Workers Rehabilitation and Compensation (Scales of Charges—Medical Practitioners) Variation Regulations 2007 (SA)
Case
South Australia
Workers Rehabilitation and Compensation (Scales of Charges—Medical Practitioners) Variation Regulations 2007
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
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 2007.
2—Commencement
These regulations will come into operation on 1 July 2007.
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—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 must be read in conjunction with the Medical Schedule A Guidelines.
| Item Description Maximum Charge (Excl GST) | ||
| Group A1 - General Practitioner attendances to which no other item applies | ||
| Urgent attendance after hours | ||
| 00001 | Professional attendance at a place other than consulting rooms, by a general practitioner on not more than 1 patient on the 1 occasion - each attendance, other than an attendance between 11pm and 7am, in an after hours period, if: a) the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken after hours period; and b) the patient's medical condition requires urgent treatment | $152.15 |
| 00002 | Professional attendance at consulting rooms, by a general practitioner on not more than 1 patient on the 1 occasion - each attendance, other than an attendance between 11pm and 7am, in an after hours period, if; a) the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken after hours period; and b) the patient's medical condition requires urgent treatment; and c) it is necessary for the practitioner to return to, and specially open, consulting rooms for the attendance | $152.15 |
| 00601 | Professional attendance at a place other than consulting rooms, by a general practitioner on not more than 1 patient on the 1 occasion - each attendance between 11pm and 7am if: a) the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken after-hours period; and b) the patient's medical condition requires urgent treatment | $160.95 |
| 00602 | Professional attendance, at consulting rooms, by a general practitioner on not more than 1 patient on the 1 occasion - each attendance between 11pm and 7am, if: a) the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken after-hours period; and b) the patient's medical condition requires urgent treatment; and c) it is necessary for the practitioner to return to, and specially open, consulting rooms for the attendance | $160.95 |
| General practitioner attendances | ||
| 00003 | Professional attendance at consulting rooms (not being a service to which any other item applies) by a 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 | $19.10 |
| 00004 | Professional attendance, other than a service to which any other item applies, and not being an attendance at consulting rooms, an institution, a hospital or a residential aged care facility by a 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 - an attendance on 1 or more patients on 1 occasion - each patient Derived fee: The fee for Item 3 ($19.10), plus $28.70 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 $1.90 per patient. | DF |
| 00013 | Professional attendance at an institution (not being a service to which any other item applies) by a 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 an attendance on 1 or more patients at 1 institution on 1 occasion each patient Derived fee: The fee for Item 3 ($19.10), plus $28.70 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 $1.90 per patient. | DF |
| 00019 | Professional attendance at a hospital (not being a service to which any other item applies) by a 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 an attendance on 1 or more patients at 1 hospital on 1 occasion each patient Derived fee: The fee for Item 3 ($19.10), plus $28.70 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 $1.90 per patient. | DF |
| 00020 | 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 consulting rooms situated within such a complex where the patient is accommodated in a residential aged care facility (not being accommodation in a self-contained unit) by a 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 an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion each patient Derived fee: The fee for Item 3 ($19.10), plus $28.70 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 $1.90 per patient. | DF |
| 00023 | Professional attendance at consulting rooms (not being a service to which any other item applies) by a 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 minutes duration involving components of a service to which item 36 or 44 applies each attendance | $49.60 |
| 00024 | Professional attendance, other than a service to which any other item applies, and not being an attendance at consulting rooms, an institution, a hospital or a residential aged care facility by a general practitioner 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 minutes duration involving components of a service to which item 37 to 47 applies - an attendance on 1 or more patients on 1 occasion each patient Derived fee: The fee for Item 23 ($49.60), plus $28.70 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 $1.90 per patient. | DF |
| 00025 | Professional attendance at an institution (not being a service to which any other item applies) by a 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 minutes duration involving components of a service to which item 38 or 48 applies an attendance on 1 or more patients at 1 institution on 1 occasion each patient Derived fee:The fee for Item 23 ($49.60), plus $28.70 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 $1.90 per patient. | DF |
| 00033 | Professional attendance at a hospital (not being a service to which any other item applies) by a 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 minutes duration involving components of a service to which item 40 or 50 applies an attendance on 1 or more patients at 1 hospital on 1 occasion each patient Derived fee: The fee for Item 23 ($49.60), plus $28.70 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 $1.90 per patient. | DF |
| 00035 | 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 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) by a 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 minutes duration involving components of a service to which item 43 or 51 applies an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion each patient Derived fee: The fee for Item 23 ($49.60), plus $28.70 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 $1.90 per patient. | DF |
| 00036 | Professional attendance at consulting rooms (not being a service to which any other item applies) by a 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 a service to which item 44 applies each attendance | $79.35 |
| 00037 | Professional attendance, other than a service to which any other item applies, and not being an attendance at consulting rooms, an institution, a hospital or a residential aged care facility by a general practitioner 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, or a professional attendance of less than 40 minutes duration involving components of a service to which item 47 applies - an attendance on 1 or more patients on 1 occasion each patient Derived fee: The fee for Item 36 ($79.35), plus $28.70 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 $1.90 per patient. | DF |
| 00038 | Professional attendance at an institution (not being a service to which any other item applies) by a 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 a service to which item 48 applies an attendance on 1 or more patients at 1 institution on 1 occasion each patient Derived fee: The fee for Item 36 ($79.35), plus $28.70 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 $1.90 per patient. | DF |
| 00040 | Professional attendance at a hospital (not being a service to which any other item applies) by a 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 a service to which item 50 applies an attendance on 1 or more patients at 1 hospital on 1 occasion each patient Derived fee: The fee for Item 36 ($79.35), plus $28.70 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 $1.90 per patient. | DF |
| 00043 | 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 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) by a 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 a service to which item 51 applies an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion each patient Derived fee: The fee for Item 36 ($79.35), plus $28.70 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 $1.90 per patient. | DF |
| 00044 | Professional attendance at consulting rooms (not being a service to which any other item applies) by a 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 minutes duration for implementation of a management plan each attendance | $106.60 |
| 00047 | Professional attendance, other than a service to which any other item applies, and not being an attendance at consulting rooms, an institution, a hospital or a residential aged care facility by a general practitioner 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 minutes duration for implementation of a management plan - an attendance on 1 or more patients on 1 occasion each patient Derived fee: The fee for Item 44 ($106.60), plus $28.70 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 $1.90 per patient. | DF |
| 00048 | Professional attendance at an institution (not being a service to which any other item applies) by a 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 minutes duration for implementation of a management plan an attendance on 1 or more patients at 1 institution on 1 occasion each patient Derived fee: The fee for Item 44 ($106.60), plus $28.70 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 $1.90 per patient. | DF |
| 00050 | Professional attendance at a hospital (not being a service to which any other item applies) by a 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 minutes duration for implementation of a management plan an attendance on 1 or more patients at 1 hospital on 1 occasion each patient Derived fee: The fee for Item 44 ($106.60), plus $28.70 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 $1.90 per patient. | DF |
| 00051 | 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 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) by a 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 minutes duration for implementation of a management plan an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion each patient Derived fee: The fee for Item 44 ($106.60), plus $28.70 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 $1.90 per patient. | DF |
| Group A2 - Other non-referred attendances to which no other item applies | ||
| Surgery consultations | ||
| 00052 | 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 |
| 00053 | 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 practitioner) each attendance | N/A |
| 00054 | 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 practitioner) each attendance | N/A |
| 00057 | 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 |
| 00058 | 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 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 | N/A |
| 00059 | 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 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 | N/A |
| 00060 | 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 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 | N/A |
| 00065 | 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 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 $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 | N/A |
| 00081 | 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 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 | N/A |
| 00083 | 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 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 | N/A |
| 00084 | 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 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 | N/A |
| 00086 | 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 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 | N/A |
| 00087 | 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 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 | N/A |
| 00089 | 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 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 | N/A |
| 00090 | 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 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 | N/A |
| 00091 | 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 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 | N/A |
| 00092 | 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 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 residential aged 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 | N/A |
| 00093 | 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 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 or more 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 | N/A |
| 00095 | 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 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 or more 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 | N/A |
| 00096 | 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 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 care facility 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 | N/A |
| Group A2 - Other non-referred attendances to which no other item applies | ||
| Urgent attendances after hours | ||
| 00097 | Professional attendance at a place other than consulting rooms, by a medical practitioner (other than a general practitioner) on not more than 1 patient on the 1 occasion - each attendance, other than an attendance between 11pm and 7am, in an after-hours period if: a) the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken after hours period; and b) the patient's medical condition requires urgent treatment | $152.15 |
| 00098 | Professional attendance at consulting rooms, by a medical practitioner (other than a general practitioner) on not more than 1 patient on the 1 occasion - each attendance, other than an attendance between 11pm and 7am, in an after-hours period, if: a) the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken after hours period; and b) the patient's medical condition requires urgent treatment; and c) it is necessary for the practitioner to return to, and specially open, consulting rooms for the attendance | $152.15 |
