Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020 (Cth)
Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020
made under the
Health Insurance Act 1973
Compilation No. 8
Compilation date: 1 January 2022
Includes amendments up to: F2021L01814
Registered: 1 February 2022
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 January 2022 (the compilation date).
The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.
Uncommenced amendments
The effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Legislation Register ( The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the series page on the Legislation Register for the compiled law.
Application, saving and transitional provisions for provisions and amendments
If the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.
Editorial changes
For more information about any editorial changes made in this compilation, see the endnotes.
Modifications
If the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the series page on the Legislation Register for the compiled law.
Self‑repealing provisions
If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.
Contents
1............................ Name............................................................................................................. 1
3............................ Authority....................................................................................................... 1
4............................ Diagnostic imaging services table................................................................. 1
Schedule 1—Diagnostic imaging services table 2
Part 1—Preliminary 2
Division 1.1—Interpretation 2
1.1.1...................... References to diagnostic imaging services.................................................... 2
1.1.2...................... References in this Schedule to items include items determined under section 3C of the Act 2
1.1.3...................... Dictionary..................................................................................................... 2
Division 1.2—General application provisions 3
Subdivision A—Capital sensitivity requirements 3
1.2.1...................... Restriction on items—services performed on aged equipment...................... 3
1.2.2...................... Age of equipment.......................................................................................... 3
Subdivision B—Exemptions from capital sensitivity requirements 5
1.2.3...................... Outer regional, remote and very remote areas and Norfolk Island................ 5
1.2.4...................... Meaning of relevant proprietor.................................................................... 5
1.2.5...................... Inner regional areas—applying for exemptions............................................. 5
1.2.6...................... Inner regional areas—granting exemptions................................................... 6
1.2.7...................... Equipment unable to be replaced etc. before end of applicable life age—applying for exemptions 7
1.2.8...................... Equipment unable to be replaced etc. before end of applicable life age—granting exemptions 8
1.2.9...................... Equipment unable to be replaced etc. before end of applicable life age—applying for extensions of exemption periods.......................................................................................................... 9
1.2.10.................... Equipment unable to be replaced etc. before end of applicable life age—extending exemption periods 10
1.2.11.................... Reconsideration by Secretary—applying for reconsideration...................... 11
1.2.12.................... Reconsideration by Secretary—reconsidering decisions............................. 12
1.2.13.................... Review by AAT.......................................................................................... 12
1.2.14.................... Delegation................................................................................................... 13
Subdivision C—Other provisions 13
1.2.15.................... Meaning of symbols (R) and (NR).............................................................. 13
1.2.16.................... Who may provide a diagnostic imaging service.......................................... 13
1.2.17.................... Restriction on items—report requirements for R‑type diagnostic imaging services 13
1.2.18.................... Bulk‑billing incentive.................................................................................. 13
1.2.19.................... Bulk‑billing—magnetic resonance imaging................................................. 14
1.2.21.................... Reduction in fees—multiple services on same day—general...................... 14
1.2.22.................... Restriction on items—services provided with autologous injections of blood or blood products 15
1.2.23.................... Restriction on items—services provided with harvesting, storage, in vitro processing or injection of non‑haematopoietic stem cells..................................................................... 16
Part 2—Services and fees 17
Division 2.1—Group I1: ultrasound 17
Subdivision A—General 17
2.1.1...................... Restriction on items—ultrasound services.................................................. 17
2.1.2...................... Restriction on items—R‑type ultrasound services....................................... 17
Subdivision B—Subgroups 1 to 4 of Group I1 18
2.1.2A................... Reduction in fees—multiple services on same day—vascular ultrasounds. 18
2.1.3...................... Items in Subgroups 1 to 4 of Group I1....................................................... 18
Subdivision C—Subgroup 5 of Group I1: obstetric and gynaecological 24
2.1.4...................... Obstetric and gynaecological ultrasound services—limits........................... 24
2.1.5...................... Obstetric and gynaecological services—referrals and clinical notes............ 25
2.1.6...................... Items in Subgroup 5 of Group I1................................................................ 25
Subdivision D—Subgroup 6 of Group I1: musculoskeletal ultrasound 30
2.1.7...................... Musculoskeletal ultrasound services—personal attendance........................ 30
2.1.8...................... Unilateral item cannot be claimed twice if bilateral item could have been claimed 30
2.1.9...................... Musculoskeletal ultrasound services—comparison ultra‑sonography......... 31
2.1.10.................... Items in Subgroup 6 of Group I1................................................................ 31
Subdivision E—Subgroup 7 of Group I1: Transthoracic and stress echocardiograms 36
2.1.11.................... Restrictions on items for transthoracic echocardiograms—assessments..... 36
2.1.12.................... Restriction on item 55126—timing............................................................. 37
2.1.13.................... Restriction on items for stress echocardiograms—patients, requests and requirements 37
2.1.14.................... Stress echocardiograms—patients............................................................... 37
2.1.15.................... Stress echocardiograms—requirements...................................................... 39
2.1.16.................... Restrictions on items for stress echocardiograms—timing.......................... 40
2.1.17.................... Reduction in fees—multiple services on same day—transthoracic and stress echocardiograms 40
2.1.18.................... Items in Subgroup 7 of Group I1................................................................ 40
Division 2.2—Group I2: computed tomography (examination) 45
Subdivision A—General 45
2.2.1...................... CT services—eligible services.................................................................... 45
2.2.2...................... Restriction on items—attenuation correction and anatomical correlation..... 45
2.2.3...................... Application of items 56001 and 56007 if axial scan performed for exclusion of acoustic neuroma 45
2.2.4...................... CT services—assessment of headache........................................................ 46
2.2.5...................... CT services—number of services............................................................... 46
2.2.5A................... Restriction on item 57360—patients........................................................... 46
Subdivision B—Subgroups 1 to 13 of Group I2 46
2.2.6...................... Items in Subgroups 1 to 13 of Group I2..................................................... 46
Division 2.3—Group I3: diagnostic radiology 54
Subdivision A—General 54
