Health Insurance (Diagnostic Imaging Services Table) Regulations 2001 Amendment Regulations 2002 (No. 1) 2002 No. 75
EXPLANATORY STATEMENT
STATUTORY RULES 2002 No. 75
Issued by the Authority of the Minister for Health and Ageing
Health Insurance Act 1973
Health Insurance (Diagnostic Imaging Services Table) Regulations 2001 Amendment Regulations 2002 (No. 1)
Section 133 of the Health Insurance Act 1973 (the Act) provides that the Governor-General may make Regulations prescribing matters for the purposes of the Act.
Section 10 of the Act provides for payments to eligible persons for professional services by way of Medicare benefits.
Section 4AA of the Act provides that the table of diagnostic imaging services may be prescribed by the Regulations. The Health Insurance (Diagnostic Imaging Services Table) Regulations 2001 prescribe such a table.
Section 9 of the Act provides that Medicare benefits shall be calculated by reference to the fees for medical services (including diagnostic imaging services) set out in the table which included the Diagnostic Imaging Services Table (the Table).
A number of changes to the Regulations have been made as part of the ongoing management of the Table. The Regulations incorporate the following changes to the Table:
• Introduction of a new rule for the calculation of payments for multiple vascular ultrasound services.
• Amendments to Schedule fees for vascular ultrasound items 55238, 55244, 55246, 55248,55252, 55274, 55276, 55278, 55280, 55282, 55284, 55292 and 55294.
• The deletion of nine vascular ultrasound items 55256, 55262, 55264, 55266, 55270, 55277, 55279, 55288 and 55290.
• The amendment of two item for vascular ultrasound items descriptors, 55276 and 55278.
• The amendment of cardiac ultrasound items 55113, 55114, 55115, 55116, 55117 and 55118.
These changes have been developed in consultation with the Australian and New Zealand Association of Physicians in Nuclear Medicine, the Royal Australian and New Zealand College of Radiologists, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the Royal Australian College of General Practitioners, the Royal Australasian College of Surgeons, the Cardiac Society of Australia and New Zealand, the Australian Society of Ultrasound in Medicine, the Australian Sonographer's Association and the Australian Diagnostic Imaging Association.
Details of the Regulations are in the attachment.
The Regulations came into effect on 1 May 2002.
ATTACHMENT A
Details of the Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2002 (No. 1)
Regulation 1 provides that the name of the regulations will be the Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2002 (No. 1).
Regulation 2 provides for the regulations to commence on 1 May 2002.
Regulation 3 provides that the Health Insurance (Diagnostic Imaging Services Table) Regulations 2000 will be amended by Schedule 1 of the proposed Regulations.
Changes to the Table
The May 2002 Diagnostic Imaging Services Table differs from the existing tables in the following way:
• It introduces a new rule for the calculation of payments for multiple vascular .ultrasound services. The introduction of this rule will address current inequities within the Table for the reimbursement of multiple scans.
* This rule, applies to any vascular ultrasound services (items 55238 to 55296) provided to the same person on the same date of service, irrespective of whether or not the same provider has rendered the services or requested the services.
* The Schedule fee for the services will be calculated as follows:
- 100% of the Schedule fee (as listed in the Regulations) for the first service;
- 60% of the Schedule fee (as listed in the Regulations) for the second service; and
- 50% of the Schedule fee (as listed in the Regulations) for the third and any subsequent services.
* Where the Schedule fee for one or more of the services is of equal amount, one of the services will be treated as being the higher amount for the calculation of the fee.
* Amendments to Schedule fees for vascular ultrasound items 55238, 55244, 55246, 55248, 55252, 55274, 55276, 55278, 55280, 55282, 55284, 55292 and 55294 will be introduced as part of the implementation strategy of the new Multiple Vascular Ultrasound Services Site Rule (MVUSSR), to keep the restructure of vascular ultrasound cost neutral.
* The implementation strategy of the new rule includes the deletion of nine vascular ultrasound items 55256, 55262, 55264, 55266, 55270, 55277, 55279, 55288 and 55290 as these services are specific multiple site scans and will no longer be required under the revised structure of vascular ultrasound;
• It amends two item descriptors, 55276 and 55278, to remove references to time; and
• It permits of the claiming of a transoesophageal and transthoracic ultrasound on the same day by an amendment to the wording of items 55113, 55114, 55115, 55116, 55117 and 55118.