Health Insurance Legislation Amendment (2020 Measures No. 2) Regulations 2020 (Cth)

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Health Insurance Legislation Amendment (2020 Measures No. 2) Regulations 2020

I, General the Honourable David Hurley AC DSC (Retd), Governor‑General of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, make the following regulations.

Dated 15 October 2020

David Hurley

Governor‑General

By His Excellency’s Command

Greg Hunt

Minister for Health

Contents

1Name

This instrument is the Health Insurance Legislation Amendment (2020 Measures No. 2) Regulations 2020.

2Commencement
  1. (1)

    Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.

Commencement information

Column 1

Column 2

Column 3

Provisions

Commencement

Date/Details

1.

The whole of this instrument

1 November 2020.

1 November 2020

Note: This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.

  1. (2)

    Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.

3Authority

This instrument is made under the Health Insurance Act 1973.

4Schedules

Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.

Schedule 1—Amendments

Part 1Chemotherapy services

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

1

Subclause 1.2.11(1) of Schedule 1

Omit “13915 to 13948,”.

2

Schedule 1 (items 13915 to 13948)

Repeal the items, substitute:

13950

Parenteral administration of one or more antineoplastic agents, including agents used in cytotoxic chemotherapy or monoclonal antibody therapy but not agents used in anti‑resorptive bone therapy or hormonal therapy, by or on behalf of a specialist or consultant physician—attendance for one or more episodes of administration

111.40

3

Schedule 1 (item 14221)

Omit “13945”, substitute “13950”.

Part 2Blood product services

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

4

Subclause 1.2.11(1) of Schedule 1

Omit “13709,”.

5

Schedule 1 (item 13703)

Omit “donor”, substitute “donor, when used for intra‑operative normovolaemic haemodilution”.

6

Schedule 1 (item 13709)

Repeal the item.

7

Schedule 1 (cell at item 13760, column 2)

Repeal the cell, substitute:

In vitro processing with cryopreservation of bone marrow or peripheral blood, for autologous stem cell transplantation for a patient receiving high‑dose chemotherapy for management of:

(a) aggressive malignancy; or

(b) malignancy that has proven refractory to prior treatment

Part 3Neurology and neurosurgery services

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

8

Subclause 1.2.11(1) of Schedule 1

Omit “11006,”.

  1. 9

    Schedule 1 (item 11000, column 2, paragraph (a))

Omit “11003, 11006”, substitute “11003”.

10

Schedule 1 (cell at item 11003, column 2)

Repeal the cell, substitute:

Electroencephalography, prolonged recording lasting at least 3 hours, that requires multi‑channel recording using:

(a) for a service not associated with a service to which an item in Group T8 applies—standard 10‑20 electrode placement; or

(b) for a service associated with a service to which an item in Group T8 applies—either standard 10‑20 electrode placement or a different electrode placement and number of recorded channels;

other than a service:

(c) associated with a service to which item 11000, 11004 or 11005 applies; or

(d) involving quantitative topographic mapping using neurometrics or similar devices

11

Schedule 1 (cell at item 11004, column 2)

Repeal the cell, substitute:

Electroencephalography, ambulatory or video, prolonged recording lasting at least 3 hours and up to 24 hours, that requires multi‑channel recording using standard10‑20 electrode placement, first day, other than a service:

(a) associated with a service to which item 11000, 11003 or 11005 applies; or

(b) involving quantitative topographic mapping using neurometrics or similar devices

12

Schedule 1 (item 11005, column 2)

Repeal the cell, substitute:

Electroencephalography, ambulatory or video, prolonged recording lasting at least 3 hours and up to 24 hours, that requires multi‑channel recording using standard 10‑20 electrode placement, each day after the first day, other than a service:

(a) associated with a service to which item 11000, 11003 or 11004 applies; or

(b) involving quantitative topographic mapping using neurometrics or similar devices

13

Schedule 1 (item 11006)

Repeal the item.

14

Schedule 1 (cell at item 11009, column 3)

Repeal the cell, substitute:

335.85

15

Clause 5.2.7 of Schedule 1 (heading)

Omit “14242”, substitute “14237”.

16

Clause 5.2.7 of Schedule 1

Omit “14242”, substitute “14237”.

17

Schedule 1 (items 14230 to 14242)

Repeal the items, substitute:

14234

Infusion pump or components of an infusion pump, removal or replacement of, and connection to intrathecal or epidural catheter, and loading of reservoir with baclofen, with or without programming of the pump, for the management of severe chronic spasticity (H) (Anaes.)

373.20

14237

Infusion pump or components of an infusion pump, subcutaneous implantation of, and intrathecal or epidural spinal catheter insertion, and connection of pump to catheter, and loading of reservoir with baclofen, with or without programming of the pump, for the management of severe chronic spasticity (H) (Anaes.)

680.55

18

Before clause 5.10.19 of Schedule 1

Insert:

5.10.19ARestrictions on items 39015, 39503, 39906 and 40104—services provided with intracranial stereotactic procedure

Items 39015, 39503, 39906 and 40104 do not apply to a service if the service is provided in conjunction with the service described in item 40803.

19

Schedule 1 (items 39003 to 39012)

Repeal the items, substitute:

39007

Procedure to obtain access to intracranial space (including subdural space, ventricle or basal cistern), percutaneously or by burr‑hole (Anaes.)

164.40

20

Schedule 1 (cell at item 39015, column 2)

Repeal the cell, substitute:

Intracranial parenchymal pressure monitoring device, insertion of—including burr‑hole (excluding after‑care) (H) (Anaes.)

21

Schedule 1 (item 39018)

Repeal the item, substitute:

39018

Cerebrospinal reservoir, ventricular reservoir or external ventricular drain, insertion of, with or without stereotaxy (H) (Anaes.)

