Workers Rehabilitation and Compensation (Scales of Charges—Medical Practitioners) Variation Regulations 2006 (SA)
South Australia
Workers Rehabilitation and Compensation (Scales of Charges—Medical Practitioners) Variation Regulations 2006
under the Workers Rehabilitation and Compensation Act 1986
Contents
Part 1—Preliminary
Short title
Commencement
Variation provisions
Part 2—Variation of Workers Rehabilitation and Compensation (Scales of Charges—Medical Practitioners) Regulations 1999
Variation of regulation 4—Interpretation
Insertion of regulation 7
7WorkCover may issue guidelines
Substitution of Schedules A and B
Schedule A—Clinical medical services
Schedule B—Workers compensation services
Part 1—Preliminary
1—Short title
These regulations may be cited as the Workers Rehabilitation and Compensation (Scales of Charges—Medical Practitioners) Variation Regulations 2006.
2—Commencement
These regulations will come into operation 1 month after the day on which they are made.
3—Variation provisions
In these regulations, a provision under a heading referring to the variation of specified regulations varies the regulations so specified.
Part 2—Variation of Workers Rehabilitation and Compensation (Scales of Charges—Medical Practitioners) Regulations 1999
4—Variation of regulation 4—Interpretation
Regulation 4(1)—after the definition of Act insert:
DF, in an item in Schedule A or B, means the derived fee determined in accordance with the item;
Regulation 4, definition of MBS Book—delete the definition
Regulation 4(2)—delete subregulation (2) and substitute:
(2)A reference in these regulations to specified schedule guidelines is a reference to the guidelines of the specified name issued by WorkCover, as in force from time to time.
(3)If a charge prescribed in a scale of charges is expressed as an amount per hour—
(a)a charge is payable for services provided for less than or more than an hour; and
(b)the amount payable is to be determined by multiplying the amount per hour by the proportion that the number of minutes for which the services are provided rounded to the nearest 5 minutes bears to 60 minutes.
Note—
These regulations apply for the purposes of section 127A of the Motor Vehicles Act 1959 subject to modifications specified by that section and modifications specified by notice in the Gazette under that section.
5—Insertion of regulation 7
After regulation 6 insert:
7—WorkCover may issue guidelines
WorkCover may issue guidelines from time to time for the purposes of these regulations.
6—Substitution of Schedules A and B
Schedules A and B—delete the Schedules and substitute:
Schedule A—Clinical medical services
Note—
The item numbers and service descriptions in Schedule A are the subject of Commonwealth of Australia copyright and are reproduced by permission.
This Schedule should be read in conjunction with the Schedule A guidelines.
Group A1 - General Practitioner attendances to which no other item
Emergency attendance after hours
Professional attendance being an attendance at other than consulting rooms, by a general practitioner on $146.30
not more than 1 patient on the 1 occasion - each attendance, other than an attendance between 11pm and
7am, on a public holiday, on a Sunday, before 8 a.m. or after 1 p.m. on a Saturday or at any time other than
between 8 a.m. and 8 p.m. on a day not being a Saturday, Sunday or public holiday, where the attendance
is initiated by or on behalf of the patient in the same unbroken after hours period and where the patient'smedical condition requires immediate treatment
Professional attendance being an attendance at consulting rooms, by a general practitioner on not more than $146.30
1 patient on the 1 occasion - each attendance, other than an attendance between 11pm and 7am, on a
public holiday, on a Sunday, before 8 a.m. or after 1 p.m. on a Saturday or at any time other than between 8
a.m. and 8 p.m. on a day not being a Saturday, Sunday or public holiday, where the attendance is initiated
by or on behalf of the patient in the same unbroken after hours period and where the patient's medical
condition requires immediate treatment and where it is necessary for the doctor to return to, and speciallyopen, consulting rooms for the attendance
Professional attendance, being an attendance at other than consulting rooms, by a general practitioner on $154.75
not more than 1 patient on the 1 occasion - each attendance on any day of the week between 11pm and
7am, where the attendance is initiated by or on behalf of the patient in the same unbroken after-hours periodand where the patient's medical condition requires immediate treatment
Professional attendance, being an attendance at consulting rooms, by a general practitioner on not more $154.75
than 1 patient on the 1 occasion - each attendance on any day of the week between 11pm and 7am, where
the attendance is initiated by or on behalf of the patient in the same unbroken after-hours period and where
the patient's medical condition requires immediate treatment and where it is necessary for the doctor toreturn to, and specially open, consulting rooms for the attendance
General practitioner attendances
Professional attendance at consulting rooms (not being a service to which any other item applies) by a $18.35
general practitioner for an obvious problem characterised by the straightforward nature of the task that
requires a short patient history and, if required, limited examination and management each attendance
Home visit - level A Professional attendance on 1 or more patients on 1 occasion at a place other than
consulting rooms, hospital, residential aged care facility or institution. DF
Derived fee: The fee for Item 3 ($18.35), plus $27.60 divided by the number of patients seen, up to a
maximum of 6 patients. For 7 or more patients - the fee for Item 3 plus $1.85 per patient.
Consultation at an institution other than a hospital or residential aged care facility –
level A Professional attendance on 1 or more patients in 1 institution on 1 occasion - each patient. DF
Derived fee: The fee for Item 3 ($18.35), plus $27.60 divided by the number of patients seen, up to a
maximum of 6 patients. For 7 or more patients - the fee for Item 3 plus $1.85 per patient.
Consultation at a hospital - level A Professional attendance on 1 or more patients in 1 hospital on 1 occasion
- each patient. DF
Derived fee: The fee for Item 3 ($18.35), plus $27.60 divided by the number of patients seen, up to a
maximum of 6 patients. For 7 or more patients - the fee for Item 3 plus $1.85 per patient.
Consultation at a residential aged care facility - level A Professional attendance on 1 or more patients in 1
hospital on 1 occasion - each patient. DF
Derived fee: The fee for Item 3 ($18.35), plus $27.60 divided by the number of patients seen, up to a
maximum of 6 patients. For 7 or more patients - the fee for Item 3 plus $1.85 per patient.
Professional attendance at consulting rooms (not being a service to which any other item applies) by a $47.70
general practitioner involving taking a selective history, examination of the patient with implementation of a
management plan in relation to 1 or more problems, or a professional attendance of less than 20 minutesduration involving components of a service to which item 36 or 44 applies each attendance
Home visit - level B Professional attendance on 1 or more patients on 1 occasion at a place other than
consulting rooms, hospital, residential aged care facility or institution. DF
Derived fee: The fee for Item 23 ($47.70), plus $27.60 divided by the number of patients seen, up to a
maximum of 6 patients. For 7 or more patients - the fee for Item 23 plus $1.85 per patient.
Consultation at an institution other than a hospital or residential aged care facility –
level B Professional attendance on 1 or more patients in 1 hospital on 1 occasion - each patient. DF
Derived fee: The fee for Item 23 ($47.70), plus $27.60 divided by the number of patients seen, up to a
maximum of 6 patients. For 7 or more patients - the fee for Item 23 plus $1.85 per patient.
Consultation at a hospital - level B Professional attendance on 1 or more patients in 1 hospital on 1 occasion
- each patient. DF
Derived fee: The fee for Item 23 ($47.70), plus $27.60 divided by the number of patients seen, up to a
maximum of 6 patients. For 7 or more patients - the fee for Item 23 plus $1.85 per patient.
Consultation at a residential aged care facility - level B Professional attendance on 1 or more patients in 1
hospital on 1 occasion - each patient. DF
Derived fee: The fee for Item 23 ($47.70), plus $27.60 divided by the number of patients seen, up to a
maximum of 6 patients. For 7 or more patients - the fee for Item 23 plus $1.85 per patient.
Professional attendance at consulting rooms (not being a service to which any other item applies) by a $76.30
general practitioner involving taking a detailed history, an examination of multiple systems, arranging any
necessary investigations and implementing a management plan in relation to 1 or more problems, and lasting
at least 20 minutes, or a professional attendance of less than 40 minutes duration involving components of aservice to which item 44 applies each attendance
Home visit - level C Professional attendance on 1 or more patients on 1 occasion at a place other than
consulting rooms, hospital, residential aged care facility or institution. DF
Derived fee: The fee for Item 36 ($76.30), plus $27.60 divided by the number of patients seen, up to a
maximum of 6 patients. For 7 or more patients - the fee for Item 36 plus $1.85 per patient.
Consultation at an institution other than a hospital or residential aged care facility –
level C Professional attendance on 1 or more patients in 1 hospital on 1 occasion - each patient. DF
Derived fee: The fee for Item 36 ($76.30), plus $27.60 divided by the number of patients seen, up to a
maximum of 6 patients. For 7 or more patients - the fee for Item 36 plus $1.85 per patient.
Consultation at a hospital - level C Professional attendance on 1 or more patients in 1 hospital on 1 occasion
- each patient. DF
Derived fee: The fee for Item 36 ($76.30), plus $27.60 divided by the number of patients seen, up to a
maximum of 6 patients. For 7 or more patients - the fee for Item 36 plus $1.85 per patient.
Consultation at a residential aged care facility - level C Professional attendance on 1 or more patients in 1
hospital on 1 occasion - each patient. DF
Derived fee: The fee for Item 36 ($76.30), plus $27.60 divided by the number of patients seen, up to a
maximum of 6 patients. For 7 or more patients - the fee for Item 36 plus $1.85 per patient.
Professional attendance at consulting rooms (not being a service to which any other item applies) by a $102.50
general practitioner involving taking an exhaustive history, a comprehensive examination of multiple
systems, arranging any necessary investigations and implementing a management plan in relation to 1 or
more complex problems, and lasting at least 40 minutes, or a professional attendance of at least 40 minutesduration for implementation of a management plan each attendance
Home visit - level D Professional attendance on 1 or more patients on 1 occasion at a place other than
consulting rooms, hospital, residential aged care facility or institution. DF
Derived fee: The fee for Item 44 ($102.50), plus $27.60 divided by the number of patients seen, up to a
maximum of 6 patients. For 7 or more patients - the fee for Item 44 plus $1.85 per patient.
Consultation at an institution other than a hospital or residential aged care facility –
level D Professional attendance on 1 or more patients in 1 hospital on 1 occasion - each patient. DF
Derived fee: The fee for Item 44 ($102.50), plus $27.60 divided by the number of patients seen, up to a
maximum of 6 patients. For 7 or more patients - the fee for Item 44 plus $1.85 per patient.
Consultation at a hospital - level D Professional attendance on 1 or more patients in 1 hospital on 1 occasion
- each patient. DF
Derived fee: The fee for Item 44 ($102.50), plus $27.60 divided by the number of patients seen, up to a
maximum of 6 patients. For 7 or more patients - the fee for Item 44 plus $1.85 per patient.
