Health Insurance (General Medical Services Table) Regulation 2015 (Cth)
Health Insurance (General Medical Services Table) Regulation 2015
Select Legislative Instrument No. 84, 2015
made under the
Health Insurance Act 1973
Compilation No. 5
Compilation date: 1 May 2016
Includes amendments up to: F2016L00388
Registered: 20 June 2016
About this compilation
This compilation
This is a compilation of the Health Insurance (General Medical Services Table) Regulation 2015 that shows the text of the law as amended and in force on 1 May 2016 (the compilation date).
The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.
Uncommenced amendments
The effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Legislation Register ( The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the series page on the Legislation Register for the compiled law.
Application, saving and transitional provisions for provisions and amendments
If the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.
Editorial changes
For more information about any editorial changes made in this compilation, see the endnotes.
Modifications
If the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the series page on the Legislation Register for the compiled law.
Self‑repealing provisions
If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.
Contents
1............................ Name.................................................................................. 1
3............................ Authority............................................................................ 1
4............................ Schedules........................................................................... 1
5............................ General medical services table........................................... 1
6............................ Dictionary........................................................................... 1
Schedule 1—General medical services table 2
Part 1—Preliminary 2
Division 1.1—Interpretation 2
1.1.1...................... Meaning of eligible non‑vocationally recognised medical practitioner 2
1.1.1A................... Meaning of general practitioner........................................ 3
1.1.2...................... Meaning of multidisciplinary case conference.................. 4
1.1.3...................... Meaning of multidisciplinary case conference team......... 4
1.1.4...................... Meaning of single course of treatment.............................. 5
1.1.5...................... Meaning of symbol (G)...................................................... 5
1.1.6...................... Meaning of symbol (H)...................................................... 6
1.1.7...................... Meaning of symbol (S)....................................................... 6
Division 1.2—General application provisions 7
1.2.1...................... Application......................................................................... 7
1.2.2...................... Attendance by specialist or consultant physician.............. 7
1.2.3...................... Professional attendance services........................................ 7
1.2.4...................... Personal attendance by medical practitioners generally.... 8
1.2.5...................... Personal attendance by medical practitioners.................... 8
1.2.6...................... Consultant occupational physician..................................... 9
1.2.7...................... Application of items—services provided with non‑medicare services 9
1.2.7A................... Application of items—services provided with autologous injections of blood or blood products.................................................................... 9
1.2.8...................... Services that may be provided by persons other than medical practitioners 9
1.2.9...................... Meaning of participating in a video conferencing consultation 10
Part 2—Services and fees 11
Division 2.1—Groups A1 to A9 11
2.1.1...................... Meaning of amount under clause 2.1.1............................ 11
Division 2.2—Group A1: General practitioner attendances to which no other item applies 13
Division 2.3—Group A2: Other non‑referred attendances to which no other item applies 17
2.3.1...................... Effect of determination under section 106TA of Act...... 17
Division 2.4—Group A3: Specialist attendances to which no other item applies 20
2.4.1...................... Limitation of item 99....................................................... 20
Division 2.5—Group A4: Consultant physician (other than psychiatry) attendances to which no other item applies 22
2.5.1...................... Limitation of items 112 to 114......................................... 22
Division 2.5A—Group A29: Early intervention services for children with autism, pervasive developmental disorder or disability 25
2.5A.1................... Meanings of eligible allied health provider and risk assessment 25
2.5A.2................... Meaning of eligible disability.......................................... 25
Division 2.6—Group A28: Geriatric medicine 28
2.6.1...................... Limitation of item 149..................................................... 28
Division 2.7—Group A5: Prolonged attendances to which no other item applies 31
2.7.1...................... Application of items 160 to 164....................................... 31
Division 2.8—Group A6: Group therapy 32
Division 2.9—Group A7: Acupuncture 33
2.9.1...................... Meaning of qualified medical acupuncturist................... 33
Division 2.10—Group A8: Consultant physician in practice of psychiatry for attendances to which no other item applies 35
2.10.1.................... Application of items 291, 293 and 359............................ 35
2.10.2.................... Application of items 342, 344 and 346............................ 35
2.10.3.................... Restriction of telepsychiatry consultations to regional, rural and remote areas 35
2.10.4.................... Limitation of item 288..................................................... 35
2.10.5.................... Meanings of eligible allied health provider and risk assessment 35
Division 2.11—Group A12: Consultant occupational physician attendances to which no other item applies 45
2.11.1.................... Limitation of items 384 and 389...................................... 45
Division 2.12—Group A13: Public health physician attendances to which no other item applies 47
2.12.1.................... Public health physicians................................................... 47
Division 2.13—Miscellaneous services 50
Division 2.14—Group A21: Emergency physician attendances to which no other item applies 51
2.14.1.................... Meaning of recognised emergency department............... 51
2.14.2.................... Meaning of problem focussed history.............................. 51
2.14.3.................... Attendance for emergency evaluation of critically ill patients 51
Division 2.15—Group A11: Urgent attendances after hours 54
2.15.1.................... Meaning of patient’s medical condition requires urgent treatment 54
2.15.2.................... Meaning of responsible person........................................ 54
2.15.3.................... Application of Group A11............................................... 54
2.15.4.................... Effect of determination under section 106TA of Act...... 54
Division 2.16—Group A14: Health assessments 56
2.16.1.................... Application of Group A14............................................... 56
2.16.2.................... Types of health assessments............................................ 56
2.16.3.................... Application of item 715 to certain patients only.............. 57
2.16.5.................... Type 2 Diabetes Risk Evaluation..................................... 58
2.16.6.................... 45 year old Health Assessment........................................ 58
2.16.7.................... Older Person’s Health Assessment.................................. 59
2.16.8.................... Comprehensive Medical Assessment for permanent resident of residential aged care facility....................................................................... 60
2.16.9.................... Health assessment for a person with an intellectual disability 60
2.16.10.................. Health assessment for a refugee or other humanitarian entrant 62
2.16.10A............... Australian Defence Force Post‑discharge GP Health Assessment 63
2.16.11.................. Aboriginal and Torres Strait Islander child health assessment 64
2.16.12.................. Aboriginal and Torres Strait Islander adult health assessment 66
2.16.13.................. Aboriginal and Torres Strait Islander Older Person’s Health Assessment 67
2.16.14.................. Restrictions on health assessments for Group A14.......... 68
Division 2.17—Group A15: GP management plans, team care arrangements and multidisciplinary care plans and case conferences 70
Subdivision A—General 70
2.17.1.................... Service by medical practitioners...................................... 70
Subdivision B—Subgroup 1 of Group A15 70
2.17.2.................... Meaning of associated medical practitioner................... 70
2.17.3.................... Meaning of contribute to a multidisciplinary care plan.. 70
2.17.4.................... Meaning of coordinating the development of team care arrangements 71
2.17.5.................... Meaning of coordinating a review of team care arrangements 71
2.17.6.................... Meaning of multidisciplinary care plan........................... 72
2.17.7.................... Meaning of preparing a GP management plan............... 72
2.17.8.................... Meaning of reviewing a GP management plan............... 73
2.17.9.................... Application of items 721, 723, 729, 731 and 732............ 73
2.17.10.................. Application of items 701 to 723 and 732......................... 74
2.17.10A............... Application of items in relation to items 721, 723 and 732 75
2.17.11.................. Limitation on items 721, 723, 729, 731 and 732............. 75
Subdivision C—Subgroup 2 of Group A15 77
2.17.12.................. Meaning of multidisciplinary discharge case conference 77
2.17.13.................. Meaning of multidisciplinary case conference in a residential aged care facility 77
2.17.14.................. Meaning of organise and coordinate............................... 78
2.17.15.................. Meaning of participate..................................................... 78
2.17.16.................. Meaning of coordinating................................................. 78
2.17.17.................. Meaning of case conference team.................................... 79
2.17.18.................. Application of item 880................................................... 79
Division 2.18—Group A17: Domiciliary and residential medication management reviews 84
2.18.1.................... Meaning of living in a community setting........................ 84
2.18.2.................... Meaning of residential medication management review. 84
2.18.3.................... Application of items 900 and 903.................................... 85
Division 2.18A—Group A30: Medical practitioner video conferencing consultation 86
2.18A.1................. Application of items......................................................... 86
2.18A.2................. Application of items 2125, 2138, 2179 and 2220............ 86
2.18A.3................. Meaning of amount under clause 2.18A.3....................... 86
2.18A.4................. Limitation of items........................................................... 87
Division 2.19—Groups A18 (General practitioner attendances associated with PIP payments) and A19 (Other non‑referral attendances associated with PIP payments to which no other item applies) 92
2.19.1.................... Application of Subgroup 2 of Groups A18 and A19....... 92
2.19.2.................... Application of Subgroup 3 of Groups A18 and A19....... 93
Division 2.20—Group A20: Mental health care 102
2.20.1.................... Definitions...................................................................... 102
2.20.2.................... Meaning of amount under clause 2.20.2........................ 102
2.20.3.................... Meaning of preparation of a GP mental health treatment plan 103
2.20.4.................... Meaning of review of a GP mental health treatment plan 104
2.20.5.................... Meaning of associated medical practitioner................. 104
2.20.6.................... Application of Subgroup 1 of Group A20..................... 105
2.20.7.................... Focussed psychological strategies................................. 106
Division 2.21—Group A24: Palliative and pain medicine 109
2.21.1.................... Meaning of organise and coordinate............................. 109
2.21.2.................... Meaning of participate................................................... 109
2.21.3.................... Application of Group A24............................................. 110
2.21.4.................... Limitation on items........................................................ 110
2.21.5.................... Limitation of items......................................................... 110
Division 2.22—Group A27: Pregnancy support counselling 116
2.22.1.................... Application of item 4001............................................... 116
Division 2.23—Group A22: General practitioner after‑hours attendances to which no other item applies 117
2.23.1.................... Application of Group A22............................................. 117
Division 2.24—Group A23: Other non‑referred after‑hours attendances to which no other item applies 121
2.24.1.................... Application of Group A23............................................. 121
