Health Insurance (General Medical Services Table) Amendment Regulations 2002 (No. 1) (Cth)
Health Insurance (General Medical Services Table) Amendment Regulations 2002 (No. 1) 1
Statutory Rules 2002 No. 76 2
I, PETER JOHN HOLLINGWORTH, Governor-General of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, make the following Regulations under the
Health Insurance Act 1973 .Dated 11 April 2002
PETER HOLLINGWORTH
Governor-General
By His Excellency’s Command
KAY PATTERSON
Minister for Health and Ageing
These Regulations are the
Health Insurance (General Medical Services Table) Amendment Regulations 2002 (No. 1) .
These Regulations commence on 1 May 2002.
3 Amendment of Health Insurance (General Medical Services Table) Regulations 2001 Schedule 1 amends the
Health Insurance (General Medical Services Table) Regulations 2001 .
(regulation 3)
insert
An item in Part 3 does not apply to a service provided in contravention of a law of the Commonwealth or of a State or Territory.
[ 2 ] Schedule 1, Part 2, subrule 45 (1), except the example
substitute
(1) A multidisciplinary care plan team:
(a) includes a medical practitioner; and
(b) includes at least 2 other members, each of whom provides a different kind of care or service to the patient and is not a family carer of the patient, and 1 of whom may be another medical practitioner; and
(c) may additionally include a family carer of the patient.
substitute
53 Meaning of organise and co-ordinate a multidisciplinary case conference and participation in a multidisciplinary case conference
insert
55A Application of Subgroup 2 of Group A18 and Subgroup 2 of Group A19
(1) An item in Subgroup 2 of Group A18 or Subgroup 2 of Group A19 does not apply to a service that is provided to a patient who has already been provided, in the previous 12 months, with another service to which an item in either of those Subgroups applies.
(2) For any item in Subgroup 2 of Group A18 or Subgroup 2 of Group A19, a professional attendance
completes the minimum requirements for an annual cycle of care of a patient with established diabetes mellitus if the attendance involves the following:
(a) provision of the necessary services to a patient so that, at the completion of the attendance, the patient will have:
(i) at least 1 assessment of diabetes control, by having his or her HbA
1c measured, in the previous 12 months; and(ii) at least 1 comprehensive eye examination in the previous 24 months; and
(iii) his or her weight and height measured and his or her BMI calculated at least once every 6 months in the previous 12 months; and
(iv) his or her feet examined at least once every 6 months in the previous 12 months; and
(v) his or her total cholesterol, triglycerides and HDL cholesterol measured at least once in the previous 12 months; and
(vi) his or her microalbuminuria tested at least once in the previous 12 months;
(b) provision of self-management education to the patient regarding diabetes;
(c) a review of the patient’s diet, and provision of information to the patient about appropriate dietary choices;
(d) a review of the patient’s level of physical activity, and provision of information to the patient about the appropriate level of physical activity;
(e) checking the patient’s smoking status, and, if relevant, encouraging the patient to stop smoking;
(f) a review of the patient’s medication.
substitute
56 Application of Subgroup 3 of Group A18 and Subgroup 3 of Group A19
(1) An item in Subgroup 3 of Group A18 or Subgroup 3 of Group A19 does not apply to a service that:
(a) is provided to a patient who has already been provided, in the previous 12 months, with another service to which an item in either of those Subgroups applies; and
(b) is not clinically indicated.
(2) For any item in Subgroup 3 of Group A18 or Subgroup 3 of Group A19, a professional attendance
completes the minimum requirements of the Asthma 3+ Visit Plan if the attendance completes a series of attendances that involve, over a period of not less than 4 weeks and not more than 4 months, the following, for a patient with moderate to severe asthma:
(a) at least 3 asthma related consultations, at least 2 of which are consultations that have been planned at a previous consultation;
(b) documented diagnosis and documented assessment of severity;
(c) a review of the patient’s use of asthma related medication;
(d) provision of:
(i) a written asthma action plan; and
(ii) self-management education to the patient regarding asthma;
(e) a review of the patient’s asthma action plan.
omit
substitute
(1) An item in the range 23010 to 24136 applies to perfusion in addition to any other item that applies to the perfusion.
