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2.2.2 CT services—eligible services

2.2.3 CT services—exclusion of attenuation correction and anatomical correlation

2.2.4 CT services—exclusion of acoustic neuroma

2.2.5 CT services—assessment of headache

2.2.6 CT services—number of services

Division 2.3 Group I3—Diagnostic radiology

2.3.1 Who must perform diagnostic imaging procedure

Subdivision A Subgroups 1 to 9 of Group I3

Subdivision B Subgroup 10 of Group I3—Radiographic examination of breasts

2.3.2 Mammography services—eligible services

Subdivision C Subgroups 11 to 14 of Group I3

Subdivision D Subgroup 15 of Group I3—Fluoroscopic examination

Subdivision E Subgroup 16 of Group I3—Preparation for radiological procedure

2.3.3 Preparation of patients for radiological procedures

Subdivision F Subgroup 17 of Group I3—Interventional techniques

2.3.4 Meaning of angiography suite in item 61109

Division 2.4 Group I4—Nuclear medicine imaging

2.4.1 Nuclear scanning services—other than PET

2.4.2 PET nuclear scanning services

2.4.3 PET nuclear scanning services—performance under personal supervision

2.4.4 PET nuclear scanning services—equipment

2.4.5 PET nuclear scanning services—statutory declaration

Division 2.5 Group I5—Magnetic resonance imaging

Subdivision A General

2.5.1 MRI and MRA services—eligible services

2.5.2 MRI and MRA services—request

2.5.3 MRI and MRA services—permissible circumstances for performance

2.5.4 MRI and MRA services—eligible provider

2.5.5 MRI and MRA services—eligible equipment

2.5.6 MRI and MRA services—partial eligible equipment

2.5.7 MRI and MRA services—meaning of scan

2.5.8 MRI and MRA services—multiple services

2.5.9 MRI or MRA services—related services that can be claimed in a 12 month period

Subdivision B Subgroups 1 to 19 of Group I5

Subdivision C Subgroup 20 of Group I5—Scans of pelvis and upper abdomen—for specified conditions

2.5.10 MRI services—limit for items 63470 and 63473

2.5.11 MRI and MRA services—modifying items

Subdivision D Subgroups 21 and 22 of Group I5

Subdivision E Subgroup 33 of Group I5

Division 2.6 Group I6—Management of bulk‑billed services

2.6.1 Application of items 64990 and 64991

Dictionary

Notes

1 Name of regulation [see Note 1]

This regulation is the Health Insurance (Diagnostic Imaging Services Table) Regulation 2012.

4 Dictionary

The Dictionary at the end of this regulation defines certain words and expressions and includes references to certain words and expressions that are defined elsewhere in this regulation.

5 Diagnostic imaging services table

For subsection 4AA (1) of the Act, this regulation prescribes a table of diagnostic imaging services set out in Schedule 1.

Schedule 1 Diagnostic imaging services table

(regulation 5)

Part 1 Preliminary

Division 1.1 Interpretation

1.1.1 Interpretation of table

A reference to a diagnostic imaging service in an item in Part 2 includes a reference to the undertaking of the diagnostic imaging procedure used for rendering the service.

Division 1.2 General application provisions

1.2.1 Meaning of symbols (R) and (NR) in the 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.

1.2.2 Who may provide a diagnostic imaging service

Unless the contrary intention appears, items in this table relating to diagnostic imaging services apply 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.

1.2.3 Report requirements for certain services

(1) An item in Part 2 (except an item to which subclause (2) applies) applies only if the providing practitioner gives a report of the service performed to the practitioner, participating midwife or participating nurse practitioner who requested the service.
(2) This subclause applies to the following items:

(a) items 55054, 55130, 55135, 55848, 55850, 57341, 57345, 59312, 59314, 60506, 60509 and 61109, being items of services performed in conjunction with a surgical procedure;

(b) items 60918 and 60927, being items of service performed in preparation for a radiological procedure.

1.2.4 Angiography services—meaning of symbols (K) and (NK) in items

(1) An item that includes the symbol (NK) at the end of the item applies to a service that is performed on equipment that is at least 10 years old.
(2) An item that includes the symbol (K) at the end of the item applies to a service that is performed on equipment that is less than 10 years old.
(3) The date from which the age of equipment is worked out for this clause is:

(a) the date that the equipment was first installed in Australia; or

(b) if the equipment was imported as used equipment—the date of manufacture of the oldest component of the equipment.

1.2.5 Bulk‑billing incentive

(1) This clause applies if:

(a) a service that is mentioned in an item in Divisions 2.1 to 2.4 of this table is provided; and

(b) the service is not provided in a hospital; and

(c) the service is bulk‑billed.

(2) The fee for the service is 95% of the fee mentioned in this table for the service.
(3) For paragraph 10 (2) (aa) of the Act, the benefit payable is the amount calculated under subclause (2).

Note Under subparagraph 6EF (b) (ii) of the Health Insurance Regulations 1975, the medicare benefit payable is 100% of the amount calculated under subclause (2).

(4) This clause does not apply to the service specified in item 61369.

1.2.5A Bulk‑billing—magnetic resonance imaging

(1) This clause applies if:

(a) a service that is mentioned in an item in Division 2.5 of this table is provided; and

(b) the service is not provided in a hospital; and

(c) the service is bulk‑billed.

(2) The fee for the service is 100% of the fee mentioned in this table for the service.

(3) For paragraph 10 (2) (aa) of the Act, the benefit payable is the amount calculated under subclause (2).

