Health Insurance (General Medical Services Table) Regulations 2021 (Cth)

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Health Insurance (General Medical Services Table) Regulations 2021

made under the

Health Insurance Act 1973

Compilation No. 20

Compilation date:1 November 2025

Includes amendments:F2025L01232 and F2025L01239

This compilation is in 2 volumes

Volume 1:sections 1–4

Schedule 1 (clauses 1.1.1–4.2.2)

Volume 2: Schedule 1 (clauses 5.1.1–7.1.1)

Endnotes

Each volume has its own contents

About this compilation

This compilation

This is a compilation of the Health Insurance (General Medical Services Table) Regulations 2021 that shows the text of the law as amended and in force on 1 November 2025 (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. The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. Any uncommenced amendments affecting the law are accessible on the Register ( saving and transitional provisions

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.

Presentational changes

The Legislation Act 2003 provides for First Parliamentary Counsel to make presentational changes to a compilation. Presentational changes are applied to give a more consistent look and feel to legislation published on the Register, and enable the user to more easily navigate those documents.

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. Any modifications affecting the law are accessible on the Register.

Self‑repealing provisions

If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.

Contents

1Name

This instrument is the Health Insurance (General Medical Services Table) Regulations 2021.

3Authority

This instrument is made under the Health Insurance Act 1973.

4General medical services table

For the purposes of subsection 4(1) of the Health Insurance Act 1973, Schedule 1 is prescribed as a table of medical services.

Schedule 1General medical services table

Note: See section 4.

Part 1PreliminaryDivision 1.1Interpretation1.1.1Dictionary

The Dictionary in Part 7 defines certain words and expressions that are used in this Schedule, and includes references to certain words and expressions that are defined elsewhere in this Schedule.

1.1.2Meaning of eligible non‑vocationally recognised medical practitioner
  1. (1)

    In this Schedule:

    eligible non‑vocationally recognised medical practitioner means:

    1. (a)

      a medical practitioner:

      1. (i)

        who is registered under the MedicarePlus for Other Medical Practitioners Program; and

      2. (ii)

        who successfully completed the requirements of that Program, as evidenced by written advice from the Chief Executive Medicare; or

    Note: The MedicarePlus for Other Medical Practitioners Program will cease on 31 December 2023.

    1. (b)

      a medical practitioner who:

      1. (i)

        as at 30 June 2023, was registered under:

        1. (A)

          the After Hours Other Medical Practitioners Program; or

        2. (B)

          the Outer Metropolitan (Other Medical Practitioners) Relocation Incentive Program; or

        3. (C)

          the Rural Other Medical Practitioners’ Program; and

      2. (ii)

        is registered under, and providing general medical services in accordance with, the Other Medical Practitioners Extension Program; or

    2. (c)

      a medical practitioner:

      1. (i)

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

      2. (ii)

        providing general medical services in accordance with that Program.

    Note: The MedicarePlus for Other Medical Practitioners Program will cease on 31 December 2023.

  2. (2)

    In subclause (1):

    After Hours Other Medical Practitioners Program means the program by that name that, before 1 July 2023, was administered by the Chief Executive Medicare.

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

    Other Medical Practitioners Extension Program means the program by that name 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 the program by that name that, before 1 July 2023, was administered by the Chief Executive Medicare.

    Rural Other Medical Practitioners’ Program means the program by that name that, before 1 July 2023, was administered by the Chief Executive Medicare.

    Note 1: The After Hours Other Medical Practitioners Program, the Outer Metropolitan (Other Medical Practitioners) Relocation Incentive Program and the Rural Other Medical Practitioners’ Program ceased on 30 June 2023.

    Note 2: The MedicarePlus for Other Medical Practitioners Program will cease on 31 December 2023.

1.1.3General practitioners

For the purposes of paragraph (b) of the definition of general practitioner in subsection 3(1) of the Act, the following medical practitioners are specified:

  1. (a)

    a medical practitioner who is undertaking a placement in general practice that is approved by the Royal Australian College of General Practitioners (the RACGP):

    1. (i)

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

    2. (ii)

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

  2. (b)

    an eligible non‑vocationally recognised medical practitioner;

  3. (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;

  4. (d)

    a medical practitioner who is undertaking a placement in general practice that is approved by the Australian College of Rural and Remote Medicine (the ACRRM):

    1. (i)

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

    2. (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 16 of the Health Insurance Regulations 2018.

1.1.4Meaning of multidisciplinary case conference

In this Schedule:

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

  1. (a)

    discussing a patient’s history;

  2. (b)

    identifying the patient’s multidisciplinary care needs;

  3. (c)

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

  4. (d)

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

  5. (e)

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

1.1.5Meaning of multidisciplinary case conference team
  1. (1)

    In this Schedule, a multidisciplinary case conference team for a patient:

    1. (a)

      includes a medical practitioner; and

    2. (b)

      either:

      1. (i)

        for items 235, 236, 237, 238, 239, 240,735, 739, 743, 747, 750, 758, 825 to 828, 930, 933, 935, 937, 943, 945, 946, 948, 959, 961, 962, 964, 969, 971, 972, 973, 975, 986, 6029 to 6042 and 6064 to 6075—includes at least 2 other members; or

      2. (ii)

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

    3. (c)

      may also include a family member of the patient.

  2. (2)

    For the members mentioned in paragraph (1)(b):

    1. (a)

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

    2. (b)

      each member must not be an unpaid carer of the patient; and

    3. (c)

      one member may be another medical practitioner.

    Example: Other members may be allied health and other primary health care 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) dietitians;

    (h) mental health workers;

    (i) occupational therapists;

    (j) optometrists;

    (k) orthoptists;

    (l) orthotists or prosthetists;

    (m) pharmacists;

    (n) physiotherapists;

    (o) podiatrists;

    (p) psychologists;

    (q) registered nurses;

    (r) social workers;

    (s) speech pathologists;

    (t) education providers;

    (u) “meals on wheels” providers;

    (v) personal care workers;

    (w) probation officers.

  3. (3)

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

1.1.6Meaning of single course of treatment
  1. (1)

    Use this clause for items 104 to 133, 385 to 388, 2801 to 2840, 3005 to 3028, 6007 to 6015, 6018, 6019, 6024, 6051, 6052, 6058, 6062, 6063, 16401, 16404, 16406, 51700 and 51703.

  2. (2)

    A single course of treatment for a patient:

    1. (a)

      includes:

      1. (i)

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

      2. (ii)

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

      3. (iii)

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

    2. (b)

      does not include:

      1. (i)

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

      2. (ii)

        an attendance (the later attendance) on the patient by the specialist or consultant physician, after the end of the period of validity of the last referral to have application under section 102 of the Health Insurance Regulations 2018 if:

        1. (A)

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

        2. (B)

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

    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 this Schedule specifies a service that is to be rendered by a specialist or consultant physician to a patient who has been referred.

1.1.7Meaning of symbol (H)

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

1.1.8References in this Schedule to items include items determined under section 3C of the Act

A reference in this Schedule to an item includes a reference to an item relating to a health service that, under a determination in force under subsection 3C(1) of the Act, is treated as if there were an item in the table that relates to the service.

Division 1.2General application provisions1.2.1Application

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

1.2.2Restrictions on certain items – attendances by specialists and consultant physicians without referrals
  1. (1)

    Use this clause for items 104 to 111, 115 to 137, 141 to 147, 289 to 388, 2801 to 2840, 3005 to 3028, 6007 to 6015, 6018 to 6028, 6051 to 6063, 16401, 16404, 16407, 16408, 16508, 16509, 16533, 16534, 17640 to 17655, 90260, 90261, 90266 and 90267.

  2. (2)

    The item does not apply to an attendance on a patient by a specialist or consultant physician if:

    1. (a)

      the attendance forms part of a single course of treatment for the patient; and

    2. (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 initial attendance on the patient by the specialist or consultant physician in the single course of treatment; and

    3. (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 this Schedule specifies a service that is to be rendered by a specialist or consultant physician to a patient who has been referred.

1.2.3Restrictions on certain items – attendances by specialist radiologists in conjunction with certain diagnostic imaging services
  1. (1)

    Use this clause for items 52, 53, 54, 57, 104, 105 and 151.

  2. (2)

    The item does not apply to an attendance on a patient by a specialist in the specialty of diagnostic radiology if the attendance is in association with a service to which any of the following items of the diagnostic imaging services table applies:

    1. (a)

      an item in Subgroup 6 of Group I1;

    2. (b)

      an item in any of Subgroups 1 to 7 of Group I3;

    3. (c)

      items 58900 and 58903 in Subgroup 8 of Group I3;

    4. (d)

      item 59103 in Subgroup 9 of Group I3.

