Health Insurance (1996-97 General Medical Services Table) Regulations (Cth)
made under the
This compilation was prepared on 1 August 2001
taking into account amendments up to SR 1997 No. 88
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 (1996-97 General Medical Services Table) Regulations.
These Regulations commence on 1 November 1996.
Statutory Rules 1995 Nos. 298 and 350 and 1996 No. 106 are repealed.
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 .
(regulation 4)
(1) In this table, unless the contrary intention appears:
Act means theHealth Insurance Act 1973 .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.
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.
comprehensive hyperbaric medicine facility means a separate hospital area that, on a 24 hour basis:(a) is equipped and staffed so that it is capable of providing to a patient:
(i) hyperbaric oxygen therapy at a treatment pressure of at least 2.8 atmospheric pressure absolute (180 kilopascal gauge pressure); and
(ii) mechanical ventilation and invasive cardiovascular monitoring within a multiplace chamber for the duration of the hyperbaric treatment; and
(b) is supported by:
(i) at least 1 specialist anaesthetist, consultant physician or medical practitioner who holds the Diploma of Diving and Hyperbaric Medicine of the South Pacific Underwater Medicine Society, and who is rostered and immediately available to the hyperbaric facility during normal working hours; and
(ii) a registered medical practitioner who is present in the hospital and immediately available to the facility at all times when patients are being treated at the hyperbaric facility; and
(iii) a registered nurse with specific training in hyperbaric patient care to the published standards of the Hyperbaric Technicians and Nurses Association, and who is present during hyperbaric oxygen therapy; and
(c) has defined admission and discharge policies.
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.
(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 61503 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.
(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 within the meaning of the Health Insurance Regulations, 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).
(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 31 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.
In items 1 to 172, 300 to 338, 348 to 352 and 10900 to 10929
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.
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 andn2 are other numbers;the service that is provided by the medical practitioner who administers the anaesthetic is the service described in item n.
(1) In items 104 to 131 and 300 to 352, 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 within the meaning of the Health Insurance Regulations, 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 131 and 300 to 352, 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.
(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 $17.35 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 $17.35 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 $17.35 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 $17.35 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) or 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 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.
(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.
(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 1 to 164, 173 to 340, 348 to 10815, 11012, 11015, 11018, 11021, 11212, 11304, 11500, 11600, 11601, 11627, 11701,11712, 11921, 12000, 12003, 13030, 13100, 13103, 13106, 13109, 13112, 13209, 13300, 13303, 13306, 13309, 13312, 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, 14100, 14103, 14106, 14109, 14112, 14115, 14118, 14200, 14203, 14206, 14209, 14212, 16000 to 16512 and 16515 to 51312.
(3) Items 170, 171, 172, 342, 344 and 346 apply only to a service provided in the course of a personal attendance by a medical practitioner.
(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 1 to 10815, 11012, 11015, 11018, 11021, 11212, 11304, 11500, 11600, 11601, 11627, 11701, 11712, 11921, 12000, 12003, 13030, 13100, 13103, 13106, 13109, 13112, 13209, 13300, 13303, 13306, 13309, 13312, 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, 14100, 14103, 14106, 14109, 14112, 14115, 14118, 14200, 14203, 14206, 14209, 14212, 16000 to 16512 and 16515 to 51312.
(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, 11235, 11300, 11303, 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, 12012, 12015, 12018, 12021, 12200, 12203, 12206, 12500 to 12533, 13020, 13025, 13200, 13203, 13206, 13212, 13215, 13218, 13221, 13750, 13755, 13760, 13915 to 13948, 14050, 14053, 15000 to 15536 and 16514.
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.
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.
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) 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) Royal Perth Hospital, Perth, Western Australia;
(q) Royal Hobart Hospital, Hobart, Tasmania;
(r) The Canberra Hospital, Garran, Australian Capital Territory.
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 — $12.55 for each field separately treated in excess of 1 up to a maximum of 5 additional fields; or
(ii) for item 15103 — $13.85 for each field separately treated in excess of 1 up to a maximum of 5 additional fields; or
(iii) for item 15109 — $16.65 for each field separately treated in excess of 1 up to a maximum of 5 additional fields; or
(iv) for item 15204 — $21.85 for each field separately treated in excess of 1 up to a maximum of 5 additional fields; or
(v) for item 15208 — $21.85 for each field separately treated in excess of 1 up to a maximum of 5 additional fields; or
(vi) for item 15214 — $18.35 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 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 — $13.65 for each field separately treated in excess of 1 up to a maximum of 5 additional fields; or
(ii) for item 15115 — $34.65 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 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).
