Health Insurance (1994-1995 General Medical Services Table) Regulations (Cth)
HEALTH INSURANCE (1994-1995 GENERAL MEDICAL SERVICES TABLE) REGULATIONS
- In force under the Health Insurance Act 1973
- Updated as at 14 July 1995 (HISTREG CHAP 1104 #DATE 14:07:1995)
- In force under the Health Insurance Act 1973
- Updated as at 14 July 1995 (HISTREG CHAP 1104 #DATE 14:07:1995)
*1* The Health Insurance (1994-1995 General Medical Services Table) Regulations in force under the Health Insurance Act 1973 as shown in this reprint comprise Statutory Rules 1994 No. 362 amended as indicated in the Tables below.
Year and Date of Date of Application
Number Notification commencement saving or
in Gazette transitional
provisions
1994 No. 362 31 Oct 1994 1 Nov 1994 -
I995 No. 160 30 June 1995 1 July 1995 -
Table of Amendments
ad=added or inserted am=amended rep=repealed rs=repealed and substituted
Provision affected How affected
Schedule am. 1995 No. 160
#ADD 1:8:1995
HEALTH INSURANCE (1994-1995 GENERAL MEDICAL SERVICES TABLE) REGULATIONS -
TABLE OF PROVISIONSTABLE
TABLE OF PROVISIONS
Regulation
1. Citation
2. Commencement
3. Repeal of Health Insurance (1993-1994 General Medical
Services Table) Regulations
4. General medical services table
SCHEDULE
TABLE OF GENERAL MEDICAL SERVICES
Part
1 Rules of Interpretation
2 Services and Fees
ATTENDANCES
A1 General Practitioner Attendances to which no other Item
applies
A2 Other Non-referred Attendances to which no other Item
applies
A3 Emergency After Hours Attendances to which no other Item
applies
A4 Specialist Attendances to which no other Item applies
A5 Consultant Physician Attendances to which no other Item
applies
A6 Consultant Psychiatrist Attendances to which no other Item
applies
A7 Prolonged Attendances to which no other Item applies
A8 Group Therapy
A9 Acupuncture
A10 Contact lenses
A11 Optometrical Consultations
DIAGNOSTIC PROCEDURES AND INVESTIGATIONS
D1 Miscellaneous Diagnostic Procedures and Investigations
1 Neurology
2 Ophthalmology
3 Otolaryngology
4 Respiratory
5 Vascular
6 Cardiovascular
7 Gastroenterology and Colorectal
8 Genito-Urinary Physiological Investigations
9 Allergy Testing
10 Other Diagnostic Procedures and Investigations
D2 Nuclear Medicine (Non-imaging)
THERAPEUTIC PROCEDURES
T1 Miscellaneous Therapeutic Procedures
1 Hyperbaric Oxygen Therapy
2 Dialysis
3 Assisted Reproductive Services
4 Paediatric and Neonatal
5 Cardiovascular
6 Gastroenterology
7 Perfusion
8 Haemotology
9 Procedures Associated with Intensive Care and
Cardiopulmonary Support
10 Management and Procedures Undertaken in an Intensive Care
Unit
11 Chemotherapeutic Procedures
12 Dermatology
13 Other Therapeutic Procedures
T2 Radiation Oncology
1 Superficial
2 Orthovoltage
3 Megavoltage
4 Brachytherapy
5 Computerised Planning
T3 Therapeutic Nuclear Medicine
T4 Obstetrics
T5 Assistance in the Administration of an Anaesthetic
T6 Anaesthetics
1 Examination by an Anaesthetist
2 Administration of an Anaesthetic in connection with a
Medical Service
3 Administration of an Anaesthetic in connection with a
Dental Service
T7 Regional or Field Nerve Blocks
T8 Surgical Operations
1 General
2 Colorectal
3 Vascular
4 Gynaecological
5 Urological
6 Cardio-thoracic
7 Neurosurgical
8 Ear, Nose and Throat
9 Ophthalmology
10 Operations for Osteomyelitis
11 Paediatric
12 Amputations
13 Plastic and Reconstructive Surgery
14 Hand Surgery
15 Orthopaedic
T9 Assistance at Operations
ORAL AND MAXILLOFACIAL SERVICES
O1 Consultations
O2 Assistance at Operation
O3 General Surgery
O4 Plastic and Reconstructive
O5 Preprosthetic
O6 Neurosurgical
O7 Ear, Nose and Throat
O8 Temporomandibular Joint
O9 Treatment of Fractures
TREATMENT OF CLEFT LIP AND CLEFT PALATE CONDITIONS
C1 Orthodontic Services
C2 Oral and Maxillofacial Surgical Services
C3 General and Prosthodontic Services
HEALTH INSURANCE (1994-1995 GENERAL MEDICAL SERVICES TABLE) REGULATIONS - REG
1
1 Citation
1. These Regulations may be cited as the Health Insurance (1994-1995 General Medical Services Table) Regulations.
HEALTH INSURANCE (1994-1995 GENERAL MEDICAL SERVICES TABLE) REGULATIONS - REG
2
Commencement
2. These Regulations commence on 1 November 1994.
HEALTH INSURANCE (1994-1995 GENERAL MEDICAL SERVICES TABLE) REGULATIONS - REG
3
Repeal of Health Insurance (1993-1994 General Medical Services Table)
Regulations
3. Statutory Rules 1993 No. 272 and 1994 No. 112 are repealed.
HEALTH INSURANCE (1994-1995 GENERAL MEDICAL SERVICES TABLE) REGULATIONS - REG
4
General medical services table
4. The table of medical services (other than diagnostic imaging services and pathology services) set out in the Schedule is prescribed for the purposes of subsection 4 (1) of the Health Insurance Act 1973.
