Health Insurance (Share by Default) Rules 2025

This instrument works by specifying, for purposes of subsection 19AD(1) of the Act, three linked elements: the scope of services captured, the content that must be shared, and the time period for sharing. Each of those elements is expressed in precise, cross‑referenced terms.

Scope: The services captured are not described directly in this instrument as item numbers; instead the instrument points to existing statutory tables and to types of services defined in the Act. Diagnostic imaging services are defined by reference to R‑type diagnostic imaging items in Part 2 of the Diagnostic Imaging Services Table and certain medical services in Part 4 of the General Medical Services Table rendered by or on behalf of a radiologist (s 5(2)(a)-(b)). Pathology services are similarly defined by reference to the Pathology Services Table and to pathologist‑determinable services rendered by or on behalf of an approved pathology practitioner (s 8(2)(a), (c)). The instrument also imports services treated as items under determinations made under subsection 3C(1) of the Act (s 5(2)(c); s 8(2)(b)(i)), so services treated as equivalent under existing Act determinations are captured.

Content: For both diagnostic imaging and pathology, the specified information is information included in a report or other document created in respect of the service and authorised by the relevant practitioner,the radiologist or approved pathology practitioner,who rendered the service or on whose behalf it was rendered (ss 6(1), 9). The rules make clear that images are excluded from the diagnostic imaging specified information (s 6(2)). The instrument uses the phrase “report or other document”, which is broader than “report” alone and thus covers documents prepared in respect of the service that are capable of being authorised by the relevant practitioner.

Timing: The instrument sets a 24‑hour window for sharing. The period is the 24 hours beginning at the time the information is first provided to the requesting practitioner, or if there was no request, the treating practitioner (ss 7(2), 10(2)). That creates an objective start point tied to the practitioner receiving the information rather than, for example, the time of authorisation, completion of the report, or time of billing.

Administrative link to Medicare payments: The instrument’s procedural effect is connected to Medicare benefit payment. Notes in ss 6 and 9 state that the specified information is required to be shared with My Health Record for a Medicare benefit to be payable for the service, unless an exception applies. The instrument itself does not set out the Medicare benefit mechanics; rather it specifies the conditions for the purposes of s 19AD(1) of the Act.

Delegation and “rendered by or on behalf of”: The capture of services “rendered by or on behalf of” a radiologist or approved pathology practitioner (ss 5(2), 8(2)) means that the obligation can apply where those practitioners are principal signatories but other staff or entities deliver elements of the service. Correspondingly, authorisation of reports may be performed by the practitioner who rendered the service or on whose behalf it was rendered (ss 6(1), 9), which allows authorised signatures by the responsible practitioner for reports produced through delegated workflows.

Cross‑instrument dependency: The instrument’s scope depends on the content of other regulations and determinations (the diagnostic imaging, general medical services and pathology tables and any s 3C determinations). Any modification to those source tables or determinations will affect the services captured by these rules without amending this instrument. The instrument expressly defines “Act” and “radiologist” for its purposes (s 4).

Primary regulated entities: Radiologists and approved pathology practitioners are the central legal actors named in the instrument. The obligations to authorise and to cause sharing to My Health Record attach to information that must be “authorised by the radiologist who rendered the service, or on whose behalf the service was rendered” (s 6(1)) and likewise for the approved pathology practitioner (s 9). The specified services are those “rendered by or on behalf of” those practitioners (ss 5(2), 8(2)), so both individual specialists and entities acting under their authority are caught.

Other healthcare practitioners: The timing trigger for the 24‑hour period is the time the information is first provided to either the practitioner who requested the service or, if there was no such request, the treating practitioner (ss 7(2), 10(2)). Therefore requesting practitioners and treating practitioners become relevant operational nodes in the compliance chain. They will receive reports and thereby create the clock start for the 24‑hour sharing requirement.

Organisations and third parties: Facilities, laboratories, diagnostic imaging providers and third‑party IT vendors that prepare reports, host systems, or operate interfaces to My Health Record will be materially affected. The instrument captures services rendered “on behalf of” the relevant practitioner (ss 5(2), 8(2)), which includes instances where a private clinic, hospital radiology department, or pathology laboratory performs work under the ultimate professional responsibility of a radiologist or approved pathology practitioner. Those organisations will have to implement processes to ensure authorised reports are uploaded within the prescribed timeframe.