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.
(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 theNational 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.
(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 75150 to 75621 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.
In items 11000 to 12206,
report means a report prepared by a medical practitioner.
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.
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 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 16515 and 16519,
delivery 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) evacuation of the products of conception by manual removal.
The procedures mentioned in item 16519, 16520, 16564, 16567, 16570, 16571 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 46534 apply only to a service provided in the course of an operation on a hand or hands.
(1) Items 51300 to 51312 apply only to assistance rendered by a medical practitioner other than:
(a) the practitioner performing the operation; or
(b) the anaesthetist administering the anaesthetic in connection with the operation, if any; or
(c) the assistant anaesthetist, if any.
(2) Items 51800 and 51803 apply only to assistance rendered by an approved dental practitioner other than:
(a) the practitioner performing the operation; or
(b) the anaesthetist administering the anaesthetic in connection with the operation, if any; or
(c) the assistant anaesthetist, if any.
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 34 , in relation to an amount payable for assistance at an operation or series of operations, means an amount equal to 20% of the sum of the fees payable under the Act for the services at that operation or series of operations of the practitioner to whom the assistance was given.
(1) In item 51309,
Amount under rule 35 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 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 $13.95 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.
For the purposes of items 30196 to 30205, the requirement for histopathological proof of malignancy is satisfied where multiple lesions are to be removed from the 1 anatomical region if a single lesion from that region is histologically tested and proven positive for malignancy.
In items 16633 and 16636,
Amount under rule 38 means the amount that is equal to 50% of the amount of the fee for the service specified in an item specified in those items that is provided in relation to the second, or to a subsequent, foetus of a multiple pregnancy.
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.
In item 31340
Amount under rule 40 , in relation to an amount payable for the excision of muscle, bone or cartilage in association with the excision of a malignant tumour of skin under another item, means an amount equal to 75% of the fee payable under that other item.
In item 17503,
Amount under rule 41 , for an amount payable for assistance in the administration of an anaesthetic, means an amount equal to 30% of the fee for the services at that treatment of the anaesthetist to whom the assistance was given.
In item 51318,
previous significant surgical complication means:
(a) vitreous loss; or
(b) rupture of posterior capsule; or
(c) loss of nuclear material into the vitreous; or
(d) intraocular haemorrhage; or
(e) intraocular infection (endophthalmitis); or
(f) cystoid macular oedema; or
(g) corneal decompensation; or
(h) retinal detachment.
1 | Professional attendance, being an attendance at other than consulting rooms, by a general practitioner on not more than 1 patient on 1 occasion — 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 | $46.20 | |
2 | Professional attendance, being an attendance at consulting rooms, by a general practitioner on not more than 1 patient on 1 occasion — 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, and where it is necessary for the doctor to return to, and specially open, consulting rooms for the attendance | $46.20 | |
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 | $11.60 | |
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 | $29.10 | |
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 | ||
$24.50 | |||
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 | $41.85 | |
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 | $44.25 | |
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 | $61.70 | |
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 | $65.20 | |
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 | $82.65 | |
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 omprehensive 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 | |
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 | |
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 | $46.20 | |
