AUSTRALIAN GOVERNMENT
DEPARTMENT OF HEALTH, DISABILITY AND AGEING
HEALTH INSURANCE ACT 1973
Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Commonwealth Medicare Urgent Care Clinic Program – Victorian State Urgent Care Clinics) Direction (No. 1) 2025
I, Nigel Murray, Assistant Secretary, MBS Policy and Specialist Programs Branch, Medicare Benefits and Digital Health Division, Health Resourcing Group, delegate for the Minister for Health and Ageing, acting under subsection 19(2) of the Health Insurance Act 1973 (the Act), hereby:
- REPEAL the Health Insurance (Medicare Benefits Payable in Respect of Professional Services –Commonwealth Urgent Care Clinic Program – Victorian Priority Primary Care Centres) Direction (No. 3) 2024; and
- DIRECT that Medicare Benefits shall be payable in respect of:
- A professional service (as defined in section 3 of the Act) which has been agreed to be provided:
- between the Commonwealth (represented by the Department of Health and Aged Care, ABN: 83 605 426 759) and the State of Victoria (represented by the Victorian Department of Health, ABN: 74 410 330 756) by a Victorian Urgent Care Clinic that has been assessed as meeting the requirements of the Commonwealth Urgent Care Clinic program; and
- for which items specified in Schedules A, B and C of this Direction and of the general medical services table (means the table prescribed under subsection 4(1) of the Act), the diagnostic imaging services table (means the table prescribed under section 4AA of the Act) or the pathology service table (means the table prescribed under section 4A of the Act) relates; and
- Where the professional service is provided to:
- an eligible person (as defined in section 3 of the Act);
- a patient who is not receiving the service as part of an episode of hospital treatment (as defined in section 121-5 of the Private Health Insurance Act 2007); and
- a patient who also is not receiving a service which attracts a payment through the 2020-2025 Addendum to the National Health Reform Agreement for a service rendered to a public patient; and
- The professional services referred to in paragraph (2)(a) must be provided:
- if the service is specified in Schedule A:
- at a practice location specified in Schedule D or E of this Direction; and
- by a general practitioner, prescribed medical practitioner or participating nurse practitioner who is registered to provide services with Services Australia under the Commonwealth Urgent Care Clinic program mentioned in paragraph (2)(a).
- if the service is specified in Schedule B:
- at a practice location specified in Schedule D of this Direction; and
- by a prescribed medical practitioner who is registered to provide services with Services Australia under the Commonwealth Urgent Care Clinic program mentioned in paragraph (2)(a).
- if the service is specified in Schedule C:
- at a practice location specified in Schedule E of this Direction; and
- by a prescribed medical practitioner who is registered to provide services with Services Australia under the Commonwealth Urgent Care Clinic program mentioned in paragraph (2)(a).
- if the service is specified in Schedule A:
- DECLARE that this Direction commences on 1 June 2025 and ceases to have effect at the end of 30 June 2026 unless earlier revoked.
Note, a number of expressions used in this direction are defined in the below instruments:
- Health Insurance Act 1973: the meaning of general practitioner, participating nurse practitioner and professional service; and
- Health Insurance (General Medical Services Table) Regulations 2021: the meaning of prescribed medical practitioner.
Dated 28 May 2025
Nigel Murray
Assistant Secretary
MBS Policy and Specialist Programs Branch
Medicare Benefits and Digital Health Division
Health Resourcing Group
Department of Health, Disability and Ageing
SCHEDULE A
MEDICARE BENEFITS SCHEDULE ITEMS AS AGREED under the Urgent care clinic program
For services listed in the below tables, all provisions of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under the National Health Act 1953, relating to medical services, professional services or items apply.
General Medical Services Table
Group | Group Name | Subgroup | Subgroup Name | Item Number |
A1 | General practitioner attendances to which no other item applies | 3, 23, 36, 44, 123 | ||
A5 | Prolonged attendances to which no other item applies | |||
A7 | Acupuncture and non-specialist practitioner items | 9 | Prescribed medical practitioner mental health care | 279 |
A20 | GP Mental health treatment | 1 | GP mental health treatment plans | 2713 |
A22 | General practitioner after-hours attendances to which no other item applies | 5000, 5020, 5040, 5060, 5071 | ||
D1 | Miscellaneous diagnostic procedures and investigations | 6 | Cardiovascular | 11707 |
T4 | Obstetrics | 16500 | ||
T7 | Regional or field nerve blocks | 18213 | ||
T8 | Surgical operations | 1 | General | 30003, 30006, 30026, 30029, 30032, 30035, 30038, 30042, 30045, 30049, 30061, 30064, 30099, 30216, 30219 |
2 | Colorectal | 32147 | ||
5 | Urological | 36800 | ||
8 | Ear, nose and throat | 41500, 41659, 41677 | ||
9 | Ophthalmology | 42644, 42650 | ||
14 | Hand or wrist surgery | 46513, 46528, 46531 | ||
15 | Orthopaedic | 47904, 47915, 47916, 47015, 47030, 47042, 47057, 47063, 47069, 47301, 47348, 47354, 47361, 47387, 47423, 47444, 47453, 47462, 47466, 47471, 47543, 47561, 47579, 47595, 47637, 47663, 47735 | ||
M1 | Management of bulk-billed services | 1 | Management of general bulk-billed services | 10990, 10991, 10992, 75855, 75856, 75857, 75858 |
2 | General support service | 75870, 75871, 75872, 75873, 75874, 75875, 75876 | ||
M14 | Nurse practitioners | 1 | Nurse practitioners | 82200, 82205, 82210, 82215 |
*Note: Claims under any item in Group A7 in the General Medical Services Table may only be exempt from subsection 19(2) of the Act when the services are claimed by a Prescribed Medical Practitioner operating under the Medicare Urgent Care Clinic Program.
Diagnostic Imaging Services Table
I1 | Ultrasound | 1 | General | 55028, 55032, 55036, 55038, 55048, 55054, 55065, 55066, 55070, 55071, 55076 |
3 | Vascular | 55238, 55244, 55246, 55252, 55274, 55276, 55278 | ||
4 | Urological | 55600 | ||
5 | Obstetric And Gynaecological | 55700, 55704, 55706, 55707, 55712, 55718, 55721 | ||
6 | Musculoskeletal | 55812, 55844, 55848, 55850, 55856, 55858, 55860, 55862, 55864, 55866, 55868, 55870, 55872, 55874, 55876, 55878, 55880, 55882, 55884, 55886, 55888, 55890, 55892, 55894 | ||
7 | Transthoracic Echocardiogram and Stress Echocardiogram | 55126, 55132, 55133, 55141 | ||
I2 | Computed Tomography | 1 | Head | 56001, 56007, 56013, 56016, 56022, 56028, 56030, 56036, |
2 | Neck | 56101, 56107 | ||
3 | Spine | 56220, 56221, 56223, 56226, 56233, 56237, | ||
4 | Chest and upper abdomen | 56301, 56307 | ||
5 | Upper abdomen only | 56401, 56407, 56409, 56412 | ||
6 | Upper abdomen and pelvis | 56501, 56507 | ||
7 | Extremities | 56620, 56622, 56623, 56627, 56629, | ||
8 | Chest, abdomen, pelvis and neck | 56801, 56807 | ||
9 | Brain, chest and upper abdomen | 57001, 57007 | ||
11 | Interventional techniques | 57341 | ||
12 | Spiral angiography | 57352, 57353, 57354, 57357 | ||
I3 | Diagnostic Radiology | 1 | Radiographic Examination Of Extremities | 57509, 57515, 57521, 57523, 57527 |
2 | Radiographic Examination Of Shoulder Or Pelvis | 57703, 57709, 57712, 57715 | ||
3 | Radiographic Examination Of Head | 57901, 57907, 57915, 57921, 57924, 57927, 57945, 57960, 57963, 57969 | ||
4 | Radiographic Examination Of Spine | 58100, 58103, 58106, 58109, 58112, 58115 | ||
6 | Radiographic Examination Of Thoracic Region | 58503, 58509, 58521, 58524 | ||
7 | Radiographic Examination Of Urinary Tract | 58700 | ||
8 | Radiographic Examination Of Alimentary Tract And Biliary System | 58903, 58909 | ||
9 | Radiographic Examination For Localisation Of Foreign Bodies | 59103 | ||
10 | Radiographic Examination Of Breasts | 59300, 59302, 59303, 59305, 59314 | ||
12 | Radiographic Examination With Opaque Or Contrast Media | 59751 | ||
17 | Interventional Techniques | 61109 | ||
I4 | Nuclear Medicine Imaging | 1 | Nuclear medicine- non PET | 61329, 61345, 61357, 61421, 61425, 61473 |
3 | Adjunctive services | 61505 | ||
I5 | Magnetic Resonance Imaging | 1 | Scan Of Head – For Specified Conditions | 63001, 63007 |
2 | Scan Of Head - For Specified Conditions | 63040, 63049, 63058, 63064 | ||
6 | Scan Of Spine - One Region Or Two Contiguous Regions - For Infection or Tumour | 63151 | ||
7 | Scan Of Spine - One Region Or Two Contiguous Regions - For Other Conditions | 63161, 63167, 63173, 63176, 63179, 63182, 63185 | ||
8 | Scan Of Spine - Three Contiguous Regions Or Two Non-Contiguous Regions - For Infection or Tumour | 63201 | ||
9 | Scan Of Spine - Three Contiguous Regions Or Two Non-Contiguous Regions - For Other Conditions | 63219, 63228 | ||
11 | Scan Of Musculoskeletal System - For Tumour, Infection or Osteonecrosis | 63301 | ||
12 | Scan Of Musculoskeletal System - For Joint Derangement | 63322, 63325, 63328, 63331, 63334, 63337, 63340 | ||
19 | Scan Of Body - For Specified Conditions | 63461 | ||
20 | Scans Of Pelvis And Upper Abdomen - For Specified Conditions | 63740 | ||
33 | Scan of Body - Person Under the Age of 16 Years - General Practice Requests | 63507, 63513, 63522 | ||
34 | Scan of Body - Person Over the Age of 16 Years - General Practice Requests | 63551, 63554, 63557, 63560 |
Pathology Services Table
Group | Group Name | Item Number |
|
|
|
P1 | Haematology | 65060, 65070, 65072, 65075, 65078, 65081, 65090, 65093, 65096, 65111, 65114, 65120, 65123, 65126, 65129, 65137, 65144, 65156, 65178, 65179 |
P2 | Chemical | 66500, 66503, 66506, 66509, 66512, 66518, 66519, 66536, 66542, 66548, 66551, 66554, 66560, 66563, 66566, 66584, 66593, 66596, 66605, 66607, 66623, 66626, 66632, 66635, 66638, 66641, 66650, 66653, 66655, 66656, 66659, 66660, 66665, 66686, 66695, 66697, 66698, 66701, 66704, 66707, 66716, 66719, 66722, 66725, 66728, 66731, 66734, 66750, 66751, 66752, 66756, 66758, 66764, 66767, 66770, 66779, 66800, 66803, 66812, 66816, 66819, 66820, 66822, 66828, 66833, 66837, 66838, 66839, 66840, 66841, 66900 |
P3 | Microbiology | 69300, 69303, 69306, 69309, 69312, 69317, 69318, 69319, 69321, 69324, 69330, 69333, 69336, 69345, 69354, 69363, 69384, 69387, 69390, 69393, 69396, 69400, 69401, 69405, 69411, 69413, 69415, 69471, 69474, 69475, 69478, 69480, 69481, 69482, 69483, 69484, 69488, 69491, 69494, 69495, 69496, 69497, 69498, 69499 |
P4 | Immunology | 71057, 71058, 71059, 71060, 71069, 71071, 71072, 71073, 71075, 71079, 71083, 71085, 71097, 71099, 71101, 71103, 71106, 71119, 71123, 71125, 71143, 71147, 71151, 71153, 71155, 71157, 71163, 71164, 71165, 71165, 71166, 71167, 71168, 71180, 71183, 71186, 71198, 71200 |
P5 | Tissue Pathology | 72816, 72817, 72818, 72823, 72824, 72825, 72830, 72846, 72847, 72849 |
P6 | Cytology | 73045, 73071, 73072, 73074, 73076 |
P7 | Genetics | 73289, 73292, 73308, 73311, 73314, 73317, 73320, 73325 |
P8 | Infertility and Pregnancy Test | 73523, 73527, 73529 |
P9 | Simple basic pathology tests | 73806 |
P10 | Patient Episode Initiation | 73922, 73924, 73926, 73928, 73930, 73932, 73934, 73936, 73937, 73938, 73939 |
P11 | Specimen Referred | 73940 |
SCHEDULE B
MEDICARE BENEFITS SCHEDULE ITEMS where a clinic is located in MMM 1 locations
For services listed in the below tables, all provisions of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under the National Health Act 1953, relating to medical services, professional services or items apply.