852.50

22

Schedule 1 (items 39106 and 39109)

Repeal the items, substitute:

39109

Trigeminal gangliotomy by radiofrequency, balloon or glycerol, including stereotaxy (Anaes.)

1,461.90

23

Schedule 1 (item 39112)

Repeal the item, substitute:

39113

Cranial nerve, neurectomy or intracranial decompression of, using microsurgical techniques, including stereotaxy and cranioplasty (H) (Anaes.)

2,452.40

24

Schedule 1 (item 39500)

Repeal the item.

25

Schedule 1 (items 39600 to 39609)

Repeal the items, substitute:

39604

Any of the following procedures for intracranial haemorrhage or swelling:

(a) craniotomy, craniectomy or burr‑holes for removal of intracranial haemorrhage, including stereotaxy;

(b) craniotomy or craniectomy for brain swelling, stroke or raised intracranial pressure, including for subtemporal decompression, including stereotaxy;

(c) post‑operative re‑opening, including for swelling or post‑operative cerebrospinal fluid leak

(H) (Anaes.) (Assist.)

1,849.60

39610

Fractured skull, without brain laceration or dural penetration, repair of (H) (Anaes.) (Assist.)

984.85

26

Schedule 1 (item 39612, column 2)

Omit “compound, depressed or complicated, with dural penetration and brain laceration, operation for”, substitute “with brain laceration or dural penetration but without cerebrospinal fluid, rhinorrhoea or otorrhoea, repair of,”.

27

Schedule 1 (items 39615 to 39812)

Repeal the items, substitute:

39615

Fractured skull, after trauma, with cerebrospinal fluid, rhinorrhoea or otorrhoea, repair of, including stereotaxy and dermofat graft (H) (Anaes.) (Assist.)

1, 971.75

39638

Anterior or middle cranial fossa or cavernous sinus, tumour or vascular lesion, removal or radical excision of, including stereotaxy and cranioplasty—conjoint surgery, principal surgeon (H) (Anaes.) (Assist.)

4,390.15

39639

Anterior or middle cranial fossa or cavernous sinus, tumour or vascular lesion, removal or radical excision of, including stereotaxy and cranioplasty—conjoint surgery, co‑surgeon (H) (Assist.)

3,508.20

39641

Anterior or middle cranial fossa or cavernous sinus, tumour or vascular lesion, removal or radical excision of, including stereotaxy and cranioplasty—one surgeon (H) (Anaes.) (Assist.)

4,630.50

39651

Petro‑clival, clival or foramen magnum tumour or vascular lesion, removal or radical excision of, including stereotaxy and cranioplasty—one surgeon (H) (Anaes.) (Assist.)

5,712.85

39654

Petro‑clival, clival or foramen magnum tumour or vascular lesion, removal or radical excision of, including stereotaxy and cranioplasty—conjoint surgery, principal surgeon (H) (Anaes.) (Assist.)

4,390.15

39656

Petro‑clival, clival or foramen magnum tumour or vascular lesion, removal or radical excision of, including stereotaxy and cranioplasty—conjoint surgery, co‑surgeon (H) (Assist.)

3,508.20

39700

Skull tumour, benign or malignant, excision of, including stereotaxy and cranioplasty (H) (Anaes.) (Assist.)

1,869.00

39703

Intracranial tumour, cyst or other brain tissue, either or both of the following:

(a) burr‑hole and biopsy of;

(b) drainage of;

including stereotaxy (H) (Anaes.) (Assist.)

1,500.70

39710

Intracranial tumour, one or more, biopsy, drainage, decompression or removal of, through a single craniotomy, including stereotaxy and cranioplasty (H) (Anaes.) (Assist.)

2,499.10

39712

Transcranial tumour, removal or biopsy of one or more of any of the following:

(a) meningioma;

(b) pinealoma;

(c) cranio‑pharyngioma;

(d) pituitary tumour;

(e) intraventricular lesion;

(f) brain stem lesion;

(g) any other intracranial tumour;

by any means (with or without endoscopy), through a single craniotomy, including stereotaxy and cranioplasty (H) (Anaes.) (Assist.)

3,817.30

39715

Pituitary tumour, removal of, by transphenoidal approach, including stereotaxy and dermis, dermofat or fascia grafting, other than a service associated with a service to which item 40600 applies (H) (Anaes.) (Assist.)

2,786.00

39718

Arachnoidal cyst, craniotomy for, including stereotaxy and neuroendoscopy (H) (Anaes.) (Assist.)

1,682.90

39720

Awake craniotomy for functional neurosurgery (H) (Anaes.) (Assist.)

3,571.05

39801

Aneurysm, clipping, proximal ligation, or reinforcement of sac, including stereotaxy and cranioplasty (H) (Anaes.) (Assist.)

5,712.85

39803

Intracranial arteriovenous malformation or fistula, treatment through a craniotomy, including stereotaxy, cranioplasty and all angiography (H) (Anaes.) (Assist.)

5,712.85

28

Schedule 1 (items 39818 to 40015)

Repeal the items, substitute:

39818

Intracranial vascular bypass using indirect techniques, including stereotaxy (H) (Anaes.) (Assist.)

2,500.95

39821

Intracranial vascular bypass using direct anastomosis techniques, including stereotaxy (H) (Anaes.) (Assist.)

3,563.35

39900

Intracranial infection, treated by burr‑hole, including stereotaxy, other than a service associated with a service to which item 40600 applies (H) (Anaes.) (Assist.)

1,500.70

39903

Intracranial infection, treated by craniotomy, including stereotaxy, other than a service associated with a service to which item 40600 applies (H) (Anaes.) (Assist.)

2,252,90

39906

Osteomyelitis of skull or removal of infected bone flap, craniectomy for, other than a service associated with a service to which item 40600 applies (H) (Anaes.) (Assist.)

