if more than 1 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 1 R‑type diagnostic imaging service and at least 1 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 subrules (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) Rules 29 and 38 apply, subject to subrules (7) and (8), in addition to this rule.
(7) For rule 29, if a medical practitioner provides:
(a) 2 or more vascular ultrasound services for the same patient on the same day; and
(b) 1 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 rule, to be an amount payable for 1 diagnostic imaging service.
(8) For rule 38, if a medical practitioner provides:
(a) 2 or more MRI services described in Subgroup 12 or 13 of Group I5 in this table for the same patient on the same day; and
(b) 1 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 rule, to be an amount payable for 1 diagnostic imaging service.
(9) This rule 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 rule does not apply to the fee specified in item 59103, 64990 or 64991.
(11) In this rule:
consultation means a service under an item listed in Groups A1 to A21 of the general medical services table.
highest fee means the highest fee specified for an item in the first claim submitted to the Medicare Australia CEO for the services provided.
non‑consultation service means a service under an item listed in the general medical services table other than in Groups A1 to A21.
(1) Subject to subrules (2), (2A) and (2B), items 63001 to 63482 apply only to an MRI or MRA service performed:
(a) at the request of a specialist or consultant physician, made in accordance with rule 32; and
(b) in a permissible circumstance, in accordance with rule 31; and
(c) with eligible equipment, in accordance with rule 33 or 35.
(2) If a service described in an item mentioned in subrule (1) is performed with eligible equipment described in paragraph 36 (1) (c) or (d), the item for the service applies only if the service is bulk‑billed for the fee for the service.
(2A) If a service described in an item mentioned in subrule (1) is performed with eligible equipment described in paragraph 36 (1) (e), the item for the service applies only if:
(a) for a service performed on a concessional beneficiary — the service is bulk‑billed; or
(b) for a service performed on a person who is not a concessional beneficiary — the medical expenses incurred by the person for the service are not more than the fee specified for the item.
(2B) If a service described in an item mentioned in subrule (1) is performed with eligible equipment described in paragraph 36 (1) (f), the item for the service applies only if:
(a) for a service performed on a concessional beneficiary or a child under 16 — the maximum charge is the sum of the medicare benefit and any private health insurance benefit payable for the service; and
(b) all the conditions of the agreement, mentioned in the following table, that applies to the eligible equipment are met.
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(3) In this rule:
concessional beneficiary means:
(a) a person who is the holder of a seniors health card, a health care card or a pensioner concession card under the
Social Security Act 1991 ; or(b) a person (other than the holder of the card) whose name is included in a card mentioned in paragraph (a).
Items 63001 to 63482 apply only to a service for which the request:
(a) was made in writing; and
(b) identified the clinical indications for the service.
33 MRI and MRA services — permissible circumstances for performance For rule 31, a service is performed in a permissible circumstance only if it is:
(a) both:
(i) performed under the professional 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:
(i) in an emergency; or
(ii) because of medical necessity, in a remote location.
(1) For subrule 33 (1), an
eligible provider , for an MRI or MRA service performed with equipmentto which rule 35 or paragraph 36 (1) (a) applies, is a specialist in diagnostic radiology who is aneligible provider within the meaning of rule 30 of Part 2 of Schedule 1 to theHealth Insurance (Diagnostic Imaging Services Table) Regulations 2000 , as in force on 31 October 2001.(2) For subrule 33 (1), an
eligible provider , for an MRI or MRA service performed with equipment to which paragraph 36 (1) (b), (c), (d), (e) or (f) applies, is a specialist in diagnostic radiology who has satisfied the Medicare Australia CEO that he or she is a participant in the Royal Australian and New Zealand College of Radiologists’ Quality and Accreditation Program.
For rule 31, equipment is
eligible equipment if the equipment iseligible equipment within the meaning of rule 31 of Part 2 of Schedule 1 to theHealth Insurance (Diagnostic Imaging Services Table) Regulations 2000 , as in force on 31 October 2001.
