Health Insurance (1992-1993 General Medical Services Table) Regulations (Cth)
__________________
I, The Governor-General of the
Commonwealth of Australia, acting with the advice of the Federal Executive
Council, make the following Regulations under the
Dated 20 October 1992.
BILL HAYDEN
Governor-General
By His Excellency’s Command,
B. HOWE
Minister of State for Health, Housing and Community Services
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________________
SCHEDULE Regulation 4
TABLE OF GENERAL MEDICAL SERVICES
RULES OF INTERPRETATION
(a) is a second or subsequent attendance on the patient, in the course of a single course of treatment by the consultant physician, during which it is not necessary for the consultant physician to carry out a physical examination of the patient; and
(b) does not result in a substantial alteration to the treatment of the patient;
(a) disadvantaged children; or
(b) juvenile offenders; or
(c) aged persons; or
(d) chronically ill psychiatric patients; or
(e) homeless persons; or
(f) unemployed persons; or
(g) persons suffering from alcoholism; or
(h) persons addicted to drugs; or
(i) physically or mentally handicapped persons;
(a) in the case of all referrals—a medical practitioner; and
(b) if the referral is given to a specialist who is an ophthalmologist—an optometrist; and
(c) if the referral:
(i) arises out of a dental service given by a dental practitioner; and
(ii) is given to a specialist (but not a consultant physician);
a dental practitioner.
(a) to a patient who has been referred to the specialist, if the service is the first given by the specialist after the referral; or
(b) to a patient who has been referred to the specialist:
(i) if the service is part of a single course of treatment given for the condition identified in the referral; or
(ii) if no condition was identified in the referral—for the condition identified by the specialist; and
the service is given within the period of validity of the referral applicable under regulation 12 of the Health Insurance Regulations; or
(c) to a patient who has declared that a written referral completed by a named referring practitioner has been lost, stolen or destroyed before the service was given, if the service is the first given by the specialist in accordance with the referral; or
(d) to a patient who has not been referred to the specialist if, in an emergency, the specialist decides that it is necessary in the patient’s interests to give the service as soon as practicable without a referral.
(a) the:
(i) initial attendance by a specialist or consultant physician; and
(ii) continuing management or treatment up to and including the stage when the patient is referred back to the care of the referring practitioner; and
(b) any subsequent review of the patient’s condition by the specialist or consultant physician that may be necessary, whether the review is initiated by the referring practitioner or the specialist or consultant physician.
(a) a referring practitioner considers it necessary for a patient’s condition to be reviewed; and
(b) the patient is attended by the specialist or consultant physician after the end of the period of validity of the last referral applicable under regulation 12 of the Health Insurance Regulations; and
(c) the patient was last attended by the specialist or consultant physician more than 9 months before the attendance mentioned in paragraph (b);
the attendance mentioned in paragraph (b) initiates a new course of treatment.
(a) includes an attendance by a specialist, or consultant physician, in the practice of his or her specialty:
(i) if the patient has declared that a written referral of the patient was completed by a medical practitioner
(ii) if, in an emergency, the patient has not been referred to the specialist, or consultant physician, who decides that it is necessary in the patient’s interests to give the service mentioned in the item as soon as practicable without a referral; but
(b) does not include an attendance by a specialist, or consultant physician, in the practice of his or her specialty if:
(i) the attendance forms part of a single course of treatment in which the first service was given more than 12 months (or such other period, if any, set by the referring practitioner in, or in connection with, the referral) before the attendance; and
(ii) a later referral has not been given.
(a) the evaluation of the patient’s condition or conditions including, if applicable, evaluation using the health screening services mentioned in in subsection 19 (5) of the Act;
(b) the formulation of a plan for the management and, if applicable, for the treatment of the patient’s condition or conditions;
(c) the provision:
(i) of advice to the patient about the patient’s condition or conditions and, if applicable, about treatment; and
(ii) if the patient has so authorised, of advice to another person, or other persons, about the patient’s condition or conditions and, if applicable, about treatment;
(d) the recording of the clinical details of the service or services given to the patient.
(a) the fee set out in item 3; and:
(b) either:
(i) for each patient attended at a single attendance up to a maximum of 6 patients—an amount equal to $17.00 divided by the number of patients so attended; or
(ii) for each patient attended at a single attendance if the number of patients so attended is in excess of 6—$1.15.
(a) the fee set out in item 23; and:
(b) either:
(i) for each patient attended at a single attendance up to a maximum of 6 patients—an amount equal to $17.00 divided by the number of patients so attended; or
(ii) for each patient attended at a single attendance if the number of patients so attended is in excess of 6—$1.15.
(a) the fee set out in item 36; and:
(b) either:
(i) for each patient attended at a single attendance up to a maximum of 6 patients—an amount equal to $17.00 divided by the number of patients so attended; or
(ii) for each patient attended at a single attendance if the number of patients so attended is in excess of 6—$1.15.
(a) the fee set out in item 44; and:
(b) either:
(i) for each patient attended at a single attendance up to a maximum of 6 patients—an amount equal to $17.00 divided by the number of patients so attended; or
(ii) for each patient attended at a single attendance if the number of patients so attended is in excess of 6—$1.15.
(a) the fee set out in item 52; and:
(b) either:
(i) for each patient attended at a single attendance up to a maximum of 6 patients—an amount equal to $10.50 divided by the number of patients so attended; or
(ii) for each patient attended at a single attendance if the number of patients so attended is in excess of 6—70 cents.
(a) the fee set out in item 53; and:
(b) either:
(i) for each patient attended at a single attendance up to a maximum of 6 patients—an amount equal to $10.50 divided by the number of patients so attended; or
(ii) for each patient attended at a single attendance if the number of patients so attended is in excess of 6—70 cents.
(a) the fee set out in item 54; and:
(b) either:
(i) for each patient attended at a single attendance up to a maximum of 6 patients—an amount equal to $10.50 divided by the number of patients so attended; or
(ii) for each patient attended at a single attendance if the number of patients so attended is in excess of 6—70 cents.
(a) the fee set out in item 57; and:
(b) either:
(i) for each patient attended at a single attendance up to a maximum of 6 patients—an amount equal to $10.50 divided by the number of patients so attended; or
(ii) for each patient attended at a single attendance if the number of patients so attended is in excess of 6—70 cents.
(a) because the patient does not want to wear spectacles for reasons of appearance; or
(b) because the patient wants contact lenses for work, or sporting, purposes; or
(c) because the patient has difficulty in using, or cannot use, spectacles for psychological reasons.
a structural, or functional, change in the eye; or
an allergic response.
(a) who:
(i) does not have access to the original prescription; and
(ii) does a total refit where an item mentioned in subrule (1) applies; and
(b) who is not:
(i) the optometrist who initially fitted the contact lenses; or
(ii) an optometrist at, or operating from, the same practice location at which the optometrist who initially fitted the contact lenses practised when the contact lenses were initially fitted.
(a) a medical practitioner other than a medical practitioner employed by the proprietor of a hospital other than a private hospital; or
(b) a medical practitioner:
(i) who is employed by the proprietor of a hospital other than a private hospital; and
(ii) who gives the service otherwise than in the course of employment by that proprietor;
whether or not another person provides essential assistance to that medical practitioner in accordance with accepted medical practice.
(a) a medical practitioner; or
(b) a person, other than a medical practitioner, who is employed by a medical practitioner or, in accordance with accepted medical practice, acts under the supervision of a medical practitioner.
Items 11309, 11312, 11315, 11318 and 11321 apply only to a service given:
(a) in conditions that allow the establishment of determinate thresholds; and
(b) in a sound-attenuated environment with background noise conditions that comply with Australian Standard AS 1269-1983, of the Standards Association of Australia, as in force on 1 August 1987; and
(c) using calibrated equipment that complies with Australian Standard AS 2586-1983, of the Standards Association of Australia, as in force on 1 August 1987.
15. In item 18013,“prescribed locations” means:
(a) Royal North Shore Hospital, St Leonards, New South Wales;
(b) Royal Prince Alfred Hospital, Camperdown, New South Wales;
(c) Westmead Hospital, Westmead, New South Wales;
(d) Royal Melbourne Hospital, Parkville, Victoria;
(e) St Vincent’s Hospital, Fitzroy, Victoria;
(f) Alfred Group of Hospitals, Prahran, Victoria;
(g) Austin Hospital, Heidelberg, Victoria;
(h) Princess Alexandra Hospital, Woolloongabba, Queensland;
(i) Royal Brisbane Hospital, Herston, Queensland;
(j) Royal Adelaide Hospital, Adelaide, South Australia;
(k) Flinders Medical Centre, Bedford Park, South Australia;
(l) Sir Charles Gairdner Hospital, Nedlands, Western Australia;
(m) Royal Hobart Hospital, Hobart, Tasmania.
(a) the amount of the fee set out in the other item that applies to radiotherapy treatment of the kind mentioned in the first-mentioned item when given to 1 field only; and:
(b) the following amount:
(i) for item 15003—$12.00 for each field separately treated in excess of 1 up to a maximum of 5 additional fields; or
(ii) for item 15103—$13.40 for each field separately treated in excess of 1 up to a maximum of 5 additional fields; or
(iii) for item 15109—$16.00 for each field separately treated in excess of 1 up to a maximum of 5 additional fields; or
(iv) for item 15204—$21.00 for each field separately treated in excess of 1 up to a maximum of 5 additional fields; or
(v) for item 15208—$21.00 for each field separately treated in excess of 1 up to a maximum of 5 additional fields; or
(vi) for item 15214—$17.60 for each field separately treated in excess of 1 up to a maximum of 5 additional fields.
(a) the amount of the fee set out in the other item that applies to treatment, by a single dose of radiotherapy, of the kind mentioned in the first-mentioned item when given to 1 field only; and:
(b) the following amount:
(i) for item 15009—$13.00 for each field separately treated in excess of 1 up to a maximum of 5 additional fields; or
(ii) for item 15115—$33.50 for each field separately treated in excess of 1 up to a maximum of 5 additional fields.
