Health Insurance (General Medical Services Table) Regulations 2018 (Cth)
Health Insurance (General Medical Services Table) Regulations 2018
made under the
Health Insurance Act 1973
Compilation No. 5
Compilation date: 1 March 2019
Includes amendments up to: F2019L00179
Registered: 7 March 2019
About this compilation
This compilation
This is a compilation of the Health Insurance (General Medical Services Table) Regulations 2018 that shows the text of the law as amended and in force on 1 March 2019 (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If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.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
1............................ Name............................................................................................................. 1
3............................ Authority....................................................................................................... 1
4............................ General medical services table....................................................................... 1
5............................ Dictionary..................................................................................................... 1
Schedule 1—General medical services table 2
Part 1—Preliminary 2
Division 1.1—Definitions 2
1.1.1...................... Meaning of eligible non‑vocationally recognised medical practitioner......... 2
1.1.2...................... General practitioners for the purposes of the table........................................ 3
1.1.3...................... Meaning of multidisciplinary case conference.............................................. 3
1.1.4...................... Meaning of multidisciplinary case conference team..................................... 4
1.1.5...................... Meaning of single course of treatment.......................................................... 5
1.1.6...................... Meaning of symbol (H)................................................................................ 5
Division 1.2—General application provisions 6
1.2.1...................... Application.................................................................................................... 6
1.2.2...................... Attendance by specialist or consultant physician........................................... 6
1.2.3...................... Limitation of items—certain attendances by specialists and consultant physicians 6
1.2.4...................... Professional attendance services................................................................... 6
1.2.5...................... Personal attendance by medical practitioners generally................................. 7
1.2.6...................... Personal attendance by medical practitioners................................................. 8
1.2.7...................... Application of items—services provided with non‑medicare services.......... 8
1.2.8...................... Application of items—services rendered in certain circumstances................ 8
1.2.8A................... Application of items—services provided with harvesting, storage, in vitro processing or injection of non‑haematopoietic stem cells.................................................... 9
1.2.9...................... Services that may be provided by persons other than medical practitioners.. 9
Part 2—Services and fees 10
Division 2.1—Groups A1 to A35 10
2.1.1...................... Meaning of amount under clause 2.1.1...................................................... 10
Division 2.2—Group A1: General practitioner attendances to which no other item applies 12
Division 2.3—Group A2: Other non‑referred attendances to which no other item applies 14
2.3.1...................... Effect of determination under section 106TA of Act................................... 14
Division 2.4—Group A3: Specialist attendances to which no other item applies 15
2.4.1...................... Limitation of items 99 and 113.................................................................... 15
Division 2.5—Group A4: Consultant physician (other than psychiatry) attendances to which no other item applies 17
2.5.1...................... Limitation of items 112 and 114.................................................................. 17
Division 2.6—Group A29: Early intervention services for children with autism, pervasive developmental disorder or disability 21
2.6.1...................... Meanings of eligible allied health provider and risk assessment................ 21
2.6.2...................... Meaning of eligible disability...................................................................... 21
Division 2.7—Group A28: Geriatric medicine 23
2.7.1...................... Limitation of item 149................................................................................. 23
Division 2.8—Group A5: Prolonged attendances to which no other item applies 27
2.8.1...................... Application of items 160 to 164.................................................................. 27
Division 2.9—Group A6: Group therapy 27
Division 2.10—Group A7: Acupuncture and Non‑Specialist Practitioner Items 28
2.10.1.................... Meaning of qualified medical acupuncturist............................................... 28
Division 2.11—Group A8: Consultant physician in practice of psychiatry for attendances to which no other item applies 30
2.11.1.................... Application of items 291, 293 and 359....................................................... 30
2.11.2.................... Application of items 342, 344 and 346....................................................... 30
2.11.3.................... Restriction of telepsychiatry consultations to regional, rural and remote areas 30
2.11.4.................... Limitation of item 288................................................................................. 30
2.11.5.................... Meanings of eligible allied health provider and risk assessment................ 30
Division 2.12—Group A12: Consultant occupational physician attendances to which no other item applies 41
2.12.1.................... Consultant occupational physician.............................................................. 41
2.12.2.................... Limitation of items 384 and 389.................................................................. 41
Division 2.13—Group A13: Public health physician attendances to which no other item applies 43
2.13.1.................... Public health physicians.............................................................................. 43
Division 2.14—Miscellaneous services 45
Division 2.15—Group A21: Emergency physician attendances to which no other item applies 45
2.15.1.................... Meaning of recognised emergency department.......................................... 45
2.15.2.................... Meaning of problem focussed history......................................................... 45
2.15.3.................... Attendance for emergency evaluation of critically ill patients...................... 46
Division 2.16—Group A11: Urgent attendances after hours 48
2.16.1.................... Meaning of patient’s medical condition requires urgent assessment......... 48
2.16.2.................... Meaning of responsible person.................................................................. 49
2.16.3.................... Application of Group A11.......................................................................... 49
2.16.4.................... Meaning of after‑hours rural area............................................................. 49
2.16.5.................... References to general practitioner in items do not include certain participants in After Hours Other Medical Practitioners Program.......................................................... 49
Division 2.17—Group A14: Health assessments 51
2.17.1.................... Application of Group A14.......................................................................... 51
2.17.2.................... Types of health assessments....................................................................... 51
2.17.3.................... Application of item 715 to certain patients only.......................................... 52
2.17.4.................... Type 2 Diabetes Risk Evaluation................................................................ 53
2.17.5.................... 45 year old Health Assessment................................................................... 54
2.17.6.................... Older Person’s Health Assessment............................................................. 54
2.17.7.................... Comprehensive Medical Assessment for permanent resident of residential aged care facility.................................................................................................................... 55
2.17.8.................... Health assessment for a person with an intellectual disability..................... 56
2.17.9.................... Health assessment for a refugee or other humanitarian entrant.................... 57
2.17.10.................. Australian Defence Force Post‑discharge GP Health Assessment.............. 58
2.17.11.................. Aboriginal and Torres Strait Islander child health assessment.................... 59
2.17.12.................. Aboriginal and Torres Strait Islander adult health assessment.................... 61
2.17.13.................. Aboriginal and Torres Strait Islander Older Person’s Health Assessment.. 62
2.17.14.................. Restrictions on health assessments for Group A14..................................... 63
Division 2.18—Group A15: GP management plans, team care arrangements and multidisciplinary care plans and case conferences 65
Subdivision A—General 65
2.18.1.................... Service by medical practitioners.................................................................. 65
Subdivision B—Subgroup 1 of Group A15 65
2.18.2.................... Meaning of associated general practitioner............................................... 65
2.18.3.................... Meaning of contribute to a multidisciplinary care plan.............................. 65
2.18.4.................... Meaning of coordinating the development of team care arrangements...... 66
2.18.5.................... Meaning of coordinating a review of team care arrangements.................. 66
2.18.6.................... Meaning of multidisciplinary care plan...................................................... 67
2.18.7.................... Meaning of preparing a GP management plan.......................................... 68
2.18.8.................... Meaning of reviewing a GP management plan........................................... 68
2.18.9.................... Application of items 721, 723, 729, 731 and 732....................................... 69
2.18.10.................. Application of items 721, 723 and 732....................................................... 70
2.18.11.................. Application of items in relation to items 721, 723 and 732......................... 70
2.18.12.................. Limitation on items 721, 723, 729, 731 and 732......................................... 70
Subdivision C—Subgroup 2 of Group A15 72
