Health Insurance (General Medical Services Table) Regulations 2017 (Cth)

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Health Insurance (General Medical Services Table) Regulations 2017

made under the

Health Insurance Act 1973

Compilation No. 6

Compilation date: 1 May 2018

Includes amendments up to: F2018L00514

Registered: 8 May 2018

About this compilation

This compilation

This is a compilation of the Health Insurance (General Medical Services Table) Regulations 2017 that shows the text of the law as amended and in force on 1 May 2018 (the compilation date).

The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.

Uncommenced amendments

The effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Legislation Register ( The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the series page on the Legislation Register for the compiled law.

Application, saving and transitional provisions for provisions and amendments

If the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.

Editorial changes

For more information about any editorial changes made in this compilation, see the endnotes.

Modifications

If the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the series page on the Legislation Register for the compiled law.

Self‑repealing provisions

If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.

Contents

1Name

This instrument is the Health Insurance (General Medical Services Table) Regulations 2017.

3Authority

This instrument is made under the Health Insurance Act 1973.

5General medical services table

For the purposes of subsection 4(1) of the Act, this instrument prescribes a table of medical services set out in Schedule 1.

6Dictionary

The Dictionary in Part 3 of Schedule 1 defines certain words and expressions that are used in this instrument, and includes references to certain words and expressions that are defined elsewhere in this instrument.

Schedule 1General medical services table

Note: See section 5.

Part 1PreliminaryDivision 1.1Interpretation1.1.1Meaning of eligible non‑vocationally recognised medical practitioner
  1. (1)

    In the table:

eligible non‑vocationally recognised medical practitioner means:

  1. (a)

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

    1. (i)

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

    2. (ii)

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

  2. (b)

    a medical practitioner who:

    1. (i)

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

    2. (ii)

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

    3. (iii)

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

      1. (A)

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

      2. (B)

        of which the Chief Executive Medicare has written notice; or

  3. (c)

    a medical practitioner who:

    1. (i)

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

    2. (ii)

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

    3. (iii)

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

  4. (d)

    a medical practitioner who:

    1. (i)

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

    2. (ii)

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

    3. (iii)

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

  1. (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:

  1. (a)

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

  2. (b)

    a practitioner who:

    1. (i)

      is a Fellow of the RACGP; and

    2. (ii)

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

    3. (iii)

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

  3. (c)

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

  4. (d)

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

    1. (i)

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

    2. (ii)

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

  5. (e)

    an eligible non‑vocationally recognised medical practitioner; or

  6. (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:

  1. (a)

    discussing a patient’s history;

  2. (b)

    identifying the patient’s multidisciplinary care needs;

  3. (c)

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

  4. (d)

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

  5. (e)

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

1.1.3Meaning of multidisciplinary case conference team
  1. (1)

    A multidisciplinary case conference team for a patient:

    1. (a)

      includes a medical practitioner; and

    2. (b)

      either:

      1. (i)

        for items 735 to 758, 825 to 828, 855 to 858, 6029 to 6042 and 6064 to 6075—includes at least 2 other members; or

      2. (ii)

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

    3. (c)

      may also include a family member of the patient.

  2. (2)

    For the members mentioned in paragraph (b):

    1. (a)

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

    2. (b)

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

    3. (c)

      one member may be another medical practitioner.

    Example: Other members may be allied health professionals, home and community service providers and care organisers, including the following:

    (a) Aboriginal and Torres Strait Islander health practitioners;

    (b) asthma educators;

    (c) audiologists;

    (d) dental therapists;

    (e) dentists;

    (f) diabetes educators;

    (g) dieticians;

    (h) mental health workers;

    (i) occupational therapists;

    (j) optometrists;

    (k) orthoptists;

    (l) orthotists or prosthetists;

    (m) pharmacists;

    (n) physiotherapists;

    (o) podiatrists;

    (p) psychologists;

    (q) registered nurses;

    (r) social workers;

    (s) speech pathologists;

    (t) education providers;

    (u) “meals on wheels” providers;

    (v) personal care workers;

    (w) probation officers.

  3. (3)

    For the purposes of 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. (1)

    Use this clause for items 104 to 131, 133, 384 to 388, 2799, 2801 to 2840, 3003, 3005 to 3028, 6004, 6007 to 6015, 6018, 6019, 6024, 6025, 6026, 6051, 6052, 6058, 6059, 6060, 6062, 6063, 16401, 16404, 16406, 51700 and 51703.

  2. (2)

    A single course of treatment for a patient:

    1. (a)

      includes:

      1. (i)

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

      2. (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

      3. (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

    2. (b)

      does not include:

      1. (i)

        referral of the patient to the specialist or consultant physician; or

      2. (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:

        1. (A)

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

        2. (B)

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

1.1.6Meaning of symbol (H)

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

Division 1.2General application provisions1.2.1Application

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. (1)

    Use this clause for items 99 to 137, 141 to 149, 288 to 389, 2799, 2801 to 2840, 3003, 3005 to 3028, 6004, 6007 to 6016, 6018 to 6028, 6051 to 6063, 13210, 16399, 16401, 16404, 16407, 16408, 16508, 16509, 16533, 16534, 17609 and 17640 to 17655.

  2. (2)

    An attendance on a patient by a specialist or consultant physician:

    1. (a)

      includes an attendance on a patient if:

      1. (i)

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

      2. (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

    2. (b)

      does not include an attendance on a patient if:

      1. (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

      2. (ii)

        a later referral has not been made.

  3. (3)

    In this clause:

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

1.2.2ALimitation of items – certain attendances by specialists and consultant physicians
  1. (1)

    Use this clause for items 105, 116, 119, 386, 2806, 2814, 3010, 3014, 6019, 6052 and 16404.

  2. (2)

    The item does not apply to a service if:

    1. (a)

      the service is an attendance on a patient by a specialist or a consultant physician on the same day as the day on which an operation is performed on the patient by the specialist or consultant physician; and

    2. (b)

      the operation is a service to which an item in Group T8 applies; and

    3. (c)

      the amount specified in the item in Group T8 as the fee for a service to which that item applies is $300 or more.

1.2.3Professional attendance services
  1. (1)

    Use this clause for items 3 to 338, 348 to 389, 410 to 417, 501 to 600, 900, 903, 2497 to 2840, 3003, 3005 to 3028, 5000 to 5267, 6004, 6007 to 6016, 6018 to 6026, 6051 to 6063, 13210, 16399, 16401, 16404, 16406, 16407, 16508, 16509, 16533, 16534 and 17609 to 17690.

  2. (2)

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

    1. (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;

    2. (b)

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

    3. (c)

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

    4. (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;

    5. (e)

      providing appropriate preventive health care;

    6. (f)

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

  3. (3)

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

    1. (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

    2. (b)

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

1.2.4Personal attendance by medical practitioners generally
  1. (1)

    Use this clause for items 3 to 149, 173 to 338, 348 to 536, 585 to 600, 2100 to 2220, 2497 to 2840, 3003, 3005 to 3028, 4001 to 6016, 6018 to 6024, 6051 to 6058, 6062, 6063, 10801 to 10816, 11012 to 11021, 11212, 11304, 11600, 11627, 11701, 11724, 11921 to 12003, 12201, 13030 to 13112, 13209, 13210, 13290 to 13700, 13815 to 13888, 14100 to 14200, 14203 to 14212, 14224, 15600, 16003 to 16512 and 16515 to 51318.

  2. (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. (3)

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

    1. (a)

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

    2. (b)

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

    3. (c)

      participating in a video conferencing consultation referred to in items 99, 112 to 114, 149, 288, 384, 389, 2100, 2122, 2125, 2126, 2137, 2138, 2143, 2147, 2179, 2195, 2199, 2220, 2799, 2820, 3003, 3015, 6004, 6016, 6025, 6026, 6059, 6060, 13210, 16399 and 17609.

1.2.5Personal attendance by medical practitioners
  1. (1)

    Use this clause for items 3 to 723, 732, 900 to 6016, 6018 to 6024, 6028, 6051 to 6058, 6062, 6063, 10801 to 10816, 11012 to 11021, 11212, 11304, 11600, 11627, 11701, 11722, 11724, 11728, 11820, 11823, 11921, 12000, 12003, 12201, 13030 to 13112, 13209, 13210, 13290 to 13700, 13815 to 13888, 14100 to 14200, 14203 to 14212, 14224, 15600, 16003 to 16512, 16515 to 51318.

  2. (2)

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

    1. (a)

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

    2. (b)

      a medical practitioner who:

      1. (i)

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

      2. (ii)

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

  3. (3)

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

  4. (4)

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

    1. (a)

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

    2. (b)

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

    3. (c)

      participating in a video conferencing consultation referred to in items 99, 112 to 114, 149, 288, 384, 389, 2100, 2122, 2125, 2126, 2137, 2138, 2143, 2147, 2179, 2195, 2199, 2220, 2799, 2820, 3003, 3015, 6004, 6016, 6025, 6026, 6059, 6060, 13210, 16399 and 17609.

1.2.6Consultant occupational physician

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

  1. (a)

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

    1. (i)

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

    2. (ii)

      affects the patient’s capacity to be employed;

  2. (b)

    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;

  3. (c)

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

1.2.7Application of items – services provided with non‑medicare services

Items 3 to 10816 do not apply to a service mentioned in the item if the service is provided at the same time as, or in connection with, a non‑medicare service.

1.2.7AApplication of items – services provided with autologous injections of blood or blood products

An item in the table does not apply to a service mentioned in the item if the service is provided to a patient at the same time, or in connection with, an injection of blood or a blood product that is autologous.

1.2.8Services that may be provided by persons other than medical practitioners
  1. (1)

    Use this clause for items 10983 to 10989, 10997, 11000, 11003, 11004, 11005, 11006, 11009, 11024, 11027, 11200, 11203, 11204, 11205, 11210, 11211, 11215, 11218, 11221, 11222, 11224, 11225, 11235, 11237, 11240, 11241, 11242, 11243, 11244, 11300, 11303, 11306, 11309, 11312, 11315, 11318, 11324, 11327, 11330, 11332, 11333, 11336, 11339, 11503, 11506, 11509, 11512, 11602, 11604, 11605, 11610, 11611, 11612, 11614, 11615, 11700, 11702, 11708, 11709, 11710, 11711, 11712, 11713, 11715, 11718, 11721, 11725, 11726, 11727, 11800, 11810, 11830, 11833, 11900, 11903, 11906, 11909, 11912, 11915, 11919, 12012, 12017, 12021, 12022, 12024, 12200, 12203, 12207, 12210, 12213, 12215, 12217, 12250, 12500 to 12530, 13015, 13020, 13025, 13200 to 13203, 13206, 13212, 13215, 13218, 13221, 13703, 13706, 13709, 13750, 13755, 13757, 13760, 13915 to 13948, 14050, 14053, 14218, 14221, 15000 to 15336, 15339 to 15357, 15500 to 15539 and 16514.

  2. (2)

    The item applies whether the medical service is given by:

    1. (a)

      a medical practitioner; or

    2. (b)

      a person, other than a medical practitioner, who:

      1. (i)

        is employed by a medical practitioner; or

      2. (ii)

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

1.2.9Meaning of participating in a video conferencing consultation

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

  1. (a)

    in relation to his or her speciality to the patient; and

  2. (b)

    by way of a video conferencing consultation.

Part 2Services and feesDivision 2.1Groups A1 to A9

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

2.1.1Meaning of amount under clause 2.1.1

In an item of the table mentioned in column 1 of table 2.1.1:

amount under clause 2.1.1 means the sum of:

  1. (a)

    the fee mentioned in column 2 for the item; and

  2. (b)

    either:

    1. (i)

      if a practitioner attends not more than 6 patients in a single attendance—the amount mentioned in column 3 for the item, divided by the number of patients attended; or

    2. (ii)

      if a practitioner attends more than 6 patients in a single attendance—the amount mentioned in column 4 for the item.

Table 2.1.1—Amount under clause 2.1.1

Item

Column 1

Item/s of the table

Column 2

Fee

Column 3

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

Column 4

Amount if more than 6 patients ($)

1

4

The fee for item 3

25.95

2.00

2

20

The fee for item 3

46.70

3.30

3

24

The fee for item 23

25.95

2.00

4

35

The fee for item 23

46.70

3.30

5

37

The fee for item 36

25.95

2.00

6

43

The fee for item 36

46.70

3.30

7

47

The fee for item 44

25.95

2.00

8

51

The fee for item 44

46.70

3.30

9

58

$8.50

15.50

0.70

10

59, 2610, 2631, 2673

$16.00

17.50

0.70

11

60, 2613, 2633, 2675

$35.50

15.50

0.70

12

65, 2616, 2635, 2677

$57.50

15.50

0.70

13

92

$8.50

27.95

1.25

14

93

$16.00

31.55

1.25

15

95

$35.50

27.95

1.25

16

96

$57.50

27.95

1.25

17

195

The fee for item 193

25.95

2.00

18

414

The fee for item 410

25.45

1.95

19

415

The fee for item 411

25.45

1.95

20

416

The fee for item 412

25.45

1.95

21

417

The fee for item 413

25.45

1.95

22

2503

The fee for item 2501

25.95

2.00

23

2506

The fee for item 2504

25.95

2.00

24

2509

The fee for item 2507

25.95

2.00

25

2518

The fee for item 2517

25.95

2.00

26

2522

The fee for item 2521

25.95

2.00

27

2526

The fee for item 2525

25.95

2.00

28

2547

The fee for item 2546

25.95

2.00

29

2553

The fee for item 2552

25.95

2.00

30

2559

The fee for item 2558

25.95

2.00

31

5003

The fee for item 5000

25.95

2.00

32

5010

The fee for item 5000

46.70

3.30

33

5023

The fee for item 5020

25.95

2.00

34

5028

The fee for item 5020

46.70

3.30

35

5043

The fee for item 5040

25.95

2.00

36

5049

The fee for item 5040

46.70

3.30

37

5063

The fee for item 5060

25.95

2.00

38

5067

The fee for item 5060

46.70

3.30

39

5220

$18.50

15.50

0.70

40

5223

$26.00

17.50

0.70

41

5227

$45.50

15.50

0.70

42

5228

$67.50

15.50

0.70

43

5260

$18.50

27.95

1.25

44

5263

$26.00

31.55

1.25

45

5265

$45.50

27.95

1.25

46

5267

$67.50

27.95

1.25

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

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

Item

Description

Fee ($)

3

Professional attendance at consulting rooms (other than a service to which another item applies) by a general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management—each attendance

16.95

4

Professional attendance by a general practitioner (other than attendance at consulting rooms or a residential aged care facility or a service to which another item in the table applies) that requires a short patient history and, if necessary, limited examination and management—an attendance on one or more patients at one place on one occasion—each patient

Amount under clause 2.1.1

20

Professional attendance (other than a service to which another item applies) at a residential aged care facility (other than a professional attendance at a self‑contained unit) or professional attendance at consulting rooms situated within such a complex if the patient is accommodated in a residential aged care facility (other than accommodation in a self‑contained unit) by a general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management—an attendance on one or more patients at one residential aged care facility on one occasion—each patient

Amount under clause 2.1.1

23

Professional attendance by a general practitioner at consulting rooms (other than a service to which another item in the table applies), lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation—each attendance

37.05

24

Professional attendance by a general practitioner (other than attendance at consulting rooms or a residential aged care facility or a service to which another item in the table applies), lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation—an attendance on one or more patients at one place on one occasion—each patient

Amount under clause 2.1.1

35

Professional attendance by a general practitioner at a residential aged care facility to residents of the facility (other than a service to which another item in the table applies), lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation—an attendance on one or more patients at one residential aged care facility on one occasion—each patient

Amount under clause 2.1.1

36

Professional attendance by a general practitioner at consulting rooms (other than a service to which another item in the table applies), lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation—each attendance

71.70

37

Professional attendance by a general practitioner (other than attendance at consulting rooms or a residential aged care facility or a service to which another item in the table applies), lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation—an attendance on one or more patients at one place on one occasion—each patient

Amount under clause 2.1.1

43

Professional attendance by a general practitioner at a residential aged care facility to residents of the facility (other than a service to which another item in the table applies), lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation—an attendance on one or more patients at one residential aged care facility on one occasion—each patient