Consultation at a residential aged care facility - level D Professional attendance on 1 or more patients in 1
hospital on 1 occasion - each patient. DF
Derived fee: The fee for Item 44 ($102.50), plus $27.60 divided by the number of patients seen, up to a
maximum of 6 patients. For 7 or more patients - the fee for Item 44 plus $1.85 per patient.
Group A2 - Other non-referred attendances to which no other item
Surgery consultations
Professional attendance at consulting rooms of not more than 5 minutes duration (not being a service to
which any other item applies) by a medical practitioner (not being a general practitioner) each attendance N/A
Professional attendance at consulting rooms of more than 5 minutes duration but not more than 25 minutes
duration (not being a service to which any other item applies) by a medical practitioner (not being a general N/A
practitioner) each attendance
Professional attendance at consulting rooms of more than 25 minutes duration but not more than 45 minutes
duration (not being a service to which any other item applies) by a medical practitioner (not being a general N/A
practitioner) each attendance
Professional attendance at consulting rooms of more than 45 minutes duration (not being a service to which
any other item applies) by a medical practitioner (not being a general practitioner) each attendance N/A
Professional attendance (not being an attendance at consulting rooms, an institution, a hospital or a
residential aged care facility) of not more than 5 minutes duration (not being a service to which any other N/A
item applies) by a medical practitioner (not being a general practitioner) - an attendance on 1 or more
patients on 1 occasion each patient
An amount equal to $8.50, plus $15.50 divided by the number of patients seen, up to a maximum of six
patients. For seven or more patients - an amount equal to $8.50 plus $.70 per patient
Professional attendance (not being an attendance at consulting rooms, an institution, a hospital or a
residential aged care facility) of more than 5 minutes duration but not more than 25 minutes duration (not N/A
being a service to which any other item applies) by a medical practitioner (not being a general practitioner) -an attendance on 1 or more patients on 1 occasion each patient
An amount equal to $16.00, plus $17.50 divided by the number of patients seen, up to a maximum of six
patients. For seven or more patients - an amount equal to $16.00 plus $.70 per patient
Professional attendance (not being an attendance at consulting rooms, an institution, a hospital or a
residential aged care facility) of more than 25 minutes duration but not more than 45 minutes duration (not N/A
being a service to which any other item applies) by a medical practitioner (not being a general practitioner) -an attendance on 1 or more patients on 1 occasion each patient
An amount equal to $35.50, plus $15.50 divided by the number of patients seen, up to a maximum of six
patients. For seven or more patients - an amount equal to $35.50 plus $.70 per patient
Professional attendance (not being an attendance at consulting rooms, an institution, a hospital or a
residential aged care facility) of more than 45 minutes duration (not being a service to which any other item N/A
applies) by a medical practitioner (not being a general practitioner) - an attendance on 1 or more patients on1 occasion each patient
An amount equal to $57.50, plus $15.50 divided by the number of patients seen, up to a maximum of six
patients. For seven or more patients - an amount equal to $57.50 plus $.70 per patient
Professional attendance at an institution of not more than 5 minutes duration (not being a service to which
any other item applies) by a medical practitioner (not being a general practitioner) an attendance on 1 or N/A
more patients at 1 institution on 1 occasion each patient
An amount equal to $8.50, plus $15.50 divided by the number of patients seen, up to a maximum of six
patients. For seven or more patients - an amount equal to $8.50 plus $.70 per patient
Professional attendance at an institution of more than 5 minutes duration but not more than 25 minutes
duration (not being a service to which any other item applies) by a medical practitioner (not being a general N/A
practitioner) an attendance on 1 or more patients at 1 institution on 1 occasion each patient
An amount equal to $16.00, plus $17.50 divided by the number of patients seen, up to a maximum of six
patients. For seven or more patients - an amount equal to $16.00 plus $.70 per patient
Professional attendance at an institution of more than 25 minutes duration but not more than 45 minutes
duration (not being a service to which any other item applies) by a medical practitioner (not being a general N/A
practitioner) an attendance on 1 or more patients at 1 institution on 1 occasion each patient
An amount equal to $35.50, plus $15.50 divided by the number of patients seen, up to a maximum of six
patients. For seven or more patients - an amount equal to $35.50 plus $.70 per patient
Professional attendance at an institution of more than 45 minutes duration (not being a service to which any
other item applies) by a medical practitioner (not being a general practitioner) an attendance on 1 or more N/A
patients at 1 institution on 1 occasion each patient
An amount equal to $57.50, plus $15.50 divided by the number of patients seen, up to a maximum of six
patients. For seven or more patients - an amount equal to $57.50 plus $.70 per patient
Professional attendance at a hospital of not more than 5 minutes duration (not being a service to which any
other item applies) by a medical practitioner (not being a general practitioner) an attendance on 1 or more N/A
patients at 1 hospital on 1 occasion each patient
An amount equal to $8.50, plus $15.50 divided by the number of patients seen, up to a maximum of six
patients. For seven or more patients - an amount equal to $8.50 plus $.70 per patient
Professional attendance at a hospital of more than 5 minutes duration but not more than 25 minutes duration
(not being a service to which any other item applies) by a medical practitioner (not being a general N/A
practitioner) an attendance on 1 or more patients at 1 hospital on 1 occasion each patient
An amount equal to $16.00, plus $17.50 divided by the number of patients seen, up to a maximum of six
patients. For seven or more patients - an amount equal to $16.00 plus $.70 per patient
Professional attendance at a hospital of more than 25 minutes duration but not more than 45 minutes
duration (not being a service to which any other item applies) by a medical practitioner (not being a general N/A
practitioner) an attendance on 1 or more patients at 1 hospital on 1 occasion each patient
An amount equal to $35.50, plus $15.50 divided by the number of patients seen, up to a maximum of six
patients. For seven or more patients - an amount equal to $35.50 plus $.70 per patient
Professional attendance at a hospital of more than 45 minutes duration (not being a service to which any
other item applies) by a medical practitioner (not being a general practitioner) an attendance on 1 or more N/A
patients at 1 hospital on 1 occasion each patient
An amount equal to $57.50, plus $15.50 divided by the number of patients seen, up to a maximum of six
patients. For seven or more patients - an amount equal to $57.50 plus $.70 per patient
Professional attendance (not being a service to which any other item applies) at a residential aged care
facility (other than a professional attendance at a self-contained unit) or professional attendance at N/A
consulting rooms situated within such a complex where the patient is accommodated in the residential aged
care facility (not being accommodation in a self-contained unit) of not more than 5 minutes duration by a
medical practitioner (not being a general practitioner) an attendance on 1 or more patients at 1 residentialaged care facility on 1 occasion each patient
An amount equal to $8.50, plus $15.50 divided by the number of patients seen, up to a maximum of six
patients. For seven or more patients - an amount equal to $8.50 plus $.70 per patient
Professional attendance (not being a service to which any other item applies) at a residential aged care
facility, (other than a professional attendance at a self contained unit) or professional attendance at N/A
consulting rooms situated within such a complex where the patient is accommodated in the residential aged
care facility (not being accommodation in a selfcontained unit) of more than 5 minutes duration but not more
than 25 minutes duration by a medical practitioner (not being a general practitioner) an attendance on 1 ormore patients at 1 residential aged care facility on 1 occasion each patient
An amount equal to $16.00, plus $17.50 divided by the number of patients seen, up to a maximum of six
patients. For seven or more patients - an amount equal to $16.00 plus $.70 per patient
Professional attendance (not being a service to which any other item applies) at a residential aged care
facility (other than a professional attendance at a self contained unit) or professional attendance at N/A
consulting rooms situated within such a complex where the patient is accommodated in the residential aged
care facility (not being accommodation in a selfcontained unit) of more than 25 minutes duration but not more
than 45 minutes duration) by a medical practitioner (not being a general practitioner) an attendance on 1 ormore patients at 1 residential aged care facility on 1 occasion each patient
An amount equal to $35.50, plus $15.50 divided by the number of patients seen, up to a maximum of six
patients. For seven or more patients - an amount equal to $35.50 plus $.70 per patient
Professional attendance (not being a service to which any other item applies) at a residential aged care
facility (other than a professional attendance at a self contained unit) or professional attendance at N/A
consulting rooms situated within such a complex where the patient is accommodated in the residential aged
care facility (not being accommodation in a selfcontained unit) of more than 45 minutes duration by a medical
practitioner (not being a general practitioner) an attendance on 1 or more patients at 1 residential aged carefacility on 1 occasion each patient
An amount equal to $57.50, plus $15.50 divided by the number of patients seen, up to a maximum of six
patients. For seven or more patients - an amount equal to $57.50 plus $.70 per patient
Emergency attendances after hours
Professional attendance being an attendance at other than consulting rooms, by a medical practitioner (not $146.30
being a general practitioner) on not more than 1 patient on the 1 occasion - each attendance, other than an
attendance between 11pm and 7am, on a public holiday, on a Sunday, before 8 a.m. or after 1 p.m. on a
Saturday or at any time other than between 8 a.m. and 8 p.m. on a day not being a Saturday, Sunday or
public holiday, where the attendance is initiated by or on behalf of the patient in the same unbroken afterhours period and where the patient's medical condition requires immediate treatment
Professional attendance being an attendance at consulting rooms, by a medical practitioner (not being a $146.30
general practitioner) on not more than 1 patient on the 1 occasion - each attendance, other than an
attendance between 11pm and 7am, on a public holiday, on a Sunday, before 8 a.m. or after 1 p.m. on a
Saturday or at any time other than between 8 a.m. and 8 p.m. on a day not being a Saturday, Sunday or
public holiday, where the attendance is initiated by or on behalf of the patient in the same unbroken after
hours period and where the patient's medical condition requires immediate treatment and where it isnecessary for the doctor to return to , and specially open, consulting rooms for the attendance
Professional attendance, being an attendance at other than consulting rooms, by a medical practitioner, (not $154.75
being a general practitioner) on not more than 1 patient on the 1 occasion - each attendance on any day of
the week between 11pm and 7am, where the attendance is initiated by or on behalf of the patient in thesame unbroken after-hours period and where the patient's medical condition requires immediate treatment
Professional attendance, being an attendance at consulting rooms, by a medical practitioner (not being a $154.75
general practitioner) on not more than 1 patient on the 1 occasion - each attendance on any day of the
week between 11pm and 7am, where the attendance is initiated by or on behalf of the patient in the same
unbroken after-hours period and where the patient's medical condition requires immediate treatment andwhere it is necessary for the doctor to return to, and specially open, consulting rooms for the attendance
Group A3 - Specialist attendances to which no other item applies
Professional attendance by a specialist in the practice of his or her specialty where the patient is referred to $111.30
him or her an attendance (other than a second or subsequent attendance in a single course of treatment)
where that attendance is at consulting rooms or hospital, not being a service to which item 106 or 109 apply
0104A Professional attendance at consulting rooms or hospital by a specialist in the practice of his or her specialty $153.70
where the patient is referred to him or her.