| 00697 | Professional attendance, at a place other than consulting rooms, by a medical practitioner, (other than a general practitioner) on not more than 1 patient on the 1 occasion - each attendance between 11pm and 7am, if: a) the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken after-hours period; and b) the patient's medical condition requires urgent treatment | $160.95 |
| 00698 | Professional attendance, at consulting rooms, by a medical practitioner (other than a general practitioner) on not more than 1 patient on the 1 occasion - each attendance between 11pm and 7am, if: a) the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken after-hours period; and a) the patient's medical condition requires urgent treatment; and b) it is necessary for the practitioner to return to, and specially open, consulting rooms for the attendance | $160.95 |
| Group A3 - Specialist attendances to which no other item applies | ||
| 00104 | Professional attendance by a specialist in the practice of his or her specialty where the patient is referred to 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 apply. Specialist, referred consultation of 25 minutes or LESS – surgery or hospital | $115.75 |
| 0104A | Professional attendance at consulting rooms or hospital by a specialist in the practice of his or her specialty 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 applies Specialist, referred consultation of MORE THAN 25 minutes – surgery or hospital Note 1: Item number 0104A is not to be charged for independent medical examinations. Refer to Schedule B for IME consultation. 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 worker for their discussion with their rehabilitation provider. | $159.85 |
| 00105 | Professional attendance by a specialist in the practice of his or her specialty where the patient is referred to 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 | $66.15 |
| 00106 | - initial specialist ophthalmologist attendance in a single course of treatment, being an attendance at which 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 | $102.95 |
| 00107 | Professional attendance by a specialist in the practice of his or her specialty where the patient is referred to 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 | $136.35 |
| 00108 | Professional attendance by a specialist in the practice of his or her specialty where the patient is referred to 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 | $88.10 |
| 00109 | 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 14 years or under with developmental delay, not being a service to which item 104, 106 or any of items 10801 to 10816 applies | N/A |
| Group A4 - Consultant Physician attendances to which no other item applies | ||
| 00110 | Professional attendance at consulting rooms or hospital, by a consultant physician in the 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 | $192.90 |
| 00116 | Professional attendance at consulting rooms or hospital by a consultant physician in the practice of his or 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 of treatment | $99.20 |
| 00119 | Professional attendance at consulting rooms or hospital by a consultant physician in the 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 | $51.15 |
| 00122 | Professional attendance at a place other than consulting rooms or hospital, by a consultant physician in the 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 | $215.55 |
| 00128 | Professional attendance at a place other than consulting rooms or hospital by a consultant physician in the 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 first in a single course of treatment | $123.80 |
| 00131 | Professional attendance at a place other than consulting rooms or hospital by a consultant physician in the 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 | $93.50 |
| Group A5 - Prolonged attendances to which no other item applies | ||
| 00160 | Professional attendance for a period of not less than 1 hour but less than 2 hours (not being a service to 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 | $250.20 |
| 00161 | Professional attendance for a period of not less than 2 hours but less than 3 hours (not being a service to 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 | $405.70 |
| 00162 | Professional attendance for a period of not less than 3 hours but less than 4 hours (not being a service to 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 | $545.70 |
| 00163 | Professional attendance for a period of not less than 4 hours but less than 5 hours (not being a service to 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 | $679.05 |
| 00164 | Professional attendance for a period of 5 hours or more (not being a service to 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 | $803.65 |
| Group A6 - Group Therapy | ||
| 00170 | Professional attendance for the purpose of group therapy of not less than 1 hours duration given under the 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 personal relationships with that family each group of 2 patients | $170.85 |
| 00171 | Professional attendance for the purpose of group therapy of not less than 1 hours duration given under the 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 personal relationships with that family each group of 3 patients | $175.60 |
| 00172 | Professional attendance for the purpose of group therapy of not less than 1 hours duration given under the 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 personal relationships with that family each group of 4 or more patients | $220.25 |
| Group A7 - Acupuncture | ||
| 00173 | Attendance at which acupuncture is performed by a medical practitioner by application of stimuli on or through the surface of the skin by any means, 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 | $38.60 |
| 00193 | Professional attendance by a general practitioner who is a qualified medical acupuncturist, at a place other than a hospital, on one occasion, involving either: (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 acupuncture is performed by the general practitioner by the application of stimuli on or through the surface of the skin by any means; 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 | |
| 00195 | Professional attendance by a general practitioner who is a qualified medical acupuncturist, on 1 or more patients at a hospital, on one occasion, involving either: (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 acupuncture is performed by the general practitioner by the application of stimuli on or through the surface of the skin by any means; 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 Derived fee: The fee for Item 193 ($49.60), plus $28.70 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 $1.90 per patient. | DF |
| 00197 | professional attendance by a general practitioner who is a qualified medical acupuncturist, at a place other than a hospital, involving either:(i) 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(ii) a professional attendance of at least 20 minutes but less than 40 minutes duration involving components of a service to which item 44, 47, 48, 50 or 51 applies and at which acupuncture is performed by the general practitioner by the application of stimuli on or through the surface of the skin by any means; 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 | $79.35 |
| 00199 | professional attendance by a general practitioner who is a qualified medical acupuncturist, at a place other than a hospital, involving either: (i) 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 a least 40 minutes; or (ii) a professional attendance of at least 40 minutes duration for implementation of a management plan and at which acupuncture is performed by the general practitioner by the application of stimuli on or through the surface of the skin by any means; 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 | $106.60 |
| Group A8 - Consultant psychiatrist attendances to which no other item applies | ||
| 00291 | Consultant psychiatrist, referred patient assessment and management Professional attendance by a 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 preceding 12 months, payment has been made under this item | $422.05 |
| 00293 | Consultant psychiatrist, review of referred patient assessment and management Professional attendance 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 management 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 preceding 12 months, payment has been made under item 291, payable no more than once in any 12 month period | $264.95 |
| 00296 | Consultant psychiatrist, initial consultation on a new patient, consulting rooms Professional attendance of more than 45 minutes by a consultant physician in the practice of his or her speciality of psychiatry where a patient is referred to him or her by a medical practitioner, and where the patient: - is a new patient for this consultant psychiatrist; or - is a patient who has not received a professional attendance from this consultant psychiatrist in the preceding 24 months. Not being an attendance on a patient in respect of whom payment has been made under this item, items 297 or 299, or any of items 300 to 346 or 353 to 370 in the preceding 24 month period | $358.80 |
| 00297 | Consultant psychiatrist, initial consultation on a new patient, hospital Professional attendance of more than 45 minutes at hospital by a consultant physician in the practice of his or her speciality of psychiatry where a patient is referred to him or her by a medical practitioner, and where the patient: - is a new patient for this consultant psychiatrist; or - is a patient who has not received a professional attendance from this consultant psychiatrist in the preceding 24 months. Not being an attendance on a patient in respect of whom payment has been made under this item, items 296 or 299 or any of items 300 to 346 or 353 to 370 in the preceding 24 month period | $358.80 |
| 00299 | Consultant psychiatrist, initial consultation on a new patient, home visits Professional attendance of more than 45 minutes at a place other than consulting rooms or hospital by a consultant physician in the practice of his or her speciality of psychiatry where a patient is referred to him or her by a medical practitioner, and where the patient: - is a new patient for this consultant psychiatrist; or - is a patient who has not received a professional attendance from this consultant psychiatrist in the preceding 24 months. Not being an attendance on a patient in respect of whom payment has been made under this item, items 296 or 297, or any of items 300 to 346 or 353 to 370 in the preceding 24 month period | $358.80 |
| 00300 | 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 an attendance of not more than 15 minutes duration at consulting rooms, where that attendance and any other attendance to which items 296, 300 to 308 and items 353 to 370 apply have not exceeded the sum of 50 attendances in a calendar year | $63.95 |
| 00302 | 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 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 296, 300 to 308 and items 353 to 370 apply have not exceeded the sum of 50 attendances in a calendar year | $128.95 |
| 00304 | 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 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 296, 300 to 308 and items 353 to 370 apply have not exceeded the sum of 50 attendances in a calendar year | $190.75 |
| 00306 | 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 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 296, 300 to 308 and items 353 to 370 apply have not exceeded the sum of 50 attendances in a calendar year | $275.60 |
| 00308 | 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 an attendance of more than 75 minutes duration at consulting rooms, where that attendance and any other attendance to which items 296, 300 to 308 and items 353 to 370 apply have not exceeded the sum of 50 attendances in a calendar year | $319.70 |
| 00310 | 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 an attendance of not more than 15 minutes duration at consulting rooms, where that attendance and any other attendance to which items 296, 300 to 318 and items 353 to 370 apply exceed 50 attendances in a calendar year. | $26.75 |
| 00312 | 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 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 296, 300 to 318 and items 353 to 370 apply exceed 50 attendances in a calendar year. | $95.80 |
| 00314 | 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 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 296, 300 to 318 and items 353 to 370 apply exceed 50 attendances in a calendar year. | $147.15 |
| 00316 | 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 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 296, 300 to 318 and items 353 to 370 apply exceed 50 attendances in a calendar year. | $143.20 |
| 00318 | 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 an attendance of more than 75 minutes duration at consulting rooms, where that attendance and any other attendance to which items 296, 300 to 318 and items 353 to 370 apply exceed 50 attendances in a calendar year. | $202.15 |
| 00319 | 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 - 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 296, 300 to 308 and items 353 to 370 apply do not exceed 160 attendances in a calendar year. | $213.10 |
| 00320 | 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 an attendance of not more than 15 minutes duration at hospital | $63.95 |
| 00322 | 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 an attendance of more than 15 minutes duration but not more than 30 minutes duration at hospital | $128.95 |
| 00324 | 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 an attendance of more than 30 minutes duration but not more than 45 minutes duration at hospital | $190.75 |
| 00326 | 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 an attendance of more than 45 minutes duration but not more than 75 minutes duration at hospital | $275.60 |
| 00328 | 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 an attendance of more than 75 minutes duration at hospital | $319.70 |
