Health Insurance (General Medical Services Table) Regulations 2011 (Cth)

Health Insurance (General Medical Services Table) Regulations 2011

Select Legislative Instrument 2011 No. 187 as amended

made under the

Health Insurance Act 1973

This compilation was prepared on 1 July 2012
taking into account amendments up to 2012 No. 140

Prepared by the Office of Legislative Drafting and Publishing,
Attorney‑General’s Department, Canberra

Contents

1Name of Regulations [see Note 1]                           11

2Commencement                                                11

3Repeal                                                           11

4Dictionary                                                       11

5General medical services table                               11

Schedule 1General medical services table                            12

Part 1Preliminary                                                      12

Division 1.1              Interpretation                                                     

1.1.1Meaning of eligible non‑vocationally recognised medical practitioner  12

1.1.1AMeaning of general practitioner                              14

1.1.2Meaning of multidisciplinary case conference              14

1.1.3Meaning of multidisciplinary case conference team       15

1.1.4Meaning of single course of treatment                      16

1.1.5Meaning of symbol (G)                                        17

1.1.6Meaning of symbol (H)                                         17

1.1.7Meaning of symbol (S)                                         17

Division 1.2              General application provisions                               

1.2.1Application                                                      18

1.2.2Attendance by specialist or consultant physician          19

1.2.3Professional attendance services                            19

1.2.4Personal attendance by medical practitioners generally   20

1.2.5Personal attendance by medical practitioners              21

1.2.6Consultant occupational physician                           22

1.2.7Application of items 3 to 10943                               22

1.2.8Services that may be provided by persons other than medical practitioners    23

1.2.9Meaning of by video conference                             23

Part 2Services and fees                                              24

Division 2.1              Groups A1 to A10                                               

2.1.1Meaning of amount under clause 2.1.1                     24

Division 2.2              Group A1 — General practitioner attendances to which no other item applies   

Division 2.3              Group A2 — Other non‑referred attendances to which no other item applies    

2.3.1Effect of determination under section 106TA of Act       30

Division 2.4              Group A3 — Specialist attendances to which no other item applies      

Division 2.5              Group A4 — Consultant physician (other than psychiatry) attendances to which no other item applies                                               

Division 2.5A           Group A29 — Early intervention services for children with autism, pervasive developmental disorder or disability                        

2.5A.1Meaning of eligible allied health provider and risk assessment        39

2.5A.2Meaning of eligible disability                                  39

Division 2.6              Group A28 — Geriatric medicine                            

Division 2.7              Group A5 — Prolonged attendances to which no other item applies     

2.7.1Application of items 160 to 164                               46

Division 2.8              Group A6 — Group therapy                                   

Division 2.9              Group A7 — Acupuncture                                     

2.9.1Meaning of qualified medical acupuncturist                48

Division 2.10            Group A8 — Consultant physician in practice of psychiatry for attendances to which no other item applies                                           

2.10.1Application of items 291, 293 and 359                      50

2.10.2Application of items 342, 344 and 346                      50

2.10.3Restriction of telepsychiatry consultations to regional, rural and remote areas 50

2.10.4Meaning of eligible allied health provider and risk assessment        64

Division 2.11            Group A12 — Consultant occupational physician attendances to which no other item applies                                                             

Division 2.12            Group A13 — Public health physician attendances to which no other item applies                                                                       

2.12.1Public health physicians                                       66

Division 2.14            Group A21 — Emergency physician attendances to which no other item applies                                                                       

2.14.1Meaning of recognised emergency department           69

2.14.2Meaning of problem focussed history                        69

2.14.3Attendance for emergency evaluation of critically ill patients  70

Division 2.15            Group A11 — Urgent attendances after hours            

2.15.1Meaning of patient’s medical condition requires urgent treatment     73

2.15.2Meaning of responsible person                               74

2.15.3Application of Group A11                                     74

2.15.4Effect of determination under section 106TA of Act       74

Division 2.16            Group A14 — Health assessments                          

2.16.1Application of Group A14                                     76

2.16.2Types of health assessments                                 76

2.16.3Application of item 715 to certain patients only            78

2.16.4Healthy Kids Check                                            79

2.16.5Type 2 Diabetes Risk Evaluation                            80

2.16.645 year old Health Assessment                              81

2.16.7Older Person’s Health Assessment                         82

2.16.8Comprehensive Medical Assessment for permanent resident of residential aged care facility                                                            83

2.16.9Health assessment for a person with an intellectual disability 84

2.16.10Health assessment for a refugee or other humanitarian entrant       86

2.16.11Aboriginal and Torres Strait Islander child health assessment         87

2.16.12Aboriginal and Torres Strait Islander adult health assessment        89

2.16.13Aboriginal and Torres Strait Islander Older Person’s Health Assessment     91

2.16.14Restrictions on health assessments for Group A14       92

Division 2.17            Group A15 — GP management plans, team care arrangements and multidisciplinary care plans and case conferences                            

Subdivision A             General                                                                            

2.17.1Service by medical practitioners                             95

Subdivision B            Subgroup 1 of Group A15                                                  

2.17.2Meaning of associated medical practitioner                95

2.17.3Meaning of contribute to a multidisciplinary care plan     95

2.17.4Meaning of coordinating the development of team care arrangements         96

2.17.5Meaning of coordinating a review of team care arrangements         97

2.17.6Meaning of multidisciplinary care plan                       98

2.17.7Meaning of preparing a GP management plan             99

2.17.8Meaning of reviewing a GP management plan           100

2.17.9Application of items 721, 723, 729, 731 and 732         100

2.17.10Application of items 701 to 723 and 732                   102

2.17.11Limitation on items 721, 723, 729, 731 and 732          102

Subdivision C            Subgroup 2 of Group A15                                                  

2.17.12Meaning of multidisciplinary discharge case conference 105

2.17.13Meaning of multidisciplinary case conference in a residential aged care facility        105

2.17.14Meaning of organise and coordinate                       106

2.17.15Meaning of participate                                        106

2.17.16Meaning of coordinating                                     107

2.17.17Meaning of case conference team                         107

2.17.18Application of item 880                                       108

Division 2.18            Group A17 — Domiciliary and residential medication management reviews      

2.18.1Meaning of living in a community setting                  114

2.18.2Meaning of residential medication management review  115

2.18.3Application of items 900 and 903                           116

Division 2.18A         Group A30 — medical practitioner video conferencing consultation      

2.18A.1Application of items                                          117

2.18A.2Application of items 2125, 2138, 2179 and 2220         117

2.18A.3Meaning of amount under clause 2.18A.3                117

Division 2.19            Groups A18 (General practitioner attendances associated with PIP payments) and A19 (Other non‑referral attendances associated with PIP payments to which no other item applies)                                                      

2.19.2Application of Subgroup 2 of Groups A18 and A19      123

2.19.3Application of Subgroup 3 of Groups A18 and A19      125

Division 2.20            Group A20 — Mental health care                            

2.20.1Definitions                                                      136

2.20.2Meaning of amount under clause 2.20.2                   137

2.20.3Meaning of preparation of a GP mental health treatment plan         137

2.20.4Meaning of review of a GP mental health treatment plan 139

2.20.5Meaning of associated medical practitioner               140

2.20.6Application of Subgroup 1 of Group A20                  140

2.20.7Focussed psychological strategies                         142

Division 2.21            Group A24 — Palliative and pain medicine                

2.21.1Meaning of organise and coordinate                       145

2.21.2Meaning of participate                                        146

2.21.3Application of Group A24                                    147

2.21.4Limitation on items                                            147

Division 2.22            Group A27 — Pregnancy support counselling            

2.22.1Application of item 4001                                     154

Division 2.23            Group A22 — General practitioner after‑hours attendances to which no other item applies                                                             

2.23.1Application of Group A22                                    155

Division 2.24            Group A23 — Other non‑referred after‑hours attendances to which no other item applies                                                             

2.24.1Application of Group A23                                    160

Division 2.26            Group A26 — Neurosurgery attendances to which no other item applies         

Division 2.27            Group A9 — Contact lenses                                   

2.27.1Application of item 10809                                    164

Division 2.28            Group A10 — Optometric services provided by participating optometrist         