  3. (3)

    The item also does not apply to an attendance on a patient if the attendance is in association with a service to which an item in Group I5 of the diagnostic imaging services table applies, unless the practitioner providing the service considers the attendance is necessary for the management or treatment of the patient.

1.2.4Restrictions on certain items – attendances by specialists and consultant physicians on same day as they perform certain surgical operations
  1. (1)

    Use this clause for items 105, 116, 119, 386, 2806, 2814, 3010, 3014, 6009 to 6015, 6019, 6052, 16404, 91823, 91825, 91826, 91833, 91836, 92611, 92612, 92613, 92614 and 92618.

    Note: Some of these items are specified in determinations made under subsection 3C(1) of the Act.

  2. (2)

    The item does not apply to a service if:

    1. (a)

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

    2. (b)

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

    3. (c)

      the amount specified in the item in Group T8 as the fee for a service to which that item applies is $349.95 or more.

1.2.5Professional attendance services – matters included
  1. (1)

    Use this clause for items 3 to 338, 348 to 388, 392, 393, 410 to 417, 585 to 600, 733, 737, 741, 745, 761, 763, 766, 769, 772, 776, 788, 789, 792, 900, 903, 965, 967, 969, 971, 972, 973, 975, 986, 2497 to 2840, 3005 to 3028, 5000 to 5267, 6007 to 6015, 6018 to 6024, 6051 to 6063, 13899, 16401, 16404, 16406, 16407, 16508, 16509, 16533, 16534, 17610 to 17690, 90020 to 90096, 90098, 90183, 90188, 90202, 90212, 90215 and 90250 to 90278.

  2. (2)

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

    1. (a)

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

    2. (b)

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

    3. (c)

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

    4. (d)

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

    5. (e)

      providing appropriate preventive health care;

    6. (f)

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

  3. (3)

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

    1. (a)

      the vaccine is supplied to the patient in connection with a professional attendance mentioned in any of items 3 to 65, 123, 124, 151, 165, 179, 181, 185, 187, 189, 191, 203, 206, 301, 303, 5000 to 5267 and 90020 to 90098; and

    2. (b)

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

1.2.6Personal attendance by medical practitioners generally – application and matters included
  1. (1)

    Use this clause for items 3 to 147, 151, 165, 177, 179, 181, 185, 187, 189, 191, 193 to 338, 348 to 388, 410 to 417, 585 to 600, 733, 737, 741, 745, 761, 763, 766, 769, 772, 776, 788, 789, 792, 2497 to 2840, 3005 to 3028, 35570, 35571, 35573, 35577, 35581, 35582, 35585, 4001 to 6015, 6018 to 6024, 6051 to 6058, 6062, 6063, 10801 to 10816, 11012 to 11021, 11304, 11600, 11627, 11705, 11724, 11731, 12000 to 12004, 12201, 13030 to 13104, 13106 to 13110, 13209, 13290 to 13700, 13815 to 13899, 14100 to 14124, 14203 to 14212, 14216, 14219, 14224, 14255 to 14288, 15942, 15944, 15946, 15948, 16003 to 16512, 16515 to 51318, 90020 to 90096, 90098, 90183, 90188, 90202, 90212,90215 and 90250 to 90278.

  2. (2)

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

  3. (3)

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

    1. (a)

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

    2. (b)

      participating in a video conferencing consultation referred to in item 294.

1.2.7Personal attendance by medical practitioners – application and matters included
  1. (1)

    Use this clause for items 3 to 230, 233, 245 to 723, 733, 737, 741, 745, 761, 763, 766, 769, 772, 776, 788, 789, 792, 900, 903, 965, 967, 2700 to 6015, 6018 to 6024, 6028, 6051 to 6058, 6062, 6063, 10801 to 10816, 11012 to 11021, 11304, 11600, 11627, 11705, 11724, 11728, 11731, 11820, 11823, 12000, 12003, 12004, 12201, 13030 to 13104, 13106 to 13110, 13209, 13290 to 13700, 13815 to 13899, 14100 to 14124, 14203 to 14212, 14216, 14219, 14224, 14255 to 14288, 15942, 15944, 15946, 15948, 16003 to 16512, 16515 to 51318, 90020 to 90096, 90098, 90183, 90188, 90202, 90212, 90215 and 90250 to 90278.

  2. (2)

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

    1. (a)

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

    2. (b)

      a medical practitioner who:

      1. (i)

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

      2. (ii)

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

  3. (3)

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

  4. (4)

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

    1. (a)

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

    2. (b)

      participating in a video conferencing consultation referred to in item 294.

1.2.8Restriction on items – services provided with non‑medicare services

Items 3 to 10816, 90020 to 90096, 90098, 90183, 90188, 90202, 90212, 90215 and 90250 to 90278 do not apply to a service described in the item if the service is provided at the same time as, or in connection with, a non‑medicare service.

1.2.9Restrictions on items – services rendered in certain circumstances or for certain purposes

An item in this Schedule does not apply to a service described in the item if the service is rendered in any of the following circumstances:

  1. (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;

  2. (b)

    the service is rendered in association with the injection of human chorionic gonadotrophin in the management of obesity;

  3. (c)

    the service is rendered in relation to the use of hyperbaric oxygen therapy in the treatment of multiple sclerosis;

  4. (d)

    the service is rendered for the purpose of, or in relation to, the removal of tattoos;

  5. (e)

  1. the service is rendered for the purposes of, or in relation to, the removal from a cadaver of kidneys for transplantation;

  2. (f)

    the service is rendered to a patient of a hospital for the purposes of, or in relation to:

    1. (i)

      the transplantation of a thoracic or abdominal organ, other than a kidney, or of part of an organ of that kind; or

    2. (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;

  3. (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;

  4. (h)

    the service is rendered to a patient at the same time as, or in connection with, an injection of blood or a blood product that is autologous.

Note: Paragraph (h) does not apply to a service to which item 22002 applies.

1.2.10Restriction on items – services provided with harvesting, storage, in vitro processing or injection of non‑haematopoietic stem cells

An item in this Schedule does not apply to a service described 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.

1.2.11Services that may be provided by persons other than medical practitioners
  1. (1)

    Use this clause for items 10983 to 10989, 10997, 11000, 11003, 11004, 11005, 11009, 11024, 11027, 11200, 11203, 11204, 11205, 11210, 11211, 11215, 11218, 11221, 11224, 11235, 11237, 11240, 11241, 11242, 11243, 11244, 11300, 11302, 11303, 11306, 11309, 11312, 11315, 11318, 11324, 11332, 11340, 11341, 11342, 11343, 11345, 11503, 11505, 11506, 11507, 11508, 11512, 11602, 11604, 11605, 11607, 11610, 11611, 11612, 11614, 11615, 11704, 11707, 11713, 11714, 11716, 11717, 11721, 11723, 11725, 11726, 11727, 11729, 11730, 11732, 11735, 11800, 11810, 11830, 11833, 11900, 11912, 11919, 12012, 12017, 12021, 12022, 12024, 12200, 12203, 12204, 12205, 12207, 12208, 12210, 12213, 12215, 12217, 12250 to 12272, 12500 to 12527, 13015, 13020, 13025, 13200 to 13203, 13212, 13215, 13218, 13221, 13703, 13706, 13750, 13755, 13757, 13760, 14050, 14217, 14218, 14220, 14221, 15900 to 15984, 16514 and 41764.

  2. (2)

    The item applies whether the medical service is given by:

    1. (a)

      a medical practitioner; or

    2. (b)

      a person, other than a medical practitioner, who:

      1. (i)

        is employed by a medical practitioner; or

      2. (ii)

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

1.2.12Restriction on items – services involving video conferences between patients and medical practitioners separated by at least 15 km

If it is a condition of a service, in an item, involving a video conference between a patient and a medical practitioner that the patient and practitioner be at least 15 km by road from one another, the item does not apply if the patient or the practitioner travels to ensure that the condition is met.

Note: This clause has effect whether the condition is set out in the item or not.

1.2.13Restriction on items – attendances on same day as electrocardiogram services are performed
  1. (1)

    An item in Part 2 of this Schedule does not apply to a service (the attendance service) provided by a specialist, consultant physician or medical practitioner to a patient on a day if an electrocardiogram service to which item 11716, 11717, 11723, 11729, 11732 or 11735 applies is provided by the specialist, consultant physician or medical practitioner to the patient on the same day.

