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HEALTH INSURANCE (DIAGNOSTIC IMAGING SERVICES TABLE) REGULATIONS 2001 2001 NO. 293
EXPLANATORY STATEMENTSTATUTORY RULES 2001 No. 293
Issued by the Authority of the Minister for Health and Aged Care
Health Insurance Act 1973
Health Insurance (Diagnostic Imaging Services Table) Regulations 2001
Section 133 of the Health Insurance Act 1973 (the Act) provides that the Governor-General may
make regulations prescribing matters for the purposes of the Act.
The Act provides for payments of Medicare benefits in respect of professional services rendered to eligible persons. Section 9 of the Act provides that Medicare benefits shall be calculated by reference to the fees for medical services, including diagnostic imaging services, set out in prescribed Tables.
Subsection 4AA(1) of the Act provides that the regulations may prescribe a table of diagnostic imaging services setting out items of diagnostic imaging services; the amount of fees applicable in respect of each item; and rules for interpretation of the table. Subsection 4AA(2) provides that, unless sooner repealed, regulations made under section 4AA cease to be in force and are taken to be repealed on the day next following the 15 h sitting day of the House of Representatives after the expiration of a period of 12 months commencing on the day on which the regulations are notified in the Gazette.
The Health Insurance (Diagnostic Imaging Services Table) Regulations 2001 (the Regulations) prescribe a table of diagnostic imaging services for the 12 month period commencing on 1 November 2001. The new table replaces the table contained in the Health Insurance (Diagnostic Imaging Services Table) Regulations 2000. The Regulations set out the items of diagnostic imaging services which are eligible for Medicare benefits, the amount of fees applicable in respect of each item and rules for interpretation of the table.
The Regulations contain the following changes made as part of the ongoing management of the diagnostic imaging services table:
• introduction of a rule which includes the report as part of each diagnostic service, where relevant (rule 6);
• consequential amendments following from the introduction of new arrangements for the Medicare funding of anaesthesia services;
• amendments to denote existing items which potentially attract anaesthesia services, and to extend these items to include all CT services, selective coronary arteriography items and item 60100;
• introduction of new requirements for ultrasound services which are consequential upon new arrangements for the accreditation and registration of medical sonographers (rule 9); deletion of vascular ultrasound items 55240, 55242, 55245, 55247, 55250, 55254, 55258, 55260, 55263, 55265, 55268 and 55272 and the addition of vascular ultrasound items 55292, 55294 and 55296;
• introduction of a rule which excludes the payment of benefits for computed tomography (CT) scans performed using a hybrid positron emission tomography (PET)/CT scanner (rule 21),
• deletion of CT items 56210, 56216, 56256 and 56250 and the addition of CT items 56220 to 562400;
• addition of two CT spiral angiography services, items 57351 and 57356,
• deletion of the general orthopantomography item 57936 and the addition of items 57948, 57951, 57954 and 57957;
• amendments to diagnostic radiology items 58112 and 58115, and the addition of item 58108;
• amendments to the magnetic resonance imaging (MRI) eligible provider requirements;
• adjustments to clarify the restrictions on the number of MRI scans of the musculoskeletal system which attract benefits;
• fee adjustments for CT scans of facial bones, paranasal sinuses and the brain, items 56030, 56036, 56070 and 56076; and
• fee adjustments for items 61302 to 61499 as part of the Nuclear Medicine Agreement.
These changes have been developed in consultation with the relevant professional bodies, including the Royal Australian and New Zealand College of Radiologists, the Australian Diagnostic Imaging Association and the Australian and New Zealand Association of Physicians in Nuclear Medicine.
An additional change, fee adjustments for items 56001 to 57356, has been implemented as part of the management of Medicare expenditure under the Diagnostic Imaging Agreement.
Details of the Regulations are provided in the Attachment.
The regulations commence on 1 November 2001.