2.28.1Application of items 10900, 10940 and 10941            167

2.28.2Application of item 10929                                    167

2.28.3Limitation on items                                            167

2.28.4Application of items 10931, 10932 and 10933            168

2.28.5Limitation of item 10943                                     168

Division 2.29            Miscellaneous services                                         

Division 2.30            Group M12—Services provided by a practice nurse, an Aboriginal health worker or an Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner                                                       

2.30.1Definitions for item 10997                                    175

2.30.2Application of item 10986                                    175

2.30.3Restrictions on item 10986                                  176

2.30.4Application of item 10988                                    176

2.30.5Application of item 10989                                    177

Division 2.31            Group M1 — Management of bulk‑billed services        

2.31.1Definitions for Division 2.31                                 179

2.31.2Application of items 10990, 10991 and 10992            181

Division 2.33            Diagnostic Procedures and investigations                

Division 2.34            Group D1 — Miscellaneous diagnostic procedures and investigations   

2.34.1Meaning of report                                             183

2.34.2Meaning of qualified sleep medicine practitioner         183

2.34.3Application of Group D1                                     185

Division 2.35            Group D2 — Nuclear medicine (non‑imaging)            

2.35.1Application of Group D2                                     209

Division 2.36            Therapeutic procedures                                        

2.36.1Definition                                                       210

2.36.2Medical services that may be provided by medical practitioner or specialist trainee     210

Division 2.37            Group T1 — Miscellaneous therapeutic procedures     

2.37.1Meaning of comprehensive hyperbaric medicine facility 211

2.37.2Meaning of embryology laboratory services               212

2.37.3Meaning of treatment cycle                                 212

2.37.4Items provided as part of treatment cycle relating to assisted reproductive services not to apply                                                           212

2.37.5Application of items 13020 to 14245                       213

2.37.6Limitation on item 13104                                     213

2.37.7Items relating to assisted reproductive services not to apply in certain pregnancy‑related circumstances                                                 213

2.37.8Application of items 14227 to 14242                       213

2.37.9Application of item 14245                                    214

Division 2.38            Group T2 — Radiation oncology                             

2.38.1Meaning of amount under clause 2.38.1                   228

2.38.2Meaning of approved site                                    229

2.38.3Application of Group T2                                     229

2.38.4Application of items 15556, 15559 and 15562            229

Division 2.39            Group T3 — Therapeutic nuclear medicine                

2.39.1Application of Group T3                                     242

Division 2.40            Group T4 — Obstetrics                                         

2.40.1Definitions for item 16400                                    243

2.40.2Meaning of amount under clause 2.40.2                   243

2.40.3Meaning of delivery                                          243

2.40.4Application of Group T4                                     244

2.40.5Application of item 16400                                    244

2.40.6Limitation of items 16590 and 16591                       245

Division 2.41            Group T6 — Examination by anaesthetist                  

2.41.1Application of Group T6                                     254

Division 2.42            Group T7 — Regional or field nerve blocks               

2.42.1Meaning of amount under clause 2.42.1                   258

2.42.2Application of Group T7                                     259

Division 2.42A         Group T11 — Botulinum toxin                                

2.42A.1Injection of botulinum toxin                                  262

2.42A.2Limitation of items 18360 and 18364                       262

Division 2.43            Group T10 — Anaesthesia performed in connection with certain services (Relative Value Guide)                                                      

2.43.1Meaning of amount under clause 2.43.1                   265

2.43.2Meaning of amount under clause 2.43.2                   266

2.43.3Meaning of complex paediatric case                       266

2.43.4Meaning of service time                                     267

2.43.5Application of Group T10                                     267

2.43.6Application of Subgroup 21 of Group T10                 268

2.43.7Services mentioned in Subgroups 21 to 25 of Group T10 268

2.43.8Application of Subgroups 22 and 23 of Group T10       268

2.43.9Application of Subgroups 24 and 25 of Group T10       269

Division 2.44            Group T8 — Surgical operations                            

Subdivision A             General                                                                            

2.44.1Meaning of approved site                                    308

2.44.2Application of Group T8                                     308

Subdivision B            Subgroup 1 of Group T8                                                     

2.44.4Meaning of amount under clause 2.44.4                   308

2.44.5Meaning of amount under clause 2.44.5                   308

2.44.6Meaning of qualified surgeon                                309

2.44.7Meaning of qualified radiologist                            309

2.44.8Histopathological proof of malignancy in certain cases for purposes of certain items relating to surgical procedures                                        309

2.44.9Application of items 30299 and 30300                     309

2.44.10Application of items 30440, 30451, 30492 and 30495    310

2.44.11Application of items 30688, 30690, 30692 and 30694    310

2.44.12Application of item 35412                                    310

Subdivision C            Subgroups 2 and 3 of Group T8                                          

2.44.13Meaning of foreign body in items 35360 to 35363       363

2.44.14Application of items 32500 to 32517 and 35321          363

2.44.15Application of items 35404, 35406 and 35408            363

Subdivision D            Subgroups 4, 5 and 6 of Group T8                                      

2.44.16Application of items 38365, 38368 and 38654            390

2.44.17Application of items 38470 to 38766                       391

Subdivision E             Subgroups 7 to 11 of Group T8                                           

Subdivision F             Subgroups 12 and 13                                                        

2.44.18Meaning of amount under clause 2.44.18                 480

2.44.19Meaning of maxilla                                            480

Subdivision G            Subgroup 14                                                                    

2.44.20Items 46300 to 46534 apply only in certain circumstances 507

Subdivision H            Subgroup 15                                                                    

2.44.21Limitation of item 50303                                     514

Division 2.45            Group T9 — Assistance at operations                      

2.45.1Meaning of amount under clause 2.45.1                   563

2.45.2Meaning of amount under clause 2.45.2                   564

2.45.3Meaning of amount under clause 2.45.3                   564

2.45.4Meaning of previous significant surgical complication     564

2.45.5Application of Group T9                                     564

2.45.6Assistance at operations                                     565

Division 2.46            Oral and Maxillofacial services                               

2.46.1Application of Groups O1 to O11                           566

Division 2.47            Group O1 — Consultations                                    

Division 2.48            Group O2 — Assistance at operation                       

2.48.1Meaning of amount under clause 2.48.1                   567

2.48.2Assistance at operations                                     567

Division 2.49            Group O3 — General surgery                                 

Division 2.50            Group O4 — Plastic and reconstructive                    

2.50.1Meaning of maxilla                                            575

Division 2.51            Group O5 — Preprosthetic                                     

Division 2.52            Group O6 — Neurosurgical                                    

Division 2.53            Group O7 — Ear, nose and throat                            

Division 2.54            Group O8 — Temporomandibular joint                     

Division 2.55            Group O9 — Treatment of fractures                         

Division 2.56            Group O10 — Diagnostic procedures and investigations

Division 2.57            Group O11 — Regional or field nerve blocks              

Division 2.58            Cleft lip and cleft palate services                            

Division 2.59            Group C1 — Orthodontic services                           

2.59.1Cleft lip and cleft palate services                            587

2.59.2Orthodontic services                                         588

Division 2.60            Group C2 — Oral and maxillofacial services              

2.60.1Meaning of symbol (AD)                                     591

2.60.2Meaning of symbol (AOS)                                   592

2.60.3Meaning of accredited orthodontist                        592

2.60.4Cleft lip and cleft palate services                            593

Division 2.61            Group C3 — General and prosthodontic services       

2.61.1Meaning of symbol (AD)                                     595

2.61.2Cleft lip and cleft palate services                            595

Dictionary599

Notes 608

1. Name of Regulations [see Note 1]

These Regulations are the Health Insurance (General Medical Services Table) Regulations 2011.

1. Commencement

These Regulations commence on 1 November 2011.

1. Repeal

The Health Insurance (General Medical Services Table) Regulations 2010 are repealed.

1. Dictionary

The Dictionary at the end of these Regulations defines certain words and expressions that are used in these Regulations, and includes references to certain words and expressions that are defined elsewhere in these Regulations.

1. General medical services table

For subsection 4 (1) of the Act, these Regulations prescribe a table of medical services set out in Schedule 1.

Note Under section 4 of the Act, the table of medical services sets out the following:

(a)items of medical services;

(b)the amount of fees applicable for each item;

(c)rules for the interpretation of the table.

Schedule 1          General medical services table

(regulation 5)

Part 1           Preliminary

Division 1.1            Interpretation

1.1.1Meaning of eligible non‑vocationally recognised medical practitioner

(1)In the table:

eligible non‑vocationally recognised medical practitioner means:

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

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

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

(b)a medical practitioner who:

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

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

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

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

(B)of which the Chief Executive Medicare has written notice; or

(c)a medical practitioner who:

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

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

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

(d)a medical practitioner who:

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

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

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

(2)In subclause (1):

After Hours Other Medical Practitioners Program means a program administered by the Chief Executive Medicare that, for medical services provided in accordance with the Program, provides a particular level of medicare benefits.

MedicarePlus for Other Medical Practitioners Program means a program administered by the Chief Executive Medicare that, for medical services provided in accordance with the Program, provides a particular level of medicare benefits.

Outer Metropolitan (Other Medical Practitioners) Relocation Incentive Program means a program administered by the Department that, for medical services provided in accordance with the Program, provides a particular level of medicare benefits.

Rural Other Medical Practitioners’ Program means a program administered by the Chief Executive Medicare that, for medical services provided in accordance with the Program, provides a particular level of medicare benefits.

1.1.1AMeaning of general practitioner

In the table:

general practitioner means:

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

(b)a practitioner who:

(i)is a Fellow of the RACGP; and

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

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

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

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

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

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

(e)an eligible non‑vocationally recognised medical practitioner; or

(f)a practitioner who is undertaking a placement in general practice as part of the Pre‑vocational General Practice Placements Program administered by the 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.

1.1.2Meaning of multidisciplinary case conference

A multidisciplinary case conference means a process by which a multidisciplinary case conference team carries out all of the following activities:

(a)discussing a patient’s history;

(b)identifying the patient’s multidisciplinary care needs;

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

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

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

1.1.3Meaning of multidisciplinary case conference team

(1)A multidisciplinary case conference team for a patient:

(a)includes a medical practitioner; and

(b)either:

(i)for items 735 to 758 — includes at least 2 other members; or

(ii)for an item mentioned in subclause (3) — includes at least 3 other members; and

(c)may also include a family member of the patient.

(2)For the members mentioned in paragraph (b):

(a)each member must provide a different kind of care or service to the patient; and

(b)each member must not be a family carer of the patient; and

(c)1 member may be another medical practitioner.

Examples

Other members may include the following:

(a)allied health professionals, including:

·    Aboriginal health 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

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

·    education providers

·    ‘meals on wheels’ providers

·    personal care workers

·    probation officers.

(3)For subparagraph (1) (b) (ii), the items are items 820, 822, 823, 830, 832, 834, 2946, 2949, 2954, 2978, 2984, 2988, 3032, 3040, 3044, 3069 and 3074.

1.1.4Meaning of single course of treatment

(1)Use this clause for:

(a)items 104 to 131, 133, 385 to 388, 2801 to 2840, 3005 to 3028, 6007 to 6015, 16401, 16404, 16406, 51700 and 51703; and

(b)the meaning of attendance in clause 1.1.1; and

(c)the meaning of symbol (S) in clause 1.1.10; and

(d)the definition of minor attendance in the Dictionary.

(2)A single course of treatment for a patient:

(a)includes:

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

(ii)the continuing management or treatment up to and including the stage when the patient is referred back to the care of the referring practitioner; and

(iii)any subsequent review of the patient’s condition by the specialist or consultant physician that may be necessary, whether the review is initiated by the referring practitioner or by the specialist or consultant physician; but

(b)does not include:

(i)referral of the patient to the specialist or consultant physician; or

(ii)an attendance (the later attendance) on the patient by the specialist or consultant physician, after the end of the period of validity of the last referral to have application under regulation 31 of the Health Insurance Regulations 1975 if:

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

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

1.1.5Meaning of symbol (G)

An item including the symbol (G) applies only to a service not provided by a specialist in the practice of his or her specialty.

1.1.6Meaning of symbol (H)

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

1.1.7Meaning of symbol (S)

(1)An item including the symbol (S) applies only to a service performed by a specialist in the practice of his or her specialty, if:

(a)the service is:

(i)provided to a patient who has been referred to the specialist; and

(ii)the first service performed by the specialist in accordance with the referral; or

(b)the service is:

(i)provided to a patient who has been referred to the specialist; and

(ii)part of a single course of treatment given for the condition identified in the referral or, if no condition was identified in the referral, part of a single course of treatment for the condition identified by the specialist; and

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

(c)the service is:

(i)provided to a patient who has declared that a written referral completed by a named referring practitioner has been lost, stolen or destroyed before the service was provided; and

(ii)the first service performed by the specialist in accordance with the referral; or

(d)the service is:

(i)provided to a patient who has not been referred to the specialist; and

(ii)a service that, in an emergency, the specialist decides is necessary in the patient’s interests to be provided as soon as practicable without a referral.

(2)In this clause:

emergency has the same meaning as in subregulation 30 (5) of the Health Insurance Regulations 1975.

Division 1.2            General application provisions

1.2.1Application

An item in Part 2 does not apply to a service provided in contravention of a law of the Commonwealth, a State or Territory.

1.2.2Attendance by specialist or consultant physician

(1)Use this clause for items 99 to 137, 141 to 149, 288 to 389, 2801 to 2840, 3005 to 3028, 6007 to 6016, 13210, 16399, 16401, 16404, 17609, 17640 to 17655.

(2)An attendance on a patient by a specialist or consultant physician:

(a)includes an attendance on a patient if:

(i)the patient declares that a written referral of the patient was completed by a medical practitioner; or

(ii)in an emergency, the patient has not been referred to the specialist, or consultant physician, if the specialist or consultant physician decides that it is necessary in the patient’s interests to provide the service mentioned in the item as soon as practicable without a referral; but

(b)does not include an attendance on a patient if:

(i)the attendance forms part of a single course of treatment for the patient in which the first service was provided to the patient more than 12 months (or another period, if any, set by the referring practitioner in, or in connection with, the referral) before the attendance; and

(ii)a later referral has not been made.

(3)In this clause:

emergency has the same meaning as in subregulation 30 (5) of the Health Insurance Regulations 1975.

1.2.3Professional attendance services

(1)Use this clause for items 3 to 338, 348 to 389, 410 to 417, 501 to 600, 900, 903, 2497 to 2840, 3005 to 3028, 5000 to 5267, 6007 to 6016, 10900 to 10929, 13210, 16399, 16401, 16404, 16406, 16590, 16591 and 17609 to 17690.

(2)A professional attendance includes the provision, for a patient, of any of the following services:

(a)evaluating the patient’s condition or conditions including, if applicable, evaluation using a health screening service mentioned in subsection 19 (5) of the Act;

(b)formulating a plan for the management and, if applicable, for the treatment of the patient’s condition or conditions;

(c)giving advice to the patient about the patient’s condition or conditions and, if applicable, about treatment;

(d)if authorised by the patient — giving advice to another person, or other persons, about the patient’s condition or conditions and, if applicable, about treatment;

(e)providing appropriate preventive health care;

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

(3)However, a professional attendance does not include the supply of a vaccine to a patient if:

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

(b)the cost of the vaccine is not subsidised by the Commonwealth or a State.

1.2.4Personal attendance by medical practitioners generally

(1)Use this clause for items 3 to 149, 173 to 338, 348 to 536, 597 to 600, 2100 to 2220, 2497 to 2840, 3005 to 3028, 4001 to 10816, 11012 to 11021, 11212, 11304, 11500, 11600, 11627, 11701, 11724, 11921, to 12003, 12201, 13030 to 13112, 13209, 13210, 13290 to 13700, 13815 to 13888, 14100 to 14200, 14203 to 14215, 14224, 15600, 16003 to 16512 and 16515 to 51318.

(2)The item applies to a service provided in the course of a personal attendance by a single medical practitioner on a single patient on a single occasion.

(3)A personal attendance by the medical practitioner on the patient includes any of the following:

(a)a telepsychiatry consultation to which any of items 353 to 361 applies;

(b)the planning, management and supervision of the patient on home dialysis to which item 13104 applies;

(c)participating in a video conferencing consultation referred to in items 99, 112, 149, 288, 389, 2100, 2122, 2125, 2126, 2137, 2138, 2143, 2147, 2179, 2195, 2199, 2220, 2820, 3015, 6016, 13210, 16399, 17609.

1.2.5Personal attendance by medical practitioners

(1)Use this clause for items 3 to 723, 732, 900 to 10816, 11012 to 11021, 11212, 11304, 11500, 11600, 11627, 11701, 11722, 11724, 11820, 11823, 11921, 12000, 12003, 12201, 13030 to 13112, 13209, 13210, 13290 to 13700, 13815 to 13888, 14100 to 14200, 14203 to 14215, 14224, 15600, 16003 to 16512, 16515 to 51318.

(2)The item applies to a service provided during a personal attendance by:

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

(b)a medical practitioner who:

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

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

(3)Subclause (2) applies whether or not another person provides essential assistance to the medical practitioner in accordance with accepted medical practice.

(4)A personal attendance by the medical practitioner on the patient includes any of the following:

(a)a telepsychiatry consultation to which any of items 353 to 361 applies;

(b)the planning, management and supervision of the patient on home dialysis to which item 13104 applies;

(c)participating in a video conferencing consultation referred to in items 99, 112, 149, 288, 389, 2100, 2122, 2125, 2126, 2137, 2138, 2143, 2147, 2179, 2195, 2199, 2220, 2820, 3015, 6016, 13210, 16399, 17609.

1.2.6Consultant occupational physician

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)evaluating and assessing a patient’s rehabilitation requirements when, in the consultant’s opinion, the patient has an accepted medical condition that:

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

(ii)affects the patient’s capacity to be employed;

(b)managing an accepted medical condition that, in the consultant’s opinion, may affect a patient’s capacity for continued employment, or return to employment, following a non‑compensable accident, injury or ill‑health;

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

1.2.7Application of items 3 to 10943

Items 3 to 10943 do not apply to a service mentioned in the item if the service is provided at the same time as, or in connection with, a non‑medicare service.

1.2.8Services that may be provided by persons other than medical practitioners

(1)Use this clause for items 10983 to 10989, 10997, 11000, 11003, 11004, 11005, 11006, 11009, 11024, 11027, 11200, 11203, 11204, 11205, 11210, 11211, 11215, 11218, 11221, 11222, 11224, 11225, 11235, 11237, 11240, 11241, 11242, 11243, 11300, 11303, 11306, 11309, 11312, 11315, 11318, 11321, 11324, 11327, 11330, 11332, 11333, 11336, 11339, 11503, 11506, 11509, 11512, 11602, 11604, 11605, 11610, 11611, 11612, 11614, 11615, 11700, 11702, 11708, 11709, 11710, 11711, 11712, 11713, 11715, 11718, 11721, 11800, 11810, 11830, 11833, 11900, 11903, 11906, 11909, 11912, 11915, 11919, 12012, 12015, 12018, 12021, 12200, 12203, 12207, 12210, 12213, 12215, 12217, 12250, 12500 to 12530, 13020, 13025, 13200 to 13203, 13206, 13212, 13215, 13218, 13221, 13703, 13706, 13709, 13750, 13755, 13757, 13760, 13915 to 13948, 14050, 14053, 14218, 14221, 15000 to 15336, 15339 to 15357, 15500 to 15539, 16514 and 17610 to 17690.

(2)The item applies whether the medical service is given by:

(a)a medical practitioner; or

(b)a person, other than a medical practitioner, who:

(i)is employed by a medical practitioner; or

(ii)in accordance with accepted medical practice, acts under the supervision of a medical practitioner.

1.2.9Meaning of by video conference

A medical practitioner participates in a consultation with a specialist or consultant physician by video conference if the medical practitioner attends a patient who is receiving a service under an item in the table from a specialist or consultant physician who is providing the service:

(a)in relation to his or her speciality to the patient; and

(b)by way of a video conferencing consultation.

Part 2           Services and fees

Division 2.1            Groups A1 to A10

Note   Groups A1 to A10 include Groups A1, A2, A3, A4, A28, A5, A6, A7, A8, A12, A13, A21, A11, A14, A15, A17, A18, A19, A20, A24, A27, A22, A23, A26, A9 and A10.

2.1.1Meaning of amount under clause 2.1.1

In an item of the table mentioned in column 2 of Table 2.1.1:

amount under clause 2.1.1 means the sum of:

(a)the fee mentioned in column 3 for the item; and

(b)either:

(i)if a practitioner attends not more than 6 patients in a single attendance — the amount mentioned in column 4 for the item, divided by the number of patients attended; or

(ii)if a practitioner attends more than 6 patients in a single attendance — the amount mentioned in column 5 for the item.

Table 2.1.1
Item	Item/s of the table	Fee	Amount if not more than 6 patients (to be divided by the number of patients)	Amount if more than 6 patients
1	4	The fee for item 3	$25.00	$1.90
2	20	The fee for item 3	$44.95	$3.20
3	24	The fee for item 23	$25.00	$1.90
4	35	The fee for item 23	$44.95	$3.20
5	37	The fee for item 36	$25.00	$1.90
6	43	The fee for item 36	$44.95	$3.20
7	47	The fee for item 44	$25.00	$1.90
8	51	The fee for item 44	$44.95	$3.20
9	58	$8.50	$15.50	$0.70
10	59, 2610, 2631, 2673	$16.00	$17.50	$0.70
11	60, 2613, 2633, 2675	$35.50	$15.50	$0.70
12	65, 2616, 2635, 2677	$57.50	$15.50	$0.70
13	92	$8.50	$27.95	$1.25
14	93	$16.00	$31.55	$1.25
15	95	$35.50	$27.95	$1.25
16	96	$57.50	$27.95	$1.25
17	195	The fee for item 193	$25.00	$1.90
18	414	The fee for item 410	$25.00	$1.90
19	415	The fee for item 411	$25.00	$1.90
20	416	The fee for item 412	$25.00	$1.90
21	417	The fee for item 413	$25.00	$1.90
22	2503	The fee for item 2501	$25.00	$1.90
23	2506	The fee for item 2504	$25.00	$1.90
24	2509	The fee for item 2507	$25.00	$1.90
25	2518	The fee for item 2517	$25.00	$1.90
26	2522	The fee for item 2521	$25.00	$1.90
27	2526	The fee for item 2521	$25.00	$1.90
28	2547	The fee for item 2546	$25.00	$1.90
29	2553	The fee for item 2552	$25.00	$1.90
30	2559	The fee for item 2558	$25.00	$1.90
31	5003	The fee for item 5000	$25.00	$1.90
32	5010	The fee for item 5000	$44.95	$3.20
33	5023	The fee for item 5020	$25.00	$1.90
34	5028	The fee for item 5020	$44.95	$3.20
35	5043	The fee for item 5040	$25.00	$1.90
36	5049	The fee for item 5040	$44.95	$3.20
37	5063	The fee for item 5060	$25.00	$1.90
38	5067	The fee for item 5060	$44.95	$3.20
39	5220	$18.50	$15.50	$0.70
40	5223	$26.00	$17.50	$0.70
41	5227	$45.50	$15.50	$0.70
42	5228	$67.50	$15.50	$0.70
43	5260	$18.50	$27.95	$1.25
44	5263	$26.00	$31.55	$1.25
45	5265	$45.50	$27.95	$1.25
46	5267	$67.50	$27.95	$1.25

Division 2.2            Group A1 — General practitioner attendances to which no other item applies

Group A1 — General practitioner attendances to which no other item applies
Item	Description	Fees $
3	Professional attendance at consulting rooms (other than a service to which another item applies) by a general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management — each attendance	16.30
4	Professional attendance by a general practitioner (other than attendance at consulting rooms or a residential aged care facility or a service to which another item in the table applies) that requires a short patient history and, if necessary, limited examination and management — an attendance on 1 or more patients at 1 place on 1 occasion — each patient	Amount under clause 2.1.1
20	Professional attendance (other than a service to which another item applies) at a residential aged care facility (other than a professional attendance at a self‑contained unit) or professional attendance at consulting rooms situated within such a complex if the patient is accommodated in a residential aged care facility (other than accommodation in a self‑contained unit) by a general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management — an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion — each patient	Amount under clause 2.1.1
23	Professional attendance by a general practitioner at consulting rooms (other than a service to which another item in the table applies), lasting less than 20 minutes and including any of the following that are clinically relevant:    (a)  taking a patient history;   (b)  performing a clinical examination;    (c)  arranging any necessary investigation;   (d)  implementing a management plan;	35.60
(e)  providing appropriate preventive health care; for 1 or more health‑related issues, with appropriate documentation — each attendance
24	Professional attendance by a general practitioner (other than attendance at consulting rooms or a residential aged care facility or a service to which another item in the table applies), lasting less than 20 minutes and including any of the following that are clinically relevant:	Amount under clause 2.1.1
(a)  taking a patient history;   (b)  performing a clinical examination;    (c)  arranging any necessary investigation;
(d)  implementing a management plan;    (e)  providing appropriate preventive health care; for 1 or more health‑related issues, with appropriate documentation — an attendance on 1 or more patients at 1 place on 1 occasion — each patient
35	Professional attendance by a general practitioner at a residential aged care facility to residents of the facility (other than a service to which another item in the table applies), lasting less than 20 minutes and including any of the following that are clinically relevant:    (a)  taking a patient history;   (b)  performing a clinical examination;    (c)  arranging any necessary investigation;   (d)  implementing a management plan;    (e)  providing appropriate preventive health care; for 1 or more health‑related issues, with appropriate documentation — an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion — each patient	Amount under clause 2.1.1
36	Professional attendance by a general practitioner at consulting rooms (other than a service to which another item in the table applies), lasting at least 20 minutes and including any of the following that are clinically relevant:    (a)  taking a detailed patient history;	69.00
(b)  performing a clinical examination;    (c)  arranging any necessary investigation;   (d)  implementing a management plan;    (e)  providing appropriate preventive health care; for 1 or more health‑related issues, with appropriate documentation — each attendance
37	Professional attendance by a general practitioner (other than attendance at consulting rooms or a residential aged care facility or a service to which another item in the table applies), lasting at least 20 minutes and including any of the following that are clinically relevant:	Amount under clause 2.1.1
(a)  taking a detailed patient history;   (b)  performing a clinical examination;
(c)  arranging any necessary investigation;
(d)  implementing a management plan;    (e)  providing appropriate preventive health care; for 1 or more health‑related issues, with appropriate documentation — an attendance on 1 or more patients at 1 place on 1 occasion — each patient
43	Professional attendance by a general practitioner at a residential aged care facility to residents of the facility (other than a service to which another item in the table applies), lasting at least 20 minutes and including any of the following that are clinically relevant:    (a)  taking a detailed patient history;   (b)  performing a clinical examination;    (c)  arranging any necessary investigation;   (d)  implementing a management plan;    (e)  providing appropriate preventive health care; for 1 or more health‑related issues, with appropriate documentation — an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion — each patient	Amount under clause 2.1.1
44	Professional attendance by a general practitioner at consulting rooms (other than a service to which another item in the table applies), lasting at least 40 minutes and including any of the following that are clinically relevant:    (a)  taking an extensive patient history;   (b)  performing a clinical examination;    (c)  arranging any necessary investigation;   (d)  implementing a management plan;    (e)  providing appropriate preventive health care; for 1 or more health‑related issues, with appropriate documentation — each attendance	101.55
47	Professional attendance by a general practitioner (other than attendance at consulting rooms or a residential aged care facility or a service to which another item in the table applies), lasting at least 40 minutes and including any of the following that are clinically relevant:    (a)  taking an extensive patient history;   (b)  performing a clinical examination;    (c)  arranging any necessary investigation;	Amount under clause 2.1.1
(d)  implementing a management plan;    (e)  providing appropriate preventive health care; for 1 or more health‑related issues, with appropriate documentation — an attendance on 1 or more patients at 1 place on 1 occasion — each patient
51	Professional attendance by a general practitioner at a residential aged care facility to residents of the facility (other than a service to which another item in the table applies), lasting at least 40 minutes and including any of the following that are clinically relevant:    (a)  taking an extensive patient history;   (b)  performing a clinical examination;    (c)  arranging any necessary investigation;   (d)  implementing a management plan;	Amount under clause 2.1.1
(e)  providing appropriate preventive health care; for 1 or more health‑related issues, with appropriate documentation — an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion — each patient

Division 2.3            Group A2 — Other non‑referred attendances to which no other item applies

2.3.1Effect of determination under section 106TA of Act

(1)This clause applies to a general practitioner, if:

(a)the practitioner is the subject of a final determination that is in force under section 106TA of the Act; and

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

(c)the determination states that the practitioner is disqualified for a service mentioned in an item in Group A1; and

(d)the practitioner provides a service mentioned in an item in Group A2.

(2)The determination applies to the service mentioned in paragraph (1) (d).

Group A2 — Other non‑referred attendances to which no other item applies
Item	Description	Fee $
52	Professional attendance at consulting rooms of not more than 5 minutes in duration (other than a service to which any other item applies)—each attendance, by:   (a)  a medical practitioner (who is not a general practitioner); or (b)  a general practitioner to whom clause 2.3.1 applies	11.00
53	Professional attendance at consulting rooms of more than 5 minutes in duration but not more than 25 minutes (other than a service to which any other item applies)—each attendance, by:   (a)  a medical practitioner (who is not a general practitioner); or (b)  a general practitioner to whom clause 2.3.1 applies	21.00
54	Professional attendance at consulting rooms of more than 25 minutes in duration but not more than 45 minutes (other than a service to which any other item applies)—each attendance, by:   (a)  a medical practitioner (who is not a general practitioner); or (b)  a general practitioner to whom clause 2.3.1 applies	38.00
57	Professional attendance at consulting rooms of more than 45 minutes in duration (other than a service to which any other item applies)—each attendance, by:   (a)  a medical practitioner (who is not a general practitioner); or (b)  a general practitioner to whom clause 2.3.1 applies	61.00
58	Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a service to which any other item in the table applies), not more than 5 minutes in duration—an attendance on one or more patients at one place on one occasion—each patient, by:   (a)  a medical practitioner (who is not a general practitioner); or (b)  a general practitioner to whom clause 2.3.1 applies	Amount under clause 2.1.1
59	Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a service to which any other item in the table applies) of more than 5 minutes in duration but not more than 25 minutes—an attendance on one or more patients at one place on one occasion—each patient, by:   (a)  a medical practitioner (who is not a general practitioner); or (b)  a general practitioner to whom clause 2.3.1 applies	Amount under clause 2.1.1
60	Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a service to which any other item in the table applies) of more than 25 minutes in duration but not more than 45 minutes—an attendance on one or more patients at one place on one occasion—each patient, by:   (a)  a medical practitioner (who is not a general practitioner); or (b)  a general practitioner to whom clause 2.3.1 applies	Amount under clause 2.1.1
65	Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a service to which any other item in the table applies) of more than 45 minutes in duration—an attendance on one or more patients at one place on one occasion—each patient, by:    (a)  a medical practitioner (who is not a general practitioner); or   (b)  a general practitioner to whom clause 2.3.1 applies	Amount under clause 2.1.1
92	Professional attendance (other than a service to which any other item applies) at a residential aged care facility (other than a professional attendance at a self‑contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (that is not accommodation in a self‑contained unit) of not more than 5 minutes in duration—an attendance on one or more patients at one residential aged care facility on one occasion — each patient, by:   (a)  a medical practitioner (who is not a general practitioner); or (b)  a general practitioner to whom clause 2.3.1 applies	Amount under clause 2.1.1
93	Professional attendance (other than a service to which any other item applies) at a residential aged care facility (other than a professional attendance at a self‑contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (that is not accommodation in a self‑contained unit) of more than 5 minutes in duration but not more than 25 minutes—an attendance on one or more patients at one residential aged care facility on one occasion — each patient, by:   (a)  a medical practitioner (who is not a general practitioner); or (b)  a general practitioner to whom clause 2.3.1 applies	Amount under clause 2.1.1
95	Professional attendance (other than a service to which any other item applies) at a residential aged care facility (other than a professional attendance at a self‑contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (that is not accommodation in a self‑contained unit) of more than 25 minutes in duration but not more than 45 minutes—an attendance on one or more patients at one residential aged care facility on one occasion—each patient, by:   (a)  a medical practitioner (who is not a general practitioner); or (b)  a general practitioner to whom clause 2.3.1 applies	Amount under clause 2.1.1
96	Professional attendance (other than a service to which any other item applies) at a residential aged care facility (other than a professional attendance at a self‑contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (that is not accommodation in a self‑contained unit) of more than 45 minutes in duration—an attendance on one or more patients at one residential aged care facility on one occasion—each patient, by:	Amount under clause 2.1.1
(a)  a medical practitioner (who is not a general practitioner); or (b)  a general practitioner to whom clause 2.3.1 applies

Division 2.4            Group A3 — Specialist attendances to which no other item applies

Group A3 — Specialist attendances to which no other item applies
Item	Description	Fee $
99	Professional attendance by a specialist practicing in his or her specialty:    (a)  by video conference; and   (b)  rendered to a patient who:         (i)   is a care recipient in a residential care service; or        (ii)   is at an Aboriginal Medical Service or an Aboriginal Community Controlled Health Service for which a direction made under subsection 19 (2) of the Act applies; or       (iii)   is located outside an inner metropolitan area and is not an admitted patient; and    (c)  for a service provided with item 104 or 105	50% of the fee for item 104 or 105
104	Professional attendance at consulting rooms or hospital by a specialist in the practice of his or her specialty after referral of the patient to him or her — each attendance, other than a second or subsequent attendance, in a single course of treatment, other than a service to which item 106, 109 or 16401 applies	83.95
105	Professional attendance by a specialist in the practice of his or her specialty following referral of the patient to him or her — an attendance after the first in a single course of treatment, if that attendance is at consulting rooms or hospital	42.20
106	Professional attendance by a specialist in the practice of his or her specialty of ophthalmology and following referral of the patient to him or her — an attendance (other than a second or subsequent attendance in a single course of treatment) at which the only service provided is refraction testing for the issue of a prescription for spectacles or contact lenses, if that attendance is at consulting rooms or hospital (other than a service to which any of items 104, 109 and 10801 to 10816 applies)	69.70
107	Professional attendance by a specialist in the practice of his or her specialty following referral of the patient to him or her — an attendance (other than a second or subsequent attendance in a single course of treatment), if that attendance is at a place other than consulting rooms or hospital	123.15
108	Professional attendance by a specialist in the practice of his or her specialty following referral of the patient to him or her — each attendance after the first in a single course of treatment, if that attendance is at a place other than consulting rooms or hospital	77.95
109	Professional attendance by a specialist in the practice of his or her specialty of ophthalmology following referral of the patient to him or her — an attendance (other than a second or subsequent attendance in a single course of treatment) at which a comprehensive eye examination, including pupil dilation, is performed on:    (a)  a patient aged 9 years or younger; or   (b)  a patient aged 14 years or younger with developmental delay; (other than a service to which any of items 104, 106 and 10801 to 10816 applies)	189.20

Division 2.5            Group A4 — Consultant physician (other than psychiatry) attendances to which no other item applies

Group A4 — Consultant physician attendances to which no other item applies
Item	Description	Fee $
110	Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a referring practitioner — initial attendance in a single course of treatment	148.10
112	Professional attendance by a consultant physician practicing in his or her specialty:    (a)  by video conference; and   (b)  rendered to a patient who:         (i)   is a care recipient in a residential care service; or        (ii)   is at an Aboriginal Medical Service or an Aboriginal Community Controlled Health Service for which a direction made under subsection 19 (2) of the Act applies; or       (iii)   is located outside an inner metropolitan area and is not an admitted patient; and    (c)  for a service provided with item 110, 116, 119, 132 or 133.	50% of the fee for item 110, 116, 119, 132 or 133
116	Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a referring practitioner — each attendance (other than a service to which item 119 applies) after the first in a single course of treatment	74.10
119	Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a referring practitioner — each minor attendance after the first in a single course of treatment	42.20
122	Professional attendance at a place other than consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a referring practitioner — initial attendance in a single course of treatment	179.70
128	Professional attendance at a place other than consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a referring practitioner — each attendance (other than a service to which item 131 applies) after the first in a single course of treatment	108.70
131	Professional attendance at a place other than consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a referring practitioner — each minor attendance after the first in a single course of treatment	78.25
132	Professional attendance by a consultant physician in the practice of his or her specialty (other than psychiatry) of at least 45 minutes in duration for an initial assessment of a patient with at least 2 morbidities (which may include complex congenital, developmental and behavioural disorders) following referral of the patient to him or her by a referring practitioner, if:	259.00
(a)  an assessment is undertaken that covers:         (i)   a comprehensive history, including psychosocial history and medication review; and        (ii)   comprehensive multi or detailed single organ system assessment; and
(iii)   the formulation of differential diagnoses; and
(b)  a consultant physician treatment and management plan of significant complexity is prepared and provided to the referring practitioner, which involves:         (i)   an opinion on diagnosis and risk assessment; and        (ii)   treatment options and decisions; and       (iii)   medication recommendations; and
(c)  an attendance on the patient to which item 110, 116 or 119 applies did not take place on the same day by the same consultant physician; and
(d)  this item has not applied to an attendance on the patient in the preceding 12 months by the same consultant physician
133	Professional attendance by a consultant physician in the practice of his or her specialty (other than psychiatry) of at least 20 minutes in duration after the first attendance in a single course of treatment for a review of a patient with at least 2 morbidities (which may include complex congenital, developmental and behavioural disorders) if:	129.65
(a)  a review is undertaken that covers:         (i)   review of initial presenting problems and results of diagnostic investigations; and        (ii)   review of responses to treatment and medication plans initiated at time of initial consultation; and       (iii)   comprehensive multi or detailed single organ system assessment; and       (iv)   review of original and differential diagnoses; and
(b)  the modified consultant physician treatment and management plan is provided to the referring practitioner, which involves, if appropriate:         (i)   a revised opinion on the diagnosis and risk assessment; and        (ii)   treatment options and decisions; and       (iii)   revised medication recommendations; and
(c)  an attendance on the patient to which item 110, 116 or 119 applies did not take place on the same day by the same consultant physician; and
(d)  item 132 has applied for an attendance by same consultant physician on the patient in the preceding 12 months; and    (e)  this item has not applied more than twice in any 12 month period

Division 2.5A        Group A29 — Early intervention services for children with autism, pervasive developmental disorder or disability

2.5A.1Meaning of eligible allied health provider and risk assessment

In items 135, 137 and 139:

eligible allied health provider means any of the following:

(a)an audiologist;

(b)an occupational therapist;

(c)a participating optometrist;

(d)an orthoptist;

(e)a physiotherapist;

(f)a psychologist;

(g)a speech pathologist.

risk assessment means an assessment of:

(a)the risk to the patient of a contributing co‑morbidity; and

(b)environmental, physical, social and emotional risk factors that may apply to the patient or to another individual.

2.5A.2Meaning of eligible disability

An eligible disability means any of the following:

(a)sight impairment that results in vision of less than or equal to 6/18 vision or equivalent field loss in the better eye, with correction;

(b)hearing impairment that results in:

(i)a hearing loss of 40 decibels or greater in the better ear, across 4 frequencies; or

(ii)permanent conductive hearing loss and auditory neuropathy;

(c)cerebral palsy;

(d)Down syndrome;

(e)Fragile X syndrome.

