Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020 (Cth)

Case
No judgment structure available for this case.
Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020

made under the

Health Insurance Act 1973

Compilation No. 23

Compilation date:1 November 2025

Includes amendments:F2025L01232

About this compilation

This compilation

This is a compilation of the Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020 that shows the text of the law as amended and in force on 1 November 2025 (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. The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. Any uncommenced amendments affecting the law are accessible on the Register ( saving and transitional provisions

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.

Presentational changes

The Legislation Act 2003 provides for First Parliamentary Counsel to make presentational changes to a compilation. Presentational changes are applied to give a more consistent look and feel to legislation published on the Register, and enable the user to more easily navigate those documents.

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. Any modifications affecting the law are accessible on the Register.

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If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.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. 2) 2020.

3Authority

This instrument is made under the Health Insurance Act 1973.

4Diagnostic imaging services table

For the purposes of section 4AA of the Health Insurance Act 1973, Schedule 1 is prescribed as a table of diagnostic imaging services.

Schedule 1Diagnostic imaging services table

Note: See section 4.

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
  1. (1)

    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.

  2. (2)

    If reinstatement under clause 1.2.10B is granted in respect of diagnostic imaging equipment, an item in this Schedule does not apply to a service that is performed on that equipment on a day:

    1. (a)

      that is before the day the reinstatement was granted; and

    2. (b)

      on which the age of the equipment exceeded its new effective life age.

  3. (3)

    If:

    1. (a)

      reinstatement under clause 1.2.10B is granted in respect of diagnostic imaging equipment that has not been upgraded; and

    2. (b)

      the equipment is not upgraded within 3 months after the end of the equipment’s new effective life age;

    an item in this Schedule does not apply to a service that is performed on that equipment on a day that is after the end of 3 months after the end of the equipment’s new effective life age.

1.2.2Age of equipment

Working out age of equipment

(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)

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)

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

(4)

Diagnostic imaging equipment has been upgraded if:

  1. (a)

    an additional reasonable investment has been made, within the period mentioned in subclause (5), 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 has been accredited under The Royal Australian and New Zealand College of Radiologists’ Mammography Quality Assurance Program.

(5)

For the purposes of paragraph (4)(a), the period is:

  1. (a)

    the new effective life age for the equipment; or

  2. (b)

    for equipment for which an exemption under clause 1.2.8 has been granted—the exemption period of the exemption; or

  3. (c)

    for equipment for which reinstatement under clause 1.2.10B has been granted—3 months after the end of the equipment’s new effective life age.

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.

Subdivision BExemptions from capital sensitivity requirements1.2.7Equipment unable to be replaced etc. before end of applicable life age – applying for exemptions

Applying for exemption

(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)

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:

    1. (i)

      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; and

    2. (ii)

      the steps taken by the proprietor to replace the equipment (or upgrade the equipment, if it has not already been upgraded).

Notifying proprietor of receipt of application

(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

(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)

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

(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.

(3)

The Secretary must not grant the exemption unless the Secretary is satisfied that both of the following apply:

  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;

  2. (b)

    the proprietor is taking reasonable steps 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).

(4)

The period specified under paragraph (2)(a) must end no later than 6 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 or further extended under clause 1.2.10.

(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

(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 or further extended under clause 1.2.10, if applicable).

(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)

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

(2)

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

Note: For relevant proprietor, see clause 1.2.4.

(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:

    1. (i)

      reasons why the proprietor continues to be unable to replace or upgrade the equipment; and

    2. (ii)

      the steps taken by the proprietor to replace the equipment (or upgrade the equipment, if it has not already been upgraded).

Notifying proprietor of receipt of application

(4)

If:

  1. (a)

    the Secretary receives an application under subclause (2) of this clause for an extension or further 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

(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)

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 or further extension of the exemption period of an exemption in respect of the equipment.

Secretary may extend exemption period

(2)

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

  1. (a)

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

  2. (b)

    refuse to extend, or further extend, the exemption period.

(3)

The Secretary must not extend or further extend the exemption period unless the Secretary is satisfied that both of the following apply:

  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;

  2. (b)

    the proprietor is taking reasonable steps to replace the equipment (or upgrade the equipment, if it has not already been upgraded) before the end of the exemption period as extended or further extended.

(4)

The extension or further extension must be for no more than 3 months.

(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

(6)

If the Secretary refuses to extend, or further 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, or further 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, or further 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).

Subdivision BAReinstatement for capital sensitivity requirements1.2.10AEquipment not upgraded before end of new effective life age – applying for reinstatement of subsequently upgraded equipment

Applying for reinstatement

(1)

The relevant proprietor for diagnostic imaging equipment may apply to the Secretary for reinstatement under clause 1.2.10B in respect of the equipment if:

  1. (a)

    the equipment was not upgraded before the end of its new effective life age; and

  2. (b)

    the relevant proprietor did not apply for an exemption under clause 1.2.8 in respect of the equipment before the end of its new effective life age.

Note: For relevant proprietor, see clause 1.2.4.

(2)

The application must:

  1. (a)

    be in writing; and

  2. (b)

    be made within 3 months after the end of the equipment’s new effective life age; and

  3. (c)

    set out:

    1. (i)

      reasons why the proprietor was unable to upgrade the equipment before the end of its new effective life age; and

    2. (ii)

      reasons why the proprietor was unable to apply for an exemption under clause 1.2.8 in respect of the equipment before the end of its new effective life age; and

    3. (iii)

      an explanation of how the equipment has been, or will be, upgraded; and

    4. (iv)

      if the equipment has not been upgraded—the steps taken by the proprietor to ensure that it will be upgraded within 3 months after the end of its new effective life age, and the date on which the upgrade will occur.

Notifying proprietor of receipt of application

(3)

If:

  1. (a)

    the Secretary receives an application under subclause (1) of this clause for reinstatement 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.

1.2.10BEquipment not upgraded before end of new effective life age – granting reinstatement of subsequently upgraded equipment

Scope of this clause

(1)

This clause applies if, under subclause 1.2.10A(3), the Secretary notifies the relevant proprietor for diagnostic imaging equipment that the Secretary has received an application for reinstatement in respect of the equipment.

Granting reinstatement

(2)

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

  1. (a)

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

  2. (b)

    refuse to grant the reinstatement.

(3)

The Secretary must not grant the reinstatement unless the Secretary is satisfied that both of the following apply:

  1. (a)

    the proprietor was unable to upgrade the equipment before the end of its new effective life age;

  2. (b)

    the equipment has been or will be upgraded within 3 months after the end of its new effective life age.

(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).

Subdivision BBReconsideration and review of decisions1.2.11Reconsideration by Secretary – applying for reconsideration

Scope of this clause

(1)

This clause applies to:

  1. (a)

    a decision under clause 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, or further extend, the exemption period of an exemption in respect of diagnostic imaging equipment; or

  3. (c)

    a decision under clause 1.2.10B to refuse to grant reinstatement in respect of diagnostic imaging equipment.

Applying for reconsideration of decision

(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.

(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

    1. (ii)

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

  2. (c)

    identify the decision for reconsideration; and

  3. (d)

    set out the reasons for the application.

(4)

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

Notifying proprietor of receipt of application

(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—exemption decisions

(6)

Clause 1.2.1 does not apply to a service that is performed on equipment to which a decision mentioned in paragraph (1)(a) or (b) relates 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)

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

(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.

(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 exemption decisions on capital sensitivity requirements

(4)

If the Secretary affirms a decision mentioned in paragraph 1.2.11(1)(a) or (b), clause 1.2.1 does not apply to a service that is performed on equipment to which the decision relates 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 Review 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 section 18 of the Administrative Review Tribunal Act 2024.

1.2.13Review by ART

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

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

  3. (3)

    An item in this Schedule including the symbol (H)applies only to a service performed or provided in a hospital.

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 2.5 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 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, 61466 or 61485.

1.2.21Reduction in fees—multiple services on same day – general
  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 2.1.2A, 2.1.17 and 2.5.8 apply, subject to subclauses (7), (8) and (8A), in addition to this clause.

  7. (7)

    For the purposes of clause 2.1.2A, 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.

  8. (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.

  9. (8A)

    For the purposes of clause 2.1.17, if a medical practitioner provides:

    1. (a)

      2 or more echocardiogram services mentioned in subclause 2.1.17(1) 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 echocardiogram services is taken, for this clause, to be an amount payable for one diagnostic imaging service.

  10. (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.

  11. (10)

    This clause does not apply to the fee specified in item 59103, 64990, 64991, 64992, 64993, 64994 or 64995.

  12. (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 I12.1.2AReduction in fees—multiple services on same day – vascular ultrasounds
  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 reduced 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.

2.1.3Items in Subgroups 1 to 4 of Group I1

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

Note: The fees in Group I1 are indexed in accordance with clause 2.7.1.

Group I1—Ultrasound

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 1—General

55028

Head, ultrasound scan of (R)

110.75

55029

Head, ultrasound scan of (NR)

38.40

55030

Orbital contents, ultrasound scan of (R)

110.75

55031

Orbital contents, ultrasound scan of (NR)

38.40

55032

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

110.75

55033

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

38.40

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)

112.95

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)

38.40

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)

110.75

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)

38.40

55048

Scrotum, ultrasound scan of (R)

111.15

55049

Scrotum, ultrasound scan of (NR)

38.40

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)

110.75

55065

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

(a) the service is not solely a service to which an item (other than item 55736 or 55739) 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)

99.70

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)

221.45

55068

Pelvis, ultrasound scan of, by any or all approaches, if the service is not solely a service to which an item (other than item 55736 or 55739) 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)

35.50

55070

Breast, one, ultrasound scan of (R)

99.70

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)

210.45

55073

Breast, one, ultrasound scan of (NR)

34.55

55076

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

110.75

55079

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

38.40

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)

99.70

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)

34.55

Subgroup 2—Cardiac

55118

Heart, two‑dimensional or three‑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 digital media; and

(b) the service is not:

(i) an intra‑operative service; or

(ii) a service associated with a service to which an item in Subgroup 3 of this Group applies

(R) (H) (Anaes.)

279.65

55130

Intraoperative two‑dimensional or three‑dimensional real time transoesophageal echocardiography, if the service:

(a) includes Doppler techniques with colour flow mapping and recordings on digital media; and

(b) is performed during cardiac surgery; and

(c) incorporates sequential assessment of cardiac function before and after the surgical procedure; and

(d) is not associated with a service to which item 55135, or an item in Subgroup 3, applies

(R) (H) (Anaes.)

172.55

55135

Intraoperative two‑dimensional or three‑dimensional real time transoesophageal echocardiography, if the service:

(a) is provided on the same day as a service to which item 38477, 38484, 38499, 38516 or 38517 applies; and

(b) includes Doppler techniques with colour flow mapping and recordings on digital media; and

(c) is performed during cardiac valve surgery (replacement or repair); and

(d) incorporates sequential assessment of cardiac function and valve competence before and after the surgical procedure; and

(e) is not associated with a service to which item 22054, 55130, or an item in Subgroup 3, applies

(R) (H) (Anaes.)