| 00330 | 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 an attendance of not more than 15 minutes duration where that attendance is at a place other than consulting rooms or hospital | $86.90 |
| 00332 | 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 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 hospital | $141.10 |
| 00334 | 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 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 hospital | $192.90 |
| 00336 | 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 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 hospital | $275.60 |
| 00338 | 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 an attendance of more than 75 minutes duration where that attendance is at a place other than consulting rooms or hospital | $319.70 |
| 00342 | Group psychotherapy (including any associated consultations with a patient taking place on the same 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 patient | $65.45 |
| 00344 | Group psychotherapy (including any associated consultations with a patient taking place on the same 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 patient | $85.75 |
| 00346 | Group psychotherapy (including any associated consultations with a patient taking place on the same 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 patient | $128.55 |
| 00348 | 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, 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 patient | $181.35 |
| 00350 | 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, 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 patient | $250.45 |
| 00352 | 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, 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 period | $181.35 |
| 00353 | Consultant psychiatrist, referred consultation via telepsychiatry for assessment, diagnosis and treatment a 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. | $66.80 |
| 00355 | A telepsychiatry consultation of more than 15 minutes duration but not more than 30 minutes duration. | $133.35 |
| 00356 | A telepsychiatry consultation of more than 30 minutes duration but not more than 45 minutes duration. | $195.55 |
| 00357 | A telepsychiatry consultation of more than 45 minutes duration but not more than 75 minutes duration | $269.85 |
| 00358 | A telepsychiatry consultation of more than 75 minutes duration | $328.75 |
| 00364 | Consultant psychiatrist, referred consultation for assessment, diagnosis and treatment following 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. | $58.05 |
| 00366 | A face-to-face attendance of more than 15 minutes duration but not more than 30 minutes duration | $115.95 |
| 00367 | A face-to-face attendance of more than 30 minutes duration but not more than 45 minutes duration. | $170.00 |
| 00369 | A face-to-face attendance of more than 45 minutes duration but not more than 75 minutes duration | $234.60 |
| 00370 | A face-to-face attendance of more than 75 minutes duration. | $285.85 |
| Group A12 - Consultant occupational physician attendances to which no other item applies | ||
| 00385 | 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 medical practitioner - initial attendance in a single course of treatment | N/A |
| 00386 | 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 medical practitioner - each attendance subsequent to the first in a single course of treatment | N/A |
| 00387 | 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 or her by a medical practitioner - initial attendance in a single course of treatment | N/A |
| 00388 | 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 or her by a medical practitioner- each attendance subsequent to the first in a single course of treatment | N/A |
| Group A13 - Public health physician attendances to which no other item applies | ||
| 00410 | 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 straightforward nature of the task that requires a short patient history and, if required, limited examination and management | N/A |
| 00411 | Professional 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 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 applies | N/A |
| 00412 | Professional 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 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 applies | N/A |
| 00413 | Professional 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 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 | N/A |
| 00414 | 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 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 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 | N/A |
| 00415 | 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 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 | N/A |
| 00416 | 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 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 | N/A |
| 00417 | 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 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 patient | N/A |
| Group A16 - Medical practitioner (Sports Physician) attendances to which no other item applies | ||
| 00444 | 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 nature of the task that requires a short patient history and, if required, limited examination and management | N/A |
| 00445 | 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 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 applies | N/A |
| 00446 | Professional 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 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 applies | N/A |
| 00447 | Professional 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 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 | N/A |
| Emergency attendances after hours | ||
| 00448 | 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 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 holiday | N/A |
| 00449 | 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 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 7am | N/A |
| Group A21 - Medical practitioner (Emergency Physician) attendances to which no other item applies | ||
| Consultations | ||
| 00501 | Medical practitioner (emergency physician) attendances emergency department level 1 professional 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. | $48.95 |
| 00503 | Medical practitioner (emergency physician) attendances emergency department level 2 professional 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. | $82.65 |
| 00507 | Medical practitioner (emergency physician) attendances emergency department level 3 professional 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. | $139.00 |
| 00511 | Medical practitioner (emergency physician) attendances emergency department level 4 professional 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. | $136.25 |
| 00515 | Medical practitioner (emergency physician) attendances emergency department level 5 professional 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. | $217.95 |
| 00519 | Medical practitioner (emergency physician) attendances emergency department professional 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 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 patient | $145.50 |
| 00520 | For a period of not less than 1 hour but less than 2 hours of total physician time spent with each patient. | $291.15 |
| 00530 | For a period of not less than 2 hours but less than 3 hours of total physician time spent with each patient | $485.15 |
| 00532 | For a period of not less than 3 hours but less than 4 hours of total physician time spent with each patient. | $679.10 |
| 00534 | For a period of not less than 4 hours but less than 5 hours of total physician time spent with each patient. | $873.45 |
| 00536 | For a period of 5 hours or more of total physician time spent with each patient. | $970.45 |
| Group A14 - Health Assessments | ||
| 00700 | 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 - 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 706 | N/A |
| 00702 | Attendance 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 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 706 | N/A |
| 00704 | 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 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 706 | $182.30 |
| 00706 | Attendance 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 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 704 | $299.10 |
| 00708 | Aboriginal 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 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 item | N/A |
| 00710 | aboriginal 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 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 item | N/A |
| 00712 | Attendance 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 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. | N/A |
| 00714 | Health assessment for refugees and other humanitarian entrants 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 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. Benefits are payable for a service provided to a patient within 12 months of them arriving in Australia or receiving residency (whichever is the later) Note: Benefits are payable on one occasion only for a service included in this item or item716 | |
| 00716 | Attendance 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 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. Benefits are payable for a service provided to a patient within 12 months of them arriving in Australia or receiving residency (whichever is the later) Note: Benefits are payable on one occasion only for a service included in this item or item 714 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. | N/A |
| 00717 | 45 year old health check. Attendance by a medical practitioner (including a general practitioner but not including a specialist or consultant physician) at a place other than a hospital to undertake a health check for a patient between the age of 45 and 49 (inclusive) at risk of developing a chronic disease. Benefits are payable on one occasion only for each eligible patient. | N/A |
| Group A15 - GP management plans, team care arrangements, multidisciplinary care plans and case conferences | ||
| 00721 | 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 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 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. | N/A |
| 00723 | 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 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 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. | N/A |
| 00725 | 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 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. | N/A |
| 00727 | 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 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. | N/A |
| 00729 | 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 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, item 727, 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. | N/A |
| 00731 | Contribution by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) to: (a) a multidisciplinary care plan for a patient in a residential aged care facility, prepared by that facility, or to a review of such a plan prepared by such a facility; or (b) a multidisciplinary care plan prepared for a resident by another provider before the resident is discharged from a hospital or an approved day-hospital facility, or to a review of such a 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 three months of a previous claim for the same item or within three months of a claim for item 721, 723, 725, 727, 729, 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. | N/A |
| Case conferences | ||
| 00734 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a case conference team, to organise and coordinate a case conference in a residential aged care facility, where the conference time is at least 15 minutes, but less than 30 minutes (not being a service associated with a service to which item 730 applies) | N/A |
| 00736 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a case conference team, to organise and coordinate a case conference in a residential aged care facility, where the conference time is at least 30 minutes, but less than 45 minutes (not being a service associated with a service to which item 730 applies) | N/A |
| 00738 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a case conference team, to organise and coordinate a case conference in a residential aged care facility, where the conference time is at least 45 minutes, (not being a service associated with a service to which item 730 applies) | N/A |
| 00740 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a case conference team, to organise and coordinate a community case conference, where the conference time is at least 15 minutes, but less than 30 minutes (not being a service associated with a service to which items 720 to 730 apply) | N/A |
| 00742 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a case conference team, to organise and coordinate a community case conference, where the conference time is at least 30 minutes, but less than 45 minutes (not being a service associated with a service to which items 720 to 730 apply) | N/A |
| 00744 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a case conference team, to organise and coordinate a community case conference, where the conference time is at least 45 minutes (not being a service associated with a service to which items 720 to 730 apply) | N/A |
| 00746 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a case conference team, to organise and coordinate a discharge case conference, where the conference time is at least 15 minutes, but less than 30 minutes (not being a service associated with a service to which item 720 to 730 apply) - payable not more than once for each hospital admission | N/A |
| 00749 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a case conference team, to organise and coordinate a discharge case conference, where the conference time is at least 30 minutes, but less than 45 minutes (not being a service associated with a service to which items 720 to 730 apply) - payable not more than once for each hospital admission | N/A |
| 00757 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a case conference team, to organise and coordinate a discharge case conference, where the conference time is at least 45 minutes (not being a service associated with a service to which items 720 to 730 apply) - payable not more than once for each hospital admission | N/A |