- Initial attendance in a single course of treatment, not being a service to which item 106 appliesSpecialist, referred consultation of MORE THAN 25 minutes – surgery or hospital
Note 1: Item number 0104A is not to be charged for independent medical examinations.
Note 2: These item numbers are for initial consultations only. Doctors should bill subsequent consultations in
the usual manner.
Note 3: The majority of consultations should fall into the 00104 category. The fact that a patient is a workers
compensation claimant should not necessitate a longer consultation. Factors that would extend the length of
the consultation include:
- the need to obtain a more detailed history or perform a more extensive examination than usual
- additional time is required to review previous investigations, results or reports
- previous intervention or other related medical complaints necessitate increased time and effort in order to
determine appropriate treatment
- extensive advice/counselling regarding ongoing treatment is required
- a course of rehabilitation treatment is recommended to the injured worker for their discussion with theirvocational rehabilitation service provider.
Professional attendance by a specialist in the practice of his or her specialty where the patient is referred to $63.60
him or her each attendance subsequent to the first in a single course of treatment where that attendance is
at consulting rooms, hospital or residential aged care facility
- initial specialist ophthalmologist attendance in a single course of treatment, being an attendance at which $99.00
the sole service provided is refraction testing for the issue of a prescription for spectacles or contact
lenses not being a service to which items 104, 109 or 10801 to 10816 apply
Professional attendance by a specialist in the practice of his or her specialty where the patient is referred to $131.10
him or her an attendance (other than a second or subsequent attendance in a single course of treatment)
where that attendance is at a place other than consulting rooms or hospital
Professional attendance by a specialist in the practice of his or her specialty where the patient is referred to $84.70
him or her each attendance subsequent to the first in a single course of treatment where that attendance is
at a place other than consulting rooms or hospital or residential aged care facility
Initial specialist ophthalmologist paediatric attendance in a single course of treatment, being an attendance at
which a comprehensive eye examination is performed on a child aged 8 years or under, or on a child aged N/A
14 years or under with developmental delay, not being a service to which item 104, 106 or any of items10801 to 10816 applies
Group A4 - Consultant Physician attendances to which no other item applies
Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of his or $185.50
her specialty (other than psychiatry) where the patient is referred to him or her by a medical practitioner -
initial attendance in a single course of treatment
Professional attendance at consulting rooms or hospital by a consultant physician in the practice of his or $95.40
her specialty (other than psychiatry) where the patient is referred to him or her by a medical practitioner
each attendance (not being a service to which item 119 applies) subsequent to the first in a single course oftreatment
Professional attendance at consulting rooms or hospital by a consultant physician in the practice of his or $49.20
her specialty (other than psychiatry) where the patient is referred to him or her by a medical practitioner
each minor attendance subsequent to the first in a single course of treatment
Professional attendance at a place other than consulting rooms or hospital, by a consultant physician in the $207.25
practice of his or her specialty (other than psychiatry) where the patient is referred to him or her by a
medical practitioner initial attendance in a single course of treatment
Professional attendance at a place other than consulting rooms or hospital by a consultant physician in the $119.05
practice of his or her specialty (other than psychiatry) where the patient is referred to him or her by a
medical practitioner each attendance (other than a service to which item 131 applies) subsequent to the firstin a single course of treatment
Professional attendance at a place other than consulting rooms or hospital by a consultant physician in the $89.90
practice of his or her specialty (other than psychiatry) where the patient is referred to him or her by a
medical practitioner each minor attendance subsequent to the first in a single course of treatment
Group A5 - Prolonged attendances to which no other item applies
Professional attendance for a period of not less than 1 hour but less than 2 hours (not being a service to $240.60
which any other item applies) on a patient in imminent danger of death requiring continuous attendance on
the patient to the exclusion of all other patients
Professional attendance for a period of not less than 2 hours but less than 3 hours (not being a service to $390.10
which any other item applies) on a patient in imminent danger of death requiring continuous attendance on
the patient to the exclusion of all other patients
Professional attendance for a period of not less than 3 hours but less than 4 hours (not being a service to $524.70
which any other item applies) on a patient in imminent danger of death requiring continuous attendance on
the patient to the exclusion of all other patients
Professional attendance for a period of not less than 4 hours but less than 5 hours (not being a service to $652.95
which any other item applies) on a patient in imminent danger of death requiring continuous attendance on
the patient to the exclusion of all other patients
Professional attendance for a period of 5 hours or more (not being a service to which any other item $772.75
applies) on a patient in imminent danger of death requiring continuous attendance on the patient to the
exclusion of all other patients
Group A6 - Group Therapy
Professional attendance for the purpose of group therapy of not less than 1 hours duration given under the $164.30
direct continuous supervision of a medical practitioner, other than a consultant physician in the practice of
his or her specialty of psychiatry, involving members of a family and persons with close personalrelationships with that family each group of 2 patients
Professional attendance for the purpose of group therapy of not less than 1 hours duration given under the $168.85
direct continuous supervision of a medical practitioner, other than a consultant physician in the practice of
his or her specialty of psychiatry, involving members of a family and persons with close personalrelationships with that family each group of 3 patients
Professional attendance for the purpose of group therapy of not less than 1 hours duration given under the $211.80
direct continuous supervision of a medical practitioner, other than a consultant physician in the practice of
his or her specialty of psychiatry, involving members of a family and persons with close personalrelationships with that family each group of 4 or more patients
Group A7 - Acupuncture
Attendance at which a medical practitioner performs acupuncture by application of stimuli on or through the $37.10
surface of the skin by acupuncture needle only, including any consultation on the same occasion and any
other attendance on the same day related to the condition for which the acupuncture was performed.
Professional attendance by a general practitioner at a place other than a hospital, involving either: $47.70
1.taking a selective history, examination of the patient with implementation of a management plan in relation
to 1 or more problems; or 2.a professional attendance of less than 20 minutes duration involving
components of a service to which item 36, 37, 38, 40, 43, 44, 47, 48, 50 or 51 [check these in new MBS
book] applies and at which the medical practitioner performs acupuncture by the application of stimuli on or
through the surface of the skin by acupuncture needle only, including any consultation on the same
occasion and any other attendance on the same day related to the condition for which the acupuncturewas performed.
Professional attendance by a general practitioner on 1 or more patients at a hospital, on 1 occasion,
involving either: DF
(i) taking a selective history, examination of the patient with implementation of a management plan in relation
to 1 or more problems; OR
(ii) a professional attendance of less than 20 minutes duration involving components of a service to which
item 36, 37, 38, 40, 43, 44, 47, 48, 50, or 51 applies AND at which the medical practitioner performs
acupuncture by the application of stimuli on or through the surface of the skin by acupuncture needle only;
including any consultation on the same occasion and any other attendance on the same day related to thecondition for which the acupuncture was performed.
Derived fee: The fee for Item 193 ($47.70), plus $27.60 divided by the number of patients seen, up to a
maximum of 6 patients. For 7 or more patients - the fee for Item 193 plus $1.85 per patient.
Professional attendance by a general practitioner at a place other than a hospital, involving either: $76.30
1.taking a detailed history, an examination of multiple systems, arranging any necessary investigations and
implementing a management plan in relation to 1 or more problems and lasting at least 20 minutes; or 2. a
professional attendance of less than 40 minutes duration involving components of a service to which item
44, 47, 48, 50 or 51 applies and at which the medical practitioner performs acupuncture by the application of
stimuli on or through the surface of the skin by acupuncture needle only, including any consultation on the
same occasion and any other attendance on the same day related to the condition for which theacupuncture was performed.
Professional attendance by a general practitioner at a place other than a hospital, involving either: $102.50
1.taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary
investigations and implementing a management plan in relation to 1 or more complex problems and lasting at
least 40 minutes; or 2.a professional attendance of at least 40 minutes duration for the implementation of a
management plan and at which the medical practitioner performs acupuncture by the application of stimuli on
or through the surface of the skin by acupuncture needle only, including any consultation on the same
occasion and any other attendance on the same day related to the condition for which the acupuncturewas performed.
In accordance with Schedule A guidelines, acupuncture may only be performed by a legally qualified
medical practitioner who is a qualified medical acupuncturist, who has been accredited
by the Australian Medical Acupuncture College (AMAC) and RACGP Joint Medical Acupuncture Working
Party, and participates in on-going Quality Assurance (QA) and Continuing Professional Development (CDP)requirements to maintain eligibility.
Group A8 - Consultant psychiatrist attendances to which no other item
applies
Consultant psychiatrist, referred patient assessment and management Professional attendance by a $405.80
consultant physician in the practice of his or her speciality of psychiatry where the patient is referred for
the provision of an assessment and management plan by a medical practitioner practising in general practice
(including a general practitioner, but not including a specialist or consultant physician) where the
attendance is initiated by that medical practitioner and where the consultant psychiatrist provides the
referring medical practitioner with an assessment and management plan to be undertaken by that medical
practitioner in general practice for the patient, where clinically appropriate. An attendance of more than 45
minutes duration at consulting rooms during which: - An outcome tool is used where clinically appropriate -
a mental state examination is conducted - a psychiatric diagnosis is made - The consultant psychiatrist
decides that the patient can be appropriately managed by the referring medical practitioner without the need
for ongoing treatment by the psychiatrist - a 12 month management plan, appropriate to the diagnosis, is
provided to the referring medical practitioner which must: a) comprehensively evaluate biological,
psychological and social issues; b) address diagnostic psychiatric issues; c) make management
recommendations addressing biological, psychological and social issues; and d) be provided to the medical
practitioner within two weeks of completing the assessment of the patient. - The diagnosis and management
plan is explained and provided, unless clinically inappropriate, to the patient and/or the carer (with the
patient's agreement) - The diagnosis and management plan is communicated in writing to the referring
medical practitioner Not being an attendance on a patient in respect of whom, in the preceeding 12 months,payment has been made under this item
Consultant psychiatrist, review of referred patient assessment and management Professional attendance $254.75
by a consultant physician in the practice of his or her speciality of psychiatry to review a management plan
previously prepared by that consultant psychiatrist for a patient and claimed under item 291, where the
review is initiated by the referring medical practitioner practising in general practice. An attendance of more
than 30 minutes but not more than 45 minutes duration at consulting rooms where that attendance follows
item 291 and during which: - An outcome tool is used where clinically appropriate - a mental state
examination is conducted - a psychiatric diagnosis is made - a management plan provided under Item 291 is
reviewed and revised - The reviewed managment plan is explained and provided, unless clinically
inappropriate, to the patient and/or the carer (with the patient's agreement) - The reviewed management
plan is communicated in writing to the referring medical practitioner Being an attendance on a patient in
respect of whom, in the preceeding 12 months, payment has been made under item 291, payable no morethan once in any 12 month period
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry $61.50
where the patient is referred to him or her by a medical practitioner an attendance of not more than 15
minutes duration at consulting rooms, where that attendance and any other attendance to which items 300to 308 and items 353 to 370 apply have not exceeded the sum of 50 attendances in a calendar year
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry $124.00
where the patient is referred to him or her by a medical practitioner an attendance of more than 15 minutes
duration but not more than 30 minutes duration at consulting rooms, where that attendance and any other
attendance to which items 300 to 308 and items 353 to 370 apply have not exceeded the sum of 50attendances in a calendar year
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry $183.40
where the patient is referred to him or her by a medical practitioner an attendance of more than 30 minutes
duration but not more than 45 minutes duration at consulting rooms, where that attendance and any other
attendance to which items 300 to 308 and items 353 to 370 apply have not exceeded the sum of 50attendances in a calendar year
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry $265.00
where the patient is referred to him or her by a medical practitioner an attendance of more than 45 minutes
duration but not more than 75 minutes duration at consulting rooms, where that attendance and any other
attendance to which items 300 to 308 and items 353 to 370 apply have not exceeded the sum of 50attendances in a calendar year
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry $307.40
where the patient is referred to him or her by a medical practitioner an attendance of more than 75 minutes
duration at consulting rooms, where that attendance and any other attendance to which items 300 to 308and items 353 to 370 apply have not exceeded the sum of 50 attendances in a calendar year
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry $25.75
where the patient is referred to him or her by a medical practitioner an attendance of not more than 15
minutes duration at consulting rooms, where that attendance and any other attendance to which items 300to 318 and items 353 to 370 apply exceed 50 attendances in a calendar year.
