Health Insurance Legislation Amendment (2025 Measures No. 3) Regulations 2025 (Cth)
I, the Honourable Sam Mostyn AC, Governor‑General of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, make the following regulations.
Dated 2 October 2025
Sam Mostyn AC
Governor‑General
By Her Excellency’s Command
Mark Butler
Minister for Health and Ageing
Contents
This instrument is the
Health Insurance Legislation Amendment (2025 Measures No. 3) Regulations 2025 .
(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.
The whole of this instrument | 1 November 2025. | 1 November 2025 |
Note: This table relates only to the provisions of this instrument as originally made.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.
(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.
This instrument is made under the
Health Insurance Act 1973 .
Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.
1
Clause 3.2.1 of Schedule 1 (definition of concessional beneficiary ) Repeal the definition.
2
Schedule 1 (items 10990 and 10991, column 2, paragraphs (b) and (c)) Repeal the paragraphs, substitute:
(b) the service is provided to a person who is not an admitted patient of a hospital; and
3
Schedule 1 (item 10992, column 2, paragraphs (d) and (e)) Repeal the paragraphs, substitute:
(d) the service is provided to a person who is not an admitted patient of a hospital; and
4
Schedule 1 (items 75855, 75856, 75857 and 75858, column 2, paragraphs (b) and (c)) Repeal the paragraphs, substitute:
(b) the service is provided to a person who is not an admitted patient of a hospital; and
5
Schedule 1 (items 75870 and 75871, column 2, paragraphs (a) and (b)) Repeal the paragraphs, substitute:
(a) the attendance service is provided to a patient who is not an admitted patient of a hospital; and
6
Schedule 1 (item 75872, column 2, paragraphs (c) and (d)) Repeal the paragraphs, substitute:
(c) the attendance service is provided to a patient who is not an admitted patient of a hospital; and
7
Schedule 1 (items 75873, 75874, 75875 and 75876, column 2, paragraphs (a) and (b)) Repeal the paragraphs, substitute:
(a) the attendance service is provided to a patient who is not an admitted patient of a hospital; and
8
Schedule 1 (items 75880, 75881, 75882, 75883, 75884 and 75885, column 2, paragraph (a)) Repeal the paragraph, substitute:
(a) the attendance service is provided to a patient who is enrolled in MyMedicare at the general practice through which the attendance service is provided; and
9
Clause 7.1.1 of Schedule 1 (definition of concessional beneficiary ) Repeal the definition.
Omit “paragraph (b)”, substitute “paragraph (1)(b)”.
After “allied health”, insert “and other primary health care”.
Omit “allied health providers”, substitute “allied health or other relevant health professionals”.
Omit “lasts least 10 minutes”, substitute “lasts at least 10 minutes”.
Omit “allied health providers”, substitute “allied health or other relevant health professionals”.
Repeal the note.
16
Subclauses 2.15.14(4) and 2.16.10(3) of Schedule 1 Omit “Aboriginal health workers”, substitute “Aboriginal and Torres Strait Islander health workers”.
Omit “allied health providers”, substitute “allied health or other relevant health professionals”.
Repeal the note.
Repeal the note.
Omit “
Aboriginal health worker ”, substitute “Aboriginal and Torres Strait Islander health worker ”.
Omit “
Aboriginal health worker ”, substitute “Aboriginal and Torres Strait Islander health worker ”.
22
Schedule 1 (Subgroup 1 of Group M12 table, heading) Omit “
Aboriginal health worker ”, substitute “Aboriginal and Torres Strait Islander health worker ”.
Omit “Aboriginal health worker”, substitute “Aboriginal and Torres Strait Islander health worker”.
24
Schedule 1 (item 13105, column 2, paragraph (a)) Omit “Aboriginal health worker”, substitute “Aboriginal and Torres Strait Islander health worker”.
25
Clause 7.1.1 of Schedule 1 (paragraph (a) of the definition of Aboriginal and Torres Strait Islander health practitioner ) Omit “a law of a State or Territory as an Aboriginal and Torres Strait Islander health practitioner”, substitute “the National Law in the Aboriginal and Torres Strait Islander health practice profession”.