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 | $46.20 | |
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 | $62.85 | |
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 | $31.45 | |
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 | $51.70 | |
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 | $92.10 | |
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 | ||
$58.25 | |||
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 | $110.75 | |
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 | $55.45 | |
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 | $31.45 | |
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 | $134.45 | |
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 | $81.25 | |
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 | $58.50 | |
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 attendance on the patient to the exclusion of all other patients | $150.00 | |
161 | Professional attendance for a period of not less than 2 hours but less than 3 hours (not being a service to which any other item applies) on a patient in imminent danger of death requiring continuous attendance on the patient to the exclusion of all other patients | $250.00 | |
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 attendance on the patient to the exclusion of all other patients | $350.00 | |
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 attendance on the patient to the exclusion of all other patients | $450.00 | |
164 | Professional attendance for a period of 5 hours or more (not being a service to which any other item applies) on a patient in imminent danger of death requiring continuous attendance on the patient to the exclusion of all other patients | $500.00 | |
170 | Professional attendance for the purpose of group therapy of not less than 1 hours 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 | $93.45 | |
171 | Professional attendance for the purpose of group therapy of not less than 1 hours 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 | $98.50 | |
172 | Professional attendance for the purpose of group therapy of not less than 1 hours 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 | $119.80 | |
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 | $21.65 | |
300 | 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 at consulting rooms, where that attendance and any other attendance to which item 302, 304, 306 or 308 applies have not exceeded the sum of 50 attendances in a 12 month period | $31.75 | |
302 | 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 at consulting rooms, where that attendance and any other attendance to which item 300, 304, 306 or 308 applies have not exceeded the sum of 50 attendances in a 12 month period | $63.50 | |
304 | 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 at consulting rooms, where that attendance and any other attendance to which item 300, 302, 306 or 308 applies have not exceeded the sum of 50 attendances in a 12 month period | $93.10 | |
306 | 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 at consulting rooms, where that attendance and any other attendance to which item 300, 302, 304 or 308 applies have not exceeded the sum of 50 attendances in a 12 month period | $128.50 | |
308 | 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 at consulting rooms, where that attendance and any other attendance to which item 300, 302, 304 or 306 applies have not exceeded the sum of 50 attendances in a 12 month period | $156.60 | |
310 | 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 at consulting rooms, where that attendance and any other attendance to which item 300, 302, 304, 306, 308, 312, 314, 316 or 318 applies exceed 50 attendances in a 12 month period | $15.90 | |
312 | 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 at consulting rooms, where that attendance and any other attendance to which item 300, 302, 304, 306, 308, 310, 314, 316 or 318 applies exceed 50 attendances in a 12 month period | $31.75 | |
314 | 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 at consulting rooms, where that attendance and any other attendance to which item 300, 302, 304, 306, 308, 310, 312, 316 or 318 applies exceed 50 attendances in a 12 month period | $46.55 | |
316 | 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 at consulting rooms, where that attendance and any other attendance to which item 300, 302, 304, 306, 308, 310, 312, 314 or 318 applies exceed 50 attendances in a 12 month period | $64.25 | |
318 | 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 at consulting rooms, where that attendance and any other attendance to which item 300, 302, 304, 306, 308, 310, 312, 314 or 316 applies exceed 50 attendances in a 12 month period | $78.30 | |
