Accident Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2016

2016/236

Coat of Arms of New Zealand

Accident Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2016

Patsy Reddy, Governor-General

Order in Council

At Wellington this 17th day of October 2016

Present:
Her Excellency the Governor-General in Council

These regulations are made under section 324 of the Accident Compensation Act 2001—

(a)

on the advice and with the consent of the Executive Council; and

(b)

on the recommendation of the Minister for ACC given in accordance with section 324(2).

Regulations

1 Title

These regulations are the Accident Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2016.

2 Commencement

These regulations come into force on 1 December 2016.

3 Principal regulations
4 Regulation 9 amended (Counsellors’ costs)

(1)

In regulation 9(2)(a), replace “$92.18” with “$94.23”.

(2)

In regulation 9(2)(b), replace “$72.28” with “$73.88”.

5 Regulation 11 amended (Hyperbaric oxygen treatment costs)

In regulation 11(2)(a), replace “$51.93” with “$53.08”.

6 Regulation 13 amended (Medical practitioners’ costs)

(1)

In regulation 13(2)(a)(i), replace “$54.85” with “$56.07”.

(2)

In regulation 13(2)(a)(ii), replace “$30.85” with “$31.53”.

(3)

In regulation 13(5)(b), replace “$42.49” with “$43.43”.

7 Regulation 14 amended (Nurses’ costs)

(1)

In regulation 14(2)(a)(i), replace “$19.45” with “$19.88”.

(2)

In regulation 14(2)(a)(ii), replace “$14.45” with “$14.77”.

8 Regulation 15 amended (Medical practitioners’ and nurses’ costs for combined treatment)

(1)

In regulation 15(2)(a)(i), replace “$57.73” with “$59.01”.

(2)

In regulation 15(2)(a)(ii), replace “$33.73” with “$34.48”.

9 Regulation 15A amended (Nurse practitioners’ costs)

(1)

In regulation 15A(2)(a)(i), replace “$50.45” with “$51.57”.

(2)

In regulation 15A(2)(a)(ii), replace “$26.45” with “$27.04”.

10 Regulation 16 amended (Specialists’ costs)

(1)

In regulation 16(2)(a)(i), replace “$92.18” with “$94.23”.

(2)

In regulation 16(2)(a)(ii), replace “$72.28” with “$73.88”.

(3)

In regulation 16(3)(a), replace “$36.14” with “$36.94”.

11 Regulation 17 amended (Specified treatment providers’ costs)

In regulation 17(3)(a), replace “$56.76” with “$58.02”.

12 Schedule replaced

Replace the Schedule with the Schedule set out in the Schedule of these regulations.