  2. (2)

    Subclause (1) does not apply if:

    1. (a)

      the patient has been referred to the specialist, consultant physician or medical practitioner; or

    2. (b)

      the patient is being provided with ongoing care by the specialist, consultant physician or medical practitioner; or

    3. (c)

      both of the following apply:

      1. (i)

        another medical practitioner has requested the electrocardiogram service;

      2. (ii)

        the attendance service is provided at the same time as, or after, the electrocardiogram service and is required because there is an urgent clinical need to make decisions about the patient’s care as a result of the electrocardiogram service.

1.2.14Restriction on items – attendances on same day as echocardiogram services or myocardial perfusion study services are performed
  1. (1)

    An item in Part 2 of this Schedule does not apply to a service (the attendance service) provided to a patient on a day if either of the following is provided to the patient on the same day:

    1. (a)

      an echocardiogram service to which item 55126, 55127, 55128, 55129, 55132, 55133, 55134, 55137, 55141, 55143, 55145 or 55146 applies;

    2. (b)

      a myocardial perfusion study service to which item 61321, 61324, 61325, 61329, 61345, 61349, 61357, 61394, 61398, 61406, 61410 or 61414 applies.

  2. (2)

    Subclause (1) does not apply if:

    1. (a)

      both:

      1. (i)

        the attendance service is provided after another service is provided to the patient; and

      2. (ii)

        clinical management decisions are made about the patient during that other service; or

    2. (b)

      the decision to perform the echocardiogram service or the myocardial perfusion study service on the same day is made as a result of a clinical assessment of the patient during the attendance service.

Division 1.3Indexation of fees1.3.1Indexation – 1 July 2025
  1. (1)

    At the start of 1 July 2025 (the indexation time), each amount covered by subclause (2) is replaced by the amount worked out using the following formula:

    Note: The indexed fees could in 2025 be viewed on the Department’s MBS Online website (

  2. (2)

    The amounts covered by this subclause are the fee for each item in a Group in this Schedule, other than the fee for the following:

    1. (a)

      an item in Group A2;

    2. (b)

      an item in Group A23;

    3. (c)

      items 90092, 90093, 90095, 90096 and 90098 in Group A35;

    4. (d)

      an item in Group T10.

  3. (3)

    To avoid doubt, a fee listed in any of the following items is not indexed under subclause (1):

    1. (a)

      items in a Group that list the fee as a percentage of a fee listed in another item in the Group;

    2. (b)

      items in a Group that list the fee as an amount under a specified clause in this Schedule;

    3. (c)

      a table item of the following tables:

      1. (i)

        table 2.1.1;

      2. (ii)

        table 2.1.2;

      3. (iii)

        table 2.20.2;

      4. (iv)

        table 2.20.2A.

  4. (4)

    An amount worked out under subclause (1) is to be rounded up or down to the nearest 5 cents (rounding down if the amount is an exact multiple of 2.5 cents).

Part 2AttendancesDivision 2.1Preliminary2.1.1Meaning of amount under clause 2.1.1

In an item of this Schedule mentioned in column 1 of table 2.1.1:

amount under clause 2.1.1 means the sum of:

  1. (a)

    the fee mentioned in column 2 for the item; and

  2. (b)

    either:

    1. (i)

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

    2. (ii)

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

Table 2.1.1—Amount under clause 2.1.1

Item

Column 1

Item of this Schedule

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

30.70

2.45

2

24

The fee for item 23

30.70

2.45

3

37

The fee for item 36

30.70

2.45

4

47

The fee for item 44

30.70

2.45

5

58

$8.50

15.50

0.70

6

59

$16.00

17.50

0.70

7

60

$35.50

15.50

0.70

8

65

$57.50

15.50

0.70

9

124

The fee for item 123

30.70

2.45

10

165

$88.20

15.50

0.70

11

195

The fee for item 193

30.30

2.40

12

414

The fee for item 410

30.20

2.40

13

415

The fee for item 411

30.20

2.40

14

416

The fee for item 412

30.20

2.40

15

417

The fee for item 413

30.20

2.40

16

5003

The fee for item 5000

30.30

2.40

17

5010

The fee for item 5000

54.55

3.90

18

5023

The fee for item 5020

30.30

2.40

19

5028

The fee for item 5020

54.55

3.90

20

5043

The fee for item 5040

30.30

2.40

21

5049

The fee for item 5040

54.55

3.90

22

5063

The fee for item 5060

30.30

2.40

23

5067

The fee for item 5060

54.55

3.90

24

5076

The fee for item 5071

30.30

2.40

25

5077

The fee for item 5071

54.55

3.90

26

5220

$18.50

15.50

0.70

27

5223

$26.00

17.50

0.70

28

5227

$45.50

15.50

0.70

29

5228

$67.50

15.50

0.70

30

5260

$18.50

27.95

1.25

31

5261

$112.20

15.50

0.70

32

5262

$112.20

27.95

1.25

33

5263

$26.00

31.55

1.25

34

5265

$45.50

27.95

1.25

35

5267

$67.50

27.95

1.25

36

90272

The fee for item 90271

30.30

2.40

37

90274

The fee for item 90273

30.30

2.40

38

90276

The fee for item 90275

24.20

1.90

39

90278

The fee for item 90277

24.20

1.90

2.1.2Meaning of amount under clause 2.1.2

In an item of this Schedule mentioned in column 1 of table 2.1.2:

amount under clause 2.1.2 means the sum of:

  1. (a)

    the fee mentioned in column 2 for the item; and

  2. (b)

    either:

    1. (i)

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

    2. (ii)

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

Table 2.1.2—Amount under clause 2.1.2

Item

Column 1

Item of this Schedule

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

181

The fee for item 179

24.60

1.95

2

187

The fee for item 185

24.60

1.95

3

191

The fee for item 189

24.60

1.95

4

206

The fee for item 203

24.60

1.95

5

303

The fee for item 301

24.60

1.95

Division 2.2Group A1: General practitioner attendances to which no other item applies2.2.1Items in Group A1

This clause sets out items in Group A1.

Note: The fees in Group A1 are indexed in accordance with clause 1.3.1.

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

17.90

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 this Schedule 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 this Schedule applies), lasting at least 6 minutes and 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

39.10

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 this Schedule applies), lasting at least 6 minutes and 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 this Schedule 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

75.75

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 this Schedule 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 this Schedule 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

111.50

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 this Schedule 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

123

Professional attendance by a general practitioner at consulting rooms (other than a service to which another item in this Schedule applies), lasting at least 60 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

191.20

124

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 this Schedule applies), lasting at least 60 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 2.3Group A2: Other non‑referred attendances to which no other item applies2.3.1Items in Group A2

This clause sets out items in Group A2.

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

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 1—Other medical practitioner attendances

52

Professional attendance at consulting rooms lasting not more than 5 minutes (other than a service to which any other item applies) by:

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

(b) a Group A1 disqualified general practitioner

11.00

53

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

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

(b) a Group A1 disqualified general practitioner

21.00

54

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

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

(b) a Group A1 disqualified general practitioner

38.00

57

Professional attendance at consulting rooms lasting more than 45 minutes, but not more than 60 minutes (other than a service to which any other item applies) by:

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

(b) a Group A1 disqualified general practitioner

61.00

151

Professional attendance at consulting rooms lasting more than 60 minutes (other than a service to which any other item applies) by:

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

(b) a Group A1 disqualified general practitioner

98.40

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 this Schedule applies), lasting not more than 5 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 Group A1 disqualified general practitioner

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 this Schedule applies) lasting more than 5 minutes, 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 Group A1 disqualified general practitioner

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 this Schedule applies) lasting more than 25 minutes, 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 Group A1 disqualified general practitioner

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 this Schedule applies) lasting more than 45 minutes, but not more than 60 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 Group A1 disqualified general practitioner

Amount under clause 2.1.1

165

Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a service to which any other item in this Schedule applies) lasting more than 60 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 Group A1 disqualified general practitioner

Amount under clause 2.1.1

Division 2.4Group A3: Specialist attendances to which no other item applies2.4.1Items in Group A3

This clause sets out items in Group A3.

Note: The fees in Group A3 are indexed in accordance with clause 1.3.1.

Group A3—Specialist attendances to which no other item applies

Column 1

Item

Column 2

Description

Column 3

Fee ($)

104

Professional attendance at consulting rooms or hospital by a specialist in the practice of the specialist’s specialty after referral of the patient to the specialist—initial attendance in a single course of treatment, other than a service to which item 106, 109, 125 or 16401 applies

90.35

105

Professional attendance by a specialist in the practice of the specialist’s specialty following referral of the patient to the specialist—an attendance after the initial attendance in a single course of treatment, if that attendance is at consulting rooms or hospital, other than a service to which item 126 or 16404 applies

45.40

106

Professional attendance by a specialist in the practice of the specialist’s specialty of ophthalmology and following referral of the patient to the specialist—an initial attendance 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)

74.95

107

Professional attendance by a specialist in the practice of the specialist’s specialty following referral of the patient to the specialist—an initial attendance, if that attendance is at a place other than consulting rooms or hospital

132.60

108

Professional attendance by a specialist in the practice of the specialist’s specialty following referral of the patient to the specialist—an attendance after the initial attendance in a single course of treatment, if that attendance is at a place other than consulting rooms or hospital

83.95

109

Professional attendance by a specialist in the practice of the specialist’s specialty of ophthalmology following referral of the patient to the specialist—an initial attendance 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)

203.65

111

Professional attendance at consulting rooms or in hospital by a specialist in the practice of the specialist’s specialty following referral of the patient to the specialist by a referring practitioner—an attendance after the initial 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 $349.95 or more

For any particular patient, once only on the same day

45.40

115

Professional attendance at consulting rooms or in hospital on a day by a medical practitioner (the attending practitioner) who is a specialist or consultant physician in the practice of the attending practitioner’s specialty after referral of the patient to the attending practitioner by a referring practitioner—an attendance after the initial attendance in a single course of treatment, if:

(a) the attending practitioner performs a scheduled operation on the patient on the same day; 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 $349.95 or more; and

(d) the attendance is unrelated to the scheduled operation; and

(e) it is considered a clinical risk to defer the attendance to a later day

For any particular patient, once only on the same day

45.40

125

Professional attendance lasting at least 45 minutes at consulting rooms or hospital, by a specialist in the practice of the specialist’s specialty of gynaecology, following referral of the patient to the specialist by a referring practitioner—initial attendance in a single course of treatment, if:

(a) the specialist takes a comprehensive history, including psychosocial history and medication review; and

(b) the specialist undertakes any of the following that are clinically relevant:

(i) a comprehensive multi‑system physical examination;

(ii) consideration of multiple complex diagnoses;

(iii) discussion of all treatment options available;

(iv) assessment of pros and cons of each treatment option given patient characteristics and medical history;

(v) consideration, discussion and provision of necessary referrals for clinically appropriate investigations or treatment;

(vi) communication of a patient‑centred management plan; and

(c) the specialist makes available to the patient or carer written documentation that outlines treatment options and information on associated risks and benefits; and

(d) another attendance on the patient did not take place on the same day by the specialist in the same single course of treatment

178.70

126

Professional attendance lasting at least 45 minutes at consulting rooms or hospital, by a specialist in the practice of the specialist’s specialty of gynaecology, following referral of the patient to the specialist by a referring practitioner—an attendance after the initial attendance in a single course of treatment, if:

(a) the specialist takes a comprehensive history, including psychosocial history and medication review; and

(b) the specialist reviews implemented management strategies; and

(c) the specialist undertakes any of the following that are clinically relevant:

(i) update of management plan;

(ii) performance of a physical examination;

(iii) discussion of treatment options;

(iv) consideration, discussion and provision of necessary referrals;

(v) provision of appropriate education; and

(d) the specialist makes available to the patient or carer written documentation that outlines treatment options and information on associated risks and benefits; and

(e) another attendance on the patient did not take place on the same day by the specialist in the same single course of treatment

89.40

Division 2.5Group A4: Consultant physician (other than psychiatry) attendances to which no other item applies2.5.1Items in Group A4

This clause sets out items in Group A4.

Note: The fees in Group A4 are indexed in accordance with clause 1.3.1.

Group A4—Consultant physician (other than psychiatry) 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 the consultant physician’s specialty (other than psychiatry) following referral of the patient to the consultant physician by a referring practitioner—initial attendance in a single course of treatment

159.35

116

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

79.75

117

Professional attendance at consulting rooms or in hospital, by a consultant physician in the practice of the consultant physician’s specialty (other than psychiatry) following referral of the patient to the consultant physician by a referring practitioner—an attendance after the initial 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 $349.95 or more

For any particular patient, once only on the same day

79.75

119

Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of the consultant physician’s specialty (other than psychiatry) following referral of the patient to the consultant physician by a referring practitioner—minor attendance

45.40

120

Professional attendance at consulting rooms or in hospital by a consultant physician in the practice of the consultant physician’s specialty (other than psychiatry) following referral of the patient to the consultant physician by a referring practitioner—minor attendance, if:

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

(b) the consultant physician 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 $349.95 or more

For any particular patient, once only on the same day

45.40

122

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

193.35

128

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

116.95

131

Professional attendance at a place other than consulting rooms or hospital, by a consultant physician in the practice of the consultant physician’s specialty (other than psychiatry) following referral of the patient to the consultant physician by a referring practitioner—minor attendance

84.25

132

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty (other than psychiatry) lasting at least 45 minutes 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 the consultant physician 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, 119, 91824, 91825, 91826 or 91836 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

278.75

133

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty (other than psychiatry) lasting at least 20 minutes after the initial 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, 119, 91824, 91825, 91826 or 91836 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 or item 92423 or 92443 has not applied more than twice in any 12 month period

139.55

Division 2.6Group A29: Attendance services for complex neurodevelopmental disorder or disability2.6.1Meaning of eligible disability

In this Schedule:

eligible disability means any of the following:

  1. (a)

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

  2. (b)

    hearing impairment that results in:

    1. (i)

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

    2. (ii)

      permanent conductive hearing loss and auditory neuropathy;

  3. (c)

    deafblindness;

  4. (d)

    cerebral palsy;

  5. (e)

    Down syndrome;

  6. (f)

    Fragile X syndrome;

  7. (g)

    Prader‑Willi syndrome;

  8. (h)

    Williams syndrome;

  9. (i)

    Angelman syndrome;

  10. (j)

    Kabuki syndrome;

  11. (k)

    Smith‑Magenis syndrome;

  12. (l)

    CHARGE syndrome;

  13. (m)

    Cri du Chat syndrome;

  14. (n)

    Cornelia de Lange syndrome;

  15. (o)

    microcephaly, if a child has:

    1. (i)

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

    2. (ii)

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

  16. (p)

    Rett’s disorder;

  17. (q)

    fetal alcohol spectrum disorder;

  18. (r)

    Lesch‑Nyhan syndrome;

  19. (s)

    22q deletion syndrome.

2.6.2Meaning of risk assessment

In items 135, 137 and 139:

risk assessment means an assessment of:

  1. (a)

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

  2. (b)

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

2.6.3Items in Group A29

This clause sets out items in Group A29.

Note: The fees in Group A29 are indexed in accordance with clause 1.3.1.

Group A29—Attendance services for complex neurodevelopmental disorder or disability

Column 1

Item

Column 2

Description

Column 3

Fee ($)

135

Professional attendance lasting at least 45 minutes by a consultant physician in the practice of the consultant physician’s specialty of paediatrics, following referral of the patient to the consultant paediatrician by a referring practitioner, for a patient aged under 25, if the consultant paediatrician:

(a) undertakes, or has previously undertaken in prior attendances, a comprehensive assessment in relation to which a diagnosis of a complex neurodevelopmental disorder (such as autism spectrum disorder) is made (if appropriate, using information provided by an eligible allied health provider); and

(b) develops a treatment and management plan, which must include:

(i) documentation of the confirmed diagnosis; and

(ii) findings of any assessments performed for the purposes of formulation of the diagnosis or contribution to the treatment and management plan; and

(iii) a risk assessment; and

(iv) treatment options (which may include biopsychosocial recommendations); and

(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, 289, 92140, 92141, 92142 or 92434)

Applicable only once per lifetime

278.75

137

Professional attendance lasting at least 45 minutes by a specialist or consultant physician (not including a general practitioner), following referral of the patient to the specialist or consultant physician by a referring practitioner, for a patient aged under 25, if the specialist or consultant physician:

(a) undertakes, or has previously undertaken in prior attendances, a comprehensive assessment in relation to which a diagnosis of an eligible disability is made (if appropriate, using information provided by an eligible allied health provider); and

(b) develops a treatment and management plan, which must include:

(i) documentation of the confirmed diagnosis; and

(ii) findings of any assessments performed for the purposes of formulation of the diagnosis or contribution to the treatment and management plan; and

(iii) a risk assessment; and

(iv) treatment options (which may include biopsychosocial recommendations); and

(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 135, 139, 289, 92140, 92141, 92142 or 92434)

Applicable only once per lifetime

278.75

139

Professional attendance lasting at least 45 minutes, at a place other than a hospital, by a general practitioner (not including a specialist or consultant physician), for a patient aged under 25, if the general practitioner:

(a) undertakes, or has previously undertaken in prior attendances, a comprehensive assessment in relation to which a diagnosis of an eligible disability is made (if appropriate, using information provided by an eligible allied health provider); and

(b) develops a treatment and management plan, which must include:

(i) documentation of the confirmed diagnosis; and

(ii) findings of any assessments performed for the purposes of formulation of the diagnosis or contribution to the treatment and management plan; and

(iii) a risk assessment; and

(iv) treatment options (which may include biopsychosocial recommendations); and

(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, 289, 92140, 92141, 92142 or 92434)

Applicable only once per lifetime

139.95

Division 2.7Group A28: Geriatric medicine2.7.1Items in Group A28

This clause sets out items in Group A28.

