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Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Commonwealth Medicare Urgent Care Clinics Program – New South Wales Urgent Care Services) Direction (No. 3) 2025

Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Commonwealth Medicare Urgent Care Clinics Program – New South Wales Urgent Care Services) Direction (No. 3) 2025

Administered by Department of Health, Disability and Ageing

Legislation au F2025N00997 Not in force Notifiable Instrument

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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. 3) 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 Medicare Urgent Care Clinic Program – New South Wales Urgent Care Services) Direction (No. 2) 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 Urgent Care Clinics program; and
2. 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) 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 K of 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:
1. if the service is specified in Schedule A:
  1. at a practice location specified in Schedule D or E 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 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 Urgent Care Clinics program mentioned in paragraph (2)(a).
3. if the service is specified in Schedule C:
1. at a practice location specified in Schedule E of this Direction; and
2. by a prescribed medical practitioner who is registered to provide services with Services Australia under the Commonwealth Urgent Care Clinics program mentioned in paragraph (2)(a).

DECLARE that this Direction commences from 1 November 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.

Date: 9 December 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 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
A5	Prolonged attendances to which no other item applies

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
M1	Management of bulk-billed services	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 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
		2	Cardiac	55118
		3	Vascular	55238, 55244, 55246, 55252, 55274, 55276, 55278
		4	Urologicals	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
		13	Angiography	60078
		17	Interventional Techniques	61109
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

Pathology Services Table

Group	Group Name	Item Number
P9	Simple basic pathology tests	73806

SCHEDULE B

MEDICARE BENEFITS SCHEDULE ITEMS WHERE A CLINIC IS LOCATED IN MMM 1 LOCATIONS

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 Clinics Program.

SCHEDULE C

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
A7	Acupuncture and non-specialist practitioner items	10	Prescribed Medical Practitioner after‑hours attendances to which no other item applies	733, 737, 741, 745

SCHEDULE D

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 E

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

Overview

The Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Commonwealth Medicare Urgent Care Clinics Program – New South Wales Urgent Care Services) Direction (No. 3) 2025, issued under the Health Insurance Act 1973, aims to facilitate the provision of urgent care services in New South Wales. This Direction was introduced to address gaps in urgent care services by ensuring that Medicare Benefits are payable for professional services provided by New South Wales Urgent Care Services that meet the requirements of the Commonwealth Urgent Care Clinics program. The Direction is issued by the Minister for Health and Ageing, through the Assistant Secretary of the MBS Policy and Specialist Programs Branch, and it specifies the professional services eligible for Medicare benefits, including those related to general practitioner attendances, diagnostic procedures, and various medical services. The Direction outlines the practice locations where these services can be provided and identifies the practitioners qualified to deliver them, ensuring a coordinated approach between the Commonwealth and the State of New South Wales. This initiative seeks to enhance the accessibility and efficiency of urgent care services, ultimately aiming to improve patient outcomes and healthcare delivery in the region.

Scope and Application

The Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Commonwealth Medicare Urgent Care Clinics Program – New South Wales Urgent Care Services) Direction (No. 3) 2025 applies to professional services provided by New South Wales Urgent Care Services that have been assessed as meeting the requirements of the Commonwealth Urgent Care Clinics program. This Direction pertains to the payment of Medicare Benefits for specified professional services listed in Schedules A, B, and C, which are provided to eligible individuals who are not receiving services attracting payments through Schedule K of the 2020-2025 Addendum to the National Health Reform Agreement for services rendered to public patients. The services must be provided by registered general practitioners, prescribed medical practitioners, or participating nurse practitioners at specified practice locations within designated Metropolitan Statistical Areas (MMM) in New South Wales. This Direction is effective from 1 November 2025 and expires on 30 June 2026 unless earlier revoked. Notably, the Direction repeals a previous Direction (No. 2) 2025, ensuring that the most recent provisions govern the payment of benefits for urgent care services. The Direction extends its application through the detailed schedules, which list the specific services, practitioner types, and practice locations eligible for Medicare benefits under the program.

Key Provisions

This legislative instrument, the Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Commonwealth Medicare Urgent Care Clinics Program – New South Wales Urgent Care Services) Direction (No. 3) 2025, introduces specific provisions regarding the payment of Medicare benefits for professional services provided under the Commonwealth Medicare Urgent Care Clinics Program in New South Wales. It repeals the previous Direction (No. 2) 2025 and outlines the services and conditions for which Medicare benefits are payable. The direction specifies that Medicare benefits will be payable for professional services agreed upon between the Commonwealth and New South Wales, provided by New South Wales Urgent Care Services meeting the requirements of the Commonwealth program. The services are categorized into three schedules (A, B, and C) and must be provided to eligible persons who are not receiving services that attract payments under Schedule K of the 2020-2025 Addendum to the National Health Reform Agreement for public patients. The Direction mandates that professional services must be provided by registered practitioners, including general practitioners, prescribed medical practitioners, and participating nurse practitioners, at specified practice locations listed in Schedules D and E. These locations are categorized by Modified Monash Model (MMM) areas, with Schedule D covering MMM 1 locations and Schedule E covering MMM 2-7 locations. The services covered include general practitioner attendances, prolonged attendances, after-hours services, diagnostic procedures, and surgical operations, among others. The obligations imposed by this Direction include ensuring that the professional services are provided by authorized practitioners at approved locations and to eligible patients. Both the Commonwealth and New South Wales must adhere to the terms and conditions outlined in the Direction, ensuring that the services meet the requirements of the Urgent Care Clinics Program. The Direction also specifies that only certain items in the General Medical Services Table and other related schedules may be exempt from specific subsections of the Act when claimed by prescribed medical practitioners operating under the Medicare Urgent Care Clinics Program. Failure to comply with the provisions of this Direction may result in legal consequences. Although the Direction does not explicitly outline penalties, breaches of the Health Insurance Act 1973 and associated regulations may incur civil or criminal penalties. Under the Act, penalties for non-compliance can include fines, and in severe cases, imprisonment. For instance, section 127 of the Act allows for fines of up to $22,200 for individuals and $111,000 for bodies corporate for providing misleading or false information to obtain benefits, while section 128A provides for imprisonment for up to five years for serious fraud offenses under the Act. These penalties underscore the importance of adhering to the terms set out in the Direction and the broader legislative framework governing the provision of Medicare benefits.

Area of Law: Health Law
Instrument: Direction
Concepts: Definitions & Interpretation; Offence Provisions; Licensing & Registration

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Sourced from the Federal Register of Legislation at 26 August 2026. For the latest information on Australian Government law please go to https://www.legislation.gov.au.

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