26
Clause 7.1.1 of Schedule 1 (definition of Aboriginal health worker ) Repeal the definition, substitute:
Aboriginal and Torres Strait Islander health worker means a person:
(a) who holds a qualification of Certificate III or higher in Aboriginal and/or Torres Strait Islander Primary Health Care from the Health (HLT) training package; and
(b) who is engaged by a medical practitioner in a general practice or a health service to which a direction made under subsection 19(2) of the Act applies.
Repeal the paragraph, substitute:
(a) Aboriginal and Torres Strait Islander health practitioner services;
(aa) Aboriginal and Torres Strait Islander health worker services;
Repeal the items.
Before “In this Schedule”, insert “(1)”.
30
Clause 2.20.4 of Schedule 1 (definition of review of a GP mental health treatment plan ) Omit “general practitioner or a prescribed medical practitioner”, substitute “practitioner covered by subclause (2)”.
31
Clause 2.20.4 of Schedule 1 (subparagraph (c)(ii) of the definition of review of a GP mental health treatment plan ) Omit “prevention;”, substitute “prevention; and”.
Add:
(2) A practitioner is covered by this subclause if the practitioner, in relation to a patient, is:
(a) if the patient is enrolled in MyMedicare—a general practitioner, or a prescribed medical practitioner, at the general practice at which the patient is so enrolled; or
(b) regardless of whether the patient is enrolled in MyMedicare—the patient’s usual medical practitioner.
Repeal the clause, substitute:
(1) Items 735 to 758 do not apply toa review of a GP mental health treatment plan.
(2) Unless exceptional circumstances exist, a service for a review of a GP mental health treatment plan cannot be claimed:
(a) more than once in a 3 month period for a particular patient; or
(b) within 4 weeks following the preparation of the GP mental health treatment plan.
(3) In this clause:
exceptional circumstances means a significant change in:
(a) the patient’s clinical condition; or
(b) the patient’s care circumstances.
Omit “2712, 2713, 2715, 2717, 272, 276, 277, 279,”, substitute “2715, 2717, 272, 276,”.
Repeal the subclause, substitute:
(2) Items 2700, 2701, 2715, 2717, 272, 276, 281 and 282 apply only to a service that is provided:
(a) to a patient in the community, or a private in‑patient (including a private in‑patient who is a resident of an aged care facility) being discharged from hospital; and
(b) by a practitioner covered by subclause 2.20.4(2); and
(c) in the course of personal attendance by a single medical practitioner on a single patient.
Omit “, or item 2713”.
37
At the end of subclause 2.20.6(3) of Schedule 1 Add:
; or (c) within 3 months following a review of a GP mental health treatment plan; or
(d) more than once in a 12 month period from the provision of a service to which any of the following items apply:
(i) items 272, 276, 281 and 282;
(ii) items 92112, 92113, 92116, 92117, 92118, 92119, 92122 and 92123 of the Telehealth Attendance Determination.
Repeal the subclauses.
Repeal the paragraph, substitute:
(a) with a service to which any of items 235 to 240 or 735 to 758 apply; or
Repeal the paragraphs, substitute:
(c) within 3 months following a review of a GP mental health treatment plan; or
(d) more than once in a 12 month period from the provision of a service to which any of the following items apply:
(i) items 2700, 2701, 2715 and 2717;
(ii) items 92112, 92113, 92116, 92117, 92118, 92119, 92122 and 92123 of the Telehealth Attendance Determination.
Repeal the subclauses.
Omit “the medical practitioner”, substitute “a practitioner covered by subclause 2.20.4(2) who is”.
Omit “the prescribed medical practitioner”, substitute “a practitioner covered by subclause 2.20.4(2) who is”.
Repeal the items.
Omit “item 279, 235 to 244, 735 to 758, 2713, 92115, 92121, 92127 or 92133 applies”, substitute “any of items 235 to 244, 735 to 758, 92115, 92121, 92127 and 92133 apply”.
Omit “279, 2713,”.
47
Clause 7.1.1 of Schedule 1 (definition of associated general practitioner ) Repeal the definition.
48
Clause 7.1.1 of Schedule 1 (definition of associated medical practitioner ) Repeal the definition, substitute:
associated medical practitioner , for items 393 and 967, has the meaning given by clause 2.16.2.
Omit “277, 279,”.
Omit “2712, 2713,”.
Omit “92114, 92115, 92116, 92117, 92118, 92119, 92120, 92121,”, substitute “92116, 92117, 92118, 92119,”.
