Health Insurance Legislation Amendment (Hospital-Only Services and Other Measures) Regulations 2025 (Cth)

Health Insurance Legislation Amendment (Hospital‑Only Services and Other Measures) Regulations 2025

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 6 February 2025

Sam Mostyn AC

Governor‑General

By Her Excellency’s Command

Mark Butler

Minister for Health and Aged Care

Contents

1Name

This instrument is the Health Insurance Legislation Amendment (Hospital‑Only Services and Other Measures) Regulations 2025.

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 March 2025.	1 March 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Note: This table relates only to the provisions of this instrument as originally made.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.

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Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.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 1Hospital‑only servicesPart 1Items to which “(H)” is to be added after the last word in the item description

Health Insurance (General Medical Services Table) Regulations 2021

1. 1

   Amendments of listed provisions—adding “(H)” after the last word in the item description

Each item (GMST item)of Schedule 1listed in the following table is amended by adding “(H)” at the end of the cell at column 2 of the item.

Item	GMST item
1	11627
2	13030
3	13100
4	13103
5	13300
6	13303
7	13306
8	13309
9	13506
10	13703
11	13706
12	13750
13	13755
14	13830
15	13832
16	13834
17	13835
18	13837
19	13838
20	13840
21	13848
22	16621
23	16624
24	16627
25	18226
26	18227
27	18282
28	20102
29	20104
30	20142
31	20143
32	20144
33	20145
34	20147
35	20162
36	20172
37	20174
38	20176
39	20190
40	20192
41	20210
42	20212
43	20214
44	20216
45	20220
46	20222
47	20225
48	20230
49	20320
50	20321
51	20330
52	20350
53	20352
54	20355
55	20401
56	20402
57	20403
58	20404
59	20405
60	20406
61	20410
62	20450
63	20452
64	20470
65	20472
66	20474
67	20500
68	20522
69	20524
70	20526
71	20528
72	20540
73	20542
74	20546
75	20548
76	20600
77	20604
78	20620
79	20622
80	20632
81	20634
82	20670
83	20680
84	20690
85	20704
86	20706
87	20740
88	20752
89	20754
90	20756
91	20770
92	20791
93	20792
94	20793
95	20794
96	20798
97	20806
98	20810
99	20830
100	20840
101	20841
102	20844
103	20845
104	20846
105	20847
106	20848
107	20850
108	20855
109	20860
110	20862
111	20863
112	20864
113	20866
114	20867
115	20868
116	20880
117	20882
118	20884
119	20902
120	20904
121	20905
122	20906
123	20911
124	20912
125	20914
126	20916
127	20924
128	20926
129	20928
130	20930
131	20932
132	20934
133	20936
134	20938
135	20942
136	20944
137	20954
138	20956
139	20960
140	21116
141	21120
142	21130
143	21140
144	21150
145	21155
146	21160
147	21170
148	21200
149	21202
150	21210
151	21212
152	21214
153	21215
154	21216
155	21220
156	21230
157	21232
158	21234
159	21270
160	21272
161	21274
162	21275
163	21280
164	21340
165	21360
166	21380
167	21382
168	21390
169	21392
170	21400
171	21402
172	21403
173	21404
174	21420
175	21430
176	21432
177	21440
178	21445
179	21464
180	21472
181	21474
182	21480
183	21482
184	21484
185	21486
186	21490
187	21500
188	21502
189	21522
190	21530
191	21532
192	21535
193	21620
194	21622
195	21630
196	21632
197	21634
198	21636
199	21638
200	21650
201	21652
202	21654
203	21656
204	21670
205	21680
206	21682
207	21685
208	21712
209	21714
210	21716
211	21730
212	21732
213	21756
214	21760
215	21772
216	21785
217	21790
218	21820
219	21830
220	21832
221	21834
222	21840
223	21842
224	21860
225	21865
226	21870
227	21872
228	21879
229	21880
230	21881
231	21882
232	21883
233	21884
234	21885
235	21886
236	21887
237	21910
238	21915
239	21916
240	21925
241	21930
242	21936
243	21941
244	21942
245	21943
246	21952
247	22002
248	22007
249	22008
250	22015
251	22020
252	22031
253	22036
254	22041
255	22051
256	22055
257	22060
258	22075
259	23010
260	25000
261	25005
262	25010
263	25013
264	25014
265	25020
266	25025
267	25030
268	25050
269	25200
270	37227
271	45888
272	47477
273	51306
274	51309
275	51312
276	51315
277	51800
278	52420

Part 2Items to which “(H)” is to be added on a new line of the item description

Health Insurance (General Medical Services Table) Regulations 2021

1. 2

   Schedule 1 (item 20560, column 2, paragraph (b))

Omit “prosthesis”, substitute:

prosthesis

(H)

