EXPLANATORY STATEMENT
Health Insurance Act 1973
Health Insurance Legislation Amendment (2025 Measures No. 3) Regulations 2025
The Health Insurance Act 1973 (the Act) sets out the principles and definitions governing the Medicare Benefits Schedule (MBS). The Act provides for payments by way of medical benefits and for other purposes.
Subsection 133(1) of the Act provides that the Governor‑General may make regulations, not inconsistent with the Act, prescribing all matters required or permitted by the Act to be prescribed, or necessary or convenient to be prescribed for carrying out or giving effect to the Act.
Part II of the Act provides for the payment of Medicare benefits for professional services rendered to eligible persons. Section 9 of the Act provides that Medicare benefits be calculated by reference to the fees for medical services set out in prescribed tables.
Section 4AA of the Act provides that regulations may prescribe a table of diagnostic imaging services which sets out items of diagnostic imaging services, the fees applicable for each item, and rules for interpreting the table. The table made under this section is referred to as the Diagnostic Imaging Services Table (DIST). The most recent version of the regulations is the Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020 (DIST Regulations).
Subsection 4(1) of the Act provides that regulations may prescribe a table of general medical services which sets out items of general medical services, the fees applicable for each item, and rules for interpreting the table. The table made under this subsection is referred to as the General Medical Services Table (GMST). The most recent version of the regulations is the Health Insurance (General Medical Services Table) Regulations 2021 (GMST Regulations).
Section 4A of the Act provides that regulations may prescribe a table of pathology services which set out items of pathology services, the fees applicable for each item, and rules for interpreting the table. The table made under this section is referred to as the Pathology Services Table (PST). The most recent version of the regulations is the Health Insurance (Pathology Services Table) Regulations 2020 (PST Regulations).
The Health Insurance Regulations 2018 (HIR) provide the overarching policy framework supporting the provision of appropriate Medicare services. For the purposes of paragraph 10(2)(aa) of the Act, section 28 of the HIR prescribes items that have a Medicare benefit equal to 100 per cent of the fee in respect of the service.
Purpose
The purpose of the Health Insurance Legislation Amendment (2025 Measures No. 3) Regulations 2025 (the Regulations) is to amend the DIST, GMST and PST Regulations and the HIR from 1 November 2025. The Regulations will introduce and amend MBS items as agreed to in the 2025-26 Budget, the 2024-25 Mid-Year Economic and Fiscal Outlook and the Minister’s delegation to approve certain Medical Services Advisory Committee recommendations outside a budget process. Additionally, the Regulations will implement administrative and machinery changes. Further detail can be found in the Attachment.
The Regulations will:
- amend Group M1 item descriptors to remove current restrictions that limit these bulk billing incentives to patients under 16 years of age and concessional beneficiaries;
- update terminology for Aboriginal and Torres Strait Islander health professionals and make consequential amendments to items and Group and Subgroup titles;
- make amendments pursuant to the Better Access Initiative;
- amend comprehensive facility requirements for positron emission tomography nuclear scanning services;
- incorporate item 63390 into the DIST, and incorporate item 15990 into the GMST;
- insert new item for dihydropyrimidine dehydrogenase genotyping to predict or diagnose fluoropyrimidine-induced toxicity and new item for faecal calprotectin testing for symptomatic patients with inflammatory bowel disease;
- amend three items for somatic gene testing of sarcoma;
- increase the assigned complexity of placental tissue examination items;
- restrict six therapeutic nuclear medicine items in Group T3 to provision by specialists or consultant physicians with training in nuclear medicine;
- amend schedule fees of long-acting reversible contraceptive (LARC) items and insert new loading item to be claimed in addition to relevant LARC items;
- clarify services that can be requested by podiatrists, and allow participating midwives to request, and sexual health physicians to render, specified services;
- make amendments to two diagnostic radiology items to clarify anatomical areas; remove the “(H)” flag from two items; add an “(H)” flag to one item; and amend 18 skin excision items to include an additional treatment service;
- make consequential changes to five face-to-face attendance items to update co-claiming restrictions to reflect introduction of nine telehealth equivalent items; and
- make amendments to clarify co-claiming for 25 cardiothoracic procedure items, add a co-claiming restriction for an endoscopic mucosal resection item, and clarify co-claiming for 15 myringoplasty and tympanomastoid procedures items.
Consultation
The Department of Health, Disability and Ageing consulted with key stakeholders on the Regulations. Stakeholders were generally supportive of the changes being implemented by the Regulations.
For changes to the DIST Regulations, stakeholders included:
- Australasian Association of Nuclear Medicine Specialists
- Australasian Sonographers Association
- Australian and New Zealand Society of Nuclear Medicine
- Australian College of Nurse Practitioners
- Australian Diagnostic Imaging Association
- Australian Medical Association
- Australian Podiatry Association
- Australian Society of Ultrasound in Medicine
- Australian Sonographer Accreditation Registry
- Royal Australasian College of Physicians
- Royal Australasian College of Surgeons
- Royal Australian and New Zealand College of Radiologists
- Royal Australian College of General Practitioners
- Rural Alliance in Nuclear Scintigraphy
For changes to the GMST Regulations, stakeholders included:
- Allied Health Professions Australia
- Australasian Association of Nuclear Medicine Specialists
- Australasian College of Dermatologists
- Australian and New Zealand Society of Cardiac and Thoracic Surgeons
- Australian and New Zealand Society of Nuclear Medicine
- Australian Association of Psychologists Inc
- Australian Association of Social Workers
- Australian Clinical Psychology Association
- Australian College of Mental Health Nurses
- Australian College of Rural and Remote Medicine
- Australian Diagnostic Imaging Association
- Australian Health Practitioner Regulation Agency
- Australian Indigenous Doctors Association
- Australian Medical Association
- Australian Psychological Society
- Australian Society of Anaesthetists
- Australian Society of Plastic Surgeons
- Gastroenterological Society of Australia
- Gayaa Dhuwi (Proud Spirit) Australia
- General Practice Mental Health Standards Collaboration
- Indigenous Allied Health Australia, and
- Mental Health Australia
- Mental Health Carers Australia
- National Association of Specialist Obstetricians and Gynaecologists
- Otolaryngology Head and Neck Surgery Clinical Committee
- Private Health Care Australia
- Private Hospitals Association
- Royal Australasian College of Physicians
- Royal Australian and New Zealand College of Obstetricians and Gynaecologists
- Royal Australian and New Zealand College of Ophthalmology
- Royal Australian and New Zealand College of Radiologists
- Royal Australian College of General Practitioners
- Rural Alliance in Nuclear Scintigraphy
- Skin Cancer College Australasia
- The Colorectal Surgical Society of Australia and New Zealand
- Thoracic Society of Australia and New Zealand
For changes to the PST Regulations, stakeholders included:
- Australasian Gastro-Intestinal Trials Group
- Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists
- Australian Genomics
- Australian Pathology
- Bowel Cancer Australia
- Crohn’s and Colitis Australia
- Crohn’s Colitis Cure
- DiaSorin Australia
- Gastroenterological Nurses College of Australia
- Gastroenterological Society of Australia
- Medical Services Advisory Committee Executive
- Melbourne Genomics Health Alliance
- National Pathology Accreditation Advisory Council
- PathWest Laboratory Medicine, QEII Medical Centre, Nedlands
- Pharmaceutical Benefits Advisory Committee
- Public Pathology Australia
- Royal Australian and New Zealand College of Obstetricians and Gynaecologists
- Royal College of General Practitioners
- Royal College of Pathologists of Australasia
- The Society of Hospital Pharmacists of Australia
- Therapeutic Goods Administration
For changes to the HIR, stakeholders included:
- Allied Health Professions Australia
- Australasian Sonographers Association
- Australian Association of Psychologists Inc
- Australian Association of Social Workers
- Australian Clinical Psychology Association
- Australian College of Mental Health Nurses
- Australian College of Midwives
- Australian College of Rural and Remote Medicine
- Australian Health Practitioner Regulation Agency
- Australian Indigenous Doctors Association
- Australian Medical Association
- Australian Pathology
- Australian Psychological Society
- Berkshire Hathaway Speciality Insurance
- Consumers Health Forum of Australia
- Gayaa Dhuwi (Proud Spirit) Australia
- General Practice Mental Health Standards Collaboration
- Guild Insurance
- Indigenous Allied Health Australia
- Mental Health Australia
- Mental Health Carers Australia
- National Mental Health Consumer Alliance
- Occupational Therapy Australia
- Public Pathology Australia
- Royal Australian and New Zealand College of Obstetricians and Gynaecologists
- Royal Australian and New Zealand College of Psychiatrists
- Royal Australian and New Zealand College of Radiologists
- Royal Australian College of General Practitioners
- Royal College of Pathologists of Australasia
The Act specifies no conditions that need to be satisfied before the power to make the Regulations may be exercised.