DETAILS OF THE HEALTH INSURANCE (DIAGNOSTIC IMAGING SERVICES TABLE) REGULATIONS 2001
Regulation 1 provides that the name of the regulations will be the Health Insurance (Diagnostic Imaging Services Table) Regulations 2001.
Regulation 2 provides that the regulations commence on 1 November 2001.
Regulation 3 repeals the Health Insurance (Diagnostic Imaging Services Table) Regulations 2000 (as amended).
Regulation 4 defines certain terms used in the Regulations.
Regulation 5 provides that the table of diagnostic imaging services set out in Schedule 1 is prescribed for the purposes of subsection 4AA(1) of the Act.
Changes to the Table - Schedule 1
The November 2001 Diagnostic Imaging Services Table differs from the previous table in the following ways:
General
• Addition of Rule 6 which includes the report as part of each diagnostic imaging service, unless that service has been rendered in conjunction with a surgical procedure or in preparation for a radiological procedure. This rule is intended to discourage practitioners who render a diagnostic imaging service from withholding the report component of the service from the requesting practitioner.
Where the service has been rendered in conjunction with a surgical procedure (items 55054, 55130, 55848, 55850, 57341, 57345, 59312, 59314, 60506, 60509, and 61109) the providing practitioner may note the findings on the record of the surgical procedure.
Diagnostic imaging items with an anaesthesia component
• Deletion of the anaesthesia formula from the rules of interpretation and from items containing the formula in their descriptions. This accounts for new arrangements for the Medicare funding of anaesthesia services which were introduced into the General Medical Services Table (GMST) with effect from 1 November 2001. The arrangements removed the use of the formula and introduced a new schedule of anaesthesia services.
• The term 'anaes' has been inserted or retained in diagnostic imaging items which potentially attract anaesthesia services, to denote them as eligible services for this purpose.
• All computerised tomography items now have the term 'anaes' in the item description (items 56001 to 57356). Previously, only computerised tomography of the brain and computerised tomography of the body potentially attracted an anaesthesia service. Expert medical advice indicates that all computed tomography items would require the administration of anaesthesia in some cases.
• The range of services which potentially attract anaesthesia services has been expanded to include items 59912, 59970 to 59974 and 60100. Expert medical advice indicates that the rendering of these services would require the administration of anaesthesia in some cases.
New requirements for the accreditation of medical sonographers
• Addition of Rule 9 which outlines new requirements for the accreditation of medical sonographers. Under the rule, sonographers performing medical ultrasound examinations (either referred or non-referred type items) on behalf of a medical practitioner must be suitably qualified and involved in a relevant and appropriate Continuing Professional Development program. Accredited sonographers will be identified on a register administered by the Australian Sonographer Accreditation Registry with the Health Insurance Commission.
• A definition of 'registered sonographer' has been inserted into rule 2.
• The descriptors for the following items have been amended to delete the requirement that the ultrasound scan be performed by, or on behalf of, a medical practitioner: 55028, 55030, 55032, 55036, 55038, 55044, 55048, 55070, 55076, 55700, 55704, 55706, 55712 to 55721, 55725 to 55728, 55731, 55736, 55759 to 55768, 55772 to 55846, 55850 to 55854.
• The new arrangements will address the existing anomaly of the lack of mandatory requirements for sonographers rendering Medicare funded ultrasound scans. This is inconsistent with other parts of the Medicare Benefits Schedule which outlines minimum requirements for various professionals rendering Medicare funded services.
Vascular ultrasound
• Deletion of the following vascular ultrasound items: 55240, 55242, 55245, 55247, 55250, 55254, 55258, 55260, 55263, 55265, 55268 and 55272. These items combine vascular ultrasound services and a GMST service such as examination of peripheral vessels at rest. Given that there are equivalent vascular ultrasound items which do not include the GMST service component, the overall impact on the diagnostic imaging services table will be minimal.
• Addition of three vascular ultrasound items which provide for the following services: arteriovenous fistula imaging (55292), conduit mapping prior to surgery (55294), and skin marking of perforating veins (55296). It appears that, previously, these services have been incorrectly itemised against other vascular ultrasound items.