Amount under clause 2.1.1

44

Professional attendance by a general practitioner at consulting rooms (other than a service to which another item in the table applies), lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation—each attendance

105.55

47

Professional attendance by a general practitioner (other than attendance at consulting rooms or a residential aged care facility or a service to which another item in the table applies), lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation—an attendance on one or more patients at one place on one occasion—each patient

Amount under clause 2.1.1

51

Professional attendance by a general practitioner at a residential aged care facility to residents of the facility (other than a service to which another item in the table applies), lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation—an attendance on one or more patients at one residential aged care facility on one occasion—each patient

Amount under clause 2.1.1

Division 2.3Group A2: Other non‑referred attendances to which no other item applies2.3.1Effect of determination under section 106TA of Act
  1. (1)

    This clause applies to a general practitioner, if:

    1. (a)

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

    2. (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

    3. (c)

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

    4. (d)

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

  2. (2)

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

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

Item

Description

Fee ($)

52

Professional attendance at consulting rooms of not more than 5 minutes in duration (other than a service to which any other item applies)—each attendance, by:

(a) a medical practitioner (who is not a general practitioner); or

(b) a general practitioner to whom clause 2.3.1 applies

11.00

53

Professional attendance at consulting rooms of more than 5 minutes in duration but not more than 25 minutes (other than a service to which any other item applies)—each attendance, by:

(a) a medical practitioner (who is not a general practitioner); or

(b) a general practitioner to whom clause 2.3.1 applies

21.00

54

Professional attendance at consulting rooms of more than 25 minutes in duration but not more than 45 minutes (other than a service to which any other item applies)—each attendance, by:

(a) a medical practitioner (who is not a general practitioner); or

(b) a general practitioner to whom clause 2.3.1 applies

38.00

57

Professional attendance at consulting rooms of more than 45 minutes in duration (other than a service to which any other item applies)—each attendance, by:

(a) a medical practitioner (who is not a general practitioner); or

(b) a general practitioner to whom clause 2.3.1 applies

61.00

58

Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a service to which any other item in the table applies), not more than 5 minutes in duration—an attendance on one or more patients at one place on one occasion—each patient, by:

(a) a medical practitioner (who is not a general practitioner); or

(b) a general practitioner to whom clause 2.3.1 applies

Amount under clause 2.1.1

59

Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a service to which any other item in the table applies) of more than 5 minutes in duration but not more than 25 minutes—an attendance on one or more patients at one place on one occasion—each patient, by:

(a) a medical practitioner (who is not a general practitioner); or

(b) a general practitioner to whom clause 2.3.1 applies

Amount under clause 2.1.1

60

Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a service to which any other item in the table applies) of more than 25 minutes in duration but not more than 45 minutes—an attendance on one or more patients at one place on one occasion—each patient, by:

(a) a medical practitioner (who is not a general practitioner); or

(b) a general practitioner to whom clause 2.3.1 applies

Amount under clause 2.1.1

65

Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a service to which any other item in the table applies) of more than 45 minutes in duration—an attendance on one or more patients at one place on one occasion—each patient, by:

(a) a medical practitioner (who is not a general practitioner); or

(b) a general practitioner to whom clause 2.3.1 applies

Amount under clause 2.1.1

92

Professional attendance (other than a service to which any other item applies) at a residential aged care facility (other than a professional attendance at a self‑contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (that is not accommodation in a self‑contained unit) of not more than 5 minutes in duration—an attendance on one or more patients at one residential aged care facility on one occasion—each patient, by:

(a) a medical practitioner (who is not a general practitioner); or

(b) a general practitioner to whom clause 2.3.1 applies

Amount under clause 2.1.1

93

Professional attendance (other than a service to which any other item applies) at a residential aged care facility (other than a professional attendance at a self‑contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (that is not accommodation in a self‑contained unit) of more than 5 minutes in duration but not more than 25 minutes—an attendance on one or more patients at one residential aged care facility on one occasion—each patient, by:

(a) a medical practitioner (who is not a general practitioner); or

(b) a general practitioner to whom clause 2.3.1 applies

Amount under clause 2.1.1

95

Professional attendance (other than a service to which any other item applies) at a residential aged care facility (other than a professional attendance at a self‑contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (that is not accommodation in a self‑contained unit) of more than 25 minutes in duration but not more than 45 minutes—an attendance on one or more patients at one residential aged care facility on one occasion—each patient, by:

(a) a medical practitioner (who is not a general practitioner); or

(b) a general practitioner to whom clause 2.3.1 applies

Amount under clause 2.1.1

96

Professional attendance (other than a service to which any other item applies) at a residential aged care facility (other than a professional attendance at a self‑contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (that is not accommodation in a self‑contained unit) of more than 45 minutes in duration—an attendance on one or more patients at one residential aged care facility on one occasion—each patient, by:

(a) a medical practitioner (who is not a general practitioner); or

(b) a general practitioner to whom clause 2.3.1 applies

Amount under clause 2.1.1

Division 2.4Group A3: Specialist attendances to which no other item applies2.4.1Limitation of item 99

Item 99 does not apply if the patient or the specialist travels to a place to satisfy the requirement in sub‑subparagraph (d)(i)(B) of the item.

Group A3—Specialist attendances to which no other item applies

Item

Description

Fee ($)

99

Professional attendance on a patient by a specialist practising in his or her specialty if:

(a) the attendance is by video conference; and

(b) the attendance is for a service:

(i) provided with item 104 lasting more than 10 minutes; or

(ii) provided with item 105; and

(c) the patient is not an admitted patient; and

(d) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 kms by road from the specialist; or

(ii) is a care recipient in a residential care service; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

for which a direction made under subsection 19(2) of the Act applies

50% of the fee for item 104 or 105

104

Professional attendance at consulting rooms or hospital by a specialist in the practice of his or her specialty after referral of the patient to him or her—each attendance, other than a second or subsequent attendance, in a single course of treatment, other than a service to which item 106, 109 or 16401 applies

85.55

105

Professional attendance by a specialist in the practice of his or her specialty following referral of the patient to him or her—an attendance after the first in a single course of treatment, if that attendance is at consulting rooms or hospital, other than a service to which item 16404 applies

43.00

106

Professional attendance by a specialist in the practice of his or her specialty of ophthalmology and following referral of the patient to him or her—an attendance (other than a second or subsequent attendance in a single course of treatment) at which the only service provided is refraction testing for the issue of a prescription for spectacles or contact lenses, if that attendance is at consulting rooms or hospital (other than a service to which any of items 104, 109 and 10801 to 10816 applies)

71.00

107

Professional attendance by a specialist in the practice of his or her specialty following referral of the patient to him or her—an attendance (other than a second or subsequent attendance in a single course of treatment), if that attendance is at a place other than consulting rooms or hospital

125.50

108

Professional attendance by a specialist in the practice of his or her specialty following referral of the patient to him or her—each attendance after the first in a single course of treatment, if that attendance is at a place other than consulting rooms or hospital

79.45

109

Professional attendance by a specialist in the practice of his or her specialty of ophthalmology following referral of the patient to him or her—an attendance (other than a second or subsequent attendance in a single course of treatment) at which a comprehensive eye examination, including pupil dilation, is performed on:

(a) a patient aged 9 years or younger; or

(b) a patient aged 14 years or younger with developmental delay;

(other than a service to which any of items 104, 106 and 10801 to 10816 applies)

192.80

111

Professional attendance at consulting rooms or in hospital by a specialist in the practice of his or her specialty following referral of the patient to him or her by a referring practitioner—an attendance after the first attendance in a single course of treatment, if:

(a) during the attendance, the specialist determines the need to perform an operation on the patient that had not otherwise been scheduled; and

(b) the specialist subsequently performs the operation on the patient, on the same day; and

(c) the operation is a service to which an item in Group T8 applies; and

(d) the amount specified in the item in Group T8 as the fee for a service to which that item applies is $300 or more

For any particular patient, once only on the same day

43.00

113

Initial professional attendance of 10 minutes or less in duration on a patient by a specialist in the practice of his or her speciality if:

(a) the attendance is by video conference; and

(b) the patient is not an admitted patient; and

(c) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 kms by road from the specialist; or

(ii) is a care recipient in a residential care service; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

for which a direction made under subsection 19(2) of the Act applies; and

(d) no other initial consultation has taken place for a single course of treatment

64.20

Division 2.5Group A4: Consultant physician (other than psychiatry) attendances to which no other item applies2.5.1Limitation of items 112 to 114

Items 112, 113 and 114 do not apply if the patient, specialist or physician travels to a place to satisfy the requirement in:

  1. (a)

    for item 112—sub‑subparagraph (d)(i)(B) of the item; and

  2. (b)

    for items 113 and 114—sub‑subparagraph (c)(i)(B) of the item.