319 | An attendance of more than 45 minutes duration at consulting rooms, where that attendance and any other attendance to which item 300 to 308 or 319 applies exceed 50 but not more than 160 attendances in a 12 month period and where the patient has: (a) a history of severe sexual or physical abuse which has led to psychiatric illness, or has been diagnosed as suffering from borderline personality disorder or anorexia nervosa or bulimia nervosa; and (b) been rated with a level of functional impairment within the range 1 to 50 according to the Global Assessment of Functioning Scale; and (c) a history of failed related psychiatric treatment | $128.50 | |
320 | 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 at a hospital or nursing home | $31.75 | |
322 | 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 at a hospital or nursing home | $63.50 | |
324 | 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 at a hospital or nursing home | $93.10 | |
326 | 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 at a hospital or nursing home | $128.50 | |
328 | 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 at a hospital or nursing home | $156.60 | |
330 | 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 | $58.35 | |
332 | 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 | $91.60 | |
334 | 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 | $127.05 | |
336 | 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 | $153.65 | |
338 | 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 | $183.20 | |
340 | Attendance for electroconvulsive therapy, with or without the use of stimulus dosing techniques, including any electroencephalographic monitoring and associated consultation (Anaes. 17705 = 4B + 1T) | $51.55 | |
342 | 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 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 | $36.25 | |
344 | 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 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 | $48.10 | |
346 | 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 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 | $71.10 | |
348 | 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 | $38.40 | |
350 | 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 | $86.40 | |
352 | 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 | $38.40 | |
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 | $89.45 | |
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 | $89.45 | |
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 | $89.45 | |
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 | $89.45 | |
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) | $89.45 | |
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 | $89.45 | |
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 | $89.45 | |
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 | $89.45 | |
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 | ||
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 (Anaes. 17711 = 5B + 6T) (Assist.) | $347.95 | |
52324 | Direct flap repair, using tongue, first stage (Anaes. 17711 = 5B + 6T) (Assist.) | $347.95 | |
52327 | Direct flap repair, using tongue, second stage (Anaes. 17711 = 5B + 6T) | $172.60 | |
52330 | Palatal defect (oro-nasal fistula), plastic closure of, including services to which item 52300, 52303, 52306 or 52324 applies (Anaes. 17716 = 7B + 9T) (Assist.) | $574.20 | |
52333 | Cleft palate, primary repair (Anaes. 17715 = 7B + 8T) (Assist.) | $574.20 | |
52336 | Cleft palate, secondary repair, closure of fistula using local flaps (Anaes. 17714 = 7B + 7T) (Assist.) | $358.90 | |
52337 | Alveolar cleft (congenital) unilateral, grafting of, including plastic closure of associated oro-nasal fistulae and ridge augmentation (Anaes. 17714 = 7B + 7T) (Assist.) | $785.00 | |
52339 | Cleft palate, secondary repair, lengthening procedure (Anaes. 17713 = 7B + 6T) (Assist.) | $408.65 | |
52342 | Mandible or maxilla, unilateral osteotomy or osteectomy of, including transposition of nerves and vessels and bone grafts taken from the same site (Anaes. 17718 = 10B + 8T) (Assist.) | $709.85 | |
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 (Anaes. 17720 = 10B + 10T) (Assist.) | $800.60 | |
52348 | Mandible or maxilla, bilateral osteotomy or osteectomy of, including transposition of nerves and vessels and bone grafts taken from the same site (Anaes. 17725 = 10B + 15T) (Assist.) | $904.70 | |
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 (Anaes. 17729 = 10B + 19T) (Assist.) | $1015.95 | |
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 (Anaes. 17729 = 10B + 19T) (Assist.) | $1029.95 | |
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 (Anaes. 17732 = 10B + 22T) (Assist.) | $1159.55 | |