2.18.13.................. Meaning of multidisciplinary discharge case conference........................... 72
2.18.14.................. Meaning of multidisciplinary case conference in a residential aged care facility 73
2.18.15.................. Meaning of organise and coordinate.......................................................... 73
2.18.16.................. Meaning of participate................................................................................ 73
2.18.17.................. Meaning of coordinating............................................................................ 74
2.18.18.................. Meaning of case conference team............................................................... 74
2.18.19.................. Application of item 880............................................................................... 74
Division 2.19—Group A17: Domiciliary and residential medication management reviews 79
2.19.1.................... Meaning of living in a community setting................................................... 79
2.19.2.................... Meaning of residential medication management review............................. 79
2.19.3.................... Application of items 900 and 903............................................................... 80
Division 2.20—Group A30: Medical practitioner video conferencing consultation 81
2.20.1.................... Application of items.................................................................................... 81
2.20.2.................... Application of items 2125, 2138, 2179 and 2220....................................... 82
2.20.3.................... Meaning of amount under clause 2.20.3.................................................... 82
2.20.4.................... Limitation of items...................................................................................... 82
Division 2.21—Groups A18 (General practitioner attendances associated with PIP payments) and A19 (Other non‑referral attendances associated with PIP payments to which no other item applies) 86
2.21.1.................... Application of Subgroup 2 of Groups A18 and A19.................................. 86
2.21.2.................... Application of Subgroup 3 of Groups A18 and A19.................................. 88
Division 2.22—Group A20: Mental health care 97
2.22.1.................... Definitions.................................................................................................. 97
2.22.2.................... Meaning of amount under clause 2.22.2.................................................... 97
2.22.3.................... Meaning of preparation of a GP mental health treatment plan.................. 98
2.22.4.................... Meaning of review of a GP mental health treatment plan........................... 99
2.22.5.................... Meaning of associated general practitioner............................................... 99
2.22.6.................... Application of Subgroup 1 of Group A20................................................ 100
2.22.7.................... Focussed psychological strategies............................................................. 101
Division 2.23—Group A24: Palliative and pain medicine 103
2.23.1.................... Meaning of organise and coordinate........................................................ 103
2.23.2.................... Meaning of participate.............................................................................. 104
2.23.3.................... Application of Group A24........................................................................ 104
2.23.4.................... Limitation on items.................................................................................... 104
2.23.5.................... Limitation of items.................................................................................... 105
Division 2.24—Group A31: Addiction medicine 111
2.24.1.................... Meaning of organise and coordinate........................................................ 111
2.24.2.................... Meaning of participate.............................................................................. 111
2.24.3.................... Limitation of items 6025 and 6026............................................................ 112
2.24.4.................... Application of item 6028........................................................................... 112
Division 2.25—Group A32: Sexual health medicine 116
2.25.1.................... Meaning of organise and coordinate........................................................ 116
2.25.2.................... Meaning of participate.............................................................................. 116
2.25.3.................... Limitation of items 6059 and 6060............................................................ 117
Division 2.26—Group A27: Pregnancy support counselling 121
2.26.1.................... Application of item 4001........................................................................... 121
Division 2.27—Group A22: General practitioner after‑hours attendances to which no other item applies 122
2.27.1.................... Application of Group A22........................................................................ 122
Division 2.28—Group A23: Other non‑referred after‑hours attendances to which no other item applies 125
2.28.1.................... Application of Group A23........................................................................ 125
Division 2.29—Group A26: Neurosurgery attendances to which no other item applies 127
2.29.1.................... Limitation of items 6004 and 6016............................................................ 127
Division 2.30—Group A9: Contact lenses 129
2.30.1.................... Application of item 10809......................................................................... 129
Division 2.30A—Group A35: Non‑referred attendance at a residential aged care facility 131
2.30A.1................. Fee in relation to the first patient during each attendance at a residential aged care facility.................................................................................................................. 131
Division 2.31—Miscellaneous services 133
Division 2.32—Group M12: Services provided by a practice nurse, an Aboriginal health worker or an Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner 133
2.32.1.................... Definitions for item 10997........................................................................ 133
2.32.2.................... Application of item 10988......................................................................... 134
2.32.3.................... Application of item 10989......................................................................... 134
2.32.4.................... Limitation of item 10983........................................................................... 134
Division 2.33—Group M1: Management of bulk‑billed services 136
2.33.1.................... Definitions for Division 2.33.................................................................... 136
2.33.2.................... Application of items 10990, 10991 and 10992......................................... 137
Division 2.34—Diagnostic procedures and investigations 139
Division 2.35—Group D1: Miscellaneous diagnostic procedures and investigations 139
2.35.1.................... Meaning of report..................................................................................... 139
2.35.2.................... Meaning of qualified sleep medicine practitioner..................................... 139
2.35.2A................. Meaning of Berlin Questionnaire............................................................. 141
2.35.2B.................. Meaning of Epworth Sleepiness Scale...................................................... 141
2.35.2C.................. Meaning of OSA50................................................................................... 141
2.35.2D................. Meaning of STOP‑Bang........................................................................... 141
2.35.3.................... Application of item 11801......................................................................... 142
2.35.4.................... Application of items 12306 to 12322........................................................ 142
Division 2.36—Group D2: Nuclear medicine (non‑imaging) 171
2.36.1.................... Application of Group D2.......................................................................... 171
Division 2.37—Group T1: Miscellaneous therapeutic procedures 172
2.37.1.................... Meaning of comprehensive hyperbaric medicine facility.......................... 172
2.37.2.................... Meaning of embryology laboratory services............................................ 172
2.37.3.................... Meaning of treatment cycle....................................................................... 173
2.37.4.................... Items provided as part of treatment cycle relating to assisted reproductive services not to apply......................................................................................................... 173
2.37.5.................... Application of items 13020 to 14245........................................................ 173
2.37.6.................... Limitation on item 13104.......................................................................... 173
2.37.7.................... Items relating to assisted reproductive services not to apply in certain pregnancy‑related circumstances............................................................................................ 174
2.37.8.................... Application of items 14227 to 14242........................................................ 174
2.37.9.................... Application of item 14245......................................................................... 174
2.37.10.................. Limitation of item 13210........................................................................... 174
Division 2.38—Group T2: Radiation oncology 184
2.38.1.................... Meaning of amount under clause 2.38.1.................................................. 184
2.38.2.................... Meaning of approved site......................................................................... 185
2.38.3.................... Meaning of IGRT...................................................................................... 185
2.38.4.................... Meaning of IMRT..................................................................................... 185
2.38.5.................... Application of Group T2........................................................................... 186
2.38.6.................... Application of items 15215 to 15272........................................................ 186
2.38.7.................... Application of items 15556, 15559 and 15562......................................... 186
Division 2.39—Group T3: Therapeutic nuclear medicine 197
2.39.1.................... Application of Group T3........................................................................... 197
Division 2.40—Group T4: Obstetrics 198
2.40.1.................... Definitions for item 16400........................................................................ 198
