{"id":"F2019L00480","name":"Health Insurance (Section 3C Diagnostic Imaging Services – Liver and Obstetric MRI Services) Determination 2019","slug":"health-insurance-section-3c-diagnostic-imaging-services-liver-and-obstetric-mri-services-determinati","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"repealed","isInForce":false,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":99080,"registerId":"commonwealth-F2019L00480-current","compilationNumber":null,"startDate":"2026-04-02","status":"Repealed","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"Contents","sectionType":"subdivision","heading":"Contents","content":"#### Contents\n\n1. Name 1\n\n2. Commencement 1\n\n3. Authority 1\n\n4. Definitions 1\n\n5. Treatment of relevant services 2\n\n6. Bulk-billing—magnetic resonance imaging 3\n\n7. Application of items 63454 and 63460 3\n\n8. Application of items 63545 and 63546 3\n\n9. Application of contrast 4\n\nSchedule 1 – relevant services 5\n\nPart 1 – MRI obstetric services for suspected fetal central nervous system abnormality 5\n\nPart 2 – MRI services for colorectal or hepatocellular carcinomas 6\n\nPart 3 – Hepatobiliary-specific contrast agent services 7\n\nEndnotes 8\n\nEndnote 1—About the endnotes 8\n\nEndnote 2—Abbreviation key 9\n\nEndnote 3—Legislation history 10\n\nEndnote 4—Amendment history 11","sortOrder":0},{"sectionNumber":"1. Name","sectionType":"part","heading":"1. Name","content":"# 1. Name\n\n This Determination is the Health Insurance (Section 3C Diagnostic Imaging Services – Liver and Obstetric MRI Services) Determination 2019.","sortOrder":1},{"sectionNumber":"2. Commencement","sectionType":"part","heading":"2. 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 May 2019