Medicare and payors: The instrument links sharing to Medicare benefit payment via notes in ss 6 and 9. That means payors and administrators of Medicare benefits will be affected operationally; benefit eligibility will depend on whether sharing occurred as prescribed, subject to any exception in the Act.

Patients: Patients whose services are captured will experience their clinical reports being uploaded to their My Health Record by default in relation to the specified services, unless an exception applies. The instrument excludes images from the diagnostic imaging specified information (s 6(2)), so patients’ images are not mandated to be shared under this instrument, though reports will be.

Regulatory decision makers: The Minister made the rules under the Act (s 3). The instrument also relies on definitions and determinations in the Act (s 4 note and ss 5(2)(c), 8(2)(b)(i)). Any regulatory authority enforcing or clarifying the instrument will need to coordinate with the administrative provisions of the Act, particularly subsection 19AD(1) which the instrument cites as its operative purpose.

Indirect stakeholders: Clinical coders, medical administrators, and practice managers will need to adjust workflows to ensure authorisation and upload within the 24‑hour window. Vendors that integrate electronic medical record systems or manage My Health Record interfaces will have to ensure compatibility and logging to support compliance evidence.

Excluded or limited groups: Images are specifically excluded from the diagnostic imaging information requirement (s 6(2)). The instrument does not mention non‑approved pathology staff, non‑radiologist specialists other than where services are rendered “on behalf of” a radiologist or approved pathology practitioner, or services outside the referenced tables.

Duties established by the instrument are narrowly specified and tied to the Act via subsection 19AD(1). The principal duties are to create, authorise and share certain reports or documents to the My Health Record system within 24 hours of first provision to the requesting or treating practitioner for particular diagnostic imaging and pathology services.

Obligation to create and authorise information: For a professional service specified in s 5 (diagnostic imaging), the specified information is that which is included in a report or other document created in respect of that professional service and authorised by the relevant radiologist (s 6(1)). For pathology (s 8), the same structure applies with the approved pathology practitioner as the authorising practitioner (s 9). The duty to ensure authorisation exists in order that the document be covered by the specified information requirement. Authorisation must come from “the radiologist who rendered the service, or on whose behalf the service was rendered” (s 6(1)); for pathology the parallel phrase applies (s 9). The formulation contemplates authorisation by the practitioner who holds the professional responsibility, whether they personally compiled the report or authorised it in a delegated workflow.

Obligation to share within 24 hours: Once the specified information has been created and authorised, the instrument prescribes a 24‑hour timeframe for sharing with My Health Record. The 24‑hour period runs from the time the information is first provided to the requesting practitioner, or if there was no such request, the treating practitioner (ss 7(2), 10(2)). This assigns operational responsibility for timestamping the moment of first provision to practitioners and their organisations.

Medicare benefit linkage: The instrument links compliance with the sharing obligation to Medicare benefit eligibility for the specified services. The notes in ss 6 and 9 state that the information is required to be shared with My Health Record for a Medicare benefit to be payable for the service, unless an exception applies. The instrument itself does not set out the conditions or administrative process for withholding or restoring benefits; it establishes the sharing condition as a payment precondition for the purposes of s 19AD(1) of the Act.

Delegation and “on behalf of” arrangements: The duty applies where services are rendered “by or on behalf of” the named practitioner (ss 5(2), 8(2)), and the required authorisation may be by the practitioner “or on whose behalf the service was rendered” (ss 6(1), 9). That creates a legal structure that allows delegation of service delivery while preserving a duty on the responsible specialist to authorise the report and ensure sharing.

Rights and non‑duties expressed or implied by the instrument: The instrument does not grant express rights to patients or providers beyond the operational direction to share reports and the note tying that to Medicare benefit. It does not create explicit appeal, review or exemption processes within the instrument itself. The instrument excludes images from the diagnostic imaging specified information, which functions as a limitation right for practitioners or patients concerned specifically about image sharing (s 6(2)). The instrument also acknowledges exceptions by noting that sharing is required for Medicare benefit “unless an exception applies” (ss 6 and 9), but it does not specify the exceptions,those will be found in the Act or in other legal instruments or guidance.

