Workers Rehabilitation and Compensation (Scales of Charges—Medical Practitioners) Variation Regulations 2008 (SA)
Case
South Australia
Workers Rehabilitation and Compensation (Scales of Charges—Medical Practitioners) Variation Regulations 2008
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 2008.
2—Commencement
These regulations will come into operation on 1 July 2008.
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 No | Description | Max fee (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: 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 the patient's medical condition requires urgent treatment | $157.50 |
| 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: 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 the patient's medical condition requires urgent treatment; bandit is necessary for the practitioner to return to, and specially open, consulting rooms for the attendance | $157.50 |
| 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: 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 the patient's medical condition requires urgent treatment | $166.60 |
| 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: 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 the patient's medical condition requires urgent treatment; and it is necessary for the practitioner to return to, and specially open, consulting rooms for the attendance | $166.60 |
| 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 | $19.80 |
| 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 ($19.80), plus $29.70 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 $2.00 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 ($19.80), plus $29.70 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 $2.00 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 ($19.80), plus $29.70 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 $2.00 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 ($19.80), plus $29.70 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 $2.00 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 | $51.30 |
| 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 ($51.30), plus $29.70 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 $2.00 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 ($51.30), plus $29.70 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 $2.00 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 ($51.30), plus $29.70 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 $2.00 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 ($51.30), plus $29.70 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 $2.00 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 | $82.10 |
| 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 ($82.10), plus $29.70 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 $2.00 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 ($82.10), plus $29.70 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 $2.00 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 ($82.10), plus $29.70 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 $2.00 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 ($82.10), plus $29.70 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 $2.00 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 | $110.30 |
| 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 ($110.30), plus $29.70 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 $2.00 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 ($110.30), plus $29.70 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 $2.00 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 ($110.30), plus $29.70 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 $2.00 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 ($110.30), plus $29.70 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 $2.00 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 | 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 | 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 | 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 | 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 | 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 | 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 | 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 | 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 | 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 | 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 | 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 | 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 | 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 self-contained 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 | 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 self-contained 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 | 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 self-contained 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 | 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: 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 the patient's medical condition requires urgent treatment | $157.50 |
| 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: 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 the patient's medical condition requires urgent treatment; bandit is necessary for the practitioner to return to, and specially open, consulting rooms for the attendance | $157.50 |
| 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: 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 the patient's medical condition requires urgent treatment | $166.60 |
| 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: 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 the patient's medical condition requires urgent treatment; bandit is necessary for the practitioner to return to, and specially open, consulting rooms for the attendance | $166.60 |
| Group A3 - Specialist attendances to which no other item applies | ||
| 00104 | 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 or 109 apply. Specialist, referred consultation of 25 minutes or LESS – surgery or hospital | $119.80 |
| 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 or 109 apply. 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 | $165.50 |
| 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 | $68.50 |
| 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 | $106.60 |
| 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 | $141.10 |
| 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 | $91.20 |
| 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 | $199.70 |
| 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 | $102.70 |
| 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 | $52.90 |
| 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 | $223.10 |
| 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 | $128.10 |
| 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 | $96.80 |
| 00132 | Professional attendance of at least 45 minutes duration for an initial assessment of a patient with at least two morbidities (this can include complex congenital, developmental and behavioural disorders), where the patient is referred by a medical practitioner, and where (a) assessment is undertaken that covers: a comprehensive history, including psychosocial history and medication review; comprehensive multi or detailed single organ system assessment; the formulation of differential diagnoses; and (b) a consultant physician treatment and management plan of significant complexity is developed and provided to the referring practitioner that involves: an opinion on diagnosis and risk assessment treatment options and decisions medication recommendations not being an attendance on a patient in respect of whom, an attendance under items 110, 116 and 119 has been received on the same day by the same consultant physician. Not being an attendance on the patient in respect of whom, in the preceding 12 months, payment has been made under this item for attendance by the same consultant physician | N/A |
| 00133 | Professional attendance of at least 20 minutes duration subsequent to the first attendance in a single course of treatment for a review of a patient with at least two morbidities (this can include complex congenital, developmental and behavioural disorders), where (a) a review is undertaken that covers: review of initial presenting problem/s and results of diagnostic investigations review of responses to treatment and medication plans initiated at time of initial consultation comprehensive multi or detailed single organ system assessment, review of original and differential diagnoses; and (b) a modified consultant physician treatment and management plan is provided to the referring practitioner that involves, where appropriate: a revised opinion on the diagnosis and risk assessment treatment options and decisions revised medication recommendations not being an attendance on a patient in respect of whom, an attendance under item 110, 116 and 119 has been received on the same day by the same consultant physician. Being an attendance on a patient in respect of whom, in the preceding 12 months, payment has been made under item 132 by the same consultant physician, payable no more than twice in any 12 month period | N/A |
| Group A28 - Consultant Physician/Specialist | ||
| 00141 | Professional attendance at consulting rooms or hospital by a consultant physician or specialist in the practice of his or her specialty of geriatric medicine, where the patient is at least 65 years old and referred 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 the medical practitioner for the provision of a comprehensive assessment and management plan. an attendance of more than 60 minutes at consulting rooms or hospital during which: the medical, physical, psychological and social aspects of the patient's health are evaluated in detail, utilising appropriately validated assessment tools where indicated ('assessment'), the patient's various health problems and care needs are identified and prioritised ('formulation'), a detailed management plan is developed ('management plan'), the management plan is explained and discussed with the patient and/or their family and carer(s) where appropriate, and the management plan is communicated in writing to the referring medical practitioner. The management plan should include: the prioritised list of health problems and care needs, short and longer term management goals, recommended actions or intervention strategies to be undertaken by the patient's general practitioner or other relevant health care providers that are: likely to improve or maintain health status, readily available, and acceptable to the patient, their family and carer(s). Not being an attendance on a patient in respect of whom, an attendance under items 104, 105, 107, 108, 110, 116 and 119 has been received on the same day by the same practitioner. Not being an attendance on a patient in respect of whom, in the preceding 12 months, payment has been made under this item or item 145 by the same practitioner | N/A |
| 00143 | Professional attendance at consulting rooms or hospital by a consultant physician or specialist in the practice of his or her specialty of geriatric medicine to review a management plan previously prepared by that consultant physician or specialist in geriatric medicine and claimed under item 141 or 145, where the review is initiated by the referring medical practitioner practising in general practice. an attendance of more than 30 minutes duration at consulting rooms or hospital where that attendance follows item 141 or 145 and during which: the patient's health status is reassessed, a management plan provided under items 141 or 145 is reviewed and revised, the revised management plan is explained to the patient and/or their family and carer(s) and communicated in writing to the referring medical practitioner. Not being an attendance on a patient in respect of whom, an attendance under items 104, 105, 107, 108, 110, 116 and 119 has been received on the same day by the same practitioner. Being an attendance on a patient in respect of whom, in the preceding 12 months, payment has been made under items 141 or 145 by the same practitioner, payable no more than once in any 12 month period, except for where there has been a significant change in the patient's clinical condition or care circumstances that requires a further review | N/A |
| 00145 | Professional attendance at a place other than consulting rooms or hospital by a consultant physician or specialist in the practice of his or her specialty of geriatric medicine, where the patient is at least 65 years old and has been referred 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 the medical practitioner for the provision of a comprehensive assessment and management plan. An attendance of more than 60 minutes at a place other than consulting rooms or hospital during which: the medical, physical, psychological and social aspects of the patient's health are evaluated in detail, utilising appropriately validated assessment tools where indicated ('assessment'), the patient's various health problems and care needs are identified and prioritised ('formulation'), a detailed management plan is developed ('management plan'), the management plan is explained and discussed with the patient and/or their family and carer(s) where appropriate, the management plan is communicated in writing to the referring medical practitioner. the management plan should include: the prioritised list of health problems and care needs, short and longer term management goals, recommended actions or intervention strategies to be undertaken by the patient's general practitioner or other relevant health care providers that are: likely to improve or maintain health status readily available acceptable to the patient, their family and carer(s) not being an attendance on a patient in respect of whom, an attendance under items 104, 105, 107, 108, 110, 116 and 119 has been received on the same day by the same practitioner. Not being an attendance on a patient in respect of whom, in the preceding 12 months, payment has been made under this item or 141 by the same practitioner | |
| 00147 | Professional attendance at a place other than consulting rooms or hospital by a consultant physician or specialist in the practice of his or her specialty of geriatric medicine to review a management plan previously prepared by that consultant physician or specialist in geriatric medicine and claimed under items 141 or 145, where the review is initiated by the referring medical practitioner practising in general practice. An attendance of more than 30 minutes duration at a place other than consulting rooms or hospital where that attendance follows items 141 or 145 and during which: the patient's health status is reassessed, a management plan provided under items 141 or 145 is reviewed and revised, the revised management plan is explained to the patient and/or their family and carer(s) and communicated in writing to the referring medical practitioner. Not being an attendance on a patient in respect of whom, an attendance under items 104, 105, 107, 108, 110, 116 and 119 has been received on the same day by the same practitioner. Being an attendance on a patient in respect of whom, in the preceding 12 months, payment has been made under items 141 or 145 by the same practitioner, payable no more than once in any 12 month period, except for where there has been a significant change in the patient's clinical condition or care circumstances that requires a further review | N/A |
| 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 | $259.00 |
| 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 | $419.90 |
| 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 | $564.80 |
| 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 | $702.80 |
| 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 | $831.80 |
| 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 | $176.80 |
| 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 | $181.70 |
| 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 | $228.00 |
| 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 | $40.00 |
| 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 | $51.30 |
| 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 ($51.30), plus $29.70 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 $2.00 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 | $82.10 |
| 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 | $110.30 |
| 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 | $436.80 |
| 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, and no payment has been made under item 359, payable no more than once in any 12 month period | $274.20 |
| 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 358 or 361 to 370 in the preceding 24 month period | $371.40 |
| 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 358 or 361 to 370 in the preceding 24 month period | $371.40 |
| 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 358 or 361 to 370 in the preceding 24 month period | $371.40 |
| 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 358 or 361 to 370 apply have not exceeded the sum of 50 attendances in a calendar year | $66.20 |
| 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 358 or 361 to 370 apply have not exceeded the sum of 50 attendances in a calendar year | $133.50 |
| 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 358 or 361 to 370 apply have not exceeded the sum of 50 attendances in a calendar year | $197.40 |
| 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 358 or 361 to 370 apply have not exceeded the sum of 50 attendances in a calendar year | $285.20 |
| 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 358 or 361 to 370 apply have not exceeded the sum of 50 attendances in a calendar year | $330.90 |
| 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 358 or 361 to 370 apply exceed 50 attendances in a calendar year | $27.70 |
| 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 358 or 361 to 370 apply exceed 50 attendances in a calendar year | $99.20 |
| 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 358 or 361 to 370 apply exceed 50 attendances in a calendar year | $152.30 |
| 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 358 or 361 to 370 apply exceed 50 attendances in a calendar year | $148.20 |
| 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 358 or 361 to 370 apply exceed 50 attendances in a calendar year | $209.20 |
| 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 358 or 361 to 370 apply do not exceed 160 attendances in a calendar year | $220.60 |
| 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 | $66.20 |
| 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 | $133.50 |
| 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 | $197.40 |
| 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 | $285.20 |
| 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 | $330.90 |
| 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 | $89.90 |
| 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 | $146.00 |
| 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 | $199.70 |
| 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 | $285.20 |
| 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 | $330.90 |
| 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 | $67.70 |
| 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 | $88.80 |
| 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 | $133.00 |
| 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 | $187.70 |
| 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 | $259.20 |
| 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 | $187.70 |
| 00353 | A telepsychiatry consultation by a consultant physician in the practice of his or her specialty of psychiatry (not being an attendance to which items 291 to 319 apply), where: -the patient is referred to him or her by a medical practitioner for assessment, diagnosis and/or treatment and is located in a regional, rural or remote area (rrma3-7), -that consultation and any other consultation to which items 353 to 361 apply, have not exceeded 12 consultations in a calendar year, - any other attendance to which items 300 to 308 and 353 to 358 or 361 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 | $69.10 |
| 00355 | A telepsychiatry consultation of more than 15 minutes duration but not more than 30 minutes duration | $138.00 |
| 00356 | A telepsychiatry consultation of more than 30 minutes duration but not more than 45 minutes duration | $202.40 |
| 00357 | A telepsychiatry consultation of more than 45 minutes duration but not more than 75 minutes duration | $279.30 |
| 00358 | A telepsychiatry consultation of more than 75 minutes duration | $340.30 |
| 00359 | A telepsychiatry consultation of more than 30 minutes but not more than 45 minutes duration by a consultant physician in the practice of his or her specialty of psychiatry where: the patient is located in a regional, rural or remote area (rrma 3-7) in the preceding 12 months, payment has been made under item 291 an outcome tool is used where clinically appropriate mental state examination is conducted psychiatric diagnosis is made 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 not being an attendance on a patient in respect of whom payment has been made under this item or item 293 in the preceding 12 month period | $456.20 |
| 00361 | A telepsychiatry consultation of more than 45 minutes by a consultant physician in the practice of his or her specialty of psychiatry where: the patient is a new patient for this consultant psychiatrist, or a patient who has not received a professional attendance from this consultant psychiatrist in the preceding 24 months the patient is located in a regional, rural or remote area (rrma3-7) not being an attendance on a patient in respect of whom payment has been made under this item, items 296 to 299, or any of items 300 to 346 or 353 to 370 in the preceding 24 month period | $419.60 |
| 00364 | CONSULTANT PSYCHIATRIST, REFERRED CONSULTATION FOR ASSESSMENT, DIAGNOSIS AND TREATMENT FOLLOWING 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 a telepsychiatry consultation (items 353 to 361), - that attendance and any other attendance to which items 300 to 308 and 353 to 358 or 361 to 370 apply, have not exceeded the sum of 50 attendances in a calendar year. These items may only be used after telepsychiatry consultation(s) have been conducted in accordance with items 353 to 361. A face-to-face attendance of not more than 15 minutes duration | $60.10 |
| 00366 | A face-to-face attendance of more than 15 minutes duration but not more than 30 minutes duration | $120.00 |
| 00367 | A face-to-face attendance of more than 30 minutes duration but not more than 45 minutes duration | $175.90 |
| 00369 | A face-to-face attendance of more than 45 minutes duration but not more than 75 minutes duration | $242.80 |
| 00370 | A face-to-face attendance of more than 75 minutes duration | $295.90 |
| 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 | $26.50 |
| 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 | $57.90 |
| 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 | $109.90 |
| 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 | $161.80 |
| 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 Derived fee: The fee for item 410 ($26.50), plus $29.70 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 $2.00 per patient | DF |
| 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 Derived fee: The fee for item 411 ($57.90), plus $29.70 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 $2.00 per patient | DF |
| 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 Derived fee: The fee for item 412 ($109.90), plus $29.70 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 $2.00 per patient | DF |
| 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 Derived fee: The fee for item 413 ($161.80), plus $29.70 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 $2.00 per patient | DF |
| Group A16 - Medical practitioner (Sports Physician) attendances to which no other item applies | ||
| Surgery consultations | ||
| 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 | $26.50 |
| 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 | $57.90 |
| 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 | $109.90 |
| 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 | $161.80 |
| Urgent attendances after hours | ||
| 00448 | MEDICAL PRACTITIONER (SPORTS PHYSICIAN) ATTENDANCES - URGENT AFTER-HOURS(on not more than 1 patient on the 1 occasion) 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 - each attendance (other than an attendance between 11pm and 7am) in an after-hours period, if: 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 the patient's medical condition requires urgent treatment; bandit is necessary for the practitioner to return to, and specially open, consulting rooms for the attendance | $202.80 |
| 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 - each attendance between 11pm and 7am if: 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 the patient's medical condition requires urgent treatment; bandit is necessary for the practitioner to return to, and specially open, consulting rooms for the attendance | $239.00 |
| Group A21 - Medical practitioner (Emergency Physician) attendances to which no other item applies | ||
| 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 | $50.70 |
| 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 | $85.50 |
| 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 | $143.90 |
| 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 | |
| 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 | $225.60 |
| 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 | $150.60 |
| 00520 | For a period of not less than 1 hour but less than 2 hours of total physician time spent with each patient | $301.30 |
| 00530 | For a period of not less than 2 hours but less than 3 hours of total physician time spent with each patient | $502.10 |
| 00532 | For a period of not less than 3 hours but less than 4 hours of total physician time spent with each patient | $702.90 |
| 00534 | For a period of not less than 4 hours but less than 5 hours of total physician time spent with each patient | $904.00 |
| 00536 | For a period of 5 hours or more of total physician time spent with each patient | $1,004.40 |
| 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 | $188.70 |
| 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 | $309.60 |
| 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 item 716 | N/A |
| 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 | 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. Note: Benefits are payable on one occasion only for each eligible patient | N/A |
| 00718 | 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 with an intellectual disability - 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 719 | N/A |
| 00719 | 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 residential aged care facility for a health assessment - of a patient with an intellectual disability - not being a health assessment for a patient in respect of whom, in the preceding 12 months, a payment has been made under this item or item 718. | 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 |
| 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 731 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 731 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 731 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 721 to 731 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 721 to 731 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 721 to 731 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 721 to 731 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 721 to 731 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 721 to 731 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 721 to 731 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 721 to 731 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 721 to 731 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 721 to 731 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 721 to 731 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 721 to 731 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 731 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 731 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 731 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 | $205.60 |
| 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 management 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 | $140.80 |
| Group A18 - General Practitioner attendance associated with PIP incentive payments | ||
| Taking of a cervical smear from an unscreened or significantly underscreened woman | ||
| 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) | $22.50 |
| 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) | $49.20 |
| 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 Derived fee: The fee for item 2501 ($49.20), plus $29.70 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 $2.00 per patient | DF |
| 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) | $93.50 |
| 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 Derived fee: The fee for item 2504 ($93.50), plus $29.70 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 $2.00 per patient | DF |
| 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) | $137.60 |
| 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 Derived fee: The fee for item 2507 ($137.60), plus $29.70 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 $2.00 per patient | DF |
| 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 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) | $49.20 |
| 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 Derived fee: The fee for item 2517 (49.20), plus $29.70 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 $2.00 per patient | DF |
| 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) | $93.50 |
| 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 Derived fee: The fee for item 2521 ($93.50), plus $29.70 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for 2521 plus $2.00 per patient | DF |
| 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) | $137.60 |
| 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 Derived fee: The fee for item 2525 ($137.60), plus $29.70 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for 2525 plus $2.00 per patient | |
| Completion of the asthma cycle of care | ||
| 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) | $49.20 |
| 02547 | 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) Derived fee: The fee for item 2546 ($49.20), plus $29.70 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 $2.00 per patient | DF |
| 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) | $93.50 |
| 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) Derived fee: The fee for item 2552 ($93.50), plus $29.70 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 $2.00 per patient | DF |
| 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) | $137.60 |
| 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) Derived fee: The fee or item 2558 ($137.60), plus $29.70 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 $2.00 per patient | DF |
| 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 undersceened 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 | N/A |
| 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 | 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 | 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 | 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 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 duration and 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 | 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 | 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 | N/A |
| Completion of the asthma cycle of care | ||
| 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 | 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 | N/A |
| 02677 | Prolonged consultation of more than 45 minutes duration and which completes the minimum requirements of the Asthma Cycle of Care | 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 former 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 | $242.20 |
| 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 | $161.50 |
| 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) | $106.60 |
| 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 former 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) | $108.30 |
| 02723 | Out-of-surgery consultation (professional attendance at a place other than consulting rooms) Derived fee: The fee for item 02721 ($108.30), plus $29.70 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 $2.00 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) | $140.00 |
| 02727 | Out-of-surgery consultation (professional attendance at a place other than consulting rooms) Derived fee: The fee for item 02725 ($140.00), plus $29.70 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 $2.00 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 | $199.70 |
| 02806 | —Each attendance (other than a service to which item 2814 applies) subsequent to the first in a single course of treatment | $102.70 |
| 02814 | —Each minor attendance subsequent to the first in a single course of treatment | $52.90 |
| 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 | $223.10 |
| 02832 | —Each attendance (other than a service to which item 2840 applies) subsequent to the first in a single course of treatment | $128.10 |
| 02840 | —Each minor attendance subsequent to the first in a single course of treatment | $96.80 |
| 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 | $206.00 |
| 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 | $309.10 |
| 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 | $411.90 |
| 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 | $148.10 |
| 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 | $236.00 |
| 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 | $324.00 |
| 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 | $206.00 |
| 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 | $309.10 |
| 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 | $411.90 |
| 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 | $148.10 |
| 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 | $236.00 |
| 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 | $324.00 |
| 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 | $199.70 |
| 03010 | —Each attendance (other than a service to which item 3014 applies) subsequent to the first in a single course of treatment | $102.70 |
| 03014 | —Each minor attendance subsequent to the first in a single course of treatment | $52.90 |
| 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 palliative medicine, where the patient was referred to him or her by a medical practitioner - initial attendance in a single course of treatment | $223.10 |
| 03023 | —Each attendance (other than a service to which item 3028 applies) subsequent to the first in a single course of treatment | $128.10 |
| 03028 | —Each minor attendance subsequent to the first in a single course of treatment | $96.80 |
| Palliative medicine case conferences | ||
| 03032 | Case conferences - palliative 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 | $206.00 |
| 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 | $309.10 |
| 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 | $411.90 |
| 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 | $148.10 |
| 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 | $236.00 |
| 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 | $324.00 |
| 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 | $206.00 |
| 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 | $309.10 |
| 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 | $411.90 |
| 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 | $148.10 |
| 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 | $236.00 |
| 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 | $324.00 |
| 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) | $101.70 |
| 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 | $33.80 |
| 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 ($33.80), plus $29.70 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 $2.00 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 ($33.80), plus $29.70 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 $2.00 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 ($33.80), plus $29.70 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 $2.00 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.) | $68.00 |
| 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 ($68.00), plus $29.70 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 $2.00 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 ($68.00), plus $29.70 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 $2.00 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 ($68.00), plus $29.70 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 $2.00 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.) | $96.20 |
| 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 ($96.20), plus $29.70 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 $2.00 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 ($96.20), plus $29.70 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 $2.00 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 ($96.20), plus $29.70 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 $2.00 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.) | $123.10 |
| 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 ($123.10), plus $29.70 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 $2.00 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 ($123.10), plus $29.70 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 $2.00 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 ($123.10), plus $29.70 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 $2.00 per patient | |
| 71165 | Antibodies to tissue antigens (acetylcholine receptor, adrenal cortex, heart, histone, insulin, insulin receptor, intrinsic factor, islet cell, lymphocyte, neuron, ovary, parathyroid, platelet, salivary gland, skeletal muscle, skin basement membrane and intercellular substance, thyroglobulin, thyroid microsome or thyroid stimulating hormone receptor) - detection, including quantitation if required, of 1 antibody (Item is subject to rule 6) | $52.70 |
| 71166 | Detection of 2 antibodies described in item 71165 (Item is subject to rule 6) | $72.40 |
| 71167 | Detection of 3 antibodies described in item 71165 (Item is subject to rule 6) | $92.00 |
| 71168 | Detection of 4 or more antibodies described in item 71165 (Item is subject to rule 6) | $111.70 |
| 71169 | A test described in item 71165, if rendered by a receiving APP, where no tests in the item have been rendered by the referring APP 1 test (Item is subject to rule 6 and 18) | $52.70 |
| 71170 | Tests described in item 71165, other than that described in 71169, if rendered by a receiving APP - each test to a maximum of 3 tests (Item is subject to rule 6 and 18) | $19.70 |
| 71180 | Antibody to cardiolipin or beta-2 glycoprotein i detection, including quantitation if required; one antibody specificity (igg or igm) | $54.50 |
| 71183 | Detection of two antibodies described in item 71180 | $74.90 |
| 71186 | Detection of three or more antibodies described in item 71180 | $95.20 |
| 71189 | Detection of specific igg antibodies to 1 or more respiratory disease allergens not elsewhere specified | $24.40 |
| 71192 | 2 items described in item 71189 | $44.80 |
| 71195 | 3 or more items described in item 71189 | $63.20 |
| 71198 | Estimation of serum tryptase for the evaluation of unexplained acute hypotension or suspected anaphylactic event, assessment of risk in stinging insect anaphylaxis, exclusion of mastocytosis, monitoring of known mastocytosis | $64.00 |
| 71200 | Detection and quantitation, if present, of free kappa or lambda light chains in serum for the diagnosis or monitoring of amyloidosis, myeloma or plasma cell dyscrasias | $56.40 |
| 71203 | Determination of hlab5701 status by flow cytometry or cytotoxity assay prior to the initiation of abacavir therapy including item 73323 if performed | $64.00 |
| Group P5 - Tissue pathology | ||
| 72813 | Examination of complexity level 2 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions - 1 or more separately identified specimens (Item is subject to rule 13) | $141.00 |
| 72816 | Examination of complexity level 3 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions - 1 separately identified specimen (Item is subject to rule 13) | $146.90 |
| 72817 | Examination of complexity level 3 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions - 2 to 4 separately identified specimens (Item is subject to rule 13) | $155.10 |
| 72818 | Examination of complexity level 3 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions - 5 or more separately identified specimens (Item is subject to rule 13) | $178.90 |
| 72823 | Examination of complexity level 4 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions - 1 separately identified specimen (Item is subject to rule 13) | $155.10 |
| 72824 | Examination of complexity level 4 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions - 2 to 4 separately identified specimens (Item is subject to rule 13) | $170.40 |
| 72825 | Examination of complexity level 4 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions - 5 to 7 separately identified specimens (Item is subject to rule 13) | $269.20 |
| 72826 | Examination of complexity level 4 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions - 8 or more separately identified specimens (Item is subject to rule 13) | $325.20 |
| 72830 | Examination of complexity level 5 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions - 1 or more separately identified specimens (Item is subject to rule 13) | $326.50 |
| 72836 | Examination of complexity level 6 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions - 1 or more separately identified specimens (Item is subject to rule 13) | $502.90 |
| 72838 | Examination of complexicity level 7 biopsy material with multiple tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions - 1 or more separately identified specimens (Item is subject to rule 13) | $611.40 |
| 72844 | Enzyme histochemistry of skeletal muscle for investigation of primary degenerative or metabolic muscle diseases or of muscle abnormalities secondary to disease of the central or peripheral nervous system - 1 or more tests | $47.60 |
| 72846 | Immunohistochemical examination of biopsy material by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen - 1 to 3 antibodies (Item is subject to rule 13) except those listed in 72848 | $63.40 |
| 72847 | Immunohistochemical examination of biopsy material by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen - 4 or more antibodies (Item is subject to rule 13) | $70.50 |
| 72848 | Immunohistochemical examination of biopsy material by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen - 1 to 3 of the following antibodies - oestrogen, progesterone and c-erb-b2 (her2) (Item is subject to rule 13) | $85.50 |
| 72851 | Electron microscopic examination of biopsy material - 1 separately identified specimen (Item is subject to rule 13) | $235.00 |