Schedule Schedule replaced

r 12

Schedule Costs of treatment

rr 6, 7, 9–17

Item numberTreatmentCost ($)
Counsellors’ costs
C1Consultation provided by a counsellor who is a specialist
C2Consultation provided by a counsellor
Dentists’ costs
Examination
DE1Dental consultation, including examination45.87
DE2Periodic oral examination or review29.50
DE3Extended initial examination (complex cases relating to dental implants, orthodontics, and advanced restorative work), including study models, photographs, and tomography126.66
Radiological examination and interpretation
DX1Periapical or bitewing film (each)22.93
DX2Occlusal (each)22.93
DX3Panorex59.94
DX4Other additional images (per treatment episode)9.05
DX7Acute sedation (IV only) (initial consultation only)158.32
Emergency temporary cover
DT1Emergency temporary cover44.42
General oral surgery
Extractions
DG1Extraction of permanent or rooted deciduous tooth (per first tooth)118.47
DG2Surgical removal of tooth, including insertion and removal of sutures189.99
DG4Extraction of subsequent permanent or deciduous tooth in the same quadrant arch as for DG164.74
Surgery
DG5Management of lacerations by suturing (per operative site)123.49
DG7Incision and drainage abscess cellulitis139.32
DG8Excision of traumatic mucous cyst164.66
DG10Splint application or removal (for 3 splint units)94.99
DG11Cleaning of wound and removal of debris43.42
DG14Reduction of fractured alveolar process92.48
DG15Repositioning of displaced tooth (per tooth) or replacing avulsed tooth46.23
DG17Occlusal adjustment (simple)30.80
DG22Minor surgical operations not otherwise covered by this schedule132.62
DG23Provision of bite splints189.99
Restorative
DR1Amalgam 1 surface filling (including 2 fillings on the one surface)84.14
DR2Amalgam 2 surface filling (approximo-occlusal)110.05
DR3Complex amalgam restoration159.22
DR6Non-metallic simple fillings (including 2 fillings on the one surface)97.07
DR7Non-metallic filling (2 or more surfaces per tooth)129.45
DR8Rebonding tooth fragment or coronal portion87.02
DR9Complex reconstruction in composite resin, direct172.84
Prosthodontics
DP1Plastic denture (1 tooth—material of choice)484.59
DP2Each additional tooth (all dentures)21.71
DP5Metal-framed partial denture (1 tooth)1,109.74
DP7Transitional denture replacing missing tooth or teeth441.49
DP8Full upper or lower denture723.75
DP11Reline or rebase denture226.58
DP13Repair (all types)74.01
DP14Addition of tooth to existing denture (includes additional tooth)135.93
Crown and bridge
Inlay or onlay and veneers
DC3Indirect inlay or onlay276.33
DC6Porcelain veneer813.50
DC7Composite resin veneer177.31
DC8Post (wrought or preformed)94.99
DC9Composite or amalgam core114.00
DC11Cast post and core (metal or ceramic)217.85
Crowns
DC15All ceramic crown961.87
DC16Porcelain fused to metal crown924.95
DC17Cast gold crown (full and three-quarters)869.50
Bridges
DC19Maryland bridge670.20
DC20Composite bridge (per unit)221.64
DC25Re-cementing crown, bridge, veneer, or inlay33.29
DC26Non-composite bridge (on injured teeth that meet the requirement for a crown) (3 units)2,265.35
DC27Replacement of non-composite bridge2,710.46
Endodontics
DN1Pulpotomy or pulpectomy126.66
DN2Irrigation and dressing of root canal system128.56
DN3Complete preparation and obturation of root canal (per canal)—open or closed apex284.98
DN5Apicectomy and retrograde filling (per canal)277.45
DN6Removal of root filling (per canal)222.60
DN7Removal of post, post crown, or crown222.60
DN8Bleaching, 1 non-vital tooth (per treatment)158.32
DN9Pulp capping36.99
DN10Removal of fractured post or instrument222.60
DN11Repair of perforation222.60
DN13Negotiation of calcified canal (can be used with item DN3)222.60
Periodontics
DD1Gingivectomy106.07
DD2Crown lengthening (per tooth)221.64
DD4Subgingival curettage (per tooth)88.50
DD7Site preparation for dental implant323.68
DD8Placement of membrane346.79
DD9Substitute bone material138.71
Dental implants
DM1Resilient linings (tooth or teeth)66.59
DM2Fixture head impressions and copings (per fixture)356.04
DM3Dental implant crown (per single unit)1,109.76
