Health Insurance (General Medical Services Table) Regulations (No. 2) 2020 (Cth)

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Health Insurance (General Medical Services Table) Regulations (No. 2) 2020

made under the

Health Insurance Act 1973

Compilation No. 6

Compilation date:   16 June 2021

Includes amendments up to:            F2020L01608

Registered:   24 June 2021

About this compilation

This compilation

This is a compilation of the Health Insurance (General Medical Services Table) Regulations (No. 2) 2020 that shows the text of the law as amended and in force on 16 June 2021 (the compilation date).

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

Uncommenced amendments

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

Application, saving and transitional provisions for provisions and amendments

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

Editorial changes

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

Modifications

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

Self‑repealing provisions

If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.

Contents

1............................ Name............................................................................................................. 1

3............................ Authority....................................................................................................... 1

4............................ General medical services table....................................................................... 1

Schedule 1—General medical services table  2

Part 1—Preliminary  2

Division 1.1—Interpretation  2

1.1.1...................... Dictionary..................................................................................................... 2

1.1.2...................... Meaning of eligible non‑vocationally recognised medical practitioner......... 2

1.1.3...................... General practitioners..................................................................................... 3

1.1.4...................... Meaning of multidisciplinary case conference.............................................. 4

1.1.5...................... Meaning of multidisciplinary case conference team..................................... 4

1.1.6...................... Meaning of single course of treatment.......................................................... 5

1.1.7...................... Meaning of symbol (H)................................................................................ 6

1.1.8...................... References in this Schedule to items include items determined under section 3C of the Act    6

Division 1.2—General application provisions  7

1.2.1...................... Application.................................................................................................... 7

1.2.2...................... Restrictions on certain items—attendances by specialists and consultant physicians without referrals    7

1.2.3...................... Restrictions on certain items—attendances by specialist radiologists in conjunction with certain diagnostic imaging services............................................................................................ 7

1.2.4...................... Restrictions on certain items—attendances by specialists and consultant physicians on same day as they perform certain surgical operations............................................................... 8

1.2.5...................... Professional attendance services—matters included...................................... 8

1.2.6...................... Personal attendance by medical practitioners generally—application and matters included      9

1.2.7...................... Personal attendance by medical practitioners—application and matters included     9

1.2.8...................... Restriction on items—services provided with non‑medicare services......... 10

1.2.9...................... Restrictions on items—services rendered in certain circumstances or for certain purposes      10

1.2.10.................... Restriction on items—services provided with harvesting, storage, in vitro processing or injection of non‑haematopoietic stem cells..................................................................... 11

1.2.11.................... Services that may be provided by persons other than medical practitioners 11

1.2.12.................... Restriction on items—services involving video conferences between patients and medical practitioners separated by at least 15 km.......................................................................... 11

1.2.13.................... Restriction on items—attendances on same day as electrocardiogram services are performed 11

1.2.14.................... Restriction on items—attendances on same day as echocardiogram services or myocardial perfusion study services are performed................................................................................ 12

Part 2—Attendances  13

Division 2.1—Preliminary  13

2.1.1...................... Meaning of amount under clause 2.1.1...................................................... 13

Division 2.2—Group A1: General practitioner attendances to which no other item applies     15

2.2.1...................... Items in Group A1...................................................................................... 15

Division 2.3—Group A2: Other non‑referred attendances to which no other item applies     18

2.3.1...................... Items in Group A2...................................................................................... 18

Division 2.4—Group A3: Specialist attendances to which no other item applies 20

2.4.1...................... Items in Group A3...................................................................................... 20

Division 2.5—Group A4: Consultant physician (other than psychiatry) attendances to which no other item applies  23

2.5.1...................... Items in Group A4...................................................................................... 23

Division 2.6—Group A29: Early intervention services for children with autism, pervasive developmental disorder or disability  27

2.6.1...................... Meaning of eligible disability...................................................................... 27

2.6.2...................... Meaning of risk assessment........................................................................ 27

2.6.3...................... Items in Group A29.................................................................................... 28

Division 2.7—Group A28: Geriatric medicine  30

2.7.1...................... Items in Group A28.................................................................................... 30

Division 2.8—Group A5: Prolonged attendances to which no other item applies 34

2.8.1...................... Restrictions on items in Group A5.............................................................. 34

2.8.2...................... Items in Group A5...................................................................................... 34

Division 2.9—Group A6: Group therapy  35

2.9.1...................... Items in Group A6...................................................................................... 35

Division 2.10—Group A7: Acupuncture and non‑specialist practitioner items    36

2.10.1.................... Meaning of qualified medical acupuncturist............................................... 36

2.10.2.................... Items in Group A7...................................................................................... 36

Division 2.11—Group A8: Consultant psychiatrist attendances to which no other item applies          38

2.11.1.................... Restriction on timing of services in items 291, 293 and 359....................... 38

2.11.2.................... Restriction on items 342, 344 and 346........................................................ 38

2.11.3.................... Restriction on items 353 to 361—location of patient................................... 38

2.11.4.................... Meaning of risk assessment........................................................................ 38

2.11.5.................... Items in Group A8...................................................................................... 38

Division 2.12—Group A12: Consultant occupational physician attendances to which no other item applies  49

2.12.1.................... Restrictions on items in Group A12—attendances by consultant occupational physicians      49

2.12.2.................... Items in Group A12.................................................................................... 49

Division 2.13—Group A13: Public health physician attendances to which no other item applies        51

2.13.1.................... Restrictions on items in Group A13—attendances by public health physicians       51

2.13.2.................... Items in Group A13.................................................................................... 51

Division 2.14—Group A11: Urgent attendances after—hours  54

2.14.1.................... Meaning of patient’s medical condition requires urgent assessment......... 54

2.14.2.................... Restrictions on items in Group A11............................................................ 54

2.14.4.................... Restrictions on items in Group A11—practitioners.................................... 54

2.14.5.................... Items in Group A11.................................................................................... 55

Division 2.15—Group A14: Health assessments  57

2.15.1.................... Restrictions on items in Group A14............................................................ 57

2.15.2.................... Types of health assessments....................................................................... 57

2.15.3.................... Application of item 715............................................................................... 58

2.15.4.................... Type 2 Diabetes Risk Evaluation................................................................ 58

2.15.5.................... 45 year old Health Assessment................................................................... 59

2.15.6.................... Older Person’s Health Assessment............................................................. 60

2.15.7.................... Comprehensive Medical Assessment for care recipient in a residential aged care facility        61

2.15.8.................... Health assessment for a person with an intellectual disability..................... 61

2.15.9.................... Health assessment for a refugee or other humanitarian entrant.................... 63

2.15.10.................. Australian Defence Force Post‑discharge GP Health Assessment.............. 63

2.15.11.................. Aboriginal and Torres Strait Islander child health assessment.................... 65

2.15.12.................. Aboriginal and Torres Strait Islander adult health assessment.................... 66

2.15.13.................. Aboriginal and Torres Strait Islander Older Person’s Health Assessment.. 68

2.15.14.................. Restrictions on health assessments for Group A14..................................... 68

2.15.15.................. Items in Group A14.................................................................................... 69

Division 2.16—Group A15: GP management plans, team care arrangements and multidisciplinary care plans and case conferences  71

