{"id":"F2025L01015","name":"Health Insurance (Section 3C Diagnostic Imaging Services – Complex gynaecological ultrasound) Determination 2025","slug":"health-insurance-section-3c-diagnostic-imaging-services-complex-gynaecological-ultrasound-determinat","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442946,"registerId":"F2025L01015-fast-fetch-1775957855334","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Health Insurance (Section 3C Diagnostic Imaging Services – Complex gynaecological ultrasound) Determination 2025","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\n---\n\n![Commonwealth Coat of Arms of Australia](image.001.jpeg)\n\n \n\nHealth Insurance (Section 3C Diagnostic Imaging Services – Complex gynaecological ultrasound) Determination 2025\n\nI, Mary Warner, delegate of the Minister for Health and Ageing, make the following determination.\n\nDated 26 August 2025\n\n \n\n \n\n \n\n \n\n \n\nMary Warner\n\nAssistant Secretary\n\nDiagnostic Imaging and Pathology Branch\n\nMedicare Benefits and Digital Health Division\n\nHealth Resourcing Group\n\nDepartment of Health, Disability and Ageing\n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\nContents\n\n1.  Name \n\n2.  Commencement\n\n3.  Authority\n\n4.  Definitions\n\n5.  Treatment of relevant services\n\n6.  Application of provisions of the diagnostic imaging services table\n\nSchedule 1 – Relevant services\n\n \n\n1.  Name\n\n This instrument is the Health Insurance (Section 3C Diagnostic Imaging Services – Complex gynaecological ultrasound) Determination 2025.\n\n2.  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 \n\n- Commencement information\n- Column 1 Column 2 Column 3\n- Provisions Commencement Date/Details\n- 1. The whole of this instrument 1 November 2025. 1 November 2025\n\n\n Note: This table relates only to the provisions of this instrument as originally made.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.\n\n3.  Authority\n\n This instrument is made under subsection 3C(1) of the Health Insurance Act 1973.\n\n4.  Definitions\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 (1) In this instrument:\n\nAct means the Health Insurance Act 1973.\n\n(R) has the meaning given by subsection 1.2.15(1) of the diagnostic imaging services table.\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 10AC(1) of the Act, that is specified in a Schedule.\n\nSchedule means a Schedule to this instrument.\n\n \n\n5.  Treatment of relevant services\n\nFor 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 is:\n\n(i) related to the service; and\n\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 \n\n6.  Application of provisions of the diagnostic imaging services table\n\nClause 2.1.2 of the diagnostic imaging services table shall have effect as if item 55080 of Schedule 1 of this Determination was also specified in clause 2.1.2 of the diagnostic imaging services table.\n\n \n\nSchedule 1 – Relevant services\n\n \n\n- Group I1—Ultrasound\n- Column 1Item Column 2Description Column 3Fee ($)\n- Subgroup 1—General\n- 55080 Pelvis, ultrasound scan of, by any or all approaches (including transvaginal), if:(a) the patient is known to have, or the requesting practitioner suspects, a complex gynaecological condition; and (b) the service is considered a complex investigation requiring a minimum of 30 minutes scanning time; and(c) within 24 hours of the service, a service mentioned in item 55038, 55065, 55700, 55704, 55736, or 55739 is not performed on the same patient. (R) 255.00\n\n\n \n","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":3,"scope_assessment":{"changed":false,"description":"This instrument performs exactly the narrow, technical function intended by section 3C of the Health Insurance Act 1973: adding a specific new diagnostic imaging service to Medicare with defined fees and conditions. It has not expanded beyond its original statutory purpose."},"complexity_factors":["Short instrument: only 6 substantive clauses plus one Schedule","Minimal defined terms: only 4 definitions in section 4, plus references to existing Act definitions","Single operational mechanism: uses section 3C(1) of the parent Act to 'deem' services into the diagnostic imaging table","One cross-reference complexity: clause 6 modifies the effect of clause 2.1.2 of the diagnostic imaging services table by deeming item 55080 into it","Conditional eligibility in Schedule 1: three cumulative conditions (complex condition + 30 min minimum + 24-hour exclusion rule)","Reference to external table: relies on understanding of the '(R)' restricted status from the diagnostic imaging services table (subsection 1.2.15(1))"],"plain_english_summary":"The rule creates Medicare item 55080, a $255 rebate for complex gynaecological pelvic ultrasounds that take at least 30 minutes and are used for known or suspected complex gynaecological conditions. It bars claiming this rebate within 24 hours of other pelvic ultrasound items to prevent duplicate payments and is marked (R) for restricted practitioner eligibility.\n\nLegally, the Determination uses the Health Insurance Act power to treat this service as listed for Medicare reimbursement."},"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":true,"description":"This Determination expands the scope of Medicare-covered diagnostic imaging by adding a dedicated item for complex gynaecological pelvic ultrasound that is treated as both a professional and diagnostic imaging service, with specified eligibility criteria and a $255 fee. It therefore changes what services are recognised and payable under the diagnostic imaging services table and sets new billing/documentation rules. (Clause 5; Clause 6; Schedule 1, item 55080)"},"complexity_factors":["Single substantive change: inserts one new item (55080) into the diagnostic imaging services framework (Schedule 1). (Schedule 1)","Cross-reference to Health Insurance Act subsection 3C(1) as authority for treatment of services under Medicare rules. (Clause 3; Clause 5)","Interaction with existing diagnostic imaging services table: treated as if specified in clause 2.1.2 of that table, requiring alignment with existing billing rules. (Clause 6)","Eligibility conditions impose operational requirements: known/suspected complex gynaecological condition and minimum 30 minutes scanning time, creating documentation and clinical judgment obligations for providers. (Schedule 1, item 55080)","Mutual-exclusivity rule: item is not payable if certain other items (55038, 55065, 55700, 55704, 55736, 55739) are performed on same patient within 24 hours — increases billing complexity and audit risk. (Schedule 1, item 55080(c))","Fixed fee specification ($255) alters provider reimbursement incentives and may influence clinical coding and service length decisions. (Schedule 1, Column 3)","\"(R)\" marker references diagnostic imaging table definition (subsection 1.2.15(1)), requiring users to consult that table for related rules and meanings. (Definitions; Schedule 1)","Administrative timing: a clear commencement date requires systems and communications updates ahead of 1 November 2025. (Clause 2)"],"plain_english_summary":"This instrument adds a new Medicare diagnostic imaging item (55080) for complex gynaecological pelvic ultrasound, effective 1 November 2025. The item is payable only where a complex gynaecological condition is known or suspected, the scan is a complex investigation requiring at least 30 minutes of scanning, and certain other ultrasound items are not performed within 24 hours. It sets a flat fee of $255 and treats the service as both a professional and diagnostic imaging service under the Health Insurance Act."},"flash_summary_failed":{"failed":true,"reason":"Unauthenticated. Configure AI_GATEWAY_API_KEY or use a provider module. Learn more: https://ai-sdk.dev/unauthenticated-ai-gateway","source":"analysis-cron"}},"importantCases":[],"_links":{"self":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-complex-gynaecological-ultrasound-determinat","history":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-complex-gynaecological-ultrasound-determinat/history","analysis":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-complex-gynaecological-ultrasound-determinat/analysis","conflicts":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-complex-gynaecological-ultrasound-determinat/conflicts","importantCases":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-complex-gynaecological-ultrasound-determinat/important-cases","documents":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-complex-gynaecological-ultrasound-determinat/documents"}}