(1) For rule 31,
eligible equipment is equipment other than equipment to which rule 35 applies, being:
(a) equipment:
(i) that is registered under the scheme, administered
by the Department, titled ‘MRI Additional Units Eligibility Scheme’, as in force on 27 June 2001; and
(ii) for which the registration has not been cancelled or otherwise ceased to have effect; or
(b) equipment:
(i) that is registered under the scheme, administered by the Department, titled ‘2004 MRI Additional Units Eligibility Scheme’, as in force on 29 November 2004; and
(ii) for which the registration has not been cancelled or otherwise ceased to have effect; or
(c) equipment that:
(i) is situated in the radiology department at a location specified in column 2 of an item in Table 1; and
(ii) is described in columns 3 and 4 of that item by reference to the manufacturer, scanner model and magnet strength; or
(d) equipment that:
(i) is situated in a location specified in column 2 of an item in Table 2; and
(ii) is described in columns 3 and 4 of that item by reference to the manufacturer, scanner model and magnet strength; and
(iii) forms part of a comprehensive radiology department that provides x‑ray, computed tomography and ultrasound services; and
(iv) except for periods reasonably required for maintenance, repairs and upgrades, is available for use:
(A) from 9 am to 5 pm, Monday to Friday, excluding public holidays, for the provision of routine services; and
(B) at all times for the provision of emergency services; or
(e) the Siemens Symphony equipment situated at Orana Radiology, 168‑172 Brisbane Street, Dubbo, NSW 2830 that:
(i) has a magnet strength of 1.5T; and
(ii) forms part of a comprehensive radiology department that provides x‑ray, computed tomography and ultrasound services; and
(iii) except for periods reasonably required for maintenance, repairs and upgrades, is available for use:
(A) from 9 am to 5 pm, Monday to Friday, excluding public holidays, for the provision of routine services; and
(B) at all times for the provision of emergency services; or
(f) equipment that:
(i) is situated in a location specified in column 2 of an item in Table 3; and
(ii) is described in columns 3 and 4 of that item by reference to the manufacturer, scanner model and magnet strength; and
(iii) forms part of a comprehensive radiology department, or a medical practice, that provides x‑ray, computed tomography and ultrasound services; and
(iv) except for periods reasonably required for maintenance, repairs and upgrades, is available for use at least from 9 am to 5 pm, Monday to Friday, excluding public holidays.
(2) In this rule:
medical practice means:
(a) a medical practice conducted by a group of practitioners within the meaning of subsection 16A (9) or (10) of the Act or by a sole practitioner; or
(b) a medical entrepreneur as defined in section 3 of the Act.
Table 1 Eligible equipment — paragraph 36 (1) (c)
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Table 2 Eligible equipment — paragraph 36 (1) (d)
1 | Fremantle Public Hospital Alma Street Fremantle WA 6160 | Siemens Magnetom Avanto SQ | 1.5T |
2 | Gosford Public Hospital Holden Street Gosford NSW 2250 | Siemens Avanto | 1.5T |
3 | Mater Misericordiae Hospital 21‑37 Fulham Road Townsville QLD 4812 | Picker / Phillips Eclipse | 1.5T |
4 | Whistler Radiology 33 Berry Street Nowra NSW 2541 | Philips Medical Systems Intera Master System | 1.5T |
5 | Knox Private Hospital 262 Mountain Hwy Wantirna VIC 3152 | General Electric Signa Excite | 1.5T |
6 | St Vincent’s Hospital Victoria Street Darlinghurst NSW 2010 | Philips (16 Channel) Quasar Dual | 3.0T |
7 | Blacktown Hospital Blacktown Road Blacktown NSW 2148 | Siemens Magnetom Trio Tim | 3.0T |
8 | Sunshine Public Hospital 176 Furlong Road St Albans VIC 3021 | General Electric HDx | 3.0T |
9 | Goulburn Valley Health Graham Street Shepparton VIC 3630 | Philips Medical Systems Achieva | 3.0T |
10 | Southernex Imaging Group Pring Street Ipswich QLD 4305 | General Electric Signa Excite | 1.5T |
11 | Wollongong Hospital Crown Street Wollongong NSW 2500 | Philips Achieva Nova Dual | 1.5T |
12 | Launceston General Hospital 287‑289 Charles Street Launceston TAS 7250 | Magnetom Avanto with Tim 76X18 SQ Engine | 1.5T |
13 | Medical Imaging Department Ground Floor, C Block Cairns Base Hospital The Esplanade Cairns QLD 4870 | Siemens Magnetom Verio | 3.0T |
14 | Medical Imaging Department Ground Floor Medical Services Building Rockhampton Hospital 1 Canning Street Rockhampton QLD 4700 | Siemens Magnetom Verio | 3.0T |
Table 3 Eligible equipment — paragraph 36 (1) (f)
| Monash Medical Centre 246 Clayton Road Clayton VIC 3168 | Siemens Magnetom Verio | 3.0T |
| Suite 1 38‑40 Urunga Parade Miranda NSW 2228 | General Electric HDx | 1.5T |
| Bundaberg Mater Misericordiae Hospital 313 Bourbong Street Bundaberg QLD 4670 | General Electric Prodigy | 1.5T |
| Radiology Department Level 1 Clinical Services Building Royal Melbourne Hospital Grattan Street Parkville VIC 3050 | Siemens Magnetom Trio | 3.0T |
| Suite 1 Maitland Specialist Centre Maitland Private Hospital Corner Chisholm Road and New England Highway East Maitland NSW 2323 | General Electric Echospeed Excite 8 | 1.5T |
| SKG Radiology Kelmscott 2964 Albany Highway Kelmscott WA 6111 | Siemens Avanto | 1.5T |
| SKG Radiology Duncraig Units 3‑5 54 Arnisdale Road Duncraig WA 6023 | Siemens Avanto | 1.5T |
| Benson Radiology 115 Main South Road Morphett Vale SA 5162 | Siemens Magnetom Espree | 1.5T |
| Bankstown Hospital Eldridge Street Bankstown NSW 2200 | Siemens Magnetom Avanto | 1.5T |
Note 1 The MRI Additional Units Eligibility Scheme mentioned in subparagraph (a) (i) is the scheme of that title published inGazette No. GN20 on 23 May 2001, as amended by amendments published inGazette No. S226 on 27 June 2001.
Note 2 The 2004 MRI Additional Units Eligibility Scheme mentioned in subparagraph (b) (i) is the scheme of that title published inGazette No. S 479 on 29 November 2004.
In items 63001 to 63482:
scan means a minimum of 3 sequences.
(1) If an MRI service described in an item in Subgroup 1, 2, 4, 5 or 14 of Group I5 in this table, and an MRA service described in an item in Subgroup 3 or 15 of that Group, 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 described in Subgroup 12 or 13 of Group I5 in this table 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 subrule (2):
(a) if 2 or more applicable fees are equally the highest, 1 only of those fees is taken to be the highest fee; and
(b) if a reduced fee calculated under subrule (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.
39 MRI or MRA services — related services that can be claimed in a 12 month period
(1) An MRI or MRA item mentioned in column 2 of the table in subrule (2) does not apply to the service described in that item if the service is provided to a person who, in the 12 months before the service, has been provided with the maximum number of those services mentioned in column 3 of the table for that item.
(2) For subrule (1), the items and maximum number of services are:
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(1) Item 63470 does not apply to the service described in that item if the person to whom the service is provided has previously been provided with that service or a service described in item 63473.
(2) Item 63473 does not apply to the service described in that item if the person to whom the service is provided has previously been provided with that service or a service described in item 63470.
(1) Subject to subrules (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 of this table that applies to the service.
(2) If 2 or more MRI or MRA services described in item 63494 are performed for a person on the same day, the fee specified in that item applies to 1 of those services only.
