1
Citation \[see Note 1\]
1 Citation [see Note 1]
These Regulations may be cited as the Health Insurance
(1996-97 Diagnostic Imaging Services Table) Regulations.
//
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Commonwealth legislation
This Act has been repealed and is no longer in force. It is retained for historical reference.
These Regulations set a detailed list of diagnostic imaging services and fixed fees payable under the Health Insurance Act 1973, replacing the 1995–96 table and commencing 1 November 1996. They define who may provide each service, specialist‑only items, fee formulas and reductions for multiple services. This matters because it determines what imaging attracts a Medicare benefit, the exact amounts providers can claim and the likely out‑of‑pocket charge for patients, thereby altering provider billing and referral incentives.
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Direct links to the current provisions in Health Insurance (1996-97 Diagnostic Imaging Services Table) Regulations.
1 Citation [see Note 1]
These Regulations may be cited as the Health Insurance
(1996-97 Diagnostic Imaging Services Table) Regulations.
2 Commencement
These Regulations commence on 1 November 1996.
3 Repeal of Health Insurance (1995-96 Diagnostic Imaging Services Table) Regulations
Statutory Rules 1995 No. 299 and 1996 No. 128 are repealed.
4 Diagnostic imaging services table
The table of diagnostic imaging services set out in the Schedule is prescribed for the purposes of subsection 4AA (1) of the Health Insurance Act 1973.
Schedule Table of diagnostic imaging services
(regulation 4)
Part 1 Rules of interpretation
1 General
In this table, unless the contrary intention appears:
the Act means the Health Insurance Act 1973.
2 References to items in the general medical services table
A reference by number to an item in the series 11603 to 11612 (inclusive) is a reference to the item so numbered in the general medical services table.
3 Meaning of (R) and (NR)
(1) An item including the symbol (R) is an R-type diagnostic imaging service.
(2) An item including the symbol (NR) is an NR-type diagnostic imaging service.
4 Meaning of (S)
An item including the symbol (S) applies only to a service provided by a specialist in the practice of diagnostic radiology.
5 Who may provide a diagnostic imaging service
A diagnostic imaging service set out in this table is a diagnostic imaging service for the purposes of the Act, whether the service is provided by:
(a) a medical practitioner; or
(b) a person, other than a medical practitioner, who:
(i) is employed by a medical practitioner; or
(ii) provides the service under the supervision of a medical practitioner in accordance with accepted medical practice.
6 Meaning of report in certain items
In items 55028 to 61109 (inclusive), report means a report prepared by a medical practitioner.
7 Administration of anaesthetics in connection with certain services
If a general anaesthetic is administered in connection with a service specified in an item that includes the formula:
Anaes. n = n1 B + n2 T
in which:
(a) n is a number; and
(b) n1 and n2 are other numbers;
the service that is provided by the medical practitioner who administers the anaesthetic is the service described in item n in the general medical services table.
8 Meaning of group of practitioners
In this table, group of practitioners has the same meaning as in subsection 16A (10) of the Act.
9 Meaning of medical practitioner in certain items
(1) In items 55028 to 55033 (inclusive), medical practitioner in the phrase referred by a medical practitioner or the referring medical practitioner includes a dental practitioner who is approved by the Minister under paragraph (b) of the definition of professional service in subsection 3 (1) of the Health Insurance Act 1973.
(2) In items 55050 to 55053 (inclusive), medical practitioner in the phrase referred by a medical practitioner or the referring medical practitioner includes a dental practitioner who is:
(a) approved by the Minister under paragraph (b) of the definition of professional service in subsection 3 (1) of the Health Insurance Act 1973; or
(b) a prosthodontist.
10 Meaning of Amount under rule 10 in certain items
In items 59103 and 59739, Amount under rule 10 means an amount equal to the sum of:
(a) the fee set out in another item for the radiographic examination in conjunction with which a service referred to in item 59103 or 59739 is provided; and
(b) 1 of the following amounts:
(i) in the case of item 59103 — $21.10;
(ii) in the case of item 59739 — $22.40.
11 Preparation of patients for radiological procedures
Items 60903 to 60981 (inclusive) apply only to the preparation of a patient for a radiological procedure for a service to which an item in Group I3 applies by:
(a) injecting opaque or contrast media; or
(b) removing fluid and replacing it with air, oxygen or other contrast media; or
(c) a similar method.
12 Meaning of angiography suite in item 61109
In item 61109, angiography suite means a room that contains only equipment designed for angiography that is able to perform digital subtraction or rapid sequence film angiography.
