Health Insurance (Diagnostic Imaging Services Table) Regulations 2009

1 Prescription of table

For section 4AA of the Act, these Regulations prescribe a table of diagnostic imaging services that sets out:

(a) in Part 2 — rules for interpretation of the table; and

(b) in Part 3:

(i) items of diagnostic imaging services; and

(ii) the fee applicable for each item.

Part 2 Rules of interpretation

2 General

(1) In this table, unless the contrary intention appears:

accredited site means a site accredited by ANZAPNM as a site for advanced training in PET.

(Anaes.) — see the general medical services table.

ANZAPNM means the Australian and New Zealand Association of Physicians in Nuclear Medicine (ABN 99 665 425 983).

bulk‑billed, for a service, means:

(a) a medicare benefit is payable to a person in relation to the service; and

(b) under an agreement entered into under section 20A of the Act:

(i) the person assigns to the eligible provider by whom, or on whose behalf, the service is provided, his or her right to the payment of the medicare benefit; and

(ii) the eligible provider accepts the assignment in full payment of his or her fee for the service provided.

comprehensive facility means a building or part of a building, or more than 1 building if public access between the buildings is by a covered pedestrian walkway, where all of the following services are performed (whether or not other services are also performed):

(a) PET;

(b) computed tomography;

(c) diagnostic ultrasound;

(d) medical oncology;

(e) neurology;

(f) radiation oncology;

(g) surgical oncology;

(h) x-ray.

computed tomography means a service performed (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.

credentialled specialist means a specialist or consultant physician credentialled under the ‘Joint Nuclear Medicine Specialist Credentialling Program for the Recognition of the Credentials of Nuclear Medicine Specialists for Positron Emission Tomography’ overseen by the JNMCAC.

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.

FDG means 18F-fluorodeoxyglucose.

GEJ means gastro-oesophageal junction.

group of practitioners has the same meaning as in subsection 16A (10) of the Act.

item means:

(a) an item mentioned, by number, in column 1 of:

(i) Part 3; or

(ii) Part 3 of the pathology services table; or

(iii) Part 3 of the general medical services table; and

(b) in a reference immediately followed by a number — the item so numbered.

Example

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.

JNMCAC means the Joint Nuclear Medicine Credentialling and Accreditation Committee of the RACP and RANZCR.

MRA means magnetic resonance angiography.

MRI means magnetic resonance imaging.

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).

PET means positron emission tomography.

providing practitioner, for a service mentioned in an item in Group I1 of Part 3, means the medical practitioner by whom, or under whose supervision or direction, the service was performed.

RACP means The Royal Australasian College of Physicians (ABN 90 270 343 237).

RANZCR means The Royal Australian and New Zealand College of Radiologists (ABN 37 000 029 863).

registered sonographer means a person whose name is entered on the Register of Sonographers kept by the Medicare Australia CEO.

remote location means a place within Australia that is more than 30 kilometres by road from:

(a) a hospital that provides a radiology or computed tomography service under the direction of a specialist in the specialty of diagnostic radiology; or

(b) a free‑standing radiology or computed tomography facility under the direction of a specialist in the specialty of diagnostic radiology.

report means a report prepared by a medical practitioner.

sequence, for 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 A number of words and expressions used in this table are defined in subsection 3 (1) of the Act, including:

Note:  diagnostic imaging service

Note:  general medical services table

Note:  pathology services table

Note:  specialist.

(2) A reference to a Group in the table includes every item in the Group and a reference to a Subgroup in the table includes every item in the Subgroup.
(3) A reference to a diagnostic imaging service in an item in Part 3 includes a reference to the undertaking of the diagnostic imaging procedure used for rendering the service.

3 Meaning of (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.

4 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.

5 Report requirements for certain services

(1) An item in Part 3 (except an item to which subrule (2) applies) applies only if the providing practitioner gives a report of the service performed to the practitioner who requested the service.
(2) This subrule 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.

6 Meaning of medical practitioner in certain items

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 Act.

8 Ultrasound services — eligible services

Items 55028 to 55854 (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.

9 Ultrasound services — R‑type eligible services

(1) Items 55028 to 55854 (except items 55600 and 55603), if 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 subrule (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 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 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.

10 Angiography services — meaning of (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 rule 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.

