Health Insurance (General Medical Services Table) Regulations 2000 (Cth)
made under the
This compilation was prepared on 1 May 2001
taking into account amendments up to SR 2001 No. 79
Prepared by the Office of Legislative Drafting,
Attorney-General’s Department, Canberra
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These Regulations are the
Health Insurance (General Medical Services Table) Regulations 2000 .
These Regulations commence on 1 November 2000.
The following statutory rules are repealed:
· 1999 No. 256
· 2000 Nos. 60 and 148.
In these Regulations:
Act means theHealth Insurance Act 1973 .
this table means these Regulations.
The table of medical services (other than diagnostic imaging services and pathology services) set out in Schedule 1 is prescribed for subsection 4 (1) of the Act.
(regulation 5)
For section 4 of the Act, these Regulations prescribe a table of general medical services that sets out:
(a) in Part 2 — rules for interpretation of the table; and
(b) in Part 3:
(i) items of general medical services; and
(ii) the amount of fees applicable for each item.
(1) In this table, unless the contrary intention appears:
attendance of a minor nature orminor 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.
closed reduction:
(a) means treatment of a dislocation or fracture by non-operative reduction; and
(b) includes the use of percutaneous fixation, or external splintage by cast or splints.
comprehensive hyperbaric medicine facility means a separate hospital area that, on a 24-hour basis:(a) is equipped and staffed so that it is capable of providing to a patient:
(i) hyperbaric oxygen therapy at a treatment pressure of at least 2.8 atmospheric pressure absolute (180 kilopascal gauge pressure); and
(ii) mechanical ventilation and invasive cardiovascular monitoring within a multiplace chamber for the duration of the hyperbaric treatment; and
(b) is supported by:
(i) at least 1 specialist anaesthetist, consultant physician or medical practitioner who holds the Diploma of Diving and Hyperbaric Medicine of the South Pacific Underwater Medicine Society, and who is rostered and immediately available to the facility during normal working hours; and
(ii) at least 1 registered medical practitioner who is present in the hospital and immediately available to the facility at all times when patients are being treated at the facility; and
(iii) at least 1 registered nurse with specific training in hyperbaric patient care to the published standards of the Hyperbaric Technicians and Nurses Association who is present during hyperbaric oxygen therapy; and
(c) has admission and discharge policies in operation.
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) at least 1 specialist or consultant physician in the specialty of intensive care who is immediately available and exclusively rostered to the intensive care unit during normal working hours; and
(ii) at least 1 registered medical practitioner who is present in the hospital and immediately available to the unit at all times; and
(iii) at least 1 registered nurse for at least 18 hours each day; and
(c) has admission and discharge policies in operation.
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 who is undertaking a placement in general practice that is approved:
(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 an equivalent standard; or
(iii) as part of the Rural and Remote Area Placement Program administered by the Australian College of Rural and Remote Medicine; or
(d) an eligible non-vocationally recognised medical practitioner.
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 3; or
(ii) Part 3 of the diagnostic imaging services table; or
(iii) Part 3 of the pathology services table; and
(b) in a reference immediately followed by a number — the item so numbered.
Example A reference (if any) by number to item 55028 is a reference to the item so numbered in the diagnostic imaging services table.
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) at least 1 consultant physician in paediatric medicine who is immediately available and exclusively rostered to the intensive care unit during normal working hours; and
(ii) at least 1 registered medical practitioner who is present in the hospital and immediately available to the unit at all times; and
(iii) at least 1 registered nurse for at least 18 hours each day; and
(c) has admission and discharge policies in operation.
open reduction means treatment of a dislocation or fracture by either:(a) operative exposure, including the use of any internal or external fixation; or
(b) non-operative (closed) reduction where intra-medullary fixation or external fixation is used.
RACGP means the Royal Australian College of General Practitioners.referring practitioner , for the referral of a patient, means:(a) in the case of all referrals — a medical practitioner; and
(b) for a referral made to a specialist who is an ophthalmologist — an optometrist; and
(c) for a referral that arises out of a dental service provided by a dental practitioner and is made to a specialist (but not a consultant physician) — a dental practitioner; and
(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 is made to a consultant physician — a dental practitioner.
(2) In this table, a reference by number in an item to a combined anaesthetic unit value is a reference to the number that is calculated using the formula:
n1+ n2
where:
n1 is:
(a) if the service in connection with which the anaesthetic is administered is a service described in another item that includes the formula described in rule 6 — the number associated with
B in the formula in the other item; and(b) in any other case — 0.
n2 is:
(a) if the service in connection with which the anaesthetic is administered is a service described in another item that includes the formula described in rule 6 — the number associated with
T in the formula in the other item; and(b) in any other case — the number of whole periods, commencing when the medical practitioner begins to prepare the patient for anaesthesia and ending when he or she ceases to attend the patient, being:
(i) 15 minutes in a period of up to 6 hours; and
(ii) 10 minutes in any period in excess of that period.
(3) A reference to a Group in the table includes every item in the Group, and a reference to a Subgroup in the table includes every item in the Subgroup.
(4) A reference in the table to an
eligible non-vocationally recognised medical practitioner is a reference to a medical practitioner (including an overseas trained practitioner or a temporary resident medical practitioner) who:
(a) is providing general medical services in rural and remote areas under the Rural, Remote and Metropolitan Areas Classification, as in force on 1 January 2001; and
(b) is registered as a medical practitioner under the Rural Other Medical Practitioners’ Program; and
(c) not being a practitioner vocationally registered under section 3F of the Act, is undertaking, or has indicated in writing an intention to undertake, additional training:
(i) that could enable vocational registration within 4 years or, on written application, 5 years, of commencing that training; and
(ii) of which the Health Insurance Commission has written notice.
(5) For subrule (4):
(a) the
Rural, Remote and Metropolitan Areas Classification sets out certain categories of areas in Australia, that have been determined by the Department of Health and Aged Care 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; and(b) the Rural Other Medical Practitioners’ Program is a program administered by the Health Insurance Commission that, in relation to medical services provided to patients in rural and remote areas, provides a particular level of medicare benefits.
(1) An item including the symbol
( S ) applies only to a service performed by a specialist (and not to a service performed by a consultant physician) in the practice of his or her specialty, being:(a) a service that:
(i) is provided to a patient who has been referred to the specialist; and
(ii) is the first service performed by the specialist in accordance with the referral; or
(b) a service that:
(i) is provided to a patient who has been referred to the specialist; and
(ii) is 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) is provided within the period of validity of the referral applicable under regulation 31 of the
Health Insurance Regulations 1975 ; or
(c) a service that:
(i) is provided to a patient who has declared that a written referral completed by a named referring practitioner has been lost, stolen or destroyed before the service was provided; and
(ii) is the first service performed by the specialist in accordance with the referral; or
(d) a service that:
(i) is provided to a patient who has not been referred to the specialist; and
(ii) is a service that, in an emergency within the meaning of subregulation 30 (5) of the
Health Insurance Regulations 1975 , the specialist decides is necessary in the patient’s interests to be provided as soon as practicable without a referral.
(2) An item including the symbol
( G ) applies only to a service provided otherwise than by a specialist in accordance with subrule (1).4 Meaning of single course of treatment in certain circumstances (1) In subrule 2 (1), rules 3 and 7 and items 104, 105, 106, 107, 108, 110, 116, 119, 122, 128, 131, 385, 386, 387 and 388,
single course of treatment includes:(a) the initial attendance on the patient by a specialist or consultant physician; and
(b) the continuing management or treatment up to and including the stage when the patient is referred back to the care of the referring practitioner; and
(c) any subsequent review of the patient’s condition by the specialist or consultant physician that may be necessary, whether the review is initiated by the referring practitioner or the specialist or consultant physician.
(2) For subrule (1), an unrelated illness that requires referral of the patient to the specialist’s or consultant physician’s care, initiates a new course of treatment for which a new referral is necessary.
(3) For subrule (1), where the patient is attended by the specialist or consultant physician after the end of the period of validity of the last referral applicable under regulation 31 of the
Health Insurance Regulations 1975 , the attendance initiates a new course of treatment if:(a) the referring practitioner considers it necessary for the patient’s condition to be reviewed; and
(b) the patient was last attended by the specialist or consultant physician more than 9 months before the attendance that initiates the new course of treatment.
5 Meaning of professional attendance in certain items (1)In items 1 to 172, 193 to 338, 348 to 388, 410 to 417, 601, 602, 697, 698 and 10900 to 10929,
professional attendance includes (but is not limited to) the provision in relation to a patient of 1, or more than 1, of the following services:(a) the evaluation of the patient’s condition or conditions including, if applicable, evaluation using a health screening service mentioned in subsection 19 (5) of the Act;
(b) the formulation of a plan for the management and, if applicable, for the treatment of the patient’s condition or conditions;
(c) the provision of advice to the patient about the patient’s condition or conditions and, if applicable, about treatment;
(d) if authorised by the patient, the provision of advice to another person, or other persons, about the patient’s condition or conditions and, if applicable, about treatment;
(e) the recording of the clinical details of the service or services provided to the patient.
(2) If:
(a) in connection with a professional attendance mentioned in any of items 3 to 96, vaccine is supplied to a patient; and
(b) the cost of the vaccine is not subsidised by the Commonwealth or a State;
the professional attendance is taken not to include that supply.
6 Administration of anaesthetics in connection with certain services If a general anaesthetic is administered in connection with a service specified in an item that includes the formula:
Anaes.
where:
(a)
n is a number; and(b)
n1 andn2 are other numbers;the service that is provided by the medical practitioner who administers the anaesthetic is the service described in item
n .
(1) If an item that describes a service includes the word ‘(Assist.)’, the item in Group T9 or O2 in Part 3 that describes the assistance given applies to the provision of that assistance.
(2) An item that applies because of subrule (1) is in addition to:
(a) an item that applies to the practitioner who performs the operation; and
(b) for a service mentioned in rule 6 — an item that applies to the practitioner who administers the anaesthetic.
7 Interpretation of items 104 to 131 and 300 to 388 (1) In items 104 to 131 and 300 to 388, a reference to an attendance on a patient by a specialist, or consultant physician, in the practice of his or her specialty following referral of the patient to him or her:
(a) includes an attendance by a specialist, or consultant physician, in the practice of his or her specialty:
(i) if the patient has declared that a written referral of the patient was completed by a medical practitioner; or
(ii) if, in an emergency within the meaning of subregulation 30 (5) of the
Health Insurance Regulations 1975 , the patient has not been referred to the specialist, or consultant physician, who decides that it is necessary in the patient’s interests to provide the service mentioned in the item as soon as practicable without a referral; but
(b) does not include an attendance by a specialist, or consultant physician, in the practice of his or her specialty if:
(i) the attendance forms part of a single course of treatment in which the first service was provided more than 12 months (or such other period, if any, set by the referring practitioner in, or in connection with, the referral) before the attendance; and
(ii) a later referral has not been made.