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry $92.10
where the patient is referred to him or her by a medical practitioner an attendance of more than 15 minutes
duration but not more than 30 minutes duration at consulting rooms, where that attendance and any other
attendance to which items 300 to 318 and items 353 to 370 apply exceed 50 attendances in a calendaryear.
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry $141.50
where the patient is referred to him or her by a medical practitioner an attendance of more than 30 minutes
duration but not more than 45 minutes duration at consulting rooms, where that attendance and any other
attendance to which items 300 to 318 and items 353 to 370 apply exceed 50 attendances in a calendaryear.
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry $137.70
where the patient is referred to him or her by a medical practitioner an attendance of more than 45 minutes
duration but not more than 75 minutes duration at consulting rooms, where that attendance and any other
attendance to which items 300 to 318 and items 353 to 370 apply exceed 50 attendances in a calendaryear.
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry $194.40
where the patient is referred to him or her by a medical practitioner an attendance of more than 75 minutes
duration at consulting rooms, where that attendance and any other attendance to which items 300 to 318and items 353 to 370 apply exceed 50 attendances in a calendar year.
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry $204.90
where the patient is referred to him or her by a medical practitioner - an attendance of more than 45 minutes
duration at consulting rooms, where the patient has: (a) been diagnosed as suffering severe personality
disorder, anorexia nervosa, bulimia nervosa, dysthymic disorder, substance-related disorder, somatoform
disorder or a pervasive development disorder; and (b) for persons 18 years and over, been rated with a
level of functional impairment within the range 1 to 50 according to the Global Assessment of Functioning
Scale - where that attendance and any other attendance to which items 300 to 308 and items 353 to 370apply do not exceed 160 attendances in a calendar year.
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry $61.50
where the patient is referred to him or her by a medical practitioner an attendance of not more than 15
minutes duration at hospital
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry $124.00
where the patient is referred to him or her by a medical practitioner an attendance of more than 15 minutes
duration but not more than 30 minutes duration at hospital
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry $183.40
where the patient is referred to him or her by a medical practitioner an attendance of more than 30 minutes
duration but not more than 45 minutes duration at hospital
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry $265.00
where the patient is referred to him or her by a medical practitioner an attendance of more than 45 minutes
duration but not more than 75 minutes duration at hospital
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry $307.40
where the patient is referred to him or her by a medical practitioner an attendance of more than 75 minutes
duration at hospital
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry $83.55
where the patient is referred to him or her by a medical practitioner an attendance of not more than 15
minutes duration where that attendance is at a place other than consulting rooms or hospital
Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry $135.70
where the patient is referred to him or her by a medical practitioner an attendance of more than 15 minutes
duration but not more than 30 minutes duration where that attendance is at a place other than consulting
rooms or hospitalProfessional attendance by a consultant physician in the practice of his or her specialty of psychiatry $185.50
where the patient is referred to him or her by a medical practitioner an attendance of more than 30 minutes
duration but not more than 45 minutes duration where that attendance is at a place other than consulting
rooms or hospitalProfessional attendance by a consultant physician in the practice of his or her specialty of psychiatry $265.00
where the patient is referred to him or her by a medical practitioner an attendance of more than 45 minutes
duration but not more than 75 minutes duration where that attendance is at a place other than consulting
rooms or hospitalProfessional attendance by a consultant physician in the practice of his or her specialty of psychiatry $307.40
where the patient is referred to him or her by a medical practitioner an attendance of more than 75 minutes
duration where that attendance is at a place other than consulting rooms or hospitalGroup psychotherapy (including any associated consultations with a patient taking place on the same $62.95
occasion and relating to the condition for which group therapy is conducted) of not less than 1 hours
duration given under the continuous direct supervision of a consultant physician in the practice of his or her
specialty of psychiatry, involving a group of 2 to 9 unrelated patients or a family group of more than 3
patients, each of whom is referred to the consultant physician by a medical practitioner each patientGroup psychotherapy (including any associated consultations with a patient taking place on the same $82.45
occasion and relating to the condition for which group therapy is conducted) of not less than 1 hours
duration given under the continuous direct supervision of a consultant physician in the practice of his or her
specialty of psychiatry, involving a family group of 3 patients, each of whom is referred to the consultant
physician by a medical practitioner each patientGroup psychotherapy (including any associated consultations with a patient taking place on the same $123.60
occasion and relating to the condition for which group therapy is conducted) of not less than 1 hours
duration given under the continuous direct supervision of a consultant physician in the practice of his or her
specialty of psychiatry, involving a family group of 2 patients, each of whom is referred to the consultant
physician by a medical practitioner each patientProfessional attendance by a consultant physician in the practice of his or her specialty of psychiatry, $174.40
where the patient is referred to him or her by a medical practitioner, involving an interview of a person other
than the patient of not less than 20 minutes duration but less than 45 minutes duration, in the course of initial
diagnostic evaluation of a patientProfessional attendance by a consultant physician in the practice of his or her specialty of psychiatry, $240.80
where the patient is referred to him or her by a medical practitioner, involving an interview of a person other
than the patient of not less than 45 minutes duration, in the course of initial diagnostic evaluation of a patientProfessional attendance by a consultant physician in the practice of his or her specialty of psychiatry, $174.40
where the patient is referred to him or her by a medical practitioner, involving an interview of a person other
than the patient of not less than 20 minutes duration, in the course of continuing management of a patient -
payable not more than 4 times in any 12 month periodConsultant psychiatrist, referred consultation via telepsychiatry for assessment, diagnosis and treatment a $64.25
telepsychiatry consultation by a consultant physician in the practice of his or her specialty of psychiatry
(not being an attendance to which items 300 to 319 apply), where: the patient is referred to him or her by a
medical practitioner for assessment, diagnosis and/or treatment, that consultation and any other consultation
to which items 353 to 358 apply, have not exceeded 12 consultations in a calendar year, -a minimum of one
face-to-face consultation (items 364 to 370) is conducted with the patient after every fourth telepsychiatry
consultation, and -any other attendance to which items 300 to 308 and 353 to 370 apply, have not exceeded
the sum of 50 attendances in a calendar year. a telepsychiatry consultation of not more than 15 minutes
duration.A telepsychiatry consultation of more than 15 minutes duration but not more than 30 minutes duration. $128.25
A telepsychiatry consultation of more than 30 minutes duration but not more than 45 minutes duration. $188.05
A telepsychiatry consultation of more than 45 minutes duration but not more than 75 minutes duration $259.50
A telepsychiatry consultation of more than 75 minutes duration $316.10
Consultant psychiatrist, referred consultation for assessment, diagnosis and treatment following $55.80
telepsychiatry professional attendance by a consultant physician in the practice of his or her specialty of
psychiatry, where: the patient is referred to him or her by a medical practitioner, that attendance occurs
following four telepsychiatry consultations (items 353 to 358), where that attendance and any other
attendance to which items 364 to 370 apply does not exceed three consultations per patient in a calendar
year. -any other attendance to which items 300 to 308 and 353 to 370 apply, have not exceeded the sum
of 50 attendances in a calendar year. these items may only be used after every fourth telepsychiatry
consultation conducted in accordance with items 353 to 358. a face-to-face attendance of not more than 15
minutes duration.A face-to-face attendance of more than 15 minutes duration but not more than 30 minutes duration $111.50
A face-to-face attendance of more than 30 minutes duration but not more than 45 minutes duration. $163.45
A face-to-face attendance of more than 45 minutes duration but not more than 75 minutes duration $225.60
A face-to-face attendance of more than 75 minutes duration. $274.85
Group A12 - Consultant occupational physician attendances to which no
other item applies
Professional attendance at consulting rooms or hospital by a consultant occupational physician in the
practice of his or her specialty of occupational medicine where the patient is referred to him or her by a N/A
medical practitioner - initial attendance in a single course of treatment
Professional attendance at consulting rooms or hospital by a consultant occupational physician in the
practice of his or her specialty of occupational medicine where the patient is referred to him or her by a N/A
medical practitioner - each attendance subsequent to the first in a single course of treatment
Professional attendance at a place other than consulting rooms or hospital by a consultant occupational
physician in the practice of his or her specialty of occupational medicine where the patient is referred to him N/A
or her by a medical practitioner - initial attendance in a single course of treatment
Professional attendance at a place other than consulting rooms or hospital by a consultant occupational
physician in the practice of his or her specialty of occupational medicine where the patient is referred to him N/A
or her by a medical practitioner- each attendance subsequent to the first in a single course of treatment
Group A13 - Public health physician attendances to which no other item
applies
Professional attendance at consulting rooms by a public health physician in the practice of his or her
speciality of public health medicine - attendance for an obvious problem characterised by the N/A
straightforward nature of the task that requires a short patient history and, if required, limited examination
and managementProfessional attendance at consulting rooms by a public health physician in the practice of his or her
speciality of public health medicine - attendance involving taking a selective history, examination of the N/A
patient with implementation of a management plan in relation to 1 or more problems, or an attendance of less
than 20 minutes duration involving components of a service to which item 412 appliesProfessional attendance at consulting rooms by a public health physician in the practice of his or her
speciality of public health medicine - attendance involving taking a detailed history, an examination of multiple N/A
systems, arranging any necessary investigations and implementing a management plan in relation to 1 or
more problems, and lasting at least 20 minutes, OR an attendance of less than 40 minutes duration involving
components of a service to which item 413 appliesProfessional attendance at consulting rooms by a public health physician in the practice of his or her
speciality of public health medicine - attendance involving taking an exhaustive history, a comprehensive N/A
examination of multiple systems, arranging any necessary investigations and implementing a management
plan in relation to 1 or more complex problems, and lasting at least 40 minutes, or an attendance of at least
40 minutes duration for implementation of a management planProfessional attendance at other than consulting rooms by a public health physician in the practice of his or
her speciality of public health medicine - attendance for an obvious problem characterised by the N/A
straightforward nature of the task that requires a short patient history and, if required, limited examination
and management
The fee for item 410, plus $22.00 divided by the number of patients seen, up to a maximum of six patients.
For seven or more patients - the fee for item 410 plus $1.60 per patient
Professional attendance at other than consulting rooms by a public health physician in the practice of his or
her speciality of public health medicine - attendance involving taking a selective history, examination of the N/A
patient with implementation of a management plan in relation to 1 or more problems, or an attendance of less
than 20 minutes duration involving components of a service to which item 416 applies
The fee for item 411, plus $22.00 divided by the number of patients seen, up to a maximum of six patients.
For seven or more patients - the fee for item 411 plus $1.60 per patient
Professional attendance at other than consulting rooms by a public health physician in the practice of his or
her speciality of public health medicine - Attendance involving taking a detailed history, an examination of N/A
multiple systems, arranging any necessary investigations and implementing a management plan in relation to
1 or more problems, and lasting at least 20 minutes, or an attendance of less than 40 minutes duration
involving components of a service to which item 417 applies
The fee for item 412, plus $22.00 divided by the number of patients seen, up to a maximum of six patients.
For seven or more patients - the fee for item 412 plus $1.60 per patient
Professional attendance at other than consulting rooms by a public health physician in the practice of his or
her speciality of public health medicine - attendance involving taking an exhaustive history, a comprehensive N/A
examination of multiple systems, arranging any necessary investigations and implementing a management
plan in relation to 1 or more complex problems, and lasting at least 40 minutes, or an attendance of at least
40 minutes duration for implementation of a management plan
The fee for item 413, plus $22.00 divided by the number of patients seen, up to a maximum of six patients.
For seven or more patients - the fee for item 413 plus $1.60 per patientGroup A16 - Medical practitioner (Sports Physician) attendances to which
no other item applies
Surgery consultations
Professional attendance at consulting rooms by a medical practitioner who is a sports physician in the
practice of sports medicine - attendance for an obvious problem characterised by the straightforward N/A
nature of the task that requires a short patient history and, if required, limited examination and management
Professional attendance at consulting rooms by a medical practitioner who is a sports physician in the
practice of sports medicine attendance involving taking a selective history, examination of the patient with N/A
implementation of a management plan in relation to 1 or more problems, or an attendance of less than 20
minutes duration involving components of a service to which item 446 appliesProfessional attendance at consulting rooms by a medical practitioner who is a sports physician in the
practice of sports medicine attendance involving taking a detailed history, an examination of multiple N/A
systems, arranging any necessary investigations and implementing a management plan in relation to 1 or
more problems, and lasting at least 20 minutes, or an attendance of less than 40 minutes duration involving
components of a service to which item 447 appliesProfessional attendance at consulting rooms by a medical practitioner who is a sports physician in the
practice of sports medicine attendance involving taking an exhaustive history, an comprehensive N/A
examination of multiple systems, arranging any necessary investigations and implementing a management
plan in relation to 1 or more complex problems, and lasting at least 40 minutes, or an attendance of at least
40 minutes duration for implementation of a management planGroup A16 - Medical practitioner (Sports Physician) attendances to which
no other item applies
Emergency attendances after hours
Professional attendance at consulting rooms by a medical practitioner who is a sports physician in the
practice of sports medicine professional attendance at consulting rooms where the attendance is initiated N/A
by or on behalf of the patient in the same unbroken after hours period and where the patient's medical
condition requires immediate treatment and where it is necessary for the doctor to return to, and specially
open, consulting rooms for the attendance - each attendance other than an attendance between 11pm and
7am, on a public holiday, on a Sunday, before 8am or after 1pm on a Saturday, or at any time other than
between 8am and 8pm on a day not being a Saturday, Sunday or public holidayProfessional attendance at consulting rooms by a medical practitioner who is a sports physician in the
practice of sports medicine professional attendance, at consulting rooms, where the attendance is initiated N/A
by or on behalf of the patient in the same unbroken after hours period and where the patient's medical
condition requires immediate treatment and where it is necessary for the doctor to return to, and specially
open, consulting rooms for the attendance - each attendance on any day of the week between 11pm and
7amGroup A21 - Medical practitioner (Emergency Physician) attendances to
which no other item applies
Consultations
Medical practitioner (emergency physician) attendances emergency department level 1 professional $47.05
attendance on a patient at a recognised emergency department of a private hospital by a medical
practitioner who is an emergency physician in the practice of emergency medicine - attendance for the
unscheduled evaluation and management of a patient requiring the taking of a problem focussed history,
limited examination, diagnosis and initiation of appropriate treatment interventions involving straightforward
medical decision making.Medical practitioner (emergency physician) attendances emergency department level 2 professional $79.50
attendance on a patient at a recognised emergency department of a private hospital by a medical
practitioner who is an emergency medicine physician in the practice of emergency medicine - attendance
for the unscheduled evaluation and management of a patient requiring the taking of an expanded problem
focussed history, expanded examination of one or more systems and the formulation and documentation of
a diagnosis and management plan in relation to one or more problems, and the initiation of appropriate
treatment interventions involving medical decision making of low complexity.Medical practitioner (emergency physician) attendances emergency department level 3 professional $133.65
attendance on a patient at a recognised emergency department of a private hospital by a medical
practitioner who is an emergency physician in the practice of emergency medicine - attendance for the
unscheduled evaluation and management of a patient requiring the taking of an expanded problem focussed
history, expanded examination of one or more systems, ordering and evaluation of appropriate
investigations, the formulation and documentation of a diagnosis and management plan in relation to one or
more problems, and the initiation of appropriate treatment interventions involving medical decision making of
moderate complexity.Medical practitioner (emergency physician) attendances emergency department level 4 professional $131.00
attendance on a patient at a recognised emergency department of a private hospital by a medical
practitioner who is an emergency physician in the practice of emergency medicine - attendance for the
unscheduled evaluation and management of a patient requiring the taking of a detailed history, detailed
examination of one or more systems, ordering and evaluation of appropriate investigations, the formulation
and documentation of a diagnosis and management plan in relation to one or more problems, the initiation of
appropriate treatment interventions, liaison with relevant health care professionals and discussion with the
patient, his/her agent/s and/or relatives, involving medical decision making of moderate complexity.Medical practitioner (emergency physician) attendances emergency department level 5 professional $209.55
attendance on a patient at a recognised emergency department of a private hospital by a medical
practitioner who is an emergency physician in the practice of emergency medicine - attendance for the
unscheduled evaluation and management of a patient requiring the taking of a comprehensive history,
comprehensive examination of one or more systems, ordering and evaluation of appropriate investigations,
the formulation and documentation of a diagnosis and management plan in relation to one or more problems,
the initiation of appropriate treatment interventions, liaison with relevant health care professionals and
discussion with the patient, his/her agent/s and/or relatives, involving medical decision making of high
complexity.Medical practitioner (emergency physician) attendances emergency department professional attendance on $139.90
a patient at a recognised emergency department of a private hospital by a medical practitioner who is an
emergency physician in the practice of emergency medicine - attendance for emergency evaluation of a
critically ill patient with an immediately life threatening problem requiring immediate and rapid assessment,
initiation of resuscitation and electronic vital signs monitoring, comprehensive history and evaluation whilst
undertaking resuscitative measures, ordering and evaluation of appropriate investigations, transitional
evaluation and monitoring, the formulation and documentation of a diagnosis and management plan in relation
to one or more problems, the initiation of appropriate treatment interventions, liaison with relevant health
care professionals and discussion with the patient, his/her agent/s and/or relatives prior to admission to an
in-patient hospital bed - for a period of not less than 30 minutes but less than 1 hour of total physician time
spent with each patientFor a period of not less than 1 hour but less than 2 hours of total physician time spent with each patient. $279.95
For a period of not less than 2 hours but less than 3 hours of total physician time spent with each patient $466.50
For a period of not less than 3 hours but less than 4 hours of total physician time spent with each patient. $653.00
For a period of not less than 4 hours but less than 5 hours of total physician time spent with each patient. $839.85
For a period of 5 hours or more of total physician time spent with each patient. $933.15
Group A14 - Health Assessments
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or
consultant physician) at consulting rooms for a health assessment - of a patient who is at least 75 years old N/A
- not being a health assessment of a patient in respect of whom, in the preceding 12 months, a payment
has been made under this item or item 702, 704 or 706Attendance by a medical practitioner (including a general practitioner, but not including a specialist or
consultant physician) not being an attendance at consulting rooms, a hospital or a residential aged care N/A
facility, for a health assessment - of a patient who is at least 75 years old - not being a health assessment
of a patient in respect of whom, in the preceding 12 months, a payment has been made under this item or
item 700, 704 or 706Attendance by a medical practitioner (including a general practitioner, but not including a specialist or $175.30
consultant physician) at consulting rooms for a health assessment - of a patient who is at least 55 years old
and of Aboriginal or Torres Strait Islander descent - not being a health assessment of a patient in respect of
whom, in the preceding 12 months, a payment has been made under this item or item 700, 702 or 706Attendance by a medical practitioner (including a general practitioner, but not including a specialist or $287.60
consultant physician) not being an attendance at consulting rooms, a hospital or a residential aged care
facility, for a health assessment - of a patient who is at least 55 years old and of Aboriginal or Torres Strait
Islander descent - not being a health assessment of a patient in respect of whom, in the preceding 12
months, a payment has been made under this item or item 700, 702 or 704Aboriginal and torres strait islander child health check Attendance by a medical practitioner, other than a
specialist or a consultant physician, at consulting rooms or in another place other than a hospital or N/A
Residential Aged Care Facility, for a child health check of a patient who is of Aboriginal or Torres Strait
Islander descent and aged 0 to 14 years inclusive - not being a child health check of a patient in respect of
whom, in the preceding 9 months, a payment has been made under this itemaboriginal and torres strait islander adult health check Attendance by a medical practitioner, other than a
specialist or a consultant physician, at consulting rooms or in another place other than a hospital or N/A
Residential Aged Care Facility, for an adult health check of a patient who is of Aboriginal or Torres Strait
Islander descent and aged at least 15 years old and less than 55 years old - not being an adult health check
of a patient in respect of whom, in the preceding 18 months, a payment has been made under this itemAttendance by a medical practitioner (including a general practitioner but not including a specialist or
consultant physician) at a residential aged care facility or at consulting rooms for a comprehensive medical N/A
assessment (cma) of a permanent resident of a residential aged care facility - not being a cma of a resident
in respect of whom, in the preceding 12 months, a payment has been made under this item. Benefits under
this item are payable in respect of one cma for new residents on admission to a Residential Aged Care
Facility and for continuing residents on an as required basis, with a maximum of one cma for a resident in
any twelve month period.Attendance by a medical practitioner (including a general practitioner, but not including a specialist or
consultant physician) at consulting rooms for a health assessment of a patient that has been granted N/A
residency in Australia under the Humanitarian Program, not being a health assessment of a patient in
respect of whom, a payment has been made under this item or item 700, 702, 712 or 716. This item may be
claimed by patients within 12 months of receiving residency or arrival (whichever is later) in AustraliaAttendance by a medical practitioner (including a general practitioner, but not including a specialist or
consultant physician) not being an attendance at consulting rooms, a hospital or a residential aged care N/A
facility for a health assessment of a patient that has been granted residency in Australia under the
Humanitarian Program, not being a health assessment of a patient in respect of whom, a payment has been
made under this item or item 700, 702, 712 or 714. This item may be claimed by patients within 12 months of
receiving residency or arrival (whichever is later) in Australia
The fee for item 714, plus $22.00 divided by the number of patients seen, up to a maximum of six patients.