Details of the Regulations are set out in the Attachment.
The Regulations are a legislative instrument for the purposes of the Legislation Act 2003.
The Regulations will commence on 1 November 2025.
Authority: Subsection 133(1) of the
Health Insurance Act 1973
ATTACHMENT
Details of the Health Insurance Legislation Amendment (2025 Measures No. 3) Regulations 2025
Section 1 – Name
This section provides for the instrument to be referred to as the Health Insurance Legislation Amendment (2025 Measures No. 3) Regulations 2025 (the Regulations).
Section 2 – Commencement
This section provides for the Regulations to commence on 1 November 2025.
Section 3 – Authority
This section provides that the Regulations are made under the Health Insurance Act 1973 (the Act).
Section 4 – Schedules
This section provides that each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.
Schedule 1
Part 1—Amendments to remove restrictions on bulk billed services
Health Insurance (General Medical Services Table) Regulations 2021
Item 1 makes a consequential amendment to remove the definition of concessional beneficiary from clause 3.2.1, as this definition is not required following the amendments to relevant services in Group M1 (see items 2 to 8).
Items 2 to 8 amend items 10990, 10991, 10992, 75855, 75856, 75857, 75858, 75870, 75871, 75872, 75873, 75874, 75875, 75876, 75880, 75881, 75882, 75883, 75884 and 75885 in Group M1 to specify that bulk-billing incentives will be available to all Medicare-eligible persons, and will no longer be restricted to children under 16 years of age or concessional beneficiaries.
Item 9 makes a consequential amendment to remove the definition of concessional beneficiary from clause 7.1.1, as this definition is not required following the amendments to relevant services in Group M1 (see items 2 to 8).
Part 2—Amendments relating to allied health and Aboriginal and Torres Strait Islander health professionals
Health Insurance (General Medical Services Table) Regulations 2021
Item 10 makes an administrative amendment to subclause 1.1.5(2) to clarify that that the reference to paragraph “(b)” relates to paragraph “1(b)”.
Item 11 amends the example to subclause 1.1.5(2) to cover “other primary health care providers”.
Item 12 amends item 243 to specify that the service can be rendered by allied health providers or other relevant health professionals.
Items 13 and 14 amend item 244 to fix a typographical error, and to specify that the service can be rendered by allied health providers or other relevant health professionals.
Item 15 makes an administrative amendment to remove the note from the item descriptor to item 792, as it is not relevant to items in the general medical services table (GMST).
Item 16 amends subclauses 2.15.14(4) and 2.16.10(3) to update the terminology used to describe Aboriginal and Torres Strait Islander health workers, as per the amendment described in item 26 below.
Item 17 amends items 871 and 872 to specify that the services can be rendered by allied health providers or other relevant health professionals.
Items 18 and 19 make administrative amendments to remove the notes to subclause 2.22.1(2) and to item 4001, as they are not relevant to items in the GMST.
Item 20 amends the heading of Division 3.1 of Schedule 1 to reflect the updated terminology used to describe Aboriginal and Torres Strait Islander health workers, as per the amendment described in item 26.
Items 21 and 22 amend the table heading of Group M12 and the table heading of Subgroup 1 of Group M12 at Schedule 1 to reflect the updated terminology used to describe Aboriginal and Torres Strait Islander health workers, as per the amendment described in item 26.
Items 23 and 24 amend item 10983 and 13105 to reflect the updated terminology used to describe Aboriginal and Torres Strait Islander health workers, as per the amendment described in item 26.
Item 25 amends the definition of an Aboriginal and Torres Strait Islander health practitioner in clause 7.1.1 to clarify that the definition relates to the Health Practitioner Regulation National Law in the Aboriginal and Torres Strait Islander health practice profession.
