In this table, unless the contrary intention appears:
Act means the Health Insurance Act 1973.
computed tomography means a service rendered (with or without intravenous contrast):
(a) using a detector coupled to an X-ray tube that emits a finely collimated X-ray beam as it rotates within a gantry around a patient either in incremental or helical manner; and
(b) registering a resulting variable amount of X-rays and transforming that information into a cross‑sectional image after the application of complex algorithms.
CT means computed tomography.
CT equipment includes the following components:
(a) a gantry;
(b) a couch;
(c) a computer;
(d) an operator station;
(e) a generator.
exclusion, in relation to a condition for which a MRI or MRA service is requested, means use of the service as the initial imaging modality for diagnosis of the condition.
MRA means magnetic resonance angiography.
MRI means magnetic resonance imaging.
remote location means a place within Australia that is:
(a) more than 30 kilometres by road from a hospital that provides a radiology or computed tomography service under the direction of a specialist in the specialty of diagnostic radiology; or
(b) more than 30 kilometres by road from a free standing radiology or computed tomography facility under the direction of a specialist in the specialty of diagnostic radiology.
sequence, in relation to 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).
Note Specialist and other words and expressions used in this table are defined in subsection 3 (1) of the Act.
2 References to items in the general medical services table
A reference by number to any of items 11240, 11603 to 11612 (inclusive), 30361 and 30488 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
Unless the contrary intention appears, a diagnostic imaging service in the table is a diagnostic imaging service for 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) and 63000 to 63946 (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, 55030 and 55032, 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 and 55052, 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.
9A Computed tomography services — meaning of (K) and (NK)
(1) In any of items 56001 to 57355, the symbol (K) means:
(a) for CT equipment that the Commission is satisfied was first installed and used as new equipment at a site in Australia:
(i) the service was rendered earlier than 10 years after the earliest date on which any component of the equipment was first installed and ready for use; or
(ii) the service was rendered in a remote location; or
(b) for CT equipment imported as pre-used equipment:
(i) the service was rendered earlier than 10 years after the earliest date of manufacture of any component of the equipment; or
(ii) the service was rendered in a remote location.
(2) In any of items 56001 to 57355, the symbol (NK) means the service was rendered 10 years or more after:
(a) for CT equipment that the Commission is satisfied was first installed and used as new equipment in Australia — the earliest date on which any component of the equipment was first installed and ready for use; or
(b) for CT equipment imported as pre-used equipment — the earliest date of manufacture of any component of the equipment.
(3) In this rule:
CT equipment imported as pre-used equipment means equipment that has been used to render CT services before being imported into Australia.
installed and ready for use, in relation to a component, means ready for immediate income‑producing purposes whether or not it is so used.
9B CT services — eligible services
Items 56001 to 57355 apply only to a computed tomography service performed:
(a) under the professional supervision of a specialist in the specialty of diagnostic radiology who is available:
(ii) if necessary — to personally attend on the patient; or
10 Meaning of Amount under rule 10 in certain items
In item 59103, 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 is provided; and
(b) $21.30.
10AA Ultrasound services — eligible services
(1) Items 55028 to 55603 apply only to an ultrasound service performed for items marked with the symbol (R):
(a) under the professional supervision of a specialist or a consultant physician in the practice of his or her specialty who is available:
(ii) if necessary — to personally attend the patient; or
(ii) in a remote location that is not less than 30 kilometres by the most direct road route from another practice where services that comply with subparagraph (a) are available; or
(c) by or on behalf of a practitioner who is not a specialist or consultant physician but who meets the requirements of subrule (2); or
(d) by or on behalf of a practitioner in circumstances mentioned in subrule (3).
(2) The requirements of this subrule are that, between 1 September 1997 and 31 August 1999, at least 50 services were rendered by or on behalf of the practitioner at the location where the service was rendered and the rendering of those services resulted in the payment of a medicare benefit.
(3) For paragraph (1) (d), the circumstances are that between 1 September 1997 and 31 August 1999, at least 50 services were rendered by or on behalf of the practitioner to a patient in a nursing home or at the patient’s residence and the rendering of those services resulted in the payment of a medicare benefit.
10A Mammography services — eligible services
Items 59300 to 59318 apply only to a mammography service performed:
(a) under the professional supervision of a specialist in the specialty of diagnostic radiology who is available:
(ii) if necessary — to personally attend on the patient; or
11 Preparation of patients for radiological procedures
Items 60903 to 60927 (inclusive) apply only to the preparation of a patient for a radiological procedure for a service to which items 59900 to 59970 (inclusive) 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 61499 (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) $113.55.
