{"id":"F2009L04065","name":"Health Insurance (Gippsland and South Eastern New South Wales Mobile MRI Service and Rockhampton, Bundaburg and Gladstone Mobile MRI Service) Determination 2009","slug":"health-insurance-gippsland-and-south-eastern-new-south-wales-mobile-mri-service-and-rockhampton-bund","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"repealed","isInForce":false,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":81598,"registerId":"commonwealth-F2009L04065-current","compilationNumber":null,"startDate":"2026-04-02","status":"Repealed","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"Contents","sectionType":"subdivision","heading":"Contents","content":"#### Contents\n\n1. Name of Determination\n\n2. Commencement\n\n3. Cessation\n\n4. Interpretation\n\n5. Circumstances where this Determination applies - Gippsland and South Eastern New South Wales mobile MRI services\n\n5AA Circumstances where this Determination applies- Rockhampton, Bundaburg and Gladstone mobile MRI services 6\n\n5A. Bulk billing incentive\n\n6. Treatment of a relevant service\n\n7. MRI and MRA services – meaning of scan\n\n8. MRI and MRA services – related services that can be claimed in a 12 month period\n\n9. MRI services – limit for items 63472 and 63475\n\n10. MRI services – limit for item 63478\n\n11. MRI and MRA services – modifying items\n\n12. Diagnostic imaging services which dental practitioners may request\n\nSchedule - Specified health services\n\n#","sortOrder":0},{"sectionNumber":"1. Name of Determination","sectionType":"part","heading":"1. Name of Determination","content":"# 1. Name of Determination\n\nThis Determination is the Health Insurance (Gippsland and South Eastern New South Wales Mobile MRI Service and Rockhampton, Bundaburg and Gladstone Mobile MRI Service) Determination 2009.","sortOrder":1},{"sectionNumber":"2. Commencement","sectionType":"part","heading":"2. Commencement","content":"# 2. Commencement\n\nThis Determination commences on 1 November 2009.","sortOrder":2},{"sectionNumber":"3. Cessation","sectionType":"part","heading":"3. Cessation","content":"# 3. Cessation\n\nThis Determination ceases to have effect at 23:59, 30 June 2013.","sortOrder":3},{"sectionNumber":"4. Interpretation","sectionType":"part","heading":"4. Interpretation","content":"# 4. Interpretation\n\n(1) In this Determination, unless the contrary intention appears:\n\nAct means the Health Insurance Act 1973.\n\nafter hours means from 5pm on Mondays, Tuesdays, Wednesdays and Thursdays to 9am on the following day, and from 5pm on Fridays to 9am on Mondays.\n\nBega means Bega, New South Wales, 2250.\n\ndiagnostic imaging services table means the table prescribed under section 4AA of the Act.\n\neligible provider means a specialist in diagnostic radiology who has satisfied the Chief Executive Medicare that he or she is a participant in the Royal Australian and New Zealand College of Radiologists’ Quality and Accreditation Program.\n\nLSPN means a location specific practice number allocated under section 23DZQ of the Act.\n\nitem means an item in the Schedule.\n\nMRA means magnetic resonance angiography.\n\nMRI means magnetic resonance imaging.\n\nrelevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in the Schedule.\n\nRIL funding agreement means the funding agreement between Regional Imaging Pty Ltd \\[ABN 81 095 630 792\\] and the Commonwealth of Australia as represented by the Department of Health and Ageing as in force on 31 December 2011.\n\nSchedule means the Schedule to this Determination.\n\nteleradiology means the electronic transmission of radiological images in digital form from one location to another using a data communication link provided by a third party carrier.\n\nTraralgon means Traralgon, Victoria, 3844.\n\nNote 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.\n\n(2) For the avoidance of doubt, in this Determination:\n\n(a) a reference to the Act includes a reference to regulations made under the Act; and\n\n(b) a reference to the National Health Act 1953 includes a reference to regulations made under that Act; and\n\n(c) a reference to any legislation shall be construed as a reference to that legislation as in force from time to time.","sortOrder":4},{"sectionNumber":"5. Circumstances where this Determinatio","sectionType":"part","heading":"5. Circumstances where this Determination applies — Gippsland and South Eastern New South Wales Mobile MRI services","content":"# 5. Circumstances where this Determination applies – Gippsland and South Eastern New South Wales Mobile MRI services\n\n(1) This Determination applies to a relevant service provided using mobile diagnostic imaging equipment that has as its base for mobile diagnostic imaging the Latrobe Regional Hospital, Princes Highway Traralgon West, Victoria 3844 where the following circumstances apply:\n\n(a) in respect of items 63002 to 63483, where the service is performed pursuant to a request that is in accordance with subsection (2);\n\n(b) where the service is performed pursuant to the RIL funding agreement; and\n\n(c) where the service is performed in a permissible circumstance in accordance with subsection (3), (4), (5), (6), (7) or (8); and\n\n(d) where the service is a service of a kind referred to in paragraph 10(2)(a) of the Act – the patient in respect of whom the service is provided is charged a fee that is no more than 75% of the amount specified in the Schedule as the fee applicable to the item that relates to the service; and\n\n(e) where the service is not a service to which paragraph (d) applies – the patient in respect of whom the service is provided is charged a fee that is no more than 85% of the amount specified in the Schedule as the fee applicable to the item that relates to the service.\n\n(2) The request referred to in paragraph (1)(a) must:\n\n(a) be made by a practitioner who is a specialist, consultant physician or dental practitioner; and\n\n(b) be made in writing; and\n\n(c) identify the clinical indications for the service.\n\nNote: Subsection 16B(2) of the Act limits the R-type diagnostic imaging services in respect of which a medicare benefit is payable where the service is requested by a dental practitioner. See section 12 below.\n\n(3) For paragraph (1)(c), subject to subsection (4), a relevant service is performed in a permissible circumstance if the service is performed in Bega and it is:\n\n(a) performed under the professional supervision of an eligible provider who is available to monitor and influence the conduct and diagnostic quality of the examination via telephone and real-time teleradiology; and\n\n(b) reported by an eligible provider; and\n\n(c) monitored by a medical practitioner by personal attendance on the patient if the circumstances are such as to require on-site monitoring by a medical practitioner.\n\n(4) If subsection (3) is not complied with, a relevant service is performed in a permissible circumstance if the service is performed in Bega and it is performed in an emergency.\n\n(5) For paragraph (1)(c), subject to subsection (6), a relevant service is performed in a permissible circumstance if the service is performed in Traralgon during after hours and it is:\n\n(a) performed under the professional supervision of an eligible provider who is available to monitor and influence the conduct and diagnostic quality of the examination via telephone and real-time teleradiology; and\n\n(b) reported by an eligible provider; and\n\n(c) monitored by a medical practitioner by personal attendance on the patient if the circumstances are such as to require on-site monitoring by a medical practitioner; and\n\n(d) not a service to which items 63492 to 63495 are attributable.\n\n(6) If subsection (5) is not complied with, a relevant service is performed in a permissible circumstance if the service is performed in Traralgon during after hours and it is performed in an emergency.\n\n(7) For paragraph (1)(c), subject to subsection (8), a relevant service is performed in a permissible circumstance if it is:\n\n(a) performed under the professional supervision of an eligible provider who is available to monitor and influence the conduct and diagnostic quality of the examination, including, if necessary, by personal attendance on the patient; and\n\n(b) reported by an eligible provider.\n\n(8) If subsection (7) is not complied with, a relevant service is performed in a permissible circumstance if it is performed:\n\n(c) in an emergency; or\n\n(d) because of medical necessity, in a remote location.","sortOrder":5},{"sectionNumber":"5AA","sectionType":"part","heading":"Circumstances where this Determination applies — Rockhampton, Bundaburg and Gladstone Mobile MRI services","content":"## 5AA Circumstances where this Determination applies – Rockhampton, Bundaburg and Gladstone Mobile MRI services\n\n(1) This Determination applies to a relevant service provided using mobile diagnostic imaging equipment that has as its base for mobile diagnostic imaging the Mater Misericordiae Hospital Rockhampton, Ward St Rockhampton, Queensland 4700, where the following circumstances apply:\n\n(a) in respect of items 63002 to 63483, where the service is performed pursuant to a request that is in accordance with subsection (2); and\n\n(b) the service is:\n\n(i) both:\n\n(A) performed under the professional supervision of an eligible provider who is available to monitor and influence the conduct and diagnostic quality of the examination including, if necessary, by personal attendance on the patient; and\n\n(B) reported by an eligible provider; or\n\n(ii) performed in emergency; and\n\n(c) the equipment is operated at a location mentioned in the Table; and\n\n(d) the equipment used to perform the service is a General Electric Signa Echo Speed with Excite with a magnet strength of 1.5 Tesla and is mounted on a specifically built semi-trailer.\n\n(2) The request referred to in paragraph (1)(a) must:\n\n(a) be made by a practitioner who is a specialist, consultant physician or dental practitioner; and\n\n(b) be made in writing; and\n\n(c) identify the clinical indications for the service.\n\n(3) For paragraph (1)(c), the operation of equipment at a location includes the operation of the equipment within the grounds of the location.\n\nTable\n\n| Item | Location |\n| ---- | ---------------------------------------------------------------------- |\n| 1 | Mater Misericordiae Hospital Gladstone50 Rossella StGladstone QLD 4680 |\n| 2 | Friendly Society Private Hospital19 – 23 Bingara StBundaberg QLD 4670 |\n| 3 | Mater Misericordiae Hospital RockhamptonWard StRockhampton QLD 4700 |\n\n5A. Bulk billing incentive\n\nParagraph 1.2.5A(1)(a) of Part 2 of Schedule 1 of the diagnostic imaging services table shall have effect as if the reference to “a service that is mentioned in an item in Division 2.5 of the table” in that clause included a reference to a service mentioned in an item in the Schedule to this Determination.","sortOrder":6},{"sectionNumber":"6. Treatment of a relevant service","sectionType":"part","heading":"6. Treatment of a relevant service","content":"# 6. Treatment of a relevant service\n\nA relevant service shall be treated as if:\n\n(a) it were both a professional service and a medical service for the purposes of the provisions of the Act and the National Health Act 1953 that relate to professional and medical services; and\n\n(b) there was an item in the diagnostic imaging services table that related to the relevant service and 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; and\n\n(c) the item specified in paragraph (b) was part of Group I5 of the diagnostic imaging services table and of the relevant subgroup of Group I5 as is specified in the Schedule.","sortOrder":7},{"sectionNumber":"7. MRI and MRA services — meaning of sca","sectionType":"part","heading":"7. MRI and MRA services — meaning of scan","content":"# 7. MRI and MRA services – meaning of scan\n\nClause 2.5.7 of Part 2 of Schedule 1 of the diagnostic imaging services table shall have effect as if the reference to “items 63001 to 63482” in that clause was a reference to “items 63002 to 63483” of the Schedule.","sortOrder":8},{"sectionNumber":"8. MRI and MRA services — related servic","sectionType":"part","heading":"8. MRI and MRA services — related services that can be claimed in a 12 month period","content":"# 8. MRI and MRA services – related services that can be claimed in a 12 month period\n\nSubclause 2.5.9(2) of Part 2 of Schedule 1 of the diagnostic imaging services table shall have effect as if the references to the items mentioned in column 1 of the table below (Existing references) include references to the items mentioned in column 2 of the following table (Additional references).\n\n \n\n| Existing references | Additional references |\n| ---------------------- | ---------------------- |\n| 63040 to 63073 | 63041 to 63065 |\n| 63101 | 63102 |\n| 63125 to 63131 | 63126 to 63132 |\n| 63161 to 63185 | 63163 to 63177 |\n| 63219 to 63243 | 63220 to 63244 |\n| 63271 to 63280 | 63272 to 63281 |\n| 63322 to 63340 | 63323 to 63332 |\n| 63361 | 63363 |\n| 63385 to 63391 | 63386 to 63389 |\n| 63401 and 63404 | 63402 and 63405 |\n| 63416 | 63417 |\n| 63425 and 63428 | 63426 and 63429 |\n| 63461, 63464 and 63467 | 63463, 63466 and 63469 |\n| 63482 | 63483 |","sortOrder":9},{"sectionNumber":"9. MRI services — limit for items 63472 ","sectionType":"part","heading":"9. MRI services — limit for items 63472 and 63475","content":"# 9. MRI services – limit for items 63472 and 63475\n\nClause 2.5.10 of Part 2 of Schedule 1 of the diagnostic imaging services table shall have effect as if:\n\n(a) the reference to item 63473 in subclause (1) was a reference to “item 63472, 63473 or 63475”;\n\n(b) the reference to item 63470 in subclause (2) was a reference to “item 63470, 63472 or 63475”;\n\n(c) there is an additional subclause (3) as follows “Item 63472 does not apply to the service described in that item if the person to whom the service is provided has previously been provided with that service or a service described in items 63470, 63473 or 63475”; and\n\n(d) there is an additional subclause (4) as follows “Item 63475 does not apply to the service described in that item if the person to whom the service is provided has previously been provided with that service or a service described in item 63470, 63472 or 63473”.","sortOrder":10},{"sectionNumber":"10. MRI services — limit for item 63478","sectionType":"part","heading":"10. MRI services — limit for item 63478","content":"# 10. MRI services – limit for item 63478\n\nItem 63478 does not apply to the service described in that item if the person to whom the service is provided has previously been provided with that service or a service described in item 63476 of Part 2 of Schedule 1 of the diagnostic imaging services table.","sortOrder":11},{"sectionNumber":"11. MRI and MRA services — modifying ite","sectionType":"part","heading":"11. MRI and MRA services — modifying items","content":"# 11. MRI and MRA services – modifying items\n\nClause 2.5.11 of Part 2 of Schedule 1 of the diagnostic imaging services table shall have effect as if:\n\n(a) the reference to item 63491 in that clause was a reference to item 63492; and\n\n(b) the references to item 63494 in that clause were references to item 63493; and\n\n(c) the references to item 63497 in that clause were references to item 63495.","sortOrder":12},{"sectionNumber":"12. Diagnostic imaging services which de","sectionType":"part","heading":"12. Diagnostic imaging services which dental practitioners may request","content":"# 12. Diagnostic imaging services which dental practitioners may request\n\nRegulation 10 of the Health Insurance Regulations 1975 shall have effect as if the paragraphs of that regulation mentioned in column 1 of the table below (Existing references) include references to the items mentioned in column 2 of the table below (Additional references).\n\n| Existing references | Additional references |\n| ------------------- | --------------------- |\n| paragraph 10(1)(a) | 63008, 63329 |\n| paragraph 10(1)(b) | 63329 |\n| paragraph 10(1)(c) | 63329 |\n| paragraph 10(1)(d) | 63008, 63329 |\n\nSchedule - Specified health services\n\n| Item | Health Service | Fee for all States | Relevant subgroup of Group I5 |\n| ----- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ------------------ | ---------------------------------------------------------------------------------------------------------- |\n| 63002 | MRI — scan of head (including MRA, if performed) fortumour of the brain or meninges (R) (Anaes.) (Contrast) | 403.20 | Subgroup 1 – Scan of head – for specified conditions |\n| 63005 | MRI — scan of head (including MRA, if performed) forinflammation of brain or meninges (R) (Anaes.) (Contrast) | 403.20 | Subgroup 1 – Scan of head – for specified conditions |\n| 63008 | MRI — scan of head (including MRA, if performed) forskull base or orbital tumour (R) (Anaes.) (Contrast) | 403.20 | Subgroup 1 – Scan of head – for specified conditions |\n| 63011 | MRI — scan of head (including MRA, if performed) forstereotactic scan of brain, with fiducials in place, for thesole purpose of allowing planning for stereotacticneurosurgery (R) (Anaes.) (Contrast) | 336.00 | Subgroup 1 – Scan of head – for specified conditions |\n| 63041 | MRI — scan of head (including MRA, if performed) foracoustic neuroma (R) (Anaes.) (Contrast) | 336.00 | Subgroup 2 – Scan of head – for specified conditions |\n| 63042 | MRI — scan of head (including MRA, if performed) forpituitary tumour (R) (Anaes.) (Contrast) | 358.40 | Subgroup 2 – Scan of head – for specified conditions |\n| 63044 | MRI — scan of head (including MRA, if performed) fortoxic or metabolic or ischaemic encephalopathy (R)(Anaes.) (Contrast) | 403.20 | Subgroup 2 – Scan of head – for specified conditions |\n| 63045 | MRI — scan of head (including MRA, if performed) fordemyelinating disease of the brain (R) (Anaes.) (Contrast) | 403.20 | Subgroup 2 – Scan of head – for specified conditions |\n| 63047 | MRI — scan of head (including MRA, if performed) forcongenital malformation of the brain or meninges (R)(Anaes.) (Contrast) | 403.20 | Subgroup 2 – Scan of head – for specified conditions |\n| 63048 | MRI — scan of head (including MRA, if performed) forvenous sinus thrombosis (R) (Anaes.) (Contrast) | 403.20 | Subgroup 2 – Scan of head – for specified conditions |\n| 63051 | MRI — scan of head (including MRA, if performed) forhead trauma (R) (Anaes.) (Contrast) | 403.20 | Subgroup 2 – Scan of head – for specified conditions |\n| 63054 | MRI — scan of head (including MRA, if performed) forepilepsy (R) (Anaes.) (Contrast) | 403.20 | Subgroup 2 – Scan of head – for specified conditions |\n| 63057 | MRI — scan of head (including MRA, if performed) forstroke (R) (Anaes.) (Contrast) | 403.20 | Subgroup 2 – Scan of head – for specified conditions |\n| 63060 | MRI — scan of head (including MRA, if performed) forcarotid or vertebral artery dissection (R) (Anaes.)(Contrast) | 403.20 | Subgroup 2 – Scan of head – for specified conditions |\n| 63063 | MRI — scan of head (including MRA, if performed) forintracranial aneurysm (R) (Anaes.) (Contrast) | 403.20 | Subgroup 2 – Scan of head – for specified conditions |\n| 63065 | MRI — scan of head (including MRA, if performed) forintracranial arteriovenous malformation (R) (Anaes.)(Contrast) | 403.20 | Subgroup 2 – Scan of head – for specified conditions |\n| 63102 | MRI and MRA of extracranial or intracranial circulation(or both) — scan of head and neck vessels for stroke (R) (Anaes.) (Contrast) | 492.80 | Subgroup 3 – Scan of head and neck vessels – for specified conditions |\n| 63113 | MRI — scan of head and cervical spine (including MRA, if performed) for tumour of the central nervous system or meninges (R) (Anaes.) (Contrast) | 492.80 | Subgroup 4 – Scan of head and cervical spine – for specified conditions |\n| 63116 | MRI — scan of head and cervical spine (including MRA, if performed) for inflammation of the central nervous system or meninges (R) (Anaes.) (Contrast) | 492.80 | Subgroup 4 – Scan of head and cervical spine – for specified conditions |\n| 63126 | MRI — scan of head and cervical spine (including MRA, if performed) for demyelinating disease of the central nervous system (R) (Anaes.) (Contrast) | 492.80 | Subgroup 5 – Scan of head and cervical spine – for specified conditions |\n| 63129 | MRI — scan of head and cervical spine (including MRA, if performed) for congenital malformation of the central nervous system or meninges (R) (Anaes.) (Contrast) | 492.80 | Subgroup 5 – Scan of head and cervical spine – for specified conditions |\n| 63132 | MRI — scan of head and cervical spine (including MRA, if performed) for syrinx (congenital or acquired) (R) (Anaes.) (Contrast) | 492.80 | Subgroup 5 – Scan of head and cervical spine – for specified conditions |\n| 63152 | MRI — scan of 1 region or 2 contiguous regions of thespine for infection (R) (Anaes.) (Contrast) | 358.40 | Subgroup 6 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions |\n| 63155 | MRI — scan of 1 region or 2 contiguous regions of thespine for tumour (R) (Anaes.) (Contrast) | 358.40 | Subgroup 6 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions |\n| 63163 | MRI — scan of 1 region or 2 contiguous regions of thespine for demyelinating disease (R) (Anaes.) (Contrast) | 358.40 | Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions |\n| 63165 | MRI — scan of 1 region or 2 contiguous regions of thespine for congenital malformation of the spinal cord or the cauda equina or the meninges (R) (Anaes.) (Contrast) | 358.40 | Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions |\n| 63168 | MRI — scan of 1 region or 2 contiguous regions of thespine for myelopathy (R) (Anaes.) (Contrast) | 358.40 | Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions |\n| 63169 | MRI — scan of 1 region or 2 contiguous regions of thespine for syrinx (congenital or acquired) (R) (Anaes.)(Contrast) | 358.40 | Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions |\n| 63171 | MRI — scan of 1 region or 2 contiguous regions of thespine for cervical radiculopathy (R) (Anaes.) (Contrast) | 358.40 | Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions |\n| 63172 | MRI — scan of 1 region or 2 contiguous regions of thespine for sciatica (R) (Anaes.) (Contrast) | 358.40 | Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions |\n| 63174 | MRI — scan of 1 region or 2 contiguous regions of thespine for spinal canal stenosis (R) (Anaes.) (Contrast) | 358.40 | Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions |\n| 63175 | MRI — scan of 1 region or 2 contiguous regions of thespine for previous spinal surgery (R) (Anaes.) (Contrast) | 358.40 | Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions |\n| 63177 | MRI — scan of 1 region or 2 contiguous regions of thespine for trauma (R) (Anaes.) | 358.40 | Subgroup 7 – Scan of spine – 1 region or 2 contiguous regions – for specified conditions |\n| 63202 | MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for infection (R) (Anaes.) (Contrast) | 448.00 | Subgroup 8 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions |\n| 63205 | MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for tumour (R) (Anaes.) (Contrast) | 448.00 | Subgroup 8 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions |\n| 63220 | MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for demyelinating disease (R) (Anaes.) (Contrast) | 448.00 | Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions |\n| 63223 | MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for congenital malformation of the spinal cord or the cauda equina or the meninges (R) (Anaes.) (Contrast) | 448.00 | Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions |\n| 63224 | MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for myelopathy (R) (Anaes.) (Contrast) | 448.00 | Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions |\n| 63226 | MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for syrinx (congenital or acquired) (R) (Anaes.) (Contrast) | 448.00 | Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions |\n| 63227 | MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for cervical radiculopathy (R) (Anaes.) (Contrast) | 448.00 | Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions |\n| 63229 | MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for sciatica (R) (Anaes.) (Contrast) | 448.00 | Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions |\n| 63230 | MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for spinal canal stenosis (R) (Anaes.) (Contrast) | 448.00 | Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions |\n| 63232 | MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for previous spinal surgery (R) (Anaes.) (Contrast) | 448.00 | Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions |\n| 63244 | MRI — scan of 3 contiguous or 2 non-contiguous regions of the spine for trauma (R) (Anaes.) | 448.00 | Subgroup 9 – Scan of spine – 3 contiguous or 2 non-contiguous regions – for specified conditions |\n| 63272 | MRI — Scan of cervical spine and brachial plexus fortumour (R) (Anaes.) (Contrast) | 492.80 | Subgroup 10 – Scan of cervical spine and brachial plexus – for specified conditions |\n| 63275 | MRI — Scan of cervical spine and brachial plexus fortrauma (R) (Anaes.) (Contrast) | 492.80 | Subgroup 10 – Scan of cervical spine and brachial plexus – for specified conditions |\n| 63278 | MRI — Scan of cervical spine and brachial plexus forcervical radiculopathy (R) (Anaes.) (Contrast) | 492.80 | Subgroup 10 – Scan