Group A29 — Early intervention services for children with autism, pervasive developmental disorder or disability
Item		Description	Fee $
135	Professional attendance of at least 45 minutes in duration at consulting rooms or hospital, by a consultant physician in the practice of his or her specialty of paediatrics, following referral of the patient to the consultant by a referring practitioner, for assessment, diagnosis and preparation of a treatment and management plan for a patient aged under 13 years with autism or another pervasive developmental disorder, if the consultant paediatrician does all of the following:		259.00
(a)  undertakes a comprehensive assessment and makes a diagnosis (if appropriate, using information provided by an eligible allied health provider);
(b)  develops a treatment and management plan, which must include the following:         (i)   an assessment and diagnosis of the patient’s condition;        (ii)   a risk assessment;       (iii)   treatment options and decisions;       (iv)   if necessary — medical recommendations;    (c)  provides a copy of the treatment and management plan to:         (i)   the referring practitioner; and
(ii)   one or more allied health providers, if appropriate, for the treatment of the patient; (other than attendance on a patient for whom payment has previously been made under this item or item 137, 139 or 289)
137	Professional attendance of at least 45 minutes in duration at consulting rooms or hospital, by a specialist or consultant physician (not including a general practitioner) following referral of the patient to the consultant by a referring practitioner, for assessment, diagnosis and preparation of a treatment and management plan for a patient under 13 years with an eligible disability if the specialist or consultant physician does all of the following:		259.00
(a)  undertakes a comprehensive assessment and makes a diagnosis (if appropriate, using information provided by an eligible allied health provider);
(b)  develops a treatment and management plan, which must include the following:         (i)   an assessment and diagnosis of the patient’s condition;        (ii)   a risk assessment;       (iii)   treatment options and decisions;       (iv)   if necessary — medication recommendations;    (c)  provides a copy of the treatment and management plan to one or more allied health providers, if appropriate, for the treatment of the patient; (other than attendance on a patient for whom payment has previously been made under this item or item 135, 139 or 289)
139	Professional attendance of at least 45 minutes in duration at consulting rooms only, by a general practitioner (not including a specialist or consultant physician) for assessment, diagnosis and preparation of a treatment and management plan for a patient under 13 years with an eligible disability if the general practitioner does all of the following:    (a)  undertakes a comprehensive assessment and makes a diagnosis (if appropriate, using information provided by an eligible allied health provider);		127.50
(b)  develops a treatment and management plan, which must include the following:         (i)   an assessment and diagnosis of the patient’s condition;        (ii)   a risk assessment;       (iii)   treatment options and decisions;       (iv)   if necessary — medication recommendations;    (c)  provides a copy of the treatment and management plan to one or more allied health providers, if appropriate, for the treatment of the patient; (other than attendance on a patient for whom payment has previously been made under this item or item 135, 137 or 289)

Division 2.61               Group C3 — General and prosthodontic services

2.61.1     Meaning of symbol (AD)

               Items 75800 to 75854 that include the symbol (AD) apply only to a service provided by a dental practitioner.

2.61.2     Cleft lip and cleft palate services

               Items 75800 to 75854 apply only to a service provided to a prescribed dental patient.

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

Group C3 — General and prosthodontic services
Item	Description	Fee $
75800	Attendance comprising consultation, preventive treatment and prophylaxis, of not less than 30 minutes in duration — each attendance to a maximum of 3 attendances in any period of 12 months (AD)	80.90
75803	Provision and fitting of acrylic base partial denture, including retainers — 1 tooth (AD)	323.60
75806	Provision and fitting of acrylic base partial denture, including retainers — 2 teeth (AD)	379.55
75809	Provision and fitting of acrylic base partial denture, including retainers — 3 teeth (AD)	449.40
75812	Provision and fitting of acrylic base partial denture, including retainers — 4 teeth (AD)	499.35
75815	Provision and fitting of acrylic base partial denture, including retainers — 5 to 9 teeth (AD)	609.30
75818	Provision and fitting of acrylic base partial denture, including retainers — 10 to 12 teeth (AD)	719.05
75821	Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 1 tooth (AD)	579.15
75824	Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 2 teeth (AD)	669.10
75827	Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 3 teeth (AD)	769.15
75830	Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 4 teeth (AD)	848.95
75833	Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 5 to 9 teeth (AD)	1,038.60
75836	Provision and fitting of cast metal base (cobalt chromium alloy) partial denture including casting and retainers — 10 to 12 teeth (AD)	1,188.45
75839	Provision and fitting of retainers (other than treatment associated with treatment to which item 75803, 75806, 75809, 75812, 75815, 75818, 75821, 75824, 75827, 75830, 75833 or 75836 applies) — each retainer (AD)	26.85
75842	Adjustment of partial denture (other than treatment associated with treatment to which item 75803, 75806, 75809, 75812, 75815, 75818, 75821, 75824, 75827, 75830, 75833 or 75836 applies) (AD)	40.00
75845	Relining of partial denture by laboratory process and associated fitting (AD)	199.85
75848	Remodelling and fitting of partial denture of more than 4 teeth (AD)	239.70
75851	Repair to cast metal base of partial denture — 1 or more points (AD)	119.85
75854	Addition of a tooth or teeth to a partial denture to replace extracted tooth or teeth, including taking of necessary impression (AD)	119.85

Dictionary

Note   All references in the Dictionary to a provision are references to a provision in Schedule 1 of these Regulations unless otherwise indicated.

(AD):

(a)for Division 2.60 — see clause 2.60.1.

(b)for Division 2.61 — see clause 2.61.1.

(AO) — see clause 2.59.2.

(AOS):

(a)for Division 2.59 — see clause 2.59.2; and

(b)for Division 2.60 — see clause 2.60.2.

(G) — see clause 1.1.5.

(H) — see clause 1.1.6.

(S) — see clause 1.1.7.

3 Step Mental Health Process, for Division 2.20 — see clause 2.20.1.

Aboriginal and Torres Strait Islander health practitioner means a person:

(a)who is registered under a law of a State or Territory as an Aboriginal and Torres Strait Islander health practitioner; and

(b)who is employed by, or whose services are otherwise retained by, a medical practitioner in a general practice or a health service to which a direction made under subsection 19 (2) of the Act applies.

aboriginal health worker means a person:

(a)who holds a Certificate III in Aboriginal or Torres Strait Islander Health Worker Primary Health Care (Clinical) or other appropriate qualification; and

(b)who is engaged by a medical practitioner in a general practice or a health service to which a direction made under subsection 19(2) of the Act applies.

accredited orthodontist— see clause 2.60.3.

ACRRM means the Australian College of Rural and Remote Medicine.

Act means the Health Insurance Act 1973.

after‑hours period means any of the following:

(a)a public holiday;

(b)a Sunday;

(c)before 8 am, or after 12 noon, on a Saturday;

(d)before 8 am, or after 6 pm, on any day other than a Saturday, Sunday or public holiday.

amount under clause 2.1.1 — see clause 2.1.1.

amount under clause 2.19.1— see clause 2.19.1.

amount under clause 2.20.2— see clause 2.20.2.

amount under clause 2.38.1 — see clause 2.38.1.

amount under clause 2.40.2:

(a)for item 16633 — see clause 2.40.2; and

(b)for item16636  — see clause 2.40.2.

amount under clause 2.42.1 — see clause 2.42.1.

amount under clause 2.43.1 — see clause 2.43.1.

amount under clause 2.43.2— see clause 2.43.2.

amount under clause 2.44.4 — see clause 2.44.4.

amount under clause 2.44.5— see clause 2.44.5.

amount under clause 2.44.18— see clause 2.44.18.

amount under clause 2.45.1 — see clause 2.45.1.

amount under clause 2.45.2 — see clause 2.45.2.

amount under clause 2.45.3 — see clause 2.45.3.

amount under clause 2.48.1 — see clause 2.48.1.

approved site:

(a)for item 15338 — see clause 2.38.2; and

(b)for items 37220 and 37227 — see clause 2.44.1.

ASGC — see clause 2.31.1.

associated medical practitioner:

(a)for item 732 — see clause 2.17.2; and

(b)for item 2712 — see clause 2.20.5.

bulk‑billed:

(a)for items 10931, 10932 and 10933 — see clause 2.28.4; and

(b)for Division 2.31 — see clause 2.31.1.

care recipient means a person receiving residential care under s21‑2 of the Aged Care Act 1997.

case conference team — see clause 2.17.17.

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

Commonwealth concession card holder — see clause 2.31.1.

community case conference means a case conference for community based patients.

completed mental health skills training — see clause 2.20.5A

complex paediatric case — see clause 2.43.3.

comprehensive hyperbaric medicine facility — see clause 2.37.1.

completes the minimum requirements for a cycle of care of a patient with established diabetes mellitus — see clause 2.19.2.

completes the minimum requirements of the Asthma Cycle of Care — see clause 2.19.3.

contribute to a multidisciplinary care plan — see clause 2.17.3.

coordinating — see clause 2.17.16.

coordinating a review of a GP management plan, for item 732 — see clause 2.17.5.

coordinating the development of team care arrangements, for item 723 — see clause 2.17.4.

delivery— see clause 2.40.3.

eligible allied health provider:

(a)for items 135, 137 and 139 — see clause 2.5A.1; and

(b)for item 289 — see clause 2.10.4.

eligible area — see clause 2.31.1.

eligible disability— see clause 2.5A.2.

eligible non‑vocationally recognised medical practitioner — see clause 1.1.1.

embryology laboratory services — see clause 2.37.2.

family carer, of a patient, includes a person if the person is:

(a)a relative or friend of the patient; and

(b)providing care to the patient other than for payment.

focussed psychological strategies — see clause 2.20.1.

foreign body — see clause 2.44.13.

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

general practitioner — see clause 1.1.1A.

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

GP management plan — see clause 2.30.1.

immunisation means the administration of a registered vaccine to a person for any purpose other than as part of a mass immunisation of persons.

immunisation recommended for a 4 year old child means the immunisation recommended for a 4 year old child by the National Immunisation Program Schedule as in effect on 1 July 2007.

Note   The National Immunisation Program Schedule can be viewed at

inner metropolitan area means an area which is not classified a Telehealth Eligible Service Area in the document Telehealth Eligible Service Areas.

Note   The Telehealth Eligible Services Areas can be viewed at

institution means a place (other than a hospital or residential aged care facility) at which residential accommodation or day care is, or both residential accommodation and day care are, made available to:

(a)disadvantaged children; or

(b)juvenile offenders; or

(c)aged persons; or

(d)chronically ill psychiatric patients; or

(e)homeless persons; or

(f)unemployed persons; or

(g)persons suffering from alcoholism; or

(h)persons addicted to drugs; or

(i)physically or intellectually disabled persons.

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

item means:

(a)an item mentioned, by number, in column 1 of:

(i)Part 2; or

(ii)Part 2 of the diagnostic imaging services table; or

(iii)Part 2 of the pathology services table; and

(b)in a reference immediately followed by a number — the item so numbered.

Note   Because of the determination about allied health services under subsection 3C (1) of the Act, certain health services are treated as if there were an item for the service mentioned in the table. A note is included at the end of a provision of these Regulations if an item mentioned in the provision is that kind of item: see subclause 2.20.3 (2) for an example.

living in a community setting, for item 900 — see clause 2.18.1.

maxilla:

(a)for items 45720 to 45752 — see clause 2.44.19; and

(b)for items 52342 to 52375 — see clause 2.50.1.

mental disorder, for Division 2.20 — see clause 2.20.1.

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

(a)is a second or subsequent attendance on the patient, in the course of a single course of treatment by the consultant physician, during which it is not necessary for the consultant physician to carry out a physical examination of the patient; and

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

multidisciplinary care plan:

(a)for items 729 and 731 — see clause 2.17.6; and

(b)for item 10997 — see clause 2.30.1.

multidisciplinary case conference — see clause 1.1.2.

multidisciplinary case conference in a residential aged care facility— see clause 2.17.13.

multidisciplinary case conference team — see clause 1.1.3.

multidisciplinary discharge case conference — see clause 2.17.12.

non‑directive pregnancy support counselling — see clause 2.22.1.

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.

non‑medicare service means any of the following:

(a)endoluminal gastroplication, for the treatment of gastro‑oesophageal reflux disease;

(c)gamma knife surgery;

(d)intradiscal electro thermal arthroplasty;

(e)intravascular ultrasound, except if used in conjunction with intravascular brachytherapy;

(f)intro‑articular viscosupplementation, for the treatment of osteoarthritis of the knee;

(g)low intensity ultrasound treatment, for the acceleration of bone fracture healing, using a bone growth stimulator;

(h)lung volume reduction surgery, for advanced emphysema;

(i)photodynamic therapy, for skin and mucosal cancer;

(j)placement of artificial bowel sphincters, in the management of faecal incontinence;

(k)selective internal radiation therapy for any condition other than hepatic metastases that are secondary to colorectal cancer;

(l)specific mass measurement of bone alkaline phosphatise;

(m)transmyocardial laser revascularisation;

(n)vertebral axial decompression therapy, for chronic back pain;

(o)autologous chondrocyte implantation and matrix‑induced autologous chondrocyte implantation;

(p)vertebroplasty.

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

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

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

organise and coordinate:

(a)for items 735, 739, 743, 820 to 823, 830 to 838, 855 to 858 and 861 to 866 — see clause 2.17.14; and

(b)for Division 2.21 — see clause 2.21.1

outcome measurement tool — see clause 2.20.1.

participate:

(a)for items 747, 750, 758, 825 to 828 and 835 to 838 — see clause 2.17.15; and

(b)for items 2958, 2972, 2974, 2992, 2996, 3000, 3051, 3055, 3062, 3083, 3088, 3093 — see clause 2.21.2.

participating in a video conferencing consultation — see clause 1.2.10.

patient’s medical condition requires urgent treatment — see clause 2.15.1.

patient’s usual medical practitioner means a medical practitioner:

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

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

(c)located at a medical practice that:

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

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

person with a chronic disease — see clause 2.30.1.

practice location — see clause 2.31.1.

practice nurse means a registered or an enrolled nurse who is employed by, or whose services are otherwise retained by, a general practice or by a health service to which a direction made under subsection 19 (2) of the Act applies.

preparation of a GP mental health treatment plan — see clause 2.20.3.

preparing a GP management plan — see clause 2.17.7.

previous significant surgical complication — see clause 2.45.4.

problem focussed history — see clause 2.14.2.

qualified medical acupuncturist — see clause 2.9.1.

qualified radiologist — see clause 2.44.7.

qualified sleep medicine practitioner — see clause 2.34.2.

qualified surgeon — see clause 2.44.6.

RACGP means the Royal Australian College of General Practitioners.

recognised emergency department — see clause 2.14.1.

referral means referral by a referring practitioner.

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

(a)for all referrals — a medical practitioner; 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; and

(e)for a referral made to a specialist in the specialty of obstetrics or paediatrics (however described) that arises out of a midwifery service provided by a participating midwife — a participating midwife; and

(f)for a referral made to a specialist or consultant physician that arises out of a nurse practitioner service provided by a participating nurse practitioner — a participating nurse practitioner.

regional, rural or remote area means an area classified as RRMAs 3‑7 under the Rural, Remote and Metropolitan Areas Classification.

registered vaccine means a vaccine that is included in the part of the Australian Register of Therapeutic Goods for registered goods, being the Register maintained under section 9A of the Therapeutic Goods Act 1989.

report — see clause 2.34.1.

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

residential care service has the meaning given by clause 1 of Schedule 1 to the Aged Care Act 1997.

residential medication management review — see clause 2.18.2.

responsible person — see clause 2.15.2.

review of a GP mental health treatment plan — see clause 2.20.4.

reviewing a GP management plan — see clause 2.17.8.

risk assessment:

(a)for items 135, 137 and 139 — see clause 2.5A.1; and

(b)for item 289 — see clause 2.10.4.

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.

service time— see clause 2.43.4.

single course of treatment — see clause 1.1.4.

SLA — see clause 2.31.1.

specialist trainee under the supervision of a medical practitioner — see clause 2.36.1.

SSD — see clause 2.31.1.

team care arrangements means a plan under item 723 or 732 (for a review of team care arrangements under item 723).

treatment cycle — see clause 2.37.3.

unreferred service — see clause 2.31.1.

unsociable hours means the period starting at 11 pm and ending at 7 am on any day.

Notes to the Health Insurance (General Medical Services Table) Regulations 2011

Note 1

The Health Insurance (General Medical Services Table) Regulations 2011 (in force under the Health Insurance Act 1973) as shown in this compilation comprise Select Legislative Instrument 2011 No. 187 amended as indicated in the Tables below.

Table of Instruments

Year and Number	Date of FRLI registration	Date of commencement	Application, saving or transitional provisions
2011 No. 187	25 Oct 2011 (see F2011L02108)	1 Nov 2011
2011 No. 186	25 Oct 2011 (see F2011L02117)	1 Jan 2012	—
2011 No. 226	23 Nov 2011 (see F2011L02407)	1 Nov 2011	—
2012 No. 16	24 Feb 2012 (see F2012L00398)	1 Mar 2012	—
2012 No. 139	29 June 2012 (see F2012L01431)	Ss. 1–3 and Schedule 1: 1 Nov 2011 S. 4 and Schedule 2: 1 July 2012	—
2012 No. 140	30 June 2012 (see F2012L01479)	1 July 2012	—

Table of Amendments

ad. = added or inserted   am. = amended   rep. = repealed   rs. = repealed and substituted
Provision affected	How affected
Schedule 1
Schedule 1..........................	am. 2011 Nos. 186 and 226; 2012 Nos. 16, 139 and 140
Dictionary
Dictionary.............................	am. 2011 Nos. 186 and 226; 2012 Nos. 16 and 139