Accident Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2018

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2018/215

Coat of Arms of New Zealand

Accident Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2018

Rt Hon Dame Sian Elias, Administrator of the Government

Order in Council

At Wellington this 5th day of November 2018

Present:
Her Excellency the Administrator of the Government 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) of that Act.

Regulations

1 Title

These regulations are the Accident Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2018.

2 Commencement

These regulations come into force on 1 December 2018.

3 Principal regulations
4 Regulation 3 amended (Interpretation)

In regulation 3, insert in their appropriate alphabetical order:

community services card means—

(a)

a community services card issued under the Health Entitlement Cards Regulations 1993; or

(b)

a corresponding card issued under corresponding regulations made or deemed to have been made under either or both of section 92(3) of the New Zealand Public Health and Disability Act 2000 and section 437 of the Social Security Act 2018

dependent child has the meaning given to it by section 3(1) of the Social Security Act 1964, but does not include a child for whom an orphan’s benefit or an unsupported child’s benefit is paid under that Act

5 Regulation 9 amended (Counsellors’ costs)

(1)

In regulation 9(2)(a), replace “$94.23” with “$95.70”.

(2)

In regulation 9(2)(b), replace “$73.88” with “$75.03”.

6 Regulation 11 amended (Hyperbaric oxygen treatment costs)

In regulation 11(2)(a), replace “$53.08” with “$53.91”.

7 Regulation 13 amended (Medical practitioners’ costs)

(1)

Replace regulation 13(2)(a) with:

(a)

whichever of the following applies:

(i)

$56.94, if the claimant is under 14 years old when the visit takes place:

(ii)

$32.02, if the claimant is 14 years old or over when the visit takes place and is not the holder of a community services card or the dependent child of a holder:

(iii)

$53.33, if the claimant is 14 years old or over when the visit takes place and is the holder of a community services card:

(iv)

$58.54, if the claimant is 14 years old or over but under 18 years old when the visit takes place and is the dependent child of a holder of a community services card; plus

(2)

In regulation 13(5)(b), replace “$43.43” with “$44.11”.

8 Regulation 14 amended (Nurses’ costs)

Replace regulation 14(2)(a) with:

(a)

whichever of the following applies:

(i)

$31.93, if the claimant is under 14 years old when the visit takes place:

(ii)

$15.00, if the claimant is 14 years old or over when the visit takes place and is not the holder of a community services card or the dependent child of a holder:

(iii)

$27.61, if the claimant is 14 years old or over when the visit takes place and is the holder of a community services card:

(iv)

$32.83, if the claimant is 14 years old or over but under 18 years old when the visit takes place and is the dependent child of a holder of a community services card; plus

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

Replace regulation 15(2)(a) with:

(a)

whichever of the following applies:

(i)

$59.93, if the claimant is under 14 years old when the visit takes place:

(ii)

$35.02, if the claimant is 14 years old or over when the visit takes place and is not the holder of a community services card or the dependent child of a holder:

(iii)

$56.32, if the claimant is 14 years old or over when the visit takes place and is the holder of a community services card:

(iv)

$61.54, if the claimant is 14 years old or over but under 18 years old when the visit takes place and is the dependent child of a holder of a community services card; plus

10 Regulation 15A amended (Nurse practitioners’ costs)

Replace regulation 15A(2)(a) with:

(a)

whichever of the following applies:

(i)

$52.37, if the claimant is under 14 years old when the visit takes place:

(ii)

$27.46, if the claimant is 14 years old or over when the visit takes place and is not the holder of a community services card or the dependent child of a holder:

(iii)

$49.06, if the claimant is 14 years old or over when the visit takes place and is the holder of a community services card:

(iv)

$53.86, if the claimant is 14 years old or over but under 18 years old when the visit takes place and is the dependent child of a holder of a community services card; plus

11 Regulation 16 amended (Specialists’ costs)

(1)

In regulation 16(2)(a)(i), replace “$94.23” with “95.70”.

(2)

In regulation 16(2)(a)(ii), replace “$73.88” with “75.03”.

(3)

In regulation 16(3)(a), replace “$36.94” with “37.52”.

12 Regulation 17 amended (Specified treatment providers’ costs)

In regulation 17(3)(a), replace “$58.02” with “58.93”.