Subdivision A—General  71

2.16.1.................... Restrictions on items 729 to 866—services by certain medical practitioners 71

Subdivision B—Subgroup 1 of Group A15  71

2.16.2.................... Meaning of associated general practitioner............................................... 71

2.16.3.................... Meaning of contribute to a multidisciplinary care plan.............................. 71

2.16.4.................... Meaning of coordinating the development of team care arrangements...... 72

2.16.5.................... Meaning of coordinating a review of team care arrangements.................. 72

2.16.6.................... Meaning of multidisciplinary care plan...................................................... 73

2.16.7.................... Meaning of preparing a GP management plan.......................................... 74

2.16.8.................... Meaning of reviewing a GP management plan........................................... 74

2.16.9.................... Restrictions on items 721, 723, 729, 731 and 732—services for certain patients     75

2.16.10.................. Restrictions on items 721, 723 and 732...................................................... 76

2.16.11.................. Restrictions on other items—services provided on same day as services in items 721, 723 and 732       76

2.16.12.................. Conditions relating to timing of services in items 721, 723, 729, 731 and 732 if exceptional circumstances do not exist....................................................................................................... 76

2.16.13.................. Items in Subgroup 1 of Group A15............................................................ 78

Subdivision C—Subgroup 2 of Group A15  79

2.16.14.................. Meaning of multidisciplinary discharge case conference........................... 79

2.16.15.................. Meaning of organise and coordinate.......................................................... 79

2.16.16.................. Meaning of participate................................................................................ 80

2.16.17.................. Meaning of coordinating............................................................................ 80

2.16.18.................. Meaning of case conference team............................................................... 80

2.16.19.................. Restrictions on item 880—certain patients.................................................. 81

2.16.20.................. Items in Subgroup 2 of Group A15............................................................ 81

Division 2.17—Group A17: Domiciliary and residential medication management reviews     86

2.17.1.................... Meaning of living in a community setting................................................... 86

2.17.2.................... Meaning of residential medication management review............................. 86

2.17.3.................... Restrictions on items 900 and 903.............................................................. 87

2.17.4.................... Items in Group A17.................................................................................... 87

Division 2.18—Group A30: Medical practitioner video conferencing consultation     89

2.18.1.................... Restrictions on items in Subgroups 1 and 2 of Group A30—services provided in association with certain other services.............................................................................................. 89

2.18.2.................... Location of attendance in items 2125, 2138, 2179 and 2220....................... 89

2.18.3.................... Meaning of amount under clause 2.18.3.................................................... 89

2.18.4.................... Restrictions on items in Subgroups 5 and 6 of Group A30 (video conferencing consultation attendances for patients in rural and remote areas)............................................................... 90

2.18.5.................... Items in Group A30.................................................................................... 90

Division 2.19—Groups A18 and A19 (Attendances associated with Practice Incentive Program payments)  96

2.19.1.................... Restrictions on items in Subgroup 2 of Groups A18 and A19—timing..... 96

2.19.2.................... Restrictions on items in Subgroup 3 of Groups A18 and A19—timing..... 97

2.19.3.................... Items in Group A18.................................................................................... 97

2.19.4.................... Items in Group A19.................................................................................. 103

Division 2.20—Group A20: Mental health care  107

2.20.1.................... Definitions................................................................................................ 107

2.20.2.................... Meaning of amount under clause 2.20.2.................................................. 107

2.20.3.................... Meaning of preparation of a GP mental health treatment plan................ 108

2.20.4.................... Meaning of review of a GP mental health treatment plan......................... 109

2.20.5.................... Meaning of associated general practitioner............................................. 109

2.20.6.................... Restrictions on items in Subgroup 1 of Group A20 (GP mental health treatment plans)         110

2.20.7.................... Restrictions on items in Subgroup 2 of Group A20 (focussed psychological strategies)         111

2.20.8.................... Items in Group A20.................................................................................. 112

Division 2.21—Group A24: Palliative and pain medicine  114

2.21.1.................... Meaning of organise and coordinate........................................................ 114

2.21.2.................... Meaning of participate.............................................................................. 114

2.21.3.................... Restrictions on items in Subgroups 2 and 4 of Group A24—timing........ 115

2.21.4.................... Items in Group A24.................................................................................. 115

Division 2.22—Group A27: Pregnancy support counselling  122

2.22.1.................... Restrictions on item 4001.......................................................................... 122

2.22.2.................... Items in Group A27.................................................................................. 122

Division 2.23—Group A21: Professional attendances at recognised emergency departments of private hospitals  123

2.23.1.................... Items in Group A21.................................................................................. 123

Division 2.24—Group A22: General practitioner after‑hours attendances to which no other item applies  127

2.24.1.................... Restrictions on items in Group A22—timing............................................ 127

2.24.2.................... Items in Group A22.................................................................................. 127

Division 2.25—Group A23: Other non‑referred after‑hours attendances to which no other item applies  131

2.25.1.................... Restrictions on items in Group A23—timing............................................ 131

2.25.2.................... Items in Group A23.................................................................................. 131

Division 2.26—Group A26: Neurosurgery attendances to which no other item applies          133

2.26.1.................... Items in Group A26.................................................................................. 133

Division 2.27—Group A31: Addiction medicine  135

2.27.1.................... Meaning of organise and coordinate........................................................ 135

2.27.2.................... Meaning of participate.............................................................................. 135

2.27.3.................... Restrictions on item 6028.......................................................................... 136

2.27.4.................... Items in Group A31.................................................................................. 136

Division 2.28—Group A32: Sexual health medicine  140

2.28.1.................... Meaning of organise and coordinate........................................................ 140

2.28.2.................... Meaning of participate.............................................................................. 140

2.28.3.................... Items in Group A32.................................................................................. 141

Division 2.29—Group A9: Contact lenses  145

2.29.1.................... Restrictions on item 10809........................................................................ 145

2.29.2.................... Items in Group A9.................................................................................... 145

Division 2.30—Group A35: Non‑referred attendance at a residential aged care facility        147

2.30.1.................... Fee in relation to the first patient during each attendance at a residential aged care facility       147

2.30.2.................... Items in Group A35.................................................................................. 147

Division 2.31—Group A36: Eating disorder services  150

2.31.1.................... Application of items in Group A36........................................................... 150

2.31.2.................... Eating disorder services—patients............................................................ 151

2.31.3.................... Eating disorder services—requirements for eating disorder treatment and management plan   152

2.31.4.................... Eating disorder services—requirements for review of eating disorder treatment and management plan   152

2.31.5.................... Eating disorder services—medical practitioners for providing treatments. 153

2.31.6.................... Eating disorder services—mental health care management strategies for use in providing treatments      153

2.31.7.................... Restrictions on items in Group A36—general.......................................... 154

2.31.8.................... Restrictions on items in Group A36—attendance by video conference..... 154

2.31.9.................... Restriction on items in Group A36—limitation on number of services providing treatments under a plan.................................................................................................................. 155

2.31.10.................. Items in Group A36.................................................................................. 156

Part 3—Miscellaneous services  159

Division 3.1—Group M12: Services provided by a practice nurse, an Aboriginal health worker or an Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner  159

3.1.1...................... Definitions for item 10997........................................................................ 159

3.1.2...................... Restrictions on item 10988........................................................................ 159

3.1.3...................... Restrictions on item 10989........................................................................ 159