11 Obstetric and gynaecological ultrasound services — limits

(1) For NR‑type diagnostic imaging services described in any of items 55700 to 55774, the specified fee for no more than 3 services provided to the same patient in any 1 pregnancy applies.
(2) For any patient, items 55706, 55707, 55708, 55709, 55718, 55723, 55759, 55762, 55768 and 55770 are applicable not more than once in a pregnancy.

12 Obstetric and gynaecological services — clinical indications

(1) For items in which clinical conditions are listed (items 55700, 55704, 55707, 55718, 55759 and 55768), or for which a clinical indication is required for performance of subsequent scans (items 55712, 55721, 55764 and 55772), the referral must identify the relevant clinical indication for the service.
(2) If the service is self‑determined (items 55703, 55705, 55708, 55715, 55723, 55725, 55762, 55766, 55770 and 55774), the clinical condition or indication must be recorded in the medical practitioner’s clinical notes.

13 Obstetric and gynaecological services — referral forms

Items 55712, 55721, 55764 and 55772 apply to a service for which a referral is given by a medical practitioner who has obstetric privileges at a non‑metropolitan hospital only if the words ‘non‑metropolitan obstetric privileges’ are specified on the referral form.

14 Musculoskeletal ultrasound services — personal attendance

Items 55800 to 55854 apply to a musculoskeletal ultrasound service only if:

(a) the medical practitioner responsible for the conduct and report of the examination personally attends during the performance of the scan and personally examines the patient; or

(b) the service is performed, because of medical necessity, in a location that is more than 30 kilometres by the most direct road route from another practice where services that comply with paragraph (a) are available.

15 Musculoskeletal ultrasound services — comparison ultra‑sonography

For items 55800 to 55854, the fee applicable for the item includes any views of another part of the patient taken for comparison purposes.

16 Musculoskeletal ultrasound services — equipment

Items 55800 to 55854 apply only to an ultrasound service performed using an ultrasound system that has available on‑site a transducer capable of operation at a frequency of at least 7.5 MHz.

18 CT services — meaning of (K) and (NK)

(1) In any of items 56001 to 57356, 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 performed 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 57356, 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 perform CT services before being imported into Australia.

installed and ready for use, for a component, means ready for immediate income‑producing purposes, whether or not it is so used.

19 CT services — eligible services

(1) Subject to subrule (2), items 56001 to 57356 apply only to a CT service that is:

(a) performed 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 attend on the patient personally; and

(b) reported by a specialist in the specialty of diagnostic radiology.

(2) Items 56001 to 57360 apply to a CT service that fails to comply with subrule (1) if the service is performed:

(a) in an emergency; or

(b) because of medical necessity, in a remote location.

20 CT services — exclusion of attenuation correction and anatomical correlation

Items 56001 to 57356 do not apply to a CT service that is performed for the purpose of attenuation correction or anatomical correlation of another diagnostic imaging procedure.

21 CT services — exclusion of acoustic neuroma

If an axial scan is performed for the exclusion of acoustic neuroma, item 56001 or 56007 applies instead of any other item in this table that might be taken to apply to the service.

22 CT services — assessment of headache

(1) If the service described in item 56007 or 56047 is used for the assessment of a 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 performed on the patient; and

(b) the service is required because the result of the scan 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.

23 CT services — number of services

Items 56220 to 56240 and 56619 to 56665 apply once only for a service described in any of those items, regardless of the number of patient attendances required to complete the service.

24 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:

(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) if paragraph (a) cannot be complied with:

(i) in an emergency; or

(ii) because of medical necessity, in a remote location.

25 Preparation of patients for radiological procedures

Items 60918 and 60927 apply only to the preparation of a patient for a radiological procedure for a service to which any of items 59903 to 59974 apply 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.

26 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.

27 Nuclear scanning services — other than PET

Items 61302 to 61505 and item 61650 apply only if:

(a) the performance of the service does not involve the use of positron‑emission radio‑isotopes or a PET scanner; and

(b) the service is performed:

(i) by a specialist or consultant physician whose name is included in a register, given to the Medicare Australia CEO by the JNMCAC, of participants in the Joint Nuclear Medicine Specialist Credentialling Program of the JNMCAC; or

(ii) by a person acting on behalf of a specialist or consultant physician mentioned in subparagraph (i); and

(c) the final report of the service is compiled by the specialist or consultant physician who performed the preliminary examination of the patient and the estimation and administration of the dosage of radiopharmaceuticals.