Division 2.26—Group A26: Neurosurgery attendances to which no other item applies 123
2.26.1.................... Limitation of items 6004 and 6016................................ 123
Division 2.27—Group A9: Contact lenses 125
2.27.1.................... Application of item 10809............................................. 125
Division 2.29—Miscellaneous services 127
Division 2.30—Group M12: Services provided by a practice nurse, an Aboriginal health worker or an Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner 128
2.30.1.................... Definitions for item 10997............................................. 128
2.30.4.................... Application of item 10988............................................. 128
2.30.5.................... Application of item 10989............................................. 128
2.30.6.................... Limitation of item 10983............................................... 129
Division 2.31—Group M1: Management of bulk‑billed services 131
2.31.1.................... Definitions for Division 2.31......................................... 131
2.31.2.................... Application of items 10990, 10991 and 10992.............. 132
Division 2.33—Diagnostic procedures and investigations 134
Division 2.34—Group D1: Miscellaneous diagnostic procedures and investigations 135
2.34.1.................... Meaning of report.......................................................... 135
2.34.2.................... Meaning of qualified sleep medicine practitioner......... 135
2.34.3.................... Application of item 11801............................................. 136
Division 2.35—Group D2: Nuclear medicine (non‑imaging) 153
2.35.1.................... Application of Group D2............................................... 153
Division 2.37—Group T1: Miscellaneous therapeutic procedures 154
2.37.1.................... Meaning of comprehensive hyperbaric medicine facility 154
2.37.2.................... Meaning of embryology laboratory services................. 154
2.37.3.................... Meaning of treatment cycle............................................ 154
2.37.4.................... Items provided as part of treatment cycle relating to assisted reproductive services not to apply..................................................................... 155
2.37.5.................... Application of items 13020 to 14245............................. 155
2.37.6.................... Limitation on item 13104............................................... 155
2.37.7.................... Items relating to assisted reproductive services not to apply in certain pregnancy‑related circumstances................................... 155
2.37.8.................... Application of items 14227 to 14242............................. 155
2.37.9.................... Application of item 14245............................................. 156
2.37.10.................. Limitation of item 13210............................................... 156
Division 2.38—Group T2: Radiation oncology 166
2.38.1.................... Meaning of amount under clause 2.38.1........................ 166
2.38.2.................... Meaning of approved site.............................................. 166
2.38.2A................. Meaning of IGRT........................................................... 166
2.38.2B.................. Meaning of IMRT.......................................................... 167
2.38.3.................... Application of Group T2................................................ 167
2.38.3A................. Application of items 15215 to 15272............................. 167
2.38.4.................... Application of items 15556, 15559 and 15562.............. 167
Division 2.39—Group T3: Therapeutic nuclear medicine 178
2.39.1.................... Application of Group T3................................................ 178
Division 2.40—Group T4: Obstetrics 179
2.40.1.................... Definitions for item 16400............................................. 179
2.40.2.................... Meaning of amount under clause 2.40.2........................ 179
2.40.3.................... Meaning of delivery....................................................... 179
2.40.4.................... Application of Group T4................................................ 180
2.40.5.................... Application of item 16400............................................. 180
2.40.5A................. Limitation of item 16399............................................... 180
2.40.6.................... Limitation of items 16590 and 16591............................ 180
Division 2.41—Group T6: Examination by anaesthetist 185
2.41.1.................... Application of Group T6................................................ 185
2.41.2.................... Limitation of item 17609............................................... 185
Division 2.42—Group T7: Regional or field nerve blocks 188
2.42.1.................... Meaning of amount under clause 2.42.1........................ 188
2.42.2.................... Application of Group T7................................................ 188
Division 2.42A—Group T11: Botulinum toxin 191
2.42A.1................. Supply of botulinum toxin............................................. 191
2.42A.2................. Limitation of certain items............................................. 191
Division 2.43—Group T10: Anaesthesia performed in connection with certain services (Relative Value Guide) 195
2.43.1.................... Meaning of amount under clause 2.43.1........................ 195
2.43.2.................... Meaning of amount under clause 2.43.2........................ 195
2.43.3.................... Meaning of complex paediatric case............................. 196
2.43.4.................... Meaning of service time................................................. 196
2.43.5.................... Application of Group T10.............................................. 196
2.43.6.................... Application of Subgroup 21 of Group T10.................... 197
2.43.7.................... Services mentioned in Subgroups 21 to 25 of Group T10 197
2.43.8.................... Application of Subgroups 22 and 23 of Group T10....... 197
2.43.9.................... Application of Subgroups 24 and 25 of Group T10....... 197
Division 2.44—Group T8: Surgical operations 226
Subdivision A—General 226
2.44.1.................... Meaning of approved site.............................................. 226
2.44.2.................... Application of Group T8................................................ 226
Subdivision B—Subgroup 1 of Group T8 226
2.44.4.................... Meaning of amount under clause 2.44.4........................ 226
2.44.5.................... Meaning of amount under clause 2.44.5........................ 226
2.44.6.................... Meaning of qualified surgeon........................................ 226
2.44.7.................... Meaning of qualified radiologist................................... 226
2.44.8.................... Histopathological proof of malignancy in certain cases for purposes of certain items relating to surgical procedures............................. 227
2.44.9.................... Application of items 30299 and 30300.......................... 227
2.44.10.................. Application of items 30440, 30451, 30492 and 30495.. 227
2.44.11.................. Application of items 30688, 30690, 30692 and 30694.. 227
2.44.12.................. Application of item 35412............................................. 227
2.44.12A............... Application of items 31569, 31572, 31575, 31578, 31581, 31584, 31587 and 31590.............................................................................. 227
Subdivision C—Subgroups 2 and 3 of Group T8 267
2.44.13.................. Meaning of foreign body in items 35360 to 35363........ 267
2.44.14.................. Application of items 32500 to 32517 and 35321........... 267
2.44.15.................. Application of items 35404, 35406 and 35408.............. 268
2.44.15A............... Sacral nerve stimulation................................................. 268
2.44.15B................ Artificial bowel sphincter............................................... 268
Subdivision D—Subgroups 4, 5 and 6 of Group T8 287
2.44.17.................. Application of items 38470 to 38766............................. 287
Subdivision E—Subgroups 7 to 11 of Group T8 323
Subdivision F—Subgroups 12 and 13 350
2.44.18.................. Meaning of amount under clause 2.44.18...................... 350
2.44.19.................. Meaning of maxilla........................................................ 350
Subdivision G—Subgroup 14 370
2.44.20.................. Items 46300 to 46534 apply only in certain circumstances 370
Subdivision H—Subgroup 15 374
2.44.21.................. Limitation of item 50303............................................... 374
Division 2.45—Group T9: Assistance at operations 408
2.45.1.................... Meaning of amount under clause 2.45.1........................ 408
2.45.2.................... Meaning of amount under clause 2.45.2........................ 408
2.45.3.................... Meaning of amount under clause 2.45.3........................ 408
2.45.4.................... Meaning of previous significant surgical complication 408
2.45.5.................... Application of Group T9................................................ 409
2.45.6.................... Assistance at operations................................................. 409
Division 2.46—Oral and Maxillofacial services 410
2.46.1.................... Application of Groups O1 to O11.................................. 410
Division 2.47—Group O1: Consultations 411
Division 2.48—Group O2: Assistance at operation 412
2.48.1.................... Meaning of amount under clause 2.48.1........................ 412
2.48.2.................... Assistance at operations................................................. 412
Division 2.49—Group O3: General surgery 413
Division 2.50—Group O4: Plastic and reconstructive 418
2.50.1.................... Meaning of maxilla........................................................ 418
Division 2.51—Group O5: Preprosthetic 421
Division 2.52—Group O6: Neurosurgical 422
Division 2.53—Group O7: Ear, nose and throat 423
Division 2.54—Group O8: Temporomandibular joint 424
Division 2.55—Group O9: Treatment of fractures 426
Division 2.56—Group O10: Diagnostic procedures and investigations 428
Division 2.57—Group O11: Regional or field nerve blocks 429
Part 3—Dictionary 430
Endnotes439
Endnote 1—About the endnotes 439
Endnote 2—Abbreviation key 440
Endnote 3—Legislation history 441
Endnote 4—Amendment history 442
1Name
This is the Health Insurance (General Medical Services Table) Regulation 2015.
3Authority
This instrument is made under the Health Insurance Act 1973.
4Schedules
Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.
5General medical services table
For subsection 4(1) of the Act, this instrument prescribes a table of medical services set out in Schedule 1.
6Dictionary
The Dictionary in Part 3 of Schedule 1 defines certain words and expressions that are used in this instrument, and includes references to certain words and expressions that are defined elsewhere in this instrument.
Schedule 1—General medical services table
Note:See section 5.
Part 1—Preliminary
Division 1.1—Interpretation
1.1.1Meaning of eligible non‑vocationally recognised medical practitioner
(1)In the table:
eligible non‑vocationally recognised medical practitioner means:
(a)a medical practitioner (including an overseas trained practitioner or a temporary resident medical practitioner) who:
(i)is registered as a medical practitioner under the Rural Other Medical Practitioners’ Program; and
(ii)is providing general medical services in accordance with that Program; or
(b)a medical practitioner who:
(i)is registered as a medical practitioner under the Outer Metropolitan (Other Medical Practitioners) Relocation Incentive Program; and
(ii)is providing general medical services in accordance with that Program; and
(iii)is not vocationally registered under section 3F of the Act, but is required under that Program to undertake additional training or other activities:
(A)that could enable vocational registration within 4 years or, on written application, 5 years, after commencing the training or other activities; and
(B)of which the Chief Executive Medicare has written notice; or
(c)a medical practitioner who:
(i)is registered as a medical practitioner under the MedicarePlus for Other Medical Practitioners Program; and
(ii)is providing general medical services in accordance with that Program; and
(iii)is not vocationally registered under section 3F of the Act; or
(d)a medical practitioner who:
(i)is registered as a medical practitioner under the After Hours Other Medical Practitioners Program; and
(ii)is providing general medical services in accordance with that Program; and
(iii)is not vocationally registered under section 3F of the Act.
(2)In subclause (1):
After Hours Other Medical Practitioners Program means a program administered by the Chief Executive Medicare that, for medical services provided in accordance with the Program, provides a particular level of medicare benefits.
MedicarePlus for Other Medical Practitioners Program means a program administered by the Chief Executive Medicare that, for medical services provided in accordance with the Program, provides a particular level of medicare benefits.
Outer Metropolitan (Other Medical Practitioners) Relocation Incentive Program means a program administered by the Department that, for medical services provided in accordance with the Program, provides a particular level of medicare benefits.
Rural Other Medical Practitioners’ Program means a program administered by the Chief Executive Medicare that, for medical services provided in accordance with the Program, provides a particular level of medicare benefits.