358.90

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)

172.05

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)

172.05

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)

172.05

55248

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the upper limb or of arteries and bypass grafts in the upper limb, not being a service associated with a service to which an item in Subgroup 4 applies (R)

172.05

55252

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the upper limb, not being a service associated with a service to which an item in Subgroup 4 applies (R)

172.05

55274

Duplex scanning, bilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of extra‑cranial bilateral carotid and vertebral vessels, with or without subclavian and innominate vessels, with or without oculoplethysmography or peri‑orbital Doppler examination, not being a service associated with a service to which an item in Subgroup 4 applies (R)

172.05

55276

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of intra‑abdominal, aorta and iliac arteries or inferior vena cava and iliac veins or of intra‑abdominal, aorta and iliac arteries and inferior vena cava and iliac veins, excluding pregnancy related studies, not being a service associated with a service to which an item in Subgroup 4 applies (R)

172.05

55278

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of renal or visceral vessels or of renal and visceral vessels, including aorta, inferior vena cava and iliac vessels as required excluding pregnancy related studies, not being a service associated with a service to which an item in Subgroup 4 applies (R)

172.05

55280

Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of intra‑cranial vessels, not being a service associated with a service to which an item in Subgroup 4 applies (R)

172.05

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

(d) if the specialist or consultant physician interprets the results and prepares a report, not being a service associated with a service to which an item in Subgroup 4 applies (R)

172.05

55284

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

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

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

(i) priapism; or

(ii) fibrosis of any type; or

(iii) fracture of the tunica; or

(iv) arteriovenous malformations; and

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

(d) if the specialist or consultant physician interprets the results and prepares a report, not being a service associated with a service to which an item in Subgroup 4 applies (R)

172.05

55292

Duplex scanning, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of surgically created arteriovenous fistula or surgically created arteriovenous access grafts in the upper or lower limbs, not being a service associated with a service to which an item in Subgroup 4 applies (R)

172.05

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)

172.05

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)

112.70

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)

110.75

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)

110.75

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 (other than item 55758), 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, 55742, 55743, 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, 55740, 55742, 55757, 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, 55741, 55743, 55758, 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.

Note: The fees in Group I1 are indexed in accordance with clause 2.7.1.

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 (the current ultrasound) scan of, by any or all approaches, for determining the gestation, location, viability or number of fetuses, if:

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

(b) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in item 55704, 55705, 55707, 55708, 55740, 55741, 55742 or 55743 (R)

60.90

55703

Pelvis or abdomen, pregnancy‑related or pregnancy complication, ultrasound (the current ultrasound) scan of, by any or all approaches, for determining the gestation, location, viability or number of fetuses, if:

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

(b) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in item 55704, 55705, 55707, 55708, 55740, 55741, 55742 or 55743 (NR)

35.50

55704

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, for determining the structure, gestation, location, viability or number of fetuses, if:

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

(b) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in another item in this Subgroup (R)

71.05

55705

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, for determining the structure, gestation, location, viability or number of fetuses, if:

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

(b) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in another item in this Subgroup (NR)

35.50

55706

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound (the current 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 the current ultrasound) is 17 to 22 weeks of gestation; and

(b) the current ultrasound:

(i) is not performed in the same pregnancy as item 55709; and

(ii) is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (R)

101.50

55707

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

(a) the pregnancy (as confirmed by the current 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 current ultrasound is not performed on the same patient within 24 hours of a service mentioned in another item in this Subgroup (R)

71.05

55708

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

(a) the pregnancy (as confirmed by the current 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 current ultrasound is not performed on the same patient within 24 hours of a service mentioned in another item in this Subgroup (NR)

35.50

55709

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound (the current 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 the current ultrasound) is 17 to 22 weeks of gestation; and

(b) the current ultrasound:

(i) is not performed in the same pregnancy as item 55706; and

(ii) is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (NR)

38.55

55712

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:

(a) the current ultrasound 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 the current 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; and

(d) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (R)

116.70

55715

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound (the current 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 the current 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; and

(c) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (NR)

40.60

55718

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

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

(b) the current ultrasound:

(i) is not performed in the same pregnancy as item 55723; and

(ii) is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (R)

101.50

55721

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

(a) the current ultrasound 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 current 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; and

(d) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (R)

116.70

55723

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

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

(b) the current ultrasound:

(i) is not performed in the same pregnancy as item 55718; and

(ii) is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (NR)

38.55

55725

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound (the current 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 the current 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; and

(c) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (NR)

40.60

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)

27.65

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)

128.90

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)

57.85

55740

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, for determining the structure, gestation, location, viability or number of fetuses, if:

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

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

(c) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in another item in this Subgroup (R)

108.30

55741

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, for determining the structure, gestation, location, viability or number of fetuses, if:

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

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

(c) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in another item in this Subgroup (NR)

54.10

55742

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

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

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

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

(d) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in another item in this Subgroup (R)

108.30

55743

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

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

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

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

(d) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in another item in this Subgroup (NR)

54.10

55757

Pelvis or abdomen, ultrasound (the current ultrasound) scan of, for cervical length assessment for risk of preterm labour, by any or all approaches, if:

(a) the dating of the pregnancy (as confirmed by the current ultrasound) is between 14 and 30 weeks of gestation; and

(b) any of the following apply:

(i) the patient has a history indicating high risk of preterm labour or birth or second trimester fetal loss;

(ii) the patient has symptoms suggestive of threatened preterm labour or second trimester fetal loss;

(iii) the patient’s cervical length is less than 25 mm on an ultrasound before 28 weeks gestation; and

(c) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in another item in this Subgroup (R)

51.55

55758

Pelvis or abdomen, ultrasound (the current ultrasound) scan of, for cervical length assessment for risk of preterm labour, by any or all approaches, if:

(a) the dating of the pregnancy (as confirmed by the current ultrasound) is between 14 and 30 weeks of gestation; and

(b) any of the following apply:

(i) the patient has a history indicating high risk of preterm labour or birth or second trimester fetal loss;

(ii) the patient has symptoms suggestive of threatened preterm labour or second trimester fetal loss;

(iii) the patient’s cervical length is less than 25 mm on an ultrasound before 28 weeks gestation; and

(c) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in another item in this Subgroup (NR)

19.60

55759

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:

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

(b) the dating of the pregnancy (as confirmed by the current 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 current ultrasound during the same pregnancy; and

(d) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (R)

152.25

55762

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound (the current ultrasound) scan of, by any or all approaches, with measurement of all parameters for dating purposes, if:

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

(b) the dating of the pregnancy (as confirmed by the current 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 current ultrasound during the same pregnancy; and

(d) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (NR)

60.90

55764

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound (the current 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) an ultrasound of the same pregnancy confirms a multiple pregnancy; and

(c) the dating of the pregnancy (as confirmed by the current 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 current ultrasound during the same pregnancy; and

(f) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (R))

162.40

55766

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound (the current 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) an ultrasound of the same pregnancy confirms a multiple pregnancy; and

(b) the dating of the pregnancy (as confirmed by the current 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 current ultrasound during the same pregnancy; and

(e) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (NR)

65.95

55768

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

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

(b) an 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 current ultrasound during the same pregnancy; and

(e) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (R)

152.25

55770

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

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

(b) an 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 current ultrasound during the same pregnancy; and

(e) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (NR)

60.90

55772

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

(a) dating of the pregnancy as confirmed by the current 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 an ultrasound is a multiple pregnancy; and

(e) the service mentioned in item 55718, 55721, 55723 or 55725 is not performed in conjunction with the current ultrasound during the same pregnancy; and

(f) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (R)

162.40

55774

Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound (the current 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 the current 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 an ultrasound is a multiple pregnancy; and

(d) the service mentioned in item 55718, 55721, 55723 or 55725 is not performed in conjunction with the current ultrasound during the same pregnancy; and

(e) the current ultrasound is not performed on the same patient within 24 hours of a service mentioned in item 55757 or 55758 (NR)

65.95

Subdivision DSubgroup 6 of Group I1: musculoskeletal ultrasound2.1.8Unilateral 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.

Note: The fees in Group I1 are indexed in accordance with clause 2.7.1.

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)

110.75

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)

38.40

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)

88.65

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)

38.40

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)

138.65

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)

183.05

55852

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

110.75

55854

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

38.40

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)

110.75

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)

38.40

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)

122.90

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)

42.65

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)

110.75

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)

38.40

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)

122.90

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)

42.65

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)

110.75

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)

38.40

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)

122.90

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)

42.65

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)

110.75

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)

38.40

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)

122.90

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)

42.65

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)

110.75

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)

38.40

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)

122.90

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)

42.65

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)

110.75

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)

38.40

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)

122.90

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)

42.65

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)

110.75

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)

38.40

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)

122.90

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)

42.65

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)

110.75

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)

38.40

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)

122.90

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)

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.

Note: The fees in Group I5 are indexed in accordance with clause 2.7.1.

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 services2.6.1Application of items 64990, 64991, 64992, 64993, 64994 and 64995
  1. (2)

    If item 64990, 64991, 64992, 64993, 64994 or 64995 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.

  2. (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.

Note: The fees in Group I6 are indexed in accordance with clause 2.7.1.

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, 64992, 64993, 64994 or 64995) 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

7.15

64991

A diagnostic imaging service to which an item in this Schedule (other than this item or item 64990, 64992, 64993, 64994 or 64995) 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 a Modified Monash 2 area

10.80

64992

A diagnostic imaging service to which an item in this Schedule (other than this item or item 64990, 64991, 64993, 64994 or 64995) 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 in relation to 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 3 area; or

(ii) a Modified Monash 4 area

11.55

64993

A diagnostic imaging service to which an item in this Schedule (other than this item or item 64990, 64991, 64992, 64994 or 64995) 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 in relation to 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 a Modified Monash 5 area

12.25

64994

A diagnostic imaging service to which an item in this Schedule (other than this item or item 64990, 64991, 64992, 64993 or 64995) 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 in relation to 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 a Modified Monash 6 area

13.00

64995

A diagnostic imaging service to which an item in this Schedule (other than this item or item 64990, 64991, 64992, 64993 or 64994) 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 in relation to 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 a Modified Monash 7 area

14.25

Division 2.7Indexation of fees2.7.1Indexation – 1 July 2025
  1. (1)

    At the start of 1 July 2025 (the indexation time), each amount covered by subclause (2) is replaced by the amount worked out using the following formula:

    Note: The indexed fees could in 2025 be viewed on the Department’s MBS Online website ( amounts covered by this subclause are the following:

    1. (a)

      the fee for each item in the following:

      1. (i)

        Group I1 (ultrasound services);

      2. (ii)

        Group I2 (computer tomography services);

      3. (iii)

        Group I3 (diagnostic radiology services);

      4. (iiia)

        Subgroup 1 of Group I4 (nuclear medicine imaging services—non PET);

      5. (iv)

        Group I5 (magnetic resonance imaging services);

      6. (v)

        Group I6 (bulk‑billed services);

    2. (b)

      the amount mentioned in each of subclauses 2.3.3(2) and (3) (increased fee for certain diagnostic radiology services carried out at residential aged care facilities).

  2. (3)

    An amount worked out under subclause (1) is to be rounded up or down to the nearest 5 cents (rounding down if the amount is an exact multiple of 2.5 cents).

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 July 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 July 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 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.

CT:seecomputed tomography.

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

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

FDG means 18 F‑fluorodeoxyglucose.

(H) has the meaning given by subclause 1.2.15(3).

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 1 area means an area that is not a Modified Monash 2 to 7 area.

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.

nuclear medicine credentialled specialist means a specialist or consultant physician whose name is included in a register, given to the Chief Executive Medicare by the JNMCAC, of participants in the Joint Nuclear Medicine Specialist Credentialling Program of the JNMCAC.

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

PET means positron emission tomography.