(a) for item 17977—85% of the fee, for the administration of an anaesthetic, for the item relating to an original amputation of the kind performed (being any of items 44324 to 44373 (inclusive)); or
(b) for item 44376—75% of the fee for the item relating to an original amputation of the kind performed (being any of items 44324 to 44373 (inclusive)).
(a) a dental practitioner who is registered or licensed as an orthodontist or oral surgeon under the relevant law; or
(b) a dental practitioner:
(i) who is not registered or licensed under the relevant law as an orthodontist or an oral surgeon or who practises in a State or Territory in which there is no provision for the registration or licensing of orthodontists or oral surgeons; and
(ii) whose qualifications or experience demonstrate to the Committee his or her competence in the field of orthodontics that is applicable to the giving of the services specified in items 75000 to 75051 (inclusive); and
(iii) who is accredited by the Minister for the purposes of this rule;
(a) registered under the relevant law as an oral surgeon; and
(b) a dental practitioner approved by the Minister for the purposes of the definition of “professional service” in subsection 3 (1) of the Act.
(a) begins:
(i) if treatment with superovulatory drugs is given—on the day on which that treatment begins; or
(ii) if treatment with superovulatory drugs is not given—on the first day of the menstrual cycle of the patient; and
(b) ends not more than 30 days after that day.
(a) in an item in subgroup 3 of group T1 (assisted reproductive services); and
(b) in another item outside that subgroup;
is given as part of a treatment cycle to which that subgroup applies, it is not a medical service for the purposes of that other item.
(a) egg recovery from aspirated follicular fluid; and
(b) insemination; and
(c) monitoring of fertilisation and embryo development; and
(d) preparation of gametes or embryos for transfer or freezing;
but does not include semen preparation.
(a) induction of labour by surgical or intravenous infusion methods; and
(b) forceps or vacuum extraction; and
(c) breech delivery; and
(d) management of multiple deliveries; and
(e) episiotomy; and
(f) repair of tears; and
(g) a medical service mentioned in item 16558 or 16561 when performed at the time of delivery; and
(h) evacuation of the products of conception by manual removal.
(a) means treatment of a dislocation or fracture by non-operative reduction; and
(b) includes the use of percutaneous fixation, or external splintage by cast or splints;
(a) operative exposure including the use of any internal or external fixation; or
(b) non-operative (closed reduction) where intra-medullary fixation or external fixation is used.
SERVICES AND FEES
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CATEGORY 1—ATTENDANCES
GROUP A1—GENERAL PRACTITIONER
ATTENDANCES (NOT COVERED BY ANY OTHER
ITEM)
Subgroup 1—Vocationally registered
3 | Professional attendance at consulting rooms (not being a service to which any other item applies) by a vocationally registered general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management—each attendence | 11.40 |
4 | Professional attendance, other than a service to which any other item applies, and not being an attendance at consulting rooms, an institution, a hospital or a nursing home by a vocationally registered general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management—each attendance | 28.50 |
13 | Professional attendance at an institution (not being a service to which any other item applies) by a vocationally registered general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management—an attendance on 1 or more patients at 1 institution on 1 occasion—each patient | Amount under rule 6 |
19 | Professional attendance at a hospital (not being a service to which any other item applies) by a vocationally registered general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management—an attendance on 1 or more patients at 1 hospital on 1 occasion—each patient | Amount under rule 6 |
SERVICES AND FEES
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20 | Professional attendance (not being a service to which any other item applies) at a nursing home including aged persons' accommodation attached to a nursing home or aged persons' accommodation situated within a complex that includes a nursing home (other than a professional attendance at a self contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in a nursing home or aged persons' accommodation (not being accommodation in a self contained unit) by a vocationally registered general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management—an attendance on 1 or more patients at 1 nursing home on 1 occasion—each patient | Amount under rule 6 |
23 | Professional attendance at consulting rooms (not being a service to which any other item applies) by a vocationally registered general practitioner involving taking a selective history, examination of the patient with implementation of a management plan in relation to one or more problems, or a professional attendance of less than 20 minutes duration involving components of a service to which item 36 or 44 applies—each attendance | 24.00 |
24 | Professional attendance, other than a service to which any other item applies, and not being an attendance at consulting rooms, an institution, a hospital or a nursing home by a vocationally registered general practitioner involving taking a selective history, examination of the patient with implementation of a management, plan in relation to 1 or more problems, or a professional attendance of less than 20 minutes duration involving components of aservice to which item 37 or 47 applies—each attendance | 41.00 |
SERVICES AND FEES
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25 | Professional attendance at an institution (not being a service to which any other item applies) by a vocationally registered general practitioner involving taking a selective history, examination of the patient with implementation of a management plan in relation to one or more problems, or a professional attendance of less than 20 minutes duration involving components of a service to which item 38 or 48 applies—an attendance on 1 or more patients at 1 institution on 1 occasion—each patient | Amount under rule 6 |
33 | Professional attendance at a hospital (not being a service to which any other item applies) by a vocationally registered general practitioner involving taking a selective history, examination of the patient with implementation of a management plan in relation to 1 or more problems, or a professional attendance of less than 20 minutes duration involving components of a service to which item 40 or 50 applies—an attendance on 1 or more patients at 1 hospital on 1 occasion—each patient | Amount under rule 6 |
35 | Professional attendance (not being a service to which any other item applies) at a nursing home, including aged persons' accommodation attached to a nursing home or aged persons' accommodation situated within a complex that includes a nursing home (other than a professional attendance at a self contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the nursing home or aged persons' accommodation (not being accommodation in a self-contained unit) by a vocationally registered general practitioner involving taking a selective history, examination of the patient with implementation of a management plan in relation to 1 or more problems, or a professional attendance of less than 20 minutes duration involving components of a service to which item 43 or 51 applies—an attendance on 1 or more patients at 1 nursing home on 1 occasion—each patient | Amount under rule 6 |
SERVICES AND FEES
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36 | Professional attendance at consulting rooms (not being a service to which any other item applies) by a vocationally registered general practitioner involving taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more problems, and lasting at least 20 minutes, or a professional attendance of less than 40 minutes duration involving components of a service to which item 44 applies—each attendance | 43.50 |
37 | and not being an attendance at consulting rooms, an institution, a hospital or a nursing home by a vocationally registered general practitioner involving taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more problems, and lasting at least 20 minutes, or a professional attendance of less than 40 minutes duration involving components of a service to which item 47 applies—each attendance | 60.00 |
38 | Professional attendance at an institution (not being a service to which any other item applies) by a vocationally registered general practitioner involving taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more problems, and lasting at least 20 minutes, or a professional attendance of less than 40 minutes duration involving components of a service to which item 48 applies—an attendance on 1 or more patients at 1institution on 1 occasion—each patient | Amount under rule 6 |
SERVICES AND FEES
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40 | Professional attendance at a hospital (not being a service to which any other item applies) by a vocationally registered general practitioner involving taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more problems, and lasting at least 20 minutes, or a professional attendance of less than 40 minutes duration involving components of a service to which item 50 applies—an attendance on 1 or more patients at 1 hospital on 1 occasion—each patient | Amount under rule 6 |
43 | Professional attendance (not being a service to which any other item applies) at a nursing home including aged persons' accommodation attached to a nursing home or aged persons' accommodation situated within a complex that includes a nursing home (other than a professional attendance at a self contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the nursing home or aged persons' accommodation (not being accommodation in a self-contained unit) by a vocationally registered general practitioner involving taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more problems, and lasting at least 20 minutes, or a professional attendance of less than 40 minutes duration involving components of a service to which item 51 applies—an attendance on 1 or more patients at 1 nursing home on 1 occasion—each patient | Amount under rule 6 |
SERVICES AND FEES
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44 | Professional attendance at consulting rooms (not being a service to which any other item applies) by a vocationally registered general practitioner involving taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more complex problems, and lasting at least 40 minutes, or a professional attendance of at least 40 minutes duration for implementation of a management plan—each attendance | 64.00 |
47 | Professional attendance, other than a service to which any other item applies, and not being an attendance at consulting rooms, an institution, a hospital or a nursing home by a vocationally registered general practitioner involving taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more complex problems and lasting at least 40 minutes, or a professional attendance of at least 40 minutes duration for implementation of a management plan—each attendance | 81.00 |
48 | Professional attendance at an institution (not being a service to which any other item applies) by a vocationally registered general practitioner involving taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more complex problems, and lasting at least 40 minutes, or a professional attendance of at least 40 minutes duration for implementation of a management plan—an attendance on 1 or more patients at 1 institution on 1 occasion—each patient | Amount under rule 6 |
