Health Insurance Legislation Amendment (2026 Measures No. 1) Regulations 2026

EXPLANATORY STATEMENT

Health Insurance Act 1973

Health Insurance Legislation Amendment (2026 Measures No. 1) Regulations 2026

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 (2026 Measures No. 1) Regulations 2026 (the Regulations) is to amend the DIST, GMST and PST Regulations and the HIR from 1 March 2026. The Regulations will implement changes to introduce and amend MBS services as agreed to in the 2025-26 Budget, the 2025-26 and 2023-24 Mid-Year and Economic Fiscal Outlook, and through 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 items for three dimensional tomosynthesis of the breast to clarify patient population and clinical indications;
• enable item 55080 to be requested by participating midwives and nurse practitioners;
• insert new item 18355 for IncobotulinumtoxinA (Xeomin) treatment of chronic sialorrhea, and amend existing item 18354 to allow for the use of Xeomin to treat spasticity of the lower limb;
• specify a co-claiming restriction for cardiac item 38502 and introduce a frequency limitation for the application of cardiac item 38511;
• update clinical requirements for electrocardiogram items 11707 and 11714;
• insert new item 38620 for insertion of a left ventricular assist device and amend existing item 38621 to extend to replacement of a left or right ventricular assist device;
• update the definition of “eligible disability” to include severe speech and language disorders;
• amend existing items and clauses to clarify requirements for health assessments; 
• introduce 24 new items for patient end support services;
• clarify in and out of hospital requirements for various items, and amend surgical item 30281 to clarify its operation;
• amend level 3 megavoltage items 15912, 15916, 15938 and 15940 to clarify requirements for services;
• make administrative amendments to renumber existing Subgroups 1 – 4 of Group T2 (radiation oncology) as Subgroups 11 – 14;
• make consequential amendments to update co-claiming restrictions and referral clauses for claiming of telehealth items;
• make administrative amendments to pathology provisions to align drug names with spelling listed under the Pharmaceutical Benefits Scheme; and
• make administrative amendments to four patient episode initiation items to clarify where services may be provided in relation to pathology specimen collection.

Consultation

The Department of Health, Disability and Ageing consulted with relevant stakeholders on the Regulations, by way of public consultation and targeted consultation with individual stakeholders. Stakeholders were generally supportive of the changes being implemented by the Regulations.

For changes to the DIST Regulations, the Royal Australian and New Zealand College of Radiologists was consulted.

For changes to the GMST Regulations, stakeholders included:

• Advanced Heart Failure and Cardiac Transplant Service
• Allied Health Professions’ Office of Queensland
• Audiology Australia
• Australasian Academy of Cerebral Palsy and Developmental Medicine
• Australasian Society for Developmental Paediatrics
• Australian and New Zealand Association of Oral and Maxillofacial Surgeons
• Australian and New Zealand Society for Geriatric Medicine
• Australian and New Zealand Society of Cardiothoracic Surgeons
• Australian and New Zealand Association of Neurologists
• Australian and New Zealand Society of Reproductive Endocrinology and Infertility
• Australian College of Midwives
• Australian College of Nurse Practitioners
• Australian College of Physiotherapy
• Australian College of Rural and Remote Medicine
• Australian Medical Association
• Australian Physiotherapy Association
• Australian Primary Health Care Nurse Association
• Australian Psychological Society
• Australian Society of Anaesthetists
• Australian Society of Otolaryngology Head and Neck Surgery
• Australian Society of Plastic Surgeons
• Breast Cancer Network Australia
• Cancer Australia
• Cancer Council Australia
• Cardiac Society of Australia and New Zealand
• Central and Eastern Sydney PHN Clinical Council
• Cerebral Palsy Australia
• CHearts4heart
• Chiropractors Association of Australia
• CleftPALS NSW
• CleftPALS VIC
• Dietitians Association of Australia
• Fertility Society of Australia
• Fiona Stanley Hospital Perth, Central Adelaide Local Health Network
• Indigenous Allied Health Australia
• MND Australia
• Movement Disorder Society of Australia and New Zealand
• National Aboriginal Community Controlled Health Organisation
• Neurodevelopment Australia
• Osteopathy Australia
• Parkinson’s Australia
• Private Healthcare Australia
• Radiation Oncology Access Coalition
• Rehabilitation Medicine Society of Australia and New Zealand
• Royal Adelaide Hospital – Department of Cardiology
• Royal Australian and New Zealand College of Obstetricians and Gynaecologists
• Royal Australian and New Zealand College of Radiologists
• Royal Australian College of General Practitioners
• Rural Doctors Association of Australia
• Services for Australian Rural and Remote Allied Health
• Speech Pathology Australia
• Stroke Foundation
• Thoracic Society of Australia and New Zealand
• Urological Society of Australia