PET credentialled specialist means:

  1. (a)

    a specialist or consultant physician who is 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; or

  2. (b)

    a specialist or consultant physician who:

    1. (i)

      is a Fellow of the RACP or RANZCR; and

    2. (ii)

      has reported 400 or more studies forming part of PET services for which a Medicare benefit was payable; and

    3. (iii)

      is authorised under State or Territory law to prescribe and administer to humans the PET radiopharmaceuticals that are to be administered to a person; and

    4. (iv)

      met the requirements of subparagraphs (i), (ii) and (iii) before 1 November 2011.

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.

PSA is short for prostate specific antigen.

(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 63563 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 1Health Insurance (Diagnostic Imaging Services Table) Amendment (Equipment Capital Sensitivity) Regulations 20224.1Definitions

In this Division:

amending instrument means the Health Insurance (Diagnostic Imaging Services Table) Amendment (Equipment Capital Sensitivity) Regulations 2022.

commencement day means the day the amending instrument commences.

4.2Application of amendments

The amendments of clauses 1.2.8 and 1.2.10 of this instrument made by the amending instrument apply in relation to a decision on an application made by the Secretary on or after the commencement day, regardless of when the application was made.

Division 2Health Insurance Legislation Amendment (2024 Measures No. 2) Regulations 20244.3Definitions

In this Division:

amending instrument means the Health Insurance Legislation Amendment (2024 Measures No. 2) Regulations 2024.

4.4Exemptions from capital sensitivity requirements
  1. (1)

    The amendments of this instrument made by items 2 to 4 and 6 to 14 of Part 1 of Schedule 2 to the amending instrument apply in relation to a decision on an application made by the Secretary on or after 1 July 2024, regardless of when the application was made.

  2. (2)

    The amendments of this instrument made by items 1 and 5 of Part 1 of Schedule 2 to the amending instrument apply in relation to applications made on or after 1 July 2024.

Division 3Health Insurance Legislation Amendment (2025 Measures No. 2) Regulations 2025Subdivision APreliminary4.6Definitions

In this Division:

amending instrument means the Health Insurance Legislation Amendment (2025 Measures No. 2) Regulations 2025.

commencement day means the day the amending instrument commences.

pre‑commencement period, for relevant MRI equipment, means the period:

  1. (a)

    that begins on the date from which the age of the equipment is worked out under subclause 1.2.2(1); and

  2. (b)

    that ends immediately before the commencement day.

relevant MRI equipment means MRI equipment, in relation to which:

  1. (a)

    immediately before the commencement day, both of the following apply:

    1. (i)

      the equipment is located at the premises of a comprehensive practice located in a Modified Monash 1 area;

    2. (ii)

      the equipment is neither eligible equipment nor partial eligible equipment (within the meaning of this instrument as in force immediately before the commencement day); and

  2. (b)

    on and after the commencement day, all of the following apply:

    1. (i)

      the equipment continues to be located at the premises of, and is included on the Diagnostic Imaging Register in relation to the location specific practice number for, the comprehensive practice;

    2. (ii)

      the equipment is made available to the comprehensive practice by a person who is subject to a current deed with the Commonwealth that relates to the equipment so included on the Diagnostic Imaging Register;

    3. (iii)

      the age of the equipment exceeds the new effective life age for MRI equipment.

Subdivision BCapital sensitivity requirements for relevant MRI equipment4.7Applicable life age and restriction on items for relevant MRI equipment

Applicable life age

(1)

Despite subclause 1.2.2(2), the applicable life age for relevant MRI equipment is the maximum extended life age of the equipment if subclause (2) or (3) of this clause applies.

(2)

This subclause applies to relevant MRI equipment if:

  1. (a)

    an additional reasonable investment has been made during the pre‑commencement period for the equipment; and

  2. (b)

    the investment improves the overall performance of the equipment so that it is equivalent to new MRI equipment supplied in Australia at the time of the improvement.

(3)

This subclause applies to relevant MRI equipment if:

  1. (a)

    the Secretary grants a validation under subclause 4.9(2) in respect of the equipment; and

  2. (b)

    before the end of the period of 12 months beginning on the day the validation is granted, the equipment is improved such that its overall performance is equivalent to new MRI equipment supplied in Australia at the time of the improvement.

Restriction on items—services performed on validated relevant MRI equipment

(4)

If the Secretary grants a validation under subclause 4.9(2) in respect of relevant MRI equipment, an item in this Schedule does not apply to a service that is performed on that equipment on a day that is before the day the validation was granted.

Subdivision CValidation of relevant MRI equipment subsequently meeting capital sensitivity requirements4.8Equipment unable to be improved before commencement day – applying for validation of subsequently improved equipment

Applying for validation

(1)

The relevant proprietor for relevant MRI equipment may apply to the Secretary for validation under clause 4.9 in respect of the equipment if:

  1. (a)

    during the pre‑commencement period for the equipment, the relevant proprietor took steps to make an additional reasonable investment that would improve the overall performance of the equipment so that it would be equivalent to new MRI equipment supplied in Australia at the time of the improvement; and

  1. (b)

    the improvement is not completed before the commencement day.

Note: For relevant proprietor, see clause 1.2.4.

(2)

The application must:

  1. (a)

    be in writing; and

  2. (b)

    be made within the period of 3 months beginning on the commencement day; and

  3. (c)

    set out:

    1. (i)

      reasons why the proprietor was unable to complete the improvement before the commencement day; and

    2. (ii)

      an explanation of how the equipment has been, or will be, improved; and

    3. (iii)

      if the improvement has not been completed—the steps taken by the proprietor to ensure that it will be completed before the end of the period of 12 months beginning on the day the validation is granted, and the date on which it will be completed.

Notifying proprietor of receipt of application

(3)

If:

  1. (a)

    the Secretary receives an application under subclause (1) for a validation 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.

4.9Equipment unable to be improved before commencement day – granting validation of subsequently improved equipment

Scope of this clause

(1)

This clause applies if, under subclause 4.8(3), the Secretary notifies the relevant proprietor for relevant MRI equipment that the Secretary has received an application for validation of the equipment.