2.40.2.................... Meaning of midwife in items 16400 and 16408........................................ 198
2.40.3.................... Application of Group T4........................................................................... 199
2.40.4.................... Application of item 16400......................................................................... 199
2.40.5.................... Limitation of item 16399........................................................................... 199
Division 2.41—Group T6: Examination by anaesthetist 206
2.41.1.................... Application of Group T6........................................................................... 206
2.41.2.................... Limitation of item 17609........................................................................... 206
Division 2.42—Group T7: Regional or field nerve blocks 208
2.42.1.................... Meaning of amount under clause 2.42.1.................................................. 208
2.42.2.................... Application of Group T7........................................................................... 208
Division 2.43—Group T11: Botulinum toxin 211
2.43.1.................... Supply of botulinum toxin........................................................................ 211
2.43.2.................... Limitation of certain items......................................................................... 211
Division 2.44—Group T10: Anaesthesia performed in connection with certain services (Relative Value Guide) 215
2.44.1.................... Meaning of amount under clause 2.44.1.................................................. 215
2.44.2.................... Meaning of amount under clause 2.44.2.................................................. 215
2.44.3.................... Meaning of complex paediatric case......................................................... 216
2.44.4.................... Meaning of service time............................................................................ 216
2.44.5.................... Application of Group T10......................................................................... 216
2.44.6.................... Application of Subgroup 21 of Group T10............................................... 217
2.44.7.................... Services mentioned in Subgroups 21 to 25 of Group T10........................ 217
2.44.8.................... Application of Subgroups 22 and 23 of Group T10................................. 217
2.44.9.................... Application of Subgroups 24 and 25 of Group T10................................. 217
Division 2.45—Group T8: Surgical operations 245
Subdivision A—General 245
2.45.1.................... Meaning of approved site......................................................................... 245
2.45.2.................... Application of Group T8........................................................................... 246
Subdivision B—Subgroup 1 of Group T8 246
2.45.3.................... Meaning of amount under clause 2.45.3.................................................. 246
2.45.4.................... Meaning of amount under clause 2.45.4.................................................. 246
2.45.5.................... Meaning of qualified surgeon................................................................... 246
2.45.6.................... Meaning of qualified radiologist............................................................... 246
2.45.7.................... Histopathological proof of malignancy in certain cases for purposes of certain items relating to surgical procedures............................................................................... 247
2.45.8.................... Application of items 30299 and 30300..................................................... 247
2.45.9.................... Application of items 30440, 30451, 30492 and 30495............................. 247
2.45.10.................. Application of items 30688, 30690, 30692 and 30694............................. 247
2.45.11.................. Application of item 35412......................................................................... 247
2.45.12.................. Application of items 31569, 31572, 31575, 31578, 31581, 31587 and 31590....... 247
Subdivision C—Subgroups 2 and 3 of Group T8 284
2.45.13.................. Meaning of foreign body in items 35360 to 35363................................... 284
2.45.14.................. Application of items 32084, 32087, 32090 and 32093............................. 284
2.45.15.................. Application of items 32500 to 32517 and 35321...................................... 284
2.45.16.................. Application of items 35404, 35406 and 35408......................................... 284
2.45.17.................. Artificial bowel sphincter.......................................................................... 284
2.45.18.................. Meaning of eligible stroke centre.............................................................. 285
Subdivision D—Subgroups 4, 5 and 6 of Group T8 307
2.45.19.................. Application of items 38470 to 38766........................................................ 307
Subdivision E—Subgroups 7 to 11 of Group T8 346
Subdivision F—Subgroups 12 and 13 of Group T8 373
2.45.20.................. Meaning of amount under clause 2.45.20................................................ 373
2.45.20A............... Meaning of NOSE Scale........................................................................... 373
2.45.21.................. Meaning of maxilla................................................................................... 373
Subdivision G—Subgroup 14 of Group T8 397
2.45.22.................. Items 46300 to 46534 apply only in certain circumstances....................... 397
Subdivision H—Subgroups 15, 16 and 17 of Group T8 402
2.45.23.................. Limitation of item 50303........................................................................... 402
2.45.24.................. Application of items 51011 to 51171........................................................ 402
2.45.25.................. Application of items 51061 to 51066........................................................ 402
2.45.26.................. Meaning of motion segment...................................................................... 402
Division 2.46—Group T9: Assistance at operations 439
2.46.1.................... Meaning of amount under clause 2.46.1.................................................. 439
2.46.2.................... Meaning of amount under clause 2.46.2.................................................. 440
2.46.3.................... Meaning of amount under clause 2.46.3.................................................. 440
2.46.4.................... Meaning of previous significant surgical complication............................ 440
2.46.5.................... Application of Group T9........................................................................... 440
2.46.6.................... Assistance at operations............................................................................ 440
Division 2.47—Oral and Maxillofacial services 441
2.47.1.................... Application of Groups O1 to O11............................................................ 441
Division 2.48—Group O1: Consultations 441
Division 2.49—Group O2: Assistance at operation 442
2.49.1.................... Meaning of amount under clause 2.49.1.................................................. 442
2.49.2.................... Assistance at operations............................................................................ 442
Division 2.50—Group O3: General surgery 443
Division 2.51—Group O4: Plastic and reconstructive 447
2.51.1.................... Meaning of maxilla................................................................................... 447
Division 2.52—Group O5: Preprosthetic 451
Division 2.53—Group O6: Neurosurgical 452
Division 2.54—Group O7: Ear, nose and throat 452
Division 2.55—Group O8: Temporomandibular joint 453
Division 2.56—Group O9: Treatment of fractures 455
Division 2.58—Group O11: Regional or field nerve blocks 456
Part 3—Dictionary 457
3.1......................... Dictionary................................................................................................. 457
Endnotes469
Endnote 1—About the endnotes 469
Endnote 2—Abbreviation key 470
Endnote 3—Legislation history 471
Endnote 4—Amendment history 472
1 Name
This instrument is the Health Insurance (General Medical Services Table) Regulations 2018.
3 Authority
This instrument is made under the Health Insurance Act 1973.
4 General 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.
5 Dictionary
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 1—General medical services table
Note: See section 4.
Part 1—Preliminary
Division 1.1—Definitions
1.1.1 Meaning of eligible non‑vocationally recognised medical practitioner
(1) In the table:
eligible non‑vocationally recognised medical practitioner means:
(a) a medical practitioner (including an overseas trained practitioner or a temporary resident medical practitioner) who:
(i) is registered as a medical practitioner under the Rural Other Medical Practitioners’ Program; and
(ii) is providing general medical services in accordance with that Program; or
(b) a medical practitioner who:
(i) is registered as a medical practitioner under the Outer Metropolitan (Other Medical Practitioners) Relocation Incentive Program; and
(ii) is providing general medical services in accordance with that Program; and
(iii) is not vocationally registered under section 3F of the Act, but is required under that Program to undertake additional training or other activities:
(A) that could enable vocational registration within 4 years or, on written application, 5 years, after commencing the training or other activities; and
(B) of which the Chief Executive Medicare has written notice; or
(c) a medical practitioner who:
(i) is registered as a medical practitioner under the MedicarePlus for Other Medical Practitioners Program; and
(ii) is providing general medical services in accordance with that Program; and
(iii) is not vocationally registered under section 3F of the Act; or
(d) a medical practitioner who:
(i) is registered as a medical practitioner under the After Hours Other Medical Practitioners Program; and
(ii) is providing general medical services in accordance with that Program; and
(iii) is not vocationally registered under section 3F of the Act.
(2) In subclause (1):
After Hours Other Medical Practitioners Program means a program administered by the Chief Executive Medicare that, for medical services provided in accordance with the Program, provides a particular level of medicare benefits.
MedicarePlus for Other Medical Practitioners Program means a program administered by the Chief Executive Medicare that, for medical services provided in accordance with the Program, provides a particular level of medicare benefits.
Outer Metropolitan (Other Medical Practitioners) Relocation Incentive Program means a program administered by the Department that, for medical services provided in accordance with the Program, provides a particular level of medicare benefits.