\n```\n\nNote: This table relates only to the provisions of this instrument as originally made.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":2},{"sectionNumber":"3. Authority","sectionType":"part","heading":"3. Authority","content":"# 3. Authority\n\nThis Determination is made under subsection 3C(1) of the Health Insurance Act 1973.","sortOrder":3},{"sectionNumber":"4. Definitions","sectionType":"part","heading":"4. Definitions","content":"# 4. Definitions\n\n(1) In this Determination:\n\nAct means the Health Insurance Act 1973.\n\neligible equipment has the meaning given by clause 2.5.5 of the diagnostic imaging services table.\n\neligible provider has the meaning given by clause 2.5.4 (item 1) of the diagnostic imaging services table.\n\n(K) has the meaning given by subclause 1.2.1(2) of the diagnostic imaging services table.\n\n(NK) has the meaning given by subclause 1.2.1(1) of the diagnostic imaging services table.\n\npartial eligible equipment has the meaning given by clause 2.5.6 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 that Act, 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 the Schedule.\n\nremote location has the meaning given by the same term in Part 3 of the diagnostic imaging services table.\n\nscan means a minimum of 3 sequences.\n\nsequence, for a scan, means a series of images collected at the same time with similar image parameters (not including a scan designed to establish patient position and subsequently used to plan other scans).\n\nSchedule means the Schedule to this Determination.\n\nNote: The following terms are defined in subsection 3(1) of the Act:\n\n- clinically relevant service\n- consultant physician\n- diagnostic imaging services table\n- general medical services table\n- item\n- professional service\n- specialist\n\nNote: For the effect of the term (Anaes.) used in items in this table, see subclause 2.44.5(2) of the general medical services table.\n\n(2) Unless the contrary intention appears, a reference in this Determination 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":4},{"sectionNumber":"5. Treatment of relevant services","sectionType":"part","heading":"5. Treatment of relevant services","content":"# 5. Treatment of relevant services\n\nFor subsection 3C(1) of the Act a relevant service, provided in accordance with this Determination 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(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.","sortOrder":5},{"sectionNumber":"6. Bulk-billing—magnetic resonance imagi","sectionType":"part","heading":"6. Bulk-billing—magnetic resonance imaging","content":"# 6. Bulk-billing—magnetic resonance imaging\n\n Clause 1.2.10 of the diagnostic imaging services table shall have effect as if an item in Schedule 1 of this Determination were specified in paragraph 1.2.10(1)(a) of the diagnostic imaging services table.","sortOrder":6},{"sectionNumber":"7. Application of items 63454 and 63460","sectionType":"part","heading":"7. Application of items 63454 and 63460","content":"# 7. Application of items 63454 and 63460\n\n(1) For any particular patient, items 63454 and 63460 apply to a service performed:\n\n(a) in a permissible circumstance; and\n\n(b) using:\n\n(i) eligible equipment; or\n\n(ii) partial eligible equipment.\n\n(2) For any particular patient, a request for items 63454 and 63460 must be:\n\n(a) made in writing; and\n\n(b) identify the clinical indications for the service.\n\n(3) For the purposes of paragraph 7(1)(a), a service is performed in a permissible circumstance only if it is:\n\n(a) both:\n\n(i) performed under the supervision of an eligible provider who is available to monitor and influence the conduct and diagnostic quality of the examination, including, if necessary, by personal attendance on the patient; and\n\n(ii) reported by an eligible provider; or\n\n(b) performed in an emergency; or\n\n(c) performed because of medical necessity, in a remote location.","sortOrder":7},{"sectionNumber":"8. Application of items 63545 and 63546","sectionType":"part","heading":"8. Application of items 63545 and 63546","content":"# 8. Application of items 63545 and 63546\n\n (1) For any particular patient, items 63545 and 63546 apply to a service performed:\n (a) at the request of a specialist or consultant physician in accordance with subsection 8(2); and\n (b) in a permissible circumstance; and\n (c) using:\n (i) eligible equipment; or\n (ii) partial eligible equipment.\n (2) For any particular patient, a request for items 63545 and 63546 must be:\n (a) made in writing; and\n (b) identify the clinical indications for the service.\n (3) For the purposes of paragraph 8(1)(b), a service is performed in a permissible circumstance only if it is:\n (a) both:\n (i) performed under the supervision of an eligible provider who is available to monitor and influence the conduct and diagnostic quality of the examination, including, if necessary, by personal attendance on the patient; and\n (ii) reported by an eligible provider; or\n (b) performed in an emergency; or\n (c) performed because of medical necessity, in a remote location.","sortOrder":8},{"sectionNumber":"9. Application of contrast","sectionType":"part","heading":"9. Application of contrast","content":"# 9. Application of contrast\n\n (1) An item in the Determination including the symbol (Contrast) applies in addition to:\n (a) Item 63491 of the diagnostic imaging services table, if the service to which items 63454 or 63460 applies is performed using a contrast agent; or\n (b) Item 63496 of the Determination, if the service to which items 63545 or 63546 applies is performed using a hepatobiliary-specific contrast agent; or\n (c) Item 63491 of the diagnostic imaging services table, if the service to which items 63545 or 63546 applies is:\n (i) performed using an extracellular contrast agent; and\n (ii) the requesting practitioner indicates the need for imaging with an extracellular contrast agent.","sortOrder":9},{"sectionNumber":"Schedule 1","sectionType":"part","heading":"relevant services","content":"# Schedule 1 – relevant services\n\n# Part 1 – MRI obstetric services for suspected fetal central nervous system abnormality\n\n```html\n

Group I5 – Magnetic Resonance Imaging

Subgroup 19 – Scan of Body – for specified conditions

Item

Service

Fee ($)

63454

MRI – scan of the pelvis or abdomen, if:

(a) the pregnancy is on, or after, 18 weeks gestation; and

(b) fetal central nervous system abnormality is suspected; and

(c) an ultrasound has been performed and is provided by, or on behalf of, or at the request of, a specialist who is practising in the specialty of obstetrics, and diagnosis is indeterminate or requires further examination; and

(d) the service is requested by a specialist practising in the specialty of obstetrics.