Stakeholders were generally supportive of the change to add an “(H)” flag to and remove the “(H)” flag from the descriptors for various MBS items. The department determined in response to stakeholder queries that for some items, it was not appropriate to reinstate the 85% benefit, based on data showing that these items were not used for out-of-hospital claiming and following consultation with the department’s medical advisors.

For changes to the HIR, stakeholders included:

• Australasian Society for Ultrasound in Medicine
• Australasian Society of Breast Physicians
• Australasian Sonographers Association
• Australian Association of Obstetrical and Gynaecological Ultrasonologists
• Australian College of Midwives
• Australian College of Nurse Practitioners
• Australian College of Nursing
• Australian College of Rural and Remote Medicine
• Australian Diagnostic Imaging Association
• Australian Medical Association
• Australian Women’s Health Alliance
• Breast Cancer Network Australia
• Cancer Council Australia
• Consumer Health Forum Australia
• EndoActive
• Endometriosis Australia
• Medical Oncology Group of Australia
• National Association of Specialist Obstetricians and Gynaecologists
• National Breast Cancer Foundation
• National Rural Women’s Coalition
• Royal Australasian College of Physicians
• Royal Australasian College of Surgeons
• Royal Australian and New Zealand College of Obstetricians and Gynaecologists
• Royal Australian and New Zealand College of Radiologists
• Royal Australian College of General Practitioners
• Society of Obstetric Medicine of Australia and New Zealand
• Urological Society of Australian and New Zealand

The changes to the GMST Regulations and the HIR as part of the implementation of the new patient end support (PES) items are being introduced pursuant to recommendation 10 of the Telehealth Post-Implementation Review Final Report by the MBS Review Advisory Committee (MRAC), released in March 2024. More than 450 responses were received through this public consultation on the Telehealth Post-Implementation Review, which includes members from health organisations, peak bodies and consumers. Stakeholders were broadly supportive of these new items, although consultation feedback included advocacy to extend PES services to other practitioners. A future expansion to allied health providers and nurse practitioners for PES for consultations by general practitioners was agreed by the Government in the 2025-26 Mid-Year Economic and Fiscal Outlook.

No consultation was undertaken for changes to the PST Regulations, as these changes are administrative and machinery in nature.

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 March 2026.

                                                                     Authority:  Subsection 133(1) of the

                                                                                         Health Insurance Act 1973 

ATTACHMENT

Details of the Health Insurance Legislation Amendment (2026 Measures No. 1) Regulations 2026

Section 1 – Name

This section provides for the instrument to be referred to as the Health Insurance Legislation Amendment (2026 Measures No. 1) Regulations 2026 (the Regulations).

Section 2 – Commencement

This section provides for the Regulations to commence on 1 March 2026.

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—Diagnostic radiography

Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020

Item 1 repeals and substitutes the descriptor for item 59302. Item 59302 describes a service for three-dimensional tomosynthesis of both breasts that is applicable where there is reason to suspect the presence of breast malignancy due to:

• past occurrence of breast malignancy in the patient;
• significant family history of breast or ovarian malignancy; or
• symptoms or signs found on examination by a medical practitioner.

The substituted item descriptor removes the current reference to symptoms or indications of “breast disease” found on examination of the patient, and instead refers in the revised paragraph (c) to “symptoms or signs” found on examination.

Item 2 repeals and substitutes the descriptor for item 59303 to make a minor administrative amendment to correct the subparagraph numbering under paragraph (b).

Item 3 repeals and substitutes the descriptor for item 59305. Item 59305 describes a service for three-dimensional tomosynthesis of one breast that is applicable where there is reason to suspect the presence of breast malignancy due to:

• past occurrence of breast malignancy in the patient;
• significant family history of breast or ovarian malignancy; or
• symptoms or signs found on examination by a medical practitioner.

