Health Insurance (Positron Emission Tomography) Facilities Determination 2010 (No. 2)
 
I, RICHARD BARTLETT, delegate of the Minister for Health and Ageing, make this Determination under subsection 3C(1) of the Health Insurance Act 1973.
Dated   19 October 2010
 
 
 
 
RICHARD BARTLETT
Delegate of the Minister for Health and Ageing
 

 
 
 
 
 
Contents
 
1.           Name of Determination                                         3
2.           Commencement                                                              3
3.                     Revocation of Health Insurance (Positron Emission Tomography) Facilities Determination 2010            3
4.           Interpretation                                                                  3
5.           Circumstances where this Determination applies     4
6.           Treatment of certain positron emission tomography services                                                                         4
7.           Certain positron emission tomography services—items and specifications etc                                                         5
Schedule – Specified health services                                                      6
1.             Name of Determination
                This Determination is the Health Insurance (Positron Emission Tomography) Facilities Determination 2010 (No. 2).
2.             Commencement
                This Determination commences on 1 November 2010.
 
3.             Revocation of Health Insurance (Positron Emission Tomography) Facilities Determination 2010
                The Health Insurance (Positron Emission Tomography) Facilities Determination 2010 is revoked.
4.             Interpretation
         (1)   In this Determination
Act means the Health Insurance Act 1973.
FDG means 18F-fluorodeoxyglucose.
PET means positron emission tomography.
relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in the Schedule.
         (2)   Unless the contrary intention appears, in this Determination a reference to a provision of the Act or regulations made under the Act or the National Health Act 1953 or regulations made 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.
Note     Unless the contrary intention appears, expressions used in this determination have the same meanings as in the Act—see section 13 of the Legislative Instruments Act 2003.
 
5.             Circumstances where this Determination applies
This Determination applies to a relevant service in the following circumstances:
                      (a)        where there is in force a written agreement between the owner or operator of a PET facility and the Commonwealth that relates to the rendering of the service by means of the facility; and
                      (b)        where the service is rendered pursuant to a written request made by a specialist or a consultant physician (not being the practitioner who renders the service) who determined that the service was necessary and whose patient the person was.
Note          The circumstance in paragraph (b) mirrors the requirement in paragraph 16B(1)(b) of the Act that for a medicare benefit to be payable in respect of an R-type diagnostic imaging service, the service must be rendered pursuant to a written request, but limits which practitioners may request a relevant service.
6.             Treatment of certain positron emission tomography services
                A relevant service shall be treated for the purposes of the provisions of the Act and of regulations made under the Act and the provisions of the National Health Act 1953 and of regulations made under the National Health Act 1953
                that make provision in respect of professional services or medical services as if:
                (a)    it was both a professional service and a medical service; and
(b)     there was an item of an R-type diagnostic imaging service in the diagnostic imaging services table that:
(i)      related to the relevant service; and
(ii)      specified in respect of the relevant service a fee in relation to a State, being the fee specified in the Schedule in relation to the State specified.
 
7.             Certain positron emission tomography services—items and specifications etc
                (1)        Each of the following provisions:
                             (a)     subclause 1.2.1(1) of Schedule 1 to the   
Health Insurance (Diagnostic Imaging Services Table) Regulations 2010 or regulations that replace them;
                             (b)     any regulation made under the Act that identifies    an item in the diagnostic imaging services table           as an R-type diagnostic imaging service; and
                             (c)      regulation 13 of the Health Insurance           
         Regulations 1975, so far as it relates to
         professional services generally or diagnostic
         imaging services specifically;
(d)     paragraph 1.2.5(1)(a) of Schedule 1 to the Health Insurance (Diagnostic Imaging Services Table) Regulations 2010 or regulations that replace them,
shall have effect as if a relevant service, and the items that by virtue of paragraph 6 (b) relate to a relevant service, were also specified in the provision.
 
SCHEDULE – Specified health services
 
Item
Health Service (PET service)
Fee ($)
(for each State)


61535
FDG PET study of the brain performed for the evaluation of a suspected primary brain tumour to guide surgical biopsy of the lesion and to assist in treatment planning (R).
$901.00

61538
FDG PET study of the brain performed for the evaluation of a residual structural brain lesion based on anatomical imaging findings, after definitive therapy for glioma (R).
$901.00

61562
FDG PET study of the heart, performed for the evaluation of ischaemic heart disease and impaired left ventricular function, where revascularisation surgery is being considered and standard myocardial viability tests are negative or equivocal for ischaemia (R).
$899.00

61571
Whole body FDG PET study, performed for the primary staging of proven carcinoma of the uterine cervix, prior to planned radical radiation therapy or combined modality therapy (R).
$953.00

61574
Whole body FDG PET study, performed for the primary staging of proven carcinoma of the uterine cervix, prior to planned radical radiation therapy or combined modality therapy, with catheterisation of the bladder (R).
$975.00

61589
FDG PET study for follow-up of a cancer shown to be positive by an earlier FDG PET service (the earlier service), if (a) the earlier service was eligible for Medicare benefit because of Health Insurance Determination HS/3/1997, (b) the service is required to assess response to treatment or possible tumour recurrence, and (c) the service is not otherwise eligible for Medicare benefit (R).
$953.00

61592
FDG PET study, with catheterisation of the bladder, for follow-up of a cancer shown to be positive by an earlier FDG PET service (the earlier service), if (a) the earlier service was eligible for Medicare benefit because of Health Insurance Determination HS/3/1997, (b) the service is required to assess response to treatment or possible tumour recurrence, and (c) the service is not otherwise eligible for Medicare benefit (R).
$975.00

61616
Whole body FDG PET study for staging of newly diagnosed or previously untreated Hodgkin’s or non-Hodgkin’s lymphoma (R).
$953.00

61619
Whole body FDG PET study for staging of newly diagnosed or previously untreated Hodgkin’s or non-Hodgkin’s lymphoma, with catheterisation of the bladder (R).
$975.00

61622
Whole body FDG PET study for evaluation of a residual mass after treatment of Hodgkin’s or non-Hodgkin’s lymphoma (R).
$953.00

61625
Whole body FDG PET study for evaluation of a residual mass after treatment of Hodgkin’s or non-Hodgkin’s lymphoma, with catheterisation of the bladder (R).
$975.00

61628
Whole body FDG PET study for restaging of suspected recurrent or residual Hodgkin’s or non-Hodgkin’s lymphoma (R).
$953.00

61631
Whole body FDG PET study for restaging of suspected recurrent or residual Hodgkin’s or non-Hodgkin’s lymphoma, with catheterisation of the bladder (R).
$975.00

61634
Whole body FDG PET study to guide biopsy of a suspected bone or soft tissue sarcoma, where structural imaging suggests lesional heterogeneity (R).
$999.00

61637
Whole body FDG PET study to guide biopsy of a suspected bone or soft tissue sarcoma, where structural imaging suggests lesional heterogeneity, with catheterisation of the bladder (R).
$1,021.00

61640
Whole body FDG PET study for staging of biopsy-proven bone or soft tissue sarcoma being considered for resection of the primary or limited metastatic disease (R).
$999.00

61643
Whole body FDG PET study for staging of biopsy-proven bone or soft tissue sarcoma being considered for resection of the primary or limited metastatic disease, with catheterisation of the bladder (R).
$1,021.00

61646
Whole body FDG PET study for the evaluation of suspected residual or recurrent sarcoma on structural imaging after definitive therapy (R).
$999.00

61649
Whole body FDG PET study for the evaluation of suspected residual or recurrent sarcoma on structural imaging after definitive therapy, with catheterisation of the bladder (R).
$1,021.00

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