Health Insurance (Gippsland, Rockhampton and Gladstone Mobile MRI Service) Determination 2014 (No. 1) (Cth)
Health Insurance (Gippsland, Rockhampton and Gladstone Mobile MRI Service) Determination 2014 (No. 1)
as amended
made under subsection 3C(1) of the Health Insurance Act 1973
Compilation start date: 1 November 2014
Includes amendments up to: Health Insurance (Gippsland, Rockhampton and Gladstone Mobile MRI Service) Amendment Determination 2014
About this compilation
This compilation
This is a compilation of the Health Insurance (Gippsland, Rockhampton and Gladstone Mobile MRI Service) Determination 2014 (No. 1) as in force on 1 November 2014. It includes any commenced amendment affecting the legislation to that date.
This compilation was prepared on 24 November 2014.
The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of each amended provision.
Uncommenced amendments
The effect of uncommenced amendments is not reflected in the text of the compiled law but the text of the amendments is included in the endnotes.
Application, saving and transitional provisions for provisions and amendments
If the operation of a provision or amendment is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.
Modifications
If a provision of the compiled law is affected by a modification that is in force, details are included in the endnotes.
Provisions ceasing to have effect
If a provision of the compiled law has expired or otherwise ceased to have effect in accordance with a provision of the law, details are included in the endnotes.
Contents
1. Name of Determination 1
2. Commencement 1
3. Cessation 1
4. Interpretation 1
5. Circumstances where this Determination applies - Gippsland 2
Mobile MRI Services
5AA. Circumstances where this Determination applies - Rockhampton 4 and Gladstone Mobile MRI Services
5A. Bulk billing incentive 6
6. Treatment of a relevant service 6
7. MRI and MRA services – meaning of scan 6
8. MRI and MRA services – related services that can be claimed
in a 12 month period 7
9. MRI services – limit for items 63478 7
10. MRI and MRA services – modifying items 7 11. Diagnostic imaging services which dental practitioners may request 8
Schedule - Specified health services 9
Name of Determination
This Determination is the Health Insurance (Gippsland, Rockhampton and Gladstone Mobile MRI Service) Determination 2014 (No. 1)
Commencement
This Determination commences on 1 July 2014.
Cessation
This Determination is repealed at 23:59, 30 June 2015.
Interpretation
(1)In this Determination, unless the contrary intention appears:
Act means the Health Insurance Act 1973.
after hours means from 5pm on Mondays, Tuesdays, Wednesdays and Thursdays to 9am on the following day, and from 5pm on Fridays to 9am on Mondays.
diagnostic imaging services table means the table prescribed under section 4AA of the Act.
eligible provider means a specialist in diagnostic radiology who has satisfied the Chief Executive Medicare that he or she is a participant in the Royal Australian and New Zealand College of Radiologists’ Quality and Accreditation Program.
item means an item in the Schedule.
MRA means magnetic resonance angiography.
MRI means magnetic resonance imaging.
relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in the Schedule.
RIL funding agreement means the funding agreement between Regional Imaging Pty Ltd [ABN 21 095 630 792] and the Commonwealth of Australia as represented by the Department of Health as in force on 1 July 2014.
Schedule means the Schedule to this Determination.
teleradiology means the electronic transmission of radiological images in digital form from one location to another using a data communication link provided by a third party carrier.
Traralgon means Traralgon, Victoria, 3844.
Note Unless the contrary intention appears, expressions used in this Determination have the same meanings as in the Act—see section 13 of the Legislative Instruments Act 2003.
(2)For the avoidance of doubt, in this Determination:
(a) a reference to the Act includes a reference to regulations made under the Act; and
(b) a reference to the National Health Act 1953 includes a reference to regulations made under that Act; and
(c) a reference to any legislation shall be construed as a reference to that legislation as in force from time to time.
Circumstances where this Determination applies – Gippsland Mobile MRI Services
(1)This Determination applies to a relevant service provided using mobile diagnostic imaging equipment that has as its base for mobile diagnostic imaging the Latrobe Regional Hospital, Princes Highway Traralgon West, Victoria 3844 where the following circumstances apply:
(a) in respect of items 63002 to 63483 and items 63740 to 63747, where the service is performed pursuant to a request that is in accordance with subsection (2); and
(b) in respect of items 63525 to 63530 and items 63584 to 63587, where the service is performed pursuant to a request that is in accordance with subsection (3); and
(c) where the service is performed pursuant to the RIL funding agreement; and
(d) where the service is performed in a permissible circumstance in accordance with subsection (6), (7), (8) or (9); and
(e) where the service is a service of a kind referred to in paragraph 10(2)(a) of the Act – the patient in respect of whom the service is provided is charged a fee that is no more than 75% of the amount specified in the Schedule as the fee applicable to the item that relates to the service; and
(f) where the service is not a service to which paragraph (e) applies – the patient in respect of whom the service is provided is charged a fee that is no more than 85% of the amount specified in the Schedule as the fee applicable to the item that relates to the service.
