DETERMINATION HS/1/1997
COMMONWEALTH OF AUSTRALIA
HEALTH INSURANCE ACT 1973
DETERMINATION UNDER SUBSECTION 3C(1)
I, MICHAEL RICHARD LEWIS WOOLDRIDGE, Minister for Health and Family Services, pursuant to subsection 3C(1) of the Health Insurance Act 1973 ("the Act"), HEREBY DETERMINE:
(1) that a health service specified in Column 2 of the Schedule to this determination, not being a service specified in the General Medical Services Table, as in force from time to time, shall be treated, for the purposes of:
(a) section 4 of the National Health Act 1953;
(b) subsections 3(1) and 19(6) and sections 8, 9, 10, 14, 15, 16, 17, 18, 20, 20A, 20B and 20BA of the Act; and
(c) regulations 13, 27, 28, 29, 30 and 31 of the Health Insurance Regulations, as amended;
as if that health service were both a professional and a medical service and there were an item prescribed in the General Medical Services Table:
(i) that related to that health service;
(ii) specified, in respect of that health service, the fee specified in Column 3 opposite to that health service;
(2) that this determination shall come into effect on and from 19 June 1997.
Dated this 30th day of May 1997
Michael Wooldridge
Minister for Health and Family Services
SCHEDULE
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Column 1 Column 2 Column 3
Item No. Health Service Fee
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ATTENDANCES
10816 ATTENDANCE FOR THE REFITTING OF $89.45
CONTACT LENSES with keratometry and testing with trial lenses and the issue of a prescription, where the patient requires a change in contact lens material or basic lens parameters, other than simple power change, because of a structure or functional change in the eye or an allergic response within 36 months of the fitting of a contact lens to which Items 10801 to 10809 apply
MISCELLANEOUS DIAGNOSTIC PROCEDURES
11222 FULL QUANTITATIVE COMPUTERISED $49.75
PERIMETRY (automated absolute static threshold), performed by a specialist in the practice of his or her specialty, with assessment and report, bilateral, where it
can be demonstrated that a further examination is
indicated in the same 12 month period to which Item
11221 applies due to presence of one of the following
conditions:-
. established glaucoma (where surgery is being
considered or has been performed) where there
has been definite progression of damage over a 12
month period;
. progressive neurologic disease; or
. for the monitoring of systemic drug toxicity,
where there is also other disease such as
glaucoma or neurologic disease
- each additional examination
SCHEDULE
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Column 1 Column 2 Column 3
Item No. Health Service Fee
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11225 FULL QUANTITATIVE COMPUTERISED $30.00
PERIMETRY - (automated absolute static threshold) performed by a specialist in the practice of his or her specialty, with assessment and report, unilateral, where it can be demonstrated that a further examination is indicated in the same 12 month period to which Item 11224 applies due to presence of one of the following conditions:
. established glaucoma (where surgery is being
considered or has been performed) where there
has been definite progression of damage over a 12
month period;
. progressive neurologic disease; or
. for the monitoring of systemic drug toxicity,
where there is also other disease such as
glaucoma or neurologic disease,
- each additional examination
SCHEDULE
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Column 1 Column 2 Column 3
Item No. Health Service Fee
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12207 OVERNIGHT INVESTIGATION FOR SLEEP $436.05
APNOEA FOR A PERIOD OF AT LEAST 8 HOURS
DURATION, WHERE:
(a) continuous monitoring of oxygen saturation and breathing using a multi-channel polygraph, and recordings of EEG, EOG, submental EMG, anterior tibial EMG, respiratory movement, airflow, oxygen saturation and ECG are performed;
(b) a technician is in continuous attendance under the supervision of a consultant physician in thoracic medicine, or a specialist where the investigation is performed in the sleep laboratory of a recognised hospital;
(c) the patient is referred by a medical practitioner;
(d) the necessity for the investigation is determined by the supervising medical practitioner prior to the investigation;
(e) polygraphic records are analysed (for assessment of sleep stage, arousals, respiratory events and assessment of clinically significant alterations in heart rate and limb movement) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute, and stored for interpretation and preparation of report; and
(f) interpretation and report are provided by the supervising medical practitioner based on reviewing the direct original recording of polygraphic data from the patient
where it can be demonstrated that a further
investigation is indicated in the same 12 month period
to which Item 12203 applies for the adjustment and/or
testing of the effectiveness of a positive pressure ventilatory support device (other than nasal continuous positive airway pressure) in sleep, in a patient with severe cardio-respiratory failure, and where previous studies have demonstrated failure of continuous positive airway pressure or oxygen - each additional investigation
SCHEDULE
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Column 1 Column 2 Column 3
Item No. Health Service Fee
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MISCELLANEOUS THERAPEUTIC
PROCEDURES
14120 LASER PHOTOCOAGULATION using laser light $112.00
within the wavelength of 510-600nm in the treatment of severely disfiguring vascular lesions of the head or neck where abnormality is visible from 4 metres, including any associated consultation - session of at least 30 minutes duration - where it can be demonstrated that a 7th or subsequent session (including any sessions to which Items 14100 to 14118 and 30213 apply) is indicated in
a 12 month period (Anaes. 17708 = 5B+3T)
14122 LASER PHOTOCOAGULATION using laser light $137.45