Granting validation

(2)

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

  1. (a)

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

  2. (b)

    refuse to grant the validation.

(3)

The Secretary must not grant the validation unless the Secretary is satisfied that both of the following apply:

  1. (a)

    due to circumstances beyond the control of the proprietor, the proprietor was unable to complete the improvement before the commencement day;

  2. (b)

    the improvement has been or will be completed before the end of the period of 12 months beginning on the day the validation is granted.

(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 validation on capital sensitivity requirements

(5)

If the Secretary grants a validation in relation to equipment that is still to be improved, 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 grants the validation; and

  2. (b)

    ending on the earliest of the following:

    1. (i)

      the day the improvement is completed;

    2. (ii)

      the day that is 12 months after the day the validation is granted.

Note: If the improvement is completed as proposed within the period of 12 months beginning on the day the validation is granted, then the applicable life age of the equipment is the maximum extended life age of MRI equipment: see clause 4.7.

Subdivision DModified application of Subdivision BB of Division 1.24.10Reconsideration by Secretary – refusal to validate relevant MRI equipment
  1. (1)

    For the purposes of a decision under clause 4.9 to refuse to grant a validation in respect of relevant MRI equipment, clauses 1.2.11 and 1.2.12 are modified as set out in this clause.

  2. (2)

    Subclause 1.2.11(1) is modified by adding at the end of the subclause:

    1. “; or (d)

      a decision under clause 4.9 to refuse to grant a validation in respect of relevant MRI equipment.”

  3. (3)

    Clause 1.2.11 is modified by omitting subclause (6).

  4. (4)

    Clause 1.2.12 is modified by omitting subclause (4).

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 how an amendment is to be made. If, despite the misdescription, the amendment can be given effect as intended, then the misdescribed amendment can be incorporated through an editorial change made under section 15V of the Legislation Act 2003.

If a misdescribed amendment cannot be given effect as intended, the amendment is not incorporated and “(md not incorp)” is added to the amendment history.

Endnote 2Abbreviation key

ad = added or inserted

orig = original

am = amended

p = page(s)

amdt = amendment

para = paragraph(s)/subparagraph(s)

C[x] = Compilation No. x

/sub‑subparagraph(s)

ch = Chapter(s)

pres = present

cl = clause(s)

prev = previous

cont. = continued

(prev…) = previously

def = definition(s)

pt = Part(s)

Dict = Dictionary

r = regulation(s)/Court rule(s)

disallowed = disallowed by Parliament

reloc = relocated

div = Division(s)

renum = renumbered

ed = editorial change

rep = repealed

exp = expires/expired or ceases/ceased to have

rs = repealed and substituted

effect

s = section(s)/subsection(s)

gaz = gazette

/rule(s)/subrule(s)/order(s)/suborder(s)

LA = Legislation Act 2003

sch = Schedule(s)

LIA = Legislative Instruments Act 2003

SLI = Select Legislative Instrument

(md) = misdescribed amendment can be given

SR = Statutory Rules

effect

sub ch = Sub‑Chapter(s)

(md not incorp) = misdescribed amendment

sub div = Subdivision(s)

cannot be given effect

sub pt = Subpart(s)

mod = modified/modification

underlining = whole or part not

No. = Number(s)

commenced or to be commenced

Ord = Ordinance

Endnote 3Legislation history

Name

Registration

Commencement

Application, saving and transitional provisions

Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020

15 June 2020 (F2020L00713)

1 July 2020 (s 2(1) item 1)

Health Insurance Legislation Amendment (2020 Measures No. 1) Regulations 2020

6 July 2020 (F2020L00882)

Sch 1 (items 1–4): 1 Aug 2020 (s 2(1) item 1)

—

Health Insurance Legislation Amendment (Bulk‑billing Incentive (No. 2)) Regulations 2020

23 Sept 2020 (F2020L01203)

Sch 1 (items 1, 2): 1 Oct 2020 (s 2(1) item 1)

—

Health Insurance Legislation Amendment (2020 Measures No. 2) Regulations 2020

20 Oct 2020 (F2020L01330)

Sch 1 (items 150–152): 1 Nov 2020 (s 2(1) item 1)

—

Health Legislation Amendment (Administration) Regulations 2020

14 Dec 2020 (F2020L01602)

Sch 1 (item 1): 15 Dec 2020 (s 2(1) item 1)

—

Health Insurance Legislation Amendment (2020 Measures No. 3) Regulations 2020

14 Dec 2020 (F2020L01608)

Sch 1 (items 10–24, 67, 69–80): 1 Mar 2021 (s 2(1) items 2, 4)

—

Health Insurance Legislation Amendment (2021 Measures No. 1) Regulations 2021

2 June 2021 (F2021L00681)

Sch 1 (items 1–5, 8–33, 40–42, 96–100): 1 July 2021 (s 2(1) items 2–4)

—

Health Insurance Legislation Amendment (2021 Measures No. 2) Regulations 2021

17 Sept 2021 (F2021L01281)

Sch 2: 1 Nov 2021 (s 2(1) item 1)

—

Health Insurance Legislation Amendment (Rural Bulk‑billing Incentive) Regulations 2021

9 Dec 2021 (F2021L01748)

Sch 1 (items 1–8): 1 Jan 2022 (s 2(1) item 1)

—

Health Insurance (Diagnostic Imaging Services Table) Amendment (Equipment Capital Sensitivity) Regulations 2021

9 Dec 2021 (F2021L01749)

1 May 2022 (s 2(1) item 1)

—

Health Insurance Legislation Amendment (2021 Measures No. 3) Regulations 2021

17 Dec 2021 (F2021L01814)

Sch 1 (items 1–5): 1 Jan 2022 (s 2(1) item 1)