SERVICES AND FEES
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50 | Professional attendance at a hospital (not being a service to which any other item applies) by a vocationally registered general practitioner involving taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more complex problems, and lasting at least 40 minutes, or a professional attendance of at least 40 minutes duration for implementation of a management plan—an attendance on 1 or more patients at 1 hospital on 1 occasion—each patient | Amount under rule 6 |
51 | Professional attendance (not being a service to which any other item applies) at a nursing home, including aged persons' accommodation attached to a nursing home or aged persons' accommodation situated within a complex that includes a nursing home (other than a professional attendance at a self contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the nursing home or aged persons' accommodation (not being accommodation in a self-contained unit) by a vocationally registered general practitioner involving taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more complex problems, and lasting at least 40 minutes, or a professional attendance of at least 40 minutes duration for implementation of a management plan—an attendance on 1 or more patients at 1 nursing home on 1 occasion—each patient | Amount under rule 6 |
SERVICES AND FEES
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Subgroup 2—Other than vocationally registered
52 | Professional attendance at consulting rooms of not more than 5 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a vocationally registered general practitioner)—each attendance |
11.00 | ||
53 | Professional attendance at consulting rooms of more than 5 minutes duration but not more than 25 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a vocationally registered general practitioner)—each attendance | 21.00 |
54 | Professional attendance at consulting rooms of more than 25 minutes duration but not more than 45 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a vocationally registered general practitioner)—each attendance | 38.00 |
57 | Professional attendance at consulting rooms of more than 45 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a vocationally registered general practitioner)—each attendance | 61.00 |
58 | Professional attendance (not being an attendance at consulting rooms, an institution, a hospital or a nursing home) of not more than 5 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a vocationally registered general practitioner)—each attendance | 24.00 |
59 | Professional attendance (not being an attendance at consulting rooms, an institution, a hospital or a nursing home) of more than 5 minutes duration but not more than 25 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a vocationally registered general practitioner)—each attendance | 31.50 |
SERVICES AND FEES
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60 | Professional attendance (not being an attendance at consulting rooms, an institution, a hospital or a nursing home) of more than 25 minutes duration but not more than 45 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a vocationally registered general practitioner)—each attendance | 51.00 |
65 | Professional attendance (not being an attendance at consulting rooms, an institution, a hospital or a nursing home) of more than 45 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a vocationally registered general practitioner)—each attendance | 73.00 |
81 | Professional attendance at an institution of not more than 5 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a vocationally registered general practitioner)—an attendance on 1 or more patients at 1 institution on 1 occasion—each patient | Amount under rule 6 |
83 | Professional attendance at an institution of more than 5 minutes duration but not more than 25 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a vocationally registered general practitioner)—an attendance on 1 or more patients at 1 institution on 1 occasion—each patient | Amount under rule 6 |
84 | Professional attendance at an institution of more than 25 minutes duration but not more than 45 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a vocationally registered general practitioner)—an attendance on 1 or more patients at 1 institution on 1 occasion—each patient | Amount under rule 6 |
86 | Professional attendance at an institution of more than 45 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a vocationally registered general practitioner)—an attendance on 1 or more patients at 1 institution on 1 occasion—each patient | Amount under rule 6 |
SERVICES AND FEES
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87 | Professional attendance at a hospital of not more than 5 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a vocationally registered general practitioner)—an attendance on 1 or more patients at 1 hospital on 1 occasion—each patient | Amount under rule 6 |
89 | Professional attendance at a hospital of more than 5 minutes duration but not more than 25 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a vocationally registered general practitioner)—an attendance on 1 or more patients at 1 hospital on 1 occasion—each patient | Amount under rule 6 |
90 | Professional attendance at a hospital of more than 25 minutes duration but not more than 45 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a vocationally registered general practitioner)—an attendance on 1 or more patients at 1 hospital on 1 occasion—each patient | Amount under rule 6 |
91 | hospital on the one occasion—each patient | Amount under rule 6 |
92 | Professional attendance (not being a service to which any other item applies) at a nursing home, including aged persons’ accommodation attached to a nursing home or aged persons’ accommodation situated within a complex that includes a nursing home (other than a professional attendance at a self contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the nursing home or aged persons' accommodation (not being accommodation in a self-contained unit) of not more than 5 minutes duration by a medical practitioner (not being a vocationally registered general practitioner)—an attendance on 1 or more patients at 1 nursing home on 1 occasion—each patient | Amount under rule 6 |
SERVICES AND FEES
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93 | Professional attendance (not being a service to which any other item applies) at a nursing home, including aged persons' accommodation attached to a nursing home or aged persons' accommodation situated within a complex that includes a nursing home (other than a professional attendance at a self contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the nursing home or aged persons' accommodation (not being accommodation in a self-contained unit) of more than 5 minutes duration but not more than 25 minutes duration by a medical practitioner (not being a vocationally registered general practitioner)—an attendance on 1 or more patients at 1 nursing home on 1 occasion—each patient | Amount under rule 6 |
95 | Professional attendance (not being a service to which any other item applies) at a nursing home, including aged persons' accommodation attached to a nursing home or aged persons' accommodation situated within a complex that includes a nursing home (other than a professional attendance at a self contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the nursing home or aged persons' accommodation (not being accommodation in a self-contained unit) of more than 25 minutes duration but not more than 45 minutes duration by a medical practitioner (not being a vocationally registered general practitioner)—an attendance on 1 or more patients at 1 nursing home on 1 occasion—each patient | Amount under rule 6 |
SERVICES AND FEES
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96 | Professional attendance (not being a service to which any other item applies) at a nursing home, including aged persons' accommodation attached to a nursing home or aged persons' accommodation situated within a complex that includes a nursing home (other than a professional attendance at a self contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the nursing home or aged persons' accommodation (not being accommodation in a self-contained unit) of more than 45 minutes duration by a medical practitioner (not being a vocationally registered general practitioner)—an attendance on 1 or more patients at 1 nursing home on 1 occasion—each patient | Amount under rule 6 |
Subgroup 3 - After hours
97 | Professional attendance being an attendance at other than consulting rooms, on not more than 1 patient on 1 occasion by a medical practitioner—each attendance on a public holiday, on a Sunday, before 8 am or after 1 pm on a Saturday or at any time other than between 8 am and 8 pm on a day not being a Saturday, Sunday or public holiday, where the attendance is initiated by or on behalf of the patient in the same unbroken after hours period and where the patient's medical condition requires immediate treatment | 45.50 |
98 | Professional attendance being an attendance at consulting rooms, on not more than 1 patient on 1 occasion by a medical practitioner—each attendance on a public holiday, on a Sunday, before 8 am or after 1 pm on a Saturday or at any time other than between 8 am and 8 pm on a day not being a Saturday, Sunday or public holiday, where the attendance is initiated by or on behalf of the patient in the same unbroken after hours period, where the patient's medical condition requires immediate treatment, and where it is necessary for the doctor to return to, and specially open, consulting rooms for the attendance | 45.50 |
SERVICES AND FEES
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GROUP A2 - SPECIALIST ATTENDANCES
TO WHICH NO OTHER ITEM APPLIES
104 | Professional attendance by a specialist in the practice of his or her specialty where the patient is referred to him or her—an attendance (other than a second or subsequent attendance in a single course of treatment) where that attendance is at consulting rooms, hospital or nursing home, not being a service to which item 106 applies | 60.00 |
105 | Professional attendance by a specialist in the practice of his or her specialty where the patient is referred to him or her—each attendance subsequent to the first in a single course of treatment where that attendance is at consulting rooms, hospital or nursing home | 30.00 |
106 | Professional attendance by a specialist in the practice of his or her speciality where the patient is referred to him or her—an attendance (other than a second or subsequent attendance in a single course of treatment) at which refraction is performed by a specialist ophthalmologist, and the attendance results in the issuing of a prescription for spectacles or contact lenses, including any consultation on the same occasion and any other attendance on the same day (other than a service to which item 10801, 10802, 10803, 10804, 10805, 10806, 10807, 10808, 10809 or 10815 applies), where the attendance is at consulting rooms, hospital or nursing home | 49.50 |
107 | Professional attendance by a specialist in the practice of his or her specialty where the patient is referred to him or her—an attendance (other than a second or subsequent attendance in a single course of treatment) where that attendance is at a place other than consulting rooms, hospital or nursing home | 88.00 |
