Health Insurance (1993-1994 General Medical Services Table) Regulations (Cth)
made under the
This compilation was prepared on 17 July 2001
taking into account amendments up to SR 1994 No. 112
Prepared by the Office of Legislative Drafting,
Attorney-General’s Department, Canberra
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These Regulations may be cited as the Health Insurance (1993-1994 General Medical Services Table) Regulations.
These Regulations commence on 1 November 1993.
Statutory Rules 1992 Nos. 338, 347 and 398, and 1993 No. 145 are repealed.
The table of general medical services in the Schedule is prescribed for the purposes of subsection 4 (2) of the
Health Insurance Act 1973 .
(regulation 4)
(1) In this table, unless the contrary intention appears:
attendance of a minor nature orminor attendance , in relation to an attendance on a patient by a consultant physician, means an attendance that:(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.
general intensive care unit means a separate hospital area that:(a) is equipped and staffed so as to be capable of providing to a patient:
(i) mechanical ventilation for a period of several days; and
(ii) invasive cardiovascular monitoring; and
(b) is supported by:
(i) at least one specialist or consultant physician in the specialty of intensive care who is immediately available during normal working hours; and
(ii) a registered medical practitioner who is present in the hospital and immediately available to the unit at all times; and
(iii) a registered nurse for at least 18 hours each day; and
(c) has defined admission and discharge policies.
general practitioner means:(a) a practitioner who is vocationally registered under section 3F of the Act; or
(b) a practitioner who:
(i) is a Fellow of the RACGP; and
(ii) participates in the quality assurance and continuing medical education of the RACGP; and
(iii) meets the RACGP requirements for quality assurance and continuing education; or
(c) a practitioner who is undertaking an approved placement in general practice:
(i) as part of a training program for general practice leading to the award of the Fellowship of the RACGP; or
(ii) as part of some other training program recognised by the RACGP as being of an equivalent standard.
institution means a place (other than a hospital, a nursing home or accommodation for aged persons that is attached to a nursing home or situated within a nursing home complex) at which residential accommodation or day care is, or both residential accommodation and day care are, made available to:(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.
intensive care unit means a general intensive care unit or a neo-natal intensive care unit.neo-natal intensive care unit means a separate hospital area that:(a) is equipped and staffed so as to be capable of providing to a patient who is a newly born child:
(i) mechanical ventilation for a period of several days; and
(ii) invasive cardiovascular monitoring; and
(b) is supported by:
(i) at least one consultant physician in paediatric medicine who is immediately available during normal working hours; and
(ii) a registered medical practitioner who is present in the hospital and immediately available to the unit at all times; and
(iii) a registered nurse for at least 18 hours each day; and
(c) has defined admission and discharge policies.
RACGP means the Royal Australian College of General Practitioners.referring practitioner , in relation to a referral, means:(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; and
(d) if the referral:
(i) arises out of a dental service given by a dental practitioner who is approved by the Minister for the purposes of paragraph (b) of the definition of
professional service in subsection 3 (1) of the Act; and(ii) is given to a consultant physician;
a dental practitioner.
the Act means theHealth Insurance Act 1973 .(2) In this table, a reference by number to an item in the series 65001 to 73921 is a reference to the item so numbered in the pathology services table.
(3) In this table, a reference by number to an item in the series 55028 to 61502 is a reference to the item so numbered in the diagnostic imaging services table.
(4) In this table, the symbol
(AU n) (wheren is a number) is explained in items 17901 to 17959.
(1) An item including the symbol
(S) applies only to a service given by a specialist (and not to a service given by a consultant physician) in the practice of his or her specialty, being:(a) a service that:
(i) is given to a patient who has been referred to the specialist; and
(ii) is the first service given by the specialist in accordance with the referral; or
(b) a service that:
(i) is given to a patient who has been referred to the specialist; and
(ii) is either:
(A) part of a single course of treatment given for the condition identified in the referral; or
(B) if no condition was identified in the referral — part of a single course of treatment for the condition identified by the specialist; and
(iii) is given within the period of validity of the referral applicable under regulation 31 of the Health Insurance Regulations; or
(c) a service that:
(i) is given 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; and
(ii) is the first service given by the specialist in accordance with the referral; or
(d) a service that:
(i) is given to a patient who has not been referred to the specialist; and
(ii) is a service that, in an emergency, the specialist decides is necessary in the patient’s interests to be given as soon as practicable without a referral.
(2) An item including the symbol
(G) applies only to a service given otherwise than by a specialist in accordance with subrule (1).
(1) In subrule 1 (1), rules 2 and 4 and items 104, 105, 106, 107, 108, 110, 116, 119, 122, 128 and 131,
single course of treatment includes:(a) the initial attendance by a specialist or consultant physician; and
(b) the continuing management or treatment up to and including the stage when the patient is referred back to the care of the referring practitioner; and
(c) 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.
(2) For the purposes of subrule (1), an unrelated illness that requires referral of the patient to the specialist’s or consultant physician’s care, initiates a new course of treatment for which a new referral is required.
(3) For the purposes of subrule (1), if:
(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.
(1) In items 104 to 159, a reference to an attendance on a patient by a specialist, or consultant physician, in the practice or his or her specialty where the patient is referred to him or her:
(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; or
(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.
(2) In subrule (1) and in items 104 to 159, a reference to the referring of a patient to a specialist, or consultant physician, is a reference to the referring of a patient to a specialist, or consultant physician, by a referring practitioner.
In items 3, 4, 13, 19, 20, 23, 24, 25, 33, 35, 36, 37, 38, 40, 43, 44, 47, 48, 50 and 51,
professional attendance includes (but is not limited to) the provision in relation to a patient of 1 or more of the following services:
(a) the evaluation of the patient’s condition or conditions including, if applicable, evaluation using the health screening services mentioned 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 of advice to the patient about the patient’s condition or conditions and, if applicable, about treatment;
(d) if authorised by the patient, the provision of advice to another person, or other persons, about the patient’s condition or conditions and, if applicable, about treatment;
(e) the recording of the clinical details of the service or services given to the patient.
(1) In items 13, 19 and 20,
Amount under rule 6 means an amount equal to the sum of:(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 $17.10 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.
(2) In items 25, 33 and 35,
Amount under rule 6 means an amount equal to the sum of:(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 $17.10 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.
(3) In items 38, 40 and 43,
Amount under rule 6 means an amount equal to the sum of:(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 $17.10 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.
(4) In items 48, 50 and 51,
Amount under rule 6 means an amount equal to the sum of:(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 patientsan amount equal to $17.10 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.