13 Nuclear scanning services
Items 61302 to 61503 (inclusive) apply to a nuclear scanning service only if:
(a) the performance of the scan is undertaken:
(i) by a specialist or consultant physician; or
(ii) by a person acting on behalf of a specialist or consultant physician in the presence of the specialist or consultant physician; and
(b) the compilation of the final report is undertaken by the specialist or consultant physician who undertook the preliminary examination of the patient and the estimation and administration of the dosage.
14 Meaning of Amount under rule 14 in item 61462
In item 61462, Amount under rule 14 means an amount equal to the sum of:
(a) the fee set out in the item in group I4 in conjunction with which a service referred to in item 61462 is provided; and
(b) $110.00.
15 Multiple services
(1) If a medical practitioner renders 2 or more diagnostic imaging services for the same patient on the same day, the fees set out in the items that apply to the services, other than the item with the highest fee, are reduced by $5.00.
(2) If a medical practitioner renders:
(a) at least 1 R-type diagnostic imaging service; and
(b) at least 1 consultation;
for the same patient on the same day, the highest fee, set out in the items that apply to any diagnostic imaging services rendered by the medical practitioner for the same patient on the same day, is reduced by the least of:
(c) if the fee for the consultation is at least $40.00-$35.00; or
(d) if the fee for the consultation is less than $40.00-$15.00; or
(e) that fee.
(3) Subrule (2) only applies to the consultation for which the highest fee is set out in the items that apply to the consultations.
(4) If a medical practitioner renders:
(a) at least 1 R-type diagnostic imaging service; and
(b) at least 1 non-consultation service;
for the same patient on the same day, the highest fee, set out in the items that apply to any diagnostic imaging services rendered by the medical practitioner for the same patient on the same day, is reduced by $5.00.
(5) If a medical practitioner renders:
(a) an R-type diagnostic imaging service; and
(b) a consultation; and
(c) a non-consultation service;
for the same patient on the same day, the sum of the reductions under subrules (2) and (4) is not to exceed the highest fee set out in the items that apply to any diagnostic imaging services rendered by the medical practitioner for the same patient on the same day.
(6) This rule does not apply to diagnostic imaging services that are rendered in a remote area by a medical practitioner for whom a remote area exemption under section 23DX of the Act is in force for that area.
(7) In this rule:
consultation means a service under an item listed in Groups A1 to A9 of the general medical services table.
non-consultation service means a service under an item listed in the general medical service table other than in Groups A1 to A9.
(8) A reference in this rule to a highest fee is a reference to a fee for an item in the first claim processed by the Commission for which subrule (1), (2) or (4) applies.
Sourced from the Federal Register of Legislation (legislation.gov.au), CC BY 4.0.
Health Insurance (1996-97 Diagnostic Imaging Services Table) Regulations
Statutory Rules 1996 No. 233 as amended
made under the
Health Insurance Act 1973
This compilation was prepared on 7 August 2001
taking into account amendments up to SR 1997 No. 12
[Note: These regulations were repealed by SR 1997 No. 297]
Prepared by the Office of Legislative Drafting,
Attorney-General’s Department, Canberra
Contents
Page
1 Citation [see Note 1]
2 Commencement
3 Repeal of Health Insurance (1995-96 Diagnostic Imaging Services Table) Regulations
4 Diagnostic imaging services table
Schedule Table of diagnostic imaging services
Part 1 Rules of interpretation
1 General
2 References to items in the general medical services table
3 Meaning of (R) and (NR)
4 Meaning of (S)
5 Who may provide a diagnostic imaging service
6 Meaning of report in certain items
7 Administration of anaesthetics in connection with certain services
8 Meaning of group of practitioners
9 Meaning of medical practitioner in certain items
10 Meaning of Amount under rule 10 in certain items
11 Preparation of patients for radiological procedures
12 Meaning of angiography suite in item 61109
13 Nuclear scanning services
14 Meaning of Amount under rule 14 in item 61462
15 Multiple services
Part 2 Services and fees
Notes
1 Citation [see Note 1]
These Regulations may be cited as the Health Insurance
(1996-97 Diagnostic Imaging Services Table) Regulations.
2 Commencement
These Regulations commence on 1 November 1996.
3 Repeal of Health Insurance (1995-96 Diagnostic Imaging Services Table) Regulations
Statutory Rules 1995 No. 299 and 1996 No. 128 are repealed.
4 Diagnostic imaging services table
The table of diagnostic imaging services set out in the Schedule is prescribed for the purposes of subsection 4AA (1) of the Health Insurance Act 1973.
Schedule Table of diagnostic imaging services
(regulation 4)
Part 1 Rules of interpretation
1 General
In this table, unless the contrary intention appears:
the Act means the Health Insurance Act 1973.