(R) (K) (Anaes.) (Contrast)

1200.00

63460

MRI – scan of the pelvis or abdomen, if:

(a) the pregnancy is on, or after, 18 weeks gestation; and

(b) fetal central nervous system abnormality is suspected; and

(c) an ultrasound has been performed and is provided by, or on behalf of, or at the request of, a specialist who is practising in the specialty of obstetrics, and diagnosis is indeterminate or requires further examination; and

(d) the service is requested by a specialist practising in the specialty of obstetrics.

(R) (NK) (Anaes.) (Contrast)

600.00

\n```\n\n# Part 2 – MRI services for colorectal or hepatocellular carcinomas\n\n```html\n

Group I5 – Magnetic Resonance Imaging

Subgroup 21 – Scan of Body – for specified conditions

Item

Service

Fee ($)

63545

MRI – multiphase scans of the liver (including delayed imaging, if performed) with a contrast agent, for characterisation or intervention planning, in a patient with:

(a) known colorectal carcinoma; and

(b) known, suspected, or possible liver metastasis; and

(c) computed tomography or ultrasound imaging have identified a mass lesion in the liver.

For any particular patient—applicable not more than once in a 12 month period (R) (K) (Anaes.) (Contrast)

550.00

63546

MRI – multiphase scans of the liver (including delayed imaging, if performed) with a contrast agent, for diagnosis or staging, in a patient with known or suspected hepatocellular carcinoma, and:

(a) chronic liver disease, that has been confirmed by a specialist or consultant physician; and

(b) liver function identified as Child-Pugh class A or B; and

(c) an identified hepatic lesion over 10 mm in diameter.

For any particular patient—applicable not more than once in a 12 month period (R) (K) (Anaes.) (Contrast)

550.00

\n```\n\n# Part 3 – Hepatobiliary-specific contrast agent services\n\n```html\n

Group I5 – Magnetic Resonance Imaging

Subgroup 22 – Modifying items

Item

Service

Fee

63496

MRI service to which an item in 63545 or 63546 applies if:

a) the service is performed under the supervision of an eligible provider; and

b) the service is performed on a person using a hepatobiliary-specific contrast agent.

250.00

\n```","sortOrder":10},{"sectionNumber":"Part 1","sectionType":"part","heading":"MRI obstetric services for suspected fetal central nervous system abnormality","content":"# Part 1 – MRI obstetric services for suspected fetal central nervous system abnormality\n\n```html\n

Group I5 – Magnetic Resonance Imaging

Subgroup 19 – Scan of Body – for specified conditions

Item

Service

Fee ($)

63454

MRI – scan of the pelvis or abdomen, if:

(a) the pregnancy is on, or after, 18 weeks gestation; and

(b) fetal central nervous system abnormality is suspected; and

(c) an ultrasound has been performed and is provided by, or on behalf of, or at the request of, a specialist who is practising in the specialty of obstetrics, and diagnosis is indeterminate or requires further examination; and

(d) the service is requested by a specialist practising in the specialty of obstetrics.

(R) (K) (Anaes.) (Contrast)

1200.00

63460

MRI – scan of the pelvis or abdomen, if:

(a) the pregnancy is on, or after, 18 weeks gestation; and

(b) fetal central nervous system abnormality is suspected; and

(c) an ultrasound has been performed and is provided by, or on behalf of, or at the request of, a specialist who is practising in the specialty of obstetrics, and diagnosis is indeterminate or requires further examination; and

(d) the service is requested by a specialist practising in the specialty of obstetrics.

