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This instrument is the Health Insurance (Section 3C Diagnostic Imaging – Additional Nuclear Medicine Services) Determination 2022.
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This Determination adds specified nuclear medicine positron emission tomography (PET) services to Medicare’s diagnostic‑imaging framework by treating them as both professional services and diagnostic imaging items and by setting state‑by‑state fees in its Schedule. It affects practitioners who supply PET scans and Medicare claim administrators; during thallous chloride (T1‑201) supply interruptions it limits one substitute item (61644) to clinically urgent cases and requires the practitioner’s report to justify the substitution.
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Direct links to the current provisions in Health Insurance (Section 3C Diagnostic Imaging – Additional Nuclear Medicine Services) Determination 2022.
This instrument is the Health Insurance (Section 3C Diagnostic Imaging – Additional Nuclear Medicine Services) Determination 2022.
This instrument is made under subsection 3C(1) of the Health Insurance Act 1973.
(1) In this instrument:
Act means the Health Insurance Act 1973.
PET means positron emission tomography.
relevant provisions means all provisions, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under the National Health Act 1953, relating to medical services, professional services or items.
relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in a Schedule.
Schedule means a Schedule to this instrument.
Note: The following terms are defined in subsection 3(1) of the Act:
clinically relevant service;
diagnostic imaging services table;
item;
professional service.
(2) Unless the contrary intention appears, a reference in this instrument to a provision of the Act or the National Health Act 1953 or regulations made under the Act or under the National Health Act 1953 as applied, adopted or incorporated in relation to specifying a matter is a reference to those provisions as in force from time to time and any other reference to provisions of an Act or regulations is a reference to those provisions as in force from time to time.
For subsection 3C(1) of the Act, a relevant service, provided in accordance with this instrument and as a clinically relevant service, is to be treated, for the relevant provisions, as if:
(a) it were both a professional service and a diagnostic imaging service; and
(b) there were an item in the diagnostic imaging services table that:
related to the service; and
specified for the service a fee in relation to each State, being the fee specified in the Schedule in relation to the service.
(1) Paragraphs 2.4.1(b) and (c) of the diagnostic imaging services table shall have effect as if items in Schedule 1 of this instrument were specified for the purpose of those paragraphs. (2) Clause 2.4.2 of the diagnostic imaging services table shall have effect as if the items in Schedule 1 of this instrument were specified in subclause 2.4.2(1).
(1) Item 61644 only applies to a service described in the item, if:
(a) the patient’s clinical condition requires the service to be performed before the resumption of normal thallous chloride 201 (T1‑201) supply is anticipated by the practitioner who provides the service; and
(b) the report of the service performed includes a justification for the substitute service, which describes the unavailability of a service to which item 61325 applies.
Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.
Sourced from the Federal Register of Legislation (legislation.gov.au), CC BY 4.0.
This instrument is the Health Insurance (Section 3C Diagnostic Imaging – Additional Nuclear Medicine Services) Determination 2022.
This instrument is made under subsection 3C(1) of the Health Insurance Act 1973.
(1) In this instrument:
Act means the Health Insurance Act 1973.
PET means positron emission tomography.
relevant provisions means all provisions, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under the National Health Act 1953, relating to medical services, professional services or items.
relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in a Schedule.
Schedule means a Schedule to this instrument.
Note: The following terms are defined in subsection 3(1) of the Act:
clinically relevant service;
diagnostic imaging services table;
item;
professional service.
(2) Unless the contrary intention appears, a reference in this instrument to a provision of the Act or the National Health Act 1953 or regulations made under the Act or under the National Health Act 1953 as applied, adopted or incorporated in relation to specifying a matter is a reference to those provisions as in force from time to time and any other reference to provisions of an Act or regulations is a reference to those provisions as in force from time to time.
For subsection 3C(1) of the Act, a relevant service, provided in accordance with this instrument and as a clinically relevant service, is to be treated, for the relevant provisions, as if:
(a) it were both a professional service and a diagnostic imaging service; and
(b) there were an item in the diagnostic imaging services table that:
related to the service; and
specified for the service a fee in relation to each State, being the fee specified in the Schedule in relation to the service.
(1) Paragraphs 2.4.1(b) and (c) of the diagnostic imaging services table shall have effect as if items in Schedule 1 of this instrument were specified for the purpose of those paragraphs. (2) Clause 2.4.2 of the diagnostic imaging services table shall have effect as if the items in Schedule 1 of this instrument were specified in subclause 2.4.2(1).
(1) Item 61644 only applies to a service described in the item, if:
(a) the patient’s clinical condition requires the service to be performed before the resumption of normal thallous chloride 201 (T1‑201) supply is anticipated by the practitioner who provides the service; and
(b) the report of the service performed includes a justification for the substitute service, which describes the unavailability of a service to which item 61325 applies.
Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.