(3) If 2 or more MRI or MRA services described in item 63497 are performed for a person on the same day, the fee specified in that item applies to 1 of those services only.
(4) If:
(a) 1 or more MRI or MRA services described in item 63494; and
(b) 1 or more MRI or MRA services described in item 63497;
are performed for a person on the same day, the fee specified in item 63494 or item 63497, but not both those items, applies to 1 of those services only.
(1) If the diagnostic imaging service described 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 items 64990 and 64991:
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 .
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.
(4) For item 64991:
ASGC means the document titled Australian Standard Geographical Classification (ASGC) 2002, published by the Australian Bureau of Statistics, as in force on 1 July 2002.
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 Medicare Australia CEO.
regional, rural or remote area means an area classified as RRMAs 3‑7 under the Rural, Remote and Metropolitan Areas Classification.
Rural, Remote and Metropolitan Areas Classification has the meaning given by subrule 3 (1) of Part 2 of Schedule 1 to the general medical services table.
SLA means a Statistical Local Area specified in the ASGC.
SSD means a Statistical Subdivision specified in the ASGC.
55028 | Head, ultrasound scan of, if:
| 109.10 | ||
55029 | Head, ultrasound scan of, if the patient is not referred by a medical practitioner, not being a service associated with a service to which an item in Subgroup 2 or 3 applies (NR) | 37.85 | ||
55030 | Orbital contents, ultrasound scan of, if:
| 109.10 | ||
55031 | Orbital contents, ultrasound scan of, if the patient is not referred by a medical practitioner, not being a service associated with a service to which an item in Subgroup 2 or 3 applies (NR) | 37.85 | ||
55032 | Neck, 1 or more structures of, ultrasound scan of, if:
| 109.10 | ||
55033 | Neck, 1 or more structures of, ultrasound scan of, if the patient is not referred by a medical practitioner, not being a service associated with a service to which an item in Subgroup 2 or 3 applies (NR) | 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 | ||
55044 | Pelvis, male, ultrasound scan of, by any or all approaches, if:
| 111.30 | ||
| ||||
55045 | Pelvis, male, ultrasound scan of, by any or all approaches, if:
| 37.85 | ||
55048 | Scrotum, ultrasound scan of, if:
| 109.50 | ||
55049 | Scrotum, ultrasound scan of, if the patient is not referred by a medical practitioner, not being a service associated with a service to which an item in Subgroup 2 or 3 applies (NR) | 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) | 109.10 | ||
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: | 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:
| 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:
| 230.65 | ||
| ||||
55116 | Exercise stress echocardiography performed in conjunction with item 11712:
| 261.65 | ||
| ||||
55117 | Pharmacological stress echocardiography performed in conjunction with item 11712:
| 261.65 | ||
| ||||
55118 | Heart, two‑dimensional real time transoesophageal examination of, from at least 2 levels, and in more than 1 plane at each level:
| 275.50 | ||
| ||||
55130 | Intra‑operative 2 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 applies (R) (Anaes.) | 170.00 | ||
55135 | Intra‑operative 2 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 applies (R) (Anaes.) | 353.60 | ||
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 item 55054) or 4 applies (R) | 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 item 55054) or 4 applies (R) | 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 item 55054) or 4 applies (R) | 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 item 55054) or 4 applies (R) | 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 item 55054) or 4 applies (R) | 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 item 55054) or 4 applies (R) | 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 item 55054) or 4 applies (R) | 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 item 55054) or 4 applies (R) | 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 item 55054) or 4 applies (R) | 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 item 55054) or 4 applies (R) | 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 item 55054), 3 or 4 applies (R) | 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 item 55054), 3 or 4 applies (R) | 111.05 | ||
55600 | Prostate, bladder base and urethra, transrectal ultrasound scan of, if performed:
