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Health Insurance (Diagnostic Imaging Capital Sensitivity) Amendment Determination 2012 (No. 2)

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Health Insurance (Diagnostic Imaging Capital Sensitivity) Amendment Determination 2012 (No.2) 
Health Insurance Act 1973
I, Dr Richard Bartlett, First Assistant Secretary, Medical Benefits Division, Department of Health and Ageing, make this Determination under subsection 3C (1) of the Health Insurance Act 1973.
Dated    25 October 2012
DR RICHARD BARTLETT
First Assistant Secretary
Medical Benefits Division
Department of Health and Ageing
 
1            Name of Determination
This Determination is the Health Insurance (Diagnostic Imaging Capital Sensitivity) Amendment Determination 2012 (No. 2).
 
2            Commencement
This Determination commences on 1 November 2012.
 
3            Amendment of Health Insurance (Diagnostic Imaging Capital Sensitivity) Determination 2011
The Schedule amends the Health Insurance (Diagnostic Imaging Capital Sensitivity) Determination 2011.
Schedule  - Amendments
 
 [1] Schedule 1, after Subdivision D      Subgroups 21 and 22 of Group I5
 
insert
 
Subdivision E                      Subgroup 33 of Group 15
 
Group I5—Magnetic resonance imaging
 
 
Item
 
Health service
 
 
Fee ($)
(for each state)
 
_____________________________________________________________________________________
Subgroup 33 —Scan of body—for specified conditions
 
 
63508
 
MRI—scan of head for a patient under 16 years if the service is for:
(a) an unexplained seizure (R) (NK) (Anaes.) (Contrast); or
(b) an unexplained headache if significant pathology is suspected (R) (NK) (Anaes.) (Contrast); or
(c) paranasal sinus pathology that has not responded to conservative therapy (R) (NK) (Anaes.) (Contrast)
 
 
201.60

 
63511
 
MRI—scan of spine following radiographic examination for a patient under 16 years if the service is for:
(a) significant trauma (R) (NK) (Anaes.) (Contrast); or
(b) unexplained neck or back pain with associated neurological signs (R) (NK)  (Anaes.) (Contrast); or
(c) unexplained back pain if significant pathology is suspected (R) (NK)  (Anaes.) (Contrast)
 
 
224.00

 
63514
 
MRI—scan of knee following radiographic examination for internal joint derangement for a patient under 16 years (NK)
 
 
201.60

 
63517
 
MRI—scan of hip following radiographic examination for a patient under 16 years if any of the following is suspected:
(a) septic arthritis (R) (NK) (Anaes.) (Contrast);
(b) slipped capital femoral epiphysis (R) (NK) (Anaes.) (Contrast);
(c) Perthes disease (R) (NK) (Anaes.) (Contrast)
 
 
201.60

 
63520
 
MRI—scan of elbow following radiographic examination for a patient under 16 years if a significant fracture or avulsion injury, which would change the way in which the patient is managed, is suspected (R)(NK) (Anaes.) (Contrast)
 
 
201.60

 
63523
 
MRI—scan of wrist following radiographic examination for a patient under 16 years if a scaphoid fracture is suspected (R)(NK) (Anaes.) (Contrast)
 
 
224.00



 
 
[2]         Schedule 2, items 1, 2 and 3
 
substitute
 
 
1.             Diagnostic imaging services table - clauses
 
 
Column 1
Column 2
Column 3

 
Provision of diagnostic imaging services table
Existing item reference of diagnostic imaging services table
Additional item reference

Preliminary

(a)     
Clause 1.1.1 and subclause 1.2.3(1)
Item in Part 2
The items in Schedule 1

(b)    
Paragraph 1.2.3(2)(a)
55054, 55130, 55135, 55848, 55850, 57341, 57345, 59312, 59314, 60506, 60509 and 61109
55026, 55131, 55136, 55849, 55851, 59313, 59315, 60507, 60510, 61110

(c)     
Subclause 1.2.5(4)
61369
61671

(d)    
Subclause 1.2.7(10)
59103, 64990 or 64991
59104

Ultrasound

(e)     
Clause 2.1.1  and subclause 2.1.2 (1)
55600 and 55603
55601, 55604

(f)     
Clause 2.1.3
55028, 55030 and 55032
55005, 55008, 55011

(g)    
Subclause 2.1.4(2)
55706, 55707, 55708, 55709, 55718, 55723, 55759, 55762, 55768 and 55770
55713, 55714, 55716, 55717, 55722, 55726, 55760, 55763, 55769, 55771

(h)    
Subclause 2.1.5 (1)
55700, 55704, 55707, 55718, 55759 and 55768
55701, 55710, 55714, 55722, 55760, 55769

(i)      
Subclause 2.1.5(1)
55712, 55721, 55764 and 55772
55719, 55724, 55765, 55773

(j)      
Subclause 2.1.5(2)
55703, 55705, 55708, 55715, 55723, 55725, 55762, 55766, 55770 and 55774
55702, 55711, 55716, 55720, 55726, 55727, 55763, 55767, 55771, 55775