27A PET nuclear scanning services

(1) Items 61523 to 61613 apply only if the service is performed on a person:

(a) at the written request of a specialist or consultant physician (the requesting practitioner) if:

(i) the person is the requesting practitioner’s patient; and

(ii) the requesting practitioner decides that the service is necessary; and

(b) at an accredited site in a comprehensive facility; and

(c) in accordance with rules 27B and 27C.

(2) Also, the items apply only if the owner or operator of the equipment used to perform the service is not in breach of rule 27D.

27B PET nuclear scanning services — performance under personal supervision

(1) For rule 27A, the service must be performed on a person by or under the personal supervision of:

(a) a credentialled specialist other than the requesting practitioner; or

(b) a medical practitioner other than the requesting practitioner if the medical practitioner:

(i) is a Fellow of the RACP or RANZCR; and

(ii) has reported 400 or more studies forming part of PET services for which a medicare benefit was payable; and

(iii) is authorised under State or Territory law to prescribe and administer to humans the PET radiopharmaceuticals that are to be administered to the person.

(2) In this rule:

requesting practitioner has the same meaning as in paragraph 27A (1) (a).

27C PET nuclear scanning services — equipment

For rule 27A, the service must be performed on a person using equipment that meets the following requirements:

(a) the Requirements for PET Accreditation (Instrumentation & Radiation Safety) dated 4 May 2007 issued by the Australian and New Zealand Society of Nuclear Medicine Inc;

(b) the NEMA Standards Publication NU 2-2007, Performance Measurements of Positron Emission Tomographs, published by the National Electrical Manufacturers Association (USA).

27D PET nuclear scanning services — statutory declaration

(1) The owner or operator mentioned in subrule 27A (2) must have given a statutory declaration to the Medicare Australia CEO that includes the following information:

(a) whether the owner or operator is a credentialled specialist or a medical practitioner who satisfies the requirements mentioned in subparagraphs 27B (1) (b) (i) to (iii);

(b) whether the place where the owner or operator provides the service is an accredited site in a comprehensive facility;

(c) whether the equipment meets the requirements mentioned in rule 27C;

(d) the facility’s address;

(e) the provider number for the facility given by the Medicare Australia CEO;

(f) the location specific practice number for the facility given by the Minister;

(g) the models, serial numbers and manufacturers of the equipment.

(2) If the matters declared in the statutory declaration change, the owner or operator must give the Medicare Australia CEO written notice of the change as soon as the owner or operator knows about the change.

28 Bulk‑billing incentive

(1) This rule applies if:

(a) a service that is mentioned in an item in Groups I1 to I5 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 subsection 10 (2) of the Act, the benefit payable is the amount calculated under subrule (2).

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

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

Note Item 61369 is taken to be an item in the table — see the Health Insurance (Indium‑labelled Octreotide Study) Determination HS/09/2006.

29 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 subrule (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 1 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 subrule (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 rule does not apply to the fee specified in item 64990 or 64991.

30 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 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 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 subrule (2), if more than 1 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 1 R‑type diagnostic imaging service and at least 1 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 subrules (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) Rules 29 and 38 apply, subject to subrules (7) and (8), in addition to this rule.
(7) For rule 29, if a medical practitioner provides:

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

(b) 1 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 rule, to be an amount payable for 1 diagnostic imaging service.

(8) For rule 38, if a medical practitioner provides:

(a) 2 or more MRI services described in Subgroup 12 or 13 of Group I5 in this table for the same patient on the same day; and

(b) 1 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 rule, to be an amount payable for 1 diagnostic imaging service.

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

consultation means a service under an item listed in Groups A1 to A21 of the general medical services table.

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

non‑consultation service means a service under an item listed in the general medical services table other than in Groups A1 to A21.

31 MRI and MRA services — eligible services

(1) Subject to subrules (2), (2A) and (2B), items 63001 to 63482 apply only to an MRI or MRA service performed:

(a) at the request of a specialist or consultant physician, made in accordance with rule 32; and

(b) in a permissible circumstance, in accordance with rule 31; and

(c) with eligible equipment, in accordance with rule 33 or 35.