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 (Anaes. 17726 = 10B + 16T) (Assist.) | $1183.00 | |
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 (Anaes. 17732 = 10B + 22T) (Assist.) | $1330.70 | |
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) (Assist.) | $1301.35 | |
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) (Assist.) | $1463.20 | |
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) (Assist.) | $1419.65 | |
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) (Assist.) | $1590.20 | |
52378 | Genioplasty including transposition of nerves and vessels and bone grafts taken from the same site (Anaes. 17713 = 5B + 8T) (Assist.) | $549.70 | |
52379 | Face, contour reconstruction of 1 region, using autogenous bone or cartilage graft (Anaes. 17713 = 5B + 8T) (Assist.) | $938.65 | |
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) (Assist.) | $1599.75 | |
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) (Assist.) | $1917.55 | |
52420 | Mandible, fixation by intermaxillary wiring, excluding wiring for obesity | $177.05 | |
52600 | Mandibular or palatal exostosis, excision of (Anaes. 17710 = 5B + 5T) (Assist.) | $248.45 | |
52603 | Mylohyoid ridge, reduction of (Anaes. 17711 = 5B + 6T) (Assist.) | $237.40 | |
52606 | Maxillary tuberosity, reduction of (Anaes. 17711 = 5B + 6T) | $181.10 | |
52609 | Papillary hyperplasia of the palate, removal of — less than 5 lesions (Anaes. 17709 = 5B + 4T) (Assist.) | $237.40 | |
52612 | Papillary hyperplasia of the palate, removal of — 5 to 20 lesions (Anaes. 17711 = 5B + 6T) (Assist.) | $298.10 | |
52615 | Papillary hyperplasia of the palate, removal of — more than 20 lesions (Anaes. 17712 = 5B + 7T) (Assist.) | $369.95 | |
52618 | Vestibuloplasty, submucosal or open, including excision of muscle and skin or mucosal graft when performed — unilateral or bilateral (Anaes. 17713 = 5B + 8T) (Assist.) | $430.65 | |
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) (Assist.) | $430.65 | |
52624 | Alveolar ridge augmentation with bone or alloplast or both — unilateral (Anaes. 17713 = 5B + 8T) (Assist.) | $347.85 | |
52626 | Alveolar ridge augmentation — unilateral, insertion of tissue expanding device into maxillary or mandibular alveolar ridge region for (Anaes. 17713 = 5B + 8T) (Assist.) | $213.25 | |
52627 | Osseo-integration procedure — extra oral implantation of titanium fixture (Anaes. 17711 = 5B + 6T) (Assist.) | $369.95 | |
52630 | Osseo-integration procedure — fixation of transcutaneous abutment (Anaes. 17707 = 5B + 2T) | $136.95 | |
52633 | Osseo-integration procedure — intra-oral implantation of titanium fixture to facilitate restoration of the dentition following resection of part of the maxilla or mandible for benign or malignant tumours (Anaes. 17711 = 6B + 5T) | $369.95 | |
52636 | Osseo-integration procedure — fixation of transmucosal abutment to fixtures placed following resection of part of the maxilla or mandible for benign or malignant tumours (Anaes. 17706 = 4B + 2T) | $136.95 | |
52800 | Neurolysis by open operation, without transposition, not being a service associated with a service to which item 52803 applies (Anaes. 17707 = 5B + 2T) (Assist.) | $203.20 | |
52803 | Nerve trunk, internal (interfascicular), neurolysis of, using microsurgical techniques (Anaes. 17713 = 5B + 8T) (Assist.) | $292.60 | |
52806 | Neurectomy, neurotomy or removal of tumour from superficial peripheral nerve (Anaes. 17708 = 5B + 3T) (Assist.) | $203.20 | |
52809 | Neurectomy, neurotomy or removal of tumour from deep peripheral nerve (Anaes. 17709 = 5B + 4T) (Assist.) | $347.95 | |
52812 | Nerve trunk, primary repair of, using microsurgical techniques (Anaes. 17713 = 5B + 8T) (Assist.) | $496.95 | |
52815 | Nerve trunk, secondary repair of, using microsurgical techniques (Anaes. 17713 = 4B + 9T) (Assist.) | $524.50 | |
52818 | Nerve, transposition of (Anaes. 17709 = 5B + 4T) (Assist.) | $347.95 | |
52821 | Nerve graft to nerve trunk (cable graft) including harvesting of nerve graft using microsurgical techniques (Anaes. 17718 = 5B + 13T) (Assist.) | $756.40 | |
52824 | Peripheral branches of the trigeminal nerve, cryosurgery of, for pain relief (Anaes. 17709 = 5B + 4T) (Assist.) | $325.75 | |
53000 | Maxillary antrum, proof puncture and lavage of (Anaes. 17707 = 5B + 2T) | $23.90 | |
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) | $67.55 | |
53006 | Antrostomy (radical) (Anaes. 17710 = 5B + 5T) (Assist.) | $382.70 | |
53009 | Antrum, intranasal operation on or removal of foreign body from (Anaes. 17709 = 5B + 4T) (Assist.) | $217.10 | |
53012 | Antrum, drainage of, through tooth socket (Anaes. 17708 = 5B + 3T) | $86.30 | |
53015 | Oro-antral fistula, plastic closure of (Anaes. 17712 = 5B + 7T) (Assist.) | $431.45 | |