| 00759 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a case conference team, to participate in a community case conference (other than to organise and coordinate the conference), where the conference time is at least 15 minutes, but less than 30 minutes (not being a service associated with a service to which items 720 to 730 apply) | N/A |
| 00762 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a case conference team, to participate in a community case conference (other than to organise and coordinate the conference), where the conference time is at least 30 minutes, but less than 45 minutes (not being a service associated with a service to which items 720 to 730 apply) | N/A |
| 00765 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a case conference team, to participate in a community case conference (other than to organise and coordinate the conference), where the conference time is at least 45 minutes (not being a service associated with a service to which items 720 to 730 apply) | N/A |
| 00768 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a case conference team, to participate in a discharge case conference (other than to organise and coordinate the conference), where the conference time is at least 15 minutes, but less than 30 minutes (not being a service associated with a service to which items 720 to 730 apply) - payable not more than once for each hospital admission | N/A |
| 00771 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a case conference team, to participate in a discharge case conference (other than to organise and coordinate the conference), where the conference time is at least 30 minutes, but less than 45 minutes (not being a service associated with a service to which items 720 to 730 apply) - payable not more than once for each hospital admission | N/A |
| 00773 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a case conference team, to participate in a discharge case conference (other than to organise and coordinate the conference), where the conference time is at least 45 minutes, (not being a service associated with a service to which items 720 to 730 apply) - payable not more than once for each hospital admission | N/A |
| 00775 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a case conference team, to participate in a case conference in a residential aged care facility, (other than to organise and coordinate the conference), where the conference time is at least 15 minutes, but less than 30 minutes (not being a service associated with a service to which item 730 applies) | N/A |
| 00778 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a case conference team, to participate in a case conference in a residential aged care facility, (other than to organise and coordinate the conference), where the conference time is at least 30 minutes, but less than 45 minutes (not being a service associated with a service to which item 730 applies) | N/A |
| 00779 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a case conference team, to participate in a case conference in a residential aged care facility, (other than to organise and coordinate the conference), where the conference time is at least 45 minutes, (not being a service associated with a service to which item 730 applies) | N/A |
| 00820 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to organise and coordinate a community case conference of at least 15 minutes but less than 30 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines | N/A |
| 00822 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to organise and coordinate a community case conference of at least 30 minutes but less than 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines | N/A |
| 00823 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to organise and coordinate a community case conference of at least 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines | N/A |
| 00825 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to participate in a community case conference (other than to organise and to coordinate the conference) of a least 15 minutes but less than 30 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines | N/A |
| 00826 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to participate in a community case conference (other than to organise and to coordinate the conference) of at least 30 minutes but less than 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines | N/A |
| 00828 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to participate in a community case conference (other than to organise and to coordinate the conference) of at least 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines | N/A |
| 00830 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to organise and coordinate a discharge case conference of at least 15 minutes but less than 30 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines | N/A |
| 00832 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to organise and coordinate a discharge case conference of at least 30 minutes but less than 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines | N/A |
| 00834 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to organise and coordinate a discharge case conference of at least 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines | N/A |
| 00835 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to participate in a discharge case conference of at least 15 minutes but less than 30 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines | N/A |
| 00837 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to participate in a discharge case conference of at least 30 minutes but less than 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines | N/A |
| 00838 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to participate in a discharge case conference of at least 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines | N/A |
| 00855 | Case conference - consultant psychiatrist attendance by a consultant physician in the practice of his or her specialty of psychiatry, as a member of a case conference team, to organise and coordinate a community case conference of at least 15 minutes, but less than 30 minutes with a multidisciplinary team of at least two other formal care providers of different disciplines | N/A |
| 00857 | Attendance by a consultant physician in the practice of his or her specialty of psychiatry, as a member of a case conference team, to organise and coordinate a community case conference of at least 30 minutes, but less than 45 minutes with a multidisciplinary team of at least two other formal care providers of different disciplines | N/A |
| 00858 | Attendance by a consultant physician in the practice of his or her specialty of psychiatry, as a member of a case conference team, to organise and coordinate a community case conference of at least 45 minutes with a multidisciplinary team of at least two other formal care providers, of different disciplines | N/A |
| 00861 | Case conference - consultant psychiatrist attendance by a consultant physician in the practice of his or her specialty of psychiatry, as a member of a case conference team, to organise and coordinate a discharge case conference, of at least 15 minutes, but less than 30 minutes with a multidisciplinary team of at least two other formal care providers of different disciplines | N/A |
| 00864 | Attendance by a consultant physician in the practice of his or her specialty of psychiatry, as a member of a case conference team, to organise and coordinate a discharge case conference, of at least 30 minutes, but less than 45 minutes with a multidisciplinary team of at least two other formal care providers of different disciplines | N/A |
| 00866 | Attendance by a consultant physician in the practice of his or her specialty of psychiatry, as a member of a case conference team, to organise and coordinate a discharge case conference, of at least 45 minutes with a multidisciplinary team of at least two other formal care providers of different disciplines | N/A |
| 00871 | Multidisciplinary cancer care case conference Attendance by a medical practitioner (including a specialist or consultant physician in the practice of his or her specialty or a general practitioner), as a member of a case conference team, to lead and coordinate a multidisciplinary case conference on a patient with cancer to develop a multidisciplinary treatment plan, where the case conference is of at least 10 minutes, with a multidisciplinary team of at least three other medical practitioners from different areas of medical practice (which may include general practice), and, in addition, allied health providers. | N/A |
| 00872 | Attendance by a medical practitioner (including a specialist or consultant physician in the practice of his or her specialty or a general practitioner), as a member of a case conference team, to participate in a multidisciplinary case conference on a patient with cancer to develop a multidisciplinary treatment plan, where the case conference is of at least 10 minutes, with a multidisciplinary team of at least four medical practitioners from different areas of medical practice (which may include general practice), and, in addition, allied health providers. | N/A |
| 00880 | Consultant physician in geriatric or rehabilitation medicine Attendance by a consultant physician in the practice of his or her specialty of geriatric or rehabilitation medicine, as a member of a case conference team, to coordinate a case conference on an admitted hospital patient of at least 10 minutes but less than 30 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines | N/A |
| Group A17 - Domiciliary medication management review | ||
| 00900 | Participation by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) in a Domiciliary Medication Management Review (dmmr) for patients living in the community setting, where the medical practitioner: - assesses a patient's medication management needs, and following that assessment, refers the patient to a community pharmacy for a dmmr, and provides relevant clinical information required for the review, with the patient's consent; and - discusses with the reviewing pharmacist the results of that review including suggested medication management strategies; and - develops a written medication management plan following discussion with the patient. Benefits under this item are payable not more than once in each 12 month period, except where there has been a significant change in the patient's condition or medication regimen requiring a new dmmr. | N/A |
| 00903 | Participation by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) in a collaborative Residential Medication Management Review (rmmr) for a permanent resident of a residential aged care facility, where the medical practitioner: discusses and seeks consent for an rmmr from the new or existing resident; collaborates with the reviewing pharmacist regarding the pharmacy component of the review; provides input from the resident's Comprehensive Medical Assessment (cma), or if a cma has not been undertaken, provides relevant clinical information for the resident's rmmr; discusses findings of the pharmacist review and proposed medication management strategies with the reviewing pharmacist (unless exceptions apply); - develops and/or revises a written medication plan for the resident; and consults with the resident to discuss the medication mangement plan and its implementation. Benefits under this item are payable for one rmmr service 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 rmmr for a resident in any 12 month period, except where there has been a significant change in medical condition or medication regimen requiring a new rmmr. | N/A |
| Group A18 - General Practitioner attendance associated with PIP incentive payments | ||
| 02497 | Level 'a' Professional attendance involving taking a short patient history and if required, limited examination and management and at which a cervical smear is taken from a woman between the ages of 20 and 69 years inclusive, who has not had a cervical smear in the last 4 years. This item cannot be claimed in conjunction with items 10994, 10995, 10998 or 10999 surgery consultation (Professional attendance at consulting rooms) | N/A |
| 02501 | Level 'b' Professional attendance involving taking a selective history, examination of the patient with the implementation of a management plan in relation to one or more problems, or 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 a cervical smear is taken from a woman between the ages of 20 and 69 years inclusive, who has not had a cervical smear in the last 4 years.This item cannot be claimed in conjunction with items 10994, 10995, 10998 or 10999. surgery consultation (Professional attendance at consulting rooms) | N/A |
| 02503 | Out-of-surgery consultation(Professional attendance at a place other than consulting rooms). This item cannot be claimed in conjunction with items 10994, 10995, 10998 or 10999. The fee for item 2501, 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 2501 plus $1.60 per patient | N/A |
| 02504 | Level 'c' Professional attendance involving taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to one or more problems and lasting at least 20 minutes, or 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 a cervical smear is taken from a woman between the ages of 20 and 69 years inclusive, who has not had a cervical smear in the last 4 years. This item cannot be claimed in conjunction with items 10994, 10995, 10998 or 10999. surgery consultation(Professional attendance at consulting rooms) | N/A |
| 02506 | Out-of-surgery consultation(Professional attendance at a place other than consulting rooms). This item cannot be claimed in conjunction with items 10994, 10995, 10998 or 10999. The fee for item 2504, 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 2504 plus $1.60 per patient | N/A |
| 02507 | Level 'd' Professional attendance involving taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to one or more complex problems and lasting at least 40 minutes, or a professional attendance of at least 40 minutes duration for implementation of a management plan; and at which a cervical smear is taken from a woman between the ages of 20 and 69 years inclusive, who has not had a cervical smear in the last 4 years. This item cannot be claimed in conjunction with items 10994, 10995, 10998 or 10999. surgery consultation (Professional attendance at consulting rooms) | N/A |