1.1.1AMeaning of general practitioner
In the table:
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 program of the RACGP; and
(iii)meets the RACGP requirements for quality assurance and continuing education; or
(c)a practitioner in relation to whom a determination is in force under regulation 6DA of the Health Insurance Regulations 1975 recognising that he or she meets the fellowship standards of the ACRRM; or
(d)a practitioner who is undertaking a placement in general practice that is approved by the RACGP:
(i)as part of a training program for general practice leading to the award of Fellowship of the RACGP; or
(ii)as part of another training program recognised by the RACGP as being of an equivalent standard; or
(e)an eligible non‑vocationally recognised medical practitioner; or
(g)a practitioner who is undertaking a placement in general practice as part of the Remote Vocational Training Scheme administered by Remote Vocational Training Scheme Limited.
1.1.2Meaning of multidisciplinary case conference
A multidisciplinary case conference means a process by which a multidisciplinary case conference team carries out all of the following activities:
(a)discussing a patient’s history;
(b)identifying the patient’s multidisciplinary care needs;
(c)identifying outcomes to be achieved by members of the multidisciplinary case conference team giving care and service to the patient;
(d)identifying tasks that need to be undertaken to achieve these outcomes, and allocating those tasks to members of the multidisciplinary case conference team;
(e)assessing whether previously identified outcomes (if any) have been achieved.
1.1.3Meaning of multidisciplinary case conference team
(1)A multidisciplinary case conference team for a patient:
(a)includes a medical practitioner; and
(b)either:
(i)for items 735 to 758—includes at least 2 other members; or
(ii)for an item mentioned in subclause (3)—includes at least 3 other members; and
(c)may also include a family member of the patient.
(2)For the members mentioned in paragraph (b):
(a)each member must provide a different kind of care or service to the patient; and
(b)each member must not be a family carer of the patient; and
(c)one member may be another medical practitioner.
Example:Other members may be allied health professionals, home and community service providers and care organisers, including the following:
(a) Aboriginal and Torres Strait Islander health practitioners;
(b) asthma educators;
(c) audiologists;
(d) dental therapists;
(e) dentists;
(f) diabetes educators;
(g) dieticians;
(h) mental health workers;
(i) occupational therapists;
(j) optometrists;
(k) orthoptists;
(l) orthotists or prosthetists;
(m) pharmacists;
(n) physiotherapists;
(o) podiatrists;
(p) psychologists;
(q) registered nurses;
(r) social workers;
(s) speech pathologists;
(t) education providers;
(u) “meals on wheels” providers;
(v) personal care workers;
(w) probation officers.
(3)For subparagraph (1)(b)(ii), the items are items 820, 822, 823, 830, 832, 834, 2946, 2949, 2954, 2978, 2984, 2988, 3032, 3040, 3044, 3069 and 3074.
1.1.4Meaning of single course of treatment
(1)Use this clause for:
(a)items 104 to 131, 133, 384 to 388, 2799, 2801 to 2840, 3003, 3005 to 3028, 6004, 6007 to 6015, 16401, 16404, 16406, 51700 and 51703; and
(b)the meaning of attendance in clause 1.1.1; and
(c)the meaning of symbol (S) in clause 1.1.10; and
(d)the definition of minor attendance in the Dictionary.
(2)A single course of treatment for a patient:
(a)includes:
(i)the initial attendance on the patient by a specialist or consultant physician; and
(ii)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
(iii)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 by the specialist or consultant physician; but
(b)does not include:
(i)referral of the patient to the specialist or consultant physician; or
(ii)an attendance (the later attendance) on the patient by the specialist or consultant physician, after the end of the period of validity of the last referral to have application under regulation 31 of the Health Insurance Regulations 1975 if:
(A)the referring practitioner considers the later attendance necessary for the patient’s condition to be reviewed; and
(B)the patient was most recently attended by the specialist or consultant physician more than 9 months before the later attendance.
1.1.5Meaning of symbol (G)
An item including the symbol (G) applies only to a service not provided by a specialist in the practice of his or her specialty.
1.1.6Meaning of symbol (H)
An item including the symbol (H) applies only to a service performed or provided in a hospital.
1.1.7Meaning of symbol (S)
(1)An item including the symbol (S) applies only to a service performed by a specialist in the practice of his or her specialty, if:
(a)the service is:
(i)provided to a patient who has been referred to the specialist; and
(ii)the first service performed by the specialist in accordance with the referral; or
(b)the service is:
(i)provided to a patient who has been referred to the specialist; and
(ii)part of a single course of treatment given for the condition identified in the referral or, if no condition was identified in the referral, part of a single course of treatment for the condition identified by the specialist; and
(iii)provided within the period of validity of the referral that is applicable under regulation 31 of the Health Insurance Regulations 1975; or
(c)the service is:
(i)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)the first service performed by the specialist in accordance with the referral; or
(d)the service is:
(i)provided to a patient who has not been referred to the specialist; and
(ii)a service that, in an emergency, the specialist decides is necessary in the patient’s interests to be provided as soon as practicable without a referral.
(2)In this clause:
emergency has the same meaning as in subregulation 30(5) of the Health Insurance Regulations 1975.
Division 1.2—General application provisions
1.2.1Application
An item in Part 2 does not apply to a service provided in contravention of a law of the Commonwealth, a State or Territory.
1.2.2Attendance by specialist or consultant physician
(1)Use this clause for items 99 to 137, 141 to 149, 288 to 389, 2799, 2801 to 2840, 3003, 3005 to 3028, 6004, 6007 to 6016, 13210, 16399, 16401, 16404, 17609 and 17640 to 17655.
(2)An attendance on a patient by a specialist or consultant physician:
(a)includes an attendance on a patient if:
(i)the patient declares that a written referral of the patient was completed by a medical practitioner; or
(ii)in an emergency, the patient has not been referred to the specialist, or consultant physician, if the specialist or consultant physician 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 on a patient if:
(i)the attendance forms part of a single course of treatment for the patient in which the first service was provided to the patient more than 12 months (or another 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.
(3)In this clause:
emergency has the same meaning as in subregulation 30(5) of the Health Insurance Regulations 1975.
1.2.3Professional attendance services
(1)Use this clause for items 3 to 338, 348 to 389, 410 to 417, 501 to 600, 900, 903, 2497 to 2840, 3003, 3005 to 3028, 5000 to 5267, 6004, 6007 to 6016, 13210, 16399, 16401, 16404, 16406, 16590, 16591 and 17609 to 17690.
(2)A professional attendance includes the provision, for a patient, of any of the following services:
(a)evaluating the patient’s condition or conditions including, if applicable, evaluation using a health screening service mentioned in subsection 19(5) of the Act;
(b)formulating a plan for the management and, if applicable, for the treatment of the patient’s condition or conditions;
(c)giving advice to the patient about the patient’s condition or conditions and, if applicable, about treatment;
(d)if authorised by the patient—giving advice to another person, or other persons, about the patient’s condition or conditions and, if applicable, about treatment;
(e)providing appropriate preventive health care;
(f)recording the clinical details of the service or services provided to the patient.
(3)However, a professional attendance does not include the supply of a vaccine to a patient if:
(a)the vaccine is supplied to the patient in connection with a professional attendance mentioned in any of items 3 to 96 and 5000 to 5267; and
(b)the cost of the vaccine is not subsidised by the Commonwealth or a State.
1.2.4Personal attendance by medical practitioners generally
(1)Use this clause for items 3 to 149, 173 to 338, 348 to 536, 597 to 600, 2100 to 2220, 2497 to 2840, 3003, 3005 to 3028, 4001 to 10816, 11012 to 11021, 11212, 11304, 11500, 11600, 11627, 11701, 11724, 11921 to 12003, 12201, 13030 to 13112, 13209, 13210, 13290 to 13700, 13815 to 13888, 14100 to 14200, 14203 to 14212, 14224, 15600, 16003 to 16512 and 16515 to 51318.
(2)The item applies to a service provided in the course of a personal attendance by a single medical practitioner on a single patient on a single occasion.
(3)A personal attendance by the medical practitioner on the patient includes any of the following:
(a)a telepsychiatry consultation to which any of items 353 to 361 applies;
(b)the planning, management and supervision of the patient on home dialysis to which item 13104 applies;
(c)participating in a video conferencing consultation referred to in items 99, 112 to 114, 149, 288, 384, 389, 2100, 2122, 2125, 2126, 2137, 2138, 2143, 2147, 2179, 2195, 2199, 2220, 2799, 2820, 3003, 3015, 6004, 6016, 13210, 16399 and 17609.
1.2.5Personal attendance by medical practitioners
(1)Use this clause for items 3 to 723, 732, 900 to 10816, 11012 to 11021, 11212, 11304, 11500, 11600, 11627, 11701, 11722, 11724, 11820, 11823, 11921, 12000, 12003, 12201, 13030 to 13112, 13209, 13210, 13290 to 13700, 13815 to 13888, 14100 to 14200, 14203 to 14212, 14224, 15600, 16003 to 16512, 16515 to 51318.
(2)The item applies to a service provided during a personal attendance by:
(a)a medical practitioner (other than a medical practitioner employed by the proprietor of a hospital that is not a private hospital); or
(b)a medical practitioner who:
(i)is employed by the proprietor of a hospital that is not a private hospital; and
(ii)provides the service otherwise than in the course of employment by that proprietor.
(3)Subclause (2) applies whether or not another person provides essential assistance to the medical practitioner in accordance with accepted medical practice.
(4)A personal attendance by the medical practitioner on the patient includes any of the following:
(a)a telepsychiatry consultation to which any of items 353 to 361 applies;
(b)the planning, management and supervision of the patient on home dialysis to which item 13104 applies;
(c)participating in a video conferencing consultation referred to in items 99, 112 to 114, 149, 288, 384, 389, 2100, 2122, 2125, 2126, 2137, 2138, 2143, 2147, 2179, 2195, 2199, 2220, 2799, 2820, 3003, 3015, 6004, 6016, 13210, 16399 and 17609.
1.2.6Consultant occupational physician
A fee specified for an attendance by a consultant occupational physician applies only if the attendance relates to one or more of the following matters:
(a)evaluating and assessing a patient’s rehabilitation requirements when, in the consultant’s opinion, the patient has an accepted medical condition that:
(i)may be affected by the patient’s working environment; or
(ii)affects the patient’s capacity to be employed;
(b)managing an accepted medical condition that, in the consultant’s opinion, may affect a patient’s capacity for continued employment, or return to employment, following a non‑compensable accident, injury or ill‑health;
(c)evaluating and forming an opinion about, including management as the case requires, a patient’s medical condition when causation may be related to acute or chronic exposure to scientifically acknowledged environmental hazards or toxins.