53016 | Nasal septum, septoplasty, submucous resection or closure of septal perforation (Anaes. 17708 = 5B + 3T) (Assist.) | $354.85 | |
53018 | Turbinectomy or turbinectomies, partial or total, unilateral (Anaes. 17707 = 5B + 2T) | $100.20 | |
53019 | Maxillary sinus, bone graft to floor of maxillary sinus following elevation of mucosal lining (sinus lift procedure), (unilateral) (Anaes. 17717 = 5B + 12T) (Assist.) | $426.50 | |
53200 | Mandible, treatment of a dislocation of, not requiring open reduction (Anaes. 17706 = 5B + 1T) | $34.80 | |
53203 | Mandible, treatment of a dislocation of, requiring open reduction (Anaes. 17707 = 5B + 2T) | $87.20 | |
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) | $104.90 | |
53209 | Glenoid fossa, zygomatic arch and temporal bone, reconstruction of (Obwegeser technique) (Anaes. 17719 = 5B + 14T) (Assist.) | $1210.85 | |
53212 | Absent condyle and ascending ramus in hemifacial microsomia, construction of, not including harvesting of graft material (Anaes. 17716 = 5B + 11T) (Assist.) | $654.15 | |
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) (Assist.) | $300.00 | |
53218 | Temporomandibular joint, arthroscopy of, removal of loose bodies, debridement, or treatment of adhesions — 1 or more of such procedures (Anaes. 17713 = 5B + 8T) (Assist.) | $480.00 | |
53221 | Temporomandibular joint, open surgical exploration of, with or without microsurgical techniques (Anaes. 17713 = 5B + 8T) (Assist.) | $640.55 | |
53224 | Temporomandibular joint, open surgical exploration of, with condylectomy or condylotomy, with or without microsurgical techniques (Anaes. 17715 = 5B + 10T) (Assist.) | $710.00 | |
53225 | Arthrocentesis, irrigation of temporomandibular joint after insertion of 2 cannuli into the appropriate joint space(s) (Anaes. 17709 = 5B + 4T) (Assist.) | $213.25 | |
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) (Assist.) | $872.45 | |
53230 | Temporomandibular joint, open surgical exploration of, with meniscus, capsular and condylar head surgery, with or without microsurgical techniques (Anaes. 17721 = 5B + 16T) (Assist.) | $982.85 | |
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) (Assist.) | $1104.30 | |
53400 | Maxilla, unilateral or bilateral, treatment of fracture of, not requiring splinting | $94.90 | |
53403 | Mandible, treatment of fracture of, not requiring splinting | $115.95 | |
53406 | Maxilla, treatment of fracture of, requiring splinting, wiring of teeth, circumosseous fixation or external fixation (Anaes. 17714 = 5B + 9T) (Assist.) | $298.60 | |
53409 | Mandible, treatment of fracture of, requiring splinting, wiring of teeth, circumosseous fixation or external fixation (Anaes. 17714 = 5B + 9T) (Assist.) | $298.60 | |
53410 | Zygomatic bone, treatment of fracture of, not requiring surgical reduction | $62.95 | |
53411 | Zygomatic bone, treatment of fracture of, requiring surgical reduction, by temporal, intra-oral or other approach (Anaes. 17707 = 5B + 2T) | $175.35 | |
53412 | Zygomatic bone, treatment of fracture of, requiring surgical reduction and involving internal or external fixation at 1 site (Anaes. 17709 = 5B + 4T) (Assist.) | $287.90 | |
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) (Assist.) | $351.85 | |
53414 | Zygomatic bone, treatment of, requiring surgical reduction and involving internal or external fixation or both at 3 sites (Anaes. 17711 = 5B + 6T) (Assist.) | $405.15 | |
53415 | Maxilla, treatment of fracture of, requiring open reduction (Anaes. 17709 = 5B + 4T) (Assist.) | $319.90 | |
53416 | Mandible, treatment of fracture of, requiring open reduction (Anaes. 17709 = 5B + 4T) (Assist.) | $319.90 | |
53418 | Maxilla, treatment of fracture of, requiring open reduction and internal fixation not involving plate(s) (Anaes. 17711 = 5B + 6T) (Assist.) | $415.80 | |
53419 | Mandible, treatment of fracture of, requiring open reduction and internal fixation not involving plate(s) (Anaes. 17711 = 5B + 6T) (Assist.) | $415.80 | |
53422 | Maxilla, treatment of fracture of, requiring open reduction and internal fixation involving plate(s) (Anaes. 17712 = 5B + 7T) (Assist.) | $527.80 | |
53423 | Mandible, treatment of fracture of, requiring open reduction and internal fixation involving plate(s) (Anaes. 17712 = 5B + 7T) (Assist.) | $527.80 | |
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) (Assist.) | $452.80 | |
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) (Assist.) | $452.80 | |
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) (Assist.) | $618.40 | |
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) (Assist.) | $618.40 | |
53439 | Mandible, treatment of a closed fracture of, involving a joint surface (Anaes. 17707 = 5B + 2T) | $175.35 | |