As with amendment item 1, the substituted item descriptor removes the current reference to symptoms or indications of “breast disease” found on examination of the patient, and instead refers in the revised paragraph (c) to “symptoms or signs” found on examination.

Part 2—R‑type diagnostic imaging services

Health Insurance Regulations 2018

Item 4 amends section 43 to include reference to item 55080 in the list of services referenced in column 2 of table item 1. This will allow item 55080 to be requested by participating midwives.

Item 5 amends section 44 to include reference to item 55080 in the list of services referenced in column 2 of table item 1. This will allow item 55080 to be requested by participating nurse practitioners.

Schedule 2—General medical services

Part 1—Telehealth

Health Insurance (General Medical Services Table) Regulations 2021

Item 1 makes an administrative amendment to subclause 1.1.6(1) to add reference to existing telehealth items 91825, 92422, 92423, 92440 and 92443. This will have the effect that clause 1.1.6, which sets out the meaning of the words “single course of treatment”, also applies to these additional telehealth items, in line with the original policy intent.

Item 2 makes an administrative amendment to subclause 1.2.2(1) to add reference to existing telehealth items 91825, 92172, 92173, 92423, 92436, 92440, 92441, 92442, 92443, 92444, 92445, 92446, 92447, 92448, 92612, 92613, 92614 and 92624. This will have the effect that clause 1.2.2, which sets out restrictions for specified items for attendances by specialists and consultant physicians without referrals, also applies to these telehealth items, in line with the original policy intent.

Item 3 makes an administrative amendment to subclause 1.2.4(1) to add reference to telehealth items 92440, 92445, 92446 and 92447. This will have the effect that clause 1.2.4, which sets out restrictions for specified items for attendances by specialists and consultant physicians on the same day as they perform surgical operations, also applies to these telehealth items, in line with the original policy intent.

Items 4 and 5 amend the descriptor for item 132 to update co-claiming restrictions between face-to-face attendance item 132 and related telehealth attendance items. Specifically, the changes will specify that item 132 does not apply where a service to which item 92440 (or other items specified in paragraph (c) of item 132) applies takes place on the same day by the same consultant physician, and does not apply where either item 132 or 92422 has applied in the preceding 12 months to an attendance on the patient by the same consultant physician. These changes will align the service with the original policy intent.

Item 6 and 7 amend the descriptor for item 133 to update co-claiming restrictions between face-to-face attendance item 133 and related telehealth attendance items. Specifically, the changes will specify that item 133 does not apply where a service to which item 92440 (or other items specified in paragraph (c) of item 132) applies took place on the same day by the same practitioner. Additionally, it will specify that item 133 applies where a service to which item 132 or 92422 applies was provided to the patient by the same consultant physician or a locum tenens in the preceding 12 months, and where not more than two services to which item 133, 92423 or 92443 applies have been provided to the patient by the same consultant physician or a locum tenens in any 12 month period. These changes will align the service with the original policy intent.

Item 8 amends the descriptor for item 141 to include reference to telehealth items 91825 and 92440 in paragraph (d). This will specify that item 141 does not apply where a service to which item 91825 or 92440 (or other items set out in paragraph (d)) applies has been provided to the patient on the same day by the same practitioner. These changes will align the service with the original policy intent.

Item 9 amends the descriptor for item 143 to include reference to telehealth items 91825 and 92440 in paragraph (c). This will specify that item 143 does not apply where a service to which item 91825 or 92440 (or any other item specified in paragraph (c)) applies has been provided to the patient on the same day by the same practitioner. These changes will align the service with the original policy intent.

Item 10 amends the descriptor for item 145 to include reference to telehealth items 91825 and 92440 in paragraph (d). This will specify that item 145 does not apply where a service to which item 91825 or 92440 (or any other item specified in paragraph (d)) applies has been provided to the patient on the same day by the same practitioner. These changes will align the service with the original policy intent.

Item 11 amends the descriptor for item 147 to include reference to telehealth items 91825 and 92440 in paragraph (c). This will specify that item 147 does not apply where a service to which item 91825 or 92440 (or any other item specified in paragraph (c)) applies has been provided to the patient on the same day on the same day by the same practitioner. These changes will align the service with the original policy intent.

Item 12 makes an administrative amendment to clause 2.11.3 to include reference to telehealth item 92436. The amendment will specify that item 92436 (or any other item specified in clause 2.11.3) may be provided by video conference rather than at consulting rooms, if the service is associated with a service to which item 294 applies. This will align clause 2.11.3 with the original policy intent for item 92436.