1.2.7Application of items—services provided with non‑medicare services
Items 3 to 10816 do not apply to a service mentioned in the item if the service is provided at the same time as, or in connection with, a non‑medicare service.
1.2.7AApplication of items—services provided with autologous injections of blood or blood products
An item in the table does not apply to a service mentioned in the item if the service is provided to a patient at the same time, or in connection with, an injection of blood or a blood product that is autologous.
1.2.8Services that may be provided by persons other than medical practitioners
(1)Use this clause for items 10983 to 10989, 10997, 11000, 11003, 11004, 11005, 11006, 11009, 11024, 11027, 11200, 11203, 11204, 11205, 11210, 11211, 11215, 11218, 11221, 11222, 11224, 11225, 11235, 11237, 11240, 11241, 11242, 11243, 11244, 11300, 11303, 11306, 11309, 11312, 11315, 11318, 11321, 11324, 11327, 11330, 11332, 11333, 11336, 11339, 11503, 11506, 11509, 11512, 11602, 11604, 11605, 11610, 11611, 11612, 11614, 11615, 11700, 11702, 11708, 11709, 11710, 11711, 11712, 11713, 11715, 11718, 11721, 11725, 11726, 11727, 11800, 11810, 11830, 11833, 11900, 11903, 11906, 11909, 11912, 11915, 11919, 12012, 12015, 12018, 12021, 12200, 12203, 12207, 12210, 12213, 12215, 12217, 12250, 12500 to 12530, 13015, 13020, 13025, 13200 to 13203, 13206, 13212, 13215, 13218, 13221, 13703, 13706, 13709, 13750, 13755, 13757, 13760, 13915 to 13948, 14050, 14053, 14218, 14221, 15000 to 15336, 15339 to 15357, 15500 to 15539 and 16514.
(2)The item applies whether the medical service is given by:
(a)a medical practitioner; or
(b)a person, other than a medical practitioner, who:
(i)is employed by a medical practitioner; or
(ii)in accordance with accepted medical practice, acts under the supervision of a medical practitioner.
1.2.9Meaning of participating in a video conferencing consultation
A medical practitioner is participating in a video conferencing consultation if the medical practitioner attends a patient who is receiving a service under an item in the table from a specialist or consultant physician who is providing the service:
(a)in relation to his or her speciality to the patient; and
(b)by way of a video conferencing consultation.
Part 2—Services and fees
Division 2.1—Groups A1 to A9
Note:Groups A1 to A9 include Groups A1, A2, A3, A4, A28, A5, A6, A7, A8, A12, A13, A21, A11, A14, A15, A17, A18, A19, A20, A24, A27, A22, A23, A26 and A9.
2.1.1Meaning of amount under clause 2.1.1
In an item of the table mentioned in column 1 of table 2.1.1:
amount under clause 2.1.1 means the sum of:
(a)the fee mentioned in column 2 for the item; and
(b)either:
(i)if a practitioner attends not more than 6 patients in a single attendance—the amount mentioned in column 3 for the item, divided by the number of patients attended; or
(ii)if a practitioner attends more than 6 patients in a single attendance—the amount mentioned in column 4 for the item.
| Table 2.1.1—Amount under clause 2.1.1 | ||||
| Item |
Column 1 Item/s of the table |
Column 2 Fee |
Column 3 Amount if not more than 6 patients (to be divided by the number of patients) ($) |
Column 4 Amount if more than 6 patients ($) |
| 1 | 4 | The fee for item 3 | 25.95 | 2.00 |
| 2 | 20 | The fee for item 3 | 46.70 | 3.30 |
| 3 | 24 | The fee for item 23 | 25.95 | 2.00 |
| 4 | 35 | The fee for item 23 | 46.70 | 3.30 |
| 5 | 37 | The fee for item 36 | 25.95 | 2.00 |
| 6 | 43 | The fee for item 36 | 46.70 | 3.30 |
| 7 | 47 | The fee for item 44 | 25.95 | 2.00 |
| 8 | 51 | The fee for item 44 | 46.70 | 3.30 |
| 9 | 58 | $8.50 | 15.50 | 0.70 |
| 10 | 59, 2610, 2631, 2673 | $16.00 | 17.50 | 0.70 |
| 11 | 60, 2613, 2633, 2675 | $35.50 | 15.50 | 0.70 |
| 12 | 65, 2616, 2635, 2677 | $57.50 | 15.50 | 0.70 |
| 13 | 92 | $8.50 | 27.95 | 1.25 |
| 14 | 93 | $16.00 | 31.55 | 1.25 |
| 15 | 95 | $35.50 | 27.95 | 1.25 |
| 16 | 96 | $57.50 | 27.95 | 1.25 |
| 17 | 195 | The fee for item 193 | 25.95 | 2.00 |
| 18 | 414 | The fee for item 410 | 25.45 | 1.95 |
| 19 | 415 | The fee for item 411 | 25.45 | 1.95 |
| 20 | 416 | The fee for item 412 | 25.45 | 1.95 |
| 21 | 417 | The fee for item 413 | 25.45 | 1.95 |
| 22 | 2503 | The fee for item 2501 | 25.95 | 2.00 |
| 23 | 2506 | The fee for item 2504 | 25.95 | 2.00 |
| 24 | 2509 | The fee for item 2507 | 25.95 | 2.00 |
| 25 | 2518 | The fee for item 2517 | 25.95 | 2.00 |
| 26 | 2522 | The fee for item 2521 | 25.95 | 2.00 |
| 27 | 2526 | The fee for item 2525 | 25.95 | 2.00 |
| 28 | 2547 | The fee for item 2546 | 25.95 | 2.00 |
| 29 | 2553 | The fee for item 2552 | 25.95 | 2.00 |
| 30 | 2559 | The fee for item 2558 | 25.95 | 2.00 |
| 31 | 5003 | The fee for item 5000 | 25.95 | 2.00 |
| 32 | 5010 | The fee for item 5000 | 46.70 | 3.30 |
| 33 | 5023 | The fee for item 5020 | 25.95 | 2.00 |
| 34 | 5028 | The fee for item 5020 | 46.70 | 3.30 |
| 35 | 5043 | The fee for item 5040 | 25.95 | 2.00 |
| 36 | 5049 | The fee for item 5040 | 46.70 | 3.30 |
| 37 | 5063 | The fee for item 5060 | 25.95 | 2.00 |
| 38 | 5067 | The fee for item 5060 | 46.70 | 3.30 |
| 39 | 5220 | $18.50 | 15.50 | 0.70 |
| 40 | 5223 | $26.00 | 17.50 | 0.70 |
| 41 | 5227 | $45.50 | 15.50 | 0.70 |
| 42 | 5228 | $67.50 | 15.50 | 0.70 |
| 43 | 5260 | $18.50 | 27.95 | 1.25 |
| 44 | 5263 | $26.00 | 31.55 | 1.25 |
| 45 | 5265 | $45.50 | 27.95 | 1.25 |
| 46 | 5267 | $67.50 | 27.95 | 1.25 |
Division 2.2—Group A1: General practitioner attendances to which no other item applies
| Group A1—General practitioner attendances to which no other item applies | ||
| Item | Description | Fee ($) |
| 3 | Professional attendance at consulting rooms (other than a service to which another 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 | 16.95 |
| 4 | Professional attendance by a general practitioner (other than attendance at consulting rooms or a residential aged care facility or a service to which another item in the table applies) that requires a short patient history and, if necessary, limited examination and management—an attendance on one or more patients at one place on one occasion—each patient | Amount under clause 2.1.1 |
| 20 | Professional attendance (other than a service to which another item applies) at a residential aged care facility (other than a professional attendance at a self‑contained unit) or professional attendance at consulting rooms situated within such a complex if the patient is accommodated in a residential aged care facility (other than 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 one or more patients at one residential aged care facility on one occasion—each patient | Amount under clause 2.1.1 |
| 23 |
Professional attendance by a general practitioner at consulting rooms (other than a service to which another item in the table applies), lasting less than 20 minutes and including any of the following that are clinically relevant: (a) taking a patient history; (b) performing a clinical examination; (c) arranging any necessary investigation; (d) implementing a management plan; (e) providing appropriate preventive health care; for one or more health‑related issues, with appropriate documentation—each attendance |
37.05 |
| 24 |
Professional attendance by a general practitioner (other than attendance at consulting rooms or a residential aged care facility or a service to which another item in the table applies), lasting less than 20 minutes and including any of the following that are clinically relevant: (a) taking a patient history; (b) performing a clinical examination; (c) arranging any necessary investigation; (d) implementing a management plan; (e) providing appropriate preventive health care; for one or more health‑related issues, with appropriate documentation—an attendance on one or more patients at one place on one occasion—each patient |
Amount under clause 2.1.1 |
| 35 |
Professional attendance by a general practitioner at a residential aged care facility to residents of the facility (other than a service to which another item in the table applies), lasting less than 20 minutes and including any of the following that are clinically relevant: (a) taking a patient history; (b) performing a clinical examination; (c) arranging any necessary investigation; (d) implementing a management plan; (e) providing appropriate preventive health care; for one or more health‑related issues, with appropriate documentation—an attendance on one or more patients at one residential aged care facility on one occasion—each patient |
Amount under clause 2.1.1 |
| 36 |
Professional attendance by a general practitioner at consulting rooms (other than a service to which another item in the table applies), lasting at least 20 minutes and including any of the following that are clinically relevant: (a) taking a detailed patient history; (b) performing a clinical examination; (c) arranging any necessary investigation; (d) implementing a management plan; (e) providing appropriate preventive health care; for one or more health‑related issues, with appropriate documentation—each attendance |
71.70 |
| 37 |
Professional attendance by a general practitioner (other than attendance at consulting rooms or a residential aged care facility or a service to which another item in the table applies), lasting at least 20 minutes and including any of the following that are clinically relevant: (a) taking a detailed patient history; (b) performing a clinical examination; (c) arranging any necessary investigation; (d) implementing a management plan; (e) providing appropriate preventive health care; for one or more health‑related issues, with appropriate documentation—an attendance on one or more patients at one place on one occasion—each patient |
Amount under clause 2.1.1 |
| 43 |
Professional attendance by a general practitioner at a residential aged care facility to residents of the facility (other than a service to which another item in the table applies), lasting at least 20 minutes and including any of the following that are clinically relevant: (a) taking a detailed patient history; (b) performing a clinical examination; (c) arranging any necessary investigation; (d) implementing a management plan; (e) providing appropriate preventive health care; for one or more health‑related issues, with appropriate documentation—an attendance on one or more patients at one residential aged care facility on one occasion—each patient |
Amount under clause 2.1.1 |
| 44 |
Professional attendance by a general practitioner at consulting rooms (other than a service to which another item in the table applies), lasting at least 40 minutes and including any of the following that are clinically relevant: (a) taking an extensive patient history; (b) performing a clinical examination; (c) arranging any necessary investigation; (d) implementing a management plan; (e) providing appropriate preventive health care; for one or more health‑related issues, with appropriate documentation—each attendance |
105.55 |
| 47 |
Professional attendance by a general practitioner (other than attendance at consulting rooms or a residential aged care facility or a service to which another item in the table applies), lasting at least 40 minutes and including any of the following that are clinically relevant: (a) taking an extensive patient history; (b) performing a clinical examination; (c) arranging any necessary investigation; (d) implementing a management plan; (e) providing appropriate preventive health care; for one or more health‑related issues, with appropriate documentation—an attendance on one or more patients at one place on one occasion—each patient |
Amount under clause 2.1.1 |
| 51 |
Professional attendance by a general practitioner at a residential aged care facility to residents of the facility (other than a service to which another item in the table applies), lasting at least 40 minutes and including any of the following that are clinically relevant: (a) taking an extensive patient history; (b) performing a clinical examination; (c) arranging any necessary investigation; (d) implementing a management plan; (e) providing appropriate preventive health care; for one or more health‑related issues, with appropriate documentation—an attendance on one or more patients at one residential aged care facility on one occasion—each patient |
Amount under clause 2.1.1 |
Division 2.3—Group A2: Other non‑referred attendances to which no other item applies
2.3.1Effect of determination under section 106TA of Act
(1)This clause applies to a general practitioner, if:
(a)the practitioner is the subject of a final determination that is in force under section 106TA of the Act; and
(b)the determination contains a direction, given under subparagraph 106U(1)(g)(i) of the Act, that the practitioner be disqualified for a professional service; and
(c)the determination states that the practitioner is disqualified for a service mentioned in an item in Group A1; and
(d)the practitioner provides a service mentioned in an item in Group A2.