| 02509 | Out-of-surgery consultation(Professional attendance at a place other than consulting rooms). This item cannot be claimed in conjunction with items 10994, 10995, 10998 or 10999 The fee for item 2507, 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 2507 plus $1.60 per patient | N/A |
| Completion of an annual cycle of care for patients with diabetes mellitus | ||
| 02517 | The minimum requirements of care needed to be assessed to complete a cycle of care for patients with established diabetes mellitus are: - Assess diabetes control by measuring Hba1c At least once every year - Ensure that a comprehensive eye examination is carried out* At least once every two years - Measure weight and height and calculate bmi** At least twice every cycle of care - Measure blood pressure At least twice every cycle of care - Examine feet*** At least twice every cycle of care - Measure total cholesterol, triglycerides and hdl cholesterol At least once every year - Test for microalbuminuria At least once every year - Provide self-care education Patient education regarding diabetes management - Review diet Reinforce information about appropriate dietary choices - Review levels of physical activity Reinforce information about appropriate levels of physical activity - Check smoking status Encourage cessation of smoking (if relevant) - Review of medication Medication review * Not required if the patient is blind or does not have both eyes. ** Initial visit: measure height and weight and calculate bmi as part of the initial patient assessment. Subsequent visits: measure weight. *** Not required if the patient does not have both feet. level 'b' Professional attendance involving taking a selective history, examination of the patient with the implementation of a management plan in relation to one or more problems, or 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 which completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus surgery consultation (Professional attendance at consulting rooms) | N/A |
| 02518 | Out-of-surgery consultation(Professional attendance at a place other than consulting rooms) and which completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus The fee for item 2517, 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 2517 plus $1.60 per patient | N/A |
| 02521 | Level 'c' Professional attendance involving taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to one or more problems and lasting at least 20 minutes, or 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 which completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus surgery consultation (Professional attendance at consulting rooms) | N/A |
| 02522 | Out-of-surgery consultation (Professional attendance at a place other than consulting rooms) and which completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus The fee for item 2521, 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 2521 plus $1.60 per patient | N/A |
| 02525 | Level 'd' Professional attendance involving taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to one or more complex problems and lasting at least 40 minutes, or a professional attendance of at least 40 minutes duration for implementation of a management plan and which completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus surgery consultation (Professional attendance at consulting rooms) | N/A |
| 02526 | Out-of-surgery consultation (Professional attendance at a place other than consulting rooms) and which completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus The fee for item 2525, 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 2525 plus $1.60 per patient | N/A |
| Completion of the asthma 3+ visit plan | ||
| 02546 | Note: Benefits are payable for only one service included in Subgroup 3 or a19, Subgroup 3 in a 12-month period, unless a further Asthma Cycle of Care is clinically indicated. At a minimum the Asthma Cycle of Care must include: - at least 2 asthma related consultations within 12 months for a patient with moderate to severe asthma (at least 1 of which (the review consultation) is a consultation that was planned at a previous consultation) - documented diagnosis and assessment of level of asthma control and severity of asthma - review of the patient's use of and access to asthma related medication and devices - provision to the patient of a written asthma action plan (if the patient is unable to use a written asthma action plan - discussion with the patient about an alternative method of providing an asthma action plan, and documentation of the discussion in the patient's medical records - provision of asthma self-management education to the patient - review of the written or documented asthma action plan level 'b' Professional attendance involving taking a selective history, examination of the patient with the implementation of a management plan in relation to one or more problems, or 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 which completes the minimum requirements of the Asthma Cycle of Care. surgery consultation (Professional attendance at consulting rooms) | N/A |
| 02547 | Out-of-surgery consultationand which completes the minimum requirements of the Asthma Cycle of Care. (Professional attendance at a place other than consulting rooms) The fee for item 2546, 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 2546 plus $1.60 per patient | N/A |
| 02552 | Level 'c' Professional attendance involving taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to one or more problems and lasting at least 20 minutes, or 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 which completes the minimum requirements of the Asthma Cycle of Care.surgery consultation (Professional attendance at consulting rooms) | N/A |
| 02553 | Out-of-surgery consultation and which completes the minimum requirements of the Asthma Cycle of Care. (Professional attendance at a place other than consulting rooms) The fee for item 2552, 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 2552 plus $1.60 per patient | N/A |
| 02558 | Level 'd' Professional attendance involving taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to one or more complex problems and lasting at least 40 minutes, or a professional attendance of at least 40 minutes duration for implementation of a management plan and which completes the minimum requirements of the Asthma Cycle of Care Plan.surgery consultation (Professional attendance at consulting rooms) | N/A |
| 02559 | Out-of-surgery consultation and which completes the minimum requirements of the Asthma Cycle of Care. (Professional attendance at a place other than consulting rooms) The fee or item 2558, 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 2558 plus $1.60 per patient | N/A |
| Completion of the 3 step mental health process | ||
| 02574 | Note: Benefits included in Subgroup 4, a18 or a19, are payable for one 3 Step Mental Health Process per patient only in a 12-month period, unless a further 3 Step Mental Health Process is clinically indicated. At a minimum the 3 Step Mental Health Process must include: - at least 2 consultations of more than twenty minutes each for a patient with an assessed mental health disorder; - at least one of the consultations to have been a planned visit which must include the review step; - an assessment and formulation or diagnosis of the mental health disorder/s; - provision of a written mental health plan and appropriate education to the patient and/or the carer (with the patient's agreement); - a review of the patient's progress against the goals included in the mental health plan. This review to have been conducted a minimum of 4 weeks and a maximum of 6 months from the consultation in which the mental health plan was prepared; and - utilising an outcome tool in the assessment and review stages except where considered clinically inappropriate. The 3 Step Mental Health Process can only be provided by a general practitioner, who practices in general practice and has been notified to the hic as having the required credentials. level c Professional attendance involving taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to one or more problems and lasting at least 20 minutes, or 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 which completes the requirements of the 3 Step Mental Health Process. surgery consultation (Professional attendance at consulting rooms) | $79.35 |
| 02575 | Out-of-surgery consultation (Professional attendance at a place other than consulting rooms) The fee for item 2574, 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 2574 plus $1.60 per patient. | N/A |
| 02577 | Level 'd' professional attendance 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 minutes duration for implementation of a management plan; and which completes the requirements of the 3 step mental health process.surgery consultation (Professional attendance at consulting rooms) | $106.60 |
| 02578 | Out-of-surgery consultation (professional attendance at a place other than consulting rooms) The fee for item 2577, 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 2577 plus $1.60 per patient. | N/A |
| Group A19 - Other non-referred attendances associated with PIP incentive payments to which no other item applies | ||
| Taking of a cervical smear from an unscreened or significantly underscreened woman | ||
| 02598 | Surgery consultations (Professional attendance at consulting rooms) brief consultation of not more than 5 minutes duration and at which a cervical smear is taken from a woman between the ages of 20 and 69 years inclusive, who has not had a cervical smear in the last 4 years. This item cannot be claimed in conjunction with items 10994, 10995, 10998 or 10999 | N/A |
| 02600 | Surgery consultations (Professional attendance at consulting rooms) standard consultation of more than 5 minutes duration but not more than 25 minutes duration and at which a cervical smear is taken from a woman between the ages of 20 and 69 years inclusive, who has not had a cervical smear in the last 4 years. This item cannot be claimed in conjunction with items 10994, 10995, 10998 or 10999. | |
| 02603 | Long consultation of more than 25 minutes duration but not more than 45 minutes duration and at which a cervical smear is taken from a woman between the ages of 20 and 69 years inclusive, who has not had a cervical smear in the last 4 years. This item cannot be claimed in conjunction with items 10994, 10995, 10998 or 10999. | N/A |
| 02606 | Prolonged consultation of more than 45 minutes duration and at which a cervical smear is taken from a woman between the ages of 20 and 69 years inclusive who has not had a cervical smear in the last 4 years. This item cannot be claimed in conjunction with items 10994, 10995, 10998 or 10999. | N/A |
| 02610 | Out-of-surgery consultations(Professional attendance at a place other than consulting rooms) standard consultation of more than 5 minutes duration but not more than 25 minutes duration and at which a cervical smear is taken from a woman between the ages of 20 and 69 years inclusive, who has not had a cervical smear in the last 4 years. This item cannot be claimed in conjunction with items 10994, 10995, 10998 or 10999. 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 $0.70 per patient | N/A |
| 02613 | Long consultation of more than 25 minutes duration but not more than 45 minutes duration and at which a cervical smear is taken from a woman between the ages of 20 and 69 years inclusive, who has not had a cervical smear in the last 4 years. This item cannot be claimed in conjunction with items 10994, 10995, 10998 or 10999. 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 $0.70 per patient | N/A |
| 02616 | Prolonged consultation of more than 45 minutes duration and at which a cervical smear is taken from a woman between the ages of 20 and 69 years inclusive who has not had a cervical smear in the last 4 years. This item cannot be claimed in conjunction with items 10994, 10995, 10998 or 10999. 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 $0.70 per patient | N/A |
| Completion of an annual cycle of care for patients with diabetes mellitus | ||
| 02620 | The minimum requirements of care needed to be assessed to complete a cycle of care for patients with established diabetes mellitus are: - Assess diabetes control by measuring Hba1c At least once every year - Ensure that a comprehensive eye examination is carried out* At least once every two years - Measure weight and height and calculate bmi** At least twice every cycle of care - Measure blood pressure At least twice every cycle of care - Examine feet*** At least twice every cycle of care - Measure total cholesterol, triglycerides and hdl cholesterol At least once every year - Test for microalbuminuria At least once every year - Provide self-care education Patient education regarding diabetes management - Review diet Reinforce information about appropriate dietary choices - Review levels of physical activity Reinforce information about appropriate levels of physical activity - Check smoking status Encourage cessation of smoking (if relevant) - Review of medication Medication review * Not required if the patient is blind or does not have both eyes. ** Initial visit: measure height and weight and calculate bmi as part of the initial patient assessment. Subsequent visits: measure weight. *** Not required if the patient does not have both feet. surgery consultations (Professional attendance at consulting rooms) standard consultation of more than 5 minutes duration but not more than 25 minutes duration and which completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus. | N/A |
| 02622 | Long consultation of more than 25 minutes duration but not more than 45 minutes durationand which completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus | N/A |
| 02624 | Prolonged consultation of more than 45 minutes duration and which completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus | N/A |
| 02631 | Out-of-surgery consultations (Professional attendance at a place other than the consulting rooms) standard consultation of more than 5 minutes duration but not more than 25 minutes duration and which completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus 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 $0.70 per patient | N/A |
| 02633 | Long consultation of more than 25 minutes duration but not more than 45 minutes duration and which completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus 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 $0.70 per patient | N/A |
| 02635 | Prolonged consultation of more than 45 minutes duration and which completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus 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 $0.70 per patient | N/A |
| Completion of the asthma 3+ visit plan | ||
| 02664 | Note: Benefits are payable for only one service included in Subgroup 3 or a18, Subgroup 3 in a 12-month period, unless a further Asthma Cycle of Care is clinically indicated. At a minimum the Asthma Cycle of Care must include: - at least 2 asthma related consultations within 12 months for a patient with moderate to severe asthma (at least 1 of which (the review consultation) is a consultation that was planned at a previous consultation) - documented diagnosis and assessment of level of asthma control and severity of asthma - review of the patient's use of and access to asthma related medication and devices - provision to the patient of a written asthma action plan (if the patient is unable to use a written asthma action plan - discussion with the patient about an alternative method of providing an asthma action plan, and documentation of the discussion in the patient's medical records - provision of asthma self-management education to the patient - review of the written or documented asthma action plan surgery consultations (Professional attendance at consulting rooms) standard consultations of more than 5 minutes duration but not more than 25 minutes duration and which completes the minimum requirements of the Asthma Cycle of Care. | N/A |
| 02666 | Long consultation of more than 25 minutes duration but not more than 45 minutes duration and which completes the minimum requirements of the Asthma Cycle of Care. | N/A |
| 02668 | Prolonged consultation of more than 45 minutes duration and which completes the minimum requirements of the Asthma Cycle of Care. | N/A |
| 02673 | Out-of-surgery consultations (Professional attendance at a place other than the consulting rooms) standard consultation of more than 5 minutes duration but not more than 25 minutes duration and which completes the minimum requirements of the Asthma Cycle of Care. 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 $0.70 per patient. | N/A |
| 02675 | Long consultation of more than 25 minutes duration but not more than 45 minutes duration and which completes the minimum requirements of the Asthma Cycle of Care. 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 $0.70 per patient | N/A |
| 02677 | Prolonged consultation of more than 45 minutes duration and which completes the minimum requirements of the Asthma Cycle of Care. 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 $0.70 per patient | N/A |
| Completion of the 3 step mental health process | ||
| 02704 | Note: Benefits included in Subgroup 4, a18 or a19, are payable for one service per patient only in a 12-month period, unless a further 3 Step Mental Health Process is clinically indicated. At a minimum the 3 Step Mental Health Process must include: - at least 2 consultations of more than twenty minutes each for a patient with an assessed mental health disorder; - at least one of the consultations to have been a planned visit which must include the review step; - an assessment and formulation or diagnosis of the mental health disorder/s; - provision of a written mental health plan and appropriate education to the patient and/or the carer (with the patient's agreement); - a review of the patient's progress against the goals included in the mental health plan. This review to have been conducted a minimum of 4 weeks and a maximum of 6 months from the consultation in which the mental health plan was prepared; and - utilising an outcome tool in the assessment and review stages except where considered clinically inappropriate. The 3 Step Mental Health Process can only be provided by a medical practitioner (not including a general practitioner, a specialist or consultant physician), who practices in general practice and has been notified to Medicare Australia as having the required credentials. surgery consultations (Professional attendance at consulting rooms) long consultation of more than 25 minutes duration but not more than 45 minutes duration and which completes the requirements of the 3 Step Mental Health Process. | N/A |
| 02705 | Prolonged consultation of more than 45 minutes duration and which completes the requirements of the 3 step mental health process. | N/A |
| 02707 | Out-of-surgery consultations (professional attendance at a place other than the consulting rooms) long consultation of more than 25 minutes duration but not more than 45 minutes duration and which completes the requirements of the 3 step mental health process. 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 $0.70 per patient. | N/A |
| 02708 | Prolonged consultation of more than 45 minutes duration and which completes the requirements of the 3 Step Mental Health Process. 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 $0.70 per patient. | N/A |
| Group A20 - GP mental health care | ||
| GP mental health care plans | ||
| 02710 | Preparation by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) of a gp mental health care plan for a patient (not being a service associated with a service to which items 2713 or 734 to 779 apply). a rebate will not be paid within twelve months of a previous claim for the same item, within twelve months of a claim for a 3 Step Mental Health Process (items 2574, 2575, 2577, 2578 and 2704, 2705, 2707, 2708) or within three months following a claim for item 2712, 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 Mental Health Care Plan. | $234.00 |
| 02712 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) to review a gp mental health care plan prepared by that medical practitioner (or an associated medical practitioner) to which item 2710 applies or to review a psychiatrist assessment and management plan to which item 291 applies (not being a service associated with a service to which items 2713 or 734 to 779 apply). a rebate will not be paid within three months of a previous claim for the same item or within four weeks following a claim for item 2710, 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 Mental Health Care Plan. | $156.00 |
| 02713 | Professional attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) involving taking relevant history, identifying presenting problem(s), providing treatment, advice and/or referral for other services or treatments and documenting the outcomes of the consultation, on a patient in relation to a mental disorder and lasting at least 20 minutes (not being a service associated with a service to which items 2710 or 2712 apply).surgery consultation (Professional attendance at consulting rooms) | $102.95 |
| Group A20 - Focussed psychological strategies | ||
| Focussed psychological strategies | ||
| 02721 | Medical practitioner attendance (including a general practitioner, but not including a specialist or consultant physician) associated with provision of focussed psychological strategies Note: These services may only be provided by a medical practitioner who is registered with Medicare Australia as having satisfied the requirements for higher level mental health skills for the provision of the service. The medical practitioner must provide the service in a general practice participating in the pip or which is accredited. Focussed psychological strategies are specific mental health care management strategies, derived from evidence based psychological therapies, that have been shown to integrate the best external evidence of clinical effectiveness with general practice clinical expertise. These strategies are required to be provided to patients by a credentialled medical practitioner and are time limited; being deliverable, in general, in up to 12 planned sessions comprising two groups of up to six sessions. In exceptional circumstances, following review by the practitioner managing either the 3 Step Mental Health Process, the gp Mental Health Care Plan or the Psychiatric Assessment and Management Plan, up to a further 6 sessions may be approved in a calendar year to an individual patient. Medical practitioners must be notified to Medicare Australia by the General Practice Mental Health Standards Collaboration that they have met the required standards for higher level mental health skills. a session should last for a minimum of 30 minutes. fps attendance Professional attendance for the purpose of providing focussed psychological strategies (from the list included in the Explanatory Notes) for assessed mental disorders by a medical practitioner registered with Medicare Australia as meeting the credentialling requirements for provision of this service, and lasting at least 30 minutes to less than 40 minutes. surgery consultation (Professional attendance at consulting rooms) | $104.60 |
| 02723 | Out-of-surgery consultation (professional attendance at a place other than consulting rooms). Derived fee: The fee for item 02721 ($104.60), plus $28.70 divided by the number of patients seen, up to a maximum of 6 patients. For 7 or more patients - the fee for item 02721 plus $1.90 per patient. | DF |
| 02725 | Fps extended attendance professional attendance for the purpose of providing focussed psychological strategies for assessed mental health disorders, by a medical practitioner registered with Medicare Australia as meeting the credentialling requirements for provision of this service, and lasting at least 40 minutes.surgery consultation (professional attendance at consulting rooms). | $135.30 |
| 02727 | Out-of-surgery consultation (professional attendance at a place other than consulting rooms) Derived fee:The fee for item 02725 ($135.30), plus $28.70 divided by the number of patients seen, up to a maximum of 6 patients. For 7 or more patients - the fee for item 02725 plus $1.90 per patient. | DF |
| Group A24 - Pain and Palliative Medicine | ||
| Pain medicine attendances | ||
| 02801 | Medical practitioner (pain medicine specialist) attendance - surgery or hospital Professional attendance at consulting rooms or hospital by a consultant physician or specialist practising in the specialty of pain medicine, where the patient was referred to him or her by a medical practitioner - initial attendance in a single course of treatment | $192.90 |
| 02806 | - each attendance (other than a service to which item 2814 applies) subsequent to the first in a single course of treatment | $99.20 |
| 02814 | - each minor attendance subsequent to the first in a single course of treatment | $51.15 |
| 02824 | Medical practitioner (pain medicine specialist) attendance - home visit Professional attendance at a place other than consulting rooms or hospital by a consultant physician or specialist practising in the specialty of pain medicine, where the patient was referred to him or her by a medical practitioner - initial attendance in a single course of treatment | $215.55 |
| 02832 | - each attendance (other than a service to which item 2840 applies) subsequent to the first in a single course of treatment | $123.80 |
| 02840 | - each minor attendance subsequent to the first in a single course of treatment | $93.50 |
| Pain medicine case conferences | ||
| 02946 | Case conferences - pain medicine specialist Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to organise and coordinate a community case conference, where the conference time is at least 15 minutes, but less than 30 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines | $199.00 |
| 02949 | Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to organise and coordinate a community case conference, where the conference time is at least 30 minutes, but less than 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines | $298.65 |
| 02954 | Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to organise and coordinate a community case conference, where the conference time is at least 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines | $398.00 |
| 02958 | Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to participate in a community case conference, (other than to organise and to coordinate the conference) where the conference time is at least 15 minutes, but less than 30 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines | $143.05 |
| 02972 | Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to participate in a community case conference, (other than to organise and to coordinate the conference) where the conference time is at least 30 minutes, but less than 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines | $228.00 |
| 02974 | Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to participate in a community case conference, (other than to organise and to coordinate the conference) where the conference time is at least 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines | $313.05 |
| 02978 | Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to organise and coordinate a discharge case conference, where the conference time is at least 15 minutes, but less than 30 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines | $199.00 |
| 02984 | Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to organise and coordinate a discharge case conference, where the conference time is at least 30 minutes, but less than 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines | $298.65 |
| 02988 | Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to organise and coordinate a discharge case conference, where the conference time is at least 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines | $398.00 |
| 02992 | Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to participate in a discharge case conference, where the conference time is at least 15 minutes, but less than 30 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines | $143.05 |
| 02996 | Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to participate in a discharge case conference, where the conference time is at least 30 minutes, but less than 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines | $228.00 |
| 03000 | Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to participate in a discharge case conference, where the conference time is at least 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines | $313.05 |
| Palliative medicine attendances | ||
| 03005 | Medical practitioner (palliative medicine specialist) attendance - surgery or hospital Professional attendance at consulting rooms or hospital by a consultant physician or specialist practising in the specialty of palliative medicine, where the patient was referred to him or her by a medical practitioner - initial attendance in a single course of treatment | $192.90 |
| 03010 | - each attendance (other than a service to which item 3014 applies) subsequent to the first in a single course of treatment | $99.20 |
| 03014 | - each minor attendance subsequent to the first in a single course of treatment | $51.15 |
| 03018 | Medical practitioner (palliative medicine specialist) attendance - home visit Professional attendance at a place other than consulting rooms or hospital by a consultant physician or specialist practising in the specialty of pallitive medicine, where the patient was referred to him or her by a medical practitioner - initial attendance in a single course of treatment | $215.55 |
| 03023 | - each attendance (other than a service to which item 3028 applies) subsequent to the first in a single course of treatment | $123.80 |
| 03028 | - each minor attendance subsequent to the first in a single course of treatment | $93.50 |
| Palliative medicine case conferences | ||
| 03032 | Case conferences - pallitive medicine specialist Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to organise and coordinate a community case conference, where the conference time is at least 15 minutes, but less than 30 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines | $199.00 |
| 03040 | Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to organise and coordinate a community case conference, where the conference time is at least 30 minutes, but less than 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines | $298.65 |
| 03044 | Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to organise and coordinate a community case conference, where the conference time is at least 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines | $398.00 |
| 03051 | Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to participate in a community case conference, (other than to organise and to coordinate the conference) where the conference time is at least 15 minutes, but less than 30 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines | $143.05 |
| 03055 | Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to participate in a community case conference, (other than to organise and to coordinate the conference) where the conference time is at least 30 minutes, but less than 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines | $228.00 |
| 03062 | Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to participate in a community case conference, (other than to organise and to coordinate the conference) where the conference time is at least 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines | $313.05 |
| 03069 | Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to organise and coordinate a discharge case conference, where the conference time is at least 15 minutes, but less than 30 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines | $199.00 |
| 03074 | Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to organise and coordinate a discharge case conference, where the conference time is at least 30 minutes, but less than 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines | $298.65 |
| 03078 | Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to organise and coordinate a discharge case conference, where the conference time is at least 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines | $398.00 |
| 03083 | Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to participate in a discharge case conference, where the conference time is at least 15 minutes, but less than 30 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines | $143.05 |
| 03088 | Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to participate in a discharge case conference, where the conference time is at least 30 minutes, but less than 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines | $228.00 |
| 03093 | Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to participate in a discharge case conference, where the conference time is at least 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines | $313.05 |
| Group A27 - Pregnancy support counselling | ||
| 04001 | Medical practitioner attendance (including a general practitioner, but not including a specialist or consultant physician) associated with provision of non-directive pregnancy support counselling services Professional attendance for the purpose of providing non- directive pregnancy support counselling to a woman who is concerned about a current pregnancy or a pregnancy that occurred in the preceding 12 months, by a medical practitioner registered with Medicare Australia as meeting the credentialling requirements for provision of this service, and lasting at least 20 minutes. The service may be used to address any pregnancy related issues for which non-directive counselling is appropriate. This service may not be provided by a medical practitioner who has a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination. To a maximum of 3 non-directive pregnancy support counselling services per patient, per pregnancy from any of the following items - 4001, 81000, 81005 and 81010 (see Explanatory note m.8). surgery consultation (professional attendance at consulting rooms) | N/A |
| Group A22 - General Practitioner after-hours attendances to which no other item applies | ||
| 05000 | level 'a' professional attendance 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 surgery consultation professional attendance at consulting rooms. the attendance must be initiated either on a public holiday, on a sunday, before 8am or after 1pm on a saturday, or before 8am or after 8pm on any other day. | $32.65 |
| 05003 | Home visit (professional attendance on 1 or more patients on 1 occasion at a place other than consulting rooms, hospital, residential aged care facility or institution. the attendance must be initiated either on a public holiday, on a sunday, before 8am or after 1pm on a saturday, or before 8am or after 8pm on any other day.) Derived fee: The fee for Item 05000 ($32.65), plus $28.70 divided by the number of patients seen, up to a maximum of 6 patients. For 7 or more patients - the fee for Item 05000 plus $1.90 per patient. | DF |
| 05007 | Consultation at an institution other than a hospital or residential aged care facility (Professional attendance on 1 or more patients in 1 institution on 1 occasion) each patient. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 1pm on a Saturday, or before 8am or after 8pm on any other day.) Derived fee: The fee for Item 05000 ($32.65), plus $28.70 divided by the number of patients seen, up to a maximum of 6 patients. For 7 or more patients - the fee for Item 05000 plus $1.90 per patient. | DF |
| 05010 | Consultation at a residential aged care facility (Professional attendance on 1 or more patients in 1 residential aged care facility (but excluding a professional attendance at a self- contained unit) or attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (excluding accommodation in a self-contained unit) on 1 occasion) each patient. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 1pm on a Saturday, or before 8am or after 8pm on any other day.) Derived fee: The fee for Item 05000 ($32.65), plus $28.70 divided by the number of patients seen, up to a maximum of 6 patients. For 7 or more patients - the fee for Item 05000 plus $1.90 per patient. | DF |
| 05020 | Level 'b' Professional attendance 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 minutes duration involving components of a service to which item 5040, 5043, 5046, 5049, 5060, 5063, 5064 or 5067 applies surgery consultation (Professional attendance at consulting rooms. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 1pm on a Saturday, or before 8am or after 8pm on any other day.) | $65.70 |
| 05023 | Home visit (Professional attendance on 1 or more patients on 1 occasion at a place other than consulting rooms, hospital, residential aged care facility or institution. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 1pm on a Saturday, or before 8am or after 8pm on any other day.) Derived fee: The fee for Item 05020 ($65.70), plus $28.70 divided by the number of patients seen, up to a maximum of 6 patients. For 7 or more patients - the fee for Item 05020 plus $1.90 per patient. | DF |
| 05026 | Consultation at an institution other than a hospital or residential aged care facility (Professional attendance on 1 or more patients in 1 institution on 1 occasion) each patient. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 1pm on a Saturday, or before 8am or after 8pm on any other day.) Derived fee: The fee for Item 05020 ($65.70), plus $28.70 divided by the number of patients seen, up to a maximum of 6 patients. For 7 or more patients - the fee for Item 05020 plus $1.90 per patient. | DF |
| 05028 | Consultation at a residential aged care facility (Professional attendance on 1 or more patients in 1 residential aged care facility (but excluding a professional attendance at a self- contained unit) or attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (excluding accommodation in a self-contained unit) on 1 occasion) each patient the attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 1pm on a Saturday, or before 8am or after 8pm on any other day.) Derived fee: The fee for Item 05020 ($65.70), plus $28.70 divided by the number of patients seen, up to a maximum of 6 patients. For 7 or more patients - the fee for Item 05020 plus $1.90 per patient. | DF |
| 05040 | Level 'c' Professional attendance 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 a service to which item 5060, 5063, 5064 or 5067 applies surgery consultation (Professional attendance at consulting rooms. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 1pm on a Saturday, or before 8am or after 8pm on any other day.) | $92.90 |
| 05043 | Home visit (Professional attendance on 1 or more patients on 1 occasion at a place other than consulting rooms, hospital, residential aged care facility or institution). The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 1pm on a Saturday, or before 8am or after 8pm on any other day.) Derived fee: The fee for Item 05040 ($92.90), plus $28.70 divided by the number of patients seen, up to a maximum of 6 patients. For 7 or more patients - the fee for Item 05040 plus $1.90 per patient. | DF |
| 05046 | Consultation at an institution other than a hospital or residential aged care facility (Professional attendance on 1 or more patients in 1 institution on 1 occasion) each patient. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 1pm on a Saturday, or before 8am or after 8pm on any other day.) Derived fee: The fee for Item 05040 ($92.90), plus $28.70 divided by the number of patients seen, up to a maximum of 6 patients. For 7 or more patients - the fee for Item 05040 plus $1.90 per patient. | DF |
| 05049 | Consultation at a residential aged care facility (Professional attendance on 1 or more patients in 1 residential aged care facility (but excluding a professional attendance at a self- contained unit) or attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (excluding accommodation in a self-contained unit) on 1 occasion) each patient. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 1pm on a Saturday, or before 8am or after 8pm on any other day.) Derived fee: The fee for Item 05040 ($92.90), plus $28.70 divided by the number of patients seen, up to a maximum of 6 patients. For 7 or more patients - the fee for Item 05040 plus $1.90 per patient. | DF |
| 05060 | level 'd' Professional attendance 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 minutes duration for implementation of a management plan surgery consultation (Professional attendance at consulting rooms. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 1pm on a Saturday, or before 8am or after 8pm on any other day.) | $118.90 |
| 05063 | Home visit (Professional attendance on 1 or more patients on 1 occasion at a place other than consulting rooms, hospital, residential aged care facility or institution. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 1pm on a Saturday, or before 8am or after 8pm on any other day.) Derived fee: The fee for Item 05060 ($118.90), plus $28.70 divided by the number of patients seen, up to a maximum of 6 patients. For 7 or more patients - the fee for Item 05060 plus $1.90 per patient. | DF |
| 05064 | Consultation at an institution other than a hospital or residential aged care facility (Professional attendance on 1 or more patients in 1 institution on 1 occasion) each patient. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 1pm on a Saturday, or before 8am or after 8pm on any other day.) Derived fee: The fee for Item 05060 ($118.90), plus $28.70 divided by the number of patients seen, up to a maximum of 6 patients. For 7 or more patients - the fee for Item 05060 plus $1.90 per patient. | DF |
| 05067 | Consultation at a residential aged care facility (Professional attendance on 1 or more patients in 1 residential aged care facility (but excluding a professional attendance at a self- contained unit) or attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (excluding accommodation in a self-contained unit) on 1 occasion) each patient. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 1pm on a Saturday, or before 8am or after 8pm on any other day.) Derived fee: The fee for Item 05060 ($118.90), plus $28.70 divided by the number of patients seen, up to a maximum of 6 patients. For 7 or more patients - the fee for Item 05060 plus $1.90 per patient. | DF |
| Group A23 - Other non-referred after-hours attendances to which no other item applies | ||
| 05200 | Professional attendance at consulting rooms. brief consultation of not more than 5 minutes duration. The attendance must be initiated either on a public holiday, on a sunday, before 8am or after 1pm on a Saturday, or before 8am or after 8pm on any other day.) | |
employer.