(2)The request referred to in paragraph (1)(a) must:
(a) be made by a practitioner who is a specialist, consultant physician or dental practitioner; and
(b) be made in writing; and
(c) identify the clinical indications for the service.
Note: Subsection 16B(2) of the Act limits the R-type diagnostic imaging services in respect of which a medicare benefit is payable where the service is requested by a dental practitioner. See section 12 below.
(3)the request referred to in paragraph (1)(b) must:
(a)be at the request of a medical practitioner other than a specialist or consultant physician; and
(b)be made in writing; and
(c)identify the clinical indications for the service.
(6)For paragraph (1)(d), subject to subsection (7), a relevant service is performed in a permissible circumstance if the service is performed in Traralgon during after hours and it is:
(a)performed under the professional supervision of an eligible provider who is available to monitor and influence the conduct and diagnostic quality of the examination via telephone and real-time teleradiology; and
(b)reported by an eligible provider; and
(c)monitored by a medical practitioner by personal attendance on the patient if the circumstances are such as to require on-site monitoring by a medical practitioner; and
(d)not a service to which items 63492 to 63495 are attributable.
(7)If subsection (6) is not complied with, a relevant service is performed in a permissible circumstance if the service is performed in Traralgon during after hours and it is performed in an emergency.
(8)For paragraph (1)(d), subject to subsection (9), a relevant service is performed in a permissible circumstance if it is:
(a) performed under the professional supervision of an eligible provider who is available to monitor and influence the conduct and diagnostic quality of the examination, including, if necessary, by personal attendance on the patient; and
(b) reported by an eligible provider.
(9)If subsection (8) is not complied with, a relevant service is performed in a permissible circumstance if it is performed:
(a) in an emergency; or
(b) because of medical necessity, in a remote location
5AA Circumstances where this Determination applies – Rockhampton and Gladstone Mobile MRI Services
(1)This Determination applies to a relevant service provided using mobile diagnostic imaging equipment that has as its base for mobile diagnostic imaging the Mater Misericordiae Hospital Rockhampton, Ward St Rockhampton, Queensland 4700, where the following circumstances apply:
(a)in respect of items 63002 to 63483 and items 63740 to 63747, where the service is performed pursuant to a request that is in accordance with subsection (2); and
(b)in respect of items 63525 to 63530 and items 63584 to 63587, where the service is performed pursuant to a request that is in accordance with subsection (3); and
(c)the service is:
(i) both:
(A)performed under the professional supervision of an eligible provider who is available to monitor and influence the conduct and diagnostic quality of the examination including, if necessary, by personal attendance on the patient; and
(B)reported by an eligible provider; or
(ii) performed in emergency; and
(d) the equipment is operated at a location mentioned in the table; and
(e) the equipment used to perform the service is a General Electric Signa Echo Speed with Excite with a magnet strength of 1.5 Tesla and is mounted on a specifically built semi-trailer.
(2)The request referred to in paragraph (1)(a) must:
(a)be made by a practitioner who is a specialist, consultant physician or dental practitioner; and
(b)be made in writing; and
(c)identify the clinical indications for the service.
(3)The request referred to in paragraph (1)(b) must:
(a)be at the request of a medical practitioner other than a specialist or consultant physician; and
(b)be made in writing; and
(c)identify the clinical indications for the service.
(4)For paragraph (1)(c), the operation of equipment at a location mentioned in an item in the Table includes the operation of the equipment within the grounds of the location.
Table
| Item | Location |
| 1 | Mater Misericordiae Hospital Gladstone 50 Rossella St Gladstone QLD 4680 |
| 2 | Mater Misericordiae Hospital Rockhampton Ward St Rockhampton QLD 4700 |
5A. Bulk billing incentive
Paragraph 1.2.10(1)(a) of Part 1 of Schedule 1 of the diagnostic imaging services table shall have effect as if the reference to a “service that is mentioned in an item in Division 2.5 of the table” in that clause included a reference to a service mentioned in an item in the Schedule to this Determination.
Treatment of a relevant service
A relevant service shall be treated as if:
(a) it were both a professional service and a medical service for the purposes of the provisions of the Act and the National Health Act 1953 that relate to professional and medical services; and
(b) there was an item in the diagnostic imaging services table that related to the relevant service and specified in respect of the service a fee in relation to a State, being the fee specified in the Schedule in relation to the State specified; and
(c) the item specified in paragraph (b) was part of Group I5 of the diagnostic imaging services table and of the relevant subgroup of Group I5 as is specified in the Schedule.
MRI and MRA services – meaning of scan
Clause 2.5.7 of Part 2 of Schedule 1 of the diagnostic imaging services table shall have effect as if the reference to “items 63001 to 63561” also included reference to items 63002 to 63483, items 63525 to 63530, items 63584 to 63587 and items 63740 to 63747 specified in the Schedule.
MRI and MRA services – related services that can be claimed in a 12 month period
Clause 2.5.9 of Part 2 of Schedule 1 of the diagnostic imaging services table shall have effect as if the references to the items mentioned in column 1 of the table below (Existing references) include references to the items mentioned in column 2 of the following table (Additional references).
| Existing references | Additional references |
| 63040 to 63085 | 63041 to 63065 |
| 63101 and 63104 | 63102 |
| 63125 to 63136 | 63126 to 63132 |
| 63161 to 63194 | 63163 to 63177 |
| 63219 to 63265 | 63220 to 63244 |
| 63271 to 63285 | 63272 to 63281 |
| 63322 to 63348 | 63323 to 63332 |
| 63361 and 63364 | 63363 |
| 63385 to 63394 | 63386 to 63389 |
| 63401 to 63408 | 63402 and 63405 |
| 63416 and 63419 | 63417 |
| 63425 to 63433 | 63426 and 63429 |
| 63455 to 63467 | 63463, 63466 and 63469 |
| 63482 and 63486 | 63483 |
| 63507 to 63561 | 63525 to 63530 and 63584 to 63587 |
MRI services – limit for item 63478
Item 63478 does not apply to the service described in that item if the person to whom the service is provided has previously been provided with that service or a service described in item 63476 of Part 2 of Schedule 1 of the diagnostic imaging services table.
MRI and MRA services – modifying items
Clause 2.5.11 of Part 2 of Schedule 1 of the diagnostic imaging services table shall have effect as if:
(a) the reference to item 63491 in that clause was a reference to item 63492; and
(b) the references to item 63494 in that clause were references to item 63493; and
(c) the references to item 63497 in that clause were references to item 63495.
Diagnostic imaging services which dental practitioners may request
Regulation 10 of the Health Insurance Regulations 1975 shall have effect as if the paragraphs of that regulation mentioned in column 1 of the table below (Existing references) include references to the items mentioned in column 2 of the table below (Additional references).
| Existing references | Additional references |
| paragraph 10(1)(a) | 63008, 63329 |
| paragraph 10(1)(b) | 63329 |
| paragraph 10(1)(c) | 63329 |
| paragraph 10(1)(d) | 63008, 63329 |
Schedule - Specified health services
| Item | Health Service | Fee for all States | Relevant subgroup of Group I5 |
| 63002 | MRI — scan of head (including MRA, if performed) for tumour of the brain or meninges (R) (Anaes.) (Contrast) | 403.20 | Subgroup 1 – Scan of head – for specified conditions |
| 63005 | MRI — scan of head (including MRA, if performed) for inflammation of brain or meninges (R) (Anaes.) (Contrast) | 403.20 | Subgroup 1 – Scan of head – for specified conditions |
| 63008 | MRI — scan of head (including MRA, if performed) for skull base or orbital tumour (R) (Anaes.) (Contrast) | 403.20 | Subgroup 1 – Scan of head – for specified conditions |
| 63011 | MRI — scan of head (including MRA, if performed) for neurosurgery (R) (Anaes.) (Contrast) | 336.00 | Subgroup 1 – Scan of head – for specified conditions |
| 63041 | MRI — scan of head (including MRA, if performed) for acoustic neuroma (R) (Anaes.) (Contrast) | 336.00 | Subgroup 2 – Scan of head – for specified conditions |
| 63042 | MRI — scan of head (including MRA, if performed) for pituitary tumour (R) (Anaes.) (Contrast) | 358.40 | Subgroup 2 – Scan of head – for specified conditions |
| 63044 | MRI — scan of head (including MRA, if performed) for (Anaes.) (Contrast) | 403.20 | Subgroup 2 – Scan of head – for specified conditions |
| 63045 | MRI — scan of head (including MRA, if performed) for demyelinating disease of the brain (R) (Anaes.) (Contrast) | 403.20 | Subgroup 2 – Scan of head – for specified conditions |
| 63047 | MRI — scan of head (including MRA, if performed) for (Anaes.) (Contrast) | 403.20 | Subgroup 2 – Scan of head – for specified conditions |
| 63048 | MRI — scan of head (including MRA, if performed) for venous sinus thrombosis (R) (Anaes.) (Contrast) | 403.20 | Subgroup 2 – Scan of head – for specified conditions |
| 63051 | MRI — scan of head (including MRA, if performed) for head trauma (R) (Anaes.) (Contrast) | 403.20 | Subgroup 2 – Scan of head – for specified conditions |
| 63054 | MRI — scan of head (including MRA, if performed) for epilepsy (R) (Anaes.) (Contrast) | 403.20 | Subgroup 2 – Scan of head – for specified conditions |
| 63057 | MRI — scan of head (including MRA, if performed) for stroke (R) (Anaes.) (Contrast) | 403.20 | Subgroup 2 – Scan of head – for specified conditions |