| 72852 | Electron microscopic examination of biopsy material - 2 or more separately identified specimens (Item is subject to rule 13) | $323.20 |
| 72855 | Intraoperative consultation and examination of biopsy material by frozen section or tissue imprint or smear - 1 separately identified specimen (Item is subject to rule 13) | $235.00 |
| 72856 | Intraoperative consultation and examination of biopsy material by frozen section or tissue imprint or smear - 2 to 4 separately identified specimens (Item is subject to rule 13) | $323.20 |
| 72857 | Intraoperative consultation and examination of biopsy material by frozen section or tissue imprint or smear - 5 or more separately identified specimens (Item is subject to rule 13) | $479.20 |
| Group P6 - Cytology | ||
| 73043 | Cytology (including serial examinations) of nipple discharge or smears from skin, lip, mouth, nose or anus for detection of precancerous or cancerous changes 1 or more tests | $31.20 |
| 73045 | Cytology (including serial examinations) for malignancy (other than an examination mentioned in item 73053); and including any Group P5 service, if performed on: (a) specimens resulting from washings or brushings from sites not specified in item 73043; or (b) a single specimen of sputum or urine; or (c) 1 or more specimens of other body fluids; 1 or more tests | $63.40 |
| 73047 | Cytology of a series of 3 sputum or urine specimens for malignant cells | $132.20 |
| 73049 | Cytology of material obtained directly from a patient by fine needle aspiration of solid tissue or tissues | $86.50 |
| 73051 | Cytology of material obtained directly from a patient by fine needle aspiration of solid tissue or tissues if: (a) the aspiration is performed by a recognised pathologist; or (b) a recognised pathologist attends the aspiration and performs cytological examination during the attendance | $293.50 |
| 73053 | Cytology of a smear from cervix where the smear is prepared by direct application of the specimen to a slide, excluding the use of liquid based slide preparation techniques, and the stained smear is microscopically examined by or on behalf of a pathologist - each examination (a) for the detection of precancerous or cancerous changes in women with no symptoms, signs or recent history suggestive of cervical neoplasia, or (b) if a further specimen is taken due to an unsatisfactory smear taken for the purposes of paragraph (a) or (c) if there is inadequate information provided to use item 73055; | $32.50 |
| 73055 | Cytology of a smear from cervix, not associated with item 73053, where the smear is prepared by direct application of the specimen to a slide, excluding the use of liquid based slide preparation techniques, and the stained smear is microscopically examined by or on behalf of a pathologist - each test (a) for the management of previously detected abnormalities including precancerous or cancerous conditions; or (b) for the investigation of women with symptoms, signs or recent history suggestive of cervical neoplasia; | $32.50 |
| 73057 | Cytology of smears from vagina, not associated with item 73053 or 73055 and not to monitor hormone replacement therapy, where the smear is prepared by direct application of the specimen to a slide, excluding the use of liquid based slide preparation techniques, and the stained smear is microscopically examined by or on behalf of a pathologist - each test | $32.50 |
| 73059 | Immunocytochemical examination of material obtained by procedures described in items 73045, 73047, 73049 and 73051 for the characterisation of a malignancy by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen - 1 to 3 antibodies except those listed in 73061 (Item is subject to rule 13) | $62.30 |
| 73060 | Immunocytochemical examination of material obtained by procedures described in items 73045, 73047, 73049 and 73051 for the characterisation of a malignancy by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen - 4 or more antibodies (Item is subject to rule 13) | $72.90 |
| 73061 | Immunocytochemical examination of material obtained by procedures described in items 73045, 73047, 73049 and 73051 for the characterisation of a malignancy by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen - 1 to 3 of the following antibodies - oestrogen, progesterone and c-erb-B2 (HER2) (Item is subject to rule 13) | $85.50 |
| Group P7 - Genetics | ||
| 73287 | Chromosome studies, including preparation, count, karyotyping and identification by banding techniques of 1 or more of any tissue or fluid except blood - 1 or more tests | $696.90 |
| 73289 | Chromosome studies, including preparation, count, karyotyping and identification by banding techniques of blood - 1 or more tests | $635.70 |
| 73300 | Detection of genetic mutation of the FMR1 gene by nucleic acid amplification (NAA) where: (a) the patient exhibits one or more of the clinical features of fragile X (A) syndrome, including intellectual disabilities; or (b) the patient has a relative with a fragile X (A) mutation 1 or more tests | $171.10 |
| 73305 | Detection of genetic mutation of the fmr1 gene by Southern Blot where the results in item 73300 are inconclusive | $342.30 |
| 73308 | Characterisation of the genotype of a patient for Factor v Leiden gene mutation, or detection of the other relevant mutations in the investigation of proven venous thrombosis or pulmonary embolism - 1 or more tests | $57.00 |
| 73309 | A test described in item 73308, if rendered by a receiving APP - 1 or more tests(Item is subject to rule 18) | $55.70 |
| 73311 | Characterisation of the genotype of a person who is a first degree relative of a person who has proven to have 1 or more abnormal genotypes under item 73308 - 1 or more tests | $61.60 |
| 73312 | A test described in item 73311, if rendered by a receiving APP - 1 or more tests(Item is subject to rule 18) | $55.70 |
| 73314 | Characterisation of gene rearrangement by nucleic acid amplification in the diagnosis and monitoring of patients with laboratory evidence of: (a) acute myeloid leukaemia; or (b) acute promyelocytic leukaemia; or (c) acute lymphoid leukaemia; or (d) chronic myeloid leukaemia; each test to a maximum of 4 tests in a 12 month period | $402.20 |
| 73315 | A test described in item 73314, if rendered by a receiving APP - 1 or more tests(Item is subject to rule 18 and 25) | $352.50 |
| 73317 | Detection of the c282y genetic mutation of the hfe gene and, if performed, detection of other mutations for haemochromatosis where: (a) the patient has an elevated transferrin saturation or elevated serum ferritin on testing of repeated specimens; or (b) the patient has a first degree relative with haemochromatosis; or (c) the patient has a first degree relative with homozygosity for the c282y genetic mutation, or with compound heterozygosity for recognised genetic mutations for haemochromatosis (Item is subject to rule 20) | $61.60 |
| 73318 | A test described in item 73317, if rendered by a receiving APP - 1 or more tests(Item is subject to rule 18 and 20) | $55.70 |
| 73320 | Detection of hla-b27 by nucleic acid amplification includes a service described in 71147 unless the service in item 73320 is rendered as a pathologist determinable service (Item is subject to rule 27) | $70.60 |
| 73321 | A test described in item 73320, if rendered by a receiving APP - 1 or more tests (Item is subject to rule 18 and 27) | $61.90 |
| 73323 | Determination of hlab5701 status by molecular techniques or cytotoxity assay prior to the initiation of abacavir therapy including item 71203 if performed | $64.00 |
| Group P8 - Infertility and pregnancy tests | ||
| 73521 | Semen examination for presence of spermatozoa or examination of cervical mucus for spermatozoa (Huhner's test) | $16.20 |
| 73523 | Semen examination (other than post- vasectomy semen examination), including: (a) measurement of volume, sperm count and motility; and (b) examination of stained preparations; and (c) morphology; and (if performed) (d) differential count and 1 or more chemical tests (Item is subject to rule 25) | $74.10 |
| 73525 | Sperm antibodies - sperm-penetrating ability - 1 or more tests | $47.90 |
| 73527 | Human chorionic gonadotrophin (hcg) - detection in serum or urine by 1 or more methods for diagnosis of pregnancy - 1 or more tests | $16.90 |
| 73529 | Human chorionic gonadotrophin (HCG), quantitation in serum by 1 or more methods (except by latex, membrane, strip or other pregnancy test kit) for diagnosis of threatened abortion, or follow up of abortion or diagnosis of ectopic pregnancy, including any services performed in item 73527 - 1 test | $48.40 |
| Group P9 - Simple basic pathology tests | ||
| 73801 | Semen examination for presence of spermatozoa | $11.50 |
| 73802 | Leucocyte count, erythrocyte sedimentation rate, examination of blood film (including differential leucocyte count), haemoglobin, haematocrit or erythrocyte count - 1 test | $8.70 |
| 73803 | 2 tests described in item 73802 | $11.70 |
| 73804 | 3 or more tests described in item 73802 | $15.90 |
| 73805 | Microscopy of urine, whether stained or not, or catalase test | $7.70 |
| 73806 | Pregnancy test by 1 or more immunochemical methods | $16.90 |
| 73807 | Microscopy for wet film other than urine, including any relevant stain | $12.90 |
| 73808 | Microscopy of Gram-stained film, including (if performed) a service described in item 73805 or 73807 | $19.90 |
| 73809 | Chemical tests for occult blood in faeces by reagent stick, strip, tablet or similar method | $5.60 |
| 73810 | Microscopy for fungi in skin, hair or nails - 1 or more sites | $12.90 |
| 73811 | Mantoux test | $21.10 |
| Group P10 - Patient episode initiation | ||
| 73922 | Initiation of a patient episode that consists only of a service described in item 73053, 73055 or 73057. Unless item 73923 applies | $12.40 |
| 73923 | Initiation of a patient episode that consists only of a service described in items 73053, 73055 or 73057 from a person who is a private patient in a recognised hospital or the service is rendered by a prescribed laboratory | $3.60 |
| 73924 | Initiation of a patient episode that consists only of 1 or more services described in items 72813, 72816, 72817, 72818, 72823, 72824, 72825, 72826, 72830 and 72836 from a person who is an in-patient of a hospital. Unless item 73925 applies | $22.10 |
| 73925 | Initiation of a patient episode that consists only of 1 or more services described in items 72813, 72816, 72817, 72818, 72823, 72824, 72825, 72826, 72830 and 72836 from a person who is a private patient in a recognised hospital or the service is rendered to a private patient in a hospital by a prescribed laboratory | $3.60 |
| 73926 | Initiation of a patient episode that consists only of 1 or more services described in items 72813, 72816, 72817, 72818, 72823, 72824, 72825, 72826, 72830 and 72836 from a person who is not an in-patient of a private hospital. Unless item 73927 applies | $12.40 |