2.3.1...................... Application of items in Subdivision B, D, E or G to services rendered using diagnostic imaging procedures carried out in metropolitan areas and certain inner regional areas................ 54
2.3.2...................... Restriction on items—certain services requested by chiropractors, osteopaths and physiotherapists 54
2.3.3...................... Increased fees for certain diagnostic radiology services carried out at residential aged care facilities 55
Subdivision B—Subgroups 1 to 9 of Group I3 55
2.3.4...................... Items in Subgroups 1 to 9 of Group I3....................................................... 55
Subdivision C—Subgroup 10 of Group I3: radiographic examination of breasts 59
2.3.5...................... Mammography services—eligible services................................................. 59
2.3.6...................... Items in Subgroup 10 of Group I3.............................................................. 59
Subdivision D—Subgroups 12 and 13 of Group I3 60
2.3.7...................... Items in Subgroups 12 and 13 of Group I3................................................ 60
Subdivision E—Subgroup 15 of Group I3: fluoroscopic examination 62
2.3.8...................... Items in Subgroup 15 of Group I3.............................................................. 62
Subdivision F—Subgroup 16 of Group I3: preparation for radiological procedure 62
2.3.9...................... Preparation of patients for radiological procedures..................................... 62
2.3.10.................... Items in Subgroup 16 of Group I3.............................................................. 63
Subdivision G—Subgroup 17 of Group I3: interventional techniques 63
2.3.11.................... Meaning of angiography suite.................................................................... 63
2.3.12.................... Items in Subgroup 17 of Group I3.............................................................. 63
Division 2.4—Group I4: nuclear medicine imaging 64
Subdivision A—General 64
2.4.1...................... Nuclear scanning services (other than PET nuclear scanning services) and adjunctive services 64
2.4.1A................... Restriction on items for stress myocardial perfusion studies—patients, requests and requirements 64
2.4.1B.................... Stress myocardial perfusion studies—patients............................................ 64
2.4.1C.................... Stress myocardial perfusion studies—requirements.................................... 66
2.4.2...................... PET nuclear scanning services.................................................................... 66
2.4.3...................... PET nuclear scanning services—performance under personal supervision. 66
2.4.4...................... PET nuclear scanning services—equipment................................................ 67
2.4.5...................... PET nuclear scanning services—statutory declaration................................ 67
Subdivision B—Subgroups 1, 2 and 3 of Group I4 67
2.4.6...................... Items in Subgroups 1, 2 and 3 of Group I4................................................ 67
Division 2.5—Group I5: magnetic resonance imaging 79
Subdivision A—General 79
2.5.1...................... Application of items to certain MRI and MRA services............................. 79
2.5.2...................... MRI and MRA services—request.............................................................. 79
2.5.3...................... MRI and MRA services—permissible circumstances for performance...... 79
2.5.4...................... MRI and MRA services—eligible provider................................................ 80
2.5.5...................... MRI and MRA services—eligible equipment............................................. 80
2.5.6...................... MRI and MRA services—partial eligible equipment.................................. 80
2.5.7...................... MRI and MRA services—meaning of scan................................................ 80
2.5.8...................... Restriction on items—multiple services in certain subgroups on a day....... 81
2.5.8A................... Restriction on items—multiple services in certain subgroups in an attendance....... 81
2.5.8B.................... Reduction in fees—multiple services on same day—Subgroups 12 and 13 81
2.5.9...................... Restriction on items—related MRI or MRA services................................. 82
2.5.9A................... Circumstances for suspecting prostate cancer for item 63541..................... 83
2.5.9B.................... Restriction on item 63543—timing and purpose......................................... 84
Subdivision B—Subgroups 1 to 19 of Group I5 84
2.5.10.................... Items in Subgroups 1 to 19 of Group I5..................................................... 84
Subdivision C—Subgroup 20 of Group I5: scans of pelvis and upper abdomen for specified conditions 92
2.5.11.................... Restriction on items 63470, 63473, 63740 and 63743................................ 92
2.5.12.................... MRI and MRA services—modifying items................................................ 92
2.5.13.................... Items in Subgroup 20 of Group I5.............................................................. 92
Subdivision D—Subgroups 21 and 22 of Group I5 94
2.5.14.................... Items in Subgroups 21 and 22 of Group I5................................................ 94
Subdivision E—Subgroup 33 of Group I5 95
2.5.15.................... Items in Subgroup 33 of Group I5.............................................................. 95
Subdivision F—Subgroup 34 of Group I5 96
2.5.16.................... Items in Subgroup 34 of Group I5.............................................................. 96
Division 2.6—Group I6: management of bulk‑billed services 97
2.6.1...................... Application of items 64990, 64991, 64992, 64993, 64994 and 64995....... 97
2.6.2...................... Items in Group I6........................................................................................ 97
Division 2.7—Indexation of fees 100
2.7.1...................... Indexation—1 July 2021........................................................................... 100
Part 3—Dictionary 101
3.1......................... Dictionary................................................................................................. 101
Part 4—Application, saving and transitional provisions 105
Division 1—General provisions 105
4.1......................... Definitions................................................................................................ 105
4.2......................... Transitional provisions—exemptions from capital sensitivity requirements 105
Endnotes108
Endnote 1—About the endnotes 108
Endnote 2—Abbreviation key 109
Endnote 3—Legislation history 110
Endnote 4—Amendment history 111
Endnote 5—Editorial changes 114
1 Name
This instrument is the Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020.
3 Authority
This instrument is made under the Health Insurance Act 1973.
4 Diagnostic 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 1—Diagnostic imaging services table
Note: See section 4.
Part 1—Preliminary
Division 1.1—Interpretation
1.1.1 References to diagnostic imaging services
A reference to a diagnostic imaging service in an item in Part 2 includes a reference to the undertaking of the diagnostic imaging procedure used for rendering the service.
1.1.2 References 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.
1.1.3 Dictionary
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 1.2—General application provisions
Subdivision A—Capital sensitivity requirements
1.2.1 Restriction on items—services performed on aged equipment
Subject to Subdivision B, an item in this Schedule does not apply to a service that is performed on diagnostic imaging equipment if the age of the equipment exceeds the applicable life age of the equipment.
1.2.2 Age 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:
(a) the date the equipment was first installed in Australia; or
(b) if the equipment was imported as used equipment—the date of manufacture of the oldest component of the equipment.
(2) The applicable life age:
(a) for diagnostic imaging equipment that has not been upgraded—is the new effective life age of the equipment; and
(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:
(a) an additional reasonable investment has been made within the new effective life age for the equipment that improves the overall performance of the imaging system so that it is equivalent to new equipment supplied in Australia at the time of the improvement; or
(b) 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
(c) the equipment is currently accredited under The Royal Australian and New Zealand College of Radiologists’ Mammography Quality Assurance Program.
Subdivision B—Exemptions from capital sensitivity requirements
1.2.3 Outer regional, remote and very remote areas and Norfolk Island
(1) Clause 1.2.1 does not apply to a service that is performed on diagnostic imaging equipment if:
(a) the equipment is ordinarily located at diagnostic imaging premises; and
(b) the diagnostic imaging premises are located in an area that is:
(i) Outer Regional Australia; or
(ii) Remote Australia; or
(iii) Very Remote Australia; or
(iv) Norfolk Island.
(2) Clause 1.2.1 does not apply to a service that is performed on diagnostic imaging equipment if:
(a) the equipment is not ordinarily located at diagnostic imaging premises; and
(b) the equipment is ordinarily located, when not in use, at a base for mobile diagnostic imaging equipment; and
(c) the base is located in an area that is:
(i) Outer Regional Australia; or
(ii) Remote Australia; or
(iii) Very Remote Australia; or
(iv) Norfolk Island.
1.2.4 Meaning of relevant proprietor
The relevant proprietor for diagnostic imaging equipment is:
(a) if the equipment is ordinarily located at diagnostic imaging premises—the proprietor of the premises; or
(b) if the equipment:
(i) is not ordinarily located at diagnostic imaging premises; and
(ii) is ordinarily located, when not in use, at a base for mobile diagnostic imaging equipment;
the proprietor of the base.
1.2.5 Inner regional areas—applying for exemptions
Scope of this clause
(1) This clause applies to diagnostic imaging equipment if:
(a) all of the following subparagraphs apply:
(i) the equipment is ordinarily located at diagnostic imaging premises;
(ii) the diagnostic imaging premises are located in an area that is Inner Regional Australia;
(iii) the diagnostic imaging premises are located in an area that is RRMA4 or RRMA5; or
(b) all of the following subparagraphs apply:
(i) the equipment is not ordinarily located at diagnostic imaging premises;
(ii) the equipment is ordinarily located at a base for mobile diagnostic imaging equipment when not in use;
(iii) the base is located in an area that is Inner Regional Australia;
(iv) the base is located in an area that is RRMA4 or RRMA5.
Applying for exemption
(2) The relevant proprietor for the equipment may apply to the Secretary for an exemption under clause 1.2.6 in respect of the equipment.
Note: For relevant proprietor, see clause 1.2.4.
(3) The application must:
(a) be in writing; and
(b) be made no later than 3 years after the end of the maximum extended life age of the equipment.
Notifying proprietor of receipt of application
(4) If:
(a) the Secretary receives an application under subclause (2) of this clause for an exemption in respect of the equipment; and
(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.
(5) To avoid doubt, the Secretary is not required to notify the relevant proprietor under subclause (4) if the equipment does not meet the requirements of subclause (1).
Effect of application on capital sensitivity requirements
(6) Clause 1.2.1 does not apply to a service that is performed on the equipment during the period:
(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
(b) ending when the Secretary makes a decision on the application under clause 1.2.6, or the application is withdrawn.
1.2.6 Inner regional areas—granting exemptions
Scope of this clause
(1) This clause applies if, under subclause 1.2.5(4), the Secretary notifies the relevant proprietor for diagnostic imaging equipment that the Secretary has received an application for an exemption in respect of the equipment.
Granting exemption
(2) The Secretary must, by notice in writing given to the proprietor:
(a) subject to subclause (3) of this clause, grant the exemption; or
(b) refuse to grant the exemption.
(3) The Secretary must not grant the exemption unless the Secretary is satisfied that the equipment:
(a) is operated on a rare and sporadic basis; and
(b) provides crucial patient access to diagnostic imaging services.
(4) The Secretary must make a decision on the application under subclause (2) within 28 days after notifying the proprietor as mentioned in subclause (1).
Effect of exemption on capital sensitivity requirements
(5) If the Secretary grants the exemption, clause 1.2.1 does not apply to a service that is performed on the equipment while the exemption is in force.
(6) If the Secretary refuses to grant the exemption, clause 1.2.1 does not apply to a service that is performed on the equipment during the period:
(a) starting when the Secretary refuses to grant the exemption; and
(b) ending:
(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
(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.
1.2.7 Equipment 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:
(a) be in writing; and
(b) be made before the end of the equipment’s applicable life age; and
(c) set out reasons why the proprietor is unable to replace the equipment (or upgrade the equipment, if it has not already been upgraded) before the end of the equipment’s applicable life age.
Notifying proprietor of receipt of application
(3) If:
(a) the Secretary receives an application under subclause (2) of this clause for an exemption in respect of the equipment; and
(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:
(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
(b) ending when the Secretary makes a decision on the application under clause 1.2.8, or the application is withdrawn.
1.2.8 Equipment 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:
(a) subject to subclauses (3) and (4) of this clause, grant the exemption for a specified period; or
(b) refuse to grant the exemption.
(3) The Secretary must not grant the exemption unless the Secretary is satisfied that:
(a) due to circumstances beyond the control of the proprietor, the proprietor is unable to replace the equipment (or upgrade the equipment, if it has not already been upgraded) before the end of its applicable life age; and
(b) the proprietor will be able to replace the equipment (or upgrade the equipment, if it has not already been upgraded) before the end of the period specified under paragraph (2)(a).
(4) The period specified under paragraph (2)(a) must end no later than 3 months after the end of the equipment’s applicable life age.
Note: The period specified under paragraph (2)(a) is the initial exemption period of the exemption: see clause 3.1. The exemption period can be extended under clause 1.2.10.
(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 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:
(a) starting when the Secretary refuses to grant the exemption; and
(b) ending:
(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
(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.
1.2.9 Equipment 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 the exemption period of the exemption under clause 1.2.10.
Note: For relevant proprietor, see clause 1.2.4.
(3) The application must:
(a) be in writing; and
(b) be made before the end of the current exemption period of the exemption; and
(c) set out reasons why the proprietor continues to be unable to replace or upgrade the equipment.
Notifying proprietor of receipt of application
(4) If:
(a) the Secretary receives an application under subclause (2) of this clause for an extension of the exemption; and
(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:
(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
(b) ending when the Secretary makes a decision on the application under clause 1.2.10, or the application is withdrawn.
1.2.10 Equipment 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 of the exemption period of an exemption in respect of the equipment.
Secretary may extend extension period
(2) The Secretary must, by notice in writing given to the proprietor:
(a) subject to subclauses (3) and (4) of this clause, extend the exemption period for a specified period; or
(b) refuse to extend the exemption period.