| 63060 | MRI — scan of head (including MRA, if performed) for (Contrast) | 403.20 | Subgroup 2 – Scan of head – for specified conditions |
| 63063 | MRI — scan of head (including MRA, if performed) for intracranial aneurysm (R) (Anaes.) (Contrast) | 403.20 | Subgroup 2 – Scan of head – for specified conditions |
63065 | MRI — scan of head (including MRA, if performed) for (Contrast) | 403.20 | Subgroup 2 – Scan of head – for specified conditions |
| 63102 | MRI and MRA of extracranial or intracranial circulation (or both) — scan of head and neck vessels for stroke (R) (Anaes.) (Contrast) | 492.80 | Subgroup 3 – Scan of head and neck vessels – for specified conditions |
| 63113 | MRI — scan of head and cervical spine (including MRA, if performed) for tumour of the central nervous system or meninges (R) (Anaes.) (Contrast) | 492.80 | Subgroup 4 – Scan of head and cervical spine – for specified conditions |
| 63116 | MRI — scan of head and cervical spine (including MRA, if performed) for inflammation of the central nervous system or meninges (R) (Anaes.) (Contrast) | 492.80 | Subgroup 4 – Scan of head and cervical spine – for specified conditions |
| 63126 | MRI — scan of head and cervical spine (including MRA, if performed) for demyelinating disease of the central nervous system (R) (Anaes.) (Contrast) | 492.80 | Subgroup 5 – Scan of head and cervical spine – for specified conditions |
| 63129 | MRI — scan of head and cervical spine (including MRA, if performed) for congenital malformation of the central nervous system or meninges (R) (Anaes.) (Contrast) | 492.80 | Subgroup 5 – Scan of head and cervical spine – for specified conditions |
| 63132 | MRI — scan of head and cervical spine (including MRA, if performed) for syrinx (congenital or acquired) (R) (Anaes.) (Contrast) | 492.80 | Subgroup 5 – Scan of head and cervical spine – for specified conditions |
| 63152 | MRI — scan of 1 region or 2 contiguous regions of the spine for infection (R) (Anaes.) (Contrast) | 358.40 | Subgroup 6 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions |
| 63155 | MRI — scan of 1 region or 2 contiguous regions of the spine for tumour (R) (Anaes.) (Contrast) | 358.40 | Subgroup 6 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions |
| 63163 | MRI — scan of 1 region or 2 contiguous regions of the spine for demyelinating disease (R) (Anaes.) (Contrast) | 358.40 | Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions |
| 63165 | MRI — scan of 1 region or 2 contiguous regions of the spine for congenital malformation of the spinal cord or the cauda equina or the meninges (R) (Anaes.) (Contrast) | 358.40 | Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions |
| 63168 | MRI — scan of 1 region or 2 contiguous regions of the spine for myelopathy (R) (Anaes.) (Contrast) | 358.40 | Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions |
| 63169 | MRI — scan of 1 region or 2 contiguous regions of the (Contrast) | 358.40 | Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions |
| 63171 | MRI — scan of 1 region or 2 contiguous regions of the spine for cervical radiculopathy (R) (Anaes.) (Contrast) | 358.40 | Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions |
| 63172 | MRI — scan of 1 region or 2 contiguous regions of the spine for sciatica (R) (Anaes.) (Contrast) | 358.40 | Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions |
| 63174 | MRI — scan of 1 region or 2 contiguous regions of the spine for spinal canal stenosis (R) (Anaes.) (Contrast) | 358.40 | Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions |
| 63175 | MRI — scan of 1 region or 2 contiguous regions of the spine for previous spinal surgery (R) (Anaes.) (Contrast) | 358.40 | Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions |
| 63177 | MRI — scan of 1 region or 2 contiguous regions of the spine for trauma (R) (Anaes.) | 358.40 | Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions |
| 63202 | MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for infection (R) (Anaes.) (Contrast) | 448.00 | Subgroup 8 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions |
| 63205 | MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for tumour (R) (Anaes.) (Contrast) | 448.00 | Subgroup 8 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions |
| 63220 | MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for demyelinating disease (R) (Anaes.) (Contrast) | 448.00 | Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions |
| 63223 | MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for congenital malformation of the spinal cord or the cauda equina or the meninges (R) (Anaes.) (Contrast) | 448.00 | Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions |
| 63224 | MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for myelopathy (R) (Anaes.) (Contrast) | 448.00 | Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions |
63226 | MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for syrinx (congenital or acquired) (R) (Anaes.) (Contrast) | 448.00 | Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions |
| 63227 | MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for cervical radiculopathy (R) (Anaes.) (Contrast) | 448.00 | Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions |
| 63229 | MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for sciatica (R) (Anaes.) (Contrast) | 448.00 | Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions |
| 63230 | MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for spinal canal stenosis (R) (Anaes.) (Contrast) | 448.00 | Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions |
| 63232 | MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for previous spinal surgery (R) (Anaes.) (Contrast) | 448.00 | Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions |
| 63244 | MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for trauma (R) (Anaes.) | 448.00 | Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions |
| 63272 | MRI — Scan of cervical spine and brachial plexus for tumour (R) (Anaes.) (Contrast) | 492.80 | Subgroup 10 – Scan of cervical spine and brachial plexus – for specified conditions |
| 63275 | MRI — Scan of cervical spine and brachial plexus for trauma (R) (Anaes.) (Contrast) | 492.80 | Subgroup 10 – Scan of cervical spine and brachial plexus – for specified conditions |
| 63278 | MRI — Scan of cervical spine and brachial plexus for cervical radiculopathy (R) (Anaes.) (Contrast) | 492.80 | Subgroup 10 – Scan of cervical spine and brachial plexus – for specified conditions |
| 63281 | MRI — Scan of cervical spine and brachial plexus for previous surgery (R) (Anaes.) (Contrast) | 492.80 | Subgroup 10 – Scan of cervical spine and brachial plexus – for specified conditions |
| 63302 | MRI — scan of musculoskeletal system for tumour arising in bone or musculoskeletal system, excluding tumours arising in breast, prostate or rectum (R) (Anaes.) (Contrast) | 380.80 | Subgroup 11 – Scan of musculoskeletal system – for specified conditions |
63305 | MRI — scan of musculoskeletal system for infection infection arising in breast, prostate or rectum (R) (Anaes.) (Contrast) | 380.80 | Subgroup 11 – Scan of musculoskeletal system – for specified conditions |
| 63308 | MRI — scan of musculoskeletal system for osteonecrosis (R) (Anaes.) (Contrast) | 380.80 | Subgroup 11 – Scan of musculoskeletal system – for specified conditions |
| 63323 | MRI — scan of musculoskeletal system for derangement of hip or its supporting structures (R) (Anaes.) (Contrast) | 403.20 | Subgroup 12 – Scan of musculoskeletal system – for specified conditions |
| 63324 | MRI — scan of musculoskeletal system for derangement of shoulder or its supporting structures (R) (Anaes.) (Contrast) | 403.20 | Subgroup 12 – Scan of musculoskeletal system – for specified conditions |
| 63326 | MRI — scan of musculoskeletal system for derangement of knee or its supporting structures (R) (Anaes.) (Contrast) | 403.20 | Subgroup 12 – Scan of musculoskeletal system – for specified conditions |
| 63327 | MRI — scan of musculoskeletal system for derangement of ankle or foot (or both) or its supporting structures (R) (Anaes.) (Contrast) | 403.20 | Subgroup 12 – Scan of musculoskeletal system – for specified conditions |
| 63329 | MRI — scan of musculoskeletal system for derangement of 1 or both temporomandibular joints or their supporting structures (R) (Anaes.) (Contrast) | 336.00 | Subgroup 12 – Scan of musculoskeletal system – for specified conditions |
| 63330 | MRI — scan of musculoskeletal system for derangement of wrist or hand (or both) or its supporting structures (R) (Anaes.) (Contrast) | 448.00 | Subgroup 12 – Scan of musculoskeletal system – for specified conditions |
| 63332 | MRI — scan of musculoskeletal system for derangement of elbow or its supporting structures (R) (Anaes.) (Contrast) | 403.20 | Subgroup 12 – Scan of musculoskeletal system – for specified conditions |
| 63363 | MRI — scan of musculoskeletal system for Gaucher disease (R) (Anaes.) | 403.20 | Subgroup 13 – Scan of musculoskeletal system – for specified conditions |
| 63386 | MRI — scan of cardiovascular system for congenital (Contrast) | 448.00 | Subgroup 14 – Scan of cardiovascular system – for specified conditions |
| 63387 | MRI — scan of cardiovascular system for tumour of the heart or a great vessel (R) (Anaes.) (Contrast) | 448.00 | Subgroup 14 – Scan of cardiovascular system – for specified conditions |
| 63389 | MRI — scan of cardiovascular system for abnormality of thoracic aorta (R) (Anaes.) (Contrast) | 403.20 | Subgroup 14 – Scan of cardiovascular system – for specified conditions |
| 63402 | MRA — if the request for the scan specifically identifies the clinical indication for the scan — scan of cardiovascular system for vascular abnormality in a patient with a previous anaphylactic reaction to an iodinated contrast medium (R) (Anaes.) (Contrast) | 403.20 | Subgroup 15 – Magnetic resonance angiography – scan of cardiovascular system – for specified conditions |
| 63405 | MRA — if the request for the scan specifically identifies the clinical indication for the scan — scan of (Anaes.) (Contrast) | 403.20 | Subgroup 15 – Magnetic resonance angiography – scan of cardiovascular system – for specified conditions |
| 63417 | MRA — scan of person under the age of 16 for the vasculature of limbs prior to limb or digit transfer surgery in congenital limb deficiency syndrome (R) (Anaes.) (Contrast) | 403.20 | Subgroup 16 – Magnetic resonance angiography – for specified conditions – person under the age of 16 years |
| 63426 | MRI — scan of person under the age of 16 for (Anaes.) | 403.20 | Subgroup 17 – Magnetic resonance imaging – for specified conditions – person under the age of 16 years |
| 63429 | MRI — scan of person under the age of 16 for Gaucher disease (R) (Anaes.) | 403.20 | Subgroup 17 – Magnetic resonance imaging – for specified conditions – person under the age of 16 years |
| 63441 | MRI — scan of person under the age of 16 for pelvic or abdominal mass (R) (Anaes.) (Contrast) | 403.20 | Subgroup 18 – Magnetic resonance imaging – for specified conditions – person under the age of 16 years |
| 63442 | MRI — scan of person under the age of 16 for mediastinal mass (R) (Anaes.) (Contrast) | 403.20 | Subgroup 18 – Magnetic resonance imaging – for specified conditions – person under the age of 16 years |
| 63444 | MRI — scan of person under the age of 16 for congenital uterine or anorectal abnormality (R) (Anaes.) (Contrast) | 403.20 | Subgroup 18 – Magnetic resonance imaging – for specified conditions – person under the age of 16 years |
| 63463 | MRI — scan of the body for adrenal mass in a patient with a malignancy that is otherwise resectable (R) (Anaes.) | 358.40 | Subgroup 19 – Scan of body – for specified conditions |
| 63466 | MRI – scan of both breasts for the detection of cancer, if a dedicated breast coil is used, the request for the scan identifies that the woman is asymptomatic and is less than 50 years of age, and the request for the scan identifies: (a) that the patient is at high risk of developing breast cancer due to 1 of the following: (i) 3 or more first or second degree relatives on the same side of the family diagnosed with breast or ovarian cancer; (ii) 2 or more first or second degree relatives on the same side of the family diagnosed with breast or ovarian cancer, if any of the following applies to at least 1 of the relatives: (A) has been diagnosed with bilateral breast cancer: (iii) 1 first or second degree relative diagnosed with breast cancer at age 45 years or younger plus another first or second degree relative on the same side of the family with bone or soft tissue sarcoma at age 45 years or younger; or (b) that genetic testing has identified the presence of a high risk breast cancer gene mutation. (R) (Anaes) | 690.00 | Subgroup 19 – Scan of body – for specified conditions |
| 63469 | MRI – scan of both breasts for the detection of cancer, if: (a) a dedicated breast coil is used: and (b) the woman has had an abnormality detected as a result of a service described in item 63464 or 63466 performed in the previous 12 months (R) (Anaes) | 690.00 | Subgroup 19 – Scan of body – for specified conditions |
| 63472 | MRI — scan of the pelvis for the staging of histologically diagnosed cervical cancer at FIGO stages 1B or greater, if the request for scan identifies that: (a) a histological diagnosis of carcinoma of the cervix has been made; and (b) the patient has been diagnosed with cervical cancer at FIGO stage 1B or greater. (R) (Anaes.) (Contrast) | 403.20 | Subgroup 20 – Scan of pelvis and upper abdomen – for specified conditions |
| 63475 | MRI — scan of the pelvis and upper abdomen, in a single examination, for the staging of histologically diagnosed cervical cancer at FIGO stage 1B or greater, if the request for scan identifies that: (a) a histological diagnosis of carcinoma of the cervix has been made; and (b) the patient has been diagnosed with cervical cancer at FIGO stage 1B or greater. (R) (Anaes.) (Contrast) | 627.20 | Subgroup 20 – Scan of pelvis and upper abdomen – for specified conditions |
| 63478 | MRI — scan of the pelvis for the initial staging of rectal cancer, if: (a) a phased array body coil is used; and (b) the request for scan identifies that the indication is for the initial staging of rectal cancer (including cancer of the rectosigmoid and anorectum). (R) (Anaes.) (Contrast) | 403.20 | Subgroup 20 – Scan of pelvis and upper abdomen – for specified conditions |