(2) In subrule (1) and in items 104 to 131 and 300 to 388, a reference to the referral of a patient to a specialist, or consultant physician, is a reference to the referral of a patient to a specialist, or consultant physician, by a referring practitioner.
(1) In items 4, 13, 19 and 20,
amount under rule 8 means an amount equal to the sum of:(a) the fee for item 3; and
(b) either:
(i) for each patient attended at a single attendance, to a maximum of 6 patients — $19.55 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.35 for each patient.
(2) In items 24, 25, 33 and 35,
amount under rule 8 means an amount equal to the sum of:(a) the fee for item 23; and
(b) either:
(i) for each patient attended at a single attendance, to a maximum of 6 patients — $19.55 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.35 for each patient.
(3) In items 37, 38, 40 and 43,
amount under rule 8 means an amount equal to the sum of:(a) the fee for item 36; and
(b) either:
(i) for each patient attended at a single attendance, to a maximum of 6 patients — $19.55 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.35 for each patient.
(4) In items 47, 48, 50 and 51,
amount under rule 8 means an amount equal to the sum of:(a) the fee for item 44; and
(b) either:
(i) for each patient attended at a single attendance, to a maximum of 6 patients — $19.55 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.35 for each patient.
(5) In items 58, 81, 87 and 92,
amount under rule 8 means an amount equal to the sum of:(a) $8.50; and
(b) either:
(i) for each patient attended at a single attendance, to a maximum of 6 patients — $15.50 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — 70 cents for each patient.
(6) In items 59, 83, 89 and 93,
amount under rule 8 means an amount equal to the sum of:(a) $16.00; and
(b) either:
(i) for each patient attended at a single attendance, to a maximum of 6 patients — $17.50 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — 70 cents for each patient.
(7) In items 60, 84, 90 and 95,
amount under rule 8 means an amount equal to the sum of:(a) $35.50; and
(b) either:
(i) for each patient attended at a single attendance, to a maximum of 6 patients — $15.50 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — 70 cents for each patient.
(8) In items 65, 86, 91 and 96,
amount under rule 8 means an amount equal to the sum of:(a) $57.50; and
(b) either:
(i) for each patient attended at a single attendance, to a maximum of 6 patients — $15.50 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — 70 cents for each patient.
(9) In item 195,
amount under rule 8 means an amount equal to the sum of:(a) the fee for item 193; and
(b) either:
(i) for each patient attended at a single attendance, to a maximum of 6 patients — $19.55 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.35 for each patient.
(10) In item 414,
amount under rule 8 means an amount equal to the sum of:
(a) the fee for item 410; and
(b) either:
(i) for each patient attended at a single attendance, to a maximum of 6 patients — $19.15 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.30 for each patient.
(11) In item 415,
amount under rule 8 means an amount equal to the sum of:(a) the fee for item 411; and
(b) either:
(i) for each patient attended at a single attendance, to a maximum of 6 patients — $19.15 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.30 for each patient.
(12) In item 416,
amount under rule 8 means an amount equal to the sum of:(a) the fee for item 412; and
(b) either:
(i) for each patient attended at a single attendance, to a maximum of 6 patients — $19.15 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.30 for each patient.
(13) In item 417,
amount under rule 8 means an amount equal to the sum of:(a) the fee for item 413; and
(b) either:
(i) for each patient attended at a single attendance, to a maximum of 6 patients — $19.15 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.30 for each patient.
9 Items 10809 and 10929 not to apply in certain circumstances Items 10809 and 10929 do not apply if the patient’s requirement for contact lenses is only for any of the following reasons:
(a) because the patient does not want to wear spectacles for reasons of appearance;
(b) because the patient wants contact lenses for work or sporting purposes;
(c) because the patient has difficulty in using, or cannot use, spectacles for psychological reasons.
10 Personal attendance by medical practitioners generally (1) The items mentioned in subrule (2) apply only to a service provided in the course of a personal attendance by a medical practitioner on a single patient on a single occasion.
(2) The items are items 1 to 164, 173 to 338, 348 to 10816, 11012, 11015, 11018, 11021, 11212, 11304, 11500, 11600, 11601, 11627, 11701, 11712, 11724, 11921, 12000, 12003, 13030, 13100, 13103, 13106, 13109, 13110, 13112, 13209, 13290, 13292, 13300, 13303, 13306, 13309, 13312, 13318, 13319, 13400, 13500, 13503, 13506, 13600, 13603, 13604, 13606, 13609, 13612, 13700, 13815, 13818, 13830, 13839, 13842, 13845, 13848, 13851, 13854, 13857, 13870, 13873, 13876, 13879, 13882, 13885, 13888, 14100, 14103, 14106, 14109, 14112, 14115, 14118, 14120, 14122, 14124, 14126, 14128, 14130, 14132, 14200, 14203, 14206, 14209, 14212, 14215, 14224, 15600, 16003 to 16512 and 16515 to 51318.
(3) Items 170, 171, 172, 342, 344 and 346 apply only to a service provided in the course of a personal attendance by a medical practitioner.
11 Personal attendance by certain medical practitioners (1) The items mentioned in subrule (3) apply only to a service provided in the course of a personal attendance by:
(a) a medical practitioner other than a medical practitioner employed by the proprietor of a hospital other than a private hospital; or
(b) a medical practitioner who:
(i) is employed by the proprietor of a hospital other than a private hospital; and
(ii) provides the service otherwise than in the course of employment by that proprietor.
(2) Paragraph (1) (b) applies whether or not another person provides essential assistance to that medical practitioner in accordance with accepted medical practice.
(3) The items are items 1 to 10816, 11012, 11015, 11018, 11021, 11212, 11304, 11500, 11600, 11601, 11627, 11701, 11712, 11724, 11921, 12000, 12003, 13030, 13100, 13103, 13106, 13109, 13110, 13112, 13209, 13290, 13292, 13300, 13303, 13306, 13309, 13312, 13318, 13319, 13400, 13500, 13503, 13506, 13600, 13603, 13604, 13606, 13609, 13612, 13700, 13815, 13818, 13830, 13839, 13842, 13845, 13848, 13851, 13854, 13857, 13870, 13873, 13876, 13879, 13882, 13885, 13888, 14100, 14103, 14106, 14109, 14112, 14115, 14118, 14120, 14122, 14124, 14126, 14128, 14130, 14132, 14200, 14203, 14206, 14209, 14212, 14215, 14224, 15600, 16003 to 16512 and 16515 to 51318.
12 Certain services may be provided by persons other than medical practitioners (1)The items mentioned in subrule (2) apply whether the medical service is given by:
(a) a medical practitioner; or
(b) a person, other than a medical practitioner, who is employed by a medical practitioner or, in accordance with accepted medical practice, acts under the supervision of a medical practitioner.
(2) The items are items 11000, 11003, 11006, 11009, 11024, 11027, 11200, 11203, 11206, 11209, 11215, 11218, 11221, 11222, 11224, 11225, 11235, 11240, 11300, 11303, 11306, 11309, 11312, 11315, 11318, 11321, 11324, 11327, 11330, 11332, 11333, 11336, 11339, 11503, 11506, 11509, 11512, 11603, 11606, 11609, 11612, 11615, 11618, 11621, 11624, 11700, 11702, 11706, 11708, 11709, 11710, 11711, 11713, 11715, 11718, 11721, 11800, 11810, 11830, 11833, 11900, 11903, 11906, 11909, 11912, 11915, 11918, 12012, 12015, 12018, 12021, 12200, 12203, 12207, 12500 to 12533, 13020, 13025, 13200, 13203, 13206, 13212, 13215, 13218, 13221, 13703, 13706, 13709, 13750, 13755, 13757, 13760, 13915 to 13948, 14050, 14053, 14218, 14221, 15000 to 15536 and 16514.
13 Conditions under which certain services to be provided Items 11309, 11312, 11315, 11318 and 11321 apply only to a service provided:
(a) in conditions that allow the establishment of determinate thresholds; and
(b) in a sound-attenuated environment with background noise conditions that comply with Australian Standard AS1269‑1983 of the Standards Association of Australia, as in force on 1 August 1987; and
(c) using calibrated equipment that complies with Australian Standard AS2586-1983 of the Standards Association of Australia, as in force on 1 August 1987.
Items 51700 to 53706 apply only to a service provided in the course of dental practice by a dental practitioner approved by the Minister for the purposes of the definition of
professional service in subsection 3 (1) of the Act.
15 Meaning of administration of an anaesthetic in items 18102 to 18119 In items 18102 to 18119,
administration of an anaesthetic means the administration of an anaesthetic in connection with a dental service, other than a dental service that is a prescribed medical service for the purposes of paragraph (b) of the definition ofprofessional service in subsection 3 (1) of the Act.
16 Meaning of amount under rule 16 in certain items (1) In item 15003,
amount under rule 16 means an amount equal to the sum of:
(a) the fee for item 15000; and
(b) $13.30 for each field separately treated in excess of 1.
(2) In item 15103,
amount under rule 16 means an amount equal to the sum of:
(a) the fee for item 15100; and
(b) $14.65 for each field separately treated in excess of 1.
(3) In item 15109,
amount under rule 16 means an amount equal to the sum of:
(a) the fee for item 15106; and
(b) $17.65 for each field separately treated in excess of 1.
(4) In item 15204,
amount under rule 16 means an amount equal to the sum of:
(a) the fee for item 15203; and
(b) $29.55 for each field separately treated in excess of 1.
(5) In item 15208,
amount under rule 16 means an amount equal to the sum of:
(a) the fee for item 15207; and
(b) $29.55 for each field separately treated in excess of 1.
(6) In item 15214,
amount under rule 16 means an amount equal to the sum of:
(a) the fee for item 15211; and
(b) $24.80 for each field separately treated in excess of 1.
17 Meaning of amount under rule 17 in certain items (1) In item 15009,
amount under rule 17 means an amount equal to the sum of:
(a) the fee for item 15006; and
(b) $14.45 for each field separately treated in excess of 1.
(2) In item 15115,
amount under rule 17 means an amount equal to the sum of:
(a) the fee for item 15112; and
(b) $36.80 for each field separately treated in excess of 1.
18 Meaning of amount under rule 18 in certain items In items 17977 and 44376 (reamputation),
amount under rule 18 means:
(a) for item 17977 — an amount equal to 85% of the fee specified for the item relating to the administration of anaesthetic for an original amputation (any of items 44325 to 44373) of the body part for which the reamputation is performed; or
(b) for item 44376 — an amount equal to 75% of the fee specified for the item relating to an original amputation (any of items 44325 to 44373) of the body part for which the reamputation is performed.