Repeal the item.
Omit “(1)”.
Repeal the paragraph, substitute:
(b) at the premises of a comprehensive practice; and
Repeal the subclause.
Omit “paragraph 2.4.2(1)(c)”, substitute “paragraph 2.4.2(c)”.
Repeal the clause.
58
Clause 3.1 of Schedule 1 (definition of comprehensive facility ) Repeal the definition.
Repeal the clause.
60
Clause 2.5.4 of Schedule 1 (table item 1, column 1) After “items”, insert “63390 and”.
61
Clause 2.5.4 of Schedule 1 (at the end of the table) Add:
3 | A service to which item 63390 applies | A person who is: (a) a specialist in diagnostic radiology; or
|
Insert:
63390 | MRI—scan of cardiovascular system for assessment of myocardial structure, function andcharacterisation, if the request for the scan indicates that the patient has:
(R) (Anaes.) (Contrast) | 616.60 |
63
Schedule 1 (Group T2 table, at the end of the table) Add:
15990 | Proton beam dosimetry, and proton‑photon comparative plan reporting, to assess eligibility for proton beam therapy via the Medical Treatment Overseas Program if:
(g) the final proton dosimetry plan is:
(i) the service is bulk‑billed | 7,532.80 |
Insert:
Medical Treatment Overseas Program means the program by that name administered by the Department.
Insert:
66525 | Faecal calprotectin test for the management of a symptomatic patient with diagnosed inflammatory bowel disease, requested by or on behalf of a specialist or consultant physician | 75.00 |
Insert:
73322 | Genetic testing in the DPYD gene to diagnose or predict fluoropyrimidine‑induced toxicity in a patient, if:
Applicable once per lifetime | 182.00 |
Repeal the cell, substitute:
Analysis of tumour tissue, requested by a specialist or consultant physician, that:
analysis in relation to only one gene Applicable once per tumour diagnostic episode |
Repeal the cell, substitute:
An analysis described in item 73374—analysis in relation to only 2 or 3 genes Applicable once per tumour diagnostic episode |
Repeal the cell, substitute:
An analysis described in item 73374—analysis in relation to 4 or more genes Applicable once per tumour diagnostic episode |
70
Clause 3.1 of Schedule 1 (table item dealing with Placenta—not third trimester) Repeal the item.
71
Clause 3.1 of Schedule 1 (table item dealing with Placenta—third trimester, abnormal pregnancy or delivery) Repeal the item, substitute:
Placenta—live birth at any gestation | 5 |
Placenta—live birth at any gestation, associated with neonatal death within 7 days of birth | 6 |
Placenta—second trimester pregnancy at or after 12 weeks gestation but less than 20 weeks gestation, excluding specimens from dilation and curettage procedure | 5 |
Placenta—stillbirth of a baby delivered at or after 20 weeks gestation | 6 |
72
Clause 3.1 of Schedule 1 (table item dealing with Products of conception, spontaneous or missed abortion) Omit “, spontaneous or missed abortion”, substitute “—first trimester pregnancy (at less than 12 weeks gestation) excluding termination of pregnancy, or second trimester pregnancy at or after 12 weeks gestation but less than 20 weeks gestation with specimens from dilation and curettage procedure only”.
73
Clause 3.1 of Schedule 1 (table item dealing with Products of conception, termination of pregnancy) After “pregnancy”, insert “less than 12 weeks gestation”.
74
Division 5.4 of Schedule 1 (before clause 5.4.1) Insert:
An item in Group T3 applies only to a service provided by a specialist, or a consultant physician, in the practice of the specialist’s or consultant physician’s specialty of nuclear medicine.
Insert:
Omit “37.05”, substitute “100.40”.
Omit “, as an independent procedure”.
Omit “63.20”, substitute “105.15”.
Insert:
35501 | A medical service to which item 35503, 35506, 14206 or 30062 applies, if the service is bulk‑billed in relation to the fees for: (a) that item; and
| 40% of the fee for the relevant item referred to in paragraph (a) of column 2 |
After “30062,”, insert “35501,”.
Omit “83.40”, substitute “215.95”.
Omit “item 35503”, substitute “item 35501 or 35503”.
Omit “55.85”, substitute “134.45”.
