Commonwealth Numbered Regulations - Explanatory Statements Commonwealth Numbered Regulations - Explanatory Statements[Index] [Search] [Download] [Related Items] [Help]
HEALTH INSURANCE (1996-97 DIAGNOSTIC IMAGING SERVICES TABLE) REGULATIONS1996 NO. 233
EXPLANATORY STATEMENTSTATUTORY RULES 1996 No. 233
Issued by the authority of the Minister for Health and Family Services
Health Insurance Act 1973
Health Insurance (1996-97 Diagnostic Imaging Services Table) Regulations
The Health Insurance Act 1973 (the Act) provides in part for the payment of Medicare benefits for professional services rendered by medical practitioners and for certain professional services rendered by dental practitioners and optometrists.
Section 133 of the Act provides that the Governor-General may make regulations for the purposes of the Act.
Section 4AA of the Act provides that regulations may prescribe a table of diagnostic imaging services (the table). The Health Insurance (1995-96 Diagnostic Imaging Services Table) Regulations as amended prescribe such a table. The Act provides that, if not sooner repealed, regulations made under section 4AA cease to have effect on the day after the 15th sitting day after the end of the 12 month period commencing from the date of Gazettal. The date of Gazettal of the current regulations was 26 October 1995.
Section 9 of the Act provides that Medicare benefits shall be calculated by reference to the fees for diagnostic imaging services set out in the table.
The purpose of the Regulations is to prescribe a new table of diagnostic imaging services and rules of interpretation which incorporate new services, the deletion of obsolete services and amendments to services and fees for other services. The Regulations also provide for the repeal of the Health Insurance (1995-96 Diagnostic Imaging Services Table) Regulations as amended.
Further details of the Regulations are set out in the Attachment.
The Regulations come into effect from 1 November 1996.
Attachment
DETAILS OF THE PROPOSED HEALTH INSURANCE (1996-97 DIAGNOSTIC IMAGING SERVICES TABLE) REGULATIONS
Regulation 2 provides for the Regulations to commence on 1 November 1996.
Regulation 3 provides for the repeal of the Health Insurance (1995-96 Diagnostic Imaging Services Table) Regulations as amended.
Regulation 4 prescribes a new table of diagnostic imaging services and rules of interpretation.
Rules of Interpretation
Amended rules have been introduced for the purpose of interpreting the table. These are as follows:
(a) Rule 3 of the previous rules* has been deleted and subsequent rules have been re-numbered from rule 3.
The previous rule* provided definitions of symbols that applied to nuclear medicine imaging services in the table, distinguishing between services rendered at a nuclear medicine unit that had computerised processing facilities and services rendered at a nuclear medicine unit that did not have computerised facilities.
The new items prescribed for nuclear medicine services do not distinguish between computerised and non-computerised facilities because all modem facilities are now' computerised.
(b) A new rule has been introduced to define the words "medical practitioner" when used in the context of the referring practitioner in general ultrasound items 55028, 55030 and 55032 to include dental practitioners who are approved by the Minister under paragraph (b) of the definition of "professional service" in subsection 3(1) of the Act. These practitioners are oral and maxillofacial surgeons.
Items 55028, 55030 and 55032 relate respectively to ultrasound of the head, orbital contents and the neck.
The rule also defines the words "medical practitioner" when used in the context of the referring practitioner in general ultrasound in items 55050 and 55052 to include dental practitioners who are approved by the Minister under paragraph (b) of the definition of "professional service" in subsection 3(1) of the Act and dental practitioners who are prosthodontists.
Items 55050 and 55052 relate respectively to ultrasound of musculo-skeletal regions and joints.
The items referred to above are R-type diagnostic imaging services where, under subsection 16B(1) of the Act, a written request is necessary (unless exempted). The description of the items include a requirement that the service can only be rendered when referred by a medical practitioner.
By defining "medical practitioner´ to include oral and maxillofacial surgeons and prosthodontists, the new rules will allow those practitioners to refer the patient for the above ultrasound services.
Items which cover the same body regions as the R-type items referred to above but are indentified as "(NR)" (not requested services) are also included in the rule for consistency. These items are 55029, 55031, 55033, 55051 and 55053.
This rule has been numbered rule 9.
(c) Rule 10 of the previous rules* has been deleted and subsequent rules have been re-numbered.
The previous rule* provided a formula to calculate the fee for a computerised tomography service where that service was rendered as a dynamic scan under item 57303. The item has now been deleted.
The items for computerised tomography services have been restructured and adjustments have been made to the fees for the revised items to account, where necessary, for those services which are rendered as dynamic scans.
(d) Rule 11 of the previous rules* has been amended to delete reference to item 60300. "Stereoscopic examination of any region and report" as it is obsolete. The previous rule provided a formula to calculate the fee for a diagnostic radiology service when that service was rendered as a stereoscopic examination.