Recordkeeping and evidence duties: While the instrument does not prescribe recordkeeping steps, compliance will require evidence as to when information was first provided to the requesting or treating practitioner and that the authorised document was uploaded to My Health Record within 24 hours. Practices and organisations will need to implement timestamping, audit logs and delegation records to demonstrate compliance in the event of a benefit dispute under the Act.

No standalone penalty clauses: The instrument contains no standalone offence or penalty clauses. Enforcement as to Medicare benefit payment is indicated by the notes and the instrument’s connection to subsection 19AD(1) of the Act; any specific sanctions, review rights or administrative procedures must be sourced from the Act or other instruments.

The instrument does not itself prescribe criminal offences, civil penalties or detailed enforcement mechanisms. Its operational enforcement is expressed indirectly through its connection to subsection 19AD(1) of the Health Insurance Act 1973. The instrument repeatedly states that its sections are specified “for the purposes of subsection 19AD(1) of the Act” (see ss 5, 6, 7, 8, 9, 10). The attendant notes in ss 6 and 9 state that the specified information “is required to be shared with the My Health Record system for medicare benefit to be payable for the service, unless an exception applies”. That wording indicates the primary enforcement lever is the conditionality of Medicare benefit payment rather than a new standalone offence in this instrument.

Because the instrument does not itself set out the mechanics of benefit denial, recovery, or penalties, practitioners and organisations must look to the Health Insurance Act 1973 for the statutory mechanisms that follow from subsection 19AD(1). This instrument supplies the operative definitions and time frames that the Act will use when determining whether the sharing obligation has been met. Any administrative enforcement, decisions about benefit withholding, recovery of payments, review rights, or appeals will thus be governed by the Act and any other instruments or departmental processes that implement subsection 19AD(1).

Operational enforcement in practice will likely involve Medicare administrators verifying that the specified report or document was uploaded to My Health Record within the 24‑hour period specified (ss 7(2), 10(2)). To the extent evidence is required, audit logs, timestamps on transmissions to My Health Record, authorisation metadata indicating the responsible radiologist or approved pathology practitioner, and internal records of when information was first provided to the requesting or treating practitioner will be the factual basis of compliance assessments. The instrument itself does not mandate particular formats of evidence or records.

There is an exception caveat: the notes in ss 6 and 9 say “unless an exception applies”. The instrument does not define or enumerate those exceptions; they must be sought in the Act or other policy instruments. The existence of unspecified exceptions introduces an administrative discretion pathway: decision makers applying the Act will need to determine whether any claimed exception puts the service outside the Medicare payment conditioning set by these rules.

In short, enforcement is mediated through Medicare benefit eligibility and the Act’s administrative machinery, not by new penalty provisions in this instrument. Those seeking to assess enforcement risk should cross‑refer to subsection 19AD(1) of the Act and any departmental guidance implementing the Act’s enforcement framework.

This instrument is expressly made under the Health Insurance Act 1973 (s 3) and repeatedly frames its provisions as being “for the purposes of subsection 19AD(1) of the Act” (see ss 5-10). Consequently, its legal effect is derived from and co‑dependent with the Act. The instrument does not operate in isolation; it is a specification instrument that defines terms and timeframes the Act will apply in determining Medicare benefit eligibility for particular services.

Cross‑references to other regulations: The instrument relies on items listed in other Health Insurance regulations. For diagnostic imaging the instrument refers to the table in Part 2 of the Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020 and to Part 4 of the Health Insurance (General Medical Services Table) Regulations 2021 (s 5(2)(a)-(b)). For pathology it refers to the table in Part 2 of the Health Insurance (Pathology Services Table) Regulations 2020 (s 8(2)(a)). Therefore any amendments to those external tables will ripple through to the services captured by this instrument without further amendment to these rules. Practitioners and administrators must map service codes in their billing and clinical IT systems to those tables to determine applicability.

