{"id":"F2024L01517","name":"Health Insurance (Section 3C Diagnostic Imaging Services – Cardiac MRI for Myocarditis) Determination 2024","slug":"health-insurance-section-3c-diagnostic-imaging-services-cardiac-mri-for-myocarditis-determination-20","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":105478,"registerId":"commonwealth-F2024L01517-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 Services – Cardiac MRI for Myocarditis) Determination 2024.","sortOrder":0},{"sectionNumber":"2","sectionType":"section","heading":"Commencement","content":"#### 2 Commencement\n\n (1) Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.\n\n```html\n

Commencement information

Column 1

Column 2

Column 3

Provisions

Commencement

Date/Details

1. The whole of this instrument

1 January 2025

1 January 2025

\n```\n\nNote: This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.\n\n (2) Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.","sortOrder":1},{"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":2},{"sectionNumber":"4","sectionType":"section","heading":"Definitions","content":"#### 4 Definitions\n\n> Note: A number of expressions used in this instrument are defined in subsection 3(1) of the Act, including the following:\n\n (a) clinically relevant service;\n (b) diagnostic imaging services table;\n (c) general medical services table;\n (d) item;\n (e) professional service.\n In this instrument:\n\n> Act means the Health Insurance Act 1973.\n\n> (Anaes.) has the meaning given by subsection 5.9.4(1) of the general medical services table.\n\n> MRI has the meaning given by the diagnostic imaging services table.\n\n> (R) has the meaning given by subsection 1.2.15(1) of the diagnostic imaging services table.\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> (1) 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":3},{"sectionNumber":"5","sectionType":"section","heading":"Treatment of relevant services","content":"#### 5 Treatment of relevant services\n\n (1) 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.\n\n> Note: For this Determination, an internal Territory is deemed to form part of the State of New South Wales – see subsection 3C(7) of the Act.","sortOrder":4},{"sectionNumber":"6","sectionType":"section","heading":"Application of provisions of the diagnostic imaging services table","content":"#### 6 Application of provisions of the diagnostic imaging services table\n\n (1) The item in the Schedule applies to an MRI service if all of the following apply:\n (a) it is performed in a permissible circumstance, as described in clause 2.5.3 of the diagnostic imaging services table;\n (b) it is performed by a person who is:\n (i) a specialist in diagnostic radiology; and satisfies the Chief Executive Medicare that the specialist is a participant in the Royal Australian and New Zealand College of Radiologists’ Quality and Accreditation Program; or\n (ii) a specialist in diagnostic radiology or a consultant physician; and is recognised by the Conjoint Committee for Certification in Cardiac MRI;\n (c) it is performed using equipment that is:\n (i) eligible equipment, as described in clause 2.5.5 of the diagnostic imaging services table; or\n (ii) partial eligible equipment, as described in clause 2.5.6 of the diagnostic imaging services table.\n (2) Subject to paragraph (1)(b), clause 2.5.4 of the diagnostic imaging services table shall have effect as if the item in the Schedule were also specified in column 1 of item 1 and 2 of table 2.5.4.","sortOrder":5},{"sectionNumber":"7","sectionType":"section","heading":"Application of contrast","content":"#### 7 Application of contrast\n\n (1) If a service to which an item in the Schedule applies is performed using a contrast agent, the fee specified in that item applies in addition to the schedule fee in item 63491 of the diagnostic imaging services table.\n\nSchedule 1—Relevant services\n\n```html\n

Group I5—Magnetic Resonance Imaging

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 14—scan of cardiovascular system – for specified conditions

63390

MRI – scan of the cardiovascular system for the assessment of myocardial structure and function and characterisation, if the service is requested by a specialist or consultant physician who has assessed the patient, and the request for the scan indicates:

(a) acute onset (less than 3 months) heart failure caused by suspected myocarditis which would otherwise require endomyocardial biopsy to confirm the diagnosis of myocarditis; or

(b) unexplained arrhythmia caused by suspected myocarditis which would otherwise require endomyocardial biopsy to confirm the diagnosis of myocarditis; or

(c) suspected drug-induced myocarditis, where the results from the following examinations are inconclusive to form a diagnosis:

i. troponin; and

ii. chest x-ray, and

iii. transthoracic echocardiogram.

