Part 2
Service and Fees
Part 2 Service and Fees
Notes
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Commonwealth legislation
This Act has been repealed and is no longer in force. It is retained for historical reference.
This is Medicare’s 1999–2000 price list and rulebook for diagnostic imaging (X‑ray, ultrasound, CT, MRI, nuclear medicine). It sets which scans attract a rebate, how much providers are paid, and referral and equipment rules that determine eligibility.
Patients, imaging clinics and referring doctors are affected: the R/NR referral system changes rebate levels; CT/MRI payments depend on equipment age and location; obstetric scans are limited per pregnancy. The instrument therefore controls who gets subsidised imaging and at what cost.
Want the full deep dive?
Zoe can write the in-depth analysis on top of the summary above: how it works, who it affects and what each part actually does.
Direct links to the current provisions in Health Insurance (1999-2000 Diagnostic Imaging Services Table) Regulations 1999.
Part 2 Service and Fees
Notes
1 Name of Regulations [see Note 1]
These Regulations are the Health Insurance (1999-2000 Diagnostic Imaging Services Table) Regulations 1999.
2 Commencement
These Regulations commence on 1 November 1999.
3 Repeal of Health Insurance (1998-99 Diagnostic Imaging Services Table) Regulations 1998
The following statutory rules are repealed:
1998 No. 302
1999 No. 20
1999 No. 193
1999 No. 219.
4 Diagnostic imaging services table
The table of diagnostic imaging services set out in Schedule 1 is prescribed for the purposes of subsection 4AA (1) of the Health Insurance Act 1973.
Schedule 1 Table of diagnostic imaging services
(regulation 4)
Sourced from the Federal Register of Legislation (legislation.gov.au), CC BY 4.0.
Health Insurance (1999-2000 Diagnostic Imaging Services Table) Regulations 1999
Statutory Rules 1999 No. 255 as amended
made under the
Health Insurance Act 1973
This compilation was prepared on 1 July 2000
taking into account amendments up to SR 2000 No. 147
Prepared by the Office of Legislative Drafting,
Attorney-General’s Department, Canberra
Health Insurance (1999-2000 Diagnostic Imaging Services Table) Regulations 1999
Statutory Rules 1999 No. 255 as amended
made under the
Health Insurance Act 1973
Contents
Page
1 Name of Regulations [see Note 1]
2 Commencement
3 Repeal of Health Insurance (1998-99 Diagnostic Imaging Services Table) Regulations 1998
4 Diagnostic imaging services table
Schedule 1 Table of diagnostic imaging services
Part 1 Rules of interpretation
10AA Ultrasound services — eligible services
Part 2 Service and Fees
Notes
1 Name of Regulations [see Note 1]
These Regulations are the Health Insurance (1999-2000 Diagnostic Imaging Services Table) Regulations 1999.
2 Commencement
These Regulations commence on 1 November 1999.
3 Repeal of Health Insurance (1998-99 Diagnostic Imaging Services Table) Regulations 1998
The following statutory rules are repealed:
1998 No. 302
1999 No. 20
1999 No. 193
1999 No. 219.
4 Diagnostic imaging services table
The table of diagnostic imaging services set out in Schedule 1 is prescribed for the purposes of subsection 4AA (1) of the Health Insurance Act 1973.
Schedule 1 Table of diagnostic imaging services
(regulation 4)
Part 1 Rules of interpretation
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 subs 3 (1) of the Act.
A reference by number to any of items 11240, 11603 to 11612, 30361 and 30488 is a reference to the item so numbered in the general medical services table.
(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.
An item including the symbol (S) applies only to a service provided by a specialist in the practice of diagnostic radiology.
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.
In items 55028 to 61109 and 63000 to 63946, report means a report prepared by a medical practitioner.
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.
In this table, group of practitioners has the same meaning as in subsection 16A (10) of the Act.
(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.
(1) In any of items 56001 to 57355, the symbol (K) means:
(a) for CT equipment that 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 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.
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:
(i) to monitor and influence the conduct and diagnostic quality of the examination; and
(ii) if necessary — to personally attend on the patient; or
(b) if paragraph (a) cannot be complied with:
(i) in an emergency; or
(ii) because of medical necessity — in a remote location.
Where axial scans are undertaken for the exclusion of acoustic neuroma, medicare benefits are payable under item 56001 or 56007.
(1) If the service described in item 56007 or 56047 is to be used for the assessment of headache of a patient to whom this rule applies, the fee mentioned in the item applies only if:
(a) a scan without intravenous contrast medium has been undertaken on the patient; and
(b) the service is required because the result of the scan mentioned in paragraph (a) is abnormal.
(2) This rule applies to a patient who:
(a) is under 50 years; and
(b) is (apart from the headache) otherwise well; and
(c) has no localising symptoms or signs; and
(d) has no history of malignancy or immunosuppression.
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 55739 apply only to an ultrasound service (the eligible 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:
(i) to monitor and influence the conduct and diagnostic quality of the examination; and
(ii) if necessary, to personally attend the patient; or
(b) under the professional supervision of a practitioner who:
(i) is not a specialist or consultant physician; and
(ii) meets the requirements of subrule (2); and
(iii) is available to monitor and influence the conduct and diagnostic quality of the examination and, if necessary, to personally attend the patient; or
(c) in circumstances mentioned in subrule (3), and under the professional supervision of a practitioner who is available:
(i) to monitor and influence the conduct and diagnostic quality of the examination; and
(ii) if necessary, to personally attend the patient; or
(d) if paragraph (a), (b) or (c) cannot be complied with:
(i) in an emergency; 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 paragraph (a) or (b) are available.
(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 eligible service was rendered, and the rendering of those services resulted in the payment of a medicare benefit.
(3) For paragraph (1) (c), the circumstances are that, between 1 September 1997 and 31 August 1999, at least 50 services were rendered in nursing homes or patients’ residences by or on behalf of the practitioner, and the rendering of those services resulted in the payment of medicare benefits.
The fees mentioned in items in the item range from 55700 to 55728 in Part 2 of the table are applicable to no more than 3 items of NR-type diagnostic imaging for the same patient in any 1 pregnancy.
(1) For items where clinical conditions are listed, or where a clinical indication is required for performance of subsequent scans (items 55712, 55715, 55721 or 55725), the referral must identify the relevant clinical indication for the service.
(2) If the service is self-determined, the clinical condition or indication must be recorded in the medical practitioner's clinical notes.
In an item in subgroup 5 of Group I1:
non-metropolitan hospital means a hospital that is located outside the Sydney, Melbourne, Brisbane, Adelaide, Perth, Greater Hobart, Darwin and Canberra major statistical divisions, as defined in the Australian Standard Geographical Classification 1999 published by the Australian Bureau of Statistics (publication number 1216.0 of 1999).
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:
(i) to monitor and influence the conduct and diagnostic quality of the examination; and
(ii) if necessary — to personally attend on the patient; or
(b) if paragraph (a) cannot be complied with:
(i) in an emergency; or
(ii) because of medical necessity — in a remote location.
Items 60903 to 60927 apply only to the preparation of a patient for a radiological procedure for a service to which items 59900 to 59970 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.
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.
Items 61302 to 61499 apply to a nuclear scanning service only if:
(a) the performance of the scan does not involve the use of positron-emission radio-isotopes or a Positron Emission Tomography (PET) scanner; and
(b) 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
(c) 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.
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.
(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 liste
This is an opening excerpt, not the complete document.