(3) The Secretary must not extend the exemption period unless the Secretary is satisfied that:
(a) due to circumstances beyond the control of the proprietor, the proprietor is unable to replace the equipment (or upgrade the equipment, if it has not already been upgraded) before the end of the current exemption period of the exemption; and
(b) the proprietor will be able to replace the equipment (or upgrade the equipment, if it has not already been upgraded) before the end of the exemption period as extended.
(4) The 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 the exemption period, clause 1.2.1 does not apply to a service that is performed on the equipment during the period:
(a) starting when the Secretary refuses to extend the exemption period; and
(b) ending:
(i) when the relevant proprietor for the equipment applies under clause 1.2.11 for reconsideration of the decision to refuse to extend the exemption period; or
(ii) if the relevant proprietor does not apply for such consideration—at the end of the period in which the proprietor could have applied for such reconsideration.
Note: Clause 1.2.1 does not apply to a service provided using the equipment during the extended exemption period: see subclause 1.2.8(6).
1.2.11 Reconsideration by Secretary—applying for reconsideration
Scope of this clause
(1) This clause applies to:
(a) a decision under clause 1.2.6 or 1.2.8 to refuse to grant an exemption in respect of diagnostic imaging equipment; or
(b) a decision under clause 1.2.10 to refuse to extend the exemption period of an exemption in respect of diagnostic imaging equipment.
Applying for reconsideration of decision
(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:
(a) be in writing; and
(b) be made within:
(i) 28 days after the Secretary makes the decision; or
(ii) if the Secretary is satisfied that special circumstances exist—within such further period (if any) as the Secretary allows; and
(c) identify the decision for reconsideration; and
(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:
(a) the Secretary receives an application under subclause (2) of this clause for reconsideration of the decision; and
(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
(6) Clause 1.2.1 does not apply to a service that is performed on the equipment during the period:
(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
(b) ending when the Secretary makes a decision on the application under clause 1.2.12, or the application is withdrawn.
1.2.12 Reconsideration 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:
(a) reconsider the decision; and
(b) by notice in writing given to the proprietor:
(i) affirm the decision; or
(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 decision on capital sensitivity requirements
(4) If the Secretary affirms the decision, clause 1.2.1 does not apply to a service that is performed on the equipment during the period:
(a) starting when the Secretary affirms the decision; and
(b) ending:
(i) if an application for review of the decision to affirm is made under clause 1.2.13—when each party to the proceeding has been given a copy of the decision of the Administrative Appeals Tribunal on review; or
(ii) otherwise—when the time for making such an application for review expires.
Note: For the time for making an application for review, see paragraph 29(1)(d) and subsection 29(2) of the Administrative Appeals Tribunal Act 1975.
1.2.13 Review by AAT
Applications may be made to the Administrative Appeals Tribunal for review of decisions of the Secretary under clause 1.2.12.
1.2.14 Delegation
The Secretary may, by written notice, delegate any of the Secretary’s powers under this Subdivision to an SES employee, or acting SES employee, in the Department.
Subdivision C—Other provisions
1.2.15 Meaning of symbols (R) and (NR)
(1) A service corresponding to an item including the symbol (R) is an R‑type diagnostic imaging service.
(2) A service corresponding to an item including the symbol (NR) is an NR‑type diagnostic imaging service.
1.2.16 Who may provide a diagnostic imaging service
Items in this Schedule relating to diagnostic imaging services apply whether the service is provided by:
(a) a medical practitioner; or
(b) a person, other than a medical practitioner, who provides the service under the supervision of a medical practitioner in accordance with accepted medical practice.
1.2.17 Restriction on items—report requirements for R‑type diagnostic imaging services
(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) This subclause applies to:
(a) items 55054, 55130, 55135, 55848, 57341, 59312, 59314, 60506, 60509 and 61109; and
(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.
1.2.18 Bulk‑billing incentive
(1) This clause applies if:
(a) a service that is mentioned in an item in Divisions 2.1 to 2.4 of this Schedule is provided; and
(b) the service is not provided in a hospital; and
(c) the service is bulk‑billed.
(2) The fee for the service is 95% of the fee mentioned in this 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) This clause does not apply to the service specified in item 61369.
1.2.19 Bulk‑billing—magnetic resonance imaging
(1) This clause applies if:
(a) a service that is mentioned in an item in Division 2.5 of this Schedule is provided; and
(b) the service is not provided in a hospital; and
(c) the service is bulk‑billed.
(2) The fee for the service is 100% of the fee mentioned in this Schedule for the service.
Note: Under paragraph 10(2)(aa) of the Act and subsection 28(2) of the Health Insurance Regulations 2018, the medicare benefit payable is 100% of the fee for the service.
1.2.21 Reduction in fees—multiple services on same day—general
(1) If a medical practitioner renders 2 or more diagnostic imaging services for the same patient on the same day, the fees set out in the items that apply to the services, other than the item with the highest fee, are reduced by $5.
(2) If a medical practitioner renders at least one R‑type diagnostic imaging service and at least one consultation service for the same patient on the same day, the highest fee, set out in the items that apply to diagnostic imaging services rendered by the practitioner for that patient on that day, is reduced:
(a) if the fee for the relevant consultation is at least $40—by $35; or
(b) if that fee is less than $40 but more than $15—by $15; or
(c) if that fee is less than $15—by the amount of that fee.
(3) For the purposes of subclause (2), if more than one consultation has occurred, the relevant consultation is the consultation having the highest fee set out in the items that apply to the consultation.
(4) If a medical practitioner renders at least one R‑type diagnostic imaging service and at least one non‑consultation service for the same patient on the same day, the highest fee that applies to any diagnostic imaging services performed by the medical practitioner for the same patient on the same day, is reduced by $5.
(5) If a medical practitioner renders an R‑type diagnostic imaging service, a consultation and a non‑consultation service for the same patient on the same day, the sum of the reductions under subclauses (2) and (4) must not exceed the highest fee that applies to any diagnostic imaging services rendered by the medical practitioner for the same patient on the same day.
(6) Clauses 2.1.2A, 2.1.17 and 2.5.8 apply, subject to subclauses (7), (8) and (8A), in addition to this clause.
(7) For the purposes of clause 2.1.2A, if a medical practitioner provides:
(a) 2 or more vascular ultrasound services for the same patient on the same day; and
(b) one or more other diagnostic imaging services for that patient on that day;
the amount of the fees payable for the vascular ultrasound services is taken, for this clause, to be an amount payable for one diagnostic imaging service.
(8) For the purposes of clause 2.5.8, if a medical practitioner provides:
(a) 2 or more MRI services mentioned in Subgroup 12 or 13 of Group I5 for the same patient on the same day; and
(b) one or more other diagnostic imaging services for that patient on that day;
the amount of the fees payable for the MRI services is taken, for this clause, to be an amount payable for one diagnostic imaging service.
(8A) For the purposes of clause 2.1.17, if a medical practitioner provides:
(a) 2 or more echocardiogram services mentioned in subclause 2.1.17(1) for the same patient on the same day; and
(b) one or more other diagnostic imaging services for that patient on that day;
the amount of the fees payable for the echocardiogram services is taken, for this clause, to be an amount payable for one diagnostic imaging service.
(9) This clause does not apply to diagnostic imaging services that are rendered in a remote area by a medical practitioner for whom a remote area exemption under section 23DX of the Act is in force for that area.
(10) This clause does not apply to the fee specified in item 59103, 64990, 64991, 64992, 64993, 64994 or 64995.
(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.
1.2.22 Restriction 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.
1.2.23 Restriction 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 2—Services and fees
Division 2.1—Group I1: ultrasound
Subdivision A—General
2.1.1 Restriction 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:
(a) by a medical practitioner; or
(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.
2.1.2 Restriction on items—R‑type ultrasound services
(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:
(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:
(i) to monitor and influence the conduct and diagnostic quality of the examination; and
(ii) if necessary, to attend on the patient personally; or
(b) under the supervision of a practitioner who:
(i) is not a specialist or consultant physician; and
(ii) meets the requirement of subclause (2); and
(iii) is available to monitor and influence the conduct and diagnostic quality of the examination and, if necessary, to attend on the patient personally; or
(c) in the circumstance mentioned in subclause (3), and under the supervision of a practitioner who is available:
(i) to monitor and influence the conduct and diagnostic quality of the examination; and
(ii) if necessary, to attend on the patient personally; or
(d) if paragraph (a), (b) or (c) cannot be complied with:
(i) in an emergency; or
(ii) in a location that is not less than 30 kilometres by the most direct road route from another practice where services that comply with paragraph (a) or (b) are available.
(2) For the purposes of subparagraph (1)(b)(ii), the requirement is that, between 1 September 1997 and 31 August 1999, at least 50 services were rendered by or on behalf of the practitioner at the location where the eligible service was rendered, and the rendering of those services entitled payment of medicare benefits.
(3) For the purposes of paragraph (1)(c), the circumstance is that, between 1 September 1997 and 31 August 1999, at least 50 services were rendered in nursing homes or patients’ residences by or on behalf of the practitioner, and the rendering of those services entitled payment of medicare benefits.
Subdivision B—Subgroups 1 to 4 of Group I1
2.1.2A Reduction in fees—multiple services on same day—vascular ultrasounds
(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:
(a) the second highest fee is reduced by 40%;
(b) any other fee, except the highest, is reduced by 50%.
(2) For the purposes of subclause (1):
(a) if 2 or more applicable fees are equally the highest:
(i) only one of those fees is taken to be the highest fee; and
(ii) the other, or another, highest fee is taken to be the second highest fee; and
(b) if 2 or more fees are equally second highest—any one of those fees may be taken to be the second highest for the purpose of paragraph (1)(b); and
(c) if a reduced fee calculated under subclause (1) is not a multiple of 5 cents—the reduced fee is taken to be the nearest amount that is a multiple of 5 cents.
(3) This clause does not apply to the fee specified in item 64990 or 64991.
2.1.3 Items 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) (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) (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 55130, or an item in Subgroup 3, applies (R) (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, 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 C—Subgroup 5 of Group I1: obstetric and gynaecological
2.1.4 Obstetric and gynaecological ultrasound services—limits
(1) For NR‑type diagnostic imaging services mentioned in an item in this Subdivision, the specified fee for no more than 3 services provided to the same patient in any one pregnancy applies.
(2) For any patient, items 55706, 55707, 55708, 55709, 55718, 55723, 55759, 55762, 55768 and 55770 are applicable only once in a pregnancy.
2.1.5 Obstetric and gynaecological services—referrals and clinical notes
(1) A referral for a service mentioned in item 55700, 55704, 55707, 55712, 55718, 55721, 55759, 55764, 55768 and 55772 must state the relevant condition or clinical indication for the service.
(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) A medical practitioner’s clinical notes for a service mentioned in item 55703, 55705, 55708, 55715, 55723, 55725, 55762, 55766, 55770 or 55774 must state the relevant condition or clinical indication for the service.
2.1.6 Items 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 scan of, by any or all approaches, for determining the gestation, location, viability or number of foetuses, if the dating of the pregnancy (as confirmed by ultrasound) is less than 12 weeks of gestation (R) | 60.90 |
| 55703 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, ultrasound scan of, by any or all approaches, for determining the gestation, location, viability or number of foetuses, if the dating of the pregnancy (as confirmed by ultrasound) is less than 12 weeks of gestation (NR) | 35.50 |
| 55704 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, for determining the structure, gestation, location, viability or number of foetuses, if the dating of the pregnancy (as confirmed by ultrasound) is 12 to 16 weeks of gestation (R) | 71.05 |
| 55705 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, for determining the structure, gestation, location, viability or number of foetuses, if the dating of the pregnancy (as confirmed by ultrasound) is 12 to 16 weeks of gestation (NR) | 35.50 |
| 55706 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, if: (a) the dating for the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and (b) the service is not performed in the same pregnancy as item 55709 (R) | 101.50 |
| 55707 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if: (a) the pregnancy (as confirmed by ultrasound) is dated by a fetal crown rump length of 45 to 84 mm; and (b) nuchal translucency measurement is performed to assess the risk of fetal abnormality; and (c) the service is not performed with item 55700, 55703, 55704 or 55705 on the same patient within 24 hours (R) | 71.05 |
| 55708 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if: (a) the pregnancy (as confirmed by ultrasound) is dated by a crown rump length of 45 to 84 mm; and (b) nuchal translucency measurement is performed to assess the risk of fetal abnormality; and (c) the service is not performed with item 55700, 55703, 55704 or 55705, on the same patient within 24 hours (NR) | 35.50 |
| 55709 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, if: (a) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and (b) the service is not performed in the same pregnancy as item 55706 (NR) | 38.55 |
| 55712 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, if: (a) the service is requested by a medical practitioner who: (i) is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; or (ii) has a Diploma of Obstetrics; or (iii) has a qualification recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists as being equivalent to a Diploma of Obstetrics; or (iv) has obstetric privileges at a non‑metropolitan hospital; and (b) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and (c) further examination is clinically indicated after performance, in the same pregnancy, of a scan mentioned in item 55706 or 55709 (R) | 116.70 |
| 55715 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, performed by or on behalf of a medical practitioner who is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, if: (a) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and (b) further examination is clinically indicated after performance, in the same pregnancy, of a scan mentioned in item 55706 or 55709 (NR) | 40.60 |
| 55718 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if: (a) the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and (b) the service is not performed in the same pregnancy as item 55723 (R) | 101.50 |
| 55721 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if: (a) the service is requested by a medical practitioner who: (i) is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; or (ii) has a Diploma of Obstetrics; or (iii) has a qualification recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists as being equivalent to a Diploma of Obstetrics; or (iv) has obstetric privileges at a non‑metropolitan hospital; and (b) the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and (c) further examination is clinically indicated in the same pregnancy to which item 55718 or 55723 applies (R) | 116.70 |
| 55723 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if: (a) the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and (b) the service is not performed in the same pregnancy as item 55718 (NR) | 38.55 |
| 55725 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, performed by or on behalf of a medical practitioner who is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, if: (a) the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and (b) further examination is clinically indicated in the same pregnancy to which item 55718 or 55723 applies (NR) | 40.60 |
| 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 |
| 55759 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, if: (a) ultrasound of the same pregnancy confirms a multiple pregnancy; and (b) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks gestation; and (c) the service mentioned in item 55706, 55709, 55712, 55715 or 55762 is not performed in conjunction with the scan during the same pregnancy (R) | 152.25 |
| 55762 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, if: (a) ultrasound of the same pregnancy confirms a multiple pregnancy; and (b) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks gestation; and (c) the service mentioned in item 55706, 55709, 55712, 55715 or 55759 is not performed in conjunction with the scan during the same pregnancy (NR) | 60.90 |
| 55764 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, if: (a) the service is requested by a medical practitioner who: (i) is a Member or Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; or (ii) has a Diploma of Obstetrics; or (iii) has a qualification recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists as equivalent to a Diploma of Obstetrics; or (iv) has obstetric privileges at a non‑metropolitan hospital; and (b) ultrasound of the same pregnancy confirms a multiple pregnancy; and (c) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks gestation; and (d) further examination is clinically indicated in the same pregnancy in which item 55759 or 55762 has been performed; and (e) the service mentioned in item 55706, 55709, 55712 or 55715 is not performed in conjunction with the scan during the same pregnancy (R) | 162.40 |
| 55766 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, performed by or on behalf of a medical practitioner, who is a Member or Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, if: (a) ultrasound of the same pregnancy confirms a multiple pregnancy; and (b) the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and (c) further examination is clinically indicated in the same pregnancy in which item 55759 or 55762 has been performed; and (d) the service mentioned in item 55706, 55709, 55712 or 55715, is not performed in conjunction with the scan during the same pregnancy (NR) | 65.95 |
| 55768 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if: (a) dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and (b) the ultrasound confirms a multiple pregnancy; and (c) the service is not performed in the same pregnancy as item 55770; and (d) the service mentioned in item 55718, 55721, 55723 or 55725 is not performed in conjunction with the scan during the same pregnancy (R) | 152.25 |
| 55770 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if: (a) dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and (b) the ultrasound confirms a multiple pregnancy; and (c) the service is not performed in the same pregnancy as item 55768; and (d) the service mentioned in item 55718, 55721, 55723 or 55725 is not performed in conjunction with the scan during the same pregnancy (NR) | 60.90 |
| 55772 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if: (a) dating of the pregnancy as confirmed by ultrasound is after 22 weeks of gestation; and (b) the service is requested by a medical practitioner who: (i) is a Member or Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; or (ii) has a Diploma of Obstetrics; or (iii) has a qualification recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists as equivalent to a Diploma of Obstetrics; or (iv) has obstetric privileges at a non‑metropolitan hospital; and (c) further examination is clinically indicated in the same pregnancy to which item 55768 or 55770 has been performed; and (d) the pregnancy as confirmed by ultrasound is a multiple pregnancy; and (e) the service mentioned in item 55718, 55721, 55723 or 55725 is not performed in conjunction with the scan during the same pregnancy (R) | 162.40 |
| 55774 | Pelvis or abdomen, pregnancy‑related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, performed by or on behalf of a medical practitioner who is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, if: (a) dating of the pregnancy as confirmed by ultrasound is after 22 weeks of gestation; and (b) further examination is clinically indicated in the same pregnancy to which item 55768 or 55770 has been performed; and (c) the pregnancy as confirmed by ultrasound is a multiple pregnancy; and (d) the service mentioned in item 55718, 55721, 55723 or 55725 is not performed in conjunction with the scan during the same pregnancy (NR) | 65.95 |
Subdivision D—Subgroup 6 of Group I1: musculoskeletal ultrasound
2.1.7 Musculoskeletal ultrasound services—personal attendance
Items in this Subdivision apply to a musculoskeletal ultrasound service only if:
(a) the medical practitioner responsible for the conduct and report of the examination personally attends during the performance of the scan and personally examines the patient; or
(b) the service is performed, because of medical necessity, in a location that is more than 30 kilometres by the most direct road route from another practice where services that comply with paragraph (a) are available.
2.1.8 Unilateral item cannot be claimed twice if bilateral item could have been claimed
If:
(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
(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 |
2.1.9 Musculoskeletal 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.
2.1.10 Items 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) | 42.65 |
| 55888 | Ankle or hind foot, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55890 (R) | 110.75 |
| 55889 | Ankle or hind foot, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55891 (NR) | 38.40 |
| 55890 | Ankle or hind foot, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55888 (R) | 122.90 |
| 55891 | Ankle or hind foot, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55889 (NR) | 42.65 |
| 55892 | Mid foot or fore foot, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55894 (R) | 110.75 |
| 55893 | Mid foot or fore foot, or both, left or right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55895 (NR) | 38.40 |
| 55894 | Mid foot or fore foot, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55892 (R) | 122.90 |
| 55895 | Mid foot or fore foot, or both, left and right, ultrasound scan of, if the service is not performed in conjunction with a service mentioned in item 55893 (NR) | 42.65 |
consultation has the meaning given by clause 1.2.21.
credentialled specialist means a specialist or consultant physician credentialled under the Joint Nuclear Medicine Specialist Credentialling Program for the Recognition of the Credentials of Nuclear Medicine Specialists for Positron Emission Tomography overseen by the JNMCAC.
