Statutory Rules 1986 No. 1951
Health
Insurance (Variation of Fees and Medical Services) (No. 42) Regulations
I, THE GOVERNOR-GENERAL of the Commonwealth of Australia,
acting with the advice of the Federal Executive Council, hereby make the
following Regulations under the Health Insurance Act 1973.
Dated 30 July 1986.
N. M. STEPHEN
Governor-General
By His Excellency's Command,
NEAL BLEWETT
Minister of State for Health
–––––––––––
Citation
1. These
Regulations may be cited as the Health Insurance (Variation of Fees and Medical
Services) (No. 42) Regulations.
Commencement
2. These
Regulations shall come into operation on 1 August 1986.
Amendments of the Schedule to the
Health Insurance (Variation of Fees and Medical Services) (No. 37) Regulations
3. The
Schedule to the Health Insurance (Variation of Fees and Medical Services) (No.
37) Regulations, being that Schedule as amended by—
(a) the
Health Insurance (Variation of Fees and Medical Services) (No. 39) Regulations;
(b) the
Health Insurance (Variation of Fees and Medical Services) (No. 40) Regulations;
and
(c) the
Health Insurance (Variation of Fees and Medical Services) (No. 41) Regulations,
is amended as set out in the Schedule to these Regulations.
SCHEDULE Regulation 3
AMENDMENTS OF THE SCHEDULE TO THE
HEALTH INSURANCE (VARIATION OF FEES AND MEDICAL SERVICES) (No. 37) REGULATIONS
1. Insert in the heading to the
Schedule "GENERAL" after "TABLE OF".
2. Omit from rule 7, paragraphs (1)
(c), (d) and (e), substitute the following paragraphs:
"(c)
item 290 in Part 2;
(d) item
887, 888, 889, 996, 997 or 998 in Part 6;
(e) an item
to which rule 6 applies; or
(f) an item
in Part 10 that includes the symbol 'D',".
3. Insert in sub-rule 8 (2)—
(a)
"931," after "929,";
(b)
"939," after "938,"; and
(c)
"953, 954," after "951,".
4. Omit from sub-rule 8 (2)
"981, 982".
5. Insert in rule 9 "in item
290 in Part 2 or" after "specified".
6. After rule 9 insert the following
rule:
"9A. (1) A medical service to which an
item in Division 5 of Part 6 relates, other than item 882, 883 or 884, shall be
taken to be a medical service for the purposes of the Act if and only if it is
rendered—
(a) in
conditions which allow the establishment of determinate thresholds; and
(b) in a
sound attenuated environment using calibrated equipment which complies with
Australian Standard AS 2586-1983 as in force or existing on 1 August 1986.
"(2) In
sub-rule (1), 'Australian Standard AS 2586-1983' means the Australian Standard
for Audiometers published by the Standards Association of Australia on 7
February 1983.".
7. Omit rules 11 to 18 (inclusive)
and rules 27 to 33 (inclusive).
8. | After
item 284 insert the following item: |
"290 Antenatal cardiotocography
in the management of high risk pregnancy...................................................
| 20.00 | 20.00 | 20.00 | 20.00 | 20.00 | 20.00". |
9. | Omit item 481, substitute the
following item: |
"481 Administration of an anaesthetic
in connection with forceps delivery, vacuum extraction delivery, breech
delivery by manipulation, delivery of second twin by manipulation, rotation of
head followed by delivery— where an epidural needle or catheter has not been
inserted earlier in labour (G)
| 54.00 | 53.00 | 53.00 | 52.00 | 52.00 | 45.50". |
10. | Omit item 552, substitute the
following item: |
"552 Administration of an anaesthetic
in connection with forceps delivery, vacuum extraction delivery, breech
delivery by manipulation, delivery of second twin by manipulation, rotation of
head followed by delivery— where an epidural needle or catheter has not been
inserted earlier in labour (S)
| 65.00 | 65.00 | 65.00 | 63.00 | 63.00 | 57.00". |
SCHEDULE—continued
11. | Omit item 748, substitute the
following item: |
"748 Regional or Field Nerve
Block, being one of the following nerve blocks—abdominal (in association with
an intraperitoneal operation), brachial plexus, caudal, cervical plexus (not
including the uterine cervix), epidural (peridural), ilio inguinal-ilio
hypogastric- genitofemoral, intercostal (involving any four or more nerves,
one or both sides), paravertebral (thoracic or lumbar), pudendal, retrobulbar
with facial nerve, sacral or spinal (intrathecal).............................................................
| 51.00 | 51,00 | 51.00 | 51,00 | 51.00 | 51.00". |
12. | Omit items 755 and 756, substitute
the following items:
|
"755 Nerve block with local
anaesthetic agent of the coeliac plexus, the lumbar sympathetic chain, the
thoracic sympathetic chain, the glossopharyngeal nerve or the obturator nerve,
with or without X-ray control (AU 8).............................................................
| 75.00 | 74.00 | 74.00 | 73.00 | 73.00 | 65.00 |
"756 Nerve block with
alcohol, phenol or other neurolytic agent of the coeliac plexus, the
splanchnic nerves, the lumbar sympathetic chain, the thoracic sympathetic
chain or a cranial nerve (other than the trigeminal nerve) or an epidural or
caudal block with or without X-ray control, localization by electrical
stimulator or preliminary block with local anaesthetic (AU 8)...........
| 84.00 | 83.00 | 83.00 | 81.00 | 81.00 | 74.00". |
13. | After item 860 insert the
following item: |
"862 Non-determinate
audiometry........ | 12.00 | 12.00 | 12.00 | 12.00 | 12.00 | 12.00". |
14. | Omit item 865, substitute the
following item: |
"865 Audiogram, air and bone
conduction or air conduction and speech discrimination.......................
| 20.50 | 20.50 | 20.50 | 20.50 | 20.50 | 20.50". |
15. | After item 874 insert the
following item: |
"875 Glycerol induced cochlear
function changes assessed by a minimum of four air conduction and speech
discrimination tests (Klockoff's test)........................
| 63.00 | 63.00 | 63.00 | 63.00 | 63.00 | 63.00". |
16. | After item 882 insert the
following item: |
"883 Simultaneous bithermal
caloric test of labyrinths
| 24.50 | 24.50 | 24.50 | 24.50 | 24.50 | 24.50". |
17. | After item 931 insert the
following item: |
"932 Administration of
cytotoxic agent by intravenous drip infusion..............................................
| 32.50 | 32.50 | 32.50 | 32.50 | 32.50 | 32.50". |
SCHEDULE—continued
18. | Omit item 955. |
19. | Omit Part 7. |
20. | Omit item 2557, substitute the
following item: |
"2557 Femur, internal
fixation of neck or intertrochanteric (pertrochanteric) fracture.................
| 83.00 | 83.00 | 83.00 | 83.00 | 83.00 | 83.00". |
21. | Omit item 3664, substitute the
following item: |
3664 Breast, excision of cyst,
fibro adenoma or other local lesion or segmental resection for any other
reasons (S) (AU 7).........................................................
| 140.00 | 140.00 | 140.00 | 140.00 | 140.00 | 140.00". |
22. | Omit item 3722, substitute the
following item: |
"3722 Laparotomy involving
caecostomy, enterostomy, colostomy, enterostomy, colotomy, cholecystostomy,
gastrostomy, gastrotomy, reduction of intussusception, removal of Meckel's
diverticulum, suture of perforated peptic ulcer, simple repair of ruptured
viscus, reduction of volvulus, pyloroplasty (adult) or drainage of pancreas
(AU 11)....................................................
| 285.00 | 285.00 | 285.00 | 285.00 | 285.00 | 285.00". |
23. | Omit item 4087, substitute the
following item: |
"4087 Laparotomy for drainage
of pelvic abscess, appendiceal abscess, ruptured appendix or for peritonitis
from any cause—with or without appendicectomy (G) (AU 10)
| 215.00 | 215.00 | 215.00 | 215.00 | 215.00 | 215.00". |
24. | Omit item 4093, substitute the
following item: |
"4093 Laparotomy for drainage
of pelvic abscess, appendiceal abscess, ruptured appendix or for peritonitis
from any cause—with or without appendicectomy (S) (AU 10)
| 270.00 | 270.00 | 270.00 | 270.00 | 270.00 | 270.00". |
25. | Omit item 4130. |
26. | Omit item 4824, substitute the
following item: |
"4824 Central vein
catheterisation by open exposure using subcutaneous tunnel with pump or
access, port as with a Hickman or Broviac catheter (AU 8)
| 200.00 | 200.00 | 200.00 | 200.00 | 200.00 | 200.00". |
27. | After item 5068 insert the
following items: |
"5069 Meatoplasty involving removal
of cartilage or bone or both cartilage and bone not covered by item 5070 (AU
9)
| 320.00 | 320.00 | 320.00 | 320.00 | 320.00 | 320.00 |
"5070 Meatoplasty involving
removal of cartilage or bone or both cartilage and bone associated with items
5078, 5091, 5095, 5098 or 5100 (AU 7).............
| 210.00 | 210.00 | 210.00 | 210.00 | 210.00 | 210.00". |
SCHEDULE—continued
28. | After
item 5072 insert the following items: |
"5073 Correction of auditory
canal stenosis, including meatoplasty, with or without grafting (AU 12)..................................
| 540.00 | 540.00 | 540.00 | 540.00 | 540.00 | 540.00 |
5074 Reconstruction of external
auditory canal in association with items 5095, 5098, 5100 (AU 9)...............................................
| 156.00 | 156.00 | 156.00 | 156.00 | 156.00 | 156.00". |
29. | After item 5078 insert the
following items: |
"5079 Atticotomy without reconstruction
of the bony defect, with or without myringoplasty (AU 12)...............................................
| 625.00 | 625.00 | 625.00 | 625.00 | 625.00 | 625.00 |
"5080 Atticotomy with
reconstruction of the bony defect, with or without myringoplasty (AU 14)...............................................
| 700.00 | 700.00 | 700.00 | 700.00 | 700.00 | 700.00". |
30. | After item 5091 insert the
following items: |
"5093 Mastoidectomy, intact
wall technique, with myringoplasty (AU 16)..........
| 870.00 | 870.00 | 870.00 | 870.00 | 870.00 | 870.00 |
"5094 Mastoidectomy, intact
wall technique, with myringoplasty and ossicular chain reconstruction (AU 18)..........
| 1025.00 | 1025.00 | 1025.00 | 1025.00 | 1025.00 | 1025.00". |
31. | After item 5100 insert the
following item: |
"5101 Revision of
mastoidectomy (radical, modified radical or intact wall), including
myringoplasty (AU 16)..................................
| 595.00 | 595.00 | 595.00 | 595.00 | 595.00 | 595.00". |
32. | Omit item 5147, substitute the
following items: |
"5147 Round window surgery
including repair or cochleotomy (AU 11)............
| 595.00 | 595.00 | 595.00 | 595.00 | 595.00 | 595.00 |
"5148 Cochlear implant,
insertion of, including mastoidectomy (AU 23)........
| 1035.00 | 1035.00 | 1035.00 | 1035.00 | 1035.00 | 1035.00". |
33. | After item 5172 insert the following
items: |
"5173 Clearance of middle ear
for granuloma, cholesteatoma and polyp, one or more, with or without myringoplasty
(AU 10)
| 625.00 | 625.00 | 625.00 | 625.00 | 625.00 | 625.00 |
"5174 Clearance of middle ear
for granuloma, cholesteatoma and polyp, one or more, with or without
myringoplasty with ossicular chain reconstruction (AU 16)..........
| 780.00 | 780.00 | 780.00 | 780.00 | 780.00 | 780.00". |
34. | After item 5176 insert the
following item: |
"5177 Excision of rim of ear
drum perforation, not associated with myringoplasty (AU 6)
| 78.00 | 78.00 | 78.00 | 78.00 | 78.00 | 78.00". |
35. | Omit item 5217, substitute the
following item: |
"5217 Nasal septum, septoplasty,
submucous resection or closure of septal perforation (AU 9)...............................................
| 245.00 | 265.00 | 178.00 | 178.00 | 245.00 | 178.00". |
SCHEDULE— continued
36. | Omit
item 5230, substitute the following item: |
"5230 Nasal haemorrhage,
arrest of during an episode of epistaxis by cauterisation or nasal cavity
packing or both (AU 7)..........................
| 49.00 | 49.00 | 49.00 | 49.00 | 49.00 | 49.00". |
37. | After item 5233 insert the
following item: |
"5234 Division of nasal
adhesions, with or without stenting not associated with any other operation
on the nose and not performed during the postoperative period of a nasal
operation (AU 6).......
| 64.00 | 64.00 | 64.00 | 64.00 | 64.00 | 64.00". |
38. | Omit items 5237 and 5241,
substitute the following items:
|
"5237 Turbinectomy or
turbinectomies, partial or total, unilateral (AU 6)...................
| 75.00 | 75.00 | 75.00 | 75.00 | 75.00 | 75.00 |
"5241 Turbinates, submucous resection
of, unilateral (AU 8)
| 97.00 | 97.00 | 97.00 | 97.00 | 97.00 | 97.00". |
39. | After item 5291 insert the
following items: |
"5292 Ethmoidal artery or
arteries, transorbital ligation of (unilateral) (AU 10)..............
| 245.00 | 245.00 | 245.00 | 245.00 | 245.00 | 245.00 |
"5293 Lateral rhinotomy with
removal of tumour (AU 12).............................................
| 490.00 | 490.00 | 490.00 | 490.00 | 490.00 | 490.00". |
40. | Omit items 5348 and 5354,
substitute the following items:
|
"5348 Post-nasal space,
direct examination of, with or without biopsy (AU 7)..........
| 67.00 | 67.00 | 67.00 | 67.00 | 67.00 | 67.00 |
"5349 Nasendoscopy or
sinoscopy or fibreoptic examination or nasopharynx and larynx (AU 7)
| 67.00 | 67.00 | 67.00 | 67.00 | 67.00 | 67.00 |
"5350 Nasopharyngeal
angiofibroma, transpalatal removal (AU 12)................................
| 400.00 | 400.00 | 400.00 | 400.00 | 400.00 | 400.00 |
"5354 Pharyngeal pouch,
removal of, with or without cricopharyngeal myotomy (AU 16)
| 385.00 | 385.00 | 385.00 | 385.00 | 385.00 | 385.00". |
41. | After item 5357 insert the
following item: |
"5358 Cricopharyngeal myotomy
with or without inverson of pharyngeal pouch (AU 10)
| 320.00 | 320.00 | 320.00 | 320.00 | 320.00 | 320.00". |
42. | After item 5360 insert the
following items: |
"5361 Partial pharyngectomy via
pharyngotomy (AU 12).............................................
| 520.00 | 520.00 | 520.00 | 520.00 | 520.00 | 520.00 |
"5362 Partial pharyngectomy via
pharyngotomy with partial or total glossectomy (AU 14)
| 645.00 | 645.00 | 645.00 | 645.00 | 645.00 | 645.00". |
43. | Omit item 5492, substitute the
following item: |
"5492 Oesophagus, endoscopic
pneumatic dilatation of (AU 8)..................................
| 124.00 | 124.00 | 124.00 | 124.00 | 124.00 | 124.00". |
44. | After item 5498 insert the
following items: |
"5499 Vertical hemi-laryngectomy
including tracheostomy (AU 17)................................
| 675.00 | 675.00 | 675.00 | 675.00 | 675.00 | 675.00 |
"5500 Supraglottic
laryngectomy including tracheostomy (AU 21)................................
| 830.00 | 830.00 | 830.00 | 830.00 | 830.00 | 830.00". |
SCHEDULE—continued
45. | After item 5534 insert the
following items: |
"5538 Microlaryngoscopy with
removal of juvenile papillomata (AU 10).................
| 270.00 | 270.00 | 270.00 | 270.00 | 270.00 | 270.00 |
"5539 Microlaryngoscopy with
removal of papillomata by laser surgery (AU 13)................
| 330.00 | 330.00 | 330.00 | 330.00 | 330.00 | 330.00". |
46. | After item 5540 insert the
following item: |
"5541 Microlaryngoscopy with
arytenoidectomy (AU 13).................................................
| 335.00 | 335.00 | 335.00 | 335.00 | 335.00 | 335.00". |
47. | Omit item 5556, substitute the
following items: |
"5556 Larynx, external
operation on, or laryngofissure, with or without cordectomy (AU 13)
| 320.00 | 320.00 | 320.00 | 320.00 | 320.00 | 320.00 |
"5557 Laryngoplasty or tracheoplasty,
including tracheostomy (AU 17)...............