(5) In items 81, 87 and 92,
Amount under rule 6 means an amount equal to the sum of:(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.
(6) In items 83, 89 and 93,
Amount under rule 6 means an amount equal to the sum of:(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.
(7) In items 84, 90 and 95,
Amount under rule 6 means an amount equal to the sum of:(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.
(8) In items 86, 91 and 96,
Amount under rule 6 means an amount equal to the sum of:(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.
Items 10809 and 10929 do not apply if the patient requires contact lenses only for 1 or more of the following reasons:
(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.
(1) For the purposes of items 10921 to 10929, a patient has an ocular condition which necessitates a further course of attention within 36 months of the previous initial consultation only in the circumstances mentioned in subrules (2) and (3).
(2) The patient requires a change in contact lens material, or basic lens parameters, other than a simple power change, because of:
(a) a structural, or functional, change in the eye; or
(b) an allergic response.
(3) A lost, damaged or otherwise unsatisfactory contact lens is replaced by an optometrist:
(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.
. (1) The items mentioned in subrule (2) apply only to a service given in the course of a personal attendance by a medical practitioner on a single patient on a single occasion.
(2) The items are items 3 to 153, 157 to 164, 173 to 10815, 11012, 11015, 11018, 11021, 11212, 11303, 11500, 11600, 11627, 11630, 11701,11712, 11921, 12000, 12003, 12100, 12103, 12106, 12109, 12112, 12115, 13000, 13003, 13006, 13009, 13100, 13103, 13106, 13109, 13112, 13209, 13300, 13303, 13306, 13309, 13312, 13315, 13318, 13400, 13500, 13503, 13600, 13603, 13606, 13700, 13703, 13706, 13709, 13809, 13812, 13815, 13818, 13819, 13821, 13824, 13827, 13830, 13833, 13836, 14200, 14203, 14206, 14209, 16000 to 16552 and 16558 to 51309.
(3) Items 154, 155, 156, 170, 171 and 172 apply only to a service given in the course of a personal attendance by a medical practitioner.
(1) The items mentioned in subrule (2) apply only to a service given in the course of a personal attendance by:
(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 who:
(i) is employed by the proprietor of a hospital other than a private hospital; and
(ii) 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.
(2) The items are items 3 to 10815, 11012, 11015, 11018, 11021, 11212, 11303, 11500, 11600, 11627, 11630, 11701, 11712, 11921, 12000, 12003, 12100, 12103, 12106, 12109, 12112, 12115, 13000, 13003, 13006, 13009, 13100, 13103, 13106, 13109, 13112, 13209, 13300, 13303, 13306, 13309, 13312, 13315, 13318, 13400, 13500, 13503, 13600, 13603, 13606, 13700, 13703, 13706, 13709, 13809, 13812, 13815, 13818, 13819, 13821, 13824, 13827, 13830, 13833, 13836, 14200, 14203, 14206, 14209, 16000 to 16552 and 16558 to 51309.
(1) The items mentioned in subrule (2) apply whether the medical service is given by:
(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.
(2) The items are items 11000, 11003, 11006, 11009, 11024, 11027, 11200, 11203, 11206, 11209, 11215, 11218, 11221, 11224, 11227, 11300, 11306, 11309, 11312, 11315, 11318, 11321, 11324, 11327, 11330, 11333, 11336, 11339, 11503, 11506, 11509, 11512, 11603, 11606, 11609, 11612, 11615, 11618, 11621, 11624, 11700, 11702, 11706, 11708, 11709, 11710, 11711, 11713, 11715, 11718, 11721, 11800, 11810, 11830, 11833, 11900, 11903, 11906, 11909, 11912, 11915, 11918, 12006, 12009, 12200, 12500 to 12530, 13200, 13203, 13206, 13212, 13215, 13218, 13221, 13915 to 13948, 14050, 14053, 15000 to 15533, 15536 and 16555.
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 AS1269-1983 of the Standards Association of Australia, as in force on 1 August 1987; and
(c) using calibrated equipment that complies with Australian Standard AS2586-1983 of the Standards Association of Australia, as in force on 1 August 1987.
Items 51700 to 53455 apply only to a service given in the course of dental practice by a dental practitioner approved by the Minister for the purposes of the definition of
professional service in subsection 3 (1) of the Act.
In items 18102 to 18118,
administration of an anaesthetic means the administration of an anaesthetic in connection with a dental service, other than a dental service that is a prescribed medical service for the purposes of paragraph (b) of the definition ofprofessional service in subsection 3 (1) of the Act.
In item 18013,
prescribed location means any of the following:
(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;
(n) Townsville Hospital, Townsville, Queensland;
(o) Royal Perth Hospital, Perth, Western Australia;
(p) Prince of Wales Hospital, Randwick, New South Wales;
(q) John Hunter Hospital, New Lambton, New South Wales;
(r) Woden Valley Hospital, Woden, Australian Capital Territory.
In an item mentioned in subparagraph (b) (i), (ii), (iii), (iv), (v) or (vi),
Amount under rule 16 means an amount equal to the sum of:
(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 — $12.20 for each field separately treated in excess of 1 up to a maximum of 5 additional fields; or
(ii) for item 15103 — $13.45 for each field separately treated in excess of 1 up to a maximum of 5 additional fields; or
(iii) for item 15109 — $16.15 for each field separately treated in excess of 1 up to a maximum of 5 additional fields; or
(iv) for item 15204 — $21.20 for each field separately treated in excess of 1 up to a maximum of 5 additional fields; or
(v) for item 15208 — $21.20 for each field separately treated in excess of 1 up to a maximum of 5 additional fields; or
(vi) for item 15214 — $17.80 for each field separately treated in excess of 1 up to a maximum of 5 additional fields.
In an item mentioned in subparagraph (b) (i) or (ii),
Amount under rule 17 means an amount equal to the sum of:
(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 — $13.25 for each field separately treated in excess of 1 up to a maximum of 5 additional fields; or
(ii) for item 15115 — $33.60 for each field separately treated in excess of 1 up to a maximum of 5 additional fields.
In an item to which paragraph (a) or (b) applies,
Amount under rule 18 means an amount equal to:
(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); 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).
An item in the series 75200 to 75854 that includes the symbol
(AD) applies only to a service given by a State registered dental practitioner practising as a dentist.
(1) In this rule:
accredited orthodontist means:(a) a dental practitioner who is registered or licensed as an orthodontist under the relevant law; or
(b) a dental practitioner:
(i) who is not registered or licensed under the relevant law as an orthodontist or who practises in a State or Territory in which there is no provision for the registration or licensing of orthodontists; 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; and
(iii) who is accredited by the Minister for the purposes of this rule.