19 Meaning of (AD) in Group C2 — Oral and maxillofacial surgical services and Group C3 — General and prosthodontic services An item in the series 75200 to 75206 and 75800 to 75854 that includes the symbol
( AD ) applies only to a service provided by a dental practitioner practising as a dentist.
(1) In this rule:
accredited orthodontist means:
(a) a dental practitioner who is:
(i) registered or licensed as an orthodontist under the relevant law; and
(ii) accredited by the Minister for the purposes of this rule; or
(b) a dental practitioner:
(i) who is not registered or licensed under the relevant law as an orthodontist or who practises in a State or Territory in which there is no provision for the registration or licensing of orthodontists; and
(ii) whose qualifications or experience demonstrate to the Committee his or her competence in the field of orthodontics that is applicable to the giving of the services specified in items 75001 to 75051; and
(iii) who is accredited by the Minister for the purposes of this rule.
appropriate law , in relation to a service rendered to a patient, means the law of the State or Territory in which the service is rendered that provides for the registration or licensing of oral and maxillofacial surgeons.Committee means the Medical Benefits (Dental Practitioners) Advisory Committee established under section 136 of theNational Health Act 1953 .relevant law , in relation to a service provided to a patient, means the law of the State or Territory in which the service is provided that provides for the registration or licensing of orthodontists.(2) An item in the series 75001 to 75006 or 75024 to 75051 that includes the symbol
(AO ) applies only to a service provided by an accredited orthodontist.(3) An item in the series 75009 to 75023 that includes the symbol
( AO ) and the symbol( AOS ) applies only to a service provided by:(a) an accredited orthodontist; or
(b) a dental practitioner who is:
(i) registered under the appropriate law as an oral and maxillofacial surgeon; and
(ii) a dental practitioner approved by the Minister for the purposes of the definition of
professional service in subsection 3 (1) of the Act.
(1) In this rule,
relevant law , in relation to a service rendered to a patient, means the law of the State or Territory in which the service is rendered that provides for the registration or licensing of oral and maxillofacial surgeons.(2) An item in the series 75150 to 75621 that includes the symbol
( AOS ) applies only to a service provided by a dental practitioner who is:(a) registered under the relevant law as an oral and maxillofacial surgeon; and
(b) a dental practitioner approved by the Minister for the purposes of the definition of
professional service in subsection 3 (1) of the Act.
22 Meaning of report in Group D1 — Miscellaneous diagnostic procedures and investigations In items 11000 to 12207,
report means a report prepared by a medical practitioner.
In rule 24 and items 13200 to 13221,
treatment cycle of a patient means a series of treatments of the patient that:
(a) begins:
(i) if treatment with superovulatory drugs is given — on the day on which that treatment begins; or
(ii) if treatment with superovulatory drugs is not given — on the first day of a menstrual cycle of the patient; and
(b) ends not more than 30 days after that day.
24 Items provided as part of treatment cycle relating to assisted reproductive services not to apply (1) Subrule (2) applies to a service mentioned in:
(a) an item in Subgroup 3 of Group T1 (assisted reproductive services); and
(b) any other item associated with an item in Subgroup 3 of Group T1.
(2) A service provided as part of a treatment cycle to which an item in paragraph (1) (a) applies, is not a medical service for the purposes of the item mentioned in paragraph (1) (b).
25 Items relating to assisted reproductive services not to apply in certain pregnancy-related circumstances Items 13200 to 13221 do not apply to a service in relation to a patient’s pregnancy, or intended pregnancy, that is, at the time of the service, the subject of an agreement, or arrangement, under which the patient makes provision for guardianship of, or custodial rights to, a child born as a result of the pregnancy to be transferred to another person.
26 Meaning of embryology laboratory services in items 13200 and 13206 In items 13200 and 13206,
embryology laboratory services does not include semen preparation but includes:
(a) egg recovery from aspirated follicular fluid; and
(b) insemination; and
(c) monitoring of fertilisation and embryo development; and
(d) preparation of gametes or embryos for transfer or freezing.
In items 16515, 16519 and 16522,
delivery includes:
(a) induction of labour by surgical or intravenous infusion methods; and
(b) forceps or vacuum extraction; and
(c) breech delivery; and
(d) management of multiple deliveries; and
(e) episiotomy; and
(f) repair of tears; and
(g) evacuation of the products of conception by manual removal.
28 Certain obstetrical procedures constitute a single operation The fee mentioned for item 16519, 16520, 16522, 16564, 16567, 16570, 16571 or 16573 applies inclusively to:
(a) the procedure, or procedures, mentioned in the item; and
(b) the administration of anaesthetic or the giving of assistance, within the meaning of subsection 16 (2), (3) or (4) of the Act.
In items 45720 to 45752 and 52342 to 52375,
maxilla includes the zygoma.
30 Items 46300 to 46534 apply only in certain circumstances Items 46300 to 46534 apply only to a service provided in the course of an operation on a hand or hands.
(1) Items 51300 to 51318 apply only to assistance rendered by a medical practitioner other than:
(a) the practitioner performing the operation; or
(b) the anaesthetist administering the anaesthetic in connection with the operation, if any; or
(c) the assistant anaesthetist, if any.
(2) Items 51800 and 51803 apply only to assistance rendered by an approved dental practitioner other than:
(a) the practitioner performing the operation; or
(b) the anaesthetist administering the anaesthetic in connection with the operation, if any; or
(c) the assistant anaesthetist, if any.
32 Services in association with spinal fusion services Items 48678, 48681, 48684, 48687 and 48690 apply only if the service is undertaken in association with a spinal fusion service to which item 48642, 48645, 48648, 48651, 48654, 48657, 48660, 48663, 48666, 48669, 48672 or 48675 applies.
33 Meaning of amount under rule 33 in items 51303 and 51803 In items 51303 and 51803,
amount under rule 33 , in relation to an amount payable for assistance at an operation or series of operations, means an amount equal to 20% of the sum of the fees payable under the Act for the services at that operation or series of operations of the practitioner to whom the assistance was given.
(1) In item 51309,
amount under rule 34 ,in relation to an amount payable for assistance at a series or combination of operations, means an amount equal to 20% of the sum of the fees payable under the Act for the services at those operations of the practitioner to whom the assistance was given.(2) For subrule (1), the amount payable for the caesarean section component of the operations is the fee applicable to item 16520.
In item 18219,
amount under rule 35 means an amount equal to the sum of:
(a) the fee for item 18216; and
(b) $14.80 for each additional period of 15 minutes, or part of a period of 15 minutes, for continuous attendance by the medical practitioner beyond the first hour of attendance.
36 Histopathological proof of malignancy in certain cases for purposes of certain items relating to surgical procedures For items 30196 to 30205, the requirement for histopathological proof of malignancy is satisfied where multiple lesions are to be removed from the 1 anatomical region if a single lesion from that region is histologically tested and proven positive for malignancy.
37 Meaning of amount under rule 37 in items 16633 and 16636 In items 16633 and 16636,
amount under rule 37 means the amount that is equal to 50% of the amount of the fee for the service specified in an item for those services that are provided in relation to the second, or to a subsequent, foetus of a multiple pregnancy.
In item 51312,
amount under rule 38 , in relation to an amount payable for assistance at a procedure, means an amount equal to 20% of the sum of the fees payable under the Act for the services at that procedure of the practitioner to whom the assistance was given.
In item 31340,
amount under rule 39 , in relation to an amount payable for the excision of muscle, bone or cartilage in association with the excision of a malignant tumour of skin under another item, means an amount equal to 75% of the fee payable under that other item.
40 Meaning of amount under rule 40 in items 17503 and 17506 In items 17503 and 17506,
amount under rule 40 , for an amount payable for assistance in the administration of an anaesthetic, means an amount equal to 30% of the fee for the services at that treatment of the anaesthetist to whom the assistance was given.
41 Meaning of previous significant surgical complication in item 51318 In item 51318, previous significant surgical complication means:
(a) vitreous loss; or
(b) rupture of posterior capsule; or
(c) loss of nuclear material into the vitreous; or
(d) intraocular haemorrhage; or
(e) intraocular infection (endophthalmitis); or
(f) cystoid macular oedema; or
(g) corneal decompensation; or
(h) retinal detachment.
(1) In item 13604,
amount under rule 42 means the fee, worked out in accordance with subrule (2), for a cardiopulmonary bypass, involving perfusion, that lasts longer than 6 hours.(2) The fee is the sum of:
(a) $548.50; and
(b) $14.80 for each additional period of 10 minutes (or part of a period of 10 minutes) after 6 hours.
43 Meaning of amount under rule 43 in items 17800, 17805 and 17810 In items 17800, 17805 and 17810,
amount under rule 43 means the fee worked out by multiplying $14.80 for each additional anaesthetic time unit applying beyond the assigned number of anaesthetic time units, as follows:(a) for item 17800 (anaesthetic time exceeds the assigned number of anaesthetic time units for the surgical procedure by more than 1 hour) — for a procedure that has been assigned 1 to 12 anaesthetic time units;
(b) for item 17805 (anaesthetic time exceeds the assigned number of anaesthetic time units for the surgical procedure by more than 1 hour and 30 minutes) — for a procedure that has been assigned 13 to 24 anaesthetic time units;
(c) for item 17810 (anaesthetic time exceeds the assigned number of anaesthetic time units for the surgical procedure by more than 2 hours) — for a procedure that has been assigned 25 anaesthetic time units or more.
In item 17970,
amount under rule 44 means 50% of the scheduled fee that would normally apply for administration of an anaesthetic in connection with a surgical procedure if that surgical procedure had not been discontinued before completion.
In item 30001,
amount under rule 45 means 50% of the scheduled fee that would normally apply for a surgical procedure if the surgical procedure had not been discontinued before completion.
46 Meaning of complex paediatric case in certain circumstances
For item 17506, a
complex paediatric case involves 1 or more of the following services:
(a) invasive monitoring, either intravascular or transoesophageal;
(b) organ transplantation;
(c) craniofacial surgery;
(d) major tumour resection;
(e) separation of conjoint twins.
In item 18033,
amount under rule 47 means an amount that is equal to the sum of:
(a) $59.20; and
(b) $14.80 for each 15 minutes of anaesthesia time.
An attendance by a consultant occupational physician will only attract a benefit if the attendance relates to 1 or more of the following matters:
(a) evaluation and assessment of a patient’s rehabilitation requirements where, in the consultant’s opinion, the patient has an accepted medical condition which may be affected by his or her working environment or ability to be employed;
(b) management of 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) evaluation and forming an opinion, including management as the case requires, of a patient’s medical condition where causation may be related to acute or chronic exposure from scientifically accepted environmental hazards or toxins.
For items 12203 and 12207, a person is a
qualified sleep medicine practitioner if:
(a) the person has been assessed:
(i) by the Credentialling Subcommittee (the
Credentialling Subcommittee ) of the Specialist Advisory Committee in Thoracic and Sleep Medicine of the Royal Australasian College of Physicians (theAdvisory Committee ); or(ii) on appeal from an adverse assessment of the Credentialling Subcommittee, by the Appeal Committee of the Royal Australasian College of Physicians (the
Appeal Committee );as having had, before 1 March 1999, sufficient training and experience in sleep medicine to be competent in independent clinical assessment and management of patients with respiratory sleep disorders and in reporting sleep studies; or
(b) the person has been assessed:
(i) by the Credentialling Subcommittee; or
(ii) on appeal from an adverse assessment of the Credentialling Subcommittee, by the Appeal Committee;
as:
(iii) having had, before 1 March 1999, substantial training or experience in sleep medicine; but
(iv) requiring further specified training or experience in sleep medicine to be competent in independent clinical assessment and management of patients with respiratory sleep disorders and in reporting sleep studies;
and either:
(v) the period of 2 years immediately following that assessment has not expired; or
(vi) the person has been assessed by the Credentialling Subcommittee as having satisfactorily finished the further training or gained the further experience specified for that person; or
(c) the person has attained Level I or Level II of the Advanced Training Program in Sleep Medicine of the Thoracic Society of Australia and New Zealand and the Australasian Sleep Association, after having completed at least 12 months core training, including clinical practice in sleep medicine and in reporting sleep studies; or
(d) the Advisory Committee has recognised, in writing, the person as having training equivalent to the training mentioned in paragraph (c).
Items 410 to 417 apply to an attendance on a patient by a public health physician only if the attendance relates to 1 or more of the following matters:
(a) management of a patient’s vaccination requirements for immunisation programs;
(b) prevention or management of sexually transmitted disease;
(c) prevention or management of disease caused by scientifically accepted environmental hazards or toxins;
(d) prevention or management of infection arising from an outbreak of an infectious disease;
(e) prevention or management of an exotic disease.
Note An exotic disease is medically accepted as a disease that is of foreign origin.
51 Application of items in Group A14 to certain patients only (1) Items 700, 702, 704 and 706 apply only to a service in relation to a patient who:
(a) is either:
(i) at least 75 years old; or
(ii) at least 55 years old and of Aboriginal or Torres Strait Islander descent; and
(b) is not an in-patient of a hospital or day-hospital facility, or a care recipient in a residential aged care facility.
(2) For subrule (1), a person is of
Aboriginal or Torres Strait Islander descent if the person identifies himself or herself as being of that descent.
52 Application of items in Group A15 to certain patients only (1) Items 720, 724, 726, 740, 742, 744, 759, 762 and 765 apply only to a service in relation to a patient who:
(a) suffers from at least 1 medical condition that:
(i) has been (or is likely to be) present for at least 6 months; or
(ii) is terminal; and
(b) is not an in-patient of a hospital or day-hospital facility, or a care recipient in a residential aged care facility.
(2) Items 722, 728, 746, 749, 757, 768, 771 and 773 apply only to a service in relation to a patient who:
(a) suffers from at least 1 medical condition that:
(i) has been (or is likely to be) present for at least 6 months; or
(ii) is terminal; and
(b) is an in-patient of a hospital or day-hospital facility; and
(c) is not a care recipient in a residential aged care facility.
(3) Items 730, 734, 736, 738, 775, 778 and 779 apply only to a service in relation to a patient who:
(a) suffers from at least 1 medical condition that:
(i) has been (or is likely to be) present for at least 6 months; or
(ii) is terminal; and
(b) is a care recipient in a residential aged care facility; and
(c) is not an in-patient of a hospital or day-hospital facility.
(1) For items 700, 702, 704 and 706,
health assessment means the assessment, in accordance with this rule, of:(a) a patient’s health and physical, psychological and social function; and
(b) whether preventative health care and education should be offered to the patient, to improve the patient’s health and physical, psychological and social function.
(2) The health assessment must include a personal attendance by the medical practitioner.
(3) The assessment must also include:
(a) measurement of the patient’s blood pressure, pulse rate and rhythm; and
(b) an assessment of the patient’s medication; and
(c) an assessment of the patient’s continence; and
(d) an assessment of the patient’s immunisation status for influenza, tetanus and pneumococcus; and
(e) an assessment of the patient’s physical function, including the patient’s activities of daily living and whether or not the patient has had a fall in the last 3 months; and
(f) an assessment of the patient’s psychological function, including the patient’s cognition and mood; and
(g) an assessment of the patient’s social function, including:
(i) the availability and adequacy of paid, and unpaid, help; and
(ii) whether the patient is responsible for caring for another person.
(4) The assessment must also include:
(a) keeping a record of the health assessment, signed by the patient; and
(b) offering the patient a written report about the health assessment, with recommendations about matters covered by the health assessment.
(1) For items 720, 722, 724, 726, 728 and 730 preparation of a
multidisciplinary care plan means the preparation of a written plan describing the following matters:(a) an assessment of the patient’s health care needs;
(b) an assessment of the kinds of treatment, health services and health care that the patient is likely to need;
(c) an assessment of any other kinds of services and care that the patient is likely to need;
(d) arrangements for giving the treatment, services and care referred to in paragraphs (b) and (c);
(e) management goals with which the patient agrees;
(f) arrangements to review the plan by a day specified in the plan.
Example For paragraph (c), other kinds of services and care may include home and community care service providers.
(2) Preparation of the plan must also include:
(a) discussing the preparation of the plan with the patient; and
(b) telling the patient which persons will be included in the multidisciplinary care plan team; and
(c) recording the plan and the patient’s agreement to the preparation of the plan; and
(d) giving copies of relevant parts of the plan to persons who, under the plan, will give the patient the treatment, service and care mentioned in the plan; and
(e) offering a copy of the plan (and evidence of the contribution made to the plan by members of the team) to the patient; and
(f) if the patient is eligible to be provided with treatment, under Part V of the
Veterans’ Entitlement Act 1986 , giving a copy of the plan to the Department of Veterans’ Affairs.
A multidisciplinary care plan team includes:
(a) a medical practitioner; and
(b) at least 2 other members, each of whom provides a different kind of care or service to the patient, and 1 of whom may be another medical practitioner.
Example Examples of persons who, for paragraph (b), may be included in a team are allied health professionals such as:
· Aboriginal health care workers
· audiologists
· dental therapists
· dentists
· dieticians
· occupational therapists
· optometrists
· orthoptists
· orthotists or prosthetists
· pharmacists
· physiotherapists
· podiatrists
· psychologists
· registered nurses
· social workers
· speech pathologists.
A team may also include home and community service providers, or care organisers, such as:
· education providers
· meals on wheels’ providers
· personal care workers
· probation officers.
56 Meaning of multidisciplinary discharge care plan For items 722 and 728, a
multidisciplinary discharge care plan is a multidisciplinary care plan that is prepared for a patient before the patient is discharged from a hospital.
57 Meaning of review of a multidisciplinary care plan (1) For item 724,
review of a multidisciplinary care plan means a process by which the medical practitioner:
(a) reviews the matters mentioned in subrule 54 (1); and
(b) considers whether the arrangements for treatment, service and care have been carried out; and
(c) considers, in consultation with other members of the multidisciplinary care plan team, whether different arrangements need to be made to achieve the management goals mentioned in the plan; and
(d) if different arrangements need to be made, prepares a revised multidisciplinary care plan stating those arrangements.
(2) The review of the plan must also include:
(a) discussing the review of the plan with the patient; and
(b) recording the patient’s agreement to reviewing the plan; and
(c) offering a copy of relevant parts of the revised multidisciplinary care plan (if any) to the patient, and giving copies to persons who, under the revised plan, will give the patient the treatment, service and care mentioned in the plan; and
(d) if paragraph 54 (2) (f) applies to the patient, giving a copy of the revised multidisciplinary care plan (if any) to the Department of Veterans’ Affairs.
(1) For items 726, 728 and 730, a
contribution to a multidisciplinary care plan, a multidisciplinary discharge care plan or a multidisciplinary care plan in a residential aged care facility must be at the request of the person (or residential aged care facility) who prepares the plan, and may include:(a) preparation of a part of the plan that relates to the treatment, service or care that the medical practitioner will give to the patient; and
(b) giving advice to the person who prepares the plan.
(2) Contribution to a plan does not necessarily include preparation of the plan or part of the plan.
(1) For the items mentioned in Subgroup 2 of Group A15, a
multidisciplinary case conference is a process by which a multidisciplinary case conference team (see rule 62) carries out the activities mentioned in subrule (2).(2) For subrule (1), the activities are:
(a) discussing a patient’s history; and
(b) identifying the patient’s multidisciplinary care needs; and
(c) identifying outcomes to be achieved by members of the case conference team giving care and service to the patient; and
(d) identifying tasks that need to be undertaken to achieve these outcomes, and allocating those tasks to members of the case conference team; and
(e) assessing whether previously identified outcomes (if any) have been achieved.
60 Meaning of multidisciplinary discharge case conference For items 746, 749, 757, 768, 771 and 773, a
multidisciplinary discharge case conference is a multidisciplinary case conference carried out in relation to a patient before the patient is discharged from a hospital or day-hospital facility.61 Meaning of multidiciplinary case conference in a residential aged care facility For items 734, 736, 738, 775, 778 and 779, a
multidisciplinary case conference in a residential aged care facility is a multidisciplinary case conference carried out in relation to a care recipient in a residential aged care facility.62 Meaning of multidisciplinary case conference team For the items mentioned in rules 59, 60 and 61 a
multidisciplinary case conference team :(a) includes a medical practitioner; and
(b) includes at least 2 other members, each of whom provides a different kind of care or service to the patient, and 1 of whom may be another medical practitioner.
Example Examples of persons who, for paragraph (b), may be included in a team are allied health professionals such as:
· Aboriginal health care workers
· audiologists
· dental therapists
· dentists
· dieticians
· occupational therapists
· optometrists
· orthoptists
· orthotists or prosthetists
· pharmacists
· physiotherapists
· podiatrists
· psychologists
· registered nurses
· social workers
· speech pathologists.
A team may also include home and community service providers, or care organisers, such as:
· education providers
· ‘meals on wheels’ providers
· personal care workers
· probation officers.
63 Meaning of organise and co-ordinate a multidisciplinary case conference and participation in a multidisciplinary case conference (1) For items 734, 736, 738, 740, 742, 744, 746, 749 and 757,
organise and co-ordinate a multidisciplinary case conference means undertaking the following activities in relation to a case conference:(a) explaining to the patient the nature of a multidisciplinary case conference, and asking the patient whether the patient agrees to the conference taking place; and
(b) recording the patient’s agreement to the conference; and
(c) recording the day on which the conference was held, and the times at which the conference started and ended; and
(d) recording the names of the participants; and
(e) recording the matters mentioned in subrule 59 (2), and putting a copy of that record in the patient’s medical records; and
(f) offering the patient, and giving each other member of the team, a summary of the conference.