—

Health Insurance Legislation Amendment (2022 Measures No. 1) Regulations 2022

22 Mar 2022 (F2022L00367)

Sch 1 (items 1–3, 38, 39, 44–48): 1 July 2022 (s 2(1) items 2, 3)

—

Health Insurance Legislation Amendment (2022 Measures No. 3) Regulations 2022

22 Aug 2022 (F2022L01099)

Sch 2: 1 Nov 2022 (s 2(1) item 2)

—

Health Insurance (Diagnostic Imaging Services Table) Amendment (Equipment Capital Sensitivity) Regulations 2022

16 Sept 2022 (F2022L01220)

17 Sept 2022 (s 2(1) item 1)

—

Health Insurance Legislation Amendment (2023 Measures No. 1) Regulations 2023

4 Apr 2023 (F2023L00416)

Sch 2 (items 1, 2) and Sch 3 (items 1–7): 1 July 2023 (s 2(1) items 3, 4)

—

Health Insurance Legislation Amendment (2023 Measures No. 2) Regulations 2023

8 June 2023 (F2023L00744)

Sch 1 (items 1–4): 1 July 2023 (s 2(1) item 1)

—

Health Insurance Legislation Amendment (2023 Measures No. 3) Regulations 2023

16 Oct 2023 (F2023L01386)

Sch 2 (items 1, 2) and Sch 3: 1 Nov 2023 (s 2(1) items 3, 4)

—

Health Insurance Legislation Amendment (2024 Measures No. 1) Regulations 2024

2 Feb 2024 (F2024L00134)

Sch 1 (items 50, 51): 1 Mar 2024 (s 2(1) item 1)

—

Health Insurance Legislation Amendment (2024 Measures No. 2) Regulations 2024

23 May 2024 (F2024L00573)

Sch 1 (items 1, 2) and Sch 2 (items 1‑23): 1 July 2024 (s 2(1) items 2, 3)

—

Health Insurance (Diagnostic Imaging Services Table) Amendment (Equipment Capital Sensitivity) Regulations 2024

29 Aug 2024 (F2024L01089)

sch 2: 1 Dec 2024 (s 2(1) item 3)

Remainder: 30 Aug 2024 (s 2(1) items 1, 2)

—

Health Insurance Legislation Amendment (2024 Measures No. 4) Regulations 2024

26 Sept 2024 (F2024L01219)

sch 1: 1 Nov 2024 (s 2(1) item 1)

—

Administrative Review Tribunal Legislation Consequential Amendments (2024 Measures No. 1) Regulations 2024

11 Oct 2024 (F2024L01299)

sch 7 (items 7–10): 14 Oct 2024 (s 2(1) item 1)

—

Health Insurance Legislation Amendment (Hospital‑Only Services and Other Measures) Regulations 2025

7 Feb 2025 (F2025L00092)

sch 1 (items 17–24): 1 Mar 2025 (s 2(1) item 1)

—

Health Insurance Legislation Amendment (Indexation) Regulations 2025

25 Feb 2025 (F2025L00190)

sch 1 (items 1–4): 1 July 2025 (s 2(1) item 1)

—

Health Insurance Legislation Amendment (2025 Measures No. 2) Regulations 2025

3 June 2025 (F2025L00636)

sch 1 (items 1–15): 1 July 2025 (s 2(1) item 1)

—

Health Insurance Legislation Amendment (2025 Measures No. 3) Regulations 2025

3 Oct 2025 (F2025L01232)

sch 1 (items 53-62, 87, 88): 1 Nov 2025 (s 2(1) item 1)

—

Endnote 4Amendment history

Provision affected

How affected

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

rep LA s 48D

s 4.............................................

am F2020L01602

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

rep LA s 48C

Schedule 1

Part 1

Division 1.2

Subdivision A

c 1.2.1........................................

am F2024L01089

c 1.2.2........................................

am F2024L01089

Subdivision B heading.................

rep F2024L01089

c 1.2.3........................................

rep F2021L01749

c 1.2.5........................................

rep F2021L01749

c 1.2.6........................................

rep F2021L01749

Subdivision B

Subdivision B heading.................

ad F2024L01089

c 1.2.7........................................

am F2024L00573

c 1.2.8........................................

am F2022L01220; F2024L00573

c 1.2.9........................................

am F2024L00573

c 1.2.10......................................

am F2022L01220; F2024L00573; F2024L01089

Subdivision BA

Subdivision BA...........................

ad F2024L01089

c 1.2.10A...................................

ad F2024L01089

c 1.2.10B....................................

ad F2024L01089

Subdivision BB heading...............

ad F2024L01089

c 1.2.11......................................

am F2021L01749; F2024L00573; F2024L01089

c 1.2.12......................................

am F2024L01089; F2024L01299

c 1.2.13......................................

am F2024L01299

c 1.2.14......................................

rep F2024L00573

Subdivision C

c 1.2.15......................................

am F2025L00092

c 1.2.18......................................

am F2022L00367; F2022L01099; F2023L01386

c 1.2.19......................................

rep F2022L00367

c 1.2.20......................................

rep F2021L01281

am F2021L01748 (amdt never applied (Sch 1 item 1))

c 1.2.21......................................

am F2020L01608; F2021L01281; F2021L01748

ed C8

Part 2

Division 2.1

Subdivision B

c 2.1.2A.....................................

ad F2021L01281

c 2.1.3........................................

am F2021L00681; F2021L01814

Group I1 Table...........................

am F2020L00882; F2020L01330; F2020L01608; F2021L00681; F2021L01281; F2024L00134; F2025L00092; F2025L01232

Subdivision C

c 2.1.4........................................

am F2022L01099

c 2.1.5........................................

am F2022L01099

c 2.1.6........................................

am F2021L00681; F2021L01814

Group I1 Table...........................

am F2022L01099

ed C12

Subdivision D

c 2.1.7........................................

rep F2023L01386

c 2.1.10......................................

am F2021L00681; F2021L01814

Subdivision E

Subdivision E.............................

