Health Insurance (Allied Health Services) Amendment Determination 2012 (No. 4) (Cth)

Case

Health Insurance (Allied Health Services) Amendment Determination 2012 (No. 4)

Health Insurance Act 1973

I, RICHARD BARTLETT, First Assistant Secretary, Medical Benefits Division, Department of Health and Ageing, make this Determination under subsection 3C (1) of the Health Insurance Act 1973.

Dated      23 October 2012

Richard Bartlett

RICHARD BARTLETT

First Assistant Secretary

Medical Benefits Division

Department of Health and Ageing

  1. Name of Determination

This Determination is the Health Insurance (Allied Health Services) Amendment Determination 2012 (No. 4).

  1. Commencement

This Determination commences on 1 November 2012.

  1. Amendment of Health Insurance (Allied Health Services) Determination 2011

Schedule 1 amends the Health Insurance (Allied Health Services) Determination 2011.

Schedule 1        Amendments

(section 3)

[1]           After section 11

insert

12    Requests for diagnostic audiology services

(1)This section applies to items 82300 to 82332 in Schedule 2.

(2)The request must be in writing and must contain:

(a) the date of the request; and

(b) the name of the eligible practitioner who requested the service and either the address of his or her place of practice or the provider number in respect of his or her place of practice; and

(c) a description of the service which provides sufficient information to identify the service as relating to a particular item mentioned in subsection (1) but need not specify the item number.

(3)A request may be for the performance of more than one diagnostic audiology service making up a single audiological assessment but cannot be for more than one audiological assessment.

[2]           Schedule 1, item 7, Focussed psychological strategies health service

omit

Until midnight 31 October 2012, a person is also an allied health professional in relation to the provision of a focused psychological strategies health service if he or she was such a person on 30 June 2012 because of paragraph (c) of item 7 of Schedule 1 of this Determination as in force on that date. 

[3]           Schedule 1, item 8, Mental health service

omit

Until midnight 31 October 2012, a person is also an allied health professional in relation to the provision of a mental health service if he or she was such a person on 30 June 2012 because of paragraph (c) of item 8 of Schedule 1 of this Determination as in force on that date.

[4]           Schedule 1, item 10, Occupational therapy health service

omit

Until midnight 31 October 2012, a person is also an allied health professional in relation to the provision of an occupational therapy health service if he or she was such a person on 30 June 2012.

[5]           Schedule 2

Item no.

omit

insert

10950

61.10

62.25

10951

61.10

62.25

10952

61.10

62.25

10953

61.10

62.25

10954

61.10

62.25

10956

61.10

62.25

10958

61.10

62.25

10960

61.10

62.25

10962

61.10

62.25

10964

61.10

62.25

10966

61.10

62.25

10968

61.10

62.25

10970

61.10

62.25

80000

97.90

99.75

80005

122.35

124.65

80010

143.70

146.45

80015

168.15

171.35

80020

36.50

37.20

80100

69.35

70.65

80105

94.35

96.15

80110

97.90

99.75

80115

122.95

125.30

80120

25.00

25.45

80125

61.10

62.25

80130

86.05

87.70

80135

86.30

87.95

80140

111.25

113.35

80145

21.95

22.35

80150

61.10

62.25

80155

86.05

87.70

80160

86.30

87.95

80165

111.25

113.35

80170

21.95

22.35

81000

71.80

73.15

81005

71.80

73.15

81010

71.80

73.15

81100

78.35

79.85

81105

19.55

19.90

81110

78.35

79.85

81115

19.55

19.90

81120

78.35

79.85

81125

19.55

19.90

82000

97.90

99.75

82005

86.30

87.95

82010

86.30

87.95

82015

97.90

99.75

82020

86.30

87.95

82025

86.30

87.95

82030

86.30

87.95

82035

86.30

87.95

81300

61.10

62.25

81305

61.10

62.25

81310

61.10

62.25

81315

61.10

62.25

81320

61.10

62.25

81325

61.10

62.25

81330

61.10

62.25

81335

61.10

62.25

81340

61.10

62.25

81345

61.10

62.25

81350

61.10

62.25

81355

61.10

62.25

81360

61.10

62.25

[6]           Schedule 2, after Part 6

insert

Part 7          Services and fees — audiology services (diagnostic)

Item

Service

          Fee ($)

82300

Audiology health service, consisting of brain stem evoked response audiometry, performed on a person by an eligible audiologist if:

   (a)  the service is performed pursuant to a written request made by an eligible practitioner to assist the eligible practitioner in the diagnosis and/or treatment and/or management of ear disease or a related disorder in the person; and

  (b)  the eligible practitioner is a specialist in the specialty of otolaryngology head and neck surgery; and

   (c)  the service is not performed for the purpose of a hearing screening; and

  (d)  the person is not an admitted patient of a hospital; and

   (e)  the service is performed on the person individually and in person; and

   (f)  after the service, the eligible audiologist provides a copy of the results of the service performed, together with relevant comments in writing that the eligible audiologist has on those results, to the eligible practitioner who requested the service; and

   (g)  a service to which item 11300 applies has not been performed on the person on the same day. 