822.00

40004

Ventricular, lumbar or cisternal shunt diversion, insertion or revision of, including stereotaxy (H) (Anaes.) (Assist.)

1,706.15

40012

Endoscopic ventriculostomy for treatment of cerebrospinal fluid circulation disorders, including stereotaxy (H) (Anaes.) (Assist.)

1,764.30

29

Schedule 1 (items 40100 to 40118)

Repeal the items, substitute:

40104

Spinal myelomeningocele or spinal meningocele, excision and closure of, other than a service associated with a service to which item 40600 applies (H) (Anaes.) (Assist.)

1,046.95

40106

Chiari malformation, decompression or reconstruction of, including laminectomy, dermofat graft and stereotaxy, other than a service associated with a service to which item 40600 applies (H) (Anaes.) (Assist.)

2,485.45

40109

Encephalocoele or cranial meningocele, excision and closure of, including stereotaxy and dermofat graft (H) (Anaes.) (Assist.)

1,929.05

40112

Tethered cord, release of, including lipomeningocele or diastematomyelia, multiple levels, including laminectomy and rhizolysis, other than a service associated with a service to which item 40600 applies (H) (Anaes.) (Assist.)

2,464.15

40119

Craniostenosis, operation for, other than a service associated with a service to which item 40600 applies (H) (Anaes.) (Assist.)

984.85

30

Schedule 1 (cell at item 40600, column 2)

Repeal the cell, substitute:

Cranioplasty, reconstructive, other than a service associated with a service to which item 39113, 39638, 39639, 39641, 39651, 39654, 39656, 39700, 39710, 39712, 39715, 39801, 39803 or 40703 applies (H) (Anaes.) (Assist.)

31

Schedule 1 (item 40700)

Repeal the item, substitute:

40700

Corpus callosotomy, for epilepsy, including stereotaxy (H) (Anaes.) (Assist.)

2,415.70

32

Schedule 1 (item 40703)

Repeal the item, substitute:

40703

Corticectomy, topectomy or partial lobectomy, for epilepsy, including stereotaxy and cranioplasty (H) (Anaes.) (Assist.)

2,499.10

33

Schedule 1 (item 40706)

Repeal the item, substitute:

40706

Hemispherectomy or functional hemispherectomy, for intractable epilepsy, including stereotaxy (H) (Anaes.) (Assist.)

3,571.10

34

Schedule 1 (items 40709 and 40712)

Repeal the items, substitute:

40709

Intracranial electrode placement by burr‑hole, including stereotaxy (H) (Anaes.) (Assist.)

1,500.70

40712

Intracranial electrode placement by craniotomy, single or multiple, including stereotactic EEG, including stereotaxy (H) (Anaes.) (Assist.)

3,571.10

35

Schedule 1 (item 40800)

Repeal the item.

36

Schedule 1 (item 40801, column 2)

Omit “lesion production”, substitute “lesion production, by any method,”.

37

Schedule 1 (cell at item 40803, column 2)

Repeal the cell, substitute:

Intracranial stereotactic procedure by any method, other than:

(a) a service to which item 40801 applies; or

(b) a service associated with a service to which item 39018, 39109, 39113, 39604, 39615, 39638, 39639, 39641, 39651, 39654, 39656, 39700, 39703, 39710, 39712, 39715, 39718, 39720, 39801, 39803, 39818, 39821, 39900, 39903, 40004, 40012, 40106, 40109, 40700, 40703, 40706, 40709 or 40712 applies

(Anaes.) (Assist.)

38

Schedule 1 (item 40903)

Repeal the item.

39

Schedule 1 (cell at item 40905, column 2)

Repeal the cell, substitute:

Craniotomy, performed by a neurosurgeon in conjunction with the correction of craniofacial abnormalities (H) (Anaes.) (Assist.)

40

Schedule 1 (cell at item 45018, column 2)

Repeal the cell, substitute:

Dermis, dermofat or fascia graft (other than transfer of fat by injection):

(a) if the service is not associated with neurosurgical services for spinal disorders mentioned in any of items 51011 to 51171; and

(b) other than a service associated with a service to which item 39615, 39715, 40106 or 40109 applies

(Anaes.) (Assist.)

Part 4Urology services

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

41

Schedule 1 (item 11919)

Omit “electromyography; including all imaging associated with cystometrography”, substitute “electromyography, being a service associated with a service to which item 60506 or 60509 applies”.

42

Schedule 1 (item 30450)

Omit “36627, 36630, 36645 or 36648”, substitute “36627 or 36645”.

43

Schedule 1 (after item 30628)

Insert:

30629

Orchidectomy, radical, including spermatic cord, unilateral, for tumour, inguinal approach, without insertion of testicular prosthesis, other than a service associated with a service to which item 30631, 30635, 30641, 30643 or 30644 applies (H) (Anaes.) (Assist.)

537.55

30630

Insertion of testicular prosthesis, at least 6 months after orchidectomy (H) (Assist.) (Anaes.)

244.30

44

Schedule 1 (item 30635)

Omit “other than a service associated with a service to which item”, substitute “including microsurgical techniques, other than a service associated with a service to which item 30390, 30627,”.

45

Schedule 1 (items 30642 to 30644)

Repeal the items, substitute:

30642

Orchidectomy, radical, including spermatic cord, unilateral, for tumour, inguinal approach, with insertion of testicular prosthesis, other than a service associated with a service to which item 30631, 30635, 30641, 30643, 30644 or 45051 applies (H) (Anaes.) (Assist.)

781.85

30643

Exploration of spermatic cord, inguinal approach, with or without testicular biopsy, with or without excision of spermatic cord lesion, for a patient under 10 years of age, other than a service associated with a service to which item 30629, 30630 or 30642 applies (H) (Anaes.) (Assist.)