108 | Professional attendance by a specialist in the practice of his or her specialty where the patient is referred to him or her—each attendance subsequent to the first in a single course of treatment where that attendance is at a place other than consulting rooms, hospital or nursing home | 56.00 |
SERVICES AND FEES
|
|
|
GROUP A3—CONSULTANT PHYSICIAN
ATTENDANCES TO WHICH NO OTHER ITEM APPLIES
110 | Professional attendance at consulting rooms, hospital or nursing home by a consultant physician in the practice of his/ or her specialty (other than psychiatry) where the patient is referred to him or her by a medical practitioner—initial attendance in a single course of treatment | 106.00 |
116 | Professional attendance at consulting rooms, hospital or nursing home by a consultant physician in the practice of his/ or her specialty (other than psychiatry) where the patient is referred to him or her by a medical practitioner—each attendance (other than an attendance covered by item 119) subsequent to the first in a single course of treatment | 53.00 |
119 | Professional attendance at consulting rooms, hospital or nursing home by a consultant physician in the practice of his/her specialty (other than psychiatry) where the patient is referred to him or her by a medical practitioner—each minor attendance subsequent to the first in a single course of treatment | 30.00 |
122 | Professional attendance at a place other than consulting rooms, hospital or nursing home by a consultant physician in the practice of his or her specialty (other than in psychiatry) where the patient is referred to him or her by a medical practitioner—initial attendance in a single course of treatment | 128.00 |
128 | Professional attendance at a place other than consulting rooms, hospital or nursing home by a consultant physician in the practice of his or her specialty (other than in psychiatry) where the patient is referred to him or her by a medical practitioner—each attendance (other than an attendance to which item 131 applies) subsequent to the first in a single course of treatment | 78.00 |
SERVICES AND FEES
|
|
|
131 | Professional attendance at a place other than consulting rooms, hospital or nursing home by a consultant physician in the practice of his or her specialty (other than in psychiatry) where the patient is referred to him or her by a medical practitioner—each minor attendance subsequent to the first in a single course of treatment | 56.00 |
GROUP A4—CONSULTANT PSYCHIATRIST
ATTENDANCES TO WHICH NO OTHER ITEM APPLIES
134 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry where the patient is referred to hi or her by a medical practitioner—an attendance of not more than 15 minutes duration where that attendance is at consulting rooms, hospital or nursing home | 30.50 |
136 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry where the patient is referred to him or her by a medical practitioner—an attendance of more than 15 minutes duration but not more than 30 minutes duration where that attendance is at consulting rooms, hospital or nursing home | 61.00 |
138 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry where the patient is referred to him or her by a medical practitioner—an attendance of more than 30 minutes duration but not more than 45 minutes duration where that attendance is at consulting rooms, hospital or nursing home | 89.00 |
140 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry where the patient is referred to him or her by a medical practitioner—an attendance of more than 45 minutes duration but not more than 75 minutes duration where that attendance is at consulting rooms, hospital or nursing home | 124.00 |
SERVICES AND FEES
|
|
|
142 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry where the patient is referred to him or her by a medical practitioner—an attendance of more than 75 minutes duration where that attendance is at consulting rooms, hospital or nursing home | 150.00 |
144 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry where the patient is referred to him or her by a medical practitioner—an attendance of not more than 15 minutes duration where that attendance is at a place other than consulting rooms, hospital or nursing home | 56.00 |
146 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry where the patient is referred to him or her by a medical practitioner—an attendance of more than 15 minutes duration but not more than 30 minutes duration where that attendance is at a place other than consulting rooms, hospital or nursing home | 88.00 |
148 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry where the patient is referred to him or her by a medical practitioner—an attendance of more than 30 minutes duration but not more than 45 minutes duration where that attendance is at a place other than consulting rooms, hospital or nursing home | 122.00 |
150 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry where the patient is referred to him or her by a medical practitioner—an attendance of more than 45 minutes duration but not more than 75 minutes duration where that attendance is at a place other than consulting rooms, hospital or nursing home | 148.00 |
152 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry where the patient is referred to him or her by a medical practitioner—an attendance of more than 75 minutes duration where that attendance is at a place other than consulting rooms, hospital or nursing home | 176.00 |
SERVICES AND FEES
|
|
|
153 | (AU 3) | 40.00 |
154 | Group psychotherapy (including any associated consultations with a patient taking place on the same occasion and relating to the condition for which group therapy is conducted) of not less than 1 hour’s duration given under the continuous direct supervision of a consultant physician in the practice of his or her specialty of psychiatry, involving a group of 2-9 unrelated patients or a family group of more than 3 patients, each of whom is referred to the consultant physician by a medical practitioner—each patient | 35.00 |
155 | Group psychotherapy (including any associated consultations with a patient taking place on the same occasion and relating to the condition for which group therapy is conducted) of not less than 1 hour’s duration given under the continuous direct supervision of a consultant physician in the practice of his or her specialty of psychiatry, involving a family group of 3 patients, each of whom is referred to the consultant physician by a medical practitioner—each patient | 46.00 |
156 | Group psychotherapy (including any associated consultations with a patient taking place on the same occasion and relating to the condition for which group therapy is conducted) of not less than 1 hour’s duration given under the continuous direct supervision of a consultant physician in the practice of his or her specialty of psychiatry, involving a family group of 2 patients, each of whom is referred to the consultant physician by a medical practitioner—each patient | 68.00 |
157 | Professional attendance by a consultant physician in the practice of his or her recognised specialty of psychiatry, where the patient is referred to him or her by a medical practitioner, involving an interview of a person other than the patient of not less than 20 minute’s duration but less than 45 minutes duration, in the course of initial diagnostic evaluation of a patient | 37.00 |
SERVICES AND FEES
|
|
|
158 | Professional attendance by a consultant physician in the practice of his or her recognised specialty of psychiatry, where the patient is referred to him or her by a medical practitioner, involving an interview of a person other than the patient of not less than 45 minute’s duration, in the course of initial diagnostic evaluation of a patient | 83.00 |
159 | Professional attendance by a consultant physician in the practice of his or her recognised specialty of psychiatry, where the patient is referred to him or her by a medical practitioner, involving an interview of a person other than the patient of not less than 20 minutes duration, in the course of continuing management of a patient—payable not more than twice in any twelve month period |
37.00 |
GROUP A5—PROLONGED ATTENDANCES
TO WHICH NO OTHER ITEM APPLIES
160 | Professional attendance for a period of not less than 1 hour but less than 2 hours (not being a service to which any other item applies) on a patient in imminent danger of death requiring continuous life saving emergency treatment (not being treatment of a counselling nature) to the exclusion of all other patients | 87.00 |
161 | Professional attendance for a period of not less than 2 hours but less than 3 hours (not being a service to which any other item applies) on a patient in imminent danger of death requiring continuous life saving emergency treatment (not being treatment of a counselling nature) to the exclusion of all other patients | 142.00 |
162 | Professional attendance for a period of not less than 3 hours but less than 4 hours (not being a service to which any other item applies) on a patient in imminent danger of death requiring continuous life saving emergency treatment (not being treatment of a counselling nature) to the exclusion of all other patients | 196.00 |
SERVICES AND FEES
|
|
|
163 | Professional attendance for a period of not less than 4 hours but less than 5 hours (not being a service to which any other item applies) on a patient in imminent danger of death requiring continuous life saving emergency treatment (not being treatment of a counselling nature) to the exclusion of all other patients | 250.00 |
164 | Professional attendance for a period of 5 hours or more (not being a service to which any other item applies) on a patient in imminent danger of death requiring continuous life saving emergency treatment (not being treatment of a counselling nature) to the exclusion of all other patients | 305.00 |
GROUP A6—GROUP THERAPY
170 | Professional attendance for the purpose of group therapy of not less than 1 hour’s duration given under the direct continuous supervision of a medical practitioner, other than a consultant physician in the practice of his or her specialty of psychiatry, involving members of a family and persons with close personal relationships with that family—each group of 2 patients | 92.00 |
171 | Professional attendance for the purpose of group therapy of not less than 1 hour’s duration given under the direct continuous supervision of a medical practitioner, other than a consultant physician in the practice of his or her specialty of psychiatry, involving members of a family and persons with close personal relationships with that family—each group of 3 patients | 97.00 |
172 | Professional attendance for the purpose of group therapy of not less than 1 hour’s duration given under the direct continuous supervision of a medical practitioner, other than a consultant physician in the practice of his or her specialty of psychiatry, involving members of a family and persons with close personal relationships with that family—each group of 4 or more patients | 118.00 |
SERVICES AND FEES
|
|
|
GROUP A7—ACUPUNCTURE
173 | Attendance at which acupuncture is performed by a medical practitioner by application of stimuli on or through the surface of the skin by any means, including any consultation on the same occasion and any other attendance on the same day related to the condition for which the acupuncture was performed | 21.50 |
GROUP A8—CONTACT LENSES
10801 | Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription—1 service in any period of 36 consecutive months—patients with myopia of 4.0 dioptres or greater (spherical equivalent) in 1 eye | 86.00 |