13 Schedule replaced

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

Schedule Schedule replaced

r 13

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 examination46.59
DE2Periodic oral examination or review29.96
DE3Extended initial examination (complex cases relating to dental implants, orthodontics, and advanced restorative work), including study models, photographs, and tomography128.64
Radiological examination and interpretation
DX1Periapical or bitewing film (each)23.29
DX2Occlusal (each)23.29
DX3Panorex60.88
DX4Other additional images (per treatment episode)9.19
DX7Acute sedation (IV only) (initial consultation only)160.79
Emergency temporary cover
DT1Emergency temporary cover45.11
General oral surgery
Extractions
DG1Extraction of permanent or rooted deciduous tooth (per first tooth)120.32
DG2Surgical removal of tooth, including insertion and removal of sutures 192.95
DG4Extraction of subsequent permanent or deciduous tooth in the same quadrant arch as for DG1 65.75
Surgery
DG5Management of lacerations by suturing (per operative site)125.42
DG7Incision and drainage abscess cellulitis141.49
DG8Excision of traumatic mucous cyst167.23
DG10Splint application or removal (for 3 splint units)96.47
DG11Cleaning of wound and removal of debris44.10
DG14Reduction of fractured alveolar process93.92
DG15Repositioning of displaced tooth (per tooth) or replacing avulsed tooth46.95
DG17Occlusal adjustment (simple)31.28
DG22Minor surgical operations not otherwise covered by this schedule134.69
DG23Provision of bite splints192.95
Restorative
DR1Amalgam 1 surface filling (including 2 fillings on the one surface)85.45
DR2Amalgam 2 surface filling (approximo-occlusal)111.77
DR3Complex amalgam restoration161.70
DR6Non-metallic simple fillings (including 2 fillings on the one surface)98.58
DR7Non-metallic filling (2 or more surfaces per tooth)131.47
DR8Rebonding tooth fragment or coronal portion88.38
DR9Complex reconstruction in composite resin (direct)175.54
Prosthodontics
DP1Plastic denture (1 tooth—material of choice)492.15
DP2Each additional tooth (all dentures)22.05
DP5Metal-framed partial denture (1 tooth)1,127.05
DP7Transitional denture replacing missing tooth or teeth448.38
DP8Full upper or lower denture735.04
DP11Reline or rebase denture230.11
DP13Repair (all types)75.16
DP14Addition of tooth to existing denture (includes additional tooth)138.05
Crown and bridge
Inlay or onlay and veneers
DC3Indirect inlay or onlay280.64
DC6Porcelain veneer826.19
DC7Composite resin veneer180.08
DC8Post (wrought or preformed)96.47
DC9Composite or amalgam core115.78
DC11Cast post and core (metal or ceramic)221.25
Crowns
DC15All ceramic crown976.88
DC16Porcelain fused to metal crown939.38
DC17Cast gold crown (full and three-quarters)883.06
Bridges
DC19Maryland bridge680.66
DC20Composite bridge (per unit)225.10
DC25Re-cementing crown, bridge, veneer, or inlay33.81
DC26Non-composite bridge (on injured teeth that meet the requirement for a crown) (3 units)2,300.69
DC27Replacement of non-composite bridge2,752.74
Endodontics
DN1Pulpotomy or pulpectomy128.64
DN2Irrigation and dressing of root canal system130.57
DN3Complete preparation and obturation of root canal (per canal)—open or closed apex289.43
DN5Apicectomy and retrograde filling (per canal)281.78
DN6Removal of root filling (per canal)226.07
DN7Removal of post, post crown, or crown226.07
DN8Bleaching, 1 non-vital tooth (per treatment)160.79
DN9Pulp capping37.57
DN10Removal of fractured post or instrument226.07
DN11Repair of perforation226.07
DN13Negotiation of calcified canal (can be used with item DN3)226.07
Periodontics
DD1Gingivectomy107.72
DD2Crown lengthening (per tooth)225.10
DD4Subgingival curettage (per tooth)89.88
DD7Site preparation for dental implant 328.73
DD8Placement of membrane352.20
DD9Substitute bone material140.87
Dental implants
