AUSTRALIAN GOVERNMENT
DEPARTMENT OF HEALTH, DISABILITY AND AGEING
HEALTH INSURANCE ACT 1973
Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Council of Australian Governments’ Improving Access to Primary Care in Rural and Remote Areas – COAG s19(2) Exemptions Initiative – South Australia) Direction (No. 1) 2026
I, Michelle Trainor, Acting 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 – Council of Australian Governments’ Improving Access to Primary Care in Rural and Remote Areas – COAG s19(2) Exemptions Initiative – South Australia) 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 under the Memorandum of Understanding (MOU) between the Department of Health, Disability and Ageing (ABN: 83 605 426 759) and South Australia (ABN: 52 786 403 404) dated 28 April 2025 as part of the Council of Australian Governments’ Improving Access to Primary Care in Rural and Remote Areas – COAG s19(2) Exemptions Initiative relating to primary care services 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 services table (means the table prescribed under subsection 4AA(1) of the Act) or pathology services table (means the table prescribed under subsection 4A(1) 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 is not part of an episode of hospital treatment (as defined in Section 121-5 of the Private Health Insurance Act 2007); and
- The professional service referred to in paragraph (2)(a):
- is provided at an approved Modified Monash Model 5-7 area (as defined in Section 7.1.1 of the general medical services table) practice location specified in Schedule B; and
- is either:
- a professional non-referred service provided by a state remunerated prescribed medical practitioner, participating midwife, or participating nurse practitioner; or
- a professional referred service provided by a state remunerated allied health professional or dental practitioner.
- DECLARE that this Direction commences on the day after registration and ceases to have effect at the end of 30 June 2027 unless earlier repealed.
Note, a number of expressions used in this direction are defined in the below instruments:
- Health Insurance Act 1973: the meaning of dental practitioner, participating midwife, participating nurse practitioner, and professional service; and
- Health Insurance (General Medical Services Table) Regulations 2021: the meaning of prescribed medical practitioner.
- Health Insurance (Section 3C General Medical Services – Allied Health Services) Determination 2024: the meaning of allied health professional.
Date: 6 January 2026
Michelle Trainor
Acting 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 AT Approved Practice Locations AS AGREED under the Council of Australian Governments’ Improving Access to Primary Care in Rural and Remote Areas – COAG s19(2) Exemptions Initiative – south australia
For services listed in the below tables, all provisions of the Health Insurance Act 1973 (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 |
| ||
A2 | Other non‑referred attendances to which no other item applies |
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A5 | Prolonged attendances to which no other item applies |
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A6 | Group therapy |
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A7 | Acupuncture and non‑specialist practitioner items |
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A9 | Contact lenses |
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A10 | Optometric services provided by optometrist |
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A11 | Urgent attendances after hours |
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A14 | Health assessments |
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A15 | GP chronic condition management plans, multidisciplinary care plans and case conferences | 1 | GP chronic condition management plans and multidisciplinary care plans |
|
2 | Case Conferences | 735, 739, 743, 747-758, 930-945 | ||
A17 | Domiciliary and residential medication management reviews |
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A20 | Mental health care |
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A22 | General practitioner after‑hours attendances to which no other item applies |
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A23 | Other non‑referred after‑hours attendances to which no other item applies |
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A27 | Pregnancy support counselling |
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A29 | Attendance services for complex neurodevelopmental disorder or disability | 139 | ||
A35 | Non‑referred attendance at a residential aged care facility |
| ||
A36 | Eating disorders | 1 | Preparation of eating disorder treatment and management plans: general practitioners and non‑specialist medical practitioners | 90250-90257 |
3 | