{"id":"F2018L00257","name":"Health Insurance (Permitted benefits — diagnostic imaging services) Determination 2018","slug":"health-insurance-permitted-benefits-diagnostic-imaging-services-determination-2018","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":96889,"registerId":"commonwealth-F2018L00257-current","compilationNumber":null,"startDate":"2026-04-02","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Health Insurance (Permitted benefits — diagnostic imaging services) Determination 2018","content":"![](image.001.png)\n\nHealth Insurance (Permitted benefits — diagnostic imaging services) Determination 2018\n\nHealth Insurance Act 1973\n\nI, Celia Street, delegate of the Minister for Health, make this Determination under section 23DZZIG of the Health Insurance Act 1973.\n\nDated 13 March 2018\n\nCELIA STREET\n\nAssistant Secretary\n\nDiagnostic Imaging and Pathology Branch\n\nMedical Benefits Division\n\nDepartment of Health\n\n1 Name\n\nThis Determination is the Health Insurance (Permitted benefits — diagnostic imaging services) Determination 2018.\n\n2 Commencement\n\nThis Determination commences on the day after it is registered.\n\n3 Authority\n\nThis Determination is made under section 23DZZIG of the Health Insurance Act 1973.\n\n4 Definitions\n\nIn this Determination:\n\n> Act means the Health Insurance Act 1973.\n\n> Note: Diagnostic imaging equipment, diagnostic imaging service, hospital and specialist are defined in subsection 3(1) of the Act. Provider, requester and connected are defined in subsection 23DZZID(1) of the Act.\n\n5 Repeal\n\nThe Health Insurance (Permitted benefits – diagnostic imaging services) Determination 2008 is repealed.\n\n6 Permitted benefits for diagnostic imaging services\n\n(1) For section 23DZZIG of the Act, a benefit mentioned in Schedule 1 is a class of permitted benefit if:\n\n(a) a beneficiary who is, or is connected to, a requester of a kind of diagnostic imaging service, asks for, or accepts, the benefit from a provider, or a person connected to a provider, of a kind of diagnostic imaging service; or\n\n(b) a provider, or a person connected to a provider, of a kind of diagnostic imaging service offers or provides the benefit to a beneficiary who is, or is connected to, a requester of a kind of diagnostic imaging service.\n\n(2) However, a benefit is not a permitted benefit if:\n\n(a) it is related to the number, kind or value of requests for diagnostic imaging services made by a requester to a particular provider; or\n\n(b) taken with other benefits of the same kind, it exceeds the number that would usually be needed by the beneficiary’s practice.\n\nSchedule 1 Classes of permitted benefits\n\n(section 6)\n\n    1 Items related to diagnostic imaging that help the requester to read film or images, or to make requests for the rendering of services relating to diagnostic imaging, if:\n\n(a) they do not have the effect of preventing the requester from reading film or images produced by a provider other than the provider of the benefit or making requests for the rendering of services relating to diagnostic imaging to a provider other than the provider of the benefit; and\n\n(b) one of the following applies:\n\n(i) they can only be used for purposes connected with diagnostic imaging;\n\n(ii) if an item has more than 1 use — it has special features that help the requester to request the rendering of diagnostic imaging services or view images.\n\nExamples\n\n1 Light box\n\n2 Requesting software\n\n3 Digital imaging reading software\n\n4 Monitor designed specifically to enable the requester to view images\n\n    2 The provision of staff or diagnostic imaging equipment at premises of the beneficiary if:\n\n(a) the premises are located more than 30 km by road from a radiology facility that is under the direction of a specialist in the specialty of diagnostic radiology; or\n\n(b) the premises are a hospital; or\n\n(c) the staff or equipment are stationed at the premises for the sole purpose of enabling services relating to diagnostic imaging to be rendered during a surgical procedure performed at the premises (including a procedure performed by fine needle aspiration).\n\n    3 Free or discounted diagnostic imaging services to a patient who is, or is connected to, the requester.\n    4 Educational material about diagnostic imaging, including material that may be given to patients.\n    5 Education sessions on diagnostic imaging for the beneficiary if:\n\n(a) the primary objective of the session is to provide relevant information about diagnostic imaging; and\n\n(b) the venue is appropriate for the educational purpose of the session; and\n\n(c) any hospitality given is secondary to the educational purpose of the session; and\n\n(d) the cost of any hospitality is reasonable having regard to the venue and the conduct of the session; and\n\n(e) no travel or accommodation costs of the beneficiary are paid by the provider of the benefit; and\n\n(f) the session does not include, and is not held with, a sporting event or other entertainment.\n\nExamples of topics for educational material or sessions\n\n1 Appropriate requesting of diagnostic imaging services\n\n2 Understanding results and reports for areas of diagnostic imaging and for particular processes\n\n    6 Gifts or hospitality if:\n\n(a) they are a non‑cash benefit that is not convertible to cash; and\n\n(b) they are given infrequently and only in relation to a significant occasion; and\n\n(c) they are not given as inducement, consideration or reward for the beneficiary requesting diagnostic imaging services from a particular provider; and\n\n(d) the cost of the gift or hospitality is reasonable in the circumstances.