698.85

30644

Exploration of spermatic cord, inguinal approach, with or without testicular biopsy, with or without excision of spermatic cord lesion, for a patient at least 10 years of age, other than a service associated with a service to which item 30629, 30630 or 30642 applies (H) (Anaes.) (Assist.)

537.55

46

Schedule 1 (item 30654)

Omit “penis (other than a service to which item 30658 applies)”, substitute “penis, with topical or local analgesia, other than a service to which item 30658 applies”.

47

Schedule 1 (item 30658)

After “performed”, insert “under general or regional anaesthesia and”.

48

Schedule 1 (item 35551)

Repeal the item, substitute:

35551

Pelvic lymph nodes, radical excision of, unilateral, or sentinel node dissection (including any pre‑operative injection) (H) (Anaes.) (Assist.)

953.60

35552

Pelvic lymph nodes, radical excision of, unilateral, following previous similar dissection, radiation or chemotherapy (H) (Anaes.) (Assist.)

1,434.60

49

Schedule 1 (item 35599)

Repeal the item, substitute:

35599

Stress incontinence, procedure using a female synthetic mid‑urethral sling, with diagnostic cystoscopy to assess the integrity of the lower urinary tract, other than a service associated with a service to which item 30405 or 36812 applies (H) (Anaes.) (Assist.)

781.55

50

Schedule 1 (item 36516)

Omit “complete”, substitute “complete, by open, laparoscopic or robot‑assisted approach, other than a service associated with a service to which item 30390 or 30627 applies”.

51

Schedule 1 (item 36519)

Omit “complete, complicated by previous surgery on the same kidney”, substitute “complete, by open, laparoscopic or robot‑assisted approach, complicated by previous surgery on the same kidney, other than a service associated with a service to which item 30390 or 30627 applies”.

52

Schedule 1 (item 36522)

Omit “partial”, substitute “partial, by open, laparoscopic or robot‑assisted approach, other than a service associated with a service to which item 30390 or 30627 applies”.

53

Schedule 1 (cell at item 36525, column 2)

Repeal the cell, substitute:

Nephrectomy, partial, by open, laparoscopic or robot‑assisted approach:

(a) if complicated by previous surgery or ablative procedure on the same kidney; or

(b) for a patient with a solitary functioning kidney; or

(c) for a patient with an estimated glomerular filtration rate (eGFR) of less than 60ml/min/1.73m2;

other than a service associated with a service to which item 30390 or 30627 applies (H) (Anaes.) (Assist.)

54

Schedule 1 (items 36526 and 36527)

Repeal the items.

55

Schedule 1 (cell at item 36528, column 2)

Repeal the cell, substitute:

Nephrectomy, radical, by open, laparoscopic or robot‑assisted approach, with or without en bloc dissection of lymph nodes, with or without adrenalectomy, for a tumour less than 10 cm in diameter, other than a service associated with a service to which item 30390 or 30627 applies (H) (Anaes.) (Assist.)

56

Schedule 1 (cell at item 36529, column 2)

Repeal the cell, substitute:

Nephrectomy, radical, by open, laparoscopic or robot‑assisted approach, with or without en bloc dissection of lymph nodes, with or without adrenalectomy:

(a) for a tumour 10 cm or more in diameter; or

(b) if complicated by previous open or laparoscopic surgery on the same kidney;

other than a service associated with a service to which item 30390 or 30627 applies (H) (Anaes.) (Assist.)

57

Schedule 1 (cell at item 36531, column 2)

Repeal the cell, substitute:

Nephroureterectomy, complete, by open, laparoscopic or robot‑assisted approach, including associated bladder repair and any associated endoscopic procedure, other than a service associated with a service to which item 30390 or 30627 applies (H) (Anaes.) (Assist.)

58

Schedule 1 (cell at item 36532, column 2)

Repeal the cell, substitute:

Nephroureterectomy, for tumour, by open, laparoscopic or robot‑assisted approach, with or without en bloc dissection of lymph nodes, including associated bladder repair and any associated endoscopic procedures, other than a service to which item 36533 applies or a service associated with a service to which item 30390 or 30627 applies (H) (Anaes.) (Assist.)

59

Schedule 1 (cell at item 36533, column 2)

Repeal the cell, substitute:

Nephroureterectomy, for tumour, by open, laparoscopic or robot‑assisted approach, with or without en bloc dissection of lymph nodes, including associated bladder repair and any associated endoscopic procedures, if complicated by previous open or laparoscopic surgery on the same kidney or ureter, other than a service associated with a service to which item 30390 or 30627 applies (H) (Anaes.) (Assist.)

60

Schedule 1 (item 36540)

Repeal the item.

61

Schedule 1 (cell at item 36543, column 2)

Repeal the cell, substitute:

Nephrolithotomy or pyelolithotomy, or both, extended, for one or more renal stones, including one or more of nephrostomy, pyelostomy, pedicle control with or without freezing, calyorrhaphy or pyeloplasty (Anaes.) (Assist.)

62

Schedule 1 (item 36549)

Omit “Ureterolithotomy”, substitute “Ureterolithotomy, by open, laparoscopic or robot‑assisted approach”.

63

Schedule 1 (item 36561)

Omit “biopsy”, substitute “biopsy, performed under image guidance”.

64

Schedule 1 (item 36564)

Omit “open exposure, laparoscopy or laparoscopic assisted techniques”, substitute “open, laparoscopic or robot‑assisted approach, with or without the use of a retroperitoneal approach”.

65

Schedule 1 (items 36567 and 36570)

Omit “open exposure”, substitute “open, laparoscopic or robot‑assisted approach, with or without the use of a retroperitoneal approach”.