10802 | Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription—1 service in any period of 36 consecutive months—patients with manifest hyperopia of 5.0 dioptres or greater (spherical equivalent) in 1 eye | 86.00 |
10803 | Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription—1 service in any period of 36 consecutive months—patients with astigmatism of 3.0 dioptres or greater in 1 eye | 86.00 |
SERVICES AND FEES
|
|
|
10804 | Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription—1 service in any period of 36 consecutive months—patients with irregular astigmatism in either eye, being a condition the existence of which has been confirmed by keratometric observation, if the maximum visual acuity obtainable with spectacle correction is less than 6/12 and if that corrected acuity would be improved by an additional 1 line on the Snellen chart by the use of a contact lens | 86.00 |
10805 | Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription—1 service in any period of 36 consecutive months—patients with anisometropia of 3.0 dioptres or greater (difference between spherical equivalents) | 86.00 |
10806 | Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription—1 service in any period of 36 consecutive months—patients with subnormal corrected visual acuity of not greater than 6/30 in either eye, being patients for whom a contact lens is prescribed as part of a telescopic system | 86.00 |
10807 | Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription—1 service in any period of 36 consecutive months—patients for whom a wholly or segmentally opaque contact lens is prescribed for the alleviation of dazzle, distortion or diplopia caused by pathological mydriasis, aniridia, coloboma of the iris, pupillary malformation or distortion, significant ocular deformity or corneal opacity—whether congenital, traumatic or surgical in origin | 86.00 |
SERVICES AND FEES
|
|
|
10808 | Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription—1 service in any period of 36 consecutive months—patients who, by reason of physical deformity, are unable to wear spectacles | 86.00 |
10809 | Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription—1 service in any period of 36 consecutive months—patients who have a medical or optical condition (other than myopia, hyperopia, astigmatism, anisometropia or a condition to which item 10806, 10807 or 10808 applies) requiring the use of a contact lens for correction and which condition must be specified on the patient's account | 86.00 |
10815 | Attendance for the refitting of contact lenses with keratometry and testing with trial lenses and the issue of a prescription being a subsequent fitting of contact lenses within a period of 36 months of the initial fitting to which an item of items 10801 to 10809 (inclusive) applies | 6.10 |
GROUP A9—OPTOMETRICAL
10900 | Professional attendance that is the sole or first attendance in a single course of attention of a patient by a participating optometrist at, or operating from, the same practice location—once only in a period of 24 months. | 49.50 |
10902 | Professional attendance that is the sole or first attendance in a single course of attention of a patient by a participating optometrist at, or operating from, the same practice location, where the patient has a significant change of visual function requiring complete reassessment which necessitates a comprehensive optometric consultation within 24 months of the previous initial or comprehensive consultation to which item 10900, 10902, 10903 or 10904 applies. | 49.50 |
SERVICES AND FEES
|
|
|
10903 | Professional attendance that is the sole or first attendance in a single course of attention of a patient by a participating optometrist at, or operating from, the same practice location, where the patient has new signs or symptoms, unrelated to the earlier course of attention, requiring complete reassessment that necessitates a comprehensive optometric consultation within 24 months of the previous initial or comprehensive consultation to which item 10900, 10902, 10903 or 10904 applies. | 49.50 |
10904 | Professional attendance that is the sole or first attendance in a single course of attention of a patient by a participating optometrist at, or operating from, the same practice location, where the patient has a progressive disorder (excluding presbyopia) requiring complete reassessment that necessitates a comprehensive optometric consultation within 24 months of the previous initial or comprehensive consultation to which item 10900, 10902, 10903 or 10904 applies. | 49.50 |
10908 | Professional attendance (not being an attendance relating to the prescription and fitting of contact lenses) that is the second attendance in a single course of attention in respect of which the first attendance is a service to which item 10900, 10902, 10903 or 10904 applies. | 25.00 |
10909 | Professional attendance (not being an attendance relating to the prescription and fitting of contact lenses) that is the third or subsequent attendance in a single course of attention of a patient in respect of whom the attending optometrist has certified that, in his or her professional opinion, there is a need for that attendance, being a course of attention in respect of which the first attendance is a service to which item 10900, 10902, 10903 or 10904 applies. | 25.00 |
SERVICES AND FEES
|
|
|
10921 | All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention in respect of which the first attendance is a service to which item 10900, 10902, 10903 or 10904 applies. The Medicare benefit is payable only once in a period of 36 consecutive months for any of these items, unless the examining optometrist has certified on the patient's account that, in his or her professional opinion the patient had an ocular condition that necessitated a further course of attention being commenced within 36 months of the previous initial consultation—patients with myopia of 4.0 dioptres or greater (spherical equivalent) in 1 eye. | 126.00 |
10922 | All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention in respect of which the first attendance is a service to which item 10900, 10902, 10903 or 10904 applies. The Medicare benefit is payable only once in a period of 36 consecutive months for any of these items, unless the examining optometrist has certified on the patient's account that, in his or her professional opinion the patient had an ocular condition that necessitated a further course of attention being commenced within 36 months of the previous initial consultation—patients with manifest hyperopia of 5.0 dioptres or greater (spherical equivalent) in 1 eye | 126.00 |
SERVICES AND FEES
|
|
|
10923 | All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention in respect of which the first attendance is a service to which item 10900, 10902, 10903 or 10904 applies. The Medicare benefit is payable only once in a period of 36 consecutive months for any of these items, unless the examining optometrist has certified on the patient's account that, in his or her professional opinion the patient had an ocular condition that necessitated a further course of attention being commenced within 36 months of the previous initial consultation—patients with astigmatism of 3.0 dioptres or greater in 1 eye | 126.00 |
10924 | All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention in respect of which the first attendance is a service to which item 10900, 10902, 10903 or 10904 applies. The Medicare benefit is payable only once in a period of 36 consecutive months for any of these items, unless the examining optometrist has certified on the patient's account that, in his or her professional opinion the patient had an ocular condition that necessitated a further course of attention being commenced within 36 months of the previous initial consultation—patients with irregular astigmatism in either eye, being a condition the existence of which has been confirmed by keratometric observation, if the maximum visual acuity obtainable with spectacle correction is less than 6/12 and if that corrected acuity would be improved by an additional 1 line on the Snellen chart by the use of a contact lens | 126.00 |
SERVICES AND FEES
|
|
|
10925 | All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention in respect of which the first attendance is a service to which item 10900, 10902, 10903 or 10904 applies. The Medicare benefit is payable only once in a period of 36 consecutive months for any of these items, unless the examining optometrist has certified on the patient's account that, in his/ or her professional opinion the patient had an ocular condition that necessitated a further course of attention being commenced within 36 months of the previous initial consultation—patients with anisometropia of 3.0 dioptres or greater (difference between spherical equivalents) | 126.00 |
10926 | All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention in respect of which the first attendance is a service to which item 10900, 10902, 10903 or 10904 applies. The Medicare benefit is payable only once in a period of 36 consecutive months for any of these items, unless the examining optometrist has certified on the patient's account that, in his or her professional opinion the patient had an ocular condition that necessitated a further course of attention being commenced within 36 months of the previous initial consultation—patients with subnormal corrected visual acuity of not greater than 6/30 in either eye, being patients for whom a contact lens is prescribed as part of a telescopic system | 126.00 |
SERVICES AND FEES
|
|
|
10927 | All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention in respect of which the first attendance is a service to which item 10900, 10902, 10903 or 10904 applies. The Medicare benefit is payable only once in a period of 36 consecutive months for any of these items, unless the examining optometrist has certified on the patient's account that, in his or her professional opinion the patient had an ocular condition that necessitated a further course of attention being commenced within 36 months of the previous initial consultation—patients for whom a wholly or segmentally opaque contact lens is prescribed for the alleviation of dazzle, distortion or diplopia caused by: pathological mydriasis, aniridia, coloboma of the iris, pupillary malformation or distortion, significant ocular deformity or corneal opacity—whether congenital, traumatic or surgical in origin | 126.00 |
10928 | All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention in respect of which the first attendance is a service to which item 10900, 10902, 10903 or 10904 applies. The Medicare benefit is payable only once in a period of 36 consecutive months for any of these items, unless the examining optometrist has certified on the patient's account that, in his or her professional opinion the patient had an ocular condition that necessitated a further course of attention being commenced within 36 months of the previous initial consultation—patients who, by reason of physical deformity, are unable to wear spectacles | 126.00 |
SERVICES AND FEES
|
|
|
10929 | service to which item 10900, 10902, 10903 or 10904 applies. The Medicare benefit is payable only once in a period of 36 consecutive months for any of these items, unless the examining optometrist has certified on the patient's account that, in his/ or her professional opinion the patient had an ocular condition that necessitated a further course of attention being commenced within 36 months of the previous initial consultation—patients who have a medical or optical condition (other than myopia, hyperopia, astigmatism, anisometropia or a condition to which item 10926, 10927 or 10928 applies) requiring the use of a contact lens for correction and which condition must be specified on the patient's account | 126.00 |
