Health Insurance (Positron Emission Tomography) Facilities Determination 2008 (Cth)
Health Insurance (Positron Emission Tomography) Facilities Determination 2008
I, TONY KINGDON, delegate of the Minister for Health and Ageing, make this Determination under subsection 3C(1) of the Health Insurance Act 1973.
Dated 13 NOVEMBER 2008
TONY KINGDON
Delegate of the Minister for Health and Ageing
1 Name of Determination
This Determination is the Health Insurance (Positron Emission Tomography) Facilities Determination 2008.
. Commencement
This Determination commences on 1 December 2008.
3. Revocation of Health Insurance Determination HS/6/01
The Health Insurance Determination HS/6/01, as amended is revoked.
4. Interpretation
(1) In this Determination
Act means the Health Insurance Act 1973.
FDG means 18F-fluorodeoxyglucose.
PET means positron emission tomography.
relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in the Schedule.
(2) Unless the contrary intention appears, in this Determination a reference to a provision of the Act or regulations made under the Act as applied, adopted or incorporated in relation to specifying a matter is a reference to those provisions as in force from time to time and any other reference to provisions of an Act or regulations is a reference to those provisions as in force from time to time.
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.
5. Circumstances where this Determination applies
This Determination applies to a relevant service in the following circumstances:
(a) where there is in force a written agreement between the owner or operator of a positron emission tomography facility and the Commonwealth that relates to the rendering of the service by means of the facility; and
(b) where the service is rendered pursuant to a written request made by a specialist or a consultant physician (not being the practitioner who renders the service) who determined that the service was necessary and whose patient the person was.
Note The circumstance in paragraph (b) mirrors the requirement in paragraph 16B(1)(b) of the Act that for a medicare benefit to be payable in respect of an R-type diagnostic imaging service, the service must be rendered pursuant to a written request, but limits which practitioners may request a relevant service.
. Treatment of certain positron emission tomography services
A relevant service shall be treated for the purposes of the provisions of the Act and of regulations made under the Act and the provisions of the National Health Act 1953 and of regulations made under the National Health Act 1953
that make provision in respect of professional services or medical services as if:
(a) it was both a professional service and a medical service; and
(b) there was an item of an R-type diagnostic imaging service in the diagnostic imaging services table that:
(i) related to the relevant service; and
(ii) 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.
7. Certain positron emission tomography services—items and specifications etc
(1) Each of the following provisions:
(a) subrule 3(1) of Part 2 of Schedule 1 of the Health Insurance (Diagnostic Imaging Services Table) Regulations 2007 or the regulations that replace them;
(b) any regulation made under the Act that identifies an item in the diagnostic imaging services table as an R-type diagnostic imaging service;
(c) regulation 13 of the Health Insurance Regulations 1975, so far it relates to professional services generally or diagnostic imaging services specifically;
shall have effect as if a relevant service, and the items that, by virtue of paragraph 6 (b), relate to a relevant service, were also specified in the provision.
SCHEDULE
| Item | Health Service (PET service) | Fee ($) |
| 61535 | FDG PET study of the brain performed for the evaluation of a suspected primary brain tumour to guide surgical biopsy of the lesion and to assist in treatment planning (R). | $901.00 |
| 61538 | FDG PET study of the brain performed for the evaluation of a residual structural brain lesion based on anatomical imaging findings, after definitive therapy for glioma (R). | $901.00 |
| 61562 | FDG PET study of the heart, performed for the evaluation of ischaemic heart disease and impaired left ventricular function, where revascularisation surgery is being considered and standard myocardial viability tests are negative or equivocal for ischaemia (R). | $899.00 |
| 61571 | Whole body FDG PET study, performed for the primary staging of proven carcinoma of the uterine cervix, prior to planned radical radiation therapy or combined modality therapy (R). | $953.00 |
| 61574 | Whole body FDG PET study, performed for the primary staging of proven carcinoma of the uterine cervix, prior to planned radical radiation therapy or combined modality therapy, with catheterisation of the bladder (R). | $975.00 |