| 63483 | MRI — scan of pancreas and biliary tree for suspected biliary or pancreatic pathology (R) (Anaes.) | 403.20 | Subgroup 21 – Scan of body – for specified conditions |
| 63492 | MRI or MRA service to which an item in this Group (b) the service is performed using a contrast agent | 44.80 | Subgroup 22 – Modifying items |
| 63493 | MRI or MRA service to which an item in this Group intravenous or intra muscular sedation | 44.80 | Subgroup 22 – Modifying items |
| 63495 | MRI or MRA service to which an item in this Group who is qualified to perform an anaesthetic | 156.80 | Subgroup 22 – Modifying items |
| 63525 | MRI—scan of head for a patient under 16 years if the service is for: (a) an unexplained seizure (R) (Anaes.) (Contrast); or (b) an unexplained headache if significant pathology is suspected (R) (Anaes.) (Contrast); or (c) paranasal sinus pathology that has not responded to conservative therapy (R) (Anaes.) (Contrast) | 403.20 | Subgroup 33 – Scan of body - for specified conditions |
| 63526 | MRI—scan of spine following radiographic examination for a patient under 16 years if the service is for: (a) significant trauma (R) (Anaes.) (Contrast); or (b) unexplained neck or back pain with associated neurological signs (R) (Anaes.) (Contrast); or (c) unexplained back pain if significant pathology is suspected (R) (Anaes.) (Contrast) | 448.00 | Subgroup 33 – Scan of body - for specified conditions |
| 63527 | MRI—scan of knee following radiographic examination for internal joint derangement for a patient under 16 years (R) (Anaes.) (Contrast) | 403.20 | Subgroup 33 – Scan of body - for specified conditions |
| 63528 | MRI—scan of hip following radiographic examination for a patient under 16 years if any of the following is suspected: (a) septic arthritis (R) (Anaes.) (Contrast); (b) slipped capital femoral epiphysis (R) (Anaes.) (Contrast); (c) Perthes disease (R) (Anaes.) (Contrast) | 403.20 | Subgroup 33 – Scan of body - for specified conditions |
| 63529 | MRI—scan of elbow following radiographic examination for a patient under 16 years if a significant fracture or avulsion injury, which would change the way in which the patient is managed, is suspected (R) (Anaes.) (Contrast) | 403.20 | Subgroup 33 – Scan of body - for specified conditions |
| 63530 | MRI—scan of wrist following radiographic examination for a patient under 16 years if a scaphoid fracture is suspected (R) (Anaes.) (Contrast) | 448.00 | Subgroup 33 – Scan of body- for specified conditions |
| 63584 | Scan of head for a patient 16 years or older, after referral by a medical practitioner (other than a specialist or consultant physician), for any of the following: | 403.20 | Subgroup 34 – Scan of body- for specified conditions |
| 63585 | Scan of spine for a patient 16 years or older, after referral by a medical practitioner (other than a specialist or consultant physician), for suspected cervical radiculopathy (R) (Contrast) (Anaes.) | 358.40 | Subgroup 34 – Scan of body- for specified conditions |
| 63586 | Scan of spine for a patient 16 years or older, after referral by a medical practitioner (other than a specialist or consultant physician), for suspected cervical spinal trauma (R) (Contrast) (Anaes.) | 492.80 | Subgroup 34 – Scan of body- for specified conditions |
| 63587 | Scan of knee following acute knee trauma, after referral by a medical practitioner (other than a specialist or consultant physician), for a patient 16 years or older with: (a) inability to extend the knee suggesting the possibility of acute meniscal tear; or (b) clinical findings suggesting acute anterior cruciate ligament tear (R) (Contrast) (Anaes.) | 403.20 | Subgroup 34 – Scan of body- for specified conditions |
| 63740 | MRI – scan to evaluate small bowel Crohn’s disease if the service is provided to a patient for: (a) Evaluation of disease extent at time of initial diagnosis of Crohn’s disease; (b) Evaluation of exacerbation/suspected complications of known Crohn’s disease; (c) Evaluation of known or suspected Crohn’s disease in pregnancy; or (d) Assessment of change to therapy in a patient with small bowel Crohn’s disease. This item applies only once in a 12 month period where the service is provided for assessment of change to therapy in a patient with small bowel Crohn’s disease. (R) (K) (Contrast) | 457.20 | |
| 63741 | MRI – scan with enteroclysis for Crohn’s disease if the service is related to item 63740. (R) (K) | 265.25 | |
| 63743 | MRI – scan for fistulising perianal Crohn’s disease if the service is provided to a patient for: Evaluation of pelvic sepsis and fistulas associated with established or suspected Crohn’s disease; or Assessment of change to therapy of pelvis sepsis and fistulas from Crohn’s disease. This item applies only once in a 12 month period where the service is provided for assessment of change to therapy of pelvis sepsis and fistulas from Crohn’s disease. (R) (K) (Contrast) | 403.20 | |