66

Schedule 1 (cell at item 36576, column 2)

Repeal the cell, substitute:

Kidney, exposure and exploration of, including repair or nephrectomy, for trauma, by open, laparoscopic or robot‑assisted approach, other than a service associated with:

(a) any other procedure performed on the kidney, renal pelvis or renal pedicle; or

(b) a service to which item 30390 or 30627 applies

(H) (Anaes.) (Assist.)

67

Schedule 1 (cell at item 36579, column 2)

Repeal the cell, substitute:

Ureterectomy, complete or partial:

(a) for a tumour within the ureter, proven by histopathology at the time of surgery; or

(b) for congenital anomaly;

with or without associated bladder repair (H) (Anaes.) (Assist)

68

Schedule 1 (item 36604)

Omit “imaging techniques”, substitute “radiology techniques, but not including imaging”.

69

Schedule 1 (item 36605)

Repeal the item.

70

Schedule 1 (item 36607)

Omit “imaging techniques”, substitute “radiology techniques, but not including imaging”.

71

Schedule 1 (item 36608)

Omit “imaging techniques”, substitute “radiology techniques, but not including imaging”.

72

Schedule 1 (item 36609)

Omit “conduit or”, substitute “conduit, reservoir or”.

73

Schedule 1 (after item 36609)

Insert:

36610

Intestinal urinary conduit, incontinent, formation of (including associated small bowel resection and anastomosis), including implantation of one or both ureters into reservoir (H) (Anaes.) (Assist.)

1,830.50

36611

Intestinal urinary reservoir, continent, formation of (including associated small bowel resection and anastomosis), including formation of non‑return valves and implantation of one or both ureters into reservoir, performed by open, laparoscopic or robot‑assisted approach (H) (Anaes.) (Assist.)

2,887.20

74

Schedule 1 (cell at item 36615, column 2)

Repeal the cell, substitute:

Ureterolysis, unilateral, with or without repositioning of the ureter, for obstruction of the ureter, if:

(a) the obstruction:

(i) is evident either radiologically or by proximal ureteric dilatation at operation; and

(ii) is secondary to retroperitoneal fibrosis; and

(b) there is biopsy proven fibrosis, endometriosis or cancer at the site of the obstruction at time of surgery

(H) (Anaes.) (Assist.)

75

Schedule 1 (item 36624)

Omit “imaging techniques”, substitute “radiology techniques, but not including imaging”.

76

Schedule 1 (item 36627)

Omit “36639, 36642, 36645 or 36648”, substitute “36639 or 36645”.

77

Schedule 1 (item 36630)

Repeal the item.

78

Schedule 1 (items 36633 and 36636)

Omit “36639, 36642, 36645 or 36648”, substitute “36639 or 36645”.

79

Schedule 1 (item 36639)

Omit “lasers (other than a service to which item 36645 or 36648 applies)”, substitute “lasers, other than a service to which item 36645 applies”.

80

Schedule 1 (items 36642 and 36648)

Repeal the items.

81

Schedule 1 (item 36649)

Omit “exchange of—but not including”, substitute “exchange of, using interventional radiology techniques, but not including”.

82

Schedule 1 (item 36650)

Omit “imaging techniques”, substitute “radiology techniques, but not including imaging”.

83

Schedule 1 (item 36803)

Omit “36824, 36848 or 36857”, substitute “36824 or 36848”.

84

Schedule 1 (cell at item 36806, column 2)

Repeal the cell, substitute:

Ureteroscopy, of one ureter:

(a) with or without one or more of the following:

(i) cystoscopy;

(ii) endoscopic incision of pelviureteric junction or ureteric stricture;

(iii) ureteric meatotomy;

(iv) ureteric dilatation; and

(b) with either or both of the following:

(i) extraction of stone from the ureter;

(ii) biopsy or diathermy of the ureter;

other than:

(c) a service associated with a service to which item 36803 or 36812 applies; or

(d) a service associated with a service, performed on the same ureter, to which item 36809, 36824 or 36848 applies

(H) (Anaes.) (Assist.)

85

Schedule 1 (item 36809)

Omit “36824, 36848 or 36857”, substitute “36824 or 36848”.

86

Schedule 1 (cell at item 36811, column 2)

Repeal the cell, substitute:

Cystoscopy, with insertion of one or more urethral or prostatic prostheses, other than a service associated with a service to which item 37203, 37207 or 37230 applies (Anaes.)

87

Schedule 1 (cell at item 36812, column 2)

Repeal the cell, substitute:

Either or bothof cystoscopyand urethroscopy, with or without urethral dilatation, other than a service associated with any other urological endoscopic procedure on the lower urinary tract (Anaes.)

88

Schedule 1 (cell at item 36818, column 2)

Repeal the cell, substitute:

Cystoscopy, with ureteric catheterisation, unilateral or bilateral, guided by fluoroscopic imaging of the upper urinary tract, other than a service associated with a service to which item 36824 or 36830 applies (Anaes.)

89

Schedule 1 (item 36821)

Omit “unilateral, other than a service associated with a service to which item 36824 or 36830 applies”, substitute “unilateral”.

90

Schedule 1 (after item 36821)

Insert:

36822

Cystoscopy, with ureteric catheterisation, unilateral:

(a) guided byfluoroscopic imaging of the upper urinary tract; and

(b) including one or more of ureteric dilatation, insertion of ureteric stent, or brush biopsy of ureter or of renal pelvis;

other than a service associated with a service to which item 36818, 36821 or 36830 applies (Anaes.) (Assist.)