In all other aspects, the previous rule* is unchanged and has been re-numbered as rule 10.
(e) Rule 12 of the previous rules* has been amended to provide:
(i) a revised range of item numbers for the preparation of a patient for radiological procedures. The revised range takes account of the deletion of obsolete items; and
(ii) the removal of an exclusion from the requirement that preparation items could only be used with a diagnostic radiology service. The exclusion provided that the preparation item 60957 (Myelography), could be used in conjunction with a computerised tomography scan of the spine with intrathecal contrast medium (previous item 56218).
The exclusion is no longer necessary as the relevant computerised tomography scan of the spine (new item 56219) incorporates a fee for the preparation of the patient.
This rule has been re-numbered as rule 11.
(f) Rule 14 of the previous rules* has been amended to provide:
(i) a revised range of item numbers that apply to a nuclear scanning service.
The revised range takes account of a restructure of these services which are now identified with different item numbers; and
(ii) that the words "medical practitioner" are replaced with the words "specialist or consultant physician". The change recognises that these services are performed by appropriately qualified medical practitioners.
This rule has been re-numbered as rule 13.
(g) Rule 15 of the previous rules* has been deleted.
The previous rule* provided a formula to calculate the fee for two nuclear medicine imaging services when those services were rendered as a cardiac first pass blood flow study, cardiac shunt study or cardiac output study under previous items 61322 and 61323. These items have now been deleted.
The items for nuclear medicine imaging services have been restructured and adjustments have been made to the fees for the revised items to account, where necessary, for those services which are rendered under the previous items.
(h) Rule 16 of the previous rules* has been deleted.
The previous rule* provided for a formula to calculate the fee for a service when rendered with single photon emission tomography imaging technique under item 61490. The item has been deleted.
The items for nuclear medicine imaging services have been restructured and adjustments have been made to the fees for the revised items to account, where necessary. for those services which are rendered with the single photon emission tomography technique.
(i) A new rule has been introduced to provide a formula to calculate the fee for a service where that service is a repeat service using the same administration of a radiopharmaceutical agent as was used in the first service, subject to certain conditions. The rule is provided to take account of the differing item numbers that would apply for repeat services.
This rule has been numbered rule 14.
The remaining rules are unchanged.
The "Previous rules" or "previous rule" refers to rules current under the Health Insurance (19951996 Diagnostic Imaging Services Table) Regulations.
Services and Fees
Group 11 - Ultrasound
Items 55207 and 55210 have been amended to provide that the services may also be rendered by a specialist or consultant physician in nuclear medicine. The amendment has the support of professional organisations.
Group 12 - Computerised Tomography
Items in Computerised Tomography have been restructured in consultation with the Royal Australasian College of Radiologists.
The restructure combines some items so that, where appropriate, the number of items involving contrast injections has been reduced to one for each relevant region. New items have been introduced and obsolete items have been deleted.
The item concerning scan of the spine requiring intrathecal contrast has been amended to incorporate the preparation of the patient rather than using the preparation item from Group 13 - Diagnostic Radiology relating to preparation for myelography. The new item for this service (item 56219) also incorporates consequential exclusions associated with the change.
The item concerning dynamic scans (previous item 57303) when rendered in association with another computerised tomography service has been deleted. The fees for the related items has been adjusted in recognition that a proportion of those services are rendered as dynamic scans.
Group 13 - Diagnostic Radiology
Some items in Diagnostic Radiology have been restructured and this restructuring has been undertaken in consultation with the Royal Australasian College of Radiologists.
The restructure provides for minor rewording for some items dealing with the extremities, the deletion of items for sacro-iliac joints and functional views of the spine with adjustments to the fees for related items in recognition that a proportion of the related items are sometimes rendered in conjunction with the deleted items.
Other amendments concern clarification of what was intended for services covered by items, deletion of obsolete items, amendments to myelography items which are consequential upon amendments to computerised tomography spinal scan of the spine (CT myelography) and the insertion of a new item for angiography with fluoroscopy using a mobile image intensifier. This last mentioned item (number 59970) is designed so that other, more expensive angiography items are not used where the service is rendered using less expensive equipment.
Group 14 - Nuclear Medicine Imaging
Items in Nuclear Medicine Imaging have been restructured in consultation with the Australian and New Zealand Association of Physicians in Nuclear Medicine.
The restructure provides for an updated list of services and fees for most of the items. Obsolete items have been deleted, including the previous distinction where different fees applied for the same service depending on whether the service was rendered in a nuclear medicine unit with or without computerised facilities. Since all modem nuclear medicine units are now computerised, the non-computerised items are obsolete.
The item concerning single photon emission tomography (previous item 61490) when rendered in association with another nuclear medicine imaging service has been deleted. The descriptions and fees for the related items has been amended in recognition that those services are rendered using the single photon emission tomography imaging technique.