Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Commonwealth Medicare Urgent Care Clinics Program – New South Wales Urgent Care Services) Direction (No. 1) 2026 - Legislation

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 Clinics Program – New South Wales Urgent Care Services) Direction (No. 1) 2026

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 Medicare Urgent Care Clinic Program – New South Wales Urgent Care Services) Direction (No. 3) 2025; 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:
1. between the Commonwealth (represented by the Department of Health, Disability and Ageing, ABN: 83 605 426 759) and the State of New South Wales (represented by the New South Wales Department of Health, ABN: 92 697 899 630) by New South Wales Urgent Care Services that have been assessed as meeting the requirements of the Commonwealth Medicare Urgent Care Clinics Program; and
2. for which items specified in Schedules A and B of this Direction and of the general medical services table (means the table prescribed under subsection 4(1) of the Act) and pathology service table (means the table prescribed under section 4A of the Act) and diagnostic imaging table (means the table prescribed under 4AA of the Act) relates; and
Where the professional service is provided to:

an eligible person (as defined in section 3 of the Act); and
a patient who also is not receiving a service which attracts a payment through Schedule L of the Addendum to the 2026-2031 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:
1. if the service is specified in Schedule A:
  1. at a practice location specified in Schedule C or D of this Direction; and
  2. by a general practitioner, prescribed medical practitioner or participating nurse practitioner who is registered to provide services with Services Australia under the Commonwealth Medicare Urgent Care Clinics Program mentioned in paragraph (2)(a).
2. if the service is specified in Schedule B:
1. at a practice location specified in Schedule D of this Direction; and
2. by a prescribed medical practitioner who is registered to provide services with Services Australia under the Commonwealth Medicare Urgent Care Clinics Program mentioned in paragraph (2)(a).

DECLARE that this Direction commences from 1 July 2026 and ceases to have effect at the end of 30 June 2027 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.

Date 24 June 2026

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 COMMONWEALTH MEDICARE Urgent care clinicS 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
A2		Other non‑referred attendances to which no other item applies		1		Other medical practitioner attendances			52, 53, 54, 57, 151
A5		Prolonged attendances to which no other item applies
A7		Acupuncture and non‑specialist practitioner items		3		Prescribed medical practitioner prolonged attendances to which no other item applies		214, 215, 218, 219, 220
				10		Prescribed Medical Practitioner after‑hours attendances to which no other item applies		733, 737, 741, 745, 2197
A22		General practitioner after-hours attendances to which no other item applies							5000, 5020, 5040, 5060, 5071
A23		Other non‑referred after‑hours attendances to which no other item applies							5200, 5203, 5207, 5208, 5209
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, 30052, 30055, 30061, 30064, 30068, 30099, 30207, 30216, 30219
				2		Colorectal			32147, 32174
				5		Urological			36800
				8		Ear, nose and throat			41500, 41647, 41659, 41677
				9		Ophthalmology			42644, 42650
				14		Hand or wrist surgery			46513, 46528, 46531
				15		Orthopaedic			47015, 47018, 47024, 47030, 47042, 47057, 47063, 47069, 47301, 47348, 47354, 47361, 47387, 47423, 47444, 47453, 47462, 47466, 47471, 47543, 47561, 47579, 47595, 47637, 47663, 47735, 47904, 47915, 47916
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, 82216, 82226, 82227

*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 Clinics Program.

Diagnostic Imaging Services Table

Group	Group Name	Subgroup	Subgroup Name	Item Number
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	57357
I3	Diagnostic Radiology	1	Radiographic Examination Of Extremities	57506, 57509, 57512, 57515, 57518, 57521, 57522, 57523, 57524, 57527
		2	Radiographic Examination Of Shoulder Or Pelvis	57700, 57703, 57706, 57709, 57712, 57715
		3	Radiographic Examination Of Head	57901, 57905, 57907, 57915, 57921, 57924, 57927, 57930, 57933, 57945, 57960, 57963, 57969
		4	Radiographic Examination Of Spine	58100, 58103, 58106, 58108, 58109, 58112, 58115
		6	Radiographic Examination Of Thoracic Region	58500, 58503, 58509, 58521, 58524, 58527
		7	Radiographic Examination Of Urinary Tract	58700
		8	Radiographic Examination Of Alimentary Tract And Biliary System	58900, 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
I4	Nuclear Medicine Imaging	1	Nuclear medicine- non PET	61329, 61345, 61357, 61421, 61425, 61473
I4	Nuclear Medicine Imaging	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
I6	Management of bulk‑billed services			64990, 64991, 64992, 64993, 64994, 64995

Pathology Services Table

Group	Group Name	Item Number
P9	Simple basic pathology tests	73806, 73809, 73813, 73833, 73836
P12	Management of bulk‑billed services	74990, 74991, 75861, 75862, 75863, 75864

SCHEDULE B

MEDICARE BENEFITS SCHEDULE ITEMS WHERE A CLINIC IS LOCATED IN MMM 2-7 LOCATIONS

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, 301

Group

Group Name

Subgroup

Subgroup Name

Item Number

Acupuncture and non-specialist practitioner items

Prescribed medical practitioner attendance to which no other item applies

179, 185, 189, 203, 301

SCHEDULE C

APPROVED MMM 1 PRACTICE LOCATIONS AS AGREED UNDER THE URGENT CARE SERVICES AGREEMENT BETWEEN THE COMMONWEALTH AND THE STATE OF NEW SOUTH WALES

Approved primary care locations:

STATE	MMM 1 LOCATION	PRACTICE NAME	LEGAL NAME	STREET ADDRESS
NSW	Auburn	NAS Advance Medical Centre Auburn	NOUSSAIR & NOSIR PTY LTD & RAOUL SELIM PTY LTD	79 Auburn Road, Auburn NSW 2144,
NSW	Belmore	Belmore Medical Services	Belmore Medical Services Pty Ltd	479 Burwood Road, Belmore NSW 2192
NSW	Caringbah	Caringbah Medical and Dental Centre	The Trustee for ARTLU UNIT TRUST	42 President Avenue, Caringbah NSW 2229
NSW	Castle Hill	Health Zone Barwell Medical Centre	Health Zone Pty Ltd	16, 7-9 Barwell Avenue, Castle Hill NSW 2154
NSW	Green Square	Green Square Health	Core Clinical Solution Pty Ltd	4/965 Bourke Street, Waterloo NSW 2017
NSW	Gregory Hills	My Family Health Medical Centre	The Trustee for ak and ds unit trust	Unit 2, 3 Rodeo Road, Gregory Hills NSW 2557
NSW	Marsden Park	Castle Medical Marsden Park	Castle Medical Centre Marsden Park PTY LTD	5/101 Elara Blvd, Marsden Park NSW 2765
NSW	North Richmond	MyHealth North Richmond	MyHealth North Richmond Pty Ltd	North Richmond Village Level 1, 6-16 Riverview Street, North Richmond NSW 2754

SCHEDULE D

APPROVED MMM 2-7 PRACTICE LOCATIONS AS AGREED UNDER THE URGENT CARE SERVICES AGREEMENT BETWEEN THE COMMONWEALTH AND THE STATE OF NEW SOUTH WALES

Approved primary care locations:

STATE	MMM 3 LOCATION	PRACTICE NAME	LEGAL NAME	STREET ADDRESS
NSW	Orange	Bloomfield Medical Group	The Trustee for BMG Service Trust	Level 2, 1521 Forest Road, Orange NSW 2800

Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Commonwealth Medicare Urgent Care Clinics Program – New South Wales Urgent Care Services) Direction (No. 1) 2026

Administered by Department of Health, Disability and Ageing

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