Group A4—Consultant physician attendances to which no other item applies

Item

Description

Fee ($)

110

Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a referring practitioner—initial attendance in a single course of treatment

150.90

112

Professional attendance on a patient by a consultant physician practising in his or her specialty if:

(a) the attendance is by video conference; and

(b) the attendance is for a service:

(i) provided with item 110 lasting more than 10 minutes; or

(ii) provided with item 116, 119, 132 or 133; and

(c) the patient is not an admitted patient; and

(d) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 kms by road from the physician; or

(ii) is a care recipient in a residential care service; or

50% of the fee for item 110, 116, 119, 132 or 133

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

for which a direction made under subsection 19(2) of the Act applies

114

Initial professional attendance of 10 minutes or less in duration on a patient by a consultant physician practising in his or her specialty if:

(a) the attendance is by video conference; and

(b) the patient is not an admitted patient; and

(c) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 kms by road from the physician; or

(ii) is a care recipient in a residential care service; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

for which a direction made under subsection 19(2) of the Act applies; and

(d) no other initial consultation has taken place for a single course of treatment

113.20

116

Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a referring practitioner—each attendance (other than a service to which item 119 applies) after the first in a single course of treatment

75.50

117

Professional attendance at consulting rooms or in 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—an attendance after the first attendance in a single course of treatment, if:

(a) the attendance is not a minor attendance; and

(b) during the attendance, the consultant physician determines the need to perform an operation on the patient that had not otherwise been scheduled; and

(c) the consultant physician subsequently performs the operation on the patient, on the same day; and

(d) the operation is a service to which an item in Group T8 applies; and

(e) the amount specified in the item in Group T8 as the fee for a service to which that item applies is $300 or more

For any particular patient, once only on the same day

75.50

119

Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a referring practitioner—each minor attendance after the first in a single course of treatment

43.00

120

Professional attendance at consulting rooms or in 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—an attendance after the first attendance in a single course of treatment, if:

(a) the attendance is a minor attendance; and

(b) during the attendance, the consultant physician determines the need to perform an operation on the patient that had not otherwise been scheduled; and

(c) the consultant physician subsequently performs the operation on the patient, on the same day; and

(d) the operation is a service to which an item in Group T8 applies; and

(e) the amount specified in the item in Group T8 as the fee for a service to which that item applies is $300 or more

For any particular patient, once only on the same day

43.00

122

Professional attendance at a place other than consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a referring practitioner—initial attendance in a single course of treatment

183.10

128

Professional attendance at a place other than consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a referring practitioner—each attendance (other than a service to which item 131 applies) after the first in a single course of treatment

110.75

131

Professional attendance at a place other than consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a referring practitioner—each minor attendance after the first in a single course of treatment

79.75

132

Professional attendance by a consultant physician in the practice of his or her specialty (other than psychiatry) of at least 45 minutes in duration for an initial assessment of a patient with at least 2 morbidities (which may include complex congenital, developmental and behavioural disorders) following referral of the patient to him or her by a referring practitioner, if:

(a) an assessment is undertaken that covers:

(i) a comprehensive history, including psychosocial history and medication review; and

(ii) comprehensive multi or detailed single organ system assessment; and

(iii) the formulation of differential diagnoses; and

(b) a consultant physician treatment and management plan of significant complexity is prepared and provided to the referring practitioner, which involves:

(i) an opinion on diagnosis and risk assessment; and

(ii) treatment options and decisions; and

(iii) medication recommendations; and

(c) an attendance on the patient to which item 110, 116 or 119 applies did not take place on the same day by the same consultant physician; and

(d) this item has not applied to an attendance on the patient in the preceding 12 months by the same consultant physician

263.90

133

Professional attendance by a consultant physician in the practice of his or her specialty (other than psychiatry) of at least 20 minutes in duration after the first attendance in a single course of treatment for a review of a patient with at least 2 morbidities (which may include complex congenital, developmental and behavioural disorders) if:

(a) a review is undertaken that covers:

(i) review of initial presenting problems and results of diagnostic investigations; and

(ii) review of responses to treatment and medication plans initiated at time of initial consultation; and

(iii) comprehensive multi or detailed single organ system assessment; and

(iv) review of original and differential diagnoses; and

(b) the modified consultant physician treatment and management plan is provided to the referring practitioner, which involves, if appropriate:

(i) a revised opinion on the diagnosis and risk assessment; and

(ii) treatment options and decisions; and

(iii) revised medication recommendations; and

(c) an attendance on the patient to which item 110, 116 or 119 applies did not take place on the same day by the same consultant physician; and

(d) item 132 applied to an attendance claimed in the preceding 12 months; and

(e) the attendance under this item is claimed by the same consultant physician who claimed item 132 or a locum tenens; and

(f) this item has not applied more than twice in any 12 month period

132.10

Division 2.5AGroup A29: Early intervention services for children with autism, pervasive developmental disorder or disability2.5A.1Meanings of eligible allied health provider and risk assessment

In items 135, 137 and 139:

eligible allied health provider means any of the following:

  1. (a)

    an audiologist;

  2. (b)

    an occupational therapist;

  3. (c)

    an optometrist;

  4. (d)

    an orthoptist;

  5. (e)

    a physiotherapist;

  6. (f)

    a psychologist;

  7. (g)

    a speech pathologist.

Risk assessment means an assessment of:

  1. (a)

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

  2. (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:

  1. (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;

  2. (b)

    hearing impairment that results in:

    1. (i)

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

    2. (ii)

      permanent conductive hearing loss and auditory neuropathy;

  3. (c)

    deafblindness;

  4. (d)

    cerebral palsy;

  5. (e)

    Down syndrome;

  6. (f)

    Fragile X syndrome;

  7. (g)

    Prader‑Willi syndrome;

  8. (h)

    Williams syndrome;

  9. (i)

    Angelman syndrome;

  10. (j)

    Kabuki syndrome;

  11. (k)

    Smith‑Magenis syndrome;

  12. (l)

    CHARGE syndrome;

  13. (m)

    Cri du Chat syndrome;

  14. (n)

    Cornelia de Lange syndrome;

  15. (o)

    microcephaly, if a child has:

    1. (i)

      a head circumference less than the third percentile for age and sex; and

    2. (ii)

      a functional level at or below 2 standard deviations below the mean for age on a standard development test or an IQ score of less than 70 on a standardised test of intelligence;

  16. (p)

    Rett’s disorder.

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:

(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)

263.90

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:

(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)

263.90

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);

(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)

132.50

Division 2.6Group A28: Geriatric medicine2.6.1Limitation of item 149

Item 149 does not apply if the patient, physician or specialist travels to a place to satisfy the requirement in sub‑subparagraph (d)(i)(B) of the item.