475.95

36823

Cystoscopy, with removal of ureteric stent and ureteric catheterisation, unilateral:

(a) guided byfluoroscopic imaging of the upper urinary tract; and

(b) including either or both of the following:

(i) ureteric dilatation;

(ii) insertion of ureteric stent of ureter or of renal pelvis;

other than a service associated with a service to which item 36818, 36821, 36830 or 36833 applies (Anaes.) (Assist.)

547.25

91

Schedule 1 (item 36824)

Omit “or 36821”.

92

Schedule 1 (item 36825)

Repeal the item.

93

Schedule 1 (item 36827)

Omit “bladder”, substitute “bladder, other than a service associated with a service to which item 37011 or 37245 applies”.

94

Schedule 1 (item 36833)

Omit “body (Anaes.) (Assist.)”, substitute “body in the lower urinary tract, unilateral (Anaes.)”.

95

Schedule 1 (cell at item 36840, column 2)

Repeal the cell, substitute:

Cystoscopy, with diathermy, resection or visual laser destruction of bladder tumour or other lesion of the bladder, for:

(a) a tumour or lesion in only one quadrant of the bladder; or

(b) a solitary tumour of not more than 2 cm in diameter;

other than a service associated with a service to which item 36845 applies (Anaes.)

96

Schedule 1 (cell at item 36842, column 2)

Repeal the cell, substitute:

Cystoscopy, with lavage of blood clots from bladder, including any associated cautery of prostate or bladder, other than a service associated with a service to which any of items 36812, 36827 to 36863, 37203, 37206, 37230 and 37233 apply (H) (Anaes.)

97

Schedule 1 (cell at item 36845, column 2)

Repeal the cell, substitute:

Cystoscopy, with diathermy, resection or visual laser destruction of:

(a) multiple tumours in 2 or more quadrants of the bladder; or

(b) a solitary bladdertumour of more than 2 cm in diameter

(Anaes.)

98

Schedule 1 (item 36857)

Repeal the item.

99

Schedule 1 (item 36863)

Omit “(Assist.)”.

100

Schedule 1 (cell at item 37008, column 2)

Repeal the cell, substitute:

Open cystostomy or cystotomy, suprapubic, other than:

(a) a service to which item 37011 applies; or

(b) a service associated with a service to which item 37245 applies; or

(c) another open bladder procedure

(Anaes.) (Assist.)

101

Schedule 1 (item 37011)

Omit “items 37200 to 37221 or 37226 apply”, substitute “item 36827 applies”.

102

Schedule 1 (after item 37014)

Insert:

37015

Bladder, total excision of, following previous open, laparoscopic or robot‑assisted surgery, or radiation therapy or chemotherapy, to the pelvis (H) (Anaes.) (Assist.)

1,319.50

37016

Cystectomy, including prostatectomy and pelvic lymph node dissection, other than a service associated with a service to which item 37000, 37014, 37015, 37209, 35551 or 36502 applies (H) (Anaes) (Assist)

2,057.55

37018

Cystectomy, including prostatectomy and pelvic lymph node dissection, following previous open, laparoscopic or robot‑assisted surgery, or radiation therapy or chemotherapy, to the pelvis, other than a service associated with a service to which item 37000, 37014, 37015, 37016, 37209, 35551 or 36502 applies (H) (Anaes.) (Assist.)

3,086.35

37019

Cystectomy, including anterior exenteration and pelvic lymph node dissection, other than a service associated with a service to which any of items 37000, 37014, 37015, 35551, 36502 and 35653 to 35756 apply (H) (Anaes.) (Assist.)

2,055.20

103

Schedule 1 (after item 37020)

Insert:

37021

Cystectomy, including anterior exenteration and pelvic lymph node dissection, following previous open, laparoscopic or robot‑assisted surgery, or radiation therapy or chemotherapy, to the pelvis, other than a service associated with a service to which any of items 37000, 37014, 37015, 35551, 36502 and 35653 to 35756 apply (H) (Anaes.) (Assist.)

3,082.80

104

Schedule 1 (after item 37038)

Insert:

37039

Bladder stress incontinence, sling procedure for, using a non‑autologous biological sling (H) (Anaes.) (Assist.)

695.60

105

Schedule 1 (cell at item 37040, column 2)

Repeal the cell, substitute:

Bladder stress incontinence, sling procedure for, using a non‑adjustable synthetic male sling system, other than a service associated with a service to which item 30405 or 37042 applies (H) (Anaes.) (Assist.)

106

Schedule 1 (items 37042, 37043 and 37044)

Omit “with or without mesh,”.

107

Schedule 1 (after item 37045)

Insert:

37046

Suprapubic or perineal procedure for excision of graft material, either singly or in multiple pieces, for a symptomatic patient with graft related complications (including graft related pain or discharge and bleeding related to graft exposure), if not more than one service to which this item applies has been provided to the patient by the same practitioner in the preceding 12 months (H) (Anaes.) (Assist.)

714.05

108

Schedule 1 (after item 37047)

Insert:

37048

Bladder neck closure for the management of urinary incontinence (H) (Anaes.) (Assist.)

953.60

109

Schedule 1 (item 37200)

Omit “open”, substitute “by open, laparoscopic or robot‑assisted approach”.

110

Schedule 1 (item 37203)

Omit “Prostatectomy (endoscopic, using diathermy or cold punch)”, substitute “Prostatectomy, transurethral resection using cautery”.

111

Schedule 1 (cell at item 37206, column 2)

Repeal the cell, substitute:

Prostatectomy, endoscopic, using diathermy or other ablative techniques:

(a) with or without cystoscopy and with or without urethroscopy; and

(b) including services to which one or more of items 36854, 37303, 37321 and 37324 apply;

continuation, within 10 days, of treatment of benign prostatic hyperplasia that had to be discontinued for medical reasons (H) (Anaes.)