Committee means the Medical Benefits (Dental Practitioners) Advisory Committee established under section 136 of theNational Health Act 1953 .relevant law , in relation to a service given to a patient, means the law of the State or Territory in which the service is given that provides for the registration or licensing of orthodontists.(2) An item in the series 75000 to 75051 that includes the symbol
(AO) applies only to a service given by an accredited orthodontist.
(1) In this rule,
relevant law, in relation to a service given to a patient, means the law of the State or Territory in which the service is given that provides for the registration or licensing of oral surgeons.(2) An item in the series 75200 to 75609 that includes the symbol
(AOS) applies only to a service given by a dental practitioner who is:(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.
In items 11000 to 12200
, report means a report prepared by a medical practitioner.
In rule 24 and items 13200 to 13221,
treatment cycle of a patient means a series of treatments of the patient that:
(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.
If a service mentioned:
(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.
Items 13200 to 13221 do not apply to a service in relation to a patient’s pregnancy, or intended pregnancy, that is, at the time of the service, the subject of an agreement, or arrangement, under which the patient makes provision for guardianship of, or custodial rights to, a child born as a result of the pregnancy to be transferred to another person.
In items 13200 and 13206,
embryology laboratory services includes:
(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.
In items 16507, 16510, 16513 and 16517,
confinement includes:
(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.
The procedures mentioned in item 16517, 16520, 16564, 16567, 16570 or 16573 constitute, for the purposes of that item, a single operation for the purposes of subsections 16 (2), (3) and (4) of the Act.
In items 45719 to 45752 and 52342 to 52375,
maxilla includes the zygoma.
Items 46300 to 46510 apply only to a service given in the course of an operation on a hand or hands.
In items 47000 to 50239:
closed reduction :
(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.
open reduction means treatment of a dislocation or fracture by either:
(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.
Items 48678, 48681, 48684, 48687 and 48690 apply only if the service is undertaken in association with a spinal fusion service to which item 48642, 48645, 48648, 48651, 48654, 48657, 48660, 48663, 48666, 48669, 48672 or 48675 applies.
In items 51303 and 51803,
Amount under rule 33 , in relation to an amount payable for assistance at an operation, means an amount equal to 20% of the sum of the fees payable under the Act for the services at that operation of the practitioner to whom the assistance was given.
(1) In item 51309,
Amount under rule 34 in relation to an amount payable for assistance at a series, or combination, of operations, means an amount equal to 20% of the sum of the fees payable under the Act for the services at those operations of the practitioner to whom the assistance was given.(2) For the purposes of subrule (1), the amount payable for the Caesarean section component of the operations is the fee applicable to item 16520.
(1) In item 18219,
Amount under rule 35 means an amount equal to the sum of:(a) the amount of the fee for the service shown in item 18216 including continuous attendance by the medical practitioner for 1 hour; and
(b) an amount of $13.15 for each additional 15 minutes or part thereof for continuous attendance by the medical practitioner beyond the first hour.
For the purposes of items 30196 to 30203, the requirement for histopathological proof of malignancy is satisfied where multiple lesions are to be removed from the one anatomical region if a single lesion from that region is histologically tested and proven positive for malignancy.
3 | Professional attendance at consulting rooms (not being a service to which any other item applies) by a 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 | $11.45 | ||
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 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 | $28.65 | ||
13 | Professional attendance at an institution (not being a service to which any other item applies) by a 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 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 | ||
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 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 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 36 or 44 applies — each attendance | $24.15 | ||
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 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 37 or 47 applies — each attendance | $41.25 | ||
25 | Professional attendance at an institution (not being a service to which any other item applies) by a 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 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 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 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 | ||
36 | Professional attendance at consulting rooms (not being a service to which any other item applies) by a 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 | $43.55 | ||
37 | 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 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 | $60.75 | ||
38 | Professional attendance at an institution (not being a service to which any other item applies) by a 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 1 institution on 1 occasion —each patient | Amount under rule 6 | ||
40 | Professional attendance at a hospital (not being a service to which any other item applies) by a 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 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 | ||
44 | Professional attendance at consulting rooms (not being a service to which any other item applies) by a 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 | $64.20 | ||
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 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 | $81.40 | ||
48 | Professional attendance at an institution (not being a service to which any other item applies) by a 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 | ||||
50 | Professional attendance at a hospital (not being a service to which any other item applies) by a 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 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 | ||
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 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 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 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 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 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 general practitioner) — each attendance | $31.50 | ||
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 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 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 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 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 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 general practitioner) — an attendance on 1 or more patients at 1 institution on 1 occasion — each patient | Amount under rule 6 | ||
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 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 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 general practitioner) — an attendance on 1 or more patients at 1 hospital on 1 occasion — each patient | Amount under rule 6 | ||