CT: see computed tomography.
eligible provider, for an MRI or MRA service, has the meaning given by clause 2.5.4.
exemption period of an exemption under clause 1.2.5B means the period mentioned in paragraph 1.2.8(2)(a) (as extended under clause 1.2.10 if applicable).
FDG means 18F‑fluorodeoxyglucose.
highest fee has the meaning given by clause 1.2.21.
Inner Regional Australia means a Remoteness Area classified as Inner Regional Australia under the ASGC 2006.
JNMCAC means the Joint Nuclear Medicine Credentialling and Accreditation Committee of the RACP and RANZCR.
maximum extended life age has the meaning given by subclause 1.2.2(3).
Modified Monash 2 area has the meaning given by the general medical services table.
Modified Monash 3 area has the meaning given by the general medical services table.
Modified Monash 4 area has the meaning given by the general medical services table.
Modified Monash 5 area has the meaning given by the general medical services table.
Modified Monash 6 area has the meaning given by the general medical services table.
Modified Monash 7 area has the meaning given by the general medical services table.
MRA means magnetic resonance angiography.
MRI means magnetic resonance imaging.
new effective life age has the meaning given by subclause 1.2.2(3).
non‑consultation service has the meaning given by clause 1.2.21.
non‑metropolitan hospital means a hospital that is located outside the Sydney, Melbourne, Brisbane, Adelaide, Perth, Greater Hobart, Darwin and Canberra statistical divisions, as defined in the ASGC 2010.
(NR) has the meaning given by clause 1.2.15.
Outer Regional Australia means a Remoteness Area classified as Outer Regional Australia under the ASGC 2006.
PET means positron emission tomography.
practice location has the meaning given by clause 2.6.1.
providing practitioner has the same meaning as in subsection 16B(1) of the Act.
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:
(a) a hospital that provides a radiology or computed tomography service under the direction of a specialist in the specialty of diagnostic radiology; or
(b) a free‑standing radiology or computed tomography facility under the direction of a specialist in the specialty of diagnostic radiology.
report means a report prepared by a medical practitioner.
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 Classification has the meaning given by the general medical services table.
scan, for items 63001 to 63560 and 63740 to 63743, has the meaning given by clause 2.5.7.
sequence, for a scan, means a series of images collected at the same time with similar image parameters (not including images designed to establish patient position and subsequently used to plan other scans).
unreferred service has the meaning given by clause 2.6.1.
upgraded has the meaning given by subclause 1.2.2(4).
Very Remote Australia means a Remoteness Area classified as Very Remote Australia under the ASGC 2006.
Part 4—Application, saving and transitional provisions
Division 1—General provisions
4.1 Definitions
In this Division:
old table means Schedule 1 to the Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 1) 2020 as in force immediately before 1 July 2020.
4.2 Transitional provisions—exemptions from capital sensitivity requirements
Applications for exemptions
(1) If:
(a) a valid application was made under subclause 1.2.5(2) of the old table before 1 July 2020; and
(b) the Department did not notify the relevant proprietor of receipt of the valid application as mentioned in subclause 1.2.5(4) of the old table before 1 July 2020;
subclauses 1.2.5(4) and (5) of this Schedule apply in relation to the application as if it were an application made under subclause 1.2.5(2) of this Schedule.
Notifications of receipt of valid applications
(2) If:
(a) the Department notified the relevant proprietor of receipt of a valid application as mentioned in subclause 1.2.5(4) of the old table before 1 July 2020; and
(b) the Secretary did not make a decision on the application under subclause 1.2.6(2) of the old table before 1 July 2020;
subclause 1.2.5(6) and clause 1.2.6 of this Schedule apply in relation to the notification as if it were a notification given under subclause 1.2.5(4) of this Schedule.
Exemptions
(3) An exemption:
(a) granted under subclause 1.2.6(2) of the old table; and
(b) in force immediately before 1 July 2020;
has effect, from 1 July 2020, as if it had been granted under clause 1.2.6 of this Schedule.
Refusals to grant exemptions
(4) If:
(a) the Secretary refused to grant an exemption under subclause 1.2.6(2) of the old table before 1 July 2020; and
(b) the proprietor who applied for the exemption did not apply under clause 1.2.11 of the old table for reconsideration of the decision before 1 July 2020; and
(c) the period to apply for such reconsideration did not end before 1 July 2020;
subclause 1.2.6(6) and clause 1.2.11 of this Schedule apply in relation to the decision to refuse to grant the exemption as if it were a decision under paragraph 1.2.6(2)(b) of this Schedule to refuse to grant an exemption.
Applications for reconsideration of refusals
(5) If:
(a) the Secretary refused to grant an exemption under subclause 1.2.6(2) of the old table in respect of diagnostic imaging equipment; and
(b) the proprietor who applied for the exemption applied under clause 1.2.11 of the old table for reconsideration of the decision before 1 July 2020; and
(c) the Secretary did not make a decision under clause 1.2.12 of the old table on the application for reconsideration before 1 July 2020;
for the purposes of subclause 1.2.11(6) and clause 1.2.12 of this Schedule, the Secretary is taken to have notified the proprietor under subclause 1.2.11(5) of this Schedule, when the Secretary received the application for reconsideration, that the Secretary had received an application for reconsideration of a decision under clause 1.2.6 of this Schedule to refuse to grant an exemption in respect of the equipment.
Affirmations of refusals
(6) If:
(a) the Secretary affirmed a decision under subparagraph 1.2.12(2)(b)(i) of the old table before 1 July 2020; and
(b) application was not made for review of the decision to affirm under clause 1.2.13 of the old table before 1 July 2020; and
(c) the time for making such an application for review did not end before 1 July 2020;
subclause 1.2.12(4) and clause 1.2.13 of this Schedule apply in relation to the decision as if it were a decision under subparagraph 1.2.12(2)(b)(i) of this Schedule to affirm a decision under paragraph 1.2.6(2)(b) of this Schedule.