Item 26 repeals and substitutes the definition of Aboriginal health worker in clause 7.1.1 to update the terminology used to describe Aboriginal and Torres Strait Islander health workers. The new definition specifies that an Aboriginal and Torres Strait Islander health worker means a person who holds a qualification of Certificate III or higher in Aboriginal and/or Torres Strait Islander Primary Health Care from the Health (HLT) training package, and who is engaged by a medical practitioner in a general practice or a health service to which a direction made under subsection 19(2) of the Act applies.
Health Insurance Regulations 2018
Item 27 repeals and substitutes paragraph 12(a) to add reference to “Aboriginal and Torres Strait Islander health practitioner services” to the meaning of a health service, and to introduce a new paragraph 12(aa) for “Aboriginal and Torres Strait Islander health worker services”.
Part 3—Amendments relating to mental health services
Health Insurance (General Medical Services Table) Regulations 2021
Item 28 repeals items 277 and 279, which are for a review of a mental health treatment plan and for the ongoing management of a patient with a mental disorder, respectively.
Items 29 to 32 amend clause 2.20.4 to specify that a general practitioner or prescribed medical practitioner is covered by the definition of review of a GP mental health treatment plan where a patient is enrolled in a MyMedicare practice, or the patient is being treated by their usual medical practitioner.
Item 33 repeals and substitutes clause 2.20.5 to remove reference to items 2712 and 277, which will be repealed by items 44 and 28. Additionally, this item amends clause 2.20.5 to provide that case conferencing items 735 and 758 do not apply to a review of a GP mental health treatment plan, and to set out restrictions on claiming for a review of a GP mental health treatment plan.
Item 34 makes a consequential administrative amendment to subclause 2.20.6(1) to remove reference to items 277, 279, 2712 and 2713, which will be repealed by items 28 and 44.
Item 35 repeals and substitutes subclause 2.20.6(2) to remove reference to item 2712, which will be repealed by item 44, and to item 277, which will be repealed by item 28. This amendment item provides that the specified items also apply where a service meets the requirements for it to be provided by a general practitioner or prescribed medical practitioner at a patient’s MyMedicare registered practice or their usual medical practitioner, as set out in the proposed subclause 2.20.4(2) (see item 32).
Item 36 makes a consequential administrative amendment to paragraph 2.20.6(3)(a) to remove reference to item 2713, which will be repealed by item 44.
Item 37 amends subclause 2.20.6(3) to insert new paragraphs (c) and (d), providing that items 2700, 2701, 2715 and 2717 cannot be claimed within 3 months following a review of a GP mental health treatment plan, or more than once in a 12 month period from the provision of a service to which items 272, 276, 281, 282, 92112, 92113, 92116, 92117, 92118, 92119, 92122 or 92123 applies.
Item 38 makes consequential administrative amendments to repeal subclauses 2.20.6(4) to (7), as they relate to items 2712 and 2713, which will be repealed by item 44.
Item 39 repeals and substitutes paragraph 2.20.6(8A)(a), making consequential administrative amendments to remove reference to item 279, which will be repealed by item 28.
Item 40 repeals and substitutes paragraphs 2.20.6(8A)(c) and (d) to provide that items 272, 276, 281 and 282 cannot be claimed within 3 months following a review of a GP mental health treatment plan, or more than once in a 12 month period from the provision of a service to which item 2700, 2701, 2715, 2717, 92112, 92113, 92116, 92117, 92118, 92119, 92122 or 92123 applies.
Item 41 makes consequential administrative amendments to repeal subclauses 2.20.6(8B) to (8D), as they relate to items 277 and 279, which will be repealed by item 28.
Items 42 and 43 amend subparagraphs 2.20.7(2)(a)(ii) and 2.20.7A(a)(ii) to specify that the subparagraphs apply where a service meets the requirements for it to be provided by a general practitioner or prescribed medical practitioner at a patient’s MyMedicare registered practice or their usual medical practitioner, as set out in the proposed subclause 2.20.4(2) (see item 32).
Item 44 repeals items 2712 and 2713 for a review of a mental health treatment plan and for the ongoing management of a patient with a mental disorder, respectively.