CATEGORY 2—DIAGNOSTIC PROCEDURES
AND INVESTIGATIONS
GROUP D1—MISCELLANEOUS
DIAGNOSTIC PROCEDURES AND
INVESTIGATIONS
Subgroup 1—NEUROLOGY
11000 | Electroencephalography, not associated with item 11003, 11006 or 11009 (AU 6) | 87.00 |
11003 | Electroencephalography, prolonged recording of at least three hours duration, not associated with item 11000, 11006 or 11009 | 230.00 |
11006 | Electroencephalography, emporosphenoidal | 118.00 |
11009 | Electrocorticography | 160.00 |
SERVICES AND FEES
|
|
|
11012 | Neuromuscular electrodiagnosis—conduction studies on 1 nerve or electromyography of 1 or more muscles using concentic needle electrodes or both these examinations (not associated with item 11015 or 11018) | 79.00 |
11015 | Neuromuscular electrodiagnosis—conduction studies on 2 or 3 nerves with or without electromyography (not associated with item 11012 or 11018) | 106.00 |
11018 | Neuromuscular electrodiagnosis—conduction studies on 4 or more nerves with or without electromyography or recordings from single fibres of nerves and muscles or both of these examinations (not associated with item 11012 or 11015) | 158.00 |
11021 | Neuromuscular electrodiagnosis—repetitive stimulation for study of neuromuscular conduction or electromyography with quantitative computerised analysis or both of these examinations | 106.00 |
11024 | Investigation of central nervous system evoked responses by computerised averaging techniques—1 or 2 studies | 80.00 |
11027 | Investigation of central nervous system evoked responses by computerised averaging techniques—3 or more studies |
630.00 | ||
49839 | Foot, correction of hallux rigidus or hallux valgus by prosthetic arthroplasty—unilateral (AU 11) | 365.00 |
49842 | Foot, correction of hallux rigidus or hallux valgus by prosthetic arthroplasty—bilateral (AU 14) | 630.00 |
49845 | Foot, arthrodesis of, first metatarso-phalangeal joint (AU 10) | 330.00 |
49848 | Foot, correction of claw or hammer toe (AU 8) | 112.00 |
49851 | Foot, correction of claw or hammer toe with internal fixation (AU 8) | 146.00 |
49854 | Foot, radical plantar fasciotomy or fasciectomy of (AU 9) | 265.00 |
49857 | Foot, metatarso-phalangeal joint replacement (AU 12) | 245.00 |
49860 | Foot, synovectomy of metatarso-phalangeal joint, single joint (AU 9) | 198.00 |
49863 | Foot, synovectomy of metatarso-phalangeal joint, two or more joints (AU 11) | 300.00 |
49866 | Foot, neurectomy for plantar digital neuritis (Morton's or Bett's syndrome) (AU 7) | 210.00 |
49869 | Talipes equinovarus, posterior release of (AU 8) | 265.00 |
49872 | Talipes equinovarus, medial release of (AU 8) | 265.00 |
49875 | Talipes Equinovarus, combined postero-medial release of (AU 9) | 400.00 |
49878 | Talipes equinovarus, calcaneo valgus or metatarsus varus, treatment by cast, splint or manipulation—each attendance (AU 6) | 40.00 |
50100 | Joint, diagnostic arthroscopy of (including biopsy), not covered by any other item in this Group and not associated with any other arthroscopic procedure (AU 8) | 192.00 |
SERVICES AND FEES
|
|
|
50103 | Joint, arthrotomy of, not covered by any other item in this Group (AU 9) | 230.00 |
50106 | Joint, stabilisation of, involving one or more of: repair of capsule, repair of ligament or internal fixation, not covered by any other item in this Group (AU 10) | 330.00 |
50109 | Joint, arthrodesis of, not covered by any other item in this Group (AU 11) | 330.00 |
50112 | (AU 10) | 265.00 |
50115 | Joint or joints, manipulation of, performed in the operating theatre of a hospital or approved day hospital facility not associated with any other item in this Group (AU 4) | 99.00 |
50118 | Subtalar joint, arthrodesis of (AU 11) | 305.00 |
50121 | Greater Trochanter, transplantation of ileopsoas tendon to (AU 13) | 595.00 |
50124 | Joint or other synovial cavity, aspiration of, injection into, or both of these procedures; payable on not more than 25 occasions in any twelve month period (AU 5) | 21.00 |
50200 | Aggressive or potentially malignant bone or deep soft tissue tumour, biopsy of (not including aftercare) (AU 5) | 132.00 |
50203 | Bone or malignant deep soft tissue tumour, lesional or marginal excision of (AU 8) | 290.00 |
50206 | Bone tumour, lesional or marginal excision of, combined with any one of; liquid nitrogen freezing, autograft, allograft or cementation (AU 9) | 430.00 |
50209 | Bone tumour, lesional or marginal excision of, combined with any two or more of; liquid nitrogen freezing, autograft, allograft or cementation (AU 10) | 530.00 |
50212 | Malignant or aggresive soft tissue tumour affecting the long bones of leg or arm, enbloc resection of, with compartmental or wide excision of soft tissue, without reconstruction (AU 19) | 1,160.00 |
50215 | Malignant or aggressive soft tissue tumour affecting the long bones of leg or arm, enbloc resection of, with compartmental or wide excision of soft tissue, with intercalary reconstruction (prosthesis, allograft or autograft) (AU 21) | 1,460.00 |
50218 | Malignant tumour of long bone, enbloc resection of, with replacement or arthrodesis of adjacent joint (AU 21) | 1,925.00 |
50221 | Malignant or aggressive soft tissue tumour of pelvis, sacrum or spine; or scapula and shoulder, enbloc resection of (AU 22) | 1,790.00 |
50224 | Malignant or aggressive soft tissue tumour of pelvis, sacrum or spine; or scapula and shoulder, enbloc resection of, with reconstruction by prosthesis, allograft or autograft (AU 25) | 1,990.00 |
50227 | Malignant bone tumour, enbloc resection of, with massive anatomic specific allograft or autograft, with or without prosthetic replacement (AU 27) | 2,320.00 |
50230 | Benign tumour, resection of, requiring anatomic specific allograft, with or without internal fixation (AU 19) | 1,195.00 |
50233 | Malignant tumour, amputation for, hemipelvectomy or interscapulo-thoracic (AU 26) | 1,525.00 |
50236 | Malignant tumour, amputation for, hip dis-articulation, shoulder dis-articulation or proximal third femur (AU 20) | 1,195.00 |
50239 | Malignant tumour, amputation for, not covered by any other item in this Group (AU 13) | 795.00 |
GROUP T9—ASSISTANCE AT OPERATIONS
51300 | Assistance at any operation for which the fee exceeds 178 but does not exceed 320 or at a series or a combination of operations where the fee for at least one of the operations exceeds 178 but where the fee for the series or combination of operations does not exceed 320 | 61.00 |
51303 | Assistance at any operation for which the fee exceeds 320 or at a combination of operations for which the aggregate fee exceeds 320 provided that the fee for at least one of the operations exceeds 178 | Amount under rule 33 |
51306 | Assistance at a delivery involving Caesarean section | 88.00 |
51309 | Assistance at a series or combination of operations, one of which is a delivery involving Caesarean section | Amount under rule 34 |
SERVICES AND FEES
|
|
|
MAXILLOFACIAL SERVICES
GROUP O1—CONSULTATIONS
51700 | Professional attendance (other than a second or subsequent attendance in a single course of treatment) by an approved dental practitioner where the patient is referred to him/her—being an attendance related to a subsequent operative procedure described in an item in Groups O3 to O9 where that attendance is at consulting rooms, hospital or nursing home | 60.00 |
51703 | Professional attendance by an approved dental practitioner where the patient is referred to him/her—each attendance related to an operative procedure described in an item in Groups O3 to O9 subsequent to the first in a single course of treatment where that attendance is at consulting rooms, hospital or nursing home | 30.00 |
GROUP O2—ASSISTANCE AT OPERATION
51800 | Assistance by an approved dental practitioner at any operation for which the fee exceeds $178 but does not exceed $320 or at a series or a combination of operations where the fee for one of the operations exceeds $178 but where the fee for the series or combination of operations does not exceed $320 | 60.00 |
51803 | Assistance by an approved dental practitioner at any operation for which the fee exceeds $320 or at a combination of operations for which the aggregate fee exceeds $320 provided that the fee for at least one of the operations exceeds $178 | Amount under rule 33 |
SERVICES AND FEES
|
|
|
GROUP O3—GENERAL SURGERY
52000 | Skin and subcutaneous tissue or mucous membrane, repair of recent wound of, on face or neck, small (not more than 7 centimetres long), superficial (AU 7) | 58.00 |
52001 | Operative procedure on tissue, organ or region not covered by any other item in Groups O3 to O9, including any consultation on the same occasion | 5.10 |
52003 | Skin and subcutaneous tissue or mucous membrane, repair of recent wound of, on face or neck, small (not more than 7 centimetres long), involving deeper tissue (AU 7) | 83.00 |
52006 | (AU 7) | 83.00 |
52009 | (AU 8) | 132.00 |
52012 | Superficial foreign body, removal of, as an independent procedure (AU 5) | 16.60 |
52015 | Subcutaneous foreign body, removal of, requiring incision and suture, as an independent procedure (AU 6) | 77.00 |
52018 | (AU 7) | 194.00 |
52021 | Aspiration biopsy of one or more jaw cysts as an independent procedure to obtain material for diagnostic purposes and not associated with an operative procedure on the same day (AU 6) | 21.00 |
52024 | Biopsy of skin or mucous membrane, as an independent procedure (AU 5) | 37.00 |
52027 | Biopsy of lymph gland, muscle or other deep tissue or organ, as an independent procedure (AU 6) | 106.00 |
52030 | (AU 6) | 64.00 |
52033 | Sinus, excision of, involving muscle and deep tissue (AU 7) | 130.00 |
SERVICES AND FEES
|
|
|
52036 | Tumours, cysts, ulcers or scars (other than a scar removed during the surgical approach at an operation), up to 3 centimetres in diameter, removal from cutaneous or subcutaneous tissue or from mucous membrane, where the removal is by surgical excision and suture, not covered by item 52039 (AU 6) | 89.00 |
52039 | (AU 9) | 230.00 |
52042 | Tumour, cyst, ulcer or scar (other than a scar removed during the surgical approach at an operation), more than 3 centimetres in diameter, removal from cutaneous or subcutaneous tissue or from mucous membrane (AU 6) | 120.00 |
52045 | Tumour, cyst (other than a cyst associated with a tooth or tooth fragment unless it has been established by radiological examination that there is a minimum of 5mm separation between the cyst lining and tooth structure or where a tumour or cyst has been proven by positive histopathology), ulcer or scar (other than a scar removed during the surgical approach at an operation), removal of, not covered by any other item in Groups O3 to O9, involving muscle, bone, or other deep tissue (AU 8) | 174.00 |
52048 | Tumour or deep cyst (other than a cyst associated with a tooth or tooth fragment unless it has been established by radiological examination that there is a minimum of 5mm separation between the cyst lining and tooth structure or where a tumour or cyst has been proven by positive histopathology), removal of, requiring wide excision, not covered by any other item in Groups O3 to O9 (AU 8) | 260.00 |
52051 | Tumour, removal of, from soft tissue (including muscle, fascia and connective tissue), extensive excision of, without skin or mucosal graft (AU 8) | 355.00 |
SERVICES AND FEES
|
|
|
52054 | Tumour, removal of, from soft tissue (including muscle, fascia and connective tissue), extensive excision of, with skin or mucosal graft (AU 10) | 415.00 |