53453 | Orbital cavity, reconstruction of a wall or floor with or without foreign implant (Anaes. 17713 = 5B + 8T) (Assist.) | $354.85 | |
53455 | Orbital cavity, bone or cartilage graft to orbital wall or floor including reduction of prolapsed or entrapped orbital contents (Anaes. 17715 = 5B + 10T) | ||
53458 | Nasal bones, treatment of fracture of, not being a service to which item 53459 or 53460 applies | $31.50 | |
53459 | Nasal bones, treatment of fracture of, by reduction (Anaes. 17707 = 5B + 2T) | $172.85 | |
53460 | Nasal bones, treatment of fractures of, by open reduction involving osteotomies (Anaes. 17710 = 5B + 5T) (Assist.) | $352.60 | |
75001 | Initial professional attendance in a single course of treatment by an accredited orthodontist (AO) | $62.85 | |
75004 | Professional attendance by an accredited orthodontist subsequent to the first professional attendance by the orthodontist in a single course of treatment (AO) | $31.45 | |
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, 75036, 75037, 75039, 75045 or 75051 applies; or (b) an item in group T8 or groups 03 to 09 applies; in a single course of treatment (AO) | $56.00 | |
75009 | Orthodontic radiography — orthopantomography (panoramic radiography), including any consultation on the same occasion (AOS) (AO) | $50.05 | |
75012 | Orthodontic radiography — anteroposterior cephalometric radiography with cephalometric tracings or lateral cephalometric radiography with cephalometric tracings including any consultation on the same occasion (AOS) (AO) | $79.25 | |
75015 | Orthodontic radiography — anteroposterior and lateral cephalometric radiography, with cephalometric tracings including any consultation on the same occasion (AOS) (AO) | $109.10 | |
75018 | Orthodontic radiography — anteroposterior and lateral cephalometric radiography, with cephalometric tracings and orthopantomography including any consultation on the same occasion (AOS) (AO) | $138.95 | |
75021 | Orthodontic radiography — hand-wrist studies (including growth prediction) including any consultation on the same occasion (AO) | $170.35 | |
75023 | Intraoral radiography — single area, periapical or bitewing film (AO) | $34.05 | |
75024 | Pre-surgical infant maxillary arch repositioning, including supply of appliances and all adjustments of appliances and supervision — where 1 appliance is used (AO) | $440.70 | |
75027 | Pre-surgical infant maxillary arch repositioning, including supply of appliances and all adjustments of appliances and supervision — where 2 appliances are used (AO) | $604.25 | |
75030 | Maxillary ach expansion not being a service 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) | $538.00 | |
75033 | Mixed dentition treatment — incisor alignment using fixed applicances in maxillary arch, including supply of appliances, all adjustments of appliances, removal of the appliances and retention (AO) | $881.75 | |
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) | $448.80 | |
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) | $1218.00 | |
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) | $1534.00 | |
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) | $407.65 | |
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) | $152.45 | |
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) | $816.15 | |
75048 | Permanent dentition treatment — 2 arch (mandibular and maxillary) treatment (correction and alignment) using fixed appliances, including supply of appliances — each subsequent 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) | ||
$209.25 | |||
75049 | Retention, fixed or removable, single arch (mandibular or maxillary) — supply of retainer and supervision of retention (AO) | $244.95 | |
75050 | Retention, fixed or removable, 2-arch (mandibular and maxillary) — supply of retainers and supervision of retention (AO) | $472.90 | |
75051 | Jaw growth guidance using removable or functional appliances, including supply of appliances and all adjustments to appliances (AO) | $725.95 | |
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) | $62.85 | |
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) | $31.45 | |
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 52330 to 52382, 52600 to 52630, 53400 to 53409 or 53415 to 53429 applies; in a single course of treatment (AD) | $56.00 | |
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) | $40.35 | |
75203 | Removal of tooth or tooth fragment under general anaesthesia, where the patient is referred by an accredited orthodontist (AD) | $60.50 | |
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) | $20.05 | |
75400 | Surgical removal of erupted tooth, where the patient is referred by an accredited orthodontist (AOS) | $121.05 | |