Note: The fees in Group A28 are indexed in accordance with clause 1.3.1.

Group A28—Geriatric medicine

Column 1

Item

Column 2

Description

Column 3

Fee ($)

141

Professional attendance lasting more than 60 minutes at consulting rooms or hospital by a consultant physician or specialist in the practice of the consultant physician’s or specialist’s 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

478.05

143

Professional attendance lasting more than 30 minutes at consulting rooms or hospital by a consultant physician or specialist in the practice of the consultant physician’s or specialist’s 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, 92448 or 92624 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

298.85

145

Professional attendance lasting more than 60 minutes at a place other than consulting rooms or hospital by a consultant physician or specialist in the practice of the consultant physician’s or specialist’s 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

579.65

147

Professional attendance lasting more than 30 minutes at a place other than consulting rooms or hospital by a consultant physician or specialist in the practice of the consultant physician’s or specialist’s 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 item 143, 92448 or 92624 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

362.35

Division 2.8Group A5: Prolonged attendances to which no other item applies2.8.1Restrictions on items in Group A5
  1. (1)

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

  2. (2)

    If the personal attendance is provided by one or more general practitioners, specialists or consultant physicians concurrently, each general practitioner, specialist or consultant physician may claim an attendance fee.

  3. (3)

    However, if the personal attendance is not continuous, the occasion on which the service is provided is taken to be the total time of the attendance.

2.8.2Items in Group A5

This clause sets out items in Group A5.

Note: The fees in Group A5 are indexed in accordance with clause 1.3.1.

Group A5—Prolonged attendances to which no other item applies

Column 1

Item

Column 2

Description

Column 3

Fee ($)

160

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

230.50

161

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

384.15

162

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

537.55

163

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

691.50

164

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

768.30

Division 2.9Group A6: Group therapy2.9.1Items in Group A6

This clause sets out items in Group A6.

Note: The fees in Group A6 are indexed in accordance with clause 1.3.1.

Group A6—Group therapy

Column 1

Item

Column 2

Description

Column 3

Fee ($)

170

Professional attendance for the purpose of group therapy lasting at least 1 hour given under the direct continuous supervision of a general practitioner, specialist or consultant physician (other than a consultant physician in the practice of the consultant physician’s specialty of psychiatry) involving members of a family and persons with close personal relationships with that family—each group of 2 patients

122.35

171

Professional attendance for the purpose of group therapy lasting at least 1 hour given under the direct continuous supervision of a general practitioner, specialist or consultant physician (other than a consultant physician in the practice of the consultant physician’s specialty of psychiatry) involving members of a family and persons with close personal relationships with that family—each group of 3 patients

128.90

172

Professional attendance for the purpose of group therapy lasting at least 1 hour given under the direct continuous supervision of a general practitioner, specialist or consultant physician (other than a consultant physician in the practice of the consultant physician’s specialty of psychiatry) involving members of a family and persons with close personal relationships with that family—each group of 4 or more patients

156.80

Division 2.10Group A7: Acupuncture and non‑specialist practitioner items

Note 1: Various restrictions, limitations and other requirements apply to items in Subgroups 5, 6, 7, 9 and 11 of Group A7. The restrictions, limitations and other requirements are set out in the following Divisions:

(a) for items in Subgroup 5—Division 2.15;

(b) for items in Subgroup 6—Division 2.16;

(c) for items in Subgroup 7—Division 2.17;

(d) for items in Subgroup 9—Division 2.20;

(e) for items in Subgroup 11—Division 2.22.

Note 2: A number of expressions used in Subgroups 6, 7 and 9 of Group A7 are defined in Divisions 2.16, 2.17 and 2.20, including the following:

(a) contribute to a multidisciplinary care plan (see clause 2.16.3);

(c) multidisciplinary care plan (see clause 2.16.6);

(d) organise and coordinate (see clause 2.16.15);

(e) participate (see clause 2.16.16);

(f) preparing a GP chronic condition management plan (see clause 2.16.7);

(g) residential medication management review (see clause 2.17.2);

(h) review of a GP mental health treatment plan (see clause 2.20.4).

2.10.1Restriction on treatment time

For the purposes of items 193 to 199, treatment time for a medical practitioner does not include the period:

  1. (a)

    commencing immediately after the practitioner has completed applying all acupuncture stimuli on or through a patient’s skin; and

  2. (b)

    ending immediately before the practitioner begins to remove the acupuncture stimuli from the patient;

unless the practitioner personally attends the patient during that period for a consultation related to the condition for which the acupuncture was performed or another consultation.

2.10.1AApplication of items 214 to 220
  1. (1)

    Items 214 to 220 apply only to a service provided in the course of a personal attendance by one or more prescribed medical practitioners on a single patient on a single occasion.

  2. (2)

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

  3. (3)

    However, if the personal attendance is not continuous, the occasion on which the service is provided is taken to be the total time of the attendance.

2.10.2Items in Group A7

This clause sets out items in Group A7.

Note: The fees in Group A7 are indexed in accordance with clause 1.3.1.

Group A7—Acupuncture and non‑specialist practitioner items

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 1—Acupuncture

193

Professional attendance by a medical practitioner who holds endorsement of registration for acupuncture with the Medical Board of Australia or is registered by the Chinese Medicine Board of Australia as an acupuncturist, at a place other than a hospital, for treatment lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

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

38.55

195

Professional attendance by a medical practitioner who holds endorsement of registration for acupuncture with the Medical Board of Australia or is registered by the Chinese Medicine Board of Australia as an acupuncturist, on one or more patients at a hospital, for treatment lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

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

Amount under clause 2.1.1

197

Professional attendance by a medical practitioner who holds endorsement of registration for acupuncture with the Medical Board of Australia or is registered by the Chinese Medicine Board of Australia as an acupuncturist, at a place other than a hospital, for treatment lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

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

74.60

199

Professional attendance by a medical practitioner who holds endorsement of registration for acupuncture with the Medical Board of Australia or is registered by the Chinese Medicine Board of Australia as an acupuncturist, at a place other than a hospital, for treatment lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

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

109.85

Subgroup 2—Prescribed medical practitioner attendance to which no other item applies

179

Professional attendance at consulting rooms lasting not more than 5 minutes (other than a service to which any other item applies) by a prescribed medical practitioner in an eligible area—each attendance

15.15

181

Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a service to which any other item applies) lasting not more than 5 minutes—an attendance on one or more patients at one place on one occasion by a prescribed medical practitioner in an eligible area—each patient

Amount under clause 2.1.2

185

Professional attendance at consulting rooms lasting more than 5 minutes but not more than 25 minutes (other than a service to which any other item applies) by a prescribed medical practitioner in an eligible area—each attendance

33.10

187

Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a service to which any other item applies) lasting more than 5 minutes but not more than 25 minutes—an attendance on one or more patients at one place on one occasion by a prescribed medical practitioner in an eligible area—each patient

Amount under clause 2.1.2

189

Professional attendance at consulting rooms lasting more than 25 minutes but not more than 45 minutes (other than a service to which any other applies) by a prescribed medical practitioner in an eligible area—each attendance

64.10

191

Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a service to which any other item applies) lasting more than 25 minutes but not more than 45 minutes—an attendance on one or more patients at one place on one occasion by a prescribed medical practitioner in an eligible area—each patient

Amount under clause 2.1.2

203

Professional attendance at consulting rooms lasting more than 45 minutes but not more than 60 minutes (other than a service to which any other item applies) by a prescribed medical practitioner in an eligible area—each attendance

94.40

206

Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a service to which any other item applies) lasting more than 45 minutes but not more than 60 minutes—an attendance on one or more patients at one place on one occasion by a prescribed medical practitioner in an eligible area—each patient