This item is subject to sections 9 and 12.

153.95

82306

Audiology health service, consisting of non-determinate audiometry performed on a person by an eligible audiologist if:

   (a)  the service is performed pursuant to a written request made by an eligible practitioner to assist the eligible practitioner in the diagnosis and/or treatment and/or management of ear disease or a related disorder in the person; and

  (b)  the eligible practitioner is a specialist in the specialty of otolaryngology head and neck surgery; and

   (c)  the service is not performed for the purpose of a hearing screening; and

  (d)  the person is not an admitted patient of a hospital; and

   (e)  the service is performed on the person individually and in person; and

   (f)  after the service, the eligible audiologist provides a copy of the results of the service performed, together with relevant comments in writing that the eligible audiologist has on those results, to the eligible practitioner who requested the service; and

   (g)  a service to which item 11306 applies has not been performed on the person on the same day. 

This item is subject to sections 9 and 12.

17.50

82309

Audiology health service, consisting of an air conduction audiogram performed on a person by an eligible audiologist if:

   (a)  the service is performed pursuant to a written request made by an eligible practitioner to assist the eligible practitioner in the diagnosis and/or treatment and/or management of ear disease or a related disorder in the person; and

  (b)  the eligible practitioner is:          

         (i)   a specialist in the specialty of otolaryngology head and neck surgery; or

        (ii)   a specialist or consultant physician in the specialty of neurology; and

   (c)  the service is not performed for the purpose of a hearing screening; and

  (d)  the person is not an admitted patient of a hospital; and

   (e)  the service is performed on the person individually and in person; and

   (f)  after the service, the eligible audiologist provides a copy of the results of the service performed, together with relevant comments in writing that the eligible audiologist has on those results, to the eligible practitioner who requested the service; and

   (g)  a service to which item 11309 applies has not been performed on the person on the same day. 

This item is subject to sections 9 and 12.

21.05
Item Service Fee ($)
82312

Audiology health service, consisting of an air and bone conduction audiogram or air conduction and speech discrimination audiogram performed on a person by an eligible audiologist if:

   (a)  the service is performed pursuant to a written request made by an eligible practitioner to assist the eligible practitioner in the diagnosis and/or treatment and/or management of ear disease or a related disorder in the person; and

  (b)  the eligible practitioner is:          

         (i)   a specialist in the specialty of otolaryngology head and neck surgery; or

        (ii)   a specialist or consultant physician in the specialty of neurology; and

   (c)  the service is not performed for the purpose of a hearing screening; and

  (d)  the person is not an admitted patient of a hospital; and

   (e)  the service is performed on the person individually and in person; and

   (f)  after the service, the eligible audiologist provides a copy of the results of the service performed, together with relevant comments in writing that the eligible audiologist has on those results, to the eligible practitioner who requested the service; and

   (g)  a service to which item 11312 applies has not been performed on the person on the same day.

This item is subject to sections 9 and 12.

29.70
82315

Audiology health service, consisting of an air and bone conduction and speech discrimination audiogram performed on a person by an eligible audiologist if:

   (a)  the service is performed pursuant to a written request made by an eligible practitioner to assist the eligible practitioner in the diagnosis and/or treatment and/or management of ear disease or a related disorder in the person; and

  (b)  the eligible practitioner is:          

         (i)   a specialist in the specialty of otolaryngology head and neck surgery; or

        (ii)   a specialist or consultant physician in the specialty of neurology; and

   (c)  the service is not performed for the purpose of a hearing screening; and

  (d)  the person is not an admitted patient of a hospital; and

   (e)  the service is performed on the person individually and in person; and

   (f)  after the service, the eligible audiologist provides a copy of the results of the service performed, together with relevant comments in writing that the eligible audiologist has on those results, to the eligible practitioner who requested the service; and

   (g)  a service to which item 11315 applies has not been performed on the person on the same day.

This item is subject to sections 9 and 12.