(2) If a service described in an item mentioned in subrule (1) is performed with eligible equipment described in paragraph 36 (1) (c) or (d), the item for the service applies only if the service is bulk‑billed for the fee for the service.
(2A) If a service described in an item mentioned in subrule (1) is performed with eligible equipment described in paragraph 36 (1) (e), the item for the service applies only if:

(a) for a service performed on a concessional beneficiary — the service is bulk‑billed; or

(b) for a service performed on a person who is not a concessional beneficiary — the medical expenses incurred by the person for the service are not more than the fee specified for the item.

(2B) If a service described in an item mentioned in subrule (1) is performed with eligible equipment described in paragraph 36 (1) (f), the item for the service applies only if:

(a) for a service performed on a concessional beneficiary or a child under 16 — the maximum charge is the sum of the medicare benefit and any private health insurance benefit payable for the service; and

(b) all the conditions of the agreement, mentioned in the following table, that applies to the eligible equipment are met.

(3) In this rule:

concessional beneficiary means:

(a) a person who is the holder of a seniors health card, a health care card or a pensioner concession card under the Social Security Act 1991; or

(b) a person (other than the holder of the card) whose name is included in a card mentioned in paragraph (a).

32 MRI and MRA services — requests

Items 63001 to 63482 apply only to a service for which the request:

(a) was made in writing; and

(b) identified the clinical indications for the service.

33 MRI and MRA services — permissible circumstances for performance

For rule 31, a service is performed in a permissible circumstance only if it is:

(a) both:

(i) performed 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; and

(ii) reported by an eligible provider; or

(b) performed:

(i) in an emergency; or

(ii) because of medical necessity, in a remote location.

34 MRI and MRA services — eligible provider

(1) For subrule 33 (1), an eligible provider, for an MRI or MRA service performed with equipment to which rule 35 or paragraph 36 (1) (a) applies, is a specialist in diagnostic radiology who is an eligible provider within the meaning of rule 30 of Part 2 of Schedule 1 to the Health Insurance (Diagnostic Imaging Services Table) Regulations 2000, as in force on 31 October 2001.
(2) For subrule 33 (1), an eligible provider, for an MRI or MRA service performed with equipment to which paragraph 36 (1) (b), (c), (d), (e) or (f) applies, is a specialist in diagnostic radiology who has satisfied the Medicare Australia CEO that he or she is a participant in the Royal Australian and New Zealand College of Radiologists’ Quality and Accreditation Program.

35 MRI and MRA services — eligible equipment

For rule 31, equipment is eligible equipment if the equipment is eligible equipment within the meaning of rule 31 of Part 2 of Schedule 1 to the Health Insurance (Diagnostic Imaging Services Table) Regulations 2000, as in force on 31 October 2001.

36 MRI and MRA services — eligible equipment

(1) For rule 31, eligible equipment is equipment other than equipment to which rule 35 applies, being:

(a) equipment:

(i) that is registered under the scheme, administered
by the Department, titled ‘MRI Additional Units Eligibility Scheme’, as in force on 27 June 2001; and

(ii) for which the registration has not been cancelled or otherwise ceased to have effect; or

(b) equipment:

(i) that is registered under the scheme, administered by the Department, titled ‘2004 MRI Additional Units Eligibility Scheme’, as in force on 29 November 2004; and

(ii) for which the registration has not been cancelled or otherwise ceased to have effect; or

(c) equipment that:

(i) is situated in the radiology department at a location specified in column 2 of an item in Table 1; and

(ii) is described in columns 3 and 4 of that item by reference to the manufacturer, scanner model and magnet strength; or

(d) equipment that:

(i) is situated in a location specified in column 2 of an item in Table 2; and

(ii) is described in columns 3 and 4 of that item by reference to the manufacturer, scanner model and magnet strength; and

(iii) forms part of a comprehensive radiology department that provides x‑ray, computed tomography and ultrasound services; and

(iv) except for periods reasonably required for maintenance, repairs and upgrades, is available for use:

(A) from 9 am to 5 pm, Monday to Friday, excluding public holidays, for the provision of routine services; and

