Health Insurance (General Medical Services Table) Regulations 2009 (Cth)
made under the
This compilation was prepared on 1 July 2010
taking into account amendments up to SLI 2010 No. 127
Prepared by the Office of Legislative Drafting and Publishing,
Attorney-General’s Department, Canberra
These Regulations are the
Health Insurance (General Medical Services Table) Regulations 2009 .
These Regulations commence on 1 November 2009.
The
Health Insurance (General Medical Services Table) Regulations 2008 are repealed.
In these Regulations:
Act means theHealth Insurance Act 1973 .
this table means the table of general medical services set out in Schedule 1.
The table of medical services (other than diagnostic imaging services and pathology services) set out in Schedule 1 is prescribed for subsection 4 (1) of the Act.
(regulation 5)
For section 4 of the Act, these Regulations prescribe a table of general medical services that sets out:
(a) in Part 2 — rules for interpretation of the table; and
(b) in Part 3:
(i) items of general medical services; and
(ii) the amount of fees applicable for each item; and
(c) in Part 4 — additional supporting information.
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.
(1) In this table, unless the contrary intention appears:
2004 General Medical Services Table (or2004 GMST ) means the table prescribed for subsection 4 (1) of the Act bythe
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:
(a) a public holiday;
(b) a Sunday;
(c) before 8 am, or after 12 noon, on a Saturday;
(d) before 8 am, or after 6 pm, on any day other than a Saturday, Sunday or public holiday.
attendance of a minor nature orminor attendance , for an attendance on a patient by a consultant physician, means an attendance that:
(a) is a second or subsequent attendance on the patient, in the course of a single course of treatment by the consultant physician, during which it is not necessary for the consultant physician to carry out a physical examination of the patient; and
(b) does not result in a substantial alteration to the treatment of the patient.
closed reduction 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 facility means a separate hospital area that, on a 24‑hour basis:
(a) is equipped and staffed so that it is capable of providing to a patient:
(i) hyperbaric oxygen therapy at a treatment pressure of at least 2.8 atmospheric pressure absolute (180 kilopascal gauge pressure); and
(ii) mechanical ventilation and invasive cardiovascular monitoring within a monoplace or multiplace chamber for the duration of the hyperbaric treatment; and
(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:
(i) is a specialist with training in diving and hyperbaric medicine; or
(ii) holds a Diploma of Diving and Hyperbaric Medicine of the South Pacific Underwater Medicine Society; and
(c) is staffed by:
(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
(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
(d) has admission and discharge policies in operation.
general intensive care unit means a separate hospital area that:
(a) is equipped and staffed so that it is capable of providing to a patient:
(i) mechanical ventilation for a period of several days; and
(ii) invasive cardiovascular monitoring; and
(b) is supported by:
(i) 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
(ii) at all times — at least 1 registered medical practitioner who is present in the hospital and immediately available to that area; and
(iii) at least 18 hours each day — at least 1 registered nurse; and
(c) has admission and discharge policies in operation.
general practitioner means:
(a) a practitioner who is vocationally registered under section 3F of the Act; or
(b) a practitioner who:
(i) is a Fellow of the RACGP; and
(ii) participates in the quality assurance and continuing medical education program of the RACGP; and
(iii) meets the RACGP requirements for quality assurance and continuing education; or
(c) a practitioner in relation to whom a determination is in force under regulation 6DA of the
Health Insurance Regulations 1975 recognising that he or she meets the fellowship standards of the ACRRM; or(d) a practitioner who is undertaking a placement in general practice that is approved by the RACGP:
(i) as part of a training program for general practice leading to the award of Fellowship of the RACGP; or
(ii) as part of another training program recognised by the RACGP as being of an equivalent standard; or
(iii) as part of the Rural and Remote Area Placement Program administered by the Australian College of Rural and Remote Medicine; or
(e) an eligible non‑vocationally recognised medical practitioner; or
(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
(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 theCorporations Act 2001 as General Practice Education and Training Limited (ACN 095 433 140).
immunisation recommended for a 4 year old child means the immunisation recommended for a 4 year old child by the National Immunisation Program Schedule as in effect on 1 July 2007.
Note The National Immunisation Program Schedule can be viewed atmeans a place (other than a hospital or residential aged care facility) at which residential accommodation or day care is, or both residential accommodation and day care are, made available to:
(a) disadvantaged children; or
(b) juvenile offenders; or
(c) aged persons; or
(d) chronically ill psychiatric patients; or
(e) homeless persons; or
(f) unemployed persons; or
(g) persons suffering from alcoholism; or
(h) persons addicted to drugs; or
(i) physically or intellectually disabled persons.
intensive care unit means a general intensive care unit or a neo‑natal intensive care unit.
item means:
(a) an item mentioned, by number, in column 1 of:
(i) Part 3; or
(ii) Part 3 of the diagnostic imaging services table; or
(iii) Part 3 of the pathology services table; and
(b) in a reference immediately followed by a number — the item so numbered.
Example A reference (if any) by number to item 55028 is a reference to the item so numbered in the diagnostic imaging services table.
Note Because of theHealth 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:
(a) is equipped and staffed so that it is capable of providing to a patient who is a newly born child:
(i) mechanical ventilation for a period of several days; and
(ii) invasive cardiovascular monitoring; and
(b) is supported by:
(i) during normal working hours — at least 1 consultant physician in paediatric medicine who is immediately available, and exclusively rostered, to that area; and
(ii) at all times — at least 1 registered medical practitioner who is present in the hospital and immediately available to that area; and
(iii) at least 18 hours each day — at least 1 registered nurse; and
(c) has admission and discharge policies in operation.
open reduction means treatment of a dislocation or fracture by either:
(a) operative exposure, including the use of any internal or external fixation; or
(b) non‑operative (closed) reduction using intra‑medullary fixation or external fixation.
patient’s usual medical practitioner means a medical practitioner:
(a) who has provided the majority of services to the patient in the past 12 months; or
(b) who is likely to provide the majority of services to the patient in the following 12 months; or
(c) located at a medical practice that:
(i) has provided the majority of services to the patient in the past 12 months; or
(ii) is likely to provide the majority of services to the patient in the next 12 months.
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 theHealth Insurance Act 1973.
RACGP means the Royal Australian College of General Practitioners.
referring practitioner , for the referral of a patient, means:
(a) for all referrals — a medical practitioner; and
(b) for a referral made to a specialist who is an ophthalmologist — an optometrist; and
(c) for a referral that arises out of a dental service provided by a dental practitioner and that is made to a specialist (but not a consultant physician) — a dental practitioner; and
(d) for a referral that arises out of a dental service provided by a dental practitioner who is approved by the Minister for the purposes of paragraph (b) of the definition of
professional service in subsection 3 (1) of the Act and that is made to a consultant physician — a dental practitioner.
registered Aboriginal health worker means a person registered as an Aboriginal health worker under theHealth 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 theAged 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.
unsociable hours means between 11 pm and 7 am on any day.
(2) A reference to a
Group in the table includes every item in the Group, and a reference to aSubgroup in the table includes every item in the Subgroup.(3) A reference in the table to an eligible non‑vocationally recognised medical practitioner is a reference to:
(a) a medical practitioner (including an overseas trained practitioner or a temporary resident medical practitioner) who:
(i) is registered as a medical practitioner under the Rural Other Medical Practitioners’ Program; and
(ii) is providing general medical services in accordance with that Program; or
(b) a medical practitioner who:
(i) is registered as a medical practitioner under the Outer Metropolitan (Other Medical Practitioners) Relocation Incentive Program; and
(ii) is providing general medical services in accordance with that Program; and
(iii) is not vocationally registered under section 3F of the Act, but is required under that Program to undertake additional training or other activities:
(A) that could enable vocational registration within 4 years or, on written application, 5 years, after commencing the training or other activities; and
(B) of which the Medicare Australia CEO has written notice; or
(c) a medical practitioner who:
(i) is registered as a medical practitioner under the MedicarePlus for Other Medical Practitioners Program; and
(ii) is providing general medical services in accordance with that Program; and
(iii) is not vocationally registered under section 3F of the Act; or
(d) a medical practitioner who:
(i) is registered as a medical practitioner under the After Hours Other Medical Practitioners Program; and
(ii) is providing general medical services in accordance with that Program; and
(iii) is not vocationally registered under section 3F of the Act.
(4) For subrule (3):
(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(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(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(d) the
After Hours 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.
(1) An item including the symbol
( S ) applies only to a service performed by a specialist (and not to a service performed by a consultant physician) in the practice of his or her specialty, being:
(a) a service that:
(i) is provided to a patient who has been referred to the specialist; and
(ii) is the first service performed by the specialist in accordance with the referral; or
(b) a service that:
(i) is provided to a patient who has been referred to the specialist; and
(ii) is part of a single course of treatment given for the condition identified in the referral or, if no condition was identified in the referral, part of a single course of treatment for the condition identified by the specialist; and
(iii) is provided within the period of validity of the referral that is applicable under regulation 31 of the
Health Insurance Regulations 1975 ; or(c) a service that:
(i) is provided to a patient who has declared that a written referral completed by a named referring practitioner has been lost, stolen or destroyed before the service was provided; and
(ii) is the first service performed by the specialist in accordance with the referral; or
(d) a service that:
(i) is provided to a patient who has not been referred to the specialist; and
(ii) is a service that, in an emergency within the meaning of subregulation 30 (5) of the
Health Insurance Regulations 1975 , the specialist decides is necessary in the patient’s interests to be provided as soon as practicable without a referral.(2) An item including the symbol
( G ) applies only to a service provided otherwise than by a specialist in accordance with subrule (1).
An item including the symbol
( H ) applies only to a service performed or provided in a hospital.
(1) Subrule (2) applies to a general practitioner if:
(a) the practitioner is the subject of a final determination under section 106TA of the Act; and
(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
(c) the determination specifies the practitioner is disqualified in respect of a service described in an item in Group A1.
(2) If, while the determination is in force, the general practitioner provides a service described in an item in Group A2 or in item 598 or 600 in Group A11, that item applies to the service in accordance with the determination.
(1) For items 448, 449, 597, 598, 599 and 600,
a patient’s medical condition requires urgent treatment if:
(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
(b) treatment could not be delayed until the start of the next in‑hours period.
(2) For subrule (1), medical opinion is to a particular effect if:
(a) the attending practitioner is of that opinion; and
(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) For items 448, 449, 597, 598, 599 and 600:
responsible person , for a patient:
(a) includes a spouse, parent, carer or guardian of the patient; and
(b) does not include:
(i) the attending medical practitioner; or
(ii) an employee of the attending medical practitioner; or
(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
(iv) a call centre; or
(v) a reception service.
Items 448 and 449 do not apply to a service provided by a medical practitioner if the practitioner:
(a) routinely provides services to patients in after-hours periods at consulting rooms; or
(b) 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.
Items 597 to 600 do not apply to a service provided by a medical practitioner if:
(a) the service is provided at consulting rooms; and
(b) the practitioner:
(i) routinely provides services to patients in after‑hours periods at consulting rooms; or
(ii) 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.
(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, 6015, 16401 and 16404,
single course of treatment , in relation to a patient, includes:
(a) the initial attendance on the patient by a specialist or consultant physician; and
(b) the continuing management or treatment up to and including the stage when the patient is referred back to the care of the referring practitioner; and
(c) any subsequent review of the patient’s condition by the specialist or consultant physician that may be necessary, whether the review is initiated by the referring practitioner or 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 theHealth Insurance Regulations 1975 , initiates a new course of treatment if:
(a) the referring practitioner considers the later attendance necessary for the patient’s condition to be reviewed; and
(b) the patient was most recently attended by the specialist or consultant physician more than 9 months before the later attendance.
(1)In items 3 to 96, 104 to 338, 348 to 388, 410 to 417, 501 to 536, 597 to 600, 700 to 779, 900 to 903, 2501 to 2727, 2801 to 2840, 3005 to 3028, 5000 to 5267, 6007 to 6015, 10900 to 10929, 16401, 16404, 16590, 16591 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:
(a) the evaluation of the patient’s condition or conditions including, if applicable, evaluation using a health screening service mentioned in subsection 19 (5) of the Act;
(b) the formulation of a plan for the management and, if applicable, for the treatment of the patient’s condition or conditions;
(c) the provision of advice to the patient about the patient’s condition or conditions and, if applicable, about treatment;
(d) if authorised by the patient, the provision of advice to another person, or other persons, about the patient’s condition or conditions and, if applicable, about treatment;
(e) the provision of appropriate preventive health care;
(f) the recording of the clinical details of the service or services provided to the patient.
(2) If:
(a) in connection with a professional attendance mentioned in any of items 3 to 96 and 5000 to 5267, vaccine is supplied to a patient; and
(b) the cost of the vaccine is not subsidised by the Commonwealth or a State;
the professional attendance is taken not to include that supply.
(1) In items 104 to 147, 289 to 388, 2801 to 2840, 3005 to 3028, 6007 to 6015, 16401, 16404, 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:
(a) includes such an attendance on a patient who:
(i) has declared that a written referral of the patient was completed by a medical practitioner; or
(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(b) does not include such an attendance if:
(i) the attendance forms part of a single course of treatment in which the first service was provided more than 12 months (or such other period, if any, set by the referring practitioner in, or in connection with, the referral) before the attendance; and
(ii) a later referral has not been made.
(2) For this rule,
referral means referral by a referring practitioner.
In this table:
amount under rule 11 , for an item mentioned in the following table, means the sum of:
(a) the fee mentioned in column 3 for the item; and
(b) either:
(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
(ii) if more than 6 patients are attended at a single attendance — the amount mentioned in column 5 for the item.
| 4 | The fee for item 3 | $24.50 | $1.80 |
| 20 | The fee for item 3 | $43.25 | $3.10 |
| 24 | The fee for item 23 | $24.05 | $1.80 |
| 35 | The fee for item 23 | $43.25 | $3.10 |
| 37 | The fee for item 36 | $24.05 | $1.80 |
| 43 | The fee for item 36 | $42.30 | $3.10 |
| 47 | The fee for item 44 | $24.05 | $1.80 |
| 51 | The fee for item 44 | $43.25 | $3.10 |
| 58 | $8.50 | $15.50 | $0.70 |
10 | 59, 2610, 2631, 2673 | $16.00 | $17.50 | $0.70 |
11 | 60, 2613, 2633, 2675, 2707 | $35.50 | $15.50 | $0.70 |
12 | 65, 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 | $24.05 | $1.80 |
18 | 414 | The fee for item 410 | $24.05 | $1.80 |
19 | 415 | The fee for item 411 | $24.05 | $1.80 |
20 | 416 | The fee for item 412 | $24.05 | $1.80 |
21 | 417 | The fee for item 413 | $24.05 | $1.80 |
22 | 716 | The fee for item 714 | $24.05 | $1.80 |
23 | 5003 | The fee for item 5000 | $24.05 | $1.80 |
24 | 5010 | The fee for item 5000 | $43.25 | $3.10 |
25 | 5023 | The fee for item 5020 | $24.05 | $1.80 |
26 | 5028 | The fee for item 5020 | $43.25 | $3.10 |
27 | 5043 | The fee for item 5040 | $24.05 | $1.80 |
28 | 5049 | The fee for item 5040 | $43.25 | $3.10 |
29 | 5063 | The fee for item 5060 | $24.05 | $1.80 |
30 | 5067 | The fee for item 5060 | $42.30 | $3.05 |
31 | 5220 | $18.95 | $15.85 | $0.70 |
32 | 5223 | $26.60 | $17.90 | $0.70 |
33 | 5227 | $46.55 | $15.85 | $0.70 |
34 | 5228 | $69.05 | $15.85 | $0.70 |
35 | 5260 | $18.95 | $28.60 | $1.30 |
36 | 5263 | $26.60 | $32.30 | $1.30 |
37 | 5265 | $45.50 | $28.60 | $1.30 |
38 | 5267 | $67.50 | $28.60 | $1.30 |
(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, except for items 160 to 164, which may be provided by 1 or more medical practitioners.
(2) The items are items3 to 96, 104 to 147, 173 to 338, 348 to 536, 597 to 600, 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.
(2A) For items 160 to 164:
(a) if the personal attendance is not continuous, the occasion on which the service is provided is taken to be the total time of the attendance; and
(b) subject to paragraph (a), if personal attendance on a single patient is provided by 1 or more medical practitioners concurrently, each practitioner may claim an attendance fee.
(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 723, 732, 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:
(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;
(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.
(1) The items mentioned in subrule (3) apply only to a service provided in the course of a personal attendance by:
(a) a medical practitioner (other than a medical practitioner employed by the proprietor of a hospital that is not a private hospital); or
(b) a medical practitioner who:
(i) is employed by the proprietor of a hospital that is not a private hospital; and
(ii) provides the service otherwise than in the course of employment by that proprietor.
(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) The items are items 1 to 723, 732, 900 to 2677, 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, 16590, 16591 and 16600 to 51318.
(4) For this rule, each of the following is taken to be personal attendance by the medical practitioner on a patient:
(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;
(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.
For items 193, 195, 197 and 199, a person is a
qualified medical acupuncturist if:
(a) the person is a general practitioner; and
(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.
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.
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:
(a) evaluation and assessment of a patient’s rehabilitation requirements when, in the consultant’s opinion, the patient has an accepted medical condition that:
(i) may be affected by the patient’s working environment; or
(ii) affects the patient’s capacity to be employed;
(b) management of an accepted medical condition that, in the consultant’s opinion, may affect a patient’s capacity for continued employment, or return to employment, following a non‑compensable accident, injury or ill‑health;
(c) evaluation and forming an opinion, including management as the case requires, of a patient’s medical condition when causation may be related to acute or chronic exposure to scientifically acknowledged environmental hazards or toxins.
Items 410 to 417 apply to an attendance on a patient by a public health physician only if the attendance relates to 1 or more of the following matters:
(a) management of a patient’s vaccination requirements for immunisation programs;
(b) prevention or management of sexually transmitted disease;
(c) prevention or management of disease caused by scientifically accepted environmental hazards or toxins;
(d) prevention or management of infection arising from an outbreak of an infectious disease;
(e) prevention or management of an exotic disease.
Note An exotic disease is medically accepted as a disease that is of foreign origin.
(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) 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.
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:
(a) immediate and rapid assessment; and
(b) initiation of resuscitation and electronic monitoring of vital signs; and
(c) taking a comprehensive history and evaluation while undertaking resuscitative measures; and
(d) ordering and evaluation of appropriate investigations; and
(e) transitional evaluation and monitoring; and
(f) formulation and documentation of a diagnosis and management plan in relation to 1 or more problems; and
(g) initiation of appropriate treatment interventions; and
(h) liaison with relevant health care professionals and discussion with, as appropriate, the patient or the patient’s relatives or agent.
(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) 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.
(1) The following health assessments may be performed under items 701, 703, 705 and 707:
(a) aHealthy Kids Check, in accordance with rule 21, for a patient if the patient is:
(i) at least 3 years old and under 5 years old; and
(ii) receiving or has received the immunisation recommended for a 4 year old child; and
(iii) not an in‑patient of a hospital;
(b) aType 2 Diabetes Risk Evaluation, in accordance with rule 22, for a patient if the patient:
(i) is at least 40 years old and under 50 years old; and
(ii) has a high risk of developing type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool; and
(iii) is not an in‑patient of a hospital;
(c) a 45 year old Health Assessment, in accordance with rule 23, for a patient if the patient is:
(i) at least 45 years old and under 50 years old; and
(ii) at risk of developing a chronic disease; and
(iii) not an in‑patient of a hospital or a care recipient in a residential aged care facility;
(d) an Older Person’s Health Assessment, in accordance with rule 24, for a patient if the patient is:
(i) at least 75 years old; and
(ii) not an in‑patient of a hospital or a care recipient in a residential aged care facility;
(e) a Comprehensive Medical Assessment, in accordance with rule 24A, for a patient if the patient is a permanent resident of a residential aged care facility;
(f) a health assessment, in accordance with rule 25, for a person with an intellectual disability, if the patient is not an in‑patient of a hospital or a care recipient in a residential aged care facility;
(g) a health assessment, in accordance with rule 26, for a patient if the patient is a refugee or humanitarian entrant, with eligibility for Medicare, and the person:
(i) either:
(A) holds a relevant visa that the person has held for less than 12 months at the time of the assessment; or
(B) first entered Australia less than 12 months before the assessment is performed; and
(ii) is not an in‑patient of a hospital or a care recipient in a residential aged care facility.
Note The Australian Type 2 Diabetes Risk Assessment Tool can be viewed atthis rule:
relevant visa means any of the following visas granted under theMigration Act 1958 :
(a) Subclass 070 Bridging (Removal Pending) visa;
(b) Subclass 200 (Refugee) visa;
(c) Subclass 201 (In-country Special Humanitarian) visa;
(d) Subclass 202 (Global Special Humanitarian) visa;
(e) Subclass 203 (Emergency Rescue) visa;
(f) Subclass 204 (Woman at Risk) visa;
(g) Subclass 695 (Return Pending) visa;
(h) Subclass 786 (Temporary (Humanitarian Concern)) visa;
(i) Subclass 866 (Protection) visa.
(1) The following health assessments may be performed under item 715:
(a) an Aboriginal and Torres Strait Islander child health assessment, in accordance with rule 27, for a patient if the patient is:
(i) of Aboriginal or Torres Strait Islander descent; and
(ii) under 15 years old; and
(iii) not an in‑patient of a hospital;
(b) an Aboriginal and Torres Strait Islander adult health assessment, in accordance with rule 27A, for a patient if the patient is:
(i) of Aboriginal or Torres Strait Islander descent; and
(ii) at least 15 years old and under 55 years old; and
(iii) not an in‑patient of a hospital or a care recipient in a residential aged care facility;
(c) an Aboriginal and Torres Strait Islander Older Person’s Health Assessment, in accordance with rule 27B, for a patient if the patient is:
(i) of Aboriginal or Torres Strait Islander descent; and
(ii) at least 55 years old; and
(iii) not an in‑patient of a hospital or a care recipient in a residential aged care facility.
(2) For this rule and item 715, a person is of Aboriginal or Torres Strait Islander descent if the person identifies himself or herself as being of that descent.
(1) A Healthy Kids Check is the assessment of:
(a) a patient’s physical health, general wellbeing and development; and
(b) whether any medical intervention is required for the patient.
(2) The following may perform a Healthy Kids Check:
(a) a medical practitioner (including a general practitioner);
(b) a practice nurse or a registered Aboriginal health worker on behalf, and under the supervision, of a medical practitioner.
(3) If a practice nurse or a registered Aboriginal health worker performs a Healthy Kids Check for a patient and identifies any problems, the patient must be reviewed by the patient’s usual medical practitioner, who must arrange referrals and follow‑up services as required.
(4) A Healthy Kids Check for a patient must include the following basic physical examinations and assessments:
(a) measurement of the patient’s height and weight to calculate the patient’s body mass index and position on the growth curve;
(b) eyesight;
(c) hearing;
(d) oral health (teeth and gums);
(e) toileting;
(f) allergies.
(5) A Healthy Kids Check for a patient must also include:
(a) information collection, including taking a patient history and performing examinations and investigations, as required; and
(b) making an overall assessment of the patient; and
(c) initiating interventions or referrals, as appropriate; and
(d) giving health advice and information to the patient’s parent or carer, using the
Get Set 4 Life — habits for healthy kids guide.
Note TheGet Set 4 Life — habits for health kids guide can be viewed atperson performing a Healthy Kids Check must:
(a) note if a copy of the guide mentioned in paragraph (5) (d) has been given to the patient’s parent or carer; and
(b) record evidence that the immunisation recommended for a 4 year old child has been given to the patient.
(7) The immunisation recommended for a 4 year old child may be given to a patient when he or she has a Healthy Kids Check, and may be claimed separately.
(8) The Healthy Kids Check must not be provided more than once to an eligible person.
22 Type 2 Diabetes Risk Evaluation
(1) A Type 2 Diabetes Risk Evaluation must include:
(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
(b) initiating interventions, if appropriate, to address risk factors or to exclude diabetes.
Note The Australian Type 2 Diabetes Risk Assessment Tool can be viewed atType 2 Diabetes Risk Evaluation for a patient must also include:
(a) assessing the patient’s high risk score as determined by the Australian Type 2 Diabetes Risk Assessment Tool (to be completed by the patient within 3 months before performing the Type 2 Diabetes Risk Evaluation); and
(b) updating the patient’s history and performing physical examinations and clinical investigations; and
Note Guidelines for examination and assessment include the Royal Australian College of Surgeons publications‘Putting Prevention into Practice’ and‘Guidelines for Preventive Activities in General Practice’. These documents can be viewed atan overall assessment of the patient’s risk factors and the results of examinations and investigations; and (d) initiating interventions, if appropriate, including referrals and follow‑up services relating to the management of any risk factors identified; and
(e) giving the patient advice and information, including strategies to achieve lifestyle and behaviour changes if appropriate.
(3) A Type 2 Diabetes Risk Evaluation must not be provided more than once every 3 years to an eligible person.
(4) In this rule:
risk factors includes:
(a) lifestyle risk factors (for example smoking, physical inactivity or poor nutrition); and
(b) biomedical risk factors (for example high blood pressure, impaired glucose metabolism or excess weight); and
(c) a family history of a chronic disease.
(1) A 45 year old Health Assessment is an assessment for a patient if the patient, in the clinical judgment of the attending medical practitioner based on the identification of a specific risk factor, is at risk of developing a chronic disease.
(2) The 45 year old Health Assessment must include:
(a) information collection, including taking a patient’s history and performing examinations and investigations, as required; and
(b) making an overall assessment of the patient; and
(c) initiating interventions or referrals, as appropriate; and
(d) giving health advice and information to the patient.
(3) The medical practitioner providing the assessment is responsible for the overall health assessment of the patient.
(4) A 45 year old Health Assessment must not be given more than once to an eligible person.
(5) In this rule:
chronic disease means a disease that has been, or is likely to be, present for at least 6 months, including asthma, cancer, cardiovascular illness, diabetes mellitus, a mental health condition, arthritis or a musculoskeletal condition.
specific risk factors includes:
(a) lifestyle risk factors (for example smoking, physical inactivity, poor nutrition or alcohol misuse); and
(b) biomedical risk factors (for example high cholesterol, high blood pressure, impaired glucose metabolism or excess weight); and
(c) a family history of a chronic disease.
(1) An Older Person’s Health Assessment is the assessment of:
(a) a patient’s health and physical, psychological and social function; and
(b) whether preventive health care and education should be offered to the patient, to improve the patient’s health and physical, psychological and social function.
(2) An Older Person’s Health Assessment must include:
(a) personal attendance by a medical practitioner; and
(b) measurement of the patient’s blood pressure, pulse rate and rhythm; and
(c) assessment of the patient’s medication; and
(d) assessment of the patient’s continence; and
(e) assessment of the patient’s immunisation status for influenza, tetanus and pneumococcus; and
(f) 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; and
(g) assessment of the patient’s psychological function, including the patient’s cognition and mood; and
(h) assessment of the patient’s social function, including:
(i) the availability and adequacy of paid, and unpaid, help; and
(ii) whether the patient is responsible for caring for another person.
(3) An Older Person’s Health Assessment must also include:
(a) keeping a record of the health assessment; and
(b) offering the patient a written report on the health assessment, with recommendations about matters covered by the health assessment; and
(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.
(4) An Older Person’s Health Assessment must not be provided more than once every 12 months to an eligible person.
(1) A Comprehensive Medical Assessmentof a permanent resident of a residential aged care facility includes an assessment of the resident’s health and physical and psychological function.
(2) A Comprehensive Medical Assessment must include:
(a) a personal attendance by a medical practitioner; and
(b) taking a detailed patient history of the resident; and
(c) conducting a comprehensive medical examination of the resident; and
(d) developing a list of diagnoses and medical problems based on the medical history and examination; and
(e) giving a written copy of a summary of the outcomes of the assessment to the residential aged care facility for the resident’s medical records.
(3) A Comprehensive Medical Assessment must also include:
(a) making a written summary of the Comprehensive Medical Assessment; and
(b) giving a copy of the summary to the residential aged care facility; and
(c) offering the resident a copy of the summary.
(4) A Comprehensive Medical Assessment may be provided:
(a) on admission to a residential aged care facility, if a Comprehensive Medical Assessment has not already been provided in another residential aged care facility in the last 12 months; and
(b) at 12 month intervals after that assessment.
(5) A Comprehensive Medical Assessment may be performed in conjunction with a consultation for another purpose, but must be claimed separately.
(1) A health assessment for a person with an intellectual disability is an assessment of:
(a) the patient’s physical, psychological and social function; and
(b) whether any medical intervention and preventive health care is required.
(2) The health assessment for a person with an intellectual disability must include the following matters to the extent that they are relevant to the patient:
(a) checking dental health (including dentition);
(b) conducting an aural examination (including arranging a formal audiometry if an audiometry has not been conducted within the last 5 years);
(c) assessing ocular health (arrange review by an ophthalmologist or optometrist if a comprehensive eye examination has not been conducted within the last 5 years);
(d) assessing nutritional status (including weight and height measurements) and a review of growth and development;
(e) assessing bowel and bladder function (particularly for incontinence or chronic constipation);
(f) assessing medications including:
(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
(ii) advice to carers on the common side-effects and interactions; and
(iii) consideration of the need for a formal medication review;
(g) checking immunisation status (including influenza, tetanus, hepatitis A and B, measles, mumps, rubella and pneumococcal vaccinations) with reference to the Australian Immunisation Handbook, for appropriate vaccination schedules;
Note The Australian Immunisation Handbook can be viewed atexercise opportunities (with the aim of moderate exercise for at least 30 minutes each day); (i) checking whether the support provided for activities of daily living adequately and appropriately meets the patient’s needs, and considering formal review if required;
(j) considering the need for breast examination, mammography, papanicolaou smears, testicular examination, lipid measurement and prostate assessment as for the general population;
(k) checking for dysphagia and gastro‑oesophageal disease (especially for patients with cerebral palsy) and arranging for investigation or treatment as required;
(l) assessing risk factors for osteoporosis (including diet, exercise, Vitamin D deficiency, hormonal status, family history, medication and fracture history) and arranging for investigation or treatment as required;
(m) for a patient diagnosed with epilepsy — reviewing seizure control (including anticonvulsant drugs) and considering referral to a neurologist at appropriate intervals;
(n) screening for thyroid disease at least every 2 years (or yearly for patients with Down syndrome);
(o) for a patient without a definitive aetiological diagnosis — considering referral to a genetic clinic every 5 years;
(p) assessing or reviewing treatment for co-morbid mental health issues;
(q) considering timing of puberty and management of sexual development, sexual activity and reproductive health;
(r) considering whether there are any signs of physical, psychological or sexual abuse.
(3) A health assessment for a person with an intellectual disability must also include:
(a) keeping a record of the health assessment; and
(b) offering the patient a written report on the health assessment; and
(c) offering the patient’s carer (if any, and if the medical practitioner considers it appropriate and the patient agrees) a copy of the report or extracts of the report; and
(d) offering relevant disability professionals (if the medical 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.
(4) A health assessment for a person with an intellectual disability must not be provided more than once every 12 months to an eligible person.
(1) A health assessment for a refugee or other humanitarian entrantis the assessment of:
(a) the patient’s health and physical, psychological and social function; and
(b) whether preventive health care and education should be offered to the patient to improve their health and physical, psychological or social function.
(2) A health assessment for a refugee or other humanitarian entrant must include:
(a) a personal attendance by a medical practitioner; and
(b) taking the patient’s history; and
(c) examining the patient; and
(d) performing or arranging any required investigations; and
(e) assessing the patient, using the information gained in paragraphs (b), (c) and (d); and
(f) developing a management plan addressing the patient’s health care needs, health problems and relevant conditions; and
(g) making or arranging any necessary interventions and referrals.
(3) A health assessment for a refugee or other humanitarian entrant must also include:
(a) keeping a record of the health assessment; and
(b) offering to provide the patient with a written report of the health assessment.
(4) A health assessment for a refugee or other humanitarian entrantmust not be provided to a patient more than once.
(1) An Aboriginal and Torres Strait Islander child health assessment is the assessment of:
(a) a patient’s health and physical, psychological and social function; and
(b) whether preventive 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) An Aboriginal and Torres Strait Islander child health assessment must include:
(a) a personal attendance by a medical practitioner; and
(b) taking the patient’s history, including the following:
(i) mother’s pregnancy history;
(ii) birth and neo‑natal history;
(iii) breastfeeding history;
(iv) weaning, food access and dietary history;
(v) physical activity engaged in;
(vi) previous presentations, hospital admissions and medication use;
(vii) relevant family medical history;
(viii) immunisation status;
(ix) vision and hearing (including neo-natal hearing screening);
(x) development (including achievement of age‑appropriate milestones);
(xi) family relationships, social circumstances and whether the person is cared for by another person;
(xii) exposure to environmental factors (including tobacco smoke);
(xiii) environmental and living conditions;
(xiv) educational progress;
(xv) stressful life events experienced;
(xvi) mood (including incidence of depression and risk of self‑harm);
(xvii) substance use;
(xviii) sexual and reproductive health;
(xix) dental hygiene (including access to dental services); and
(c) examination of the patient, including the following:
(i) measurement of the patient’s height and weight to calculate the patient’s body mass index and position on the growth curve;
(ii) newborn baby check (if not previously completed);
(iii) vision (including red reflex in a newborn);
(iv) ear examination (including otoscopy);
(v) oral examination (including gums and dentition);
(vi) trachoma check, if indicated;
(vii) skin examination, if indicated;
(viii) respiratory examination, if indicated;
(ix) cardiac auscultation, if indicated;
(x) development assessment, to determine whether age‑appropriate milestones have been achieved, if indicated;
(xi) assessment of parent and child interaction, if indicated;
(xii) other examinations in accordance with national or regional guidelines or specific regional needs, or as indicated by a previous child health assessment; and
(d) performing or arranging any required investigation, in particular considering the need for the following tests:
(i) haemoglobin testing for those at a high risk of anaemia;
(ii) audiometry, especially for school age children; and
(e) assessing the patient using the information gained in the child health assessment; and
(f) making or arranging any necessary interventions and referrals, and documenting a strategy for the good health of the patient; and
(g) both:
(i) keeping a record of the health assessment; and
(ii) offering the patient, or the patient’s parent or carer, a written report on the health assessment, with recommendations on matters covered by the health assessment (including a strategy for the good health of the patient).
(1) An Aboriginal and Torres Strait Islander adult health assessment is the assessment of:
(a) a patient’s health and physical, psychological and social function; and
(b) whether preventive health care, education and other assistance should be offered to the patient to improve their health and physical, psychological or social function.
(2) An Aboriginal and Torres Strait Islander adult health assessment must include:
(a) personal attendance by a medical practitioner; and
(b) taking the patient’s history, including the following:
(i) current health problems and risk factors;
(ii) relevant family medical history;
(iii) medication use (including medication obtained without prescription or from other doctors);
(iv) immunisation status, by reference to the appropriate current age and sex immunisation schedule;
(v) sexual and reproductive health;
(vi) physical activity, nutrition and alcohol, tobacco or other substance use;
(vii) hearing loss;
(viii) mood (including incidence of depression and risk of self‑harm);
(ix) family relationships and whether the patient is a carer, or is cared for by another person; and
(c) examination of the patient, including the following:
(i) measurement of the patient’s blood pressure, pulse rate and rhythm;
(ii) measurement of height and weight to calculate the patient’s body mass index and, if indicated, measurement of waist circumference for central obesity;
(iii) oral examination (including gums and dentition);
(iv) ear and hearing examination (including otoscopy and, if indicated, a whisper test);
(v) urinalysis (by dipstick) for proteinurea; and
(d) performing or arranging any required investigation, in particular considering the need for the following tests (in accordance with national or regional guidelines or specific regional needs):
(i) fasting blood sugar and lipids (by laboratory-based test on venous sample) or, if necessary, random blood glucose levels;
(ii) papanicolaou smear;
(iii) examination for sexually transmitted infection (by urine or endocervical swab for chlamydia and gonorrhoea, especially for those 15 to 35 years old);
(iv) mammography, if eligible (by scheduling appointments with visiting services or facilitating direct referral); and
(e) assessing the patient using the information gained in the health assessment; and
(f) making or arranging any necessary interventions and referrals, and documenting a simple strategy for the good health of the patient.
(3) An Aboriginal and Torres Strait Islander adult health assessment must also include:
(a) keeping a record of the health assessment; and
(b) offering the patient a written report on the health assessment, with recommendations on matters covered by the health assessment (including a simple strategy for the good health of the patient).
(1) An Aboriginal and Torres Strait Islander Older Person’s Health Assessment is the assessment of:
(a) a patient’s health and physical, psychological and social function; and
(b) whether preventive health care and education should be offered to the patient, to improve the patient’s health and physical, psychological or social function.
(2) An Aboriginal and Torres Strait Islander Older Person’s Health Assessment must include:
(a) personal attendance by a medical practitioner; and
(b) measurement of the patient’s blood pressure, pulse rate and rhythm; and
(c) assessment of the patient’s medication; and
(d) assessment of the patient’s continence; and
(e) assessment of the patient’s immunisation status for influenza, tetanus and pneumococcus; and
(f) 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; and
(g) assessment of the patient’s psychological function, including the patient’s cognition and mood; and
(h) assessment of the patient’s social function, including:
(i) the availability and adequacy of paid, and unpaid, help; and
(ii) whether the patient is responsible for caring for another person.
(3) An Aboriginal and Torres Strait Islander Older Person’s Health Assessment must also include:
(a) keeping a record of the health assessment; and
(b) offering the patient a written report on the health assessment, with recommendations on matters covered by the health assessment; and
(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.
(1) A health assessment mentioned in rules 20 and 20A must not include a health screening service.
(2) A separate consultation must not be performed in conjunction with a health assessment, unless clinically necessary.
(3) A health assessment must be performed by the patient’s usual medical practitioner, if reasonably practicable.
(4) Practice nurses and registered Aboriginal health workers may assist medical practitioners in performing a health assessment, in accordance with accepted medical practice, and under the supervision of the medical practitioner.
(5) For subrule (4), assistance may include activities associated with:
(a) information collection, and
(b) at the direction of the medical practitioner — provision to patients of information on recommended interventions.
(6) In this rule:
health screening service has the same meaning as in subsection 19 (5) of the Act.
(1) This rule applies to the performances of services for a patient for whom exceptional circumstances do not exist.
(2) Items 721, 723, 729, 731 and 732 apply in the circumstances mentioned in the following table.
| 721 |
|
| 723 |
|
| 729 |
|
|
| 731 |
|
| 732 | Each service may be performed:
|
(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.
(1) For item 721, preparation of a
GP management plan means the preparation of a comprehensive written plan describing all of the following matters:
(a) the patient’s health care needs, health problems and relevant conditions;
(b) management goals with which the patient agrees;
(c) actions to be taken by the patient;
(d) treatment and services the patient is likely to need;
(e) arrangements for providing the treatment and services mentioned in paragraph (d);
(f) arrangements to review the plan by a day specified in the plan.
(2) Preparation of the plan also includes:
(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
(b) recording the plan; and
(c) recording the patient’s agreement to the preparation of the plan; and
(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
(e) adding a copy of the plan to the patient’s medical records.
(1) For item 723, co‑ordinating the development of
team care arrangements means a process by which the medical practitioner:
(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
(b) prepares a document that describes all of the matters specified in subrule (2); and
(c) undertakes all of the activities specified in subrule (3).
(2) The matters to be described for paragraph (1) (b) are:
(a) treatment and service goals for the patient; and
(b) treatment and services that collaborating providers will provide to the patient; and
(c) actions to be taken by the patient; and
(d) arrangements to review the matters mentioned in paragraphs (a), (b) and (c) by a day specified in the document.
(3) The activities to be undertaken for paragraph (1) (c) are:
(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
(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
(c) recording the patient’s agreement to the development of team care arrangements; and
(d) giving copies of the relevant parts of the document to the collaborating providers; and
(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
(f) adding a copy of the document to the patient’s medical records.
(4) In this rule:
collaborating provider is a person who:
(a) provides treatment or a service to a patient; and
(b) is not a family carer of the patient.
family carer includes a person who:
(a) is a relative or friend of the patient; and
(b) is providing care to the patient other than as a paid service.
(1) For items 732 and 2712, 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) In subrule (1):
general practice means a business, consisting of 1 or more medical practitioners, that provides a general practice of medical services.
(1) For item 732, a review of a GP management plan is a process by which the medical practitioner:
(a) reviews the matters mentioned in subrule 30 (1); and
(b) if different arrangements need to be made, makes amendments to the plan that:
(i) state the new arrangements; and
(ii) provide for a further review of the amended plan by a date stated in the plan.
(2) Review of the plan also includes:
(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
(b) recording the patient’s agreement to the review of the plan; and
(c) if amendments are made to the plan:
(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
(ii) adding a copy of the amended plan to the patient’s medical records.
(1) For item 732, co‑ordinating a reviewof a GP management plan or of team care arrangements is a process by which the medical practitioner:
(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 30 (1) and subrule 32 (2), as applicable; and
(b) if different arrangements need to be made, makes amendments to the plan, or to the document mentioned in paragraph 32 (1) (b), that:
(i) state the new arrangements; and
(ii) provide for the review of the amended plan or document by a date stated in the plan or document.
(2) Co‑ordinating a review of team care arrangements or of a multidisciplinary care plan also includes:
(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
(b) recording the patient’s agreement to the review of the team care arrangements or the plan; and
(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
(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
(e) adding a copy of the amended document or plan to the patient’s medical records.
(3) In this rule:
collaborating provider is a person who:
(a) provides treatment or a service to a patient; and
(b) is not a family carer of the patient.
family carer includes a person who:
(a) is a relative or friend of the patient; and
(b) is providing care to the patient other than as a paid service.
(1) For items 729 and 731, to
contribute to a multidisciplinary care plan or to the review of a plan includes:
(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
(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) In items 729 and 731 and subrule (1):
multidisciplinary care plan means a written plan that:
(a) is prepared for a patient by:
(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
(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
(b) describes, at least, treatment and services to be provided to the patient by the collaborating providers.
(3) In this rule:
collaborating provider :
(a) is a person who:
(i) provides treatment or a service to a patient; and
(ii) is not a
family carer of the patient; and(b) includes a medical practitioner.
family carer includes a person who:
(a) is a relative or friend of the patient; and
(b) is providing care to the patient other than as a paid service.
(1) Items 729 to 866 apply only to a service provided by:
(a) a medical practitioner (other than a medical practitioner employed by the proprietor of a hospital that is not a private hospital); or
(b) a medical practitioner who:
(i) is employed by the proprietor of a hospital that is not a private hospital; and
(ii) provides the service otherwise than in the course of employment by that proprietor.
(2) Paragraph (1) (b) applies whether or not another person provides essential assistance to the medical practitioner in accordance with accepted medical practice.
(1) An item in this table mentioned in the following table applies only to a service for a patient who:
(a) suffers from at least 1 medical condition that:
(i) has been (or is likely to be) present for at least 6 months; or
(ii) is terminal; and
(b) is described in column 3 of the following table.
| 721 and 732 (if the service is for the creation or review of a GP management plan) | The patient:
|
| 723 and 732 (if the service is for the creation or review of team care arrangements) | The patient:
|
| 729 | The patient:
|
| 731 | The patient:
|
(2) In this rule:
collaborating provider is a person who:
(a) provides treatment or a service to a patient; and
(b) is not a family carer of the patient.
family carer includes a person who:
(a) is a relative or friend of the patient; and
(b) is providing care to the patient other than as a paid service.
For this table, a
multidisciplinary case conference is a process by which a multidisciplinary case conference team (see rule 42) carries out all of the following activities:
(a) discussing a patient’s history;
(b) identifying the patient’s multidisciplinary care needs;
(c) identifying outcomes to be achieved by members of the case conference team giving care and service to the patient;
(d) identifying tasks that need to be undertaken to achieve these outcomes, and allocating those tasks to members of the case conference team;
(e) assessing whether previously identified outcomes (if any) have been achieved.
For items 735, 739, 743, 747, 750 and 758, 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.
For items 735, 739, 743, 747, 750 and 758, 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.
(1) For this table, a multidisciplinary case conference team:
(a) includes a medical practitioner; and
(b) includes at least 2 other members, each of whom provides a different kind of care or service to the patient and is not a family carer of the patient, and 1 of whom may be another medical practitioner; and
(c) may additionally include a family carer of the patient.
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) In subrule (1):
family carer includes a person who:
(a) is a relative or friend of the patient; and
(b) is providing care to the patient other than as a paid service.
(1) For items 735, 739 and 743,
organise and co‑ordinate a multidisciplinary case conference means undertaking all of the following activities in relation to a case conference:
(a) explaining to the patient the nature of a multidisciplinary case conference, and asking the patient whether the patient agrees to the conference taking place;
(b) recording the patient’s agreement to the conference;
(c) recording the day on which the conference was held, and the times at which the conference started and ended;
(d) recording the names of the participants;
(e) recording the matters mentioned in rule 39, and putting a copy of that record in the patient’s medical records;
(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;
(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) For items 747, 750 and 758,
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:
(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;
(b) recording the patient’s agreement to the practitioner’s participation;
(c) recording the day on which the conference was held, and the times at which the conference started and ended;
(d) recording the names of the participants;
(e) recording the matters mentioned in rule 39, and putting a copy of that record in the patient’s medical records.
(3)
Participation in a multidisciplinary case conference does not include organising and co‑ordinating a multidisciplinary case conference.
For item 880,
co‑ordinating a case conference means undertaking all of the following activities in relation to a case conference:
(a) co‑ordinating and facilitating the case conference;
(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;
(c) identifying tasks that need to be undertaken to achieve these outcomes, and allocating those tasks to members of the case conference team;
(d) recording the input of each member and the outcome of the conference.
(1) For item 880, a
case conference team :
(a) includes a specialist, or consultant physician, in the practice of his or her specialty of geriatric or rehabilitation medicine; and
(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
(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) In subrule (1):
family carer includes a person who:
(a) is a relative or friend of the patient; and
(b) is providing care to the patient other than as a paid service.
(1) Item 880 applies only if:
(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
(b) the attendance is on a patient who:
(i) is an admitted patient of a hospital; and
(ii) is not a care recipient in a residential aged care facility; and
(iii) is being provided with 1 of the following types of specialist care:
(A) geriatric evaluation and management;
(B) rehabilitation care.
(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.
For item 900, a patient is
living in a community setting if the patient is not an in‑patient of a hospital or a care recipient in a residential aged care facility.
(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) A medical practitioner’s involvement in a residential medication management review includes all of the following:
(a) discussing the proposed review with the resident and seeking the resident’s consent to the review;
(b) collaborating with the reviewing pharmacist about the pharmacist’s involvement in the review;
(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;
(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:
(i) the findings of the review; and
(ii) medication management strategies; and
(iii) means to ensure that the strategies are implemented and reviewed, including any issues for implementation and follow‑up;
(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) A medical practitioner’s involvement in a residential medication management review also includes:
(a) offering a copy of the medication management plan to the resident (or the resident’s carer or representative if appropriate); and
(b) providing copies of the plan for the resident’s records and for the nursing staff of the residential aged care facility; and
(c) discussing the plan with nursing staff if necessary.
1 049.70 | |||||||||
52180 | Aggressive or potentially malignant bone or deep soft tissue tumour in the oral and maxillofacial region, biopsy of (not including after‑care) (Anaes.) | 177.90 | |||||||
52182 | Bone or malignant deep soft tissue tumour in the oral and maxillofacial region, lesional or marginal excision of (Anaes.) (Assist.) | 391.55 | |||||||
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.) | 578.35 | |||||||
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.) | 711.90 | |||||||
52300 | Single‑stage local flap, where indicated, repair to 1 defect, with skin or mucosa (Anaes.) (Assist.) | 268.75 | |||||||
52303 | Single‑stage local flap, if indicated, repair to 1 defect, with buccal pad of fat (Anaes.) (Assist.) | 383.80 | |||||||
52306 | Single‑stage local flap, if indicated, repair to 1 defect, using temporalis muscle (Anaes.) (Assist.) | 569.35 | |||||||
52309 | Free grafting (mucosa or split skin) of a granulating area (Anaes.) | 193.45 | |||||||
52312 | Free grafting (mucosa, split skin or connective tissue) to 1 defect, including elective dissection (Anaes.) (Assist.) | 268.75 | |||||||
52315 | Free grafting, full thickness, to 1 defect (mucosa or skin) (Anaes.) (Assist.) | 447.75 | |||||||
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.) | 133.50 | |||||||
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.) | 222.55 | |||||||
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.) | 447.75 | |||||||
52324 | Direct flap repair, using tongue, first stage (Anaes.) (Assist.) | 447.75 | |||||||
52327 | Direct flap repair, using tongue, second stage (Anaes.) | 222.15 | |||||||
52330 | Palatal defect (oro‑nasal fistula), plastic closure of, including services to which item 52300, 52303, 52306 or 52324 applies (Anaes.) (Assist.) | 739.00 | |||||||
52333 | Cleft palate, primary repair (Anaes.) (Assist.) | 739.00 | |||||||
52336 | Cleft palate, secondary repair, closure of fistula using local flaps (Anaes.) (Assist.) | 461.95 | |||||||
52337 | Alveolar cleft (congenital) unilateral, grafting of, including plastic closure of associated oro‑nasal fistulae and ridge augmentation (Anaes.) (Assist.) | 1 010.40 | |||||||
52339 | Cleft palate, secondary repair, lengthening procedure (Anaes.) (Assist.) | 526.05 | |||||||
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.) | 913.70 | |||||||
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.) | 1 030.45 | |||||||
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.) | 1 164.45 | |||||||
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.) | 1 307.70 | |||||||
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.) | 1 325.70 | |||||||
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.) | 1 492.50 | |||||||
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.) | 1 522.60 | |||||||
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.) | 1 712.90 | |||||||
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.) | 1 675.00 | |||||||
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.) | 1 883.30 | |||||||
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.) | 1 827.40 | |||||||
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.) | 2 046.85 | |||||||
52378 | Genioplasty including transposition of nerves and vessels and bone grafts taken from the same site (Anaes.) (Assist.) | 707.55 | |||||||
52379 | Face, contour reconstruction of 1 region, using autogenous bone or cartilage graft (Anaes.) (Assist.) | 1 209.25 | |||||||
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.) | 2 059.05 | |||||||
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.) | 2 468.20 | |||||||
52420 | Mandible, fixation by intermaxillary wiring, excluding wiring for obesity | 227.90 | |||||||
52424 | Dermis, dermofat or fascia graft (excluding transfer of fat by injection) in the oral and maxillofacial region (Anaes.) (Assist.) | 447.65 | |||||||
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.) | 1 030.45 | |||||||
52440 | Cleft lip, unilateral — primary repair, 1 stage, without anterior palate repair (Anaes.) (Assist.) | 511.65 | |||||||
52442 | Cleft lip, unilateral — primary repair, 1 stage, with anterior palate repair (Anaes.) (Assist.) | 639.70 | |||||||
52444 | Cleft lip, bilateral — primary repair, 1 stage, without anterior palate repair (Anaes.) (Assist.) | 710.60 | |||||||
52446 | Cleft lip, bilateral — primary repair, 1 stage, with anterior palate repair (Anaes.) (Assist.) | 838.75 | |||||||
52450 | Cleft lip, partial revision, including minor flap revision alignment and adjustment, including revision of minor whistle deformity if performed (Anaes.) | 284.25 | |||||||
52452 | Cleft lip, total revision, including major flap revision, muscle reconstruction and revision of major whistle deformity (Anaes.) (Assist.) | 461.95 | |||||||
52456 | Cleft lip reconstruction using full thickness flap (Abbe or similar), first stage (Anaes.) (Assist.) | 781.90 | |||||||
52458 | Cleft lip reconstruction using full thickness flap (Abbe or similar), second stage (Anaes.) | 284.25 | |||||||
52460 | Velo‑pharyngeal incompetence, pharyngeal flap for, or pharyngoplasty for (Anaes.) | 739.00 | |||||||
52480 | Composite graft (chondro‑cutaneous or chondro‑mucosal) to nose, ear or eyelid (Anaes.) (Assist.) | 474.70 | |||||||
52482 | Macrocheilia or macroglossia, operation for (Anaes.) (Assist.) | 456.75 | |||||||
52484 | Macrostomia, operation for (Anaes.) (Assist.) | 543.70 | |||||||
52600 | Mandibular or palatal exostosis, excision of (Anaes.) (Assist.) | 319.80 | |||||||
52603 | Mylohyoid ridge, reduction of (Anaes.) (Assist.) | 305.65 | |||||||
52606 | Maxillary tuberosity, reduction of (Anaes.) | 233.15 | |||||||
52609 | Papillary hyperplasia of the palate, removal of — less than 5 lesions (Anaes.) (Assist.) | 305.65 | |||||||
52612 | Papillary hyperplasia of the palate, removal of — 5 to 20 lesions (Anaes.) (Assist.) | 383.80 | |||||||
52615 | Papillary hyperplasia of the palate, removal of — more than 20 lesions (Anaes.) (Assist.) | 476.20 | |||||||
52618 | Vestibuloplasty, submucosal or open, including excision of muscle and skin or mucosal graft when performed — unilateral or bilateral (Anaes.) (Assist.) | 554.25 | |||||||
52621 | Floor of mouth lowering (Obwegeser or similar procedure), including excision of muscle and skin or mucosal graft when performed — unilateral (Anaes.) (Assist.) | 554.25 | |||||||
52624 | Alveolar ridge augmentation with bone or alloplast or both — unilateral (Anaes.) (Assist.) | 447.65 | |||||||
52626 | Alveolar ridge augmentation — unilateral, insertion of tissue expanding device into maxillary or mandibular alveolar ridge region for (Anaes.) (Assist.) | 274.55 | |||||||
52627 | Osseo‑integration procedure — extra oral implantation of titanium fixture (Anaes.) (Assist.) | 476.20 | |||||||
52630 | Osseo‑integration procedure — fixation of transcutaneous abutment (Anaes.) | 176.25 | |||||||
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.) | 476.20 | |||||||
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.) | 176.25 | |||||||
52800 | Neurolysis by open operation, without transposition, not being a service associated with a service to which item 52803 applies (Anaes.) (Assist.) | 261.60 | |||||||
52803 | Nerve trunk, internal (interfascicular), neurolysis of, using microsurgical techniques (Anaes.) (Assist.) | 376.65 | |||||||
52806 | Neurectomy, neurotomy or removal of tumour from superficial peripheral nerve (Anaes.) (Assist.) | 261.60 | |||||||
52809 | Neurectomy, neurotomy or removal of tumour from deep peripheral nerve (Anaes.) (Assist.) | 447.75 | |||||||
52812 | Nerve trunk, primary repair of, using microsurgical techniques (Anaes.) (Assist.) | 639.70 | |||||||
52815 | Nerve trunk, secondary repair of, using microsurgical techniques (Anaes.) (Assist.) | 675.15 | |||||||
52818 | Nerve, transposition of (Anaes.) (Assist.) | 447.75 | |||||||
52821 | Nerve graft to nerve trunk (cable graft) including harvesting of nerve graft using microsurgical techniques (Anaes.) (Assist.) | 973.65 | |||||||
52824 | Peripheral branches of the trigeminal nerve, cryosurgery of, for pain relief (Anaes.) (Assist.) | 419.35 | |||||||
52826 | Injection of primary branch of trigeminal nerve with alcohol, cortisone, phenol, or similar substance (Anaes.) | 224.55 | |||||||
52828 | Cutaneous nerve, primary repair of, using microsurgical techniques (Anaes.) (Assist.) | 333.95 | |||||||
52830 | Cutaneous nerve, secondary repair of, using microsurgical techniques (Anaes.) (Assist.) | 440.50 | |||||||
52832 | Cutaneous nerve, nerve graft to, using microsurgical techniques (Anaes.) (Assist.) | 604.15 | |||||||
53000 | Maxillary antrum, proof puncture and lavage of (Anaes.) | 30.75 | |||||||
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.) | 86.90 | |||||||
53004 | Maxillary antrum, lavage of — each attendance at which the procedure is performed, including any associated consultation (Anaes.) | 33.65 | |||||||
53006 | Antrostomy (radical) (Anaes.) (Assist.) | 492.65 | |||||||
53009 | Antrum, intranasal operation on or removal of foreign body from (Anaes.) (Assist.) | 279.45 | |||||||
53012 | Antrum, drainage of, through tooth socket (Anaes.) | 111.10 | |||||||
53015 | Oro‑antral fistula, plastic closure of (Anaes.) (Assist.) | 555.35 | |||||||
53016 | Nasal septum, septoplasty, submucous resection or closure of septal perforation (Anaes.) (Assist.) | 456.75 | |||||||
53017 | Nasal septum, reconstruction of (Anaes.) (Assist.) | 569.75 | |||||||
53019 | Maxillary sinus, bone graft to floor of maxillary sinus following elevation of mucosal lining (sinus lift procedure), unilateral (Anaes.) (Assist.) | 548.95 | |||||||
53052 | Post‑nasal space, direct examination of, with or without biopsy (Anaes.) | 116.10 | |||||||
53054 | Nasendoscopy or sinoscopy or fibreoptic examination of nasopharynx — 1 or more of these procedures (Anaes.) | 116.10 | |||||||
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.) | 68.00 | |||||||
53058 | Nasal haemorrhage, posterior, arrest of, with posterior nasal packing with or without cauterisation and with or without anterior pack (excluding after‑care) (Anaes.) | 116.10 | |||||||
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.) | 95.00 | |||||||
53062 | Post‑surgical nasal haemorrhage, arrest of during an episode of epistaxis by cauterisation or nasal cavity packing or both (Anaes.) | 85.00 | |||||||
53064 | Cryotherapy to nose in the treatment of nasal haemorrhage (Anaes.) | 154.00 | |||||||
53068 | Turbinectomy or turbinectomies, partial or total, unilateral (Anaes.) | 129.00 | |||||||
53070 | Turbinates, submucous resection of, unilateral (Anaes.) | 168.25 | |||||||
53200 | Mandible, treatment of a dislocation of, not requiring open reduction(Anaes.) | 66.80 | |||||||
53203 | Mandible, treatment of a dislocation of, requiring open reduction (Anaes.) | 112.20 | |||||||
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.) | 135.10 | |||||||
53209 | Glenoid fossa, zygomatic arch and temporal bone, reconstruction of (Obwegeser technique) (Anaes.) (Assist.) | 1 558.55 | |||||||
53212 | Absent condyle and ascending ramus in hemifacial microsomia, construction of, not including harvesting of graft material (Anaes.) (Assist.) | 841.95 | |||||||
53215 | Temporomandibular joint, arthroscopy of, with or without biopsy, not being a service associated with any other arthroscopic procedure of that joint (Anaes.) (Assist.) | 386.30 | |||||||
53218 | Temporomandibular joint, arthroscopy of, removal of loose bodies, debridement, or treatment of adhesions — 1 or more of such procedures (Anaes.) (Assist.) | 617.90 | |||||||
53220 | Temporomandibular joint, arthrotomy of, not being a service to which another item in this group applies (Anaes.) (Assist.) | 311.50 | |||||||
53221 | Temporomandibular joint, open surgical exploration of, with or without microsurgical techniques (Anaes.) (Assist.) | 824.40 | |||||||
53224 | Temporomandibular joint, open surgical exploration of, with condylectomy or condylotomy, with or without microsurgical techniques (Anaes.) (Assist.) | 913.90 | |||||||
53225 | Arthrocentesis, irrigation of temporomandibular joint after insertion of 2 cannuli into the appropriate joint space (Anaes.) (Assist.) | 274.55 | |||||||
53226 | Temporomandibular joint, synovectomy of, not being a service to which another item in this group applies (Anaes.) (Assist.) | 295.20 | |||||||
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.) | 1 123.00 | |||||||
53230 | Temporomandibular joint, open surgical exploration of, with meniscus, capsular and condylar head surgery, with or without microsurgical techniques (Anaes.) (Assist.) | 1 265.00 | |||||||
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.) | 1 421.45 | |||||||
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.) | 444.85 | |||||||
53239 | Temporomandibular joint, arthrodesis of, not being a service to which another item in this group applies (Anaes.) (Assist.) | 444.85 | |||||||
53242 | Temporomandibular joint or joints, application of external fixator to, other than for treatment of fractures (Anaes.) (Assist.) | 295.20 | |||||||
53400 | Maxilla, unilateral or bilateral, treatment of fracture of, not requiring splinting | 122.10 | |||||||
53403 | Mandible, treatment of fracture of, not requiring splinting | 149.15 | |||||||
53406 | Maxilla, treatment of fracture of, requiring splinting, wiring of teeth, circumosseous fixation or external fixation (Anaes.) (Assist.) | 384.35 | |||||||
53409 | Mandible, treatment of fracture of, requiring splinting, wiring of teeth, circumosseous fixation or external fixation (Anaes.) (Assist.) | 384.35 | |||||||
53410 | Zygomatic bone, treatment of fracture of, not requiring surgical reduction | 80.95 | |||||||
53411 | Zygomatic bone, treatment of fracture of, requiring surgical reduction, by temporal, intra‑oral or other approach (Anaes.) | 225.70 | |||||||
53412 | Zygomatic bone, treatment of fracture of, requiring surgical reduction and involving internal or external fixation at 1 site (Anaes.) (Assist.) | 370.60 | |||||||
53413 | Zygomatic bone, treatment of fracture of, requiring surgical reduction and involving internal or external fixation or both at 2 sites (Anaes.) (Assist.) | 454.00 | |||||||
53414 | Zygomatic bone, treatment of, requiring surgical reduction and involving internal or external fixation or both at 3 sites (Anaes.) (Assist.) | 521.55 | |||||||
53415 | Maxilla, treatment of fracture of, requiring open reduction (Anaes.) (Assist.) | 411.75 | |||||||
53416 | Mandible, treatment of fracture of, requiring open reduction (Anaes.) (Assist.) | 411.75 | |||||||
53418 | Maxilla, treatment of fracture of, requiring open reduction and internal fixation not involving a plate (Anaes.) (Assist.) | 535.25 | |||||||
53419 | Mandible, treatment of fracture of, requiring open reduction and internal fixation not involving a plate (Anaes.) (Assist.) | 535.25 | |||||||
53422 | Maxilla, treatment of fracture of, requiring open reduction and internal fixation involving a plate (Anaes.) (Assist.) | 679.25 | |||||||
53423 | Mandible, treatment of fracture of, requiring open reduction and internal fixation involving a plate (Anaes.) (Assist.) | 679.25 | |||||||
53424 | Maxilla, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction not involving a plate (Anaes.) (Assist.) | 582.80 | |||||||
53425 | Mandible, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction not involving a plate (Anaes.) (Assist.) | 582.80 | |||||||
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.) | 796.00 | |||||||
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.) | ||||||||
796.00 | ||||||||
53439 | Mandible, treatment of a closed fracture of, involving a joint surface (Anaes.) | 225.70 | ||||||
53453 | Orbital cavity, reconstruction of a wall or floor with or without foreign implant (Anaes.) (Assist.) | 456.75 | ||||||
53455 | Orbital cavity, bone or cartilage graft to orbital wall or floor including reduction of prolapsed or entrapped orbital contents (Anaes.) (Assist.) | 536.50 | ||||||
53458 | Nasal bones, treatment of fracture of, not being a service to which item 53459 or 53460 applies | 40.65 | ||||||
53459 | Nasal bones, treatment of fracture of, by reduction (Anaes.) | 222.55 | ||||||
53460 | Nasal bones, treatment of fractures of, by open reduction involving osteotomies (Anaes.) (Assist.) | 454.00 | ||||||
53600 | Skin sensitivity testing for allergens to anaesthetics and materials used in oral and maxillofacial surgery, using 1 to 20 allergens | 36.80 | ||||||
53700 | Trigeminal nerve, primary division of, injection of an anaesthetic agent | 118.00 | ||||||
53702 | Trigeminal nerve, peripheral branch of, injection of an anaesthetic agent | 59.10 | ||||||
53704 | Facial nerve, injection of an anaesthetic agent | 35.60 | ||||||
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 | 118.00 | ||||||
75001 | Initial professional attendance in a single course of treatment by an accredited orthodontist (AO) | 80.85 | ||||||
75004 | Professional attendance by an accredited orthodontist subsequent to the first professional attendance by the orthodontist in a single course of treatment (AO) | 40.60 | ||||||
75006 | Production of dental study models (not being a service associated with a service to which item 75004 applies) prior to provision of a service to which:
in a single course of treatment (AO) | 72.10 | ||||||
75009 | Orthodontic radiography — orthopantomography (panoramic radiography), including any consultation on the same occasion (AOS) (AO) | 64.45 | ||||||
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) | 102.10 | ||||||
75015 | Orthodontic radiography — anteroposterior and lateral cephalometric radiography, with cephalometric tracings including any consultation on the same occasion (AOS) (AO) | 140.40 | ||||||
75018 | Orthodontic radiography — anteroposterior and lateral cephalometric radiography, with cephalometric tracings and orthopantomography including any consultation on the same occasion (AOS) (AO) | 178.85 | ||||||
75021 | Orthodontic radiography — hand‑wrist studies (including growth prediction) including any consultation on the same occasion (AOS) (AO) | 219.30 | ||||||
75023 | Intraoral radiography — single area, periapical or bitewing film (AOS) (AO) | 43.90 | ||||||
75024 | Pre‑surgical infant maxillary arch repositioning, including supply of appliances and all adjustments of appliances and supervision — if 1 appliance is used (AO) | 567.15 | ||||||
75027 | Pre‑surgical infant maxillary arch repositioning, including supply of appliances and all adjustments of appliances and supervision — if 2 appliances are used (AO) | 777.70 | ||||||
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) | 692.50 | ||||||
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) | 1 135.00 | ||||||
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) | 577.70 | ||||||
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) | 1 567.70 | ||||||
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) | 1 974.45 | ||||||
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) | 524.75 | ||||||
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) | 196.15 | ||||||
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) | 1 050.50 | ||||||
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) | 269.40 | ||||||
75049 | Retention, fixed or removable, single arch (mandibular or maxillary) — supply of retainer and supervision of retention (AO) | 315.30 | ||||||
75050 | Retention, fixed or removable, 2‑arch (mandibular and maxillary) — supply of retainers and supervision of retention (AO) | 608.70 | ||||||
75051 | Jaw growth guidance using removable or functional appliances, including supply of appliances and all adjustments to appliances (AO) | 934.40 | ||||||
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) | 80.85 | ||||||
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) | 40.60 | ||||||
75156 | Production of dental study models (not being a service associated with a service to which item 75153 applies) prior to provision of a service:
in a single course of treatment, if the patient is referred by an accredited orthodontist (AOS) | 72.10 | ||||||
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) | 51.90 | ||||||
75203 | Removal of tooth or tooth fragment under general anaesthesia, if the patient is referred by an accredited orthodontist (AD) | 77.90 | ||||||
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) | 25.85 | ||||||
75400 | Surgical removal of erupted tooth, if the patient is referred by an accredited orthodontist (AOS) | 155.75 | ||||||
75403 | Surgical removal of tooth with soft tissue impaction, if the patient is referred by an accredited orthodontist (AOS) | 178.85 | ||||||
75406 | Surgical removal of tooth with partial bone impaction, if the patient is referred by an accredited orthodontist (AOS) | 203.85 | ||||||
75409 | Surgical removal of tooth with complete bone impaction, if the patient is referred by an accredited orthodontist (AOS) | 230.85 | ||||||
75412 | Surgical removal of tooth fragment requiring incision of soft tissue only, if the patient is referred by an accredited orthodontist (AOS) | 128.95 | ||||||
75415 | Surgical removal of tooth fragment requiring removal of bone, if the patient is referred by an accredited orthodontist (AOS) | 155.75 | ||||||
75600 | Surgical exposure, stimulation and packing of unerupted tooth, if the patient is referred by an accredited orthodontist (AOS) | 219.30 | ||||||
75603 | Surgical exposure of unerupted tooth for the purpose of fitting a traction device, if the patient is referred by an accredited orthodontist (AOS) | 257.75 | ||||||
75606 | Surgical repositioning of unerupted tooth, if the patient is referred by an accredited orthodontist (AOS) | 257.75 | ||||||
75609 | Transplantation of tooth bud, if the patient is referred by an accredited orthodontist (AOS) | 384.75 | ||||||
75612 | Surgical procedure for intra oral implantation of osseointegrated fixture (first stage), if the patient is referred by an accredited orthodontist (AOS) | 476.20 | ||||||
75615 | Surgical procedure for fixation of trans‑mucosal abutment (second stage of osseointegrated implant), if the patient is referred by an accredited orthodontist (AOS) | 176.25 | ||||||
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) | 218.90 | ||||||
75621 | The provision and fitting of surgical template in conjunction with orthognathic surgical procedures in association with:
if the patient is referred by an accredited orthodontist (AOS) | 218.90 | ||||||
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) | 77.90 | ||||||
75803 | Provision and fitting of acrylic base partial denture, including retainers — 1 tooth (AD) | 311.65 | ||||||
75806 | Provision and fitting of acrylic base partial denture, including retainers — 2 teeth (AD) | 365.50 | ||||||
75809 | Provision and fitting of acrylic base partial denture, including retainers — 3 teeth (AD) | 432.80 | ||||||
75812 | Provision and fitting of acrylic base partial denture, including retainers — 4 teeth (AD) | 480.90 | ||||||
75815 | Provision and fitting of acrylic base partial denture, including retainers — 5 to 9 teeth (AD) | 586.80 | ||||||
75818 | Provision and fitting of acrylic base partial denture, including retainers — 10 to 12 teeth (AD) | 692.50 | ||||||
75821 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 1 tooth (AD) | 557.75 | ||||||
75824 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 2 teeth (AD) | 644.40 | ||||||
75827 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 3 teeth (AD) | 740.70 | ||||||
75830 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 4 teeth (AD) | 817.60 | ||||||
75833 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 5 to 9 teeth (AD) | 1 000.25 | ||||||
75836 | Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 10 to 12 teeth (AD) | 1 144.55 | ||||||
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) | 25.85 | ||||||
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) | 38.50 | ||||||
75845 | Relining of partial denture by laboratory process and associated fitting (AD) | 192.50 | ||||||
75848 | Remodelling and fitting of partial denture of more than 4 teeth (AD) | 230.85 | ||||||
75851 | Repair to cast metal base of partial denture — 1 or more points (AD) | 115.40 | ||||||
75854 | Addition of a tooth or teeth to a partial denture to replace extracted tooth or teeth, including taking of necessary impression (AD) | 115.40 | ||||||
1. Endoluminal gastroplication, for the treatment of gastro‑oesophageal reflux disease
2. Endovenous laser treatment, for varicose veins
3. Gamma knife surgery
4. Intradiscal electro thermal arthroplasty
5. Intravascular ultrasound (except if used in conjunction with intravascular brachytherapy)
6. Intro‑articular viscosupplementation, for the treatment of osteoarthritis of the knee
7. Low intensity ultrasound treatment, for the acceleration of bone fracture healing, using a bone growth stimulator
8. Lung volume reduction surgery, for advanced emphysema
9. Photodynamic therapy, for skin and mucosal cancer
10. Placement of artificial bowel sphincters, in the management of faecal incontinence
11. Sacral nerve stimulation, for urinary incontinence
12. Selective internal radiation therapy for any condition other than hepatic metastases that are secondary to colorectal cancer
13. Specific mass measurement of bone alkaline phosphatase
14. Transmyocardial laser revascularisation
15. Vertebral axial decompression therapy, for chronic back pain
The
2009 No. 272 | 12 Oct 2009 ( | 1 Nov 2009 | |
2009 No. 371 | 15 Dec 2009 ( | 1 Jan 2010 | — |
2010 No. 27 | 26 Feb 2010 ( | 1 Mar 2010 | — |
2010 No. 66 | 19 Apr 2010 ( | 1 May 2010 | — |
2010 No. 127 | 18 June 2010 ( | 1 July 2010 | — |
(a) Items 42698, 42701, 42702 and 42718 in Part 3, Schedule 1 of SLI 2009 No. 272 were disallowed by the Senate by a vote at 12.43 pm on 28 October 2009.
| |
Schedule 1............................ | am. 2009 No. 371; 2010 Nos. 27, 66 and 127 |
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