112

Schedule 1 (cell at item 37210, column 2)

Repeal the cell, substitute:

Prostatectomy, radical, involving total excision of the prostate, sparing of nerves around the prostate (where clinically indicated) with or without bladder neck reconstruction, other than a service associated with a service to which item 30390, 30627, 35551, 36502 or 37375 applies (H) (Anaes.) (Assist.)

113

Schedule 1 (cell at item 37211, column 2)

Repeal the cell, substitute:

Prostatectomy, radical, involving total excision of the prostate, sparing of nerves around the prostate (where clinically indicated):

(a) with or without bladder neck reconstruction; and

(b) with pelvic lymphadenectomy;

other than a service associated with a service to which item 30390, 30627, 35551, 36502 or 37375 applies (H) (Anaes.) (Assist.)

114

Schedule 1 (item 37212)

Repeal the item, substitute:

37213

Prostatectomy, radical, involving total excision of the prostate, sparing of nerves around the prostate (where clinically indicated):

(a) complicated by:

(i) previous radiation therapy (including brachytherapy) on the prostate; or

(ii) previous ablative procedures on the prostate; and

(b) with bladder neck reconstruction;

other than a service associated with a service to which item 30390, 30627, 35551, 36502 or 37375 applies (H) (Anaes.) (Assist.)

2,464.65

37214

Prostatectomy, radical, involving total excision of the prostate, sparing of nerves around the prostate (where clinically indicated):

(a) complicated by:

(i) previous radiation therapy (including brachytherapy) on the prostate; or

(ii) previous ablative procedures on the prostate; and

(b) with bladder neck reconstruction and pelvic lymphadenectomy;

other than a service associated with a service to which item 30390, 30627, 35551, 36502 or 37375 applies (H) (Anaes.) (Assist.)

2,993.70

115

Schedule 1 (item 37215)

Omit “(Assist.)”.

116

Schedule 1 (after item 37215)

Insert:

37216

Prostate or prostatic bed, needle biopsy of, by the transrectal route, using prostatic ultrasound guidance and obtaining one or more prostatic specimens, being a service associated with a service to which item 55603 applies (Anaes.)

144.85

117

Schedule 1 (item 37217)

Omit “bed”, substitute “bed, under ultrasound guidance, being an item associated with a service to which item 55603 applies”.

118

Schedule 1 (item 37218)

Omit “needle biopsy of, or injection into, excluding insertion of radioopaque”, substitute “injection into, one or more, excluding insertion of fiduciary”.

119

Schedule 1 (item 37219)

Repeal the item, substitute:

37219

Prostate or prostatic bed, needle biopsy of, by the transperineal route, using prostatic ultrasound guidance and obtaining one or more prostatic specimens, being a service associated with a service to which item 55600 or 55603 applies (Anaes.)

347.60

120

Schedule 1 (cell at item 37220, column 2)

Repeal the cell, substitute:

Prostate, radioactive seed implantation of, urological component, using transrectal ultrasound guidance:

(a) for a patient with:

(i) localised prostatic malignancy at clinical stages T1 (clinically inapparent tumour not palpable or visible by imaging) or T2 (tumour confined within prostate); and

(ii) a Gleason score of less than or equal to 7 (Grade Group 1 to Grade Group 3); and

(iii) a prostate specific antigen (PSA) of not more than 10ng/ml at the time of diagnosis; and

(b) performed by a urologist at an approved site in association with a radiation oncologist; and

(c) being a service associated with:

(i) services to which items 15338 and 55603 apply; and

(ii) a service to which item 60506 or 60509 applies

(H) (Anaes.)

121

Schedule 1 (item 37221)

Omit “(Assist)”.

122

Schedule 1 (item 37224)

Omit “visual laser destruction of lesion of”, substitute “cauterisation”.

123

Schedule 1 (cell at item 37230, column 2)

Repeal the cell, substitute:

Prostate, ablation by electrocautery or high‑energy transurethral microwave thermotherapy, with or without cystoscopy and with or without urethroscopy (Anaes.)

124

Schedule 1 (cell at item 37233, column 2)

Repeal the cell, substitute:

Prostate, ablation by electrocautery or high‑energy transurethral microwave thermotherapy, with or without cystoscopy and with or without urethroscopy, continuation, within 10 days, of a urological procedure of the prostate that had to be discontinued for medical reasons (Anaes.)

125

Schedule 1 (cell at item 37245, column 2)

Repeal the cell, substitute:

Prostate, endoscopic enucleation of, for the treatment of benign prostatic hyperplasia:

(a) with morcellation, including mechanical morcellation or by an endoscopic technique; and

(b) with or without cystoscopy; and

(c) with or without urethroscopy;

other than a service associated with a service to which item 36827, 36854, 37008, 37201, 37202, 37203, 37206, 37207, 37208, 37303, 37321 or 37324 applies (H) (Anaes.)

126

Schedule 1 (item 37315)

Repeal the item.

127

Schedule 1 (cell at item 37318, column 2)

Repeal the cell, substitute:

Urethroscopy, with or without cystoscopy, with one or more of biopsy, diathermy, visual laser destruction of urethral calculi or removal of foreign body or calculi (Anaes.)

  1. 128

    Schedule 1 (at the end of the cell at item 37324, column 2)

Add “(Assist.)”.

129

Schedule 1 (item 37338)

Omit “obstruction or erosion,”, substitute “obstruction, sling erosion, pain or infection”.

130

Schedule 1 (item 37339)

Omit “materials”, substitute “urethral bulking agents”.

131

Schedule 1 (item 37340)

Repeal the item, substitute:

37340

Urethral synthetic sling, division or removal of, for urethral obstruction, sling erosion, pain or infection following previous surgery for urinary incontinence, vaginal approach, other than a service associated with a service to which item 37341 or 37344 applies (H) (Anaes.) (Assist.)