substitute
(2) An item in the range 25000 to 25020 applies to perfusion in addition to any other item that applies to the perfusion.
substitute
820 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to organise and co-ordinate a community case conference of at least 15 minutes but less than 30 minutes, with a multidisciplinary team of at least 3 other formal care providers of different disciplines | 110.00 |
822 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to organise and co-ordinate a community case conference of at least 30 minutes but less than 45 minutes, with a multidisciplinary team of at least 3 other formal care providers of different disciplines | 165.00 |
823 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to organise and co-ordinate a community case conference of at least 45 minutes, with a multidisciplinary team of at least 3 other formal care providers of different disciplines | 220.00 |
825 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to participate in a community case conference (other than to organise and to co-ordinate the conference) of at least 15 minutes but less than 30 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines | 79.00 |
826 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to participate in a community case conference (other than to organise and to co-ordinate the conference) of at least 30 minutes but less than 45 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines | 126.00 |
828 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to participate in a community case conference (other than to organise and to co-ordinate the conference) of at least 45 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines | 173.00 |
830 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to organise and co-ordinate a discharge case conference of at least 15 minutes but less than 30 minutes, with a multidisciplinary team of at least 3 other formal care providers of different disciplines | 110.00 |
832 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to organise and co-ordinate a discharge case conference of at least 30 minutes but less than 45 minutes, with a multidisciplinary team of at least 3 other formal care providers of different disciplines | 165.00 |
834 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to organise and co-ordinate a discharge case conference of at least 45 minutes, with a multidisciplinary team of at least 3 other formal care providers of different disciplines | 220.00 |
835 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to participate in a discharge case conference (other than to organise and to co-ordinate the conference) of at least 15 minutes but less than 30 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines | 79.00 |
837 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to participate in a discharge case conference (other than to organise and to co-ordinate the conference) of at least 30 minutes but less than 45 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines | 126.00 |
838 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to participate in a discharge case conference (other than to organise and to co-ordinate the conference) of at least 45 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines | 173.00 |
substitute
2546 | Professional attendance at consulting rooms by a general practitioner:
which completes the minimum requirements of the Asthma 3+ Visit Plan | 28.75 |
2547 | Professional attendance at a place other than consulting rooms by a general practitioner:
which completes the minimum requirements of the Asthma 3+ Visit Plan | Amount under rule 55 |
2552 | Professional attendance at consulting rooms by a general practitioner:
which completes the minimum requirements of the Asthma 3+ Visit Plan | 54.60 |
2553 | Professional attendance at a place other than consulting rooms by a general practitioner:
which completes the minimum requirements of the Asthma 3+ Visit Plan | Amount under rule 55 |
2558 | Professional attendance at consulting rooms by a general practitioner:
which completes the minimum requirements of the Asthma 3+ Visit Plan | 80.40 |
2559 | Professional attendance at a place other than consulting rooms by a general practitioner:
which completes the minimum requirements of the Asthma 3+ Visit Plan | Amount under rule 55 |
omit performed in association with the administration of an anaesthetic relating to another discrete operation on the same day
substitute