(B) at all times for the provision of emergency services; or

(e) the Siemens Symphony equipment situated at Orana Radiology, 168‑172 Brisbane Street, Dubbo, NSW 2830 that:

(i) has a magnet strength of 1.5T; and

(ii) forms part of a comprehensive radiology department that provides x‑ray, computed tomography and ultrasound services; and

(iii) except for periods reasonably required for maintenance, repairs and upgrades, is available for use:

(A) from 9 am to 5 pm, Monday to Friday, excluding public holidays, for the provision of routine services; and

(B) at all times for the provision of emergency services; or

(f) equipment that:

(i) is situated in a location specified in column 2 of an item in Table 3; and

(ii) is described in columns 3 and 4 of that item by reference to the manufacturer, scanner model and magnet strength; and

(iii) forms part of a comprehensive radiology department, or a medical practice, that provides x‑ray, computed tomography and ultrasound services; and

(iv) except for periods reasonably required for maintenance, repairs and upgrades, is available for use at least from 9 am to 5 pm, Monday to Friday, excluding public holidays.

(2) In this rule:

medical practice means:

(a) a medical practice conducted by a group of practitioners within the meaning of subsection 16A (9) or (10) of the Act or by a sole practitioner; or

(b) a medical entrepreneur as defined in section 3 of the Act.

Table 1 Eligible equipment — paragraph 36 (1) (c)

Table 2 Eligible equipment — paragraph 36 (1) (d)

Table 3 Eligible equipment — paragraph 36 (1) (f)

Note 1 The MRI Additional Units Eligibility Scheme mentioned in subparagraph (a) (i) is the scheme of that title published in Gazette No. GN20 on 23 May 2001, as amended by amendments published in Gazette No. S226 on 27 June 2001.

Note 2 The 2004 MRI Additional Units Eligibility Scheme mentioned in subparagraph (b) (i) is the scheme of that title published in Gazette No. S 479 on 29 November 2004.

37 MRI and MRA services — meaning of scan

In items 63001 to 63482:

scan means a minimum of 3 sequences.

38 MRI and MRA services — multiple services rule

(1) If an MRI service described in an item in Subgroup 1, 2, 4, 5 or 14 of Group I5 in this table, and an MRA service described in an item in Subgroup 3 or 15 of that Group, are provided to the same person on the same day, only the fee specified in the item in Subgroup 1, 2, 4, 5 or 14 applies to the services.
(2) If a medical practitioner provides 2 or more MRI services described in Subgroup 12 or 13 of Group I5 in this table for the same patient on the same day, the fees specified for the items that apply to the services, other than the item with the highest fee, are reduced by 50%.
(3) For subrule (2):

(a) if 2 or more applicable fees are equally the highest, 1 only of those fees is taken to be the highest fee; and

(b) if a reduced fee calculated under subrule (2) is not a multiple of 5 cents, the reduced fee is taken to be the nearest amount that is a multiple of 5 cents.

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

(1) An MRI or MRA item mentioned in column 2 of the table in subrule (2) does not apply to the service described in that item if the service is provided to a person who, in the 12 months before the service, has been provided with the maximum number of those services mentioned in column 3 of the table for that item.
(2) For subrule (1), the items and maximum number of services are:

40 MRI services — limit for items 63470 and 63473

(1) Item 63470 does not apply to the service described in that item if the person to whom the service is provided has previously been provided with that service or a service described in item 63473.
(2) Item 63473 does not apply to the service described in that item if the person to whom the service is provided has previously been provided with that service or a service described in item 63470.

41 MRI and MRA services — modifying items

(1) Subject to subrules (2), (3) and (4), if item 63491, 63494 or 63497 applies to an MRI or MRA service, the fee specified in that item applies in addition to the fee specified in the other item in Group I5 of this table that applies to the service.
(2) If 2 or more MRI or MRA services described in item 63494 are performed for a person on the same day, the fee specified in that item applies to 1 of those services only.
(3) If 2 or more MRI or MRA services described in item 63497 are performed for a person on the same day, the fee specified in that item applies to 1 of those services only.
(4) If:

(a) 1 or more MRI or MRA services described in item 63494; and

(b) 1 or more MRI or MRA services described in item 63497;

are performed for a person on the same day, the fee specified in item 63494 or item 63497, but not both those items, applies to 1 of those services only.