Accident Compensation (Liability to Pay or Contribute toCost 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 Act2001—(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 sec-

tion 324(2).

ContentsPage

1 Title 22 Commencement 23 Principal regulations 24 Regulation 9 amended (Counsellors’ costs) 25 Regulation 11 amended (Hyperbaric oxygen treatment costs) 26 Regulation 13 amended (Medical practitioners’ costs) 27 Regulation 14 amended (Nurses’ costs) 28 Regulation 15 amended (Medical practitioners’ and nurses’ costs

for combined treatment)2

9 Regulation 15A amended (Nurse practitioners’ costs) 210 Regulation 16 amended (Specialists’ costs) 311 Regulation 17 amended (Specified treatment providers’ costs) 312 Schedule replaced 3

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ScheduleSchedule replaced

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Regulations

1 TitleThese regulations are the Accident Compensation (Liability to Pay or Contrib-ute to Cost of Treatment) Amendment Regulations 2016.

2 CommencementThese regulations come into force on 1 December 2016.

3 Principal regulationsThese regulations amend the Accident Compensation (Liability to Pay or Con-tribute to Cost of Treatment) Regulations 2003 (the 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 forcombined 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”.

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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 replacedReplace the Schedule with the Schedule set out in the Schedule of these regula-tions.

ScheduleSchedule replaced

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ScheduleCosts of treatment

rr 6, 7, 9–17

Itemnumber Treatment Cost ($)Counsellors’ costsC1 Consultation provided by a counsellor who is a specialistC2 Consultation provided by a counsellorDentists’ costs

ExaminationDE1 Dental consultation, including examination 45.87DE2 Periodic oral examination or review 29.50DE3 Extended initial examination (complex cases relating to dental implants,

orthodontics, and advanced restorative work), including study models,photographs, and tomography

126.66

Radiological examination and interpretationDX1 Periapical or bitewing film (each) 22.93DX2 Occlusal (each) 22.93DX3 Panorex 59.94DX4 Other additional images (per treatment episode) 9.05DX7 Acute sedation (IV only) (initial consultation only) 158.32

Emergency temporary coverDT1 Emergency temporary cover 44.42

General oral surgeryExtractions

DG1 Extraction of permanent or rooted deciduous tooth (per first tooth) 118.47DG2 Surgical removal of tooth, including insertion and removal of sutures 189.99

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Itemnumber Treatment Cost ($)DG4 Extraction of subsequent permanent or deciduous tooth in the same quadrant

arch as for DG164.74

SurgeryDG5 Management of lacerations by suturing (per operative site) 123.49DG7 Incision and drainage abscess cellulitis 139.32DG8 Excision of traumatic mucous cyst 164.66DG10 Splint application or removal (for 3 splint units) 94.99DG11 Cleaning of wound and removal of debris 43.42DG14 Reduction of fractured alveolar process 92.48DG15 Repositioning of displaced tooth (per tooth) or replacing avulsed tooth 46.23DG17 Occlusal adjustment (simple) 30.80DG22 Minor surgical operations not otherwise covered by this schedule 132.62DG23 Provision of bite splints 189.99

RestorativeDR1 Amalgam 1 surface filling (including 2 fillings on the one surface) 84.14DR2 Amalgam 2 surface filling (approximo-occlusal) 110.05DR3 Complex amalgam restoration 159.22DR6 Non-metallic simple fillings (including 2 fillings on the one surface) 97.07DR7 Non-metallic filling (2 or more surfaces per tooth) 129.45DR8 Rebonding tooth fragment or coronal portion 87.02DR9 Complex reconstruction in composite resin, direct 172.84

ProsthodonticsDP1 Plastic denture (1 tooth—material of choice) 484.59DP2 Each additional tooth (all dentures) 21.71DP5 Metal-framed partial denture (1 tooth) 1,109.74DP7 Transitional denture replacing missing tooth or teeth 441.49DP8 Full upper or lower denture 723.75DP11 Reline or rebase denture 226.58DP13 Repair (all types) 74.01DP14 Addition of tooth to existing denture (includes additional tooth) 135.93

Crown and bridgeInlay or onlay and veneers

DC3 Indirect inlay or onlay 276.33DC6 Porcelain veneer 813.50DC7 Composite resin veneer 177.31DC8 Post (wrought or preformed) 94.99DC9 Composite or amalgam core 114.00DC11 Cast post and core (metal or ceramic) 217.85

CrownsDC15 All ceramic crown 961.87DC16 Porcelain fused to metal crown 924.95DC17 Cast gold crown (full and three-quarters) 869.50

BridgesDC19 Maryland bridge 670.20

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Itemnumber Treatment Cost ($)DC20 Composite bridge (per unit) 221.64DC25 Re-cementing crown, bridge, veneer, or inlay 33.29DC26 Non-composite bridge (on injured teeth that meet the requirement for a crown)

(3 units)2,265.35

DC27 Replacement of non-composite bridge 2,710.46Endodontics

DN1 Pulpotomy or pulpectomy 126.66DN2 Irrigation and dressing of root canal system 128.56DN3 Complete preparation and obturation of root canal (per canal)—open or closed

apex284.98

DN5 Apicectomy and retrograde filling (per canal) 277.45DN6 Removal of root filling (per canal) 222.60DN7 Removal of post, post crown, or crown 222.60DN8 Bleaching, 1 non-vital tooth (per treatment) 158.32DN9 Pulp capping 36.99DN10 Removal of fractured post or instrument 222.60DN11 Repair of perforation 222.60DN13 Negotiation of calcified canal (can be used with item DN3) 222.60

PeriodonticsDD1 Gingivectomy 106.07DD2 Crown lengthening (per tooth) 221.64DD4 Subgingival curettage (per tooth) 88.50DD7 Site preparation for dental implant 323.68DD8 Placement of membrane 346.79DD9 Substitute bone material 138.71

Dental implantsDM1 Resilient linings (tooth or teeth) 66.59DM2 Fixture head impressions and copings (per fixture) 356.04DM3 Dental implant crown (per single unit) 1,109.76DM4 Dental stent and guide (per fixture) 120.23DM5 Definitive abutment (per fixture) 356.04DM6 Temporary abutment (per fixture) 44.39DM7 Repairs to abutments (per fixture) 77.03

Claimants under 18 years oldDY1 Dental consultation, including examination 59.72DY14 Temporary crown 110.98DY15 Temporary bridge 110.98DY21 Surgical decoronation 388.42DY22 Removal of deciduous teeth 27.14Hyperbaric oxygen treatment costsH1 Neurological assay before recompression 88.45H2 Neurological assay after recompression 79.58H3 In-chamber treatment supervision (per hour) 92.47H4 Out-of-chamber treatment supervision (per hour) 45.32

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Itemnumber Treatment Cost ($)Medical practitioners’, nurses’, and nurse practitioners’ costs

Burn or abrasionMB1 Treatment of burn not exceeding 4 cm² 30.96MB2 Treatment of burn at single site exceeding 4 cm² 60.96MB3 Treatment of significant abrasions not exceeding 4 cm² at single site 30.97MB4 Treatment of significant abrasions exceeding 4 cm² at single site 60.96MB5 Significant burns or abrasions (not including fractures) at multiple sites

(exceeding 4 cm²): necessary wound cleaning, preparation, and dressing88.82

DislocationMD1 Dislocation of finger or toe with splint or strapping 35.87MD2 Dislocation of thumb: closed reduction and immobilisation 100.52MD3 Dislocation of elbow with radiological confirmation: closed reduction and

immobilisation93.10

MD4 Dislocation of shoulder: closed reduction and collar and cuff immobilisation 67.06MD5 Dislocation of patella: closed reduction and cast immobilisation 159.56

FractureMF1 Fractured finger or toe (proximal, middle, or distal phalanx): closed reduction

and immobilisation35.87

MF2 Fractured finger or toe (proximal, middle, or distal phalanx): requiring localanaesthetic

49.60

MF3 Fractured metatarsal: closed reduction (not requiring cast): closed reduction,immobilisation by strapping

35.87

MF4 Fractured metacarpal(s) hand: with or without local anaesthetic, immobilisationby strapping

49.60

MF5 Fractured carpal bone, including scaphoid: treatment by cast immobilisation, notrequiring reduction

