EXPLANATORY STATEMENT
Issued by the authority of the Minister for Health and Ageing
Health Insurance Act 1973
Health Insurance (Radiation Oncology) Determination 2010
Subsection 3C(1) of the Health Insurance Act 1973 (the Act) provides, in part, that the Minister may determine in writing that a health service not listed in the General Medical Services Table (the Table) shall, in specified circumstances and for specified statutory provisions, be treated as if it were so listed. The Table is set out in the Health Insurance (General Medical Services Table) Regulations 2009 which are remade each year.
A determination made under subsection 3C(1) of the Act is a legislative instrument for the purposes of the Legislative Instruments Act 2003 (see subsection 3C(4) of the Act and paragraph 6(d) of the Legislative Instruments Act 2003).
The Health Insurance (Radiation Oncology) Determination 2010 (the Determination) revokes and replaces the Health Insurance (Radiation Oncology) Determination 2009 (the Previous Determination).
The Health Insurance (Radiation Oncology) Determination 2008 (the Original Determination), which commenced on 1 July 2008, specified four radiation oncology services as Medicare items. These services related to imaging procedures such as x-rays, ultrasound and computed tomography, which are used as quality assurance tools to verify that radiation oncology treatments are being applied to the correct area.
The Original Determination provided that two radiation oncology treatment verification services, one brachytherapy treatment verification service and one radiation source localisation for high dose brachytherapy treatment planning are to be treated as if they are both professional and medical services and as if there are items in the Table relating to the services and specifying a fee in relation to the services. The Original Determination was revoked and remade under Health Insurance (Radiation Oncology) Determination 2008 (No. 2) to reflect schedule fee increases effective from 1 November 2008. The Health Insurance (Radiation Oncology) Determination 2008 (No. 2) was subsequently revoked and remade under the Previous Determination to reflect a 2.3 per cent increase in the schedule fee, effective on 1 November 2009.
From 1 May 2010, changes to the radiation oncology treatment verification items will come into effect. This Determination revokes and replaces the Previous Determination to reflect changes to item descriptors for the two existing radiation oncology treatment verification items, as well as the introduction of a new radiation oncology treatment verification item to cover volumetric imaging.
The amended item descriptors reflect changes to the treatment verification items which will prevent the payment of Medicare benefits for more than one treatment verification service per attendance, will only allow the claiming of treatment verification items when prescribed by a radiation oncologist as part of a treatment plan, and will limit the claiming of items 15705 and 15710 for treatment involving three or more fields. The changes will also require the treatment verification procedure to have been prescribed by a radiation oncologist and subsequently reviewed by a radiation oncologist before the items can be claimed.
The purpose of the changes is to assist in the appropriate management of Medicare expenditure for radiation oncology treatment verification procedures.
Details of the Determination are set out in the Attachment.
The Determination commences on 1 May 2010.
Consultation
This Determination was developed in consultation with the radiation oncology profession, through a committee representing various sectors of the profession.
HEALTH TECHNOLOGY AND MEDICAL SERVICES BRANCH
DEPARTMENT OF HEALTH AND AGEING
APRIL 2010
ATTACHMENT
Health Insurance (RADIATION oNCOLOGY)
Determination 2010
Explanation of Sections
Section 1
This section provides for the name of the Determination.
Section 2
Section 2 provides that the Determination commences on 1 May 2010.
Section 3
Section 3 provides that the Determination revokes the Health Insurance (Radiation Oncology) Determination 2009.
Section 4
Subsection 4(1)
This subsection defines terms used in the Determination.
The definitions of ‘brachytherapy treatment verification’ and ‘radiation oncology treatment verification’ encompass what is involved in the treatment verification process and the types of imaging procedures used in the process. Under the definitions, x-ray images may be taken using any method, including portal imaging on a linear accelerator (which is the most common method of treatment verification), x-ray equipment or computed tomography equipment attached to a linear accelerator (often referred to as ‘on board imaging’), or stand alone diagnostic x-ray equipment. In relation to ultrasound, the equipment needs to be capable of reconstructing the images captured into at least three dimensions in order to produce a clinically acceptable image of the treatment site.
Both the above-mentioned definitions are used in the item descriptors for items 15700, 15705, 15710 and 15800 as shown in the Schedule to the Determination.
The term 'relevant service' for the purpose of this Determination means a service defined in subsection 3C(8) of the Act that is specified in the Schedule. That subsection defines the types of services that are health services for the purposes of determinations under subsection 3(C)(1) of the Act.
There is a notation at the foot of this subsection that terms used in the Determination, in accordance with statutory conventions, take their meaning from the principal Act, in this case the Health Insurance Act 1973.
Subsection 4(2)
This subsection provides that a reference to a provision of an Act or regulations in this Determination is a reference to that provision as it is in force from time to time.
Section 5
Subsection 5(a) provides that a relevant service specified in the Schedule to the Determination shall be treated as if it were both a professional service and a medical service for the purposes of the provisions of the Act, the National Health Act 1953 and the regulations made under those Acts that make provision for medical or professional services.
Subsection 5(b) provides that a relevant service specified in the Schedule to the Determination (i.e. Items 15700, 15705, 15710, 15800 and 15850) is to be treated as if there were an item in the Table that related to the service and which specified a fee in respect of that service, being the fee specified in the Determination in relation to the service.
Schedule
The Schedule sets out the relevant services and assigns to each service the applicable item number, item descriptor and fee.
Item 15700
This item covers treatment verification provided by external beam radiation (produced by a linear accelerator) where the images are taken in the one plane. Medicare benefits are payable only when treatment verification is prescribed and reviewed by a radiation oncologist and where it is not claimed on the same occasion as Item 15705 or 15710. Medicare benefits are payable for a maximum of one service per attendance.
Item 15705
This item covers treatment verification where images are taken in more than one plane, for example axial and lateral views. Medicare benefits are payable only: when treatment verification is prescribed and reviewed by a radiation oncologist; where it is not associated with Item 15700 or 15710; and where treatment involves three fields or more. Medicare benefits are payable for a maximum of one service per attendance.
Item 15710
This item covers treatment verification where images are reproduced in three dimensions, i.e. volumetrically. Medicare benefits are payable only when treatment verification is prescribed and reviewed by a radiation oncologist, where it is not associated with Item 15700 or 15705, and where treatment involves three fields or more. Medicare benefits are payable for a maximum of one service per attendance.
Item 15800
This item covers brachytherapy treatment verification. The item applies to one service only per treatment session.
Note: For the verification items above, it is not necessary that the patient have treatment at the same attendance at which verification is undertaken.
Item 15850
This item covers radiation source localisation for high dose brachytherapy treatment planning. It is similar to an existing item (Item 15513) for prostate seed implant brachytherapy, commonly known as low dose brachytherapy treatment.
The item applies to brachytherapy provided to any part of the body.