| 109.10 | ||
| ||||
55603 | Prostate, bladder base and urethra, transrectal ultrasound scan of, if performed:
| 109.10 | ||
| ||||
55700 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, ultrasound scan of, by any or all approaches, if:
| 60.00 | ||
| ||||
| ||||
| ||||
suspected or known uterine abnormality;
| ||||
55703 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, ultrasound scan of, by any or all approaches, if:
| 35.00 | ||
| ||||
| ||||
| ||||
| ||||
| ||||
suspected or known uterine abnormality;
| ||||
55704 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:
| 70.00 | ||
| ||||
| ||||
suspected or known uterine abnormality;
| ||||
55705 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:
| 35.00 | ||
| ||||
| ||||
| ||||
| ||||
suspected or known uterine abnormality;
| ||||
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 | ||
(Item is subject to subrule 11 (2)) | ||||
55707 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:
| 70.00 | ||
| ||||
| ||||
(Item is subject to subrule 11 (2)) | ||||
55708 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:
(Item is subject to subrule 11 (2)) | 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 | ||
(Item is subject to subrule 11 (2)) | ||||
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:
| 115.00 | ||
| ||||
| ||||
| ||||
| ||||
55715 | 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, performed by or on behalf of a medical practitioner who is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, if: | 40.00 | ||
| ||||
| ||||
| ||||
55718 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:
| 100.00 | ||
| ||||
| ||||
| ||||
| ||||
| ||||
alloimmunisation;
| ||||
drug dependency; | ||||
gross maternal obesity; advanced maternal age; | ||||
abdominal pain or mass (R) (Item is subject to subrule 11 (2)) | ||||
55721 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:
| 115.00 | ||
| ||||
| ||||
| ||||
55723 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:
| 38.00 | ||
| ||||
| ||||
| ||||
| ||||
| ||||
| ||||
| ||||
alloimmunisation; | ||||
| ||||
drug dependency;
gross maternal obesity; advanced maternal age; abdominal pain or mass (NR) (Item is subject to subrule 11 (2)) | ||||
55725 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, performed by or on behalf of a medical practitioner who is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, if: | |||
98.90 | ||||
60918 | Arteriography (peripheral) or phlebography — 1 vessel, when used in association with a service to which item 59903, 59912, 59925, 59970, 59971, 59972, 59973 or 59974 applies, not being a service associated with a service to which any of items 60000 to 60078 apply (NR) (Anaes.) | 47.15 | ||
60927 | Selective arteriogram or phlebogram, when used in association with a service to which item 59903, 59912, 59925, 59970, 59971, 59972, 59973 or 59974 applies, not being a service associated with a service to which any of items 60000 to 60078 apply (NR) (Anaes.) | 38.05 | ||
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 table applies (R) | 258.90 | ||
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, with planar imaging and single photon emission tomography, or planar imaging or single photon emission tomography (R) | 367.30 | ||
61313 | Gated cardiac blood pool study, (equilibrium), with planar imaging and single photon emission tomography, or planar imaging or single photon emission tomography (R) | 303.35 | ||
61314 | Gated cardiac blood pool study, and first pass blood flow or cardiac shunt study, with planar imaging and single photon emission tomography, or planar imaging, or single photon emission tomography (R) | 420.00 | ||
61316 | Gated cardiac blood pool study, with intervention, with planar imaging and single photon emission tomography, or planar imaging, or single photon emission tomography (R) | 381.15 | ||
61317 | Gated cardiac blood pool study, with intervention and first pass blood flow study or cardiac shunt study, with planar imaging and single photon emission tomography or planar imaging, or single photon emission tomography (R) | 492.40 | ||
61320 | Cardiac first pass blood flow study or cardiac shunt study, not being a service to which another item in this group applies (R) | 228.90 | ||
61328 | Lung perfusion study, with planar imaging and single photon emission tomography or planar imaging, or single photon emission tomography (R) | 227.65 | ||
61340 | Lung ventilation study using aerosol, technegas or xenon gas, with planar imaging and single photon emission tomography or planar imaging or single photon emission tomography (R) | 253.00 | ||