Interaction with Act definitions and determinations: Section 4 of the instrument notes that a number of expressions used in the instrument are defined in the Act, including “approved pathology practitioner”, “My Health Record system”, “pathologist‑determinable service”, “pathology service”, and “R‑type diagnostic imaging service”. The instrument also expressly incorporates services “treated as if [they] were an item in a table” under determinations made under subsection 3C(1) of the Act (s 5(2)(c); s 8(2)(b)(i)). Thus the instrument’s coverage depends on Act definitions, Ministerial determinations and delegated instruments.

Data sharing and privacy law: The instrument requires reports or other documents to be shared with the My Health Record system (ss 6(1), 9). Sharing of health information is regulated under existing federal privacy and health records law frameworks, and the instrument does not override those frameworks. The instrument does not itself create privacy law exceptions or obligations; it prescribes operational sharing that must be reconciled with applicable privacy obligations and any consent or exception regimes established by the Act or other Commonwealth privacy legislation. The instrument’s notes indicate that exceptions to the sharing requirement may apply, but it does not itself define them.

Medicare administration and billing law: The instrument links the sharing requirement to Medicare benefit payment (ss 6 and 9 notes). That means administrative provisions and decision‑making under the Health Insurance Act 1973 will govern benefit entitlement, denials, recoveries and appeals. Practitioners should therefore treat this instrument as setting a billing precondition that interacts with Medicare billing rules, claim submission timelines, and audit regimes under the Act.

Operational regulation and standards: The instrument does not prescribe technical standards for how data are to be formatted or transmitted to My Health Record, nor does it specify logging or authentication protocols. Those technical obligations will be governed by My Health Record operational rules, system specifications, and any administrative guidance issued by the Department or agency that operates My Health Record. Compliance therefore requires aligning clinical workflows with both this instrument’s time and authorisation requirements and the technical and privacy requirements of the My Health Record system.

State and territory law: The instrument is a Commonwealth regulation under the Health Insurance Act and therefore operates alongside state and territory health laws. It does not purport to override state or territory clinical governance or licensing regimes; practitioners remain subject to professional regulation in each jurisdiction. The instrument’s requirement to share reports to a Commonwealth system must be implemented in a way consistent with any state or territory obligations on recordkeeping, retention, or disclosure.

The instrument contains a commencement table and an explicit note on the commencement table’s scope. Section 2(1) sets out that the whole instrument commences on 1 July 2026, and the table is incorporated into the instrument to that effect. Section 2(2) contains the statutory saving that any information appearing in column 3 of the table is not part of the instrument and that that information may be edited in published versions; the instrument therefore separates operative provisions from ancillary publishing notes.

The instrument does not include any later amendments or revision history in its text. The instrument itself includes this cautionary note: “This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.” That indicates that historical publishing notes may be edited in published versions but that the text of the instrument must be updated by formal amendment if provisions are changed.

Because the instrument relies by reference on other instruments and determinations (notably the Diagnostic Imaging, General Medical Services and Pathology Services Tables and any determinations under subsection 3C(1) of the Act), changes to those source instruments or to the Act will alter the operational scope of these rules without an amendment to this instrument. For example, adding or removing items from the referenced schedules or modifying the definitions in the Act will change which services fall within the sharing requirement.

The instrument does not record any previous versions, replacement rules, or transitional arrangements apart from the start date. There are no savings or grandfathering clauses in the instrument text itself other than the commencement mechanism. Any transitional arrangements, phased rollouts, or implementation guidance would need to be located in external departmental guidance or in amendments to the Act or the other referenced tables.

Practitioners or administrators seeking to track amendments should therefore monitor:

• amendments to this instrument made under the Health Insurance Act 1973 and published in the Federal Register of Legislation;
• changes to the Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020, the Health Insurance (General Medical Services Table) Regulations 2021 and the Health Insurance (Pathology Services Table) Regulations 2020; and
• determinations under subsection 3C(1) of the Act and any amendments to definitions in the Act itself.

The instrument’s limited amendment history in its text means that external regulatory and guidance updates will likely be the principal vehicles for change in operational practice.

The instrument contains no references to case law, judicial decisions, or prior litigation. It is framed as a rule made under the Health Insurance Act 1973 without mention of court challenges or judicial interpretation. The instrument’s text does not claim any existing litigation history, nor does it cite judicial authorities.