(2)The determination applies to the service mentioned in paragraph (1)(d).
| Group A2—Other non‑referred attendances to which no other item applies | ||
| Item | Description | Fee ($) |
| 52 |
Professional attendance at consulting rooms of not more than 5 minutes in duration (other than a service to which any other item applies)—each attendance, by: (a) a medical practitioner (who is not a general practitioner); or (b) a general practitioner to whom clause 2.3.1 applies |
11.00 |
| 53 |
Professional attendance at consulting rooms of more than 5 minutes in duration but not more than 25 minutes (other than a service to which any other item applies)—each attendance, by: (a) a medical practitioner (who is not a general practitioner); or (b) a general practitioner to whom clause 2.3.1 applies |
21.00 |
| 54 |
Professional attendance at consulting rooms of more than 25 minutes in duration but not more than 45 minutes (other than a service to which any other item applies)—each attendance, by: (a) a medical practitioner (who is not a general practitioner); or (b) a general practitioner to whom clause 2.3.1 applies |
38.00 |
| 57 |
Professional attendance at consulting rooms of more than 45 minutes in duration (other than a service to which any other item applies)—each attendance, by: (a) a medical practitioner (who is not a general practitioner); or (b) a general practitioner to whom clause 2.3.1 applies |
61.00 |
| 58 |
Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a service to which any other item in the table applies), not more than 5 minutes in duration—an attendance on one or more patients at one place on one occasion—each patient, by: (a) a medical practitioner (who is not a general practitioner); or (b) a general practitioner to whom clause 2.3.1 applies |
Amount under clause 2.1.1 |
| 59 |
Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a service to which any other item in the table applies) of more than 5 minutes in duration but not more than 25 minutes—an attendance on one or more patients at one place on one occasion—each patient, by: (a) a medical practitioner (who is not a general practitioner); or (b) a general practitioner to whom clause 2.3.1 applies |
Amount under clause 2.1.1 |
| 60 |
Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a service to which any other item in the table applies) of more than 25 minutes in duration but not more than 45 minutes—an attendance on one or more patients at one place on one occasion—each patient, by: (a) a medical practitioner (who is not a general practitioner); or (b) a general practitioner to whom clause 2.3.1 applies |
Amount under clause 2.1.1 |
| 65 |
Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a service to which any other item in the table applies) of more than 45 minutes in duration—an attendance on one or more patients at one place on one occasion—each patient, by: (a) a medical practitioner (who is not a general practitioner); or (b) a general practitioner to whom clause 2.3.1 applies |
Amount under clause 2.1.1 |
| 92 |
Professional attendance (other than a service to which any other item applies) at a residential aged care facility (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 residential aged care facility (that is not accommodation in a self‑contained unit) of not more than 5 minutes in duration—an attendance on one or more patients at one residential aged care facility on one occasion—each patient, by: (a) a medical practitioner (who is not a general practitioner); or (b) a general practitioner to whom clause 2.3.1 applies |
Amount under clause 2.1.1 |
| 93 |
Professional attendance (other than a service to which any other item applies) at a residential aged care facility (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 residential aged care facility (that is not accommodation in a self‑contained unit) of more than 5 minutes in duration but not more than 25 minutes—an attendance on one or more patients at one residential aged care facility on one occasion—each patient, by: (a) a medical practitioner (who is not a general practitioner); or (b) a general practitioner to whom clause 2.3.1 applies |
Amount under clause 2.1.1 |
| 95 |
Professional attendance (other than a service to which any other item applies) at a residential aged care facility (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 residential aged care facility (that is not accommodation in a self‑contained unit) of more than 25 minutes in duration but not more than 45 minutes—an attendance on one or more patients at one residential aged care facility on one occasion—each patient, by: (a) a medical practitioner (who is not a general practitioner); or (b) a general practitioner to whom clause 2.3.1 applies |
Amount under clause 2.1.1 |
| 96 |
Professional attendance (other than a service to which any other item applies) at a residential aged care facility (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 residential aged care facility (that is not accommodation in a self‑contained unit) of more than 45 minutes in duration—an attendance on one or more patients at one residential aged care facility on one occasion—each patient, by: (a) a medical practitioner (who is not a general practitioner); or (b) a general practitioner to whom clause 2.3.1 applies |
Amount under clause 2.1.1 |
Division 2.4—Group A3: Specialist attendances to which no other item applies
2.4.1Limitation of item 99
Item 99 does not apply if the patient or the specialist
travels to a place to satisfy the requirement in sub‑subparagraph (d)(i)(B) of the item.
| Group A3—Specialist attendances to which no other item applies | ||
| Item | Description | Fee ($) |
| 99 |
Professional attendance on a patient by a specialist practising in his or her specialty if: (a) the attendance is by video conference; and (b) the attendance is for a service: (i) provided with item 104 lasting more than 10 minutes; or (ii) provided with item 105; and (c) the patient is not an admitted patient; and (d) the patient: (i) is located both: (A) within a telehealth eligible area; and (B) at the time of the attendance—at least 15 kms by road from the specialist; or (ii) is a care recipient in a residential care service; or (iii) is a patient of: (A) an Aboriginal Medical Service; or (B) an Aboriginal Community Controlled Health Service; for which a direction made under subsection 19(2) of the Act applies |
50% of the fee for item 104 or 105 |
| 104 | Professional attendance at consulting rooms or hospital by a specialist in the practice of his or her specialty after referral of the patient to him or her—each attendance, other than a second or subsequent attendance, in a single course of treatment, other than a service to which item 106, 109 or 16401 applies | 85.55 |
| 105 | Professional attendance by a specialist in the practice of his or her specialty following referral of the patient to him or her—an attendance after the first in a single course of treatment, if that attendance is at consulting rooms or hospital | 43.00 |
| 106 | Professional attendance by a specialist in the practice of his or her specialty of ophthalmology and following referral of the patient to him or her—an attendance (other than a second or subsequent attendance in a single course of treatment) at which the only service provided is refraction testing for the issue of a prescription for spectacles or contact lenses, if that attendance is at consulting rooms or hospital (other than a service to which any of items 104, 109 and 10801 to 10816 applies) | 71.00 |
| 107 | Professional attendance by a specialist in the practice of his or her specialty following referral of the patient to him or her—an attendance (other than a second or subsequent attendance in a single course of treatment), if that attendance is at a place other than consulting rooms or hospital | 125.50 |
| 108 | Professional attendance by a specialist in the practice of his or her specialty following referral of the patient to him or her—each attendance after the first in a single course of treatment, if that attendance is at a place other than consulting rooms or hospital | 79.45 |
| 109 |
Professional attendance by a specialist in the practice of his or her specialty of ophthalmology following referral of the patient to him or her—an attendance (other than a second or subsequent attendance in a single course of treatment) at which a comprehensive eye examination, including pupil dilation, is performed on: (a) a patient aged 9 years or younger; or (b) a patient aged 14 years or younger with developmental delay; (other than a service to which any of items 104, 106 and 10801 to 10816 applies) |
192.80 |
| 113 |
Initial professional attendance of 10 minutes or less in duration on a patient by a specialist in the practice of his or her speciality if: (a) the attendance is by video conference; and (b) the patient is not an admitted patient; and (c) the patient: (i) is located both: (A) within a telehealth eligible area; and (B) at the time of the attendance—at least 15 kms by road from the specialist; or (ii) is a care recipient in a residential care service; or (iii) is a patient of: (A) an Aboriginal Medical Service; or (B) an Aboriginal Community Controlled Health Service; for which a direction made under subsection 19(2) of the Act applies; and (d) no other initial consultation has taken place for a single course of treatment |
64.20 |
Division 2.5—Group A4: Consultant physician (other than psychiatry) attendances to which no other item applies
2.5.1Limitation of items 112 to 114
Items 112, 113 and 114 do not apply if the patient, specialist or physician travels to a place to satisfy the requirement in:
(a)for item 112—sub‑subparagraph (d)(i)(B) of the item; and
(b)for items 113 and 114—sub‑subparagraph (c)(i)(B) of the item.