(R) (Anaes.) (Contrast)

616.60

\n```","sortOrder":6}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This legislation remains tightly focused on its original purpose: creating a specific Medicare rebate for cardiac MRI scans to diagnose myocarditis. The scope has not expanded beyond this single, narrow clinical indication."},"complexity_factors":["Multiple nested cross-references to external documents (diagnostic imaging services table, general medical services table, Health Insurance Act 1973)","Dual qualification pathways for practitioners (clause 6(1)(b) presents two alternative certification routes with different requirements)","Conditional logic for patient eligibility — three distinct clinical scenarios with specific prerequisites, including nested sub-conditions for drug-induced myocarditis (troponin, chest x-ray, and echocardiogram must all be inconclusive)","Incorporation of external standards by reference (Royal Australian and New Zealand College of Radiologists' Quality and Accreditation Program, Conjoint Committee for Certification in Cardiac MRI)","Technical medical terminology requiring specialist knowledge (endomyocardial biopsy, transthoracic echocardiogram, troponin)","Interaction with existing Medicare item 63491 for contrast agents"],"plain_english_summary":"This law creates a new Medicare-funded cardiac MRI item for diagnosing myocarditis, making non‑invasive imaging available and subsidised for patients with suspected inflammatory heart disease who meet clinical criteria, when requested by specialist clinicians and performed by accredited radiologists.\n\nIt reduces reliance on invasive heart biopsy, increases access to appropriate imaging, and sets the framework for approved equipment, qualified providers, and Medicare rebates (including an extra payment when contrast is used)."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"Yes. The Determination adds a new specified relevant service (Schedule item 63390) for cardiac MRI for suspected myocarditis and directs that it be treated as both a professional and diagnostic imaging service under subsection 3C(1) of the Act, with a fixed fee ($616.60), conditions on requester, performer and equipment, and an additional contrast fee where used. Key provisions: treatment as a relevant service (cl.5), item conditions and fee (Schedule item 63390), performer/equipment requirements (cl.6), contrast fee application (cl.7), commencement 1 January 2025 (cl.2)."},"complexity_factors":["Cross-references to external schedules and clauses (diagnostic imaging services table clauses 2.5.3–2.5.6 and item 63491) increase interpretive load (see cl.6(1)(a),(c) and cl.7).","Provider qualification and accreditation requirements create verification obligations: Chief Executive Medicare confirmation of RANZCR Quality and Accreditation Program participation, or Conjoint Committee recognition for cardiac MRI (cl.6(1)(b)).","Narrow clinical eligibility with multiple alternative criteria and prerequisite tests (acute onset heart failure, unexplained arrhythmia, or inconclusive troponin/chest x‑ray/echocardiogram) requires documentation on specialist request (Schedule item 63390).","Fee interaction: a new fee is specified for the service and an additional contrast fee is applied referencing an existing diagnostic imaging item (cl.7; Schedule).","Administrative and compliance burden: recordkeeping to demonstrate requester, performer, equipment eligibility and clinical criteria; potential auditing by Medicare (cl.5, cl.6, Schedule).","Territorial and commencement mechanics (instrumental commencement date and internal territory deeming) affect when and where the item applies (cl.2; note to cl.5)."],"plain_english_summary":"Creates a Medicare‑recognised item for cardiac MRI scans used to assess suspected myocarditis, setting a fee ($616.60), specifying who can request and perform the scan, and requiring eligible equipment and accreditation. It also permits an additional contrast fee. The Determination takes effect 1 January 2025 and affects specialists, imaging providers and patients by making these scans claimable under the Health Insurance Act when the listed clinical criteria and administrative conditions are met."},"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"}},"importantCases":[],"_links":{"self":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-cardiac-mri-for-myocarditis-determination-20","history":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-cardiac-mri-for-myocarditis-determination-20/history","analysis":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-cardiac-mri-for-myocarditis-determination-20/analysis","conflicts":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-cardiac-mri-for-myocarditis-determination-20/conflicts","importantCases":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-cardiac-mri-for-myocarditis-determination-20/important-cases","documents":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-cardiac-mri-for-myocarditis-determination-20/documents"}}