(k)    
Clause 2.1.6
55712, 55721, 55764 and 55772
55719, 55724, 55765, 55773

Diagnostic radiology

(l)      
Clause 2.3.1(2)
57901 to 57969
57911 to 57968

(m)  
Clauses 2.3.6 and 2.3.4
61109
61110

Nuclear medicine imaging

(n)    
Clause 2.4.1
61302 to 61505 and item 61650
61651 to 61719, 61729

Magnetic resonance imaging

(o)    
Subclause 2.5.1(1) and clause 2.5.7
63001 to 63482 
63484, 63486

(p)    
Subclause 2.5.1(2) and clause 2.5.7
63464 to 63476
63457 to 63484

(q)    
Subclause 2.5.1(4) and clause 2.5.7
 
63507 to 63522
63523

(r)      
Subclause 2.5.9(2)
63040 to 63073
63074 to 63085

(s)     
Subclause 2.5.9(2)
63101
63104

(t)      
Subclause 2.5.9(2)
63125 to 63131
63134 to 63136

(u)    
Subclause 2.5.9(2)
63161 to 63185
63186 to 63194

(v)    
Subclause 2.5.9(2)
63219 to 63243
63257 to 63265

(w)  
Subclause 2.5.9(2)
63271 to 63280
63282 to 63285

(x)    
Subclause 2.5.9(2)
63322 to 63340
63341 to 63348

(y)    
Subclause 2.5.9(2)
63361
63364

(z)     
Subclause 2.5.9(2)
63385 to 63391
63392 to 63394

(aa) 
Subclause 2.5.9(2)
63401 and 63404
63407, 63408

(bb)  
Subclause 2.5.9(2)
63416
63419

(cc) 
Subclause 2.5.9(2)
63425 and 63428
63432, 63433

(dd) 
Subclause 2.5.9(2)
63461, 63464 and 63467
63455, 63457, 63458

(ee) 
Subclause 2.5.9(2)
63482
63486

(ff)  
Subclause 2.5.9(2)
63507 to 63522
63508, 63511, 63514, 63517, 63520 and 63523

(gg)  
Subclauses 2.5.10(1) and (2)
63470
63479

(hh)  
Subclause 2.5.10(1) and (2)
63473
63481

 
 
 
 
 
2.             Diagnostic imaging services table - items
 
 
Column 1
Column 2
Column 3

 
Existing   DIST item
Existing item reference
Additional item reference

Ultrasound

(a)      
55036
55038, 55044 or 55731
55017, 55020, 55732

(b)      
55038
55036, 55044 or 55731
55014, 55020, 55732

(c)      
55044
55036 or 55038
55014, 55017

(d)      
55084
11917, 55036, 55038, 55044, 55600, 55603 or 55731
55014, 55017, 55020, 55601, 55604, 55732

(e)      
55085
11917, 55037, 55039, 55045, 55600, 55603 or 55733
55016, 55019, 55022, 55601, 55604, 55734

(f)       
55113 to 55118
55054
55026

(g)      
55113 to 55117
55118 and 55130
55125, 55131

(h)      
55130
55135
55136

(i)        
55135
55130
55131

(j)       
55238 to 55296
55054
55026

(k)      
55706
55709
55717

(l)        
55707(f) and 55078(d)
55704
55710

(m)    
55707 and 55708
55700, 55703, 55704 or 55705
55701, 55702, 55710, 55711

(n)      
55709
55706
55713

(o)      
55712 and 55715
55706 or 55709
55713, 55717

(p)      
55718
55723
55726

(q)      
55721 and 55725
55718 or 55723
55722, 55726

(r)       
55723
55718
55722

(s)       
55731
55036 or 55038
55014, 55017

(t)       
55759
55706, 55709, 55712, 55715 or 55762
55713, 55717, 55719, 55720, 55763

(u)      
55762
55706, 55709, 55712, 55715 or 55759
55713, 55717, 55719, 55720, 55760

(v)      
55764 and 55766
55759 or 55762
55760, 55763

(w)     
55764 and 55766
55706, 55709, 55712 or 55715
55713, 55717, 55719, 55720

(x)      
55768
55770
55771

(y)      
55768, 55770, 55772 and 55774
55718, 55721, 55723 or 55725
55722, 55724, 55726, 55727

(z)      
55770
55768
55769

(aa)  
55772 and 55774
55768 or 55770
55769, 55771

(bb)  
55848 and 55850
55054
55026

(cc)   
55850
55800 to 55848
55849

Computed tomography

(dd)  
56219 and 56259
59724
59725

Diagnostic radiology

(ee)   
57901
57902
57914

(ff)    
57902
57901
57911

(gg)   
57945
57939 or 57942
57950, 57953

(hh)  
58112, 58115 and 58121
58100, 58103, 58106 and 58109
58102, 58105, 58111, 58117

(ii)      
58120 and 58121
58120 or 58121
58126, 58127

(jj)     
58900 and 58903
58909, 58912, 58915 or 58924
58911, 58914, 58917, 58926

(kk)  
58909
57939, 57942 or 57945
57950, 57953, 57956

(ll)      
59733
57918
57932

(mm)            
59903, 59912, 59925, 59971, 59972, and 59973
61109
61110

Nuclear medicine imaging

(nn)  
61462
61364, 61426, 61429, 61430, 61442, 61450, 61453, 61469, 61484 or 61485
61669, 61692, 61693, 61694, 61700, 61704, 61705, 61712, 61715, 61716

(oo)  
61505
61302 to 61650
61651 to 61729

Magnetic resonance imaging

(pp)  
63467
63464
63457

 
3.             Dictionary
 
 
Column 1
Column 2
Column 3

 
Definition
Existing item reference
Additional item reference

(a)      
medical practitioner
55028, 55030 and 55032
55005, 55008, 55011

(b)      
scan
63001 to 63522
63523

 
 
 
Note
1.         All legislative instruments and compilations are registered on the Federal Register of Legislative Instruments kept under the Legislative Instruments Act 2003. See http://www.frli.gov.au.