52055 | Haematoma, abscess or cellulitis not requiring a general anaesthesia, incision with drainage of (excluding after-care) | 19.20 |
52057 | Large haematoma, large abscess, carbuncle, cellulitis or similar lesion, incision with drainage of (excluding after-care), where undertaken in the operating theatre of a hospital or approved day- hospital facility (AU 5) | 114.00 |
52060 | Muscle, excision of (AU 6) | 134.00 |
52063 | Bone tumour, innocent, excision of, not covered by any other item in Groups O3 to O9 (AU 7) | 250.00 |
52066 | Submandibular gland, extirpation of (AU 8) | 315.00 |
52069 | Sublingual gland, extirpation of (AU 7) | 140.00 |
52072 | Salivary gland, dilatation or diathermy of duct (AU 6) | 41.50 |
52075 | Salivary gland, removal of calculus from duct or meatotomy or marsupialisation, one or more such procedures (AU 7) | 106.00 |
52078 | Tongue, partial excision of (AU 7) | 210.00 |
52081 | Tongue tie, division or excision of frenulum (AU 6) | 33.00 |
52084 | Tongue tie, mandibular frenulum or maxillary frenulum, division or excision of frenulum, in a person aged not less than 2 years (AU 6) | 84.00 |
52087 | Ranula or mucous cyst of mouth, removal of (AU 9) | 144.00 |
52090 | Operation on mandible or maxilla (other than alveolar margins) for osteomyelitis—one bone (AU 10) | 250.00 |
52092 | Operation on skull for osteomyelitis (AU 12) | 325.00 |
52096 | Orthopaedic pin or wire, insertion of, into maxilla or mandible or zygoma, as an independent procedure (AU 5) | 80.00 |
52099 | Buried wire, pin or screw, one or more, which were inserted for internal fixation purposes into maxilla or mandible or zygoma, removal of, requiring anaesthesia, incision, dissection and suturing, per bone, not associated with items 52102 or 52105 (AU 6) | 99.00 |
SERVICES AND FEES
|
|
|
52102 | anaesthesia, incision, dissection and suturing, where undertaken in the operating theatre of a hospital or approved day-hospital facility, per bone (AU 6) | 99.00 |
52105 | Plate, one or more of, and associated screw and wire which were inserted for internal fixation purposes into maxilla or mandible or zygoma, removal of, requiring anaesthesia, incision, dissection and suturing, per bone, not associated with items 52099 or 52102 (AU 6) | 186.00 |
52108 | Lip, full thickness wedge excision of, with repair by direct sutures (AU 8) | 230.00 |
52111 | Vermilionectomy (AU 8) | 230.00 |
52114 | Mandible or maxilla, segmental resection of, for tumours or cysts (AU 13) | 415.00 |
52117 | Mandible, including lower border, or maxilla, sub- total resection of (AU 13) | 490.00 |
52120 | Mandible, hemimandiblectomy of, including condylectomy where performed (AU 29) | 585.00 |
52122 | Mandible, hemi-mandibular reconstruction with bone graft, not associated with Item 52123 (AU 15) | 585.00 |
52123 | Mandible, total resection of both sides, including condylectomies where performed (AU 35) | 660.00 |
52126 | Maxilla, total resection of (AU 25) | 635.00 |
52129 | Maxilla, total resection of both maxillae (AU 30) | 850.00 |
52132 | Tracheostomy (AU 10) | 168.00 |
52135 | Post-operative or post-nasal haemorrhage, or both, control of, where undertaken in the operating theatre of a hospital or approved day-hospital facility (AU 7) | 102.00 |
52138 | Maxillary artery, ligation of (AU 12) | 315.00 |
52141 | Facial, mandibular or lingual artery or vein or artery and vein, ligation of, not covered by item 52138 (AU 12) | 315.00 |
52144 | Foreign body, deep, removal of using interventional imaging techniques (AU 10) | 290.00 |
52147 | Duct of major salivary gland, transposition of (AU 16) | 275.00 |
SERVICES AND FEES
|
|
|
52148 | Parotid duct, repair of, using micro-surgical techniques (AU 14) | 485.00 |
GROUP O4—PLASTIC & RECONSTRUCTIVE
52300 | Single stage local flap, where indicated, repair to one defect, with skin or mucosa (AU 7) | 200.00 |
52303 | Single stage local flap, where indicated, repair to one defect, with buccal pad of fat (AU 10) | 285.00 |
52306 | Single stage local flap, where indicated, repair to one defect, using temporalis muscle (AU 10) | 425.00 |
52309 | Free grafting (mucosa or split skin) of a granulating area (AU 7) | 144.00 |
52312 | Free grafting (mucosa or split skin) to one defect, including elective dissection (AU 8) | 200.00 |
52315 | Free grafting, full thickness, to one defect (mucosa or skin) (AU 9) | 335.00 |
52318 | Bone graft, harvesting of bone graft via separate incision, associated with any other item in Groups O3 to O9—Autogenous -small quantity (AU 7) | 99.00 |
52319 | Bone graft, harvesting of, via separate incision, associated with any other item in Groups O3 to O9—Autogenous—large quantity (AU 7) | 166.00 |
52321 | Foreign implant (non-biological), insertion of, for contour reconstruction of pathological deformity, not associated with item 52624 (AU 10) | 335.00 |
52324 | Direct flap repair, using tongue, first stage (AU 7) | 335.00 |
52327 | Direct flap repair, using tongue, second stage (AU 7) | 166.00 |
52330 | Palatal defect (oro-nasal fistula), plastic closure of, including services covered by item 52300, 52303, 52306 or 52324 (AU 14) | 550.00 |
52333 | Cleft palate, primary repair (AU 14) | 550.00 |
52336 | Cleft palate, secondary repair, closure of fistula using local flaps (AU 13) | 345.00 |
52339 | Cleft palate, secondary repair, lengthening procedure (AU 12) | 390.00 |
SERVICES AND FEES
|
|
|
52342 | Mandible or maxilla, unilateral osteotomy or osteectomy of, including transposition of nerves and vessels and bone grafts taken from the same site (AU 14) | 680.00 |
52345 | Mandible or maxilla, unilateral osteotomy or osteectomy of, including transposition of nerves and vessels and bone grafts taken from the same site and rigid fixation by bone plates, screws or both (AU 19) | 765.00 |
52348 | Mandible or maxilla, bilateral osteotomy or osteectomy of, including transposition of nerves and vessels and bone grafts taken from the same site (AU 25) | 870.00 |
52351 | Mandible or maxilla, bilateral osteotomy or osteectomy of, including transposition of nerves and vessels and bone grafts taken from the same site and rigid fixation by bone plates, screws or both (AU 29) | 975.00 |
52354 | Mandible or maxilla, osteotomies or osteectomies of, involving three or more such procedures on the one jaw, including transposition of nerves and vessels and bone grafts taken from the same site (AU 29) | 985.00 |
52357 | Mandible or maxilla, osteotomies or osteectomies of, involving three or more such procedures on the one jaw, including transposition of nerves and vessels and bone grafts taken from the same site and rigid fixation by bone plates, screws or both (AU 32) | 1,110.00 |
52360 | Mandible or maxilla, osteotomies or osteectomies of involving two such procedures of each jaw including transposition of nerves and vessels and bone grafts taken from the same site (AU 26) | 1,135.00 |
52363 | Mandible or maxilla, osteotomies or osteectomies of, involving two such procedures of each jaw, including transposition of nerves and vessels and bone grafts taken from the same site and rigid fixation by bone plates (AU 32) | 1,280.00 |
52366 | (AU 47) | 1,250.00 |
SERVICES AND FEES
|
|
|
52369 | Mandible or maxilla, complex bilateral osteotomies or osteectomies of, involving three or more such procedures of one jaw and two such procedures of the other jaw, including genioplasty when performed and transposition of nerves and vessels and bone grafts taken from the same site and rigid fixation by bone plates, screws or both (AU 50) | 1,400.00 |
52372 | Mandible or maxilla, complex bilateral osteotomies or osteectomies of, involving three or more such procedures of each jaw, including genioplasty when performed and transposition of nerves and vessels and bone grafts taken from the same site (AU 50) | 1,360.00 |
52375 | Mandible or maxilla, complex bilateral osteotomies or osteectomies of, involving three or more such procedures of each jaw, including genioplasty when performed and transposition of nerves and vessels and bone grafts taken from the same site and rigid fixation by bone plates, screws or both (AU 59) | 1,525.00 |
52378 | Genioplasty including transposition of nerves and vessels and bone grafts taken from the site (AU 16) | 525.00 |
52379 | Face, contour reconstruction of one region, using autogenous bone or cartilage graft (AU 18) | 900.00 |
52380 | Midfacial osteotomies—Le Fort II, Modified Le Fort III (Nasomalar), Modified Le Fort III (Malar- Maxillary), Le Fort III involving three or more osteotomies of the midface including transposition of nerves and vessels and bone grafts taken from the same site (AU 50) | 1,535.00 |
52382 | Midfacial osteotomies—Le Fort II, Modified Le Fort III (Nasomalar), Modified Le Fort III (Malar- Maxillary), Le Fort III involving three or more osteotomies of the midface including transposition of nerves and vessels and bone grafts taken from the same site and rigid fixation by bone plates, screws or both (AU 58) | 1,840.00 |
52420 | Mandible, fixation by intermaxillary wiring, excluding wiring for obesity | 170.00 |
SERVICES AND FEES
|
|
|
GROUP O5—PREPROSTHETIC
52600 | Mandibular or palatal exostosis, excision of (AU 10) | 240.00 |
52603 | Mylohyloid ridge, reduction of (AU 10) | 230.00 |
52606 | Maxillary tuberosity, reduction of (AU 12) | 174.00 |
52609 | Papillary hyperplasia of the palate, removal of—less than five lesions (AU 10) | 230.00 |
52612 | Papillary hyperplasia of the palate, removal of—five to twenty lesions (AU 12) | 285.00 |
52615 | Papillary hyperplasia of the palate, removal of—more than twenty lesions (AU 13) | 355.00 |
52618 | Vestibuloplasty, submucosal or open, including excision of muscle and skin or mucosal graft when performed—unilateral or bilateral (AU 19) | 415.00 |
52621 | Floor of mouth lowering (Obwegeser or similar procedure), including excision of muscle and skin or mucosal graft when performed (AU 19) | 415.00 |
52624 | Alveolar ridge augmentation with bone or alloplast or both—unilateral (AU 13) | 335.00 |
52626 | Alveolar ridge augmentation—unilateral, insertion of tissue expanding device into maxillary or mandibular alveolar ridge region for (AU 13) | 205.00 |
52627 | Osseo-integration procedure—extra oral implantation of titanium fixture (AU 11) | 355.00 |
52630 | Osseo-integration procedure—fixation of transcutaneous abutment (AU 6) | 132.00 |
GROUP O6—NEUROSURGICAL
52800 | Neurolysis by open operation, without transposition, not associated with item 52803 (AU 7) | 194.00 |
52803 | Nerve trunk, internal (interfasicular), neurolysis of, using microsurgical techniques (AU 11) | 280.00 |
52806 | Neurectomy, neurotomy or removal of tumour from superficial peripheral nerve (AU 8) | 194.00 |
SERVICES AND FEES
|
|
|
52809 | Neurectomy, neurotomy or removal of tumour from deep peripheral nerve (AU 10) | 335.00 |
52812 | Nerve trunk, primary repair of, using microsurgical techniques (AU 8) | 475.00 |
52815 | Nerve trunk, secondary repair of, using microsurgical techniques (AU 9) | 505.00 |
52818 | Nerve, transposition of (AU 8) | 335.00 |
52821 | Nerve graft to nerve trunk (cable graft) including harvesting of nerve graft using microsurgical techniques (AU 16) | 725.00 |
52824 | Peripheral branches of the trigeminal nerve, cryosurgery of, for pain relief (AU 8) | 315.00 |
GROUP O7—EAR, NOSE & THROAT
53000 | Maxillary antrum, proof puncture and lavage of (AU 6) | 23.00 |
53003 | Maxillary antrum, proof puncture and lavage of, where undertaken in the operating theatre of a hospital or approved day-hospital facility—not associated with any other item in this Group (AU 6) | 65.00 |
53006 | Antrostomy (radical) (AU 9) | 370.00 |
53009 | Antrum, intranasal operation on or removal of foreign body from (AU 8) | 210.00 |