Group A28—Geriatric medicine

Item

Description

Fee ($)

141

Professional attendance of more than 60 minutes in duration at consulting rooms or hospital by a consultant physician or specialist in the practice of his or her specialty of geriatric medicine, if:

(a) the patient is at least 65 years old and referred by a medical practitioner practising in general practice (including a general practitioner, but not including a specialist or consultant physician) or a participating nurse practitioner; and

(b) the attendance is initiated by the referring practitioner for the provision of a comprehensive assessment and management plan; and

(c) during the attendance:

(i) the medical, physical, psychological and social aspects of the patient’s health are evaluated in detail using appropriately validated assessment tools if indicated (the assessment); and

(ii) the patient’s various health problems and care needs are identified and prioritised (the formulation); and

(iii) a detailed management plan is prepared (the management plan) setting out:

(A) the prioritised list of health problems and care needs; and

(B) short and longer term management goals; and

(C) recommended actions or intervention strategies to be undertaken by the patient’s general practitioner or another relevant health care provider that are likely to improve or maintain health status and are readily available and acceptable to the patient and the patient’s family and carers; and

(iv) the management plan is explained and discussed with the patient and, if appropriate, the patient’s family and any carers; and

(v) the management plan is communicated in writing to the referring practitioner; and

(d) an attendance to which item 104, 105, 107, 108, 110, 116 or 119 applies has not been provided to the patient on the same day by the same practitioner; and

(e) an attendance to which this item or item 145 applies has not been provided to the patient by the same practitioner in the preceding 12 months

452.65

143

Professional attendance of more than 30 minutes in duration at consulting rooms or hospital by a consultant physician or specialist in the practice of his or her specialty of geriatric medicine to review a management plan previously prepared by that consultant physician or specialist under item 141 or 145, if:

(a) the review is initiated by the referring medical practitioner practising in general practice or a participating nurse practitioner; and

(b) during the attendance:

(i) the patient’s health status is reassessed; and

(ii) a management plan prepared under item 141 or 145 is reviewed and revised; and

(iii) the revised management plan is explained to the patient and (if appropriate) the patient’s family and any carers and communicated in writing to the referring practitioner; and

(c) an attendance to which item 104, 105, 107, 108, 110, 116 or 119 applies was not provided to the patient on the same day by the same practitioner; and

(d) an attendance to which item 141 or 145 applies has been provided to the patient by the same practitioner in the preceding 12 months; and

(e) an attendance to which this item or item 147 applies has not been provided to the patient in the preceding 12 months, unless there has been a significant change in the patient’s clinical condition or care circumstances that requires a further review

282.95

145

Professional attendance of more than 60 minutes in duration at a place other than consulting rooms or hospital by a consultant physician or specialist in the practice of his or her specialty of geriatric medicine, if:

(a) the patient is at least 65 years old and referred by a medical practitioner practising in general practice (including a general practitioner, but not including a specialist or consultant physician) or a participating nurse practitioner; and

(b) the attendance is initiated by the referring practitioner for the provision of a comprehensive assessment and management plan; and

(c) during the attendance:

(i) the medical, physical, psychological and social aspects of the patient’s health are evaluated in detail utilising appropriately validated assessment tools if indicated (the assessment); and

(ii) the patient’s various health problems and care needs are identified and prioritised (the formulation); and

(iii) a detailed management plan is prepared (the management plan) setting out:

(A) the prioritised list of health problems and care needs; and

(B) short and longer term management goals; and

(C) recommended actions or intervention strategies, to be undertaken by the patient’s general practitioner or another relevant health care provider that are likely to improve or maintain health status and are readily available and acceptable to the patient, the patient’s family and any carers; and

(iv) the management plan is explained and discussed with the patient and, if appropriate, the patient’s family and any carers; and

(v) the management plan is communicated in writing to the referring practitioner; and

(d) an attendance to which item 104, 105, 107, 108, 110, 116 or 119 applies has not been provided to the patient on the same day by the same practitioner; and

(e) an attendance to which this item or item 141 applies has not been provided to the patient by the same practitioner in the preceding 12 months

548.85

147

Professional attendance of more than 30 minutes in duration at a place other than consulting rooms or hospital by a consultant physician or specialist in the practice of his or her specialty of geriatric medicine to review a management plan previously prepared by that consultant physician or specialist under items 141 or 145, if:

(a) the review is initiated by the referring medical practitioner practising in general practice or a participating nurse practitioner; and

(b) during the attendance:

(i) the patient’s health status is reassessed; and

(ii) a management plan that was prepared under item 141 or 145 is reviewed and revised; and

(iii) the revised management plan is explained to the patient and (if appropriate) the patient’s family and any carers and communicated in writing to the referring practitioner; and

(c) an attendance to which item 104, 105, 107, 108, 110, 116 or 119 applies has not been provided to the patient on the same day by the same practitioner; and

(d) an attendance to which item 141 or 145 applies has been provided to the patient by the same practitioner in the preceding 12 months; and

(e) an attendance to which this item or 143 applies has not been provided by the same practitioner in the preceding 12 months, unless there has been a significant change in the patient’s clinical condition or care circumstances that requires a further review

343.10

149

Professional attendance on a patient by a consultant physician or specialist practising in his or her specialty of geriatric medicine if:

(a) the attendance is by video conference; and

(b) item 141 or 143 applies to the attendance; and

(c) the patient is not an admitted patient; and

(d) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 kms by road from the physician or specialist; or

(ii) is a care recipient in a residential care service; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service:

for which a direction made under subsection 19(2) of the Act applies

50% of the fee for item 141 or 143

Division 2.7Group A5: Prolonged attendances to which no other item applies2.7.1Application of items 160 to 164
  1. (1)

    Items 160 to 164 apply only to a service provided in the course of a personal attendance by one or more medical practitioners on a single patient on a single occasion.

  2. (2)

    If the personal attendance is provided by one or more medical practitioners concurrently, each practitioner may claim an attendance fee.

  3. (3)

    However, 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.

Group A5—Prolonged attendances to which no other item applies

Item

Description

Fee ($)

160

Professional attendance for a period of not less than 1 hour but less than 2 hours (other than a service to which another item applies) on a patient in imminent danger of death

221.50

161

Professional attendance for a period of not less than 2 hours but less than 3 hours (other than a service to which another item applies) on a patient in imminent danger of death

369.15

162

Professional attendance for a period of not less than 3 hours but less than 4 hours (other than a service to which another item applies) on a patient in imminent danger of death

516.65

163

Professional attendance for a period of not less than 4 hours but less than 5 hours (other than a service to which another item applies) on a patient in imminent danger of death

664.55

164

Professional attendance for a period of 5 hours or more (other than a service to which another item applies) on a patient in imminent danger of death

738.40

Division 2.8Group A6: Group therapy

Group A6—Group therapy

Item

Description

Fee ($)

170

Professional attendance for the purpose of Group therapy of not less than 1 hour in duration given under the direct continuous supervision of a medical practitioner (other than a consultant physician in the practice of his or her specialty of psychiatry) involving members of a family and persons with close personal relationships with that family—each Group of 2 patients

117.55

171

Professional attendance for the purpose of Group therapy of not less than 1 hour in duration given under the direct continuous supervision of a medical practitioner (other than a consultant physician in the practice of his or her specialty of psychiatry) involving members of a family and persons with close personal relationships with that family—each Group of 3 patients

123.85

172

Professional attendance for the purpose of Group therapy of not less than 1 hour in duration given under the direct continuous supervision of a medical practitioner (other than a consultant physician in the practice of his or her specialty of psychiatry) involving members of a family and persons with close personal relationships with that family—each Group of 4 or more patients

150.70

Division 2.9Group A7: Acupuncture2.9.1Meaning of qualified medical acupuncturist

A general practitioner is a qualified medical acupuncturist, for an item, if the Chief Executive Medicare has received a written notice from the Royal Australian College of General Practitioners stating that the general practitioner meets the skills requirements for providing the service described in the item.

Group A7—Acupuncture

Item

Description

Fee ($)

173

Professional attendance at which acupuncture is performed by a medical practitioner by application of stimuli on or through the surface of the skin by any means, including any consultation on the same occasion and another attendance on the same day related to the condition for which the acupuncture was performed

21.65

193

Professional attendance by a general practitioner who is a qualified medical acupuncturist, at a place other than a hospital, lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation, at which acupuncture is performed by the qualified medical acupuncturist by the application of stimuli on or through the skin by any means, including any consultation on the same occasion and another attendance on the same day related to the condition for which the acupuncture is performed

37.05

195

Professional attendance by a general practitioner who is a qualified medical acupuncturist, on one or more patients at a hospital, lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation, at which acupuncture is performed by the qualified medical acupuncturist by the application of stimuli on or through the skin by any means, including any consultation on the same occasion and another attendance on the same day related to the condition for which the acupuncture is performed

Amount under clause 2.1.1

197

Professional attendance by a general practitioner who is a qualified medical acupuncturist, at a place other than a hospital, lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation, at which acupuncture is performed by the qualified medical acupuncturist by the application of stimuli on or through the skin by any means, including any consultation on the same occasion and another attendance on the same day related to the condition for which the acupuncture is performed

71.70

199

Professional attendance by a general practitioner who is a qualified medical acupuncturist, at a place other than a hospital, lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation, at which acupuncture is performed by the qualified medical acupuncturist by the application of stimuli on or through the skin by any means, including any consultation on the same occasion and another attendance on the same day related to the condition for which the acupuncture is performed

105.55

Division 2.10Group A8: Consultant physician in practice of psychiatry for attendances to which no other item applies2.10.1Application of items 291, 293 and 359

Items 291, 293 and 359 may only apply once in a 12 month period.