3.1.4...................... Items in Group M12................................................................................. 160

Division 3.2—Group M1: Management of bulk‑billed services  162

3.2.1...................... Definitions................................................................................................ 162

3.2.2...................... Restrictions on items 10990, 10991 and 10992........................................ 163

3.2.3...................... Items in Group M1................................................................................... 163

Part 4—Diagnostic procedures and investigations  165

Division 4.1—Group D1: Miscellaneous diagnostic procedures and investigations     165

4.1.1...................... Meaning of report..................................................................................... 165

4.1.2...................... Meaning of qualified adult sleep medicine practitioner, qualified paediatric sleep medicine practitioner and qualified sleep medicine practitioner.......................................................... 165

4.1.3...................... Restriction on item 11801—service provided in association with other services     166

4.1.3A................... Restriction on items 11704, 11705 and 11723—services to include formal reports 166

4.1.3B.................... Restriction on item 11714—services to include clinical notes................... 167

4.1.3C.................... Restriction on items 11704 and 11705—financial relationship................. 167

4.1.3D................... Restrictions on items 11729 and 11730—patient limitations..................... 167

4.1.3E.................... Restriction on items 11729 and 11730—safety requirements................... 168

4.1.3F.................... Restriction on certain items—patients receiving hospital treatment or hospital‑substitute treatment         168

4.1.3G................... Restriction on certain items—other services on the same day................... 168

4.1.4...................... Restrictions on items 12306 to 12322....................................................... 168

4.1.5...................... Items in Group D1.................................................................................... 169

Division 4.2—Group D2: Nuclear medicine (non‑imaging)  205

4.2.1...................... Restriction on items in Group D2—services connected with services in item 12250               205

4.2.2...................... Items in Group D2.................................................................................... 205

Part 5—Therapeutic procedures  206

Division 5.1—Preliminary  206

5.1.1...................... Restriction on items in this Part—services connected with provision of pain pump for post‑surgical pain management.............................................................................................. 206

Division 5.2—Group T1: Miscellaneous therapeutic procedures  207

5.2.1...................... Meaning of comprehensive hyperbaric medicine facility.......................... 207

5.2.2...................... Meaning of embryology laboratory services............................................ 207

5.2.3...................... Meaning of treatment cycle....................................................................... 207

5.2.4...................... Items provided as part of treatment cycle relating to assisted reproductive services not to apply             208

5.2.5...................... Restriction on item 13104—timing........................................................... 208

5.2.6...................... Restriction on items relating to assisted reproductive services—certain pregnancy‑related circumstances.................................................................................................................. 208

5.2.7...................... Restrictions on items 14227 to 14237—patients....................................... 208

5.2.8...................... Restrictions on item 14245—practitioner and timing................................ 209

5.2.9...................... Restriction on item 13899—other services performed on the same day.... 209

5.2.10.................... Items in Group T1..................................................................................... 209

Division 5.3—Group T2: Radiation oncology  221

5.3.1...................... Meaning of amount under clause 5.3.1.................................................... 221

5.3.2...................... Restrictions on items 15215 to 15272—services provided to implement intensity‑modulated radiation therapy dosimetry plans......................................................................................... 221

5.3.3...................... Restrictions on items 15556, 15559 and 15562........................................ 221

5.3.4...................... Items in Group T2..................................................................................... 222

Division 5.4—Group T3: Therapeutic nuclear medicine  234

5.4.1...................... Items in Group T3..................................................................................... 234

Division 5.5—Group T4: Obstetrics  235

5.5.1...................... Definitions for item 16400........................................................................ 235

5.5.2...................... Meaning of practice midwife in items 16400 and 16408........................... 235

5.5.3...................... Restrictions on item 16400—provider and timing..................................... 235

5.5.4...................... Items in Group T4..................................................................................... 235

Division 5.6—Group T6: Examination by anaesthetist  243

5.6.1...................... Items in Group T6..................................................................................... 243

Division 5.7—Group T7: Regional or field nerve blocks  246

5.7.1...................... Meaning of amount under clause 5.7.1.................................................... 246

5.7.2...................... Items in Group T7..................................................................................... 246

Division 5.8—Group T11: Botulinum toxin  249

5.8.1...................... Group T11 services do not include supply of botulinum toxin................. 249

5.8.2...................... Restrictions on items in Group T11.......................................................... 249

5.8.3...................... Items in Group T11................................................................................... 249

Division 5.9—Group T10: Anaesthesia performed in connection with certain services (Relative Value Guide)  253

5.9.1...................... Meaning of amount under clause 5.9.1.................................................... 253

5.9.2...................... Meaning of amount under clause 5.9.2.................................................... 253

5.9.3...................... Meaning of service time............................................................................ 254

5.9.4...................... Restrictions on items in Group T10.......................................................... 254

5.9.5...................... Application of Subgroup 21 of Group T10............................................... 255

5.9.6...................... Meaning of anaesthesia, assistance and perfusion in Subgroups 21 to 25 of Group T10       255

5.9.7...................... Application of Subgroups 22 and 23 of Group T10................................. 255

5.9.8...................... Application of Subgroups 24 and 25 of Group T10................................. 255

5.9.9...................... Items in Group T10................................................................................... 255

Division 5.10—Group T8: Surgical operations  284

Subdivision A—Subgroup 1 of Group T8  284

5.10.1.................... Meaning of amount under clause 5.10.1.................................................. 284

5.10.2.................... Meaning of amount under clause 5.10.2.................................................. 284

5.10.3.................... Histopathological proof of malignancy in certain cases for purposes of certain items relating to surgical procedures................................................................................................. 284

5.10.4.................... Restrictions on items 30299 and 30300—patients.................................... 284

5.10.5.................... Items 30440, 30451, 30492 and 30495 do not include imaging................ 284

5.10.6.................... Restrictions on items 30688, 30690, 30692 and 30694—patient notes..... 284

5.10.7.................... Application of item 35412......................................................................... 285

5.10.8.................... Restrictions on items 31569, 31572, 31575, 31578, 31581, 31587 and 31590—services provided on same occasion.................................................................................................... 285

5.10.9.................... Items in Subgroup 1 of Group T8............................................................. 285

Subdivision B—Subgroups 2 and 3 of Group T8  320

5.10.10.................. Meaning of foreign body in items 35360 to 35363................................... 320

5.10.11.................. Application of items 32084 and 32087..................................................... 320

5.10.12.................. Restrictions on items 32500 to 32517 and 35321—methods of providing services 320

5.10.13.................. Restrictions on items 35404, 35406 and 35408........................................ 320

5.10.14.................. When artificial bowel sphincter is contraindicated for items 32220 and 32221        320

5.10.15.................. Meaning of eligible stroke centre.............................................................. 321

5.10.16.................. Items in Subgroups 2 and 3 of Group T8................................................. 321

Subdivision C—Subgroups 4, 5 and 6 of Group T8  344

5.10.17.................. Restrictions on items in Subgroups 4 and 6 of Group T8—surgical techniques      344

5.10.18.................. Items in Subgroups 4, 5 and 6 of Group T8............................................. 344

Subdivision D—Subgroups 7 to 11 of Group T8  388

5.10.19A............... Restrictions on items 39015, 39503, 39906 and 40104—services provided with intracranial stereotactic procedure.................................................................................................. 388

5.10.19.................. Items in Subgroups 7 to 11 of Group T8.................................................. 388

Subdivision E—Subgroups 12 and 13 of Group T8  416

5.10.20.................. Meaning of amount under clause 5.10.20................................................ 416

5.10.21.................. Meaning of NOSE Scale........................................................................... 417

5.10.22.................. Meaning of maxilla................................................................................... 417

5.10.23.................. Items in Subgroups 12 and 13 of Group T8............................................. 417

Subdivision F—Subgroup 14 of Group T8  440

5.10.24.................. Restriction on items 46300 to 46534—hand operations............................ 440

5.10.25.................. Items in Subgroup 14 of Group T8........................................................... 440

Subdivision G—Subgroups 15, 16 and 17 of Group T8  445

5.10.26.................. Restriction on item 50303—timing........................................................... 445

5.10.27.................. Restrictions on items 51011 to 51112 and 51115 to 51171—services provided in conjunction with other services in Group T8................................................................................. 445

5.10.28.................. Restrictions on items 51061 to 51066—services provided in conjunction with certain other services     445

5.10.29.................. Meaning of motion segment...................................................................... 445

5.10.30.................. Items in Subgroups 15, 16 and 17 of Group T8....................................... 446

Division 5.11—Group T9: Assistance at operations  482

5.11.1.................... Meaning of amount under clause 5.11.1.................................................. 482

5.11.2.................... Meaning of amount under clause 5.11.2.................................................. 482

5.11.3.................... Meaning of amount under clause 5.11.3.................................................. 482

5.11.4.................... Restrictions on items in Group T9—medical practitioner providing assistance at operations   482

5.11.5.................... Items in Group T9..................................................................................... 482

Part 6—Oral and maxillofacial services  484

Division 6.1—Preliminary  484

6.1.1...................... Restriction on items Groups O1 to O11—providers of services............... 484

Division 6.2—Group O1: Consultations  485

6.2.1...................... Items in Group O1.................................................................................... 485

Division 6.3—Group O2: Assistance at operation  486

6.3.1...................... Meaning of amount under clause 6.3.1.................................................... 486

6.3.2...................... Restrictions on items in Group O2—approved dental practitioner providing assistance at operations     486

6.3.3...................... Items in Group O2.................................................................................... 486

Division 6.4—Group O3: General surgery  487

6.4.1...................... Items in Group O3.................................................................................... 487

Division 6.5—Group O4: Plastic and reconstructive  492

6.5.1...................... Meaning of maxilla................................................................................... 492

6.5.2...................... Items in Group O4.................................................................................... 492

Division 6.6—Group O5: Preprosthetic  496

6.6.1...................... Items in Group O5.................................................................................... 496

Division 6.7—Group O6: Neurosurgical  497

6.7.1...................... Items in Group O6.................................................................................... 497

Division 6.8—Group O7: Ear, nose and throat  498

6.8.1...................... Items in Group O7.................................................................................... 498

Division 6.9—Group O8: Temporomandibular joint  500

6.9.1...................... Items in Group O8.................................................................................... 500

Division 6.10—Group O9: Treatment of fractures  502

6.10.1.................... Items in Group O9.................................................................................... 502

Division 6.11—Group O11: Regional or field nerve blocks  504

6.11.1.................... Items in Group O11.................................................................................. 504

Part 7—Dictionary  505

7.1.1...................... Dictionary................................................................................................. 505

Endnotes517

Endnote 1—About the endnotes  517

Endnote 2—Abbreviation key  518

Endnote 3—Legislation history  519

Endnote 4—Amendment history  520

1  Name

This instrument is the Health Insurance (General Medical Services Table) Regulations (No. 2) 2020.

3  Authority

This instrument is made under the Health Insurance Act 1973.

4  General medical services table

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

Schedule 1—General medical services table

Note:       See section 4.

Part 1—Preliminary

Division 1.1—Interpretation

1.1.1  Dictionary

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.

1.1.2  Meaning of eligible non‑vocationally recognised medical practitioner

(1)  In this Schedule:

eligible non‑vocationally recognised medical practitioner means:

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

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

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

(b)  a medical practitioner who:

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

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

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

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

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

(c)  a medical practitioner who:

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

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

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

(d)  a medical practitioner who:

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

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

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

(2)  In subclause (1):

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

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

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

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

1.1.3  General 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:

(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):

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

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

(b)  an eligible non‑vocationally recognised medical practitioner;

(c)  a medical practitioner who is undertaking a placement in general practice as part of the Remote Vocational Training Scheme administered by Remote Vocational Training Scheme Limited;

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

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

(ii)  as part of another training program recognised by the ACRRM as being of an equivalent standard.

Note:          For other medical practitioners who are general practitioners, see the definition of general practitioner in subsection 3(1) of the Act and section 16 of the Health Insurance Regulations 2018.

1.1.4  Meaning 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:

(a)  discussing a patient’s history;

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

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

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

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

1.1.5  Meaning of multidisciplinary case conference team

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

(a)  includes a medical practitioner; and

(b)  either:

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

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

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

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

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

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

(c)  one member may be another medical practitioner.

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

(a)    Aboriginal and Torres Strait Islander health practitioners;

(b)    asthma educators;

(c)    audiologists;

(d)    dental therapists;

(e)    dentists;

(f)    diabetes educators;

(g)    dieticians;

(h)    mental health workers;

(i)     occupational therapists;

(j)     optometrists;

(k)    orthoptists;

(l)     orthotists or prosthetists;

(m)   pharmacists;

(n)    physiotherapists;

(o)    podiatrists;

(p)    psychologists;

(q)    registered nurses;

(r)    social workers;

(s)    speech pathologists;

(t)     education providers;

(u)    “meals on wheels” providers;

(v)    personal care workers;

(w)   probation officers.

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

1.1.6  Meaning of single course of treatment

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

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

(a)  includes:

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

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

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

(b)  does not include:

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

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

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

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

Note:          Division 4 of Part 11 of the Health Insurance Regulations 2018 prescribes the manner in which patients are to be referred when an item in this Schedule specifies a service that is to be rendered by a specialist or consultant physician to a patient who has been referred.

1.1.7  Meaning of symbol (H)

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

1.1.8  References 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 1.2—General application provisions

1.2.1  Application

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

1.2.2  Restrictions on certain items—attendances by specialists and consultant physicians without referrals

(1)  Use this clause for items 99 to 137, 141 to 149, 288 to 389, 2799, 2801 to 2840, 3003, 3005 to 3028, 6004, 6007 to 6016, 6018 to 6028, 6051 to 6063, 13210, 16399, 16401, 16404, 16407, 16408, 16508, 16509, 16533, 16534, 17609, 17640 to 17655, 90260, 90261, 90262, 90263, 90266, 90267, 90268 and 90269.

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

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

(b)  the attendance is after the end of the period of validity (under section 102 of the Health Insurance Regulations 2018) of the referral that was valid for the initial attendance on the patient by the specialist or consultant physician in the single course of treatment; and

(c)  the attendance is not within the period of validity (under section 102 of the Health Insurance Regulations 2018) of a later referral.

Note:          Division 4 of Part 11 of the Health Insurance Regulations 2018 prescribes the manner in which patients are to be referred when an item in this Schedule specifies a service that is to be rendered by a specialist or consultant physician to a patient who has been referred.

1.2.3  Restrictions on certain items—attendances by specialist radiologists in conjunction with certain diagnostic imaging services

(1)  Use this clause for items 52, 53, 54, 57, 104 and 105.

(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:

(a)  an item in Subgroup 6 of Group I1;

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

(c)  items 58900 and 58903 in Subgroup 8 of Group I3;

(d)  item 59103 in Subgroup 9 of Group I3.

1.2.4  Restrictions on certain items—attendances by specialists and consultant physicians on same day as they perform certain surgical operations

(1)  Use this clause for items 105, 116, 119, 386, 2806, 2814, 3010, 3014, 6009 to 6015, 6019, 6052 and 16404.

(2)  The item does not apply to a service if:

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

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

(c)  the amount specified in the item in Group T8 as the fee for a service to which that item applies is $309.35 or more.

1.2.5  Professional attendance services—matters included

(1)  Use this clause for items 3 to 338, 348 to 389, 410 to 417, 585 to 600, 900, 903, 2497 to 2840, 3003, 3005 to 3028, 5000 to 5267, 6004, 6007 to 6016, 6018 to 6026, 6051 to 6063, 13210, 13899, 16399, 16401, 16404, 16406, 16407, 16508, 16509, 16533, 16534, 17609 to 17690, 90020 to 90096 and 90250 to 90282.

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

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

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

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

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

(e)  providing appropriate preventive health care;

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

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

(a)  the vaccine is supplied to the patient in connection with a professional attendance mentioned in any of items 3 to 65, 5000 to 5267 and 90020 to 90096; and

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

1.2.6  Personal attendance by medical practitioners generally—application and matters included

(1)  Use this clause for items 3 to 149, 173 to 338, 348 to 417, 585 to 600, 2100 to 2478, 2497 to 2840, 3003, 3005 to 3028, 35570, 35571, 35573, 35577, 35581, 35582, 35585, 4001 to 6016, 6018 to 6024, 6051 to 6058, 6062, 6063, 10801 to 10816, 11012 to 11021, 11304, 11600, 11627, 11705, 11724, 11731, 11921 to 12004, 12201, 13030 to 13104, 13106 to 13110, 13209, 13210, 13290 to 13700, 13815 to 13899, 14100 to 14124, 14203 to 14212, 14224, 14255 to 14288, 15600, 16003 to 16512, 16515 to 51318, 90020 to 90096 and 90250 to 90282.

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

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

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

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

(c)  participating in a video conferencing consultation referred to in items 99, 112 to 114, 149, 288, 384, 389, 2100, 2122, 2125, 2126, 2137, 2138, 2143, 2147, 2179, 2195, 2199, 2220, 2461, 2463, 2464, 2465, 2471, 2472, 2475, 2478, 2799, 2820, 3003, 3015, 6004, 6016, 6025, 6026, 6059, 6060, 13210, 16399, 17609, 90262, 90263, 90268, 90269, 90279, 90280, 90281 and 90282.

1.2.7  Personal attendance by medical practitioners—application and matters included

(1)  Use this clause for items 3 to 723, 732, 900 to 6016, 6018 to 6024, 6028, 6051 to 6058, 6062, 6063, 10801 to 10816, 11012 to 11021, 11304, 11600, 11627, 11705, 11724, 11728, 11731, 11820, 11823, 11921, 12000, 12003, 12004, 12201, 13030 to 13104, 13106 to 13110, 13209, 13210, 13290 to 13700, 13815 to 13899, 14100 to 14124, 14203 to 14212, 14224, 14255 to 14288, 15600, 16003 to 16512, 16515 to 51318, 90020 to 90096 and 90250 to 90282.

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

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

(b)  a medical practitioner who:

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

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

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

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

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

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

(c)  participating in a video conferencing consultation referred to in items 99, 112 to 114, 149, 288, 384, 389, 2100, 2122, 2125, 2126, 2137, 2138, 2143, 2147, 2179, 2195, 2199, 2220, 2461, 2463, 2464, 2465, 2471, 2472, 2475, 2478, 2799, 2820, 3003, 3015, 6004, 6016, 6025, 6026, 6059, 6060, 13210, 16399, 17609, 90262, 90263, 90268, 90269, 90279, 90280, 90281 and 90282.

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

Items 3 to 10816, 90020 to 90096 and 90250 to 90282 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.

1.2.9  Restrictions 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:

(a)  the service is rendered in relation to the provision of chelation therapy, in the form of the intravenous administration of ethylenediamine tetra‑acetic acid or any of its salts, otherwise than for the treatment of heavy‑metal poisoning;

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

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

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

(e)  the service is rendered for the purposes of, or in relation to, the removal from a cadaver of kidneys for transplantation;

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

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

(ii)  the transplantation of a kidney in conjunction with the transplantation of a thoracic or other abdominal organ, or of a part of an organ of that kind;

(g)  the service is rendered for the purpose of administering microwave (UHF radiowave) cancer therapy, including the intravenous injection of drugs used immediately before or during the therapy;

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

1.2.10  Restriction 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.

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

(1)  Use this clause for items 10983 to 10989, 10997, 11000, 11003, 11004, 11005, 11009, 11024, 11027, 11200, 11203, 11204, 11205, 11210, 11211, 11215, 11218, 11221, 11224, 11235, 11237, 11240, 11241, 11242, 11243, 11244, 11300, 11303, 11306, 11309, 11312, 11315, 11318, 11324, 11327, 11330, 11332, 11333, 11336, 11339, 11503, 11505, 11506, 11507, 11508, 11512, 11602, 11604, 11605, 11610, 11611, 11612, 11614, 11615, 11704, 11707, 11713, 11714, 11715, 11716, 11717, 11718, 11721, 11723, 11725, 11726, 11727, 11729, 11730, 11735, 11800, 11810, 11830, 11833, 11900, 11903, 11906, 11909, 11912, 11915, 11919, 12012, 12017, 12021, 12022, 12024, 12200, 12203, 12204, 12205, 12207, 12208, 12210, 12213, 12215, 12217, 12250 to 12272, 12500 to 12527, 13015, 13020, 13025, 13200 to 13203, 13206, 13212, 13215, 13218, 13221, 13703, 13706, 13750, 13755, 13757, 13760, 14050, 14218, 14221, 15000 to 15336, 15339 to 15357, 15500 to 15539 and 16514.

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

(a)  a medical practitioner; or

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

(i)  is employed by a medical practitioner; or

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

1.2.12  Restriction 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.

1.2.13  Restriction on items—attendances on same day as electrocardiogram services are performed

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

(2)  Subclause (1) does not apply if:

(a)  the patient has been referred to the specialist or consultant physician; or

(b)  the patient is being provided with ongoing care by the specialist or consultant physician; or

(c)  both of the following apply:

(i)  another medical practitioner has requested the electrocardiogram service;

(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.

1.2.14  Restriction on items—attendances on same day as echocardiogram services or myocardial perfusion study services are performed

(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:

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

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

(2)  Subclause (1) does not apply if:

(a)  both:

(i)  the attendance service is provided after another service is provided to the patient; and

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

(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.

Part 2—Attendances

Division 2.1—Preliminary

2.1.1  Meaning 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:

(a)  the fee mentioned in column 2 for the item; and

(b)  either:

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

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

Table 2.1.1—Amount under clause 2.1.1
Item

Column 1

Items 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 27.15 2.15
2 24 The fee for item 23 27.15 2.15
3 37 The fee for item 36 27.15 2.15
4 47 The fee for item 44 27.15 2.15
5 58 $8.50 15.50 0.70
6 59, 2610, 2631, 2673 $16.00 17.50 0.70
7 60, 2613, 2633, 2675 $35.50 15.50 0.70
8 65, 2616, 2635, 2677 $57.50 15.50 0.70
9 195 The fee for item 193 26.75 2.10
10 414 The fee for item 410 26.65 2.10
11 415 The fee for item 411 26.65 2.10
12 416 The fee for item 412 26.65 2.10
13 417 The fee for item 413 26.65 2.10
14 2503 The fee for item 2501 26.75 2.10
15 2506 The fee for item 2504 26.75 2.10
16 2509 The fee for item 2507 26.75 2.10
17 2518 The fee for item 2517 26.75 2.10
18 2522 The fee for item 2521 26.75 2.10
19 2526 The fee for item 2525 26.75 2.10
20 2547 The fee for item 2546 26.75 2.10
21 2553 The fee for item 2552 26.75 2.10
22 2559 The fee for item 2558 26.75 2.10
23 5003 The fee for item 5000 26.75 2.10
24 5010 The fee for item 5000 48.15 3.40
25 5023 The fee for item 5020 26.75 2.10
26 5028 The fee for item 5020 48.15 3.40
27 5043 The fee for item 5040 26.75 2.10
28 5049 The fee for item 5040 48.15 3.40
29 5063 The fee for item 5060 26.75 2.10
30 5067 The fee for item 5060 48.15 3.40
31 5220 $18.50 15.50 0.70
32 5223 $26.00 17.50 0.70
33 5227 $45.50 15.50 0.70
34 5228 $67.50 15.50 0.70
35 5260 $18.50 27.95 1.25
36 5263 $26.00 31.55 1.25
37 5265 $45.50 27.95 1.25
38 5267 $67.50 27.95 1.25
39 90272 The fee for item 90271 26.75 2.10
40 90274 The fee for item 90273 26.75 2.10
41 90276 The fee for item 90275 21.40 1.70
42 90278 The fee for item 90277 21.40 1.70

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

2.2.1  Items in Group A1

This clause sets out items in Group A1.

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 17.75
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 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

 38.75
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 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

 75.05
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

 110.50
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

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

2.3.1  Items 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 ($)
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 (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
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—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 2.4—Group A3: Specialist attendances to which no other item applies

2.4.1  Items in Group A3

This clause sets out items in Group A3.

Group A3—Specialist attendances to which no other item applies

Column 1

Item

Column 2

Description

Column 3

Fee ($)
99

Professional attendance on a patient by a specialist practising in the specialist’s specialty if:

(a) the attendance is by video conference; and

(b) the attendance is for a service:

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

(ii) provided with item 105; and

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

(d) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

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

(ii) is a care recipient in a residential aged care facility; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

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

 50% of the fee for item 104 or 105
104 Professional attendance at consulting rooms or hospital by a specialist in the practice of 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 or 16401 applies 89.55
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 16404 applies 45.00
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) 74.30
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 131.40
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 83.20
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)

 201.85
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 $309.35 or more

For any particular patient, once only on the same day

 45.00
113

Initial professional attendance lasting 10 minutes or less on a patient by a specialist in the practice of the specialist’s speciality if:

(a) the attendance is by video conference; and

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

(c) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

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

(ii) is a care recipient in a residential aged care facility; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

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

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

 67.20
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 309.35 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

 45.00

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

2.5.1  Items in Group A4

This clause sets out items in Group A4.

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 157.95
112

Professional attendance on a patient by a consultant physician practising in the consultant physician’s specialty if:

(a) the attendance is by video conference; and

(b) the attendance is for a service:

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

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

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

(d) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

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

(ii) is a care recipient in a residential aged care facility; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

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

 50% of the fee for item 110, 116, 119, 132 or 133
114

Initial professional attendance lasting 10 minutes or less on a patient by a consultant physician practising in the consultant physician’s specialty if:

(a) the attendance is by video conference; and

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

(c) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

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

(ii) is a care recipient in a residential aged care facility; or

(iii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

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

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

 118.50
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 79.05
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 $309.35 or more

For any particular patient, once only on the same day

 79.05
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 45.00
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 $309.35 or more

For any particular patient, once only on the same day

 45.00
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 191.65
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 115.90
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 83.50
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 or 119 applies did not take place on the same day by the same consultant physician; and

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

 276.25
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 or 119 applies did not take place on the same day by the same consultant physician; and

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

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

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

 138.30

coordinating, for item 880, has the meaning given by clause 2.16.17.

coordinating a review of team care arrangements, for item 732, has the meaning given by clause 2.16.5.

coordinating the development of team care arrangements, for item 723, has the meaning given by clause 2.16.4.

designated area has the meaning given by clause 3.2.1.

eating disorder treatment and management plan means a plan prepared in accordance with clause 2.31.3, including any modifications to the plan made in accordance with clause 2.31.4.

ECG means electrocardiogram.

EEG means electroencephalogram.

eligible allied health provider means any of the following:

(a)  an audiologist;

(b)  an occupational therapist;

(c)  an optometrist;

(d)  an orthoptist;

(e)  a physiotherapist;

(f)  a psychologist;

(g)  a speech pathologist.

eligible disability has the meaning given by clause 2.6.1.

eligible non‑vocationally recognised medical practitioner has the meaning given by clause 1.1.2.

eligible stroke centre has the meaning given by clause 5.10.15.

embryology laboratory services has the meaning given by clause 5.2.2.

EMG means electromyogram.

EOG means electrooculogram.

focussed psychological strategies has the meaning given by clause 2.20.1.

foreign body, for items 35360 and 35363, has the meaning given by clause 5.10.10.

general intensive care unit means an area within a hospital that:

(a)  is equipped and staffed so that it is capable of providing to a patient:

(i)  mechanical ventilation for a period of several days; and

(ii)  invasive cardiovascular monitoring; and

(b)  is supported by:

(i)  during normal working hours—at least one specialist, or consultant physician, in the specialty of intensive care, who is immediately available, and exclusively rostered, to that area; and

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

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

(c)  has admission and discharge policies in operation.

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

general practitioner has a meaning affected by clause 1.1.3.

GP management plan, for item 10997, has the meaning given by clause 3.1.1.

gravely ill patient lacking current goals of care means a patient to whom all of the following apply:

(a)  the patient either:

(i)  is suffering a life‑threatening acute illness or injury; or

(ii)  is suffering acute illness or injury and, apart from the illness or injury, has a high risk of dying within 12 months;

(b)  one or more alternatives to management of the illness or injury are clinically appropriate for the patient;

(c)  either:

(i)  there is not a record of goals of care for the patient that can readily be retrieved by providers of health care for the patient and that identifies interventions that should, or should not, be made in care of the patient; or

(ii)  there is such a record but it is reasonable to expect that, due to changes in the patient’s condition, the goals recorded will change substantially.

