Health Insurance (Diagnostic Imaging Services Table) Regulations 2017 (Cth)

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Health Insurance (Diagnostic Imaging Services Table) Regulations 2017

made under the

Health Insurance Act 1973

Compilation No. 2

Compilation date:  1 May 2018

Includes amendments up to:            F2018L00514

Registered:  8 May 2018

About this compilation

This compilation

This is a compilation of the Health Insurance (Diagnostic Imaging Services Table) Regulations 2017 that shows the text of the law as amended and in force on 1 May 2018 (the compilation date).

The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.

Uncommenced amendments

The effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Legislation Register ( The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the series page on the Legislation Register for the compiled law.

Application, saving and transitional provisions for provisions and amendments

If the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.

Editorial changes

For more information about any editorial changes made in this compilation, see the endnotes.

Modifications

If the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the series page on the Legislation Register for the compiled law.

Self‑repealing provisions

If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.

Contents

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

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

5............................ Diagnostic imaging services table................................................................. 1

6............................ Dictionary..................................................................................................... 1

Schedule 1—Diagnostic imaging services table  2

Part 1—Preliminary  2

Division 1.1—Interpretation  2

1.1.1...................... References to diagnostic imaging services.................................................... 2

Division 1.2—General application provisions  2

Subdivision A—Capital sensitivity  2

1.2.1...................... Application of (K) items and (NK) items...................................................... 2

1.2.2...................... Age of equipment.......................................................................................... 2

1.2.3...................... Exemptions from capital sensitivity............................................................... 4

1.2.4...................... Reconsideration of exemption decisions....................................................... 5

1.2.5...................... Delegation..................................................................................................... 6

Subdivision B—Other provisions  6

1.2.6...................... Meaning of symbols (R) and (NR) in the table............................................. 6

1.2.7...................... Who may provide a diagnostic imaging service............................................ 6

1.2.8...................... Report requirements for certain services....................................................... 6

1.2.9...................... Bulk‑billing incentive.................................................................................... 6

1.2.10.................... Bulk‑billing—magnetic resonance imaging................................................... 7

1.2.11.................... Multiple services—vascular ultrasound........................................................ 7

1.2.12.................... Multiple services........................................................................................... 7

1.2.13.................... Application of items—services provided with autologous injections of blood or blood products            9

Part 2—Services and fees  10

Division 2.1—Group I1: ultrasound  10

Subdivision A—General  10

2.1.1...................... Ultrasound services—eligible services........................................................ 10

2.1.2...................... Ultrasound services—R‑type eligible services............................................ 10

Subdivision B—Subgroups 1 to 4 of Group I1  11

2.1.3...................... Certain items taken to include referred by dental practitioner or referring dental practitioner   11

Subdivision C—Subgroup 5 of Group I1: obstetric and gynaecological  27

2.1.4...................... Obstetric and gynaecological ultrasound services—limits........................... 27

2.1.5...................... Obstetric and gynaecological services—referrals and clinical notes............ 27

2.1.6...................... Obstetric and gynaecological services—conditions..................................... 27

Subdivision D—Subgroup 6 of Group I1: musculoskeletal ultrasound  44

2.1.7...................... Musculoskeletal ultrasound services—personal attendance........................ 44

2.1.8...................... Musculoskeletal ultrasound services—comparison ultra‑sonography......... 45

2.1.9...................... Musculoskeletal ultrasound services—equipment....................................... 45

Division 2.2—Group I2: computed tomography (examination)  57

2.2.1...................... CT services—eligible services.................................................................... 57

2.2.2...................... CT services—exclusion of attenuation correction and anatomical correlation 57

2.2.3...................... CT services—exclusion of acoustic neuroma.............................................. 57

2.2.4...................... CT services—assessment of headache........................................................ 57

2.2.5...................... CT services—number of services............................................................... 58

2.2.6...................... Cone bean computed tomography—items 57362 and 57363...................... 58

Division 2.3—Group I3: diagnostic radiology  67

Subdivision A—General  67

2.3.1...................... Who must perform diagnostic imaging procedure....................................... 67

2.3.1A................... Limitation of items—certain services requested by chiropractors, osteopaths and physiotherapists         67

Subdivision B—Subgroups 1 to 9 of Group I3  67

Subdivision C—Subgroup 10 of Group I3: radiographic examination of breasts         73

2.3.2...................... Mammography services—eligible services................................................. 73

Subdivision D—Subgroups 12 to 14 of Group I3  75

Subdivision E—Subgroup 15 of Group I3: fluoroscopic examination  79

Subdivision F—Subgroup 16 of Group I3: preparation for radiological procedure     80

2.3.3...................... Preparation of patients for radiological procedures..................................... 80

Subdivision G—Subgroup 17 of Group I3: interventional techniques  80

2.3.4...................... Meaning of angiography suite..................................................................... 80

Division 2.4—Group I4: nuclear medicine imaging  81

2.4.1...................... Nuclear scanning services—other than PET............................................... 81

2.4.2...................... PET nuclear scanning services.................................................................... 81

2.4.3...................... PET nuclear scanning services—performance under personal supervision. 81

2.4.4...................... PET nuclear scanning services—equipment................................................ 82

2.4.5...................... PET nuclear scanning services—statutory declaration................................ 82

Division 2.5—Group I5: magnetic resonance imaging  91

Subdivision A—General  91

2.5.1...................... MRI and MRA services—eligible services................................................. 91

2.5.2...................... MRI and MRA services—request.............................................................. 92

2.5.3...................... MRI and MRA services—permissible circumstances for performance...... 92

2.5.4...................... MRI and MRA services—eligible provider................................................ 92

2.5.5...................... MRI and MRA services—eligible equipment............................................. 93

2.5.6...................... MRI and MRA services—partial eligible equipment.................................. 93

2.5.7...................... MRI and MRA services—meaning of scan................................................ 94

2.5.8...................... MRI and MRA services—multiple services............................................... 94

2.5.9...................... MRI or MRA services—application of items to related services provided in same period      94

Subdivision B—Subgroups 1 to 19 of Group I5  95

Subdivision C—Subgroup 20 of Group I5: scans of pelvis and upper abdomen for specified conditions           106

2.5.10.................... MRI services—limits for certain items...................................................... 106

2.5.11.................... MRI and MRA services—modifying items.............................................. 106

Subdivision D—Subgroups 21 and 22 of Group I5  108

Subdivision E—Subgroup 33 of Group I5  109

Subdivision F—Subgroup 34 of Group I5  110

Division 2.6—Group I6: management of bulk‑billed services  111

2.6.1...................... Application of items 64990 and 64991..................................................... 111

Part 3—Dictionary  114

3.1......................... Dictionary................................................................................................. 114

Endnotes118

Endnote 1—About the endnotes  118

Endnote 2—Abbreviation key  119

Endnote 3—Legislation history  120

Endnote 4—Amendment history  121

1  Name

This instrument is the Health Insurance (Diagnostic Imaging Services Table) Regulations 2017.

3  Authority

This instrument is made under the Health Insurance Act 1973.

5  Diagnostic imaging services table

For the purposes of subsection 4AA(1) of the Act, Schedule 1 prescribes a table of diagnostic imaging services.

6  Dictionary

The Dictionary in Part 3 of Schedule 1 defines certain words and expressions that are used in this instrument, and includes references to certain words and expressions that are defined elsewhere in this instrument.

Schedule 1—Diagnostic imaging services table

Note:       See section 5.

Part 1—Preliminary

Division 1.1—Interpretation

1.1.1  References to diagnostic imaging services

A reference to a diagnostic imaging service in an item in Part 2 includes a reference to the undertaking of the diagnostic imaging procedure used for rendering the service.

Division 1.2—General application provisions

Subdivision A—Capital sensitivity

1.2.1  Application of (K) items and (NK) items

(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.

1.2.2  Age of equipment

Age of equipment

(1)  The date from which the age of equipment is worked out for this instrument 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 and maximum extended life age for equipment are the periods set out in the following table for that type of equipment:

Life ages
Item

Column 1

Topic

Column 2

Modality

Column 3

New effective life age (years)

Column 4

Maximum extended life age (years)
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 15
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 15
5 Rest of diagnostic radiology Equipment used to perform a service to which an item in Subgroups 1 to 9, 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 20

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

(aa)  in the case of CT or angiography equipment that was not more than 15 years old on 1 January 2015—an additional reasonable investment has been made before 1 January 2016 that improves the overall performance of the imaging system so that it is equivalent to new equipment supplied in Australia at the time of the improvement; or

(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 ( Exemptions 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 instrument.

(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 instrument.

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

(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 instrument.

(7)  An application under subclause (6) must be made in writing to the Department.

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 the purposes of 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 the purposes of 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 the purposes of subclause (1):

(a)  if 2 or more applicable fees are equally the highest:

(i)  only one of those fees is taken to be the highest fee; and

(ii)  the other, or another, highest fee is taken to be the second highest fee; and

(b)  if 2 or more fees are equally second highest—any one of those fees may be taken to be the second highest for the purpose of paragraph (1)(b); and

(c)  if a reduced fee calculated under subclause (1) is not a multiple of 5 cents—the reduced fee is taken to be the nearest amount that is a multiple of 5 cents.

(3)  This clause does not apply to the fee specified in item 64990 or 64991.

1.2.12  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 the purposes of subclause (2), if more than one consultation has occurred, the relevant consultation is the consultation having the highest fee set out in the items that apply to the consultation.

(4)  If a medical practitioner renders at least one R‑type diagnostic imaging service and at least one non‑consultation service for the same patient on the same day, the highest fee that applies to any diagnostic imaging services performed by the medical practitioner for the same patient on the same day, is reduced by $5.

(5)  If a medical practitioner renders an R‑type diagnostic imaging service, a consultation and a non‑consultation service for the same patient on the same day, the sum of the reductions under subclauses (2) and (4) must not exceed the highest fee that applies to any diagnostic imaging services rendered by the medical practitioner for the same patient on the same day.

(6)  Clauses 1.2.11 and 2.5.8 apply, subject to subclauses (7) and (8), in addition to this clause.

(7)  For the purposes of 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 the purposes of clause 2.5.8, if a medical practitioner provides:

(a)  2 or more MRI services mentioned in Subgroup 12 or 13 of 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.

1.2.13  Application of items—services provided with autologous injections of blood or blood products

An item in the table does not apply to a service mentioned in the item if the service is provided to a patient at the same time as, or in connection with, an injection of blood or a blood product that is autologous.

Part 2—Services and fees

Division 2.1—Group I1: ultrasound

Subdivision A—General

2.1.1  Ultrasound services—eligible services

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.

2.1.2  Ultrasound services—R‑type eligible services

(1)  Items in this Division (except items 55600, 55601, 55603 and 55604) marked with the symbol (R) apply to an ultrasound service (the eligible service) only if the service is performed:

(a)  under the supervision of a specialist or a consultant physician in the practice of 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 supervision of a practitioner who:

(i)  is not a specialist or consultant physician; and

(ii)  meets the requirement of subclause (2); and

(iii)  is available to monitor and influence the conduct and diagnostic quality of the examination and, if necessary, to attend on the patient personally; or

(c)  in the circumstance mentioned in subclause (3), and under the supervision of a practitioner who is available:

(i)  to monitor and influence the conduct and diagnostic quality of the examination; and

(ii)  if necessary, to attend on the patient personally; or

(d)  if paragraph (a), (b) or (c) cannot be complied with:

(i)  in an emergency; or

(ii)  in a location that is not less than 30 kilometres by the most direct road route from another practice where services that comply with paragraph (a) or (b) are available.

(2)  For the purposes of subparagraph (1)(b)(ii), the requirement is that, between 1 September 1997 and 31 August 1999, at least 50 services were rendered by or on behalf of the practitioner at the location where the eligible service was rendered, and the rendering of those services entitled payment of medicare benefits.

(3)  For the purposes of paragraph (1)(c), the circumstance is that, between 1 September 1997 and 31 August 1999, at least 50 services were rendered in nursing homes or patients’ residences by or on behalf of the practitioner, and the rendering of those services entitled payment of medicare benefits.

Subdivision B—Subgroups 1 to 4 of Group I1

2.1.3  Certain items taken to include referred by dental practitioner or referring dental practitioner

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.

Group I1—Ultrasound
Item Description Fee ($)
Subgroup 1—General
55005

Head, ultrasound scan of, if:

(a) the patient is referred by a medical practitioner; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (R) (NK)

 54.55
55007

Head, ultrasound scan of, if:

(a) the patient is not referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (NR) (NK)

 18.95
55008

Orbital contents, ultrasound scan of, if:

(a) the patient is referred by a medical practitioner; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (R) (NK)

 54.55
55010

Orbital contents, ultrasound scan of, if:

(a) the patient is not referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (NR) (NK)

 18.95
55011

Neck, one or more structures of, ultrasound scan of, if:

(a) the patient is referred by a medical practitioner; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (R) (NK)

 54.55
55013

Neck, one or more structures of, ultrasound scan of, if:

(a) the patient is not referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (NR) (NK)

 18.95
55014

Abdomen, ultrasound scan of (including scan of urinary tract when performed), if:

(a) the patient is referred by a medical practitioner or participating nurse practitioner; and

(b) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner; and

(d) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(e) the service is not solely a transrectal ultrasonic examination of the prostate gland, bladder base and urethra, or any of those organs; and

(f) within 24 hours of the service, a service mentioned in item 55017, 55038, 55065 or 55067 is not performed on the same patient by the providing practitioner (R) (NK)

 55.65
55016

Abdomen, ultrasound scan of (including scan of urinary tract when performed), if:

(a) the patient is not referred by a medical practitioner or participating nurse practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(c) the service is not solely a transrectal ultrasonic examination of the prostate gland, bladder base and urethra, or any of those organs (NR) (NK)

 18.95
55017

Urinary tract, ultrasound scan of, if:

(a) the patient is referred by a medical practitioner; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) the service is not solely a transrectal ultrasonic examination of the prostate gland, bladder base and urethra, or any of those organs; and

(e) within 24 hours of the service, a service mentioned in item 55014, 55038, 55065 or 55067 is not performed on the same patient by the providing practitioner (R) (NK)

 54.55
55019

Urinary tract, ultrasound scan of, if:

(a) the patient is not referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(c) the service is not solely a transrectal ultrasonic examination of the prostate gland, bladder base and urethra, or any of those organs (NR) (NK)

 18.95
55023

Scrotum, ultrasound scan of, if:

(a) the patient is referred by a medical practitioner; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (R) (NK)

 54.75
55025

Scrotum, ultrasound scan of, if:

(a) the patient is not referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (NR) (NK)

 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:

(a) the patient is referred by a medical practitioner; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (R) (K)

 109.10
55029

Head, ultrasound scan of, if:

(a) the patient is not referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (NR) (K)

 37.85
55030

Orbital contents, ultrasound scan of, if:

(a) the patient is referred by a medical practitioner; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (R) (K)

 109.10
55031

Orbital contents, ultrasound scan of, if:

(a) the patient is not referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (NR) (K)

 37.85
55032

Neck, one or more structures of, ultrasound scan of, if:

(a) the patient is referred by a medical practitioner; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (R) (K)

 109.10
55033

Neck, one or more structures of, ultrasound scan of, if:

(a) the patient is not referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (NR) (K)

 37.85
55036

Abdomen, ultrasound scan of (including scan of urinary tract when performed), if:

(a) the patient is referred by a medical practitioner or participating nurse practitioner for ultrasonic examination; and

(b) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner; and

(d) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(e) the service is not solely a transrectal ultrasonic examination of the prostate gland, bladder base and urethra, or any of those organs; and

(f) within 24 hours of the service, a service mentioned in item 55017, 55038, 55065 or 55067 is not performed on the same patient by the providing practitioner (R) (K)

 111.30
55037

Abdomen, ultrasound scan of (including scan of urinary tract when performed), if:

(a) the patient is not referred by a medical practitioner or participating nurse practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(c) the service is not solely a transrectal ultrasonic examination of the prostate gland, bladder base and urethra, or any of those organs (NR) (K)

 37.85
55038

Urinary tract, ultrasound scan of, if:

(a) the patient is referred by a medical practitioner for ultrasonic examination; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) the service is not solely a transrectal ultrasonic examination of the prostate gland, bladder base and urethra, or any of those organs; and

(e) within 24 hours of the service, a service mentioned in item 55017, 55036, 55065 or 55067 is not performed on the same patient by the providing practitioner (R) (K)

 109.10
55039

Urinary tract, ultrasound scan of, if:

(a) the patient is not referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(c) the service is not solely a transrectal ultrasonic examination of the prostate gland, bladder base and urethra, or any of those organs (NR) (K)

 37.85
55048

Scrotum, ultrasound scan of, if:

(a) the patient is referred by a medical practitioner; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (R) (K)

 109.50
55049

Scrotum, ultrasound scan of, if:

(a) the patient is not referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (NR) (K)

 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:

(a) the patient is referred by a medical practitioner or participating nurse practitioner; and

(b) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner; and

(d) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (R) (NK)

 49.15
55060

Breast, one, ultrasound scan of, if:

(a) the patient is not referred by a medical practitioner or participating nurse practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (NR) (NK)

 17.05
55061

Breasts, both, ultrasound scan of, if:

(a) the patient is referred by a medical practitioner or participating nurse practitioner; and

(b) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner; and

(d) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (R) (NK)

 54.55
55062

Breasts, both, ultrasound scan of, if:

(a) the patient is not referred by a medical practitioner or participating nurse practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (NR) (NK)

 18.95
55063

Urinary bladder, ultrasound scan of, by any or all approaches, if:

(a) the patient is referred by a medical practitioner for ultrasonic examination; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) within 24 hours of the service, a service mentioned in item 11917, 55014, 55017, 55036, 55038, 55065, 55067, 55600, 55601, 55603 or 55604 is not performed on the same patient by the providing practitioner (R) (NK)

 49.15
55064

Urinary bladder, ultrasound scan of, by any or all approaches, if:

(a) the patient is not referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(c) within 24 hours of the service, a service mentioned in item 11917, 55016, 55019, 55037, 55039, 55068, 55069, 55600, 55601, 55603 or 55604 is not performed on the same patient by the providing practitioner (NR) (NK)

 17.05
55065

Pelvis, ultrasound scan of, by any or all approaches, if:

(a) the patient is referred by a medical practitioner for ultrasonic examination; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) the service is not solely a transrectal ultrasonic examination of the prostate gland, bladder base and urethra, or any of those organs; and

(e) within 24 hours of the service, a service mentioned in item 55014, 55017, 55036 or 55038 is not performed on the same patient by the providing practitioner (R) (K)

 98.25
55067

Pelvis, ultrasound scan of, by any or all approaches, if:

(a) the patient is referred by a medical practitioner for ultrasonic examination; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) the service is not solely a transrectal ultrasonic examination of the prostate gland, bladder base and urethra, or any of those organs; and

(e) within 24 hours of the service, a service mentioned in item 55014, 55017, 55036 or 55038 is not performed on the same patient by the providing practitioner (R) (NK)

 50.25
55068

Pelvis, ultrasound scan of, by any or all approaches, if:

(a) the patient is not referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(c) the service is not solely a transrectal ultrasonic examination of the prostate gland, bladder base and urethra, or any of those organs (NR) (K)

 35.00
55069

Pelvis, ultrasound scan of, by any or all approaches, if:

(a) the patient is not referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(c) the service is not solely a transrectal ultrasonic examination of the prostate gland, bladder base and urethra, or any of those organs (NR) (NK)

 17.85
55070

Breast, one, ultrasound scan of, if:

(a) the patient is referred by a medical practitioner or participating nurse practitioner; and

(b) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner; and

(d) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (R) (K)

 98.25
55073

Breast, one, ultrasound scan of, if:

(a) the patient is not referred by a medical practitioner or participating nurse practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (NR) (K)

 34.05
55076

Breasts, both, ultrasound scan of, if:

(a) the patient is referred by a medical practitioner or participating nurse practitioner; and

(b) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) if the patient is referred by a participating nurse practitioner—the nurse practitioner does not have a business or financial arrangement with the providing practitioner; and

(d) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (R) (K)

 109.10
55079

Breasts, both, ultrasound scan of, if:

(a) the patient is not referred by a medical practitioner or participating nurse practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies (NR) (K)

 37.85
55084

Urinary bladder, ultrasound scan of, by any or all approaches, if:

(a) the patient is referred by a medical practitioner; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) within 24 hours of the service, a service mentioned in item 11917, 55014, 55017, 55036, 55038, 55065, 55067, 55600, 55601, 55603 or 55604 is not performed on the same patient by the providing practitioner (R) (K)

 98.25
55085

Urinary bladder, ultrasound scan of, by any or all approaches, if:

(a) the patient is not referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(c) within 24 hours of the service, a service mentioned in item 11917, 55016, 55019, 55037, 55039, 55068, 55069, 55600, 55601, 55603 or 55604 is not performed on the same patient by the providing practitioner (NR) (K)

 34.05
Subgroup 2—Cardiac
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:

(i) measurement of blood flow velocities across the cardiac valves using pulsed wave and continuous wave Doppler techniques; and

(ii) real time colour flow mapping from at least 2 acoustic windows; and

(iii) recordings on video tape or digital media; and

(b) not being a service associated with a service to which an item in Subgroup 1 (except items 55026 and 55054) or 3, or another item in this Subgroup (except items 55118, 55125, 55130 and 55131), applies (R) (K)

 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:

(i) measurement of blood flow velocities across the cardiac valves using pulsed wave and continuous wave Doppler techniques; and

(ii) real time colour flow mapping from at least 2 acoustic windows; and

(iii) recordings on video tape or digital media; and

(b) not being a service associated with a service to which an item in Subgroup 1 (except items 55026 and 55054) or 3, or another item in this Subgroup (except items 55118, 55125, 55130 and 55131), applies (R) (K)

 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:

(i) measurement of blood flow velocities across the cardiac valves using pulsed wave and continuous wave Doppler techniques; and

(ii) real time colour flow mapping from at least 2 acoustic windows; and

(iii) recordings on video tape or digital media; and

(b) not being a service associated with a service to which an item in Subgroup 1 (except items 55026 and 55054) or 3, or another item in this Subgroup (except items 55118, 55125, 55130 and 55131), applies (R) (K)

 230.65
55116

Exercise stress echocardiography performed in conjunction with item 11712:

(a) with:

(i) two‑dimensional recordings before exercise (baseline) from at least 3 acoustic windows; and

(ii) matching recordings from the same windows at, or immediately after, peak exercise; and

(iii) recordings on digital media with equipment permitting display of baseline and matching peak images on the same screen; and

(b) not being a service associated with a service to which an item in Subgroup 1 (except items 55026 and 55054) or 3, or another item in this Subgroup (except items 55118, 55125, 55130 and 55131), applies (R) (K)

 261.65
55117

Pharmacological stress echocardiography performed in conjunction with item 11712:

(a) with:

(i) two‑dimensional recordings before drug infusion (baseline) from at least 3 acoustic windows; and

(ii) matching recordings from the same windows at least twice during drug infusion, including a recording at the peak drug dose; and

(iii) recordings on digital media with equipment permitting display of baseline and matching peak images on the same screen; and

(b) not being a service associated with a service to which an item in Subgroup 1 (except items 55026 and 55054) or 3, or another item in this Subgroup (except items 55118, 55125, 55130 and 55131), applies (R) (K)

 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:

(i) real time colour flow mapping and, if indicated, pulsed wave Doppler examination; and

(ii) recordings on video tape or digital medium; and

(b) not being an intra‑operative service or a service associated with a service to which an item in Subgroup 1 (except items 55026 and 55054) or 3 applies (R) (K) (Anaes.)

 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:

(i) measurement of blood flow velocities across the cardiac valves using pulsed wave and continuous wave Doppler techniques; and

(ii) real time colour flow mapping from at least 2 acoustic windows; and

(iii) recordings on video tape or digital media; and

(b) not being a service associated with a service to which an item in Subgroup 1 (except items 55026 and 55054) or 3, or another item in this Subgroup (except items 55118, 55125, 55130 and 55131), applies (R) (NK)

 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:

(i) measurement of blood flow velocities across the cardiac valves using pulsed wave and continuous wave Doppler techniques; and

(ii) real time colour flow mapping from at least 2 acoustic windows; and

(iii) recordings on video tape or digital media; and

(b) not being a service associated with a service to which an item in Subgroup 1 (except items 55026 and 55054) or 3, or another item in this Subgroup (except items 55118, 55125, 55130 and 55131), applies (R) (NK)

 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:

(i) measurement of blood flow velocities across the cardiac valves using pulsed wave and continuous wave Doppler techniques; and

(ii) real time colour flow mapping from at least 2 acoustic windows; and

(iii) recordings on video tape or digital media; and

(b) not being a service associated with a service to which an item in Subgroup 1 (except items 55026 and 55054) or 3, or another item in this Subgroup (except items 55118, 55125, 55130 and 55131), applies (R) (NK)

 115.35
55122

Exercise stress echocardiography performed in conjunction with item 11712:

(a) with:

(i) two‑dimensional recordings before exercise (baseline) from at least 3 acoustic windows; and

(ii) matching recordings from the same windows at, or immediately after, peak exercise; and

(iii) recordings on digital media with equipment permitting display of baseline and matching peak images on the same screen; and

(b) not being a service associated with a service to which an item in Subgroup 1 (except items 55026 and 55054) or 3, or another item in this Subgroup (except items 55118, 55125, 55130 and 55131), applies (R) (NK)

 130.85
55123

Pharmacological stress echocardiography performed in conjunction with item 11712:

(a) with:

(i) two‑dimensional recordings before drug infusion (baseline) from at least 3 acoustic windows; and

(ii) matching recordings from the same windows at least twice during drug infusion, including a recording at the peak drug dose; and

(iii) recordings on digital media with equipment permitting display of baseline and matching peak images on the same screen; and

(b) not being a service associated with a service to which an item in Subgroup 1 (except items 55026 and 55054) or 3, or another item in this Subgroup (except items 55118, 55125, 55130 and 55131), applies (R) (NK)

 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:

(i) real time colour flow mapping and, if indicated, pulsed wave Doppler examination; and

(ii) recordings on video tape or digital medium; and

(b) not being an intra‑operative service or a service associated with a service to which an item in Subgroup 1 (except items 55026 and 55054) or 3 applies (R) (NK) (Anaes.)

 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
Subgroup 3—Vascular
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)
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:

(a) by spectral analysis of cavernosal artery of the penis following intracavernosal administration of a vasoactive agent; and

(b) performed during the period of pharmacological activity of the injected agent, to confirm a diagnosis of vascular aetiology for impotence; and

(c) if a specialist in diagnostic radiology, nuclear medicine, urology, general surgery (sub‑specialising in vascular surgery) or a consultant physician in nuclear medicine attends the patient in person at the practice location where the service is performed, immediately before or for a period during the performance of the service; and

(d) if the specialist or consultant physician interprets the results and prepares a report, 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
55232

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements:

(a) by spectral analysis of cavernosal tissue of the penis to confirm a diagnosis; and

(b) if indicated, assess the progress and management of:

(i) priapism; or

(ii) fibrosis of any type; or

(iii) fracture of the tunica; or

(iv) arteriovenous malformations; and

 84.75

(c) if a specialist in diagnostic radiology, nuclear medicine, urology, general surgery (sub‑specialising in vascular surgery) or a consultant physician in nuclear medicine attends the patient in person at the practice location where the service is performed, immediately before or for a period during the performance of the service; and

(d) if the specialist or consultant physician interprets the results and prepares a report, 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)
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:

(a) by spectral analysis of cavernosal artery of the penis following intracavernosal administration of a vasoactive agent; and

(b) performed during the period of pharmacological activity of the injected agent, to confirm a diagnosis of vascular aetiology for impotence; and

(c) if a specialist in diagnostic radiology, nuclear medicine, urology, general surgery (sub‑specialising in vascular surgery) or a consultant physician in nuclear medicine attends the patient in person at the practice location where the service is performed, immediately before or for a period during the performance of the service; and

(d) if the specialist or consultant physician interprets the results and prepares a report, 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
55284

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements:

(a) by spectral analysis of cavernosal tissue of the penis to confirm a diagnosis; and

(b) if indicated, assess the progress and management of:

(i) priapism; or

(ii) fibrosis of any type; or

(iii) fracture of the tunica; or

(iv) arteriovenous malformations; and

(c) if a specialist in diagnostic radiology, nuclear medicine, urology, general surgery (sub‑specialising in vascular surgery) or a consultant physician in nuclear medicine attends the patient in person at the practice location where the service is performed, immediately before or for a period during the performance of the service; and

(d) if the specialist or consultant physician interprets the results and prepares a report, 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
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
Subgroup 4—Urological
55600

Prostate, bladder base and urethra, l ultrasound scan of, if performed:

(a) personally by a medical practitioner (not being the medical practitioner who assessed the patient as specified in paragraph (c)) using one or more transducer probes that:

(i) have a nominal frequency of 7 to 7.5 MHz or a nominal frequency range that includes frequencies of 7 to 7.5 MHz; and

(ii) can obtain both axial and sagittal scans in 2 planes at right angles; and

(b) after a digital rectal examination of the prostate by that medical practitioner; and

(c) on a patient who has been assessed by a specialist in urology, radiation oncology or medical oncology, a consultant physician in medical oncology, who has:

(i) examined the patient in the 60 days before the scan; and

(ii) recommended the scan for the management of the patient’s current prostatic disease (R) (K)

 109.10
55601

Prostate, bladder base and urethra, l ultrasound scan of, if performed:

(a) personally by a medical practitioner (not being the medical practitioner who assessed the patient as specified in paragraph (c)) using one or more transducer probes that:

(i) have a nominal frequency of 7 to 7.5 MHz or a nominal frequency range that includes frequencies of 7 to 7.5 MHz; and

(ii) can obtain both axial and sagittal scans in 2 planes at right angles; and

(b) after a digital rectal examination of the prostate by that medical practitioner; and

(c) on a patient who has been assessed by a specialist in urology, radiation oncology or medical oncology, a consultant physician in medical oncology, who has:

(i) examined the patient in the 60 days before the scan; and

(ii) recommended the scan for the management of the patient’s current prostatic disease (R) (NK)

 54.55
55603

Prostate, bladder base and urethra, ultrasound scan of, if performed:

(a) personally by a medical practitioner who made the assessment mentioned in paragraph (c) using one or more transducer probes that:

(i) have a nominal frequency of 7 to 7.5 MHz or a nominal frequency range that includes frequencies of 7 to 7.5 MHz; and

(ii) can obtain both axial and sagittal scans in 2 planes at right angles; and

(b) after a digital rectal examination of the prostate by that medical practitioner; and

(c) on a patient who has been assessed by a specialist in urology, radiation oncology or medical oncology or a consultant physician in medical oncology who has:

(i) examined the patient in the 60 days before the scan; and

(ii) recommended the scan for the management of the patient’s current prostatic disease (R) (K)

 109.10
55604

Prostate, bladder base and urethra, ultrasound scan of, if performed:

(a) personally by a medical practitioner who made the assessment mentioned in paragraph (c) using one or more transducer probes that:

(i) have a nominal frequency of 7 to 7.5 MHz or a nominal frequency range that includes frequencies of 7 to 7.5 MHz; and

(ii) can obtain both axial and sagittal scans in 2 planes at right angles; and

(b) after a digital rectal examination of the prostate by that medical practitioner; and

(c) on a patient who has been assessed by a specialist in urology, radiation oncology or medical oncology or a consultant physician in medical oncology who has:

(i) examined the patient in the 60 days before the scan; and

(ii) recommended the scan for the management of the patient’s current prostatic disease (R) (NK)

 54.55

Subdivision C—Subgroup 5 of Group I1: obstetric and gynaecological

2.1.4  Obstetric and gynaecological ultrasound services—limits

(1)  For NR‑type diagnostic imaging services mentioned in an item in this Subdivision, the specified fee for no more than 3 services provided to the same patient in any one pregnancy applies.

(2)  For any patient, items 55706, 55707, 55708, 55709, 55713, 55714, 55716, 55717, 55718, 55722, 55723, 55726, 55759, 55760, 55762, 55763, 55768, 55769, 55770 and 55771 are applicable only once in a pregnancy.

2.1.5  Obstetric and gynaecological services—referrals and clinical notes

(1)  A referral for a service mentioned in item 55700, 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.

2.1.6  Obstetric and gynaecological services—conditions

(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.

Group I1—Ultrasound
Item Diagnostic imaging service Fee ($)
Subgroup 5—Obstetric and gynaecological
55700

Pelvis or abdomen, pregnancy‑related or pregnancy complication, ultrasound scan of, by any or all approaches, if:

(a) the patient is referred by a medical practitioner or participating midwife; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is less than 12 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(e) if the patient is referred by a participating midwife—the midwife does not have a business or financial arrangement with the providing practitioner; and

(f) one or more of the conditions mentioned in subclause 2.1.6(1) are present (R) (K)

 60.00
55701

Pelvis or abdomen, pregnancy‑related or pregnancy complication, ultrasound scan of, by any or all approaches, if:

(a) the patient is referred by a medical practitioner or participating midwife; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is less than 12 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(e) if the patient is referred by a participating midwife—the midwife does not have a business or financial arrangement with the providing practitioner; and

(f) one or more of the conditions mentioned in subclause 2.1.6(1) are present (R) (NK)

 30.00
55702

Pelvis or abdomen, pregnancy‑related or pregnancy complication, ultrasound scan of, by any or all approaches, if:

(a) the patient is not referred by a medical practitioner or participating midwife; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is less than 12 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) one or more of the conditions mentioned in subclause 2.1.6(1) are present (NR) (NK)

 17.50
55703

Pelvis or abdomen, pregnancy‑related or pregnancy complication, ultrasound scan of, by any or all approaches, if:

(a) the patient is not referred by a medical practitioner or participating midwife; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is less than 12 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) one or more of the conditions mentioned in subclause 2.1.6(1) are present (NR) (K)

 35.00
55704

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) the patient is referred by a medical practitioner or participating midwife; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is 12 to 16 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(e) if the patient is referred by a participating midwife—the midwife does not have a business or financial arrangement with the providing practitioner; and

(f) one or more of the conditions mentioned in subclause 2.1.6(1) are present (R) (K)

 70.00
55705

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) the patient is not referred by a medical practitioner or participating midwife; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is 12 to 16 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) one or more of the conditions mentioned in subclause 2.1.6(1) are present (NR) (K)

 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:

(a) the patient is referred by a medical practitioner or participating midwife; and

(b) the dating for the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(e) if the patient is referred by a participating midwife—the midwife does not have a business or financial arrangement with the providing practitioner; and

(f) the service is not performed in the same pregnancy as item 55709 or 55717 (R) (K)

 100.00
55707

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) the patient is referred by a medical practitioner or participating midwife; and

(b) the pregnancy (as confirmed by ultrasound) is dated by a fetal crown rump length of 45 to 84 mm; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(e) if the patient is referred by a participating midwife—the midwife does not have a business or financial arrangement with the providing practitioner; and

(f) nuchal translucency measurement is performed to assess the risk of fetal abnormality; and

(g) the service is not performed with item 55700, 55701, 55702, 55703, 55704, 55705, 55710 or 55711 on the same patient within 24 hours; and

(h) one or more of the conditions mentioned in subclause 2.1.6(1) are present (R) (K)

 70.00
55708

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) the patient is not referred by a medical practitioner or participating midwife; and

(b) the pregnancy (as confirmed by ultrasound) is dated by a crown rump length of 45 to 84 mm; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) nuchal translucency measurement is performed to assess the risk of fetal abnormality; and

(e) the service is not performed with item 55700, 55701, 55702, 55703, 55704, 55705, 55710 or 55711 on the same patient within 24 hours; and

(f) one or more of the conditions mentioned in subclause 2.1.6(1) are present (NR) (K)

 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:

(a) the patient is not referred by a medical practitioner; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) the service is not performed in the same pregnancy as item 55706 or 55713 (NR) (K)

 38.00
55710

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) the patient is referred by a medical practitioner or participating midwife; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is 12 to 16 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(e) if the patient is referred by a participating midwife—the midwife does not have a business or financial arrangement with the providing practitioner; and

(f) one or more of the conditions mentioned in subclause 2.1.6(1) are present (R) (NK)

 35.00
55711

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) the patient is not referred by a medical practitioner or participating midwife; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is 12 to 16 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) one or more of the conditions mentioned in subclause 2.1.6(1) are present (NR) (NK)

 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:

(a) the patient is referred by a medical practitioner who:

(i) is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; or

(ii) has a Diploma of Obstetrics; or

(iii) has a qualification recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists as being equivalent to a Diploma of Obstetrics; or

(iv) has obstetric privileges at a non‑metropolitan hospital; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and

(d) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(e) further examination is clinically indicated after performance, in the same pregnancy, of a scan mentioned in item 55706, 55709, 55713 or 55717 (R) (K)

 115.00
55713

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:

(a) the patient is referred by a medical practitioner or participating midwife; and

(b) the dating for the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(e) if the patient is referred by a participating midwife—the midwife does not have a business or financial arrangement with the providing practitioner; and

(f) the service is not performed in the same pregnancy as item 55709 or 55717 (R) (NK)

 50.00
55714

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) the patient is referred by a medical practitioner or participating midwife; and

(b) the pregnancy (as confirmed by ultrasound) is dated by a fetal crown rump length of 45 to 84 mm; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(e) if the patient is referred by a participating midwife—the midwife does not have a business or financial arrangement with the providing practitioner; and

(f) nuchal translucency measurement is performed to assess the risk of fetal abnormality; and

(g) the service is not performed with item 55700, 55701, 55702, 55703, 55704, 55705, 55710 or 55711 on the same patient within 24 hours; and

(h) one or more of the conditions mentioned in subclause 2.1.6(1) are present (R) (NK)

 35.00
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:

(a) the patient is not referred by a medical practitioner; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) further examination is clinically indicated after performance, in the same pregnancy, of a scan mentioned in item 55706, 55709, 55713 or 55717 (NR) (K)

 40.00
55716

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) the patient is not referred by a medical practitioner or participating midwife; and

(b) the pregnancy (as confirmed by ultrasound) is dated by a crown rump length of 45 to 84 mm; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) nuchal translucency measurement is performed to assess the risk of fetal abnormality; and

(e) the service is not performed with item 55700, 55701, 55702, 55703, 55704, 55705, 55710 or 55711on the same patient within 24 hours; and

(f) one or more of the conditions mentioned in subclause 2.1.6(1) are present (NR) (NK)

 17.50
55717

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:

(a) the patient is not referred by a medical practitioner; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) the service is not performed in the same pregnancy as item 55706 or 55713 (NR) (NK)

 19.00
55718

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) the patient is referred by a medical practitioner or participating midwife; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(e) if the patient is referred by a participating midwife—the midwife does not have a business or financial arrangement with the providing practitioner; and

(f) the service is not performed in the same pregnancy as item 55723 or 55726; and

(g) one or more of the conditions mentioned in subclause 2.1.6(2) are present (R) (K)

 100.00
55719

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:

(a) the patient is referred by a medical practitioner who:

(i) is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; or

(ii) has a Diploma of Obstetrics; or

(iii) has a qualification recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists as being equivalent to a Diploma of Obstetrics; or

(iv) has obstetric privileges at a non‑metropolitan hospital; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and

(d) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(e) further examination is clinically indicated after performance, in the same pregnancy, of a scan mentioned in item 55706, 55709, 55713 or 55717 (R) (NK)

 57.50
55720

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:

(a) the patient is not referred by a medical practitioner; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) further examination is clinically indicated after performance, in the same pregnancy, of a scan mentioned in item 55706, 55709, 55713 or 55717 (NR) (NK)

 20.00
55721

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) the patient is referred by a medical practitioner who:

(i) is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; or

(ii) has a Diploma of Obstetrics; or

(iii) has a qualification recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists as being equivalent to a Diploma of Obstetrics; or

(iv) has obstetric privileges at a non‑metropolitan hospital; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and

(d) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(e) further examination is clinically indicated in the same pregnancy to which item 55718, 55722, 55723 or 55726 applies (R) (K)

 115.00
55722

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) the patient is referred by a medical practitioner or participating midwife; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) if the patient is referred by a medical practitioner—the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(e) if the patient is referred by a participating midwife—the midwife does not have a business or financial arrangement with the providing practitioner; and

(f) the service is not performed in the same pregnancy as item 55723 or 55726; and

(g) one or more of the conditions mentioned in subclause 2.1.6(2) are present (R) (NK)

 50.00
55723

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) the patient is not referred by a medical practitioner; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) the service is not performed in the same pregnancy as item 55718 or 55722; and

(e) one or more of the conditions mentioned in subclause 2.1.6(2) are present (NR) (K)

 38.00
55724

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) the patient is referred by a medical practitioner who:

(i) is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; or

(ii) has a Diploma of Obstetrics; or

(iii) has a qualification recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists as being equivalent to a Diploma of Obstetrics; or

(iv) has obstetric privileges at a non‑metropolitan hospital; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and

(d) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(e) further examination is clinically indicated in the same pregnancy to which item 55718, 55722, 55723 or 55726 applies (R) (NK)

 57.50
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:

(a) the patient is not referred by a medical practitioner; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) further examination is clinically indicated in the same pregnancy to which item 55718, 55722, 55723 or 55726 applies (NR) (K)
55726

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) the patient is not referred by a medical practitioner; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) the service is not performed in the same pregnancy as item 55718 or 55722; and

(e) one or more of the conditions mentioned in subclause 2.1.6(2) are present (NR) (NK)

 19.00
55727

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:

(a) the patient is not referred by a medical practitioner; and

(b) the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and

(c) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(d) further examination is clinically indicated in the same pregnancy to which item 55718, 55722, 55723 or 55726 applies (NR) (NK)

 30.00
55729

Duplex scanning, if:

(a) the service involves:

(i) B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of the umbilical artery; and

(ii) measured assessment of amniotic fluid volume after the 24th week of gestation; and

(b) the patient is referred by a medical practitioner for this procedure; and

(c) there is reason to suspect intrauterine growth retardation or a significant risk of fetal death; and

(d) the service is not associated with a service to which an item in this group applies;

—examination and report (R) (K)

 27.25
55730

Duplex scanning, if:

(a) the service involves:

(i) B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of the umbilical artery; and

(ii) measured assessment of amniotic fluid volume after the 24th week of gestation; and

(b) the patient is referred by a medical practitioner for this procedure; and

(c) there is reason to suspect intrauterine growth retardation or a significant risk of fetal death; and

(d) the service is not associated with a service to which an item in this group applies;

—examination and report (R) (NK)

 13.65
55735

Pelvis, ultrasound scan of, in association with saline infusion of the endometrial cavity, by any or all approaches, if:

(a) the patient is referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(c) the medical practitioner is not a member of a group of medical practitioners of which the providing practitioner is a member; and

(d) a previous transvaginal ultrasound has revealed an abnormality of the uterus or fallopian tube (R) (NK)

 63.50
55736

Pelvis, ultrasound scan of, in association with saline infusion of the endometrial cavity, by any or all approaches, if:

(a) the patient is referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(c) the medical practitioner is not a member of a group of medical practitioners of which the providing practitioner is a member; and

(d) a previous transvaginal ultrasound has revealed an abnormality of the uterus or fallopian tube (R) (K)

 127.00
55737

Pelvis, ultrasound scan of, in association with saline infusion of the endometrial cavity, by any or all approaches, if:

(a) the patient is not referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(c) a previous transvaginal ultrasound has revealed an abnormality of the uterus or fallopian tube (NR) (NK)

 28.50
55739

Pelvis, ultrasound scan of, in association with saline infusion of the endometrial cavity, by any or all approaches, if:

(a) the patient is not referred by a medical practitioner; and

(b) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(c) a previous transvaginal ultrasound has revealed an abnormality of the uterus or fallopian tube (NR) (K)

 57.00
55759

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:

(a) the patient is referred by a medical practitioner; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) ultrasound of the same pregnancy confirms a multiple pregnancy; and

(d) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks gestation; and

(e) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(f) the service mentioned in item 55706, 55709, 55712, 55713, 55715, 55717, 55719, 55720, 55762 or 55763 is not performed in conjunction with the scan during the same pregnancy (R) (K)

 150.00
55760

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:

(a) the patient is referred by a medical practitioner; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) ultrasound of the same pregnancy confirms a multiple pregnancy; and

(d) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks gestation; and

(e) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(f) the service mentioned in item 55706, 55709, 55712, 55713, 55715, 55717, 55719, 55720, 55762 or 55763 is not performed in conjunction with the scan during the same pregnancy (R) (NK)

 75.00
55762

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:

(a) the patient is not referred by a medical practitioner; and

(b) ultrasound of the same pregnancy confirms a multiple pregnancy; and

(c) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks gestation; and

(d) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(e) the service mentioned in item 55706, 55709, 55712, 55713, 55715, 55717, 55719, 55720, 55759 or 55760 is not performed in conjunction with the scan during the same pregnancy (NR) (K)

 60.00
55763

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:

(a) the patient is not referred by a medical practitioner; and

(b) ultrasound of the same pregnancy confirms a multiple pregnancy; and

(c) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks gestation; and

(d) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(e) the service mentioned in item 55706, 55709, 55712, 55713, 55715, 55717, 55719, 55720, 55759 or 55760 is not performed in conjunction with the scan during the same pregnancy (NR) (NK)

 30.00
55764

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:

(a) the patient is referred by a medical practitioner who:

(i) is a Member or Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; or

(ii) has a Diploma of Obstetrics; or

(iii) has a qualification recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists as equivalent to a Diploma of Obstetrics; or

(iv) has obstetric privileges at a non‑metropolitan hospital; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) ultrasound of the same pregnancy confirms a multiple pregnancy; and

(d) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks gestation; and

(e) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(f) further examination is clinically indicated in the same pregnancy in which item 55759, 55760, 55762 or 55763 has been performed; and

(g) the service mentioned in item 55706, 55709, 55712, 55713, 55715, 55717, 55719 or 55720 is not performed in conjunction with the scan during the same pregnancy (R) (K)

 160.00
55765

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:

(a) the patient is referred by a medical practitioner who:

(i) is a Member or Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; or

(ii) has a Diploma of Obstetrics; or

(iii) has a qualification recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists as equivalent to a Diploma of Obstetrics; or

(iv) has obstetric privileges at a non‑metropolitan hospital; and

(b) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(c) ultrasound of the same pregnancy confirms a multiple pregnancy; and

(d) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks gestation; and

(e) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(f) further examination is clinically indicated in the same pregnancy in which item 55759, 55760, 55762 or 55763 has been performed; and

(g) the service mentioned in item 55706, 55709, 55712, 55713, 55715, 55717, 55719 or 55720 is not performed in conjunction with the scan during the same pregnancy (R) (NK)

 80.00
55766

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 Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, if:

(a) the patient is not referred by a medical practitioner; and

(b) ultrasound of the same pregnancy confirms a multiple pregnancy; and

(c) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and

(d) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(e) further examination is clinically indicated in the same pregnancy in which item 55759, 55760, 55762 or 55763 has been performed; and

(f) the service mentioned in item 55706, 55709, 55712, 55713, 55715, 55717, 55719 or 55720 is not performed in conjunction with the scan during the same pregnancy (NR) (K)

 65.00
55767

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 Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, if:

(a) the patient is not referred by a medical practitioner; and

(b) ultrasound of the same pregnancy confirms a multiple pregnancy; and

(c) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and

(d) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(e) further examination is clinically indicated in the same pregnancy in which item 55759, 55760, 55762 or 55763 has been performed; and

(f) the service mentioned in item 55706, 55709, 55712, 55713, 55715, 55717, 55719 or 55720 is not performed in conjunction with the scan during the same pregnancy (NR) (NK)

 32.50
55768

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and

(b) the ultrasound confirms a multiple pregnancy; and

(c) the patient is referred by a medical practitioner; and

(d) the service is not performed in the same pregnancy as item 55770 or 55771; and

(e) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(f) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(g) the service mentioned in item 55718, 55721, 55722, 55723, 55724, 55725, 55726 or 55727 is not performed in conjunction with the scan during the same pregnancy (R) (K)

 150.00
55769

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and

(b) the ultrasound confirms a multiple pregnancy; and

(c) the patient is referred by a medical practitioner; and

(d) the service is not performed in the same pregnancy as item 55770 or 55771; and

(e) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(f) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(g) the service mentioned in item 55718, 55721, 55722, 55723, 55724, 55725, 55726 or 55727 is not performed in conjunction with the scan during the same pregnancy (R) (NK)

 75.00
55770

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and

(b) the ultrasound confirms a multiple pregnancy; and

(c) the patient is not referred by a medical practitioner; and

(d) the service is not performed in the same pregnancy as item 55768 or 55769; and

(e) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(f) the service mentioned in item 55718, 55721, 55722, 55723, 55724, 55725, 55726 or 55727 is not performed in conjunction with the scan during the same pregnancy (NR) (K)

 60.00
55771

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and

(b) the ultrasound confirms a multiple pregnancy; and

(c) the patient is not referred by a medical practitioner; and

(d) the service is not performed in the same pregnancy as item 55768 or 55769; and

(e) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(f) the service mentioned in item 55718, 55721, 55722, 55723, 55724, 55725, 55726 or 55727 is not performed in conjunction with the scan during the same pregnancy (NR) (NK)

 30.00
55772

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) dating of the pregnancy as confirmed by ultrasound is after 22 weeks of gestation; and

(b) the patient is referred by a medical practitioner who:

(i) is a Member or Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; or

(ii) has a Diploma of Obstetrics; or

(iii) has a qualification recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists as equivalent to a Diploma of Obstetrics; or

(iv) has obstetric privileges at a non‑metropolitan hospital; and

(c) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(d) further examination is clinically indicated in the same pregnancy to which item 55768, 55769, 55770 or 55771 has been performed; and

(e) the pregnancy as confirmed by ultrasound is a multiple pregnancy; and

(f) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(g) the service mentioned in item 55718, 55721, 55722, 55723, 55724, 55725, 55726 or 55727 is not performed in conjunction with the scan during the same pregnancy (R) (K)

 160.00
55773

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:

(a) dating of the pregnancy as confirmed by ultrasound is after 22 weeks of gestation; and

(b) the patient is referred by a medical practitioner who:

(i) is a Member or Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; or

(ii) has a Diploma of Obstetrics; or

(iii) has a qualification recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists as equivalent to a Diploma of Obstetrics; or

(iv) has obstetric privileges at a non‑metropolitan hospital; and

(c) the medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and

(d) further examination is clinically indicated in the same pregnancy to which item 55768, 55769, 55770 or 55771 has been performed; and

(e) the pregnancy as confirmed by ultrasound is a multiple pregnancy; and

(f) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(g) the service mentioned in item 55718, 55721, 55722, 55723, 55724, 55725, 55726 or 55727 is not performed in conjunction with the scan during the same pregnancy (R) (NK)

 80.00
55774

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:

(a) dating of the pregnancy as confirmed by ultrasound is after 22 weeks of gestation; and

(b) the patient is not referred by a medical practitioner; and

(c) further examination is clinically indicated in the same pregnancy to which item 55768, 55769, 55770 or 55771 has been performed; and

(d) the pregnancy as confirmed by ultrasound is a multiple pregnancy; and

(e) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(f) the service mentioned in item 55718, 55721, 55722, 55723, 55724, 55725, 55726 or 55727 is not performed in conjunction with the scan during the same pregnancy (NR) (K)

 65.00
55775

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:

(a) dating of the pregnancy as confirmed by ultrasound is after 22 weeks of gestation; and

(b) the patient is not referred by a medical practitioner; and

(c) further examination is clinically indicated in the same pregnancy to which item 55768, 55769, 55770 or 55771 has been performed; and

(d) the pregnancy as confirmed by ultrasound is a multiple pregnancy; and

(e) the service is not associated with a service to which an item in Subgroup 2 or 3 applies; and

(f) the service mentioned in item 55718, 55721, 55722, 55723, 55724, 55725, 55726 or 55727 is not performed in conjunction with the scan during the same pregnancy (NR) (NK)

 32.50

Subdivision C—Subgroup 20 of Group I5: scans of pelvis and upper abdomen for specified conditions

2.5.10  MRI services—limits for certain items

(1)  Item 63470 or 63479 does not apply to the service mentioned in that item if the person to whom the service is provided has previously been provided with that service or a service mentioned in item 63473 or 63481.

(2)  Item 63473 or 63481 does not apply to the service mentioned in that item if the person to whom the service is provided has previously been provided with that service or a service mentioned in item 63470 or 63479.

(3)  For any patient, if the service mentioned in item 63740 or 63744 is provided for assessment of change to therapy in a patient with small bowel Crohn’s disease, the item applies to that service only once in a 12 month period.

(4)  For any patient, if the service mentioned in item 63743 or 63747 is provided for assessment of change to therapy of pelvis sepsis and fistulas from Crohn’s disease, the item applies to that service only once in a 12 month period.

2.5.11  MRI and MRA services—modifying items

(1)  Subject to subclauses (2), (3) and (4), if item 63491, 63494 or 63497 applies to an MRI or MRA service, the fee specified in that item applies in addition to the fee specified in the other item in Group I5 of this table that applies to the service.

(2)  If 2 or more MRI or MRA services mentioned in item 63494 are performed for a person on the same day, the fee specified in that item applies to one of those services only.

(3)  If 2 or more MRI or MRA services mentioned in item 63497 are performed for a person on the same day, the fee specified in that item applies to one of those services only.

(4)  If:

(a)  one or more MRI or MRA services mentioned in item 63494; and

(b)  one or more MRI or MRA services mentioned in item 63497;

are performed for a person on the same day, the fee specified in item 63494 or item 63497, but not both those items, applies to one of those services only.

Group I5—Magnetic resonance imaging
Item Description Fee ($)
Subgroup 20—Scans of pelvis and upper abdomen—for specified conditions
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:

(a) a histological diagnosis of carcinoma of the cervix has been made; and

(b) the patient has been diagnosed with cervical cancer at FIGO stage 1B or greater (R) (K) (Anaes.) (Contrast)

 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:

(a) a histological diagnosis of carcinoma of the cervix has been made; and

(b) the patient has been diagnosed with cervical cancer at FIGO stage 1B or greater (R) (K) (Anaes.) (Contrast)

 627.20
63476

MRI—scan of the pelvis for the initial staging of rectal cancer, if:

(a) a phased array body coil is used; and

(b) the request for scan identifies that the indication is for the initial staging of rectal cancer (including cancer of the rectosigmoid and anorectum) (R) (K) (Anaes.) (Contrast)

 403.20
63479

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:

(a) a histological diagnosis of carcinoma of the cervix has been made; and

(b) the patient has been diagnosed with cervical cancer at FIGO stage 1B or greater (R) (NK) (Anaes.) (Contrast)

 201.60
63481

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:

(a) a histological diagnosis of carcinoma of the cervix has been made; and

(b) the patient has been diagnosed with cervical cancer at FIGO stage 1B or greater (R) (NK) (Anaes.) (Contrast)

 313.60
63484

MRI—scan of the pelvis for the initial staging of rectal cancer, if:

(a) a phased array body coil is used; and

(b) the request for scan identifies that the indication is for the initial staging of rectal cancer (including cancer of the rectosigmoid and anorectum) (R) (NK) (Anaes.) (Contrast)

 201.60
63740

MRI—scan to evaluate small bowel Crohn’s disease if the service is provided to a patient for:

(a) evaluation of disease extent at time of initial diagnosis of Crohn’s disease; or

(b) evaluation of exacerbation, or suspected complications, of known Crohn’s disease; or

(c) evaluation of known or suspected Crohn’s disease in pregnancy; or

(d) assessment of change to therapy in a patient with small bowel Crohn’s disease (R) (K) (Contrast)

 457.20
63741 MRI—scan with enteroclysis for Crohn’s disease if the service is related to item 63740 (R) (K) 265.25
63743

MRI—scan for fistulising perianal Crohn’s disease if the service is provided to a patient for:

(a) evaluation of pelvic sepsis and fistulas associated with established or suspected Crohn’s disease; or

(b) assessment of change to therapy of pelvis sepsis and fistulas from Crohn’s disease (R) (K) (Contrast)

 403.20
63744

MRI—scan to evaluate small bowel Crohn’s disease if the service is provided to a patient for:

(a) evaluation of disease extent at time of initial diagnosis of Crohn’s disease; or

(b) evaluation of exacerbation, or suspected complications, of known Crohn’s disease; or

(c) evaluation of known or suspected Crohn’s disease in pregnancy; or

(d) assessment of change to therapy in a patient with small bowel Crohn’s disease (R) (NK) (Contrast)

 228.60
63746 MRI—scan with enteroclysis for Crohn’s disease if the service is related to item 63744 (R) (NK) 132.65
63747

MRI—scan for fistulising perianal Crohn’s disease if the service is provided to patients for:

(a) evaluation of pelvic sepsis and fistulas associated with established or suspected Crohn’s disease; or

(b) assessment of change to therapy of pelvis sepsis and fistulas from Crohn’s disease (R) (NK) (Contrast)

 201.60

Subdivision D—Subgroups 21 and 22 of Group I5

Group I5—Magnetic resonance imaging
Item Description Fee ($)
Subgroup 21—Scan of body—for specified conditions
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
Subgroup 22—Modifying items
63491

MRI or MRA service to which an item in this Group (other than an item in this Subgroup) applies if:

(a) the service is performed in accordance with clause 2.5.1; and

(b) the item for the service includes in its description ‘(Contrast)’; and

(c) the service is performed using a contrast agent

 44.80
63494

MRI or MRA service to which an item in this Group (other than an item in this Subgroup) applies if:

(a) the service is performed in accordance with clause 2.5.1; and

(b) the service is performed on a person using intravenous or intra muscular sedation

 44.80
63497

MRI or MRA service to which an item in this Group (other than an item in this Subgroup) applies if:

(a) the service is performed in accordance with clause 2.5.1; and

(b) the service is performed on a person under anaesthetic in the presence of a medical practitioner who is qualified to perform an anaesthetic

 156.80

Note: Subgroups 23 to 32 of Group I5 of this table are set out in a determination made under subsection 3C(1) of the Act.