61348 | Lung perfusion study and lung ventilation study using aerosol, technegas or xenon gas, with planar imaging and single photon emission tomography, or planar imaging, or single photon emission tomography (R) | 443.35 | ||
61352 | Liver and spleen study (colloid) — planar imaging (R) | 259.35 | ||
61353 | Liver and spleen study (colloid), with single photon emission tomography and with planar imaging when performed (R) | 386.60 | ||
61356 | Red blood cell spleen or liver study, including single photon emission tomography when performed (R) | 392.80 | ||
61360 | Hepatobiliary study, including morphine administration or pre‑treatment with cholecystokinin (CCK) when performed (R) | 403.35 | ||
61361 | Hepatobiliary study with formal quantification following baseline imaging, using an infusion of cholecystokinin (CCK) (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:
| 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 following 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 | ||
61401 | Testicular study (R) | 162.30 | ||
61402 | Cerebral perfusion study, with single photon emission tomography and with planar imaging when performed (R) | 605.05 | ||
61405 | Brain study with blood brain barrier agent, with planar imaging and single photon emission tomography, or planar imaging, or single photon emission tomography (R) | 346.00 | ||
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 | ||
61417 | Dynamic blood flow study or regional blood volume quantitative study, not being a service associated with a service to which another item in this group applies (R) | 118.85 | ||
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 | ||
61437 | Whole body study using thallium (R) | 542.75 | ||
61438 | Whole body study using thallium, with single photon emission tomography (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 | Localised bone or joint study, including when undertaken, blood flow, blood pool and repeat imaging on a separate occasion (R) | 333.55 | ||
61449 | Localised bone or joint study and single photon emission tomography, including when undertaken, blood flow, blood pool and 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 | ||
61458 | Localised study using thallium (R) | 396.95 | ||
61461 | Localised study using thallium, with single photon emission tomography (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, 61484 or 61485, if there is no additional administration of radiopharmaceutical and if the previous radionuclide scan was abnormal or equivocal (R) | 129.00 | ||
61465 | Venography (R) | 265.50 | ||
61469 | Lymphoscintigraphy (R) | 348.10 | ||
61473 | Thyroid study including uptake measurement when performed (R) | 175.40 | ||
61480 | Parathyroid study, planar imaging and single photon emission tomography when performed (R) | 386.85 | ||
61484 | Adrenal study (R) | 880.85 | ||
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 performed at the same time and covering the same body area as single photon emission tomography for the purpose of anatomic localisation or attenuation correction if no separate diagnostic CT report is issued and only in association with items 61302 to 61650 (R) | 100.00 | ||
61523 | Whole body FDG PET study, performed for evaluation of a solitary pulmonary nodule, if:
| 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 | ||
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 | ||
61544 | 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, with catheterisation of the bladder (R) | 975.00 | ||
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 | ||
61556 | 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, with catheterisation of the bladder (R) | 1 021.00 | ||
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 | ||
61568 | 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, with catheterisation of the bladder (R) | 975.00 | ||
61577 | Whole body FDG PET study, performed for the staging of proven oesophageal or GEJ carcinoma, in a patient considered suitable for active therapy (R) | 953.00 | ||
61580 | Whole body FDG PET study, performed for the staging of proven oesophageal or GEJ carcinoma, in a patient considered suitable for active therapy, with catheterisation of the bladder (R) | 975.00 | ||
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 | ||
61613 | Whole body FDG PET study performed for the evaluation of metastatic squamous cell carcinoma from an unknown primary site involving cervical nodes, with catheterisation of the bladder (R) | 975.00 | ||