| 61577 | Whole body FDG PET study, performed for the staging of proven oesophageal carcinoma, where curative surgery or chemoradiation is planned (R). | $953.00 |
| 61580 | Whole body FDG PET study, performed for the staging of proven oesophageal carcinoma, where curative surgery or chemoradiation is planned, with catheterisation of the bladder (R). | $975.00 |
| 61583 | Whole body FDG PET study, performed for the staging of proven gastric carcinoma, where curative surgery is planned (R). | $953.00 |
| 61586 | Whole body FDG PET study, performed for the staging of proven gastric carcinoma, where curative surgery is planned, with catheterisation of the bladder (R). | $975.00 |
| 61589 | FDG PET study for follow-up of a cancer shown to be positive by an earlier FDG PET service (the earlier service), if (a) the earlier service was eligible for Medicare benefit because of Health Insurance Determination HS/3/1997, (b) the service is not eligible for Medicare benefit otherwise than because of Health Insurance Determination HS/02/2001, and (c) the service is required to assess response to treatment or possible tumour recurrence (R). | $953.00 |
| 61592 | FDG PET study, with catheterisation of the bladder, for follow-up of a cancer shown to be positive by an earlier FDG PET service (the earlier service), if (a) the earlier service was eligible for Medicare benefit because of Health Insurance Determination HS/3/1997, (b) the service is not eligible for Medicare benefit otherwise than because of Health Insurance Determination HS/02/2001, and (c) the service is required to assess response to treatment or possible tumour recurrence (R). | $975.00 |
| 61595 | FDG PET study for the primary staging of carcinoma of the head and neck (R). | $918.00 |
| 61598 | Whole body FDG PET study for the primary staging of carcinoma of the head and neck (R). | $953.00 |
| 61601 | FDG PET study for the further investigation of suspected residual or recurrent carcinoma of the head and neck (R). | $918.00 |
| 61604 | Whole body FDG PET study for the further investigation of suspected residual or recurrent carcinoma of the head and neck (R). | $953.00 |
| 61607 | FDG PET study for the evaluation of metastatic squamous cell carcinoma involving cervical nodes from an unknown primary site (R). | $918.00 |
| 61610 | Whole body FDG PET study for the evaluation of metastatic squamous cell carcinoma involving cervical nodes from an unknown primary site (R). | $953.00 |
| 61613 | Whole body FDG PET study for the evaluation of metastatic squamous cell carcinoma involving cervical nodes from an unknown primary site, with catheterisation of the bladder (R). | $975.00 |
| 61616 | Whole body FDG PET study for staging of newly diagnosed or previously untreated Hodgkin’s or non-Hodgkin’s lymphoma (R). | $953.00 |
| 61619 | Whole body FDG PET study for staging of newly diagnosed or previously untreated Hodgkin’s or non-Hodgkin’s lymphoma, with catheterisation of the bladder (R). | $975.00 |
| 61622 | Whole body FDG PET study for evaluation of a residual mass after treatment of Hodgkin’s or non-Hodgkin’s lymphoma (R). | $953.00 |
| 61625 | Whole body FDG PET study for evaluation of a residual mass after treatment of Hodgkin’s or non-Hodgkin’s lymphoma, with catheterisation of the bladder (R). | $975.00 |
| 61628 | Whole body FDG PET study for restaging of suspected recurrent or residual Hodgkin’s or non-Hodgkin’s lymphoma (R). | $953.00 |
| 61631 | Whole body FDG PET study for restaging of suspected recurrent or residual Hodgkin’s or non-Hodgkin’s lymphoma, with catheterisation of the bladder (R).. | $975.00 |
| 61634 | Whole body FDG PET study to guide biopsy of a suspected bone or soft tissue sarcoma, where structural imaging suggests lesional heterogeneity (R).. | $999.00 |
| 61637 | Whole body FDG PET study to guide biopsy of a suspected bone or soft tissue sarcoma, where structural imaging suggests lesional heterogeneity, with catheterisation of the bladder (R).. | $1,021.00 |
| 61640 | Whole body FDG PET study for staging of biopsy-proven bone or soft tissue sarcoma being considered for resection of the primary or limited metastatic disease (R). | $999.00 |
| 61643 | Whole body FDG PET study for staging of biopsy-proven bone or soft tissue sarcoma being considered for resection of the primary or limited metastatic disease, with catheterisation of the bladder (R). | $1,021.00 |
| 61646 | Whole body FDG PET study for the evaluation of suspected residual or recurrent sarcoma on structural imaging after definitive therapy (R). | $999.00 |
| 61649 | Whole body FDG PET study for the evaluation of suspected residual or recurrent sarcoma on structural imaging after definitive therapy, with catheterisation of the bladder (R). | $1,021.00 |
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