of cervical spine and brachial plexus – for specified conditions |\n| 63281 | MRI — Scan of cervical spine and brachial plexus forprevious surgery (R) (Anaes.) (Contrast) | 492.80 | Subgroup 10 – Scan of cervical spine and brachial plexus – for specified conditions |\n| 63302 | MRI — scan of musculoskeletal system for tumour arising in bone or musculoskeletal system, excluding tumours arising in breast, prostate or rectum (R) (Anaes.) (Contrast) | 380.80 | Subgroup 11 – Scan of musculoskeletal system – for specified conditions |\n| 63305 | MRI — scan of musculoskeletal system for infectionarising in bone or musculoskeletal system, excludinginfection arising in breast, prostate or rectum (R) (Anaes.) (Contrast) | 380.80 | Subgroup 11 – Scan of musculoskeletal system – for specified conditions |\n| 63308 | MRI — scan of musculoskeletal system for osteonecrosis (R) (Anaes.) (Contrast) | 380.80 | Subgroup 11 – Scan of musculoskeletal system – for specified conditions |\n| 63323 | MRI — scan of musculoskeletal system for derangement of hip or its supporting structures (R) (Anaes.) (Contrast) | 403.20 | Subgroup 12 – Scan of musculoskeletal system – for specified conditions |\n| 63324 | MRI — scan of musculoskeletal system for derangement of shoulder or its supporting structures (R) (Anaes.) (Contrast) | 403.20 | Subgroup 12 – Scan of musculoskeletal system – for specified conditions |\n| 63326 | MRI — scan of musculoskeletal system for derangement of knee or its supporting structures (R) (Anaes.) (Contrast) | 403.20 | Subgroup 12 – Scan of musculoskeletal system – for specified conditions |\n| 63327 | MRI — scan of musculoskeletal system for derangement of ankle or foot (or both) or its supporting structures (R) (Anaes.) (Contrast) | 403.20 | Subgroup 12 – Scan of musculoskeletal system – for specified conditions |\n| 63329 | MRI — scan of musculoskeletal system for derangement of 1 or both temporomandibular joints or their supporting structures (R) (Anaes.) (Contrast) | 336.00 | Subgroup 12 – Scan of musculoskeletal system – for specified conditions |\n| 63330 | MRI — scan of musculoskeletal system for derangement of wrist or hand (or both) or its supporting structures (R) (Anaes.) (Contrast) | 448.00 | Subgroup 12 – Scan of musculoskeletal system – for specified conditions |\n| 63332 | MRI — scan of musculoskeletal system for derangement of elbow or its supporting structures (R) (Anaes.) (Contrast) | 403.20 | Subgroup 12 – Scan of musculoskeletal system – for specified conditions |\n| 63363 | MRI — scan of musculoskeletal system for Gaucherdisease (R) (Anaes.) | 403.20 | Subgroup 13 – Scan of musculoskeletal system – for specified conditions |\n| 63386 | MRI — scan of cardiovascular system for congenitaldisease of the heart or a great vessel (R) (Anaes.)(Contrast) | 448.00 | Subgroup 14 – Scan of cardiovascular system – for specified conditions |\n| 63387 | MRI — scan of cardiovascular system for tumour of theheart or a great vessel (R) (Anaes.) (Contrast) | 448.00 | Subgroup 14 – Scan of cardiovascular system – for specified conditions |\n| 63389 | MRI — scan of cardiovascular system for abnormality of thoracic aorta (R) (Anaes.) (Contrast) | 403.20 | Subgroup 14 – Scan of cardiovascular system – for specified conditions |\n| 63402 | MRA — if the request for the scan specifically identifies the clinical indication for the scan — scan ofcardiovascular system for vascular abnormality in a patient with a previous anaphylactic reaction to an iodinated contrast medium (R) (Anaes.) (Contrast) | 403.20 | Subgroup 15 – Magnetic resonance angiography – scan of cardiovascular system – for specified conditions |\n| 63405 | MRA — if the request for the scan specifically identifies the clinical indication for the scan — scan ofcardiovascular system for obstruction of the superior vena cava, inferior vena cava or a major pelvic vein (R)(Anaes.) (Contrast) | 403.20 | Subgroup 15 – Magnetic resonance angiography – scan of cardiovascular system – for specified conditions |\n| 63417 | MRA — scan of person under the age of 16 for thevasculature of limbs prior to limb or digit transfer surgery in congenital limb deficiency syndrome (R) (Anaes.) (Contrast) | 403.20 | Subgroup 16 – Magnetic resonance angiography – for specified conditions – person under the age of 16 years |\n| 63426 | MRI — scan of person under the age of 16 forpost-inflammatory or post-traumatic physeal fusion (R)(Anaes.) | 403.20 | Subgroup 17 – Magnetic resonance imaging – for specified conditions – person under the age of 16 years |\n| 63429 | MRI — scan of person under the age of 16 for Gaucherdisease (R) (Anaes.) | 403.20 | Subgroup 17 – Magnetic resonance imaging – for specified conditions – person under the age of 16 years |\n| 63441 | MRI — scan of person under the age of 16 for pelvic orabdominal mass (R) (Anaes.) (Contrast) | 403.20 | Subgroup 18 – Magnetic resonance imaging – for specified conditions – person under the age of 16 years |\n| 63442 | MRI — scan of person under the age of 16 for mediastinal mass (R) (Anaes.) (Contrast) | 403.20 | Subgroup 18 – Magnetic resonance imaging – for specified