For seven or more patients - the fee for item 714 plus $1.60 per patient.Group A15 - GP management plans, team care arrangements,
multidisciplinary care plans and case conferences
GP management plans, team care arrangements, multidisciplinary care
plans and case conferences
Preparation by a medical practitioner (including a general practitioner, but not including a specialist or
consultant physician) of a gp management plan for a patient (not being a service associated with a service N/A
to which items 734 to 779 apply). a rebate will not be paid within twelve months of a previous claim for the
same item or former item 720, or within three months of a claim for items 725, 727, 729 or 731, except
where there has been a significant change in the patient's clinical condition or care circumstances that
requires the preparation of a new gp Management Plan.Attendance by a medical practitioner (including a general practitioner, but not including a specialist or
consultant physician) to coordinate the development of team care arrangements for a patient (not being a N/A
service associated with a service to which items 734 to 779 apply). a rebate will not be paid within twelve
months of a previous claim for the same item or former item 720, or within three months of a claim for item
727, except where there has been a significant change in the patient's clinical condition or care
circumstances that requires the coordination of new Team Care Arrangements.Attendance by a medical practitioner (including a general practitioner, but not including a specialist or
consultant physician) to review: (a) a gp management plan prepared by that medical practitioner (or an N/A
associated medical practitioner) to which item 721 applies; or (b) a multidisciplinary community care plan to
which former item 720 applied, or a multidisciplinary discharge care plan to which former item 722 applied,
prepared by that medical practitioner (or an associated medical practitioner); (not being a service associated
with a service to which items 734 to 779 apply). a rebate will not be paid within three months of a previous
claim for the same item or within three months of a claim for item 721, except where there has been a
significant change in the patient's clinical condition or care circumstances that requires the preparation of a
new review of a gp Management plan.Attendance by a medical practitioner (including a general practitioner, but not including a specialist or
consultant physician) to coordinate a review of (a) team care arrangements coordinated by that medical N/A
practitioner (or an associated medical practitioner) to which item 723 applies; or (b) a multidisciplinary
community care plan to which former item 720 applied or a multidisciplinary discharge care plan to which
former item 722 applied, prepared by that medical practitioner (or an associated medical practitioner); (not
being a service associated with a service to which items 734 to 779 apply). a rebate will not be paid within
three months of a previous claim for the same item or within three months of a claim for item 723, except
where there has been a significant change in the patient's clinical condition or care circumstances that
requires the coordination of a new review of Team Care Arrangements.Contribution by a medical practitioner (including a general practitioner, but not including a specialist or
consultant physician) to a multidisciplinary care plan prepared by another provider or to a review of a N/A
multidisciplinary care plan prepared by another provider (not being a service associated with a service to
which items 734 to 779 apply). a rebate will not be paid within twelve months of a claim by the same
practitioner for item 721 or 723, within three months of a claim for the same item or within three months of a
claim for item 725, former item 726, item 727, former item 728 or item 731, except where there has been a
significant change in the patient's clinical condition or care circumstances that requires a new contribution to
the multidisciplinary care plan.
prior reports or other information forwarded or approved by the requestor in DF
order to prepare a report.Derived fee: The fee for item WMG55 is $47.70 for reading time up to and including
12 pages, plus $4.00 per page thereafter.
WMP55Consultant Physicians: Reading time payable to a treating doctor for reading
prior reports or other information forwarded or approved by the requestor in DF
order to prepare a report.Derived fee: The fee for item WMP55 is $95.40 for reading time up to and including
12 pages, plus $7.60 per page thereafter.
WMS55Specialists in a surgical discipline: Reading time payable to a treating doctor
for reading prior reports or other information forwarded or approved by the DF
requestor in order to prepare a report.Derived fee: The fee for item WMS55 is $95.40 for reading time up to and including
12 pages, plus $7.60 per page thereafter.
WMY55Psychiatrists: Reading time payable to a treating doctor for reading prior
reports or other information forwarded or approved by the requestor in order DF
to prepare a report.Derived fee: The fee for item WMY55 is $124.00 for reading time up to and including
12 pages, plus $7.60 per page thereafter.
Note 1: Payment for the reading of written material will only be made where the reading is
required in order for the doctor to prepare a report, and where the reading is at the
request or approval of:- a claims agent or self-insured employer; or
- a injured worker’s representative or advocate.
Note 2: A fee is not payable for the reading of case notes, clinical material or any other material
that is not directly supplied or approved by the parties listed in note 1.
MEDICAL REPORT CLARIFICATION - TREATING DOCTOR
WMG25 General Practitioners: Clarification of a medical report, re-examination not $45.00
required.
WMP25 Consultant Physicians: Clarification of a medical report, re-examination not $81.70
required.
WMS25 Specialists in a surgical discipline: Clarification of a medical report, $81.70
re-examination not required.
Note 1: The requestor must specify that he or she is seeking a clarification of a previous
medical report.Note 2: A clarification of a medical report must be requested in writing and may be requested by:
- a claims agent or self-insured employer; or
- a injured worker’s representative or advocate.
Note 3: A fee is not payable for the clarification of a medical report if the clarification is sought
as a result of failure by the doctor to address the original questions in the letter of request.
TELEPHONE CALL (EXCLUDING CALLS MADE TO OR RECEIVED FROM
INJURED WORKERS)
WMG24 General Practitioners: Telephone call up to and including 60 minutes duration. $200.00
per hour
WMP24 Consultant Physicians: Telephone call up to and including 60 minutes duration. $392.00
per hour
WMS24 Specialists in a surgical discipline: Telephone call up to and including 60 $392.00
minutes duration. per hour
Note 1: Telephone contact between treating/referring medical providers which forms part of the
clinical management of the case is not chargeable.Note 2: Telephone calls are chargeable if of a case specific nature, made to or received from:
- a claims agent or self-insured employer; or
- an employer;
- a injured worker’s representative or advocate;
- a WorkCover Corporation medical consultant; or
- a vocational rehabilitation service provider contracted by WorkCover.
Note 3: A fee is payable if the telephone contact occurs during a consultation with the injured
worker provided that the consultation duration excludes the duration of the telephone call.
For example, if the consultation and telephone call duration is 20 minutes and the call
duration alone is 10 minutes, the consultation should be charged as a 10 minute consultation.Note 4: Invoices for telephone calls in accordance with this item must record the name of the other
party and the duration of the phone call in minutes.Note 5: Any part of an hour should be charged proportionately (eg a general practitioner would
charge $66.65 for a 20 minute call).
CASE CONFERENCE
WMG09 General Practitioners: Case conference to determine details of limitations to $200.00
work, recommendations facilitating a return to work and options for per hour
management of the injured worker’s recovery, including medical treatment
strategies.
WMP09 Consultant Physicians: Case conference to determine details of limitations to $392.00
work, recommendations facilitating a return to work and options for per hour
management of the injured worker’s recovery, including medical treatment
strategies.
WMS09 Specialists in a surgical discipline: Case conference to determine details of $392.00
limitations to work, recommendations facilitating a return to work and options per hour
for management of the injured worker’s recovery, including medical treatment
strategies.
Note 1: This service must be authorised by the claims agent or self-insured employer.
Note 2: A case conference may be requested by:
- a treating medical expert;
- an employer;
- a injured worker, injured worker’s representative or advocate;
- a claims agent or self-insured employer; or
- a vocational rehabilitation service provider contracted by WorkCover.
Note 3: The claims agent or self-insured employer must be represented at the case conference.
The injured worker, or injured worker’s advocate or representative must always be invited
to attend the case conference.Note 4: Case conferences conducted by telephone (teleconferencing) are chargeable under this item.
Note 5: It is the responsibility of the claims agent or self-insured employer to make a written and
signed record of the case conference that is to be distributed to all attendees. Differences
of opinion should be noted in the record. No fee is payable for records made by any medical
practitioner during the case conference.Note 6: Any part of an hour should be charged proportionately (eg a general practitioner would
charge $66.65 for a 20 minute attendance).
WORKSITE ASSESSMENT
WMG08 General Practitioners: Worksite assessment, for the purpose of assessing $200.00
and reporting the duties that are or can be made available, and the capacity of per hour
the injured worker to undertake these duties.
WMP08 Consultant Physicians: Worksite assessment, for the purpose of assessing $392.00
and reporting the duties that are or can be made available, and the capacity of per hour
the injured worker to undertake these duties.
WMS08 Specialists in a surgical discipline: Worksite assessment, for the purpose of $392.00
assessing and reporting the duties that are or can be made available, and the per hour
capacity of the injured worker to undertake these duties.Note 1: A worksite assessment may be requested by:
- a claims agent or self-insured employer; or
- a injured worker, injured worker’s representative or advocate.
Note 2: The claims agent or self-insured employer will authorise the service if it is reasonable.
Note 3: At worksite visits it is expected that the employer, injured worker or injured worker’s
representative, a claims agent or self-insured employer representative should be present.Note 4: The claims agent or self-insured employer should contact the employer to ensure
appropriate access to the worksite and to arrange for an employer representative to be
available to help maximise the value of time spent in the workplace.Note 5: The worksite assessment must include an assessment of the physical environment,
mental work demands, human behaviour, working conditions, educational requirements
and other conditions.Note 6: The report of a worksite assessment is to be completed and distributed to relevant parties
in attendance during the worksite assessment. A copy must also be provided to the claims
manager, treating doctor and injured worker (if not present) within one week of the
assessment. No additional fee is payable for completion of the form.Note 7: Any part of an hour should be charged proportionately (eg a general practitioner would
charge $66.65 for a 20 minute attendance).