91 | Professional attendance at a hospital of more than 45 minutes’ duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients at 1 hospital on 1 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 general practitioner) — an attendance on 1 or more patients at 1 nursing home on 1 occasion — each patient | Amount under rule 6 | ||
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 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 general practitioner) — an attendance on 1 or more patients at 1 nursing home on 1 occasion — each patient | Amount under rule 6 | ||
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 general practitioner) — an attendance on 1 or more patients at 1 nursing home on 1 occasion — each patient | Amount under rule 6 | ||
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 a.m. or after 1 p.m. on a Saturday or at any time other than between 8 a.m. and 8 p.m. 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 a.m. or after 1 p.m. on a Saturday or at any time other than between 8 a.m. and 8 p.m. 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 | ||
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 | $61.00 | ||
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 | $30.50 | ||
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 (not being 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 | $50.15 | ||
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 | $89.30 | ||
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 | $56.50 | ||
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 | $107.45 | ||
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 (not being a service to which item 119 applies) subsequent to the first in a single course of treatment | $53.75 | ||
119 | 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 minor attendance subsequent to the first in a single course of treatment | $30.50 | ||
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 psychiatry) where the patient is referred to him or her by a medical practitioner — initial attendance in a single course of treatment | $130.40 | ||
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 psychiatry) where the patient is referred to him or her by a medical practitioner — each attendance (other than a service to which item 131 applies) subsequent to the first in a single course of treatment | $78.80 | ||
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 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 | $56.75 | ||
134 | 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 consulting rooms, hospital or nursing home | $30.80 | ||
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 | $61.60 | ||
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 | $90.30 | ||
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 | $124.65 | ||
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 | $151.90 | ||
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 | $56.60 | ||
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 | $88.85 | ||
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 | $123.25 | ||
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 | $149.05 | ||
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 | $177.70 | ||
153 | Attendance for electroconvulsive therapy, including associated consultation (AU 3) | $40.55 | ||
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 to 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 | $35.15 | ||
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 | $46.65 | ||
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 | |||
$68.95 | ||||
157 | 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, involving an interview of a person other than the patient of not less than 20 minutes’ duration but less than 45 minutes’ duration, in the course of initial diagnostic evaluation of a patient | $37.20 | ||
158 | 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, involving an interview of a person other than the patient of not less than 45 minutes’ duration, in the course of initial diagnostic evaluation of a patient | $83.80 | ||
159 | 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, 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 12 month period | $37.25 | ||
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 | $87.55 | ||
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 | $143.00 | ||
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 | $198.45 | ||
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 | $253.85 | ||
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 | $306.40 | ||
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 | ||
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 | ||
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 | $86.75 | ||
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 | $86.75 | ||
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 | $86.75 | ||
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 | $86.75 | ||
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) | $86.75 | ||
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 | $86.75 | ||
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 | $86.75 | ||
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 | $86.75 | ||
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 | $86.75 | ||
10815 | Attendance for the refitting of contact lenses with keratotomy 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 item 10801, 10802, 10803, 10804, 10805, 10806, 10807, 10808 or 10809 applies | $6.20 | ||
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 | $50.15 | ||
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 | $50.15 | ||
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 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 | $50.15 | ||
10904 | Professional attendance that is the sole or first attendance in 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 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 | $50.15 | ||
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 | $25.15 | ||
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 | $25.15 | ||
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, 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 | $126.40 | ||
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, 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 | $126.40 | ||
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, 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 | $126.40 | ||
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, 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 | $126.40 | ||
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, 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) | $126.40 | ||
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, 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 | $126.40 | ||
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, 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 | $126.40 | ||
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, 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 | $126.40 | ||
10929 | 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, 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 | $126.40 | ||
11000 | Electroencephalography, not being a service associated with a service to which item 11003, 11006 or 11009 applies (AU 6) | $87.60 | ||
11003 | Electroencephalography, prolonged recording of at least 3 hours’ duration, not being a service associated with a service to which item 11000, 11006 or 11009 applies | $232.00 | ||
11006 | Electroencephalography, temporosphenoidal | $118.95 | ||
11009 | Electrocorticography | $162.20 | ||
11012 | Neuromuscular electrodiagnosis — conduction studies on 1 nerve or electromyography of 1 or more muscles using concentric needle electrodes or both these examinations (not being a service associated with a service to which item 11015 or 11018 applies) | $79.75 | ||
11015 | Neuromuscular electrodiagnosis — conduction studies on 2 or 3 nerves with or without electromyography (not being a service associated with a service to which item 11012 or 11018 applies) | $106.80 | ||
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 being a service associated with a service to which item 11012 or 11015 applies) | |||
$21.10 | |||
50127 | Joint or joints, arthroplasty of, by any technique not being a service to which another item applies (AU 15) | $500.40 | |
50130 | Joint or joints, application of external fixator to, other than for treatment of fractures (AU 9) | $222.40 | |
50200 | Aggressive or potentially malignant bone or deep soft tissue tumour, biopsy of (not including aftercare) (AU 5) | $134.10 | |
50203 | Bone or malignant deep soft tissue tumour, lesional or marginal excision of (AU 8) | $295.05 | |
50206 | Bone tumour, lesional or marginal excision of, combined with any 1 of: liquid nitrogen freezing, autograft, allograft or cementation (AU 9) | $435.85 | |
50209 | Bone tumour, lesional or marginal excision of, combined with any 2 or more of: liquid nitrogen freezing, autograft, allograft or cementation (AU 10) | $536.45 | |
50212 | 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, without reconstruction (AU 19) | $1,173.45 | |
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) | $1,475.20 | |
50218 | Malignant tumour of long bone, enbloc resection of, with replacement or arthrodesis of adjacent joint (AU 21) | $1,944.55 | |
50221 | Malignant or aggressive soft tissue tumour of pelvis, sacrum or spine; or scapula and shoulder, enbloc resection of (AU 22) | $1,810.45 | |
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) | $2,011.60 | |
50227 | Malignant bone tumour, enbloc resection of, with massive anatomic specific allograft or autograft, with or without prosthetic replacement (AU 27) | $2,346.90 | |
50230 | Benign tumour, resection of, requiring anatomic specific allograft, with or without internal fixation (AU 19) | $1,206.95 | |
50233 | Malignant tumour, amputation for, hemipelvectomy or interscapulo-thoracic (AU 26) | $1,542.25 | |
50236 | Malignant tumour, amputation for, hip disarticulation, shoulder disarticulation or proximal third femur (AU 20) | $1,206.95 | |
50239 | Malignant tumour, amputation for, not being a service to which another item in this Group applies (AU 13) | $804.65 | |
51300 | Assistance at any operation for which the fee exceeds $180.90 but does not exceed $321.35 or at a series or a combination of operations where the fee for at least 1 of the operations exceeds $180.90 but where the fee for the series or combination of operations does not exceed $321.35 | $61.45 | |
51303 | Assistance at any operation for which the fee exceeds $321.35 or at a combination of operations for which the aggregate fee exceeds $321.35 provided that the fee for at least 1 of the operations exceeds $180.90 | Amount under rule 33 | |
51306 | Assistance at a delivery involving Caesarean section | $88.85 | |
51309 | Assistance at a series or combination of operations, 1 of which is a delivery involving Caesarean section | Amount under rule 34 | |
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 the approved dental practitioner — 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 | $61.05 | |
51703 | Professional attendance by an approved dental practitioner where the patient is referred to the approved dental practitioner — 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 | $30.55 | |
51800 | Assistance by an approved dental practitioner at any operation for which the fee exceeds $180.90 but does not exceed $321.35 or at a series or a combination of operations where the fee for 1 of the operations exceeds $180.90 but where the fee for the series or combination of operations does not exceed $321.35 | $61.05 | |
51803 | Assistance by an approved dental practitioner at any operation for which the fee exceeds $321.35 or at a combination of operations for which the aggregate fee exceeds $321.35 provided that the fee for at least 1 of the operations exceeds $180.90 | Amount under rule 33 | |
52000 | Skin and subcutaneous tissue or mucous membrane, repair of recent wound of, on face or neck, small (not more than 7 cm long), superficial (AU 7) | $58.90 | |
52001 | Operative procedure on tissue, organ or region, not being a service to which another item in Groups O3 to O9 applies, including any consultation on the same occasion | $5.15 | |
52003 | Skin and subcutaneous tissue or mucous membrane, repair of recent wound of, on face or neck, small (not more than 7 cm long), involving deeper tissue (AU 7) | $83.55 | |
52006 | Skin and subcutaneous tissue or mucous membrane, repair of recent wound of, on face or neck, large (more than 7 cm long), superficial (AU 7) | $83.55 | |
52009 | Skin and subcutaneous tissue or mucous membrane, repair of recent wound of, on face or neck, large (more than 7 cm long), involving deeper tissue (AU 8) | $132.85 | |
52012 | Superficial foreign body, removal of, as an independent procedure (AU 5) | $16.70 | |
52015 | Subcutaneous foreign body, removal of, requiring incision and suture, as an independent procedure (AU 6) | $78.20 | |
52018 | Foreign body in muscle, tendon or other deep tissue, removal of, as an independent procedure (AU 7) | $197.10 | |
52021 | Aspiration biopsy of 1 or more jaw cysts as an independent procedure to obtain material for diagnostic purposes and not being a service 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) | $37.25 | |
52027 | Biopsy of lymph gland, muscle or other deep tissue or organ, as an independent procedure (AU 6) | $107.10 | |
52030 | Sinus, excision of, involving superficial tissue only (AU 6) | $64.25 | |
52033 | Sinus, excision of, involving muscle and deep tissue (AU 7) | $130.70 | |
52036 | Tumour, cyst, ulcer or scar (other than a scar removed during the surgical approach at an operation), up to 3 cm in diameter, removal from cutaneous or subcutaneous tissue or from mucous membrane, where the removal is by surgical excision and suture, not being a service to which item 52039 applies (AU 6) | $90.00 | |
52039 | Tumours, cysts, ulcers or scars (other than a scar removed during the surgical approach at an operation), up to 3 cm in diameter, removal from cutaneous or subcutaneous tissue or from mucous membrane, where the removal is by surgical excision and suture, and the procedure is performed on more than 3 but not more than 10 lesions (AU 9) | $230.30 | |
52042 | Tumour, cyst, ulcer or scar (other than a scar removed during the surgical approach at an operation), more than 3 cm in diameter, removal from cutaneous or subcutaneous tissue or from mucous membrane (AU 6) | $122.10 | |
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 5 mm 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 being a service to which another item in Groups O3 to O9 applies, involving muscle, bone, or other deep tissue (AU 8) | $175.65 | |
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 5 mm 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 being a service to which another item in Groups O3 to O9 applies (AU 8) | $262.45 | |
52051 | Tumour, removal of, from soft tissue (including muscle, fascia and connective tissue), extensive excision of, without skin or mucosal graft (AU 8) | $358.85 | |
52054 | Tumour, removal of, from soft tissue (including muscle, fascia and connective tissue), extensive excision of, with skin or mucosal graft (AU 10) | $417.75 | |
52055 | Haematoma, abscess or cellulitis not requiring a general anaesthesia, incision with drainage of (excluding after-care) | $19.45 | |
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) | $115.70 | |
52060 | Muscle, excision of (AU 6) | $134.95 | |