DM4Dental stent and guide (per fixture)120.23
DM5Definitive abutment (per fixture)356.04
DM6Temporary abutment (per fixture)44.39
DM7Repairs to abutments (per fixture)77.03
Claimants under 18 years old
DY1Dental consultation, including examination59.72
DY14Temporary crown110.98
DY15Temporary bridge110.98
DY21Surgical decoronation388.42
DY22Removal of deciduous teeth27.14
Hyperbaric oxygen treatment costs
H1Neurological assay before recompression88.45
H2Neurological assay after recompression79.58
H3In-chamber treatment supervision (per hour)92.47
H4Out-of-chamber treatment supervision (per hour)45.32
Medical practitioners’, nurses’, and nurse practitioners’ costs
Burn or abrasion
MB1Treatment of burn not exceeding 4 cm²30.96
MB2Treatment of burn at single site exceeding 4 cm²60.96
MB3Treatment of significant abrasions not exceeding 4 cm² at single site30.97
MB4Treatment of significant abrasions exceeding 4 cm² at single site60.96
MB5Significant burns or abrasions (not including fractures) at multiple sites (exceeding 4 cm²): necessary wound cleaning, preparation, and dressing88.82
Dislocation
MD1Dislocation of finger or toe with splint or strapping35.87
MD2Dislocation of thumb: closed reduction and immobilisation100.52
MD3Dislocation of elbow with radiological confirmation: closed reduction and immobilisation93.10
MD4Dislocation of shoulder: closed reduction and collar and cuff immobilisation67.06
MD5Dislocation of patella: closed reduction and cast immobilisation159.56
Fracture
MF1Fractured finger or toe (proximal, middle, or distal phalanx): closed reduction and immobilisation35.87
MF2Fractured finger or toe (proximal, middle, or distal phalanx): requiring local anaesthetic49.60
MF3Fractured metatarsal: closed reduction (not requiring cast): closed reduction, immobilisation by strapping35.87
MF4Fractured metacarpal(s) hand: with or without local anaesthetic, immobilisation by strapping49.60
MF5Fractured carpal bone, including scaphoid: treatment by cast immobilisation, not requiring reduction111.72
MF6Fractured tarsal or metatarsal bones (excluding calcaneum or talus): treatment by cast immobilisation159.56
MF7Fractured calcaneum or talus: treatment by cast immobilisation159.56
MF8Fractured clavicle67.06
MF9Fractured distal radius and ulna: cast immobilisation not requiring reduction111.72
MF10Fractured distal radius and ulna requiring closed reduction, involving regional or other form of anaesthesia133.58
MF11Fractured shaft radius and ulna: treatment by cast immobilisation111.72
MF12Fractured distal humerus (supracondylar or condylar): treatment by cast immobilisation111.72
MF13Fractured proximal or shaft humerus: immobilisation by collar and cuff or U-slab67.75
MF14Fractured shaft tibia or fibula, or both: treatment by cast immobilisation with reduction159.56
MF15Fractured distal tibia or fibula, or both: treatment by cast immobilisation with reduction159.56
MF16Fractured fibula (without tibial fracture): immobilisation with soft tissue strapping67.75
Miscellaneous
MM1Abscess or haematoma: drainage with incision (with or without local anaesthetic agent)27.94
MM2Insertion of IV line for administration of IV medications or electrolytes or transfusion (if provided under local or national guideline approved by the Corporation)55.88
MM3Nail, simple removal22.37
MM4Nail, removal or wedge resection requiring the use of digital anaesthesia93.10
MM5Removal of embedded or impacted foreign body from cornea or conjunctiva (with use of topical anaesthetic), or from auditory canal or nasal passages, or from skin or subcutaneous tissue with incision, or from rectum or vagina30.08
MM6Pinch skin graft69.86
MM7Dental anaesthetic26.10
MM8Epistaxis: arrest during episode by nasal cavity packing with or without cautery41.26
Open wound
MW1Closure of open wounds less than 2 cm: any necessary care and treatment, including cleaning and debriding, exploration, administration of anaesthetic, and dressing32.90
MW2Closure of open wound (or wounds) of skin and subcutaneous tissue or mucous membrane 2 cm to 7 cm long: any necessary care and treatment, including cleaning and debriding, exploration, administration of anaesthetic, and dressing62.77