DM1Resilient linings (tooth or teeth)67.63
DM2Fixture head impressions and copings (per fixture) 361.59
DM3Dental implant crown (per single unit)1,127.07
DM4Dental stent and guide (per fixture)122.11
DM5Definitive abutment (per fixture)361.59
DM6Temporary abutment (per fixture)45.08
DM7Repairs to abutments (per fixture) 78.23
Claimants under 18 years old
DY1Dental consultation (including examination)60.65
DY14Temporary crown112.71
DY15Temporary bridge112.71
DY21Surgical decoronation394.48
DY22Removal of deciduous teeth27.56
Hyperbaric oxygen treatment costs
H1Neurological assay before recompression89.83
H2Neurological assay after recompression 80.82
H3In-chamber treatment supervision (per hour)93.91
H4Out-of-chamber treatment supervision (per hour) 46.03
Medical practitioners’, nurses’, and nurse practitioners’ costs
Burn or abrasion
MB1Treatment of burn not exceeding 4 cm²31.44
MB2Treatment of burn at single site exceeding 4 cm²61.91
MB3Treatment of significant abrasions not exceeding 4 cm² at single site31.45
MB4Treatment of significant abrasions exceeding 4 cm² at single site61.91
MB5Significant burns or abrasions (not including fractures) at multiple sites (exceeding 4 cm²): necessary wound cleaning, preparation, and dressing90.21
Dislocation
MD1Dislocation of finger or toe with splint or strapping36.43
MD2Dislocation of thumb: closed reduction and immobilisation 102.09
MD3Dislocation of elbow with radiological confirmation: closed reduction and immobilisation94.55
MD4Dislocation of shoulder: closed reduction and collar and cuff immobilisation 68.11
MD5Dislocation of patella: closed reduction and cast immobilisation162.05
Fracture
MF1Fractured finger or toe (proximal, middle, or distal phalanx): closed reduction and immobilisation 36.43
MF2Fractured finger or toe (proximal, middle, or distal phalanx): requiring local anaesthetic 50.37
MF3Fractured metatarsal: closed reduction (not requiring cast): closed reduction, immobilisation by strapping 36.43
MF4Fractured metacarpal(s) hand: with or without local anaesthetic, immobilisation by strapping 50.37
MF5Fractured carpal bone, including scaphoid: treatment by cast immobilisation, not requiring reduction113.46
MF6Fractured tarsal or metatarsal bones (excluding calcaneum or talus): treatment by cast immobilisation162.05
MF7Fractured calcaneum or talus: treatment by cast immobilisation 162.05
MF8Fractured clavicle 68.11
MF9Fractured distal radius and ulna: cast immobilisation not requiring reduction 113.46
MF10Fractured distal radius and ulna requiring closed reduction, involving regional or other form of anaesthesia135.66
MF11Fractured shaft radius and ulna: treatment by cast immobilisation 113.46
MF12Fractured distal humerus (supracondylar or condylar): treatment by cast immobilisation113.46
MF13Fractured proximal or shaft humerus: immobilisation by collar and cuff or U-slab68.81
MF14Fractured shaft tibia or fibula, or both: treatment by cast immobilisation with reduction 162.05
MF15Fractured distal tibia or fibula, or both: treatment by cast immobilisation with reduction162.05
MF16Fractured fibula (without tibial fracture): immobilisation with soft tissue strapping 68.81
Miscellaneous
MM1Abscess or haematoma: drainage with incision (with or without local anaesthetic agent)28.38
MM2Insertion of IV line for administration of IV medications or electrolytes or transfusion (if provided under local or national guideline approved by the Corporation)56.75
MM3Nail, simple removal22.72
MM4Nail, removal or wedge resection requiring the use of digital anaesthesia94.55
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 vagina30.55
MM6Pinch skin graft 70.95
MM7Dental anaesthetic 26.51
MM8Epistaxis: arrest during episode by nasal cavity packing with or without cautery41.90
Open wound