Item 13 amends item 294 to include reference to telehealth items 92436 or 92444 to paragraph (b) of the item descriptor. This will specify that item 294 applies if, except for the requirement for the attendance to be at consulting rooms, item 92436 or 92444 (or any other item specified in paragraph (b)) would otherwise apply to the attendance. These changes will align the service with the original policy intent.

Items 14 and 15 amend the descriptor for item 6023 to clarify and update co-claiming restrictions between face-to-face attendance item 6023 and related telehealth attendance items. Specifically, the changes will specify that item 6023 does not apply where a service to which item 91825, 92422, 92423, 92440 or 92443 (or any other item specified in paragraph (c)) applies took place on the same day by the same addiction medicine specialist, and will clarify the existing co-claiming restriction in paragraph (d). These changes will align the service with the original policy intent.

Items 16 and 17 amend the descriptor for item 6024 to clarify and update co-claiming restrictions between face-to-face attendance item 6024 and related telehealth attendance items. Specifically, the changes will specify that item 6024 does not apply where a service to which item 91825, 92422, 92423, 92440 or 92443 (or any other item specified in paragraph (c)) applies took place on the same day by the same addiction medicine specialist, and will clarify and consolidate the existing co-claiming restrictions in the current paragraphs (d), (e) and (f). These changes will align the service with the original policy intent.

Items 18 and 19 amend the descriptor for item 6057 to clarify and update co-claiming restrictions between face-to-face attendance item 6057 and related telehealth attendance items. Specifically, the changes will specify that item 6057 does not apply where a service to which item 91825, 92422, 92423, 92440 or 92443 (or any other item specified in paragraph (c)) applies took place on the same day by the same sexual health medicine specialist, and will clarify the existing co-claiming restriction in paragraph (d). These changes will align the service with the original policy intent.

Items 20 and 21 amend the descriptor for item 6058 to clarify and update co-claiming restrictions between face-to-face attendance item 6058 and related telehealth attendance items. Specifically, the changes will specify that item 6058 does not apply where a service to which item 91825, 92422, 92423, 92440 or 92443 (or any other item specified in paragraph (c)) applies took place on the same day by the same  sexual health medicine specialist, and will clarify the existing co-claiming restrictions in paragraphs (d), (e) and (f). These changes will align the service with the original policy intent.

Item 22 amends subclause 2.31.7(4) to include reference to telehealth items 92440 and 92443. The change will specify that item 90261 does not apply to a service performed in association with a service to which item 92440 and 92443 (or any other item specified in subclause 2.31.7(4)) applies.

Part 2—Definition of eligible disability

Health Insurance (General Medical Services Table) Regulations 2021

Item 23 amends paragraph (f) of the definition of “eligible disability” to replace the word “Fragile” with “fragile”, such that paragraph (f) will refer to “fragile X syndrome”. This amendment will correct the capitalisation to reflect the appropriate clinical term for this condition.

Item 24 amends paragraph (p) of the definition of “eligible disability” to change the word “disorder” to “syndrome”, such that paragraph (p) will refer to “Rett’s syndrome”. This amendment will reflect updated clinical terminology for this condition.

Item 25 expands the list of eligible disabilities set out in clause 2.6.1 to include specified severe speech and language disorders, including:

• stuttering;
• speech sound disorders, including an articulation disorder, a phonological disorder, childhood apraxia of speech (also known as dyspraxia, developmental verbal dyspraxia or speech apraxia), dysarthria;
• cleft lip;
• cleft palate; and
• cleft lip and palate.

This amendment will broaden the scope of eligible disabilities to reflect contemporary clinical practice and terminology, enabling people with specified severe speech and language disorders to access a number of assessment and treatment services.

Part 3—Health assessments

Health Insurance (General Medical Services Table) Regulations 2021

Items 26 and 27 amend subclause 1.2.5(1) to insert reference to face-to-face health assessment items 701 to 707 and 715, and to the telehealth equivalent services 92004 and 92011. Clause 1.2.5 sets out a range of matters included in a professional attendance, such as evaluating the patient’s condition and formulating a plan for the management of the patient’s condition, with subclause 1.2.5(1) specifying the specific items that are subject to clause 1.2.5.

