Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 1) 2020 (Cth)

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Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 1) 2020

made under the

Health Insurance Act 1973

Compilation No. 1

Compilation date:1 May 2020

Includes amendments up to:F2020L00341

Registered:22 May 2020

About this compilation

This compilation

This is a compilation of the Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 1) 2020 that shows the text of the law as amended and in force on 1 May 2020 (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If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.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

1Name

This instrument is the Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 1) 2020.

2Commencement
  1. (1)

    Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.

Commencement information

Column 1

Column 2

Column 3

Provisions

Commencement

Date/Details

1.

The whole of this instrument

1 May 2020.

1 May 2020

Note: This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.

  1. (2)

    Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.

3Authority

This instrument is made under the Health Insurance Act 1973.

4Diagnostic imaging services table

For the purposes of subsection 4AA(1) of the Health Insurance Act 1973, Schedule 1 prescribes a table of diagnostic imaging services.

5Schedule 2

Each instrument that is specified in Schedule 2 to this instrument is amended or repealed as set out in the applicable items in that Schedule, and any other item in that Schedule has effect according to its terms.

Schedule 1Diagnostic imaging services table

Note: See sections 4 and 5.

Part 1PreliminaryDivision 1.1Interpretation1.1.1References 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.

1.1.2References in this Schedule to items include items determined under section 3C of the Act

A reference in this Schedule to an item includes a reference to an item relating to a health service that, under a determination in force under subsection 3C(1) of the Act, is treated as if there were an item in the table that relates to the service.

1.1.3Dictionary

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

Division 1.2General application provisionsSubdivision ACapital sensitivity requirements1.2.1Restriction on items – services performed on aged equipment

Subject to Subdivision B, an item in this Schedule does not apply to a service that is performed on diagnostic imaging equipment if the age of the equipment exceeds the applicable life age of the equipment.

1.2.2Age of equipment

Working out age of equipment

  1. (1)

    The date from which the age of equipment is worked out for the purposes of this instrument is:

    1. (a)

      the date the equipment was first installed in Australia; or

    2. (b)

      if the equipment was imported as used equipment—the date of manufacture of the oldest component of the equipment.

  2. (2)

    The applicable life age:

    1. (a)

      for diagnostic imaging equipment that has not been upgraded—is the new effective life age of the equipment; and

    2. (b)

      for diagnostic imaging equipment that has been upgraded—is the maximum extended life age of the equipment.

  3. (3)

    The new effective life age and maximum extended life age for diagnostic imaging equipment are the periods set out in table 1.2.2 for that type of equipment. The type of equipment is defined by the type of service that is rendered using diagnostic imaging procedures carried out using the equipment:

Table 1.2.2—Life ages

Item

Column 1

Type of equipment

Column 2

Definition of type of equipment

Column 3

New effective life age (years)

Column 4

Maximum extended life age (years)

1

Ultrasound equipment

Equipment primarily used in carrying out a diagnostic imaging procedure used in rendering a service to which an item in Group I1 applies

10

15

2

CT equipment

Equipment primarily used in carrying out a diagnostic imaging procedure used in rendering a service to which an item in Group I2 applies

10

15

3

Mammography equipment

Equipment primarily used in carrying out a diagnostic imaging procedure used in rendering a service to which an item in Subgroup 10 of Group I3 applies

10

15

4

Angiography equipment

Equipment primarily used in carrying out a diagnostic imaging procedure used in rendering a service to which an item in Subgroup 13 of Group I3 applies

10

15

5

Other diagnostic radiology equipment

Equipment primarily used in carrying out a diagnostic imaging procedure used in rendering a service to which an item in Subgroups 1 to 9, 12, 14, 15 or 17 of Group I3 applies

15

20

6

Nuclear medicine imaging equipment (other than for PET)

Equipment primarily used in carrying out a diagnostic imaging procedure used in rendering a service to which an item in Group I4 applies (other than items 61523 to 61647)

10

15

7

MRI equipment

Equipment primarily used in carrying out a diagnostic imaging procedure used in rendering a service to which an item in Group I5 applies

10

20

Upgrades

  1. (4)

    Diagnostic imaging equipment has been upgraded if:

    1. (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

    2. (b)

      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

    3. (c)

      the equipment is currently accredited under The Royal Australian and New Zealand College of Radiologists’ Mammography Quality Assurance Program.

Subdivision BExemptions from capital sensitivity requirements1.2.3Outer regional, remote and very remote areas and Norfolk Island
  1. (1)

    Clause 1.2.1 does not apply to a service that is performed on diagnostic imaging equipment if:

    1. (a)

      the equipment is ordinarily located at diagnostic imaging premises; and

    2. (b)

      the diagnostic imaging premises are located in an area that is:

      1. (i)

        Outer Regional Australia; or

      2. (ii)

        Remote Australia; or

      3. (iii)

        Very Remote Australia; or

      4. (iv)

        Norfolk Island.

  2. (2)

    Clause 1.2.1 does not apply to a service that is performed on diagnostic imaging equipment if:

    1. (a)

      the equipment is not ordinarily located at diagnostic imaging premises; and

    2. (b)

      the equipment is ordinarily located, when not in use, at a base for mobile diagnostic imaging equipment; and

    3. (c)

      the base is located in an area that is:

      1. (i)

        Outer Regional Australia; or

      2. (ii)

        Remote Australia; or

      3. (iii)

        Very Remote Australia; or

      4. (iv)

        Norfolk Island.

1.2.4Meaning of relevant proprietor

The relevant proprietor for diagnostic imaging equipment is:

  1. (a)

    if the equipment is ordinarily located at diagnostic imaging premises—the proprietor of the premises; or

  2. (b)

    if the equipment:

    1. (i)

      is not ordinarily located at diagnostic imaging premises; and

    2. (ii)

      is ordinarily located, when not in use, at a base for mobile diagnostic imaging equipment;

the proprietor of the base.

1.2.5Inner regional areas – applying for exemptions

Scope of this clause

  1. (1)

    This clause applies to diagnostic imaging equipment if:

    1. (a)

      all of the following subparagraphs apply:

      1. (i)

        the equipment is ordinarily located at diagnostic imaging premises;

      2. (ii)

        the diagnostic imaging premises are located in an area that is Inner Regional Australia;

      3. (iii)

        the diagnostic imaging premises are located in an area that is RRMA4 or RRMA5; or

    2. (b)

      all of the following subparagraphs apply:

      1. (i)

        the equipment is not ordinarily located at diagnostic imaging premises;

      2. (ii)

        the equipment is ordinarily located at a base for mobile diagnostic imaging equipment when not in use;

      3. (iii)

        the base is located in an area that is Inner Regional Australia;

      4. (iv)

        the base is located in an area that is RRMA4 or RRMA5.

Applying for exemption

  1. (2)

    The relevant proprietor for the equipment may apply to the Secretary for an exemption under clause 1.2.6 in respect of the equipment.

    Note: For relevant proprietor, see clause 1.2.4.

  2. (3)

    The application must:

    1. (a)

      be in writing; and

    2. (b)

      be made no later than 3 years after the end of the maximum extended life age of the equipment.

Notifying proprietor of receipt of application

  1. (4)

    If:

    1. (a)

      the Secretary receives an application under subclause (2) of this clause for an exemption in respect of the equipment; and

    2. (b)

      the application complies with subclause (3);

the Secretary must notify the relevant proprietor for the equipment in writing that the Secretary has received the application.

  1. (5)

    To avoid doubt, the Secretary is not required to notify the relevant proprietor under subclause (4) if the equipment does not meet the requirements of subclause (1).

Effect of application on capital sensitivity requirements

  1. (6)

    Clause 1.2.1 does not apply to a service that is performed on the equipment during the period:

    1. (a)

      starting when the Secretary notifies the relevant proprietor under subclause (4) of this clause that the Secretary has received an application in respect of the equipment; and

    2. (b)

      ending when the Secretary makes a decision on the application under clause 1.2.6, or the application is withdrawn.

1.2.6Inner regional areas – granting exemptions

Scope of this clause

  1. (1)

    This clause applies if, under subclause 1.2.5(4), the Secretary notifies the relevant proprietor for diagnostic imaging equipment that the Secretary has received an application for an exemption in respect of the equipment.

Granting exemption

  1. (2)

    The Secretary must, by notice in writing given to the proprietor:

    1. (a)

      subject to subclause (3) of this clause, grant the exemption; or

    2. (b)

      refuse to grant the exemption.

  2. (3)

    The Secretary must not grant the exemption unless the Secretary is satisfied that the equipment:

    1. (a)

      is operated on a rare and sporadic basis; and

    2. (b)

      provides crucial patient access to diagnostic imaging services.

  3. (4)

    The Secretary must make a decision on the application under subclause (2) within 28 days after notifying the proprietor as mentioned in subclause (1).

Effect of exemption on capital sensitivity requirements

  1. (5)

    If the Secretary grants the exemption, clause 1.2.1 does not apply to a service that is performed on the equipment while the exemption is in force.

  2. (6)

    If the Secretary refuses to grant the exemption, clause 1.2.1 does not apply to a service that is performed on the equipment during the period:

    1. (a)

      starting when the Secretary refuses to grant the exemption; and

    2. (b)

      ending:

      1. (i)

        when the relevant proprietor for the equipment applies under clause 1.2.11 for reconsideration of the decision to refuse to grant the exemption; or

      2. (ii)

        if the relevant proprietor does not apply for such consideration—at the end of the period in which the proprietor could have applied for such reconsideration.

1.2.7Equipment unable to be replaced etc. before end of applicable life age – applying for exemptions

Applying for exemption

  1. (1)

    The relevant proprietor for diagnostic imaging equipment may apply to the Secretary for an exemption under clause 1.2.8 in respect of the equipment.

    Note: For relevant proprietor, see clause 1.2.4.

  2. (2)

    The application must:

    1. (a)

      be in writing; and

    2. (b)

      be made before the end of the equipment’s applicable life age; and

    3. (c)

      set out reasons why the proprietor is unable to replace the equipment (or upgrade the equipment, if it has not already been upgraded) before the end of the equipment’s applicable life age.

Notifying proprietor of receipt of application

  1. (3)

    If:

    1. (a)

      the Secretary receives an application under subclause (2) of this clause for an exemption in respect of the equipment; and

    2. (b)

      the application complies with subclause (2);

the Secretary must notify the relevant proprietor for the equipment in writing that the Secretary has received the application.

Effect of application on capital sensitivity requirements

  1. (4)

    Clause 1.2.1 does not apply to a service that is performed on the equipment during the period:

    1. (a)

      starting when the Secretary notifies the relevant proprietor under subclause (3) of this clause that the Secretary has received an application in respect of the equipment; and

    2. (b)

      ending when the Secretary makes a decision on the application under clause 1.2.8, or the application is withdrawn.

1.2.8Equipment unable to be replaced etc. before end of applicable life age – granting exemptions

Scope of this clause

  1. (1)

    This clause applies if, under subclause 1.2.7(3), the Secretary notifies the relevant proprietor for diagnostic imaging equipment that the Secretary has received an application for an exemption in respect of the equipment.

Granting exemption

  1. (2)

    The Secretary must, by notice in writing given to the proprietor:

    1. (a)

      subject to subclauses (3) and (4) of this clause, grant the exemption for a specified period; or

    2. (b)

      refuse to grant the exemption.

  2. (3)

    The Secretary must not grant the exemption unless the Secretary is satisfied that:

    1. (a)

      due to circumstances beyond the control of the proprietor, the proprietor is unable to replace the equipment (or upgrade the equipment, if it has not already been upgraded) before the end of its applicable life age; and

    2. (b)

      the proprietor will be able to replace the equipment (or upgrade the equipment, if it has not already been upgraded) before the end of the period specified under paragraph (2)(a).

  3. (4)

    The period specified under paragraph (2)(a) must end no later than 3 months after the end of the equipment’s applicable life age.

    Note: The period specified under paragraph (2)(a) is the initial exemption period of the exemption: see clause 3.1. The exemption period can be extended under clause 1.2.10.

  4. (5)

    The Secretary must make a decision on the application under subclause (2) within 28 days after notifying the proprietor as mentioned in subclause (1).

Effect of exemption or refusal on capital sensitivity requirements

  1. (6)

    If the Secretary grants the exemption, clause 1.2.1 does not apply to a service that is performed on the equipment during the exemption period of the exemption (including the exemption period as extended under clause 1.2.10, if applicable).

  2. (7)

    If the Secretary refuses to grant the exemption, clause 1.2.1 does not apply to a service that is performed on the equipment during the period:

    1. (a)

      starting when the Secretary refuses to grant the exemption; and

    2. (b)

      ending:

      1. (i)

        when the relevant proprietor for the equipment applies under clause 1.2.11 for reconsideration of the decision to refuse to grant the exemption; or

      2. (ii)

        if the relevant proprietor does not apply for such consideration—at the end of the period in which the proprietor could have applied for such reconsideration.

1.2.9Equipment unable to be replaced etc. before end of applicable life age – applying for extensions of exemption periods

Scope of this clause

  1. (1)

    This clause applies if an exemption under clause 1.2.8 in respect of diagnostic imaging equipment is in force.

Applying for extension of exemption period

  1. (2)

    The relevant proprietor for the equipment may apply to the Secretary to extend the exemption period of the exemption under clause 1.2.10.

    Note: For relevant proprietor, see clause 1.2.4.

  2. (3)

    The application must:

    1. (a)

      be in writing; and

    2. (b)

      be made before the end of the current exemption period of the exemption; and

    3. (c)

      set out reasons why the proprietor continues to be unable to replace or upgrade the equipment.

Notifying proprietor of receipt of application

  1. (4)

    If:

    1. (a)

      the Secretary receives an application under subclause (2) of this clause for an extension of the exemption; and

    2. (b)

      the application complies with subclause (3);

the Secretary must notify the relevant proprietor for the equipment in writing that the Secretary has received the application.

Effect of application on capital sensitivity requirements

  1. (5)

    Clause 1.2.1 does not apply to a service that is performed on the equipment during the period:

    1. (a)

      starting when the Secretary notifies the relevant proprietor under subclause (4) of this clause that the Secretary has received an application in respect of the equipment; and

    2. (b)

      ending when the Secretary makes a decision on the application under clause 1.2.10, or the application is withdrawn.

1.2.10Equipment unable to be replaced etc. before end of applicable life age – extending exemption periods

Scope of this clause

  1. (1)

    This clause applies if, under subclause 1.2.9(4), the Secretary notifies the relevant proprietor for diagnostic imaging equipment that the Secretary has received an application for an extension of the exemption period of an exemption in respect of the equipment.

Secretary may extend extension period

  1. (2)

    The Secretary must, by notice in writing given to the proprietor:

    1. (a)

      subject to subclauses (3) and (4) of this clause, extend the exemption period for a specified period; or

    2. (b)

      refuse to extend the exemption period.

  2. (3)

    The Secretary must not extend the exemption period unless the Secretary is satisfied that:

    1. (a)

      due to circumstances beyond the control of the proprietor, the proprietor is unable to replace the equipment (or upgrade the equipment, if it has not already been upgraded) before the end of the current exemption period of the exemption; and

    2. (b)

      the proprietor will be able to replace the equipment (or upgrade the equipment, if it has not already been upgraded) before the end of the exemption period as extended.

  3. (4)

    The extension must be for no more than 3 months.

  4. (5)

    The Secretary must make a decision on the application under subclause (2) within 28 days after notifying the proprietor as mentioned in subclause (1).

Effect of refusal on capital sensitivity requirements

  1. (6)

    If the Secretary refuses to extend the exemption period, clause 1.2.1 does not apply to a service that is performed on the equipment during the period:

    1. (a)

      starting when the Secretary refuses to extend the exemption period; and

    2. (b)

      ending:

      1. (i)

        when the relevant proprietor for the equipment applies under clause 1.2.11 for reconsideration of the decision to refuse to extend the exemption period; or

      2. (ii)

        if the relevant proprietor does not apply for such consideration—at the end of the period in which the proprietor could have applied for such reconsideration.

    Note: Clause 1.2.1 does not apply to a service provided using the equipment during the extended exemption period: see subclause 1.2.8(6).

1.2.11Reconsideration by Secretary – applying for reconsideration

Scope of this clause

  1. (1)

    This clause applies to:

    1. (a)

      a decision under clause 1.2.6 or 1.2.8 to refuse to grant an exemption in respect of diagnostic imaging equipment; or

    2. (b)

      a decision under clause 1.2.10 to refuse to extend the exemption period of an exemption in respect of diagnostic imaging equipment.

Applying for reconsideration of decision

  1. (2)

    The relevant proprietor for the equipment may apply to the Secretary for reconsideration of the decision under clause 1.2.12.

    Note: For relevant proprietor, see clause 1.2.4.

  2. (3)

    The application must:

    1. (a)

      be in writing; and

    2. (b)

      be made within:

      1. (i)

        28 days after the Secretary makes the decision; or

      2. (ii)

        if the Secretary is satisfied that special circumstances exist—within such further period (if any) as the Secretary allows; and

    3. (c)

      identify the decision for reconsideration; and

    4. (d)

      set out the reasons for the application.

  3. (4)

    The application may provide new material for the Secretary to consider.

Notifying proprietor of receipt of application

  1. (5)

    If:

    1. (a)

      the Secretary receives an application under subclause (2) of this clause for reconsideration of the decision; and

    2. (b)

      the application complies with subclause (3);

the Secretary must notify the relevant proprietor for the equipment in writing that the Secretary has received the application.

Effect of application on capital sensitivity requirements

  1. (6)

    Clause 1.2.1 does not apply to a service that is performed on the equipment during the period:

    1. (a)

      starting when the Secretary notifies the relevant proprietor under subclause (5) of this clause that the Secretary has received an application in respect of the equipment; and

    2. (b)

      ending when the Secretary makes a decision on the application under clause 1.2.12, or the application is withdrawn.

1.2.12Reconsideration by Secretary – reconsidering decisions

Scope of this clause

  1. (1)

    This clause applies if, under subclause 1.2.11(5), the Secretary notifies the relevant proprietor of diagnostic imaging equipment that the Secretary has received an application for reconsideration of a decision in respect of the equipment.

Reconsidering decisions

  1. (2)

    The Secretary must:

    1. (a)

      reconsider the decision; and

    2. (b)

      by notice in writing given to the proprietor:

      1. (i)

        affirm the decision; or

      2. (ii)

        set aside the decision and make a decision in substitution for it.

  2. (3)

    The Secretary must make a decision on the application under subclause (2) within 28 days after notifying the proprietor as mentioned in subclause (1).

Effect of affirmation of decision on capital sensitivity requirements

  1. (4)

    If the Secretary affirms the decision, clause 1.2.1 does not apply to a service that is performed on the equipment during the period:

    1. (a)

      starting when the Secretary affirms the decision; and

    2. (b)

      ending:

      1. (i)

        if an application for review of the decision to affirm is made under clause 1.2.13—when each party to the proceeding has been given a copy of the decision of the Administrative Appeals Tribunal on review; or

      2. (ii)

        otherwise—when the time for making such an application for review expires.

    Note: For the time for making an application for review, see paragraph 29(1)(d) and subsection 29(2) of the Administrative Appeals Tribunal Act 1975.

1.2.13Review by AAT

Applications may be made to the Administrative Appeals Tribunal for review of decisions of the Secretary under clause 1.2.12 to affirm decisions.

1.2.14Delegation

The Secretary may, by written notice, delegate any of the Secretary’s powers under this Subdivision to an SES employee, or acting SES employee, in the Department.

Subdivision COther provisions1.2.15Meaning of symbols (R) and (NR)
  1. (1)

    A service corresponding to an item including the symbol (R) is an R‑type diagnostic imaging service.

  2. (2)

    A service corresponding to an item including the symbol (NR) is an NR‑type diagnostic imaging service.

1.2.16Who may provide a diagnostic imaging service

Items in this Schedule relating to diagnostic imaging services apply whether the service is provided by:

  1. (a)

    a medical practitioner; or

  2. (b)

    a person, other than a medical practitioner, who provides the service under the supervision of a medical practitioner in accordance with accepted medical practice.

1.2.17Restriction on items – report requirements for R‑type diagnostic imaging services
  1. (1)

    An item relating to an R‑type diagnostic imaging service (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. (2)

    This subclause applies to:

    1. (a)

      items 55054, 55130, 55135, 55848, 57341, 59312, 59314, 60506, 60509 and 61109; and

    2. (b)

      items 60918 and 60927.

    Note: The items in paragraph (a) relate to services performed in conjunction with a surgical procedure. The items in paragraph (b) relate to services performed in preparation for a radiological procedure.

1.2.18Bulk‑billing incentive
  1. (1)

    This clause applies if:

    1. (a)

      a service that is mentioned in an item in Divisions 2.1 to 2.4 of this Schedule is provided; and

    2. (b)

      the service is not provided in a hospital; and

    3. (c)

      the service is bulk‑billed.

  2. (2)

    The fee for the service is 95% of the fee mentioned in this Schedule for the service.

    Note: Under paragraph 10(2)(aa) of the Act and subsection 28(2) of the Health Insurance Regulations 2018, the medicare benefit payable is 100% of the fee for the service.

  3. (3)

    This clause does not apply to the service specified in item 61369.

1.2.19Bulk‑billing – magnetic resonance imaging
  1. (1)

    This clause applies if:

    1. (a)

      a service that is mentioned in an item in Division 2.5 of this Schedule is provided; and

    2. (b)

      the service is not provided in a hospital; and

    3. (c)

      the service is bulk‑billed.

  2. (2)

    The fee for the service is 100% of the fee mentioned in this Schedule for the service.

    Note: Under paragraph 10(2)(aa) of the Act and subsection 28(2) of the Health Insurance Regulations 2018, the medicare benefit payable is 100% of the fee for the service.

1.2.20Multiple services – vascular ultrasound
  1. (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:

    1. (a)

      the second highest fee is reduced by 40%;

    2. (b)

      any other fee, except the highest, is reduced by 50%.

  2. (2)

    For the purposes of subclause (1):

    1. (a)

      if 2 or more applicable fees are equally the highest:

      1. (i)

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

      2. (ii)

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

    2. (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

    3. (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. (3)

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

1.2.21Multiple services
  1. (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. (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:

    1. (a)

      if the fee for the relevant consultation is at least $40—by $35; or

    2. (b)

      if that fee is less than $40 but more than $15—by $15; or

    3. (c)

      if that fee is less than $15—by the amount of that fee.

  3. (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. (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. (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. (6)

    Clauses 1.2.20 and 2.5.8 apply, subject to subclauses (7) and (8), in addition to this clause.

  7. (7)

    For the purposes of clause 1.2.20, if a medical practitioner provides:

    1. (a)

      2 or more vascular ultrasound services for the same patient on the same day; and

    2. (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.

  1. (8)

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

    1. (a)

      2 or more MRI services mentioned in Subgroup 12 or 13 of Group I5 for the same patient on the same day; and

    2. (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.

  1. (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.

  2. (10)

    This clause does not apply to the fee specified in item 59103, 64990 or 64991.

  3. (11)

    In this Schedule:

consultation means a service under an item listed in Divisions 2.2 to 2.30 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 2.2 to 2.30 of the general medical services table.

1.2.22Restriction on items – services provided with autologous injections of blood or blood products

An item in this Schedule 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.

1.2.23Restriction on items – services provided with harvesting, storage, in vitro processing or injection of non‑haematopoietic stem cells

An item in this Schedule 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, the harvesting, storage, in vitro processing or injection of non‑haematopoietic stem cells.

Part 2Services and feesDivision 2.1Group I1: ultrasoundSubdivision AGeneral2.1.1Restriction on items – ultrasound services

Items in this Division (except items 55600 and 55603) apply to an ultrasound service only if the diagnostic imaging procedure used in rendering the service is performed:

  1. (a)

    by a medical practitioner; or

  2. (b)

    on behalf of a medical practitioner by a person whose name is entered on the Register of Sonographers kept by the Chief Executive Medicare.