within the wavelength of 510-600nm in the treatment of severely disfiguring vascular lesions of the head or neck where abnormality is visible from 4 metres, including any associated consultation - session of at least 60 minutes duration - where it can be demonstrated that a 7th or subsequent session (including any sessions to which Items 14100 to 14118 and 30213 apply) is indicated in a 12 month period (Anaes. 17710 = 5B+5T)
14124 LASER PHOTOCOAGULATION using laser light $112.00
within the wavelength of 510-1064nm in the treatment of port wine stains, haemangiomas, cafe-au-lait macules and naevi of Ota, other than melanocytic naevi (common moles), including any associated consultation - area of treatment up to 50cm2 - where it can be demonstrated that a 7th or subsequent session (including any
sessions to which Items 14100 to 14118 and 30213
apply) is indicated in a 12 month period (Anaes. 17707
= 5B+2T)
SCHEDULE
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Column 1 Column 2 Column 3
Item No. Health Service Fee
__________________________________________________________________________
14126 LASER PHOTOCOAGULATION using laser light $137.45
within the wavelength of 510-1064nm in the treatment of port wine stains, haemangiomas, cafe-au-lait macules and naevi of Ota, other than melanocytic naevi (common moles), including any associated consultation - area of treatment more than 50cm2 and up to 100cm2 - where it can be demonstrated that a 7th or subsequent session (including any sessions to which Items 14100 to 14118 and 30213 apply) is indicated in a 12 month period (Anaes. 17708 = 5B+3T)
14128 LASER PHOTOCOAGULATION using laser light $162.90
within the wavelength of 510-1064nm in the treatment of port wine stains, haemangiomas, cafe-au-lait macules and naevi of Ota, other than melanocytic naevi (common moles), including any associated consultation - area of treatment more than 100cm2 and up to 150cm2 - where it can be demonstrated that a 7th or subsequent session (including any sessions to which Items 14100 to 14118 and 30213 apply) is indicated in a 12 month period (Anaes. 17709 = 5B+4T)
14130 LASER PHOTOCOAGULATION using laser light $188.35
within the wavelength of 510-1064nm in the treatment of port wine stains, haemangiomas, cafe-au-lait macules and naevi of Ota, other than melanocytic naevi (common moles), including any associated consultation - area of treatment more than 150cm2 and up to 250cm2 - where it can be demonstrated that a 7th or subsequent session (including any sessions to which Items 14100 to 14118 and 30213 apply) is indicated in a 12 month period (Anaes. 17710 = 5B+5T)
SCHEDULE
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Column 1 Column 2 Column 3
Item No. Health Service Fee
__________________________________________________________________________
14132 LASER PHOTOCOAGULATION using laser light $239.25
within the wavelength of 510-1064nm in the treatment of port wine stains, haemangiomas, cafe-au-lait macules and naevi of Ota, other than melanocytic naevi (common moles), including any associated consultation - area of treatment more than 250cm2 - where it can be demonstrated that a 7th or subsequent session
(including any sessions to which Items 14100 to 14118 and 30213 apply) is indicated in a 12 month period (Anaes. 17711 = 5B+6T)
RADIATION ONCOLOGY
15600 STEREOTACTIC RADIOSURGERY, including all $1250.00
radiation oncology consultations, planning, simulation, dosimetry and treatment
SCHEDULE
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Column 1 Column 2 Column 3
Item No. Health Service Fee
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ANAESTHETICS
17800 Prolonged administration of an
anaesthetic in connection with a
professional service where the
anaesthetic time exceeds the
normal anaesthetic time for the
procedure by more than 1hour -
applicable to anaesthesia assigned
up to 12 anaesthetic time units
17805 Prolonged administration of an
anaesthetic in connection with a
professional service where the
anaesthetic time exceeds the
normal anaesthetic time for the
procedure by more than 1 hour
and 30 minutes - applicable to
anaesthesia assigned 13 to 24
anaesthetic time units
17810 Prolonged administration of an
anaesthetic in connection with a
professional service where the
anaesthetic time exceeds the
normal anaesthetic time for the
procedure by more than 2 hours
- applicable to anaesthesia
assigned more than 24
anaesthetic time units
18119 Administration of an anaesthetic
by a medical practitioner in
connection with a dental
operation where the procedure
is more than 3 hours duration
(Anaes. = 5B +12T)
$13.95 for each additional anaesthetic time unit beyond the assigned number of anaesthetic time units where one anaesthetic time unit represents:- each additional 15 minutes of anaesthesia time (or part thereof) where time to administer the anaesthesia is 6 hours or less; and each additional 10 minutes of anaesthesia time (or part thereof) which extends beyond 6 hours
$13.95 for each additional anaesthetic time unit beyond the assigned number of anaesthetic time units where one anaesthetic time unit represents:- each additional 15 minutes of anaesthesia time (or part thereof) where time to administer the anaesthesia is 6 hours or less; and each additional 10 minutes of anaesthesia time (or part thereof) which extends beyond 6 hours
$13.95 for each additional anaesthetic time unit beyond the assigned number of anaesthetic time units where one anaesthetic time unit represents each additional 10 minutes of anaesthesia time (or part thereof)
$237.15
SCHEDULE
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Column 1 Column 2 Column 3
Item No. Health Service Fee
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OPERATIONS
30214 TELANGIECTASES OR STARBURST VESSELS on $80.65
the head or neck where lesions are visible from 4 metres, diathermy or sclerosant injection of, including associated consultation - session of at least 20 minutes duration - where it can be demonstrated that a 7th or subsequent session (including any sessions to which Items 14100
to 14118 and 30213 apply) is indicated in a 12 month period.
