Health Insurance (Optical Coherence Tomography) Determination 2016

Administered by Department of Health, Disability and Ageing

Legislation au F2016L01691 Not in force Legislative Instrument

Legislation content

Health Insurance (Optical Coherence Tomography) Determination 2016

made under section 3C(1) of the

Health Insurance Act 1973

Compilation No. 1

Compilation date:    1 December 2016

Includes amendments up to: F2016L01691

Registered:    13 January 2017

About this compilation

This compilation

This is a compilation of the Health Insurance (Optical Coherence Tomography) Determination 2016 that shows the text of the law as amended and in force on 1 December 2016 (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 (www.legislation.gov.au). 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If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.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

Part 1  1

1 Name of Determination

3 Authority

4 Schedules

5 Definitions

6 Treatment of relevant services

Schedule 2—relevant services

Endnotes

Endnote 1—About the endnotes

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history

 

Part 1  

 

1 Name of Determination

  This Determination is the Health Insurance (Optical Coherence Tomography) Determination 2016.

3 Authority

  This Determination is made under subsection 3C(1) of the Health Insurance Act 1973.

4 Schedules

  Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.

5 Definitions

  (1) In this Determination:

 Act means the Health Insurance Act 1973.

 pharmaceutical benefits scheme means the scheme for the supply of pharmaceutical benefits established under Part VII of the National Health Act 1953.

 relevant provisions means all provisions, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under that Act, relating to medical services, professional services or items.

 relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in a Schedule.

 Schedule means a Schedule to this Determination.

 Note:   The following terms are defined in subsection 3(1) of the Act:

  • clinically relevant 
  • general medical services table

  (2) Unless the contrary intention appears, a reference in this Determination to               a provision of the Act or the National Health Act 1953 or regulations made               under the Act or under the National Health Act 1953 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.

6 Treatment of relevant services

  For subsection 3C(1) of the Act a relevant service, provided in accordance with this Determination and as a clinically relevant service, is to be treated, for the relevant provisions, as if:

 (a)  it were both a professional service and a medical service; and

 (b) there were an item in the general medical services table that:

 (i)  related to the service; and

 (ii)  specified for the service a fee in relation to each State, being the               fee specified in the Schedule in relation to the service.

Schedule 2—relevant services

 

 

Group D1—Miscellaneous diagnostic procedures and investigations

Item

Service

Fee ($)

Subgroup 2—Ophthalmology

11219

Optical coherence tomography to determine if the requirements relating to:

  1.        age related macular degeneration for access to initial treatment with ranibizumab or aflibercept; or
  2.        diabetic macular oedema for access to initial treatment with ranibizumab, aflibercept or dexamethasone; or
  3.        central or branch retinal vein occlusion for access to initial treatment with ranibizumab or aflibercept; or
  4.        vitreomacular traction for access to initial treatment with ocriplasmin;

 

under the pharmaceutical benefits scheme are fulfilled.

 

Maximum of one service in a 12 month period

40.00

11220

Optical coherence tomography for the assessment of the need for treatment following provision of pharmaceutical benefits schemesubsidised ocriplasmin.

 

Maximum of one service per eye per lifetime.

 

40.00

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

    /subsubparagraph(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

SubCh = SubChapter(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 (Optical Coherence Tomography) Determination 2016

31 Oct 2016 (F2016L01691)

s 1–6 and Sch 1:
1 Nov 2016 (s 2(1))
Sch 2 and 3: 1 Dec 2016 (s 2(2))

 

Endnote 4—Amendment history

 

Provision affected

How affected

s 2.....................

rep LA s 48D

Schedule 1

 

Schedule 1................

rep F2016L01691

Schedule 3

 

Schedule 3................ 

rep F2016L01691

 

Interactions

Authorises

All Versions

Sourced from the Federal Register of Legislation at 26 August 2026. For the latest information on Australian Government law please go to https://www.legislation.gov.au.