{"id":"F2022L01472","name":"Health Insurance (Section 3C Diagnostic Imaging Services – Whole Body Magnetic Resonance Imaging Scan) Determination 2022","slug":"health-insurance-section-3c-diagnostic-imaging-services-whole-body-magnetic-resonance-imaging-scan-d","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":102849,"registerId":"commonwealth-F2022L01472-current","compilationNumber":null,"startDate":"2026-04-03","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1. Name","sectionType":"section","heading":"1. Name","content":"#### 1. Name\n\n This instrument is the Health Insurance (Section 3C Diagnostic Imaging Services – Whole Body Magnetic Resonance Imaging Scan) Determination 2022.","sortOrder":0},{"sectionNumber":"3. Authority","sectionType":"section","heading":"3. Authority","content":"#### 3. Authority\n\n This instrument is made under subsection 3C(1) of the Health Insurance Act 1973.","sortOrder":1},{"sectionNumber":"4. Definitions","sectionType":"section","heading":"4. Definitions","content":"#### 4. Definitions\n\n(1) In this instrument:\n\nAct means the Health Insurance Act 1973.\n\nMRI means magnetic resonance imaging.\n\n(R) has the meaning given by clause 1.2.15(1) of the diagnostic imaging services table.\n\nrelevant provisions mean 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 3C(8) of the Act, that is specified in a Schedule.\n\nSchedule means a Schedule to this instrument.\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(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.","sortOrder":2},{"sectionNumber":"5. Treatment of relevant services","sectionType":"section","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 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:\n\ni. related to the service; and\n\nii. 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. Application of provisions of the diag","sectionType":"section","heading":"6. Application of provisions of the diagnostic imaging services table","content":"#### 6\\. Application of provisions of the diagnostic imaging services table\n\n (1) Clause 1.2.17 of the diagnostic imaging services table shall have effect as if the items in Schedule 1 of this instrument were specified for the purpose of that clause.","sortOrder":4},{"sectionNumber":"7. Limitation of items","sectionType":"section","heading":"7. Limitation of items","content":"#### 7. Limitation of items\n\n (1) A service described under item 63564 applies only if the same patient has not received a service to which the same item applies within the preceding 12 months.\n\nSchedule – relevant services\n\n```html\n

Group I5 – Magnetic Resonance Imaging

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 19 – Scan of Body – For Specified Conditions

63564

MRI – whole body scan for the early detection of cancer:

a) requested by a specialist or consultant physician in consultation with a clinical geneticist in a familial cancer or genetic clinic; and

b) the request identifies that the patient has a high risk of developing cancer malignancy

due to heritable TP53 ‑ related cancer (hTP53rc) syndrome

(R) (Anaes.)

1,655.20

\n```","sortOrder":5}],"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":3,"scope_assessment":{"changed":false,"description":"The legislation maintains a tight scope consistent with its title and purpose. It creates exactly one new Medicare item for one specific clinical indication (whole body MRI for hTP53rc syndrome). There is no scope creep — it does not expand to other cancer syndromes, other imaging modalities, or broader screening populations."},"complexity_factors":["Very short instrument (approximately 1,500 words)","Only 5 defined terms in section 4, with most definitions referencing external legislation","Single operative item in the Schedule (item 63564)","Simple conditional structure: one service, one fee, one 12-month limitation rule","Heavy reliance on external legislative framework (Health Insurance Act 1973, diagnostic imaging services table) rather than creating complex internal machinery","No nested exceptions or elaborate administrative procedures"],"plain_english_summary":"This law adds Medicare item 63564: an annual whole‑body MRI for people with confirmed heritable TP53‑related cancer (hTP53rc) syndrome, claimable when requested via a familial cancer/genetic clinic and limited to one scan per 12 months. It lets eligible patients receive early cancer surveillance without full out‑of‑pocket cost — Medicare fee $1,655.20 — affecting patients, specialist referrers, and MRI providers."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":false,"description":"The instrument defines and confines coverage to a specific clinically defined service (whole‑body MRI for hTP53rc patients) with a listed fee and an annual claim limit. The text does not indicate it alters an earlier, broader legal scope; it specifies eligibility and billing treatment rather than stating it expands or withdraws pre‑existing categories."},"complexity_factors":["Clinical eligibility gate: requires a specialist request in consultation with a clinical geneticist and explicit identification of hTP53rc risk (Schedule item 63564) — adds evidentiary and referral complexity for providers.","Statutory cross‑references: instrument operates via subsection 3C(1) of the Health Insurance Act 1973 and incorporates provisions of the diagnostic imaging services table (cl.3; cl.6), requiring interpretation of external tables (1.2.15(1), 1.2.17).","Defined‑term and incorporation rules: multiple defined terms and a saving that referenced Acts/regulations apply as in force from time to time (cl.4(1)–(2)) — creates ongoing interpretive complexity as external law changes.","Funding/claim mechanics: treats the service as both a professional and diagnostic imaging service and as if an item with a specified fee exists for each State (cl.5(b)), which affects billing and Medicare claiming procedures.","Frequency limit: a statutory 12‑month limitation on the same‑item claim per patient (cl.7(1)) imposes monitoring and compliance burdens on providers and payers.","Administrative detail in Schedule: precise fee ($1,655.20), item code (63564) and (R) Anaes. notation require alignment with billing systems and anaesthesia/ancillary billing rules."],"plain_english_summary":"This determination makes whole‑body MRI scans for early cancer detection in people with heritable TP53‑related cancer (hTP53rc) syndrome eligible for Medicare when requested by a specialist in consultation with a clinical geneticist. Medicare is treated as meeting a specified fee ($1,655.20) for the service and the scan is claimable as both a professional and diagnostic imaging item, limited to one claim per patient in any 12‑month period (see Schedule item 63564; cl.5; cl.7)."}},"importantCases":[],"_links":{"self":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-whole-body-magnetic-resonance-imaging-scan-d","history":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-whole-body-magnetic-resonance-imaging-scan-d/history","analysis":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-whole-body-magnetic-resonance-imaging-scan-d/analysis","conflicts":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-whole-body-magnetic-resonance-imaging-scan-d/conflicts","importantCases":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-whole-body-magnetic-resonance-imaging-scan-d/important-cases","documents":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-whole-body-magnetic-resonance-imaging-scan-d/documents"}}