Rural Other Medical Practitioners’ Program means a program administered by the Chief Executive Medicare that, for medical services provided in accordance with the Program, provides a particular level of medicare benefits.
1.1.2 General practitioners for the purposes of the table
For the purposes of paragraph (c) of the definition of general practitioner in subsection 3(1) of the Act, the following medical practitioners are specified for the purposes of the table:
(a) a medical practitioner who is undertaking a placement in general practice that is approved by the RACGP:
(i) as part of a training program for general practice leading to the award of Fellowship of the RACGP; or
(ii) as part of another training program recognised by the RACGP as being of an equivalent standard;
(b) an eligible non‑vocationally recognised medical practitioner;
(c) a medical practitioner who is undertaking a placement in general practice as part of the Remote Vocational Training Scheme administered by Remote Vocational Training Scheme Limited;
(d) a medical practitioner who is undertaking a placement in general practice that is approved by the ACRRM:
(i) as part of a training program for general practice leading to the award of Fellowship of the ACRRM; or
(ii) as part of another training program recognised by the ACRRM as being of an equivalent standard.
Note: For other medical practitioners who are general practitioners, see the definition of general practitioner in subsection 3(1) of the Act and section 22 of the Health Insurance Regulations 2018.
1.1.3 Meaning of multidisciplinary case conference
In the table:
multidisciplinary case conference means a process by which a multidisciplinary case conference team carries out all of the following activities:
(a) discussing a patient’s history;
(b) identifying the patient’s multidisciplinary care needs;
(c) identifying outcomes to be achieved by members of the multidisciplinary case conference team giving care and service to the patient;
(d) identifying tasks that need to be undertaken to achieve these outcomes, and allocating those tasks to members of the multidisciplinary case conference team;
(e) assessing whether previously identified outcomes (if any) have been achieved.
1.1.4 Meaning of multidisciplinary case conference team
(1) A multidisciplinary case conference team for a patient:
(a) includes a medical practitioner; and
(b) either:
(i) for items 735 to 758, 825 to 828, 855 to 858, 6029 to 6042 and 6064 to 6075—includes at least 2 other members; or
(ii) for an item mentioned in subclause (3)—includes at least 3 other members; and
(c) may also include a family member of the patient.
(2) For the members mentioned in paragraph (b):
(a) each member must provide a different kind of care or service to the patient; and
(b) each member must not be a family carer of the patient; and
(c) 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) 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.
1.1.5 Meaning of single course of treatment
(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) A single course of treatment for a patient:
(a) includes:
(i) the initial attendance on the patient by a specialist or consultant physician; and
(ii) the continuing management or treatment up to and including the stage when the patient is referred back to the care of the referring practitioner; and
(iii) any subsequent review of the patient’s condition by the specialist or consultant physician that may be necessary, whether the review is initiated by the referring practitioner or by the specialist or consultant physician; but
(b) does not include:
(i) referral of the patient to the specialist or consultant physician; or
(ii) an attendance (the later attendance) on the patient by the specialist or consultant physician, after the end of the period of validity of the last referral to have application under section 102 of the Health Insurance Regulations 2018 if:
(A) the referring practitioner considers the later attendance necessary for the patient’s condition to be reviewed; and
(B) the patient was most recently attended by the specialist or consultant physician more than 9 months before the later attendance.
Note: Division 4 of Part 11 of the Health Insurance Regulations 2018 prescribes the manner in which patients are to be referred when an item in the table specifies a service that is to be rendered by a specialist or consultant physician to a patient who has been referred.
1.1.6 Meaning of symbol (H)
An item including the symbol (H) applies only to a service performed or provided in a hospital.
Division 1.2—General application provisions
1.2.1 Application
An item in the table does not apply to a service provided in contravention of a law of the Commonwealth, a State or Territory.
1.2.2 Attendance by specialist or consultant physician
(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) The item does not apply to an attendance on a patient by a specialist or consultant physician if:
(a) the attendance forms part of a single course of treatment for the patient; and
(b) the attendance is after the end of the period of validity (under section 102 of the Health Insurance Regulations 2018) of the referral that was valid for the first attendance on the patient by the specialist or consultant physician in the single course of treatment; and
(c) the attendance is not within the period of validity (under section 102 of the Health Insurance Regulations 2018) of a later referral.
Note: Division 4 of Part 11 of the Health Insurance Regulations 2018 prescribes the manner in which patients are to be referred when an item in the table specifies a service that is to be rendered by a specialist or consultant physician to a patient who has been referred.
1.2.3 Limitation of items—certain attendances by specialists and consultant physicians
(1) Use this clause for items 105, 116, 119, 386, 2806, 2814, 3010, 3014, 6019, 6052 and 16404.
(2) The item does not apply to a service if:
(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
(b) the operation is a service to which an item in Group T8 applies; and
(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.
1.2.4 Professional attendance services
(1) Use this clause for items 3 to 338, 348 to 389, 410 to 417, 501 to 600, 900, 903, 2497 to 2840, 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, 17609 to 17690 and 90020 to 90096.
(2) A professional attendance includes the provision, for a patient, of any of the following services:
(a) evaluating the patient’s condition or conditions including, if applicable, evaluation using a health screening service mentioned in subsection 19(5) of the Act;
(b) formulating a plan for the management and, if applicable, for the treatment of the patient’s condition or conditions;
(c) giving advice to the patient about the patient’s condition or conditions and, if applicable, about treatment;
(d) if authorised by the patient—giving advice to another person, or other persons, about the patient’s condition or conditions and, if applicable, about treatment;
(e) providing appropriate preventive health care;
(f) recording the clinical details of the service or services provided to the patient.
(3) However, a professional attendance does not include the supply of a vaccine to a patient if:
(a) the vaccine is supplied to the patient in connection with a professional attendance mentioned in any of items 3 to 65, 5000 to 5267 and 90020 to 90096; and
(b) the cost of the vaccine is not subsidised by the Commonwealth or a State.
1.2.5 Personal attendance by medical practitioners generally
(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 12004, 12201, 13030 to 13104, 13106 to 13110, 13209, 13210, 13290 to 13700, 13815 to 13888, 14100 to 14200, 14203 to 14212, 14224, 15600, 16003 to 16512, 16515 to 51318 and 90020 to 90096.
(2) The item applies to a service provided in the course of a personal attendance by a single medical practitioner on a single patient on a single occasion.
(3) A personal attendance by the medical practitioner on the patient includes any of the following:
(a) a telepsychiatry consultation to which any of items 353 to 361 applies;
(b) the planning, management and supervision of the patient on home dialysis to which item 13104 applies;
(c) participating in a video conferencing consultation referred to in items 99, 112 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.
1.2.6 Personal attendance by medical practitioners
(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, 12004, 12201, 13030 to 13104, 13106 to 13110, 13209, 13210, 13290 to 13700, 13815 to 13888, 14100 to 14200, 14203 to 14212, 14224, 15600, 16003 to 16512, 16515 to 51318 and items 90020 to 90096.
(2) The item applies to a service provided during a personal attendance by:
(a) a medical practitioner (other than a medical practitioner employed by the proprietor of a hospital that is not a private hospital); or
(b) a medical practitioner who:
(i) is employed by the proprietor of a hospital that is not a private hospital; and
(ii) provides the service otherwise than in the course of employment by that proprietor.
(3) Subclause (2) applies whether or not another person provides essential assistance to the medical practitioner in accordance with accepted medical practice.
(4) A personal attendance by the medical practitioner on the patient includes any of the following:
(a) a telepsychiatry consultation to which any of items 353 to 361 applies;
(b) the planning, management and supervision of the patient on home dialysis to which item 13104 applies;
(c) participating in a video conferencing consultation referred to in items 99, 112 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.
1.2.7 Application of items—services provided with non‑medicare services
Items 3 to 10816 and 90020 to 90096 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.
1.2.8 Application of items—services rendered in certain circumstances
An item in the table does not apply to a service mentioned in the item if the service is rendered in any of the following circumstances:
(a) the service is rendered in relation to the provision of chelation therapy, in the form of the intravenous administration of ethylenediamine tetra‑acetic acid or any of its salts, otherwise than for the treatment of heavy‑metal poisoning;
(b) the service is rendered in association with the injection of human chorionic gonadotrophin in the management of obesity;
(c) the service is rendered in relation to the use of hyperbaric oxygen therapy in the treatment of multiple sclerosis;
(d) the service is rendered for the purpose of, or in relation to, the removal of tattoos;
(e) the service is rendered for the purposes of, or in relation to, the removal from a cadaver of kidneys for transplantation;
(f) the service is rendered to a patient of a hospital for the purposes of, or in relation to:
(i) the transplantation of a thoracic or abdominal organ, other than a kidney, or of part of an organ of that kind; or
(ii) the transplantation of a kidney in conjunction with the transplantation of a thoracic or other abdominal organ, or of a part of an organ of that kind;
(g) the service is rendered for the purpose of administering microwave (UHF radiowave) cancer therapy, including the intravenous injection of drugs used immediately before or during the therapy;
(h) the service is rendered to a patient at the same time, or in connection with, an injection of blood or a blood product that is autologous.
1.2.8A Application of items—services provided with harvesting, storage, in vitro processing or injection of non‑haematopoietic stem cells
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 as, or in connection with, the harvesting, storage, in vitro processing or injection of non‑haematopoietic stem cells.
1.2.9 Services that may be provided by persons other than medical practitioners
(1) Use this clause for items 10983 to 10989, 10997, 11000, 11003, 11004, 11005, 11006, 11009, 11024, 11027, 11200, 11203, 11204, 11205, 11210, 11211, 11215, 11218, 11221, 11224, 11235, 11237, 11240, 11241, 11242, 11243, 11244, 11300, 11303, 11306, 11309, 11312, 11315, 11318, 11324, 11327, 11330, 11332, 11333, 11336, 11339, 11503, 11505, 11506, 11507, 11508, 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, 12204, 12205, 12207, 12208, 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, 14218, 14221, 15000 to 15336, 15339 to 15357, 15500 to 15539 and 16514.
(2) The item applies whether the medical service is given by:
(a) a medical practitioner; or
(b) a person, other than a medical practitioner, who:
(i) is employed by a medical practitioner; or
(ii) in accordance with accepted medical practice, acts under the supervision of a medical practitioner.
Part 2—Services and fees
Division 2.1—Groups A1 to A35
2.1.1 Meaning 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:
(a) the fee mentioned in column 2 for the item; and
(b) either:
(i) if a practitioner attends not more than 6 patients in a single attendance—the amount mentioned in column 3 for the item, divided by the number of patients attended; or
(ii) if a practitioner attends more than 6 patients in a single attendance—the amount mentioned in column 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 | 26.35 | 2.05 |
| 3 | 24 | The fee for item 23 | 26.35 | 2.05 |
| 5 | 37 | The fee for item 36 | 26.35 | 2.05 |
| 7 | 47 | The fee for item 44 | 26.35 | 2.05 |
| 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 |
| 17 | 195 | The fee for item 193 | 25.95 | 2.00 |
| 18 | 414 | The fee for item 410 | 25.85 | 2.00 |
| 19 | 415 | The fee for item 411 | 25.85 | 2.00 |
| 20 | 416 | The fee for item 412 | 25.85 | 2.00 |
| 21 | 417 | The fee for item 413 | 25.85 | 2.00 |
| 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 | $67.50 | 27.95 | 1.25 |
Division 2.2—Group A1: General practitioner attendances to which no other item applies
| Group A1—General practitioner attendances to which no other item applies | ||
| Column 1 Item | Column 2 Description | Column 3 Fee ($) |
| 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 | 17.20 |
| 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 |
| 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 | 37.60 |
| 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 |
| 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 | 72.80 |
| 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 |
| 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 | 107.15 |
| 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 |
Division 2.3—Group A2: Other non‑referred attendances to which no other item applies
2.3.1 Effect of determination under section 106TA of Act
(1) This clause applies to a general practitioner, if:
(a) the practitioner is the subject of a final determination that is in force under section 106TA of the Act; and
(b) the determination contains a direction, given under subparagraph 106U(1)(g)(i) of the Act, that the practitioner be disqualified for a professional service; and
(c) the determination states that the practitioner is disqualified for a service mentioned in an item in Group A1; and
(d) the practitioner provides a service mentioned in an item in Group A2.
(2) The determination applies to the service mentioned in paragraph (1)(d).
| Group A2—Other non‑referred attendances to which no other item applies | ||
| Column 1 Item | Column 2 Description | Column 3 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 |
Division 2.4—Group A3: Specialist attendances to which no other item applies
2.4.1 Limitation of items 99 and 113
Items 99 and 113 do not apply if the patient or the specialist travels to a place to satisfy the requirement in:
(a) for item 99—sub‑subparagraph (d)(i)(B) of the item; and
(b) for item 113—sub‑subparagraph (c)(i)(B) of the item.
| Group A3—Specialist attendances to which no other item applies | ||
| Column 1 Item | Column 2 Description | Column 3 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 | 86.85 |
| 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 | 43.65 |
| 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) | 72.05 |
| 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 | 127.40 |
| 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 | 80.65 |
| 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) | 195.70 |
| 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 $300 or more For any particular patient, once only on the same day | 43.65 |
| 113 | Initial professional attendance of 10 minutes or less in duration on a patient by a specialist in the practice of his or her speciality if: (a) the attendance is by video conference; and (b) the patient is not an admitted patient; and (c) the patient: (i) is located both: (A) within a telehealth eligible area; and (B) at the time of the attendance—at least 15 kms by road from the specialist; or (ii) is a care recipient in a residential care service; or (iii) is a patient of: (A) an Aboriginal Medical Service; or (B) an Aboriginal Community Controlled Health Service; for which a direction made under subsection 19(2) of the Act applies; and (d) no other initial consultation has taken place for a single course of treatment | 65.15 |
Division 2.5—Group A4: Consultant physician (other than psychiatry) attendances to which no other item applies
2.5.1 Limitation of items 112 and 114
Items 112 and 114 do not apply if the patient, specialist or physician travels to a place to satisfy the requirement in:
(a) for item 112—sub‑subparagraph (d)(i)(B) of the item; and
(b) for item 114—sub‑subparagraph (c)(i)(B) of the item.
| Group A4—Consultant physician attendances to which no other item applies | ||
| Column 1 Item | Column 2 Description | Column 3 Fee ($) |
| 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 | 153.15 |
| 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 (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 110, 116, 119, 132 or 133 |
| 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 | 114.90 |
| 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 | 76.65 |
| 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 | 76.65 |
| 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 | 43.65 |
| 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 | 43.65 |
| 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 | 185.85 |
| 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 | 112.40 |
| 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 | 80.95 |
| 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 | 267.85 |
| 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 | 134.10 |
Division 2.6—Group A29: Early intervention services for children with autism, pervasive developmental disorder or disability
2.6.1 Meanings of eligible allied health provider and risk assessment
In items 135, 137 and 139:
eligible allied health provider means any of the following:
(a) an audiologist;
(b) an occupational therapist;
(c) an optometrist;
(d) an orthoptist;
(e) a physiotherapist;
(f) a psychologist;
(g) a speech pathologist.
Risk assessment means an assessment of:
(a) the risk to the patient of a contributing co‑morbidity; and
(b) environmental, physical, social and emotional risk factors that may apply to the patient or to another individual.
2.6.2 Meaning of eligible disability
An eligible disability means any of the following:
(a) sight impairment that results in vision of less than or equal to 6/18 vision or equivalent field loss in the better eye, with correction;
(b) hearing impairment that results in:
(i) a hearing loss of 40 decibels or greater in the better ear, across 4 frequencies; or
(ii) permanent conductive hearing loss and auditory neuropathy;
(c) deafblindness;
(d) cerebral palsy;
(e) Down syndrome;
(f) Fragile X syndrome;
(g) Prader‑Willi syndrome;
(h) Williams syndrome;
(i) Angelman syndrome;
(j) Kabuki syndrome;
(k) Smith‑Magenis syndrome;
(l) CHARGE syndrome;
(m) Cri du Chat syndrome;
(n) Cornelia de Lange syndrome;
(o) microcephaly, if a child has:
(i) a head circumference less than the third percentile for age and sex; and
(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;
(p) Rett’s disorder.
| Group A29—Early intervention services for children with autism, pervasive developmental disorder or disability | ||
| Column 1 Item | Column 2 Description | Column 3 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) | 267.85 |
| 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) | 267.85 |
| 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) | 134.50 |
Division 2.7—Group A28: Geriatric medicine
2.7.1 Limitation 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 | ||
| Column 1 Item | Column 2 Description | Column 3 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 | 459.45 |
| 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 | 287.20 |
| 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 | 557.10 |
| 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 | 348.25 |
| 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 |
eligible stroke centre has the meaning given by clause 2.45.18.
embryology laboratory services, for items 13200, 13201 and 13206, has the meaning given by clause 2.37.2.
family carer, of a patient, includes a person if the person is:
(a) a relative or friend of the patient; and
(b) providing care to the patient other than for payment.
focussed psychological strategies has the meaning given by clause 2.22.1.
foreign body, for items 35360 and 35363, has the meaning given by clause 2.45.13.
general intensive care unit means a separate hospital area that:
(a) is equipped and staffed so that it is capable of providing to a patient:
(i) mechanical ventilation for a period of several days; and
(ii) invasive cardiovascular monitoring; and
(b) is supported by:
(i) during normal working hours—at least one specialist, or consultant physician, in the specialty of intensive care, who is immediately available, and exclusively rostered, to that area; and
(ii) at all times—at least one registered medical practitioner who is present in the hospital and immediately available to that area; and
(iii) at least 18 hours each day—at least one registered nurse; and
(c) has admission and discharge policies in operation.
general practice means a business, consisting of one or more medical practitioners, that provides a general practice of medical services.
general practitioner has a meaning affected by clause 1.1.2.
GP management plan, for item 10997, has the meaning given by clause 2.32.1.
(H) has the meaning given by clause 1.1.6.
IGRT, for items 15275 and 15715, has the meaning given by clause 2.38.3.
immunisation means the administration of a registered vaccine to a person for any purpose other than as part of a mass immunisation of persons.
IMRT, for items 15275, 15555, 15565 and 15715, has the meaning given by clause 2.38.4.
institution means a place (other than a hospital or residential aged care facility) at which residential accommodation or day care is, or both residential accommodation and day care are, made available to:
(a) disadvantaged children; or
(b) juvenile offenders; or
(c) aged persons; or
(d) chronically ill psychiatric patients; or
(e) homeless persons; or
(f) unemployed persons; or
(g) persons suffering from alcoholism; or
(h) persons addicted to drugs; or
(i) physically or intellectually disabled persons.
intensive care unit means a general intensive care unit or a neo‑natal intensive care unit.
item means:
(a) an item mentioned, by number, in column 1 of a table in:
(i) this table; or
(ii) the diagnostic imaging services table; or
(iii) the pathology services table; and
(b) in a reference immediately followed by a number—the item so numbered.
Note: A health service specified in a determination made under subsection 3C(1) of the Act is treated as if there were an item for the service in this table, the diagnostic imaging services table or the pathology services table.
living in a community setting, for item 900, has the meaning given by clause 2.19.1.
maxilla:
(a) for items 45720 to 45752—has the meaning given by clause 2.45.21; and
(b) for items 52342 to 52375—has the meaning given by clause 2.51.1.
mental disorder, for Division 2.22, has the meaning given by clause 2.22.1.
minor attendance, for an attendance on a patient by a consultant physician, means an attendance that:
(a) is a second or subsequent attendance on the patient, in the course of a single course of treatment by the consultant physician, during which it is not necessary for the consultant physician to carry out a physical examination of the patient; and
(b) does not result in a substantial alteration to the treatment of the patient.
Modified Monash 2 area means a Statistical Area Level 1 under the ASGS that:
(a) is categorised under the ASGS as RA 1 (Inner Regional Australia) or RA 2 (Outer Regional Australia); and
(b) satisfies any of the following criteria:
(i) the area is in an Urban Centre and Locality with a 2013 estimated resident population of more than 50,000;
(ii) the area is in an Urban Centre and Locality, the geographic centre of which is no more than 20 kilometres road distance from the boundary of another Urban Centre and Locality with a 2013 estimated resident population of more than 50,000;
(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
(c) is not a Modified Monash 7 area.
Modified Monash 3 area means a Statistical Area Level 1 under the ASGS that:
(a) is categorised under the ASGS as RA 1 (Inner Regional Australia) or RA 2 (Outer Regional Australia); and
(b) satisfies any of the following criteria:
(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;
(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;
(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
(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:
(a) is categorised under the ASGS as RA 1 (Inner Regional Australia) or RA 2 (Outer Regional Australia); and
(b) satisfies any of the following criteria:
(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;
(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;
(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
(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:
(a) is categorised under the ASGS as RA 1 (Inner Regional Australia) or RA 2 (Outer Regional Australia); and
(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:
(a) is categorised under the ASGS as RA 3 (Remote Australia); and
(b) is not a Modified Monash 7 area.
Modified Monash 7 area means a Statistical Area Level 1 under the ASGS that:
(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
(b) is located on Magnetic Island; or
(c) is categorised under the ASGS as RA 4 (Very Remote Australia).
multidisciplinary care plan:
(a) for items 729 and 731—has the meaning given by clause 2.18.6; and
(b) for item 10997—has the meaning given by clause 2.32.1.
multidisciplinary case conference has the meaning given by clause 1.1.3.
multidisciplinary case conference in a residential aged care facility, for items 735, 739, 743, 747, 750 and 758, has the meaning given by clause 2.18.14.
multidisciplinary case conference team has the meaning given by clause 1.1.4.
multidisciplinary discharge case conference, for items 735, 739, 743, 747, 750 and 758, has the meaning given by clause 2.18.13.
neo‑natal intensive care unit means a separate hospital area that:
(a) is equipped and staffed so that it is capable of providing to a patient who is a newly born child:
(i) mechanical ventilation for a period of several days; and
(ii) invasive cardiovascular monitoring; and
(b) is supported by:
(i) during normal working hours—at least one consultant physician in paediatric medicine who is immediately available, and exclusively rostered, to that area; and
(ii) at all times—at least one registered medical practitioner who is present in the hospital and immediately available to that area; and
(iii) at least 18 hours each day—at least one registered nurse; and
(c) has admission and discharge policies in operation.
non‑directive pregnancy support counselling, for item 4001, has the meaning given by clause 2.26.1.
non‑medicare service means any of the following:
(a) endoluminal gastroplication, for the treatment of gastro‑oesophageal reflux disease;
(b) gamma knife surgery;
(c) intradiscal electro thermal arthroplasty;
(d) intravascular ultrasound, except if used in conjunction with intravascular brachytherapy;
(e) intro‑articular viscosupplementation, for the treatment of osteoarthritis of the knee;
(f) low intensity ultrasound treatment, for the acceleration of bone fracture healing, using a bone growth stimulator;
(g) lung volume reduction surgery, for advanced emphysema;
(h) photodynamic therapy, for skin and mucosal cancer;
(i) placement of artificial bowel sphincters, in the management of faecal incontinence;
(j) selective internal radiation therapy for any condition other than hepatic metastases that are secondary to colorectal cancer;
(k) specific mass measurement of bone alkaline phosphatise;
(l) transmyocardial laser revascularisation;
(m) vertebral axial decompression therapy, for chronic back pain;
(n) autologous chondrocyte implantation and matrix‑induced autologous chondrocyte implantation;
(o) vertebroplasty.
open reduction means treatment of a dislocation or fracture by either:
(a) operative exposure, including the use of any internal or external fixation; or
(b) non‑operative (closed) reduction using intra‑medullary fixation or external fixation.
organise and coordinate:
(a) for items 735, 739, 743, 820, 822, 823, 825, 826, 828, 830, 832, 834, 835, 837, 838, 855, 857, 858, 861, 864 and 866—has the meaning given by clause 2.18.15; and
(b) for items mentioned in Subgroups 2 and 4 of Group A24—has the meaning given by clause 2.23.1; and
(c) for items 6029 to 6042—has the meaning given by clause 2.24.1; and
(d) for items 6064 to 6075—has the meaning given by clause 2.25.1.
outcome measurement tool, for Division 2.22, has the meaning given by clause 2.22.1.
participate:
(a) for items 747, 750, 758, 825, 826, 828, 835, 837 and 838—has the meaning given by clause 2.18.16; and
(b) for items 2958, 2972, 2974, 2992, 2996, 3000, 3051, 3055, 3062, 3083, 3088 and 3093—has the meaning given by clause 2.23.2; and
(c) for items 6035 to 6042—has the meaning given by clause 2.24.2; and
(d) for items 6071 to 6075—has the meaning given by clause 2.25.2.
participating in a video conferencing consultation: a medical practitioner is participating in a video conferencing consultation if:
(a) the medical practitioner attends a patient who is receiving a service under an item in the table from a specialist or consultant physician; and
(b) the specialist or consultant physician is providing the service:
(i) in relation to his or her speciality to the patient; and
(ii) by way of a video conferencing consultation.
patient’s medical condition requires urgent assessment has the meaning given by clause 2.16.1.
patient’s usual general practitioner means a general practitioner:
(a) who has provided the majority of services to the patient in the past 12 months; or
(b) who is likely to provide the majority of services to the patient in the following 12 months; or
(c) located at a medical practice that:
(i) has provided the majority of services to the patient in the past 12 months; or
(ii) is likely to provide the majority of services to the patient in the next 12 months.
person with a chronic disease, for item 10997, has the meaning given by clause 2.32.1.
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 2.33.1.
practice nurse means a registered or an enrolled nurse who is employed by, or whose services are otherwise retained by, a general practice or by a health service to which a direction made under subsection 19(2) of the Act applies.
preparation of a GP mental health treatment plan has the meaning given by clause 2.22.3.
preparing a GP management plan, for item 721, has the meaning given by clause 2.18.7.
previous significant surgical complication, for item 51318, has the meaning given by clause 2.46.4.
problem focussed history, for items 501, 503 and 507, has the meaning given by clause 2.15.2.
qualified medical acupuncturist has the meaning given by clause 2.10.1.
qualified radiologist, for item 31542, has the meaning given by clause 2.45.6.
qualified sleep medicine practitioner:
(a) for items 12203, 12207, 12213 and 12217—has the meaning given by subclause 2.35.2(1); and
(b) for items 12210 and 12215—has the meaning given by subclause 2.35.2(2); and
(c) for item 12250—has the meaning given by subclause 2.35.2(3).
qualified surgeon, for items 31539 and 31545, has the meaning given by clause 2.45.5.
RACGP means the Royal Australian College of General Practitioners.
radiation oncology treatment verification means a quality assurance procedure:
(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
(b) that utilises the capture and assessment of appropriate images using any of the following:
(i) x‑rays;
(ii) computed tomography;
(iii) ultrasound, if the ultrasound equipment is capable of producing images in 3 dimensions; and
(c) that includes making a record of the assessment and correcting any significant treatment delivery inaccuracies detected.
recognised emergency department, for Division 2.15, has the meaning given by clause 2.15.1.
referring practitioner, in relation to a referral, means the person making the referral.
Note: Division 4 of Part 11 of the Health Insurance Regulations 2018 prescribes the manner in which patients are to be referred when an item in the table specifies a service that is to be rendered by a specialist or consultant physician to a patient who has been referred.
regional, rural or remote area means either of the following:
(a) an area classified as RRMAs 3‑7 under the Rural, Remote and Metropolitan Areas Classification;
(b) Norfolk Island.
registered vaccine means a vaccine that is included in the part of the Australian Register of Therapeutic Goods for registered goods, being the Register maintained under section 9A of the Therapeutic Goods Act 1989.
report, for Division 2.35, has the meaning given by clause 2.35.1.
residential aged care facility means a facility where residential care (within the meaning given by section 41‑3 of the Aged Care Act 1997) is provided.
residential care service has the meaning given by clause 1 of Schedule 1 to the Aged Care Act 1997.
residential medication management review, for item 903, has the meaning given by clause 2.19.2.
responsible person, for items 585 to 600, has the meaning given by clause 2.16.2.
reviewing a GP management plan, for item 732, has the meaning given by clause 2.18.8.
review of a GP mental health treatment plan has the meaning given by clause 2.22.4.
risk assessment:
(a) for items 135, 137 and 139—has the meaning given by clause 2.6.1; and
(b) for item 289—has the meaning given by clause 2.11.5.
Rural, Remote and Metropolitan Areas Classification means the document so titled, as existing on 1 July 2018, 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 2.44.4.
single course of treatment has the meaning given by clause 1.1.5.
SLA, for Division 2.33, has the meaning given by clause 2.33.1.
SSD, for Division 2.33, has the meaning given by clause 2.33.1.
team care arrangements means a plan under item 723 or 732 (for a review of team care arrangements under item 723).
telehealth eligible area means an area classified as a telehealth eligible area by the Minister.
Note: Maps showing telehealth eligible areas could in 2018 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 2.33, has the meaning given by clause 2.33.1.
unsociable hours means 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 1—About 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 2—Abbreviation 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 3—Legislation history
| Name | Registration | Commencement | Application, saving and transitional provisions |
| Health Insurance (General Medical Services Table) Regulations 2018 | 13 June 2018 (F2018L00766) | 1 July 2018 (s 2(1) item 1) | |
| Health Insurance Legislation Amendment (2018 Measures No. 2) Regulations 2018 | 13 June 2018 (F2018L00768) | Sch 1 (items 1–58): 1 July 2018 (s 2(1) item 2) | — |
| Health Insurance (Repeal and Consequential Amendments) Regulations 2018 | 27 Sept 2018 (F2018L01366) | Sch 1 (items 5–13): 1 Oct 2018 (s 2(1) item 1) | — |
| Health Insurance Legislation Amendment (2018 Measures No. 3) Regulations 2018 | 26 Oct 2018 (F2018L01481) | Sch 1 (items 12–102): 1 Nov 2018 (s 2(1) item 1) | — |
| Health Insurance Legislation Amendment (2018 Measures No. 4) Regulations 2018 | 5 Nov 2018 (F2018L01534) | Sch 1 (item 2): 1 Jan 2019 (s 2(1) item 1) | — |
| Health Insurance (General Medical Services Table) Amendment (After‑hours Rural Area) Regulations 2018 | 27 Nov 2018 (F2018L01616) | 1 Jan 2019 (s 2(1) item 1) | — |
| Health Insurance Legislation Amendment (Services for Patients in Residential Aged Care Facilities) Regulations 2019 | 22 Feb 2019 (F2019L00179) | Sch 1 (items 1–9): 1 Mar 2019 (s 2(1) item 1) | — |
Endnote 4—Amendment history
| Provision affected | How affected |
| s 2............................................. | rep LA s 48D |
| s 6............................................. | rep LA s 48C |
| Schedule 1 | |
| Part 1 | |
| Division 1.1 | |
| c 1.1.2....................................... | rs F2018L01366 |
| am F2018L01534 | |
| c 1.1.5....................................... | am F2018L01366 |
| Division 1.2 | |
| c 1.2.1....................................... | am F2018L01481 |
| c 1.2.2....................................... | am F2018L01366 |
| c 1.2.4....................................... | am F2019L00179 |
| c 1.2.5....................................... | am F2018L01481; F2019L00179 |
| c 1.2.6....................................... | am F2018L01481; F2019L00179 |
| c 1.2.7....................................... | am F2019L00179 |
| c 1.2.8....................................... | rs F2018L01366 |
| c 1.2.8A.................................... | ad F2018L01481 |
| c 1.2.9....................................... | am F2018L01481 |
| Part 2 | |
| Division 2.1 | |
| Division 2.1 heading................. | rs F2019L00179 |
| c 2.1.1....................................... | am F2019L00179 |
| Division 2.2 | |
| Group A1 Table........................ | am F2019L00179 |
| Division 2.3 | |
| Group A2 Table........................ | am F2019L00179 |
| Division 2.8 | |
| c 2.8.1....................................... | am F2018L00768 |
| Division 2.9 | |
| Group A6 Table........................ | am F2018L00768 |
| Division 2.10 | |
| Division 2.10 heading............... | am F2018L00768 |
| Group A7 Table heading........... | am F2018L00768 |
| Group A7 Table........................ | am F2018L00768 |
| Division 2.16 | |
| c 2.16.4..................................... | am F2018L01616 |
| Division 2.17 | |
| c 2.17.1..................................... | am F2018L00768 |
| c 2.17.5..................................... | am F2018L00768 |
| c 2.17.6..................................... | am F2018L00768 |
| c 2.17.7..................................... | am F2018L00768 |
| c 2.17.8..................................... | am F2018L00768 |
| c 2.17.9..................................... | am F2018L00768 |
| c 2.17.11................................... | am F2018L00768 |
| c 2.17.12................................... | am F2018L00768 |
| c 2.17.13................................... | am F2018L00768 |
| c 2.17.14................................... | am F2018L00768 |
| Group A14 Table...................... | am F2018L00768 |
| Division 2.18 | |
| Subdivision B | |
| c 2.18.2..................................... | rs F2018L00768 |
| c 2.18.4..................................... | am F2018L00768 |
| c 2.18.5..................................... | am F2018L00768 |
| c 2.18.6..................................... | am F2018L00768 |
| c 2.18.7..................................... | am F2018L00768 |
| c 2.18.8..................................... | am F2018L00768 |
| c 2.18.10................................... | am F2018L00768 |
| c 2.18.11................................... | am F2018L00768 |
| c 2.18.12................................... | am F2018L00768 |
| Group A15 Table...................... | am F2018L00768 |
| Division 2.19 | |
| c 2.19.2..................................... | am F2018L00768 |
| c 2.19.3..................................... | am F2018L00768 |
| Group A17 Table...................... | am F2018L00768 |
| Division 2.20 | |
| c 2.20.1..................................... | am F2018L00768 |
| Group A30 Table heading......... | am F2018L00768 |
| Group A30 Table...................... | am F2018L00768 |
| Division 2.22 | |
| c 2.22.3..................................... | am F2018L00768 |
| c 2.22.4..................................... | am F2018L00768 |
| c 2.22.5..................................... | rs F2018L00768 |
| c 2.22.6..................................... | am F2018L00768 |
| c 2.22.7..................................... | am F2018L00768 |
| Group A20 Table...................... | am F2018L00768 |
| Division 2.26 | |
| c 2.26.1..................................... | am F2018L00768 |
| Group A27 Table...................... | am F2018L00768 |
| Division 2.30A | |
| Division 2.30A......................... | ad F2019L00179 |
| c 2.30A.1.................................. | ad F2019L00179 |
| Group A35 Table...................... | ad F2019L00179 |
| Division 2.33 | |
| Group M1 Table....................... | am F2018L00768 |
| Division 2.35 | |
| c 2.35.2..................................... | am F2018L01481 |
| c 2.35.2A.................................. | ad F2018L01481 |
| c 2.35.2B.................................. | ad F2018L01481 |
| c 2.35.2C.................................. | ad F2018L01481 |
| c 2.35.2D.................................. | ad F2018L01481 |
| Group D1 Table........................ | am F2018L01481 |
| Division 2.37 | |
| Group T1 Table........................ | am F2018L01481 |
| Division 2.43 | |
| Group T11 Table...................... | am F2018L01481 |
| Division 2.44 | |
| c 2.44.5..................................... | am F2018L01481 |
| Group T10 Table...................... | am F2018L01481 |
| Division 2.45 | |
| Subdivision B | |
| c 2.45.7..................................... | am F2018L01481 |
| Group T8 Table........................ | am F2018L01481 |
| ed C3 | |
| Subdivision C | |
| Group T8 Table........................ | am F2018L01481 |
| Subdivision D | |
| Group T8 Table........................ | am F2018L01481 |
| Subdivision E | |
| Group T8 Table........................ | am F2018L01481 |
| Subdivision F | |
| Subdivision F heading............... | am F2018L01481 |
| c 2.45.20A................................ | ad F2018L01481 |
| Group T8 Table........................ | am F2018L01481 |
| Subdivision G | |
| Subdivision G heading.............. | am F2018L01481 |
| Subdivision H | |
| Subdivision H heading.............. | am F2018L01481 |
| c 2.45.24................................... | ad F2018L01481 |
| c 2.45.25................................... | ad F2018L01481 |
| c 2.45.26................................... | ad F2018L01481 |
| Group T8 Table........................ | am F2018L01481 |
| Division 2.57............................ | rep F2018L01481 |
| Group O10 Table...................... | rep F2018L01481 |
| Part 3 | |
| c 3.1.......................................... | am F2018L00768; F2018L01366; F2018L01481 |
| Schedule 2................................ | rep LA s 48C |
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