52063 | Bone tumour, innocent, excision of, not being a service to which another item in Groups O3 to O9 applies (AU 7) | $251.75 | |
52066 | Submandibular gland, extirpation of (AU 8) | $316.00 | |
52069 | Sublingual gland, extirpation of (AU 7) | $141.40 | |
52072 | Salivary gland, dilatation or diathermy of duct (AU 6) | $41.80 | |
52075 | Salivary gland, removal of calculus from duct or meatotomy or marsupialisation, 1 or more such procedures (AU 7) | $107.10 | |
52078 | Tongue, partial excision of (AU 7) | $210.00 | |
52081 | Tongue tie, division or excision of frenulum (AU 6) | $33.20 | |
52084 | Tongue tie, mandibular frenulum or maxillary frenulum, division or excision of frenulum, in a person aged not less than 2 years (AU 6) | $84.60 | |
52087 | Ranula or mucous cyst of mouth, removal of (AU 9) | $145.70 | |
52090 | Operation on mandible or maxilla (other than alveolar margins) for osteomyelitis — 1 bone (AU 10) | $253.40 | |
52092 | Operation on skull for osteomyelitis (AU 12) | $330.95 | |
52096 | Orthopaedic pin or wire, insertion of, into maxilla or mandible or zygoma, as an independent procedure (AU 5) | $80.65 | |
52099 | Buried wire, pin or screw, 1 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 being a service associated with a service to which item 52102 or 52105 applies (AU 6) | $100.30 | |
52102 | Buried wire, pin or screw, 1 or more, which were inserted for internal fixation purposes into maxilla or mandible or zygoma, removal of, requiring anaesthesia, incision, dissection and suturing, where undertaken in the operating theatre of a hospital or approved day-hospital facility, per bone (AU 6) | $100.30 | |
52105 | Plate, 1 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 being a service associated with a service to which item 52099 or 52102 applies (AU 6) | $188.25 | |
52108 | Lip, full thickness wedge excision of, with repair by direct sutures (AU 8) | $230.30 | |
52111 | Vermilionectomy (AU 8) | $230.30 | |
52114 | Mandible or maxilla, segmental resection of, for tumours or cysts (AU 13) | $417.75 | |
52117 | Mandible, including lower border, or maxilla, sub-total resection of (AU 13) | $496.45 | |
52120 | Mandible, hemimandiblectomy of, including condylectomy where performed (AU 29) | $589.15 | |
52122 | Mandible, hemi-mandibular reconstruction with bone graft, not being a service associated with a service to which item 52123 applies (AU 15) | $589.50 | |
52123 | Mandible, total resection of both sides, including condylectomies where performed (AU 35) | $667.10 | |
52126 | Maxilla, total resection of (AU 25) | $642.70 | |
52129 | Maxilla, total resection of both maxillae (AU 30) | $856.95 | |
52132 | Tracheostomy (AU 10) | $169.25 | |
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) | $102.85 | |
52138 | Maxillary artery, ligation of (AU 12) | $316.00 | |
52141 | Facial, mandibular or lingual artery or vein or artery and vein, ligation of, not being a service to which item 52138 applies (AU 12) | $316.00 | |
52144 | Foreign body, deep, removal of using interventional imaging techniques (AU 10) | $294.55 | |
52147 | Duct of major salivary gland, transposition of (AU 16) | $278.50 | |
52148 | Parotid duct, repair of, using micro-surgical techniques (AU 14) | $491.25 | |
52300 | Single-stage local flap, where indicated, repair to 1 defect, with skin or mucosa (AU 7) | $203.50 | |
52303 | Single-stage local flap, where indicated, repair to 1 defect, with buccal pad of fat (AU 10) | $289.20 | |
52306 | Single-stage local flap, where indicated, repair to 1 defect, using temporalis muscle (AU 10) | $429.20 | |
52309 | Free grafting (mucosa or split skin) of a granulating area (AU 7) | $145.70 | |
52312 | Free grafting (mucosa or split skin) to 1 defect, including elective dissection (AU 8) | $203.50 | |
52315 | Free grafting, full thickness, to 1 defect (mucosa or skin) (AU 9) | $337.40 | |
52318 | Bone graft, harvesting of, via separate incision, being a service associated with a service to which another item in Groups O3 to O9 applies — Autogenous — small quantity (AU 7) | $100.30 | |
52319 | Bone graft, harvesting of, via separate incision, being a service associated with a service to which another item in Groups O3 to O9 applies — Autogenous — large quantity (AU 7) | $167.55 | |
52321 | Foreign implant (non-biological), insertion of, for contour reconstruction of pathological deformity, not being a service associated with a service to which item 52624 applies (AU 10) | $337.40 | |
52324 | Direct flap repair, using tongue, first stage (AU 7) | $337.40 | |
52327 | Direct flap repair, using tongue, second stage (AU 7) | $167.55 | |
52330 | Palatal defect (oro-nasal fistula), plastic closure of, including services to which item 52300, 52303, 52306 or 52324 applies (AU 14) | $557.00 | |
52333 | Cleft palate, primary repair (AU 14) | $557.00 | |
52336 | Cleft palate, secondary repair, closure of fistula using local flaps (AU 13) | $348.15 | |
52339 | Cleft palate, secondary repair, lengthening procedure (AU 12) | $396.35 | |
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) | $687.80 | |
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) | $775.70 | |
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) | $878.35 | |
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) | $987.70 | |
52354 | Mandible or maxilla, osteotomies or osteectomies of, involving 3 or more such procedures on the 1 jaw, including transposition of nerves and vessels and bone grafts taken from the same site (AU 29) | $998.05 | |
52357 | Mandible or maxilla, osteotomies or osteectomies of, involving 3 or more such procedures on the 1 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) | $1,122.15 | |
52360 | Mandible or maxilla, osteotomies or osteectomies of, involving 2 such procedures of each jaw including transposition of nerves and vessels and bone grafts taken from the same site (AU 26) | $1,146.15 | |
52363 | Mandible or maxilla, osteotomies or osteectomies of, involving 2 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, screws or both (AU 32) | $1,292.80 | |
52366 | Mandible or maxilla, complex bilateral osteotomies or osteectomies of, involving 3 or more such procedures of 1 jaw and 2 such procedures of the other jaw, including genioplasty when performed and transposition of nerves and vessels and bone grafts taken from the same site (AU 47) | $1,264.00 | |
52369 | Mandible or maxilla, complex bilateral osteotomies or osteectomies of, involving 3 or more such procedures of 1 jaw and 2 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) | $1,416.90 | |
52372 | Mandible or maxilla, complex bilateral osteotomies or osteectomies of, involving 3 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) | $1,376.45 | |
52375 | Mandible or maxilla, complex bilateral osteotomies or osteectomies of, involving 3 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) | $1,541.05 | |
52378 | Genioplasty including transposition of nerves and vessels and bone grafts taken from the same site (AU 16) | $532.65 | |
52379 | Face, contour reconstruction of 1 region, using autogenous bone or cartilage graft (AU 18) | $910.15 | |
52380 | Midfacial osteotomies — Le Fort II, Modified Le Fort III (Nasomalar), Modified Le Fort III (Malar-Maxillary), Le Fort III involving 3 or more osteotomies of the midface including transposition of nerves and vessels and bone grafts taken from the same site (AU 50) | $1,551.40 | |
52382 | Midfacial osteotomies — Le Fort II, Modified Le Fort III (Nasomalar), Modified Le Fort III (Malar-Maxillary), Le Fort III involving 3 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) | $1,861.65 | |
52420 | Mandible, fixation by intermaxillary wiring, excluding wiring for obesity | $171.70 | |
52600 | Mandibular or palatal exostosis, excision of (AU 10) | $241.00 | |