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 at least 1 R-type diagnostic imaging service and at least 1 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 the least of:
(a) if the fee for the consultation is at least $40.00 — $35.00; or
(b) if the fee for the consultation is less than $40.00 — $15.00; or
(c) 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 at least 1 R-type diagnostic imaging service and 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 an R-type diagnostic imaging service, a consultation and 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.
16 MRI and MRA services — eligible services
Items 63000 to 63946 apply only to a MRI or MRA service performed:
(a) on request, in accordance with rule 17, by a specialist or consultant physician; and
(b) in a permissible circumstance, in accordance with rule 18; and
(c) with eligible equipment, in accordance with rule 20.
17 Request for MRI and MRA services — requirements
A request for any of items 63000 to 63946 must:
(a) be in writing; and
(b) identify the clinical indications for the service.
18 MRI and MRA services — permissible circumstances for performance
For rule 16, a service is performed in a permissible circumstance only if it is performed:
(a) under the professional 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; or
(b) if paragraph (a) is not complied with:
19 MRI and MRA services — eligible provider
(1) For rule 18, an eligible provider is a specialist in diagnostic radiology who satisfies the Commission that:
(a) he or she is a participant in the Royal Australasian College of Radiologists’ Quality and Accreditation Program; and
(b) the equipment he or she proposes to use for providing services of the kind mentioned in group I5 in the diagnostic imaging services table (the proposed equipment) is eligible equipment for rule 20.
(2) The specialist must give the Commission a statutory declaration:
(a) stating the matters mentioned in paragraphs (1) (a) and (b); and
(b) specifying the location of the proposed equipment; and
(c) specifying the kinds of diagnostic imaging procedures offered at that location; and
(d) if the proposed equipment has been installed at that location — stating the date that it was installed (the installation date); and
(e) if the installation date was 12 May 1998 — stating the time at which the equipment was installed.
(3) If the equipment had not been installed before 7.30 pm on 12 May 1998, Eastern Standard Time, the specialist must give the Commission, with the statutory declaration, a copy of the contract for the purchase or lease of the equipment.
(4) The Commission may request a specialist to:
(a) give the Commission documents to support statements made in the statutory declaration; and
(b) answer questions put to the specialist by the Commission about those statements.
Note The documents may include the contract for purchase or lease of the proposed equipment, if not already given to the Commission under subrule (3).
20 MRI and MRA services — eligible equipment
(1) For rule 16, eligible equipment is equipment that complies with this rule.
(2) The equipment must be located in a medical practice, or the radiology department of a hospital, that offers a comprehensive range of diagnostic imaging procedures.
(3) The equipment must:
(a) have been installed in a medical practice or hospital before 7.30 pm on 12 May 1998, Eastern Standard Time; or
(b) although uninstalled, have been purchased or leased before that time on that day under a contract, in writing, that did not contain an option to cancel the contract; or
(c) be replacement equipment for equipment mentioned in paragraph (a) or (b).
Note Equipment can be relocated to a new location without affecting its compliance with subrule (3). However, to continue to be eligible equipment, the equipment would have to continue to comply with subrule (2).
(4) Equipment mentioned in paragraph (3) (a) or (b) ceases to be eligible equipment when replaced by other equipment.
(4A) A statutory declaration under subrules 19 (2) or (3) in relation to the equipment has been given to the Commission on or before 11 October 1999.
(5) For this rule:
comprehensive, in relation to a range of diagnostic imaging procedures, means that the range includes x‑ray, ultrasound and computed tomography (CT) procedures.
medical practice means a practice conducted by a sole practitioner, a practice conducted by a group of practitioners within the meaning of subsection 16A (9) or (10) of the Act or a practice conducted by a medical entrepreneur.
21 MRI and MRA services — meaning of scan
In items 63000 to 63946:
scan means a minimum of 3 sequences.
22 MRI and MRA services — descriptions of purpose of services
The purposes for which a MRI or MRA service may be claimed (the purpose for each particular service being set out in each of items 63000 to 63946) are:
(a) the exclusion of a condition; and
(b) the further investigation of a condition, if the service is used as the secondary imaging modality:
(i) when the diagnosis is uncertain; or
(ii) to assess the severity of the condition; and
(c) the monitoring of a condition, if the service is used following confirmed diagnosis to assess progress of a condition following treatment.
Note For the meaning of exclusion of a condition, if that is the purpose of requesting a MRI or MRA service, see rule 1.
23 MRI or MRA services — number of related services that can be claimed in a 12 month period
(1) The fee mentioned in an item does not apply if:
(a) the item is included in a class mentioned in subrule (2); and
(b) the service mentioned in the item is provided to a person who, in the 12 months before the service, has been provided with the maximum number of services in that class mentioned in subrule (2).
(2) For subrule (1), the classes, and maximum number of services, are: