Health Insurance (General Medical Services Table) Regulations 2008 (Cth)

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Health Insurance (General Medical Services Table) Regulations 2008

Select Legislative Instrument 2008 No. 211 as amended

made under the

Health Insurance Act 1973

This compilation was prepared on 11 February 2010

taking into account amendments up to SLI 2010 No. 5

Prepared by the Office of Legislative Drafting and Publishing,

Attorney‑General’s Department, Canberra

Contents

1Name of Regulations [see Note 1]

These Regulations are the Health Insurance (General Medical Services Table) Regulations 2008.

2Commencement

These Regulations commence on 1 November 2008.

3Repeal

The Health Insurance(General Medical Services Table) Regulations 2007 are repealed.

4Definitions

In these Regulations:

Act means the Health Insurance Act 1973.

this table means the table of general medical services set out in Schedule 1.

5General medical services table

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.

Schedule 1Table of general medical services

(regulation 5)

Part1Prescription of table1Prescription of table

For section 4 of the Act, these Regulations prescribe a table of general medical services that sets out:

  1. (a)

    in Part 2 — rules for interpretation of the table; and

  2. (b)

    in Part 3:

    1. (i)

      items of general medical services; and

    2. (ii)

      the amount of fees applicable for each item; and

  3. (c)

    in Part 4 — additional supporting information.

Part2Rules for interpretation2Application of table

An item in Part 3 does not apply to a service provided in contravention of a law of the Commonwealth or of a State or Territory.

3General
  1. (1)

    In this table, unless the contrary intention appears:

    2004 General Medical Services Table (or 2004 GMST) means the table prescribed for subsection 4 (1) of the Act by

    the Health Insurance (General Medical Services Table) Regulations 2004 as in force immediately before 1 November 2005.

    ACRRM means the Australian College of Rural and Remote Medicine.

    after‑hours period means any of the following:

    1. (a)

      a public holiday;

    2. (b)

      a Sunday;

    3. (c)

      before 8 am, or after 1 pm, on a Saturday;

    4. (d)

      before 8 am, or after 8 pm, on any day other than a Saturday, Sunday or public holiday.

    attendance of a minor nature or minor attendance, for an attendance on a patient by a consultant physician, means an attendance that:

    1. (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

    2. (b)

      does not result in a substantial alteration to the treatment of the patient.

    closed reduction means treatment of a dislocation or fracture by non‑operative reduction, including the use of percutaneous fixation, or external splintage by cast or splints.

    comprehensive hyperbaric medicine facilitymeans a separate hospital area that, on a 24‑hour basis:

    1. (a)

      is equipped and staffed so that it is capable of providing to a patient:

      1. (i)

        hyperbaric oxygen therapy at a treatment pressure of at least 2.8 atmospheric pressure absolute (180 kilopascal gauge pressure); and

      2. (ii)

        mechanical ventilation and invasive cardiovascular monitoring within a monoplace or multiplace chamber for the duration of the hyperbaric treatment; and

    2. (b)

      is under the direction of at least 1 practitioner who is rostered, and immediately available, to the facility during normal working hours and who:

      1. (i)

        is a specialist with training in diving and hyperbaric medicine; or

      2. (ii)

        holds a Diploma of Diving and Hyperbaric Medicine of the South Pacific Underwater Medicine Society; and

    3. (c)

      is staffed by:

      1. (i)

        at least 1 medical practitioner with training in diving and hyperbaric medicine who is present in the facility and immediately available at all times when patients are being treated at the facility; and

      2. (ii)

        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

    4. (d)

      has admission and discharge policies in operation.

    general intensive care unit means a separate hospital area that:

    1. (a)

      is equipped and staffed so that it is capable of providing to a patient:

      1. (i)

        mechanical ventilation for a period of several days; and

      2. (ii)

        invasive cardiovascular monitoring; and

    2. (b)

      is supported by:

      1. (i)

        during normal working hours — at least 1 specialist, or consultant physician, in the specialty of intensive care, who is immediately available, and exclusively rostered, to that area; and

      2. (ii)

        at all times — at least 1 registered medical practitioner who is present in the hospital and immediately available to that area; and

      3. (iii)

        at least 18 hours each day — at least 1 registered nurse; and

    3. (c)

      has admission and discharge policies in operation.

    general practitioner means:

    1. (a)

      a practitioner who is vocationally registered under section 3F of the Act; or

    2. (b)

      a practitioner who:

      1. (i)

        is a Fellow of the RACGP; and

      2. (ii)

        participates in the quality assurance and continuing medical education program of the RACGP; and

      3. (iii)

        meets the RACGP requirements for quality assurance and continuing education; or

    3. (c)

      a practitioner in relation to whom a determination is in force under regulation 6DA of the Health Insurance Regulations 1975 recognising that he or she meets the fellowship standards of the ACRRM; or

    4. (d)

      a practitioner who is undertaking a placement in general practice that is approved by the RACGP:

      1. (i)

        as part of a training program for general practice leading to the award of Fellowship of the RACGP; or

      2. (ii)

        as part of another training program recognised by the RACGP as being of an equivalent standard; or

      3. (iii)

        as part of the Rural and Remote Area Placement Program administered by the Australian College of Rural and Remote Medicine; or

    5. (e)

      an eligible non‑vocationally recognised medical practitioner; or

    6. (f)

      a practitioner who is undertaking a placement in general practice as part of the Pre‑vocational General Practice Placements Program administered by the ACRRM, RACGP or GPET; or

    7. (g)

      a practitioner who is undertaking a placement in general practice as part of the Remote Vocational Training Scheme administered by Remote Vocational Training Scheme Limited.

    GPET means the body registered under the Corporations Act 2001 as General Practice Education and Training Limited (ACN 095 433 140).

    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:

    1. (a)

      disadvantaged children; or

    2. (b)

      juvenile offenders; or

    3. (c)

      aged persons; or

    4. (d)

      chronically ill psychiatric patients; or

    5. (e)

      homeless persons; or

    6. (f)

      unemployed persons; or

    7. (g)

      persons suffering from alcoholism; or

    8. (h)

      persons addicted to drugs; or

    9. (i)

      physically or intellectually disabled persons.

    intensive care unit means a general intensive care unit or a neo‑natal intensive care unit.

    item means:

    1. (a)

      an item mentioned, by number, in column 1 of:

      1. (i)

        Part 3; or

      2. (ii)

        Part 3 of the diagnostic imaging services table; or

      3. (iii)

        Part 3 of the pathology services table; and

    2. (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.

    Note Because of the Health Insurance (Allied Health Services) Determination 2007, certain health services are treated as if there were an item relating to the service in this table, the diagnostic imaging services table or the pathology services table. A reference in this table to such an item is followed by an asterisk, with a note at the foot of the provision explaining what the asterisk means: see rule 55 for an example.

    neo‑natal intensive care unit means a separate hospital area that:

    1. (a)

      is equipped and staffed so that it is capable of providing to a patient who is a newly born child:

      1. (i)

        mechanical ventilation for a period of several days; and

      2. (ii)

        invasive cardiovascular monitoring; and

    2. (b)

      is supported by:

      1. (i)

        during normal working hours — at least 1 consultant physician in paediatric medicine who is immediately available, and exclusively rostered, to that area; and

      2. (ii)

        at all times — at least 1 registered medical practitioner who is present in the hospital and immediately available to that area; and

      3. (iii)

        at least 18 hours each day — at least 1 registered nurse; and

    3. (c)

      has admission and discharge policies in operation.

    open reduction means treatment of a dislocation or fracture by either:

    1. (a)

      operative exposure, including the use of any internal or external fixation; or

    2. (b)

      non‑operative (closed) reduction using intra‑medullary fixation or external fixation.

    patient’s usual medical practitioner means a medical practitioner:

    1. (a)

      who has provided the majority of services to the patient in the past 12 months; or

    2. (b)

      who is likely to provide the majority of services to the patient in the following 12 months; or

    3. (c)

      located at a medical practice that:

      1. (i)

        has provided the majority of services to the patient in the past 12 months; or

      2. (ii)

        is likely to provide the majority of services to the patient in the next 12 months.

    practice nurse means a registered or an enrolled nurse who is employed by, or whose services are otherwise retained by, a general practice or by a health service that has an exemption to claim medicare benefits under subsection 19 (2) of the Health Insurance Act 1973.

    RACGP means the Royal Australian College of General Practitioners.

    referring practitioner, for the referral of a patient, means:

    1. (a)

      for all referrals — a medical practitioner; and

    2. (b)

      for a referral made to a specialist who is an ophthalmologist — an optometrist; and

    3. (c)

      for a referral that arises out of a dental service provided by a dental practitioner and that is made to a specialist (but not a consultant physician) — a dental practitioner; and

    4. (d)

      for a referral that arises out of a dental service provided by a dental practitioner who is approved by the Minister for the purposes of paragraph (b) of the definition of professional service in subsection 3 (1) of the Act and that is made to a consultant physician — a dental practitioner.

    registered Aboriginal health worker means a person registered as an Aboriginal health worker under the Health Practitioners Act (NT) who is employed by, or whose services are otherwise retained by, a general practice or health service in the Northern Territory in relation to which the Minister has made a direction under subsection 19 (2) of the Act.

    residential aged care facility means a facility where residential care (within the meaning given by section 41‑3 of the Aged Care Act 1997) is provided.

    Rural, Remote and Metropolitan Areas Classification means the document so titled, as in force on 1 January 2001, setting out certain categories of areas in Australia that have been determined by the Department by reference to population size and remoteness of locality on the basis of 1991 census data published by the Australian Bureau of Statistics in 1994.

    transitional hours means between:

    1. (a)

      6 pm and 8 pm on any day other than a Saturday, Sunday or public holiday; and

    2. (b)

      12 pm and 1 pm on a Saturday.

    unsociable hours means between 11 pm and 7 am on any day.

  2. (2)

    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.

  3. (2A)

    A reference in an item in the table to the administration of a therapeutic substance, is a reference to the administration of a therapeutic substance that:

    1. (a)

      is goods within the meaning of the Therapeutic Goods Act 1989, and

    2. (b)

      is registered on the Australian Register of Therapeutic Goods established under section 9A of that Act; and

    3. (c)

      is administered in accordance with a clinical indication for which it has been registered.

  4. (3)

    A reference in the table to an eligible non‑vocationally recognised medical practitioner is a reference to:

    1. (a)

      a medical practitioner (including an overseas trained practitioner or a temporary resident medical practitioner) who:

      1. (i)

        is registered as a medical practitioner under the Rural Other Medical Practitioners’ Program; and

      2. (ii)

        is providing general medical services in accordance with that Program; or

    2. (b)

      a medical practitioner who:

      1. (i)

        is registered as a medical practitioner under the Outer Metropolitan (Other Medical Practitioners) Relocation Incentive Program; and

      2. (ii)

        is providing general medical services in accordance with that Program; and

      3. (iii)

        is not vocationally registered under section 3F of the Act, but is required under that Program to undertake additional training or other activities:

        1. (A)

          that could enable vocational registration within 4 years or, on written application, 5 years, after commencing the training or other activities; and

        2. (B)

          of which the Medicare Australia CEO has written notice; or

    3. (c)

      a medical practitioner who:

      1. (i)

        is registered as a medical practitioner under the MedicarePlus for Other Medical Practitioners Program; and

      2. (ii)

        is providing general medical services in accordance with that Program; and

      3. (iii)

        is not vocationally registered under section 3F of the Act; or

    4. (d)

      a medical practitioner who:

      1. (i)

        is registered as a medical practitioner under the After Hours Other Medical Practitioners Program; and

      2. (ii)

        is providing general medical services in accordance with that Program; and

      3. (iii)

        is not vocationally registered under section 3F of the Act.

  5. (4)

    For subrule (3):

    1. (a)

      the Rural Other Medical Practitioners’ Program is a program administered by the Medicare Australia CEO that, in relation to medical services provided in accordance with the Program, provides a particular level of medicare benefits; and

    2. (b)

      the Outer Metropolitan (Other Medical Practitioners) Relocation Incentive Program is a program administered by the Department that, in relation to medical services provided in accordance with the Program, provides a particular level of medicare benefits; and

    3. (c)

      the MedicarePlus for Other Medical Practitioners Program is a program administered by the Medicare Australia CEO that, in relation to medical services provided in accordance with the Program, provides a particular level of medicare benefits; and

    4. (d)

      the After Hours Other Medical Practitioners Programis a program administered by the Medicare Australia CEO that, in relation to medical services provided in accordance with the Program, provides a particular level of medicare benefits.

4Meaning of symbols (S) and (G)
  1. (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:

    1. (a)

      a service that:

      1. (i)

        is provided to a patient who has been referred to the specialist; and

      2. (ii)

        is the first service performed by the specialist in accordance with the referral; or

    2. (b)

      a service that:

      1. (i)

        is provided to a patient who has been referred to the specialist; and

      2. (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

      3. (iii)

        is provided within the period of validity of the referral that is applicable under regulation 31 of the Health Insurance Regulations 1975; or

    3. (c)

      a service that:

      1. (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

      2. (ii)

        is the first service performed by the specialist in accordance with the referral; or

    4. (d)

      a service that:

      1. (i)

        is provided to a patient who has not been referred to the specialist; and

      2. (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. (2)

    An item including the symbol (G) applies only to a service provided otherwise than by a specialist in accordance with subrule (1).

5Meaning of symbol (H)

An item including the symbol (H) applies only to a service performed or provided in a hospital.

5AGeneral practitioners to which Group A2 items apply
  1. (1)

    Subrule (2) applies to a general practitioner if:

    1. (a)

      the practitioner is the subject of a final determination under section 106TA of the Act; and

    2. (b)

      the determination contains a direction that the practitioner be disqualified in respect of a professional service, under subparagraph 106U (1) (g) (i) of the Act; and

    3. (c)

      the determination specifies the practitioner is disqualified in respect of a service described in an item in Group A1.

  2. (2)

    If, while the determination is in force, the general practitioner provides a service described in an item in Group A2, that item applies to the service in accordance with the determination.

6Meaning of a patient’s medical condition requires urgent treatment and responsible person in certain items
  1. (1)

    For items 1, 2, 97, 98, 448, 449, 601, 602, 603, 696, 697 and 698, a patient’s medical condition requires urgent treatment if:

    1. (a)

      medical opinion is to the effect that the patient’s medical condition requires treatment within the unbroken after‑hours period in, or before, which the attendance mentioned in the item was requested; and

    2. (b)

      treatment could not be delayed until the start of the next in‑hours period.

  2. (2)

    For subrule (1), medical opinion is to a particular effect if:

    1. (a)

      the attending practitioner is of that opinion; and

    2. (b)

      in the circumstances that existed and on the information available when the opinion was formed, that opinion would be acceptable to the general body of medical practitioners.

  3. (3)

    For items 1, 2, 97, 98, 448, 449, 601, 602, 603, 696, 697 and 698:

    responsible person, for a patient:

    1. (a)

      includes a spouse, parent, carer or guardian of the patient; and

    2. (b)

      does not include:

      1. (i)

        the attending medical practitioner; or

      2. (ii)

        an employee of the attending medical practitioner; or

      3. (iii)

        a person contracted by, or an employee or member of, the general practice of which the attending medical practitioner is a contractor, employee or member; or

      4. (iv)

        a call centre; or

      5. (v)

        a reception service.

7Application of items 2, 98, 448, 449, 602 and 698

Items 2, 98, 448, 449, 602 and 698 do not apply to a service provided by a medical practitioner:

  1. (a)

    who routinely provides services to patients in after‑hours periods at consulting rooms; or

  2. (b)

    who provides the service (as a contractor, employee, member or otherwise) for a general practice or clinic that routinely provides services to patients in after‑hours periods at consulting rooms.

8Meaning of single course of treatment in certain circumstances

(1) In subrules 3 (1), 4 (1) and 8 (1) and items 104, 105, 106, 107, 108, 109, 110, 116, 119, 122, 128, 131, 133, 385, 386, 387, 388, 2801, 2806, 2814, 2824, 2832, 2840, 3005, 3010, 3014, 3018, 3023, 3028, 6007, 6009, 6011, 6013 and 6015, single course of treatment, in relation to a patient, includes:

  1. (a)

    the initial attendance on the patient by a specialist or consultant physician; and

  2. (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

  3. (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 by the specialist or consultant physician.

(2)

For subrule (1), single course of treatment does not include treatment of an unrelated illness that requires referral of the patient to the specialist’s or consultant physician’s care.

(3)

For subrule (1), an attendance (the later attendance) on the patient by the specialist or consultant physician, after the end of the period of validity of the last referral to have application under regulation 31 of the Health Insurance Regulations 1975, initiates a new course of treatment if:

  1. (a)

    the referring practitioner considers the later attendance necessary for the patient’s condition to be reviewed; and

  2. (b)

    the patient was most recently attended by the specialist or consultant physician more than 9 months before the later attendance.

9Meaning of professional attendance in certain items

(1)In items 1 to 338, 348 to 388, 410 to 417, 501 to 536, 601, 602, 603, 696, 697, 698, 700 to 799, 900 to 903, 2501 to 2727, 2801 to 2840, 3005 to 3028, 5000 to 5267, 6007 to 6015, 10900 to 10929 and 17610 to 17680, professional attendance includes (but is not limited to) the provision, in relation to a patient, of any of the following services:

  1. (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;

  2. (b)

    the formulation of a plan for the management and, if applicable, for the treatment of the patient’s condition or conditions;

  3. (c)

    the provision of advice to the patient about the patient’s condition or conditions and, if applicable, about treatment;

  4. (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;

  5. (e)

    the recording of the clinical details of the service or services provided to the patient.

(2)

If:

  1. (a)

    in connection with a professional attendance mentioned in any of items 3 to 96 and 5000 to 5267, vaccine is supplied to a patient; and

  2. (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.

10Interpretation of items 104 to 147, 289 to 388, 2801 to 2840, 3005 to 3028, 6007 to 6015, 17640, 17645, 17650 and 17655

(1) In items 104 to 147, 289 to 388, 2801 to 2840, 3005 to 3028, 6007 to 6015, 17640, 17645, 17650 and 17655 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:

  1. (a)

    includes such an attendance on a patient who:

    1. (i)

      has declared that a written referral of the patient was completed by a medical practitioner; or

    2. (ii)

      in an emergency (within the meaning of subregulation 30 (5) of the Health Insurance Regulations 1975) has not been referred to the specialist, or consultant physician, if the specialist or consultant physician decides that it is necessary in the patient’s interests to provide the service mentioned in the item as soon as practicable without a referral; but

  2. (b)

    does not include such an attendance if:

    1. (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

    2. (ii)

      a later referral has not been made.

(2) For this rule, referral means referral by a referring practitioner.

11Meaning of amount under rule 11 in certain items

In this table:

amount under rule 11, for an item mentioned in the following table, means the sum of:

  1. (a)

    the fee mentioned in column 3 for the item; and

  2. (b)

    either:

    1. (i)

      if not more than 6 patients are attended at a single attendance — the amount mentioned in column 4 for the item, divided by the number of patients attended; or

    2. (ii)

      if more than 6 patients are attended at a single attendance — the amount mentioned in column 5 for the item.

Item

Items of this table

Fee

Amount if not more than 6 patients (to be divided by the number of patients)

Amount if more than 6 patients

1

4, 13, 19

The fee for item 3

$23.50

$1.75

2

20

The fee for item 3

$42.30

$3.05

3

24, 25, 33

The fee for item 23

$23.50

$1.75

4

35

The fee for item 23

$42.30

$3.05

5

37, 38, 40

The fee for item 36

$23.50

$1.75

6

43

The fee for item 36

$42.30

$3.05

7

47, 48, 50

The fee for item 44

$23.50

$1.75

8

51

The fee for item 44

$42.30

$3.05

9

58, 81, 87

$8.50

$15.50

$0.70

10

59, 83, 89, 2610, 2631, 2673

$16.00

$17.50

$0.70

11

60, 84, 90, 2613, 2633, 2675, 2707

$35.50

$15.50

$0.70

12

65, 86, 91, 2616, 2635, 2677, 2708

$57.50

$15.50

$0.70

13

92

$8.50

$27.95

$1.25

14

93

$16.00

$31.55

$1.25

15

95

$35.50

$27.95

$1.25

16

96

$57.50

$27.95

$1.25

17

195

The fee for item 193

$23.50

$1.75

18

414

The fee for item 410

$23.50

$1.75

19

415

The fee for item 411

$23.50

$1.75

20

416

The fee for item 412

$23.50

$1.75

21

417

The fee for item 413

$23.50

$1.75

22

716

The fee for item 714

$23.50

$1.75

23

5003, 5007

The fee for item 5000

$23.50

$1.75

24

5010

The fee for item 5000

$42.30

$3.05

25

5023, 5026

The fee for item 5020

$23.50

$1.75

26

5028

The fee for item 5020

$42.30

$3.05

27

5043, 5046

The fee for item 5040

$23.50

$1.75

28

5049

The fee for item 5040

$42.30

$3.05

29

5063, 5064

The fee for item 5060

$23.50

$1.75

30

5067

The fee for item 5060

$41.35

$3.00

31

5220, 5240

$18.50

$15.50

$0.70

32

5223, 5243

$26.00

$17.50

$0.70

33

5227, 5247

$45.50

$15.50

$0.70

34

5228, 5248

$67.50

$15.50

$0.70

35

5260

$18.50

$27.95

$1.25

36

5263

$26.00

$31.55

$1.25

37

5265

$45.50

$27.95

$1.25

38

5267

$67.50

$27.95

$1.25

12Personal 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 single medical practitioner on a single patient on a single occasion.

(2)

The items are items 1 to 164, 173 to 338, 348 to 698, 2497 to 10816, 2713, 6007 to 6015, 11012, 11015, 11018, 11021, 11212, 11304, 11500, 11600, 11627, 11701, 11712, 11724, 11921, 12000, 12003, 12201, 13030, 13100, 13103, 13104, 13106, 13109, 13110, 13112, 13209, 13290, 13292, 13300, 13303, 13306, 13309, 13312, 13318, 13319, 13400, 13500, 13503, 13506, 13700, 13815, 13818, 13830, 13839, 13842, 13847, 13848, 13851, 13854, 13857, 13870, 13873, 13876, 13881, 13882, 13885, 13888, 14100, 14106, 14109, 14112, 14115, 14118, 14124, 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 single medical practitioner.

(4)

Items 700 to 727, 900, 903, 2710 and 2712 apply only to a service provided in the course of personal attendance by a single medical practitioner on a single patient.

(5)

For this rule, each of the following is taken to be personal attendance by the medical practitioner on a patient:

  1. (a)

    an attendance by a medical practitioner on a patient by way of a telepsychiatry consultation to which any of items 353 to 361 applies;

  2. (b)

    an attendance by a medical practitioner on a patient in relation to the planning, management and supervision of the patient on home dialysis to which item 13104 applies.

13Personal attendance by certain medical practitioners
  1. (1)

    The items mentioned in subrule (3) apply only to a service provided in the course of a personal attendance by:

    1. (a)

      a medical practitioner (other than a medical practitioner employed by the proprietor of a hospital that is not a private hospital); or

    2. (b)

      a medical practitioner who:

      1. (i)

        is employed by the proprietor of a hospital that is not a private hospital; and

      2. (ii)

        provides the service otherwise than in the course of employment by that proprietor.

  2. (2)

    Paragraphs (1) (a) and (b) apply whether or not another person provides essential assistance to the medical practitioner in accordance with accepted medical practice.

  3. (3)

    The items are items 1 to 727, 900 to 10816, 2710, 2712, 2713, 6007 to 6015, 11012, 11015, 11018, 11021, 11212, 11304, 11500, 11600, 11627, 11701, 11712, 11722, 11724, 11820, 11823, 11921, 12000, 12003, 12201, 13030, 13100, 13103, 13104, 13106, 13109, 13110, 13112, 13209, 13290, 13292, 13300, 13303, 13306, 13309, 13312, 13318, 13319, 13400, 13500, 13503, 13506, 13700, 13815, 13818, 13830, 13839, 13842, 13847, 13848, 13851, 13854, 13857, 13870, 13873, 13876, 13881, 13882, 13885, 13888, 14100, 14106, 14109, 14112, 14115, 14118, 14124, 14200, 14203, 14206, 14209, 14212, 14215, 14224, 15600, 16003 to 16512, 16515 to 16573 and 16600 to 51318.

  4. (4)

    For this rule, each of the following is taken to be personal attendance by the medical practitioner on a patient:

    1. (a)

      an attendance by a medical practitioner on a patient by way of a telepsychiatry consultation to which any of items 353 to 361 applies;

    2. (b)

      an attendance by a medical practitioner on a patient in relation to the planning, management and supervision of the patient on home dialysis to which item 13104 applies.

14Meaning of qualified medical acupuncturist in items 193, 195, 197 and 199

For items 193, 195, 197 and 199, a person is a qualified medical acupuncturistif:

  1. (a)

    the person is a general practitioner; and

  2. (b)

    the Medicare Australia CEO has received a written notice from the Royal Australian College of General Practitioners stating that the person meets the skills requirements for providing services to which the items apply.

15Restriction of telepsychiatry consultations to rural and remote areas

Each of items 353 to 361 applies only to a consultation that is provided to a patient located in an R1, R2, R3, Rem1 or Rem2 area within the meaning of the Rural, Remote and Metropolitan Areas Classification.

16Consultant occupational physicians

A fee specified for an attendance by a consultant occupational physician applies only if the attendance relates to 1 or more of the following matters:

  1. (a)

    evaluation and assessment of a patient’s rehabilitation requirements when, in the consultant’s opinion, the patient has an accepted medical condition that:

    1. (i)

      may be affected by the patient’s working environment; or

    2. (ii)

      affects the patient’s capacity to be employed;

  2. (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;

  3. (c)

    evaluation and forming an opinion, including management as the case requires, of a patient’s medical condition when causation may be related to acute or chronic exposure to scientifically acknowledged environmental hazards or toxins.

17Public health physicians

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:

  1. (a)

    management of a patient’s vaccination requirements for immunisation programs;

  2. (b)

    prevention or management of sexually transmitted disease;

  3. (c)

    prevention or management of disease caused by scientifically accepted environmental hazards or toxins;

  4. (d)

    prevention or management of infection arising from an outbreak of an infectious disease;

  5. (e)

    prevention or management of an exotic disease.

Note An exotic disease is medically accepted as a disease that is of foreign origin.

18Meaning of recognised emergency department and problem focussed history in Group A21
  1. (1)

    In Group A21, recognised emergency department, of a private hospital, means a department of the hospital that is licensed, under a law of the State or Territory in which the hospital is located, to operate as an emergency department.

  2. (2)

    In items 501, 503 and 507, problem focussed history means a history focussing on the medical condition of the patient that necessitates the patient presenting for emergency attention.

19Prolonged attendances by emergency physicians

In items 519 to 536, an attendance for emergency evaluation of a critically ill patient with an immediately life threatening problem means an attendance that requires:

  1. (a)

    immediate and rapid assessment; and

  2. (b)

    initiation of resuscitation and electronic monitoring of vital signs; and

  3. (c)

    taking a comprehensive history and evaluation while undertaking resuscitative measures; and

  4. (d)

    ordering and evaluation of appropriate investigations; and

  5. (e)

    transitional evaluation and monitoring; and

  6. (f)

    formulation and documentation of a diagnosis and management plan in relation to 1 or more problems; and

  7. (g)

    initiation of appropriate treatment interventions; and

  8. (h)

    liaison with relevant health care professionals and discussion with, as appropriate, the patient or the patient’s relatives or agent.

19AApplication of items 135 and 289
  1. (1)

    A service described in item 135 applies only once to a patient and only if the patient has not received a service described in item 289.

  2. (2)

    A service described in item 289 applies only once to a patient and only if the patient has not received a service described in item 135.

20Application of items in Group A14 to certain patients only
  1. (1)

    Items 700, 702, 704 and 706 apply only to a service for a patient who:

    1. (a)

      is either:

      1. (i)

        at least 75 years old; or

      2. (ii)

        at least 55 years old and of Aboriginal or Torres Strait Islander descent; and

    2. (b)

      is not an in‑patient of a hospital or a care recipient in a residential aged care facility.

  2. (1A)

    Items 709 and 711 apply only to a service for a patient who:

    1. (a)

      is a child in Australia who is 4 years old; and

    2. (b)

      is receiving or has received the immunisation recommended for a 4 year old child by the National Immunisation Program Schedule (valid from 1 July 2007), a Department of Health and Ageing document.

  3. (1B)

    A service described in item 709 applies only once to a patient and only if the patient has not received a service described in item 711.

  4. (1C)

    A service described in item 711 applies only once to a patient and only if the patient has not received a service described in item 709.

  5. (2)

    Item 710 applies only to a service for a patient who is:

    1. (a)

      of Aboriginal or Torres Strait Islander descent; and

    2. (b)

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

    3. (c)

      not an in‑patient of a hospital or a care recipient in a residential aged care facility.

  6. (2A)

    Item 713 applies only to a service for a patient who:

    1. (a)

      is at least 40 years old and less than 50 years old; and

    2. (b)

      has a high risk of developing type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool; and

    3. (c)

      is not an in‑patient of a hospital.

  7. (2B)

    In subrule (2A) and item 713, Australian Type 2 Diabetes Risk Assessment Tool means the type 2 diabetes risk assessment developed by the International Diabetes Institute on behalf of the Council of Australian Governments’ ‘Reducing the risk of type 2 diabetes’ initiative.

  8. (3)

    Item 714 applies only to a service for a patient who:

    1. (a)

      has been a humanitarian visa holder for less than 12 months at the time of the service; or

    2. (b)

      first entered Australia less than 12 months before the service.

  9. (4)

    Item 716 applies only to a service in relation to a patient who:

    1. (a)

      is a person who:

      1. (i)

        has been a humanitarian visa holder for less than 12 months at the time of the service; or

      2. (ii)

        first entered Australia less than 12 months before the service; and

    2. (b)

      is not an in‑patient of a hospital or a care recipient in a residential aged care facility.

  10. (5)

    Items 718 and 719 apply only to a service for a patient who:

    1. (a)

      has an intellectual disability; and

    2. (b)

      is not an in‑patient of a hospital, or a care recipient in a residential aged care facility.

  11. (6)

    For items 704, 706, 708 and 710, a person is of Aboriginal or Torres Strait Islander descent if the person identifies himself or herself as being of that descent.

  12. (7)

    For items 718 and 719, a person has an intellectual disability if he or she:

    1. (a)

      has general intellectual functioning at 2 standard deviations below the average intelligence quotient; and

    2. (b)

      would benefit from assistance with daily living activities.

21Meaning of health assessment in items 700, 702, 704 and 706
  1. (1)

    For items 700, 702, 704 and 706, health assessment means the assessment of:

    1. (a)

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

    2. (b)

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

  2. (2)

    A health assessment involves all of the following:

    1. (a)

      a personal attendance by the medical practitioner;

    2. (b)

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

    3. (c)

      an assessment of the patient’s medication;

    4. (d)

      an assessment of the patient’s continence;

    5. (e)

      an assessment of the patient’s immunisation status for influenza, tetanus and pneumococcus;

    6. (f)

      an assessment of the patient’s physical functions, including the patient’s activities of daily living and whether or not the patient has had a fall in the last 3 months;

    7. (g)

      an assessment of the patient’s psychological function, including the patient’s cognition and mood;

    8. (h)

      an assessment of the patient’s social function, including:

      1. (i)

        the availability and adequacy of paid, and unpaid, help; and

      2. (ii)

        whether the patient is responsible for caring for another person.

  3. (3)

    A health assessment also includes:

    1. (a)

      keeping a record of the health assessment; and

    2. (b)

      offering the patient a written report about the health assessment, with recommendations about matters covered by the health assessment; and

    3. (c)

      offering the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees) a copy of the report or extracts of the report relevant to the carer.

22Meaning of child health check in item 708
  1. (1)

    For item 708, a child health check means the assessment of:

    1. (a)

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

    2. (b)

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

  2. (2)

    A child health check of a patient involves all of the following:

    1. (a)

      a personal attendance by a medical practitioner;

    2. (b)

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

      1. (i)

        mother’s pregnancy history;

      2. (ii)

        birth and neo‑natal history;

      3. (iii)

        breastfeeding history;

      4. (iv)

        weaning, food access and dietary history;

      5. (v)

        physical activity;

      6. (vi)

        previous presentations, hospital admissions and medication usage;

      7. (vii)

        relevant family medical history;

      8. (viii)

        immunisation status;

      9. (ix)

        vision and hearing (including neonatal hearing screening);

      10. (x)

        development (including achievement of age appropriate milestones);

      11. (xi)

        family relationships, social circumstances and whether the person is cared for by another person;

      12. (xii)

        exposure to environmental factors (including tobacco smoke);

      13. (xiii)

        environmental and living conditions;

      14. (xiv)

        educational progress;

      15. (xv)

        stressful life events;

      16. (xvi)

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

      17. (xvii)

        substance use;

      18. (xviii)

        sexual and reproductive health;

      19. (xix)

        dental hygiene (including access to dental services);

    3. (c)

      examination of the patient, including the following:

      1. (i)

        measurement of height and weight to calculate body mass index and position on the growth curve;

      2. (ii)

        newborn baby check (if not previously completed);

      3. (iii)

        vision (including red reflex in a newborn);

      4. (iv)

        ear examination (including otoscopy);

      5. (v)

        oral examination (including gums and dentition);

      6. (vi)

        trachoma check, if indicated;

      7. (vii)

        skin examination, if indicated;

      8. (viii)

        respiratory examination, if indicated;

      9. (ix)

        cardiac auscultation, if indicated;

      10. (x)

        development assessment, if indicated, to determine whether age appropriate milestones have been achieved;

      11. (xi)

        assessment of parent and child interaction, if indicated;

      12. (xii)

        other examinations:

        1. (A)

          in accordance with national or regional guidelines or specific regional needs; or

        2. (B)

          as indicated by a previous child health assessment;

    4. (d)

      undertaking or arranging any required investigation, considering the need for the following tests, in particular:

      1. (i)

        haemoglobin testing for those at a high risk of anaemia;

      2. (ii)

        audiometry, if required, especially for those of school age;

    5. (e)

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

    6. (f)

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

  3. (3)

    A child health check also includes:

    1. (a)

      keeping a record of the child health check; and

    2. (b)

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

22AMeaning of Healthy Kids Check in items 709 and 711
  1. (1)

    In this rule and items 709 and 711:

    Healthy Kids Check means the assessment of:

    1. (a)

      a patient’s physical health, general wellbeing and development; and

    2. (b)

      whether any medical intervention is required.

  2. (2)

    A Healthy Kids Check should generally be undertaken by a patient’s usual medical practitioner, but may also be undertaken by any medical practitioner (including a general practitioner) or by a practice nurse on behalf of a medical practitioner.

  3. (3)

    If a practice nurse who undertakes a Healthy Kids Check identifies any problems because of the Healthy Kids Check, the patient must be reviewed by the patient’s usual medical practitioner who will arrange referrals and follow‑up as required.

  1. (4)

    A Healthy Kids Check must include the following basic physical examinations and assessments:

    1. (a)

      height and weight (plot and interpret growth curve, and calculate BMI);

    2. (b)

      eyesight;

    3. (c)

      hearing;

    4. (d)

      oral health (teeth and gums);

    5. (e)

      toileting;

    6. (f)

      allergies.

  2. (5)

    A Healthy Kids Check must also include the following:

    1. (a)

      information collection, including taking a patient history and undertaking examinations and investigations as required;

    2. (b)

      making an overall assessment of the patient;

    3. (c)

      initiating interventions or referrals as appropriate;

    4. (d)

      providing health advice and information to the patient’s parent or carer, using a healthy habits for life guide, a publication of the Department of Health and Ageing, and other relevant information such as a parent‑held child health record.

  3. (6)

    The medical practitioner or practice nurse must:

    1. (a)

      note if a copy of a healthy habits for life guide has been provided by Medicare Australia to the patient; and

    2. (b)

      record evidence that the immunisation recommended for a 4 year old child has been given to the patient.

23Meaning of adult health check in item 710
  1. (1)

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

    1. (a)

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

    2. (b)

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

  2. (2)

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

    1. (a)

      a personal attendance by a medical practitioner;

    2. (b)

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

      1. (i)

        current health problems and risk factors;

      2. (ii)

        relevant family medical history;

      3. (iii)

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

      4. (iv)

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

      5. (v)

        sexual and reproductive health;

      6. (vi)

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

      7. (vii)

        hearing loss;

      8. (viii)

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

      9. (ix)

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

    3. (c)

      examination of the patient, including the following:

      1. (i)

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

      2. (ii)

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

      3. (iii)

        oral examination (including gums and dentition);

      4. (iv)

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

      5. (v)

        urinalysis (by dipstick) for proteinurea;

    4. (d)

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

      1. (i)

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

      2. (ii)

        pap smear;

      3. (iii)

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

      4. (iv)

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

    5. (e)

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

    6. (f)

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

  3. (3)

    An adult health check also includes:

    1. (a)

      keeping a record of the adult health check; and

    2. (b)

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

24Meaning of comprehensive medical assessment in item 712
  1. (1)

    For item 712, a comprehensive medical assessmentof a resident of a residential aged care facilityis a full systems review of the resident, including an assessment of the resident’s health and physical and psychological function.

  2. (2)

    A comprehensive medical assessment involves all of the following:

    1. (a)

      a personal attendance by a medical practitioner;

    2. (b)

      taking a detailed relevant medical history;

    3. (c)

      conducting a comprehensive medical examination of the resident;

    4. (d)

      developing a list of diagnoses and medical problems based on the medical history and examination;

    5. (e)

      providing, for the resident’s records, a written summary of the outcomes of the assessment to inform the provision of care for the resident and to assist in the provision of medication management review services for the resident.

  3. (3)

    A comprehensive medical assessment also includes:

    1. (a)

      making a written summary of the comprehensive medical assessment; and

    2. (b)

      providing a copy of the summary to the residential aged care facility; and

    3. (c)

      offering the resident a copy of the summary or relevant parts of the summary.

24AMeaning of type 2 diabetes risk evaluation in item 713
  1. (1)

    For item 713, a type 2 diabetes risk evaluation means:

    1. (a)

      a review of the risk factors underlying a patient’s high risk score as identified by the Australian Type 2 Diabetes Risk Assessment Tool; and

    2. (b)

      initiating interventions, if appropriate, to address risk factors or exclusion of diabetes.

  2. (2)

    For subrule (1), risk factors include the following:

    1. (a)

      lifestyle risk factors, such as smoking, physical inactivity and poor nutrition;

    2. (b)

      biomedical risk factors, such as high blood pressure, impaired glucose metabolism and excess weight;

    3. (c)

      a family history of a chronic disease.

  3. (3)

    The type 2 diabetes risk evaluation must include the following:

    1. (a)

      evaluating a patient’s high risk score, as determined by the Australian Type 2 Diabetes Risk Assessment Tool which has been completed by the patient within a period of 3 months prior to undertaking the type 2 diabetes risk evaluation;

    2. (b)

      updating the patient’s history and undertaking physical examinations and clinical investigations in accordance with relevant guidelines;

    3. (c)

      making an overall assessment of the patient’s risk factors and of the results of relevant examinations and investigations;

    4. (d)

      initiating interventions, if appropriate, including referrals and follow‑up relating to the management of any risk factors identified;

    5. (e)

      providing the patient with advice and information (such as the Lifescript resources produced by the Department of Health and Ageing), including strategies to achieve lifestyle and behaviour changes if appropriate.

  4. (4)

    The type 2 diabetes risk evaluation should generally be undertaken by the patient’s usual medical practitioner.

  5. (5)

    The medical practitioner providing the service mentioned in item 713 is responsible for the overall conduct of the type 2 diabetes risk evaluation provided to the patient.

  6. (6)

    Elements of the type 2 diabetes risk evaluation may be delegated by the medical practitioner providing the service mentioned in item 713 to a practice nurse, a registeredAboriginal health worker or other qualified health professional, in accordance with accepted medical practice and under the supervision of the medical practitioner.

25Meaning of health assessment in items 714 and 716
  1. (1)

    In items 714 and 716, health assessment means the assessment of:

    1. (a)

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

    2. (b)

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

  2. (2)

    A health assessment involves all of the following:

    1. (a)

      a personal attendance by a medical practitioner;

    2. (b)

      taking the patient’s medical history;

    3. (c)

      examination of the patient;

    4. (d)

      undertaking or arranging any required investigations;

    5. (e)

      assessing the patient using the information gained in paragraphs (b) to (d);

    6. (f)

      developing a management plan addressing the patient’s health care needs, health problems and relevant conditions;

    7. (g)

      making or arranging any necessary interventions and referrals.

  3. (3)

    A health assessment also includes:

    1. (a)

      keeping a record of the health assessment; and

    2. (b)

      offering the patient a written report about the health assessment.

26Meaning of humanitarian visa holder in items 714 and 716

In items 714 and 716:

humanitarian visa holder means a person who is the holder of a visa of any of the following subclasses granted under the Migration Act 1958:

  1. (a)

    Subclass 200 (Refugee) visa;

  2. (b)

    Subclass 201 (In‑country Special Humanitarian) visa;

  3. (c)

    Subclass 202 (Global Special Humanitarian) visa;

  4. (d)

    Subclass 203 (Emergency Rescue) visa;

  5. (e)

    Subclass 204 (Woman at Risk) visa;

  6. (f)

    Subclass 447 (Secondary Movement Offshore Entry (Temporary)) visa;

  7. (g)

    Subclass 451 (Secondary Movement Relocation (Temporary)) visa;

  8. (h)

    Subclass 785 (Temporary Protection) visa;

  9. (i)

    Subclass 786 (Temporary (Humanitarian Concern)) visa;

  10. (j)

    Subclass 866 (Protection) visa.

27Health checks of 45 – 49 year olds – item 717
  1. (1)

    For item 717, a patient is at risk of developing a chronic disease if, in the clinical judgement of the attending medical practitioner, based on the identification of a specific risk factor, the patient is at risk of developing a chronic disease.

  2. (2)

    For subrule (1), specific risk factors include (but are not limited to):

    1. (a)

      lifestyle risk factors, such as smoking, physical inactivity, poor nutrition or alcohol misuse; and

    2. (b)

      biomedical risk factors, such as high cholesterol, high blood pressure, impaired glucose metabolism or excess weight; and

    3. (c)

      family history of a chronic disease.

  3. (3)

    For subrule (1), a chronic disease is a disease that has been, or is likely to be, present for at least 6 months, including (but not limited to) asthma, cancer, cardiovascular illness, diabetes mellitus, a mental health condition, arthritis and a musculoskeletal condition.

  4. (4)

    The health check should generally be undertaken by the patient’s usual medical practitioner.

  5. (5)

    The health check must include the following components:

    1. (a)

      information collection, including taking a patient history and undertaking examinations and investigations as required;

    2. (b)

      making an overall assessment of the patient;

    3. (c)

      interventions as indicated;

    4. (d)

      providing advice and information to the patient.

  6. (6)

    Item 717 is applicable only once for the same patient.

  7. (7)

    The medical practitioner providing the service mentioned in item 717 is responsible for the overall health check of the patient.

  8. (8)

    Elements of the health check may be delegated by the medical practitioner to a practice nurse or other qualified health professional.

  9. (9)

    Item 717 is not applicable to a service provided to an admitted patient of a hospital.

    28Meaning of health assessment in items 718 and 719

  10. (1)

    In items 718 and 719:

    health assessment means the assessment of:

    1. (a)

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

    2. (b)

      whether any medical intervention and preventative health care is required.

  11. (2)

    For subrule (1), a health assessment must include the following matters to the extent they are relevant to the patient:

    1. (a)

      check dental health (including dentition);

    2. (b)

      conduct aural examination (arrange formal audiometry if audiometry has not been conducted within 5 years);

    3. (c)

      assess ocular health (arrange review by an ophthalmologist or optometrist if a comprehensive eye examination has not been conducted within 5 years);

    4. (d)

      assess nutritional status (including weight and height measurements) and a review of growth and development;

    5. (e)

      assess bowel and bladder function (particularly for incontinence or chronic constipation);

    6. (f)

      assess medications including:

      1. (i)

        non‑prescription medicines taken by the patient, prescriptions from other doctors, medications prescribed but not taken, interactions, side effects and review of indications; and

      2. (ii)

        advice to carers of the common side effects and interactions; and

      3. (iii)

        consideration of the need for a formal medication review;

    7. (g)

      check immunisation status (including influenza, tetanus, hepatitis A and B, measles, mumps and rubella and pneumococcal vaccinations) with reference to the current Australian Standard Vaccination Schedule (a National Health and Medical Research Council document) for appropriate vaccination schedules;

    8. (h)

      check exercise opportunities (with the aim of moderate exercise for at least 30 minutes per day);

    9. (i)

      check whether the support provided for activities of daily living adequately and appropriately meets the patient’s needs, and consider formal review if required;

    10. (j)

      consider the need for breast examination, mammography, Papanicolaou smears, testicular examination, lipid measurement and prostate assessment as for the general population;

    11. (k)

      check for dysphagia and gastro‑oesophageal disease (especially for patients with cerebral palsy) and arrange for investigation or treatment as required;

    12. (l)

      assess risk factors for osteoporosis (including diet, exercise, Vitamin D deficiency, hormonal status, family history, medication and fracture history) and arrange for investigation or treatment as required;

    13. (m)

      for a patient diagnosed with epilepsy — review of seizure control (including anticonvulsant drugs) and consider referral to a neurologist at appropriate intervals;

    14. (n)

      screen for thyroid disease at least every 2 years (or yearly for patients with Down syndrome);

    15. (o)

      for a patient without a definitive aetiological diagnosis — consider referral to a genetic clinic every 5 years;

    16. (p)

      assess or review of treatment for comorbid mental health issues;

    17. (q)

      consider timing of puberty and management of sexual development, sexual activity and reproductive health;

    18. (r)

      consider whether there are any signs of physical, psychological or sexual abuse.

  12. (3)

    For subrule (1), a health assessment also includes the following:

    1. (a)

      keeping a record of the health assessment;

    2. (b)

      offering the patient a written report about the health assessment;

    3. (c)

      offering the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees) a copy of the report or extracts of the report;

    4. (d)

      offering the relevant disability professionals (if the practitioner considers it appropriate and the patient or, if appropriate, the patient’s carer, agrees) a copy of the report or extracts of the report.

29Limitation on items 721, 723, 725, 727, 729 and 731
  1. (1)

    This rule applies to the performances of services for a patient for whom exceptional circumstances do not exist.

  2. (2)

    An item in this table mentioned in the following table applies in the circumstances mentioned for the item in the following table.

Item

Items of this table

Circumstances

1

721

  1. (a)

    in the 3 months before performance of the service, a service to which item 725, 727, 729 or 731 applies has not been performed for the patient;

  2. (b)

    not more than once in a 12 month period

2

723

  1. (a)

    in the 3 months before performance of the service, a service to which item 727 applies has not been performed for the patient;

  2. (b)

    not more than once in a 12 month period

3

725

  1. (a)

    in the 3 months before performance of the service, a service to which item 721 applies has not been performed for the patient;

  2. (b)

    not more than once in a 3 month period

4

727

  1. (a)

    in the 3 months before performance of the service, a service to which item 723 applies has not been performed for the patient;

  2. (b)

    not more than once in a 3 month period

5

729

  1. (a)

    either:

    1. (i)

      in the 3 months before performance of the service, a service to which item 725, 727 or 731 applies has not been performed for the patient; or

  1. (ii)

    in the 12 months before performance of the service, a service has not been performed for the patient:

    1. (A)

      by the medical practitioner who performs the service to which item 729 would, but for this item, apply; and

    2. (B)

      for which a payment has been made under item 721 or 723;

(b)

not more than once in a 3 month period

6

731

  1. (a)

    in the 3 months before performance of the service, a service to which item 721, 723, 725, 727 or 729 applies has not been performed for the patient;

  2. (b)

    not more than once in a 3 month period

  1. (3)

    For this rule, exceptional circumstances exist for a patient if there has been a significant change in the patient’s clinical condition or care circumstances that necessitates the performance of the service for the patient.

30Meaning of GP management plan
  1. (1)

    For item 721, preparation of a GP management plan means the preparation of a comprehensive written plan describing all of the following matters:

    1. (a)

      the patient’s health care needs, health problems and relevant conditions;

    2. (b)

      management goals with which the patient agrees;

    3. (c)

      actions to be taken by the patient;

    4. (d)

      treatment and services the patient is likely to need;

    5. (e)

      arrangements for providing the treatment and services mentioned in paragraph (d);

    6. (f)

      arrangements to review the plan by a day specified in the plan.

  2. (2)

    Preparation of the plan also includes:

    1. (a)

      explaining to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees) the steps involved in preparing the plan; and

    2. (b)

      recording the plan; and

    3. (c)

      recording the patient’s agreement to the preparation of the plan; and

    4. (d)

      offering a copy of the plan to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and

    5. (e)

      adding a copy of the plan to the patient’s medical records.

31Meaning of multidisciplinary discharge care plan

For items 725 and 727, a multidisciplinary discharge care plan is a multidisciplinary care plan that is prepared for a patient before the patient is discharged from a hospital.

32Meaning of team care arrangements
  1. (1)

    For item 723, co‑ordinating the development of team care arrangements means a process by which the medical practitioner:

    1. (a)

      in consultation with at least 2 collaborating providers, each of whom provides a different kind of treatment or service, and 1 of whom may be another medical practitioner, makes arrangements for the multidisciplinary care of the patient; and

    2. (b)

      prepares a document that describes all of the matters specified in subrule (2); and

    3. (c)

      undertakes all of the activities specified in subrule (3).

  2. (2)

    The matters to be described for paragraph (1) (b) are:

    1. (a)

      treatment and service goals for the patient; and

    2. (b)

      treatment and services that collaborating providers will provide to the patient; and

    3. (c)

      actions to be taken by the patient; and

    4. (d)

      arrangements to review the matters mentioned in paragraphs (a), (b) and (c) by a day specified in the document.

  3. (3)

    The activities to be undertaken for paragraph (1) (c) are:

    1. (a)

      explaining the steps involved in the development of the arrangements to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and

    2. (b)

      discussing with the patient the collaborating providers who will contribute to the development of the team care arrangements, and provide treatment and services to the patient under those arrangements; and

    3. (c)

      recording the patient’s agreement to the development of team care arrangements; and

    4. (d)

      giving copies of the relevant parts of the document to the collaborating providers; and

    5. (e)

      offering a copy of the document to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and

    6. (f)

      adding a copy of the document to the patient’s medical records.

  4. (4)

    In this rule:

    collaborating provider is a person who:

    1. (a)

      provides treatment or a service to a patient; and

    2. (b)

      is not a family carer of the patient.

    family carer includes a person who:

    1. (a)

      is a relative or friend of the patient; and

    2. (b)

      is providing care to the patient other than as a paid service.

33Meaning of associated medical practitioner
  1. (1)

    For items 725 and 727, an associated medical practitioner is a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) who, if not engaged in the same general practice as the medical practitioner mentioned in that item, performs the service mentioned in the item at the request of the patient (or the patient’s guardian).

  2. (2)

    In subrule (1):

    general practice means a business, consisting of 1 or more medical practitioners, that provides a general practice of medical services.

34Meaning of review of plans
  1. (1)

    For item 725, review of a GP management plan, a multidisciplinary community care plan, or a multidisciplinary discharge care plan, means a process by which the medical practitioner:

    1. (a)

      reviews the matters mentioned in subrule 49 (1) of the 2004 General Medical Services Table or subrule 59 (1), as applicable; and

    2. (b)

      if different arrangements need to be made, makes amendments to the plan that:

      1. (i)

        state those new arrangements; and

      2. (ii)

        provide for further review of the amended plan by a date specified in the plan.

  2. (2)

    Review of the plan also includes:

    1. (a)

      explaining to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees) the steps involved in the review; and

    2. (b)

      recording the patient’s agreement to the review of the plan; and

    3. (c)

      if amendments are made to the plan:

      1. (i)

        offering a copy of the amended plan to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and

      2. (ii)

        adding a copy of the amended plan to the patient’s medical records.

35Meaning of co‑ordinate a review of team care arrangements or of a multidisciplinary care plan
  1. (1)

    For item 727, to co‑ordinate a review of team care arrangements, a multidisciplinary community care plan, or a multidisciplinary discharge care plan, means a process by which the medical practitioner:

    1. (a)

      in consultation with at least 2 collaborating providers, each of whom provides a different kind of treatment or service, and 1 of whom may be another medical practitioner, reviews the matters mentioned in subrule 49 (1) of the 2004 General Medical Services Table or subrule 32 (2), as applicable; and

    2. (b)

      if different arrangements need to be made, makes amendments to the document mentioned in paragraph 32 (1) (b), or to the plan, that:

      1. (i)

        state those new arrangements; and

      2. (ii)

        provide for the review of the amended document or plan by a date specified in the document or plan.

  2. (2)

    Co‑ordinating a review of team care arrangements or of a multidisciplinary care plan also includes:

    1. (a)

      explaining the steps involved in the review to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and

    2. (b)

      recording the patient’s agreement to the review of the team care arrangements or the plan; and

    3. (c)

      giving copies of the relevant parts of the amended document mentioned in paragraph (1) (b), or the amended plan, to the collaborating providers; and

    4. (d)

      offering a copy of the amended document or plan to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and

    5. (e)

      adding a copy of the amended document or plan to the patient’s medical records.

  3. (3)

    In this rule:

    collaborating provider is a person who:

    1. (a)

      provides treatment or a service to a patient; and

    2. (b)

      is not a family carer of the patient.

    family carer includes a person who:

    1. (a)

      is a relative or friend of the patient; and

    2. (b)

      is providing care to the patient other than as a paid service.

36Meaning of contribute to a multidisciplinary care plan for items 729 and 731
  1. (1)

    For items 729 and 731, to contribute to a multidisciplinary care plan or to the review of a plan includes:

    1. (a)

      preparing part of the plan or amendments to the plan, and adding a copy of that part or those amendments to the patient’s medical records; or

    2. (b)

      giving advice to a person who prepares or reviews the plan, and recording in writing, on the patient’s medical records, any advice provided to such a person.

  2. (2)

    In items 729 and 731 and subrule (1):

    multidisciplinary care plan means a written plan that:

    1. (a)

      is prepared for a patient by:

      1. (i)

        a medical practitioner, in consultation with 2 other collaborating providers, each of whom provides a different kind of treatment or service to the patient, and 1 of whom may be another medical practitioner; or

      2. (ii)

        a collaborating provider (other than a medical practitioner), in consultation with at least 2 other collaborating providers, each of whom provides a different kind of treatment or service to the patient; and

    2. (b)

      describes, at least, treatment and services to be provided to the patient by the collaborating providers.

  3. (3)

    In this rule:

    collaborating provider:

    1. (a)

      is a person who:

      1. (i)

        provides treatment or a service to a patient; and

      2. (ii)

        is not a family carer of the patient; and

    2. (b)

      includes a medical practitioner.

    family carer includes a person who:

    1. (a)

      is a relative or friend of the patient; and

    2. (b)

      is providing care to the patient other than as a paid service.

37Service by certain medical practitioners – items 729 to 866
  1. (1)

    Items 729 to 866 apply only to a service provided by:

    1. (a)

      a medical practitioner (other than a medical practitioner employed by the proprietor of a hospital that is not a private hospital); or

    2. (b)

      a medical practitioner who:

      1. (i)

        is employed by the proprietor of a hospital that is not a private hospital; and

      2. (ii)

        provides the service otherwise than in the course of employment by that proprietor.

  2. (2)

    Paragraph (1) (b) applies whether or not another person provides essential assistance to the medical practitioner in accordance with accepted medical practice.

38Application of items in Group A15 to certain patients only
  1. (1)

    An item in this table mentioned in the following table applies only to a service for a patient who:

    1. (a)

      suffers from at least 1 medical condition that:

      1. (i)

        has been (or is likely to be) present for at least 6 months; or

      2. (ii)

        is terminal; and

    2. (b)

      is described in column 3 of the following table.

Item

Items in this table

Description of patient

1

740, 742, 744, 759, 762, 765

The patient is not an in‑patient of a hospital or a care recipient in a residential aged care facility

2

721, 725

The patient:

  1. (a)

    is not an in‑patient of a hospital or a care recipient in a residential aged care facility; or

  2. (b)

    is an in‑patient and a private patient of a hospital

3

746, 749, 757, 768, 771, 773

The patient:

  1. (a)

    is an in‑patient of a hospital; and

  2. (b)

    is not a care recipient in a residential aged care facility

4

723, 727

The patient:

  1. (a)

    requires ongoing care from at least 3 collaborating providers, each of whom provides a different kind of treatment or service to the patient, and at least 1 of whom is a medical practitioner; and

  2. (b)

    either:

    1. (i)

      is not an in‑patient of a hospital or a care recipient in a residential aged care facility; or

    2. (ii)

      being an in‑patient and a private patient of a hospital

5

729

The patient:

  1. (a)

    requires ongoing care from at least 3 collaborating providers, each of whom provides a different kind of treatment or service to the patient, and at least 1 of whom is a medical practitioner; and

  2. (b)

    is not a care recipient in a residential aged care facility

6

734, 736, 738, 775, 778, 779

The patient:

  1. (a)

    is a care recipient in a residential aged care facility; and

  2. (b)

    is not an in‑patient of a hospital

7

731

The patient:

  1. (a)

    requires ongoing care from at least 3 collaborating providers, each of whom provides a different kind of treatment or service to the patient, and at least 1 of whom is a medical practitioner; and

  2. (b)

    is a care recipient in a residential aged care facility

  1. (2)

    In this rule:

    collaborating provider is a person who:

    1. (a)

      provides treatment or a service to a patient; and

    2. (b)

      is not a family carer of the patient.

    family carer includes a person who:

    1. (a)

      is a relative or friend of the patient; and

    2. (b)

      is providing care to the patient other than as a paid service.

39Meaning of multidisciplinary case conference

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 42) carries out all of the following activities:

  1. (a)

    discussing a patient’s history;

  2. (b)

    identifying the patient’s multidisciplinary care needs;

  3. (c)

    identifying outcomes to be achieved by members of the case conference team giving care and service to the patient;

  4. (d)

    identifying tasks that need to be undertaken to achieve these outcomes, and allocating those tasks to members of the case conference team;

  5. (e)

    assessing whether previously identified outcomes (if any) have been achieved.

40Meaning 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.

41Meaning of multidisciplinary 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.

42Meaning of multidisciplinary case conference team
  1. (1)

    For this table, a multidisciplinary case conference team:

    1. (a)

      includes a medical practitioner; and

    2. (b)

      includes at least 2 other members, each of whom provides a different kind of care or service to the patient and is not a family carer of the patient, and 1 of whom may be another medical practitioner; and

    3. (c)

      may additionally include a family carer of the patient.

    Example

    Examples of persons who, for paragraph (b), may be included in a team are:

    (a) allied health professionals such as:

    · Aboriginal health care workers

    · asthma educators

    · audiologists

    · dental therapists

    · dentists

    · diabetes educators

    · dieticians

    · mental health workers

    · occupational therapists

    · optometrists

    · orthoptists

    · orthotists or prosthetists

    · pharmacists

    · physiotherapists

    · podiatrists

    · psychologists

    · registered nurses

    · social workers

    · speech pathologists; and

    (b) home and community service providers, or care organisers, such as:

    · education providers

    · ‘meals on wheels’ providers

    · personal care workers

    · probation officers.

  2. (2)

    In subrule (1):

    family carer includes a person who:

    1. (a)

      is a relative or friend of the patient; and

    2. (b)

      is providing care to the patient other than as a paid service.

43Meaning of organise and co‑ordinate in a multidisciplinary case conference and participation in a multidisciplinary case conference
  1. (1)

    For items 734, 736, 738, 740, 742, 744, 746, 749 and 757, organise and co‑ordinate a multidisciplinary case conference means undertaking all of the following activities in relation to a case conference:

    1. (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;

    2. (b)

      recording the patient’s agreement to the conference;

    3. (c)

      recording the day on which the conference was held, and the times at which the conference started and ended;

    4. (d)

      recording the names of the participants;

    5. (e)

      recording the matters mentioned in rule 39, and putting a copy of that record in the patient’s medical records;

    6. (f)

      offering the patient and the patient’s carer (if any and if the practitioner considers appropriate and the patient agrees), and giving each other member of the team, a summary of the conference;

    7. (g)

      discussing the outcomes of the conference with the patient and the patient’s carer (if any and if the practitioner considers appropriate and the patient agrees).

  2. (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 involves undertaking all of the following activities in relation to a case conference:

    1. (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;

    2. (b)

      recording the patient’s agreement to the practitioner’s participation;

    3. (c)

      recording the day on which the conference was held, and the times at which the conference started and ended;

    4. (d)

      recording the names of the participants;

    5. (e)

      recording the matters mentioned in rule 39, and putting a copy of that record in the patient’s medical records.

  3. (3)

    Participation in a multidisciplinary case conference does not include organising and co‑ordinating a multidisciplinary case conference.

44Meaning of co‑ordinate in item 880

For item 880, co‑ordinating a case conference means undertaking all of the following activities in relation to a case conference:

  1. (a)

    co‑ordinating and facilitating the case conference;

  2. (b)

    resolving any disagreement or conflict to enable the members of the case conference team giving care and service to the patient to agree on the outcomes to be achieved;

  3. (c)

    identifying tasks that need to be undertaken to achieve these outcomes, and allocating those tasks to members of the case conference team;

  4. (d)

    recording the input of each member and the outcome of the conference.

45Meaning of case conference team in item 880
  1. (1)

    For item 880, a case conference team:

    1. (a)

      includes a specialist, or consultant physician, in the practice of his or her specialty of geriatric or rehabilitation medicine; and

    2. (b)

      includes at least 2 other allied health professionals, each of whom provides a different kind of care or service to the patient and is not a medical practitioner or family carer of the patient; and

    3. (c)

      may include the patient, a family carer of the patient or a medical practitioner.

    Example

    Examples of persons who, for paragraph (b), may be included in a team are:

    · dieticians

    · mental health workers

    · occupational therapists

    · pharmacists

    · physiotherapists

    · podiatrists

    · psychologists

    · social workers

    · speech pathologists.

  2. (2)

    In subrule (1):

    family carer includes a person who:

    1. (a)

      is a relative or friend of the patient; and

    2. (b)

      is providing care to the patient other than as a paid service.

46Application of item 880
  1. (1)

    Item 880 applies only if:

    1. (a)

      the attendance is by a specialist, or consultant physician, in the specialty of geriatric medicine or rehabilitation medicine for the purposes of the Act; and

    2. (b)

      the attendance is on a patient who:

      1. (i)

        is an admitted patient of a hospital; and

      2. (ii)

        is not a care recipient in a residential aged care facility; and

      3. (iii)

        is being provided with 1 of the following types of specialist care:

        1. (A)

          geriatric evaluation and management;

        2. (B)

          rehabilitation care.

  2. (2)

    In this rule:

    geriatric evaluation and management means care provided to a patient with a disability or psychosocial problem for the purpose of maximising the patient’s health status or optimising the patient’s living arrangements.

    rehabilitation care means care provided to a patient with an impairment or disability for the purpose of improving the patient’s functional status.

47Meaning of living in a community setting in item 900

For item 900, a patient is living in a community settingif the patient is not an in‑patient of a hospital or a care recipient in a residential aged care facility.

48Meaning of residential medication management review in item 903
  1. (1)

    For item 903, a residential medication management review is a collaborative service provided by a medical practitioner and a pharmacist to review the medication management needs of a permanent resident of a residential aged care facility.

  2. (2)

    A medical practitioner’s involvement in a residential medication management review includes all of the following:

    1. (a)

      discussing the proposed review with the resident and seeking the resident’s consent to the review;

    2. (b)

      collaborating with the reviewing pharmacist about the pharmacist’s involvement in the review;

    3. (c)

      providing input from the resident’s most recent comprehensive medical assessment or, if such an assessment has not been undertaken, providing relevant clinical information for the review and for the resident’s records;

    4. (d)

      subject to subrule (4), participating in a post‑review discussion (either face‑to‑face or by telephone) with the pharmacist to discuss the outcomes of the review including:

      1. (i)

        the findings of the review; and

      2. (ii)

        medication management strategies; and

      3. (iii)

        means to ensure that the strategies are implemented and reviewed, including any issues for implementation and follow‑up;

    5. (e)

      developing or revising the resident’s medication management plan after discussion with the reviewing pharmacist, and finalising the plan after discussion with the resident.

  3. (3)

    A medical practitioner’s involvement in a residential medication management review also includes:

    1. (a)

      offering a copy of the medication management plan to the resident (or the resident’s carer or representative if appropriate); and

    2. (b)

      providing copies of the plan for the resident’s records and for the nursing staff of the residential aged care facility; and

    3. (c)

      discussing the plan with nursing staff if necessary.

  4. (4)

    A post‑review discussion is not required if:

    1. (a)

      there are no recommended changes to the resident’s medication management arising out of the review; or

    2. (b)

      any changes are minor in nature and do not require immediate discussion; or

    3. (c)

      the pharmacist and medical practitioner agree that issues arising out of the review should be considered in an enhanced primary care case conference.

49Meaning of amount under rule 49 in certain items

In this table:

amount under rule 49, for an item mentioned in the following table, means the sum of:

  1. (a)

    the fee mentioned in column 3 for the item; and

  2. (b)

    either:

    1. (i)

      if not more than 6 patients are attended at a single attendance — the amount mentioned in column 4 for the item, divided by the number of patients attended; or

    2. (ii)

      if more than 6 patients are attended at a single attendance — the amount mentioned in column 5 for the item.

Item

Item of this table

Fee

Amount if not more than 6 patients (to be divided by the number of patients)

Amount if more than 6 patients

1

2503

The fee for item 2501

$23.50

$1.75

2

2506

The fee for item 2504

$23.50

$1.75

3

2509

The fee for item 2507

$23.50

$1.75

4

2518

The fee for item 2517

$23.50

$1.75

5

2522

The fee for item 2521

$23.50

$1.75

6

2526

The fee for item 2521

$23.50

$1.75

7

2547

The fee for item 2546

$23.50

$1.75

8

2553

The fee for item 2552

$23.50

$1.75

9

2559

The fee for item 2558

$23.50

$1.75

10

2723

The fee for item 2721

$23.50

$1.75

11

2727

The fee for item 2725

$23.50

$1.75

50Application of items 2497, 2501, 2503, 2504, 2506, 2507, 2509, 2598, 2600, 2603, 2606, 2610, 2613 and 2616

Items 2497, 2501, 2503, 2504, 2506, 2507, 2509, 2598, 2600, 2603, 2606, 2610, 2613 and 2616 do not apply in conjunction with any of items 10994, 10995, 10998 and 10999.

51Application of Subgroup 2 of Group A18 and Subgroup 2 of Group A19
  1. (1)

    An item in Subgroup 2 of Group A18 or Subgroup 2 of Group A19 does not apply to a service that is provided to a patient who has already been provided, in the previous 11 months, with another service to which an item in either of those Subgroups applies.

  2. (2)

    For an item in Subgroup 2 of Group A18 or Subgroup 2 of Group A19, a professional attendance completes the minimum requirements for a cycle of care of a patient with established diabetes mellitus if the attendance completes a series of attendances that involve, over a period of at least 11 months and up to 13 months, (the current cycle), the following:

    1. (a)

      at least 1 assessment of the patient’s diabetes control, by measuring the patient’s HbA1c;

    2. (b)

      subject to subrule (3), if the patient has not had a comprehensive eye examination in the cycle of care ending immediately before the current cycle — at least 1 comprehensive eye examination;

    3. (c)

      measurement of the patient’s weight and height, and calculation of the patient’s BMI;

    4. (d)

      2 further measurements of the patient’s weight with each measurement being taken at least 5 months after the previous measurement;

    5. (e)

      2 measurements of the patient’s blood pressure, taken at least 5 months but not more than 7 months apart;

    6. (f)

      subject to subrule (3), 2 examinations of the patient’s feet, carried out at least 5 months but not more than 7 months apart;

    7. (g)

      at least 1 measurement of the patient’s total cholesterol, triglycerides and HDL cholesterol;

    8. (h)

      at least 1 test of the patient’s microalbuminuria;

    9. (i)

      provision to the patient of self‑management education regarding diabetes;

    10. (j)

      a review of the patient’s diet, and provision to the patient of information about appropriate dietary choices;

    11. (k)

      a review of the patient’s level of physical activity, and provision to the patient of information about the appropriate level of physical activity;

    12. (l)

      checking the patient’s tobacco smoking activity, and, if relevant, encouraging the patient to stop smoking;

    13. (m)

      a review of the patient’s medication.

  3. (3)

    For a patient with established diabetes mellitus who is mentioned in the following table, the minimum requirements of a cycle of care for the patient in relation to paragraphs (2) (b) and (f) may be completed as set out in the table.

542.80

52095

Bone growth stimulator in the oral and maxillofacial region, insertion of (Anaes.) (Assist.)

351.75

52096

Orthopaedic pin or wire, insertion of, into maxilla or mandible or zygoma, as an independent procedure (Anaes.)

104.30

52097

External fixation in the oral and maxillofacial region, removal of, in the operating theatre of a hospital (Anaes.)

147.85

52098

External fixation in the oral and maxillofacial region, removal of, in conjunction with operations involving internal fixation or bone grafting or both (Anaes.)

173.90

52099

Buried wire, pin or screw, 1 or more, which were inserted for internal fixation purposes into maxilla or mandible or zygoma, removal of, requiring anaesthesia, incision, dissection and suturing, per bone, not being a service associated with a service to which item 52102 or 52105 applies (Anaes.)

130.50

52102

Buried wire, pin or screw, 1 or more, which were inserted for internal fixation purposes into maxilla or mandible or zygoma, removal of, requiring anaesthesia, incision, dissection and suturing, if undertaken in the operating theatre of a hospital, per bone (Anaes.)

130.50

52105

Plate, 1 or more of, and associated screw and wire which were inserted for internal fixation purposes into maxilla or mandible or zygoma, removal of, requiring anaesthesia, incision, dissection and suturing, per bone, not being a service associated with a service to which item 52099 or 52102 applies (Anaes.) (Assist.)

243.55

52106

Arch bars, 1 or more, which were inserted for dental fixation purposes to the maxilla or mandible, removal of, requiring general anaesthesia if undertaken in the operating theatre of a hospital (Anaes.)

100.60

52108

Lip, full thickness wedge excision of, with repair by direct sutures (Anaes.) (Assist.)

301.20

52111

Vermilionectomy (Anaes.) (Assist.)

301.20

52114

Mandible or maxilla, segmental resection of, for tumours or cysts (Anaes.) (Assist.)

542.85

52117

Mandible, including lower border, or maxilla, sub‑total resection of (Anaes.) (Assist.)

646.20

52120

Mandible, hemimandiblectomy of, including condylectomy where performed (Anaes.) (Assist.)

764.30

52122

Mandible, hemi‑mandibular reconstruction of, or maxilla reconstruction of, with bone graft, plate, tray or alloplast, not being a service associated with a service to which item 52123 applies (Anaes.) (Assist.)

764.30

52123

Mandible, total resection of both sides, including condylectomies where performed (Anaes.) (Assist.)

865.25

52126

Maxilla, total resection of (Anaes.) (Assist.)

831.85

52129

Maxilla, total resection of both maxillae (Anaes.) (Assist.)

1 113.60

52130

Bone graft in the oral and maxillofacial region, not being a service to which another item in Groups O3 to O9 applies (Anaes.) (Assist.)

408.75

52131

Bone graft with internal fixation, in the oral and maxillofacial region, not being a service to which another item in the range 51900 to 52186, or the range 52303 to 53460, applies (Anaes.) (Assist.)

565.35

52132

Tracheostomy (Anaes.)

229.95

52133

Cricothyrostomy by direct stab or Seldinger technique, using Minitrach or similar device (Anaes.)

84.10

52135

Post‑operative or post‑nasal haemorrhage, or both, control of, where undertaken in the operating theatre of a hospital (Anaes.)

133.35

52138

Maxillary artery, ligation of (Anaes.) (Assist.)

414.35

52141

Facial, mandibular or lingual artery or vein or artery and vein, ligation of, not being a service to which item 52138 applies (Anaes.) (Assist.)

409.90

52144

Foreign body, deep, removal of using interventional imaging techniques (Anaes.) (Assist.)

382.05

52147

Duct of major salivary gland, transposition of (Anaes.) (Assist.)

360.50

52148

Parotid duct, repair of, using micro‑surgical techniques (Anaes.) (Assist.)

637.30

52158

Submandibular ducts, relocation of, for surgical control of drooling (Anaes.) (Assist.)

1 026.10

52180

Aggressive or potentially malignant bone or deep soft tissue tumour in the oral and maxillofacial region, biopsy of (not including after‑care) (Anaes.)

173.90

52182

Bone or malignant deep soft tissue tumour in the oral and maxillofacial region, lesional or marginal excision of (Anaes.) (Assist.)

382.75

52184

Bone tumour in the oral and maxillofacial region, lesional or marginal excision of, combined with any 1 of liquid nitrogen freezing, autograft, allograft or cementation (Anaes.) (Assist.)

565.35

52186

Bone tumour in the oral and maxillofacial region, lesional or marginal excision of, combined with any 2 or more of liquid nitrogen freezing, autograft, allograft or cementation (Anaes.) (Assist.)

695.90

Group O4 — Plastic and reconstructive

52300

Single‑stage local flap, where indicated, repair to 1 defect, with skin or mucosa (Anaes.) (Assist.)

262.70

52303

Single‑stage local flap, where indicated, repair to 1 defect, with buccal pad of fat (Anaes.) (Assist.)

375.15

52306

Single‑stage local flap, where indicated, repair to 1 defect, using temporalis muscle (Anaes.) (Assist.)

556.55

52309

Free grafting (mucosa or split skin) of a granulating area (Anaes.)

189.10

52312

Free grafting (mucosa, split skin or connective tissue) to 1 defect, including elective dissection (Anaes.) (Assist.)

262.70

52315

Free grafting, full thickness, to 1 defect (mucosa or skin) (Anaes.) (Assist.)

437.70

52318

Bone graft, harvesting of, via separate incision, being a service associated with a service to which another item in Groups O3 to O9 applies — Autogenous, small quantity (Anaes.)

130.50

52319

Bone graft, harvesting of, via separate incision, being a service associated with a service to which another item in Groups O3 to O9 applies — Autogenous, large quantity (Anaes.)

217.55

52321

Foreign implant (non‑biological), insertion of, for contour reconstruction of pathological deformity, not being a service associated with a service to which item 52624 applies (Anaes.) (Assist.)

437.70

52324

Direct flap repair, using tongue, first stage (Anaes.) (Assist.)

437.70

52327

Direct flap repair, using tongue, second stage (Anaes.)

217.15

52330

Palatal defect (oro‑nasal fistula), plastic closure of, including services to which item 52300, 52303, 52306 or 52324 applies (Anaes.) (Assist.)

722.40

52333

Cleft palate, primary repair (Anaes.) (Assist.)

722.40

52336

Cleft palate, secondary repair, closure of fistula using local flaps (Anaes.) (Assist.)

451.55

52337

Alveolar cleft (congenital) unilateral, grafting of, including plastic closure of associated oro‑nasal fistulae and ridge augmentation (Anaes.) (Assist.)

987.70

52339

Cleft palate, secondary repair, lengthening procedure (Anaes.) (Assist.)

514.20

52342

Mandible or maxilla, unilateral osteotomy or osteectomy of, including transposition of nerves and vessels and bone grafts taken from the same site (Anaes.) (Assist.)

893.15

52345

Mandible or maxilla, unilateral osteotomy or osteectomy of, including transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination (Anaes.) (Assist.)

1 007.30

52348

Mandible or maxilla, bilateral osteotomy or osteectomy of, including transposition of nerves and vessels and bone grafts taken from the same site (Anaes.) (Assist.)

1 138.25

52351

Mandible or maxilla, bilateral osteotomy or osteectomy of, including transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination (Anaes.) (Assist.)

1 278.30

52354

Mandible or maxilla, osteotomies or osteectomies of, involving 3 or more such procedures on the 1 jaw, including transposition of nerves and vessels and bone grafts taken from the same site (Anaes.) (Assist.)

1 295.90

52357

Mandible or maxilla, osteotomies or osteectomies of, involving 3 or more such procedures on the 1 jaw, including transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination (Anaes.) (Assist.)

1 458.95

52360

Mandible and maxilla, osteotomies or osteectomies of, involving 2 such procedures of each jaw including transposition of nerves and vessels and bone grafts taken from the same site (Anaes.) (Assist.)

1 488.35

52363

Mandible and maxilla, osteotomies or osteectomies of, involving 2 such procedures of each jaw, including transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination (Anaes.) (Assist.)

1 674.40

52366

Mandible and maxilla, complex bilateral osteotomies or osteectomies of, involving 3 or more such procedures of 1 jaw and 2 such procedures of the other jaw, including genioplasty when performed and transposition of nerves and vessels and bone grafts taken from the same site (Anaes.) (Assist.)

1 637.35

52369

Mandible and maxilla, complex bilateral osteotomies or osteectomies of, involving 3 or more such procedures of 1 jaw and 2 such procedures of the other jaw, including genioplasty when performed and transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination (Anaes.) (Assist.)

1 840.95

52372

Mandible and maxilla, complex bilateral osteotomies or osteectomies of, involving 3 or more such procedures of each jaw, including genioplasty when performed and transposition of nerves and vessels and bone grafts taken from the same site (Anaes.) (Assist.)

1 786.30

52375

Mandible and maxilla, complex bilateral osteotomies or osteectomies of, involving 3 or more such procedures of each jaw, including genioplasty when performed and transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination (Anaes.) (Assist.)

2 000.85

52378

Genioplasty including transposition of nerves and vessels and bone grafts taken from the same site (Anaes.) (Assist.)

691.65

52379

Face, contour reconstruction of 1 region, using autogenous bone or cartilage graft (Anaes.) (Assist.)

1 182.05

52380

Midfacial osteotomies — Le Fort II, Modified Le Fort III (Nasomalar), Modified Le Fort III (Malar‑Maxillary), Le Fort III involving 3 or more osteotomies of the midface including transposition of nerves and vessels and bone grafts taken from the same site (Anaes.) (Assist.)

2 012.75

52382

Midfacial osteotomies — Le Fort II, Modified Le Fort III (Nasomalar), Modified Le Fort III (Malar‑Maxillary), Le Fort III involving 3 or more osteotomies of the midface including transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination (Anaes.) (Assist.)

2 412.70

52420

Mandible, fixation by intermaxillary wiring, excluding wiring for obesity

222.80

52424

Dermis, dermofat or fascia graft (excluding transfer of fat by injection) in the oral and maxillofacial region (Anaes.) (Assist.)

437.60

52430

Microvascular repair of the oral and maxillofacial region using microsurgical techniques, with restoration of continuity of artery or vein of distal extremity or digit (Anaes.) (Assist.)

1 007.30

52440

Cleft lip, unilateral — primary repair, 1 stage, without anterior palate repair (Anaes.) (Assist.)

500.15

52442

Cleft lip, unilateral — primary repair, 1 stage, with anterior palate repair (Anaes.) (Assist.)

625.30

52444

Cleft lip, bilateral — primary repair, 1 stage, without anterior palate repair (Anaes.) (Assist.)

694.60

52446

Cleft lip, bilateral — primary repair, 1 stage, with anterior palate repair (Anaes.) (Assist.)

819.90

52450

Cleft lip, partial revision, including minor flap revision alignment and adjustment, including revision of minor whistle deformity if performed (Anaes.)

277.85

52452

Cleft lip, total revision, including major flap revision, muscle reconstruction and revision of major whistle deformity (Anaes.) (Assist.)

451.55

52456

Cleft lip reconstruction using full thickness flap (Abbe or similar), first stage (Anaes.) (Assist.)

764.30

52458

Cleft lip reconstruction using full thickness flap (Abbe or similar), second stage (Anaes.)

277.85

52460

Velo‑pharyngeal incompetence, pharyngeal flap for, or pharyngoplasty for (Anaes.)

722.40

52480

Composite graft (chondro‑cutaneous or chondro‑mucosal) to nose, ear or eyelid (Anaes.) (Assist.)

464.05

52482

Macrocheilia or macroglossia, operation for (Anaes.) (Assist.)

446.50

52484

Macrostomia, operation for (Anaes.) (Assist.)

531.50

Group O5 — Preprosthetic

52600

Mandibular or palatal exostosis, excision of (Anaes.) (Assist.)

312.60

52603

Mylohyoid ridge, reduction of (Anaes.) (Assist.)

298.80

52606

Maxillary tuberosity, reduction of (Anaes.)

227.90

52609

Papillary hyperplasia of the palate, removal of — less than 5 lesions (Anaes.) (Assist.)

298.80

52612

Papillary hyperplasia of the palate, removal of — 5 to 20 lesions (Anaes.) (Assist.)

375.15

52615

Papillary hyperplasia of the palate, removal of — more than 20 lesions (Anaes.) (Assist.)

465.50

52618

Vestibuloplasty, submucosal or open, including excision of muscle and skin or mucosal graft when performed — unilateral or bilateral (Anaes.) (Assist.)

541.80

52621

Floor of mouth lowering (Obwegeser or similar procedure), including excision of muscle and skin or mucosal graft when performed — unilateral (Anaes.) (Assist.)

541.80

52624

Alveolar ridge augmentation with bone or alloplast or both — unilateral (Anaes.) (Assist.)

437.60

52626

Alveolar ridge augmentation — unilateral, insertion of tissue expanding device into maxillary or mandibular alveolar ridge region for (Anaes.) (Assist.)

268.40

52627

Osseo‑integration procedure — extra oral implantation of titanium fixture (Anaes.) (Assist.)

465.50

52630

Osseo‑integration procedure — fixation of transcutaneous abutment (Anaes.)

172.30

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.)

465.50

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.)

172.30

Group O6 — Neurosurgical

52800

Neurolysis by open operation, without transposition, not being a service associated with a service to which item 52803 applies (Anaes.) (Assist.)

255.70

52803

Nerve trunk, internal (interfascicular), neurolysis of, using microsurgical techniques (Anaes.) (Assist.)

368.20

52806

Neurectomy, neurotomy or removal of tumour from superficial peripheral nerve (Anaes.) (Assist.)

255.70

52809

Neurectomy, neurotomy or removal of tumour from deep peripheral nerve (Anaes.) (Assist.)

437.70

52812

Nerve trunk, primary repair of, using microsurgical techniques (Anaes.) (Assist.)

625.30

52815

Nerve trunk, secondary repair of, using microsurgical techniques (Anaes.) (Assist.)

659.95

52818

Nerve, transposition of (Anaes.) (Assist.)

437.70

52821

Nerve graft to nerve trunk (cable graft) including harvesting of nerve graft using microsurgical techniques (Anaes.) (Assist.)

951.75

52824

Peripheral branches of the trigeminal nerve, cryosurgery of, for pain relief (Anaes.) (Assist.)

409.90

52826

Injection of primary branch of trigeminal nerve with alcohol, cortisone, phenol, or similar substance (Anaes.)

219.50

52828

Cutaneous nerve, primary repair of, using microsurgical techniques (Anaes.) (Assist.)

326.45

52830

Cutaneous nerve, secondary repair of, using microsurgical techniques (Anaes.) (Assist.)

430.60

52832

Cutaneous nerve, nerve graft to, using microsurgical techniques (Anaes.) (Assist.)

590.55

Group O7 — Ear, nose and throat

53000

Maxillary antrum, proof puncture and lavage of (Anaes.)

30.05

53003

Maxillary antrum, proof puncture and lavage of, under general anaesthesia, not being a service associated with a service to which another item in Groups O3 to O9 applies (H) (Anaes.)

84.95

53004

Maxillary antrum, lavage of — each attendance at which the procedure is performed, including any associated consultation (Anaes.)

32.90

53006

Antrostomy (radical) (Anaes.) (Assist.)

481.55

53009

Antrum, intranasal operation on or removal of foreign body from (Anaes.) (Assist.)

273.15

53012

Antrum, drainage of, through tooth socket (Anaes.)

108.60

53015

Oro‑antral fistula, plastic closure of (Anaes.) (Assist.)

542.85

53016

Nasal septum, septoplasty, submucous resection or closure of septal perforation (Anaes.) (Assist.)

446.50

53017

Nasal septum, reconstruction of (Anaes.) (Assist.)

556.95

53019

Maxillary sinus, bone graft to floor of maxillary sinus following elevation of mucosal lining (sinus lift procedure), unilateral (Anaes.) (Assist.)

536.60

53052

Post‑nasal space, direct examination of, with or without biopsy (Anaes.)

113.50

53054

Nasendoscopy or sinoscopy or fibreoptic examination of nasopharynx — 1 or more of these procedures (Anaes.)

113.50

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.)

66.45

53058

Nasal haemorrhage, posterior, arrest of, with posterior nasal packing with or without cauterisation and with or without anterior pack (excluding after‑care) (Anaes.)

113.50

53060

Cauterisation (other than by chemical means) or cauterisation by chemical means when performed under general anaesthesia or diathermy of septum or turbinates 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.)

92.85

53062

Post‑surgical nasal haemorrhage, arrest of during an episode of epistaxis by cauterisation or nasal cavity packing or both (Anaes.)

83.10

53064

Cryotherapy to nose in the treatment of nasal haemorrhage (Anaes.)

150.55

53068

Turbinectomy or turbinectomies, partial or total, unilateral (Anaes.)

126.10

53070

Turbinates, submucous resection of, unilateral (Anaes.)

164.45

Group O8 — Temporomandibular joint

53200

Mandible, treatment of a dislocation of, not requiring open reduction(Anaes.)

65.30

53203

Mandible, treatment of a dislocation of, requiring open reduction (Anaes.)

109.70

53206

Temporomandibular joint, manipulation of, performed in the operating theatre of a hospital, not being a service associated with a service to which another item in Groups O3 to O9 applies (Anaes.)

132.05

53209

Glenoid fossa, zygomatic arch and temporal bone, reconstruction of (Obwegeser technique) (Anaes.) (Assist.)

1 523.50

53212

Absent condyle and ascending ramus in hemifacial microsomia, construction of, not including harvesting of graft material (Anaes.) (Assist.)

823.00

53215

Temporomandibular joint, arthroscopy of, with or without biopsy, not being a service associated with any other arthroscopic procedure of that joint (Anaes.) (Assist.)

377.60

53218

Temporomandibular joint, arthroscopy of, removal of loose bodies, debridement, or treatment of adhesions — 1 or more of such procedures (Anaes.) (Assist.)

604.00

53220

Temporomandibular joint, arthrotomy of, not being a service to which another item in this group applies (Anaes.) (Assist.)

304.50

53221

Temporomandibular joint, open surgical exploration of, with or without microsurgical techniques (Anaes.) (Assist.)

805.85

53224

Temporomandibular joint, open surgical exploration of, with condylectomy or condylotomy, with or without microsurgical techniques (Anaes.) (Assist.)

893.35

53225

Arthrocentesis, irrigation of temporomandibular joint after insertion of 2 cannuli into the appropriate joint space (Anaes.) (Assist.)

268.40

53226

Temporomandibular joint, synovectomy of, not being a service to which another item in this group applies (Anaes.) (Assist.)

288.55

53227

Temporomandibular joint, open surgical exploration of, with or without meniscus or capsular surgery, including meniscectomy when performed, with or without microsurgical techniques (Anaes.) (Assist.)

1 097.75

53230

Temporomandibular joint, open surgical exploration of, with meniscus, capsular and condylar head surgery, with or without microsurgical techniques (Anaes.) (Assist.)

1 236.55

53233

Temporomandibular joint, surgery of, involving procedures to which item 53224, 53226, 53227 or 53230 applies and also involving the use of tissue flaps, or cartilage graft, or allograft implants, with or without microsurgical techniques (Anaes.) (Assist.)

1 389.50

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.) (Assist.)

434.85

53239

Temporomandibular joint, arthrodesis of, not being a service to which another item in this group applies (Anaes.) (Assist.)

434.85

53242

Temporomandibular joint or joints, application of external fixator to, other than for treatment of fractures (Anaes.) (Assist.)

288.55

Group O9 — Treatment of fractures

53400

Maxilla, unilateral or bilateral, treatment of fracture of, not requiring splinting

119.35

53403

Mandible, treatment of fracture of, not requiring splinting

145.80

53406

Maxilla, treatment of fracture of, requiring splinting, wiring of teeth, circumosseous fixation or external fixation (Anaes.) (Assist.)

375.70

53409

Mandible, treatment of fracture of, requiring splinting, wiring of teeth, circumosseous fixation or external fixation (Anaes.) (Assist.)

375.70

53410

Zygomatic bone, treatment of fracture of, not requiring surgical reduction

79.15

53411

Zygomatic bone, treatment of fracture of, requiring surgical reduction, by temporal, intra‑oral or other approach (Anaes.)

220.65

53412

Zygomatic bone, treatment of fracture of, requiring surgical reduction and involving internal or external fixation at 1 site (Anaes.) (Assist.)

362.25

53413

Zygomatic bone, treatment of fracture of, requiring surgical reduction and involving internal or external fixation or both at 2 sites (Anaes.) (Assist.)

443.80

53414

Zygomatic bone, treatment of, requiring surgical reduction and involving internal or external fixation or both at 3 sites (Anaes.) (Assist.)

509.80

53415

Maxilla, treatment of fracture of, requiring open reduction (Anaes.) (Assist.)

402.50

53416

Mandible, treatment of fracture of, requiring open reduction (Anaes.) (Assist.)

402.50

53418

Maxilla, treatment of fracture of, requiring open reduction and internal fixation not involving a plate (Anaes.) (Assist.)

523.20

53419

Mandible, treatment of fracture of, requiring open reduction and internal fixation not involving a plate (Anaes.) (Assist.)

523.20

53422

Maxilla, treatment of fracture of, requiring open reduction and internal fixation involving a plate (Anaes.) (Assist.)

664.00

53423

Mandible, treatment of fracture of, requiring open reduction and internal fixation involving a plate (Anaes.) (Assist.)

664.00

53424

Maxilla, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction not involving a plate (Anaes.) (Assist.)

569.70

53425

Mandible, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction not involving a plate (Anaes.) (Assist.)

569.70

53427

Maxilla, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction involving the use of a plate (Anaes.) (Assist.)

778.10

53429

Mandible, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction involving the use of a plate (Anaes.) (Assist.)

778.10

53439

Mandible, treatment of a closed fracture of, involving a joint surface (Anaes.)

220.65

53453

Orbital cavity, reconstruction of a wall or floor with or without foreign implant (Anaes.) (Assist.)

446.50

53455

Orbital cavity, bone or cartilage graft to orbital wall or floor including reduction of prolapsed or entrapped orbital contents (Anaes.) (Assist.)

524.45

53458

Nasal bones, treatment of fracture of, not being a service to which item 53459 or 53460 applies

39.75

53459

Nasal bones, treatment of fracture of, by reduction (Anaes.)

217.55

53460

Nasal bones, treatment of fractures of, by open reduction involving osteotomies (Anaes.) (Assist.)

443.80

Group O10 — Diagnostic procedures and investigations

53600

Skin sensitivity testing for allergens to anaesthetics and materials used in oral and maxillofacial surgery, using 1 to 20 allergens

35.95

Group O11 — Regional or field nerve blocks

53700

Trigeminal nerve, primary division of, injection of an anaesthetic agent

115.35

53702

Trigeminal nerve, peripheral branch of, injection of an anaesthetic agent

57.75

53704

Facial nerve, injection of an anaesthetic agent

34.80

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

115.35

Cleft lip and cleft palate services

Group C1 — Orthodontic services

75001

Initial professional attendance in a single course of treatment by an accredited orthodontist (AO)

79.05

75004

Professional attendance by an accredited orthodontist subsequent to the first professional attendance by the orthodontist in a single course of treatment (AO)

39.70

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:

  1. (a)

    item 75030, 75033, 75034, 75036, 75037, 75039, 75045 or 75051 applies; or

  2. (b)

    an item in Group T8 or Groups O3 to O9 applies;

in a single course of treatment (AO)

70.50

75009

Orthodontic radiography — orthopantomography (panoramic radiography), including any consultation on the same occasion (AOS) (AO)

63.00

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)

99.80

75015

Orthodontic radiography — anteroposterior and lateral cephalometric radiography, with cephalometric tracings including any consultation on the same occasion (AOS) (AO)

137.25

75018

Orthodontic radiography — anteroposterior and lateral cephalometric radiography, with cephalometric tracings and orthopantomography including any consultation on the same occasion (AOS) (AO)

174.85

75021

Orthodontic radiography — hand‑wrist studies (including growth prediction) including any consultation on the same occasion (AOS) (AO)

214.35

75023

Intraoral radiography — single area, periapical or bitewing film (AOS) (AO)

42.90

75024

Pre‑surgical infant maxillary arch repositioning, including supply of appliances and all adjustments of appliances and supervision — if 1 appliance is used (AO)

554.40

75027

Pre‑surgical infant maxillary arch repositioning, including supply of appliances and all adjustments of appliances and supervision — if 2 appliances are used (AO)

760.20

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)

676.95

75033

Mixed dentition treatment — incisor alignment using fixed appliances in maxillary arch, including supply of appliances, all adjustments of appliances, removal of the appliances and retention (AO)

1 109.50

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)

564.70

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)

1 532.45

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)

1 930.05

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)

512.95

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)

191.75

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)

1 026.90

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)

263.35

75049

Retention, fixed or removable, single arch (mandibular or maxillary) — supply of retainer and supervision of retention (AO)

308.20

75050

Retention, fixed or removable, 2‑arch (mandibular and maxillary) — supply of retainers and supervision of retention (AO)

595.00

75051

Jaw growth guidance using removable or functional appliances, including supply of appliances and all adjustments to appliances (AO)

913.40

Group C2 — Oral and maxillofacial services

75150

Initial professional attendance in a single course of treatment by an accredited oral and maxillofacial surgeon if the patient is referred to the surgeon by an accredited orthodontist (AOS)

79.05

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 if the patient is referred to the surgeon by an accredited orthodontist (AOS)

39.70

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:

  1. (a)

    to which item 52321, 53212 or 75618 applies; or

  2. (b)

    to which an item in the series 52330 to 52382, 52600 to 52630, 53400 to 53409 or 53415 to 53429 applies;

in a single course of treatment, where the patient is referred by an accredited orthodontist (AOS)

70.50

75200

Removal of tooth or tooth fragment (not being treatment to which item 75400, 75403, 75406, 75409, 75412 or 75415 applies), if the patient is referred by an accredited orthodontist (AD)

50.75

75203

Removal of tooth or tooth fragment under general anaesthesia, if the patient is referred by an accredited orthodontist (AD)

76.15

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, if the patient is referred by an accredited orthodontist (AD)

25.25

75400

Surgical removal of erupted tooth, if the patient is referred by an accredited orthodontist (AOS)

152.25

75403

Surgical removal of tooth with soft tissue impaction, if the patient is referred by an accredited orthodontist (AOS)

174.85

75406

Surgical removal of tooth with partial bone impaction, if the patient is referred by an accredited orthodontist (AOS)

199.25

75409

Surgical removal of tooth with complete bone impaction, where the patient is referred by an accredited orthodontist (AOS)

225.65

75412

Surgical removal of tooth fragment requiring incision of soft tissue only, if the patient is referred by an accredited orthodontist (AOS)

126.05

75415

Surgical removal of tooth fragment requiring removal of bone, if the patient is referred by an accredited orthodontist (AOS)

152.25

75600

Surgical exposure, stimulation and packing of unerupted tooth, where the patient is referred by an accredited orthodontist (AOS)

214.35

75603

Surgical exposure of unerupted tooth for the purpose of fitting a traction device, if the patient is referred by an accredited orthodontist (AOS)

251.95

75606

Surgical repositioning of unerupted tooth, if the patient is referred by an accredited orthodontist (AOS)

251.95

75609

Transplantation of tooth bud, if the patient is referred by an accredited orthodontist (AOS)

376.10

75612

Surgical procedure for intra oral implantation of osseointegrated fixture (first stage), if the patient is referred by an accredited orthodontist (AOS)

465.50

75615

Surgical procedure for fixation of trans‑mucosal abutment (second stage of osseointegrated implant), if the patient is referred by an accredited orthodontist (AOS)

172.30

75618

Provision and fitting of a bite rising appliance or dental splint for the management of temporomandibular joint dysfunction syndrome, if the patient is referred by an accredited orthodontist (AOS)

214.00

75621

The provision and fitting of surgical template in conjunction with orthognathic surgical procedures in association with:

  1. (a)

    an item in the series:

    1. (i)

      45720 to 45754; or

    2. (ii)

      52342 to 52375; or

  2. (b)

    item 52380 or 52382;

if the patient is referred by an accredited orthodontist (AOS)

214.00

Group C3 — General and prosthodontic services

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)

76.15

75803

Provision and fitting of acrylic base partial denture, including retainers — 1 tooth (AD)

304.65

75806

Provision and fitting of acrylic base partial denture, including retainers — 2 teeth (AD)

357.30

75809

Provision and fitting of acrylic base partial denture, including retainers — 3 teeth (AD)

423.05

75812

Provision and fitting of acrylic base partial denture, including retainers — 4 teeth (AD)

470.10

75815

Provision and fitting of acrylic base partial denture, including retainers — 5 to 9 teeth (AD)

573.60

75818

Provision and fitting of acrylic base partial denture, including retainers — 10 to 12 teeth (AD)

676.95

75821

Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 1 tooth (AD)

545.20

75824

Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 2 teeth (AD)

629.90

75827

Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 3 teeth (AD)

724.05

75830

Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 4 teeth (AD)

799.20

75833

Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 5 to 9 teeth (AD)

977.75

75836

Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 10 to 12 teeth (AD)

1 118.80

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)

25.25

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)

37.65

75845

Relining of partial denture by laboratory process and associated fitting (AD)

188.15

75848

Remodelling and fitting of partial denture of more than 4 teeth (AD)

225.65

75851

Repair to cast metal base of partial denture — 1 or more points (AD)

112.80

75854

Addition of a tooth or teeth to a partial denture to replace extracted tooth or teeth, including taking of necessary impression (AD)

112.80

Part4Non‑medicare services
  1. 1.

    Endoluminal gastroplication, for the treatment of gastro‑oesophageal reflux disease

  2. 2.

    Endovenous laser treatment, for varicose veins

  3. 3.

    Gamma knife surgery

  4. 4.

    Intradiscal electro thermal arthroplasty

  5. 5.

    Intravascular ultrasound (except where used in conjunction with intravascular brachytherapy)

  6. 6.

    Intro‑articular viscosupplementation, for the treatment of osteoarthritis of the knee

  7. 7.

    Low intensity ultrasound treatment, for the acceleration of bone fracture healing, using a bone growth stimulator

  8. 8.

    Lung volume reduction surgery, for advanced emphysema

  9. 9.

    Photodynamic therapy, for skin and mucosal cancer

  10. 10.

    Placement of artificial bowel sphincters, in the management of faecal incontinence

  11. 11.

    Sacral nerve stimulation, for urinary incontinence

  12. 12.

    Selective internal radiation therapy for any condition other than hepatic metastases that are secondary to colorectal cancer

  13. 13.

    Specific mass measurement of bone alkaline phosphatase

  14. 14.

    Transmyocardial laser revascularisation

  15. 15.

    Vertebral axial decompression therapy, for chronic back pain

Notes to the Health Insurance (General Medical Services Table) Regulations 2008

Note 1

The Health Insurance (General Medical Services Table) Regulations 2008 (in force under the Health Insurance Act 1973) as shown in this compilation comprise Select Legislative Instrument 2008 No. 211 amended as indicated in the Tables below.

Table of Instruments

Year and

Number

Date of FRLI registration

Date of

commencement

Application, saving or

transitional provisions

2008 No. 211

22 Oct 2008 (see F2008L03446)

1 Nov 2008

2008 No. 268

18 Dec 2008 (see F2008L04283)

1 Jan 2009

—

2009 No. 61

15 Apr 2009 (see F2009L00112)

1 May 2009

—

2009 No. 138

25 June 2009 (see F2009L01719)

1 July 2009

—

2010 No. 5

11 Feb 2010 (see F2010L00292)

1 July 2009

—

Table of Amendments

  1. ad. = added or inserted

    am. = amended rep. = repealed rs. = repealed and substituted

Provision affected

How affected

Schedule 1

Schedule 1.............................

am. 2008 No. 268; 2009 Nos. 61 and 138; 2010 No. 5

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