• These changes have been formulated by the Vascular Ultrasound Working Group which consists of the principle and referring groups for the vascular ultrasound subgroup.
Computed tomography (CT)
• Addition of Rule 21 which excludes the payment of Medicare benefits for CT scans performed using a hybrid PET/CT scanner. This rule is intended to prevent practices in possession of a hybrid scanner from receiving benefits for CT scans performed in order to improve the focus of a PET scan.
• Restructuring of CT items which provide for scans of the spine: deletion of items 56210, 56216, 56256 and 56250 and addition of items 56220 to 56240. The new structure includes items which specify the region of the spine to be scanned and items which provide for the scanning of multiple regions. They will enable better monitoring of Medicare expenditure on CT imaging of the spine.
• Addition of items 57351 and 57356 which provide for follow-up CT spiral angiography studies. These items are tightly specified to restrict use to particular conditions; eg, acute or recurrent pulmonary embolism. They apply where one of the existing CT spiral angiography services (items 57350 or 57355) has been rendered within a 12 month period. Expert medical advice indicate that it is appropriate to provide Medicare funding for follow-up studies for the specified conditions.
Diagnostic radiology
• Deletion of item 57936 which provided for general orthopantomography (OPG) services. Addition of four new OPG items (57948, 57951, 57954 and 57957) which require the clinical indication for the referral and which attract the equivalent fee as the deleted item. These changes will provide data to more effectively assess expenditure on OPG services.
• Amendments to items 58112 and 58115 which provide for scans of two or three regions of the spine, to specify the regions being scanned. Addition of item 58108 which provides for the scanning of four regions of the spine. These changes will enable better monitoring of Medicare expenditure on diagnostic radiology imaging of the spine.
Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA)
• Amendments to Rule 39 which restricts the number of MRI scans of the musculoskeletal system rendered within a 12 month period which attract benefits (items 63600 to 63721, and 63745). The amendments are intended to clarify that the restriction on the number of services rendered applies to a specific anatomical site; eg, a maximum of 1 scan of the right hip to exclude derangement of the hip or its supporting structures. This was the original intention of the restriction.
The amendments limit the payment of Medicare rebates to one service per item per episode of care. This is intended to prevent practices from claiming two or more services for a scan rendered on the one occasion of service. eg, a scan of both hips rendered on the one occasion of service.
Changes to Schedule fees
• Revised Schedule fees for CT scans of facial bones, paranasal sinuses and the brain, items 56030, 56036, 56070 and 56076. The fees for these items have been reduced to the fee associated with CT scans of facial bones and paranasal sinuses. These changes have been made on the recommendation of the Diagnostic Imaging Management Committee (DIMC) which comprises the Royal Australian and New Zealand College of Radiologists (RANZCR) and the Australian Diagnostic Imaging Association (ADIA). The DIMC believes that the items are being exploited because of the fee differential, although the additional brain scans do not require significant effort.
• 1.5% increase to nuclear medicine imaging items 61302 to 61499 as part of the Nuclear Medicine Agreement. The Agreement is managed by the Nuclear Imaging Consultative and Economics Committee which comprises of representatives from the Australian and New Zealand Association of Physicians in Nuclear Medicine, Royal Australian and New Zealand College of Radiologists, Australian Diagnostic Imaging Association and the Department of Health and Aged Care. As a result of an underspend in the last financial year, a 1.5% increase to nuclear medicine imaging items has been implemented.
• 5% reduction to CT items 56001 to 57356 as part of the management of Medicare expenditure on diagnostic imaging services under the Diagnostic Imaging Agreement. Medicare expenditure on CT imaging has shown an accelerating increase in the rate of growth in the level of expenditure (eg, 11.6% increase in Medicare expenditure on CT services in 2000/01). The reduction in CT fees will assist in managing the rate of growth in CT scanning. It will also avoid the need to make more severe cuts at a later stage in order to manage expenditure under the Agreement.