Note: Maintaining a register of sonographers is a function of the Chief Executive Medicare under section 32 of the Human Services (Medicare) Regulations 2017.

2.1.2Restriction on items – R‑type ultrasound services
  1. (1)

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

    1. (a)

      under the supervision of a specialist or a consultant physician in the practice of the specialist’s or consultant physician’s specialty who is available:

      1. (i)

        to monitor and influence the conduct and diagnostic quality of the examination; and

      2. (ii)

        if necessary, to attend on the patient personally; or

    2. (b)

      under the supervision of a practitioner who:

      1. (i)

        is not a specialist or consultant physician; and

      2. (ii)

        meets the requirement of subclause (2); and

      3. (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

    3. (c)

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

      1. (i)

        to monitor and influence the conduct and diagnostic quality of the examination; and

      2. (ii)

        if necessary, to attend on the patient personally; or

    4. (d)

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

      1. (i)

        in an emergency; or

      2. (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. (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. (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 BSubgroups 1 to 4 of Group I12.1.3Items in Subgroups 1 to 4 of Group I1

This clause sets out items in Subgroups 1 to 4 of Group I1.

Group I1—Ultrasound

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 1—General

55028

Head, ultrasound scan of (R)

109.10

55029

Head, ultrasound scan of (NR)

37.85

55030

Orbital contents, ultrasound scan of (R)

109.10

55031

Orbital contents, ultrasound scan of (NR)

37.85

55032

Neck, one or more structures of, ultrasound scan of (R)

109.10

55033

Neck, one or more structures of, ultrasound scan of (NR)

37.85

55036

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

(a) the service is not solely a transrectal ultrasonic examination of any of the following:

(i) prostate gland;

(ii) bladder base;

(iii) urethra; and

(b) within 24 hours of the service, a service mentioned in item 55038 is not performed on the same patient by the providing practitioner (R)

111.30

55037

Abdomen, ultrasound scan of (including scan of urinary tract when performed), for morphological assessment, if the service is not solely a transrectal ultrasonic examination of any of the following:

(a) prostate gland;

(b) bladder base;

(c) urethra (NR)

37.85

55038

Urinary tract, ultrasound scan of, if:

(a) the service is not solely a transrectal ultrasonic examination of any of the following:

(i) prostate gland;

(ii) bladder base;

(iii) urethra; and

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

109.10

55039

Urinary tract, ultrasound scan of, if the service is not solely a transrectal ultrasonic examination of any of the following:

(a) prostate gland;

(b) bladder base;

(c) urethra (NR)

37.85

55048

Scrotum, ultrasound scan of (R)

109.50

55049

Scrotum, ultrasound scan of (NR)

37.85

55054

Ultrasonic cross‑sectional echography, in conjunction with a surgical procedure (other than a procedure to which item 55848 or 55850 applies) using interventional techniques, not being a service associated with a service to which any other item in this Group applies (R)

109.10

55065

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

(a) the service is not solely a service to which an item in Subgroup 5 of this Group applies or a transrectal ultrasonic examination of any of the following:

(i) prostate gland;

(ii) bladder base;

(iii) urethra; and

(b) within 24 hours of the service, a service mentioned in item 55038 is not performed on the same patient by the providing practitioner (R)

98.25

55066

Breasts, both, ultrasound scan of, in conjunction with a surgical procedure using interventional techniques, if:

(a) the request for the scan indicates that an ultrasound‑guided breast intervention be performed; and

(b) the service is not performed in conjunction with any other item in this Group (R)

218.20

55068

Pelvis, ultrasound scan of, by any or all approaches, if the service is not solely a service to which an item in Subgroup 5 of this Group applies or a transrectal ultrasonic examination of any of the following:

(a) prostate gland;

(b) bladder base;

(c) urethra (NR)

35.00

55070

Breast, one, ultrasound scan of (R)

98.25

55071

Breast, one, ultrasound scan of, in conjunction with a surgical procedure using interventional techniques, if:

(a) the request for the scan indicates that an ultrasound‑guided breast intervention be performed; and

(b) the service is not performed in conjunction with any other item in this group (R)

207.35

55073

Breast, one, ultrasound scan of (NR)

34.05

55076

Breasts, both, ultrasound scan of (including an ultrasound scan for post mastectomy surveillance) (R)

109.10

55079

Breasts, both, ultrasound scan of (including an ultrasound scan for post mastectomy surveillance) (NR)

37.85

55084

Urinary bladder, ultrasound scan of, by any or all approaches, if within 24 hours of the service, a service mentioned in item 11917, 55036, 55038, 55065, 55600 or 55603 is not performed on the same patient by the providing practitioner (R)

98.25

55085

Urinary bladder, ultrasound scan of, by any or all approaches, if within 24 hours of the service, a service mentioned in item 11917, 55037, 55039, 55068, 55600 or 55603 is not performed on the same patient by the providing practitioner (NR)

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, if:

(a) the service involves all of the following:

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

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

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

(b) the service is not associated with a service to which another item in this Subgroup (except items 55118 and 55130), applies (R)

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, if:

(a) the service involves all of the following:

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

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

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

(b) the service is not associated with a service to which another item in this Subgroup (except items 55118 and 55130), applies (R)

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, if:

(a) the service involves all of the following:

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

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

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

(b) the service is not associated with a service to which another item in this Subgroup (except items 55118 and 55130), applies (R)

230.65

55116

Exercise stress echocardiography performed in conjunction with a service mentioned in item 11712, if:

(a) the service involves all of the following:

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

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

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

(b) the service is not associated with a service to which another item in this Subgroup (except items 55118 and 55130), applies (R)

261.65

55117

Pharmacological stress echocardiography performed in conjunction with a service mentioned in item 11712, if:

(a) the service involves all of the following:

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

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

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

(b) the service is not associated with a service to which another item in this Subgroup (except items 55118 and 55130), applies (R)

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, if:

(a) the service includes:

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

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

(b) the service is not an intra‑operative service (R) (Anaes.)

275.50

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 applies (R) (Anaes.)

170.00

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 applies (R) (Anaes.)

353.60

Subgroup 3—Vascular

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 any of the following:

(a) a service to which an item in Subgroup 4 applies;

(b) a service to which item 55880, 55881, 55882, 55883, 55884, 55885, 55886, 55887, 55888, 55889, 55890, 55891, 55892, 55893, 55894 or 55895 applies (R)

169.50

55244

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the lower limb, below the inguinal ligament, for acute venous thrombosis, not being a service associated with any of the following:

(a) a service to which item 55246 applies;

(b) a service to which an item in Subgroup 4 applies;

(c) a service to which item 55880, 55881, 55882, 55883, 55884, 55885, 55886, 55887, 55888, 55889, 55890, 55891, 55892, 55893, 55894 or 55895 (R)

169.50

55246

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the lower limb, below the inguinal ligament, for chronic venous disease, not being a service associated with any of the following:

(a) a service to which item 55244 applies;

(b) a service to which an item in Subgroup 4 applies;

(c) a service to which item 55880, 55881, 55882, 55883, 55884, 55885, 55886, 55887, 55888, 55889, 55890, 55891, 55892, 55893, 55894 or 55895 (R)

169.50

55248

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the upper limb or of arteries and bypass grafts in the upper limb, not being a service associated with any of the following:

(a) a service to which an item in Subgroup 4 applies;

(b) a service to which item 55880, 55881, 55882, 55883, 55884, 55885, 55886, 55887, 55888, 55889, 55890, 55891, 55892, 55893, 55894 or 55895 applies (R)

169.50

55252

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the upper limb, not being a service associated with any of the following:

(a) a service to which an item in Subgroup 4 applies;

(b) a service to which item 55880, 55881, 55882, 55883, 55884, 55885, 55886, 55887, 55888, 55889, 55890, 55891, 55892, 55893, 55894 or 55895 applies (R)

169.50

55274

Duplex scanning, bilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of extra‑cranial bilateral carotid and vertebral vessels, with or without subclavian and innominate vessels, with or without oculoplethysmography or peri‑orbital Doppler examination, not being a service associated with any of the following:

(a) a service to which an item in Subgroup 4 applies;

(b) a service to which item 55880, 55881, 55882, 55883, 55884, 55885, 55886, 55887, 55888, 55889, 55890, 55891, 55892, 55893, 55894 or 55895 applies (R)

169.50

55276

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of intra‑abdominal, aorta and iliac arteries or inferior vena cava and iliac veins or of intra‑abdominal, aorta and iliac arteries and inferior vena cava and iliac veins, excluding pregnancy related studies, not being a service associated with any of the following:

(a) a service to which an item in Subgroup 4 applies;

(b) a service to which item 55880, 55881, 55882, 55883, 55884, 55885, 55886, 55887, 55888, 55889, 55890, 55891, 55892, 55893, 55894 or 55895 applies (R)

169.50

55278

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of renal or visceral vessels or of renal and visceral vessels, including aorta, inferior vena cava and iliac vessels as required excluding pregnancy related studies, not being a service associated with any of the following:

(a) a service to which an item in Subgroup 4 applies;

(b) a service to which item 55880, 55881, 55882, 55883, 55884, 55885, 55886, 55887, 55888, 55889, 55890, 55891, 55892, 55893, 55894 or 55895 applies (R)

169.50

55280

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of intra‑cranial vessels, not being a service associated with any of the following:

(a) a service to which an item in Subgroup 4 applies;

(b) a service to which item 55880, 55881, 55882, 55883, 55884, 55885, 55886, 55887, 55888, 55889, 55890, 55891, 55892, 55893, 55894 or 55895 applies (R)

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 any of the following:

(i) a service to which an item in Subgroup 4 applies;

(ii) a service to which item 55880, 55881, 55882, 55883, 55884, 55885, 55886, 55887, 55888, 55889, 55890, 55891, 55892, 55893, 55894 or 55895 applies (R)

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 any of the following:

(i) a service to which an item in Subgroup 4 applies;

(ii) a service to which item 55880, 55881, 55882, 55883, 55884, 55885, 55886, 55887, 55888, 55889, 55890, 55891, 55892, 55893, 55894 or 55895 applies (R)

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 any of the following:

(a) a service to which an item in Subgroup 4 applies;

(b) a service to which item 55880, 55881, 55882, 55883, 55884, 55885, 55886, 55887, 55888, 55889, 55890, 55891, 55892, 55893, 55894 or 55895 applies (R)

169.50

55294

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or veins, or both, including any associated skin marking, for mapping of bypass conduit before vascular surgery, not being a service associated with any of the following:

(a) a service to which an item in Subgroup 3 or 4 applies;

(b) a service to which item 55880, 55881, 55882, 55883, 55884, 55885, 55886, 55887, 55888, 55889, 55890, 55891, 55892, 55893, 55894 or 55895 applies (R)

169.50

55296

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow spectral analysis and marking of veins in the lower limbs below the inguinal ligament before varicose vein surgery, including any associated skin marking, not being a service associated with any of the following:

(a) a service to which an item in Subgroup 3 or 4 applies;

(b) a service to which item 55880, 55881, 55882, 55883, 55884, 55885, 55886, 55887, 55888, 55889, 55890, 55891, 55892, 55893, 55894 or 55895 applies (R)

111.05

Subgroup 4—Urological

55600

Prostate, bladder base and urethra, 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 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:

(i) a specialist in urology, radiation oncology or medical oncology; or

(ii) a consultant physician in medical oncology;

who has:

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

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

109.10

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 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:

(i) a specialist in urology, radiation oncology or medical oncology; or

(ii) a consultant physician in medical oncology;

who has:

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

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

109.10

Subdivision CSubgroup 5 of Group I1: obstetric and gynaecological2.1.4Obstetric and gynaecological ultrasound services – limits
  1. (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. (2)

    For any patient, items 55706, 55707, 55708, 55709, 55718, 55723, 55759, 55762, 55768 and 55770 are applicable only once in a pregnancy.

2.1.5Obstetric and gynaecological services – referrals and clinical notes
  1. (1)

    A referral for a service mentioned in item 55700, 55704, 55707, 55712, 55718, 55721, 55759, 55764, 55768 and 55772 must state the relevant condition or clinical indication for the service.

  2. (2)

    If a referral for a service mentioned in item 55712, 55721, 55764 or 55772 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. (3)

    A medical practitioner’s clinical notes for a service mentioned in item 55703, 55705, 55708, 55715, 55723, 55725, 55762, 55766, 55770 or 55774 must state the relevant condition or clinical indication for the service.

2.1.6Items in Subgroup 5 of Group I1

This clause sets out items in Subgroup 5 of Group I1.

Group I1—Ultrasound

Column 1

Item

Column 2

Diagnostic imaging service

Column 3

Fee ($)

Subgroup 5—Obstetric and gynaecological

55700

Pelvis or abdomen, pregnancy‑related or pregnancy complication, ultrasound scan of, by any or all approaches, for determining the gestation, location, viability or number of foetuses, if the dating of the pregnancy (as confirmed by ultrasound) is less than 12 weeks of gestation (R)

60.00

55703

Pelvis or abdomen, pregnancy‑related or pregnancy complication, ultrasound scan of, by any or all approaches, for determining the gestation, location, viability or number of foetuses, if the dating of the pregnancy (as confirmed by ultrasound) is less than 12 weeks of gestation (NR)

35.00

55704

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, for determining the structure, gestation, location, viability or number of foetuses, if the dating of the pregnancy (as confirmed by ultrasound) is 12 to 16 weeks of gestation (R)

70.00

55705

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, for determining the structure, gestation, location, viability or number of foetuses, if the dating of the pregnancy (as confirmed by ultrasound) is 12 to 16 weeks of gestation (NR)

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

(b) the service is not performed in the same pregnancy as item 55709 (R)

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

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

(c) the service is not performed with item 55700, 55703, 55704 or 55705 on the same patient within 24 hours (R)

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

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

(c) the service is not performed with item 55700, 55703, 55704 or 55705, on the same patient within 24 hours (NR)

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

(b) the service is not performed in the same pregnancy as item 55706 (NR)

38.00

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

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

115.00

55715

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, performed by or on behalf of a medical practitioner who is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, if:

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

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

40.00

55718

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

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

(b) the service is not performed in the same pregnancy as item 55723 (R)

100.00

55721

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

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

(c) further examination is clinically indicated in the same pregnancy to which item 55718 or 55723 applies (R)

115.00

55723

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

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

(b) the service is not performed in the same pregnancy as item 55718 (NR)

38.00

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

(b) further examination is clinically indicated in the same pregnancy to which item 55718 or 55723 applies (NR)

40.00

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

—examination and report (R)

27.25

55736

Pelvis, ultrasound scan of, in association with saline infusion of the endometrial cavity, by any or all approaches, if a previous transvaginal ultrasound has revealed an abnormality of the uterus or fallopian tube (R)

127.00

55739

Pelvis, ultrasound scan of, in association with saline infusion of the endometrial cavity, by any or all approaches, if a previous transvaginal ultrasound has revealed an abnormality of the uterus or fallopian tube (NR)

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

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

(c) the service mentioned in item 55706, 55709, 55712, 55715 or 55762 is not performed in conjunction with the scan during the same pregnancy (R)

150.00

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

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

(c) the service mentioned in item 55706, 55709, 55712, 55715 or 55759 is not performed in conjunction with the scan during the same pregnancy (NR)

60.00

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 service is requested 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) 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) further examination is clinically indicated in the same pregnancy in which item 55759 or 55762 has been performed; and

(e) the service mentioned in item 55706, 55709, 55712 or 55715 is not performed in conjunction with the scan during the same pregnancy (R)

160.00

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

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

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

(d) the service mentioned in item 55706, 55709, 55712 or 55715, is not performed in conjunction with the scan during the same pregnancy (NR)

65.00

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 service is not performed in the same pregnancy as item 55770; and

(d) the service mentioned in item 55718, 55721, 55723 or 55725 is not performed in conjunction with the scan during the same pregnancy (R)

150.00

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 service is not performed in the same pregnancy as item 55768; and

(d) the service mentioned in item 55718, 55721, 55723 or 55725 is not performed in conjunction with the scan during the same pregnancy (NR)

60.00

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 service is requested 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) further examination is clinically indicated in the same pregnancy to which item 55768 or 55770 has been performed; and

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

(e) the service mentioned in item 55718, 55721, 55723 or 55725 is not performed in conjunction with the scan during the same pregnancy (R)

160.00

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

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

(d) the service mentioned in item 55718, 55721, 55723 or 55725 is not performed in conjunction with the scan during the same pregnancy (NR)

65.00

Subdivision DSubgroup 6 of Group I1: musculoskeletal ultrasound2.1.7Musculoskeletal ultrasound services – personal attendance

Items in this Subdivision apply to a musculoskeletal ultrasound service only if:

  1. (a)

    the medical practitioner responsible for the conduct and report of the examination personally attends during the performance of the scan and personally examines the patient; or

  2. (b)

    the service is performed, because of medical necessity, in a location that is more than 30 kilometres by the most direct road route from another practice where services that comply with paragraph (a) are available.