THIRD PARTY CONSULTATION
WMG14 General Practitioners: Third party consultation at the doctor’s rooms where $200.00
the injured worker is usually not present. per hour
WMP14 Consultant Physicians: Third party consultation at the doctor’s rooms where $392.00
the injured worker is usually not present. per hour
WMS14 Specialists in a surgical discipline: Third party consultation at the doctor’s $392.00
rooms where the injured worker is usually not present. per hour
Note 1: This service must be authorised by the claims agent or self-insured employer.
Note 2: This service should involve one of the following:
- an employer;
- a claims agent or self-insured employer;
- a injured worker’s representative or advocate;
- a provider of investigative services; or
- a vocational rehabilitation provider.
Note 3: This service may include a video viewing of a injured worker’s normal duties,
alternative duties or other activities.Note 4: It is the responsibility of the claims agent or self-insured employer to ensure a written
and signed record is made of the third party consultation that is to be distributed to all
attendees. No fee is payable for records made by any medical practitioner during the
third party consultation.Note 5: If as a result of the third party consultation the medical practitioner has amended details
regarding the injured worker’s limitations to work, capacity, recommendations for
facilitating a return to work and/or options for management of the injured worker, the
medical practitioner must consider the injured worker’s input into this decision.Note 6: Any part of an hour should be charged proportionately (eg a general practitioner would
charge $66.65 for a 20 minute attendance).
ATTENDANCE AT A DISPUTE RESOLUTION
WMG15 General Practitioners: Attendance at a dispute resolution. $200.00
per hour
WMP15 Consultant Physicians: Attendance at a dispute resolution. $392.00
per hour
WMS15 Specialists in a surgical discipline: Attendance at a dispute resolution. $392.00
per hour
Note 1: Court attendances can be charged under this item.
Note 2: Attendance at a dispute resolution must be at the request of:
- a claims agent or self-insured employer;
- a injured worker, injured worker’s representative or advocate; or
- an employer or employer’s representative.
Note 3: A witness at a dispute resolution proceeding is entitled to reimbursement of any
expense that the dispute resolution authority certifies has been, or is likely to be,
reasonably incurred by the witness as a consequence of appearing before the authority.Note 4: Any part of an hour should be charged proportionately (eg a general practitioner would
charge $66.65 for a 20 minute attendance).
TRAVEL TIME: WORKSITE ASSESSMENT, CASE CONFERENCE, DISPUTE
RESOLUTION OR THIRD PARTY CONSULTATION
WMG10 General Practitioners: Travel time for the purpose of a worksite assessment, $200.00
case conference, dispute resolution or third party consultation. per hour
WMP10 Consultant Physicians: Travel time for the purpose of a worksite assessment, $392.00
case conference, dispute resolution or third party consultation. per hour
WMS10 Specialists in a surgical discipline: Travel time for the purpose of a worksite $392.00
assessment, case conference, dispute resolution or third party consultation. per hour
Note 1: Travel must be authorised by the claims agent or self-insured employer.
Note 2: All accounts must include the total time spent travelling plus the distance travelled.
Note 3: The claims agent may choose to contain costs by requesting the service from an
appropriate practitioner based in the injured worker’s locality.Note 4: Where more than one worksite assessment, case conference or dispute resolution is
conducted, the travel fee is to be apportioned accordingly.Note 5: Any part of an hour should be charged proportionately (eg a general practitioner would
charge $66.65 for 20 minutes travel).
CANCELLATION: CASE CONFERENCE, WORKSITE ASSESSMENT, DISPUTE
RESOLUTION OR THIRD PARTY CONSULTATION
WMG36 General Practitioners: Cancellation of case conference, $200.00
worksite assessment, dispute resolution or third party consultation. per hour
WMP36 Consultant Physicians: Cancellation of case conference, $392.00
worksite assessment, dispute resolution or third party consultation. per hour
WMS36 Specialists in a surgical discipline: Cancellation of case conference, worksite $392.00
assessment, dispute resolution or third party consultation. per hour
Note 1: Payment for cancellation will only be made when the attendance was at the request of:
- a claims agent or self-insured employer;
- a injured worker, injured worker’s representative or advocate; or
- an employer or employer’s representative.
Note 2: A cancellation fee is payable only if the cancellation occurs less than 24 hours before
the time of the proposed attendance.Note 3: A cancellation fee is not payable if the doctor is responsible for the cancellation.
Note 4: Any part of an hour should be charged proportionately (eg a general practitioner would
charge $66.65 where 20 minutes had been allocated for the attendance).Note 5: If the cancelled appointment is subsequently filled with another earning activity, this fee
does not apply.
JOB ANALYSIS AND/OR RECOMMENDED JOB DESCRIPTION STATEMENT
WMG56 General Practitioners: Formal job analysis and/or recommended job $77.00
descriptions. Reading of and written recommendations on the suitability of
proposals for return to work, expected to be provided within 10 business
days of receipt of the initial request.
WMP56 Consultant Physicians: Formal job analysis and/or recommended job $98.00
descriptions. Reading of and written recommendations on the suitability of
proposals for return to work, expected to be provided within 10 business
days of receipt of the initial request.
WMS56 Specialists in a surgical discipline: Formal job analysis and/or recommended $98.00
job descriptions. Reading of and written recommendations on the suitability of
proposals for return to work, expected to be provided within 10 business
days of receipt of the initial request.Note 1: A job analysis and/or job description statement must be requested in writing and may
be requested by:- a claims agent or self-insured employer;
- a worker's representative or advocate;
- a vocational rehabilitation service provider contracted by WorkCover.
Note 2: The date of request is taken to be two business days after the letter of request is posted,
or one business day after the request is faxed. A business day is any day, excluding
Saturday, Sunday and public holidays.Note 3: Payment for this service will not be made in advance.
SPECIFIED DUTIES FORM (SDF)
WMG23 General Practitioners: Completion of a specified duties form (SDF). $17.70
WMP23 Consultant Physicians: Completion of a specified duties form (SDF). $17.70
WMS23 Specialists in a surgical discipline: Completion of a specified duties form (SDF). $17.70
Note 1: This form is to be completed at the request of:
- a claims agent or self-insured employer; or
- a injured worker, injured worker’s representative or advocate.
Note 2: A fee is not payable if the form is completed during a consultation with the injured worker.
Note 3: SDFs may be obtained by contacting WorkCover Corporation on 13 18 55.
PHOTOCOPYING
WMGSP General Practitioners, Consultant Physicians, Specialists in a surgical $0.20
discipline: Photocopying of documents. per page
Note 1: The number of pages should be stated on the account. Any accounts without the
number of pages stated will be returned for amendment.Note 2: A fee is only payable if the photocopying is at the request of:
- a claims agent or self-insured employer;
- a injured worker’s representative or advocate;
- an investigator or solicitor.
Note 3: Accounts must state the name of the doctor who provided the services to which the
photocopied information is related. Accounts with the practice name only will be
returned for amendment.Note 4: Accounts for administration time are not chargeable as this cost has been factored into
the fee per page.
EMERGENCY RETRIEVAL TEAM - TRAVEL TIME
WMS51 Specialists: Travel time by a retrieval team doctor in association with a $392.00
professional attendance relating to item numbers 00160, 00161, 00162, 00163 per hour
and 00164, other than ‘out of hours’ travel (refer to item number WMS52).
WMS52 Specialists: Travel time by a retrieval team doctor between 11pm and 7am $568.00
any day of the week or on a public holiday in association with a professional per hour
attendance relating to item numbers 00160, 00161, 00162, 00163 and 00164
Note 1: Where more than one injured worker is treated at the site of the emergency, the
travel fee is to be apportioned accordingly.Note 2: Any part of an hour should be billed proportionately.
EXTRA-CORPOREAL SHOCK WAVE THERAPY
WMI11 Specialists: Initial treatment of Extra-Corporeal Shock Wave Therapy provided $116.60
by a specialist radiology practice.
WMI12 Specialists: Subsequent treatments of Extra-Corporeal Shock Wave Therapy $95.40
provided by a specialist radiology practice.
WMI13 Specialists: Double treatments (bilateral or multiple) of Extra-Corporeal Shock $159.00
Wave Therapy provided by a specialist radiology practice.
Note 1: The I in prefix WMI item number represents the letter “I” not a numeral one (1).
Note 2: This treatment has been approved by WorkCover Corporation for use in the following
conditions:- heel pain/plantar fasciitis
- calcific tendonitis of shoulder
- lateral epicondylitis (tennis elbow)
- medial epicondylitis
- non-united fractures
- patellar tendinopathy.
Note 3: Extra-Corporeal Shock Wave Therapy for any other conditions must be authorised by
the claims agent or self-insured employer prior to treatment.Note 4:Epicondylitis treatment is NOT payable by WorkCover Corporation for treatment provided
within 3 months or after 5 years from date of injury.
SERVICES DELIVERED BY EAR, NOSE AND THROAT SURGEONS
WME24 Otorhinolaryngologists: Cortical evoked response audiometry - verification. $271.70
WME2A Otorhinolaryngologists: Cortical evoked response audiometry - quantification. $271.70
WME25 Otorhinolaryngologists: Sensonics smell identification test. $118.10
SERVICES DELIVERED BY MEDICAL PRACTITIONERS
WMG26 Medical Practitioners: Fluids, intravenous drip infusion of – percutaneous. $46.65
WMG27 Medical Practitioners: Fluids, intravenous drip infusion of – open exposure. $77.40
Note 1:Item WMG26 is only payable where the service is not in association with a surgical
procedure.
SERVICES DELIVERED BY MEDICAL PRACTITIONERS IN THE PRACTICE OF
HYPNOTHERAPY
WMG31 Medical Practitioners: At consulting rooms, not more than 15 minutes. $40.00
WMG28 Medical Practitioners: At consulting rooms, 16 to 30 minutes. $69.65
WMG29 Medical Practitioners: At consulting rooms, 31 to 45 minutes. $104.50
WMG30 Medical Practitioners: At consulting rooms, more than 46 minutes. $142.35
INDEPENDENT MEDICAL EXAMINER - SHORT MEDICAL REPORT
WMPA1 Consultant Physicians: Independent medical examiner short medical report, $98.00
expected to be provided within 72 hours of receipt of the initial request.
WMSA1 Specialists in a surgical discipline: Independent medical examiner short $98.00
medical report, expected to be provided within 72 hours of receipt of the
initial request.Note 1: REPORTS WILL NOT BE PAID IN ADVANCE.
Note 2: A medical report must be requested in writing and may be requested by:
- a claims agent or self-insured employer; or
- a injured worker, injured worker’s representative or advocate.
Note 3: The date of request is taken to be two business days after the date the letter of
request is posted, or one business day after the request is faxed. A business day is
any day, excluding Saturday, Sunday and public holidays.Note 4: Reports should be concise and focused. The anticipated length of a short report is
approximately half an A4 page.Note 5:Short reports may be faxed to the requestor with the relevant account.