Item 28 repeals and substitutes the descriptor for item 228, which describes a service for a health assessment by a prescribed medical practitioner for a patient of Aboriginal or Torres Strait Islander descent. Previously, clinical requirements and restrictions for the service were listed under several clauses, which will be amended and repealed by amendment items 29 and 34, respectively. The substituted item 228 will therefore consolidate relevant service requirements for the item within the descriptor.

Item 29 repeals and substitutes clause 2.15.3 to clarify the application of items 715 and 228, set out a definition of an Aboriginal and Torres Strait Islander health assessment, and reflect the removal of the age-based stratifications in clauses 2.15.11 and 2.15.12 in relation to Aboriginal and Torres Strait Islander health assessments. This will ensure that the clinical requirements for health assessment services are consistent for people of Aboriginal and Torres Strait Islander descent regardless of age.

Item 30 amends paragraph 2.15.6(2)(e) to remove the specific references to “influenza, tetanus and pneumococcus”. This will have the effect that the health assessment will be in relation to the patient’s general immunisation status rather than any specific immunisations.

Items 31, 32 and 33 amend subclause 2.15.8(2), which sets out the requirements for a health assessment for a person with an intellectual disability. Specifically, paragraph 2.15.8(2)(g) will be repealed and substituted to remove the references to specific vaccinations, and instead refer to the patient’s general immunisation status. Paragraph 2.15.8(2)(j) will also be amended to remove the reference to “papanicolaou smears”, and a new paragraph 2.15.8(2)(ja) will be inserted to provide for checking the patient’s participation in relevant national screening programs.

Item 34 repeals clauses 2.15.11, 2.15.12 and 2.15.13, which relate to the clinical requirements for practitioners when conducting a health assessment for people of Aboriginal or Torres Strait Islander descent. These requirements will be added to the relevant item descriptors for the health assessment items (see amendment items 28 and 35), which will consolidate all relevant requirements for the services in the descriptors for item 228 and 715. This will also have the effect of removing age-based stratifications set out in clauses 2.15.11, 2.15.12 and 2.15.13 for children, adults and older persons.

Item 35 repeals and substitutes the descriptor for item 715, which describes a service for a health assessment by a general practitioner for a patient of Aboriginal or Torres Strait Islander descent. Previously, clinical requirements and restrictions for the service were listed under several clauses, which will be amended and repealed by amendment items 27 and 32, respectively. The amendment will consolidate relevant service requirements for item 715 within the descriptor.

Part 4—Miscellaneous diagnostic procedures and investigations—cardiovascular

Health Insurance (General Medical Services Table) Regulations 2021

Item 36 repeals and substitutes paragraph (a) of the descriptor for item 11707 to require that the service requires a trace to be provided to a specialist or consultant physician for a formal report. This will remove the previous requirements that the trace is required to inform clinical decision making, is reviewed in a clinically appropriate timeframe, and does not need to be fully interpreted or reported on.

Item 37 repeals and substitutes the descriptor for item 11714 to specify updated conditions for 12-lead electrocardiography, including inserting additional requirements for information to be included in the clinical note for the service. The amendment will ensure appropriate clinical documentation for the service.

Part 5—Radiation oncology

Health Insurance (General Medical Services Table) Regulations 2021

Item 38 makes an administrative amendment to replace the heading for “Subgroup 1—Targeted intraoperative radiation therapy” of Group T2 with “Subgroup 10—Targeted intraoperative radiation therapy”. This will have the effect of moving item 15900, which is the only item listed under the current Subgroup 1, to the new Subgroup 10 of Group T2.

Item 39 makes an administrative amendment to replace the heading for “Subgroup 2—Megavoltage” of Group T2 with “Subgroup 11—Megavoltage Post 1 July 2024”. This will have the effect of moving the items listed under the current Subgroup 2 to the new Subgroup 11.

Items 40, 41, 42 and 43 amend paragraph (a) of the descriptors to items 15912 and 15916, and paragraph (b) of the descriptors to items 15938 and 15940, to include reference to items 15910 or 15914 in the paragraphs. This will clarify that items 15912, 15916, 15938 and 15940 apply where an initial treatment plan has been previously prepared at a level that is equivalent to or higher than that described in item 15910 or 15914.