Insert:
4A | P7 | 73420, 73421 |
Omit “55889, 55890, 55891, 55892, 55893, 55894, 55895”, substitute “55890, 55892, 55894”.
Before “55700”, insert “55065,”.
After “hand, wrist and forearm,”, insert “or wrist and forearm,”.
88
Schedule 1 (items 55282 and 55284, column 2, paragraph (c)) After “nuclear medicine,”, insert “sexual health medicine,”.
89
Schedule 1 (at the end of the cell at item 22032, column 2) Add “(H)”.
Omit “(H)”.
Omit “
in items 231, 232, 392, 393, 729, 731, 965 and 967 ”.
92
Subclause 2.16.12(3) of Schedule 1 (table, heading) Omit “
in items 231, 232, 392, 393, 729, 731, 965 and 967 ”.
93
Subclause 2.16.12(3) of Schedule 1 (table item 1, column 2, paragraph (a)) Omit “231, 232, 393, 729,”, substitute “232, 393,”.
94
Subclause 2.16.12(3) of Schedule 1 (table item 1, column 2, subparagraph (b)(i)) Omit “393, 965, 967, 92029, 92030, 92060 or 92061”, substitute “965, 92029 or 92060”.
95
Subclause 2.16.12(3) of Schedule 1 (table item 1, column 2, subparagraph (b)(ii)) Omit “item 729 or 231”, substitute “item 729, 231, 92026 or 92057”.
Before “per day”, insert “per plan”.
Omit “surgical excision (other than by shave excision) and repair of”, substitute “definitive surgical excision of (other than by shave excision) including repair (if performed)”.
Omit “(other than by shave excision) and repair of”, substitute “of (other than by shave excision) including repair (if performed)”.
Omit “surgical excision (other than by shave excision) and repair of”, substitute “definitive surgical excision of (other than by shave excision) including repair (if performed)”.
Omit “(other than by shave excision) and repair of”, substitute “of (other than by shave excision) including repair (if performed)”.
Omit “surgical excision (other than by shave excision) and repair of”, substitute “definitive surgical excision of (other than by shave excision) including repair (if performed)”.
Omit “(other than by shave excision) and repair of”, substitute “of (other than by shave excision) including repair (if performed)”.
Omit “surgical excision (other than by shave excision) and repair of”, substitute “definitive surgical excision of (other than by shave excision) including repair (if performed)”.
104
Schedule 1 (items 31370, 31371, 31373, 31376, 31377, 31378, 31379, 31380, 31381, 31382 and 31383) Omit “(other than by shave excision) and repair of”, substitute “of (other than by shave excision) including repair (if performed)”.
105
Schedule 1 (item 133, column 2, paragraph (f)) After “this item”, insert “or item 92423 or 92443”.
106
Schedule 1 (item 143, column 2, paragraph (e)) After “item 147”, insert “, 92448 or 92624”.
107
Schedule 1 (item 147, column 2, paragraph (e)) Omit “143”, substitute “item 143, 92448 or 92624”.
After “item 92436”, insert “or 92444”.
Omit “or 30655”, substitute “, 30655, 38365, 38467, 38477, 38484, 38485, 38490, 38493, 38499, 38502, 38510, 38512, 38513, 38515, 38516, 38517, 38519, 38550, 38553, 38554, 38555, 38557, 38670, 38703, 38742 or 38764”.
Before “—one bone”, insert “other than a service to which item 38365, 38467, 38477, 38484, 38485, 38490, 38493, 38499, 38502, 38510, 38512, 38513, 38515, 38516, 38517, 38519, 38550, 38553, 38554, 38555, 38557, 38670, 38703, 38742 or 38764 applies”.
After “items 32222 to 32228”, insert “or 32230”.
112
Amendments of listed provisions—inserting “on the same side” before “(H)” Each item (
GMST item ) of Schedule 1 listed in the following table is amended by inserting “on the same side” before “(H)” in column 2 of the item.
1 | 41527 |
2 | 41530 |
3 | 41533 |
4 | 41536 |
5 | 41545 |
6 | 41551 |
7 | 41554 |
8 | 41557 |
9 | 41560 |
10 | 41563 |
11 | 41564 |
12 | 41566 |
13 | 41629 |
14 | 41635 |
15 | 41638 |
0
0
0