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HEALTH INSURANCE (DIAGNOSTIC IMAGING SERVICES TABLE) REGULATION 2016 (F2016L01303) - NOTES

Sussan Ley

Minister for Health and Aged Care

 

 

  

  

  


Contents

1............ Name............................................................................................................................. 1

2............ Commencement............................................................................................................. 1

3............ Authority....................................................................................................................... 1

4............ Schedules...................................................................................................................... 1

5............ Diagnostic imaging services table.................................................................................. 1

6............ Dictionary...................................................................................................................... 1

Schedule 1--Diagnostic imaging services table                                                         2

Part 1--Preliminary                                                                                                                                        2

Division 1.1--Interpretation                                                                                                               2

1.1.1...... References to diagnostic imaging services..................................................................... 2

Division 1.2--General application provisions                                                                           2

Subdivision A--Capital sensitivity                                                                                                   2

1.2.1...... Application of (K) items and (NK) items....................................................................... 2

1.2.2...... Age of equipment.......................................................................................................... 2

1.2.3...... Exemptions from capital sensitivity............................................................................... 4

1.2.4...... Reconsideration of exemption decisions........................................................................ 5

1.2.5...... Delegation..................................................................................................................... 5

Subdivision B--Other provisions                                                                                                     6

1.2.6...... Meaning of symbols (R) and (NR) in the table............................................................. 6

1.2.7...... Who may provide a diagnostic imaging service............................................................. 6

1.2.8...... Report requirements for certain services........................................................................ 6

1.2.9...... Bulk-billing incentive.................................................................................................... 6

1.2.10.... Bulk-billing--magnetic resonance imaging................................................................... 6

1.2.11.... Multiple services--vascular ultrasound......................................................................... 7

1.2.12.... Multiple services........................................................................................................... 7

1.2.13.... Application of items--services provided with autologous injections of blood or blood products            8

Part 2--Services and fees                                                                                                                            9

Division 2.1--Group I1: ultrasound                                                                                               9

Subdivision A--General                                                                                                                     9

2.1.1...... Ultrasound services--eligible services.......................................................................... 9

2.1.2...... Ultrasound services--R-type eligible services.............................................................. 9

Subdivision B--Subgroups 1 to 4 of Group I1                                                                            10

2.1.3...... Certain items taken to include referred by dental practitioner or referring dental practitioner    10

Subdivision C--Subgroup 5 of Group I1: obstetric and gynaecological                             24

2.1.4...... Obstetric and gynaecological ultrasound services--limits........................................... 24

2.1.5...... Obstetric and gynaecological services--referrals and clinical notes............................ 25

2.1.6...... Obstetric and gynaecological services--conditions..................................................... 25

Subdivision D--Subgroup 6 of Group I1: musculoskeletal ultrasound                                41

2.1.7...... Musculoskeletal ultrasound services--personal attendance......................................... 41

2.1.8...... Musculoskeletal ultrasound services--comparison ultra-sonography......................... 42

2.1.9...... Musculoskeletal ultrasound services--equipment....................................................... 42

Division 2.2--Group I2: computed tomography (examination)                                    53

2.2.1...... CT services--eligible services..................................................................................... 53

2.2.2...... CT services--exclusion of attenuation correction and anatomical correlation.............. 53

2.2.3...... CT services--exclusion of acoustic neuroma.............................................................. 54

2.2.4...... CT services--assessment of headache........................................................................ 54

2.2.5...... CT services--number of services................................................................................ 54

2.2.6...... Cone bean computed tomography--items 57362 and 57363...................................... 54

Division 2.3--Group I3: diagnostic radiology                                                                        62

Subdivision A--General                                                                                                                   62

2.3.1...... Who must perform diagnostic imaging procedure....................................................... 62

Subdivision B--Subgroups 1 to 9 of Group I3                                                                            63

Subdivision C--Subgroup 10 of Group I3: radiographic examination of breasts            68

2.3.2...... Mammography services--eligible services................................................................. 68

Subdivision D--Subgroups 12 to 14 of Group I3                                                                       69

Subdivision E--Subgroup 15 of Group I3: fluoroscopic examination                                 73

Subdivision F--Subgroup 16 of Group I3: preparation for radiological procedure       74

2.3.3...... Preparation of patients for radiological procedures...................................................... 74

Subdivision G--Subgroup 17 of Group I3: interventional techniques                                 75

2.3.4...... Meaning of angiography suite..................................................................................... 75

Division 2.4--Group I4: nuclear medicine imaging                                                             75

2.4.1...... Nuclear scanning services--other than PET................................................................ 75

2.4.2...... PET nuclear scanning services.................................................................................... 75

2.4.3...... PET nuclear scanning services--performance under personal supervision................. 76

2.4.4...... PET nuclear scanning services--equipment................................................................ 76

2.4.5...... PET nuclear scanning services--statutory declaration................................................. 76

Division 2.5--Group I5: magnetic resonance imaging                                                       84

Subdivision A--General                                                                                                                   84

2.5.1...... MRI and MRA services--eligible services................................................................. 84

2.5.2...... MRI and MRA services--request............................................................................... 85

2.5.3...... MRI and MRA services--permissible circumstances for performance....................... 85

2.5.4...... MRI and MRA services--eligible provider................................................................ 85

2.5.5...... MRI and MRA services--eligible equipment............................................................. 85

2.5.6...... MRI and MRA services--partial eligible equipment................................................... 86

2.5.7...... MRI and MRA services--meaning of scan................................................................ 86

2.5.8...... MRI and MRA services--multiple services................................................................ 86

2.5.9...... MRI or MRA services--related services that can be claimed in a 12 month period.... 86

Subdivision B--Subgroups 1 to 19 of Group I5                                                                          87

Subdivision C--Subgroup 20 of Group I5: scans of pelvis and upper abdomen for specified conditions               95

2.5.10.... MRI services--limits for certain items........................................................................ 95

2.5.11.... MRI and MRA services--modifying items................................................................ 96

Subdivision D--Subgroups 21 and 22 of Group I5                                                                    97

Subdivision E--Subgroup 33 of Group I5                                                                                   98

Subdivision F--Subgroup 34 of Group I5                                                                                    99

Division 2.6--Group I6: management of bulk-billed services                                       100

2.6.1...... Application of items 64990 and 64991...................................................................... 100

Part 3--Dictionary                                                                                                                                       103

Schedule 2--Repeals                                                                                                                                   107

Health Insurance (Diagnostic Imaging Services Table) Regulation 2015                             107




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