| Group A4—Consultant physician attendances to which no other item applies | ||
| Item | Description | Fee ($) |
| 110 | Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a referring practitioner—initial attendance in a single course of treatment | 150.90 |
| 112 |
Professional attendance on a patient by a consultant physician practising in his or her specialty if: (a) the attendance is by video conference; and (b) the attendance is for a service: (i) provided with item 110 lasting more than 10 minutes; or (ii) provided with item 116, 119, 132 or 133; and (c) the patient is not an admitted patient; and (d) the patient: (i) is located both: (A) within a telehealth eligible area; and (B) at the time of the attendance—at least 15 kms by road from the physician; or (ii) is a care recipient in a residential care service; or |
50% of the fee for item 110, 116, 119, 132 or 133 |
|
(iii) is a patient of: (A) an Aboriginal Medical Service; or (B) an Aboriginal Community Controlled Health Service; for which a direction made under subsection 19(2) of the Act applies |
||
| 114 |
Initial professional attendance of 10 minutes or less in duration on a patient by a consultant physician practising in his or her specialty if: (a) the attendance is by video conference; and (b) the patient is not an admitted patient; and (c) the patient: (i) is located both: (A) within a telehealth eligible area; and (B) at the time of the attendance—at least 15 kms by road from the physician; or (ii) is a care recipient in a residential care service; or (iii) is a patient of: (A) an Aboriginal Medical Service; or (B) an Aboriginal Community Controlled Health Service; for which a direction made under subsection 19(2) of the Act applies; and (d) no other initial consultation has taken place for a single course of treatment |
113.20 |
| 116 | Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a referring practitioner—each attendance (other than a service to which item 119 applies) after the first in a single course of treatment | 75.50 |
| 119 | Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a referring practitioner—each minor attendance after the first in a single course of treatment | 43.00 |
| 122 | Professional attendance at a place other than consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a referring practitioner—initial attendance in a single course of treatment | 183.10 |
| 128 | Professional attendance at a place other than consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a referring practitioner—each attendance (other than a service to which item 131 applies) after the first in a single course of treatment | 110.75 |
| 131 | Professional attendance at a place other than consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a referring practitioner—each minor attendance after the first in a single course of treatment | 79.75 |
| 132 |
Professional attendance by a consultant physician in the practice of his or her specialty (other than psychiatry) of at least 45 minutes in duration for an initial assessment of a patient with at least 2 morbidities (which may include complex congenital, developmental and behavioural disorders) following referral of the patient to him or her by a referring practitioner, if: (a) an assessment is undertaken that covers: (i) a comprehensive history, including psychosocial history and medication review; and (ii) comprehensive multi or detailed single organ system assessment; and (iii) the formulation of differential diagnoses; and (b) a consultant physician treatment and management plan of significant complexity is prepared and provided to the referring practitioner, which involves: (i) an opinion on diagnosis and risk assessment; and (ii) treatment options and decisions; and (iii) medication recommendations; and (c) an attendance on the patient to which item 110, 116 or 119 applies did not take place on the same day by the same consultant physician; and (d) this item has not applied to an attendance on the patient in the preceding 12 months by the same consultant physician |
263.90 |
| 133 |
Professional attendance by a consultant physician in the practice of his or her specialty (other than psychiatry) of at least 20 minutes in duration after the first attendance in a single course of treatment for a review of a patient with at least 2 morbidities (which may include complex congenital, developmental and behavioural disorders) if: (a) a review is undertaken that covers: (i) review of initial presenting problems and results of diagnostic investigations; and (ii) review of responses to treatment and medication plans initiated at time of initial consultation; and (iii) comprehensive multi or detailed single organ system assessment; and (iv) review of original and differential diagnoses; and (b) the modified consultant physician treatment and management plan is provided to the referring practitioner, which involves, if appropriate: (i) a revised opinion on the diagnosis and risk assessment; and (ii) treatment options and decisions; and (iii) revised medication recommendations; and (c) an attendance on the patient to which item 110, 116 or 119 applies did not take place on the same day by the same consultant physician; and (d) item 132 applied to an attendance claimed in the preceding 12 months; and (e) the attendance under this item is claimed by the same consultant physician who claimed item 132 or a locum tenens; and (f) this item has not applied more than twice in any 12 month period |
132.10 |
Division 2.5A—Group A29: Early intervention services for children with autism, pervasive developmental disorder or disability
2.5A.1Meanings of eligible allied health provider and risk assessment
In items 135, 137 and 139:
eligible allied health provider means any of the following:
(a)an audiologist;
(b)an occupational therapist;
(c)an optometrist;
(d)an orthoptist;
(e)a physiotherapist;
(f)a psychologist;
Division 2.55—Group O9: Treatment of fractures
| Group O9—Treatment of fractures | ||
| Item | Description | Fee ($) |
| 53400 | Maxilla, unilateral or bilateral, treatment of fracture of, not requiring splinting | 129.20 |
| 53403 | Mandible, treatment of fracture of, not requiring splinting | 157.85 |
| 53406 | Maxilla, treatment of fracture of, requiring splinting, wiring of teeth, circumosseous fixation or external fixation (Anaes.) (Assist.) | 406.65 |
| 53409 | Mandible, treatment of fracture of, requiring splinting, wiring of teeth, circumosseous fixation or external fixation (Anaes.) (Assist.) | 406.65 |
| 53410 | Zygomatic bone, treatment of fracture of, not requiring surgical reduction | 85.65 |
| 53411 | Zygomatic bone, treatment of fracture of, requiring surgical reduction, by temporal, intra‑oral or other approach (Anaes.) | 238.80 |
| 53412 | Zygomatic bone, treatment of fracture of, requiring surgical reduction and involving internal or external fixation at one site (Anaes.) (Assist.) | 392.10 |
| 53413 | Zygomatic bone, treatment of fracture of, requiring surgical reduction and involving internal or external fixation or both at 2 sites (Anaes.) (Assist.) | 480.35 |
| 53414 | Zygomatic bone, treatment of, requiring surgical reduction and involving internal or external fixation or both at 3 sites (Anaes.) (Assist.) | 551.85 |
| 53415 | Maxilla, treatment of fracture of, requiring open reduction (Anaes.) (Assist.) | 435.65 |
| 53416 | Mandible, treatment of fracture of, requiring open reduction (Anaes.) (Assist.) | 435.65 |
| 53418 | Maxilla, treatment of fracture of, requiring open reduction and internal fixation not involving a plate (Anaes.) (Assist.) | 566.35 |
| 53419 | Mandible, treatment of fracture of, requiring open reduction and internal fixation not involving a plate (Anaes.) (Assist.) | 566.35 |
| 53422 | Maxilla, treatment of fracture of, requiring open reduction and internal fixation involving a plate (Anaes.) (Assist.) | 718.75 |
| 53423 | Mandible, treatment of fracture of, requiring open reduction and internal fixation involving a plate (Anaes.) (Assist.) | 718.75 |
| 53424 | Maxilla, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction not involving a plate (Anaes.) (Assist.) | 616.65 |
| 53425 | Mandible, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction not involving a plate (Anaes.) (Assist.) | 616.65 |
| 53427 | Maxilla, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction involving the use of a plate (Anaes.) (Assist.) | 842.25 |
| 53429 | Mandible, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction involving the use of a plate (Anaes.) (Assist.) | 842.25 |
| 53439 | Mandible, treatment of a closed fracture of, involving a joint surface (Anaes.) | 238.80 |
| 53453 | Orbital cavity, reconstruction of a wall or floor with or without foreign implant (Anaes.) (Assist.) | 483.25 |
| 53455 | Orbital cavity, bone or cartilage graft to orbital wall or floor including reduction of prolapsed or entrapped orbital contents (Anaes.) (Assist.) | 567.65 |
| 53458 | Nasal bones, treatment of fracture of, other than a service to which item 53459 or 53460 applies | 43.05 |
| 53459 | Nasal bones, treatment of fracture of, by reduction (Anaes.) | 235.50 |
| 53460 | Nasal bones, treatment of fractures of, by open reduction involving osteotomies (Anaes.) (Assist.) | 480.35 |
Division 2.56—Group O10: Diagnostic procedures and investigations
| Group O10—Diagnostic procedures and investigations | ||
| Item | Description | Fee ($) |
| 53600 | Skin sensitivity testing for allergens to anaesthetics and materials used in oral and maxillofacial surgery, using one to 20 allergens | 38.95 |
Division 2.57—Group O11: Regional or field nerve blocks
| Group O11—Regional or field nerve blocks | ||
| Item | Description | Fee ($) |
| 53700 | Trigeminal nerve, primary division of, injection of an anaesthetic agent | 124.85 |
| 53702 | Trigeminal nerve, peripheral branch of, injection of an anaesthetic agent | 62.50 |
| 53704 | Facial nerve, injection of an anaesthetic agent | 37.65 |
| 53706 | Nerve branch in the oral and maxillofacial region, destruction by a neurolytic agent, other than a service to which another item in this Group applies | 124.85 |
Part 3—Dictionary
Note: All references in the Dictionary to a provision are references to a provision in this Schedule of this instrument unless otherwise indicated.
In this instrument:
Aboriginal and Torres Strait Islander health practitioner means a person:
(a) who is registered under a law of a State or Territory as an Aboriginal and Torres Strait Islander health practitioner; and
(b) who is employed by, or whose services are otherwise retained by, a medical practitioner in a general practice or a health service to which a direction made under subsection 19(2) of the Act applies.
aboriginal health worker means a person:
(a) who holds a Certificate III in Aboriginal or Torres Strait Islander Health Worker Primary Health Care (Clinical) or other appropriate qualification; and
(b) who is engaged by a medical practitioner in a general practice or a health service to which a direction made under subsection 19(2) of the Act applies.
ACRRM means the Australian College of Rural and Remote Medicine.
