5. Circumstances where this Determination applies – Gippsland and South Eastern New South Wales Mobile MRI services

(1) This Determination applies to a relevant service provided using mobile diagnostic imaging equipment that has as its base for mobile diagnostic imaging the Latrobe Regional Hospital, Princes Highway Traralgon West, Victoria 3844 where the following circumstances apply:

(a) in respect of items 63002 to 63483, where the service is performed pursuant to a request that is in accordance with subsection (2);

(b) where the service is performed pursuant to the RIL funding agreement; and

(c) where the service is performed in a permissible circumstance in accordance with subsection (3), (4), (5), (6), (7) or (8); and

(d) where the service is a service of a kind referred to in paragraph 10(2)(a) of the Act – the patient in respect of whom the service is provided is charged a fee that is no more than 75% of the amount specified in the Schedule as the fee applicable to the item that relates to the service; and

(e) where the service is not a service to which paragraph (d) applies – the patient in respect of whom the service is provided is charged a fee that is no more than 85% of the amount specified in the Schedule as the fee applicable to the item that relates to the service.

(2) The request referred to in paragraph (1)(a) must:

(a) be made by a practitioner who is a specialist, consultant physician or dental practitioner; and

(b) be made in writing; and

(c) identify the clinical indications for the service.

Note: Subsection 16B(2) of the Act limits the R-type diagnostic imaging services in respect of which a medicare benefit is payable where the service is requested by a dental practitioner. See section 12 below.

(3) For paragraph (1)(c), subject to subsection (4), a relevant service is performed in a permissible circumstance if the service is performed in Bega and it is:

(a) performed under the professional supervision of an eligible provider who is available to monitor and influence the conduct and diagnostic quality of the examination via telephone and real-time teleradiology; and

(b) reported by an eligible provider; and

(c) monitored by a medical practitioner by personal attendance on the patient if the circumstances are such as to require on-site monitoring by a medical practitioner.

(4) If subsection (3) is not complied with, a relevant service is performed in a permissible circumstance if the service is performed in Bega and it is performed in an emergency.

(5) For paragraph (1)(c), subject to subsection (6), a relevant service is performed in a permissible circumstance if the service is performed in Traralgon during after hours and it is:

(a) performed under the professional supervision of an eligible provider who is available to monitor and influence the conduct and diagnostic quality of the examination via telephone and real-time teleradiology; and

(b) reported by an eligible provider; and

(c) monitored by a medical practitioner by personal attendance on the patient if the circumstances are such as to require on-site monitoring by a medical practitioner; and

(d) not a service to which items 63492 to 63495 are attributable.

(6) If subsection (5) is not complied with, a relevant service is performed in a permissible circumstance if the service is performed in Traralgon during after hours and it is performed in an emergency.

(7) For paragraph (1)(c), subject to subsection (8), a relevant service is performed in a permissible circumstance if it is:

(a) 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

(b) reported by an eligible provider.

(8) If subsection (7) is not complied with, a relevant service is performed in a permissible circumstance if it is performed:

(c) in an emergency; or

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