INDEPENDENT MEDICAL EXAMINER - MEDICAL REPORT (EXCLUDING
PSYCHIATRISTS)
WMP29 Consultant Physicians: Independent medical examiner report, expected to be $470.00
provided within 10 business days of receipt of the initial request.
WMS29 Specialist in a surgical discipline: Independent medical examiner report, $470.00
expected to be provided within 10 business days of receipt of the initial
request.Note 1: REPORTS WILL NOT BE PAID IN ADVANCE.
Note 2: A medical report must be requested in writing and may be requested by:
- a claims agent or self-insured employer; or
- a injured worker, injured worker’s representative or advocate.
Note 3: The date of request is taken to be two business days after the date the letter of
request is posted, or one business day after the request is faxed. A business day
is any day, excluding Saturday, Sunday and public holidays.Note 4: There is an expectation that a consultation will be required for the preparation of a
report and this should be charged in accordance with 'Consultation: Medical review
for preparation of a report - independent medical examiner' item numbers.
INDEPENDENT MEDICAL EXAMINER - PSYCHIATRISTS MEDICAL REPORT
WMP61 Psychiatrists: Independent medical examiner standard medical report, $585.00
expected to be provided within 10 business days of receipt of the initial
request.Note 1: REPORTS WILL NOT BE PAID IN ADVANCE.
Note 2: A medical report must be requested in writing and may be requested by:
- a claims agent or self-insured employer; or
- a injured worker, injured worker’s representative or advocate.
Note 3: The date of request is taken to be two business days after the date the letter of
request is posted, or one business day after the request is faxed. A business day is
any day, excluding Saturday, Sunday and public holidays.Note 4: There is an expectation that a consultation will be required for the preparation of a report.
Note 5: Occasionally a psychiatrist will require more than one consultation with a patient to write
a report. We recommend that the psychiatrist contacts the claims manager prior to
providing a second consultation, to determine whether this is appropriate in the
circumstances of the case (eg time constraints). Where an additional consultation is
required it must be provided within 10 working days of the first consultation.Note 6: Please refer to item numbers under 'Consultation: Medical review for preparation of a
report -independent medical examiner'.
CONSULTATION: MEDICAL REVIEW FOR PREPARATION OF A REPORT -
INDEPENDENT MEDICAL EXAMINER
WMP80 Consultant Physician: Consultation: medical review for the preparation of $185.50
an independent medical examiner report.
WMS80 Specialist in a surgical discipline: Consultation: medical review for the $185.50
preparation of an independent medical examiner report.
WMY80 Psychiatrist: Consultation: medical review of not more than 15 minutes $61.50
duration for the preparation of an independent medical examiner report.
WMY81 Psychiatrist: Consultation: medical review of more than 15 minutes but not $124.00
more than 30 minutes duration for the preparation of an independent medical
examiner report.
WMY82 Psychiatrist: Consultation: medical review of more than 30 minutes but not $183.40
more than 45 minutes duration for the preparation of an independent medical
examiner report.
WMY83 Psychiatrist: Consultation: medical review of more than 45 minutes but not $265.00
more than 75 minutes duration for the preparation of an independent medical
examiner report.
WMY84 Psychiatrist: Consultation: medical review of more than 75 minutes duration for $307.40
the preparation of an independent medical examiner report.
INDEPENDENT MEDICAL EXAMINER - READING TIME
WMP32 Consultant Physicians: Reading time payable to an independent medical
examiner for reading prior reports or other information forwarded or approved DF
by the requestor in order to prepare a report.
Derived fee: The fee for item WMP32 is $95.40 for reading time up to and including
12 pages, plus $7.60 per page thereafter.
WMS32 Specialists in a surgical discipline: Reading time payable to an independent
medical examiner for reading prior reports or other information forwarded or DF
approved by the requestor in order to prepare a report.
Derived fee: The fee for item WMS32 is $95.40 for reading time up to and including
12 pages, plus $7.60 per page thereafter.
WMY32 Psychiatrists: Reading time payable to an independent medical examiner for
reading prior reports or other information forwarded or approved by the DF
requestor in order to prepare a report.
Derived fee: The fee for item WMY32 is $124.00 for reading time up to and
including 12 pages, plus $7.60 per page thereafter.
Note 1: Payment for the reading of written material will only be made where the reading is
required in order for the doctor to prepare a report, and where the reading is at the
request or approval of:- a claims agent or self-insured employer; or
- a injured worker’s representative or advocate.
Note 2: A fee is not payable for the reading of case notes, clinical material or any other material
that is not directly supplied or approved by the parties listed in note 1.
INDEPENDENT MEDICAL EXAMINER - MEDICAL REPORT CLARIFICATION
WMP33 Consultant Physicians: Clarification of a medical report, re-examination not $81.70
required.
WMS33 Specialists in a surgical discipline: Clarification of a medical report, re- $81.70
examination not required.
Note 1: The requestor must specify that he or she is seeking a clarification of a previous
medical report.Note 2: A clarification of a medical report must be requested in writing and may be requested by:
- a claims agent or self-insured employer; or
- a injured worker, injured worker’s representative or advocate.
Note 3: A fee is not payable for a clarification of a medical report if the clarification is sought
as a result of failure by the doctor to address the original questions in the letter of request.Note 4: The intention of this fee is to provide facilities for follow up questions or issues relating to
prior independent medical examinations and additional consultations may not be required.
The decision to undertake a further consultation is at the discretion of the doctor. If required,
please refer to item numbers under 'Consultation: medical review for preparation of a
report - independent medical examiner'.
INDEPENDENT MEDICAL EXAMINER - TRAVEL TIME: WORKSITE ASSESSMENT,
CASE CONFERENCE, DISPUTE RESOLUTION OR THIRD PARTY
CONSULTATION
MP940 Consultant Physicians: Travel time for the purpose of a worksite assessment, $392.00
case conference, dispute resolution or third party consultation. per hour
MS940 Specialist in a surgical discipline: Travel time for the purpose of a worksite $392.00
assessment, case conference, dispute resolution or third party consultation. per hour
Note 1: Travel will be approved for independent medical examiner services requested by:
- a claims agent or self-insured employer; or
- a injured worker, injured worker’s representative or advocate.
Note 2: Travel must be authorised by the claims agent or self-insured employer. The cost will
be authorised if it is considered reasonable.Note 3: All accounts must include the total time spent travelling as well as the distance travelled.
Note 4: When the service is requested by the claims manager he or she may choose to contain
costs by requesting the service from an appropriately based practitioner in the injured
worker’s locality.Note 5: Where more than one service is conducted, the travel fee is to be apportioned accordingly.
INDEPENDENT MEDICAL EXAMINER - CANCELLATION OF AN APPOINTMENT
OR NON-ATTENDANCE
WMP34 Consultant Physicians: Cancellation of an appointment or non-attendance, less $185.50
than 24 hours before the time of the scheduled appointment.
WMS34 Specialist in a surgical discipline: Cancellation of an appointment or non- $185.50
attendance, less than 24 hours before the time of the scheduled appointment.
WMY85 Psychiatrist: Cancellation of an appointment or non-attendance of not more $61.50
than 15 minutes duration, less than 24 hours before the time of the scheduled
appointment.
WMY86 Psychiatrist: Cancellation of an appointment or non-attendance of more than $124.00
15 minutes but not more than 30 minutes duration, less than 24 hours before
the time of the scheduled appointment.
WMY87 Psychiatrist: Cancellation of an appointment or non-attendance of more than $183.40
30 minutes but not more than 45 minutes duration, less than 24 hours before
the time of the scheduled appointment.
WMY88 Psychiatrist: Cancellation of an appointment or non-attendance of more than $265.00
45 minutes but not more than 75 minutes duration, less than 24 hours before
the time of the scheduled appointment.
WMY89 Psychiatrist: Cancellation of an appointment or non-attendance of more than $307.40
75 minutes duration, less than 24 hours before the time of the scheduled
appointment.Note 1: Fees apply only to the cancellation of medical appointments arranged by:
- a claims agent or self-insured employer; or
- a injured worker, injured worker’s representative or advocate.
Note 2:If the cancelled appointment or non-attendance is subsequently filled with another
earning activity, this fee does not apply.
INDEPENDENT MEDICAL EXAMINER - TRAVEL FOR EXAMINATIONS
WMP64 Consultant Physicians: A full day attendance at the venue more than 100 $114.50
kilometres from the Adelaide GPO for the purpose of providing an independent
medical examiner report.
WMS64 Specialists in a surgical discipline: A full day attendance at a venue more than $114.50
100 kilometres from the Adelaide GPO for the purpose of providing an
independent medical examiner report.
WMP65 Consultant Physicians: Cancellation of an attendance at a venue more than $183.40
100 kilometres from the Adelaide GPO.
WMS65 Specialists in a surgical discipline: Cancellation of an attendance at a venue $183.40
more than 100 kilometres from the Adelaide GPO.
WMP66 Consultant Physicians: Overnight accommodation including meals and $102.85
incidentals.
WMS66 Specialists in a surgical discipline: Overnight accommodation including meals $102.85
and incidentals.
WMP67 Consultant Physicians: Travel by motor vehicle, to and from a venue for the
purposes of an appointment made by the report requestor. ATO Rates
WMS67 Specialists in a surgical discipline: Travel by motor vehicle, to and from a
venue for the purposes of an appointment made by the report requestor. ATO Rates
WMP68 Consultant Physicians: Travel by aircraft, to and from a venue for the
purposes of an appointment made by the report requestor. Economy Airfare
WMS68 Specialists in a surgical discipline: Travel by aircraft, to and from a venue
for the purposes of an appointment made by the report requestor. Economy Airfare
Note 1: The first 50 kilometres of any travel is not chargeable.
Note 2:If more than one organisation has requested services from the provider at the
travel destination then items WMP/S64, WMP/S66, WMP/S67 and/or WMP/S68
must be apportioned accordingly.Note 3: A full day pursuant to item WMP/S64 refers to a stay of more than 6 hours at the
venue including travel time.Note 4: ATO Rates means the rate, applicable to the type of motor vehicle in which the medical expert travelled, published by the Australian Taxation Office as the rate per kilometre that may be claimed as a deduction for business travel expenses incurred in the previous financial year.
Note 5:Economy Airfare means the amount determined by the Corporation to be the reasonable cost of undertaking the travel using a standard economy airfare.
Note—
As required by section 10AA(2) of the Subordinate Legislation Act 1978, the Minister has certified that, in the Minister's opinion, it is necessary or appropriate that these regulations come into operation as set out in these regulations.
Made by the Governor
following consultation as required under section 32(13) of the Workers Rehabilitation and Compensation Act 1986 and with the advice and consent of the Executive Council
on 28 September 2006
No 228 of 2006
06WKC002CS
0
0
0