{"id":"F2025L00571","name":"Health Insurance (Section 3C Diagnostic Imaging Services – National Lung Cancer Screening Program) Determination 2025","slug":"health-insurance-section-3c-diagnostic-imaging-services-national-lung-cancer-screening-program-deter","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":106368,"registerId":"commonwealth-F2025L00571-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 – National Lung Cancer Screening Program) Determination 2025.","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 July 2025.

1 July 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\n```\n\nNote: This table relates only to the provisions of this instrument as originally made.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 (1) In this instrument:\n\n> Act means the Health Insurance Act 1973.\n\n> bulk‑billed has the meaning given by the Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020.\n\n> computed tomography or CT has the meaning given by the Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020.\n\n> pack-years means the number of cigarettes a person smoked per day multiplied by the number of years the person has smoked.\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 to this instrument.\n\n> remote location has the meaning given by the Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020.\n\n> smoke or smoking means the action of inhaling and exhaling cigarette tobacco and includes packaged cigarettes and roll-your-own cigarettes (rollies). It does not include other forms of tobacco or nicotine smoking or consumption, such as vaping.\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.\n\n> Note: A number of expressions used in this instrument are defined in the Act, including the following:\n\n  clinically relevant service;\n  diagnostic imaging services table;\n  item;\n  professional service.","sortOrder":3},{"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 general medical 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 1 in relation to the service.","sortOrder":4},{"sectionNumber":"6","sectionType":"section","heading":"Eligibility for services","content":"#### 6 Eligibility for services\n\n (1) A patient is eligible to receive a service specified in Schedule 1 to this instrument if they:\n (a) receive a request for the service as part of the National Lung Cancer Screening Program when they are aged between 50 years and 70 years and 364 days; and\n (b) are asymptomatic (show no signs or symptoms of lung cancer); and\n (c) currently smoke or have quit smoking in the past ten years; and\n (d) have a history of cigarette tobacco smoking of at least 30 pack-years.\n (2) If a patient has been assessed as eligible to receive a service described in items 57410 and 57413, the patient remains eligible to receive these services until they turn 71 years and 364 days.","sortOrder":5},{"sectionNumber":"7","sectionType":"section","heading":"Limitation on services","content":"#### 7 Limitation on services\n\n For the purposes of MBS items 57410 and 57413, clause 2.2.1(1)(a) of the diagnostic imaging services table does not apply if the services are provided as part of a mobile screening service provided more than 30 kilometres from a hospital that provides computed tomography radiology service or fixed radiology infrastructure.","sortOrder":6}],"analysis":{"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":false,"description":"The instrument confines scope to specified low‑dose CT services for the National Lung Cancer Screening Program (Schedule items 57410 and 57413) and related eligibility, billing and protocol requirements. The text shows no indication that it expands or narrows other existing classes of services beyond those specified."},"complexity_factors":["New MBS item creation and treatment as both professional and general medical services (s5) — interacts with multiple existing statutory regimes.","Detailed eligibility rules (age band, asymptomatic status, smoking history, pack‑years, quit within 10 years) require clinical verification and recordkeeping (s6).","Bulk‑billing requirement and fixed fee ($338.75) in Schedule — affects provider revenue and billing workflows (Schedule items 57410, 57413).","Requirement to use an agreed nodule management protocol — depends on adoption of external clinical protocols and standardised reporting (Schedule).","Linking and limitation rules for follow‑up scans (57413 linked to 57410) introduce sequencing and timing compliance obligations (Schedule, s6(2)).","Cross‑references to the diagnostic imaging services table, other regulations and clause 2.2.1(1)(a) create dependency on external provisions and definitions (ss4, 7).","Mobile screening exception (s7) introduces geographic eligibility nuances and logistical deployment considerations (>30 km from hospital).","Commencement timing (1 July 2025) requires administration and operational readiness across providers and IT/billing systems (s2)."],"plain_english_summary":"**What this does.** Creates two new MBS diagnostic items (57410, 57413) for low‑dose chest CTs under the National Lung Cancer Screening Program (commencing 1 July 2025). \n\n**Who it affects and why it matters.** Eligible, asymptomatic people aged 50–70 with ≥30 pack‑years who currently smoke or quit within 10 years can receive bulk‑billed scans that must follow an agreed nodule‑management protocol; each item pays $338.75 and a mobile‑screening exception applies for locations >30 km from a hospital."},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"The legislation remains tightly focused on its original purpose: establishing Medicare funding mechanisms for the National Lung Cancer Screening Program. It does not expand beyond creating the specific payment and eligibility framework for low-dose CT screening services."},"complexity_factors":["8 defined terms in section 4, with 4 terms referencing external regulations","Nested eligibility conditions in section 6 requiring cumulative criteria (age, smoking history, symptom status, program participation)","Cross-references to multiple external instruments: Health Insurance Act 1973, National Health Act 1953, and Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020","Conditional exception in section 7 that modifies the application of clause 2.2.1(1)(a) of the diagnostic imaging services table for remote/mobile services","Age calculation complexity with specific day counts ('70 years and 364 days', '71 years and 364 days')","Two distinct service items with different qualifying conditions (initial screening vs. follow-up with temporal linkage requirements)"],"plain_english_summary":"This law creates a new Medicare benefit funding free, bulk‑billed low‑dose CT lung‑cancer screening through the National Lung Cancer Screening Program. Eligible people (aged 50–70, current smokers or quit within 10 years, ≥30 pack‑years, asymptomatic, referred through the program) can receive an initial scan and follow‑up scans until age 71y 364d.\n\nIt also relaxes location rules so mobile screening services more than 30 km from CT‑equipped hospitals can operate, improving rural access."},"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-national-lung-cancer-screening-program-deter","history":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-national-lung-cancer-screening-program-deter/history","analysis":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-national-lung-cancer-screening-program-deter/analysis","conflicts":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-national-lung-cancer-screening-program-deter/conflicts","importantCases":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-national-lung-cancer-screening-program-deter/important-cases","documents":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-national-lung-cancer-screening-program-deter/documents"}}