2 References to items in the general medical services table
A reference by number to an item in the series 11603 to 11612 (inclusive) is a reference to the item so numbered in the general medical services table.
3 Meaning of (R) and (NR)
(1) An item including the symbol (R) is an R-type diagnostic imaging service.
(2) An item including the symbol (NR) is an NR-type diagnostic imaging service.
4 Meaning of (S)
An item including the symbol (S) applies only to a service provided by a specialist in the practice of diagnostic radiology.
5 Who may provide a diagnostic imaging service
A diagnostic imaging service set out in this table is a diagnostic imaging service for the purposes of the Act, whether the service is provided by:
(a) a medical practitioner; or
(b) a person, other than a medical practitioner, who:
(i) is employed by a medical practitioner; or
(ii) provides the service under the supervision of a medical practitioner in accordance with accepted medical practice.
6 Meaning of report in certain items
In items 55028 to 61109 (inclusive), report means a report prepared by a medical practitioner.
7 Administration of anaesthetics in connection with certain services
If a general anaesthetic is administered in connection with a service specified in an item that includes the formula:
Anaes. n = n1 B + n2 T
in which:
(a) n is a number; and
(b) n1 and n2 are other numbers;
the service that is provided by the medical practitioner who administers the anaesthetic is the service described in item n in the general medical services table.
8 Meaning of group of practitioners
In this table, group of practitioners has the same meaning as in subsection 16A (10) of the Act.
9 Meaning of medical practitioner in certain items
(1) In items 55028 to 55033 (inclusive), medical practitioner in the phrase referred by a medical practitioner or the referring medical practitioner includes a dental practitioner who is approved by the Minister under paragraph (b) of the definition of professional service in subsection 3 (1) of the Health Insurance Act 1973.
(2) In items 55050 to 55053 (inclusive), medical practitioner in the phrase referred by a medical practitioner or the referring medical practitioner includes a dental practitioner who is:
(a) approved by the Minister under paragraph (b) of the definition of professional service in subsection 3 (1) of the Health Insurance Act 1973; or
(b) a prosthodontist.
10 Meaning of Amount under rule 10 in certain items
In items 59103 and 59739, Amount under rule 10 means an amount equal to the sum of:
(a) the fee set out in another item for the radiographic examination in conjunction with which a service referred to in item 59103 or 59739 is provided; and
(b) 1 of the following amounts:
(i) in the case of item 59103 — $21.10;
(ii) in the case of item 59739 — $22.40.
11 Preparation of patients for radiological procedures
Items 60903 to 60981 (inclusive) apply only to the preparation of a patient for a radiological procedure for a service to which an item in Group I3 applies by:
(a) injecting opaque or contrast media; or
(b) removing fluid and replacing it with air, oxygen or other contrast media; or
(c) a similar method.
12 Meaning of angiography suite in item 61109
In item 61109, angiography suite means a room that contains only equipment designed for angiography that is able to perform digital subtraction or rapid sequence film angiography.
13 Nuclear scanning services
Items 61302 to 61503 (inclusive) apply to a nuclear scanning service only if:
(a) the performance of the scan is undertaken:
(i) by a specialist or consultant physician; or
(ii) by a person acting on behalf of a specialist or consultant physician in the presence of the specialist or consultant physician; and
(b) the compilation of the final report is undertaken by the specialist or consultant physician who undertook the preliminary examination of the patient and the estimation and administration of the dosage.
14 Meaning of Amount under rule 14 in item 61462
In item 61462, Amount under rule 14 means an amount equal to the sum of:
(a) the fee set out in the item in group I4 in conjunction with which a service referred to in item 61462 is provided; and
(b) $110.00.
15 Multiple services
(1) If a medical practitioner renders 2 or more diagnostic imaging services for the same patient on the same day, the fees set out in the items that apply to the services, other than the item with the highest fee, are reduced by $5.00.
(2) If a medical practitioner renders:
(a) at least 1 R-type diagnostic imaging service; and
(b) at least 1 consultation;
for the same patient on the same day, the highest fee, set out in the items that apply to any diagnostic imaging services rendered by the medical practitioner for the same patient on the same day, is reduced by the least of:
(c) if the fee for the consultation is at least $40.00-$35.00; or
(d) if the fee for the consultation is less than $40.00-$15.00; or
(e) that fee.
(3) Subrule (2) only applies to the consultation for which the highest fee is set out in the items that apply to the consultations.
(4) If a medical practitioner renders:
(a) at least 1 R-type diagnostic imaging service; and
(b) at least 1 non-consultation service;
for the same patient on the same day, the highest fee, set out in the items that apply to any diagnostic imaging services rendered by the medical practitioner for the same patient on the same day, is reduced by $5.00.
(5) If a medical practitioner renders:
(a) an R-type diagnostic imaging service; and
(b) a consultation; and
(c) a non-consultation service;
for the same patient on the same day, the sum of the reductions under subrules (2) and (4) is not to exceed the highest fee set out in the items that apply to any diagnostic imaging services rendered by the medical practitioner for the same patient on the same day.
(6) This rule does not apply to diagnostic imaging services that are rendered in a remote area by a medical practitioner for whom a remote area exemption under section 23DX of the Act is in force for that area.
(7) In this rule:
consultation means a service under an item listed in Groups A1 to A9 of the general medical services table.
non-consultation service means a service under an item listed in the general medical service table other than in Groups A1 to A9.
(8) A reference in this rule to a highest fee is a reference to a fee for an item in the first claim processed by the Commission for which subrule (1), (2) or (4) applies.
Part 2 Services and fees
<table cellspacing="0" cellpadding="0" style="border-collapse:collapse"><thead><tr><td style="width:38.85pt; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span>Item</span></p></td><td style="width:251.45pt; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span>Diagnostic imaging service</span></p></td><td style="width:45.9pt; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead" style="text-align:center"><span>Fee</span></p></td></tr></thead><tbody><tr><td colspan="3" style="width:357.8pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span>Group I1</span><span> </span><span>— Ultrasound</span></p></td></tr><tr><td colspan="3" style="width:357.8pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead2"><span>Subgroup 1</span><span> </span><span>— General</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55028</span></p></td><td style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-bottom:3pt"><span>Head, ultrasound scan of, performed by, or on behalf of, a medical practitioner where:</span></p><p class="TableP1a" style="margin-bottom:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the patient is referred by a medical practitioner for ultrasonic examination, not being a service associated with a service to which item 55055 or an item in Subgroup 2 or 3 of this Group applies; and</span></p><p class="TableP1a"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the referring medical practitioner is not a member of a group of practitioners of which the first mentioned practitioner is a member (R)</span></p></td><td style="width:45.9pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="text-align:right"><span>$98.75</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55029</span></p></td><td style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Head, ultrasound scan of, where the patient is not referred by a medical practitioner, not being a service associated with a service to which item 55055, or an item in Subgroup 2 or 3 of this Group, applies (NR)</span></p></td><td style="width:45.9pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="text-align:right"><span>$34.25</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55030</span></p></td><td style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-bottom:3pt"><span>Orbital contents, ultrasound scan of, performed by, or on behalf of, a medical practitioner where:</span></p><p class="TableP1a" style="margin-bottom:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the patient is referred by a medical practitioner for ultrasonic examination, not being a service associated with a service to which item 55055 or an item in Subgroup 2 or 3 of this Group applies; and</span></p><p class="TableP1a"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the referring medical practitioner is not a member of a group of practitioners of which the first mentioned practitioner is a member (R)</span></p></td><td style="width:45.9pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="text-align:right"><span>$98.75</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55031</span></p></td><td style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Orbital contents, ultrasound scan of, where the patient is not referred by a medical practitioner, not being a service associated with a service to which item 55055, or an item in Subgroup 2 or 3 of this Group, applies (NR)</span></p></td><td style="width:45.9pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="text-align:right"><span>$34.25</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="page-break-inside:avoid"><span>55032</span></p></td><td style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-bottom:3pt; page-break-inside:avoid"><span>Neck, 1 or more structures of, ultrasound scan of, performed by, or on behalf of, a medical practitioner where:</span></p><p class="TableP1a" style="margin-bottom:3pt; page-break-inside:avoid"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the patient is referred by a medical practitioner for ultrasonic examination, not being a service associated with a service to which item 55055 or an item in Subgroup 2 or 3 of this Group applies; and</span></p><p class="TableP1a" style="page-break-inside:avoid"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>the referring medical practitioner is not a member of a group of practitioners of which the first mentioned practitioner is a member (R)</span></p></td><td style="width:45.9pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="text-align:right; page-break-inside:avoid"><span>$98.75</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>55033</span></p></td><td style="width:251.45pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Neck, 1 or more structures of, ultrasound scan of, where the patient is not referred by a medical practitioner, not being a service associated with a service to which item 55055, or an item in Subgroup 2 or 3 of this Group, applies (NR)</span></p></td><td style="width:45.9pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="text-align:right"><span>$34.25</span></p></td></tr><tr><td style="width:38.85pt; padding-right:5.4pt; pa
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