\n\nExamples\n\n1 Flowers given because of the death of a family member of the beneficiary\n\n2 Hospitality given for Christmas parties\n\n    7 Diagnostic imaging request forms, promotional publications and promotional items, including material promoting the quality, convenience and cost to patients of diagnostic imaging services, if:\n\n(a) it has no resale value for the beneficiary; and\n\n(b) it is clearly identified as coming from the provider of the diagnostic imaging service.","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This appears to be a straightforward re-enactment/update of the 2008 Determination it repeals. The scope remains tightly focused on regulating permitted benefits in the diagnostic imaging sector, consistent with the original legislative intent under section 23DZZIG of the Health Insurance Act 1973. No significant scope creep is evident."},"complexity_factors":["Moderate cross-referencing: Relies on definitions from the parent Health Insurance Act 1973 (subsections 3(1) and 23DZZID(1)) for key terms like 'provider', 'requester', and 'connected'","Conditional logic with nested exceptions: Section 6 establishes permitted benefits through a two-tier structure—general permission in subsection (1) followed by specific exclusions in subsection (2), plus multiple qualifying conditions throughout Schedule 1","7 distinct categories of permitted benefits in Schedule 1, each with 2-6 specific qualifying conditions (e.g., item 5 has 6 sub-conditions for educational sessions)","Vague evaluative terms requiring interpretation: 'reasonable in the circumstances', 'infrequently', 'significant occasion', 'secondary to', 'usual need'—these create interpretive uncertainty","Defined terms section is minimal (only 'Act' defined) but delegates heavily to parent legislation for operational definitions"],"plain_english_summary":"It establishes a whitelist of benefits diagnostic imaging providers may give to referring doctors, replacing 2008 rules. Affecting radiology clinics, referring clinicians, and indirectly patients, it permits practical support (e.g., equipment, software, training, modest hospitality) while banning benefits tied to referral volume or value — aiming to prevent inducements and keep referrals based on clinical need."},"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"Section 5 expressly repeals the 2008 Determination and replaces it with this updated list of permitted benefits. The new Determination both specifies permitted categories (Schedule 1) and adds or clarifies constraints: a distance test for on‑site staff/equipment (>30 km) and hospital exception (Schedule 1 item 2), detailed conditions on education and hospitality (Schedule 1 item 5–6), promotional item limits (Schedule 1 item 7), and explicit exclusions for benefits tied to referral volumes or exceeding usual practice needs (s6(2))."},"complexity_factors":["Cross-references to the Health Insurance Act 1973 for key definitions (see s4: Act; note references to subsections 3(1) and 23DZZID(1)).","Conditional structure in s6: permitted benefit depends on who asks, accepts, offers or provides (s6(1) versus s6(2) exclusions).","Aggregate and inducement limits: prohibition where benefit is related to number/kind/value of requests or, with other like benefits, exceeds what the beneficiary’s practice would usually need (s6(2)(a)–(b)).","Open-text standards requiring judgment: multiple provisions use terms needing interpretation—'reasonable' cost, 'infrequently', 'primary objective', 'significant occasion' (Schedule 1 items 5 and 6).","Fact-based bright-line test: >30 km by road distance for staffing/equipment exception (Schedule 1 item 2(a)) requires geographic measurement and verification.","Mixed categories of benefits (equipment, staffing, services, education, gifts, promotional items) each carry different conditional limits, creating varied compliance checks (Schedule 1 items 1–7).","Repeal and replacement of prior Determination (s5) means implementers must map old entitlements to the new list and update policies and records."],"plain_english_summary":"This Determination lists the specific benefits diagnostic imaging providers may give to requesting doctors, their patients, or connected persons, and the conditions under which those benefits are permitted. It allows items, staffing/equipment in certain locations, free or discounted scans, education, limited gifts and promotional material, while barring benefits tied to the number/kind/value of referral requests or those exceeding what a practitioner would usually need, so providers must check distance, purpose, frequency and ‘reasonable’ cost tests."}},"importantCases":[],"_links":{"self":"/api/acts/health-insurance-permitted-benefits-diagnostic-imaging-services-determination-2018","history":"/api/acts/health-insurance-permitted-benefits-diagnostic-imaging-services-determination-2018/history","analysis":"/api/acts/health-insurance-permitted-benefits-diagnostic-imaging-services-determination-2018/analysis","conflicts":"/api/acts/health-insurance-permitted-benefits-diagnostic-imaging-services-determination-2018/conflicts","importantCases":"/api/acts/health-insurance-permitted-benefits-diagnostic-imaging-services-determination-2018/important-cases","documents":"/api/acts/health-insurance-permitted-benefits-diagnostic-imaging-services-determination-2018/documents"}}