Note 2: This service should involve one of the following:
- an employer;
- a claims agent or self-insured employer;
- a worker’s representative or advocate;
- a provider of investigative services; or
- a rehabilitation provider contracted by WorkCover.
Note 3: This service may include a video viewing of a 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 worker’s limitations to work, capacity,
recommendations for facilitating a return to work and/or options for
management of the 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 $69.35 for a 20 minute attendance), and
rounded to the nearest five minutes.
ATTENDANCE AT A DISPUTE RESOLUTION
WMG15 General Practitioners: Attendance at a dispute resolution. $208.00
per hour
WMP15 Consultant Physicians: Attendance at a dispute resolution. $407.70
per hour
WMS15 Specialists in a surgical discipline: Attendance at a dispute resolution. $407.70
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 $69.35 for a 20 minute attendance), and
rounded to the nearest five minutes.
TRAVEL TIME: WORKSITE ASSESSMENT, CASE CONFERENCE, DISPUTE
RESOLUTION OR THIRD PARTY CONSULTATION
WMG10 General Practitioners: Travel time for the purpose of a worksite $208.00
assessment, case conference, dispute resolution or third party per hour
consultation.
WMP10 Consultant Physicians: Travel time for the purpose of a worksite $407.70
assessment, case conference, dispute resolution or third party per hour
consultation.
WMS10 Specialists in a surgical discipline: Travel time for the purpose of a $407.70
worksite assessment, case conference, dispute resolution or third party per hour
consultation.
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 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 $69.35 for 20 minutes of travel), and
rounded to the nearest five minutes.
CANCELLATION: CASE CONFERENCE, WORKSITE ASSESSMENT, DISPUTE
RESOLUTION OR THIRD PARTY CONSULTATION
WMG36 General Practitioners: Cancellation of case conference, worksite $208.00
assessment, dispute resolution or third party consultation. per hour
WMP36 Consultant Physicians: Cancellation of case conference, $407.70
worksite assessment, dispute resolution or third party consultation. per hour
WMS36 Specialists in a surgical discipline: Cancellation of case conference, $407.70
worksite 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 worker, 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 $69.35 where 20 minutes had been
allocated for the attendance), and rounded to the nearest five minutes.
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 $80.10
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 $101.90
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 $101.90
recommended 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 rehabilitation 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). $18.40
WMP23 Consultant Physicians: Completion of a specified duties form (SDF). $18.40
WMS23 Specialists in a surgical discipline: Completion of a specified duties form $18.40
(SDF).
Note 1: This form is to be completed at the request of:
- a claims agent or self-insured employer; or
- a worker, worker’s representative or advocate.
Note 2: A fee is not payable if the form is completed during a consultation
with the 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 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 $407.70
professional attendance relating to item numbers 00160, 00161, 00162, per hour
00163 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 $590.70
any day of the week or on a public holiday in association with a per hour
professional attendance relating to item numbers 00160, 00161, 00162,
00163 and 00164Note 1: Where more than one 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 and rounded to
the nearest five minutes.
EXTRA-CORPOREAL SHOCK WAVE THERAPY
WMI11 Specialists: Initial treatment of Extra-Corporeal Shock Wave Therapy $121.30
provided by a specialist radiology practice.
WMI12 Specialists: Subsequent treatments of Extra-Corporeal Shock Wave $99.20
Therapy provided by a specialist radiology practice.
WMI13 Specialists: Double treatments (bilateral or multiple) of Extra-Corporeal $165.40
Shock 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. $282.60
WME2A Otorhinolaryngologists: Cortical evoked response audiometry - $282.60
quantification.
WME25 Otorhinolaryngologists: Sensonics smell identification test. $122.80
SERVICES DELIVERED BY MEDICAL PRACTITIONERS
WMG26 Medical Practitioners: Fluids, intravenous drip infusion of – percutaneous. $48.50
WMG27 Medical Practitioners: Fluids, intravenous drip infusion of – open exposure. $80.50
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. $41.60
WMG28 Medical Practitioners: At consulting rooms, 16 to 30 minutes. $72.40
WMG29 Medical Practitioners: At consulting rooms, 31 to 45 minutes. $108.70
WMG30 Medical Practitioners: At consulting rooms, more than 46 minutes. $148.00
INDEPENDENT MEDICAL EXAMINER - SHORT MEDICAL REPORT
WMPA1 Consultant Physicians: Independent medical examiner short medical report, $101.90
expected to be provided within 72 hours of receipt of the initial request.
WMSA1 Specialists in a surgical discipline: Independent medical examiner short $101.90
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 worker, 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 $488.80
be provided within 10 business days of receipt of the initial request.
WMS29 Specialist in a surgical discipline: Independent medical examiner report, $488.80
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 worker, 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, $608.40
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 worker, 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 $192.90
an independent medical examiner report.
WMS80 Specialist in a surgical discipline: Consultation: medical review for the $192.90
preparation of an independent medical examiner report.
WMY80 Psychiatrist: Consultation: medical review of not more than 15 minutes $64.00
duration for the preparation of an independent medical examiner report.
WMY81 Psychiatrist: Consultation: medical review of more than 15 minutes but not $129.00
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 $190.70
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 $275.60
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 $319.70
for 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 DF
approved by the requestor in order to prepare a report.
Derived fee: The fee for item WMP32 is $99.20 for reading time up to and
including 12 pages, plus $7.90 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 DF
or approved by the requestor in order to prepare a report.
Derived fee: The fee for item WMS32 is $99.20 for reading time up to and
including 12 pages, plus $7.90 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 $129.00 for reading time up to and
including 12 pages, plus $7.90 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 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 $85.00
required.
WMS33 Specialists in a surgical discipline: Clarification of a medical report, re- $85.00
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 worker, 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 $407.70
assessment, case conference, dispute resolution or third party per hour
consultation.
MS940 Specialist in a surgical discipline: Travel time for the purpose of a worksite $407.70
assessment, case conference, dispute resolution or third party per hour
consultation.
Note 1: Travel will be approved for independent medical examiner services
requested by:
- a claims agent or self-insured employer; or
- a worker, 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 worker’s locality.
Note 5: Where more than one service is conducted, the travel fee is to be
apportioned accordingly and rounded to the nearest five minutes.
INDEPENDENT MEDICAL EXAMINER - CANCELLATION OF AN APPOINTMENT OR
NON-ATTENDANCE
WMP34 Consultant Physicians: Cancellation of an appointment or non-attendance, $192.90
less than 24 hours before the time of the scheduled appointment.
WMS34 Specialist in a surgical discipline: Cancellation of an appointment or non- $192.90
attendance, less than 24 hours before the time of the scheduled
appointment.
WMY85 Psychiatrist: Cancellation of an appointment or non-attendance of not more $64.00
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 $129.00
than 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 $190.70
than 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 $275.60
than 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 $319.70
than 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 worker, worker’s representative or advocate.
Note 2: If the cancelled appointment or non-attendance is subsequently
filled with 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 $119.10
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 $119.10
than 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 $190.70
100 kilometres from the Adelaide GPO.
WMS65 Specialists in a surgical discipline: Cancellation of an attendance at a $190.70
venue more than 100 kilometres from the Adelaide GPO.
WMP66 Consultant Physicians: Overnight accommodation including meals and $107.00
incidentals.
WMS66 Specialists in a surgical discipline: Overnight accommodation including $107.00
meals 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’s Deputy
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 3 May 2007
No 56 of 2007
07WKC002CS
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