Amount under clause 2.1.2

301

Professional attendance at consulting rooms lasting more than 60 minutes (other than a service to which any other item in this Schedule applies) by a prescribed medical practitioner in an eligible area—each attendance

152.95

303

Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a service to which any other item applies) lasting more than 60 minutes—an attendance on one or more patients at one place on one occasion by a prescribed medical practitioner in an eligible area—each patient

Amount under clause 2.1.2

Subgroup 3—Prescribed medical practitioner prolonged attendances to which no other item applies

214

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

195.10

215

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

325.10

218

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

454.90

219

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

585.20

220

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

650.20

Subgroup 4—Prescribed medical practitioner group therapy

221

Professional attendance for the purpose of Group therapy lasting at least one hour given under the direct continuous supervision of a prescribed medical practitioner, involving members of a family and persons with close personal relationships with that family—each Group of 2 patients

103.50

222

Professional attendance for the purpose of Group therapy lasting at least one hour given under the direct continuous supervision of a prescribed medical practitioner, involving members of a family and persons with close personal relationships with that family—each Group of 3 patients

109.10

223

Professional attendance for the purpose of Group therapy lasting at least one hour given under the direct continuous supervision of a prescribed medical practitioner, involving members of a family and persons with close personal relationships with that family—each Group of 4 or more patients

132.70

Subgroup 5—Prescribed medical practitioner health assessments

224

Professional attendance by a prescribed medical practitioner to perform a brief health assessment, lasting not more than 30 minutes and including:

(a) collection of relevant information, including taking a patient history; and

(b) a basic physical examination; and

(c) initiating interventions and referrals as indicated; and

(d) providing the patient with preventive health care advice and information

52.25

225

Professional attendance by a prescribed medical practitioner to perform a standard health assessment, lasting more than 30 minutes but less than 45 minutes, including:

(a) detailed information collection, including taking a patient history; and

(b) an extensive physical examination; and

(c) initiating interventions and referrals as indicated; and

(d) providing a preventive health care strategy for the patient

121.45

226

Professional attendance by a prescribed medical practitioner to perform a long health assessment, lasting at least 45 minutes but less than 60 minutes, including:

(a) comprehensive information collection, including taking a patient history; and

12210

Overnight paediatric investigation, for at least 8 hours, for a patient less than 12 years of age, if:

(a) the patient is referred by a medical practitioner; and

(b) the necessity for the investigation is determined by a qualified paediatric sleep medicine practitioner before the investigation; and

(c) there is continuous monitoring of oxygen saturation and breathing using a multi‑channel polygraph, and recordings of the following are made, in accordance with current professional guidelines:

(i) airflow;

(ii) continuous EMG;

(iii) ECG;

(iv) EEG (with a minimum of 4 EEG leads or, in selected investigations, a minimum of 6 EEG leads);

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen);

(viii) measurement of carbon dioxide (either end‑tidal or transcutaneous); and

(d) a sleep technician, or registered nurse with sleep technology training, is in continuous attendance under the supervision of a qualified paediatric sleep medicine practitioner; and

(e) polygraphic records are:

(i) analysed (for assessment of sleep stage, and maturation of sleep indices, arousals, respiratory events and assessment of clinically significant alterations in heart rate and body movement) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(f) interpretation and report are provided by a qualified paediatric sleep medicine practitioner based on reviewing the direct original recording of polygraphic data from the patient; and

(g) the investigation is not provided to the patient on the same occasion that a service to which item 11704, 11705, 11707, 11713, 11714, 11716, 11717, 11723 or 11735 applies is provided to the patient

For each particular patient—applicable only in relation to each of the first 3 occasions the investigation is performed in any 12 month period

730.30

12213

Overnight paediatric investigation, for at least 8 hours, for a patient aged at least 12 years but less than 18 years, if:

(a) the patient is referred by a medical practitioner; and

(b) the necessity for the investigation is determined by a qualified sleep medicine practitioner before the investigation; and

(c) there is continuous monitoring of oxygen saturation and breathing using a multi‑channel polygraph, and recordings of the following are made, in accordance with current professional guidelines:

(i) airflow;

(ii) continuous EMG;

(iii) ECG;

(iv) EEG (with a minimum of 4 EEG leads or, in selected investigations, a minimum of 6 EEG leads);

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen);

(viii) measurement of carbon dioxide (either end‑tidal or transcutaneous); and

(d) a sleep technician, or registered nurse with sleep technology training, is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and

(e) polygraphic records are:

(i) analysed (for assessment of sleep stage, and maturation of sleep indices, arousals, respiratory events and assessment of clinically significant alterations in heart rate and body movement) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(f) interpretation and report are provided by a qualified sleep medicine practitioner based on reviewing the direct original recording of polygraphic data from the patient; and

(g) the investigation is not provided to the patient on the same occasion that a service to which item 11704, 11705, 11707, 11713, 11714, 11716, 11717, 11723 or 11735 applies is provided to the patient

For each particular patient—applicable only in relation to each of the first 3 occasions the investigation is performed in any 12 month period

657.90

12215

Overnight paediatric investigation, for at least 8 hours, for a patient less than 12 years of age, if:

(a) the patient is referred by a medical practitioner; and

(b) the necessity for the investigation is determined by a qualified paediatric sleep medicine practitioner before the investigation; and

(c) there is continuous monitoring of oxygen saturation and breathing using a multi‑channel polygraph, and recordings of the following are made, in accordance with current professional guidelines:

(i) airflow;

(ii) continuous EMG;

(iii) ECG;

(iv) EEG (with a minimum of 4 EEG leads or, in selected investigations, a minimum of 6 EEG leads);

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen);

(viii) measurement of carbon dioxide (either end‑tidal or transcutaneous); and

(d) a sleep technician, or registered nurse with sleep technology training, is in continuous attendance under the supervision of a qualified paediatric sleep medicine practitioner; and

(e) polygraphic records are:

(i) analysed (for assessment of sleep stage, and maturation of sleep indices, arousals, respiratory events and assessment of clinically significant alterations in heart rate and body movement) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(f) interpretation and report are provided by a qualified paediatric sleep medicine practitioner based on reviewing the direct original recording of polygraphic data from the patient; and

(g) a further investigation is indicated in the same 12 month period to which item 12210 applies to a service for the patient, for a patient using Continuous Positive Airway Pressure (CPAP) or non‑invasive or invasive ventilation, or supplemental oxygen, in either or both of the following circumstances:

(i) there is ongoing hypoxia or hypoventilation on the third study to which item 12210 applied for the patient, and further titration of respiratory support is needed to optimise therapy;

(ii) there is clear and significant change in clinical status (for example lung function or functional status) or an intervening treatment that may affect ventilation in the period since the third study to which item 12210 applied for the patient, and repeat study is therefore required to determine the need for or the adequacy of respiratory support; and

(h) the investigation is not provided to the patient on the same occasion that a service to which item 11704, 11705, 11707, 11713, 11714, 11716, 11717, 11723 or 11735 applies is provided to the patient

Applicable only once in the same 12 month period to which item 12210 applies

730.30

12217

Overnight paediatric investigation for at least 8 hours for a patient aged at least 12 years but less than 18 years, if:

(a) the patient is referred by a medical practitioner; and

(b) the necessity for the investigation is determined by a qualified sleep medicine practitioner before the investigation; and

(c) there is continuous monitoring of oxygen saturation and breathing using a multi‑channel polygraph, and recordings of the following are made, in accordance with current professional guidelines:

(i) airflow;

(ii) continuous EMG;

(iii) ECG;

(iv) EEG (with a minimum of 4 EEG leads or, in selected investigations, a minimum of 6 EEG leads);

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen);

(viii) measurement of carbon dioxide (either end‑tidal or transcutaneous); and

(d) a sleep technician, or registered nurse with sleep technology training, is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and

(e) polygraphic records are:

(i) analysed (for assessment of sleep stage, and maturation of sleep indices, arousals, respiratory events and assessment of clinically significant alterations in heart rate and body movement) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(f) interpretation and report are provided by a qualified sleep medicine practitioner based on reviewing the direct original recording of polygraphic data from the patient; and

(g) a further investigation is indicated in the same 12 month period to which item 12213 applies to a service for the patient, for a patient using Continuous Positive Airway Pressure (CPAP) or non‑invasive or invasive ventilation, or supplemental oxygen, in either or both of the following circumstances:

(i) there is ongoing hypoxia or hypoventilation on the third study to which item 12213 applied for the patient, and further titration is needed to optimise therapy;