13020 | Hyperbaric oxygen therapy, for treatment of decompression illness, gas gangrene, air or gas embolism, diabetic wounds (including diabetic gangrene and diabetic foot ulcers) or necrotising soft tissue infections (including necrotising fasciitis or Fournier’s gangrene), or for the prevention and treatment of osteoradionecrosis, performed in a comprehensive hyperbaric medicine facility, under the supervision of a medical practitioner qualified in hyperbaric medicine, for a period in the hyperbaric chamber of between 1 hour 30 minutes and 3 hours (both inclusive), including any associated attendance | 204.70 |
after neck
insert , not being a service to which another item in this subgroup applies
omit with axillary node dissection
insert , where axillary node dissection is performed
substitute
20420 | Initiation of management of anaesthesia for procedures on the skin or subcutaneous tissue of the posterior part of the chest, not being a service to which another item in this subgroup applies | 85.75 |
omit , bronchoscopy or transvenous pacemaker),
insert or bronchoscopy),
before vaginal procedures
insert per vagina and
omit oocyte collection
insert assisted reproductive services
insert
20956 | Initiation of management of anaesthesia for evacuation of retained products of conception, as a complication of confinement | 68.60 |
20958 | Initiation of management of anaesthesia for manual removal of retained placenta or for repair of vaginal or perineal tear following delivery | 85.75 |
20960 | Initiation of management of anaesthesia for vaginal procedures in the management of post partum haemorrhage, where the blood loss is greater than 500mls | 120.05 |
omit total
[ 21 ] Schedule 1, Part 3, Group T10, Subgroup 13, heading
substitute
Subgroup 13 — S houlder and axilla
omit or cardiac mapping)
insert , cardiac mapping or insertion of automatic defibrillator or transvenous pacemaker)
insert
21942 | Initiation of management of anaesthesia for cardiac electrophysiological procedures including radio frequency ablation | 171.50 |
omit each day of monitoring
omit 1 year or less or
insert less than 12 months or is
omit 35583 or
after catheterisation
insert (including hysteroscopy for insertion of device for sterilisation)
after unilateral
insert , not being a service associated with sperm harvesting for IVF
substitute
37616 | Vasovasostomy or vasoepididymostomy, unilateral, using the operating microscope, for other than reversal of previous elective sterilisation, not being a service associated with sperm harvesting for IVF (Anaes.) (Assist.) | 546.95 |
37619 | Vasovasostomy or vasoepididymostomy, unilateral, for other than reversal of previous elective sterilisation, not being a service associated with sperm harvesting for IVF (Anaes.) (Assist.) | 218.75 |
substitute
38215 | Selective coronary angiography — placement of catheters and injection of opaque material into the native coronary arteries, not being a service associated with a service to which item 38218, 38220, 38222, 38225, 38228, 38231, 38234, 38237, 38240 or 38246 applies (Anaes.) | 350.90 |
38218 | Selective coronary angiography — placement of catheters and injection of opaque material with right or left heart catheterisation or both, or aortography, not being a service associated with a service to which item 38215, 38220, 38222, 38225, 38228, 38231, 38234, 38237, 38240 or 38246 applies (Anaes.) | 526.30 |
38220 | Selective coronary graft angiography — placement of 1 or more catheters and injection of opaque material into free coronary graft attached to the aorta (irrespective of the number of grafts), not being a service associated with a service to which item 38215, 38218, 38222, 38225, 38228, 38231, 38234, 38237, 38240 or 38246 applies (Anaes.) | 175.45 |
38222 | Selective coronary graft angiography — placement of 1 or more catheters and injection of opaque material into direct internal mammary artery graft to 1 or more coronary arteries (irrespective of the number of grafts), not being a service associated with a service to which item 38215, 38218, 38220, 38225, 38228, 38231, 38234, 38237, 38240 or 38246 applies (Anaes.) | 350.90 |
38225 | Selective coronary angiography — placement of catheters and injection of opaque material into the native coronary arteries and placement of 1 or more catheters and injection of opaque material into free coronary graft attached to the aorta (irrespective of the number of grafts), not being a service associated with a service to which item 38215, 38218, 38220, 38222, 38228, 38231, 38234, 38237, 38240 or 38246 applies (Anaes.) | 526.35 |
38228 | Selective coronary angiography — placement of catheters and injection of opaque material into the native coronary arteries and placement of 1 or more catheters and injection of opaque material into direct internal mammary artery graft to 1 or more coronary arteries (irrespective of the number of grafts), not being a service associated with a service to which item 38215, 38218, 38220, 38222, 38225, 38231, 38234, 38237, 38240 or 38246 applies (Anaes.) | 701.80 |