75403 | Surgical removal of tooth with soft tissue impaction, where the patient is referred by an accredited orthodontist (AOS) | $138.95 | |
75406 | Surgical removal of tooth with partial bone impaction, where the patient is referred by an accredited orthodontist (AOS) | $158.40 | |
75409 | Surgical removal of tooth with complete bone impaction, where the patient is referred by an accredited orthodontist (AOS) | $179.30 | |
75412 | Surgical removal of tooth fragment requiring incision of soft tissue only, where the patient is referred by an accredited orthodontist (AOS) | $100.15 | |
75415 | Surgical removal of tooth fragment requiring removal of bone, where the patient is referred by an accredited orthodontist (AOS) | $121.05 | |
75600 | Surgical exposure, stimulation and packing of unerupted tooth, where the patient is referred by an accredited orthodontist (AOS) | $170.35 | |
75603 | Surgical exposure of unerupted tooth for the purpose of fitting a traction device, where the patient is referred by an accredited orthodontist (AOS) | $200.25 | |
75606 | Surgical repositioning of unerupted tooth, where the patient is referred by an accredited orthodontist (AOS) | $200.25 | |
75609 | Transplantation of tooth bud, where the patient is referred by an accredited orthodontist (AOS) | $298.95 | |
75612 | Surgical procedure for intra oral implantation of osseointegrated fixture (first stage) (AOS) | $369.95 | |
75615 | Surgical procedure for fixation of trans-mucosal abutment (second stage of osseointegrated implant) (AOS) | $136.95 | |
75618 | Provision and fitting of a bite rising appliance or dental splint for the management of temporomandibular joint dysfunction syndrome (AOS) | $170.00 | |
75621 | The provision and fitting of surgical template in conjuction with orthognathic surgical procedures in association with: (a) an item in the series 52342 to 52375; or (b) item 52380 or 52382 (AOS) | $170.00 | |
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) | $60.50 | |
75803 | Provision and fitting of acrylic base partial denture, including retainers — 1 tooth (AD) | $242.15 | |
75806 | Provision and fitting of acrylic base partial denture, including retainers — 2 teeth (AD) | $283.95 | |
75809 | Provision and fitting of acrylic base partial denture, including retainers — 3 teeth (AD) | $336.25 | |
75812 | Provision and fitting of acrylic base partial denture, including retainers — 4 teeth (AD) | $373.60 | |
75815 | Provision and fitting of acrylic base partial denture, including retainers — 5 to 9 teeth (AD) | $455.80 | |
75818 | Provision and fitting of acrylic base partial denture, including retainers — 10 to 12 teeth (AD) | $538.00 | |
75821 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 1 tooth (AD) | $433.40 | |
75824 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 2 teeth (AD) | $500.65 | |
75827 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 3 teeth (AD) | $575.35 | |
75830 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 4 teeth (AD) | $635.15 | |
75833 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 5 to 9 teeth (AD) | $777.10 | |
75836 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 10 to 12 teeth (AD) | $889.20 | |
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) | $20.05 | |
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) | $29.90 | |
75845 | Relining of partial denture by laboratory process and associated fitting (AD) | $149.45 | |
75848 | Remodelling and fitting of partial denture of more than 4 teeth (AD) | $179.30 | |
75851 | Repair to cast metal base of partial denture — 1 or more points (AD) | $89.70 | |
75854 | Addition of a tooth or teeth to a partial denture to replace extracted tooth or teeth, including taking of necessary impression (AD) | $89.70 | |
The Health Insurance
(1996-97 General Medical Services Table) Regulations (in force under the
1996 No. 230 | 30 Oct 1996 | 1 Nov 1996 | |
1997 No. 88 | 1 May 1997 | 1 May 1997 | — |
1997 No. 298 | 31 Oct 1997 | 1 Nov 1997 | — |
| |
Schedule................................. | am. 1997 No. 88 |
Schedule, Part 2 — Regulation 3.10 of Statutory Rules 1997 No. 88 provides as follows:
3.10 Schedule, Part 2:
Items are amended as set out in the following table:
30116 | 31205 |
30119 | 31210 |
30120 | 31215 |
30123 | 31220 |
30124 | 31225 |
30127 | 31230 |
30128 | 31235 |
30130 | 31240 |
30131 | 31245 |
30133 | 31250 |
30134 | 31255 |
30137 | 31260 |
30138 | 31265 |
30141 | 31270 |
30142 | 31275 |
30145 | 31280 |
30146 | 31285 |
30148 | 31290 |
30149 | 31300 |
30151 | 31305 |
30152 | 31310 |
30154 | 31315 |
30155 | 31320 |
30157 | 31325 |
30158 | 31330 |
30160 | 31335 |
30161 | 31340 |
The proposed amendments were misdescribed and are not incorporated in this compilation.
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