Health Insurance (Section 3C Diagnostic Imaging Services – National Lung Cancer Screening Program) Determination 2025

law://au/li/2025/f2025l00571@2026-11-13

Contents

1Name#

This instrument is the Health Insurance (Section 3C Diagnostic Imaging Services – National Lung Cancer Screening Program) Determination 2025.

3Authority#

This instrument is made under subsection 3C(1) of the Health Insurance Act 1973.

4Definitions#

(1)In this instrument:

Act means the Health Insurance Act 1973.

bulk-billed has the meaning given by the Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020.

computed tomography or CT has the meaning given by the Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020.

pack-years means the number of cigarettes a person smoked per day multiplied by the number of years the person has smoked.

relevant provisions means all provisions, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under the National Health Act 1953, relating to medical services, professional services or items.

relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in a Schedule to this instrument.

remote location has the meaning given by the Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020.

smoke or smoking means the action of inhaling and exhaling cigarette tobacco and includes packaged cigarettes and roll-your-own cigarettes (rollies). It does not include other forms of tobacco or nicotine smoking or consumption, such as vaping.

(2)Unless the contrary intention appears, a reference in this instrument to a provision of the Act or the National Health Act 1953 or regulations made under the Act or 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: A number of expressions used in this instrument are defined in the Act, including the following:

 clinically relevant service;

 diagnostic imaging services table;

 item;

 professional service.

5Treatment of relevant services#

For subsection 3C(1) of the Act, a relevant service, provided in accordance with this instrument and as a clinically relevant service, is to be treated, for the relevant provisions, as if:

(a)it were both a professional service and a general medical service; and

(b)there were an item in the diagnostic imaging services table that:

(i)related to the service; and

(ii)specified for the service a fee in relation to each State, being the fee specified in the Schedule 1 in relation to the service.

6Eligibility for services#

(1)A patient is eligible to receive a service specified in Schedule 1 to this instrument if they:

(a)receive a request for the service as part of the National Lung Cancer Screening Program when they are aged between 50 years and 70 years and 364 days; and

(b)are asymptomatic (show no signs or symptoms of lung cancer); and

(c)currently smoke or have quit smoking in the past ten years; and

(d)have a history of cigarette tobacco smoking of at least 30 pack-years.

(2)If a patient has been assessed as eligible to receive a service described in items 57410 and 57413, the patient remains eligible to receive these services until they turn 71 years and 364 days.

7Limitation on services#

For the purposes of MBS items 57410 and 57413, clause 2.2.1(1)(a) of the diagnostic imaging services table does not apply if the services are provided as part of a mobile screening service provided more than 30 kilometres from a hospital that provides computed tomography radiology service or fixed radiology infrastructure.

8Indexation#

(1)At the start of 1 July 2026 (the indexation time), each amount covered by subsection (2) is replaced by the amount worked out using the following formula:

Note: The indexed fees could in 2026 be viewed on the Department of Health, Disability and Ageing’s MBS Online website (www.mbsonline.gov.au).

(2)The amounts covered by this subsection are the fee for each item in Schedule 1 of this Determination.

(3)An amount worked out under subsection (1) is to be rounded up or down to the nearest 5 cents (rounding down if the amount is an exact multiple of 2.5 cents).

Schedule 1 · — Relevant services

1 Items in Subgroup 14 of Group I2 #

Group I2—Computed Tomography
Column 1Item	Column 2Description	Column 3Fee ($)
Subgroup 14—Low dose computed tomography
57410	Low-dose computed tomography (low-dose CT) scan of chest for the National Lung Cancer Screening Program, without intravenous contrast medium, where:(a) the request states that the patient’s eligibility to participate in the National Lung Cancer Screening Program has been assessed and confirmed; and(b) the service utilises the agreed nodule management protocol for standardised lung nodule identification, classification and reporting; and(c) the service is bulk-billed(R) (Anaes.)	$338.75
57413	Low-dose computed tomography (low-dose CT) scan of chest for the National Lung Cancer Screening Program, without intravenous contrast medium, where:(a) the service is:(i) performed as a clinical follow-up within 2 years of a screening low-dose CT scan of MBS item 57410; or(ii) performed as a clinical follow-up to a previous interval low-dose CT scan of MBS item 57413 linked to MBS item 57410; and(b) the service utilises the agreed nodule management protocol for standardised lung nodule identification, classification and reporting; and(c) the service is bulk-billed(R) (Anaes.)	$338.75

Sourced from the Federal Register of Legislation at legislation.gov.au, © Commonwealth of Australia, licensed under CC BY 4.0. Compilations may have been reformatted.

Health Insurance (Section 3C Diagnostic Imaging Services – National Lung Cancer Screening Program) Determination 2025

Health Insurance (Section 3C Diagnostic Imaging Services – National Lung Cancer Screening Program) Determination 2025

1Name#

3Authority#

4Definitions#

5Treatment of relevant services#

6Eligibility for services#

7Limitation on services#

8Indexation#

Schedule 1 · — Relevant services

1 Items in Subgroup 14 of Group I2 #

Defined terms · 8

Key facts

History · 1 version

Connections

1Name#

3Authority#

4Definitions#

5Treatment of relevant services#

6Eligibility for services#

7Limitation on services#

8Indexation#

Schedule 1 · — Relevant services

1 Items in Subgroup 14 of Group I2 #

1Name#

3Authority#

4Definitions#

5Treatment of relevant services#

6Eligibility for services#

7Limitation on services#

8Indexation#

Schedule 1 · — Relevant services

1 Items in Subgroup 14 of Group I2#

Defined terms · 8

Key facts

History · 1 version

Connections

1Name#

3Authority#

4Definitions#

5Treatment of relevant services#

6Eligibility for services#

7Limitation on services#

8Indexation#

Schedule 1 · — Relevant services

1 Items in Subgroup 14 of Group I2#

1 Items in Subgroup 14 of Group I2 #

1 Items in Subgroup 14 of Group I2 #