111.72

MF6 Fractured tarsal or metatarsal bones (excluding calcaneum or talus): treatmentby cast immobilisation

159.56

MF7 Fractured calcaneum or talus: treatment by cast immobilisation 159.56MF8 Fractured clavicle 67.06MF9 Fractured distal radius and ulna: cast immobilisation not requiring reduction 111.72MF10 Fractured distal radius and ulna requiring closed reduction, involving regional or

other form of anaesthesia133.58

MF11 Fractured shaft radius and ulna: treatment by cast immobilisation 111.72MF12 Fractured distal humerus (supracondylar or condylar): treatment by cast

immobilisation111.72

MF13 Fractured proximal or shaft humerus: immobilisation by collar and cuff or U-slab

67.75

MF14 Fractured shaft tibia or fibula, or both: treatment by cast immobilisation withreduction

159.56

MF15 Fractured distal tibia or fibula, or both: treatment by cast immobilisation withreduction

159.56

MF16 Fractured fibula (without tibial fracture): immobilisation with soft tissuestrapping

67.75

MiscellaneousMM1 Abscess or haematoma: drainage with incision (with or without local anaesthetic

agent)27.94

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Itemnumber Treatment Cost ($)MM2 Insertion of IV line for administration of IV medications or electrolytes or

transfusion (if provided under local or national guideline approved by theCorporation)

55.88

MM3 Nail, simple removal 22.37MM4 Nail, removal or wedge resection requiring the use of digital anaesthesia 93.10MM5 Removal of embedded or impacted foreign body from cornea or conjunctiva

(with use of topical anaesthetic), or from auditory canal or nasal passages, orfrom skin or subcutaneous tissue with incision, or from rectum or vagina

30.08

MM6 Pinch skin graft 69.86MM7 Dental anaesthetic 26.10MM8 Epistaxis: arrest during episode by nasal cavity packing with or without cautery 41.26

Open woundMW1 Closure of open wounds less than 2 cm: any necessary care and treatment,

including cleaning and debriding, exploration, administration of anaesthetic, anddressing

32.90

MW2 Closure of open wound (or wounds) of skin and subcutaneous tissue or mucousmembrane 2 cm to 7 cm long: any necessary care and treatment, includingcleaning and debriding, exploration, administration of anaesthetic, and dressing

62.77

MW3 Closure of open wound (or wounds) of skin and subcutaneous tissue or mucousmembrane exceeding 7 cm long: any necessary care and treatment, includingcleaning and debriding, exploration, administration of anaesthetic, and dressing

83.06

MW4 Amputation of digit, including use of anaesthetic, debridement of bone and softtissue, and closure of wound

93.10

Soft tissue injuryMT1 Simple soft tissue injuries: management of simple sprain of wrist, ankle, knee,

elbow, or other soft tissue injury requiring crepe bandage or similarimmobilisation not requiring formal strapping

14.61

MT2 Soft tissue injury (other than splinting of dislocated or fractured digit), unlessspecified elsewhere: application of plaster or padded splint or specific strappingwithin agreed guidelines (includes splinting of Achilles tendon injury andserious ankle sprains)

67.75

MT3 Aspiration of inflamed joint, tendon, bursa, or other subcutaneous tissue orspace (with or without injection)

32.87

MT4 Extensor tendon: primary repair 167.59MT5 Ruptured Achilles tendon: management by plaster immobilisation 164.28Radiologists’ costs

ExtremitiesRA01 Sternum 58.19RA02 Sterno-clavicular joints 66.50RA03 Clavicle 49.88RA04 Acromio-clavicular joints 49.88RA05 Scapula 49.88RA06 Shoulder 54.03RA07 Humerus 54.03RA08 Elbow joint 45.72RA09 Forearm 45.72RA10 Hand or wrist joint, or both 45.72

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Itemnumber Treatment Cost ($)RA11 Wrist or hand for bone age 45.72RA15 Upper limb (infant) 54.03RA21 Sacro-iliac joints 54.03RA22 Pelvis or both hips (1 projection) 54.03RA25 Hip joint (more than 1 projection) 58.19RA26 Femur 54.03RA27 Knee joint 49.88RA28 Knee joint (and intercondylar or axial) 58.19RA29 Tibia and fibula 49.88RA30 Ankle joint 54.03RA32 Foot 49.88RA35 Long legs (hips to ankles), including measurement 62.34RA40 Lower limb (infant) 58.19