939.80

132

Schedule 1 (cell at item 37341, column 2)

Repeal the cell, substitute:

Urethral sling, division or removal of, for urethral obstruction, sling erosion, pain or infection following previous surgery for urinary incontinence, suprapubic, combined suprapubic and vaginal or combined suprapubic and perineal approach, other than a service associated with a service to which item 37340 or 37344 applies (H) (Anaes.) (Assist.)

133

Schedule 1 (after item 37343)

Insert:

37344

Urethral autologous fascial sling (or other biological sling), division or removal of, for urethral obstruction, sling erosion, pain or infection following previous surgery for urinary incontinence, vaginal approach, other than a service to which 37340 or 37341 applies (H) (Anaes.) (Assist.)

939.80

134

Schedule 1 (cell at item 37372, column 3)

Repeal the cell, substitute:

953.60

135

Schedule 1 (after item 37387)

Insert:

37388

Artificial urinary sphincter, sterile, percutaneous adjustment of filling volume

101.00

136

Schedule 1 (cell at item 37415, column 2)

Repeal the cell, substitute:

Penis, injection of, for the investigation and treatment of erectile dysfunction

Applicable not more than twice in a 36‑month period

137

Schedule 1 (item 37417)

Omit “chordee, with or without excision of fibrous plaque or plaques and with or without grafting”, substitute “chordee by plication techniques including Nesbit’s corporoplasty”.

138

Schedule 1 (cell at item 37418, column 2)

Repeal the cell, substitute:

Penis, correction of chordee with incision or excision of fibrous plaque or plaques, with or without mobilisation of one or both of the neuro‑vascular bundle andurethra (Anaes.) (Assist.)

139

Schedule 1 (item 37420)

Repeal the item.

140

Schedule 1 (item 37423)

Omit “corpora”, substitute “corpora, in conjunction with partial penectomy or penile epispadias secondary repair, either as primary or secondary procedures”.

141

Schedule 1 (item 37438)

Omit “excision of”, substitute “excision of, for histologically proven malignancy or infection”.

142

Schedule 1 (item 37444)

Repeal the item.

143

Schedule 1 (item 37604)

Omit “unilateral”, substitute “unilateral or bilateral”.

144

Schedule 1 (items 37607 and 37610)

Repeal the items, substitute:

37607

Bilateral retroperitoneal lymph node dissection, for testicular tumour, other than a service associated with a service to which item 30390 or 30627 applies (H) (Anaes.) (Assist.)

1,430.40

37610

Bilateral retroperitoneal lymph node dissection, for testicular tumour, following previous similar retroperitoneal dissection, retroperitoneal radiation therapy or chemotherapy, other than a service associated with a service to which item 30390 or 30627 applies (H) (Anaes.) (Assist.)

2,151.95

145

Schedule 1 (items 37833 and 37834)

Omit “post‑operative”.

146

Schedule 1 (item 37842)

Omit “secondary repair with”, substitute “primary or secondary repair with or without”.

147

Schedule 1 (items 37845 and 37848)

Omit “Ambiguous genitalia with urogenital sinus, reduction clitoroplasty”, substitute “Congenital disorder of sexual differentiation with urogenital sinus, external genitoplasty”.

148

Schedule 1 (item 37851)

Omit “adrenal hyperplasia, mixed gonadal dysgenesis or similar condition”, substitute “disorder of sexual differentiation”.

149

Schedule 1 (item 37854)

Omit “(Assist.)”.

Part 5Other amendments

Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020

150

Schedule 1 (items 55248 to 55280, column 2)

Omit all the words after “associated with”, substitute “a service to which an item in Subgroup 4 applies (R)”.

  1. 151

    Schedule 1 (items 55282 and 55284, column 2, paragraph (d))

Omit all the words after “associated with”, substitute “a service to which an item in Subgroup 4 applies (R)”.

152

Schedule 1 (item 55292, column 2)

Omit all the words after “associated with”, substitute “a service to which an item in Subgroup 4 applies (R)”.

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

  1. 153

    Schedule 1 (item 293, column 2, paragraph (f))

Omit “293”, substitute “359”.

154

Clause 2.14.3 of Schedule 1

Repeal the clause.

155

Schedule 1 (cell at item 15338, column 2)

Repeal the cell, substitute:

Prostate, radioactive seed implantation of, radiation oncology component, using transrectal ultrasound guidance:

(a) for a patient with:

(i) localised prostatic malignancy at clinical stages T1 (clinically inapparent tumour not palpable or visible by imaging) or T2 (tumour confined within prostate); and

(ii) a Gleason score of less than or equal to 7 (Grade Group 1 to Grade Group 3); and

(iii) a prostate specific antigen (PSA) of not more than 10ng/ml at the time of diagnosis; and

(b) performed by an oncologist at an approved site in association with a urologist; and

(c) being a service associated with:

(i) services to which items 37220 and 55603 apply; and

(ii) a service to which item 60506 or 60509 applies

(H) (Anaes.)

156

Subclause 5.8.2(1) of Schedule 1

Omit “18361,”.

157

Schedule 1 (item 18361)

Repeal the item.

  1. 158

    Clause 7.1.1 of Schedule 1 (definition of after‑hours rural area)

Repeal the definition, substitute:

after‑hours rural area means an area that is:

  1. (a)

    a Modified Monash 2 area; or

  2. (b)

    a Modified Monash 3 area; or

  3. (c)

    a Modified Monash 4 area; or

  4. (d)

    a Modified Monash 5 area; or

  5. (e)

    a Modified Monash 6 area; or

  6. (f)

    a Modified Monash 7 area.

Health Insurance (Pathology Services Table) Regulations 2020

159

Schedule 1 (item 73354)

Omit “SH6”, substitute “MSH6”.

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