General Medical Services Table
Group | Group Name | Subgroup | Subgroup Name | Item Number |
A2 | Other non‑referred attendances to which no other item applies | 1 | Other medical practitioner attendances | 52, 53, 54, 57 |
A23 | Other non‑referred after‑hours attendances to which no other item applies | 5200, 5203, 5207, 5208 | ||
*Note: Claims under any item in Group A2 and A23 in the General Medical Services Table may only be exempt from subsection 19(2) of the Act when the services are claimed by a Prescribed Medical Practitioner operating under the Medicare Urgent Care Clinic Program.
SCHEDULE C
MEDICARE BENEFITS SCHEDULE ITEMS where a clinic is located in MMM 2-7 locations
For services listed in the below tables, all provisions of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under the National Health Act 1953, relating to medical services, professional services or items apply.
General Medical Services Table
Group | Group Name | Subgroup | Subgroup Name | Item Number |
A7 | Acupuncture and non‑specialist practitioner items | 2 | Prescribed medical practitioner attendance to which no other item applies | 179, 185, 189, 203 |
10 | Prescribed medical practitioner after‑hours attendances to which no other item applies | 733, 737, 741, 745 |
*Note: Claims under any item in Group A7 in the General Medical Services Table may only be exempt from subsection 19(2) of the Act when the services are claimed by a Prescribed Medical Practitioner operating under the Medicare Urgent Care Clinic Program.
SCHEDULE D
Approved MMM 1 PRACTICE LOCATIONS As agreed under the Priority Primary Care Centre agreement between the commonwealth and the STATE OF VICTORIA
Approved primary care locations:
State | MMM1 Location | Practice Name | Legal Name | Street Address |
VIC | Craigieburn | Craigieburn Medical and Dental Centre | The Trustee for ARTLU UNIT TRUST | 70 Central Park Avenue, Craigieburn VIC 3064 |
VIC | Forest Hill | Forest Hill Medical and Dental Centre | The Trustee for ARTLU UNIT TRUST | 490-524 Springvale Road, Forest Hill VIC 3131 |
VIC | Monash Children’s | Interconnect Healthcare - Monash Children’s | The Trustee for Interconnect Healthcare Unit Trust | Monash Children's Hospital, 246 Clayton Road, Clayton VIC 3168 |
VIC | Moonee Ponds | Moonee Ponds Medical and Dental Centre | The Trustee for ARTLU UNIT TRUST | 34/46 Holmes Road, Moonee Ponds VIC 3039 |
VIC | Richmond | Access Health and Community Richmond | ACCESS HEALTH AND COMMUNITY LIMITED | 21-31 Goodwood Street, Richmond VIC 3121 |
VIC | Royal Children’s Hospital | CoHealth | CoHealth Limited | Royal Children’s Hospital, 50 Flemington Road, Parkville VIC 3052 |
VIC | Sunshine | Sunshine Medi Health | The Trustee for Sunshine Medi‑Health Unit Trust | 421 Ballarat Road, Sunshine VIC 3020 |
SCHEDULE E
Approved MMM 2-7 PRACTICE LOCATIONS As agreed under the Priority Primary Care Centre agreement between the commonwealth and the STATE OF Victoria
Approved primary care locations:
State | MMM 2 Location | Practice Name | Legal Name | Street Address |
VIC | Wodonga | Wodonga Sarkon Medical | Sarkon Healthcare Pty Ltd | White Box Rise Shopping Centre, Shop 1A-2, 81 Victoria Cross Parade, Wodonga VIC 3690 |
State | MMM 3 Location | Practice Name | Legal Name | Street Address |
VIC | Latrobe | Latrobe Community Health Service Limited | Latrobe Community Health Service Limited | 42-44 Fowler Street, Moe VIC 3825 |
VIC | Mildura | Sunraysia Community Health | Sunraysia Community Health Services Limited | 137 Thirteenth Street, Mildura VIC 3500 |
VIC | Warrnambool | Epic Health | EPICHEALTH PTY LTD | 3 Banyan Street, Warrnambool VIC 3280 |
State | MMM 4 Location | Practice Name | Legal Name | Street Address |
VIC | Baw Baw | Central Clinic Warragul | The Trustee for Barkly Street Medical Trust | 170 Normanby Street, Warragul VIC 3820 |