61650 | LeukoScan study of the long bones and feet for suspected osteomyelitis, if patient does not have access to ex-vivo white blood cell scanning (R) | 878.70 | ||
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 | ||
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 | ||
63101 | MRI and MRA of extracranial or intracranial circulation (or both) — scan of head and neck vessels for stroke (R) (Anaes.) (Contrast) | 492.80 | ||
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 | ||
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 | ||
63151 | MRI — scan of 1 region or 2 contiguous regions of the spine for infection (R) (Anaes.) (Contrast) | 358.40 | ||
63154 | MRI — scan of 1 region or 2 contiguous regions of the spine for tumour (R) (Anaes.) (Contrast) | 358.40 | ||
63161 | MRI — scan of 1 region or 2 contiguous regions of the spine for demyelinating disease (R) (Anaes.) (Contrast) | 358.40 | ||
63164 | MRI — scan of 1 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 1 region or 2 contiguous regions of the spine for myelopathy (R) (Anaes.) (Contrast) | 358.40 | ||
63170 | MRI — scan of 1 region or 2 contiguous regions of the spine for syrinx (congenital or acquired) (R) (Anaes.) (Contrast) | 358.40 | ||
63173 | MRI — scan of 1 region or 2 contiguous regions of the spine for cervical radiculopathy (R) (Anaes.) (Contrast) | 358.40 | ||
63176 | MRI — scan of 1 region or 2 contiguous regions of the spine for sciatica (R) (Anaes.) (Contrast) | 358.40 | ||
63179 | MRI — scan of 1 region or 2 contiguous regions of the spine for spinal canal stenosis (R) (Anaes.) (Contrast) | 358.40 | ||
63182 | MRI — scan of 1 region or 2 contiguous regions of the spine for previous spinal surgery (R) (Anaes.) (Contrast) | 358.40 | ||
63185 | MRI — scan of 1 region or 2 contiguous regions of the spine for trauma (R) (Anaes.) | 358.40 | ||
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 | ||
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 | ||
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 | ||
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 | |||
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 1 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 | ||
63361 | MRI — scan of musculoskeletal system for Gaucher disease (R) (Anaes.) | 403.20 | ||
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 | ||
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 | ||
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 | ||
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 | ||
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 | ||
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 scan identifies that the woman is asymptomatic and is less than 50 years of age, and the request for the scan identifies:
| 690.00 | ||
| ||||
| ||||
| ||||
63467 | MRI — scan of both breasts for the detection of cancer, if:
| 690.00 | ||
63470 | MRI — scan of the pelvis for the staging of histologically diagnosed cervical cancer at FIGO stage 1B or greater, if the request for scan identifies that:
| 403.20 | ||
63473 | MRI — scan of the pelvis and upper abdomen, in a single examination, for the staging of histologically diagnosed cervical cancer at FIGO stage 1B or greater, if the request for scan identifies that:
| 627.20 | ||
63476 | MRI — scan of the pelvis for the initial staging of rectal cancer, if:
| 403.20 | ||
63482 | MRI — scan of pancreas and biliary tree for suspected biliary or pancreatic pathology (R) (Anaes.) | 403.20 | ||
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 | ||
| ||||
64990 | A diagnostic imaging service to which an item in this table (other than this item or item 64991) applies if:
| 6.50 | ||
| ||||
64991 | A diagnostic imaging service to which an item in this table (other than this item or item 64990) applies if:
| 9.80 | ||
| ||||
| ||||
| ||||
The
2009 No. 271 | 12 Oct 2009 ( | 1 Nov 2009 | |
2009 No. 286 | 2 Nov 2009 ( | Rr. 1–3 and Schedule 1: 9 Nov 2009 Schedule 2: 1 Jan 2010 | — |
2009 No. 305 | 13 Nov 2009 ( | 1 Jan 2010 | — |
2009 No. 370 | 15 Dec 2009 ( | 1 July 2010 | — |
2010 No. 65 | 16 Apr 2010 ( | Rr. 1–3 and Schedule 1: 1 May 2010
Schedule 2: | — |
(a) Regulation 2 (b) of theHealth Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2010 (No. 1) (SLI 2010 No. 65) provides as follows:These Regulations commence as follows:
(b) immediately after the commencement of Schedule 1 to the
Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2009 (No 6) — Schedule 2.
| |
Schedule 1............................ | am. 2009 Nos. 286, 305 and 370; 2010 No. 65 |
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