| 73927 | Initiation by a prescribed laboratory of a patient episode that consists only of 1 or more services described in items 72813, 72816, 72817, 72818, 72823, 72824, 72825, 72826, 72830 and 72836 from a person who is not a private patient in a recognised hospital nor a patient in a private hospital | $3.60 |
| 73928 | Initiation of a patient episode by collection of a specimen for 1 or more services (other than those services described in items 73922, 73924 or 73926) if the specimen is collected in an approved collection centre. Unless item 73929 applies | $26.10 |
| 73929 | Initiation of a patient episode by collection of a specimen for 1 or more services (other than those services described in items 73922, 73924 or 73926) if the specimen is collected by an approved pathology practitioner for a prescribed laboratory or by an employee of an approved pathology authority, who conducts a prescribed laboratory, if the specimen is collected in an approved pathology collection centre | $3.60 |
| 73930 | Initiation of a patient episode by collection of a specimen for a service for 1 or more services (other than those services described in items 73922, 73924 or 73926) if the specimen is collected by an approved pathology practitioner or an employee of an approved pathology authority from a person who is an in-patient of a hospital other than a recognised hospital. Unless item 73931 applies | $26.60 |
| 73931 | Initiation of a patient episode by collection of a specimen for 1 or more services (other than those services described in items 73922, 73924 or 73926) if: the specimen is collected by an approved pathology practitioner for a prescribed laboratory or by an employee of an approved pathology authority, who conducts a prescribed laboratory, from a person who is a private patient in a hospital or the person is a private patient in a recognised hospital and the specimen is collected by an approved pathology practitioner or an employee of an approved pathology authority | $3.60 |
| 73932 | Initiation of a patient episode by collection of a specimen for 1 or more services (other than those services described in items 73922, 73924 or 73926) if the specimen is collected by an approved pathology practitioner or an employee of an approved pathology authority from a person in the place where the person was residing. Unless item 73933 applies | $15.50 |
| 73933 | Initiation of a patient episode by collection of a specimen for 1 or more services (other than those services described in items 73922, 73924 or 73926) if the specimen is collected by an approved pathology practitioner for a prescribed laboratory or by an employee of an approved pathology authority, who conducts a prescribed laboratory, from a person in the place where the person is residing | $3.60 |
| 73934 | Initiation of a patient episode by collection of a specimen for 1 or more services (other than those services described in items 73922, 73924 and 73926) if the specimen is collected by an approved pathology practitioner or an employee of an approved pathology authority from a person in a residential aged care home or institution. Unless 73935 applies | $26.60 |
| 73935 | Initiation of a patient episode by collection of a specimen for 1 or more services (other than those services described in items 73922, 73924 or 73926) if the specimen is collected by an approved pathology practitioner or by an employee of an approved pathology authority, who conducts a prescribed laboratory, from a person in a residential aged care home or institution | $3.60 |
| 73936 | Initiation of a patient episode by collection of a specimen for 1 or more services (other than those services described in items 73922, 73924 or 73926) if the specimen is collected from the person by the person. | $14.70 |
| 73937 | Initiation of a patient episode by collection of a specimen for 1 or more services (other than those services described in items 73922, 73924 or73926), if the specimen is collected from the person by the person and if: the service is performed in a prescribed laboratory or the person is a private patient in a recognised hospital | $3.60 |
| 73938 | Initiation of a patient episode by collection of a specimen for 1 or more services (other than those services described in items 73922, 73924 or 73926) if the specimen is collected by or on behalf of the treating practitioner. Unless item 73939 applies | $14.70 |
| 73939 | Initiation of a patient episode by collection of a specimen for 1 or more services (other than those services described in items 73922, 73924 or 73926), if the specimen is collected by or on behalf of the treating practitioner and if: the service is performed in a prescribed laboratory or the person is a private patient in a recognised hospital | $3.60 |
| Group P11 - Specimen referred | ||
| 73940 | Receipt of a specimen by an approved pathology practitioner of an approved pathology authority from another approved pathology practitioner of a different approved pathology authority or another approved pathology authority (Item is subject to rules 14, 15 and 16) | $15.50 |
| Group P12 - Management of bulk-billed services | ||
| 74990 | A pathology service to which an item in this table (other than this item or item 74991) applies if: (a) the service is an unreferred service; and (b) the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder: and (c) the person is not an admitted patient of a hospital: and (d) the service is bulk-billed in respect of the fees for: (i) this item: and (ii) the other item in this table applying to the service | N/A |
| 74991 | A pathology service to which an item in this table (other than this item or item 64990) applies if: (a) the service is an unreferred service; and (b) the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder: and (c) the person is not an admitted patient of a hospital: and (d) the service is bulk-billed in respect of the fees for: (i) this item; and (ii) the other item in this table applying to the service; and (e) the service is provided at, or from, a practice location in: (i) a regional, rural or remote area; or (ii) Tasmania; or (iii) a geographical area included in any of the following ssd spatial units: (a) Beaudesert Shire Part a (b) Belconnen (c) Darwin City (d) Eastern Outer Melbourne (e) East Metropolitan (f) Frankston City (g) Gosford-Wyong (h) Greater Geelong City Part a (i) Gungahlin-Hall (j) Ipswich City (part in bsd) (k) Litchfield Shire (l) Melton-Wyndham (m) Mornington Peninsula Shire (n) Newcastle (o) North Canberra (p) Palmerston-East Arm (q) Pine Rivers Shire (r) Queanbeyan (s) South Canberra (t) South Eastern Outer Melbourne (u) Southern Adelaide (v) South West Metropolitan (w) Thuringowa City Part a (x) Townsville City Part a (y) Tuggeranong (z) Weston Creek-Stromlo (za) Woden Valley (zb)Yarra Ranges Shire Part a; or (iv) the geographical area included in the sla spatial unit of Palm Island (ac) | N/A |
| Group M6 - Psychological therapy services | ||
| 80000 | Professional attendance for the purpose of providing psychological assessment and therapy for a mental disorder by a clinical psychologist registered with Medicare Australia as meeting the credentialing requirements for provision of this service, lasting more than 30 minutes but less than 50 minutes, where the patient is referred by a medical practitioner, as part of a GP mental health care plan or a referred psychiatrist assessment and management plan; or referred by a specialist or consultant physician in the practice of his or her field of psychiatry or paediatrics. these therapies are time limited, being deliverable, in general, in up to 12 planned sessions in a calendar year (including services to which items 2721 to 2727; 80000 to 80015; 80100 to 80115; 80125 to 80140; 80150 to 80165 and the better outcomes in mental health care program access to allied psychological services apply). claims for this service may exceed this maximum session limit, however, where exceptional circumstances apply (Professional attendance at consulting rooms) | N/A |
| 80005 | Professional attendance at a place other than consulting rooms. As per the service requirements outlined for item 80000 | N/A |
| 80010 | Professional attendance for the purpose of providing psychological assessment and therapy for a mental disorder by a clinical psychologist registered with Medicare Australia as meeting the credentialing requirements for provision of this service, lasting at least 50 minutes, where the patient is referred by a medical practitioner, as part of a GP mental health care plan; or a referred psychiatrist assessment and management plan; or referred by a specialist or consultant physician in the practice of his or her field of psychiatry or paediatrics. these therapies are time limited, being deliverable, in general, in up to 12 planned sessions in a calendar year (including services to which items 2721 to 2727; 80000 to 80015; 80100 to 80115; 80125 to 80140; 80150 to 80165 and the better outcomes in mental health care program access to allied psychological services apply). claims for this service may exceed this maximum session limit, however, where exceptional circumstances apply (Professional attendance at consulting rooms) | N/A |
| 80015 | Professional attendance at a place other than consulting rooms As per the service requirements outlined for item 80010 | N/A |
| 80020 | Professional attendance for the purpose of providing psychological therapy for a mental disorder by a clinical psychologist registered with Medicare Australia as meeting the credentialing requirements for provision of this service, lasting for at least 60 minutes duration where the patients are referred by a medical practitioner, as part of a GP mental health care plan; or a referred psychiatrist assessment and management plan; or referred by a specialist or consultant physician in the practice of his or her field of psychiatry or paediatrics. these therapies are time limited, being deliverable, in general, in up to 12 planned sessions in a calendar year (including services to which items 80120, 80145 and 80170 apply). - group therapy with a group of 6 to 10 patients, each patient | N/A |
| Group M7 - Focussed psychological strategies (allied mental health) | ||
| 80100 | Professional attendance for the purpose of providing focussed psychological strategies services for an assessed mental disorder by a psychologist registered with Medicare Australia as meeting the credentialing requirements for provision of this service - lasting more than 20 minutes, but not more than 50 minutes - where the patient is referred by a medical practitioner, as part of a GP mental health care plan; or a psychiatrist assessment and management plan; or referred by a specialist or consultant physician in the practice of his or her field of psychiatry or paediatrics. These services are time limited, being deliverable, in general, in up to 12 planned sessions in a calendar year (including services to which items 2721 to 2727; 80000 to 80015; 80100 to 80115; 80125 to 80140; 80150 to 80165 and the better outcomes in mental health care program access to allied psychological services apply). claims for this service may exceed this maximum session limit, however, where exceptional circumstances apply (Professional attendance at consulting rooms) | N/A |
