Health Insurance (General Medical Services Table) Amendment Regulations 2004 (No. 2) (Cth)

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Health Insurance (General Medical Services Table) Amendment Regulations 2004 (No. 2)1

Statutory Rules 2004 No. 772

I, PHILIP MICHAEL JEFFERY, 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 22 April 2004

P. M. JEFFERY

Governor-General

By His Excellency’s Command

JULIE BISHOP

Minister for Ageing

1Name of Regulations

 These Regulations are the Health Insurance (General Medical Services Table) Amendment Regulations 2004 (No. 2).

2Commencement

 These Regulations commence on 1 May 2004.

3Amendment of Health Insurance (General Medical Services Table) Regulations 2003

Schedule 1 amends the Health Insurance (General Medical Services Table) Regulations 2003.

Schedule 1Amendments

(regulation 3)

Part 1Amendments of Schedule 1, Part 2

[1]Subrules 10 (2) and 11 (3)

after

12003,

insert

12201,

[2]Subrule 12 (2)

omit

11706,

[3]Rule 16A, note

substitute

Note For the meaning ofprescribed dental patient, see section 3BA of the Act.

[4]Subrule 41 (2)

substitute

  • (2)

    Item 710 applies only to a service in relation to a patient who is:

    • (a)

      of Aboriginal or Torres Strait Islander descent; and

    • (b)

      at least 15 years old and less than 55 years old; and

    • (c)

      not an in-patient of a hospital or day-hospital facility, or a care recipient in a residential aged care facility.

  • (3)

    For this rule, a person is of Aboriginal or Torres Strait Islander descent if the person identifies himself or herself as being of that descent.

[5]Paragraph 43 (1) (b)

omit

psychological and

insert

psychological or

[6]After rule 43

insert

43AMeaning of adult health check in item 710

  • (1)

    For item 710, an adult health check means the assessment of:

    • (a)

      a patient’s health and physical, psychological and social function; and

    • (b)

      whether preventative health care, education and other assistance should be offered to that patient, to improve the patient’s health and physical, psychological or social function.

  • (2)

    An adult health check of a patient involves all of the following:

    • (a)

      a personal attendance by a medical practitioner;

    • (b)

      taking the patient’s medical history, including the following:

      • (i)

        current health problems and risk factors;

      • (ii)

        relevant family medical history;

      • (iii)

        medication usage (including medication obtained without prescription or from other doctors);

      • (iv)

        immunisation status, by reference to the appropriate current age and sex immunisation schedule;

      • (v)

        sexual and reproductive health;

      • (vi)

        physical activity, nutrition and alcohol, tobacco or other substance use;

      • (vii)

        hearing loss;

      • (viii)

        mood (including incidence of depression and risk of self-harm);

      • (ix)

        family relationships and whether the patient is a carer, or is cared for by another person;

    • (c)

      examination of the patient, including the following:

      • (i)

        measurement of the patient’s blood pressure, pulse rate and rhythm;

      • (ii)

        measurement of height and weight to calculate body mass index and, if indicated, measurement of waist circumference for central obesity;

      • (iii)

        oral examination (including gums and dentition);

      • (iv)

        ear and hearing examination (including otoscopy and, if indicated, a whisper test);

      • (v)

        urinalysis (by dipstick) for proteinurea;

    • (d)

      undertaking or arranging any required investigation, considering the need for the following tests, in particular, (in accordance with national or regional guidelines or specific regional needs):

      • (i)

        fasting blood sugar and lipids (by laboratory based test on venous sample) or, if necessary, random blood glucose levels;

      • (ii)

        pap smear;

      • (iii)

        examination for sexually transmitted infection (by urine or endocervical swab for chlamydia and gonorrhoea, especially for those aged from 15 to 35 years);

      • (iv)

        mammography, where eligible (by scheduling appointments with visiting services or facilitating direct referral);

    • (e)

      assessing the patient using the information gained in the adult health check;

    • (f)

      making or arranging any necessary interventions and referrals, and documenting a simple strategy for the good health of the patient.

  • (3)

    An adult health check also includes:

    • (a)

      keeping a record of the adult health check; and

    • (b)

      offering the patient a written report about the health check, with recommendations about matters covered by the health check (including a simple strategy for the good health of the patient).

Part 2Amendments of Schedule 1, Part 3

[7]After item 706

insert

710

Attendance by a medical practitioner (other than a specialist or consultant physician) at consulting rooms or another place (other than a hospital or residential aged care facility) for an adult health check of a patient who is of Aboriginal or Torres Strait Islander descent and at least 15 years old and less than 55 years old — not being an adult health check of a patient in respect of whom, in the preceding 18 months, a payment has been made under this item

187.70

[8]Item 10907, column 2

omit

applies

insert

applies. The appropriate fee for the purpose of paragraph 23A (2) (c) of the Health Insurance Act 1973 is $59.00

