AUSTRALIAN GOVERNMENT
DEPARTMENT OF HEALTH, DISABILITY AND AGEING
HEALTH INSURANCE ACT 1973
Health Insurance (Medicare Benefits Payable in Respect of Professional Services –Commonwealth Urgent Care Clinic Program - Queensland Primary Care Pilot) 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 – Queensland Primary Care Pilot) Direction 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:
- under a Schedule to the Federation Funding Agreement executed on 13 June 2023 between the Commonwealth (represented by the Department of Health and Aged Care, ABN: 83 605 426 759) and the State of Queensland (represented by the Queensland Department of Health, ABN: 66 329 169 412); and
- as part of the Commonwealth Urgent Care Clinic Program for which items specified in Schedule A of this Direction and of the general medical services table (means the table prescribed under subsection 4(1) of the Act) , diagnostic imaging service 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);
- 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:
- at a practice location specified in Schedule B 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).
- DECLARE that this Direction commences on 01 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.
Date: 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 | 2 | Prescribed medical practitioner attendance to which no other item applies | 179, 185, 189, 203 |
9 | Prescribed medical practitioner mental health care | 279 | ||
10 | Prescribed Medical Practitioner after‑hours attendances to which no other item applies | 733, 737, 741, 745 | ||
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 | ||
13 | Angiography | 60078 | ||
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, 71166, 71167, 71168, 71180, 71183, 71186, 71198, 71200, |
P5 | Tissue Pathology | 72816, 72817, 72818, 72823, 72824, 72825, 72830, 72846, 72847, 72849 |
P6 | Cytology | 73045, 73047, 73049, 73063, 73070, 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
APPROVED PRACTICE LOCATIONS AS AGREED UNDER THE FEDERATION FUNDING AGREEMENT BETWEEN THE COMMONWEALTH AND THE STATE OF QUEENSLAND
Approved primary care locations:
State | MMM 2 Location | Practice Name | Legal Name | Street Address |
QLD | Toowoomba | Toowoomba Medical and Dental Centre | Idameneo (No. 123) Pty Ltd as the Trustee for Artlu Unit Trust | Corner West and 261-269 James Street, Toowoomba QLD 4350 |
QLD | Townsville | Eastbrooke Family Clinic Townsville | BUPA Health Centres Pty Ltd | 86 Thuringowa Drive, Thuringowa Central QLD 4817 |