Note Under subparagraph 6EF (b) (ii) of the Health Insurance Regulations 1975, the medicare benefit payable is 100% of the amount calculated under subclause (2).

1.2.6 Multiple services—vascular ultrasound

(1) If a medical practitioner provides 2 or more vascular ultrasound services for the same patient on the same day, the fees specified for the items that apply to the services are affected as follows:

(a) the second highest fee is reduced by 40%;

(b) any other fee, except the highest, is reduced by 50%.

(2) For subclause (1):

(a) if 2 or more applicable fees are equally the highest, one only of those fees is taken to be the highest fee; and

(b) if paragraph (a) applies—the other, or another, highest fee is taken to be the second highest fee; and

(c) if 2 or more fees are equally second highest, any one of those fees may be taken to be the second highest for the purpose of paragraph (1) (b); and

(d) if a reduced fee calculated under subclause (1) is not a multiple of 5 cents, the reduced fee is taken to be the nearest amount that is a multiple of 5 cents.

(3) This clause does not apply to the fee specified in item 64990 or 64991.

1.2.7 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.
(2) If a medical practitioner renders at least one R‑type diagnostic imaging service and at least one consultation service for the same patient on the same day, the highest fee, set out in the items that apply to diagnostic imaging services rendered by the practitioner for that patient on that day, is reduced:

(a) if the fee for the relevant consultation is at least $40—by $35; or

(b) if that fee is less than $40 but more than $15—by $15; or

(c) if that fee is less than $15—by the amount of that fee.

(3) For subclause (2), if more than one consultation has occurred, the relevant consultation is the consultation having the highest fee set out in the items that apply to the consultation.
(4) If a medical practitioner renders at least one R‑type diagnostic imaging service and at least one non‑consultation service for the same patient on the same day, the highest fee that applies to any diagnostic imaging services performed by the medical practitioner for the same patient on the same day, is reduced by $5.
(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 subclauses (2) and (4) must not exceed the highest fee that applies to any diagnostic imaging services rendered by the medical practitioner for the same patient on the same day.
(6) Clauses 1.2.6 and 2.5.8 apply, subject to subclauses (7) and (8), in addition to this clause.
(7) For clause 1.2.6, if a medical practitioner provides:

(a) 2 or more vascular ultrasound services for the same patient on the same day; and

(b) one or more other diagnostic imaging services for that patient on that day;

the amount of the fees payable for the vascular ultrasound services is taken, for this clause, to be an amount payable for one diagnostic imaging service.

(8) For clause 2.5.8, if a medical practitioner provides:

(a) 2 or more MRI services described in Subgroup 12 or 13 of Division 2.5 in this table for the same patient on the same day; and

(b) one or more other diagnostic imaging services for that patient on that day;

the amount of the fees payable for the MRI services is taken, for this clause, to be an amount payable for one diagnostic imaging service.

(9) This clause 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.
(10) This clause does not apply to the fee specified in item 59103, 64990 or 64991.
(11) In this clause:

consultation means a service under an item listed in Divisions 2.1 to 2.14 of the general medical services table.

highest fee means the highest fee specified for an item in the first claim submitted to the Chief Executive Medicare for the services provided.

non‑consultation service means a service under an item listed in the general medical services table other than in Divisions 2.1 to 2.14 of the general medical services table.

Part 2 Services and fees

Division 2.1 Group I1—Ultrasound

Subdivision A General

2.1.1 Ultrasound services—eligible services

Items in this Division (except items 55600 and 55603) apply to an ultrasound service only if the service is performed:

(a) by a medical practitioner; or

(b) by a registered sonographer on behalf of a medical practitioner.

2.1.2 Ultrasound services—R‑type eligible services

(1) Items in this Division (except items 55600 and 55603) marked with the symbol (R) apply to an ultrasound service (the eligible service) only if the service is performed:

(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 attend on the patient personally; or

(b) under the professional supervision of a practitioner who:

(i) is not a specialist or consultant physician; and

(ii) meets the requirement of subclause (2); and

(iii) is available to monitor and influence the conduct and diagnostic quality of the examination and, if necessary, to attend on the patient personally; or

(c) in the circumstance mentioned in subclause (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 attend on the patient personally; or

(d) if paragraph (a), (b) or (c) cannot be complied with:

(i) in an emergency; or

(ii) in a 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) For subparagraph (1) (b) (ii), the requirement is 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 entitled payment of medicare benefits.
(3) For paragraph (1) (c), the circumstance is 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 entitled payment of medicare benefits.

Subdivision B Subgroup 1 to 4 of Group I1

2.1.3 Certain items taken to include referred by dental practitioner or referring dental practitioner

(1) In items 55028, 55030 and 55032, the phrase:

(a) ‘referred by a medical practitioner’ includes referred by a dental practitioner mentioned in subclause (2); and

(b) ‘the referring medical practitioner’ includes the referring dental practitioner mentioned in subclause (2).

(2) For subclause (1), the dental practitioner is a dental practitioner who is approved by the Minister under paragraph (b) of the definition of professional service in subsection 3 (1) of the Act.

<table cellspacing="0" cellpadding="0" style="width:375.15pt; border-collapse:collapse"><thead><tr><td colspan="3" style="width:372.05pt; padding-right:1.55pt; padding-left:1.55pt; vertical-align:top"><p class="TableColHead" style="margin-bottom:0pt"><span>Group I1—Ultrasound</span></p></td></tr><tr><td style="width:34.45

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