Subdivision E—Subgroup 33 of Group I5

Group I5—Magnetic resonance imaging
Item Description Fee ($)
Subgroup 33—Scan of body—for specified conditions
63507

MRI—scan of head for a patient under 16 years if the service is for:

(a) an unexplained seizure; or

(b) an unexplained headache if significant pathology is suspected; or

(c) paranasal sinus pathology that has not responded to conservative therapy (R) (K) (Anaes.) (Contrast)

 403.20
63508

MRI—scan of head for a patient under 16 years if the service is for:

(a) an unexplained seizure; or

(b) an unexplained headache if significant pathology is suspected; or

(c) paranasal sinus pathology that has not responded to conservative therapy (R) (NK) (Anaes.) (Contrast)

 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

(b) unexplained neck or back pain with associated neurological signs; or

(c) unexplained back pain if significant pathology is suspected (R) (K) (Anaes.) (Contrast)

 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

(b) unexplained neck or back pain with associated neurological signs; or

(c) unexplained back pain if significant pathology is suspected (R) (NK) (Anaes.) (Contrast)

 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

Subdivision F—Subgroup 34 of Group I5

Group I5—Magnetic resonance imaging
Item Description Fee ($)
Subgroup 34—Magnetic resonance imaging—for specified conditions
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);

(b) unexplained chronic headache with suspected intracranial pathology (R) (K) (Contrast) (Anaes.)

 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);

(b) unexplained chronic headache with suspected intracranial pathology (R) (NK) (Contrast) (Anaes.)

 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:

(a) inability to extend the knee suggesting the possibility of acute meniscal tear; or

(b) clinical findings suggesting acute anterior cruciate ligament tear (R) (K) (Contrast) (Anaes.)

 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:

(a) inability to extend the knee suggesting the possibility of acute meniscal tear; or

(b) clinical findings suggesting acute anterior cruciate ligament tear (R) (NK) (Contrast) (Anaes.)

 201.60

Division 2.6—Group I6: management of bulk‑billed services

2.6.1  Application of items 64990 and 64991

(1)  If the diagnostic imaging service mentioned in item 64991 is provided to a person, either that item or item 64990, but not both those items, applies to the service.

(2)  If item 64990 or 64991 applies to a diagnostic imaging service, the fee specified in that item applies in addition to the fee specified in any other item in this 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 the National Health Act 1953.

practice location, for the provision of a diagnostic imaging service, means the place of practice for which the medical practitioner by whom, or on whose behalf, the service is provided, has been allocated a provider number by the Chief Executive Medicare.

regional, rural or remote area means either of the following:

(a)  an area classified as RRMAs 3‑7 under the Rural, Remote and Metropolitan Areas Classification;

(b)  Norfolk Island.

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.

Group I6—Management of bulk‑billed services
Item Description Fee ($)
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

(b) the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder; and

(c) the person is not an admitted patient of a hospital; and

(d) the service is bulk‑billed for the fees for:

(i) this item; and

(ii) the other item in this table applying to the service

 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

(b) the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder; and

(c) the person is not an admitted patient of a hospital; and

(d) the service is bulk‑billed for the fees for:

(i) this item; and

(ii) the other item in this table applying to the service; and

(e) the service is provided at, or from, a practice location in:

(i) a regional, rural or remote area; or

(ii) Tasmania; or

(iii) a geographical area to which subclause 2.6.1(3) applies; or

(iv) the geographical area included in the SLA spatial unit of Palm Island (AC)

 10.65

Part 3—Dictionary

3.1  Dictionary

Note 1:       All references in this clause to a provision are references to a provision in this table, unless otherwise indicated.

Note 2: A number of expressions used in this instrument are defined in subsection 3(1) of the Act, including 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)    professional service;

(h)    specialist.

In this table:

Act means the Health Insurance Act 1973.

(Anaes.) has the meaning given by clause 2.43.5 of the general medical services table.

angiography suite has the meaning given by clause 2.3.4.

ASGC means the July 2010 edition of the Australian Standard Geographical Classification (ASGC) (ABS catalogue number 1216.0), published by the Australian Statistician, as existing at the time when this instrument commences.

bulk‑billed: a diagnostic imaging service is bulk‑billed if:

(a)  a medicare benefit is payable to a person in relation to the service; and

(b)  under an agreement entered into under section 20A of the Act:

(i)  the person assigns to the 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) using a detector:

(a)  that is coupled to an X‑ray tube that emits a finely collimated X‑ray beam as it rotates within a gantry around a patient either in incremental or helical manner; and

(b)  that receives a series of data profiles depicting the degree of absorption encountered by the X‑ray beam, which are transformed into a cross‑sectional image after the application of complex algorithms.

cone beam computed tomography means a service performed on a rotating gantry to which an X‑ray source and a 2‑dimensional flat panel detector are fixed that produces multiple sequential planar projection images in a single revolution around the patient, which are reconstructed into a 3‑dimensional image.

consultation has the meaning given by clause 1.2.12.

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 means 18F‑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)  this table; or

(ii)  the pathology services table; or

(iii)  the general medical services table; and

(b)  in a reference immediately followed by a number—the item so numbered.

Note: A health service specified in a determination made under subsection 3C(1) of the Act is treated as if there were an item for the service in this table, the general medical services table or the pathology 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.

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 either of the following:

(a)  a very remote area as classified by the ASGC;

(b)  Norfolk Island.

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 63561 and 63740 to 63747, 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).

Endnotes

Endnote 1—About the endnotes

The endnotes provide information about this compilation and the compiled law.

The following endnotes are included in every compilation:

Endnote 1—About the endnotes

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history

Abbreviation key—Endnote 2

The abbreviation key 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 (or will amend) the compiled law. The information includes commencement details for amending laws and details of any 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 (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.

Editorial changes

The Legislation Act 2003 authorises First Parliamentary Counsel to make editorial and presentational changes to a compiled law in preparing a compilation of the law for registration. The changes must not change the effect of the law. Editorial changes take effect from the compilation registration date.

If the compilation includes editorial changes, the endnotes include a brief outline of the changes in general terms. Full details of any changes can be obtained from the Office of Parliamentary Counsel.

Misdescribed amendments

A misdescribed amendment is an amendment that does not accurately describe the amendment to be made. If, despite the misdescription, the amendment can be given effect as intended, the amendment is incorporated into the compiled law and the abbreviation “(md)” added to the details of the amendment included in the amendment history.

If a misdescribed amendment cannot be given effect as intended, the abbreviation “(md not incorp)” is added to the details of the amendment included in the amendment history.

Endnote 2—Abbreviation key

ad = added or inserted o = order(s)
am = amended Ord = Ordinance
amdt = amendment orig = original
c = clause(s) par = paragraph(s)/subparagraph(s)
C[x] = Compilation No. x     /sub‑subparagraph(s)
Ch = Chapter(s) pres = present
def = definition(s) prev = previous
Dict = Dictionary (prev…) = previously
disallowed = disallowed by Parliament Pt = Part(s)
Div = Division(s) r = regulation(s)/rule(s)
ed = editorial change reloc = relocated
exp = expires/expired or ceases/ceased to have renum = renumbered
    effect rep = repealed
F = Federal Register of Legislation rs = repealed and substituted
gaz = gazette s = section(s)/subsection(s)
LA = Legislation Act 2003 Sch = Schedule(s)
LIA = Legislative Instruments Act 2003 Sdiv = Subdivision(s)
(md) = misdescribed amendment can be given SLI = Select Legislative Instrument
    effect SR = Statutory Rules
(md not incorp) = misdescribed amendment Sub‑Ch = Sub‑Chapter(s)
    cannot be given effect SubPt = Subpart(s)
mod = modified/modification underlining = whole or part not
No. = Number(s)     commenced or to be commenced

Endnote 3—Legislation history

Name Registration Commencement Application, saving and transitional provisions
Health Insurance (Diagnostic Imaging Services Table) Regulations 2017 16 June 2017 (F2017L00679) 17 June 2017 (s 2(1) item 1)
Health Insurance Legislation Amendment (2017 Measures No. 2) Regulations 2017 12 Oct 2017 (F2017L01343) Sch 1 (item 1) and Sch 3 (items 1–3): 1 Nov 2017 (s 2(1) item 1) —
Health Insurance Legislation Amendment (2018 Measures No. 1) Regulations 2018 24 Apr 2018 (F2018L00514) Sch 1 (items 1–13): 1 May 2018 (s 2(1) item 1) —

Endnote 4—Amendment history

Provision affected How affected
s 2............................................. rep LA s 48D
s 4............................................. rep LA s 48C
Schedule 1
Part 2
Division 2.3
Subdivision A
c 2.3.1A.................................... ad F2017L01343
Division 2.4
c 2.4.2....................................... am F2018L00514
Group I4 Table......................... am F2017L01343; F2018L00514
Division 2.5
Subdivision A
c 2.5.1....................................... am F2018L00514
c 2.5.4....................................... rs F2018L00514
c 2.5.9....................................... rs F2018L00514
Subdivision B
Group I5 Table......................... am F2018L00514
Part 3
c 3.1.......................................... am F2018L00514
Schedule 2................................ rep LA s 48C
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