HEALTH INSURANCE (1994-1995 GENERAL MEDICAL SERVICES TABLE) REGULATIONS -
SCHEDULE 1SCH
SCHEDULE Regulation 4
TABLE OF GENERAL MEDICAL SERVICES
PART 1-RULES OF INTERPRETATION
General
1. (1) In this table, unless the contrary intention appears:
"attendance of a minor nature" or "minor 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;
"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;
"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 1 specialist or consultant physician in the specialty of
intensive care who is immediately available and exclusively rostered to
the intensive care unit 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 another 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 1 consultant physician in paediatric medicine who is
immediately available and exclusively rostered to the intensive care
unit 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;
"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;
"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 made to a specialist who is an
ophthalmologist-an optometrist; and
(c) if the referral:
(i) arises out of a dental service provided by a dental practitioner; and
(ii) is made to a specialist (but not a consultant physician);
a dental practitioner; and
(d) if the referral:
(i) arises out of a dental service provided 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 made to a consultant physician;
a dental practitioner;
"the Act" means the Health 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, a reference by number in an item to a combined
anaesthetic unit value is a reference to the number that is calculated
using the formula:
n1 + n2
where:
n1 is:
(a) if the service in connection with which the anaesthetic is
administered is a service described in another item that includes the
formula described in rule 5-the number associated with B in the formula
in the other item; and
(b) in any other case-0;
n2 is:
(a) if the service in connection with which the anaesthetic is
administered is a service described in another item that includes the
formula described in rule 5-the number associated with T in the formula
in the other item; and
(b) in any other case-the number of whole periods of:
(i) 15 minutes in a period of up to 6 hours; and
(ii) 10 minutes in any period in excess of that period;
that commences when the medical practitioner begins to prepare his or
her patient for anaesthesia and ends when he or she ceases to attend
the patient.
Meaning of symbols "(S)" and "(G)"
2. (1) An item including the symbol "(S)" applies only to a service
provided 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 provided to a patient who has been referred to the specialist; and
(ii) is the first service provided by the specialist in accordance with
the referral; or
(b) a service that:
(i) is provided 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 provided within the period of validity of the referral
applicable under regulation 31 of the Health Insurance Regulations; or
(c) a service that:
(i) is provided 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 provided; and
(ii) is the first service provided by the specialist in accordance with
the referral; or
(d) a service that:
(i) is provided 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 provided as soon as
practicable without a referral.
(2) An item including the symbol "(G)" applies only to a service
provided otherwise than by a specialist in accordance with subrule (1).
Meaning of "single course of treatment" in certain circumstances
3. (1) In subrule 1 (1), rules 2 and 6 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.
Meaning of "professional attendance" in certain items
4. 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 than
1, 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
provided to the patient.
Administration of anaesthetics in connection with certain services
5. If a general anaesthetic is administered in connection with a
service specified in an item that includes the formula:
Anaes. n = n1 B + n2 T
where:
(a) n is a number; and
(b) n1 and n2 are other numbers;
the service that is provided by the medical practitioner who administers
the anaesthetic is the service described in item n.
Interpretation of items 104 to 159
6. (1) In items 104 to 159, a reference to an attendance on a patient
by a specialist, or consultant physician, in the practice of his or her
specialty if 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 provide 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 provided 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 made.
(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.
Meaning of "Amount under rule 7" in certain items
7. (1) In items 13, 19 and 20, "Amount under rule 7" 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 $17.20 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 7" 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 $17.20 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 7" 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 $17.20 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 7" 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 patients-an amount equal to $17.20 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 7" 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 7" 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 7" 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 7" 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 not to apply in certain circumstances
8. Items 10809 and 10929 do not apply if the patient requires contact
lenses only for 1, or more than 1, 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.
Application of items 10921 to 10929
9. (1) For the purposes of items 10921 to 10929, a patient has an
ocular condition that 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.
Personal attendance by medical practitioners generally
10. (1) The items mentioned in subrule (2) apply only to a service
provided 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, 11304, 11500, 11600, 11601, 11627,
11701, 11712, 11921, 12000, 12003, 13000, 13003, 13006, 13009, 13100,
13103, 13106, 13109, 13112, 13209, 13300, 13303, 13306, 13309, 13312,
13315, 13318, 13400, 13500, 13503, 13506, 13600, 13603, 13606, 13609,
13700, 13703, 13706, 13709, 13815, 13818, 13830, 13839, 13842, 13845,
13848, 13851, 13854, 13857, 13870, 13873, 13876, 13879, 13882, 13885,
13888, 14200, 14203, 14206, 14209, 14212, 16000 to 16552 and 16558 to
51309.
(3) Items 154, 155, 156, 170, 171 and 172 apply only to a service
provided in the course of a personal attendance by a medical
practitioner.