2.10.2Application of items 342, 344 and 346

Items 342, 344 and 346 apply only to a service provided in the course of a personal attendance by a single medical practitioner.

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

Items 353 to 361 apply only to a consultation that is provided to a patient in a regional, rural or remote area.

2.10.4Limitation of item 288

Item 288 does not apply if the patient or physician travels to a place to satisfy the requirement in sub‑subparagraph (d)(i)(B) of the item.

2.10.5Meanings of eligible allied health provider and risk assessment

In item 289:

eligible allied health provider means any of the following:

  1. (a)

    an audiologist;

  2. (b)

    an occupational therapist;

  3. (c)

    an optometrist;

  4. (d)

    an orthoptist;

  5. (e)

    a physiotherapist;

  6. (f)

    a psychologist;

  7. (g)

    a speech pathologist.

Risk assessmentmeans an assessment of:

  1. (a)

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

  2. (b)

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

Group A8—Consultant psychiatrist attendances to which no other item applies

Item

Description

Fee ($)

288

Professional attendance on a patient by a consultant physician practising in his or her specialty of psychiatry if:

(a) the attendance is by video conference; and

(b) item 291, 293, 296, 300, 302, 304, 306, 308, 310, 312, 314, 316, 318, 319, 348, 350 or 352 applies to the attendance; and

(c) the patient is not an admitted patient; and

(d) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 kms by road from the physician; or

(ii) is a care recipient in a residential care service; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

for which a direction made under subsection 19(2) of the Act applies

50% of the fee for item 291, 293, 296, 300, 302, 304, 306, 308, 310, 312, 314, 316, 318, 319, 348, 350 or 352

289

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 psychiatry, 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 autism or another pervasive developmental disorder, if the consultant psychiatrist 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);

(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 the referring practitioner;

(d) 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 139)

263.90

291

Professional attendance of more than 45 minutes in duration at consulting rooms by a consultant physician in the practice of his or her specialty of psychiatry, if:

(a) the attendance follows referral of the patient to the consultant for an assessment or management by a medical practitioner in general practice (including a general practitioner, but not a specialist or consultant physician) or a participating nurse practitioner; and

(b) during the attendance, the consultant:

(i) uses an outcome tool (if clinically appropriate); and

(ii) carries out a mental state examination; and

(iii) makes a psychiatric diagnosis; and

(c) the consultant decides that it is clinically appropriate for the patient to be managed by the referring practitioner without ongoing treatment by the consultant; and

(d) within 2 weeks after the attendance, the consultant:

(i) prepares a written diagnosis of the patient; and

(ii) prepares a written management plan for the patient that:

(A) covers the next 12 months; and

(B) is appropriate to the patient’s diagnosis; and

(C) comprehensively evaluates the patient’s biological, psychological and social issues; and

(D) addresses the patient’s diagnostic psychiatric issues; and

(E) makes management recommendations addressing the patient’s biological, psychological and social issues; and

(iii) gives the referring practitioner a copy of the diagnosis and the management plan; and

(iv) if clinically appropriate, explains the diagnosis and management plan, and a gives a copy, to:

(A) the patient; and

(B) the patient’s carer (if any), if the patient agrees

452.65

293

Professional attendance of more than 30 minutes but not more than 45 minutes in duration at consulting rooms by a consultant physician in the practice of his or her specialty of psychiatry, if:

(a) the patient is being managed by a medical practitioner or a participating nurse practitioner in accordance with a management plan prepared by the consultant in accordance with item 291; and

(b) the attendance follows referral of the patient to the consultant for review of the management plan by the medical practitioner or a participating nurse practitioner managing the patient; and

(c) during the attendance, the consultant:

(i) uses an outcome tool (if clinically appropriate); and

(ii) carries out a mental state examination; and

(iii) makes a psychiatric diagnosis; and

(iv) reviews the management plan; and

(d) within 2 weeks after the attendance, the consultant:

(i) prepares a written diagnosis of the patient; and

(ii) revises the management plan; and

(iii) gives the referring practitioner a copy of the diagnosis and the revised management plan; and

(iv) if clinically appropriate, explains the diagnosis and the revised management plan, and gives a copy, to:

(A) the patient; and

(B) the patient’s carer (if any), if the patient agrees; and

(e) in the preceding 12 months, a service to which item 291 applies has been provided; and

(f) in the preceding 12 months, a service to which this item or item 293 applies has not been provided

282.95

296

Professional attendance of more than 45 minutes in duration by a consultant physician in the practice of his or her speciality of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance at consulting rooms if the patient:

(a) is a new patient for this consultant psychiatrist; or

(b) has not received a professional attendance from this consultant psychiatrist in the preceding 24 months;

other than attendance on a patient in relation to whom this item, item 297 or 299, or any of items 300 to 346, 353 to 358 and 361 to 370, has applied in the preceding 24 months

260.30

297

Professional attendance of more than 45 minutes by a consultant physician in the practice of his or her speciality of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance at hospital if the patient:

(a) is a new patient for this consultant psychiatrist; or

(b) has not received a professional attendance from this consultant psychiatrist in the preceding 24 months;

other than attendance on a patient in relation to whom this item, item 296 or 299, or any of items 300 to 346, 353 to 358 and 361 to 370, has applied in the preceding 24 months (H)

260.30

299

Professional attendance of more than 45 minutes by a consultant physician in the practice of his or her speciality of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance at a place other than consulting rooms or a hospital if the patient:

(a) is a new patient for this consultant psychiatrist; or

(b) has not received a professional attendance from this consultant psychiatrist in the preceding 24 months;

other than attendance on a patient in relation to whom this item, item 296 or 297, or any of items 300 to 346, 353 to 358 and 361 to 370, has applied in the preceding 24 months

311.30

300

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of not more than 15 minutes in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 300 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

43.35

302

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 15 minutes, but not more than 30 minutes, in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 300 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

86.45

304

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 30 minutes, but not more than 45 minutes, in duration at consulting rooms), if that attendance and another attendance to which any of items 296, 300 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

133.10

306

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 45 minutes, but not more than 75 minutes, in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 300 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

183.65

308

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 75 minutes in duration at consulting rooms), if that attendance and another attendance to which any of items 296, 300 to 308, 353 to 358 and 361 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

213.15

310

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of not more than 15 minutes in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 300 to 308, 353 to 358 and 361 to 370 applies exceed 50 attendances in a calendar year for the patient

21.60

312

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 15 minutes, but not more than 30 minutes, in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 300 to 308, 353 to 358 and 361 to 370 applies exceed 50 attendances in a calendar year for the patient

43.35

314

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 30 minutes, but not more than 45 minutes, in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 300 to 308, 353 to 358 and 361 to 370 applies exceed 50 attendances in a calendar year for the patient

66.65

316

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 45 minutes, but not more than 75 minutes, in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 300 to 308, 353 to 358 and 361 to 370 applies exceed 50 attendances in a calendar year for the patient

91.95

318

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a referring practitioner—an attendance of more than 75 minutes in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 300 to 308, 353 to 358 and 361 to 370 applies exceed 50 attendances in a calendar year for the patient

    1. (iii)

      the area is not in an Urban Centre and Locality, but the geographic centre of the area is no more than 20 kilometres road distance from the boundary of an Urban Centre and Locality with a 2013 estimated resident population of more than 50,000; and

  2. (c)

    is not a Modified Monash 7 area.

Modified Monash 3 area means a Statistical Area Level 1 under the ASGS that:

  1. (a)

    is categorised under the ASGS as RA 1 (Inner Regional Australia) or RA 2 (Outer Regional Australia); and

  2. (b)

    satisfies any of the following criteria:

    1. (i)

      the area is in an Urban Centre and Locality with a 2013 estimated resident population of more than 15,000 but no more than 50,000;

    2. (ii)

      the area is in an Urban Centre and Locality, the geographic centre of which is no more than 15 kilometres road distance from the boundary of another Urban Centre and Locality with a 2013 estimated resident population of more than 15,000 but no more than 50,000;

    3. (iii)

      the area is not in an Urban Centre and Locality, but the geographic centre of the area is no more than 15 kilometres road distance from the boundary of an Urban Centre and Locality with a 2013 estimated resident population of more than 15,000 but no more than 50,000; and

  3. (c)

    is not a Modified Monash 2 area or Modified Monash 7 area.

Modified Monash 4 area means a Statistical Area Level 1 under the ASGS that:

  1. (a)

    is categorised under the ASGS as RA 1 (Inner Regional Australia) or RA 2 (Outer Regional Australia); and

  2. (b)

    satisfies any of the following criteria:

    1. (i)

      the area is in an Urban Centre and Locality with a 2013 estimated resident population of at least 5,000 but no more than 15,000;

    2. (ii)

      the area is in an Urban Centre and Locality, the geographic centre of which is no more than 10 kilometres road distance from the boundary of another Urban Centre and Locality with a 2013 estimated resident population of at least 5,000 but no more than 15,000;

    3. (iii)

      the area is not in an Urban Centre and Locality, but the geographic centre of the area is no more than 10 kilometres road distance from the boundary of an Urban Centre and Locality with a 2013 estimated resident population of at least 5,000 but no more than 15,000; and

  3. (c)

    is not a Modified Monash 2 area, Modified Monash 3 area or Modified Monash 7 area.

Modified Monash 5 area means a Statistical Area Level 1 under the ASGS that:

  1. (a)

    is categorised under the ASGS as RA 1 (Inner Regional Australia) or RA 2 (Outer Regional Australia); and

  2. (b)

    is not a Modified Monash 2 area, Modified Monash 3 area, Modified Monash 4 area or Modified Monash 7 area.

Modified Monash 6 area means a Statistical Area Level 1 under the ASGS that:

  1. (a)

    is categorised under the ASGS as RA 3 (Remote Australia); and

  2. (b)

    is not a Modified Monash 7 area.

Modified Monash 7 area means a Statistical Area Level 1 under the ASGS that:

  1. (a)

    is entirely located on an island or islands more than 5 kilometres from the Australian mainland or Tasmania, as measured between coastlines at the low water mark; or

  2. (b)

    is located on Magnetic Island; or

  3. (c)

    is categorised under the ASGS as RA 4 (Very Remote Australia).

multidisciplinary care plan:

  1. (a)

    for items 729 and 731—has the meaning given by clause 2.17.6; and

  2. (b)

    for item 10997—has the meaning given by clause 2.30.1.

multidisciplinary case conference has the meaning given by clause 1.1.2.

multidisciplinary case conference in a residential aged care facility, for items 735, 739, 743, 747, 750 and 758, has the meaning given by clause 2.17.13.

multidisciplinary case conference team has the meaning given by clause 1.1.3.

multidisciplinary discharge case conference, for items 735, 739, 743, 747, 750 and 758, has the meaning given by clause 2.17.12.

neo‑natal intensive care unitmeans a separate hospital area that:

  1. (a)

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

    1. (i)

      mechanical ventilation for a period of several days; and

    2. (ii)

      invasive cardiovascular monitoring; and

  2. (b)

    is supported by:

    1. (i)

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

    2. (ii)

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

    3. (iii)

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

  3. (c)

    has admission and discharge policies in operation.

non‑directive pregnancy support counselling, for item 4001, has the meaning given by clause 2.22.1.

non‑medicare servicemeans any of the following:

  1. (a)

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

  2. (b)

    gamma knife surgery;

  3. (c)

    intradiscal electro thermal arthroplasty;

  4. (d)

    intravascular ultrasound, except if used in conjunction with intravascular brachytherapy;

  5. (e)

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

  6. (f)

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

  7. (g)

    lung volume reduction surgery, for advanced emphysema;

  8. (h)

    photodynamic therapy, for skin and mucosal cancer;

  9. (i)

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

  10. (j)

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

  11. (k)

    specific mass measurement of bone alkaline phosphatise;

  12. (l)

    transmyocardial laser revascularisation;

  13. (m)

    vertebral axial decompression therapy, for chronic back pain;

  14. (n)

    autologous chondrocyte implantation and matrix‑induced autologous chondrocyte implantation;

  15. (o)

    vertebroplasty.

open reductionmeans treatment of a dislocation or fracture by either:

  1. (a)

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

  2. (b)

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

organise and coordinate:

  1. (a)

    for items 735, 739, 743, 820, 822, 823, 825, 826, 828, 830, 832, 834, 835, 837, 838, 855, 857, 858, 861, 864 and 866—has the meaning given by clause 2.17.14; and

  2. (b)

    for items mentioned in Subgroups 2 and 4 of Group A24—has the meaning given by clause 2.21.1; and

  3. (c)

    for items 6029 to 6042—has the meaning given by clause 2.21A.1; and

  4. (d)

    for items 6064 to 6075—has the meaning given by clause 2.21B.1.

outcome measurement tool, for Division 2.20, has the meaning given by clause 2.20.1.

participate:

  1. (a)

    for items 747, 750, 758, 825, 826, 828, 835, 837 and 838—has the meaning given by clause 2.17.15; and

  2. (b)

    for items 2958, 2972, 2974, 2992, 2996, 3000, 3051, 3055, 3062, 3083, 3088 and 3093—has the meaning given by clause 2.21.2; and

  3. (c)

    for items 6035 to 6042—has the meaning given by clause 2.21A.2; and

  4. (d)

    for items 6071 to 6075—has the meaning given by clause 2.21B.2.

participating in a video conferencing consultation has the meaning given by clause 1.2.9.

patient’s medical condition requires urgent assessment has the meaning given by clause 2.15.1.

patient’s usual medical practitioner means a medical practitioner:

  1. (a)

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

  2. (b)

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

  3. (c)

    located at a medical practice that:

    1. (i)

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

    2. (ii)

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

person with a chronic disease, for item 10997, has the meaning given by clause 2.30.1.

pharmaceutical benefits scheme means the scheme for the supply of pharmaceutical benefits established under Part VII of the National Health Act 1953.

practice location has the meaning given by clause 2.31.1.

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

preparation of a GP mental health treatment plan has the meaning given by clause 2.20.3.

preparing a GP management plan, for item 721, has the meaning given by clause 2.17.7.

previous significant surgical complication, for item 51318, has the meaning given by clause 2.45.4.

problem focussed history, for items 501, 503 and 507, has the meaning given by clause 2.14.2.

qualified medical acupuncturist has the meaning given by clause 2.9.1.

qualified radiologist, for item 31542, has the meaning given by clause 2.44.7.

qualified sleep medicine practitioner:

  1. (a)

    for items 12203, 12207, 12213 and 12217—has the meaning given by subclause 2.34.2(1); and

  2. (b)

    for items 12210 and 122015—has the meaning given by subclause 2.34.2(1A); and

  3. (c)

    for item 12250—has the meaning given by subclause 2.34.2(1AA).

qualified surgeon, for items 31539 and 31545, has the meaning given by clause 2.44.6.

RACGPmeans the Royal Australian College of General Practitioners.

radiation oncology treatment verification means a quality assurance procedure:

  1. (a)

    that is designed to facilitate accurate and reproducible delivery of radiation therapy to a site or region of the body as specified in a treatment prescription or a dose plan generated from a treatment prescription; and

  2. (b)

    that utilises the capture and assessment of appropriate images using any of the following:

    1. (i)

      x‑rays;

    2. (ii)

      computed tomography;

    3. (iii)

      ultrasound, where the ultrasound equipment is capable of producing images in 3 dimensions; and

  3. (c)

    that includes making a record of the assessment and correcting any significant treatment delivery inaccuracies detected.

recognised emergency department, for Division 2.14, has the meaning given by clause 2.14.1.

referralmeans referral by a referring practitioner.

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

  1. (a)

    for all referrals—a medical practitioner; or

  2. (b)

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

  3. (c)

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

  4. (d)

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

  5. (e)

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

  6. (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 areameans either of the following:

  1. (a)

    an area classified as RRMAs 3‑7 under the Rural, Remote and Metropolitan Areas Classification;

  2. (b)

    Norfolk Island.

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

report, for Division 2.34, has the meaning given by clause 2.34.1.

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

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

residential medication management review, for item 903, has the meaning given by clause 2.18.2.

responsible person, for items 585 to 600, has the meaning given by clause 2.15.2.

reviewing a GP management plan, for item 732, has the meaning given by clause 2.17.8.

review of a GP mental health treatment plan has the meaning given by clause 2.20.4.

risk assessment:

  1. (a)

    for items 135, 137 and 139—has the meaning given by clause 2.5A.1; and

  2. (b)

    for item 289—has the meaning given by clause 2.10.5.

Rural, Remote and Metropolitan Areas Classificationmeans the document so titled, as existing at the time when this instrument commences, 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, for an item in subgroups 21, 24, 25 and 26 of Group T10, has the meaning given by clause 2.43.4.

single course of treatment has the meaning given by clause 1.1.4.

SLA, for Division 2.31, has the meaning given by clause 2.31.1.

SSD, for Division 2.31, has the meaning given by clause 2.31.1.

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

telehealth eligible areameans an area classified as a telehealth eligible area by the Minister.

Note: Maps showing telehealth eligible areas could in 2017 be viewed on the Department’s Medicare Benefits Schedule website ( cycle, for clause 2.37.4 and items 13200 to 13209, 13215 and 13218, has the meaning given by clause 2.37.3.

unreferred service, for Division 2.31, has the meaning given by clause 2.31.1.

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

Urban Centre and Locality means an area defined as an Urban Centre and Locality under the ASGS.

Endnotes

Endnote 1About the endnotes

The endnotes provide information about this compilation and the compiled law.

The following endnotes are included in every compilation:

Endnote 1—About the endnotes

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history

Abbreviation key—Endnote 2

The abbreviation key sets out abbreviations that may be used in the endnotes.

Legislation history and amendment history—Endnotes 3 and 4

Amending laws are annotated in the legislation history and amendment history.

The legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.

The amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.

Editorial changes

The Legislation Act 2003 authorises First Parliamentary Counsel to make editorial and presentational changes to a compiled law in preparing a compilation of the law for registration. The changes must not change the effect of the law. Editorial changes take effect from the compilation registration date.

If the compilation includes editorial changes, the endnotes include a brief outline of the changes in general terms. Full details of any changes can be obtained from the Office of Parliamentary Counsel.

Misdescribed amendments

A misdescribed amendment is an amendment that does not accurately describe the amendment to be made. If, despite the misdescription, the amendment can be given effect as intended, the amendment is incorporated into the compiled law and the abbreviation “(md)” added to the details of the amendment included in the amendment history.

If a misdescribed amendment cannot be given effect as intended, the abbreviation “(md not incorp)” is added to the details of the amendment included in the amendment history.

Endnote 2Abbreviation key

ad = added or inserted

o = order(s)

am = amended

Ord = Ordinance

amdt = amendment

orig = original

c = clause(s)

par = paragraph(s)/subparagraph(s)

C[x] = Compilation No. x

/sub‑subparagraph(s)

Ch = Chapter(s)

pres = present

def = definition(s)

prev = previous

Dict = Dictionary

(prev…) = previously

disallowed = disallowed by Parliament

Pt = Part(s)

Div = Division(s)

r = regulation(s)/rule(s)

ed = editorial change

reloc = relocated

exp = expires/expired or ceases/ceased to have

renum = renumbered

effect

rep = repealed

F = Federal Register of Legislation

rs = repealed and substituted

gaz = gazette

s = section(s)/subsection(s)

LA = Legislation Act 2003

Sch = Schedule(s)

LIA = Legislative Instruments Act 2003

Sdiv = Subdivision(s)

(md) = misdescribed amendment can be given

SLI = Select Legislative Instrument

effect

SR = Statutory Rules

(md not incorp) = misdescribed amendment

Sub‑Ch = Sub‑Chapter(s)

cannot be given effect

SubPt = Subpart(s)

mod = modified/modification

underlining = whole or part not

No. = Number(s)

commenced or to be commenced

Endnote 3Legislation history

Name

Registration

Commencement

Application, saving and transitional provisions

Health Insurance (General Medical Services Table) Regulations 2017

16 June 2017 (F2017L00680)

17 June 2017 (s 2(1) item 1)

Health Insurance (General Medical Services Table) Amendment (Bulk‑Billed Services) Regulations 2017

16 June 2017 (F2017L00682)

1 July 2017 (s 2(1) item 1)

—

Health Insurance (General Medical Services Table) Amendment (Obstetrics) Regulations 2017

25 Aug 2017 (F2017L01090)

1 Nov 2017 (s 2(1) item 1)

—

Health Insurance Legislation Amendment (2017 Measures No. 2) Regulations 2017

12 Oct 2017 (F2017L01343)

Sch 1 (items 2–25, 27–32), Sch 2 and Sch 3 (items 4–12): 1 Nov 2017 (s 2(1) item 1)

—

Health Insurance Legislation Amendment (2017 Measures No. 3) Regulations 2017

3 Nov 2017 (F2017L01429)

Sch 1 (items 1–8, 32, 33): 1 Dec 2017 (s 2(1) item 1)

—

Health Insurance (General Medical Services Table) Amendment (Medication Reviews) Regulations 2017

20 Dec 2017 (F2017L01682)

1 Feb 2018 (s 2(1) item 1)

—

Health Insurance Legislation Amendment (After Hours Services) Regulations 2018

30 Jan 2018 (F2018L00062)

Sch 1 (items 1–14): 1 Mar 2018 (s 2(1) item 1)

—

Health Insurance Legislation Amendment (2018 Measures No. 1) Regulations 2018

24 Apr 2018 (F2018L00514)

Sch 1 (items 14–21): 1 May 2018 (s 2(1) item 1)

—

Endnote 4Amendment history

Provision affected

How affected

s 2.............................................

rep LA s 48D

s 4.............................................

rep LA s 48C

Schedule 1

Part 1

Division 1.1

c 1.1.5........................................

rep F2017L01343

c 1.1.7........................................

rep F2017L01343

Division 1.2

c 1.2.2........................................

am F2017L01090

c 1.2.2A.....................................

ad F2017L01343

c 1.2.3........................................

am F2017L01090

c 1.2.4........................................

am F2018L00062

c 1.2.5........................................

am F2018L00514

Part 2

Division 2.4

Group A3 Table..........................

am F2017L01090; F2017L01343

Division 2.5

Group A4 Table..........................

am F2017L01343

Division 2.15

c 2.15.1......................................

am F2018L00062

c 2.15.2......................................

am F2018L00062

c 2.15.3......................................

am F2018L00062

c 2.15.4......................................

rs F2018L00062

c 2.15.5......................................

ad F2018L00062

Group A11 Table........................

am F2018L00062

Division 2.17

Subdivision B

c 2.17.10A..................................

am F2018L00062

Division 2.18

Group A17 Table........................

am F2017L01682

Division 2.19

Group A18 Table........................

am F2017L01429

Group A19 Table........................

am F2017L01429

Division 2.31

Group M1 Table.........................

am F2017L00682; F2018L00062

Division 2.34

c 2.34.4......................................

ad F2017L01343

Group D1 Table..........................

am F2017L01343; F2017L01429; F2018L00514

Division 2.38

Group T2 Table..........................

am F2018L00514

Division 2.40

c 2.40.1......................................

am F2017L01090

c 2.40.2......................................

rs F2017L01090

c 2.40.3......................................

rep F2017L01090

c 2.40.6......................................

rep F2017L01090

Group T4 Table..........................

am F2017L01090

Division 2.43

Group T10 Table.........................

am F2017L01090; F2017L01343

Division 2.44

Subdivision B

Group T8 Table..........................

am F2017L01343; F2018L00514

Subdivision C

c 2.44.13B..................................

ad F2017L01343

Group T8 Table..........................

am F2017L01343

Subdivision D

Group T8 Table..........................

am F2017L01343; F2017L01429

Subdivision E

Group T8 Table..........................

am F2017L01343

Subdivision G

Group T8 Table..........................

am F2017L01343

Subdivision H

Group T8 Table..........................

am F2017L01343

Division 2.45

Group T9 Table..........................

am F2017L01090

Part 3

c 3.1..........................................

am F2017L01090; F2017L01343; F2017L01429; F2018L00062

Schedule 2..................................

rep LA s 48C

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