Provider eligibility for R-type diagnostic imaging services for Medicare 012-42050000

This exempts a medical practitioner from the referral requirements of R-type diagnostic imaging services where the application of those requirements would cause a patient:

• physical, or
• financial hardship and the location is in a remote area

These can only be approved for a medical practitioner. This includes a general practitioner (who holds specialist recognition in the specialty of General Practice) but not a specialist or consultant physician.

Remote area exemptions for medical practitioners relate only to R-type diagnostic imaging services. Note: R-type services generally require a referral.

A remote area is:

• more than 30 kilometres (by road) from a:
• hospital that provides radiology services under the direction of a specialist in the specialty of diagnostic radiology
• free-standing radiology facility under the direction of a specialist in the specialty of diagnostic radiology
• where the facilities for rendering R-Type diagnostic imaging services in the area in which the practice is situated are such that patients in the area would suffer physical or financial hardship

Note: this includes facilities provided by practitioners visiting the area regularly.

A medical practitioner may apply for a remote area exemption by completing the Application for Remote Area Exemption for 'R Type' Diagnostic Imaging Services for Medical Practitioner form available from the Services Australia website. The Resources page contains a link to this form.

A remote area exemption is practice specific and recorded at the practice location in the mainframe system and does not appear on the Provider Directory.

Date of effect of a remote area exemption

A remote area exemption cannot be granted from a date earlier than the date the application is received by Services Australia and is valid for either:

• the period the medical practitioner is practising at the practice location
• a maximum period of 3 years, unless revoked by the Minister for Health or their authorised delegate in Services Australia

The remote area exemption application is considered to have been refused by the Minister for Health when a period of 60 days has elapsed since the lodgement of the application, where any of the following have occurred:

• no request for further information made
• a decision has not been made
• a decision made not to grant an exemption and the medical practitioner has not been advised

The applicant may appeal the decision to refuse the application to the Administrative Review Tribunal.

A medical practitioner can apply for renewal of their remote area exemption any time within the 6 months before its expiry.

A Medicare benefit is not payable for an R-type diagnostic imaging service under a remote area exemption unless the practitioner participates in an approved radiology program run by the Royal Australian College of General Practitioners (RACGP) or the Australian College of Rural and Remote Medicine (ACRRM). These programs are known as Quality Assurance and Continuing Medical Education (QA & CME).

The RACGP or ACRRM notify Services Australia when a medical practitioner has either:

• not met the QA & CME requirements
• chooses not to participate in an approved radiology program

Note: the RACGP or ACRRM advice means that the medical practitioner will not be able to access Medicare benefits under the remote area exemption.

When the RACGP or ACRRM advise Services Australia that the medical practitioner is no longer participating in their radiology program, Services Australia writes to the medical practitioner (giving at least 14 days' notice) to advise that their Medicare eligibility under the remote area exemption will cease.

Radiology QA & CME program

Direct enquiries about the radiology Quality Assurance & Continuing Medical Education (QA & CME) program to either:

• The Australian College of Rural and Remote Medicine (ACRRM)
• The Royal Australian College of General Practitioners (RACGP)

The Resources page contains links to these websites with relevant contact details.

Applying for Remote Area Exemptions and registering QA & CME participation

Enquiries about applying for Remote Area Exemptions and registering QA & CME participation should be directed to the Medicare Provider Registration.

Certain ultrasound services, specifically R-type eligible services, are not eligible for a Medicare rebate unless the diagnostic imaging procedure is performed:

• under the professional supervision of a specialist (in a specialty other than general practice) or consultant physician, or
• a medical practitioner who attended at least 50 diagnostic imaging services between 1 September 1997 and 31 August 1999

The purpose of professional supervision is to ensure ultrasound services rendered are of acceptable quality.

Medical practitioners who attended at least 50 diagnostic imaging services between 1 September 1997 and 31 August 1999 are identified on the Provider Directory.