Personal attendance by certain medical practitioners
11. (1) The items mentioned in subrule (2) apply only to a service
provided 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) provides 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, 11304, 11500, 11600, 11601, 11627, 11701, 11712, 11921, 12000,
12003, 13000, 13003, 13006, 13009, 13100, 13103, 13106, 13109, 13112,
13209, 13300, 13303, 13306, 13309, 13312, 13315, 13318, 13400, 13500,
13503, 13506, 13600, 13603, 13606, 13609, 13700, 13703, 13706, 13709,
13815, 13818, 13830, 13839, 13842, 13845, 13848, 13851, 13854, 13857,
13870, 13873, 13876, 13879, 13882, 13885, 13888, 14200, 14203, 14206,
14209, 14212, 16000 to 16552 and 16558 to 51309.
Certain services may be provided by persons other than medical
practitioners
12. (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 15536 and 16555.
Conditions under which certain services to be provided
13. Items 11309, 11312, 11315, 11318 and 11321 apply only to a service
provided:
(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.
Application of items 51700 to 53455
14. Items 51700 to 53455 apply only to a service provided 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.
Meaning of "administration of an anaesthetic" in items 18102 to 18118
15. 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 of
"professional service" in subsection 3 (1) of the Act.
Meaning of "prescribed location" in item 18013
16. 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) Prince of Wales Hospital, Randwick, New South Wales;
(e) John Hunter Hospital, New Lambton, New South Wales;
(f) Royal Melbourne Hospital, Parkville, Victoria;
(g) St Vincent's Hospital, Fitzroy, Victoria;
(h) Alfred Group of Hospitals, Prahran, Victoria;
(i) Austin Hospital, Heidelberg, Victoria;
(j) Princess Alexandra Hospital, Woolloongabba, Queensland;
(k) Royal Brisbane Hospital, Herston, Queensland;
(l) Townsville Hospital, Townsville, Queensland;
(m) Royal Adelaide Hospital, Adelaide, South Australia;
(n) Flinders Medical Centre, Bedford Park, South Australia;
(o) Sir Charles Gairdner Hospital, Nedlands, Western Australia;
(p) Poyal Perth Hospital, Perth, Western Australia;
(q) Royal Hobart Hospital, Hobart, Tasmania;
(r) Woden Valley Hospital, Garran, Australian Capital Territory.
Meaning of "Amount under rule 17" in certain items
17. In an item mentioned in subparagraph (b) (i), (ii), (iii), (iv),
(v) or (vi), "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
radiotherapy treatment of the kind mentioned in the first-mentioned
item when given for 1 field only; and:
(b) the following amount:
(i) for item 15003-$12.35 for each field separately treated in excess
of 1 up to a maximum of 5 additional fields; or
(ii) for item 15103-$13.60 for each field separately treated in excess
of 1 up to a maximum of 5 additional fields; or
(iii) for item 15109-$16.35 for each field separately treated in excess
of 1 up to a maximum of 5 additional fields; or
(iv) for item 15204-$21.45 for each field separately treated in excess
of 1 up to a maximum of 5 additional fields; or
(v) for item 15208-$21.45 for each field separately treated in excess
of 1 up to a maximum of 5 additional fields; or
(vi) for item 15214-$18.05 for each field separately treated in excess
of 1 up to a maximum of 5 additional fields.
Meaning of "Amount under rule 18" in certain items
18. In an item mentioned in subparagraph (b) (i) or (ii), "Amount under
rule 18" 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 for 1 field only; and
(b) the following amount:
(i) for item 15009-$13.40 for each field separately treated in excess
of 1 up to a maximum of 5 additional fields; or
(ii) for item 15115-$34.05 for each field separately treated in excess
of 1 up to a maximum of 5 additional fields.
Meaning of "Amount under rule 19" in certain items
19. In an item to which paragraph (a) or (b) applies, "Amount under
rule 19" 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).
Meaning of "(AD)" in Group C2-Oral and maxillofacial surgical services
and Group C3-General and Prosthodontic services
20. An item in the series 75200 to 75854 that includes the symbol
"(AD)" applies only to a service provided by a State registered dental
practitioner practising as a dentist.
Orthodontic services
21. (1) In this rule:
"accredited orthodontist" means:
(a) a dental practitioner who is:
(i) registered or licensed as an orthodontist under the relevant law;
and
(ii) accredited by the Minister for the purposes of this rule; 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 75001 to 75051; and
(iii) who is accredited by the Minister for the purposes of this rule;
"appropriate law", in relation to a service rendered to a patient, means
the law of the State or Territory in which the service is rendered that
provides for the registration or licensing of oral and maxillofacial
surgeons;
"Committee" means the Medical Benefits (Dental Practitioners) Advisory
Committee established under section 136 of the National Health Act
1953;
"relevant law", in relation to a service provided to a patient, means
the law of the State or Territory in which the service is provided that
provides for the registration or licensing of orthodontists.
(2) An item in the series 75001 to 75006 or 75024 to 75051 that includes
the symbol
"(AO)" applies only to a service provided by an accredited orthodontist.