1. 3

   Schedule 1 (item 20745, column 2, paragraph (e))

Omit “tumour”, substitute:

tumour

(H)

1. 4

   Schedule 1 (item 20790, column 2, paragraph (d))

Omit “shunts”, substitute:

shunts

(H)

1. 5

   Schedule 1 (item 22012, column 2, paragraph (e))

Omit “pressure”, substitute:

pressure

(H)

1. 6

   Schedule 1 (item 22014, column 2, paragraph (e))

Omit “pressure”, substitute:

pressure

(H)

1. 7

   Schedule 1 (item 22025, column 2, paragraph (b))

Omit “procedure”, substitute:

procedure

(H)

1. 8

   Schedule 1 (item 22065, column 2, paragraph (b))

Omit “applies”, substitute:

applies

(H)

1. 9

   Schedule 1 (item 25205, column 2, paragraph (f))

Omit “patients”, substitute:

patients

(H)

1. 10

   Schedule 1 (item 51318, column 2, paragraph (c))

Omit “damage”, substitute:

damage

(H)

Part 3Items in which “(H)” is to be inserted before “(Anaes.)”

Health Insurance (General Medical Services Table) Regulations 2021

1. 11

   Amendments of listed provisions—inserting “(H)” before “(Anaes.)”

Each item (GMST item) of Schedule 1 listed in the following table is amended by inserting “(H)” before “(Anaes.)” in column 2 of the item.

Item	GMST item
1	11801
2	13212
3	13318
4	13319
5	13700
6	13815
7	13818
8	14212
9	16520
10	16564
11	16573
12	18216
13	18219
14	18284
15	18286
16	18288
17	18294
18	18296
19	30024
20	30058
21	30183
22	30229
23	30235
24	30259
25	30269
26	30272
27	30281
28	30286
29	30287
30	30293
31	30412
32	30419
33	30428
34	30430
35	30431
36	30440
37	30450
38	30457
39	30469
40	30475
41	30478
42	30481
43	30484
44	30485
45	30488
46	30490
47	30491
48	30559
49	30563
50	30593
51	30618
52	30631
53	30639
54	30649
55	30663
56	30666
57	30676
58	30679
59	30680
60	30682
61	30684
62	30686
63	30687
64	30688
65	30690
66	30692
67	30694
68	31245
69	31400
70	31406
71	31423
72	31500
73	31503
74	31509
75	31557
76	32075
77	32084
78	32087
79	32095
80	32105
81	32106
82	32123
83	32150
84	32156
85	32165
86	32222
87	32223
88	32224
89	32225
90	32226
91	32227
92	32228
93	32229
94	33100
95	33109
96	33116
97	33119
98	33127
99	33142
100	33166
101	33518
102	33800
103	33806
104	33810
105	33812
106	34106
107	34118
108	34130
109	34154
110	34500
111	34527
112	34528
113	34529
114	34530
115	34533
116	34534
117	34538
118	34540
119	34800
120	34821
121	34830
122	35000
123	35300
124	35303
125	35306
126	35309
127	35319
128	35320
129	35321
130	35330
131	35410
132	35412
133	35500
134	35506
135	35536
136	35612
137	35680
138	36504
139	36507
140	36508
141	36543
142	36546
143	36558
144	36600
145	36604
146	36624
147	36633
148	36663
149	36664
150	36666
151	36803
152	36811
153	36818
154	36821
155	36822
156	36823
157	36824
158	36827
159	36833
160	36836
161	36840
162	36845
163	36860
164	37008
165	37215
166	37224
167	37411
168	37418
169	37604
170	37606
171	37619
172	37806
173	37807
174	37818
175	37819
176	37830
177	37831
178	38200
179	38203
180	38206
181	38209
182	38212
183	38213
184	38241
185	38244
186	38247
187	38248
188	38249
189	38251
190	38252
191	38254
192	38256
193	38270
194	38272
195	38275
196	38287
197	38293
198	38307
199	38308
200	38309
201	38310
202	38311
203	38313
204	38314
205	38316
206	38317
207	38319
208	38320
209	38322
210	38323
211	38416
212	38417
213	38419
214	38420
215	38423
216	38428
217	38829
218	39007
219	39109
220	39121
221	39140
222	39307
223	39319
224	39329
225	39332
226	39339
227	39342
228	39345
229	39815
230	40018
231	40803
232	41603
233	41614
234	41615
235	41650
236	41686
237	41746
238	41810
239	41831
240	41832
241	41876
242	41885
243	41886
244	42506
245	42512
246	42551
247	42563
248	42574
249	42576
250	42596
251	42599
252	42602
253	42605
254	42626
255	42665
256	42672
257	42673
258	42698
259	42701
260	42702
261	42703
262	42704
263	42705
264	42707
265	42710
266	42713
267	42716
268	42719
269	42734
270	42743
271	42761
272	42764
273	42773
274	42854
275	42857
276	42860
277	43530
278	43533
279	44104
280	44105
281	44130
282	44136
283	44334
284	44373
285	44376
286	45018
287	45033
288	45212
289	45227
290	45233
291	45518
292	45545
293	45548
294	45572
295	45575
296	45581
297	45632
298	45635
299	45646
300	45674
301	45692
302	45704
303	45809
304	45811
305	45813
306	45827
307	45849
308	45871
309	45873
310	46113
311	46335
312	46364
313	46401
314	46414
315	46434
316	46493
317	46502
318	46503
319	46504
320	47007
321	47009
322	47027
323	47033
324	47049
325	47053
326	47054
327	47060
328	47351
329	47357
330	47402
331	47414
332	47435
333	47465
334	47468
335	47495
336	47537
337	47540
338	47546
339	47552
340	47559
341	47568
342	47570
343	47612
344	47615
345	47621
346	47630
347	47639
348	47666
349	47678
350	47762
351	47790
352	47791
353	47903
354	47953
355	48900
356	49106
357	49124
358	49213
359	49586
360	49590
361	49803
362	49809
363	50203
364	50224
365	50354
366	50411
367	50414
368	50417
369	50423
370	50544
371	50576
372	50950
373	50952
374	51110
375	51115
376	51902
377	52048
378	52051
379	52054
380	52061
381	52062
382	52066
383	52069
384	52078
385	52092
386	52094
387	52095
388	52098
389	52102
390	52105
391	52114
392	52117
393	52120
394	52122
395	52123
396	52126
397	52129
398	52130
399	52131
400	52138
401	52141
402	52144
403	52147
404	52148
405	52158
406	52182
407	52184
408	52186
409	52303
410	52306
411	52318
412	52319
413	52321
414	52324
415	52327
416	52330
417	52333
418	52336
419	52337
420	52339
421	52378
422	52379
423	52380
424	52382
425	52424
426	52430
427	52440
428	52442
429	52444
430	52446
431	52450
432	52452
433	52456
434	52458
435	52460
436	52480
437	52482
438	52484
439	52603
440	52612
441	52615
442	52626
443	52800
444	52803
445	52809
446	52812
447	52815
448	52818
449	52821
450	52828
451	52830
452	53006
453	53015
454	53016
455	53017
456	53019
457	53056
458	53060
459	53068
460	53070
461	53203
462	53209
463	53212
464	53215
465	53218
466	53220
467	53221
468	53224
469	53225
470	53226
471	53227
472	53230
473	53233
474	53236
475	53239
476	53242
477	53406
478	53409
479	53411
480	53412
481	53413
482	53414
483	53415
484	53416
485	53418
486	53419
487	53422
488	53423
489	53424
490	53425
491	53427
492	53429
493	53453
494	53455
495	53460

Part 4Other items

Health Insurance (General Medical Services Table) Regulations 2021

12

Schedule 1 (item 16527, column 2)

Omit “(Anaes.)”.

13

Schedule 1 (item 16527, column 2)

After “pregnancy”, insert “(Anaes.)”.

14

Schedule 1 (item 16528, column 2)

Omit “(Anaes.)”.

15

Schedule 1 (item 16528, column 2)

After “pregnancy”, insert “(H) (Anaes.)”.

1. 16

   Schedule 1 (item 42504, column 2, paragraph (b))

Omit “Surgery (Anaes.)”, substitute:

Surgery

(H) (Anaes.)

Part 5Diagnostic Imaging Services Table

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

17

Clause 1.2.15 of Schedule 1 (heading)

Omit “and (NR)”, substitute “, (NR) and (H)”.

18

At the end of clause 1.2.15 of Schedule 1

Add:

1. (3)

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

19

Schedule 1 (item 55130, column 2)

Omit “applies (R) (Anaes.)”, substitute:

applies

(R) (H) (Anaes.)

20

Schedule 1 (item 55135, column 2)

Omit “applies (R) (Anaes.)”, substitute:

applies

(R) (H) (Anaes.)

1. 21

   Schedule 1 (items 60072, 60075 and 60078, column 2)

After “(NR)”, insert “(H)”.

22

Schedule 1 (item 63499, column 2)

Omit “perform an anaesthetic”, substitute “perform an anaesthetic (H)”.

23

Clause 3.1 of Schedule 1

Insert:

(H) has the meaning given by subclause 1.2.15(3).

1. 24

   Amendments of listed provisions—omitting “(R)” and substituting “(R) (H)”

Each item (DIST item) of Schedule 1 listed in the following table is amended by omitting “(R)” and substituting “(R) (H)” in column 2 of the item.