2.1.8Unilateral item cannot be claimed twice if bilateral item could have been claimed

If:

  1. (a)

    2 services (the unilateral services) to which an item listed in column 1 of an item of table 2.1.8 applies are provided in conjunction with each other; and

  2. (b)

    a service to which an item in column 2 of the item applies could have been provided instead of the 2 unilateral services;

only one of the unilateral services may be claimed.

Table 2.1.8—Unilateral and bilateral services

Item

Column 1

The service in this item cannot be claimed twice …

Column 2

if the service in this item could have been provided …

1

55856

55858

2

55857

55859

3

55860

55862

4

55861

55863

5

55864

55866

6

55865

55867

7

55868

55870

8

55869

55871

9

55872

55874

10

55873

55875

11

55876

55878

12

55877

55879

13

55880

55882

14

55881

55883

15

55884

55886

16

55885

55887

17

55888

55890

18

55889

55891

19

55892

55894

20

55893

55895

2.1.9Musculoskeletal ultrasound services – comparison ultra‑sonography

The fee applicable for items in this Subdivision includes any views of another part of the patient taken for comparison purposes.

2.1.10Items in Subgroup 6 of Group I1

This clause sets out items in Subgroup 6 of Group I1.

Group I1—Ultrasound

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 6—Musculoskeletal ultrasound

55812

Chest or abdominal wall, one or more areas, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55070, 55073, 55076 or 55079 (R)

109.10

55814

Chest or abdominal wall, one or more areas, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55070, 55073, 55076 or 55079 (NR)

37.85

55844

Assessment of a mass associated with the skin or subcutaneous structures, not being a part of the musculoskeletal system, one or more areas, ultrasound scan of (R)

87.35

55846

Assessment of a mass associated with the skin or subcutaneous structures, not being a part of the musculoskeletal system, one or more areas, ultrasound scan of (NR)

37.85

55848

Musculoskeletal ultrasound, 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, and not performed in conjunction with a service mentioned in item 55054 (R)

136.60

55850

Musculoskeletal ultrasound, in conjunction with a surgical procedure using interventional techniques, inclusive of a diagnostic musculoskeletal ultrasound service, if:

(a) a medical practitioner or nurse practitioner has indicated on a referral for a musculoskeletal ultrasound that an ultrasound guided intervention be performed if clinically indicated; and

(b) the service is not performed in conjunction with a service mentioned in item 55054 or any other item in this Subgroup (R)

180.35

55852

Paediatric spine, spinal cord and overlying subcutaneous tissues, ultrasound scan of (R)

109.10

55854

Paediatric spine, spinal cord and overlying subcutaneous tissues, ultrasound scan of (NR)

37.85

55856

Hand or wrist, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55858 (R)

109.10

55857

Hand or wrist, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55859 (NR)

37.85

55858

Hand or wrist, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55856 (R)

121.10

55859

Hand or wrist, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55857 (NR)

42.00

55860

Forearm or elbow, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55862 (R)

109.10

55861

Forearm or elbow, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55863 (NR)

37.85

55862

Forearm or elbow, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55860 (R)

121.10

55863

Forearm or elbow, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55861 (NR)

42.00

55864

Shoulder or upper arm, or both, left or right, ultrasound scan of, if

(a) the service is used for the assessment of one or more of the following suspected or known conditions:

(i) an injury to a muscle, tendon or muscle/tendon junction;

(ii) rotator cuff tear, calcification or tendinosis (biceps, subscapular, supraspinatus or infraspinatus);

(iii) biceps subluxation;

(iv) capsulitis and bursitis;

(v) a mass, including a ganglion;

(vi) an occult fracture;

(vii) acromioclavicular joint pathology; and

(b) the service is not performed in conjunction with a service mentioned in item 55866 (R)

109.10

55865

Shoulder or upper arm, or both, left or right, ultrasound scan of, if:

(a) the service is used for the assessment of one or more of the following suspected or known conditions:

(i) an injury to a muscle, tendon or muscle/tendon junction;

(ii) rotator cuff tear, calcification or tendinosis (biceps, subscapular, supraspinatus or infraspinatus);

(iii) biceps subluxation;

(iv) capsulitis and bursitis;

(v) a mass, including a ganglion;

(vi) an occult fracture;

(vii) acromioclavicular joint pathology; and

(b) the service is not performed in conjunction with a service mentioned in item 55867 (NR)

37.85

55866

Shoulder or upper arm, or both, left and right, ultrasound scan of, if:

(a) the service is used for the assessment of one or more of the following suspected or known conditions:

(i) an injury to a muscle, tendon or muscle/tendon junction;

(ii) rotator cuff tear, calcification or tendinosis (biceps, subscapular, supraspinatus or infraspinatus);

(iii) biceps subluxation;

(iv) capsulitis and bursitis;

(v) a mass, including a ganglion;

(vi) an occult fracture;

(vii) acromioclavicular joint pathology; and

(b) the service is not performed in conjunction with a service mentioned in item 55864 (R)

121.10

55867

Shoulder or upper arm, or both, left and right, ultrasound scan of, if:

(a) the service is used for the assessment of one or more of the following suspected or known conditions:

(i) an injury to a muscle, tendon or muscle/tendon junction;

(ii) rotator cuff tear, calcification or tendinosis (biceps, subscapular, supraspinatus or infraspinatus);

(iii) biceps subluxation;

(iv) capsulitis and bursitis;

(v) a mass, including a ganglion;

(vi) an occult fracture;

(vii) acromioclavicular joint pathology; and

(c) the service is not performed in conjunction with a service mentioned in item 55865 (NR)

42.00

55868

Hip or groin, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55870 (R)

109.10

55869

Hip or groin, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55871 (NR)

37.85

55870

Hip or groin, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55868 (R)

121.10

55871

Hip or groin, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55869 (NR)

42.00

55872

Paediatric hip examination for dysplasia, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55874 (R)

109.10

55873

Paediatric hip examination for dysplasia, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55875 (NR)

37.85

55874

Paediatric hip examination for dysplasia, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55872 (R)

121.10

55875

Paediatric hip examination for dysplasia, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55873 (NR)

42.00

55876

Buttock or thigh, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55878 (R)

109.10

55877

Buttock or thigh or both, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55879 (NR)

37.85

55878

Buttock or thigh, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55876 (R)

121.10

55879

Buttock or thigh, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55877 (NR)

42.00

55880

Knee, left or right, ultrasound scan of, if:

(a) the service is used for the assessment of one or more of the following suspected or known conditions:

(i) abnormality of tendons or bursae about the knee;

(ii) a meniscal cyst, popliteal fossa cyst, mass or pseudomass;

(iii) a nerve entrapment or a nerve or nerve sheath tumour;

(iv) an injury of collateral ligaments; and

(b) the service is not performed in conjunction with a service mentioned in item 55882 (R)

109.10

55881

Knee, left or right, ultrasound scan of, if:

(a) the service is used for the assessment of one or more of the following suspected or known conditions:

(i) abnormality of tendons or bursae about the knee;