Group A1 disqualified general practitioner means a general practitioner:

(a) who is partly disqualified under an agreement that is in effect under section 92 of the Act in respect of a service to which an item in Group A1 applies; or

(b) in relation to whom a final determination under section 106TA of the Act containing a direction under paragraph 106U(1)(g) that the practitioner be partly disqualified is in effect in respect of a service to which an item in Group A1 applies.

(H) has the meaning given by clause 1.1.7.

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

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

living in a community setting, for item 900, has the meaning given by clause 2.17.1.

maxilla:

(a)  for items 45720 to 45752—has the meaning given by clause 5.10.22; and

(b)  for items 52342 to 52375—has the meaning given by clause 6.5.1.

mental disorder has the meaning given by clause 2.20.1.

mental health skills training means training of that name accredited by the General Practice Mental Health Standards Collaboration.

Note:          The General Practice Mental Health Standards Collaboration operates under the auspices of the Royal Australian College of General Practitioners.

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

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

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

Modified Monash 2 area means a Statistical Area Level 1 under the ASGS that:

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

(b)  satisfies any of the following criteria:

(i)  the area is in an Urban Centre and Locality with a 2013 estimated resident population of more than 50,000;

(ii)  the area is in an Urban Centre and Locality, the geographic centre of which is no more than 20 km road distance from the boundary of another Urban Centre and Locality with a 2013 estimated resident population of more than 50,000;

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

(c)  is not a Modified Monash 7 area.

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

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

(b)  satisfies any of the following criteria:

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

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

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

(c)  is not a Modified Monash 2 area or Modified Monash 7 area.

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

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

(b)  satisfies any of the following criteria:

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

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

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

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

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

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

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

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

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

(b)  is not a Modified Monash 7 area.

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

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

(b)  is located on Magnetic Island; or

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

motion segment has the meaning given by clause 5.10.29.

multidisciplinary care plan:

(a)  for items 729 and 731—has the meaning given by clause 2.16.6; and

(b)  for item 10997—has the meaning given by clause 3.1.1.

multidisciplinary case conference has the meaning given by clause 1.1.4.

multidisciplinary case conference team has the meaning given by clause 1.1.5.

multidisciplinary discharge case conference, for items 735, 739, 743, 747, 750 and 758, has the meaning given by clause 2.16.14.

neo‑natal intensive care unit means a separate hospital area that:

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

(i)  mechanical ventilation for a period of several days; and

(ii)  invasive cardiovascular monitoring; and

(b)  is supported by:

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

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

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

(c)  has admission and discharge policies in operation.

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

non‑medicare service means any of the following:

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

(b)  gamma knife surgery;

(c)  intradiscal electro thermal arthroplasty;

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

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

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

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

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

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

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

(k)  specific mass measurement of bone alkaline phosphatise;

(l)  transmyocardial laser revascularisation;

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

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

(o)  vertebroplasty;

(p)  extracorporeal magnetic innervation.

NOSE Scale has the meaning given by clause 5.10.21.

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

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

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

organise and coordinate:

(a)  for items 735, 739, 743, 820, 822, 823, 825, 826, 828, 830, 832, 834, 835, 837, 838, 855, 857, 858, 861, 864 and 866—has the meaning given by clause 2.16.15; and

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

(c)  for items 6029 to 6042—has the meaning given by clause 2.27.1; and

(d)  for items 6064 to 6075—has the meaning given by clause 2.28.1.

outcome measurement tool has the meaning given by clause 2.20.1.

participate:

(a)  for items 747, 750, 758, 825, 826, 828, 835, 837 and 838—has the meaning given by clause 2.16.16; and

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

(c)  for items 6035 to 6042—has the meaning given by clause 2.27.2; and

(d)  for items 6071 to 6075—has the meaning given by clause 2.28.2.

participating in a video conferencing consultation: a medical practitioner is participating in a video conferencing consultation if:

(a)  the medical practitioner attends a patient who is receiving a service under an item in this Schedule from a specialist or consultant physician; and

(b)  the specialist or consultant physician is providing the service:

(i)  in relation to the specialist’s or consultant physician’s speciality to the patient; and

(ii)  by way of a video conferencing consultation.

patient’s medical condition requires urgent assessment has the meaning given by clause 2.14.1.

patient’s usual general practitioner means a general practitioner:

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

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

(c)  located at a medical practice that:

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

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

person with a chronic disease, for item 10997, has the meaning given by clause 3.1.1.

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

practice location, for the provision of a medical service, means the place of practice in relation to which the medical practitioner by whom, or on whose behalf, the service is provided, has been allocated a provider number by the Chief Executive Medicare.

practice midwife has the meaning given by clause 5.5.2.

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

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

preparation of goals of care for a patient, by a medical practitioner, means the carrying out of all of the following activities by the practitioner:

(a)  comprehensively evaluating the patient’s medical, physical, psychological and social issues;

(b)  identifying major issues that require goals of care for the patient to be set;

(c)  assessing the patient’s capacity to make decisions about goals of care for the patient;

(d)  discussing care of the patient with the patient, or a person (the surrogate) who can make decisions on the patient’s behalf about care for the patient, and as appropriate with any of the following:

(i)  members of the patient’s family;

(ii)  other persons who provide care for the patient;

(iii)  other health practitioners;

(e)  offering in that discussion reasonable options for care of the patient, including alternatives to intensive or escalated care;

(f)  agreeing with the patient or the surrogate on goals of care for the patient that address all major issues identified;

(g)  recording the agreed goals so that:

(i)  the record can be readily retrieved by other providers of health care for the patient; and

(ii)  interventions that should, or should not, be made in care of the patient are identified.

preparing a GP management plan, for item 721, has the meaning given by clause 2.16.7.

qualified adult sleep medicine practitioner has the meaning given by clause 4.1.2.

qualified medical acupuncturist has the meaning given by clause 2.10.1.

qualified paediatric sleep medicine practitioner has the meaning given by clause 4.1.2.

qualified sleep medicine practitioner has the meaning given by clause 4.1.2.

RACP Advisory Committee has the meaning given by clause 4.1.2.

RACP Appeal Committee has the meaning given by clause 4.1.2.

RACP Credentialling Subcommittee has the meaning given by clause 4.1.2.

radiation oncology treatment verification means a quality assurance procedure:

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

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

(i)  x‑rays;

(ii)  computed tomography;

(iii)  ultrasound, if the ultrasound equipment is capable of producing images in 3 dimensions; and

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

recognised emergency department of a private hospital means a department of the hospital that is licensed, under a law of the State or Territory in which the hospital is located, to operate as an emergency department.

referring practitioner, in relation to a referral, means the person making the referral.

Note:          Division 4 of Part 11 of the Health Insurance Regulations 2018 prescribes the manner in which patients are to be referred when an item in this Schedule specifies a service that is to be rendered by a specialist or consultant physician to a patient who has been referred.

regional, rural or remote area means either of the following:

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

(b)  Norfolk Island.

registered vaccine means a vaccine that is included in the part of the Australian Register of Therapeutic Goods for registered goods, being the Register maintained under section 9A of the Therapeutic Goods Act 1989, as existing on 1 July 2020.

report, for Division 4.1, has the meaning given by clause 4.1.1.

residential aged care facility means a facility where residential care (as defined in section 41‑3 of the Aged Care Act 1997) is provided.

residential medication management review, for item 903, has the meaning given by clause 2.17.2.

reviewing a GP management plan, for item 732, has the meaning given by clause 2.16.8.