39.35
82318

Audiology health service, consisting of an air and bone conduction and speech discrimination audiogram with other cochlear tests performed on a person by an eligible audiologist if:

   (a)  the service is performed pursuant to a written request made by an eligible practitioner to assist the eligible practitioner in the diagnosis and/or treatment and/or management of ear disease or a related disorder in the person; and

  (b)  the eligible practitioner is:          

         (i)   a specialist in the specialty of otolaryngology head and neck surgery; or

        (ii)   a specialist or consultant physician in the specialty of neurology; and

   (c)  the service is not performed for the purpose of a hearing screening; and

  (d)  the person is not an admitted patient of a hospital; and

   (e)  the service is performed on the person individually and in person; and

   (f)  after the service, the eligible audiologist provides a copy of the results of the service performed, together with relevant comments in writing that the eligible audiologist has on those results, to the eligible practitioner who requested the service; and

   (g)  a service to which item 11318 applies has not been performed on the person on the same day.

This item is subject to sections 9 and 12.

48.60
82324

Audiology health service, consisting of an impedance audiogram involving tympanometry and measurement of static compliance and acoustic reflex performed on a person by an eligible audiologist (not being a service associated with a service to which item 82309, 82312, 82315 or 82318 applies) if:

   (a)  the service is performed pursuant to a written request made by an eligible practitioner to assist the eligible practitioner in the diagnosis and/or treatment and/or management of ear disease or a related disorder in the person; and

  (b)  the eligible practitioner is:          

         (i)   a specialist in the specialty of otolaryngology head and neck surgery; or

        (ii)   a specialist or consultant physician in the specialty of neurology; and

   (c)  the service is not performed for the purpose of a hearing screening; and

  (d)  the person is not an admitted patient of a hospital; and

   (e)  the service is performed on the person individually and in person; and

   (f)  after the service, the eligible audiologist provides a copy of the results of the service performed, together with relevant comments in writing that the eligible audiologist has on those results, to the eligible practitioner who requested the service; and

   (g)  a service to which item 11324 applies has not been performed on the person on the same day.

This item is subject to sections 9 and 12.

26.30
82327

Audiology health service, consisting of an impedance audiogram involving tympanometry and measurement of static compliance and acoustic reflex performed on a person by an eligible audiologist (being a service associated with a service to which item 82309, 82312, 82315 or 82318 applies) if:

   (a)  the service is performed pursuant to a written request made by an eligible practitioner to assist the eligible practitioner in the diagnosis and/or treatment and/or management of ear disease or a related disorder in the person; and

  (b)  the eligible practitioner is:          

         (i)   a specialist in the specialty of otolaryngology head and neck surgery; or

        (ii)   a specialist or consultant physician in the specialty of neurology; and

   (c)  the service is not performed for the purpose of a hearing screening; and

  (d)  the person is not an admitted patient of a hospital; and

   (e)  the service is performed on the person individually and in person; and

   (f)  after the service, the eligible audiologist provides a copy of the results of the service performed, together with relevant comments in writing that the eligible audiologist has on those results, to the eligible practitioner who requested the service; and

   (g)  a service to which item 11327 applies has not been performed on the person on the same day.

This item is subject to sections 9 and 12.

15.80

82332

Audiology health service, consisting of an oto-acoustic emission audiometry for the detection of permanent congenital hearing impairment performed by an eligible audiologist on an infant or child in circumstances in which:

   (a)  the service is performed pursuant to a written request made by an eligible practitioner who is:

         (i)   a specialist in the specialty of otolaryngology head and neck surgery; or

        (ii)   a specialist or consultant physician in the specialty of neurology; and

  (b)  the infant or child is at risk due to 1 or more of the following factors:

(i) admission to a neonatal intensive care unit;

(ii) family history of hearing impairment;

(iii) intra-uterine or perinatal infection (either suspected or confirmed);

(iv) birthweight less than 1.5kg;

(v) craniofacial deformity;

(vi) birth asphyxia;

(vii) chromosomal abnormality, including Down Syndrome;

(viii) exchange transfusion; and

   (c)  middle ear pathology has been excluded by specialist opinion; and

  (d)  the infant or child is not an admitted patient of a hospital; and

   (e)  the service is performed on the infant or child individually and in person; and

   (f)  after the service, the eligible audiologist provides a copy of the results of the service performed, together with relevant comments in writing that the eligible audiologist has on those results, to the eligible practitioner who requested the service; and

   (g)  a service to which item 11332 applies has not been performed on the infant or child on the same day.

This item is subject to sections 9 and 12.

$46.85

Note

1.         All legislative instruments and compilations are registered on the Federal Register of Legislative Instruments kept under the Legislative Instruments Act 2003. See

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