[9]Item 11706

omit

[10]After item 11810

insert

11820

Capsule endoscopy to investigate an episode of obscure gastrointestinal bleeding, using a capsule endoscopy device approved by the Therapeutic Goods Administration (including administration of the capsule, imaging, image reading and interpretation, and all attendances for providing the service on the day the capsule is administered) if:

  • (a)

    the service is performed by a specialist or consultant physician with endoscopic training that is recognised by The Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy; and

  • (b)

    the patient to whom the service is provided:

    • (i)

      is aged 18 years or over; and

    • (ii)

      has recurrent or persistent bleeding; and

    • (iii)

      is anaemic or has active bleeding; and

  • (c)

    an upper gastrointestinal endoscopy and a colonoscopy have been performed on the patient and have not identified the cause of the bleeding; and

  • (d)

    the service is performed within 6 months after the upper gastrointestinal endoscopy and colonoscopy

1 694.65

[11]After item 12200

insert

12201

Administration, by a specialist or consultant physician in the practice of his or her specialty, of thyrotropin alfa-rch (recombinant human thyroid-stimulating hormone), and arranging services to which both items 61426 and 66650 apply, for the detection of recurrent well-differentiated thyroid cancer in a patient if:

  • (a)

    the patient has had a total thyroidectomy and one ablative dose of radioactive iodine; and

  • (b)

    the patient is maintained on thyroid hormone therapy; and

  • (c)

    the patient is at risk of recurrence; and

1 988.65

  • (d)

    on at least one previous whole body scan or serum thyroglobulin test when withdrawn from thyroid hormone therapy, the patient did not have evidence of well-differentiated thyroid cancer; and

  • (e)

    either:

    • (i)

      withdrawal from thyroid hormone therapy resulted in severe psychiatric disturbances when hypothyroid; or

    • (ii)

      withdrawal is medically contra-indicated because the patient has:

      • (A)

        unstable coronary artery disease; or

      • (B)

        hypopituitarism; or

      • (C)

        a high risk of relapse or exacerbation of a previous severe psychiatric illness

— payable once only in a 12 month period

[12]Item 13842, column 2

omit

cannulisation

insert

cannulation

[13]Item 30096

substitute

30096

Diagnostic scalene node biopsy, by open procedure, if the specimen excised is sent for pathological examination (Anaes.)

152.85

[14]Item 30186

substitute

30186

Palmar or plantar warts (for each wart, up to a total of 9 warts), definitive removal of, excluding ablative methods alone, not being a service to which item 30185 or 30187 applies (Anaes.)

Note Section 15 of theHealth Insurance Act 1973 provides for the reduction of the fees payable for 2 or more removals performed on the same patient on the same occasion.

39.45

[15]Item 30419, column 2

omit

by hepatic cryotherapy

insert

by hepatic cryotherapy, not being a service associated with a service to which item 50950 or 50952 applies

[16]Item 31200, column 2

after

removal by surgical excision

insert

(other than by shave excision)

[17]Item 31340, column 2

after

indicated,

insert

and where the specimen excised is sent for histological confirmation,

[18]Item 32024, column 2

omit

alone

insert

alone, not being a service associated with a service to which item 32103, 32104 or 32106 applies

[19]Item 32025, column 2

omit

stoma

insert

stoma, not being a service associated with a service to which item 32103, 32104 or 32106 applies

[20]After item 32102

insert

32103

Rectal tumour of less than 4 cm in diameter, per anal excision of, using stereoscopic rectoscopy (incorporating stereoscopic and optic systems), where removal is unable to be performed during colonoscopy or by local excision, not being a service associated with a service to which item 32024, 32025, 32104 or 32106 applies (Anaes.) (Assist.)

641.80

32104

Rectal tumour of 4 cm or greater in diameter, per anal excision of, using stereoscopic rectoscopy (incorporating stereoscopic and optic systems), where removal is unable to be performed during colonoscopy or by local excision, not being a service associated with a service to which item 32024, 32025, 32103 or 32106 applies (Anaes.) (Assist.)

830.75

[21]After item 32105

insert

32106

Anterolateral intraperitoneal rectal tumour, per anal excision of, using stereoscopic rectoscopy (incorporating stereoscopic and optic systems), where removal is unable to be performed during colonoscopy and where removal requires dissection within the peritoneal cavity, not being a service associated with a service to which item 32024, 32025, 32103 or 32104 applies (Anaes.) (Assist.)

1 134.05

[22]Items 32159 and 32162

substitute

32159

Anal fistula, treatment of, by excision or by insertion of a Seton, or by a combination of both procedures, involving the lower half of the anal sphincter mechanism (Anaes.) (Assist.)

276.95

32162

Anal fistula, treatment of, by excision or by insertion of a Seton, or by a combination of both procedures, involving the upper half of the anal sphincter mechanism (Anaes.) (Assist.)

402.20

[23]After item 34533

insert

34538

Central vein catheterisation by percutaneous technique, using subcutaneous tunnelled cuffed catheter or similar device, for the administration of haemodialysis or parenteral nutrition (Anaes.)

