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If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.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

1Name

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

3Authority

This instrument is made under the Health Insurance Act 1973.

4General medical services table

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

Schedule 1General medical services table

Note: See section 4.

Part 1PreliminaryDivision 1.1Interpretation1.1.1Dictionary

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

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

    In this Schedule:

eligible non‑vocationally recognised medical practitioner means:

  1. (a)

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

    1. (i)

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

    2. (ii)

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

  2. (b)

    a medical practitioner who:

    1. (i)

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

    2. (ii)

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

    3. (iii)

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

      1. (A)

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

      2. (B)

        of which the Chief Executive Medicare has written notice; or

  3. (c)

    a medical practitioner who:

    1. (i)

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

    2. (ii)

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

    3. (iii)

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

  4. (d)

    a medical practitioner who:

    1. (i)

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

    2. (ii)

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

    3. (iii)

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

  1. (2)

    In subclause (1):

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

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

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

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

1.1.3General practitioners

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

  1. (a)

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

    1. (i)

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

    2. (ii)

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

  2. (b)

    an eligible non‑vocationally recognised medical practitioner;

  3. (c)

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

  4. (d)

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

    1. (i)

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

    2. (ii)

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

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

1.1.4Meaning of multidisciplinary case conference

In this Schedule:

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

  1. (a)

    discussing a patient’s history;

  2. (b)

    identifying the patient’s multidisciplinary care needs;

  3. (c)

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

  4. (d)

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

  5. (e)

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

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

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

    1. (a)

      includes a medical practitioner; and

    2. (b)

      either:

      1. (i)

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

      2. (ii)

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

    3. (c)

      may also include a family member of the patient.

  2. (2)

    For the members mentioned in paragraph (b):

    1. (a)

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

    2. (b)

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

    3. (c)

      one member may be another medical practitioner.

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

    (a) Aboriginal and Torres Strait Islander health practitioners;

    (b) asthma educators;

    (c) audiologists;

    (d) dental therapists;

    (e) dentists;

    (f) diabetes educators;

    (g) dieticians;

    (h) mental health workers;

    (i) occupational therapists;

    (j) optometrists;

    (k) orthoptists;

    (l) orthotists or prosthetists;

    (m) pharmacists;

    (n) physiotherapists;

    (o) podiatrists;

    (p) psychologists;

    (q) registered nurses;

    (r) social workers;

    (s) speech pathologists;

    (t) education providers;

    (u) “meals on wheels” providers;

    (v) personal care workers;

    (w) probation officers.

  3. (3)

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

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

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

  2. (2)

    A single course of treatment for a patient:

    1. (a)

      includes:

      1. (i)

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

      2. (ii)

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

      3. (iii)

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

    2. (b)

      does not include:

      1. (i)

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

      2. (ii)

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

        1. (A)

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

        2. (B)

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

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

1.1.7Meaning of symbol (H)

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

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

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

Division 1.2General application provisions1.2.1Application

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

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

    Use this clause for items 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. (2)

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

    1. (a)

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

    2. (b)

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

    3. (c)

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

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

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

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

  2. (2)

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

    1. (a)

      an item in Subgroup 6 of Group I1;

    2. (b)

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

    3. (c)

      items 58900 and 58903 in Subgroup 8 of Group I3;

    4. (d)

      item 59103 in Subgroup 9 of Group I3.

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

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

  2. (2)

    The item does not apply to a service if:

    1. (a)

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

    2. (b)

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

    3. (c)

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

1.2.5Professional attendance services – matters included
  1. (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. (2)

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

    1. (a)

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

    2. (b)

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

    3. (c)

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

    4. (d)

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

    5. (e)

      providing appropriate preventive health care;

    6. (f)

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

  3. (3)

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

    1. (a)

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

    2. (b)

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

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

    Use this clause for items 3 to 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. (2)

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

  3. (3)

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

    1. (a)

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

    2. (b)

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

    3. (c)

      participating in a video conferencing consultation referred to in items 99, 112 to 114, 149, 288, 384, 389, 2100, 2122, 2125, 2126, 2137, 2138, 2143, 2147, 2179, 2195, 2199, 2220, 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.

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

    Use this clause for items 3 to 723, 732, 900 to 6016, 6018 to 6024, 6028, 6051 to 6058, 6062, 6063, 10801 to 10816, 11012 to 11021, 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. (2)

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

    1. (a)

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

    2. (b)

      a medical practitioner who:

      1. (i)

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

      2. (ii)

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

  3. (3)

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

  4. (4)

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

    1. (a)

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

    2. (b)

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

    3. (c)

      participating in a video conferencing consultation referred to in items 99, 112 to 114, 149, 288, 384, 389, 2100, 2122, 2125, 2126, 2137, 2138, 2143, 2147, 2179, 2195, 2199, 2220, 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.