(ii) a meniscal cyst, popliteal fossa cyst, mass or pseudomass;

(iii) a nerve entrapment or a nerve or nerve sheath tumour;

(iv) an injury of collateral ligaments; and

(b) the service is not performed in conjunction with a service mentioned in item 55883 (NR)

37.85

55882

Knee, left and right, ultrasound scan of, if:

(a) the service is used for the assessment of one or more of the following suspected or known conditions:

(i) abnormality of tendons or bursae about the knee;

(ii) a meniscal cyst, popliteal fossa cyst, mass or pseudomass;

(iii) a nerve entrapment or a nerve or nerve sheath tumour;

(iv) an injury of collateral ligaments; and

(b) the service is not performed in conjunction with a service mentioned in item 55880 (R)

121.10

55883

Knee, left and right, ultrasound scan of, if:

(a) the service is used for the assessment of one or more of the following suspected or known conditions:

(i) abnormality of tendons or bursae about the knee;

(ii) a meniscal cyst, popliteal fossa cyst, mass or pseudomass;

(iii) a nerve entrapment or a nerve or nerve sheath tumour;

(iv) an injury of collateral ligaments; and

(b) the service is not performed in conjunction with a service mentioned in item 55881 (NR)

42.00

55884

Lower leg, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55886 (R)

109.10

55885

Lower leg, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55887 (NR)

37.85

55886

Lower leg, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55884 (R)

121.10

55887

Lower leg, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55885 (NR)

42.00

55888

Ankle or hind foot, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55890 (R)

109.10

55889

Ankle or hind foot, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55891 (NR)

37.85

55890

Ankle or hind foot, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55888 (R)

121.10

55891

Ankle or hind foot, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55889 (NR)

42.00

55892

Mid foot or fore foot, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55894 (R)

109.10

55893

Mid foot or fore foot, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55895 (NR)

37.85

55894

Mid foot or fore foot, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55892 (R)

121.10

55895

Mid foot or fore foot, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55893 (NR)

42.00

Division 2.2Group I2: computed tomography (examination)Subdivision AGeneral2.2.1CT services – eligible services
  1. (1)

    Items in this Division (other than item 57360) apply to a CT service that is:

    1. (a)

      performed under the supervision of a specialist in the specialty of diagnostic radiology who is available:

      1. (i)

        to monitor and influence the conduct and diagnostic quality of the examination; and

      2. (ii)

        if necessary, to attend on the patient personally; and

    2. (b)

      reported by a specialist in the specialty of diagnostic radiology.

  2. (2)

    Item 57360 applies to a CT service that is:

    1. (a)

      performed under the supervision of a specialist or consultant physician who is recognised by the Conjoint Committee for the Recognition of Training in CT Coronary Angiography and available:

(i) known colorectal carcinoma; and

(ii) known, suspected, or possible liver metastasis; and

(b) computed tomography, or ultrasound imaging, has identified a mass lesion in patient’s liver

For any particular patient—applicable not more than once in a 12 month period (R) (Anaes.) (Contrast)

550.00

63546

MRI—multiphase scans of the liver (including delayed imaging, if performed) with a contrast agent, for diagnosis or staging, if:

(a) the patient has:

(i) known or suspected hepatocellular carcinoma; and

(ii) chronic liver disease that has been confirmed by a specialist or consultant physician; and

(b) the patient’s liver function has been identified as Child‑Pugh class A or B; and

(c) the patient has an identified hepatic lesion over 10 mm in diameter

For any particular patient—applicable not more than once in a 12 month period (R) (Anaes.) (Contrast)

550.00

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 using intravenous or intra muscular sedation

44.80

63496

MRI service to which item 63545 or 63546 applies if:

(a) the service is performed under the supervision of an eligible provider; and

(b)the service is performed using an hepatobiliary‑specific contrast agent

250.00

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 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 are set out in a determination made under subsection 3C(1) of the Act.

Subdivision ESubgroup 33 of Group I52.5.15Items in Subgroup 33 of Group I5

This clause sets out items in Subgroup 33 of Group I5.

Group I5—Magnetic resonance imaging

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 33—Scan of body—person under the age of 16 years—general practice requests

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) (Anaes.) (Contrast)

403.20

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) (Anaes.) (Contrast)

448.00

63513

MRI—scan of knee for internal joint derangement for a patient under 16 years (R) (Anaes.) (Contrast)

403.20

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) (Anaes.) (Contrast)

403.20

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) (Anaes.) (Contrast)

403.20

63522

MRI—scan of wrist following radiographic examination for a patient under 16 years if a scaphoid fracture is suspected (R) (Anaes.) (Contrast)

448.00

Subdivision FSubgroup 34 of Group I52.5.16Items in Subgroup 34 of Group I5

This clause sets out items in Subgroup 34 of Group I5.

Group I5—Magnetic resonance imaging

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 34—Scan of body—person over the age of 16 years—general practice requests

63551

Scan of head for a patient 16 years or older, after a request 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) (Contrast) (Anaes.)

403.20

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) (Contrast) (Anaes.)

358.40

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) (Contrast) (Anaes.)

492.80

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 to 49 years 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) (Contrast) (Anaes.)

403.20

Division 2.6Group I6: management of bulk‑billed services2.6.1Restriction on items 64990 and 64991
  1. (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. (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 Schedule that applies to the service.

  3. (3)

    In this Schedule:

Commonwealth concession card holderhas the same meaning as concessional beneficiary has for the purposes of Part VII 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.

unreferred service means a diagnostic imaging service that:

  1. (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

  2. (b)

    has not been referred to the medical practitioner by another medical practitioner or person with referring rights.

2.6.2Items in Group I6

This clause sets out items in Group I6.

Group I6—Management of bulk‑billed services

Column 1

Item

Column 2

Description

Column 3

Fee ($)

64990

A diagnostic imaging service to which an item in this Schedule (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 Schedule applying to the service

14.10

64991

A diagnostic imaging service to which an item in this Schedule (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 Schedule applying to the service; and

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

(i) a Modified Monash 2 area; or

(ii) a Modified Monash 3 area; or

(iii) a Modified Monash 4 area; or

(iv) a Modified Monash 5 area; or

(v) a Modified Monash 6 area; or

(vi) a Modified Monash 7 area

21.30

Part 3Dictionary3.1Dictionary

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

Note 2: A number of expressions used in this Schedule are defined in subsection 3(1) of the Act, including the following:

(a) diagnostic imaging service;

(b) general medical services table;

(c) practitioner;

(d) Secretary;

(e) specialist.

Note 3: For the effect of the term (Anaes.) used in items in this Schedule, see subclause 5.9.4(1) of the general medical services table.

In this Schedule:

Act means the Health Insurance Act 1973.

angiography suite has the meaning given by clause 2.3.11.

applicable life age has the meaning given by subclause 1.2.2(2).

ASGC 2006 means the July 2006 edition of Statistical Geography Volume 1 ‑ Australian Standard Geographical Classification (ASGC)(ABS catalogue number 1216.0), published by the Australian Statistician, as existing on 1 May 2020.

ASGC 2010 means the July 2010 edition of the Australian Standard Geographical Classification (ASGC) (ABS catalogue number 1216.0), published by the Australian Statistician, as existing on 1 May 2020.

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

  1. (a)

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

  2. (b)

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

    1. (i)

      the person assigns to the medical practitioner by whom, or on whose behalf, the service is provided, the person’s right to the payment of the medicare benefit; and

    2. (ii)

      the medical practitioner accepts the assignment in full payment of the medical practitioner’s fee for the service provided.

care recipient has the meaning given by the general medical services table.

Commonwealth concession card holder has the meaning given by clause 2.6.1.

comprehensive facility means a facility where all of the following services are performed (whether or not other services are also performed):

  1. (a)

    PET;

  2. (b)

    computed tomography;

  3. (c)

    diagnostic ultrasound;

  4. (d)

    medical oncology;

  5. (e)

    radiation oncology;

  6. (f)

    surgical oncology;

  7. (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 or CT means a service performed (with or without intravenous contrast) using a detector:

  1. (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

  2. (b)

    that receives a series of data profiles depicting the degree of absorption of 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 1.2.21.