Item 44 makes an administrative amendment to replace the heading for “Subgroup 3—Kilovoltage” of Group T2 with “Subgroup 12—Kilovoltage”. This will have the effect of moving the items listed under the current Subgroup 3 to the new Subgroup 12.

Item 45 makes an administrative amendment to replace the heading for “Subgroup 4—Brachytherapy” of Group T2 with “Subgroup 13—Brachytherapy Post 1 July 2024”. This will have the effect of moving the items listed under the current Subgroup 4 to the new Subgroup 13.

Part 6—Botulinum toxin

Health Insurance (General Medical Services Table) Regulations 2021

Item 46 repeals and substitutes the descriptor for item 18354 to update the clinical requirements for botulinum toxin injections for dynamic equinus foot deformity. The amendment will specify that the service is not restricted to patients with ambulant cerebral palsy, and will specify that the service includes injection of IncobotulinumtoxinA (Xeomin).

Item 47 inserts new item 18355 to introduce a new service for injection of Xeomin for chronic sialorrhea, if the condition is due to a neurological or neurodevelopmental disorder.

Part 7—Surgical operations—cardio‑thoracic

Health Insurance (General Medical Services Table) Regulations 2021

Item 48 amends subclause 5.10.17(2) to add reference to item 38620 (see amendment item 52) to the list of items that are excluded from the operation of the subclause. Subclause 5.10.17(2) lists items that must be performed using open exposure or minimally invasive surgery which excludes percutaneous and transcatheter techniques. The amendment will have the effect that item 38620 does not need to be performed using open exposure or minimally invasive surgery.

Items 49 and 51 amend the descriptors for items 38376 and 38616 to clarify that the imaging described in those items refers to “imaging performed by the same practitioner”. This is a minor administrative amendment to accurately reflect the policy intention for those items. 

Item 50 repeals and substitutes the descriptor for item 38511, which sets out clinical requirements for coronary artery bypass using tissue stabilisers. Specifically, the new item descriptor includes a frequency limitation specifying that item 38511 only applies once in conjunction with each service to which item 38502 applies.

Item 52 inserts new item 38620 into existing “Subgroup 6—Cardio‑thoracic” of Group T8 for insertion of a durable left ventricular assist device (LVAD) as destination therapy. The new service is intended to be used as a permanent life-sustaining treatment for eligible patients.

Item 53 amends the descriptor for item 38621 for removal of LVAD or right ventricular assist device (RVAD) to insert the words “or replacement” to specify that the service extends to the replacement of LVAD or RVAD.

Item 54 inserts a new paragraph (c) into the descriptor for item 45018 to limit the application of the item. Specifically, this will provide that item 45018 does not apply where a service to which item 38502 applies is rendered.

Part 8—Hospital‑only services

Health Insurance (General Medical Services Table) Regulations 2021

Items 55 to 58 and 60 to 65 amend the descriptors for various items to add in the in-hospital only flag “(H)”. This will specify that the affected services are to be provided in hospital settings only.

Items 59 and 66 repeal and substitute the descriptors for various items such that the new item descriptors do not include the in-hospital only flag “(H)”. This will specify that the services are not restricted to being provided in hospital settings only. Additionally, amendment item 59 will remove the requirement that the service described in item 30281 must be performed under general anaesthesia.

Part 9—Patient end support for video conferencing consultations

Health Insurance (General Medical Services Table) Regulations 2021

Item 67 introduces 12 new items (373, 374, 375, 376, 377, 378, 379, 380, 381, 382, 390 and 391) into new “Subgroup 13—Prescribed medical practitioner patient end support for video conferencing consultations with specialists or consultant physicians” of existing “Group A7—Acupuncture and non‑specialist practitioner items”, inserting the new items into the end of the table setting out items in Group A7 at clause 2.10.2.

The 12 new items will provide for patient end support professional attendances by a prescribed medical practitioner providing clinical support if:

• the attendance is provided in person, and
• the patient who is receiving the service at the time of the attendance is participating in a video conference service from a specialist or consultant physician, and
• the patient is in the same room as the prescribed medical practitioner providing the in person service mentioned above. 

Item 68 introduces 12 new items (2484, 2485, 2486, 2487, 2488, 2489, 2490, 2491, 2492, 2493, 2494, 2495) into new “Subgroup 1—Prescribed medical practitioner patient end support for video conferencing consultations with specialists or consultant physicians” of new group “Group A48—General practitioner attendances—telehealth related”. These new items are inserted into a table to clause 2.18.1 in the new Division 2.18.