| 80105 | Professional attendance at a place other than consulting rooms. As per the psychologist service requirements outlined for item 80100 | N/A |
| 80110 | Professional attendance for the purpose of providing focussed psychological strategies services for an assessed mental disorder by a psychologist registered with Medicare Australia as meeting the credentialing requirements for provision of this service - lasting more than 50 minutes - where the patient is referred by a medical practitioner, as part of a GP mental health care plan; or a referred psychiatrist assessment and management plan; or referred by a specialist or consultant physician in the practice of his or her field of psychiatry or paediatrics. These services are time limited, being deliverable, in general, in up to 12 planned sessions in a calendar year (including services to which items 2721 to 2727; 80000 to 80015; 80100 to 80115; 80125 to 80140; 80150 to 80165 and the better outcomes in mental health care program access to allied psychological services apply). claims for this service may exceed this maximum session limit, however, where exceptional circumstances apply (Professional attendance at consulting rooms) | N/A |
| 80115 | Professional attendance at a place other than consulting rooms. As per the psychologist service requirements outlined for item 80110 | N/A |
| 80120 | Professional attendance for the purpose of providing focussed psychological strategies services for an assessed mental disorder by a psychologist registered with Medicare Australia as meeting the credentialing requirements for provision of this service, lasting for at least 60 minutes duration where the patients are referred by a medical practitioner, as part of a GP mental health care plan; or a referred psychiatrist assessment and management plan; or referred by a specialist or consultant physician in the practice of his or her field of psychiatry or paediatrics. These therapies are time limited, being deliverable, in general, in up to 12 planned sessions in a calendar year (including services to which items 80020, 80145 and 80170 apply). Group therapy with a group of 6 to 10 patients, each patient | N/A |
| 80125 | Professional attendance for the purpose of providing focussed psychological strategies services for an assessed mental disorder by an occupational therapist registered with Medicare Australia as meeting the credentialing requirements for provision of this service - lasting more than 20 minutes, but not more than 50 minutes - where the patient is referred by a medical practitioner, as part of a GP mental health care plan; or a referred psychiatrist assessment and management plan; or referred by a specialist or consultant physician in the practice of his or her field of psychiatry or paediatrics. These services are time limited, being deliverable, in general, in up to 12 planned sessions in a calendar year (including services to which items 2721 to 2727; 80000 to 80015; 80100 to 80115; 80125 to 80140; 80150 to 80165 and the better outcomes in mental health care program access to allied psychological services apply). Claims for this service may exceed this maximum session limit, however, where exceptional circumstances apply (Professional services at consulting rooms) | N/A |
| 80130 | Professional attendance at a place other than consulting rooms. As per the occupational therapist service requirements outlined for item 80125 | N/A |
| 80135 | Professional attendance for the purpose of providing focussed psychological strategies services for an assessed mental disorder by an occupational therapist registered with Medicare Australia as meeting the credentialing requirements for provision of this service - lasting more than 50 minutes - where the patient is referred by a medical practitioner, as part of a GP mental health care plan; or a referred psychiatrist assessment and management plan; or referred by a specialist or consultant physician in the practice of his or her field of psychiatry or paediatrics. These services are time limited, being deliverable, in general, in up to 12 planned sessions in a calendar year (including services to which items 2721 to 2727; 80000 to 80015; 80100 to 80115; 80125 to 80140; 80150 to 80165 and the better outcomes in mental health care program access to allied psychological services apply). Claims for this service may exceed this maximum session limit, however, where exceptional circumstances apply (Professional attendance at consulting rooms) | N/A |
| 80140 | Professional attendance at a place other than consulting rooms. As per the occupational therapist service requirements outlined for item 80135 | N/A |
| 80145 | Occupational therapist registered with Medicare Australia as meeting the credentialing requirements for provision of this service, lasting for at least 60 minutes duration where the patients are referred by a medical practitioner, as part of a GP mental health care plan; or a referred psychiatrist assessment and management plan; or referred by a specialist or consultant physician in the practice of his or her field of psychiatry or paediatrics. These therapies are time limited, being deliverable, in general, in up to 12 planned sessions in a calendar year (including services to which items 80020, 80120 and 80170 apply). Group therapy with a group of 6 to 10 patients, each patient | N/A |
| 80150 | Professional attendance for the purpose of providing focussed psychological strategies services for an assessed mental disorder by a social worker registered with Medicare Australia as meeting the credentialing requirements for provision of this service - lasting more than 20 minutes, but not more than 50 minutes - where the patient is referred by a medical practitioner, as part of a GP mental health care plan; or a referred psychiatrist assessment and management plan; or referred by a specialist or consultant physician in the practice of his or her field of psychiatry or paediatrics. these services are time limited, being deliverable, in general, in up to 12 planned sessions in a calendar year (including services to which items 2721 to 2727; 80000 to 80015; 80100 to 80115; 80125 to 80140; 80150 to 80165 and the better outcomes in mental health care program access to allied psychological services apply). Claims for this service may exceed this maximum session limit, however, where exceptional circumstances apply (Professional attendance at consulting rooms) | N/A |
| 80155 | Professional attendance at a place other than consulting rooms. As per the social worker service requirements outlined for item 80150 | N/A |
| 80160 | Professional attendance for the purpose of providing focussed psychological strategies services for an assessed mental disorder by a social worker registered with Medicare Australia as meeting the credentialing requirements for provision of this service - lasting more than 50 minutes - where the patient is referred by a medical practitioner, as part of a GP mental health care plan; or a referred psychiatrist assessment and management plan; or referred by a specialist or consultant physician in the practice of his or her field of psychiatry or paediatrics. these services are time limited, being deliverable, in general, in up to 12 planned sessions in a calendar year (including services to which items 2721 to 2727; 80000 to 80015; 80100 to 80115; 80125 to 80140; 80150 to 80165 and the better outcomes in mental health care program access to allied psychological services apply). Claims for this service may exceed this maximum session limit, however, where exceptional circumstances apply (Professional attendance at consulting rooms) | N/A |
| 80165 | Professional attendance at a place other than consulting rooms. As per the social worker service requirements outlined for item 80160 | N/A |
| 80170 | professional attendance for the purpose of providing focussed psychological strategies services for an assessed mental disorder by a social worker registered with Medicare Australia as meeting the credentialing requirements for provision of this service, lasting for at least 60 minutes duration where the patients are referred by a medical practitioner, as part of a GP mental health care plan; or a referred psychiatrist assessment and management plan; or referred by a specialist or consultant physician in the practice of his or her field of psychiatry or paediatrics. These therapies are time limited, being deliverable, in general, in up to 12 planned sessions in a calendar year (including services to which items 80020, 80120 and 80145 apply). Group therapy with a group of 6 to 10 patients, each patient | N/A |
| Group M8 - Pregnancy support counselling | ||
| 81000 | Provision of a non-directive pregnancy support counselling service to a woman who is concerned about a current pregnancy or a pregnancy that occurred in the preceding 12 months, by an eligible psychologist, where the patient is referred to the psychologist by a medical practitioner (including a general practitioner, but not a specialist or consultant physician), and lasting at least 30 minutes. The service may be used to address any pregnancy related issues for which non-directive counselling is appropriate. This service may be provided by a psychologist who is registered with Medicare Australia as meeting the credentialling requirements for provision of this service. It may not be provided by a psychologist 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 three non-directive pregnancy support counselling services per patient, per pregnancy from any of the following items - 81000, 81005, 81010 and 4001 | N/A |
| 81005 | Provision of a non-directive pregnancy support counselling service to a woman who is concerned about a current pregnancy or a pregnancy that occurred in the preceding 12 months, by an eligible social worker, where the patient is referred to the social worker by a medical practitioner (including a general practitioner, but not a specialist or consultant physician), and lasting at least 30 minutes. The service may be used to address any pregnancy related issues for which non-directive counselling is appropriate. This service may be provided by a social worker who is registered with Medicare Australia as meeting the credentialling requirements for provision of this service. It may not be provided by a social worker 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 three non-directive pregnancy support counselling services per patient, per pregnancy from any of the following items -81000, 81005, 81010 and 4001 | |