Head, neck, and spineRB01 Cervical spine 62.34RB02 Thoracic spine 58.19RB03 Lumbar spine, including lumbosacral joint 58.19RB04 Sacro-coccygeal spine 54.03RB08 Spine (scoliosis views) 62.34RB10 Skull 58.19RB12 Nasal bones 49.88RB13 Facial bones 54.03RB14 Optic foramina 45.72RB16 Auditory canals (plain films only) 58.19RB21 Nasal sinuses 45.72RB22 Nasopharynx 54.03RB23 Mastoids (bilateral) 58.19RB24 Larynx or trachea, or both 49.88RB31 Upper teeth 45.72RB32 Lower teeth 45.72RB33 Mandible or OPG or lateral cephalogram 62.34RB34 Temporo-mandibular joints 62.34RB35 Salivary gland 54.03RB37 Pharynx 54.03

Chest, including breastRC05 Thoracic inlet 54.03RC06 Chest (1 view) 54.03RC07 Chest (more than 1 view) 54.03RC08 Chest and thoracic cage 66.50RC09 Chest and both oblique views 66.50

MammographyRC31 Screening mammogram 91.44RC32 Recall mammogram 124.69RC35 Problem mammogram bilateral 182.88

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Itemnumber Treatment Cost ($)RC36 Problem mammogram unilateral 120.53RC40 Needle localisation 245.22RC41 Galactogram 245.22RC45 Breast aspiration biopsy 245.22RC46 Breast biopsy with stereotaxis 245.22

GI, GU, and obstetrics—no contrast modifiers permittedRadiology

RD01 Abdomen (1 projection) 54.03RD02 Abdomen (2 or more projections) 54.03RD07 Pelvimetry (1 view) 54.03RD08 Pelvimetry (2 or more views) 54.03

ScreeningRD10 Contrast swallow (oesophagus only) 423.94RD11 Contrast study upper GI tract 423.94RD13 Small bowel meal 423.94RD14 Small bowel enema (enteroclysis) 710.72RD15 Contrast enema 423.94RD20 Dynamic proctogram 423.94RD30 ERCP 423.94RD40 IVP, including plain film and tomography 245.22RD44 Cystogram: retrograde or antegrade 423.94RD45 Urethrogram 423.94RD46 Micturating cysto-urethrogram 423.94RD47 Ascending urethrogram 423.94

Special proceduresRS42 Tube injection 245.22RS43 Dacrocystogram 245.22RS44 Sialogram 245.22RS46 Hysterosalpingogram 423.94RS61 Myelogram cervical 423.94RS62 Myelogram lumbar 423.94RS63 Myelogram multilevel 423.94RS70 Arthrogram 245.22RS71 Arthrogram—upper limb 245.22RS73 Arthrogram—lower limb 245.22

UltrasoundAbdomen and pelvis

RU01 US abdomen 128.84RU02 US abdomen and pelvis 162.09RU03 US renal tracts 120.53RU04 US abdominal aorta (without Doppler) 120.53RU06 US pelvis (trans-abdominal only) 120.53

InfantsRU10 US infant head 120.53

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Itemnumber Treatment Cost ($)RU11 US infant pylorus 120.53RU12 US infant heart 228.59RU13 US infant hips 120.53RU19 US infant miscellaneous 120.53

VariousRU20 US thyroid or neck 120.53RU21 US scrotum and testes 120.53RU22 US breast 120.53RU23 US veins 170.41RU24 US eye 120.53RU25 US chest 120.53RU27 US injection or aspiration 241.06RU28 US additional region 87.28RU29 US miscellaneous 120.53

SkeletalRU30 US shoulder 170.41RU31 US musculo-skeletal 128.84RU32 US foreign body localisation 95.59RU39 US skeletal miscellaneous 128.84

IntracavitaryRU40 US prostate 149.63RU41 US anus or rectum 149.63RU42 US female pelvis (includes trans-vaginal and trans-abdominal, or trans-vaginal

only)149.63

RU43 US trans-oesophageal 253.53RU44 US intraoperative 253.53RU49 US intracavitary miscellaneous 149.63