Item	DIST item
1	55118
2	59970
3	60000
4	60003
5	60006
6	60009
7	60012
8	60015
9	60018
10	60021
11	60024
12	60027
13	60030
14	60033
15	60036
16	60039
17	60042
18	60045
19	60048
20	60051
21	60054
22	60057
23	60060
24	60063
25	60066
26	60069
27	60500
28	60506
29	60509
30	61109

Schedule 2Other amendmentsPart 1General medical services tableDivision 1Left‑sided intravascular microaxial ventricular assist devices

Health Insurance (General Medical Services Table) Regulations 2021

1

Schedule 1 (item 13851, cell at column 2)

Repeal the cell, substitute:

Ventricular assist device (excluding intravascular microaxial ventricular assist device inserted into the right ventricle), management of, for a patient admitted to an intensive care unit for implantation of the device or for complications arising from implantation or management of the device—first day (H)

2

Schedule 1 (item 13854, cell at column 2)

Repeal the cell, substitute:

Ventricular assist device (excluding intravascular microaxial ventricular assist device inserted into the right ventricle), management of, for a patient admitted to an intensive care unit, including management of complications arising from implantation or management of the device—each day after the first day (H)

3

Subclause 5.10.17(2) of Schedule 1

After “38618,”, insert “38619,”.

4

Schedule 1 (after item 38375)

Insert:

38376 Percutaneous insertion of an intravascular microaxial ventricular assist device, into the left ventricle only, by arteriotomy, including all associated intraoperative imaging, if: (a) the patient has deteriorating symptoms of cardiogenic shock (with no evidence of significant anoxic neurological injury) that are not controlled by optimal medical therapy; or (b) the patient: (i) is on veno‑arterial extra‑corporeal membrane oxygenation, for deteriorating symptoms of cardiogenic shock (with no evidence of significant anoxic neurological injury) that are not controlled by optimal medical therapy; and (ii) due to the effects of established veno‑arterial extra‑corporeal membrane oxygenation, requires unloading of the left ventricle (H) (Anaes.) 718.00

5

Schedule 1 (after item 38615)

Insert:

38616 Surgical insertion of an intravascular microaxial ventricular assist device, into the left ventricle only, by arteriotomy, including all associated intraoperative imaging, if: (a) the patient has deteriorating symptoms of cardiogenic shock (with no evidence of significant anoxic neurological injury) that are not controlled by optimal medical therapy; or (b) the patient: (i) is on veno‑arterial extra‑corporeal membrane oxygenation, for deteriorating symptoms of cardiogenic shock (with no evidence of significant anoxic neurological injury) that are not controlled by optimal medical therapy; and (ii) due to the effects of established veno‑arterial extra‑corporeal membrane oxygenation, requires unloading of the left ventricle (H) (Anaes.) 1077.00

6

Schedule 1 (after item 38618)

Insert:

38619 Surgical removal of a left‑sided intravascular microaxial ventricular assist device (H) (Anaes.) 646.00

7

Schedule 1 (item 38621)

After “other than”, insert “a service to which item 38619 applies, or”.

Division 2Perioperative continuous nerve blockade

Health Insurance (General Medical Services Table) Regulations 2021

8

Schedule 1 (after item 22031)

Insert:

22032 Introduction of a plexus or nerve block to a peripheral nerve, perioperatively performed using an in‑situ catheter in association with anaesthesia and surgery, for post‑operative pain management 4 base units

Part 2Pathology services table

Health Insurance (Pathology Services Table) Regulations 2020

9

Schedule 1 (after item 69415)

Insert:

69421	Detection of respiratory pathogen nucleic acid from a nasal swab, throat swab, nasopharyngeal aspirate and/or lower respiratory tract sample Testing of 4 pathogens	78.25
69422	Detection of respiratory pathogen nucleic acid from a nasal swab, throat swab, nasopharyngeal aspirate and/or lower respiratory tract sample, including a service described in item 69421 Testing of 5 or more pathogens	85.55

1. 10

   Schedule 1 (item 73296, column 2, subparagraph (a)(ii))

Omit “STK11, PTEN, CDH1, PALB2 and TP53”, substitute “other relevant”.

1. 11

   Schedule 1 (item 73297, column 2, subparagraph (a)(ii))

Omit “STK11, PTEN, CDH1, PALB2 and TP53”, substitute “one or more other relevant genes”.

1. 12

   Schedule 1 (item 73297, column 2, subparagraph (b)(i))

Omit “; or”, substitute “; and”.

Part 3Other amendments

Health Insurance Regulations 2018

13

Section 31

Omit “73828” (wherever occurring), substitute “73825”.

1. 14

   Section 44 (at the end of the cell at table item 2, column 2)

Add “, 58903”.