1.2.8Restriction 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.

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

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

  1. (a)

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

  2. (b)

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

  3. (c)

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

  4. (d)

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

  5. (e)

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

  6. (f)

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

    1. (i)

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

    2. (ii)

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

  7. (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;

  1. (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.

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

An item in this Schedule does not apply to a service described in the item if the service is provided to a patient at the same time as, or in connection with, the harvesting, storage, in vitro processing or injection of non‑haematopoietic stem cells.

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

    Use this clause for items 10983 to 10989, 10997, 11000, 11003, 11004, 11005, 11009, 11024, 11027, 11200, 11203, 11204, 11205, 11210, 11211, 11215, 11218, 11221, 11224, 11235, 11237, 11240, 11241, 11242, 11243, 11244, 11300, 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. (2)

    The item applies whether the medical service is given by:

    1. (a)

      a medical practitioner; or

    2. (b)

      a person, other than a medical practitioner, who:

      1. (i)

        is employed by a medical practitioner; or

      2. (ii)

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

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

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

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

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

    An item in Part 2 of this Schedule does not apply to a service (the attendance service) provided by a specialist 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. (2)

    Subclause (1) does not apply if:

    1. (a)

      the patient has been referred to the specialist or consultant physician; or

    2. (b)

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

    3. (c)

      both of the following apply:

      1. (i)

        another medical practitioner has requested the electrocardiogram service;

      2. (ii)

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

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

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

    1. (a)

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

    2. (b)

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

  2. (2)

    Subclause (1) does not apply if:

    1. (a)

      both:

      1. (i)

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

      2. (ii)

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

    2. (b)

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

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

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

amount under clause 2.1.1 means the sum of:

  1. (a)

    the fee mentioned in column 2 for the item; and

  2. (b)

    either:

    1. (i)

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

    2. (ii)

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

Table 2.1.1—Amount under clause 2.1.1

Item

Column 1

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 2.2Group A1: General practitioner attendances to which no other item applies2.2.1Items 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 2.3Group A2: Other non‑referred attendances to which no other item applies2.3.1Items in Group A2

This clause sets out items in Group A2.

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

Column 1

Item

Column 2

Description

Column 3

Fee ($)

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 2.4Group A3: Specialist attendances to which no other item applies2.4.1Items 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 2.5Group A4: Consultant physician (other than psychiatry) attendances to which no other item applies2.5.1Items in Group A4

This clause sets out items in Group A4.

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

Division 2.6Group A29: Early intervention services for children with autism, pervasive developmental disorder or disability2.6.1Meaning of eligible disability

In this Schedule:

eligible disability means any of the following:

  1. (a)

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

  2. (b)

    hearing impairment that results in:

    1. (i)

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

    2. (ii)

      permanent conductive hearing loss and auditory neuropathy;

  3. (c)

    deafblindness;

  4. (d)

    cerebral palsy;

  5. (e)

    Down syndrome;

  6. (f)

    Fragile X syndrome;

  7. (g)

    Prader‑Willi syndrome;

  8. (h)

    Williams syndrome;

  9. (i)

    Angelman syndrome;

  10. (j)

    Kabuki syndrome;

  11. (k)

    Smith‑Magenis syndrome;

  12. (l)

    CHARGE syndrome;

  13. (m)

    Cri du Chat syndrome;

  14. (n)

    Cornelia de Lange syndrome;

  15. (o)

    microcephaly, if a child has:

    1. (i)

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

    2. (ii)

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

  16. (p)

    Rett’s disorder.

2.6.2Meaning of risk assessment

In items 135, 137 and 139:

risk assessment means an assessment of:

  1. (a)

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

  2. (b)

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

2.6.3Items in Group A29

This clause sets out items in Group A29.