MW1Closure of open wound (or wounds) less than 2 cm: any necessary care and treatment, including cleaning and debriding, exploration, administration of anaesthetic, and dressing33.41
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 dressing63.75
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 dressing84.36
MW4Amputation of digit, including use of anaesthetic, debridement of bone and soft tissue, and closure of wound94.55
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 strapping14.84
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)68.81
MT3Aspiration of inflamed joint, tendon, bursa, or other subcutaneous tissue or space (with or without injection)33.38
MT4Extensor tendon: primary repair170.20
MT5Ruptured Achilles tendon: management by plaster immobilisation166.84
Radiologists’ costs
Extremities
RA01Sternum59.09
RA02Sternoclavicular joints67.53
RA03Clavicle50.65
RA04Acromio-clavicular joints50.65
RA05Scapula50.65
RA06Shoulder54.87
RA07Humerus54.87
RA08Elbow joint46.43
RA09Forearm46.43
RA10Hand or wrist joint, or both46.43
RA11Wrist or hand for bone age46.43
RA15Upper limb (infant)54.87
RA21Sacroiliac joints54.87
RA22Pelvis or both hips (1 projection)54.87
RA25Hip joint (more than 1 projection)59.09
RA26Femur54.87
RA27Knee joint50.65
RA28Knee joint (and intercondylar or axial)59.09
RA29Tibia and fibula50.65
RA30Ankle joint54.87
RA32Foot50.65
RA35Long legs (hips to ankles), including measurement63.31
RA40Lower limb (infant)59.09
Head, neck, and spine
RB01Cervical spine63.31
RB02Thoracic spine59.09
RB03Lumbar spine, including lumbosacral joint59.09
RB04Sacro-coccygeal spine54.87
RB08Spine (scoliosis views)63.31
RB10Skull59.09
RB12Nasal bones50.65
RB13Facial bones54.87
RB14Optic foramina46.43
RB16Auditory canals (plain films only)59.09
RB21Nasal sinuses46.43
RB22Nasopharynx54.87
RB23Mastoids (bilateral)59.09
RB24Larynx or trachea, or both50.65
RB31Upper teeth46.43
RB32Lower teeth46.43
RB33Mandible or OPG or lateral cephalogram63.31
RB34Temporo-mandibular joints63.31
RB35Salivary gland54.87
RB37Pharynx54.87
Chest, including breast
RC05Thoracic inlet54.87
RC06Chest (1 view)54.87
RC07Chest (more than 1 view)54.87
RC08Chest and thoracic cage67.53
RC09Chest and both oblique views67.53
Mammography
RC31Screening mammogram92.86
RC32Recall mammogram126.63
RC35Problem mammogram bilateral185.72
RC36Problem mammogram unilateral122.40
RC40Needle localisation249.03
RC41Galactogram249.03
RC45Breast aspiration biopsy249.03
RC46Breast biopsy with stereotaxis249.03
GI, GU, and obstetrics—no contrast modifiers permitted
Radiology
RD01Abdomen (1 projection)54.87
RD02Abdomen (2 or more projections)54.87
RD07Pelvimetry (1 view)54.87
RD08Pelvimetry (2 or more views)54.87
Screening
RD10Contrast swallow (oesophagus only)430.53
RD11Contrast study upper GI tract430.53
RD13Small bowel meal 430.53
RD14Small bowel enema (enteroclysis)721.76
RD15Contrast enema430.53
RD20Dynamic proctogram430.53
RD30ERCP430.53
RD40IVP, including plain film and tomography249.03
RD44Cystogram: retrograde or antegrade430.53
RD45Urethrogram430.53
RD46Micturating cysto-urethrogram430.53
RD47Ascending urethrogram430.53
Special procedures
RS42Tube injection249.03
RS43Dacrocystogram249.03
RS44Sialogram 249.03
RS46Hysterosalpingogram430.53
RS61Myelogram cervical430.53
RS62Myelogram lumbar 430.53
RS63Myelogram multilevel430.53
RS70Arthrogram249.03
RS71Arthrogram—upper limb249.03
RS73Arthrogram—lower limb249.03
Ultrasound
Abdomen and pelvis
RU01US abdomen130.85
RU02US abdomen and pelvis164.61
RU03US renal tracts122.40
RU04US abdominal aorta (without Doppler)122.40
RU06US pelvis (transabdominal only)122.40
Infants
RU10US infant head122.40
RU11US infant pylorus122.40
RU12US infant heart232.15
RU13US infant hips122.40
RU19US infant miscellaneous122.40
Various
RU20US thyroid or neck122.40
RU21US scrotum and testes122.40
RU22US breast122.40
RU23US veins173.05
RU24US eye122.40
RU25US chest122.40