226.35

34539

Tunnelled cuffed catheter, or similar device, removal of, by open surgical procedure in the operating theatre of a hospital or approved day-hospital facility (Anaes.)

169.80

[24]Item 35321, column 2

omit

haemorrhage,

insert

haemorrhage (but not for the treatment of uterine fibroids),

[25]Items 35576 and 35580

substitute

35576

Anterior vaginal repair or posterior vaginal repair (involving repair of rectocele or enterocele or both), with or without mesh, not being a service associated with a service to which item 30405, 35580 or 35584 applies (Anaes.) (Assist.)

353.20

35580

Anterior vaginal repair or posterior vaginal repair (involving repair of rectocele or enterocele or both), with or without mesh, not being a service associated with a service to which item 30405 or 35584 applies (Anaes.) (Assist.)

445.45

[26]Item 35584, column 2

omit

prolapse

insert

prolapse, with or without mesh, not being a service associated with a service to which item 30405 applies

[27]Item 35590, column 2

omit the second mention of

vault

insert

vault, with or without mesh, not being a service associated with a service to which item 30405 applies

[28]Item 35593, column 2

omit

Vaginal repair of enterocele with or without repair of rectocele, not being a service associated with a service to which item 35576,

insert

Vaginal repair of enterocele, with or without repair of rectocele, with or without mesh, not being a service associated with a service to which item 30405, 35576,

[29]Items 35599, 35600, 35602 and 35605

substitute

35599

Stress incontinence, sling operation for, with or without mesh, not being a service associated with a service to which item 30405 applies (Anaes.) (Assist.)

560.55

35600

Stress incontinence, vaginal procedure for, with or without mesh, not being a service associated with a service to which item 30405 applies (Anaes.) (Assist.)

435.15

35602

Stress incontinence, combined synchronous

abdomino-vaginal operation for — abdominal procedure, with or without mesh, (including after-care), not being a service associated with a service to which item 30405 applies (Anaes.) (Assist.)

560.55

35605

Stress incontinence, combined synchronous

abdomino-vaginal operation for — vaginal procedure, with or without mesh, (including after-care), not being a service associated with a service to which item 30405 applies (Anaes.) (Assist.)

304.10

[30]After item 36525

insert

36526

Nephrectomy, radical with en bloc dissection of lymph nodes, with or without adrenalectomy, for a tumour of less than 10 cm in diameter, where performed if malignancy is clinically suspected but not confirmed by histopathological examination (Anaes.) (Assist.)

1 073.00

36527

Nephrectomy, radical with en bloc dissection of lymph nodes, with or without adrenalectomy, for a tumour of 10 cm or more in diameter, or complicated by previous open or laparoscopic surgery on the same kidney, where performed if malignancy is clinically suspected but not confirmed by histopathological examination (Anaes.) (Assist.)

1 324.20

[31]Item 36564

substitute

36564

Pyeloplasty (plastic reconstruction of the pelvi-ureteric junction), by open exposure, laparoscopy or laparoscopic assisted techniques (Anaes.) (Assist.)

768.40

[32]Item 37042, column 2

omit everything after

including harvesting of sling,

insert

with or without mesh, not being a service associated with a service to which item 30405 or 35599 applies (Anaes.) (Assist.)

[33]Item 37043, column 2

omit everything after

needle colposuspension,

insert

with or without mesh, not being a service associated with a service to which item 30405 or 35599 applies (Anaes.) (Assist.)

[34]Item 37044, column 2

omit everything after

Burch colposuspension,

insert

with or without mesh, not being a service associated with a service to which item 30405 or 35599 applies (Anaes.) (Assist.)

[35]Item 38436, column 2

after

intercostal catheter,

insert

where necessary,

[36]After item 40903

insert

40905

Craniotomy, performed in association with items 45767, 45776, 45782 and 45785 for the correction of craniofacial abnormalities (Anaes.)

500.00

[37]After item 50426

insert

50950

Nonresectable hepatocellular carcinoma, destruction of, by percutaneous radiofrequency ablation, including any associated imaging services, not being a service associated with a service to which item 30419 or 50952 applies (Anaes.)

679.10

50952

Nonresectable hepatocellular carcinoma, destruction of, by open or laparoscopic radiofrequency ablation, where a multi-disciplinary team has assessed that percutaneous radiofrequency ablation cannot be performed or is not practical because of one or more of the following clinical circumstances:

  • (a)

    percutaneous access cannot be achieved;

679.10

  • (b)

    vital organs or tissues are at risk of damage from the percutaneous radiofrequency ablation procedure;

  • (c)

    resection of one part of the liver is possible, however there is at least 1 primary liver tumour in a nonresectable section of the liver that is suitable for radiofrequency ablation;

including any associated imaging services, not being a service associated with a service to which item 30419 or 50950 applies (Anaes.)

Notes

1. These Regulations amend Statutory Rules 2003 No. 255, as amended by 2003 Nos. 318 and 359; 2004 No. 65.

2. Notified in the Commonwealth of Australia Gazette on 30 April 2004.

  

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