(ii) there is clear and significant change in clinical status (for example lung function or functional status) or an intervening treatment that may affect ventilation in the period since the third study to which item 12213 applied for the patient, and repeat study is therefore required to determine the need for or the adequacy of respiratory support; and

(h) the investigation is not provided to the patient on the same occasion that a service to which item 11704, 11705, 11707, 11713, 11714, 11716, 11717, 11723 or 11735 applies is provided to the patient

Applicable only once in the same 12 month period to which item 12213 applies

657.90

12250

Overnight investigation of sleep for at least 8 hours of a patient aged 18 years or more to confirm diagnosis of obstructive sleep apnoea, if:

(a) either:

(i) the patient has been referred by a medical practitioner to a qualified adult sleep medicine practitioner or a consultant respiratory physician who has determined that the patient has a high probability for symptomatic, moderate to severe obstructive sleep apnoea based on clinical screening tool results; or

(ii) following professional attendance on the patient (either face‑to‑face or by video conference) by a qualified adult sleep medicine practitioner or a consultant respiratory physician, the qualified adult sleep medicine practitioner or consultant respiratory physician determines that investigation is necessary to confirm the diagnosis of obstructive sleep apnoea; and

(b) during a period of sleep, there is continuous monitoring and recording, performed in accordance with current professional guidelines, of the following measures:

(i) airflow;

(ii) continuous EMG;

(iii) continuous ECG;

(iv) continuous EEG;

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory effort; and

(c) the investigation is performed under the supervision of a qualified adult sleep medicine practitioner; and

(d) either:

(i) the equipment is applied to the patient by a sleep technician; or

(ii) if this is not possible—the reason it is not possible for the sleep technician to apply the equipment to the patient is documented and the patient is given instructions on how to apply the equipment by a sleep technician supported by written instructions; and

(e) polygraphic records are:

(i) analysed (for assessment of sleep stage, arousals, respiratory events and cardiac abnormalities) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(f) interpretation and preparation of a permanent report is provided by a qualified adult sleep medicine practitioner with personal direct review of raw data from the original recording of polygraphic data from the patient; and

(g) the investigation is not provided to the patient on the same occasion that a service described in any of items 11000 to 11005, 11503, 11704, 11705, 11707, 11713, 11714, 11716, 11717, 11723, 11735 and 12203 is provided to the patient

Applicable only once in any 12 month period

348.85

12254

Multiple sleep latency test for the assessment of unexplained hypersomnolence in a patient aged 18 years or more, if:

(a) a qualified adult sleep medicine practitioner or neurologist determines that testing is necessary to confirm the diagnosis of a central disorder of hypersomnolence or to determine whether the eligibility criteria under the pharmaceutical benefits scheme for drugs relevant to treat that condition are met; and

(b) an overnight diagnostic assessment of sleep is performed for at least 8 hours, with continuous monitoring and recording, in accordance with current professional guidelines, of the following measures:

(i) airflow;

(ii) continuous EMG;

(iii) anterior tibial EMG;

(iv) continuous ECG;

(v) continuous EEG;

(vi) EOG;

(vii) oxygen saturation;

(viii) respiratory movement (chest and abdomen);

(ix) position; and

(c) immediately following the overnight assessment, a daytime assessment is performed where at least 4 nap periods are conducted, during which there is continuous recording of EMG, ECG, EEG and EOG; and

(d) a sleep technician is in continuous attendance under the supervision of a qualified adult sleep medicine practitioner; and

(e) polygraphic records are:

(i) analysed (for assessment of sleep stage, arousals, respiratory events, cardiac abnormalities and limb movements) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(f) interpretation and preparation of a permanent report is provided by a qualified adult sleep medicine practitioner with personal direct review of raw data from the original recording of polygraphic data from the patient; and

(g) the diagnostic assessment is not provided to the patient on the same occasion that a service described in item 11003, 12203, 12204, 12205, 12208, 12250 or 12258 is provided to the patient

Applicable only once in a 12 month period

950.70

12258

Maintenance of wakefulness test for the assessment of the ability to maintain wakefulness in a patient aged 18 years or more, if:

(a) a qualified adult sleep medicine practitioner or neurologist determines that testing is necessary to objectively confirm the ability to maintain wakefulness; and

(b) an overnight diagnostic assessment of sleep is performed for at least 8 hours, with continuous monitoring and recording, in accordance with current professional guidelines, of the following measures:

(i) airflow;

(ii) continuous EMG;

(iii) anterior tibial EMG;

(iv) continuous ECG;

(v) continuous EEG;

(vi) EOG;

(vii) oxygen saturation;

(viii) respiratory movement (chest and abdomen);

(ix) position; and

(c) immediately following the overnight assessment, a daytime assessment is performed where at least 4 wakefulness trials are conducted, during which there is continuous recording of EMG, ECG, EEG and EOG; and

(d) a sleep technician is in continuous attendance under the supervision of a qualified adult sleep medicine practitioner; and

(e) polygraphic records are:

(i) analysed (for assessment of sleep stage, arousals, respiratory events, cardiac abnormalities and limb movements) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(f) interpretation and preparation of a permanent report is provided by a qualified adult sleep medicine practitioner with personal direct review of raw data from the original recording of polygraphic data from the patient; and

(g) the diagnostic assessment is not provided to the patient on the same occasion that a service described in item 11003, 12203, 12204, 12205, 12208, 12250 or 12254 is provided to the patient

Applicable only once in a 12 month period

950.70

12261

Multiple sleep latency test for the assessment of unexplained hypersomnolence in a patient aged at least 12 years but less than 18 years, if:

(a) a qualified sleep medicine practitioner determines that testing is necessary to confirm the diagnosis of a central disorder of hypersomnolence or to determine whether the eligibility criteria under the pharmaceutical benefits scheme for drugs relevant to treat that condition are met; and

(b) an overnight diagnostic assessment of sleep is performed for at least 8 hours, with continuous monitoring of oxygen saturation and breathing using a multi‑channel polygraph, and recordings of the following, in accordance with current professional guidelines:

(i) airflow;

(ii) continuous EMG;

(iii) ECG;

(iv) EEG (with a minimum of 4 EEG leads or, in selected investigations, a minimum of 6 EEG leads);

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen);

(viii) measurement of carbon dioxide (either end‑tidal or transcutaneous); and

(c) immediately following the overnight assessment, a daytime assessment is performed where at least 4 nap periods are conducted, during which there is continuous recording of EMG, ECG, EEG and EOG; and

(d) a sleep technician is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and

(e) polygraphic records are:

(i) analysed (for assessment of sleep stage, and maturation of sleep indices, arousals, respiratory events and assessment of clinically significant alterations in heart rate and body movement) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(f) interpretation and preparation of a permanent report is provided by a qualified sleep medicine practitioner with personal direct review of raw data from the original recording of polygraphic data from the patient; and

(g) the diagnostic assessment is not provided to the patient on the same occasion that a service described in item 11003, 12213, 12217 or 12265 is provided to the patient

Applicable only once in a 12 month period

996.85

12265

Maintenance of wakefulness test for the assessment of the ability to maintain wakefulness in a patient aged at least 12 years but less than 18 years, if:

(a) a qualified sleep medicine practitioner determines that testing to objectively confirm the ability to maintain wakefulness is necessary; and

(b) an overnight diagnostic assessment of sleep is performed for at least 8 hours, with continuous monitoring of oxygen saturation and breathing using a multi‑channel polygraph, and recordings of the following, in accordance with current professional guidelines:

(i) airflow;

(ii) continuous EMG;

(iii) ECG;

(iv) EEG (with a minimum of 4 EEG leads or, in selected investigations, a minimum of 6 EEG leads);

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen);

(viii) measurement of carbon dioxide (either end‑tidal or transcutaneous); and

(c) immediately following the overnight assessment, a daytime assessment is performed where at least 4 wakefulness trials are conducted, during which there is continuous recording of EMG, ECG, EEG and EOG; and

(d) a sleep technician is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and

(e) polygraphic records are:

(i) analysed (for assessment of sleep stage, arousals, respiratory events, cardiac abnormalities and limb movements) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(f) interpretation and preparation of a permanent report is provided by a qualified sleep medicine practitioner with personal direct review of raw data from the original recording of polygraphic data from the patient; and

(g) the diagnostic assessment is not provided to the patient on the same occasion that a service described in item 11003, 12213, 12217 or 12261 is provided to the patient

Applicable only once in a 12 month period

996.85

12268

Multiple sleep latency test for the assessment of unexplained hypersomnolence for a patient less than 12 years of age, if:

(a) a qualified paediatric sleep medicine practitioner determines that testing is necessary to confirm the diagnosis of a central disorder of hypersomnolence or to determine whether the eligibility criteria under the pharmaceutical benefits scheme for drugs relevant to treat that condition are met; and

(b) an overnight diagnostic assessment of sleep is performed for at least 8 hours, with continuous monitoring of oxygen saturation and breathing using a multi‑channel polygraph, and recordings of the following, in accordance with current professional guidelines:

(i) airflow;

(ii) continuous EMG;

(iii) ECG;

(iv) EEG (with a minimum of 4 EEG leads or, in selected investigations, a minimum of 6 EEG leads);

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen);

(viii) measurement of carbon dioxide (either end‑tidal or transcutaneous); and

(c) immediately following the overnight assessment, a daytime assessment is performed where at least 4 nap periods are conducted, during which there is continuous recording of EMG, ECG, EEG and EOG; and

(d) a sleep technician is in continuous attendance under the supervision of a qualified paediatric sleep medicine practitioner; and

(e) polygraphic records are:

(i) analysed (for assessment of sleep stage, arousals, respiratory events, cardiac abnormalities and limb movements) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(f) interpretation and preparation of a permanent report is provided by a qualified paediatric sleep medicine practitioner with personal direct review of raw data from the original recording of polygraphic data from the patient; and

(g) the diagnostic assessment is not provided to the patient on the same occasion that a service described in item 11003, 12210, 12215 or 12272 is provided to the patient

Applicable only once in a 12 month period

1,069.20

12272

Maintenance of wakefulness test for the assessment of the ability to maintain wakefulness for a patient less than 12 years of age, if:

(a) a qualified paediatric sleep medicine practitioner determines that testing to objectively confirm the ability to maintain wakefulness is necessary; and

(b) an overnight diagnostic assessment of sleep is performed for at least 8 hours, with continuous monitoring of oxygen saturation and breathing using a multi‑channel polygraph, and recordings of the following, in accordance with current professional guidelines:

(i) airflow;

(ii) continuous EMG;

(iii) ECG;

(iv) EEG (with a minimum of 4 EEG leads or, in selected investigations, a minimum of 6 EEG leads);

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen);

(viii) measurement of carbon dioxide (either end‑tidal or transcutaneous); and

(c) immediately following the overnight assessment, a daytime assessment is performed where at least 4 wakefulness trials are conducted, during which there is continuous recording of EMG, ECG, EEG and EOG; and

(d) a sleep technician is in continuous attendance under the supervision of a qualified paediatric sleep medicine practitioner; and

(e) polygraphic records are:

(i) analysed (for assessment of sleep stage, arousals, respiratory events, cardiac abnormalities and limb movements) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(f) interpretation and preparation of a permanent report is provided by a qualified paediatric sleep medicine practitioner with personal direct review of raw data from the original recording of polygraphic data from the patient; and

(g) the diagnostic assessment is not provided to the patient on the same occasion that a service described in item 11003, 12210, 12215 or 12268 is provided to the patient

Applicable only once in a 12 month period

1,069.20

12306

Bone densitometry, using dual energy X‑ray absorptiometry, involving the measurement of 2 or more sites (including interpretation and reporting), for:

(a) confirmation of a presumptive diagnosis of low bone mineral density made on the basis of one or more fractures occurring after minimal trauma; or

(b) monitoring of low bone mineral density proven by bone densitometry at least 12 months previously;

other than a service associated with a service to which item 12312, 12315 or 12321 applies

For any particular patient, once only in a 24 month period

106.55

12312

Bone densitometry, using dual energy X‑ray absorptiometry, involving the measurement of 2 or more sites (including interpretation and reporting) for diagnosis and monitoring of bone loss associated with one or more of the following:

(a) prolonged glucocorticoid therapy;

(b) any condition associated with excess glucocorticoid secretion;

(c) male hypogonadism;

(d) female hypogonadism lasting more than 6 months before the age of 45;

other than a service associated with a service to which item 12306, 12315 or 12321 applies

For any particular patient, once only in a 12 month period

106.55

12315

Bone densitometry, using dual energy X‑ray absorptiometry, involving the measurement of 2 or more sites (including interpretation and reporting) for diagnosis and monitoring of bone loss associated with one or more of the following conditions:

(a) primary hyperparathyroidism;

(b) chronic liver disease;

(c) chronic renal disease;

(d) any proven malabsorptive disorder;

(e) rheumatoid arthritis;

(f) any condition associated with thyroxine excess;

other than a service associated with a service to which item 12306, 12312 or 12321 applies

For any particular patient, once only in a 24 month period

106.55

12320

Bone densitometry, using dual energy X‑ray absorptiometry or quantitative computed tomography, involving the measurement of 2 or more sites (including interpretation and reporting) for the measurement of bone mineral density, if:

(a) the patient is 70 years of age or over; and

(b) either:

(i) the patient has not previously had bone densitometry; or

(ii) the t‑score for the patient’s bone mineral density is ‑1.5 or more;

other than a service associated with a service to which item 12306, 12312, 12315, 12321 or 12322 applies

For any particular patient, once only in a 5 year period

106.55

12321

Bone densitometry, using dual energy X‑ray absorptiometry, involving the measurement of 2 or more sites at least 12 months after a significant change in therapy (including interpretation and reporting), for:

(a) established low bone mineral density; or

(b) confirming a presumptive diagnosis of low bone mineral density made on the basis of one or more fractures occurring after minimal trauma;

other than a service associated with a service to which item 12306, 12312 or 12315 applies

For any particular patient, once only in a 12 month period

106.55

12322

Bone densitometry, using dual energy X‑ray absorptiometry or quantitative computed tomography, involving the measurement of 2 or more sites (including interpretation and reporting) for measurement of bone mineral density, if:

(a) the patient is 70 years of age or over; and

(b) the t‑score for the patient’s bone mineral density is less than ‑1.5 but more than ‑2.5;

other than a service associated with a service to which item 12306, 12312, 12315, 12320 or 12321 applies

For any particular patient, once only in a 2 year period

106.55

12325

Assessment of visual acuity and bilateral retinal photography with a non‑mydriatic retinal camera, including analysis and reporting of the images for initial or repeat assessment for presence or absence of diabetic retinopathy, in a patient with medically diagnosed diabetes, if:

(a) the patient is of Aboriginal and Torres Strait Islander descent; and

(b) the assessment is performed by the medical practitioner (other than an optometrist or ophthalmologist) providing the primary glycaemic management of the patient’s diabetes; and

(c) this item and item 12326 have not applied to the patient in the preceding 12 months; and

(d) the patient does not have:

(i) an existing diagnosis of diabetic retinopathy; or

(ii) visual acuity of less than 6/12 in either eye; or

(iii) a difference of more than 2 lines of vision between the 2 eyes at the time of presentation

52.00

12326

Assessment of visual acuity and bilateral retinal photography with a non‑mydriatic retinal camera, including analysis and reporting of the images for initial or repeat assessment for presence or absence of diabetic retinopathy, in a patient with medically diagnosed diabetes, if:

(a) the assessment is performed by the medical practitioner (other than an optometrist or ophthalmologist) providing the primary glycaemic management of the patient’s diabetes; and

(b) this item and item 12325 have not applied to the patient in the preceding 24 months; and

(c) the patient does not have:

(i) an existing diagnosis of diabetic retinopathy; or

(ii) visual acuity of less than 6/12 in either eye; or

(iii) a difference of more than 2 lines of vision between the 2 eyes at the time of presentation

52.00

Division 4.2Group D2: Nuclear medicine (non‑imaging)4.2.1Restriction on items in Group D2 – services connected with services in item 12250

An item in Group D2 does not apply to a service described in the item if the service is provided at the same time as, or in connection with, the service described in item 12250.

4.2.2Items in Group D2

This clause sets out items in Group D2.

Note: The fees in Group D2 are indexed in accordance with clause 1.3.1.

Group D2—Nuclear medicine (non‑imaging)

Column 1

Item

Column 2

Description

Column 3

Fee ($)

12500

Blood volume estimation

225.40

12524

Renal function test (without imaging procedure)

164.75

12527

Renal function test (with imaging and at least 2 blood samples)

88.40

12533

Carbon‑labelled urea breath test using oral C‑13 or C‑14 urea, performed by a specialist or consultant physician, including the measurement of exhaled 13CO2 or 14CO2, for either:

(a) the confirmation of Helicobacter pylori colonisation; or

(b) the monitoring of the success of eradication of Helicobacter pylori in patients with peptic ulcer disease;

(other than a service associated with a service to which item 66900 applies)

88.10

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