Health Insurance Determination HS/6/01
as amended
made under section 3C of the
Health Insurance Act 1973
This compilation was prepared on 14 November 2008
taking into account amendments up to Health Insurance Determination HS/6/01 (Amendment) HS/06/05
Prepared by the Office of Legislative Drafting and Publishing,
Attorney-General’s Department, Canberra
Contents
1 Citation [see Note 1]
2 Interpretation
3 Commencement [see Note 1]
4 Revocation of Health Insurance Determination HS/2/01
5 Circumstances where this Determination applies
6 Treatment of certain positron emission tomography services
8 Certain positron emission tomography services — items and specifications etc
Schedule
Notes
1 Citation [see Note 1]
This determination is the Health Insurance Determination HS/6/01.
2 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.
3 Commencement [see Note 1]
This determination commences on gazettal.
4 Revocation of Health Insurance Determination HS/2/01
Health Insurance Determination HS/2/01 is revoked.
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.
6 Treatment of certain positron emission tomography services
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 of regulations made under the Act, that make provision in respect of professional services or medical services; and
(b) it were both a professional service and a medical service for the purposes of 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; and
(c) there were 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.
8 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 2004 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 (c), 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 |
61541 | Whole body FDG PET study, performed in a symptomatic patient for the evaluation of a residual structural lesion, after definitive therapy for colorectal carcinoma. (R) | $953.00 |
61544 | Whole body FDG PET study, performed in a symptomatic patient for the evaluation of a residual structural lesion, after definitive therapy for colorectal carcinoma, with catheterisation of the bladder. (R) | $975.00 |
61547 | Whole body FDG PET study, performed for the evaluation of apparently isolated liver or pulmonary metastases following previous therapy for colorectal carcinoma, where surgical resection is planned. (R) | $953.00 |
61550 | Whole body FDG PET study, performed for the evaluation of apparently isolated liver or pulmonary metastases following previous therapy for colorectal carcinoma, where surgical resection is planned, with catheterisation of the bladder. (R) | $975.00 |
61553 | Whole body FDG PET study, performed for the evaluation of apparently limited metastatic disease from malignant melanoma, where surgical resection is planned. (R) | $999.00 |
61556 | Whole body FDG PET study, performed for the evaluation of apparently limited metastatic disease from malignant melanoma, where surgical resection is planned, with catheterisation of the bladder. (R) | $1,021.00 |
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 |
61565 | Whole body FDG PET study, performed for the evaluation of epithelial ovarian carcinoma with suspected tumour recurrence following initial therapy, based on equivocal anatomical imaging findings or an elevation of CA‑125. (R) | $953.00 |
61568 | Whole body FDG PET study, performed for the evaluation of epithelial ovarian carcinoma with suspected tumour recurrence following initial therapy, based on equivocal anatomical imaging findings or an elevation of CA‑125, with catheterisation of the bladder. (R) | $975.00 |
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 |
Notes to the Health Insurance Determination HS/6/01
Note 1
The Health Insurance Determination HS/6/01 (in force under section 3C of the Health Insurance Act 1973) as shown in this compilation is amended as indicated in the Tables below.
Under the Legislative Instruments Act 2003, which came into force on 1 January 2005, it is a requirement for all non-exempt legislative instruments to be registered on the Federal Register of Legislative Instruments.
Table of Instruments
Title | Date of notification | Date of | Application, saving or |
Health Insurance Determination HS/6/01 | 31 Jan 2002 (see Gazette 2002, | 31 Jan 2002 |
|
Health Insurance Determination HS/6/01 (Amendment) HS/06/05 | 22 Dec 2005 (see F2005L04089) | 23 Dec 2005 | — |
Table of Amendments
ad. = added or inserted am. = amended rep. = repealed rs. = repealed and substituted | |
Provision affected | How affected |
Note to s. 2............ | rs. Am. HS/06/05 |
S. 5................. | am. Am. HS/06/05 |
S. 6................. | am. Am. HS/06/05 |
S. 7................. | rep. Am. HS/06/05 |
S. 8................. | am. Am. HS/06/05 |
Schedule |
|
Schedule............. | am. Am. HS/06/05 |