The 12 new items will provide for patient end support professional attendances by a general practitioner providing clinical support if:

• the attendance is provided in person; and
• the patient who is receiving the service at the time of the attendance is participating in a video conference service from a specialist or consultant physician; and
• the patient is in the same room as the general practitioner providing the service mentioned above. 

Health Insurance Regulations 2018

Item 69 amends subsection 28(1) to insert reference to new items 373, 374, 375, 376, 377, 378, 379, 380, 381, 382, 390, 391 (see amendment item 67) under new table item 16A. This will have the effect that the Medicare benefit for each of these items is 100% of the relevant schedule fee.

Item 70 amends subsection 28(1) to insert reference to new items 2484, 2485, 2486, 2487, 2488, 2489, 2490, 2491, 2492, 2493, 2494, 2495 (see amendment item 68) under new table item 28ZH. This will have the effect that the Medicare benefit for each of these items is 100% of the relevant schedule fee.

Schedule 3—Pathology services

Item 1 amends paragraph 1.2.3(2)(d) to update the drug names listed in the paragraph. Specifically, the change will replace the brand name “clozaril” with its generic name “clozapine”, and replace “sulphasalazine” with “sulfasalazine”, aligning drug names with the names listed on the Pharmaceutical Benefits Scheme (PBS).

Item 2 amends subparagraph 1.2.3(2)(f)(i) to update the spelling of drug names listed in the subparagraph. Specifically, the change will replace the name “cis-platinum” with “cisplatin”, and “cyclosporin” with “ciclosporin”, aligning drug names with the spelling listed on the PBS.

Item 3 repeals and substitutes the descriptors for items 73932, 73933, 73934 and 73935 for services related to pathology specimen collection in different settings. Specifically, this change will clarify the services that apply where a specimen is collected from a person in a care institution or a residential aged care facility, aligning the item descriptors with the original policy intent.

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. 1) Regulations 2026

These Regulations are 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 (2026 Measures No. 1) Regulations 2026 (the Regulations) is to amend 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 from 1 March 2026. The Regulations will introduce and amend Medicare Benefits Schedule (MBS) services as agreed to in the 2025-26 Budget, the 2025-26 and2023-24 Mid-Year and Economic Fiscal Outlook, and through 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 items for three dimensional tomosynthesis of the breast to clarify patient population and clinical indications;
• enable item 55080 to be requested by participating midwives and nurse practitioners;
• insert new item 18355 for IncobotulinumtoxinA (Xeomin) treatment of chronic sialorrhea, and amend existing item 18354 to allow for the use of Xeomin to treat spasticity of the lower limb;
• specify a co-claiming restriction for cardiac item 38502 and introduce a frequency limitation for the application of cardiac item 38511;
• update clinical requirements for electrocardiogram items 11707 and 11714;
• insert new item 38620 for insertion of a left ventricular assist device and amend existing item 38621 to extend to replacement of a left or right ventricular assist device;
• update the definition of “eligible disability” to include severe speech and language disorders;
• amend existing items and clauses to clarify requirements for health assessments;
• introduce 24 new items for patient end support services;
• clarify in and out of hospital requirements for various items, and amend surgical item 30281 to clarify its operation;
• amend level 3 megavoltage items 15912, 15916, 15938 and 15940 to clarify requirements for services;
• make administrative amendments to renumber existing Subgroups 1 – 4 of Group T2 (radiation oncology) as Subgroups 11 – 14;
• make consequential amendments to update co-claiming restrictions and referral clauses for claiming of telehealth items;
• make administrative amendments to pathology services to align drug names with spelling listed under the Pharmaceutical Benefits Scheme; and  
• make administrative amendments to four patient episode initiation items to clarify where services may be provided in relation to pathology specimen collection.

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 Regulations engage Articles 2, 16 and 26 of the International Covenant on Civil and Political Rights (ICCPR) specifically in relation to the right of equality and non-discrimination.

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 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, social security, as well as equality and non-discrimination by ensuring access to publicly subsidised medical services that are clinically relevant and cost-effective consistent with a universal health insurance program. The Regulations also advance these rights 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 arrangements for publicly subsidised medical services.

Mark Butler

Minister for Health and Ageing