(3) An item in the series 75009 to 75023 that includes the symbol "(AO)"
and the symbol "(AOS)"applies only to a service provided by:
(a) an accredited orthodontist; or
(b) a dental practitioner who is:
(i) registered under the appropriate law as an oral and maxillofacial
surgeon; and
(ii) a dental practitioner approved by the Minister for the purposes of
the definition of "professional service" in subsection 3 (1) of the Act.
Oral surgery services
22. (1) In this rule, "relevant law", in relation to a service rendered
to a patient, means the law of the State or Territory in which the
service is rendered that provides for the registration or licensing of
oral and maxillofacial surgeons.
(2) An item in the series 75200 to 75609 that includes the symbol
"(AOS)" applies only to a service provided by a dental practitioner who
is:
(a) registered under the relevant law as an oral and maxillofacial
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.
Meaning of "report" in Group D1-Miscellaneous diagnostic procedures and
investigations
23. In items 11000 to 12200, "report" means a report prepared by a
medical practitioner.
Meaning of "treatment cycle of a patient"
24. In rule 25 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.
Certain assisted reproductive services provided as part of treatment
cycle
25. 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 provided 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 relating to assisted reproductive services not to apply in
certain pregnancy-related circumstances
26. 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.
Meaning of "embryology laboratory services" in items 13200 and 13206
27. 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.
Meaning of "confinement" in certain items
28. 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.
Certain obstetrical procedures constitute a single operation
29. 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.
Meaning of "maxilla" in certain items
30. In items 45719 to 45752 and 52342 to 52375, "maxilla" includes the
zygoma.
Items 46300 to 46534 apply only in certain circumstances
31. Items 46300 to 46534 apply only to a service provided in the course
of an operation on a hand or hands.
Meaning of "closed reduction" and "open reduction" in items 47000 to
50239
Services in association with spinal fusion services
33. 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.
Meaning of "Amount under rule 34" in items 51303 and 51803
34. In items 51303 and 51803, "Amount under rule 34", 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.
Meaning of "Amount under rule 35" in item 51309
35. (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.
Meaning of "Amount under rule 36" in item 18219
36. (1) In item 18219, "Amount under rule 36" 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 $13.70 for each additional period of 15 minutes, or
part of a period of 15 minutes, for continuous attendance by the
medical practitioner beyond the first hour.
Histopathological proof of malignancy in certain cases for purposes of
certain items relating to surgical procedures
37. 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.
Meaning of "Amount under rule 38" in item 16633
38. In item 16633 "Amount under rule 38" means the amount equal to the
sum of:
(a) the fee specified in an item in the series 16600 to 16627 for
provision of the relevant service in relation to a foetus; and
(b) 50% of that fee for each additional foetus in relation to whom that
service is provided.
Meaning of "Amount under rule 39" in item 51312
39. In item 51312 "Amount under rule 39", in relation to an amount
payable for assistance at a procedure, means an amount equal to 20% of
the sum of the fees payable under the Act for the services at that
procedure of the practitioner to whom the assistance was given.
PART 2-SERVICES AND FEES
ATTENDANCES
GROUP A1-GENERAL PRACTITIONER ATTENDANCES TO WHICH NO
OTHER ITEM APPLIES
Item Service Fee
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 $11.50
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 $28.85
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 7
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 7
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 7
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 $24.30
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 $41.50
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 7
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 7
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 7
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 $43.85
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 $61.15
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 7
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 7
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 7
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 $64.60
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 $81.90
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 7
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 7
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 7
GROUP A2-OTHER NON-REFERRED ATTENDANCES TO WHICH NO
OTHER ITEM APPLIES
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 7
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 7
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 7
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 7
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 7
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 7
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 7
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 7
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 7
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 7
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 7
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 7
GROUP A3-EMERGENCY AFTER HOURS ATTENDANCES TO WHICH
NO OTHER ITEM APPLIES
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 $45.80
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 $45.80
GROUP A4-SPECIALIST ATTENDANCES TO WHICH NO OTHER ITEM APPLIES
104 Professional attendance by a specialist in
the practice of his or her specialty where
the patient is referred to him or her-an
attendance (other than a second or subsequent
attendance in a single course of treatment)
where that attendance is at consulting rooms,
hospital or nursing home, not being a service
to which item 106 applies $61.75
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 $30.90
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 $50.80
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 $90.45
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 $57.20
GROUP A5-CONSULTANT PHYSICIAN ATTENDANCES TO WHICH NO
OTHER ITEM APPLIES
110 Professional attendance at consulting rooms,
hospital or nursing home by a consultant
physician in the practice of his or her
specialty (other than psychiatry) where the
patient is referred to him or her by a
medical practitioner-initial attendance in a
single course of treatment $108.80
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 $54.45
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 $30.90
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 $132.05
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 $79.80
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 $57.45
GROUP A6-CONSULTANT PSYCHIATRIST ATTENDANCES TO WHICH NO
OTHER ITEM APPLIES
134 Professional attendance by a consultant
physician in the practice of his or her
specialty of psychiatry where the patient
is referred to 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 $31.20
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 $62.40
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 $91.45
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 $126.25
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 $153.85
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 $57.30
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 $90.00
148 Professional attendance by a consultant
physician in the practice of his or her
specialty of psychiatry where the patient
is referred to him or her by a medical
practitioner-an attendance of more than
30 minutes duration but not more than
45 minutes duration where that attendance
is at a place other than consulting rooms,
hospital or nursing home $124.80
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 $150.95
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 $179.95
153 Attendance for electroconvulsive therapy,
with or without the use of stimulus dosing
techniques, including any
electroencephalographic monitoring and
associated consultation
(Anaes. 17705 = 4B + 1T) $50.65
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 hours 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 $35.60
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 hours 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 $47.25
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 hours 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 $69.85
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 $37.70
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 $84.85
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 4 times in any 12 month period $37.70
GROUP A7-PROLONGED ATTENDANCES TO WHICH NO OTHER ITEM APPLIES
160 Professional attendance for a period of not
less than 1 hour but less than 2 hours (not
being a service to which any other item applies)
on a patient in imminent danger of death
requiring continuous life saving emergency
treatment (not being treatment of a
counselling nature) to the exclusion of all
other patients $88.10
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
and rigid fixation by bone plates, screws
or both (Anaes. 17732 = 10B + 22T) $1,307.15
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 (Anaes. 17753 = 10B + 43T) $1,278.35
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 (Anaes. 17758 = 10B + 48T) $1,437.35
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 (Anaes.
17758 = 10B + 48T) $1,394.55
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
(Anaes. 17771 = 10B + 61T) $1,562.10
52378 Genioplasty including transposition of
nerves and vessels and bone grafts taken
from the same site (Anaes. 17713 = 5B + 8T) $540.00
52379 Face, contour reconstruction of 1 region, using
autogenous bone or cartilage graft (Anaes.
17713 = 5B + 8T) $922.05
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 (Anaes. 17758 = 10B + 48T) $1,571.45
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 (Anaes. 17764 = 10B + 54T) $1,883.65
52420 Mandible, fixation by intermaxillary wiring,
excluding wiring for obesity $173.90
GROUP O5-PREPROSTHETIC
52600 Mandibular or palatal exostosis, excision of
(Anaes. 17710 = 5B + 5T) $244.05
52603 Mylohyoid ridge, reduction of (Anaes.
17711 = 5B + 6T) $233.20
52606 Maxillary tuberosity, reduction of (Anaes.
17711 = 5B + 6T) $177.90
52609 Papillary hyperplasia of the palate, removal
of-less than 5 lesions (Anaes. 17709 = 5B + 4T) $233.20
52612 Papillary hyperplasia of the palate, removal
of-5 to 20 lesions (Anaes. 17711 = 5B + 6T) $292.85
52615 Papillary hyperplasia of the palate, removal
of-more than 20 lesions (Anaes. 17712 = 5B + 7T) $363.40
52618 Vestibuloplasty, submucosal or open, including
excision of muscle and skin or mucosal graft
when performed-unilateral or bilateral (Anaes.
17713 = 5B + 8T) $423.05
52621 Floor of mouth lowering (Obwegeser or similar
procedure), including excision of muscle and
skin or mucosal graft when performed-unilateral
(Anaes. 17719 = 5B + 14T) $423.05
52624 Alveolar ridge augmentation with bone or
alloplast or both-unilateral (Anaes.
17713 = 5B + 8T) $341.70
52626 Alveolar ridge augmentation-unilateral,
insertion of tissue expanding device into
maxillary or mandibular alveolar ridge region
for (Anaes. 17713 = 5B + 8T) $209.50
52627 Osseo-integration procedure-extra oral
implantation of titanium fixture (Anaes.
17711 = 5B + 6T) $363.40
52630 Osseo-integration procedure-fixation of
transcutaneous abutment (Anaes. 17707 = 5B + 2T) $134.55
GROUP O6-NEUROSURGICAL
52800 Neurolysis by open operation, without
transposition, not being a service associated
with a service to which item 52803 applies
(Anaes. 17707 = 5B + 2T) $199.60
52803 Nerve trunk, internal (interfascicular),
neurolysis of, using microsurgical techniques
(Anaes. 17713 = 5B + 8T) $287.45
52806 Neurectomy, neurotomy or removal of tumour from
superficial peripheral nerve (Anaes.
17708 = 5B + 3T) $199.60
52809 Neurectomy, neurotomy or removal of tumour
from deep peripheral nerve (Anaes. 17709 = 5B + 4T) $341.80
52812 Nerve trunk, primary repair of, using
microsurgical techniques (Anaes. 17713 = 5B + 8T) $488.15
52815 Nerve trunk, secondary repair of, using
microsurgical techniques (Anaes. 17713 = 4B + 9T) $515.25
52818 Nerve, transposition of (Anaes. 17709 = 5B + 4T) $341.80
52821 Nerve graft to nerve trunk (cable graft)
including harvesting of nerve graft using
microsurgical techniques (Anaes. 17718 = 5B + 13T) $743.05
52824 Peripheral branches of the trigeminal nerve,
cryosurgery of, for pain relief (Anaes.
17709 = 5B + 4T) $320.00
GROUP O7-EAR, NOSE AND THROAT
53000 Maxillary antrum, proof puncture and lavage
of (Anaes. 17707 = 5B + 2T) $23.50
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 (Anaes.
17707 = 5B + 2T) $66.35
53006 Antrostomy (radical) (Anaes. 17710 = 5B + 5T) $375.95
53009 Antrum, intranasal operation on or removal of
foreign body from (Anaes. 17709 = 5B + 4T) $213.25
53012 Antrum, drainage of, through tooth socket
(Anaes. 17708 = 5B + 3T) $84.75
53015 Oro-antral fistula, plastic closure of (Anaes.
17712 = 5B + 7T) $423.80
53018 Turbinectomy or turbinectomies, partial or total,
unilateral (Anaes. 17707 = 5B + 2T) $98.45
53019 Maxillary sinus, bone graft to floor of
maxillary sinus following elevation of mucosal
lining (sinus lift procedure), (unilateral)
(Anaes. 17717 = 5B + 12T) $418.95
GROUP O8-TEMPOROMANDIBULAR JOINT
53200 Mandible, treatment of a dislocation of, not
requiring open reduction (Anaes. 17706 = 5B + 1T) $34.20
53203 Mandible, treatment of a dislocation of,
requiring open reduction (Anaes. 17707 = 5B + 2T) $85.65
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 (Anaes.
17706 = 5B + 1T) $103.05
53209 Glenoid fossa, zygomatic arch and temporal bone,
reconstruction of (Obwegeser technique) (Anaes.
17719 = 5B + 14T) $1,189.45
53212 Absent condyle and ascending ramus in hemifacial
microsomia, construction of, not including
harvesting of graft material (Anaes.
17716 = 5B + 11T) $642.60
53215 Temporomandibular joint, arthroscopy of, with
or without biopsy, not being a service
associated with any other arthroscopic procedure
of that joint (Anaes. 17709 = 5B + 4T) $233.20
53218 Temporomandibular joint, arthroscopy of, removal
of loose bodies, debridement, or treatment of
adhesions-1 or more of such procedures (Anaes.
17713 = 5B + 8T) $474.65
53221 Temporomandibular joint, open surgical
exploration of, with or without microsurgical
techniques (Anaes. 17713 = 5B + 8T) $629.20
53224 Temporomandibular joint, open surgical
exploration of, with condylectomy or condylotomy,
with or without microsurgical techniques (Anaes.
17715 = 5B + 10T) $699.65
53225 Arthrocentesis, irrigation of temporomandibular
joint after insertion of 2 cannuli into the
appropriate joint space(s) (Anaes. 17709 = 5B + 4T) $209.50
53227 Temporomandibular joint, open surgical exploration
of, with or without meniscus or capsular surgery,
including meniscectomy when performed, with or
without microsurgical techniques (Anaes.
17717 = 5B + 12T) $857.00
53230 Temporomandibular joint, open surgical
exploration of, with meniscus, capsular and
condylar head surgery, with or without
microsurgical techniques (Anaes. 17721 = 5B + 16T) $965.45
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 (Anaes.
17725 = 5B + 20T) $1,084.75
GROUP O9-TREATMENT OF FRACTURES
53400 Maxilla, unilateral or bilateral, treatment of
fracture of, not requiring splinting $93.20
53403 Mandible, treatment of fracture of, not
requiring splinting $113.90
53406 Maxilla, treatment of fracture of, requiring
splinting, wiring of teeth, circumosseous
fixation or external fixation (Anaes.
17714 = 5B + 9T) $293.30
53409 Mandible, treatment of fracture of, requiring
splinting, wiring of teeth, circumosseous
fixation or external fixation (Anaes.
17714 = 5B + 9T) $293.30
53410 Zygomatic bone, treatment of fracture of, not
requiring surgical reduction $61.85
53411 Zygomatic bone, treatment of fracture of,
requiring surgical reduction, by temporal,
intra-oral or other approach (Anaes.
17707 = 5B + 2T) $172.25
53412 Zygomatic bone, treatment of fracture of,
requiring surgical reduction and involving
internal or external fixation at 1 site (Anaes.
17709 = 5B + 4T) $282.80
53413 Zygomatic bone, treatment of fracture of,
requiring surgical reduction and involving
internal or external fixation or both at 2
sites (Anaes. 17710 = 5B + 5T) $345.65
53414 Zygomatic bone, treatment of, requiring
surgical reduction and involving internal or
external fixation or both at 3 sites (Anaes.
17711 = 5B + 6T) $398.00
53415 Maxilla, treatment of fracture of, requiring
open reduction (Anaes. 17709 = 5B + 4T) $314.25
53416 Mandible, treatment of fracture of, requiring
open reduction (Anaes. 17709 = 5B + 4T $314.25
53418 Maxilla, treatment of fracture of, requiring
open reduction and internal fixation not
involving plate(s) (Anaes. 17711 = 5B + 6T) $408.45
53419 Mandible, treatment of fracture of, requiring
open reduction and internal fixation not
involving plate(s) (Anaes. 17711 = 5B + 6T) $408.45
53422 Maxilla, treatment of fracture of, requiring
open reduction and internal fixation involving
plate(s) (Anaes. 17712 = 5B + 7T) $518.45
53423 Mandible, treatment of fracture of, requiring
open reduction and internal fixation involving
plate(s) (Anaes. 17712 = 5B + 7T) $518.45
53424 Maxilla, treatment of a complicated fracture of,
involving viscera, blood vessels or nerves,
requiring open reduction not involving plate(s)
(Anaes. 17712 = 5B + 7T) $444.80
53425 Mandible, treatment of a complicated fracture
of, involving viscera, blood vessels or nerves,
requiring open reduction not involving plate(s)
(Anaes. 17712 = 5B + 7T) $444.80
53427 Maxilla, treatment of a complicated fracture
of, involving viscera, blood vessels or nerves,
requiring open reduction involving the use of
plate(s) (Anaes. 17714 = 5B + 9T) $607.45
53429 Mandible, treatment of a complicated fracture
of, involving viscera, blood vessels or nerves,
requiring open reduction involving the use of
plate(s) (Anaes. 17714 = 5B + 9T) $607.45
53439 Mandible, treatment of a closed fracture of,
involving a joint surface (Anaes. 17707 = 5B + 2T) $172.25
53453 Orbital cavity, reconstruction of a wall or floor
with or without foreign implant (Anaes.
17713 = 5B + 8T) $348.60
53455 Orbital cavity, bone or cartilage graft to
orbital wall or floor including reduction of
prolapsed or entrapped orbital contents (Anaes.
17715 = 5B + 10T) $409.45
TREATMENT OF CLEFT LIP AND CLEFT PALATE CONDITIONS
GROUP C1-ORTHODONTIC SERVICES
75001 Initial professional attendance in a single
course of treatment by an accredited orthodontist
(AO) $61.75
75004 Professional attendance by an accredited
orthodontist subsequent to the first professional
attendance by the orthodontist in a single course
of treatment (AO) $30.90
75006 Production of dental study models (not being a
service associated with a service to which item
75004 applies) prior to provision of a service to
which:
(a) item 75030, 75033, 75034, 75035, 75036, 75037,
75039, 75045 or 75051 applies; or
(b) an item in Group T8 or Groups O3 to O9 applies;
in a single course of treatment (AO) $55.00
75009 Orthodontic radiography-orthopantomography
(panoramic radiography), including any consultation
on the same occasion (AO) (AOS) $49.15
75012 Orthodontic radiography-anteroposterior
cephalometric radiography with cephalometric
tracings or lateral cephalometric radiography
with cephalometric tracings, including any
consultation on the same occasion (AO) (AOS) $77.85
75015 Orthodontic radiography-anteroposterior and
lateral cephalometric radiography, with
cephalometric tracings, including any consultation
on the same occasion (AO) (AOS) $107.15
75018 Orthodontic radiography-anteroposterior and
lateral cephalometric radiography, with
cephalometric tracings and orthopantomography,
including any consultation on the same occasion
(AO) (AOS) $136.50
75021 Orthodontic radiography-hand-wrist studies
(including growth prediction), including any
consultation on the same occasion (AO) (AOS) $167.35
75023 Intraoral radiography-single area, periapical or
bitewing film (AO) (AOS) $33.45
75024 Pre-surgical infant maxillary arch repositioning,
including supply of appliances, all adjustments of
appliances and supervision-where 1 appliance is
used (AO) $432.90
75027 Pre-surgical infant maxillary arch repositioning,
including supply of appliances, all adjustments
of appliances and supervision-where 2 appliances
are used (AO) $593.55
75030 Maxillary arch expansion not associated with a
service to which item 75039, 75042, 75045 or 75048
applies, including supply of appliances, all
adjustments of the appliances, removal of the
appliances and retention (AO) $528.50
75033 Mixed dentition treatment-incisor alignment using
fixed appliances in maxillary arch, including
supply of appliances, all adjustments of
appliances, removal of the appliances and
retention (AO) $866.15
75034 Mixed dentition treatment-incisor alignment with
or without lateral arch expansion using a
removable appliance in the maxillary arch,
including supply of appliances, associated
adjustments and retention (AO) $440.85
75036 Mixed dentition treatment-lateral arch expansion
and incisor alignment using fixed appliances in
maxillary arch, including supply of appliances,
all adjustments of appliances, removal of
appliances and retention (AO) $1,196.45
75037 Mixed dentition treatment, lateral arch expansion
and incisor correction-2-arch (maxillary and
mandibular) using fixed appliances in both
maxillary and mandibular arches, including supply
of appliances, all adjustments of appliances,
removal of appliances and retention (AO) $1,506.90
75039 Permanent dentition treatment-single arch
(mandibular or maxillary) treatment (correction
and alignment) using fixed appliances, including
supply of appliances-initial 3 months of active
treatment (AO) $400.45
75042 Permanent dentition treatment-single arch
(mandibular or maxillary) treatment (correction and
alignment) using fixed appliances, including supply
of appliances-each 3 months of active treatment
(including all adjustments and maintenance and
removal of the appliances) after the first for a
maximum of a further 33 months (AO) $149.75
75045 Permanent dentition treatment-2-arch (mandibular
and maxillary) treatment (correction and alignment)
using fixed appliances, including supply of
appliances-initial 3 months of active treatment
(AO) $801.70
75048 Permanent dentition treatment-2-arch (mandibular
and maxillary) treatment (correction and alignment)
using fixed appliances, including supply of
appliances-each 3 months of active treatment
(including all adjustments and maintenance, and
removal of the appliances) after the first for a
maximum of a further 33 months (AO) $205.55
75049 Retention, fixed or removable, single arch
(mandibular or maxillary)-supply of retainer and
supervision of retention (AO) $240.60
75050 Retention, fixed or removable, 2-arch (mandibular
or maxillary)-supply of retainers and supervision
of retention (AO) $464.55
75051 Jaw growth guidance using removable or functional
appliances, including supply of appliances and all
adjustments to appliances (AO) $713.10
GROUP C2-ORAL AND MAXILLOFACIAL SURGICAL SERVICES
75150 Initial professional attendance in a single course
of treatment by an accredited oral and maxillofacial
surgeon where the patient is referred to the surgeon
by an accredited orthodontist (AD) $61.75
75153 Professional attendance by an accredited oral and
maxillofacial surgeon subsequent to the first
professional attendance by the surgeon in a single
course of treatment where the patient is referred to
the surgeon by an accredited orthodontist (AD) $30.90
75156 Production of dental study models (not being a
service associated with a service to which item
75153 applies) prior to provision of a service:
(a) to which item 52321, 53212 or 75618 applies; or
(b) to which an item in the series 52300 to 52382,
52600 to 52630, 53400 to 53409 or 53415 to 53429
applies;
in a single course of treatment (AD) $55.00
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) $39.65
75203 Removal of tooth or tooth fragment under general
anaesthesia, where the patient is referred by an
accredited orthodontist (AD) $59.45
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) $19.70
75400 Surgical removal of erupted tooth, where the
patient is referred by an accredited
orthodontist (AOS) $118.90
75403 Surgical removal of tooth with soft tissue
impaction, where the patient is referred by
an accredited orthodontist (AOS) $136.50
75406 Surgical removal of tooth with partial bone
impaction, where the patient is referred by an
accredited orthodontist (AOS) $155.60
75409 Surgical removal of tooth with complete bone
impaction, where the patient is referred by an
accredited orthodontist (AOS) $176.15
75412 Surgical removal of tooth fragment requiring
incision of soft tissue only, where the patient
is referred by an accredited orthodontist (AOS) $98.40
75415 Surgical removal of tooth fragment requiring
removal of bone, where the patient is referred
by an accredited orthodontist (AOS) $118.90
75600 Surgical exposure, stimulation and packing of
unerupted tooth, where the patient is referred
by an accredited orthodontist (AOS) $167.35
75603 Surgical exposure of unerupted tooth for the
purpose of fitting a traction device, where the
patient is referred by an accredited orthodontist
(AOS) $196.70
75606 Surgical repositioning of unerupted tooth, where
the patient is referred by an accredited
orthodontist (AOS) $196.70
75609 Transplantation of tooth bud, where the patient is
referred by an accredited orthodontist (AOS) $293.65
75612 Surgical procedure for intra oral implantation of
osseointegrated fixture (first stage) (AOS) $363.40
75615 Surgical procedure for fixation of trans-mucosal
abutment (second stage of osseointegrated implant)
(AOS) $134.55
75618 Provision and fitting of a bite rising appliance
or dental splint for the management of
temporomandibular joint dysfunction syndrome (AOS) $167.00
75621 Provision and fitting of a surgical template in
conjunction with orthognathic surgical procedures
in association with:
(a) an item in the series 52342 to 52375; or
(b) item 52380 or 52382; (AOS) $167.00
GROUP C3-GENERAL AND PROSTHODONTIC SERVICES
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) $59.45
75803 Provision and fitting of acrylic base partial
denture, including retainers-1 tooth (AD) $237.85
75806 Provision and fitting of acrylic base partial
denture, including retainers-2 teeth (AD) $278.95
75809 Provision and fitting of acrylic base partial
denture, including retainers-3 teeth (AD) $330.30
75812 Provision and fitting of acrylic base partial
denture, including retainers-4 teeth (AD) $367.00
75815 Provision and fitting of acrylic base partial
denture, including retainers-5 to 9 teeth (AD) $447.75
75818 Provision and fitting of acrylic base partial
denture, including retainers-10 to 12 teeth (AD) $528.50
75821 Provision and fitting of cast metal base (cobalt
chromium alloy) partial denture including casting
and retainers-1 tooth (AD) $425.75
75824 Provision and fitting of cast metal base (cobalt
chromium alloy) partial denture including casting
and retainers-2 teeth (AD) $491.80
75827 Provision and fitting of cast metal base (cobalt
chromium alloy) partial denture including casting
and retainers-3 teeth (AD) $565.20
75830 Provision and fitting of cast metal base (cobalt
chromium alloy) partial denture including casting
and retainers-4 teeth (AD) $623.90
75833 Provision and fitting of cast metal base (cobalt
chromium alloy) partial denture including casting
and retainers-5 to 9 teeth (AD) $763.35
75836 Provision and fitting of cast metal base (cobalt
chromium alloy) partial denture including casting
and retainers-10 to 12 teeth (AD) $873.50
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) $19.70
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) $29.35
75845 Relining of partial denture by laboratory process
and associated fitting (AD) $146.80
75848 Remodelling and fitting of partial denture of more
than 4 teeth (AD) $176.15
75851 Repair to cast metal base of partial denture-1 or
more points (AD) $88.10
75854 Addition of a tooth or teeth to a partial denture
to replace extracted tooth or teeth, including
taking of necessary impression (AD) $88.10
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