Items 45 and 46 make consequential administrative amendments to clause 2.31.7 to remove references to item 279 and 2713, which will be repealed by items 28 and 44, respectively.
Item 47 repeals the definition of associated general practitioner in clause 7.1.1.
Item 48 repeals and substitutes the definition of associated medical practitioner in clause 7.1.1, making a consequential administrative amendment to remove reference to item 277, which is being repealed by item 28.
Health Insurance Regulations 2018
Items 49 and 50 make consequential administrative amendments to subsection 28(1) to remove reference to items 277, 279, 2712 and 2713, which will be repealed by items 28 and 44.
Item 51 makes consequential administrative amendments to item 28L of the table to subsection 28(1) to remove reference to telehealth equivalent items 92114, 92115, 92120 and 92121, which will be repealed from the Health Insurance (Section 3C General Medical Services – Telehealth Attendances) Determination 2021 (the Telehealth Attendances Determination) from 1 November 2025.
Item 52 makes a consequential administrative amendment to repeal table item 28M from subsection 28(1), as telehealth equivalent items 92126, 92127, 92132 and 92133 will be repealed from the Telehealth Attendances Determination from 1 November 2025.
Part 4—Amendments relating to PET nuclear scanning services
Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020
Items 53 to 55 amend clause 2.4.2. Item 54 substitutes the reference to a service performed in a “comprehensive facility” to refer to a service performed “at the premises of a comprehensive practice” to align the rules for positron emission tomography (PET) services with the rules for magnetic resonance imaging (MRI) and magnetic resonance angiography services. Items 53 and 55 makes consequential administrative amendments to support the proposed change set out in item 57.
Item 56 makes consequential amendments to clauses 2.4.3 and 2.4.4 to support the repeal of subclause 2.4.2(2) by item 55.
Item 57 repeals clause 2.4.5 to remove the requirement that an owner or operator mentioned in subclause 2.4.2(2) (prior to the amendment in item 55) must have given a statutory declaration to the Chief Executive Medicare in relation to relevant services.
Item 58 repeals the definition of comprehensive facility in clause 3.1 following the removal of the words from the current paragraph 2.4.2(1)(b) under item 54, as the definition will no longer be relevant.
Item 59 repeals clause 4.5 following the removal of clause 2.4.5 described in item 57, as clause 4.5 will no longer be relevant.
Part 5—Amendments to incorporate items from determinations made under subsection 3C(1) of the Act
Division 1—Cardiac MRI for myocarditis
Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020
Items 60 to 62 incorporate item 63390 from the Health Insurance (Section 3C Diagnostic Imaging Services – Cardiac MRI for Myocarditis) Determination 2024 into the diagnostic imaging services table (DIST). Item 62 inserts item 63390 into the DIST, and items 60 and 61 make consequential amendments to the table to clause 2.5.4 to support the incorporation of item 63390 into the DIST.
Division 2—Proton-photon comparison plan
Health Insurance (General Medical Services Table) Regulations 2021
Item 63 incorporates item 15990 from the Health Insurance (Section 3C General Medical Services – Proton-Photon Comparison Plan) Determination (No.2) 2025 into the GMST Regulations.
Item 64 inserts a definition of Medical Treatment Overseas Program into clause 7.1.1 to specify that Medical Treatment Overseas Program means the program by that name administered by the Department of Health, Disability and Ageing.
Part 6—New pathology services items
Health Insurance (Pathology Services Table) Regulations 2020
Item 65 introduces a new item 66525 for faecal calprotectin testing into Group P2 of the pathology services table (PST).
Item 66 introduces a new item 73322 for genetic testing in the DPYD gene to diagnose or predict fluoropyrimidine-induced toxicity in a patient into Group P7 of the PST.
Part 7—Amendments relating to somatic gene testing of sarcoma
Health Insurance (Pathology Services Table) Regulations 2020
Item 67 repeals and substitutes the descriptor for item 73374 to remove the list of genes set out in paragraph (a) of the item descriptor to allow clinicians to choose the clinically relevant gene to test. Additionally, this item amends item 73374 to change the limitation on the frequency of clinically relevant testing from once per lifetime to once per tumour diagnostic episode.