VascularRU51 Duplex or Doppler of chest 203.66RU56 Duplex or Doppler of additional limb (arterial or venous) 162.09

PregnancyRU60 US routine pregnancy less than 28 weeks 128.84RU61 US problem pregnancy 162.09RU62 US pregnancy exceeding 28 weeks 162.09RU64 US with amniocentesis 241.06RU68 US pregnancy (per extra foetus exceeding 1) 62.34

AdditionalRX24 X-ray additional region 45.72RX25 Domiciliary X-ray (in addition) 87.28Specialists’ costs

Repair recent woundSR1 Not exceeding 7 cm, superficial 132.66SR2 Not exceeding 7 cm, deeper tissue 176.87SR3 Exceeding 7 cm, superficial 221.11

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Itemnumber Treatment Cost ($)SR4 Exceeding 7 cm, deeper tissue 265.32

Fractures (closed reduction)SF1 Phalanges 88.45SF2 Metacarpals, excluding Bennetts 159.20SF3 Metatarsals 123.83SF4 Bennetts 229.94SF5 Carpal bones 114.96SF6 Colles 212.24SF7 Radius and ulna—shafts 256.45SF8 Radius—head and neck 229.94SF9 Humerus 256.45SF10 Talus—neck 238.79SF11 Calcaneus 238.79SF12 Other tarsals 150.37SF13 Ankle—fracture dislocation, Potts 371.44SF14 Tibia and fibula—shaft 424.48SF15 Tibia and fibula—upper end 371.44SF16 Tibia and fibula—involving joint traction 433.31SF17 Femur, any site, with or without traction 654.43

Haematoma, abscess, or other infectionSH1 Small—aspiration 22.15SH2 Large—incision and drainage (local anaesthetic) 105.57SH3 Large—incision and drainage (general anaesthetic) 114.96

Foreign body, removal ofSB1 Under local anaesthetic 84.07SB2 Under general anaesthetic 185.70SB3 From cornea or sclera 57.52SB4 From ear, other than by simple syringing 88.45SB5 From muscle, tendon, or other deep tissue 265.32SB6 From nose, other than by simple probing 106.12SB7 From throat, additional fee 88.45

Dislocations (closed reduction)SD1 Elbow, wrist, thumb, and fingers with strapping or splint 176.87SD2 Shoulder 106.12SD3 Patella 150.37SD4 Hip 212.24

PlasterSP1 Upper limb—above elbow 132.66SP2 Upper limb—below elbow 114.96SP3 Lower limb—above knee 159.20SP4 Lower limb—below knee 132.66

OtherSM1 Aspiration of joint 22.15SM2 Amputation of all or part of 1 digit 194.58

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Itemnumber Treatment Cost ($)SM3 Extensor tendon, primary repair 309.53SM4 Nail, simple removal 88.45Specified treatment providers’ costsTMT All treatment 23.06POD3 Podiatry: abscess or haematoma: drainage with incision (with or without local

anaesthetic agent)27.94

POD4 Podiatry: nail, simple removal 22.37POD5 Podiatry: nail, removal or wedge resection requiring the use of digital

anaesthesia93.10

XRAY X-ray services provided by chiropractor (maximum of 2 films per claimant perpersonal 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 AccidentCompensation (Liability to Pay or Contribute to Cost of Treatment) Regulations2003. The amendments increase by 2.22% the amounts that the Accident Compensa-tion Corporation is liable to pay for the treatments specified in those regulations, be-ginning on 1 December 2016.

Regulatory impact statementThe Ministry of Business, Innovation and Employment produced a regulatory impactstatement on 17 August 2016 to help inform the decisions taken by the Governmentrelating to the contents of this instrument.A copy of this regulatory impact statement can be found at—• http://www.mbie.govt.nz/publications-research/publications/employment-and-

skills/ris-for-acccident-compensation-regulated-payments-for-treatment.pdf• http://www.treasury.govt.nz/publications/informationreleases/ris

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.

Wellington, New Zealand:

Published under the authority of the New Zealand Government—2016

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