| 63744 | MRI – scan to evaluate small bowel Crohn’s disease if the service is provided to a patient for: (a) Evaluation of disease extent at time of initial diagnosis of Crohn’s disease; (b) Evaluation of exacerbation/suspected complications of known Crohn’s disease; (c) Evaluation of known or suspected Crohn’s disease in pregnancy; or (d) Assessment of change to therapy in a patient with small bowel Crohn’s disease. This item applies only once in a 12 month period where the service is provided for assessment of change to therapy in a patient with small bowel Crohn’s disease. (R) (NK) (Contrast) | 228.60 | |
| 63746 | MRI – scan with enteroclysis for Crohn’s disease if the service is related to item 63744. (R) (NK) | 132.65 | |
| 63747 | MRI – scan for fistulising perianal Crohn’s disease if the service is provided to patients for: Evaluation of pelvic sepsis and fistulas associated with established or suspected Crohn’s disease; or Assessment of change to therapy of pelvis sepsis and fistulas from Crohn’s disease. This item applies only once in a 12 month period where the service is provided for assessment of change to therapy of pelvis sepsis and fistulas from Crohn’s disease. (R) (NK) (Contrast) | 201.60 |
Note Section 3C (7) of the Act deems an internal Territory to form part of the State of New South Wales
Endnotes
Endnote 1—About the endnotes
The endnotes provide details of the history of this legislation and its provisions. The following endnotes are included in each compilation:
Endnote 1—About the endnotes
Endnote 2—Abbreviation key
Endnote 3—Legislation history
Endnote 4—Amendment history
Endnote 5—Uncommenced amendments
Endnote 6—Modifications
Endnote 7—Misdescribed amendments
Endnote 8—Miscellaneous
If there is no information under a particular endnote, the word “none” will appear in square brackets after the endnote heading.
Abbreviation key—Endnote 2
The abbreviation key in this endnote 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 the compiled law. The information includes commencement information for amending laws and details of 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 level. It also includes information about any provisions that have expired or otherwise ceased to have effect in accordance with a provision of the compiled law.
Uncommenced amendments—Endnote 5
The effect of uncommenced amendments is not reflected in the text of the compiled law, but the text of the amendments is included in endnote 5.
Modifications—Endnote 6
If the compiled law is affected by a modification that is in force, details of the modification are included in endnote 6.
Misdescribed amendments—Endnote 7
An amendment is a misdescribed amendment if the effect of the amendment cannot be incorporated into the text of the compilation. Any misdescribed amendment is included in endnote 7.
Miscellaneous—Endnote 8
Endnote 8 includes any additional information that may be helpful for a reader of the compilation.
Endnote 2—Abbreviation key
| ad = added or inserted | pres = present |
| am = amended | prev = previous |
| c = clause(s) | (prev) = previously |
| Ch = Chapter(s) | Pt = Part(s) |
| def = definition(s) | r = regulation(s)/rule(s) |
| Dict = Dictionary | Reg = Regulation/Regulations |
| disallowed = disallowed by Parliament | reloc = relocated |
| Div = Division(s) | renum = renumbered |
| exp = expired or ceased to have effect | rep = repealed |
| hdg = heading(s) | rs = repealed and substituted |
| LI = legislative instrument | s = section(s) |
| LIA = Legislative Instruments Act 2003 | Sch = Schedule(s) |
| mod = modified/modification | Sdiv = Subdivision(s) |
| No = Number(s) | SLI = Select Legislative Instrument |
| o = order(s) | SR = Statutory Rules |
| Ord = Ordinance | Sub-Ch = Sub-Chapter(s) |
| orig = original | SubPt = Subpart(s) |
| par = paragraph(s)/subparagraph(s) | |
| /sub-subparagraph(s) |
Endnote 3—Legislation history
| Name | FRLI registration or gazettal | Commencement | Application, saving and transitional provisions |
| Health Insurance (Gippsland, Rockhampton and Gladstone Mobile MRI Service) Determination 2014 (No.1) | 20 June 2014 (F2014L00775) | 1 July 2014 | |
| Health Insurance (Gippsland, Rockhampton and Gladstone Mobile MRI Service) Amendment Determination 2014 | 31 October 2014 F2014L01454 | 1 November 2014 |
Endnote 4—Amendment history
| Provision affected | How affected |
| s 3 s 5 s 7 Sch | am. F2014L01454 am. F2014L01454 am. F2014L01454 am. F2014L01454 |
Endnote 5—Uncommenced amendments [none]
Endnote 6—Modifications [none]
Endnote 7—Misdescribed amendments [none]
Endnote 8—Miscellaneous [none]
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