Item 68 repeals and substitutes the descriptor for item 73375, restructuring the item to recognise that it forms a ‘ladder’ of the same test as specified under item 73374, and to change the limitation on the frequency of clinically relevant testing from once per lifetime to once per tumour diagnostic episode.
Item 69 repeals and substitutes the descriptor for item 73376, restructuring the item to recognise that it forms a ‘ladder’ of the same test as specified under item 73374, and to change the frequency limiter of clinically relevant testing from once per lifetime to once per tumour diagnostic episode.
Part 8—Amendments relating to complexity levels for specimen types
Health Insurance (Pathology Services Table) Regulations 2020
Items 70 to 73 amend clause 3.1 to specify the complexity levels for the examination of different placental tissue specimens. The amended provisions specify that the assigned complexity of placental tissue examination will increase from level 4 to level 5 or 6 where appropriate. Additionally, the amendments update the wording used to describe tissue timing aspects of the specimens.
Part 9—Amendments relating to therapeutic nuclear medicine services
Health Insurance (General Medical Services Table) Regulations 2021
Item 74 inserts new clause 5.4.1A into the GMST Regulations, which provides that an item in Group T3 applies only to a service provided by a specialist, or a consultant physician, in the practice of the specialist’s or consultant physician’s specialty of nuclear medicine.
Item 75 makes an administrative amendment to Group T3 to add reference to “Subgroup 1—Administration of nuclear medicine” to Group T3, as this reference was previously inadvertently excluded. This item also relocates existing items 16003, 16006, 16009, 16012, 16015 and 16018 into Subgroup 1.
Part 10—Amendments to increase fees
Health Insurance (General Medical Services Table) Regulations 2021
Item 76 amends the schedule fee for item 14206 to $100.40 to reflect contemporary and clinically relevant costs for administration of the service.
Item 77 removes the limitation that the service described under item 30062 applies when it is provided “as an independent procedure”.
Item 78 amends the schedule fee for item 30062 to $105.15 to reflect contemporary and clinically relevant costs for administration of the service.
Item 79 introduces new item 35501 provide a loading benefit of 40% of the fee for the relevant long-acting reversible contraceptive (LARC) services. This is intended to be claimed in addition to services provided under item 35503, 35506, 14206 or 30062, where the service is bulk-billed in relation to the fees for that item or any other item in the Schedule applying to the service. This is intended to incentivise specialists to bulk bill all services associated with a patient’s LARC insertion or removal appointment.
Item 80 amends item 35503 to add reference to new item 35501 (see item 79) to the co-claiming restrictions for item 35503.
Item 81 amends the schedule fee for item 35503 to $215.95 to reflect contemporary and clinically relevant costs for administration of the service.
Item 82 amends item 35506 to add reference to new item 35501 (see item 79) to the co-claiming restrictions for item 35506.
Item 83 amends the schedule fee for item 35506 to $134.45 to reflect contemporary and clinically relevant costs for administration of the service.
Part 11—Other Amendments
Division 1—Pathology services determined necessary by participating midwives
Health Insurance Regulations 2018
Item 84 amends the table to section 30 to add reference to items 73420 and 73421 in Group P7, to allow the services described in those items (for non-invasive prenatal testing of eligible pregnant patients to detect Rhesus D (RhD) negative pregnant patients who are carrying a RhD positive foetus) to be requested by a participating midwife.
Division 2—Requests for diagnostic imaging services
Health Insurance Regulations 2018
Item 85 removes reference to items 55889, 55891, 55893 and 55895 from the table to section 42, such that the services being removed from the table cannot be requested by a podiatrist.
Item 86 amends the table to section 43 to add item 55065, to specify that the service described in item 55065 can be requested by participating midwives.
Division 3—Amendments relating to diagnostic radiology
Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020
Item 87 amends items 57512 and 57515 to specify that the items also apply for services that cover radiography of a combination of wrist and forearm.
Division 4—Amendments relating to ultrasound
Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020
Item 88 amends items 55282 and 55284 to expand the performing rights for the items to allow sexual health physicians to render the services.
Division 5—Amendments relating to hospital only services
Health Insurance (General Medical Services Table) Regulations 2021
Item 89 amends item 22032 to add the in-hospital only “(H)” flag to specify that the item can only be claimed when the service is rendered in a hospital setting.