Act means the Health Insurance Act 1973.
after‑hours period means any of the following:
(a) a public holiday;
(b) a Sunday;
(c) before 8 am, or after 12 noon, on a Saturday;
(d) before 8 am, or after 6 pm, on any day other than a Saturday, Sunday or public holiday.
amount under clause 2.1.1 has the meaning given by clause 2.1.1.
amount under clause 2.20.2 has the meaning given by clause 2.20.2.
amount under clause 2.38.1 has the meaning given by clause 2.38.1.
amount under clause 2.40.2 has the meaning given by clause 2.40.2.
amount under clause 2.42.1 has the meaning given by clause 2.42.1.
amount under clause 2.43.1 has the meaning given by clause 2.43.1.
amount under clause 2.43.2 has the meaning given by clause 2.43.2.
amount under clause 2.44.4 has the meaning given by clause 2.44.4.
amount under clause 2.44.5 has the meaning given by clause 2.44.5.
amount under clause 2.44.18 has the meaning given by clause 2.44.18.
amount under clause 2.45.1 has the meaning given by clause 2.45.1.
amount under clause 2.45.2 has the meaning given by clause 2.45.2.
amount under clause 2.45.3 has the meaning given by clause 2.45.3.
amount under clause 2.48.1 has the meaning given by clause 2.48.1.
approved site:
(a) for item 15338—has the meaning given by clause 2.38.2; and
(b) for items 37220 and 37227—has the meaning given by clause 2.44.1.
ASGC, for Division 2.31, has the meaning given by clause 2.31.1.
associated medical practitioner:
(a) for item 732—has the meaning given by clause 2.17.2; and
(b) for item 2712—has the meaning given by clause 2.20.5.
bulk‑billed, for Division 2.31, has the meaning given by clause 2.31.1.
care recipient means a person receiving residential care under section 21‑2 of the Aged Care Act 1997.
case conference team, for item 880, has the meaning given by clause 2.17.17.
closed reduction means treatment of a dislocation or fracture by non‑operative reduction, including the use of percutaneous fixation, or external splintage by cast or splints.
Commonwealth concession card holder, for Division 2.31, has the meaning given by clause 2.31.1.
community case conference means a case conference for community based patients.
completes the minimum requirements for a cycle of care of a patient with established diabetes mellitus has the meaning given by clause 2.19.1.
completes the minimum requirements of the Asthma Cycle of Care has the meaning given by clause 2.19.2.
complex paediatric case, for item 25205, has the meaning given by clause 2.43.3.
comprehensive hyperbaric medicine facility, for items 13015, 13020, 13025 and 13030, has the meaning given by clause 2.37.1.
contribute to a multidisciplinary care plan, for items 729 and 731, has the meaning given by clause 2.17.3.
coordinating, for item 880, has the meaning given by clause 2.17.16.
coordinating a review of team care arrangements, for item 732, has the meaning given by clause 2.17.5.
coordinating the development of team care arrangements, for item 723, has the meaning given by clause 2.17.4.
delivery, for items 16515, 16519, 16522, 16527, 16590 and 16591, has the meaning given by clause 2.40.3.
eligible allied health provider:
(a) for items 135, 137 and 139—has the meaning given by clause 2.5A.1; and
(b) for item 289—has the meaning given by clause 2.10.5.
eligible area, for Division 2.31, has the meaning given by clause 2.31.1.
eligible disability has the meaning given by clause 2.5A.2.
eligible non‑vocationally recognised medical practitioner has the meaning given by clause 1.1.1.
embryology laboratory services, for items 13200, 13201 and 13206, has the meaning given by clause 2.37.2.
family carer, of a patient, includes a person if the person is:
(a) a relative or friend of the patient; and
(b) providing care to the patient other than for payment.
focussed psychological strategies has the meaning given by clause 2.20.1.
foreign body, for items 35360 and 35363, has the meaning given by clause 2.44.13.
(G) has the meaning given by clause 1.1.5.
general intensive care unit means a separate hospital area that:
(a) is equipped and staffed so that it is 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) during normal working hours—at least one specialist, or consultant physician, in the specialty of intensive care, who is immediately available, and exclusively rostered, to that area; and
(ii) at all times—at least one registered medical practitioner who is present in the hospital and immediately available to that area; and
(iii) at least 18 hours each day—at least one registered nurse; and
(c) has admission and discharge policies in operation.
general practice means a business, consisting of one or more medical practitioners, that provides a general practice of medical services.
general practitioner has the meaning given by clause 1.1.1A.
GP management plan, for item 10997, has the meaning given by clause 2.30.1.
(H) has the meaning given by clause 1.1.6.
IGRT, for items 15275 and 15715, has the meaning given by clause 2.38.2A.
immunisation means the administration of a registered vaccine to a person for any purpose other than as part of a mass immunisation of persons.
immunisation recommended for a 4 year old child means the immunisation recommended for a 4 year old child by the National Immunisation Program Schedule as in effect on 1 July 2013.
Note: The National Immunisation Program Schedule could in 2015 be viewed on the Department’s website (
IMRT, for items 15275, 15555, 15565 and 15715, has the meaning given by clause 2.38.2B.
institution means a place (other than a hospital or residential aged care facility) 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 intellectually disabled persons.
intensive care unit means a general intensive care unit or a neo‑natal intensive care unit.
item means:
(a) an item mentioned, by number, in column 1 of:
(i) Part 2; or
(ii) Part 2 of the diagnostic imaging services table; or
(iii) Part 2 of the pathology services table; and
(b) in a reference immediately followed by a number—the item so numbered.
Note: Because of the determination about allied health services under subsection 3C(1) of the Act, certain health services are treated as if there were an item for the service mentioned in the table. A note is included at the end of a provision of this instrument if an item mentioned in the provision is that kind of item: see subclause 2.20.3(2) for an example.
living in a community setting, for item 900, has the meaning given by clause 2.18.1.
maxilla:
(a) for items 45720 to 45752—has the meaning given by clause 2.44.19; and
(b) for items 52342 to 52375—has the meaning given by clause 2.50.1.
mental disorder, for Division 2.20, has the meaning given by clause 2.20.1.
minor attendance, for 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.
multidisciplinary care plan:
(a) for items 729 and 731—has the meaning given by clause 2.17.6; and
(b) for item 10997—has the meaning given by clause 2.30.1.
multidisciplinary case conference has the meaning given by clause 1.1.2.
multidisciplinary case conference in a residential aged care facility, for items 735, 739, 743, 747, 750 and 758, has the meaning given by clause 2.17.13.
multidisciplinary case conference team has the meaning given by clause 1.1.3.
multidisciplinary discharge case conference, for items 735, 739, 743, 747, 750 and 758, has the meaning given by clause 2.17.12.
neo‑natal intensive care unit means a separate hospital area that:
(a) is equipped and staffed so that it is 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) during normal working hours—at least one consultant physician in paediatric medicine who is immediately available, and exclusively rostered, to that area; and
(ii) at all times—at least one registered medical practitioner who is present in the hospital and immediately available to that area; and
(iii) at least 18 hours each day—at least one registered nurse; and
(c) has admission and discharge policies in operation.
non‑directive pregnancy support counselling, for item 4001, has the meaning given by clause 2.22.1.
non‑medicare service means any of the following:
(a) endoluminal gastroplication, for the treatment of gastro‑oesophageal reflux disease;
(b) gamma knife surgery;
(c) intradiscal electro thermal arthroplasty;
(d) intravascular ultrasound, except if used in conjunction with intravascular brachytherapy;
(e) intro‑articular viscosupplementation, for the treatment of osteoarthritis of the knee;
(f) low intensity ultrasound treatment, for the acceleration of bone fracture healing, using a bone growth stimulator;
(g) lung volume reduction surgery, for advanced emphysema;
(h) photodynamic therapy, for skin and mucosal cancer;
(i) placement of artificial bowel sphincters, in the management of faecal incontinence;
(j) selective internal radiation therapy for any condition other than hepatic metastases that are secondary to colorectal cancer;
(k) specific mass measurement of bone alkaline phosphatise;
(l) transmyocardial laser revascularisation;
(m) vertebral axial decompression therapy, for chronic back pain;
(n) autologous chondrocyte implantation and matrix‑induced autologous chondrocyte implantation;
(o) vertebroplasty.
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 using intra‑medullary fixation or external fixation.
organise and coordinate:
(a) for items 735, 739, 743, 820, 822, 823, 825, 826, 828, 830, 832, 834, 835, 837, 838, 855, 857, 858, 861, 864 and 866—has the meaning given by clause 2.17.14; and
(b) for items mentioned in Subgroups 2 and 4 of Group A24—has the meaning given by clause 2.21.1.
outcome measurement tool, for Division 2.20, has the meaning given by clause 2.20.1.
participate:
(a) for items 747, 750, 758, 825, 826, 828, 835, 837 and 838—has the meaning given by clause 2.17.15; and
(b) for items 2958, 2972, 2974, 2992, 2996, 3000, 3051, 3055, 3062, 3083, 3088 and 3093—has the meaning given by clause 2.21.2.
participating in a video conferencing consultation has the meaning given by clause 1.2.9.
patient’s medical condition requires urgent treatment, for items 597 to 600, has the meaning given by clause 2.15.1.
patient’s usual medical practitioner means a medical practitioner:
(a) who has provided the majority of services to the patient in the past 12 months; or
(b) who is likely to provide the majority of services to the patient in the following 12 months; or
(c) located at a medical practice that:
(i) has provided the majority of services to the patient in the past 12 months; or
(ii) is likely to provide the majority of services to the patient in the next 12 months.
person with a chronic disease, for item 10997, has the meaning given by clause 2.30.1.
pharmaceutical benefits scheme means the scheme for the supply of pharmaceutical benefits established under Part VII of the National Health Act 1953.
practice location has the meaning given by clause 2.31.1.
practice nurse means a registered or an enrolled nurse who is employed by, or whose services are otherwise retained by, a general practice or by a health service to which a direction made under subsection 19(2) of the Act applies.
preparation of a GP mental health treatment plan has the meaning given by clause 2.20.3.
preparing a GP management plan, for item 721, has the meaning given by clause 2.17.7.
previous significant surgical complication, for item 51318, has the meaning given by clause 2.45.4.
problem focussed history, for items 501, 503 and 507, has the meaning given by clause 2.14.2.
qualified medical acupuncturist has the meaning given by clause 2.9.1.
qualified radiologist, for item 31542, has the meaning given by clause 2.44.7.
qualified sleep medicine practitioner:
(a) for items 12203, 12207, 12213 and 12217—has the meaning given by subclause 2.34.2(1); and
(b) for items 12210 and 122015—has the meaning given by subclause 2.34.2(1A); and
(c) for item 12250—has the meaning given by subclause 2.34.2(1AA).
qualified surgeon, for items 31539 and 31545, has the meaning given by clause 2.44.6.