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

Column 1

Item

Column 2

Description

Column 3

Fee ($)

135

Professional attendance lasting at least 45 minutes at consulting rooms or hospital, by a consultant physician in the practice of the consultant physician’s specialty of paediatrics, following referral of the patient to the consultant by a referring practitioner, for assessment, diagnosis and preparation of a treatment and management plan for a patient aged under 13 years with autism or another pervasive developmental disorder, if the consultant paediatrician does all of the following:

(a) undertakes a comprehensive assessment and makes a diagnosis (if appropriate, using information provided by an eligible allied health provider);

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

(i) an assessment and diagnosis of the patient’s condition;

(ii) a risk assessment;

(iii) treatment options and decisions;

(iv) if necessary—medical recommendations;

(c) provides a copy of the treatment and management plan to:

(i) the referring practitioner; and

(ii) one or more allied health providers, if appropriate, for the treatment of the patient;

(other than attendance on a patient for whom payment has previously been made under this item or item 137, 139 or 289)

276.25

137

Professional attendance lasting at least 45 minutes at consulting rooms or hospital, by a specialist or consultant physician (not including a general practitioner) following referral of the patient to the specialist or consultant physician by a referring practitioner, for assessment, diagnosis and preparation of a treatment and management plan for a patient under 13 years with an eligible disability if the specialist or consultant physician does all of the following:

(a) undertakes a comprehensive assessment and makes a diagnosis (if appropriate, using information provided by an eligible allied health provider);

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

(i) an assessment and diagnosis of the patient’s condition;

(ii) a risk assessment;

(iii) treatment options and decisions;

(iv) if necessary—medication recommendations;

(c) provides a copy of the treatment and management plan to one or more allied health providers, if appropriate, for the treatment of the patient;

(other than attendance on a patient for whom payment has previously been made under this item or item 135, 139 or 289)

276.25

139

Professional attendance lasting at least 45 minutes at consulting rooms only, by a general practitioner (not including a specialist or consultant physician) for assessment, diagnosis and preparation of a treatment and management plan for a patient under 13 years with an eligible disability if the general practitioner does all of the following:

(a) undertakes a comprehensive assessment and makes a diagnosis (if appropriate, using information provided by an eligible allied health provider);

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

(i) an assessment and diagnosis of the patient’s condition;

(ii) a risk assessment;

(iii) treatment options and decisions;

(iv) if necessary—medication recommendations;

(c) provides a copy of the treatment and management plan to one or more allied health providers, if appropriate, for the treatment of the patient;

(other than attendance on a patient for whom payment has previously been made under this item or item 135, 137 or 289)

138.70

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

This clause sets out items in Group A28.

Group A28—Geriatric medicine

Column 1

Item

Column 2

Description

Column 3

Fee ($)

141

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

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

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

(c) during the attendance:

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

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

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

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

(B) short and longer term management goals; and

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

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

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

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

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

473.80

143

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

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

(b) during the attendance:

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

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

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

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

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

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

296.20

145

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

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

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

(c) during the attendance:

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

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

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

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

(B) short and longer term management goals; and

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

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

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

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

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

574.50

147

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

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

(b) during the attendance:

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

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

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

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

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

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

359.10

149

Professional attendance on a patient by a consultant physician or specialist practising in the consultant physician’s or specialist’s specialty of geriatric medicine if:

(a) the attendance is by video conference; and

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

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

(d) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 km by road from the physician or 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 141 or 143

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

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

  2. (2)

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

  3. (3)

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

2.8.2Items in Group A5

This clause sets out items in Group A5.

Group A5—Prolonged attendances to which no other item applies

Column 1

Item

Column 2

Description

Column 3

Fee ($)

160

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

228.45

161

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

380.70

162

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

532.75

163

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

685.35

164

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

761.45

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

This clause sets out items in Group A6.

Group A6—Group therapy

Column 1

Item

Column 2

Description

Column 3

Fee ($)

170

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

121.25

171

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

127.75

172

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

155.40

Division 2.10Group A7: Acupuncture and non‑specialist practitioner items2.10.1Meaning of qualified medical acupuncturist

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

2.10.2Items in Group A7

This clause sets out items in Group A7.

Group A7—Acupuncture and non‑specialist practitioner items

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 1—Acupuncture

173

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

21.65

193

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

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

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

38.20

195

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

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

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

Amount under clause 2.1.1

197

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

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

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

73.95

199

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

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

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

108.85

Division 2.11Group A8: Consultant psychiatrist attendances to which no other item applies2.11.1Restriction on timing of services in items 291, 293 and 359

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

2.11.2Restriction on items 342, 344 and 346

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

2.11.3Restriction on items 353 to 361 – location of patient

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

2.11.4Meaning of risk assessment

In item 289:

risk assessmentmeans an assessment of:

  1. (a)

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

  2. (b)

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

2.11.5Items in Group A8

This clause sets out items in Group A8.