ad F2020L01608

c 2.1.11......................................

ad F2020L01608

c 2.1.12......................................

ad F2020L01608

c 2.1.13......................................

ad F2020L01608

c 2.1.14......................................

ad F2020L01608

c 2.1.15......................................

ad F2020L01608

c 2.1.16......................................

ad F2020L01608

c 2.1.17......................................

ad F2020L01608

am F2021L01281

c 2.1.18......................................

ad F2020L01608

am F2022L00367

Group I1 Table...........................

am F2021L00681

Division 2.2

Subdivision A

c 2.2.1........................................

am F2021L00681

c 2.2.5A.....................................

ad F2021L01281

Subdivision B

c 2.2.6........................................

am F2021L00681; F2021L01814

Group I2 Table...........................

am F2020L01608; F2021L00681; F2021L01281; F2023L01386; F2024L01219

Division 2.3

Subdivision A

c 2.3.3........................................

rs F2020L01608

Subdivision B

c 2.3.4........................................

am F2021L00681; F2021L01814; F2025L01232

Subdivision C

c 2.3.6........................................

am F2021L00681; F2021L01814

Group I3 Table...........................

am F2023L00416

Subdivision D

c 2.3.7........................................

am F2021L00681; F2021L01814

Group I3 Table...........................

am F2021L00681; F2025L00092

Subdivision E

c 2.3.8........................................

am F2021L00681; F2021L01814

Group I3 Table...........................

am F2025L00092

Subdivision F

c 2.3.9........................................

am F2021L00681

c 2.3.10......................................

am F2021L00681; F2021L01814

Group I3 Table...........................

am F2021L00681

Subdivision G

c 2.3.12......................................

am F2021L00681; F2021L01814

Group I3 Table...........................

am F2025L00092

Division 2.4

Subdivision A

c 2.4.1........................................

am F2020L00882; F2020L01608

rs: F2024L00573

c 2.4.1A.....................................

ad F2020L01608

c 2.4.1B.....................................

ad F2020L01608

c 2.4.1C.....................................

ad F2020L01608

c 2.4.1D.....................................

ad F2020L01608

rep F2021L00681

c 2.4.2........................................

am F2023L01386; F2025L01232

c 2.4.3........................................

rs F2024L00573

am F2025L01232

c 2.4.4........................................

am F2024L00573; F2025L01232

c 2.4.5........................................

am F2024L00573

rep F2025L01232

Subdivision B

Subdivision B heading.................

am F2020L01608

c 2.4.6........................................

am F2020L01608; F2025L00190

Group I4 Table...........................

am F2020L00882; F2020L01608; F2021L00681

ed C6

am F2021L01281; F2021L01814; F2022L00367; F2022L01099; F2023L00416; F2023L01386; F2024L01219; F2025L00636

Division 2.5

Subdivision A

c 2.5.1........................................

am F2022L01099; F2023L00744; F2025L00636; F2025L01232

c 2.5.4........................................

am F2025L01232

c 2.5.5........................................

am F2022L01099

rs F2025L00636

c 2.5.6........................................

am F2022L01099

rep F2025L00636

c 2.5.7........................................

am F2022L01099

c 2.5.8........................................

rs F2021L01281

c 2.5.8A.....................................

ad F2021L01281

c 2.5.8B.....................................

ad F2021L01281

c 2.5.9........................................

am F2021L00681; F2021L01281; F2022L01099; F2023L00744

c 2.5.9A.....................................

ad F2021L01281

am F2022L00367

c 2.5.9B.....................................

ad F2021L01281

ed C7

Subdivision B

c 2.5.10......................................

amF2022L00367

Group I5 Table...........................

am F2021L00681; F2021L01281; F2022L01099; F2024L00134

Subdivision C

c 2.5.12......................................

rep F2022L01099

c 2.5.13......................................

amF2022L00367

Group I5 Table...........................

am F2021L00681; F2022L01099; F2024L00573; F2024L01219

Subdivision D

c 2.5.13A...................................

ad F2022L01099

am F2023L00744

c 2.5.14......................................

am F2022L00367; F2023L00416; F2025L00636

Group I5 Table...........................

am F2022L01099; F2023L00416; F2025L00092

Subdivision E

c 2.5.15......................................

am F2022L00367

Subdivision F

c 2.5.16......................................

am F2022L00367

Division 2.6

c 2.6.1........................................

am F2021L01748

c 2.6.2........................................

am F2021L00681; F2021L01814

Group I6 table.............................

am F2020L01203; F2021L01748

Division 2.7

Division 2.7................................

ad F2021L00681

c 2.7.1........................................

ad F2021L00681

ed C6

am F2022L00367; F2023L00416; F2023L01386; F2024L00573; F2025L00190

Part 3

c 3.1..........................................

am F2020L01608; F2021L01281; F2021L01749; F2022L01099; F2024L00573; F2025L00092; F2025L01232

Part 4

Part 4.........................................

rep F2021L01749

ad F2022L01220

Division 1

c 4.1..........................................

rep F2021L01749

ad F2022L01220

c 4.2..........................................

rep F2021L01749

ad F2022L01220

Division 2

Division 2..................................

ad F2024L00573

c 4.3..........................................

ad F2024L00573

c 4.4..........................................

ad F2024L00573

c 4.5..........................................

ad F2024L00573

rep F2025L01232

Division 3

Division 3..................................

ad F2025L00636

Subdivision A

c 4.6..........................................

ad F2025L00636

Subdivision B

c 4.7..........................................

ad F2025L00636

Subdivision C

c 4.8..........................................

ad F2025L00636

c 4.9..........................................

ad F2025L00636

Subdivision D

c 4.10.........................................

ad F2025L00636

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

rep LA s 48C

Actions
Download as PDF Download as Word Document
Cases Citing This Decision

0

Cases Cited

0

Statutory Material Cited

0