(2) For items 759, 762, 765, 768, 771, 773, 775, 778 and 779
participation in a multidisciplinary case conference must be at the request of the person who organises and co-ordinates the conference, and includes undertaking the following activities in relation to a case conference:(a) explaining to the patient the nature of a multidisciplinary case conference, and asking the patient whether the patient agrees to the practitioner’s participation in the conference; and
(b) recording the patient’s agreement to the practitioner’s participation; and
(c) recording the day on which the conference was held, and the times at which the conference started and ended; and
(d) recording the names of the participants; and
(e) recording the matters mentioned in subrule 59 (2), and putting a copy of that record in the patient’s medical records.
(3) Participation in a multidisciplinary case conference does not include organising and co-ordinating a multidisciplinary case conference.
1 | Professional attendance being an attendance at other than consulting rooms, by a general practitioner on not more than 1 patient on the 1 occasion — each attendance, other than an attendance between 11 pm and 7 am, on a public holiday, on a Sunday, before 8 am or after 1 pm on a Saturday or at any time other than between 8 am and 8 pm on a day not being a Saturday, Sunday or public holiday, where the attendance is initiated by or on behalf of the patient in the same unbroken after-hours period and where the patient’s medical condition requires immediate treatment | 89.15 | ||||
2 | Professional attendance being an attendance at consulting rooms, by a general practitioner on not more than 1 patient on the 1 occasion — each attendance, other than an attendance between 11 pm and 7 am, on a public holiday, on a Sunday, before 8 am or after 1 pm on a Saturday or at any time other than between 8 am and 8 pm on a day not being a Saturday, Sunday or public holiday, where the attendance is initiated by or on behalf of the patient in the same unbroken after-hours period and where the patient’s medical condition requires immediate treatment and where it is necessary for the doctor to return to, and specially open, consulting rooms for the attendance | 89.15 | ||||
3 | Professional attendance at consulting rooms (not being a service to which any other item applies) by a general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management — each attendance | 13.10 | ||||
4 | Professional attendance, other than a service to which any other item applies, and not being an attendance at consulting rooms, an institution, a hospital or a residential aged care facility by a general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management — an attendance on 1 or more patients on 1 occasion — each patient | Amount under rule 8 | ||||
13 | Professional attendance at an institution (not being a service to which any other item applies) by a general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management — an attendance on 1 or more patients at 1 institution on 1 occasion — each patient | Amount under rule 8 | ||||
19 | Professional attendance at a hospital (not being a service to which any other item applies) by a general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management — an attendance on 1 or more patients at 1 hospital on 1 occasion — each patient | Amount under rule 8 | ||||
20 | Professional attendance (not being 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 a residential aged care facility (not being accommodation in a self contained unit) by a general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management — an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion — each patient | Amount under rule 8 | ||||
23 | Professional attendance at consulting rooms (not being a service to which any other item applies) by a general practitioner involving taking a selective history, examination of the patient with implementation of a management plan in relation to 1 or more problems, or a professional attendance of less than 20 minutes duration involving components of a service to which item 36 or 44 applies — each attendance | |||||
27.55 | ||||||
24 | Professional attendance, other than a service to which any other item applies, and not being an attendance at consulting rooms, an institution, a hospital or a residential aged care facility by a general practitioner taking a selective history, examination of the patient with implementation of a management plan in relation to 1 or more problems, or a professional attendance of less than 20 minutes duration involving components of a service to which item 37 to 47 applies — an attendance on 1 or more patients on 1 occasion — each patient | Amount under rule 8 | ||||
25 | Professional attendance at an institution (not being a service to which any other item applies) by a general practitioner involving taking a selective history, examination of the patient with implementation of a management plan in relation to 1 or more problems, or a professional attendance of less than 20 minutes duration involving components of a service to which item 38 or 48 applies — an attendance on 1 or more patients at 1 institution on 1 occasion — each patient | Amount under rule 8 | ||||
33 | Professional attendance at a hospital (not being a service to which any other item applies) by a general practitioner involving taking a selective history, examination of the patient with implementation of a management plan in relation to 1 or more problems, or a professional attendance of less than 20 minutes duration involving components of a service to which item 40 or 50 applies — an attendance on 1 or more patients at 1 hospital on 1 occasion — each patient | Amount under rule 8 | ||||
35 | Professional attendance (not being 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 (not being accommodation in a self-contained unit) by a general practitioner involving taking a selective history, examination of the patient with implementation of a management plan in relation to 1 or more problems, or a professional attendance of less than 20 minutes duration involving components of a service to which item 43 or 51 applies — an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion — each patient | Amount under rule 8 | ||||
36 | Professional attendance at consulting rooms (not being a service to which any other item applies) by a general practitioner involving taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more problems, and lasting at least 20 minutes, or a professional attendance of less than 40 minutes duration involving components of a service to which item 44 applies — each attendance | 49.80 | ||||
37 | Professional attendance, other than a service to which any other item applies, and not being an attendance at consulting rooms, an institution, a hospital or a residential aged care facility by a general practitioner taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more problems, or a professional attendance of less than 40 minutes duration involving components of a service to which item 47 applies — an attendance on 1 or more patients on 1 occasion — each patient | Amount under rule 8 | ||||
38 | Professional attendance at an institution (not being a service to which any other item applies) by a general practitioner involving taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more problems, and lasting at least 20 minutes, or a professional attendance of less than 40 minutes duration involving components of a service to which item 48 applies — an attendance on 1 or more patients at 1 institution on 1 occasion — each patient | Amount under rule 8 | ||||
40 | Professional attendance at a hospital (not being a service to which any other item applies) by a general practitioner involving taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more problems, and lasting at least 20 minutes, or a professional attendance of less than 40 minutes duration involving components of a service to which item 50 applies — an attendance on 1 or more patients at 1 hospital on 1 occasion — each patient | Amount under rule 8 | ||||
43 | Professional attendance (not being 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 (not being accommodation in a self-contained unit) by a general practitioner involving taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more problems, and lasting at least 20 minutes, or a professional attendance of less than 40 minutes duration involving components of a service to which item 51 applies — an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion — each patient | Amount under rule 8 | ||||
44 | Professional attendance at consulting rooms (not being a service to which any other item applies) by a general practitioner involving taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more complex problems, and lasting at least 40 minutes, or a professional attendance of at least 40 minutes duration for implementation of a management plan — each attendance | 73.35 | ||||
47 | Professional attendance, other than a service to which any other item applies, and not being an attendance at consulting rooms, an institution, a hospital or a residential aged care facility by a general practitioner taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more complex problems and lasting at least 40 minutes, or a professional attendance of at least 40 minutes duration for implementation of a management plan — an attendance on 1 or more patients on 1 occasion — each patient | Amount under rule 8 | ||||
48 | Professional attendance at an institution (not being a service to which any other item applies) by a general practitioner involving taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more complex problems, and lasting at least 40 minutes, or a professional attendance of at least 40 minutes duration for implementation of a management plan — an attendance on 1 or more patients at 1 institution on 1 occasion — each patient | Amount under rule 8 | ||||
50 | Professional attendance at a hospital (not being a service to which any other item applies) by a general practitioner involving taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more complex problems, and lasting at least 40 minutes, or a professional attendance of at least 40 minutes duration for implementation of a management plan — an attendance on 1 or more patients at 1 hospital on 1 occasion — each patient | Amount under rule 8 | ||||
51 | Professional attendance (not being 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 (not being accommodation in a self-contained unit) by a general practitioner involving taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more complex problems, and lasting at least 40 minutes, or a professional attendance of at least 40 minutes duration for implementation of a management plan — an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion — each patient | Amount under rule 8 | ||||
52 | Professional attendance at consulting rooms of not more than 5 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — each attendance | 11.00 | ||||
53 | Professional attendance at consulting rooms of more than 5 minutes duration but not more than 25 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — each attendance | 21.00 | ||||
54 | Professional attendance at consulting rooms of more than 25 minutes duration but not more than 45 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — each attendance | 38.00 | ||||
57 | Professional attendance at consulting rooms of more than 45 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — each attendance | 61.00 | ||||
58 | Professional attendance (not being an attendance at consulting rooms, an institution, a hospital or a residential aged care facility) of not more than 5 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients on 1 occasion — each patient | Amount under rule 8 | ||||
59 | Professional attendance (not being an attendance at consulting rooms, an institution, a hospital or a residential aged care facility) of more than 5 minutes duration but not more than 25 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients on 1 occasion — each patient | Amount under rule 8 | ||||
60 | Professional attendance (not being an attendance at consulting rooms, an institution, a hospital or a residential aged care facility) of more than 25 minutes duration but not more than 45 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients on 1 occasion — each patient | Amount under rule 8 | ||||
65 | Professional attendance (not being an attendance at consulting rooms, an institution, a hospital or a residential aged care facility) of more than 45 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients on 1 occasion — each patient | Amount under rule 8 | ||||
81 | Professional attendance at an institution of not more than 5 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients at 1 institution on 1 occasion — each patient | Amount under rule 8 | ||||
83 | Professional attendance at an institution of more than 5 minutes duration but not more than 25 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients at 1 institution on 1 occasion — each patient | Amount under rule 8 | ||||
84 | Professional attendance at an institution of more than 25 minutes duration but not more than 45 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients at 1 institution on 1 occasion — each patient | Amount under rule 8 | ||||
86 | Professional attendance at an institution of more than 45 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients at 1 institution on 1 occasion — each patient | Amount under rule 8 | ||||
87 | Professional attendance at a hospital of not more than 5 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients at 1 hospital on 1 occasion — each patient | Amount under rule 8 | ||||
89 | Professional attendance at a hospital of more than 5 minutes duration but not more than 25 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients at 1 hospital on 1 occasion — each patient | Amount under rule 8 | ||||
90 | Professional attendance at a hospital of more than 25 minutes duration but not more than 45 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients at 1 hospital on 1 occasion — each patient | Amount under rule 8 | ||||
91 | Professional attendance at a hospital of more than 45 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients at 1 hospital on 1 occasion — each patient | Amount under rule 8 | ||||
92 | Professional attendance (not being 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 (not being accommodation in a self-contained unit) of not more than 5 minutes duration by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion — each patient | Amount under rule 8 | ||||
93 | Professional attendance (not being 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 (not being accommodation in a self-contained unit) of more than 5 minutes duration but not more than 25 minutes duration by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion — each patient | Amount under rule 8 | ||||
95 | Professional attendance (not being 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 (not being accommodation in a self-contained unit) of more than 25 minutes duration but not more than 45 minutes by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion — each patient | Amount under rule 8 | ||||
96 | Professional attendance (not being 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 (not being accommodation in a self-contained unit) of more than 45 minutes duration by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion — each patient | Amount under rule 8 | ||||
97 | Professional attendance being an attendance at other than consulting rooms, by a medical practitioner (not being a general practitioner) on not more than 1 patient on the 1 occasion — each attendance, other than an attendance between 11 pm and 7 am, on a public holiday, on a Sunday, before 8 am or after 1 pm on a Saturday or at any time other than between 8 am and 8 pm on a day not being a Saturday, Sunday or public holiday, where the attendance is initiated by or on behalf of the patient in the same unbroken after-hours period and where the patient’s medical condition requires immediate treatment | 50.95 | ||||
98 | Professional attendance being an attendance at consulting rooms, by a medical practitioner (not being a general practitioner) on not more than 1 patient on the 1 occasion — each attendance, other than an attendance between 11 pm and 7 am, on a public holiday, on a Sunday, before 8 am or after 1 pm on a Saturday or at any time other than between 8 am and 8 pm on a day not being a Saturday, Sunday or public holiday, where the attendance is initiated by or on behalf of the patient in the same unbroken after-hours period and where the patient’s medical condition requires immediate treatment and where it is necessary for the doctor to return to, and specially open, consulting rooms for the attendance | 50.95 | ||||
104 | 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) where that attendance is at consulting rooms or hospital, not being a service to which item 106 applies | 66.60 | ||||
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 (other than a second or subsequent attendance in a single course of treatment) where that attendance is at consulting rooms or hospital | 33.40 | ||||
106 | 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) at which refraction is performed by a specialist ophthalmologist, and the attendance results in the issuing of a prescription for spectacles or contact lenses, including any consultation on the same occasion and any other attendance on the same day (not being a service to which item 10801, 10802, 10803, 10804, 10805, 10806, 10807, 10808, 10809 or 10816 applies) where that attendance is at consulting rooms or hospital | 54.85 | ||||
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) where that attendance is at a place other than consulting rooms or hospital | 97.65 | ||||
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 subsequent to the first in a single course of treatment where that attendance is at a place other than consulting rooms or hospital | 61.80 | ||||
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 medical practitioner — initial attendance in a single course of treatment | |||||
(Anaes. 17726 = 8B + 18T) (Assist.) | 1 580.75 | |||||
52440 | Cleft lip, unilateral — primary repair, 1 stage, without anterior palate repair (Anaes. 17712 = 6B + 6T) (Assist.) | 421.50 | ||||
52442 | Cleft lip, unilateral — primary repair, 1 stage, with anterior palate repair (Anaes. 17716 = 7B + 9T) (Assist.) | 526.95 | ||||
52444 | Cleft lip, bilateral — primary repair, 1 stage, without anterior palate repair (Anaes. 17714 = 6B + 8T) (Assist.) | 585.45 | ||||
52446 | Cleft lip, bilateral — primary repair, 1 stage, with anterior palate repair (Anaes. 17718 = 7B + 11T) (Assist.) | 690.90 | ||||
52448 | Cleft lip, lip adhesion procedure, unilateral or bilateral (Anaes. 17711 = 6B + 5T) (Assist.) | 203.75 | ||||
52450 | Cleft lip, partial revision, including minor flap revision alignment and adjustment, including revision of minor whistle deformity if performed (Anaes. 17711 = 6B + 5T) | 234.15 | ||||
52452 | Cleft lip, total revision, including major flap revision, muscle reconstruction and revision of major whistle deformity (Anaes. 17713 = 6B + 7T) (Assist.) | 380.50 | ||||
52454 | Cleft lip, primary columella lengthening procedure, bilateral (Anaes. 17711 = 6B + 5T) | 357.15 | ||||
52456 | Cleft lip reconstruction using full thickness flap (Abbe or similar), first stage (Anaes. 17712 = 6B + 6T) (Assist.) | 644.05 | ||||
52458 | Cleft lip reconstruction using full thickness flap (Abbe or similar), second stage (Anaes. 17708 = 6B + 2T) | 234.15 | ||||
52460 | Velo-pharyngeal incompetence, pharyngeal flap for, or pharyngoplasty for (Anaes. 17711 = 5B + 6T) | 608.80 | ||||
52470 | Facial nerve palsy, excision of tissue for (Anaes. 17709 = 5B + 4T) | 215.45 | ||||
52476 | Eyelid closure in facial nerve paralysis, insertion of foreign implant for (Anaes. 17712 = 5B + 7T) (Assist.) | 427.40 | ||||
52478 | Eyelid, whole thickness reconstruction of other than by direct suture only (Anaes. 17711 = 5B + 6T) (Assist.) | 457.55 | ||||
52480 | Composite graft (chondro-cutaneous or chondro-mucosal) to nose, ear or eyelid (Anaes. 17712 = 5B + 7T) (Assist.) | 391.05 | ||||
52482 | Macrocheilia or macroglossia, operation for (Anaes. 17716 = 5B + 11T) (Assist.) | 376.25 | ||||
52484 | Macrostomia, operation for (Anaes. 17713 = 5B + 8T) (Assist.) | 447.90 | ||||
52600 | Mandibular or palatal exostosis, excision of (Anaes. 17710 = 5B + 5T) (Assist.) | 263.40 | ||||
52603 | Mylohyoid ridge, reduction of (Anaes. 17711 = 5B + 6T) (Assist.) | 251.75 | ||||
52606 | Maxillary tuberosity, reduction of (Anaes. 17711 = 5B + 6T) | 192.05 | ||||
52609 | Papillary hyperplasia of the palate, removal of — less than 5 lesions (Anaes. 17709 = 5B + 4T) (Assist.) | 251.75 | ||||
52612 | Papillary hyperplasia of the palate, removal of — 5 to 20 lesions (Anaes. 17711 = 5B + 6T) (Assist.) | 316.05 | ||||
52615 | Papillary hyperplasia of the palate, removal of — more than 20 lesions (Anaes. 17712 = 5B + 7T) (Assist.) | 392.30 | ||||
52618 | Vestibuloplasty, submucosal or open, including excision of muscle and skin or mucosal graft when performed — unilateral or bilateral (Anaes. 17713 = 5B + 8T) (Assist.) | 456.55 | ||||
52621 | Floor of mouth lowering (Obwegeser or similar procedure), including excision of muscle and skin or mucosal graft when performed — unilateral (Anaes. 17719 = 5B + 14T) (Assist.) | 456.55 | ||||
52624 | Alveolar ridge augmentation with bone or alloplast or both — unilateral (Anaes. 17713 = 5B + 8T) (Assist.) | 368.80 | ||||
52626 | Alveolar ridge augmentation — unilateral, insertion of tissue expanding device into maxillary or mandibular alveolar ridge region for (Anaes. 17713 = 5B + 8T) (Assist.) | 226.15 | ||||
52627 | Osseo-integration procedure — extra oral implantation of titanium fixture (Anaes. 17711 = 5B + 6T) (Assist.) | 392.30 | ||||
52630 | Osseo-integration procedure — fixation of transcutaneous abutment (Anaes. 17707 = 5B + 2T) | 145.20 | ||||
52633 | Osseo-integration procedure — intra-oral implantation of titanium fixture to facilitate restoration of the dentition following resection of part of the maxilla or mandible for benign or malignant tumours (Anaes. 17711 = 6B + 5T) | 392.30 | ||||
52636 | Osseo-integration procedure — fixation of transmucosal abutment to fixtures placed following resection of part of the maxilla or mandible for benign or malignant tumours (Anaes. 17706 = 4B + 2T) | 145.20 | ||||
52800 | Neurolysis by open operation, without transposition, not being a service associated with a service to which item 52803 applies (Anaes. 17707 = 5B + 2T) (Assist.) | 215.45 | ||||
52803 | Nerve trunk, internal (interfascicular), neurolysis of, using microsurgical techniques (Anaes. 17713 = 5B + 8T) (Assist.) | 310.25 | ||||
52806 | Neurectomy, neurotomy or removal of tumour from superficial peripheral nerve (Anaes. 17708 = 5B + 3T) (Assist.) | 215.45 | ||||
52809 | Neurectomy, neurotomy or removal of tumour from deep peripheral nerve (Anaes. 17709 = 5B + 4T) (Assist.) | 368.90 | ||||
52812 | Nerve trunk, primary repair of, using microsurgical techniques (Anaes. 17713 = 5B + 8T) (Assist.) | 526.95 | ||||
52815 | Nerve trunk, secondary repair of, using microsurgical techniques (Anaes. 17713 = 4B + 9T) (Assist.) | 556.10 | ||||
52818 | Nerve, transposition of (Anaes. 17709 = 5B + 4T) (Assist.) | 368.90 | ||||
52821 | Nerve graft to nerve trunk (cable graft) including harvesting of nerve graft using microsurgical techniques (Anaes. 17718 = 5B + 13T) (Assist.) | 802.00 | ||||
52824 | Peripheral branches of the trigeminal nerve, cryosurgery of, for pain relief (Anaes. 17709 = 5B + 4T) (Assist.) | 345.40 | ||||
52826 | Injection of primary branch of trigeminal nerve with alcohol, cortisone, phenol, or similar substance (Anaes. 17709 = 5B + 4T) | 185.00 | ||||
52828 | Cutaneous nerve, primary repair of, using microsurgical techniques (Anaes. 17710 = 4B + 6T) (Assist.) | 275.15 | ||||
52830 | Cutaneous nerve, secondary repair of, using microsurgical techniques (Anaes. 17711 = 4B + 7T) (Assist.) | 362.90 | ||||
52832 | Cutaneous nerve, nerve graft to, using microsurgical techniques (Anaes. 17713 = 4B + 9T) (Assist.) | 497.65 | ||||
53000 | Maxillary antrum, proof puncture and lavage of (Anaes. 17707 = 5B + 2T) | 25.30 | ||||
53003 | Maxillary antrum, proof puncture and lavage of, under general anaesthesia (requiring admission to hospital) not being a service associated with a service to which another item in Groups 03 to 09 applies (Anaes. 17707 = 5B + 2T) | 71.65 | ||||
53004 | Maxillary antrum, lavage of — each attendance at which the procedure is performed, including any associated consultation (Anaes. 17707 = 5B + 2T) | 26.15 | ||||
53006 | Antrostomy (radical) (Anaes. 17710 = 5B + 5T) (Assist.) | 405.80 | ||||
53007 | Antrostomy (radical) with transantral ethmoidectomy or transantral vidian neurectomy (Anaes. 17711 = 5B + 6T) (Assist.) | 472.20 | ||||
53009 | Antrum, intranasal operation on or removal of foreign body from (Anaes. 17709 = 5B + 4T) (Assist.) | 230.20 | ||||
53012 | Antrum, drainage of, through tooth socket (Anaes. 17708 = 5B + 3T) | 91.50 | ||||
53015 | Oro-antral fistula, plastic closure of (Anaes. 17712 = 5B + 7T) (Assist.) | 457.55 | ||||
53016 | Nasal septum, septoplasty, submucous resection or closure of septal perforation (Anaes. 17708 = 5B + 3T) (Assist.) | 376.25 | ||||
53017 | Nasal septum, reconstruction of (Anaes. 17710 = 5B + 5T) (Assist.) | 469.45 | ||||
53019 | Maxillary sinus, bone graft to floor of maxillary sinus following elevation of mucosal lining (sinus lift procedure), unilateral (Anaes. 17717 = B + 12T) (Assist.) | 452.20 | ||||
53050 | Lateral rhinotomy with removal of tumour (Anaes. 17713 = 5B + 8T) (Assist.) | 698.55 | ||||
53052 | Post-nasal space, direct examination of, with or without biopsy (Anaes. 17707 = 5B + 2T) | 95.55 | ||||
53054 | Nasendoscopy or sinoscopy or fibreoptic examination of nasopharynx and larynx, one or more of these procedures (Anaes. 17707 = 5B + 2T) | 95.50 | ||||
53056 | Examination of nasal cavity or post-nasal space, or nasal cavity and post-nasal space, under general anaesthesia, not being a service associated with a service to which another item in this group applies (Anaes. 17707 = 5B + 2T) | 56.05 | ||||
53058 | Nasal haemorrhage, posterior, arrest of, with posterior nasal packing with or without cauterisation and with or without anterior pack (excluding after-care) (Anaes. 17709 = 5B + 4T) | 95.50 | ||||
53060 | Cauterisation (other than by chemical means) or cauterisation by chemical means when performed under general anaesthesia or diathermy of septum, turbinates or pharynx for obstruction or haemorrhage secondary to surgery (or trauma) — 1 or more of these procedures (including any consultation on the same occasion) not being a service associated with any other operation on the nose (Anaes. 17707 = 5B + 2T) | 78.20 | ||||
53062 | Post-surgical nasal haemorrhage, arrest of during an episode of epistaxis by cauterisation or nasal cavity packing or both (Anaes. 17709 = 5B + 4T) | 70.05 | ||||
53064 | Cryotherapy to nose in the treatment of nasal haemorrhage (Anaes. 17708 = 5B + 3T) | 126.90 | ||||
53066 | Dislocation of turbinate or turbinates, 1 or both sides, not being a service associated with a service to which another item in this group applies (Anaes. 17707 = 5B + 2T) | 56.05 | ||||
53068 | Turbinectomy or turbinectomies, partial or total, unilateral (Anaes. 17707 = 5B + 2T) | 105.00 | ||||
53070 | Turbinates, submucous resection of, unilateral (Anaes. 17707 = 5B + 2T) | 138.65 | ||||
53200 | Mandible, treatment of a dislocation of, not requiring open reduction (Anaes. 17706 = 5B + 1T) | 55.00 | ||||
53203 | Mandible, treatment of a dislocation of, requiring open reduction (Anaes. 17707 = 5B + 2T) | 92.50 | ||||
53206 | Temporomandibular joint, manipulation of, performed in the operating theatre of a hospital or approved day‑hospital facility, not being a service associated with a service to which another item in Groups O3 to O9 applies (Anaes. 17706 = 5B + 1T) | 111.20 | ||||
53209 | Glenoid fossa, zygomatic arch and temporal bone, reconstruction of (Obwegeser technique) (Anaes. 17719 = 5B + 14T) (Assist.) | 1 283.85 | ||||
53212 | Absent condyle and ascending ramus in hemifacial microsomia, construction of, not including harvesting of graft material (Anaes. 17716 = 5B + 11T) (Assist.) | 693.60 | ||||
53215 | Temporomandibular joint, arthroscopy of, with or without biopsy, not being a service associated with any other arthroscopic procedure of that joint (Anaes. 17709 = 5B + 4T) (Assist.) | 318.10 | ||||
53218 | Temporomandibular joint, arthroscopy of, removal of loose bodies, debridement, or treatment of adhesions — 1 or more of such procedures (Anaes. 17713 = 5B + 8T) (Assist.) | 508.95 | ||||
53220 | Temporomandibular joint, arthrotomy of, not being a service to which another item in this group applies (Anaes. 17709 = 4B + 5T) (Assist.) | 256.60 | ||||
53221 | Temporomandibular joint, open surgical exploration of, with or without microsurgical techniques (Anaes. 17713 = 5B + 8T) (Assist.) | 679.15 | ||||
53224 | Temporomandibular joint, open surgical exploration of, with condylectomy or condylotomy, with or without microsurgical techniques (Anaes. 17715 = 5B + 10T) (Assist.) | 752.85 | ||||
53225 | Arthrocentesis, irrigation of temporomandibular joint after insertion of 2 cannuli into the appropriate joint space(s) (Anaes. 17709 = 5B + 4T) (Assist.) | 226.15 | ||||
53226 | Temporomandibular joint, synovectomy of, not being a service to which another item in this group applies (Anaes. 17709 = 4B + 5T) (Assist.) | 243.10 | ||||
53227 | Temporomandibular joint, open surgical exploration of, with or without meniscus or capsular surgery, including meniscectomy when performed, with or without microsurgical techniques (Anaes. 17717 = 5B + 12T) (Assist.) | 925.05 | ||||
53230 | Temporomandibular joint, open surgical exploration of, with meniscus, capsular and condylar head surgery, with or without microsurgical techniques (Anaes. 17721 = 5B + 16T) (Assist.) | 1 042.10 | ||||
53233 | Temporomandibular joint, surgery of, involving procedures to which items 53224, 53226, 53227 and 53230 apply and also involving the use of tissue flaps, or cartilage graft, or allograft implants, with or without microsurgical techniques (Anaes. 17725 = 5B + 20T) (Assist.) | 1 170.90 | ||||
53236 | Temporomandibular joint, stabilisation of, involving 1 or more of: repair of capsule, repair of ligament or internal fixation, not being a service to which another item in this group applies (Anaes. 17707 = 4B + 3T) (Assist.) | 366.45 | ||||
53239 | Temporomandibular joint, arthrodesis of, not being a service to which another item in this group applies (Anaes. 17710 = 4B + 6T) (Assist.) | 366.45 | ||||
53242 | Temporomandibular joint or joints, application of external fixator to, other than for treatment of fractures (Anaes. 17709 = 4B + 5T) (Assist.) | 243.10 | ||||
53400 | Maxilla, unilateral or bilateral, treatment of fracture of, not requiring splinting | 100.60 | ||||
53403 | Mandible, treatment of fracture of, not requiring splinting | 122.90 | ||||
53406 | Maxilla, treatment of fracture of, requiring splinting, wiring of teeth, circumosseous fixation or external fixation (Anaes. 17714 = 5B + 9T) (Assist.) | 316.60 | ||||
53409 | Mandible, treatment of fracture of, requiring splinting, wiring of teeth, circumosseous fixation or external fixation (Anaes. 17714 = 5B + 9T) (Assist.) | 316.60 | ||||
53410 | Zygomatic bone, treatment of fracture of, not requiring surgical reduction | 66.70 | ||||
53411 | Zygomatic bone, treatment of fracture of, requiring surgical reduction, by temporal, intra-oral or other approach (Anaes. 17707 = 5B + 2T) | 185.95 | ||||
53412 | Zygomatic bone, treatment of fracture of, requiring surgical reduction and involving internal or external fixation at 1 site (Anaes. 17709 = 5B + 4T) (Assist.) | 305.25 | ||||
53413 | Zygomatic bone, treatment of fracture of, requiring surgical reduction and involving internal or external fixation or both at 2 sites (Anaes. 17710 = 5B + 5T) (Assist.) | 373.05 | ||||
53414 | Zygomatic bone, treatment of, requiring surgical reduction and involving internal or external fixation or both at 3 sites (Anaes. 17711 = 5B + 6T) (Assist.) | 429.60 | ||||
53415 | Maxilla, treatment of fracture of, requiring open reduction (Anaes. 17709 = 5B + 4T) (Assist.) | 339.20 | ||||
53416 | Mandible, treatment of fracture of, requiring open reduction (Anaes. 17709 = 5B + 4T) (Assist.) | 339.20 | ||||
53418 | Maxilla, treatment of fracture of, requiring open reduction and internal fixation not involving plate(s) (Anaes. 17711 = 5B + 6T) (Assist.) | 440.90 | ||||
53419 | Mandible, treatment of fracture of, requiring open reduction and internal fixation not involving plate(s) (Anaes. 17711 = 5B + 6T) (Assist.) | 440.90 | ||||
53422 | Maxilla, treatment of fracture of, requiring open reduction and internal fixation involving plate(s) (Anaes. 17712 = 5B + 7T) (Assist.) | 559.60 | ||||
53423 | Mandible, treatment of fracture of, requiring open reduction and internal fixation involving plate(s) (Anaes. 17712 = 5B + 7T) (Assist.) | 559.60 | ||||
53424 | Maxilla, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction not involving plate(s) (Anaes. 17712 = 5B + 7T) (Assist.) | 480.10 | ||||
53425 | Mandible, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction not involving plate(s) (Anaes. 17712 = 5B + 7T) (Assist.) | 480.10 | ||||
53427 | Maxilla, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction involving the use of plate(s) (Anaes. 17714 = 5B + 9T) (Assist.) | 655.75 | ||||
53429 | Mandible, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction involving the use of plate(s) (Anaes. 17714 = 5B + 9T) (Assist.) | 655.75 | ||||
53439 | Mandible, treatment of a closed fracture of, involving a joint surface (Anaes. 17707 = 5B + 2T) | 185.95 | ||||
53453 | Orbital cavity, reconstruction of a wall or floor with or without foreign implant (Anaes. 17713 = 5B + 8T) (Assist.) | 376.25 | ||||
53455 | Orbital cavity, bone or cartilage graft to orbital wall or floor including reduction of prolapsed or entrapped orbital contents (Anaes. 17715 = 5B + 10T) (Assist.) | 441.95 | ||||
53458 | Nasal bones, treatment of fracture of, not being a service to which item 53459 or 53460 applies | 33.45 | ||||
53459 | Nasal bones, treatment of fracture of, by reduction (Anaes. 17707 = 5B + 2T) | 183.30 | ||||
53460 | Nasal bones, treatment of fractures of, by open reduction involving osteotomies (Anaes. 17710 = 5B + 5T) (Assist.) | 373.90 | ||||
53600 | Skin sensitivity testing for allergens to anaesthetics and materials used in oral and maxillofacial surgery, using 1 to 20 allergens | 30.30 | ||||
53700 | Trigeminal nerve, primary division of, injection of an anaesthetic agent | 97.20 | ||||
53702 | Trigeminal nerve, peripheral branch of, injection of an anaesthetic agent | 48.65 | ||||
53704 | Facial nerve, injection of an anaesthetic agent | 29.30 | ||||
53706 | Nerve branch in the oral and maxillofacial region, destruction by a neurolytic agent, not being a service to which any other item in this group applies | 97.20 | ||||
75001 | Initial professional attendance in a single course of treatment by an accredited orthodontist (AO) | 66.60 | ||||
75004 | Professional attendance by an accredited orthodontist subsequent to the first professional attendance by the orthodontist in a single course of treatment (AO) | 33.40 | ||||
75006 | Production of dental study models (not being a service associated with a service to which item 75004 applies) prior to provision of a service to which:
in a single course of treatment (AO) | 59.35 | ||||
75009 | Orthodontic radiography — orthopantomography (panoramic radiography), including any consultation on the same occasion (AOS) (AO) | 53.05 | ||||
75012 | Orthodontic radiography — anteroposterior cephalometric radiography with cephalometric tracings or lateral cephalometric radiography with cephalometric tracings including any consultation on the same occasion (AOS) (AO) | 84.05 | ||||
75015 | Orthodontic radiography — anteroposterior and lateral cephalometric radiography, with cephalometric tracings including any consultation on the same occasion (AOS) (AO) | 115.65 | ||||
75018 | Orthodontic radiography — anteroposterior and lateral cephalometric radiography, with cephalometric tracings and orthopantomography including any consultation on the same occasion (AOS) (AO) | 147.30 | ||||
75021 | Orthodontic radiography — hand-wrist studies (including growth prediction) including any consultation on the same occasion (AOS) | 180.65 | ||||
75023 | Intraoral radiography — single area, periapical or bitewing film (AOS) | 36.15 | ||||
75024 | Pre-surgical infant maxillary arch repositioning, including supply of appliances and all adjustments of appliances and supervision — where 1 appliance is used (AO) | 467.25 | ||||
75027 | Pre-surgical infant maxillary arch repositioning, including supply of appliances and all adjustments of appliances and supervision — where 2 appliances are used (AO) | 640.65 | ||||
75030 | Maxillary ach expansion not being a service associated with a service to which item 75039, 75042, 75045 or 75048 applies, including supply of appliances, all adjustments of the appliances, removal of the appliances and retention (AO) | 570.45 | ||||
75033 | Mixed dentition treatment — incisor alignment using fixed applicances in maxillary arch, including supply of appliances, all adjustments of appliances, removal of the appliances and retention (AO) | 934.95 | ||||
75034 | Mixed dentition treatment — incisor alignment with or without lateral arch expansion using a removable appliance in the maxillary arch, including supply of appliances, associated adjustments and retention (AO) | 475.90 | ||||
75036 | Mixed dentition treatment — lateral arch expansion and incisor alignment using fixed appliances in maxillary arch, including supply of appliances, all adjustments of appliances, removal of appliances and retention (AO) | 1 291.45 | ||||
75037 | Mixed dentition treatment — lateral arch expansion and incisor correction — 2 arch (maxillary and mandibular) using fixed appliances in both maxillary and mandibular arches, including supply of appliances, all adjustments of appliances, removal of appliances and retention (AO) | 1 626.55 | ||||
75039 | Permanent dentition treatment — single arch (mandibular or maxillary) treatment (correction and alignment) using fixed appliances, including supply of appliances — initial 3 months of active treatment (AO) | 432.25 | ||||
75042 | Permanent dentition treatment — single arch (mandibular or maxillary) treatment (correction and alignment) using fixed appliances, including supply of appliances — each 3 months of active treatment (including all adjustments and maintenance and removal of the appliances) after the first for a maximum of a further 33 months (AO) | 161.65 | ||||
75045 | Permanent dentition treatment — 2 arch (mandibular and maxillary) treatment (correction and alignment) using fixed appliances, including supply of appliances — initial 3 months of active treatment (AO) | 865.35 | ||||
75048 | Permanent dentition treatment — 2 arch (mandibular and maxillary) treatment (correction and alignment) using fixed appliances, including supply of appliances — each subsequent 3 months of active treatment (including all adjustments and maintenance, and removal of the appliances) after the first for a maximum of a further 33 months (AO) | 221.90 | ||||
75049 | Retention, fixed or removable, single arch (mandibular or maxillary) — supply of retainer and supervision of retention (AO) | 259.75 | ||||
75050 | Retention, fixed or removable, 2-arch (mandibular and maxillary) — supply of retainers and supervision of retention (AO) | 501.40 | ||||
75051 | Jaw growth guidance using removable or functional appliances, including supply of appliances and all adjustments to appliances (AO) | 769.75 | ||||
75150 | Initial professional attendance in a single course of treatment by an accredited oral and maxillofacial surgeon where the patient is referred to the surgeon by an accredited orthodontist (AOS) | 66.60 | ||||
75153 | Professional attendance by an accredited oral and maxillofacial surgeon subsequent to the first professional attendance by the surgeon in a single course of treatment where the patient is referred to the surgeon by an accredited orthodontist (AOS) | 33.40 | ||||
75156 | Production of dental study models (not being a service associated with a service to which item 75153 applies) prior to provision of a service:
in a single course of treatment (AOS) | 59.35 | ||||
75200 | Removal of tooth or tooth fragment (not being treatment to which item 75400, 75403, 75406, 75409, 75412 or 75415 applies), where the patient is referred by an accredited orthodontist (AD) | 42.75 | ||||
75203 | Removal of tooth or tooth fragment under general anaesthesia, where the patient is referred by an accredited orthodontist (AOS) | 64.15 | ||||
75206 | Removal of each additional tooth or tooth fragment at the same attendance at which a service to which item 75200 or 75203 applies is rendered (AOS) | 21.25 | ||||
75400 | Surgical removal of erupted tooth, where the patient is referred by an accredited orthodontist (AOS) | 128.30 | ||||
75403 | Surgical removal of tooth with soft tissue impaction, where the patient is referred by an accredited orthodontist (AOS) | 147.30 | ||||
75406 | Surgical removal of tooth with partial bone impaction, where the patient is referred by an accredited orthodontist (AOS) | 167.95 | ||||
75409 | Surgical removal of tooth with complete bone impaction, where the patient is referred by an accredited orthodontist (AOS) | 190.15 | ||||
75412 | Surgical removal of tooth fragment requiring incision of soft tissue only, where the patient is referred by an accredited orthodontist (AOS) | 106.20 | ||||
75415 | Surgical removal of tooth fragment requiring removal of bone, where the patient is referred by an accredited orthodontist (AOS) | 128.30 | ||||
75600 | Surgical exposure, stimulation and packing of unerupted tooth, where the patient is referred by an accredited orthodontist (AOS) | 180.65 | ||||
75603 | Surgical exposure of unerupted tooth for the purpose of fitting a traction device, where the patient is referred by an accredited orthodontist (AOS) | 212.30 | ||||
75606 | Surgical repositioning of unerupted tooth, where the patient is referred by an accredited orthodontist (AOS) | 212.30 | ||||
75609 | Transplantation of tooth bud, where the patient is referred by an accredited orthodontist (AOS) | 317.00 | ||||
75612 | Surgical procedure for intra oral implantation of osseointegrated fixture (first stage) (AOS) | 392.30 | ||||
75615 | Surgical procedure for fixation of trans-mucosal abutment (second stage of osseointegrated implant) (AOS) | 145.20 | ||||
75618 | Provision and fitting of a bite rising appliance or dental splint for the management of temporomandibular joint dysfunction syndrome (AOS) | 180.30 | ||||
75621 | The provision and fitting of surgical template in conjuction with orthognathic surgical procedures in association with: (a) an item in the series 52342 to 52375; or (b) item 52380 or 52382 (AOS) | 180.30 | ||||
75800 | Attendance comprising consultation, preventive treatment and prophylaxis, of not less than 30 minutes duration — each attendance to a maximum of 3 attendances in any period of 12 months (AD) | 64.15 | ||||
75803 | Provision and fitting of acrylic base partial denture, including retainers — 1 tooth (AD) | 256.75 | ||||
75806 | Provision and fitting of acrylic base partial denture, including retainers — 2 teeth (AD) | 301.10 | ||||
75809 | Provision and fitting of acrylic base partial denture, including retainers — 3 teeth (AD) | 356.55 | ||||
75812 | Provision and fitting of acrylic base partial denture, including retainers — 4 teeth (AD) | 396.15 | ||||
75815 | Provision and fitting of acrylic base partial denture, including retainers — 5 to 9 teeth (AD) | 483.30 | ||||
75818 | Provision and fitting of acrylic base partial denture, including retainers — 10 to 12 teeth (AD) | 570.45 | ||||
75821 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 1 tooth (AD) | 459.50 | ||||
75824 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 2 teeth (AD) | 530.85 | ||||
75827 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 3 teeth (AD) | 610.10 | ||||
75830 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 4 teeth (AD) | 673.50 | ||||
75833 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 5 to 9 teeth (AD) | 823.95 | ||||
75836 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 10 to 12 teeth (AD) | 942.80 | ||||
75839 | Provision and fitting of retainers (not being treatment associated with treatment to which item 75803, 75806, 75809, 75812, 75815, 75818, 75821, 75824, 75827, 75830, 75833 or 75836 applies) — each retainer (AD) | 21.25 | ||||
75842 | Adjustment of partial denture (not being treatment associated with treatment to which item 75803, 75806, 75809, 75812, 75815, 75818, 75821, 75824, 75827, 75830, 75833 or 75836 applies) (AD) | 31.70 | ||||
75845 | Relining of partial denture by laboratory process and associated fitting (AD) | 158.50 | ||||
75848 | Remodelling and fitting of partial denture of more than 4 teeth (AD) | 190.15 | ||||
75851 | Repair to cast metal base of partial denture — 1 or more points (AD) | 95.10 | ||||
75854 | Addition of a tooth or teeth to a partial denture to replace extracted tooth or teeth, including taking of necessary impression (AD) | 95.10 | ||||
The
2000 No. 292 | 1 Nov 2000 | 1 Nov 2000 | |
2000 No. 356 | 20 Dec 2000 | 1 Jan 2001 | — |
2001 No. 79 | 27 Apr 2001 | 1 May 2001 | — |
am. = amended rep. = repealed rs. = repealed and substituted | |
Schedule 1 ............................ | am. 2000 No. 356; 2001 No. 79 |
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