{"id":"F2022L00461","name":"Health Insurance (Section 3C Diagnostic Imaging – Additional Nuclear Medicine Services) Determination 2022","slug":"health-insurance-section-3c-diagnostic-imaging-additional-nuclear-medicine-services-determination-20","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":102353,"registerId":"commonwealth-F2022L00461-current","compilationNumber":null,"startDate":"2026-04-03","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1. Name","sectionType":"section","heading":"1. Name","content":"#### 1. Name\n\n  This instrument is the Health Insurance (Section 3C Diagnostic Imaging – Additional Nuclear Medicine Services) Determination 2022.","sortOrder":0},{"sectionNumber":"3. Authority","sectionType":"section","heading":"3. Authority","content":"#### 3. Authority\n\n  This instrument is made under subsection 3C(1) of the Health Insurance Act 1973.","sortOrder":1},{"sectionNumber":"4. Definitions","sectionType":"section","heading":"4. Definitions","content":"#### 4. Definitions\n\n(1) In this instrument:\n\nAct means the Health Insurance Act 1973.\n\nPET means positron emission tomography.\n\nrelevant 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.\n\nrelevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in a Schedule.\n\nSchedule means a Schedule to this instrument.\n\nNote: The following terms are defined in subsection 3(1) of the Act:\n\n clinically relevant service;\n\n diagnostic imaging services table;\n\n item;\n\n professional service.\n\n(2) Unless the contrary intention appears, a reference in this instrument 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.","sortOrder":2},{"sectionNumber":"5. Treatment of relevant services","sectionType":"section","heading":"5. Treatment of relevant services","content":"#### 5\\. Treatment of relevant services\n\n  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:\n\n(a) it were both a professional service and a diagnostic imaging service; and\n\n(b) there were an item in the diagnostic imaging services table that:\n\n    related to the service; and\n    specified for the service a fee in relation to each State, being the fee specified in the Schedule in relation to the service.","sortOrder":3},{"sectionNumber":"6. Application of provisions of the diag","sectionType":"section","heading":"6. Application of provisions of the diagnostic imaging services table","content":"#### 6\\. Application of provisions of the diagnostic imaging services table\n\n  (1) Paragraphs 2.4.1(b) and (c) of the diagnostic imaging services table shall have effect as if items in Schedule 1 of this instrument were specified for the purpose of those paragraphs.\n  (2) Clause 2.4.2 of the diagnostic imaging services table shall have effect as if the items in Schedule 1 of this instrument were specified in subclause 2.4.2(1).","sortOrder":4},{"sectionNumber":"7. Restriction on items — services conne","sectionType":"section","heading":"7. Restriction on items — services connected with provision of PET nuclear scanning during thallous chloride 201 (T1‑201) interruptions","content":"#### 7. Restriction on items – services connected with provision of PET nuclear scanning during thallous chloride 201 (T1‑201) interruptions\n\n  (1) Item 61644 only applies to a service described in the item, if:\n\n(a) the patient’s clinical condition requires the service to be performed before the resumption of normal thallous chloride 201 (T1‑201) supply is anticipated by the practitioner who provides the service; and\n\n(b) the report of the service performed includes a justification for the substitute service, which describes the unavailability of a service to which item 61325 applies.","sortOrder":5},{"sectionNumber":"8. Schedules","sectionType":"section","heading":"8. Schedules","content":"#### 8. Schedules\n\n  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.","sortOrder":6}],"analysis":{"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"},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"The instrument remains tightly focused on its original purpose: adding specific nuclear medicine services to Medicare via the section 3C pathway. It does not expand beyond diagnostic imaging into other health service categories."},"complexity_factors":["Multiple nested definitions requiring cross-referencing to the Health Insurance Act 1973 and National Health Act 1953","Conditional logic in section 7 requiring both clinical necessity AND documentary justification for substitute services","Incorporation by reference of external documents (diagnostic imaging services table provisions in section 6)","Technical medical terminology (PET, thallous chloride 201, nuclear scanning) requiring specialised knowledge","Dual classification treatment (services treated as both 'professional services' AND 'diagnostic imaging services')","State-based fee variations implied but not detailed in the visible text (fees specified in Schedules not shown)"],"plain_english_summary":"This instrument adds certain PET nuclear medicine scans to Australia’s Medicare so patients can claim rebates, creates corresponding Medicare item numbers with set fees by state, and lets clinicians bill for substitute PET scans when thallous chloride is unavailable — provided they document the medical necessity.\n\nIt affects patients needing advanced imaging, the doctors and clinics who provide PET scans, and Medicare’s claims processing by expanding access to key diagnostic tools."},"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":true,"description":"This instrument expands the set of services treated under subsection 3C(1) by specifying additional PET nuclear medicine services as both professional and diagnostic imaging items and by specifying state‑level fees in the Schedule. It also imposes a conditional limitation on substitute item 61644 during thallous chloride (T1‑201) supply interruptions, requiring practitioner justification in reports."},"complexity_factors":["Short instrument but relies heavily on cross‑references to the Health Insurance Act 1973, the National Health Act 1953 and the diagnostic imaging services table.","Creates itemised fees by State via a Schedule rather than embedding amounts in the primary text, requiring users to consult the Schedule.","Applies specific provisions of the diagnostic imaging services table (paragraphs 2.4.1(b),(c) and clause 2.4.2) as if the new items were specified there, creating interpretive links.","Conditional restriction on item 61644 that depends on practitioner anticipation of supply resumption and requires a justification in the report—places evidentiary and clinical‑judgement burdens on providers.","Schedules may amend or repeal other instruments, so implementation requires cross‑checking amended instruments.","Interpretation clause adopts external provisions 'as in force from time to time', creating ongoing compliance monitoring obligations."],"plain_english_summary":"This Determination adds specified nuclear medicine positron emission tomography (PET) services to Medicare’s diagnostic‑imaging framework by treating them as both professional services and diagnostic imaging items and by setting state‑by‑state fees in its Schedule. It affects practitioners who supply PET scans and Medicare claim administrators; during thallous chloride (T1‑201) supply interruptions it limits one substitute item (61644) to clinically urgent cases and requires the practitioner’s report to justify the substitution."}},"importantCases":[],"_links":{"self":"/api/acts/health-insurance-section-3c-diagnostic-imaging-additional-nuclear-medicine-services-determination-20","history":"/api/acts/health-insurance-section-3c-diagnostic-imaging-additional-nuclear-medicine-services-determination-20/history","analysis":"/api/acts/health-insurance-section-3c-diagnostic-imaging-additional-nuclear-medicine-services-determination-20/analysis","conflicts":"/api/acts/health-insurance-section-3c-diagnostic-imaging-additional-nuclear-medicine-services-determination-20/conflicts","importantCases":"/api/acts/health-insurance-section-3c-diagnostic-imaging-additional-nuclear-medicine-services-determination-20/important-cases","documents":"/api/acts/health-insurance-section-3c-diagnostic-imaging-additional-nuclear-medicine-services-determination-20/documents"}}