Because the instrument’s legal effect is to define matters “for the purposes of subsection 19AD(1) of the Act” (see ss 5-10), any litigation that would arise in future would most likely concern the statutory interpretation of subsection 19AD(1) in the Act and whether the conditions specified in this instrument have been satisfied in particular factual circumstances. Potential litigation vectors include disputes over:

• whether a particular service is captured as an item in the referenced tables or under an s 3C determination;
• whether a report or document was “authorised” by the named practitioner in the meaning intended by ss 6(1) or 9;
• the time at which information was “first provided” to the requesting or treating practitioner for the purpose of fixing the 24‑hour window (ss 7(2), 10(2)); and
• whether an exception to the sharing requirement applied, as the notes to ss 6 and 9 contemplate.

None of those scenarios are litigated in the instrument itself. Any litigated issues would have to be decided under the Act and the broader statutory and regulatory context. As this instrument itself records no litigation history, users should check subsequent case law and administrative decisions for any judicial interpretation that clarifies the meaning of the operative phrases used here.

The instrument is concise but contains several precise mechanisms and cross‑references that create practical traps for compliant implementation. Key items to flag are concrete and technical.

24‑hour clock starts on provision to practitioner: The 24‑hour period within which specified information must be shared with My Health Record commences at the time the information is first provided to the requesting practitioner, or if there was no request, the treating practitioner (ss 7(2), 10(2)). That start point is not the time of authorisation, time of billing, or time of report completion. Practices must therefore capture and retain the timestamp of first provision to the practitioner. Failure to do so may make it impossible to demonstrate compliance.

“Rendered by or on behalf of”: The instrument captures services “rendered by or on behalf of a radiologist” or an approved pathology practitioner (ss 5(2), 8(2)). That language means outsourced or delegated service delivery still falls within the obligation if a relevant practitioner is the responsible professional. Organisations that subcontract reporting, reporting authorisation or IT services will need contracts and processes that ensure the responsible practitioner provides the required authorisation and that sharing occurs within the timeframe.

Authorisation requirement: The specified information must be authorised by the radiologist or approved pathology practitioner who rendered the service, or on whose behalf the service was rendered (ss 6(1), 9). The instrument does not define “authorised” beyond that phrase. Practices need clear internal policies about who may sign, what constitutes authorisation (electronic signatures, delegation memoranda), and how authorisation is recorded to produce evidence supporting compliance.

Images excluded but reports included: Diagnostic images are explicitly excluded from the specified information requirement (s 6(2)), while reports or “other document[s]” created in respect of the service are required (s 6(1)). Billing or compliance processes that assume image upload suffices will be incorrect. Conversely, if systems automatically attempt to upload images but not the report, the requirement will not be met. Technical interfaces therefore must support document/report upload as well as metadata authorisation fields.

Dependency on external schedule definitions: The instrument refers to particular items in other regulations (ss 5(2)(a)-(b), 8(2)(a)). If a provider’s billing codes do not precisely map to the referenced items, providers may misclassify services. Changes to those referenced tables will change which services are captured here without amendment to this instrument.

“Unless an exception applies”: Notes in ss 6 and 9 tie the sharing requirement to Medicare benefits but qualify that with “unless an exception applies”. The instrument does not specify the exceptions or how they are claimed. Practitioners must consult the Act, departmental guidance, and administrative procedures to determine what exceptions exist and how to document them.

No express technical or format requirement: The instrument does not set technical standards for uploads to My Health Record, authentication methods, or logging. Compliance therefore requires coordinating with My Health Record system specifications, which are not reproduced here. Misalignment between practice IT systems and My Health Record technical requirements could cause failed uploads and thus lost Medicare benefits.

Evidence burden for audits or disputes: Because enforcement is likely to operate via Medicare benefit eligibility, providers will face audit scrutiny. The instrument itself does not specify required records, so the evidence burden will fall on providers to retain upload logs, authorisation metadata, timestamps of first provision, and delegation records.

Interplay with patient consent and privacy obligations: The instrument mandates sharing to My Health Record but does not itself alter privacy law. Practices must ensure sharing is consistent with privacy and consent obligations under Commonwealth law and any professional obligations.

No penalties in the instrument: There are no express penalties or appeals in this instrument. Providers who assume that there is no practical enforcement because of the absence of penalty clauses may be incorrect; enforcement is handled under the Act’s administrative machinery.