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

Column 1

Item

Column 2

Description

Column 3

Fee ($)

288

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

(a) the attendance is by video conference; and

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

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

(d) the patient:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance—at least 15 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 291, 293, 296, 300, 302, 304, 306, 308, 310, 312, 314, 316, 318, 319, 348, 350 or 352

289

Professional attendance lasting at least 45 minutes at consulting rooms or hospital, by a consultant physician in the practice of the consultant physician’s specialty of psychiatry, following referral of the patient to the consultant physician by a referring practitioner, for assessment, diagnosis and preparation of a treatment and management plan for a patient under 13 years with autism or another pervasive developmental disorder, if the consultant physician does all of the following:

(a) undertakes a comprehensive assessment and makes a diagnosis (if appropriate, using information provided by an eligible allied health provider);

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

(i) an assessment and diagnosis of the patient’s condition;

(ii) a risk assessment;

(iii) treatment options and decisions;

(iv) if necessary—medication recommendations;

(c) provides a copy of the treatment and management plan to the referring practitioner;

(d) provides a copy of the treatment and management plan to one or more allied health providers, if appropriate, for the treatment of the patient;

(other than attendance on a patient for whom payment has previously been made under this item or item 135, 137 or 139)

276.25

291

Professional attendance lasting more than 45 minutes at consulting rooms by a consultant physician in the practice of the consultant physician’s specialty of psychiatry, if:

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

(b) during the attendance, the consultant:

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

(ii) carries out a mental state examination; and

(iii) makes a psychiatric diagnosis; and

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

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

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

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

(A) covers the next 12 months; and

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

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

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

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

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

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

(A) the patient; and

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

473.80

293

Professional attendance lasting more than 30 minutes, but not more than 45 minutes, at consulting rooms by a consultant physician in the practice of the consultant physician’s specialty of psychiatry, if:

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

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

(c) during the attendance, the consultant:

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

(ii) carries out a mental state examination; and

(iii) makes a psychiatric diagnosis; and

(iv) reviews the management plan; and

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

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

(ii) revises the management plan; and

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

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

(A) the patient; and

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

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

(f) in the preceding 12 months, a service to which this item or item 359 applies has not been provided

296.20

296

Professional attendance lasting more than 45 minutes by a consultant physician in the practice of the consultant physician’s speciality of psychiatry following referral of the patient to the consultant physician by a referring practitioner—an attendance at consulting rooms if the patient:

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

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

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

272.50

297

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

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

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

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

272.50

299

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

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

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

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

325.80

300

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

45.35

302

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

90.50

304

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

139.30

306

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

192.25

308

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

223.10

310

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

22.60

312

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

45.35

314

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

69.80

316

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

96.25

318

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

  1. (a)

    an audiologist;

  2. (b)

    an occupational therapist;

  3. (c)

    an optometrist;

  4. (d)

    an orthoptist;

  5. (e)

    a physiotherapist;

  6. (f)

    a psychologist;

  7. (g)

    a speech pathologist.

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 unitmeans an area within a hospital that:

  1. (a)

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

    1. (i)

      mechanical ventilation for a period of several days; and

    2. (ii)

      invasive cardiovascular monitoring; and

  2. (b)

    is supported by:

    1. (i)

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

    2. (ii)

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

    3. (iii)

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

  3. (c)

    has admission and discharge policies in operation.

general practicemeans 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:

  1. (a)

    the patient either:

    1. (i)

      is suffering a life‑threatening acute illness or injury; or

    2. (ii)

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

  2. (b)

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

  3. (c)

    either:

    1. (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

    2. (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:

  1. (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

  2. (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.

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

intensive care unitmeans 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:

  1. (a)

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

  2. (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:

  1. (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

  2. (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:

  1. (a)

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

  2. (b)

    satisfies any of the following criteria:

    1. (i)

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

    2. (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;

    3. (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

  3. (c)

    is not a Modified Monash 7 area.

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

  1. (a)

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

  2. (b)

    satisfies any of the following criteria:

    1. (i)

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

    2. (ii)

      the area is in an Urban Centre and Locality, the geographic centre of which is no more than 15 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;

    3. (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

  3. (c)

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

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

  1. (a)

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

  2. (b)

    satisfies any of the following criteria:

    1. (i)

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

    2. (ii)

      the area is in an Urban Centre and Locality, the geographic centre of which is no more than 10 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;

    3. (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

  3. (c)

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

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

  1. (a)

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

  2. (b)

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

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

  1. (a)

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

  2. (b)

    is not a Modified Monash 7 area.

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

  1. (a)

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

  2. (b)

    is located on Magnetic Island; or

  3. (c)

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

motion segment has the meaning given by clause 5.10.29.

multidisciplinary care plan:

  1. (a)

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

  2. (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 unitmeans a separate hospital area that:

  1. (a)

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

    1. (i)

      mechanical ventilation for a period of several days; and

    2. (ii)

      invasive cardiovascular monitoring; and

  2. (b)

    is supported by:

    1. (i)

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

    2. (ii)

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

    3. (iii)

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

  3. (c)

    has admission and discharge policies in operation.