| 520.00 | 520.00 | 520.00 | 520.00 | 520.00 | 520.00". |
48. | After item 5699, insert the
following item: |
"5700 Extracorporeal shock
wave lithotripsy and post-operative care for three days, including preoperative
consultation in hospital for assessment for lithotripsy (AU 12)....................................
| 390.00 | 390.00 | 390.00 | 390.00 | 390.00 | 390.00". |
49. | Omit items 6513, 6517, 6532 and
6533, substitute the following items:
|
"6513 Hysterectomy,
abdominal, subtotal or total, with or without removal of uterine adnexae or
vaginal hysterectomy (with or without uterine curettage) not covered by item
6544 (G) (AU 11)
| 300.00 | 300.00 | 300.00 | 300.00 | 300.00 | 300.00 |
"6517 Hysterectomy,
abdominal, subtotal or total, with or without removal of uterine adnexae or
vaginal hysterectomy (with or without uterine curettage) not covered by item
6544 (S) (AU 11)
| 380.00 | 380.00 | 380.00 | 380.00 | 380.00 | 380.00 |
"6532 Hysterectomy,
abdominal, with excision of ovarian, paraovarian, broad ligament or other
adnexal cyst or mass, one or more, with conservation of the ovaries (G) (AU
12)..............................
| 395.00 | 395.00 | 395.00 | 395.00 | 395.00 | 395.00 |
"6533 Hysterectomy,
abdominal, with excision of ovarian, paraovarian, broad ligament or other
adnexal cyst or mass, one or more, with conservation of the ovaries (S) (AU
12)..............................
| 500.00 | 500.00 | 500.00 | 500.00 | 500.00 | 500.00". |
50. | Omit item 6544, substitute the
following item: |
"6544 Hysterectomy, vaginal
(with or without uterine curettage) with salpingectomy, oophorectomy or
excision of ovarian cyst, one or more, one or both sides (AU 12)
| 425.00 | 425.00 | 425.00 | 425.00 | 425.00 | 425.00". |
SCHEDULE— continued
51. | Omit
items 6677 and 6681. |
52. | Omit
item 6799, substitute the following item: |
"6799 Nasolacrimal tube
(unilateral) replacement of, under general anaesthesia, or lacrimal passages,
probing for obstruction, unilateral or bilateral, with or without lavage (AU
4)
| 79.00 | 79.00 | 54.00 | 54.00 | 54.00 | 54.00". |
53. | Omit item 7079, substitute the
following item: |
"7079 Injection into
trigeminal ganglion or primary branch of trigeminal nerve with alcohol (AU 8).............................................
| 150.00 | 150.00 | 150.00 | 150.00 | 150.00 | 150.00". |
54. | Omit item 7085, substitute the
following item: |
"7085 Lumbar puncture, or
spinal or epidural injection not covered by item 748 or 752 (AU 5)..........................................
| 41.50 | 41.50 | 41.50 | 41.50 | 41.50 | 41.50". |
55. | Omit item 7898, substitute the
following item: |
"7898 Femur, internal
fixation of neck or intertrochanteric (pertrochanteric) fracture (AU 11)................................
| 540.00 | 540.00 | 540.00 | 540.00 | 540.00 | 540.00". |
56. | Omit items 8179 and 8182,
substitute the following items:
|
"8179 Excision of exostosis
of large bone or excision of osteoma of palate (G) (AU 6)
| 150.00 | 150.00 | 150.00 | 150.00 | 150.00 | 150.00 |
"8182 Excision of exostosis
of large bone or excision of osteoma of palate (S)(AU 6)
| 184.00 | 184.00 | 184.00 | 184.00 | 184.00 | 184.00". |
57. | Omit item 8594, substitute the
following item: |
"8594 Rhinoplasty, correction
of lateral or alar cartilages of columella, one or more (AU 10).............................................
| 280.00 | 280.00 | 280.00 | 280.00 | 280.00 | 280.00". |
58. | Omit item 8656, substitute the
following item: |
"8656 Pharyngeal flap or
pharyngoplasty, with or without tonsillectomy (AU 15)
| 405.00 | 405.00 | 405.00 | 405.00 | 405.00 | 405.00". |
NOTE
1. Notified in the Commonwealth of Australia Gazette