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

risk assessment:

(a)  for items 135, 137 and 139—has the meaning given by clause 2.6.2; and

(b)  for item 289—has the meaning given by clause 2.11.4.

Rural, Remote and Metropolitan Areas Classification means the document so titled, as existing on 1 July 2020, setting out certain categories of areas in Australia that have been determined by the Department by reference to population size and remoteness of locality on the basis of 1991 census data published by the Australian Bureau of Statistics in 1994.

service time has the meaning given by clause 5.9.3.

single course of treatment has the meaning given by clause 1.1.6.

SLA has the meaning given by clause 3.2.1.

SSD has the meaning given by clause 3.2.1.

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

telehealth eligible area means an area classified as a telehealth eligible area by the Minister, identified as such on the Department’s website on 1 July 2020.

Note:          Maps showing telehealth eligible areas could in 2020 be viewed on the Department’s website ( cycle, in relation to assisted reproductive services, has the meaning given by clause 5.2.3.

unreferred service has the meaning given by clause 3.2.1.

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

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

Endnotes

Endnote 1—About the endnotes

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

The following endnotes are included in every compilation:

Endnote 1—About the endnotes

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history

Abbreviation key—Endnote 2

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

Legislation history and amendment history—Endnotes 3 and 4

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

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

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

Editorial changes

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

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

Misdescribed amendments

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

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

Endnote 2—Abbreviation key

ad = added or inserted o = order(s)
am = amended Ord = Ordinance
amdt = amendment orig = original
c = clause(s) par = paragraph(s)/subparagraph(s)
C[x] = Compilation No. x /sub‑subparagraph(s)
Ch = Chapter(s) pres = present
def = definition(s) prev = previous
Dict = Dictionary (prev…) = previously
disallowed = disallowed by Parliament Pt = Part(s)
Div = Division(s) r = regulation(s)/rule(s)
ed = editorial change reloc = relocated
exp = expires/expired or ceases/ceased to have renum = renumbered
effect rep = repealed
F = Federal Register of Legislation rs = repealed and substituted
gaz = gazette s = section(s)/subsection(s)
LA = Legislation Act 2003 Sch = Schedule(s)
LIA = Legislative Instruments Act 2003 Sdiv = Subdivision(s)
(md) = misdescribed amendment can be given SLI = Select Legislative Instrument
effect SR = Statutory Rules
(md not incorp) = misdescribed amendment Sub‑Ch = Sub‑Chapter(s)
cannot be given effect SubPt = Subpart(s)
mod = modified/modification underlining = whole or part not
No. = Number(s) commenced or to be commenced

Endnote 3—Legislation history

Name Registration Commencement Application, saving and transitional provisions
Health Insurance (General Medical Services Table) Regulations (No. 2) 2020 15 June 2020 (F2020L00711) 1 July 2020 (s 2(1) item 1)
Health Insurance Legislation Amendment (2020 Measures No. 1) Regulations 2020 6 July 2020 (F2020L00882) Sch 1 (items 5–17): 1 Aug 2020 (s 2(1) item 1) —
Health Insurance Legislation Amendment (Bulk‑billing Incentive (No. 2)) Regulations 2020 23 Sept 2020 (F2020L01203) Sch 1 (items 3, 4): 1 Oct 2020 (s 2(1) item 1) —
Health Insurance Legislation Amendment (2020 Measures No. 2) Regulations 2020 20 Oct 2020 (F2020L01330) Sch 1 (items 1–149, 153–158): 1 Nov 2020 (s 2(1) item 1) —
Health Insurance Legislation Amendment (2020 Measures No. 3) Regulations 2020 14 Dec 2020 (F2020L01608) Sch 1 (items 1–9, 25–64, 81–93): 1 Mar 2021 (s 2(1) items 2, 4)
Sch 1 (item 68): 1 Jan 2021 (s 2(1) item 3)
Sch 1 (items 98, 99): 16 June 2021 (s 2(1) item 5) 		—

Endnote 4—Amendment history

Provision affected How affected
s 2............................................. rep LA s 48D
s 5............................................. rep LA s 48C
Schedule 1
Part 1
Division 1.1
c 1.1.3....................................... am F2020L01608
Division 1.2
c 1.2.2....................................... am F2020L01608
c 1.2.4....................................... am F2020L01608
c 1.2.5....................................... am F2020L01608
c 1.2.6....................................... am F2020L00882; F2020L01608
c 1.2.7....................................... am F2020L00882; F2020L01608
c 1.2.8....................................... am F2020L01608
c 1.2.11..................................... am F2020L00882; F2020L01330; F2020L01608
c 1.2.13..................................... ad F2020L01608
c 1.2.14..................................... ad F2020L01608
Part 2
Division 2.1
c 2.1.1....................................... am F2020L01608
Division 2.11
Group A8 Table........................ am F2020L01330
Division 2.14
c 2.14.3..................................... rep F2020L01330
Division 2.20
c 2.20.6..................................... am F2020L01608
Group A20 Table...................... am F2020L01608
Division 2.31
Division 2.31............................ ad F2020L01608
c 2.31.1..................................... ad F2020L01608
c 2.31.2..................................... ad F2020L01608
c 2.31.3..................................... ad F2020L01608
c 2.31.4..................................... ad F2020L01608
c 2.31.5..................................... ad F2020L01608
c 2.31.6..................................... ad F2020L01608
c 2.31.7..................................... ad F2020L01608
ed C5
c 2.31.8..................................... ad F2020L01608
c 2.31.9..................................... ad F2020L01608
c 2.31.10................................... ad F2020L01608
Group A36 Table...................... ad F2020L01608
ed C5
Part 3
Division 3.2
Group M1 Table....................... am F2020L01203
Part 4
Division 4.1
c 4.1.3A.................................... ad F2020L01608
c 4.1.3B.................................... ad F2020L01608
c 4.1.3C.................................... ad F2020L01608
c 4.1.3D.................................... ad F2020L01608
c 4.1.3E.................................... ad F2020L01608
c 4.1.3F..................................... ad F2020L01608
c 4.1.3G.................................... ad F2020L01608
Group D1 Table........................ am F2020L00882; F2020L01330; F2020L01608
Part 5
Division 5.2
c 5.2.7....................................... am F2020L01330
Group T1 Table........................ am F2020L01330
Division 5.3
Group T2 Table........................ am F2020L01330; F2020L01608
Division 5.8
c 5.8.2....................................... am F2020L01330
Group T11 Table...................... am F2020L01330
Division 5.9
Group T10 Table...................... am F2020L01608
Division 5.10
Subdivision A
Group T8 Table........................ am F2020L01608
Subdivision B
Group T8 Table........................ am F2020L01608
Subdivision C
c 5.10.17................................... am F2020L01608
Group T8 Table........................ am F2020L01330
ed C3
am F2020L01608
Subdivision D
c 5.10.19A................................ ad F2020L01330
Group T8 Table........................ am F2020L01330
ed C3
am F2020L01608
Subdivision E
Group T8 Table........................ am F2020L01608
Part 7
c 7.1.1....................................... am F2020L01330; F2020L01608
Schedule 2................................ rep LA s 48C
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