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

non‑medicare servicemeans any of the following:

  1. (a)

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

  2. (b)

    gamma knife surgery;

  3. (c)

    intradiscal electro thermal arthroplasty;

  4. (d)

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

  5. (e)

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

  6. (f)

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

  7. (g)

    lung volume reduction surgery, for advanced emphysema;

  8. (h)

    photodynamic therapy, for skin and mucosal cancer;

  9. (i)

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

  10. (j)

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

  11. (k)

    specific mass measurement of bone alkaline phosphatise;

  12. (l)

    transmyocardial laser revascularisation;

  13. (m)

    vertebral axial decompression therapy, for chronic back pain;

  14. (n)

    autologous chondrocyte implantation and matrix‑induced autologous chondrocyte implantation;

  15. (o)

    vertebroplasty;

  16. (p)

    extracorporeal magnetic innervation.

NOSE Scale has the meaning given by clause 5.10.21.

open reductionmeans treatment of a dislocation or fracture by either:

  1. (a)

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

  2. (b)

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

organise and coordinate:

  1. (a)

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

  2. (b)

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

  3. (c)

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

  4. (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:

  1. (a)

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

  2. (b)

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

  3. (c)

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

  4. (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:

  1. (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

  2. (b)

    the specialist or consultant physician is providing the service:

    1. (i)

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

    2. (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:

  1. (a)

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

  2. (b)

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

  3. (c)

    located at a medical practice that:

    1. (i)

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

    2. (ii)

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

person with a chronic disease, for item 10997, has the meaning given by clause 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 midwifehas the meaning given by clause 5.5.2.

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

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

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:

  1. (a)

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

  2. (b)

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

  3. (c)

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

  4. (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:

    1. (i)

      members of the patient’s family;

    2. (ii)

      other persons who provide care for the patient;

    3. (iii)

      other health practitioners;

  5. (e)

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

  6. (f)

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

  7. (g)

    recording the agreed goals so that:

    1. (i)

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

    2. (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:

  1. (a)

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

  2. (b)

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

    1. (i)

      x‑rays;

    2. (ii)

      computed tomography;

    3. (iii)

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

  3. (c)

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

recognised emergency department 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 areameans either of the following:

  1. (a)

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

  2. (b)

    Norfolk Island.

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

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

residential aged care facilitymeans 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:

  1. (a)

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

  2. (b)

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

Rural, Remote and Metropolitan Areas Classificationmeans 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 arrangementsmeans a plan under item 723 or 732 (for a review of team care arrangements under item 723).

telehealth eligible areameans an area classified as a telehealth eligible area by the Minister, 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 hoursmeans 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 1About the endnotes

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

The following endnotes are included in every compilation:

Endnote 1—About the endnotes

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history

Abbreviation key—Endnote 2

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

Legislation history and amendment history—Endnotes 3 and 4

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

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

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

Editorial changes

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

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

Misdescribed amendments

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

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

Endnote 2Abbreviation key

ad = added or inserted

o = order(s)

am = amended

Ord = Ordinance

amdt = amendment

orig = original

c = clause(s)

par = paragraph(s)/subparagraph(s)

C[x] = Compilation No. x

/sub‑subparagraph(s)

Ch = Chapter(s)

pres = present

def = definition(s)

prev = previous

Dict = Dictionary

(prev…) = previously

disallowed = disallowed by Parliament

Pt = Part(s)

Div = Division(s)

r = regulation(s)/rule(s)

ed = editorial change

reloc = relocated

exp = expires/expired or ceases/ceased to have

renum = renumbered

effect

rep = repealed

F = Federal Register of Legislation

rs = repealed and substituted

gaz = gazette

s = section(s)/subsection(s)

LA = Legislation Act 2003

Sch = Schedule(s)

LIA = Legislative Instruments Act 2003

Sdiv = Subdivision(s)

(md) = misdescribed amendment can be given

SLI = Select Legislative Instrument

effect

SR = Statutory Rules

(md not incorp) = misdescribed amendment

Sub‑Ch = Sub‑Chapter(s)

cannot be given effect

SubPt = Subpart(s)

mod = modified/modification

underlining = whole or part not

No. = Number(s)

commenced or to be commenced

Endnote 3Legislation history

Name

Registration

Commencement

Application, saving and transitional provisions

Health Insurance (General Medical Services Table) Regulations (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 4Amendment 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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