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:seecomputed tomography.

eligible provider, for an MRI or MRA service, has the meaning given by clause 2.5.4.

eligible X‑ray procedure means a diagnostic imaging procedure used in rendering a service to which item 57509, 57515, 57521, 57527, 57703, 57709, 57712, 57715, 58503, 58521, 58524, 58527 or 58903 applies.

exemption period of an exemption under clause 1.2.5B means the period mentioned in paragraph 1.2.8(2)(a) (as extended under clause 1.2.10 if applicable).

FDG means 18 F‑fluorodeoxyglucose.

highest fee has the meaning given by clause 1.2.21.

Inner Regional Australia means a Remoteness Area classified as Inner Regional Australia under the ASGC 2006.

JNMCAC means the Joint Nuclear Medicine Credentialling and Accreditation Committee of the RACP and RANZCR.

maximum extended life age has the meaning given by subclause 1.2.2(3).

Modified Monash 2 area has the meaning given by the general medical services table.

Modified Monash 3 area has the meaning given by the general medical services table.

Modified Monash 4 area has the meaning given by the general medical services table.

Modified Monash 5 area has the meaning given by the general medical services table.

Modified Monash 6 area has the meaning given by the general medical services table.

Modified Monash 7 area has the meaning given by the general medical services table.

MRA means magnetic resonance angiography.

MRI means magnetic resonance imaging.

new effective life age has the meaning given by subclause 1.2.2(3).

non‑consultation service has the meaning given by clause 1.2.21.

non‑metropolitan hospital means a hospital that is located outside the Sydney, Melbourne, Brisbane, Adelaide, Perth, Greater Hobart, Darwin and Canberra statistical divisions, as defined in the ASGC 2010.

(NR) has the meaning given by clause 1.2.15.

Outer Regional Australia means a Remoteness Area classified as Outer Regional Australia under the ASGC 2006.

PET means positron emission tomography.

practice location has the meaning given by clause 2.6.1.

providing practitioner has the same meaning as in subsection 16B(1) of the Act.

(R) has the meaning given by clause 1.2.15.

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).

relevant proprietor has the meaning given by clause 1.2.4.

Remote Australia means a Remoteness Area classified as Remote Australia under the ASGC 2006.

remote location means a place within Australia that is more than 30 kilometres by road from:

  1. (a)

    a hospital that provides a radiology or computed tomography service under the direction of a specialist in the specialty of diagnostic radiology; or

  2. (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.

residential aged care facility has the meaning given by the general medical services table.

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 Classificationhas the meaning given by the general medical services table.

scan, for items 63001 to 63560 and 63740 to 63743, 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 images designed to establish patient position and subsequently used to plan other scans).

unreferred service has the meaning given by clause 2.6.1.

upgraded has the meaning given by subclause 1.2.2(4).

Very Remote Australia means a Remoteness Area classified as Very Remote Australia under the ASGC 2006.

Part 4Application, saving and transitional provisionsDivision 1General provisions4.1Definitions

In this Division:

old table means Schedule 1 to the Health Insurance (Diagnostic Imaging Services Table) Regulations 2019 as in force immediately before 1 May 2020.

4.2Transitional provisions – exemptions from capital sensitivity requirements

Applications for exemptions

  1. (1)

    If:

    1. (a)

      a valid application was made under subclause 1.2.3(6) of the old table before 1 May 2020; and

    2. (b)

      the Department did not notify the relevant proprietor of receipt of the valid application as mentioned in subparagraph 1.2.3(3)(a)(i) of the old table before 1 May 2020;

subclauses 1.2.5(4) and (5) of this Schedule apply in relation to the application as if it were an application made under subclause 1.2.5(2) of this Schedule.

Notifications of receipt of valid applications

  1. (2)

    If:

    1. (a)

      the Department notified the relevant proprietor of receipt of a valid application as mentioned in subparagraph 1.2.3(3)(a)(i) of the old table before 1 May 2020; and

    2. (b)

      the Secretary did not make a decision on the application under subclause 1.2.3(4) of the old table before 1 May 2020;

subclause 1.2.5(6) and clause 1.2.6 of this Schedule apply in relation to the notification as if it were a notification given under subclause 1.2.5(4) of this Schedule.

Exemptions

  1. (3)

    An exemption:

    1. (a)

      granted under subclause 1.2.3(4) of the old table; and

    2. (b)

      in force immediately before 1 May 2020;

has effect, from 1 May 2020, as if it had been granted under clause 1.2.6 of this Schedule.

Refusals to grant exemptions

  1. (4)

    If:

    1. (a)

      the Secretary refused to grant an exemption under subclause 1.2.3(4) of the old table before 1 May 2020; and

    2. (b)

      the proprietor who applied for the exemption did not apply under subclause 1.2.4(1) of the old table for reconsideration of the decision before 1 May 2020; and

    3. (c)

      the period to apply for such reconsideration did not end before 1 May 2020;

subclause 1.2.6(6) and clause 1.2.11 of this Schedule apply in relation to the decision to refuse to grant the exemption as if it were a decision under paragraph 1.2.6(2)(b) of this Schedule to refuse to grant an exemption.

Applications for reconsideration of refusals

  1. (5)

    If:

    1. (a)

      the Secretary refused to grant an exemption under subclause 1.2.3(4) of the old table in respect of diagnostic imaging equipment; and

    2. (b)

      the proprietor who applied for the exemption applied under subclause 1.2.4(1) of the old table for reconsideration of the decision before 1 May 2020; and

    3. (c)

      the Secretary did not make a decision under subclause 1.2.4(3) of the old table on the application for reconsideration before 1 May 2020;

for the purposes of subclause 1.2.11(6) and clause 1.2.12 of this Schedule, the Secretary is taken to have notified the proprietor under subclause 1.2.11(5) of this Schedule, when the Secretary received the application for reconsideration, that the Secretary had received an application for reconsideration of a decision under clause 1.2.6 of this Schedule to refuse to grant an exemption in respect of the equipment.

Affirmations of refusals

  1. (6)

    If:

    1. (a)

      the Secretary affirmed a decision under paragraph 1.2.4(3)(a) of the old table before 1 May 2020; and

    2. (b)

      application was not made for review of the decision to affirm under clause 1.2.4A of the old table before 1 May 2020; and

    3. (c)

      the time for making such an application for review did not end before 1 May 2020;

subclause 1.2.12(4) and clause 1.2.13 of this Schedule apply in relation to the decision as if it were a decision under subparagraph 1.2.12(2)(b)(i) of this Schedule to affirm a decision under paragraph 1.2.6(2)(b) of this Schedule.

Applications for AAT review

  1. (7)

    If:

    1. (a)

      an application was made under clause 1.2.4A of the old table for review of a decision before 1 May 2020; and

    2. (b)

      immediately before 1 May 2020, each party to the proceeding had not been given a copy of the decision of the Administrative Appeals Tribunal on review;

the application is taken, from 1 May 2020, to be an application made under clause 1.2.13 of this Schedule for review of a decision under subparagraph 1.2.12(2)(b)(i) of this Schedule to affirm a decision under paragraph 1.2.6(2)(b) of this Schedule.

Schedule 2Repeals

Health Insurance (Diagnostic Imaging Services Table) Regulations 2019

1

The whole of the instrument

Repeal the instrument.

Endnotes

Endnote 1About 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 2Abbreviation 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 3Legislation history

Name

Registration

Commencement

Application, saving and transitional provisions

Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 1) 2020

23 Apr 2020 (F2020L00459)

1 May 2020 (s 2(1) item 1)

Health Insurance Legislation Amendment (Bulk‑billing Incentive) Regulations 2020

29 Mar 2020 (F2020L00341)

Sch 1 (items 7, 8): 1 May 2020 (s 2(1) item 3)

—

Endnote 4Amendment history

Provision affected

How affected

s 2.............................................

rep LA s 48D

s 5.............................................

rep LA s 48C

Schedule 1

Part 2

Division 2.6

Group I6 Table...........................

am F2020L00341

Schedule 2

Schedule 2..................................

rep LA s 48C

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