Health Insurance (Section 3C General Medical Services – Cardiac Services) Determination 2020 (Cth)

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Health Insurance (Section 3C General Medical Services – Cardiac Services) Determination 2020

made under 3C(1) of the

Health Insurance Act 1973

Compilation No. 1

Compilation date:   15 September 2020

Includes amendments up to:            F2020L01158

Registered:   30 September 2020

About this compilation

This compilation

This is a compilation of the Health Insurance (Section 3C General Medical Services – Cardiac Services) Determination 2020 that shows the text of the law as amended and in force on 15 September 2020 (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If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.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

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

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

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

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

5........ Treatment and effect of relevant services............................................... 2

6........ Application of provisions of the general medical services table.. 3

7........ Application of items........................................................................................... 3

8........ Restriction of items............................................................................................ 3

Schedule 1 – Relevant services................................................................................... 6

Endnotes   12

Endnote 1—About the endnotes   12

Endnote 2—Abbreviation key   13

Endnote 3—Legislation history   14

Endnote 4—Amendment history   15

1  Name

This instrument is the Health Insurance (Section 3C General Medical Services – Cardiac Services) Determination 2020.

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 August 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.

(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

Act means the Health Insurance Act 1973.

admitted patient means a person who is receiving a service that is provided:

(a)     as part of an episode of hospital treatment; or

(b)     as part of an episode of hospital-substitute treatment in respect of which the person to whom the treatment is provided choses to receive a benefit from a private health insurer.

attendance means an item listed in Part 2 of the general medical services table.

clinical notes means a written report commenting on the significance of the trace findings and their relationship to clinical decision making for the patient in their clinical context. This interpretation does not include interpretation based solely on measurements or diagnoses automatically generated from the trace.

formal report means a written report that entails interpretation of the trace, (including indicators for the investigation) commenting on the significance of the trace findings and their relationship to clinical decision making for the patient in their clinical context, and may include a copy of the trace and any measurements taken or automatically generated.

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.

requesting practitioner means the medical practitioner making the request for the service who is not the medical practitioner rendering the service.

Schedule means a Schedule to this instrument.

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

·      clinically relevant service;

·      diagnostic imaging services table;

·      general medical services table;

·      hospital-substitute treatment;

·      hospital treatment;

·      item;

·      professional service.

trained in exercise testing means the person is capable of safely performing exercise or pharmacological stress monitoring and recording, which must include the ability to recognise the symptoms and signs of cardiac disease.

(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 and effect of relevant services

(1) 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 that service a fee in relation to each State, being the fee specified in the item relating to the service set out in Schedule 1 to this instrument.

6.  Application of provisions of the general medical services table

(1)    Clauses 1.2.6 and 1.2.7 of the general medical services table shall have the effect as if items 11705 and 11731 of this instrument were specified in subclauses 1.2.6(1) and 1.2.7(1).

(2)    Clause 1.2.11 of the general medical services table shall have effect as if items 11704, 11707, 11714, 11716, 11717, 11723, 11729, 11730 and 11735 of this instrument were specified in subclause 1.2.11(1).

7.  Application of items

(1)    Items 11716, 11717, 11723, 11729 or 11735 do not apply to a service unless:

(a)      the patient is referred to the specialist or consultant physician; or

(b)     the service is requested by a requesting practitioner.

(2)    A service to which items 11716, 11717, 11723, 11729, or 11735 applies is considered to be referred if the specialist or consultant physician who renders the service:

(a)      manages the ongoing care of the patient; or

(b)     performs an attendance to determine that testing is necessary, where the need for the test has not otherwise been scheduled; or

(c)      performs an attendance immediately after the test has been performed, at which clinical management decisions are discussed with the patient.

(3)    A service to which items 11716, 11717, 11723, 11729 or 11735 applies is taken to be requested if rendered in circumstances other than described in subsection 7(2).

8.  Restriction of items

Restriction on items 11704, 11707, 11714, 11716, 11717, 11723 and 11735 —location of service

(1)    Items 11704, 11707, 11714, 11716, 11717, 11723 or 11735 do not apply to a service if the patient is an admitted patient.

