Health Insurance (Section 3C Diagnostic Imaging Services – Complex gynaecological ultrasound) Determination 2025

Administered by Department of Health, Disability and Ageing

Legislation au F2025L01015 In force Legislative Instrument

Legislation content

Health Insurance (Section 3C Diagnostic Imaging Services – Complex gynaecological ultrasound) Determination 2025

made under subsection 3C(1) of the

Health Insurance Act 1973

Compilation No. 1

Compilation date: 1 July 2026

Includes amendments: F2026L00523

About this compilation

This compilation

This is a compilation of the Health Insurance (Section 3C Diagnostic Imaging Services – Complex gynaecological ultrasound) Determination 2025 that shows the text of the law as amended and in force on 1 July 2026 (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. The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. Any uncommenced amendments affecting the law are accessible on the Register (www.legislation.gov.au).

Application, saving and transitional provisions

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.

Presentational changes

The Legislation Act 2003 provides for First Parliamentary Counsel to make presentational changes to a compilation. Presentational changes are applied to give a more consistent look and feel to legislation published on the Register, and enable the user to more easily navigate those documents.

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. Any modifications affecting the law are accessible on the Register.

Selfrepealing 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If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.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

1. Name

3. Authority

4. Definitions

5. Treatment of relevant services

6. Application of provisions of the diagnostic imaging services table

7 Indexation

Schedule 1 – Relevant services

Endnotes

Endnote 1—About the endnotes

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history

 

1.  Name

 This instrument is the Health Insurance (Section 3C Diagnostic Imaging Services – Complex gynaecological ultrasound) Determination 2025.

3.  Authority

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

4.  Definitions

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

         clinically relevant service;

         diagnostic imaging services table;

         item;

         professional service.

 (1) In this instrument:

Act means the Health Insurance Act 1973.

(R) has the meaning given by subsection 1.2.15(1) of the diagnostic imaging services table.

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

relevant service means a health service, as defined in subsection 10AC(1) of the Act, that is specified in a Schedule.

Schedule means a Schedule to this instrument.

 

5.  Treatment of relevant services

For subsection 3C(1) of the Act, a relevant service, provided in accordance with this instrument 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 diagnostic imaging service; and

(b)                    there were an item in the diagnostic imaging services table that is:

(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.

 

6.  Application of provisions of the diagnostic imaging services table

Clause 2.1.2 of the diagnostic imaging services table shall have effect as if item 55080 of Schedule 1 of this Determination was also specified in clause 2.1.2 of the diagnostic imaging services table.

7  Indexation

 (1) At the start of 1 July 2026 (the indexation time), each amount covered by subsection (2) is replaced by the amount worked out using the following formula:

Note: The indexed fees could in 2026 be viewed on the Department of Health, Disability and Ageing’s MBS Online website (www.mbsonline.gov.au).

 (2) The amounts covered by this subsection are the fee for each item in Schedule 1 of this Determination.

 (3) An amount worked out under subsection (1) is to be rounded up or down to the nearest 5 cents (rounding down if the amount is an exact multiple of 2.5 cents).

Schedule 1 – Relevant services

 

 

Group I1—Ultrasound

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 1—General

55080

Pelvis, ultrasound scan of, by any or all approaches (including transvaginal), if:

(a) the patient is known to have, or the requesting practitioner suspects, a complex gynaecological condition; and

(b) the service is considered a complex investigation requiring a minimum of 30 minutes scanning time; and

(c) within 24 hours of the service, a service mentioned in item 55038, 55065, 55700, 55704, 55736, or 55739 is not performed on the same patient. (R)

255.00

 

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 how an amendment is to be made. If, despite the misdescription, the amendment can be given effect as intended, then the misdescribed amendment can be incorporated through an editorial change made under section 15V of the Legislation Act 2003.

If a misdescribed amendment cannot be given effect as intended, the amendment is not incorporated and “(md not incorp)” is added to the amendment history.

 

Endnote 2—Abbreviation key

 

ad = added or inserted

orig = original

am = amended

p = page(s)

amdt = amendment

para = paragraph(s)/subparagraph(s)

C[x] = Compilation No. x

/subsubparagraph(s)

ch = Chapter(s)

pres = present

cl = clause(s)

prev = previous

cont. = continued

(prev…) = previously

def = definition(s)

pt = Part(s)

Dict = Dictionary

r = regulation(s)/Court rule(s)

disallowed = disallowed by Parliament

reloc = relocated

div = Division(s)

renum = renumbered

ed = editorial change

rep = repealed

exp = expires/expired or ceases/ceased to have

rs = repealed and substituted

effect

s = section(s)/subsection(s)

gaz = gazette

/rule(s)/subrule(s)/order(s)/suborder(s)

