Health Insurance (Section 3C General Medical Services – Abdominoplasty for Postpartum Rectus Diastasis) Determination 2022 (Cth)

Health Insurance (Section 3C General Medical Services – Abdominoplasty for Postpartum Rectus Diastasis) Determination 2022

I, Travis Haslam, delegate of the Minister for Health and Aged Care, make the following determination.

Dated   8 April 2022

Travis Haslam

Acting First Assistant Secretary

Medical Benefits Division

Health Resourcing Group

Department of Health

Contents

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

2.  Commencement....................................................................................................................... 1

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

4.  Definitions............................................................................................................................... 1

5.  Treatment of relevant services................................................................................................. 2

6. Restriction on items in this schedule—services connected with provision of pain pump for post‑surgical pain management.................................................................................................................................................. 2

Schedule – relevant services   3

1.  Name

This instrument is the Health Insurance (Section 3C General Medical Services – Abdominoplasty for Postpartum Rectus Diastasis) Determination 2022.

2.  Commencement

(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 July 2022

Note:        This table relates only to the provisions of this instrument as originally made.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

3.  Authority

This instrument is made under subsection 3C(1) of the Health Insurance Act 1973.

4.  Definitions

1. In this instrument:

Act means the Health Insurance Act 1973.

(Anaes.) has the meaning given by subclause 5.9.4(1) of the general medical services table.

(H) has the meaning given by clause 1.1.7 of the general medical services table.

relevant provisions means all provisions, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under the National Health Act 1953, relating to medical services, professional services or items.

relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in a Schedule.

Schedule means a Schedule to this instrument.

Note:  The following terms are defined in subsection 3(1) of the Act:

·clinically relevant service;

·general medical services table;

·item;

·professional service.

(2)   Unless the contrary intention appears, a reference in this instrument to a provision of the Act or the National Health Act 1953 or regulations made under the Act or under the National Health Act 1953 as applied, adopted or incorporated in relation to specifying a matter is a reference to those provisions as in force from time to time and any other reference to provisions of an Act or regulations is a reference to those provisions as in force from time to time.

5.  Treatment of relevant services

For subsection 3C(1) of the Act, a relevant service, provided in accordance with this instrument and as a clinically relevant service, is to be treated, for the relevant provisions, as if:

(a)it were both a professional service and a medical service; and

(b)there were an item in the general medical services table that:

i.related to the service; and

ii.specified for the service a fee in relation to each State, being the fee specified in the Schedule in relation to the service.

6. Restriction on items in this schedule—services connected with provision of pain pump for post‑surgical pain management

1. An item in the Schedule of this Determination does not apply to a service described in the item if the service is provided at the same time as, or in connection with, the provision of a pain pump for post-surgical pain management.

Schedule – relevant services

Group T8–Surgical operations
Column 1 Item	Column 2 Description	Column 3 Fee ($)
Subgroup 1–General
30175	Radical abdominoplasty, with repair of rectus diastasis, excision of skin and subcutaneous tissue, and transposition of umbilicus, not being a laparoscopic procedure, where the patient has an abdominal wall defect as a consequence of pregnancy, if: (a)     the patient: (i)   has a diastasis of at least 3cm measured by diagnostic imaging prior to this service; and (ii)     has symptoms of at least moderate severity of pain or discomfort at the site of the diastasis in the abdominal wall during functional use and/or low back pain or urinary symptoms likely due to rectus diastasis that have been documented in the patient’s records by the practitioner providing this service; and (iii)    has failed to respond to non-surgical conservative treatment including physiotherapy; and (iv) has not been pregnant in the last 12 months (b)     the service is not a service associated with a service to which item 30165, 30651, 30655, 30168, 30171, 30172, 30176, 30177, 30179, 45530, 45564 or 45565 applies Applicable once per lifetime (H) (Anaes.) (Assist.)	1,025.60