This instrument creates discrete operational requirements. To translate the statutory text into practical compliance steps, a provider’s checklist should include mapping, workflow, IT, governance and audit items.

1. Map services to referenced items and determinations

• Identify every service performed that might fall under the diagnostic imaging or pathology tables referenced in ss 5(2) and 8(2).
• Confirm whether any services your practice provides are treated as items under a subsection 3C(1) determination (ss 5(2)(c), 8(2)(b)(i)). Update billing and clinical coding lists accordingly.

2. Ensure authorised report/document workflows

• Establish who qualifies as the authorising radiologist or approved pathology practitioner for each service. Where reports are prepared by juniors, trainees, or outsourced entities, implement clear authorisation steps showing that the named practitioner has authorised the final report as required by ss 6(1) and 9.
• Define acceptable authorisation methods consistent with clinical governance and My Health Record metadata practices (electronic signatures, credentialed logins, documented delegation).

3. Implement timestamping for “first provided” events

• Adopt a reliable method to record when the information is first provided to the requesting practitioner or, if no request, the treating practitioner (ss 7(2), 10(2)). This may be an entry in an electronic health record, an automated notification, or a secure messaging timestamp.
• Ensure that the same timestamping source is used to demonstrate that the My Health Record upload occurred within 24 hours.

4. Align IT systems with My Health Record requirements

• Confirm that the clinical systems can upload “report or other document” content to My Health Record, not just images, and that uploads capture authorisation metadata linking the document to the relevant practitioner.
• Build an audit trail that records upload time, file identity, authorising practitioner, and transmission status.

5. Address images separately

• Note that images are excluded from diagnostic imaging specified information (s 6(2)). Preserve clinical image management policies and, if images are shared for other reasons, document the separate legal or patient consent basis for such sharing.

6. Contractual and delegation arrangements

• For outsourced reporting or third‑party providers, ensure contracts require the third party to coordinate the authorised report sign‑off and the upload within 24 hours, and to provide supporting evidence for audits.
• Ensure employment and contractor agreements set out responsibilities for authorisation and recordkeeping.

7. Train staff and update clinical governance

• Train requesting practitioners, treating practitioners, radiologists, pathology practitioners, administrative and IT staff on the 24‑hour rule, the start point of the clock, and whom to notify when reports are ready.
• Update privacy and consent policies to reflect the instrument’s default sharing requirement and coordinate with organisational legal counsel on consent and privacy obligations.

8. Prepare evidence for audit and benefit disputes

• Maintain logs showing: (a) the time the information was first provided to the requesting or treating practitioner; (b) the authorisation record linking the report to the practitioner named in ss 6(1) or 9; and (c) the My Health Record upload with timestamp and transmission success confirmation.
• Retain delegation records demonstrating that authorisation was validly given “on behalf of” the named practitioner where relevant.

9. Identify and document exceptions

• Consult the Health Insurance Act 1973 and departmental guidance to determine what exceptions may apply to the sharing requirement. Document any invoked exception and the legal basis for it, in case of Medicare benefit disputes.

10. Monitor legislative and table changes

• Because the instrument’s scope depends on external tables and s 3C determinations, maintain a monitoring process for amendments to the Diagnostic Imaging, General Medical Services and Pathology Services Tables, any s 3C(1) determinations, and amendments to the Health Insurance Act 1973, as changes will alter obligations without amendment to this instrument.

11. Liaise with My Health Record administrators

• Engage with the My Health Record operators to confirm technical, metadata and authentication requirements and to test uploads, particularly for complex or high‑volume reporting environments.

12. Plan for transitional operations

• The instrument commences on 1 July 2026 (s 2). Establish a go‑live checklist with end‑to‑end testing before that date so that Medicare billing is not disrupted by failures to meet the 24‑hour requirement.

Following these steps will address the concrete duties imposed by the instrument: authorisation of reports by the responsible radiologist or approved pathology practitioner (ss 6(1), 9), uploading the specified document to My Health Record within 24 hours of first provision to the requesting or treating practitioner (ss 7(2), 10(2)), and ensuring that service classification aligns with the referenced tables (ss 5(2), 8(2)).