53012 | Antrum, drainage of, through tooth socket (AU 7) | 83.00 |
53015 | (AU 11) | 415.00 |
53018 | Turbinectomy or turbinectomies, partial or total, unilateral (AU 6) | 96.00 |
53019 | Maxillary sinus, bone graft to floor of maxillary sinus following elevation of mucosal lining (sinus lift procedure), (unilateral) (AU 20) | 410.00 |
GROUP O8—TEMPOROMANDIBULAR JOINT
53200 | Mandible, treatment of a dislocation of, not requiring open reduction (AU 4) | 33.50 |
53203 | Mandible, treatment of a dislocation of, requiring open reduction (AU 4) | 84.00 |
SERVICES AND FEES
|
|
|
53206 | Temporomandibular joint, manipulation of, performed in the operating theatre of a hospital or day- hospital facility, not associated with any other item in Groups O3 to O9 (AU 4) | 100.00 |
53209 | Glenoid fossa, zygomatic arch and temporal bone, reconstruction of (Obwegeser technique) (AU 19) | 1,160.00 |
53212 | Absent condyle and asending ramus in hemifacial microsomia, construction of, not including harvesting of graft material (AU 15) | 630.00 |
53215 | Temporomandibular joint, arthroscopy of, with or without biopsy, not associated with any other arthroscopic procedure of that joint (AU 9) | 230.00 |
53218 | Temporomandibular joint, arthroscopy of, removal of loose bodies, debridement, or treatment of adhesions—one or more of such procedures (AU 12) | 465.00 |
53221 | Temporomandibular joint, open surgical exploration of, with or without microsurgical techniques (AU 18) | 615.00 |
53224 | Temporomandibular joint, open surgical exploration of, with condylectomy or condylotomy, with or without microsurgical techniques (AU 20) | 685.00 |
53225 | Arthrocentesis, irrigation of temporomandibular joint after insertion of two cannuli into the appropriate joint space(s) (AU 13) | 205.00 |
53227 | Temporomandibular joint, open surgical exploration of, with or without meniscus or capsular surgery, including menisectomy when performed, with or without microsurgical techniques (AU 24) | 835.00 |
53230 | Temporomandibular joint, open surgical exploration of, with meniscus, capsular and condylar head surgery, with or without microsurgical techniques (AU 24) | 945.00 |
53233 | Temporomandibular joint, surgery of, involving procedures covered by items 53224, 53227 and 53230 and also involving the use of tissue flaps, or cartilage graft, or allograft implants, with or without microsurgical techniques (AU 28) | 1,060.00 |
SERVICES AND FEES
|
|
|
GROUP O9—TREATMENT OF FRACTURES
53400 | Maxilla, unilateral or bilateral, treatment of fracture of, not requiring splinting | 91.00 |
53403 | Mandible, treatment of fracture of, not requiring splinting | 112.00 |
53406 | Maxilla, treatment of fracture of, requiring splinting, wiring of teeth, circumosseous fixation or external fixation (AU 14) | 285.00 |
53409 | Mandible, treatment of fracture of, requiring splinting, wiring of teeth, circumosseous fixation or external fixation (AU 14) | 285.00 |
53410 | Zygomatic bone, treatment of fracture of, not requiring surgical reduction | 60.00 |
53411 | Zygomatic bone, treatment of fracture of, requiring surgical reduction, by temporal, intra-oral or other approach (AU 7) | 168.00 |
53412 | Zygomatic bone, treatment of fracture of, requiring surgical reduction and involving internal or external fixation at one (1) site (AU 9) | 275.00 |
53413 | Zygomatic bone, treatment of fracture of, requiring surgical reduction and involving internal and/or external fixation at two (2) sites (AU 10) | 340.00 |
53414 | Zygomatic bone, treatment of, requiring surgical reduction and involving internal and/or external fixation at three (3) sites (AU 11) | 385.00 |
53415 | Maxilla, treatment of fracture of, requiring open reduction (AU 7) | 305.00 |
53416 | Mandible, treatment of fracture of, requiring open reduction (AU 7) | 305.00 |
53418 | Maxilla, treatment of fracture of, requiring open reduction and internal fixation not involving plate(s) (AU 9) | 395.00 |
53419 | Mandible, treatment of fracture of, requiring open reduction and internal fixation not involving plate(s) (AU 9) | 395.00 |
53422 | Maxilla, treatment of fracture of, requiring open reduction and internal fixation involving plate(s) (AU 11) | 510.00 |
53423 | Mandible, treatment of fracture of, requiring open reduction and internal fixation involving plate(s) (AU 11) | 510.00 |
SERVICES AND FEES
|
|
|
53424 | Maxilla, treatment of a complicated fracture of,involving viscera, blood vessels or nerves, requiring open reduction not involving plate(s) (AU 10) | 435.00 |
53425 | Mandible, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction not involving plate(s) (AU 10) | 435.00 |
53427 | Maxilla, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction involving the use of plate(s) (AU 12) | 595.00 |
53429 | Mandible, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction involving the use of plate(s) (AU 12) | 595.00 |
53439 | Mandible, treatment of a closed fracture of involving a joint surface (AU 6) | 168.00 |
53453 | Orbital cavity, reconstruction of a wall or floor with or without foreign implant (AU 12) | 345.00 |
53455 | Orbital cavity, bone or cartilage graft to orbital wall or floor including reduction of prolapsed or entrapped orbital contents (AU 14) | 400.00 |
PALATE SERVICES
GROUP C1—ORTHODONTIC SERVICES
75000 | Professional attendance not covered by item 75003 (AO) | 28.50 |
75003 | (AO) | 58.00 |
75006 | (AO) | 28.50 |
75009 | (AO) | 48.00 |
75012 | Orthodontic radiography—anteroposterior cephalometric radiography with cephalometric tracings or lateral cephalometric radiography with cephalometric tracings (AO) | 76.00 |
SERVICES AND FEES
|
|
|
75015 | Orthodontic radiography—anteroposterior and lateral cephalometric radiography, with cephalometric tracings (AO) | 104.00 |
75018 | Orthodontic radiography—anteroposterior and lateral cephalometric radiography, with cephalometric tracings and orthopantomography (AO) | 134.00 |
75021 | Orthodontic radiography—anteroposterior and lateral cephalometric radiography, with cephalometric tracings, orthopantomography and hand-wrist studies (including growth prediction) (AO) | 164.00 |
75024 | Pre-surgical infant maxillary arch repositioning, including supply of appliances and all associated consultations—where one appliance is used (AO) | 385.00 |
75027 | Pre-surgical infant maxillary arch repositioning, including supply of appliances and all associated consultations—where two appliances are used (AO) | 460.00 |
75030 | Deciduous dentition treatment—maxillary arch expansion, including supply of appliances and all associated consultations, treatment planning and retention services beyond the period of active treatment (AO) | 515.00 |
75033 | Deciduous and permanent dentition treatment-incisor alignment using fixed appliances in maxillary arch, including supply of appliances and all associated consultations, treatment-planning and retention services beyond the period of active treatment (AO) | 845.00 |
75036 | (AO) | 1,170.00 |
SERVICES AND FEES
|
|
|
75039 | Permanent dentition treatment (not being treatment associated with treatment covered by item 75045 or 75048)—single arch (mandibular or maxillary) treatment (correction or alignment, or both) using fixed appliances, including supply of appliances and all associated consultations, treatment-planning and retention services beyond the period of active treatment—initial three months of active treatment (AO) | 385.00 |
75042 | Permanent dentition treatment (not being treatment associated with treatment covered by item 75045 or 75048)—single arch (mandibular or maxillary) treatment (correction or alignment, or both) using fixed appliances, including supply of appliances and all associated consultations, treatment-planning and retention services beyond the period of active treatment—each three months of active treatment after the first for a maximum of a further 33 months (AO) | 146.00 |
75045 | Permanent dentition treatment (not being treatment associated with treatment covered by item 75039 or 75042)—two-arch (mandibular and maxillary) treatment (correction or alignment, or both) using fixed appliances, including supply of appliances and all associated consultations, treatment-planning and retention services beyond the period of active treatment—initial three months of active treatment (AO) | 760.00 |
75048 | Permanent dentition treatment (not being treatment associated with treatment covered by item 8922 or 8923)—two-arch (mandibular and maxillary) treatment (correction or alignment, or both) using fixed appliances, including supply of appliances and all associated consultations, treatment-planning and retention services beyond the period of active treatment—each three months of active treatment after the first for a maximum of a further 33 months (AO) | 200.00 |
75051 | (AO) | 515.00 |
SERVICES AND FEES
|
|
|
GROUP C2—ORAL SURGICAL SERVICES
75200 | (AD) | 38.50 |
75203 | (AD) | 58.00 |
75206 | (AD) | 19.20 |
75400 | (AOS) | 116.00 |
75403 | (AOS) | 134.00 |
75406 | (AOS) | 152.00 |
75409 | Surgical removal of tooth with complete bone impaction, where the patient is referred by a recognized orthodontist (AOS) | 172.00 |
75412 | Surgical removal of tooth fragment requiring incision of soft tissue only, where the patient is referred by a recognized orthodontist (AOS) | 96.00 |
75415 | (AOS) | 116.00 |
75600 | Surgical exposure, stimulation and packing of unerupted tooth, where the patient is referred by a recognized orthodontist (AOS) | 164.00 |
75603 | Surgical exposure of unerupted tooth for the purpose of fitting a traction device, where the patient is referred by a recognized orthodontist (AOS) | 192.00 |
75606 | Surgical repositioning of unerupted tooth, where the patient is referred by a recognized orthodontist (AOS) | 192.00 |
SERVICES AND FEES
|
|
|
75609 | (AOS) | 285.00 |
GROUP C3—GENERAL AND PROSTHODONTIC SERVICES
75800 | Attendance comprising consultation, preventive treatment and prophylaxis, of not less than thirty minutes duration—each attendance to a maximum of three attendances in any period of twelve months (AD) | 58.00 |
75803 | (AD) | 230.00 |
75806 | Provision and fitting of acrylic base partial denture, including retainers—two teeth (AD) | 270.00 |
75809 | Provision and fitting of acrylic base partial denture, including retainers—three teeth (AD) | 325.00 |
75812 | (AD) | 360.00 |
75815 | Provision and fitting of acrylic base partial denture, including retainers—five to nine teeth (AD) | 435.00 |
75818 | (AD) | 515.00 |
75821 | (AD) | 415.00 |
75824 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers—two teeth (AD) | 480.00 |
75827 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers—three teeth (AD) | 550.00 |
75830 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers—four teeth (AD) | 610.00 |
75833 | (AD) | 745.00 |
SERVICES AND FEES
|
|
|
75836 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers—ten to twelve teeth (AD) | 855.00 |
75839 | Provision and fitting of retainers (not being treatment associated with treatment covered by item 75803, 75806, 75809, 75812, 75815, 75818, 75821, 75824, 75827, 75830, 75833 or 75836)—each retainer (AD) | 19.20 |
75842 | Adjustment of partial denture (not being treatment associated with treatment covered by item 75803, 75827, 75830, 75833 or 75836) (AD) | 28.50 |
75845 | (AD) | 144.00 |
75848 | Remodelling and fitting of partial denture of more than four teeth (AD) | 172.00 |
75851 | Repair to cast metal base of partial denture—one or more points (AD) | 86.00 |
75854 | (AD) | 86.00 |
____________________________________________________________
1. Notified in the
Commonwealth of Australia Gazette on 27 October 1992.
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