32210 GRACILIS NEOSPHINCTER PACEMAKER $187.55
replacement of (Anaes. 17710 = 6B+4T)
32501 VARICOSE VEINS where varicosity measures 2.5mm $80.65
or greater in diameter, multiple injections using continuous compression techniques, including associated consultation - 1 or both legs - not being a service associated with any other varicose vein operation on the same leg, (excluding after-care) - where it can be demonstrated that a 7th or subsequent treatment (including any treatments to which Item 32500 applies) is indicated in a 12 month period
42783 LASER TRABECULOPLASTY - each treatment to 1 $331.30
eye - where it can be demonstrated that a 5th or subsequent treatment to that eye (including any treatments to which Item 42782 applies) is indicated in a 2 year period (Anaes. 17707 = 5B+2T) (Assist)
42786 LASER IRIDOTOMY - each treatment to 1 eye - where $259.55
it can be demonstrated that a 3rd or subsequent treatment to that eye (including any treatments to which Item 42785 applies) is indicated in a 2 year period (Anaes. 17707 = 5B+2T) (Assist)
SCHEDULE
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Column 1 Column 2 Column 3
Item No. Health Service Fee
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42789 LASER CAPSULOTOMY - each treatment to 1 eye - $259.55
where it can be demonstrated that a 3rd or subsequent
treatment to that eye (including any treatments to
which Item 42788 applies) is indicated in a 2 year
period (Anaes. 17707 = 5B+2T) (Assist)
42792 LASER VITREOLYSIS OR CORTICOLYSIS OF $259.55
LENS MATERIAL OR FIBRINOLYSIS - each
treatment to 1 eye - where it can be demonstrated that a 3rd or subsequent treatment to that eye (including any treatments to which Item 42791 applies) is indicated in a 2 year period (Anaes. 17707 = 5B+2T) (Assist)
45019 FULL FACE CHEMICAL PEEL for severely sun- $291.25
damaged skin, where it can be demonstrated that the damage affects 75% of the facial skin surface area involving photodamage (dermatoheliosis) typically consisting of solar keratoses, solar lentigines, freckling, yellowing and leathering of the skin, where at least medium depth peeling agents are used, performed in the operating theatre of a hospital or approved day-hospital facility by a specialist in the practice of his or her specialty - 1 session only in a 12 month period (Anaes. 17708 = 5B+3T)
45020 FULL FACE CHEMICAL PEEL for severe chloasma $291.25
or melasma refractory to all other treatments, where
it can be demonstrated that the chloasma or melasma
affects 75% of the facial skin surface area involving
diffuse pigmentation visible at a distance of 4 metres,
where at least medium depth peeling agents are used,
performed in the operating theatre of a hospital or
approved day-hospital facility by a specialist in the
practice of his or her specialty - 1 session only in a 12
month period (Anaes. 17708 = 5B+3T)
45528 MAMMAPLASTY, AUGMENTATION, bilateral, not $544.55
being a service to which Item 45524 or 45527 applies, where it can be demonstrated that surgery is indicated because of disease, trauma or congenital malformation (Anaes. 17711 = 5B+6T) (Assist.)
SCHEDULE
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Column 1 Column 2 Column 3
Item No. Health Service Fee
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45585 LIPOSUCTION (suction assisted lipolysis) to 1 regional $463.80 area, not being a service to which Item 45584 applies,
where it can be demonstrated that the treatment is for
pathological lipodystrophy of hips, buttocks, thighs and
lower legs (excluding knees), gynaecomastia,
lymphoedema or similar conditions (Anaes. 17713 =
5B+8T)
45588 MELOPLASTY, bilateral, not being a service to which $654.15 Item 45587 applies, where it can be demonstrated that
surgery is indicated because of disease, trauma or
congenital conditions (Anaes. 17714 = 5B+9T)(Assist)
50125 JOINT OR OTHER SYNOVIAL CAVITY, aspiration $21.75 of, or injection into, or both of these procedures – where
it can be demonstrated that a 26th or subsequent
treatment (including any treatments to which Item
50124 applies) is indicated in a 12 month period
(Anaes. 17705 = 4B+ 1T)