52603 | Mylohyloid ridge, reduction of (AU 10) | $230.30 | |
52606 | Maxillary tuberosity, reduction of (AU 12) | $175.65 | |
52609 | Papillary hyperplasia of the palate, removal of — less than 5 lesions (AU 10) | $230.30 | |
52612 | Papillary hyperplasia of the palate, removal of — 5 to 20 lesions (AU 12) | $289.20 | |
52615 | Papillary hyperplasia of the palate, removal of — more than 20 lesions (AU 13) | $358.85 | |
52618 | Vestibuloplasty, submucosal or open, including excision of muscle and skin or mucosal graft when performed — unilateral or bilateral (AU 19) | $417.75 | |
52621 | Floor of mouth lowering (Obwegeser or similar procedure), including excision of muscle and skin or mucosal graft when performed — unilateral (AU 19) | $417.75 | |
52624 | Alveolar ridge augmentation with bone or alloplast or both — unilateral (AU 13) | $337.40 | |
52626 | Alveolar ridge augmentation — unilateral, insertion of tissue expanding device into maxillary or mandibular alveolar ridge region for (AU 13) | $206.85 | |
52627 | Osseo-integration procedure — extra oral implantation of titanium fixture (AU 11) | $358.85 | |
52630 | Osseo-integration procedure — fixation of transcutaneous abutment (AU 6) | $132.85 | |
52800 | Neurolysis by open operation, without transposition, not being a service associated with a service to which item 52803 applies (AU 7) | $197.10 | |
52803 | Nerve trunk, internal (interfasicular), neurolysis of, using microsurgical techniques (AU 11) | $283.85 | |
52806 | Neurectomy, neurotomy or removal of tumour from superficial peripheral nerve (AU 8) | $197.10 | |
52809 | Neurectomy, neurotomy or removal of tumour from deep peripheral nerve (AU 10) | $337.40 | |
52812 | Nerve trunk, primary repair of, using microsurgical techniques (AU 8) | $482.05 | |
52815 | Nerve trunk, secondary repair of, using microsurgical techniques (AU 9) | $508.80 | |
52818 | Nerve, transposition of (AU 8) | $337.40 | |
52821 | Nerve graft to nerve trunk (cable graft) including harvesting of nerve graft using microsurgical techniques (AU 16) | $733.75 | |
52824 | Peripheral branches of the trigeminal nerve, cryosurgery of, for pain relief (AU 8) | $316.00 | |
53000 | Maxillary antrum, proof puncture and lavage of (AU 6) | $23.05 | |
53003 | Maxillary antrum, proof puncture and lavage of, where undertaken in the operating theatre of a hospital or approved day-hospital facility — not being a service associated with a service to which another item in this Group applies (AU 6) | $65.35 | |
53006 | Antrostomy (radical) (AU 9) | $372.35 | |
53009 | Antrum, intranasal operation on or removal of foreign body from (AU 8) | $210.00 | |
53012 | Antrum, drainage of, through tooth socket (AU 7) | $83.55 | |
53015 | Oro-antral fistula, plastic closure of (AU 11) | $417.75 | |
53018 | Turbinectomy or turbinectomies, partial or total, unilateral (AU 6) | $97.50 | |
53019 | Maxillary sinus, bone graft to floor of maxillary sinus following elevation of mucosal lining (sinus lift procedure), (unilateral) (AU 20) | $413.70 | |
53200 | Mandible, treatment of a dislocation of, not requiring open reduction (AU 4) | $33.75 | |
53203 | Mandible, treatment of a dislocation of, requiring open reduction (AU 4) | $84.60 | |
53206 | Temporomandibular joint, manipulation of, performed in the operating theatre of a hospital or approved day-hospital facility, not being a service associated with a service to which another item in Groups O3 to O9 applies (AU 4) | $101.75 | |
53209 | Glenoid fossa, zygomatic arch and temporal bone, reconstruction of (Obwegeser technique) (AU 19) | $1,172.95 | |
53212 | Absent condyle and ascending ramus in hemifacial microsomia, construction of, not including harvesting of graft material (AU 15) | $636.05 | |
53215 | Temporomandibular joint, arthroscopy of, with or without biopsy, not being a service associated with any other arthroscopic procedure of that joint (AU 9) | $230.30 | |
53218 | Temporomandibular joint, arthroscopy of, removal of loose bodies, debridement, or treatment of adhesions — 1 or more of such procedures (AU 12) | $471.30 | |
53221 | Temporomandibular joint, open surgical exploration of, with or without microsurgical techniques (AU 18) | $621.30 | |
53224 | Temporomandibular joint, open surgical exploration of, with condylectomy or condylotomy, with or without microsurgical techniques (AU 20) | $690.90 | |
53225 | Arthrocentesis, irrigation of temporomandibular joint after insertion of 2 cannuli into the appropriate joint space(s) (AU 13) | $206.85 | |
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) | $846.25 | |
53230 | Temporomandibular joint, open surgical exploration of, with meniscus, capsular and condylar head surgery, with or without microsurgical techniques (AU 24) | $953.35 | |
53233 | Temporomandibular joint, surgery of, involving procedures to which items 53224, 53227 and 53230 apply and also involving the use of tissue flaps, or cartilage graft, or allograft implants, with or without microsurgical techniques (AU 28) | $1,071.15 | |
53400 | Maxilla, unilateral or bilateral, treatment of fracture of, not requiring splinting | $92.05 | |
53403 | Mandible, treatment of fracture of, not requiring splinting | $112.45 | |
53406 | Maxilla, treatment of fracture of, requiring splinting, wiring of teeth, circumosseous fixation or external fixation (AU 14) | $289.20 | |
53409 | Mandible, treatment of fracture of, requiring splinting, wiring of teeth, circumosseous fixation or external fixation (AU 14) | $289.20 | |
53410 | Zygomatic bone, treatment of fracture of, not requiring surgical reduction | $61.05 | |
53411 | Zygomatic bone, treatment of fracture of, requiring surgical reduction, by temporal, intra-oral or other approach (AU 7) | $169.25 | |
53412 | Zygomatic bone, treatment of fracture of, requiring surgical reduction and involving internal or external fixation at 1 site (AU 9) | $278.50 | |
53413 | Zygomatic bone, treatment of fracture of, requiring surgical reduction and involving internal or external fixation, or both at 2 sites (AU 10) | $342.80 | |
53414 | Zygomatic bone, treatment of, requiring surgical reduction and involving internal or external fixation, or both at 3 sites (AU 11) | $391.00 | |
53415 | Maxilla, treatment of fracture of, requiring open reduction (AU 7) | $310.65 | |
53416 | Mandible, treatment of fracture of, requiring open reduction (AU 7) | $310.65 | |
53418 | Maxilla, treatment of fracture of, requiring open reduction and internal fixation not involving plate(s) (AU 9) | $401.70 | |
53419 | Mandible, treatment of fracture of, requiring open reduction and internal fixation not involving plate(s) (AU 9) | $401.70 | |
53422 | Maxilla, treatment of fracture of, requiring open reduction and internal fixation involving plate(s) (AU 11) | $514.15 | |
53423 | Mandible, treatment of fracture of, requiring open reduction and internal fixation involving plate(s) (AU 11) | $514.15 | |
53424 | Maxilla, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction not involving plate(s) (AU 10) | $439.20 | |
53425 | Mandible, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction not involving plate(s) (AU 10) | $439.20 | |
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) | $599.85 | |
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) | $599.85 | |
53439 | Mandible, treatment of a closed fracture of, involving a joint surface (AU 6) | $169.25 | |
53453 | Orbital cavity, reconstruction of a wall or floor with or without foreign implant (AU 12) | $346.45 | |
53455 | Orbital cavity, bone or cartilage graft to orbital wall or floor including reduction of prolapsed or entrapped orbital contents (AU 14) | $403.35 | |
75000 | Professional attendance not being a service to which item 75003 applies (AO) | $29.00 | |