Item 90 amends items 23010 and 42773 to remove the in-hospital only “(H)” flag, to specify that the services can be provided outside of hospital settings and reintroduce 85% out of hospital benefits.
Division 6—Amendments relating to chronic condition management planning services
Health Insurance (General Medical Services Table) Regulations 2021
Items 91 to 95 amend clause 2.16.12 to make administrative amendments to resolve typographical errors that were introduced on 1 July 2025 by the Health Insurance Legislation Amendment (2025 Measures No. 1) Regulations 2025. The amendment items will align clause 2.16.12 with the original policy intent of the changes.
Division 7—Amendments relating to radiation oncology
Health Insurance (General Medical Services Table) Regulations 2021
Item 96 - Schedule 1 (item 15946)
This item amends item 15946 to clarify the item can only be claimed once per day per plan.
Division 8—Amendments relating to surgical operations
Health Insurance (General Medical Services Table) Regulations 2021
Items 97 to 104 amend 18 items (31356, 31357, 31358, 31360, 31363, 31364, 31369, 31370, 31371, 31373, 31376, 31377, 31378, 31379, 31380, 31381, 31382 and 31383) to specify that the items are intended to allow for another treatment service for patients where a wound is left open to heal naturally (known as healing by secondary intention), instead of repairing the wound by suture, skin flap or skin graft, where clinically appropriate.
Division 9—Amendments relating to telehealth attendances
Health Insurance (General Medical Services Table) Regulations 2021
Items 105 to 108 amend items 133, 143, 147 and 293, to make consequential amendments to co-claiming restrictions to reflect the introduction of new phone equivalent items into the Health Insurance (Section 3C General Medical Services – Telehealth Attendances) Determination 2020 from 1 November 2025.
Division 10—Amendments relating to cardiothoracic services
Health Insurance (General Medical Services Table) Regulations 2021
Item 109 amends item 30621 to clarify the co-claiming restrictions that apply to the service, providing that a service described in item 30621 applies other than when a service to which items 30655, 38365, 38467, 38477, 38484, 38485, 38490, 38493, 38499, 38502, 38510, 38512, 38513, 38515, 38516, 38517, 38519, 38550, 38553, 38554, 38555, 38557, 38670, 38703, 38742 or 38764 will apply.
Item 110 amends items 48406 and 48409 to clarify the co-claiming restrictions that apply to the services, providing that a service described in items 48406 or 48409 applies other than when a service to which items other than a service to which item 38365, 38467, 38477, 38484, 38485, 38490, 38493, 38499, 38502, 38510, 38512, 38513, 38515, 38516, 38517, 38519, 38550, 38553, 38554, 38555, 38557, 38670, 38703, 38742 or 38764 will apply.
Division 11—Amendments relating to colorectal services
Health Insurance (General Medical Services Table) Regulations 2021
Item 111 amends items 32084 and 32087 to apply a co-claiming restriction between each of the items with item 32230, which is for endoscopic mucosal resection.
Division 12—Amendments relating to co claiming of myringoplasty and tympanomastoid procedures
Health Insurance (General Medical Services Table) Regulations 2021
Item 112 amends 15 items (41527, 41530, 41533, 41536, 41545, 41551, 41554, 41557, 41560, 41563, 41564, 41566, 41629, 41635 and 41638) in Group T8 to clarify that co-claiming of the items is allowed when performed on separate sides (i.e. left or right ear).
Statement of Compatibility with Human Rights
Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011
Health Insurance Legislation Amendment (2025 Measures No. 3) Regulations 2025
This Regulation is compatible with the human rights and freedoms recognised or declared in the international instruments listed in section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.
Overview of the Disallowable Legislative Instrument
The purpose of the Health Insurance Legislation Amendment (2025 Measures No. 3) Regulations 2025 (the Regulations) is to amend from 1 November 2025 the Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020, the Health Insurance (General Medical Services Table) Regulations 2021, the Health Insurance (Pathology Services Table) Regulations 2020 and the Health Insurance Regulations 2018. The Regulations will introduce and amend MBS items as agreed to in the 2025-26 Budget, the 2024-25 Mid-Year Economic and Fiscal Outlook and the Minister’s delegation to approve certain Medical Services Advisory Committee recommendations outside a budget process. Additionally, the Regulations will implement administrative and machinery changes. Further detail can be found in the Attachment.