RU27US injection or aspiration244.81
RU28US additional region88.64
RU29US miscellaneous122.40
Skeletal
RU30US shoulder173.05
RU31US musculo-skeletal130.85
RU32US foreign body localisation97.08
RU39US skeletal miscellaneous130.85
Intracavitary
RU40US prostate151.95
RU41US anus or rectum151.95
RU42US female pelvis (includes transvaginal and transabdominal, or transvaginal only)151.95
RU43US trans-oesophageal257.47
RU44US intraoperative257.47
RU49US intracavitary (miscellaneous)151.95
Vascular
RU51Duplex or Doppler of chest206.82
RU56Duplex or Doppler of additional limb (arterial or venous)164.61
Pregnancy
RU60US routine pregnancy less than 28 weeks130.85
RU61US problem pregnancy164.61
RU62US pregnancy exceeding 28 weeks164.61
RU64US with amniocentesis244.81
RU68US pregnancy (per extra foetus exceeding 1)63.31
Additional
RX24X-ray additional region46.43
RX25Domiciliary X-ray (in addition)88.64
Specialists’ costs
Repair recent wound
SR1Not exceeding 7 cm (superficial)134.73
SR2Not exceeding 7 cm (deeper tissue)179.63
SR3Exceeding 7 cm (superficial)224.56
SR4Exceeding 7 cm (deeper tissue)269.46
Fractures (closed reduction)
SF1Phalanges89.83
SF2Metacarpals (excluding Bennetts)161.68
SF3Metatarsals125.76
SF4Bennetts233.53
SF5Carpal bones 116.75
SF6Colles215.55
SF7Radius and ulna—shafts 260.45
SF8Radius—head and neck 233.53
SF9Humerus 260.45
SF10Talus—neck 242.52
SF11Calcaneus 242.52
SF12Other tarsals 152.72
SF13Ankle—fracture dislocation, Potts 377.23
SF14Tibia and fibula—shaft431.10
SF15Tibia and fibula—upper end 377.23
SF16Tibia and fibula—involving joint traction 440.07
SF17Femur, any site (with or without traction) 664.64
Haematoma, abscess, or other infection
SH1Small—aspiration22.50
SH2Large—incision and drainage (local anaesthetic)107.22
SH3Large—incision and drainage (general anaesthetic)116.75
Foreign body, removal of
SB1Under local anaesthetic85.38
SB2Under general anaesthetic188.60
SB3From cornea or sclera58.42
SB4From ear (other than by simple syringing)89.83
SB5From muscle, tendon, or other deep tissue269.46
SB6From nose (other than by simple probing)107.78
SB7From throat (additional fee)89.83
Dislocations (closed reduction)
SD1Elbow, wrist, thumb, and fingers with strapping or splint179.63
SD2Shoulder107.78
SD3Patella152.72
SD4Hip215.55
Plaster
SP1Upper limb—above elbow134.73
SP2Upper limb—below elbow116.75
SP3Lower limb—above knee161.68
SP4Lower limb—below knee134.73
Other
SM1Aspiration of joint22.50
SM2Amputation of all or part of 1 digit197.62
SM3Extensor tendon (primary repair)314.36
SM4Nail (simple removal)89.83
Specified treatment providers’ costs
TMTAll treatment23.42
POD3Podiatry: abscess or haematoma: drainage with incision (with or without local anaesthetic agent)28.38
POD4Podiatry: nail, simple removal22.72
POD5Podiatry: nail, removal or wedge resection requiring the use of digital anaesthesia94.55
XRAYX-ray services provided by chiropractor (maximum of 2 films per claimant per personal injury)14.37

Rachel Hayward,
acting for 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 2018, amend the Accident Compensation (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003. The amendments—

  • increase by 1.56% the amounts that the Accident Compensation Corporation is liable to pay for the treatments specified in those regulations, beginning on 1 December 2018; and

  • increase the age of children who qualify for higher ACC contributions from those under 13 years to those under 14 years; and

  • provide for holders of community service cards, and their dependent children, to qualify for higher ACC contributions.

Regulatory impact statement

The Ministry of Business, Innovation and Employment produced a regulatory impact statement on 3 October 2018 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: 8 November 2018.

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