Restriction on items 11704 and 11705—financial relationship

(2)   Items 11704 or 11705 do not apply to a service if the medical practitioner who renders the service has a financial relationship with the requesting practitioner.

Restriction on items 11729 and 11730—patient limitations

(3)    Items 11729 or 11730 do not apply to a service unless:

(a)      the patient’s body habitus, or other physical condition, is suitable for exercise stress testing or pharmacological induced stress testing; and

(b)     the patient can complete the exercise sufficiently or respond adequately to pharmacological induced stress, to take the required measurements/

(4)    Item 11729 does not apply to a service performed on a patient who:

(a)      is asymptomatic and has a normal cardiac examination; or

(b)     has a known cardiac disease but the absence of symptom evolution suggests the disease has not progressed and the service is used for monitoring; or

(c)      has an abnormal resting electrocardiography result which would prevent the interpretation of results.

(5)    Item 11730 does not apply to a service performed on a patient who is asymptomatic and has a normal cardiac examination.

Restriction on items 11729 and 11730—personnel limitations

(6)    Items 11729 or 11730 do not apply to a service unless one of the persons, as described in subparagraphs b(iv) and (v) of the descriptors of those items (column 2 of the table at Schedule 1), is a medical practitioner.

Restriction on items 11704 and 11705—services performed on the same day as an attendance

(7)    Item 11704 does not apply to a service if the specialist or consultant physician who performs the service has performed a service to which an attendance applies for the same patient on the same day.

(8)    Item 11705 does not apply to a service if the specialist or consultant physician who performs the service has performed a service to which an attendance applies for the same patient on the same day, unless exceptional circumstances exist.

(9)    For the purpose of subsection 8(8), exceptional circumstances means there has been a significant change in the patient’s clinical condition or care circumstances that necessitates the performance of the attendance.

Restriction on items 11716, 11717, 11723, 11729 or 11735 —requested services performed on the same day as an attendance

(10)  Where items 11716, 11717, 11723, 11729 or 11735 are requested, an item does not apply to a service if the medical practitioner has performed a service to which an attendance applies for the same patient on the same day.

Schedule 1 – Relevant services

Group D1—Miscellaneous diagnostic procedures and investigations
Item Service Fee ($)
Subgroup 6—Cardiovascular
11704

Twelve-lead electrocardiography to produce a trace and a formal report, by a specialist or a consultant physician, if:

(a)  the service is requested by a requesting practitioner; and

(b)  a copy of formal report is provided to the requesting practitioner; and

(c)  if the service is not associated with a service to which item 12203, 12204, 12205, 12207, 12208, 12210, 12213, 12215, 12217 or 12250 applies

 32.25
11705

Preparing a formal report only on an electrocardiography trace, by a specialist or a consultant physician, if:

(a)  the service is requested by a requesting practitioner; and

(b)  the formal report uses a trace provided from twelve-lead electrocardiography for the patient which has:

(i)   been provided with the request from the requesting practitioner; and

(ii)  not been previously been reported on; and

(c)  a copy of the formal report is provided to the requesting practitioner; and

(d)  the service is not associated with a service to which item 12203, 12204, 12205, 12207, 12208, 12210, 12213, 12215, 12217 or 12250 applies

For any particular patient, applicable no more than twice on the same day

 19.00
11707

Twelve-lead electrocardiography to produce a trace only, by a medical practitioner, if the trace:

(a)  is required to inform clinical decision making; and

(b)  is reviewed in a clinically appropriate timeframe to identify potentially serious or life-threatening abnormalities; and

(c)  does not need to be fully interpreted or reported on

Not associated with a service to which item 12203, 12204, 12205, 12207, 12208, 12210, 12213, 12215, 12217 or 12250 applies

For any particular patient, applicable no more than twice on the same day

 19.00
11714

Twelve-lead electrocardiography to produce a trace and a clinical note, by a specialist or consultant physician, if a copy of the clinical note is provided to the medical practitioner managing the patient’s care, if appropriate

Not associated with a service to which item 12203, 12204, 12205, 12207, 12208, 12210, 12213, 12215, 12217 or 12250 applies

For any particular patient, applicable no more than twice on the same day

 25.00
11716

Continuous electrocardiogram recording of ambulatory patient for 12 or more hours with interpretation and report, by a specialist or consultant physician, if the service:

(a)  is indicated for the evaluation of a patient for:

(i)   syncope; or

(ii)  pre-syncopal episodes; or

(iii) palpitations where episodes are occurring greater than once a week; or

(iv) another asymptomatic arrhythmia is suspected with an expected frequency of greater than once a week; or

(v)  surveillance following cardiac surgical procedures that have an established risk of causing dysrhythmia; and

(b)  utilises a system capable of superimposition and full disclosure printout of at least 12 hours of recorded electrocardiogram data, (including resting electrocardiogram and the recording of parameters) microprocessor based scanning analysis; and

(c)  is not in association with ambulatory blood pressure monitoring; and

(d)  is other than a service on a patient in relation to whom this item and any of the items 11704, 11705, 11707 or 11714 are rendered by a single medical practitioner on a single patient on a single day; and

(e)  is applicable once in a 4 week period; and

(f)  is not associated with a service to which item 12203, 12204, 12205, 12207, 12208, 12210, 12213, 12215, 12217  12250, 11717, 11723 or 11735 applies

172.75
11717

Ambulatory electrocardiogram monitoring of a patient, by a specialist or consultant physician, if the service:

(a)  utilises a patient activated, single or multiple event memory recording device which is connected continuously to the patient for between 7 and 30 days and is capable of recording for at least 20 seconds prior to each activation and for 15 seconds after each activation; and

(b)  includes transmission, analysis, interpretation and reporting (including the indication for the investigation); and

(c)  is for investigation of recurrent episodes of:

(i)   unexplained syncope; or 

(ii)  palpitation; or

(iii) other symptoms where a cardiac rhythm disturbance is suspected and where episodes are infrequent has occurred; and

(d)  is applicable once in a 3 month period; and

(e)  is not associated with a service to which item 12203, 12204, 12205, 12207, 12208, 12210, 12213, 12215, 12217, 12250, 11716, 11723 or 11735 applies

 101.50
11723

Conducting ambulatory electrocardiogram monitoring of a patient, by a specialist or consultant physician, if the service:

(a)  utilises a patient activated, single or multiple event recording, on a memory recording device which is connected continuously to the patient for up to 7 days and is capable of recording for at least 20 seconds prior to each activation and for 15 seconds after each activation; and

(b)  includes transmission, analysis, interpretation and formal report (including the indication for the investigation); and

(c)  is for investigation of recurrent episodes of:

(i)   unexplained syncope; or 

(ii)  palpitation; or

(iii) other symptoms where a cardiac rhythm disturbance is suspected and where episodes are infrequent has occurred; and

(d)  is applicable once in a 3 month period; and

(e)  is not associated with a service to which item 12203, 12204, 12205, 12207, 12208, 12210, 12213, 12215, 12217, 12250, 11716, 11717 or 11735 applies

 53.55
11729

Multi channel electrocardiogram monitoring and recording during exercise (motorised treadmill or cycle ergometer capable of quantifying external workload in watts) or pharmacological stress, if:

(a)  the patient is aged 17 years or more; and:

(i)      has symptoms consistent with cardiac ischemia; or

(ii)     has other cardiac disease which may be exacerbated by exercise; or

(iii)    has a first degree relatives with suspected heritable arrhythmia; and

(b)  the exercise or pharmacological stress monitoring and recording:

(i)      is not less than 20 minutes in duration; and

(ii)     includes resting electrocardiogram; and

(iii)    is performed on premises equipped with standard resuscitation equipment; and

(iv)    a person trained in exercise testing and cardiopulmonary resuscitation is in continuous attendance during the monitoring and recording; and

(v)     a second person trained in cardiopulmonary resuscitation is located at the premise where the testing is performed and is immediately available to respond at the time the exercise test is performed on the patient, if required; and

(c)  a written report is produced by a medical practitioner that includes interpretation of the exercise or pharmacological stress monitoring and recording data, commenting on the significance of the data, and their relationship to clinical decision making for the patient in their clinical context; and

(d)  other than a service:

(i)      provided on the same occasion as a service described in any of items 11704, 11705, 11707 or 11714 of the general medical services table; or

(ii)     performed within 24 months of a service to which any of items 55141, 55143, 55145, 55146, 61324, 61329, 61345, 61349, 61357, 61394, 61398, 61406, 61410 or 61414 of the diagnostic imaging services table has applied

Applicable once in a 24 month period

 156.95
11730

Multi channel electrocardiogram monitoring and recording during exercise (motorised treadmill or cycle ergometer capable of quantifying external workload in watts), if:

(a)  the patient is aged under 17 years; and:

(i)   has symptoms consistent with cardiac ischemia; or

(ii)  has other cardiac disease which may be exacerbated by exercise; or

(iii) has a first degree relatives with suspected heritable arrhythmia; and

(b)  the exercise or pharmacological stress monitoring and recording:

(i)   is not less than 20 minutes in duration; and

(ii)  includes resting electrocardiogram; and

(iii) is performed on premises equipped with standard resuscitation equipment; and

(iv) a person trained in exercise testing and cardiopulmonary resuscitation is in continuous attendance during the monitoring and recording; and

(v)  a second person trained in cardiopulmonary resuscitation is located at the premise where the testing is performed and is immediately available to respond at the time the exercise test is performed on the patient, if required; and

(c)  a written report is produced by a medical practitioner that includes interpretation of the exercise or pharmacological stress monitoring and recording data, commenting on the significance of the data, and their relationship to clinical decision making for the patient in their clinical context; and

(d)  other than a service:

(i)   provided on the same occasion as a service described in any of items 11704, 11705, 11707 or 11714 of the general medical services table; or

(ii)  performed within 24 months of a service to which any of items 55141, 55143, 55145, 55146, 61324, 61329, 61345, 61349, 61357, 61394, 61398, 61406, 61410 or 61414 of the diagnostic imaging services table has applied

Applicable once in a 24 month period

 156.95
11731

Implanted electrocardiogram loop recording, by a medical practitioner, including reprogramming when required; retrieval of stored data, analysis, interpretation and report by a medical practitioner, if the service is:

(a)  an investigation for a patient with:

(i)   cryptogenic stroke; or

(ii)  recurrent unexplained syncope; and

(b)  not a service to which item 38285 of the general medical services table applies; and

(c)  applicable once in a 4 week period

 35.85
11735

Continuous electrocardiogram recording of an ambulatory patient for 7 days with interpretation and report, by a specialist or consultant physician, if the service:

(a)  utilises intelligent microprocessor based monitoring, with patient triggered recording and symptom reporting capability, real time analysis of electrocardiograms and alerts, and daily or live data uploads; and

(b)  is not in association with ambulatory blood pressure monitoring; and

(c)  is for the investigation of

(i)   episodes of suspected intermittent cardiac arrhythmia or episodes of syncope; or

(ii)  suspected intermittent cardiac arrhythmia in patients who:

A.  have had a previous cerebrovascular accident; or

B.   are at risk of cerebrovascular accident; or

C.   have had a previous transient ischemic attack/s; and

(d)  is not associated with a service to which item 11716, 11717, 11723, 12203, 12204, 12205, 12207, 12208, 12210, 12213, 12215, 12217 or 12250 applies

For any particular patient, applicable no more than four times in a 12 month period.

 131.90

Endnotes

Endnote 1—About 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 2—Abbreviation 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 3—Legislation history

Name Registration Commencement Application, saving and transitional provisions
Health Insurance (Section 3C General Medical Services – Cardiac Services) Determination 2020 16 July 2020 (F2020L00917) 1 Aug 2020 (s 2(1) item 1)
Health Insurance Legislation Amendment (Section 3C – Cardiac Services) Determination 2020 11 Sep 2020 (F2020L01158) Sch 1 (items 10‑14): 15 Sept 2020 (s 2(1) item 1) —

Endnote 4—Amendment history

Provision affected How affected
s 2............................................. rep LA s 48D
s 6............................................. am F2020L01158
s 7............................................. am F2020L01158
s 8............................................. am F2020L01158
Schedule 1
Schedule 1................................ am F2020L01158
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