MW3Closure of open wound (or wounds) of skin and subcutaneous tissue or mucous membrane exceeding 7 cm long: any necessary care and treatment, including cleaning and debriding, exploration, administration of anaesthetic, and dressing83.06
MW4Amputation of digit, including use of anaesthetic, debridement of bone and soft tissue, and closure of wound93.10
Soft tissue injury
MT1Simple soft tissue injuries: management of simple sprain of wrist, ankle, knee, elbow, or other soft tissue injury requiring crepe bandage or similar immobilisation not requiring formal strapping14.61
MT2Soft tissue injury (other than splinting of dislocated or fractured digit), unless specified elsewhere: application of plaster or padded splint or specific strapping within agreed guidelines (includes splinting of Achilles tendon injury and serious ankle sprains)67.75
MT3Aspiration of inflamed joint, tendon, bursa, or other subcutaneous tissue or space (with or without injection)32.87
MT4Extensor tendon: primary repair167.59
MT5Ruptured Achilles tendon: management by plaster immobilisation164.28
Radiologists’ costs
Extremities
RA01Sternum58.19
RA02Sterno-clavicular joints66.50
RA03Clavicle49.88
RA04Acromio-clavicular joints49.88
RA05Scapula49.88
RA06Shoulder54.03
RA07Humerus54.03
RA08Elbow joint45.72
RA09Forearm45.72
RA10Hand or wrist joint, or both45.72
RA11Wrist or hand for bone age45.72
RA15Upper limb (infant)54.03
RA21Sacro-iliac joints54.03
RA22Pelvis or both hips (1 projection)54.03
RA25Hip joint (more than 1 projection)58.19
RA26Femur54.03
RA27Knee joint49.88
RA28Knee joint (and intercondylar or axial)58.19
RA29Tibia and fibula49.88
RA30Ankle joint54.03
RA32Foot49.88
RA35Long legs (hips to ankles), including measurement62.34
RA40Lower limb (infant)58.19
Head, neck, and spine
RB01Cervical spine62.34
RB02Thoracic spine58.19
RB03Lumbar spine, including lumbosacral joint58.19
RB04Sacro-coccygeal spine54.03
RB08Spine (scoliosis views)62.34
RB10Skull58.19
RB12Nasal bones49.88
RB13Facial bones54.03
RB14Optic foramina45.72
RB16Auditory canals (plain films only)58.19
RB21Nasal sinuses45.72
RB22Nasopharynx54.03
RB23Mastoids (bilateral)58.19
RB24Larynx or trachea, or both49.88
RB31Upper teeth45.72
RB32Lower teeth45.72
RB33Mandible or OPG or lateral cephalogram62.34
RB34Temporo-mandibular joints62.34
RB35Salivary gland54.03
RB37Pharynx54.03
Chest, including breast
RC05Thoracic inlet54.03
RC06Chest (1 view)54.03
RC07Chest (more than 1 view)54.03
RC08Chest and thoracic cage66.50
RC09Chest and both oblique views66.50
Mammography
RC31Screening mammogram91.44
RC32Recall mammogram124.69
RC35Problem mammogram bilateral182.88
RC36Problem mammogram unilateral120.53
RC40Needle localisation245.22
RC41Galactogram245.22
RC45Breast aspiration biopsy245.22
RC46Breast biopsy with stereotaxis245.22
GI, GU, and obstetrics—no contrast modifiers permitted
Radiology
RD01Abdomen (1 projection)54.03
RD02Abdomen (2 or more projections)54.03
RD07Pelvimetry (1 view)54.03
RD08Pelvimetry (2 or more views)54.03
Screening
RD10Contrast swallow (oesophagus only)423.94
RD11Contrast study upper GI tract423.94
RD13Small bowel meal423.94
RD14Small bowel enema (enteroclysis)710.72
RD15Contrast enema423.94
RD20Dynamic proctogram423.94
RD30ERCP423.94
RD40IVP, including plain film and tomography245.22
RD44Cystogram: retrograde or antegrade423.94
RD45Urethrogram423.94
RD46Micturating cysto-urethrogram423.94
RD47Ascending urethrogram423.94
Special procedures
RS42Tube injection245.22
RS43Dacrocystogram245.22
RS44Sialogram245.22
RS46Hysterosalpingogram423.94
RS61Myelogram cervical423.94
RS62Myelogram lumbar423.94
RS63Myelogram multilevel423.94
RS70Arthrogram245.22
RS71Arthrogram—upper limb245.22
RS73Arthrogram—lower limb245.22
Ultrasound
Abdomen and pelvis
RU01US abdomen128.84
RU02US abdomen and pelvis162.09
RU03US renal tracts120.53
RU04US abdominal aorta (without Doppler)120.53
RU06US pelvis (trans-abdominal only)120.53
Infants
RU10US infant head120.53
RU11US infant pylorus120.53