Applications for AAT review
(7) If:
(a) an application was made under clause 1.2.13 of the old table for review of a decision before 1 July 2020; and
(b) immediately before 1 July 2020, each party to the proceeding had not been given a copy of the decision of the Administrative Appeals Tribunal on review;
the application is taken, from 1 July 2020, to be an application made under clause 1.2.13 of this Schedule for review of a decision under subparagraph 1.2.12(2)(b)(i) of this Schedule to affirm a decision under paragraph 1.2.6(2)(b) of this Schedule.
Endnotes
Endnote 1—About the endnotes
The endnotes provide information about this compilation and the compiled law.
The following endnotes are included in every compilation:
Endnote 1—About the endnotes
Endnote 2—Abbreviation key
Endnote 3—Legislation history
Endnote 4—Amendment history
Abbreviation key—Endnote 2
The abbreviation key sets out abbreviations that may be used in the endnotes.
Legislation history and amendment history—Endnotes 3 and 4
Amending laws are annotated in the legislation history and amendment history.
The legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.
The amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.
Editorial changes
The Legislation Act 2003 authorises First Parliamentary Counsel to make editorial and presentational changes to a compiled law in preparing a compilation of the law for registration. The changes must not change the effect of the law. Editorial changes take effect from the compilation registration date.
If the compilation includes editorial changes, the endnotes include a brief outline of the changes in general terms. Full details of any changes can be obtained from the Office of Parliamentary Counsel.
Misdescribed amendments
A misdescribed amendment is an amendment that does not accurately describe the amendment to be made. If, despite the misdescription, the amendment can be given effect as intended, the amendment is incorporated into the compiled law and the abbreviation “(md)” added to the details of the amendment included in the amendment history.
If a misdescribed amendment cannot be given effect as intended, the abbreviation “(md not incorp)” is added to the details of the amendment included in the amendment history.
Endnote 2—Abbreviation key
| ad = added or inserted | o = order(s) |
| am = amended | Ord = Ordinance |
| amdt = amendment | orig = original |
| c = clause(s) | par = paragraph(s)/subparagraph(s) |
| C[x] = Compilation No. x | /sub‑subparagraph(s) |
| Ch = Chapter(s) | pres = present |
| def = definition(s) | prev = previous |
| Dict = Dictionary | (prev…) = previously |
| disallowed = disallowed by Parliament | Pt = Part(s) |
| Div = Division(s) | r = regulation(s)/rule(s) |
| ed = editorial change | reloc = relocated |
| exp = expires/expired or ceases/ceased to have | renum = renumbered |
| effect | rep = repealed |
| F = Federal Register of Legislation | rs = repealed and substituted |
| gaz = gazette | s = section(s)/subsection(s) |
| LA = Legislation Act 2003 | Sch = Schedule(s) |
| LIA = Legislative Instruments Act 2003 | Sdiv = Subdivision(s) |
| (md) = misdescribed amendment can be given | SLI = Select Legislative Instrument |
| effect | SR = Statutory Rules |
| (md not incorp) = misdescribed amendment | Sub‑Ch = Sub‑Chapter(s) |
| cannot be given effect | SubPt = Subpart(s) |
| mod = modified/modification | underlining = whole or part not |
| No. = Number(s) | commenced or to be commenced |
Endnote 3—Legislation history
| Name | Registration | Commencement | Application, saving and transitional provisions |
| Health Insurance (Diagnostic Imaging Services Table) Regulations (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) | — |
Endnote 4—Amendment 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 B | |
| c 1.2.3....................................... | rep F2021L01749 |
| c 1.2.5....................................... | rep F2021L01749 |
| c 1.2.6....................................... | rep F2021L01749 |
| c 1.2.11..................................... | am F2021L01749 |
| Subdivision C | |
| 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 |
| Subdivision C | |
| c 2.1.6....................................... | am F2021L00681; F2021L01814 |
| Subdivision D | |
| 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 |
| 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 |
| Division 2.3 | |
| Subdivision A | |
| c 2.3.3....................................... | rs F2020L01608 |
| Subdivision B | |
| c 2.3.4....................................... | am F2021L00681; F2021L01814 |
| Subdivision C | |
| c 2.3.6....................................... | am F2021L00681; F2021L01814 |
| Subdivision D | |
| c 2.3.7....................................... | am F2021L00681; F2021L01814 |
| Group I3 Table......................... | am F2021L00681 |
| Subdivision E | |
| c 2.3.8....................................... | am F2021L00681; F2021L01814 |
| 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 |
| Division 2.4 | |
| Subdivision A | |
| c 2.4.1....................................... | am F2020L00882; F2020L01608 |
| 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 | |
| Subdivision B | |
| Subdivision B heading.............. | am F2020L01608 |
| c 2.4.6....................................... | am F2020L01608 |
| Group I4 Table......................... | am F2020L00882; F2020L01608; F2021L00681 |
| ed C6 | |
| am F2021L01281; F2021L01814 | |
| Division 2.5 | |
| Subdivision A | |
| 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 |
| c 2.5.9A.................................... | ad F2021L01281 |
| c 2.5.9B.................................... | ad F2021L01281 |
| ed C7 | |
| Subdivision B | |
| Group I5 Table......................... | am F2021L00681; F2021L01281 |
| Subdivision C | |
| Group I5 Table......................... | am F2021L00681 |
| 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 | |
| Part 3 | |
| c 3.1.......................................... | am F2020L01608; F2021L01281; F2021L01749 |
| Part 4 | |
| Part 4 | rep F2021L01749 |
| Division 1 | |
| c 4.1.......................................... | rep F2021L01749 |
| c 4.2.......................................... | rep F2021L01749 |
| Schedule 2................................ | rep LA s 48C |
Endnote 5—Editorial changes
In preparing this compilation for registration, the following kinds of editorial change(s) were made under the Legislation Act 2003.
Subclause 1.2.21(10)
Kind of editorial change
Give effect to the misdescribed amendment as intended
Details of editorial change
Schedule 1 item 1 of the Health Insurance Legislation Amendment (Rural Bulk‑billing Incentive) Regulations 2021 instructs to omit “or 64991” and substitute “, 64991, 64992, 64993, 64994 or 64995” in subclauses 1.2.20(3) and 1.2 21(10) of Schedule 1.
Subclause “1.2 21(10)” does not appear. However, subclause “1.2.21(10)” does appear.
This compilation was editorially changed to omit “or 64991” and substitute “, 64991, 64992, 64993, 64994 or 64995” from subclause 1.2.21(10) of Schedule 1 to give effect to the misdescribed amendment as intended.
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