38231 | Selective coronary angiography — placement of catheters and injection of opaque material into the native coronary arteries and placement of 1 or more catheters and injection of opaque material into free coronary graft attached to the aorta (irrespective of the number of grafts), and placement of 1 or more catheters and injection of opaque material into direct internal mammary artery graft to 1 or more coronary arteries (irrespective of the number of grafts), not being a service associated with a service to which item 38215, 38218, 38220, 38222, 38225, 38228, 38234, 38237, 38240 or 38246 applies (Anaes.) | 877.25 |
38234 | Selective coronary angiography — placement of catheters and injection of opaque material with right or left heart catheterisation or both, or aortography and placement of 1 or more catheters and injection of opaque material into free coronary graft attached to the aorta (irrespective of the number of grafts), not being a service associated with a service to which item 38215, 38218, 38220, 38222, 38225, 38228, 38231, 38237, 38240 or 38246 applies (Anaes.) | 701.75 |
38237 | Selective coronary angiography — placement of catheters and injection of opaque material with right or left heart catheterisation or both, or aortography and placement of 1 or more catheters and injection of opaque material into direct internal mammary artery graft to 1 or more coronary arteries (irrespective of the number of grafts), not being a service associated with a service to which item 38215, 38218, 38220, 38222, 38225, 38228, 38231, 38234, 38240 or 38246 applies (Anaes.) | 877.20 |
38240 | Selective coronary angiography — placement of catheters and injection of opaque material with right or left heart catheterisation or both, or aortography and placement of 1 or more catheters and injection of opaque material into free coronary graft attached to the aorta (irrespective of the number of grafts), and placement of 1 or more catheters and injection of opaque material into direct internal mammary artery graft to 1 or more coronary arteries (irrespective of the number of grafts), not being a service associated with a service to which item 38215, 38218, 38220, 38222, 38225, 38228, 38231, 38234, 38237 or 38246 applies (Anaes.) |
1 052.65 | ||
38243 | Placement of 1 or more catheters and injection of opaque material into any 1 or more coronary vessels or grafts prior to any coronary interventional procedure, not being a service associated with a service to which item 38246 applies (Anaes.) | 350.90 |
38246 | Selective coronary angiography — placement of catheters and injection of opaque material with right or left heart catheterisation or both, or aortography followed by placement of catheters prior to any coronary interventional procedure, not being a service associated with a service to which item 38215, 38218, 38220, 38222, 38225, 38228, 38231, 38234, 38237, 38240 or 38243 applies (Anaes.) | 877.20 |
after closure by
insert open exposure and
substitute
45557 | Breast ptosis, correction of (unilateral), following pregnancy and lactation, when performed within 6 years of the most recent pregnancy, and where it can be demonstrated that the nipple is inferior to the infra‑mammary groove (Anaes.) (Assist.) | 605.90 |
[ 33 ] Schedule 1, Part 3, items 51300, 51303, 51800 and 51803, column 2
omit each mention of 434.70
insert $441.65
Subrule 4 (1) | 7 (1) | 6 (1) |
Rule 20 | rule 23 | rule 21 |
Subrule 58 (1) | 23010 to 24136, 22060, | 22060, 23010 to 24136, |
Paragraph 64 (1) (a) | 22905 | 22900 |
Item 24 | taking | involving taking |
Item 24 | 37 to 47 | 37 or 47 |
Item 722 | of a multidisciplinary care plan | of a multidisciplinary discharge care plan |
Paragraph 2503 (b) | 2504 or 2507 | 2506 or 2509 |
Paragraph 2506 (b) | 2507 | 2509 |
Item 2517 | requirements | minimum requirements |
Paragraph 2518 (b) | 2521 or 2525 | 2522 or 2526 |
Items 2518 and 2521 | requirements | minimum requirements |
Paragraph 2522 (b) | 2525 | 2526 |
Items 2522, 2525, 2526 and 2620 to 2677 | requirements | minimum requirements |
Item 11221 | perimetry — | perimetry |
Item 12217 | 12210 | 12213 |
Item 16518 | 269.85 | 274.15 |
Item 20192 | radical | extensive |
Item 21170 | 68.60 | 137.20 |
Item 21884 | 275.25 | 257.25 |
Item 22060 | Amount under rule 59 | 343.00 |
Item 30352 | (ale), | (male), |
Item 38281 | pacemaker, | cardiac pacemaker, |
Item 42614 | of; | of, |
1. These Regulations amend Statutory Rules 2001 No. 280.
2. Notified in the
Commonwealth of Australia Gazette
0
0
0