RU12US infant heart228.59
RU13US infant hips120.53
RU19US infant miscellaneous120.53
Various
RU20US thyroid or neck120.53
RU21US scrotum and testes120.53
RU22US breast120.53
RU23US veins170.41
RU24US eye120.53
RU25US chest120.53
RU27US injection or aspiration241.06
RU28US additional region87.28
RU29US miscellaneous120.53
Skeletal
RU30US shoulder170.41
RU31US musculo-skeletal128.84
RU32US foreign body localisation95.59
RU39US skeletal miscellaneous128.84
Intracavitary
RU40US prostate149.63
RU41US anus or rectum149.63
RU42US female pelvis (includes trans-vaginal and trans-abdominal, or trans-vaginal only)149.63
RU43US trans-oesophageal253.53
RU44US intraoperative253.53
RU49US intracavitary miscellaneous149.63
Vascular
RU51Duplex or Doppler of chest203.66
RU56Duplex or Doppler of additional limb (arterial or venous)162.09
Pregnancy
RU60US routine pregnancy less than 28 weeks128.84
RU61US problem pregnancy162.09
RU62US pregnancy exceeding 28 weeks162.09
RU64US with amniocentesis241.06
RU68US pregnancy (per extra foetus exceeding 1)62.34
Additional
RX24X-ray additional region45.72
RX25Domiciliary X-ray (in addition)87.28
Specialists’ costs
Repair recent wound
SR1Not exceeding 7 cm, superficial132.66
SR2Not exceeding 7 cm, deeper tissue176.87
SR3Exceeding 7 cm, superficial221.11
SR4Exceeding 7 cm, deeper tissue265.32
Fractures (closed reduction)
SF1Phalanges88.45
SF2Metacarpals, excluding Bennetts159.20
SF3Metatarsals123.83
SF4Bennetts229.94
SF5Carpal bones114.96
SF6Colles212.24
SF7Radius and ulna—shafts256.45
SF8Radius—head and neck229.94
SF9Humerus256.45
SF10Talus—neck238.79
SF11Calcaneus238.79
SF12Other tarsals150.37
SF13Ankle—fracture dislocation, Potts371.44
SF14Tibia and fibula—shaft424.48
SF15Tibia and fibula—upper end371.44
SF16Tibia and fibula—involving joint traction433.31
SF17Femur, any site, with or without traction654.43
Haematoma, abscess, or other infection
SH1Small—aspiration22.15
SH2Large—incision and drainage (local anaesthetic)105.57
SH3Large—incision and drainage (general anaesthetic)114.96
Foreign body, removal of
SB1Under local anaesthetic84.07
SB2Under general anaesthetic185.70
SB3From cornea or sclera57.52
SB4From ear, other than by simple syringing88.45
SB5From muscle, tendon, or other deep tissue265.32
SB6From nose, other than by simple probing106.12
SB7From throat, additional fee88.45
Dislocations (closed reduction)
SD1Elbow, wrist, thumb, and fingers with strapping or splint176.87
SD2Shoulder106.12
SD3Patella150.37
SD4Hip212.24
Plaster
SP1Upper limb—above elbow132.66
SP2Upper limb—below elbow114.96
SP3Lower limb—above knee159.20
SP4Lower limb—below knee132.66
Other
SM1Aspiration of joint22.15
SM2Amputation of all or part of 1 digit194.58
SM3Extensor tendon, primary repair309.53
SM4Nail, simple removal88.45
Specified treatment providers’ costs
TMTAll treatment23.06
POD3Podiatry: abscess or haematoma: drainage with incision (with or without local anaesthetic agent)27.94
POD4Podiatry: nail, simple removal22.37
POD5Podiatry: nail, removal or wedge resection requiring the use of digital anaesthesia93.10
XRAYX-ray services provided by chiropractor (maximum of 2 films per claimant per personal injury)14.15

Michael Webster,
Clerk of the Executive Council.

Explanatory note

This note is not part of the regulations, but is intended to indicate their general effect.

These regulations, which come into force on 1 December 2016, amend the Accident Compensation (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003. The amendments increase by 2.22% the amounts that the Accident Compensation Corporation is liable to pay for the treatments specified in those regulations, beginning on 1 December 2016.

Regulatory impact statement

The Ministry of Business, Innovation and Employment produced a regulatory impact statement on 17 August 2016 to help inform the decisions taken by the Government relating to the contents of this instrument.

Issued under the authority of the Legislation Act 2012.

Date of notification in Gazette: 20 October 2016.

These regulations are administered by the Ministry of Business, Innovation, and Employment.