75003 | Professional attendance and treatment planning where treatment is deferred (AO) | $58.70 | |
75006 | Production of dental study models not being a service associated with a service to which item 75003 applies, or not being a service to which item 75024, 75027, 75030, 75033, 75036, 75039, 75042, 75045, 75048, or 75051 applies (AO) | $29.00 | |
75009 | Orthodontic radiography — orthopantomography (panoramic radiography) (AO) | $48.55 | |
75012 | Orthodontic radiography — anteroposterior cephalometric radiography with cephalometric tracings or lateral cephalometric radiography with cephalometric tracings (AO) | $76.85 | |
75015 | Orthodontic radiography — anteroposterior and lateral cephalometric radiography, with cephalometric tracings (AO) | $105.80 | |
75018 | Orthodontic radiography — anteroposterior and lateral cephalometric radiography, with cephalometric tracings and orthopantomography (AO) | $134.80 | |
75021 | Orthodontic radiography — anteroposterior and lateral cephalometric radiography, with cephalometric tracings, orthopantomography and hand-wrist studies (including growth prediction) (AO) | $165.25 | |
75024 | Pre-surgical infant maxillary arch repositioning, including supply of appliances and all associated consultations — where 1 appliance is used (AO) | $391.40 | |
75027 | Pre-surgical infant maxillary arch repositioning, including supply of appliances and all associated consultations — where 2 appliances are used (AO) | $463.90 | |
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) | $521.85 | |
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) | $855.30 | |
75036 | Deciduous and permanent dentition treatment (not being treatment associated with treatment to which item 75033 applies) — lateral arch expansion and incisor alignment using fixed appliances in maxillary arch, including supply of appliances and all associated attendances, treatment-planning and retention services beyond the period of active treatment (AO) | $1,181.45 | |
75039 | Permanent dentition treatment (not being treatment associated with treatment to which item 75045 or 75048 applies) — 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 3 months of active treatment (AO) | $391.40 | |
75042 | Permanent dentition treatment (not being treatment associated with treatment to which item 75045 or 75048 applies) — 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 3 months of active treatment after the first for a maximum of a further 33 months (AO) | $147.85 | |
75045 | Permanent dentition treatment (not being treatment associated with treatment to which item 75039 or 75042 applies) — 2-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 3 months of active treatment (AO) | $768.30 | |
75048 | Permanent dentition treatment (not being treatment associated with treatment to which item 75039 or 75042 applies) — 2-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 3 months of active treatment after the first for a maximum of a further 33 months (AO) | $202.95 | |
75051 | Pre-surgical or post-surgical jaw growth guidance using removable appliances, including supply of appliances and all associated consultations and treatment-planning (AO) | $521.85 | |
75200 | Removal of tooth or tooth fragment (not being treatment to which item 75400, 75403, 75406, 75409, 75412 or 75415 applies), where the patient is referred by an accredited orthodontist (AD) | $39.15 | |
75203 | Removal of tooth or tooth fragment under general anaesthesia, where the patient is referred by an accredited orthodontist (AD) | $58.70 | |
75206 | Removal of each additional tooth or tooth fragment at the same attendance at which a service to which item 75200 or 75203 applies is rendered (AD) | $19.45 | |
75400 | Surgical removal of erupted tooth, where the patient is referred by an accredited orthodontist (AOS) | $117.40 | |
75403 | Surgical removal of tooth with soft tissue impaction, where the patient is referred by an accredited orthodontist (AOS) | $134.80 | |
75406 | Surgical removal of tooth with partial bone impaction, where the patient is referred by an accredited orthodontist (AOS) | $153.65 | |
75409 | Surgical removal of tooth with complete bone impaction, where the patient is referred by an accredited orthodontist (AOS) | $173.95 | |
75412 | Surgical removal of tooth fragment requiring incision of soft tissue only, where the patient is referred by an accredited orthodontist (AOS) | $97.15 | |
75415 | Surgical removal of tooth fragment requiring removal of bone, where the patient is referred by an accredited orthodontist (AOS) | $117.40 | |
75600 | Surgical exposure, stimulation and packing of unerupted tooth, where the patient is referred by an accredited orthodontist (AOS) | $165.25 | |
75603 | Surgical exposure of unerupted tooth for the purpose of fitting a traction device, where the patient is referred by an accredited orthodontist (AOS) | $194.25 | |
75606 | Surgical repositioning of unerupted tooth, where the patient is referred by an accredited orthodontist (AOS) | $194.25 | |
75609 | Transplantation of tooth bud, where the patient is referred by an accredited orthodontist (AOS) | $289.95 | |
75800 | Attendance comprising consultation, preventive treatment and prophylaxis, of not less than 30 minutes’ duration — each attendance to a maximum of 3 attendances in any period of 12 months (AD) | $58.70 | |
75803 | Provision and fitting of acrylic base partial denture, including retainers — 1 tooth (AD) | $234.85 | |
75806 | Provision and fitting of acrylic base partial denture, including retainers — 2 teeth (AD) | $275.45 | |
75809 | Provision and fitting of acrylic base partial denture, including retainers — 3 teeth (AD) | $326.15 | |
75812 | Provision and fitting of acrylic base partial denture, including retainers — 4 teeth (AD) | $362.40 | |
75815 | Provision and fitting of acrylic base partial denture, including retainers — 5 to 9 teeth (AD) | $442.15 | |
75818 | Provision and fitting of acrylic base partial denture, including retainers — 10 to 12 teeth (AD) | $521.85 | |
75821 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 1 tooth (AD) | $420.40 | |
75824 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 2 teeth (AD) | $485.65 | |
75827 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 3 teeth (AD) | $558.10 | |
75830 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 4 teeth (AD) | $616.10 | |
75833 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 5 to 9 teeth (AD) | $753.80 | |
75836 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 10 to 12 teeth (AD) | $862.55 | |
75839 | Provision and fitting of retainers (not being treatment associated with treatment to which item 75803, 75806, 75809, 75812, 75815, 75818, 75821, 75824, 75827, 75830, 75833 or 75836 applies) — each retainer (AD) | $19.45 | |
75842 | Adjustment of partial denture (not being treatment associated with treatment to which item 75803, 75806, 75809, 75812, 75815, 75818, 75821, 75824, 75827, 75830, 75833 or 75836 applies) (AD) | $29.00 | |
75845 | Relining of partial denture by laboratory process and associated fitting (AD) | $144.95 | |
75848 | Remodelling and fitting of partial denture of more than 4 teeth (AD) | $173.95 | |
75851 | Repair to cast metal base of partial denture — 1 or more points (AD) | $87.00 | |
75854 | Addition of a tooth or teeth to a partial denture to replace extracted tooth or teeth, including taking of necessary impression (AD) | $87.00 | |
The Health Insurance
(1993-1994 General Medical Services Table) Regulations (in force under the
1993 No. 272 | 1 Nov 1993 | 1 Nov 1993 | |
1994 No. 112 | 29 May 1994 | 1 May 1994 | — |
1994 No. 362 | 31 Oct 1994 | 1 Nov 1994 | — |
am. = amended rep. = repealed rs. = repealed and substituted | |
Schedule................................. | am. 1994 No. 112 |
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