The Regulations will:
- amend Group M1 item descriptors to remove current restrictions that limit these bulk billing incentives to patients under 16 years of age and concessional beneficiaries;
- update terminology for Aboriginal and Torres Strait Islander health professionals and make consequential amendments to items and Group and Subgroup titles;
- make amendments pursuant to the Better Access Initiative;
- amend comprehensive facility requirements for positron emission tomography nuclear scanning services;
- incorporate item 63390 into the DIST, and incorporate item 15990 into the GMST;
- insert new item for dihydropyrimidine dehydrogenase genotyping to predict or diagnose fluoropyrimidine-induced toxicity and new item for faecal calprotectin testing for symptomatic patients with inflammatory bowel disease;
- amend three items for somatic gene testing of sarcoma;
- increase the assigned complexity of placental tissue examination items;
- restrict six therapeutic nuclear medicine items in Group T3 to provision by specialists or consultant physicians with training in nuclear medicine;
- amend schedule fees of long-acting reversible contraceptive (LARC) items and insert new loading item to be claimed in addition to relevant LARC items;
- clarify services that can be requested by podiatrists, and allow participating midwives to request, and sexual health physicians to render, specified services;
- make amendments to two diagnostic radiology items to clarify anatomical areas; remove the “(H)” flag from two items; add an “(H)” flag to one item; and amend 18 skin excision items to include an additional treatment service;
- make consequential changes to five face-to-face attendance items to update co-claiming restrictions to reflect introduction of nine telehealth equivalent items; and
- make amendments to clarify co-claiming for 25 cardiothoracic procedure items, add a co-claiming restriction for an endoscopic mucosal resection item, and clarify co-claiming for 15 myringoplasty and tympanomastoid procedures items.
Human rights implications
The Regulations engage Articles 9 and 12 of the International Covenant on Economic Social and Cultural Rights (ICESCR), specifically the rights to health and social security.
The Right to Health
The right to the enjoyment of the highest attainable standard of physical and mental health is contained in Article 12(1) of the ICESCR. The UN Committee on Economic Social and Cultural Rights (the Committee) has stated that the right to health is not a right for each individual to be healthy, but is a right to a system of health protection which provides equality of opportunity for people to enjoy the highest attainable level of health.
The Committee reports that the ‘highest attainable standard of health’ takes into account the country’s available resources. This right may be understood as a right of access to a variety of public health and health care facilities, goods, services, programs, and conditions necessary for the realisation of the highest attainable standard of health.
The Right to Social Security
The right to social security is contained in Article 9 of the ICESCR. It requires that a country must, within its maximum available resources, ensure access to a social security scheme that provides a minimum essential level of benefits to all individuals and families that will enable them to acquire at least essential health care. Countries are obliged to demonstrate that every effort has been made to use all resources that are at their disposal in an effort to satisfy, as a matter of priority, this minimum obligation.
The Committee reports that there is a strong presumption that retrogressive measures taken in relation to the right to social security are prohibited under ICESCR. In this context, a retrogressive measure would be one taken without adequate justification that had the effect of reducing existing levels of social security benefits, or of denying benefits to persons or groups previously entitled to them. However, it is legitimate for a Government to re-direct its limited resources in ways that it considers to be more effective at meeting the general health needs of all society, particularly the needs of the more disadvantaged members of society.
The right of equality and non-discrimination
The rights of equality and non-discrimination are contained in Articles 2, 16 and 26 of the International Covenant on Civil and Political Rights (ICCPR). Article 26 of the ICCPR requires that all persons are equal before the law, are entitled without any discrimination to the equal protection of the law and in this respect, the law shall prohibit any discrimination and guarantee to all persons equal and effective protection against discrimination on any ground such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status.
Analysis
The Regulations maintain the rights to health and social security and the right of equality and non-discrimination by ensuring access to publicly subsidised medical services that are clinically relevant and cost-effective as intended. The Regulations also advance the rights to health and social security and the right of equality and non‑discrimination by introducing new services which will be available as publicly subsidised medical services.
Conclusion
This instrument is compatible with human rights because it maintains and advances health arrangements and the protection of related human rights.
Mark Butler
Minister for Health and Ageing