LA = Legislation Act 2003

sch = Schedule(s)

LIA = Legislative Instruments Act 2003

SLI = Select Legislative Instrument

(md) = misdescribed amendment can be given

SR = Statutory Rules

effect

sub ch = SubChapter(s)

(md not incorp) = misdescribed amendment

sub div = Subdivision(s)

cannot be given effect

sub pt = Subpart(s)

mod = modified/modification

underlining = whole or part not

No. = Number(s)

commenced or to be commenced

Ord = Ordinance

 

 

Endnote 3—Legislation history

 

Name

Registration

Commencement

Application, saving and transitional provisions

Health Insurance (Section 3C Diagnostic Imaging Services – Complex gynaecological ultrasound) Determination 2025

1 Sept 2025 (F2025L01015)

1 Nov 2025 (s 2(1) item 1)

 

Health Insurance Legislation Amendment (Indexation) Determination 2026

8 May 2026 (F2026L00523)

sch 1 (item 3): 1 July 2026 (s 2(1) item 2)

 

Endnote 4—Amendment history

 

Provision affected

How affected

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

rep LA s 48D

s 7.....................

ad F2026L00523

 

 

Overview

The Health Insurance (Section 3C Diagnostic Imaging Services – Complex Gynaecological Ultrasound) Determination 2025 was enacted to address the gap in the provision of adequate diagnostic imaging services for complex gynaecological conditions. This legislative instrument was made under subsection 3C(1) of the Health Insurance Act 1973, with the aim of ensuring that clinically relevant complex gynaecological ultrasound services are appropriately recognised and compensated under the Medicare Benefits Schedule. By treating these services as both professional and diagnostic imaging services, the Determination ensures that patients have better access to essential diagnostic imaging for complex gynaecological conditions, aligning the service delivery with the relevant provisions of the Health Insurance Act and associated regulations. The objective is to improve the quality and accessibility of healthcare services for women with complex gynaecological conditions. The Determination is designed to integrate complex gynaecological ultrasound services into the diagnostic imaging services table, specifying fees for these services and ensuring they are indexed appropriately. This legislative measure was enacted to provide clarity and consistency in the treatment of such services, thereby addressing potential gaps in coverage and ensuring that healthcare providers are adequately reimbursed for these specialised services. The instrument also includes provisions for the indexation of fees, ensuring that the remuneration for these services keeps pace with inflation and other economic factors.

Scope and Application

The Health Insurance (Section 3C Diagnostic Imaging Services – Complex Gynaecological Ultrasound) Determination 2025 applies to diagnostic imaging services specifically related to complex gynaecological ultrasound. The determination operates under the authority of subsection 3C(1) of the Health Insurance Act 1973 and pertains to services that meet the criteria outlined in Schedule 1. These services must be provided as clinically relevant services and are treated as both professional services and diagnostic imaging services. The fees for these services are specified in the Schedule and are subject to indexation as per the provisions outlined in the determination. The application of this determination is national in scope, impacting all states and territories within Australia. It extends its application to relevant services defined under the Act and related regulations, and includes provisions for the treatment and indexing of fees. The determination does not specify any exclusions or exemptions, applying broadly to the specified diagnostic imaging services within the health insurance framework.

Key Provisions

The Health Insurance (Section 3C Diagnostic Imaging Services – Complex gynaecological ultrasound) Determination 2025 (the Determination) specifies that complex gynaecological ultrasound services, as defined in Schedule 1, will be treated as both a professional service and a diagnostic imaging service under the Health Insurance Act 1973 (the Act) (s 5). This means these services will be subject to the provisions governing professional services and diagnostic imaging services, including the fees set out in the diagnostic imaging services table (s 5(a) and (b)). Additionally, the Determination modifies the diagnostic imaging services table to include a specific fee for complex gynaecological ultrasound services (s 6). The Determination imposes obligations on healthcare providers to ensure that the specified services are performed in accordance with the requirements outlined in the Act and the Determination. It requires that these services be provided only when clinically relevant, meaning they must be necessary for the diagnosis or treatment of a complex gynaecological condition and require a minimum of 30 minutes of scanning time (s 5(a)). Furthermore, the Determination mandates that these services are billed according to the specified fee outlined in Schedule 1 of the Determination (s 5(b)). There are no explicit offences, penalties, or consequences for breach stated in the Determination. However, failure to comply with the Act and the Determination could result in legal consequences under the relevant provisions of the Act. This could include penalties for providing services that do not meet the criteria for a clinically relevant service or for incorrectly billing services. The maximum penalties for breaches under the Act can vary widely, depending on the nature and severity of the breach, and could include fines or other sanctions as determined by the relevant authorities.

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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.