About Medicare and Diagnostic Imaging
Responsibility for managing Medicare-funded Diagnostic Imaging (DI) services and determining strategies for maintaining and improving the quality, accessibility and affordability of these services is undertaken cooperatively between DI representative groups and the Government as represented by the Department of Health and Ageing (the Department).
Diagnostic Imaging (DI) is a generic term which covers ultrasound; computed tomography (CT), nuclear medicine, radiography (x-ray), magnetic resonance imaging (MRI), positron emission tomography (PET) and bone densitometry.
The Australian Government provides Medicare rebates for certain relevant DI services. For the purpose of Medicare, any practice intending to provide Medicare eligible diagnostic imaging services must be accredited under the Stage II Diagnostic Imaging Accreditation Scheme.
New Fact SheetsStrengthening the Provision of Quality Diagnostic Radiology Services
Improving Access to Magnetic Resonance Imaging (MRI) Services
Recent Changes To The Diagnostic Imaging Services Table
Changes to the Health Insurance (Diagnostic Imaging Service Table) Regulations 2010 from 1 July 2011.From 1 July 2011 there were several changes to the Health Insurance (Diagnostic Imaging Services Table) Regulations 2010. The changes included the following:
- New items to provide for computed tomography of the coronary arteries.
- New interim items to provide from cone beam computed tomography.
- Minor amendments to prostate ultrasound items to remove restrictions on the techniques that may be used.
- Expansion of access to positron emission tomography (PET) items. A number of indications that were previously claimable at certain contracted facilities will now be Medicare rebatable at all Medicare eligible PET facilities across Australia. However it is up to each facility to determine which services they will provide. There will also be amendments to a number of items and deletion of some items to reflect best clinical practice.
- Removal of specific items for PET with catheterisation. These items are an anomaly on the MBS and generally have low utilisation.
- Consequential rule changes to reflect the above.
New capital sensitivity provisions from 1 July 2011From 1 July 2011 all services listed in the Diagnostic Imaging Services Table of the Medicare Benefits Schedule (MBS), excluding Positron Emission Tomography (PET) services, will have two different rebates – K items (100% of the MBS Fee) and NK items (50% of the MBS Fee) for diagnostic imaging services provided on aged equipment.
This rule, known as ‘capital sensitivity’, is currently in place for computed tomography (CT) and angiography and will be extended to improve the quality of diagnostic imaging services by encouraging service providers to upgrade and replace as appropriate aged equipment.
For more information please go to the capital sensitivity homepage.
Medicare Australia administers the payment of Medicare rebates on behalf of the Australian Government.
The legislative basis for the DI services specified in the Diagnostic Imaging Services Table (the Table) is incorporated in the:
Health Insurance Act 1973,
Health Insurance Regulations 1975, and
Health Insurance (Diagnostic Imaging Services Table) Regulations 2009
The Table of DI Services is set out in Category 5 of the Medicare Benefits Schedule (MBS).