{"id":"F2023L00688","name":"Health Insurance (Section 3C Diagnostic Imaging – Conjunctive Thallium-201 Nuclear Medicine Imaging Service) Determination 2023","slug":"health-insurance-section-3c-diagnostic-imaging-conjunctive-thallium-201-nuclear-medicine-imaging-ser","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":104399,"registerId":"commonwealth-F2023L00688-current","compilationNumber":null,"startDate":"2026-04-03","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Name","content":"#### 1 Name\n\n  This instrument is the Health Insurance (Section 3C Diagnostic Imaging – Conjunctive Thallium‑201 Nuclear Medicine Imaging Service) Determination 2023.","sortOrder":0},{"sectionNumber":"3","sectionType":"section","heading":"Authority","content":"#### 3 Authority\n\n  This instrument is made under subsection 3C(1) of the Health Insurance Act 1973.","sortOrder":1},{"sectionNumber":"4","sectionType":"section","heading":"Definitions","content":"#### 4 Definitions\n\n  (1) In this instrument:\n\n> Act means the Health Insurance Act 1973.\n\n> bulk‑billed means:\n\n    (a) a medicare benefit is payable to a person in relation to the service; and\n    (b) under an agreement entered into under section 20A of the Act:\n    (i) the person assigns to the practitioner, by whom the service is provided, the person’s right to the payment of the medicare benefit; and\n    (ii) the practitioner accepts the assignment in full payment of the practitioner’s fee for the service provided.\n\n> PET means positron emission tomography.\n\n> 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.\n\n> relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in a Schedule.\n\n> Schedule means a Schedule to this instrument.\n\n> Note: 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 of 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","sectionType":"section","heading":"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    (a) it were both a professional service and a diagnostic imaging service; and\n    (b) there were an item in the diagnostic imaging services table that:\n    i. related to the service; and\n    ii. 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","sectionType":"section","heading":"Schedules","content":"#### 6 Schedules\n\nEach 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":4}],"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":2,"scope_assessment":{"changed":false,"description":"This instrument performs exactly the narrow, technical function suggested by its title: adding one specific diagnostic imaging service to Medicare coverage. It does not expand beyond this single purpose."},"complexity_factors":["Very short instrument (6 sections, approximately 400 words)","Only 6 defined terms in section 4, plus 4 terms referenced from parent Act","Single operative provision (section 5) with straightforward conditional logic","No nested exceptions or complex cross-referencing beyond standard incorporation of parent Act provisions","Mechanistic structure: standard template for adding MBS items under section 3C of the Health Insurance Act 1973","Schedule content not included in provided text, but structure suggests simple fee specification table"],"plain_english_summary":"This instrument adds a new Medicare Benefit Schedule item for conjunctive thallium‑201 nuclear medicine heart imaging and sets the Medicare fees by state.  \n\nIt affects patients seeking this specific subsidised scan and the cardiologists, nuclear medicine specialists and imaging practices who perform it, ensuring the test is covered by Medicare rather than fully out‑of‑pocket."},"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":true,"description":"Yes. The instrument changes how the specified thallium‑201 conjunctive nuclear medicine imaging service is treated for Medicare by declaring it both a professional and a diagnostic imaging service and by providing for an item with state‑specific fees in the diagnostic imaging table (s5). It also effects amendments/repeals of instruments listed in Schedules (s6). The practical scope change (who may claim, billing pathways, fee amounts) depends on the Schedule content and on other provisions incorporated by reference (s4(2))."},"complexity_factors":["Relies on external statutory authority (subsection 3C(1) of the Health Insurance Act 1973) so effect depends on interpretation of that provision (Authority, s3).","Dual classification as both a professional service and a diagnostic imaging service creates interaction with different itemisation and claiming rules (s5).","State‑specific fee setting requires schedules listing fees by State; practical complexity depends on the (external) Schedule content (s5).","Definitions cross‑link to other Act provisions and to section 20A agreements for bulk‑billing, adding compliance steps for practitioners (Definitions, s4).","Schedules may amend or repeal other instruments, producing cascade effects and interpretive work to reconcile instruments (s6).","Temporal incorporation clause ties references to provisions 'as in force from time to time', creating dynamic legal reference points (s4(2)).","Instrument is short on operational claiming procedures and relies on ‘relevant provisions’ in other statutes and regulations, so implementers must consult multiple sources (s5)."],"plain_english_summary":"This instrument specifies that a particular thallium‑201 conjunctive nuclear medicine imaging service is to be treated for Medicare purposes as both a professional service and a diagnostic imaging service, and that an item with state‑specific fees is to apply (s5). It affects medical practitioners who provide and bill the service and the Medicare payment rules (including bulk‑billing mechanics); it matters because it fixes how the service is classified, billed and paid under the Health Insurance Act."}},"importantCases":[],"_links":{"self":"/api/acts/health-insurance-section-3c-diagnostic-imaging-conjunctive-thallium-201-nuclear-medicine-imaging-ser","history":"/api/acts/health-insurance-section-3c-diagnostic-imaging-conjunctive-thallium-201-nuclear-medicine-imaging-ser/history","analysis":"/api/acts/health-insurance-section-3c-diagnostic-imaging-conjunctive-thallium-201-nuclear-medicine-imaging-ser/analysis","conflicts":"/api/acts/health-insurance-section-3c-diagnostic-imaging-conjunctive-thallium-201-nuclear-medicine-imaging-ser/conflicts","importantCases":"/api/acts/health-insurance-section-3c-diagnostic-imaging-conjunctive-thallium-201-nuclear-medicine-imaging-ser/important-cases","documents":"/api/acts/health-insurance-section-3c-diagnostic-imaging-conjunctive-thallium-201-nuclear-medicine-imaging-ser/documents"}}