(R) (NK) (Anaes.) (Contrast)

600.00

\n```","sortOrder":11},{"sectionNumber":"Part 2","sectionType":"part","heading":"MRI services for colorectal or hepatocellular carcinomas","content":"# Part 2 – MRI services for colorectal or hepatocellular carcinomas\n\n```html\n

Group I5 – Magnetic Resonance Imaging

Subgroup 21 – Scan of Body – for specified conditions

Item

Service

Fee ($)

63545

MRI – multiphase scans of the liver (including delayed imaging, if performed) with a contrast agent, for characterisation or intervention planning, in a patient with:

(a) known colorectal carcinoma; and

(b) known, suspected, or possible liver metastasis; and

(c) computed tomography or ultrasound imaging have identified a mass lesion in the liver.

For any particular patient—applicable not more than once in a 12 month period (R) (K) (Anaes.) (Contrast)

550.00

63546

MRI – multiphase scans of the liver (including delayed imaging, if performed) with a contrast agent, for diagnosis or staging, in a patient with known or suspected hepatocellular carcinoma, and:

(a) chronic liver disease, that has been confirmed by a specialist or consultant physician; and

(b) liver function identified as Child-Pugh class A or B; and

(c) an identified hepatic lesion over 10 mm in diameter.

For any particular patient—applicable not more than once in a 12 month period (R) (K) (Anaes.) (Contrast)

550.00

\n```","sortOrder":12},{"sectionNumber":"Part 3","sectionType":"part","heading":"Hepatobiliary-specific contrast agent services","content":"# Part 3 – Hepatobiliary-specific contrast agent services\n\n```html\n

Group I5 – Magnetic Resonance Imaging

Subgroup 22 – Modifying items

Item

Service

Fee

63496

MRI service to which an item in 63545 or 63546 applies if:

a) the service is performed under the supervision of an eligible provider; and

b) the service is performed on a person using a hepatobiliary-specific contrast agent.

250.00

\n```","sortOrder":13}],"analysis":{"kimi_summary":{"_metrics":{"model":"kimi-k2.5","source":"moonshot-realtime","completionTokens":1312},"content_quality":"ok","complexity_score":5,"scope_assessment":{"changed":false,"description":"The Determination remains focused on its original stated purpose of establishing Medicare items for liver and obstetric MRI services. The scope covers exactly the two clinical areas identified in the title (fetal central nervous system abnormalities and hepatocellular/colorectal carcinoma imaging) without expansion into unrelated medical services."},"complexity_factors":["Extensive cross-referencing to external tables (Diagnostic Imaging Services Table) and the Health Insurance Act 1973","Technical medical terminology requiring specialist knowledge (hepatobiliary-specific contrast agents, Child-Pugh classification, multiphase scans)","Multiple conditional eligibility criteria including gestational age thresholds, prior imaging requirements, and specialist referral pathways","Equipment eligibility hierarchies (eligible vs partial eligible equipment)","Symbolic notation requiring interpretation (K, NK, Anaes., Contrast, R) defined in external instruments","Dual legislative framework references (Health Insurance Act 1973 and National Health Act 1953)"],"plain_english_summary":"This Determination adds new Medicare rebate items for specialised MRI: obstetric MRIs for pregnant women ≥18 weeks when a fetal brain or spinal abnormality is suspected after an inconclusive ultrasound, and liver MRIs for patients with possible colorectal liver metastases or hepatocellular carcinoma in chronic liver disease (limited to once per 12 months). A $250 extra rebate applies when hepatobiliary-specific contrast is used. All services must use approved MRI equipment, be requested and reported by specialists, and meet emergency/remote and bulk-billing rules."}},"importantCases":[],"_links":{"self":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-liver-and-obstetric-mri-services-determinati","history":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-liver-and-obstetric-mri-services-determinati/history","analysis":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-liver-and-obstetric-mri-services-determinati/analysis","conflicts":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-liver-and-obstetric-mri-services-determinati/conflicts","importantCases":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-liver-and-obstetric-mri-services-determinati/important-cases","documents":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-liver-and-obstetric-mri-services-determinati/documents"}}