| 81010 | Provision of a non-directive pregnancy support counselling service to a woman who is concerned about a current pregnancy or a pregnancy that occurred in the preceding 12 months, by an eligible mental health nurse, where the patient is referred to the mental health nurse by a medical practitioner (including a general practitioner, but not a specialist or consultant physician), and lasting at least 30 minutes. The service may be used to address any pregnancy related issues for which non-directive counselling is appropriate. This service may be provided by a mental health nurse who is registered with Medicare Australia as meeting the credentialling requirements for provision of this service. It may not be provided by a mental health nurse 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 three non-directive pregnancy support counselling services per patient, per pregnancy from any of the following items - 81000, 81005, 81010 and 4001 | N/A |
| Group M9 - Allied health group services | ||
| 81100 | DIABETES EDUCATION SERVICE – ASSESSMENT FOR GROUP SERVICE Diabetes education health service provided to a person by an eligible diabetes educator for the purposes of ASSESSING a person's suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient's needs, and preparing the person for the group services, if:(a) the service is provided to a person who has type 2 diabetes; and (b) the person is being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a GP Management Plan [ie item 721 or 725], or if the person is a resident of an aged care facility, their medical practitioner has contributed to a multidisciplinary care plan [ie item 731]; and (c) the person is referred to an eligible diabetes educator by the medical practitioner using a referral form that has been issued by the Department of Health and Ageing, or a referral form that substantially complies with the form issued by the Department; and (d) the person is not an admitted patient of a hospital; and (e) the service is provided to the person individually and in person; and (f) the service is of at least 45 minutes duration; and (g) after the service, the eligible diabetes educator gives a written report to the referring medical practitioner mentioned in paragraph (c); and (h) in the case of a service in respect of which a private health insurance benefit is payable - the person who incurred the medical expenses in respect of the service has elected to claim the Medicare benefit in respect of the service, and not the private health insurance benefit. Benefits are payable once only in a calendar year for this or any other Assessment for Group Services item (including services to which items 81100, 81110 and 81120 apply) | N/A |
| 81105 | DIABETES EDUCATION SERVICE - GROUP SERVICE Diabetes education health service provided to a person by an eligible diabetes educator, as a GROUP SERVICE for the management of type 2 diabetes if: (a) the person has been assessed as suitable for a type 2 diabetes group service under assessment item 81100, 81110 or 81120; and (b) the service is provided to a person who is part of a group of between 2 and 12 patients; and (c) the person is not an admitted patient of a hospital; and (d) the service is provided to a person involving the personal attendance by an eligible diabetes educator; and (e) the service is of at least 60 minutes duration; and (f) after the last service in the group services program provided to the person under items 81105, 81115 or 81125, the eligible diabetes educator prepares, or contribute to, a written report to be provided to the referring medical practitioner; and (g) an attendance record for the group is maintained by the eligible diabetes educator; and (h) in the case of a service in respect of which a private health insurance benefit is payable - the person who incurred the medical expenses in respect of the service has elected to claim the Medicare benefit in respect of the service, and not the private health insurance benefit;- to a maximum of eight (8) GROUP SERVICES (including services to which items 81105, 81115 and 81125 apply) in a calendar year | N/A |
| 81110 | EXERCISE PHYSIOLOGY SERVICE - ASSESSMENT FOR GROUP SERVICES Exercise physiology health service provided to a person by an eligible exercise physiologist for the purposes of ASSESSING a person's suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient's needs, and preparing the person for the group services, if: (a) the service is provided to a person who has type 2 diabetes; and (b) the person is being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a GP Management Plan [ie item 721 or 725], or if the person is a resident of an aged care facility, their medical practitioner has contributed to a multidisciplinary care plan [ie item 731]; and (c) the person is referred to an eligible exercise physiologist by the medical practitioner using a referral form that has been issued by the Department of Health and Ageing, or a referral form that substantially complies with the form issued by the Department; and (d) the person is not an admitted patient of a hospital; and (e) the service is provided to the person individually and in person; and (f) the service is of at least 45 minutes duration; and (g) after the service, the eligible exercise physiologist gives a written report to the referring medical practitioner mentioned in paragraph (c); and (h) in the case of a service in respect of which a private health insurance benefit is payable - the person who incurred the medical expenses in respect of the service has elected to claim the Medicare benefit in respect of the service, and not the private health insurance benefit. Benefits are payable once only in a calendar year for this or any other Assessment for Group Services item (including services to which items 81100, 81110 and 81120 apply) | N/A |
| 81115 | EXERCISE PHYSIOLOGY SERVICE - GROUP SERVICE Exercise physiology health service provided to a person by an eligible exercise physiologist, as a GROUP SERVICE for the management of type 2 diabetes if: (a) the person has been assessed as suitable for a type 2 diabetes group service under assessment item 8100, 81110 or 81120; and (b) the service is provided to a person who is part of a group of between 2 and 12 patients; and (c) the person is not an admitted patient of a hospital; and (d) the service is provided to a person involving the personal attendance by an eligible exercise physiologist; and (e) the service is of at least 60 minutes duration; and (f) after the last service in the group services program provided to the person under items 81105, 81115 or 81125, the eligible exercise physiologist prepares, or contribute to, a written report to be provided to the referring medical practitioner; and (g) an attendance record for the group is maintained by the eligible exercise physiologist; and (h) in the case of a service in respect of which a private health insurance benefit is payable - the person who incurred the medical expenses in respect of the service has elected to claim the Medicare benefit in respect of the service, and not the private health insurance benefit;- to a maximum of eight (8) GROUP SERVICES (including services to which items 81105, 81115 and 81125 apply) in a calendar year | N/A |
| 81120 | DIETETICS SERVICE - ASSESSMENT FOR GROUP SERVICES Dietetics health service provided to a person by an eligible dietician for the purposes of ASSESSING a person's suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient's needs, and preparing the person for the group services, if: (a) the service is provided to a person who has type 2 diabetes; and (b) the person is being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a GP Management Plan [ie item 721 or 725], or if the person is a resident of an aged care facility, their medical practitioner has contributed to a multidisciplinary care plan [ie item 731]; and (c) the person is referred to an eligible dietician by the medical practitioner using a referral form that has been issued by the Department of Health and Ageing, or a referral form that substantially complies with the form issued by the Department; and (d) the person is not an admitted patient of a hospital; and (e) the service is provided to the person individually and in person; and (f) the service is of at least 45 minutes duration; and (g) after the service, the eligible dietician gives a written report to the referring medical practitioner mentioned in paragraph (c); and (h) in the case of a service in respect of which a private health insurance benefit is payable - the person who incurred the medical expenses in respect of the service has elected to claim the Medicare benefit in respect of the service, and not the private health insurance benefit. Benefits are payable once only in a calendar year for this or any other Assessment for Group Services item (including services to which items 81100, 81110 and item 81120 apply) | N/A |
| 81125 | DIETETICS SERVICE - GROUP SERVICE Dietetics health service provided to a person by an eligible dietician, as a GROUP SERVICE for the management of type 2 diabetes if: (a) the person has been assessed as suitable for a type 2 diabetes group service under assessment item 81100, 81110 or 81120; and (b) the service is provided to a person who is part of a group of between 2 and 12 patients; and (c) the person is not an admitted patient of a hospital; and (d) the service is provided to a person involving the personal attendance by an eligible dietician; and (e) the service is of at least 60 minutes duration; and (f) after the last service in the group services program provided to the person under items 81105, 81115 or 81125, the eligible dietician prepares, or contribute to, a written report to be provided to the referring medical practitioner; and (g) an attendance record for the group is maintained by the eligible dietician; and (h) in the case of a service in respect of which a private health insurance benefit is payable - the person who incurred the medical expenses in respect of the service has elected to claim the Medicare benefit in respect of the service, and not the private health insurance benefit;- to a maximum of eight (8) GROUP SERVICES (including services to which items 81105, 81115 and 81125 apply) in a calendar year | N/A |
Schedule B—Workers compensation services
Note—
As required by section 10AA(2) of the Subordinate Legislation Act 1978, the Minister has certified that, in the Minister's opinion, it is necessary or appropriate that these regulations come into operation as set out in these regulations.
Made by the Governor
following consultation as required under section 32(13) of the Workers Rehabilitation and Compensation Act 1986 and with the advice and consent of the Executive Council
on 26 June 20080
No 186 of 2008
08WKC0002CS
Actions
Download as PDF
Download as Word Document
Cases Citing This Decision
0
Cases Cited
0
Statutory Material Cited
0