RACGP means the Royal Australian College of General Practitioners.
recognised emergency department, for Division 2.14, has the meaning given by clause 2.14.1.
referral means referral by a referring practitioner.
referring practitioner, for the referral of a patient, means:
(a) for all referrals—a medical practitioner; or
(b) for a referral made to a specialist who is an ophthalmologist—an optometrist; or
(c) for a referral that arises out of a dental service provided by a dental practitioner and that is made to a specialist (but not a consultant physician)—a dental practitioner; or
(d) for a referral that 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 that is made to a consultant physician—a dental practitioner; or
(e) for a referral made to a specialist in the specialty of obstetrics or paediatrics (however described) that arises out of a midwifery service provided by a participating midwife—a participating midwife; or
(f) for a referral made to a specialist or consultant physician that arises out of a nurse practitioner service provided by a participating nurse practitioner—a participating nurse practitioner.
regional, rural or remote area means an area classified as RRMAs 3‑7 under the Rural, Remote and Metropolitan Areas Classification.
registered vaccine means a vaccine that is included in the part of the Australian Register of Therapeutic Goods for registered goods, being the Register maintained under section 9A of the Therapeutic Goods Act 1989.
report, for Division 2.34, has the meaning given by clause 2.34.1.
residential aged care facility means a facility where residential care (within the meaning given by section 41‑3 of the Aged Care Act 1997) is provided.
residential care service has the meaning given by clause 1 of Schedule 1 to the Aged Care Act 1997.
residential medication management review, for item 903, has the meaning given by clause 2.18.2.
responsible person, for items 597 to 600, has the meaning given by clause 2.15.2.
reviewing a GP management plan, for item 732, has the meaning given by clause 2.17.8.
review of a GP mental health treatment plan has the meaning given by clause 2.20.4.
risk assessment:
(a) for items 135, 137 and 139—has the meaning given by clause 2.5A.1; and
(b) for item 289—has the meaning given by clause 2.10.5.
Rural, Remote and Metropolitan Areas Classification means the document so titled, as in force on 1 January 2001, setting out certain categories of areas in Australia that have been determined by the Department by reference to population size and remoteness of locality on the basis of 1991 census data published by the Australian Bureau of Statistics in 1994.
(S) has the meaning given by clause 1.1.7.
service time, for an item in subgroups 21, 24, 25 and 26 of Group T10, has the meaning given by clause 2.43.4.
single course of treatment has the meaning given by clause 1.1.4.
SLA, for Division 2.31, has the meaning given by clause 2.31.1.
SSD, for Division 2.31, has the meaning given by clause 2.31.1.
team care arrangements means a plan under item 723 or 732 (for a review of team care arrangements under item 723).
telehealth eligible area means an area classified as a telehealth eligible area by the Minister.
Note: Maps showing telehealth eligible areas could in 2015 be viewed on the Department’s Medicare Benefits Schedule website (
treatment cycle, for clause 2.37.4 and items 13200 to 13209, 13215 and 13218, has the meaning given by clause 2.37.3.
unreferred service, for Division 2.31, has the meaning given by clause 2.31.1.
unsociable hours means the period starting at 11 pm and ending at 7 am on any day.
Endnotes
Endnote 1—About the endnotes
The endnotes provide information about this compilation and the compiled law.
The following endnotes are included in every compilation:
Endnote 1—About the endnotes
Endnote 2—Abbreviation key
Endnote 3—Legislation history
Endnote 4—Amendment history
Abbreviation key—Endnote 2
The abbreviation key sets out abbreviations that may be used in the endnotes.
Legislation history and amendment history—Endnotes 3 and 4
Amending laws are annotated in the legislation history and amendment history.
The legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.
The amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.
Editorial changes
The Legislation Act 2003 authorises First Parliamentary Counsel to make editorial and presentational changes to a compiled law in preparing a compilation of the law for registration. The changes must not change the effect of the law. Editorial changes take effect from the compilation registration date.
If the compilation includes editorial changes, the endnotes include a brief outline of the changes in general terms. Full details of any changes can be obtained from the Office of Parliamentary Counsel.
Misdescribed amendments
A misdescribed amendment is an amendment that does not accurately describe the amendment to be made. If, despite the misdescription, the amendment can be given effect as intended, the amendment is incorporated into the compiled law and the abbreviation “(md)” added to the details of the amendment included in the amendment history.
If a misdescribed amendment cannot be given effect as intended, the abbreviation “(md not incorp)” is added to the details of the amendment included in the amendment history.
Endnote 2—Abbreviation key
| ad = added or inserted | o = order(s) |
| am = amended | Ord = Ordinance |
| amdt = amendment | orig = original |
| c = clause(s) | par = paragraph(s)/subparagraph(s) |
| C[x] = Compilation No. x | /sub‑subparagraph(s) |
| Ch = Chapter(s) | pres = present |
| def = definition(s) | prev = previous |
| Dict = Dictionary | (prev…) = previously |
| disallowed = disallowed by Parliament | Pt = Part(s) |
| Div = Division(s) | r = regulation(s)/rule(s) |
| ed = editorial change | reloc = relocated |
| exp = expires/expired or ceases/ceased to have | renum = renumbered |
| effect | rep = repealed |
| F = Federal Register of Legislation | rs = repealed and substituted |
| gaz = gazette | s = section(s)/subsection(s) |
| LA = Legislation Act 2003 | Sch = Schedule(s) |
| LIA = Legislative Instruments Act 2003 | Sdiv = Subdivision(s) |
| (md) = misdescribed amendment can be given | SLI = Select Legislative Instrument |
| effect | SR = Statutory Rules |
| (md not incorp) = misdescribed amendment | Sub‑Ch = Sub‑Chapter(s) |
| cannot be given effect | SubPt = Subpart(s) |
| mod = modified/modification | underlining = whole or part not |
| No. = Number(s) | commenced or to be commenced |
Endnote 3—Legislation history
| Number and year | Registration | Commencement | Application, saving and transitional provisions |
| 84, 2015 | 19 June 2015 (F2015L00853) | 1 July 2015 (s 2) | |
| 143, 2015 | 21 Aug 2015 (F2015L01301) | Sch 1 (items 2–112): 1 Sept 2015 (s 2(1) item 1) | — |
| 173, 2015 | 30 Oct 2015 (F2015L01722) | Sch 1 (items 1–18): 1 Nov 2015 (s 2(1) item 1) | — |
| 238, 2015 | 15 Dec 2015 (F2015L02014) | 1 Jan 2016 (s 2 item 1) | — |
| Name | Registration | Commencement | Application, saving and transitional provisions |
| Health Insurance (General Medical Services Table) Amendment (2016 Measures No. 1) Regulation 2016 | 29 Mar 2016 (F2016L00388) |
Sch 1: 1 Apr 2016 (s 2(1) item 2) Sch 2: 1 May 2016 (s 2(1) item 3) |
— |
Endnote 4—Amendment history
| Provision affected | How affected |
| s 2............................................. | rep LIA s 48D |
| Schedule 1 | |
| Part 1 | |
| Division 1.2 | |
| c 1.2.3........................................ | am F2016L00388 |
| c 1.2.7........................................ | am No 143, 2015; F2016L00388 |
| c 1.2.8........................................ | am No 143, 2015 |
| Part 2 | |
| Division 2.1 | |
| Division 2.1 (heading)................. | rs F2016L00388 |
| am F2016L00388 | |
| Division 2.5A | |
| c 2.5A.1..................................... | am F2016L00388 |
| Division 2.10 | |
| c 2.10.5...................................... | am F2016L00388 |
| Division 2.16 | |
| c 2.16.2...................................... | am No 173, 2015 |
| c 2.16.4...................................... | rep No 173, 2015 |
| c 2.16.14.................................... | am No 143, 2015 |
| Division 2.18A | |
| c 2.18A.2................................... | am No 143, 2015 |
| Division 2.28.............................. | rep F2016L00388 |
| c 2.28.1...................................... | rep F2016L00388 |
| c 2.28.2...................................... | rep F2016L00388 |
| c 2.28.3...................................... | rep F2016L00388 |
| c 2.28.4...................................... | am No 143, 2015 |
| rep F2016L00388 | |
| c 2.28.5...................................... | rep F2016L00388 |
| c 2.28.5A................................... | ad No 143, 2015 |
| rep F2016L00388 | |
| c 2.28.5B.................................... | ad No 143, 2015 |
| rep F2016L00388 | |
| c 2.28.6...................................... | rep F2016L00388 |
| Group A10 Table........................ | am No 143, 2015; No 173, 2015 |
| rep F2016L00388 | |
| Division 2.30 | |
| c 2.30.2...................................... | rep No 173, 2015 |
| c 2.30.3...................................... | rep No 173, 2015 |
| Group M12 Table........................ | am No 173, 2015 |
| Division 2.34 | |
| c 2.34.3...................................... | ad No 143, 2015 |
| Group D1 Table.......................... | am No 143, 2015; No 173, 2015 |
| Division 2.38 | |
| c 2.38.2A................................... | ad No 238, 2015 |
| c 2.38.2B.................................... | ad No 238, 2015 |
| c 2.38.3...................................... | am No 143, 2015 |
| c 2.38.3A................................... | ad No 238, 2015 |
| Group T2 Table.......................... | am No 143, 2015; No 173, 2015; No 238, 2015 |
| Division 2.42 | |
| Group T7 Table.......................... | am No 143, 2015 |
| Division 2.43 | |
| Group T10 Table......................... | am No 173, 2015 |
| Division 2.44 | |
| Subdivision B | |
| Group T8 Table.......................... | am No 143, 2015; No 173, 2015; No 238, 2015; F2016L00388 |
| Subdivision C | |
| Group T8 Table.......................... | am No 143, 2015; No 173, 2015; F2016L00388 |
| Subdivision D | |
| Group T8 Table.......................... | am No 143, 2015; No 173, 2015; F2016L00388 |
| Subdivision E | |
| Group T8 Table.......................... | am No 143, 2015; No 173, 2015; F2016L00388 |
| Subdivision F | |
| Group T8 Table.......................... | am No 173, 2015; No 238, 2015; F2016L00388 |
| Subdivision G | |
| Group T8 Table.......................... | am F2016L00388 |
| Subdivision H | |
| Group T8 Table.......................... | am F2016L00388 |
| Division 2.49 | |
| Group O3 Table.......................... | am F2016L00388 |
| Division 2.54 | |
| Group O8 Table.......................... | am F2016L00388 |
| Part 3 | |
| Part 3......................................... | am No 238, 2015; F2016L00388 |
| Schedule 2.................................. | rep LIA s 48C |
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