conditions – person under the age of 16 years |\n| 63444 | MRI — scan of person under the age of 16 for congenital uterine or anorectal abnormality (R) (Anaes.) (Contrast) | 403.20 | Subgroup 18 – Magnetic resonance imaging – for specified conditions – person under the age of 16 years |\n| 63463 | MRI — scan of the body for adrenal mass in a patient with a malignancy that is otherwise resectable (R) (Anaes.) | 358.40 | Subgroup 19 – Scan of body – for specified conditions |\n| 63466 | MRI – scan of both breasts for the detection of cancer, if a dedicated breast coil is used, the request for the scan identifies that the woman is asymptomatic and is less than 50 years of age, and the request for the scan identifies:(a) that the patient is at high risk of developing breast cancer due to 1 of the following:(i) 3 or more first or second degree relatives on the same side of the family diagnosed with breast or ovarian cancer;(ii) 2 or more first or second degree relatives on the same side of the family diagnosed with breast or ovarian cancer, if any of the following applies to at least 1 of the relatives:(A) has been diagnosed with bilateral breast cancer:(B) had onset of breast cancer before the age of 40 years;(C) had onset of ovarian cancer before the age of 50 years;(D) has been diagnosed with breast and ovarian cancer, at the same time or at different times;(E) has Ashkenazi Jewish ancestry;(F) is a male relative who has had breast cancer;(iii) 1 first or second degree relative diagnosed with breast cancer at age 45 years or younger plus another first or second degree relative on the same side of the family with bone or soft tissue sarcoma at age 45 years or younger; or(b) that genetic testing has identified the presence of a high risk breast cancer gene mutation.(R) (Anaes) | 690.00 | Subgroup 19 – Scan of body – for specified conditions |\n| 63469 | MRI – scan of both breasts for the detection of cancer, if:(a) a dedicated breast coil is used: and(b) the woman has had an abnormality detected as a result of a service described in item 63464 or 63466 performed in the previous 12 months(R) (Anaes) | 690.00 | Subgroup 19 – Scan of body – for specified conditions |\n| 63472 | MRI — scan of the pelvis for the staging of histologically diagnosed cervical cancer at FIGO stages 1B or greater, if the request for scan identifies that:(a) a histological diagnosis of carcinoma of the cervix has been made; and(b) the patient has been diagnosed with cervicalcancer at FIGO stage 1B or greater.(R) (Anaes.) (Contrast) | 403.20 | Subgroup 20 – Scan of pelvis and upper abdomen – for specified conditions |\n| 63475 | MRI — scan of the pelvis and upper abdomen, in a single examination, for the staging of histologically diagnosed cervical cancer at FIGO stage 1B or greater, if the request for scan identifies that:(a) a histological diagnosis of carcinoma of the cervix has been made; and(b) the patient has been diagnosed with cervical cancer at FIGO stage 1B or greater.(R) (Anaes.) (Contrast) | 627.20 | Subgroup 20 – Scan of pelvis and upper abdomen – for specified conditions |\n| 63478 | MRI — scan of the pelvis for the initial staging of rectal cancer, if:(a) a phased array body coil is used; and(b) the request for scan identifies that the indication is for the initial staging of rectal cancer (including cancer of the rectosigmoid and anorectum).(R) (Anaes.) (Contrast) | 403.20 | Subgroup 20 – Scan of pelvis and upper abdomen – for specified conditions |\n| 63483 | MRI — scan of pancreas and biliary tree for suspectedbiliary or pancreatic pathology (R) (Anaes.) | 403.20 | Subgroup 21 – Scan of body – for specified conditions |\n| 63492 | MRI or MRA service to which an item in this Group(other than an item in this Subgroup) applies if:(a) the item for the service includes in its description‘(Contrast)’; and(b) the service is performed using a contrast agent | 44.80 | Subgroup 22 – Modifying items |\n| 63493 | MRI or MRA service to which an item in this Group(other than an item in this Subgroup) applies ifthe service is performed on a person usingintravenous or intra muscular sedation | 44.80 | Subgroup 22 – Modifying items |\n| 63495 | MRI or MRA service to which an item in this Group(other than an item in this Subgroup) applies ifthe service is performed on a person underanaesthetic in the presence of a medical practitionerwho is qualified to perform an anaesthetic | 156.80 | Subgroup 22 – Modifying items |\n\nNote Section 3C (7) of the Act deems an internal Territory to form part of the State of New South Wales.","sortOrder":13}],"analysis":{"flash_summary":{"complexity_score":7,"scope_assessment":{"changed":true,"description":"The Determination alters the standard scope of the diagnostic imaging services table for the named mobile MRI services by: treating those services as both professional and medical services for Act purposes (s6); specifying applicable item numbers and subgrouping (Schedule; ss7–11); imposing location/equipment/provider constraints (s5, s5AA); capping patient fees (s5(1)(d)–(e)); tying application to a regional funding agreement (s4 definition); and adding the services to bulk‑billing incentive rules (s5A). These changes reshape which Medicare benefits and billing rules apply to the affected services while the Determination is in force (ss2–3)."},"complexity_factors":["Cross‑references to the Health Insurance Act 1973 and to the diagnostic imaging services table (see Interpretation and clauses amending the table) (s4, ss7–11).","Numerous item‑level substitutions and linkage rules affecting which scan items can be claimed and how limits operate (ss7–11; Schedule).","Location‑ and equipment‑specific conditions that differ between Traralgon/Bega and Queensland sites, with separate permissible‑circumstance tests (s5, s5AA).","Eligibility and supervision requirements for reporting clinicians, including real‑time teleradiology and on‑site monitoring exceptions (definition of eligible provider; s5(3)–(8); s5AA(1)(b)).","Differential patient fee caps (75% or 85% of the scheduled fee) depending on item type (s5(1)(d)–(e)).","Linkage to an external funding agreement (RIL funding agreement) as a precondition for application (s4 definition; s5(1)(b)).","Inclusion in bulk‑billing incentive rules via a modification to the diagnostic imaging services table (s5A).","Temporal limitation (fixed commencement and cessation dates) that restricts the Determination's period of effect (ss2–3).","Specific expansion of the diagnostic items dental practitioners may request (s12) adding procedural complexity for referral sources."],"plain_english_summary":"This Determination sets Medicare rules for specific mobile MRI services based at Latrobe Regional Hospital (Traralgon) and at named hospitals in Rockhampton, Bundaberg and Gladstone. It says which Medicare item numbers apply, requires eligible diagnostic-radiology specialists for reporting/supervision (allowing teleradiology in some cases), and caps patient fees.\n\nIt matters because it changes which diagnostic‑imaging items and modifying rules apply to these mobile services, ties services to a regional funding agreement, creates after‑hours and emergency exceptions, and makes the services eligible for a bulk‑billing incentive."},"kimi_summary":{"_metrics":{"model":"kimi-k2.5","source":"moonshot-realtime","completionTokens":2360},"content_quality":"ok","complexity_score":6,"scope_assessment":{"changed":true,"description":"The determination expanded from its original scope covering only the Gippsland and South Eastern New South Wales mobile MRI service to additionally include the Rockhampton, Bundaberg and Gladstone mobile MRI service in Queensland (added as section 5AA). This introduced a second, geographically distinct operational framework with separate base hospital, equipment specifications and supervision requirements while maintaining a unified fee schedule."},"complexity_factors":["Dual geographic frameworks with distinct operational rules (Gippsland/SENSW vs Rockhampton/Bundaberg/Gladstone)","82 itemised services in the Schedule with specific clinical indications, fees and subgroup classifications","Extensive cross-referencing to the Health Insurance Act 1973, National Health Act 1953 and Diagnostic Imaging Services Table","Nested conditional logic for 'permissible circumstances' including emergency exceptions, after-hours provisions (5pm-9am), and remote location rules","Technical equipment specifications (GE Signa Echo Speed with Excite, 1.5 Tesla magnet on semi-trailer)","Teleradiology supervision protocols requiring real-time electronic transmission and telephone availability","Fee caps with differential percentages (75% vs 85%) based on service classification","Complex item modification rules mapping this Determination's items to existing Medicare Benefits Schedule items (e.g., sections 8-11)"],"plain_english_summary":"This determination allowed Medicare rebates for MRI/MRA scans performed by two specific mobile units (a Latrobe Regional Hospital service and Mater Rockhampton) using a GE Signa Echo Speed 1.5T MRI on a semi‑trailer in select regional VIC, NSW and QLD areas between 2009–2013. It required specialist referral and radiologist supervision (including approved teleradiology), capped patient fees, listed ~80 covered scan types, and modified normal Medicare rules (bulk‑billing incentives and 12‑month claim limits). It ended 30 June 2013."}},"importantCases":[],"_links":{"self":"/api/acts/health-insurance-gippsland-and-south-eastern-new-south-wales-mobile-mri-service-and-rockhampton-bund","history":"/api/acts/health-insurance-gippsland-and-south-eastern-new-south-wales-mobile-mri-service-and-rockhampton-bund/history","analysis":"/api/acts/health-insurance-gippsland-and-south-eastern-new-south-wales-mobile-mri-service-and-rockhampton-bund/analysis","conflicts":"/api/acts/health-insurance-gippsland-and-south-eastern-new-south-wales-mobile-mri-service-and-rockhampton-bund/conflicts","importantCases":"/api/acts/health-insurance-gippsland-and-south-eastern-new-south-wales-mobile-mri-service-and-rockhampton-bund/important-cases","documents":"/api/acts/health-insurance-gippsland-and-south-eastern-new-south-wales-mobile-mri-service-and-rockhampton-bund/documents"}}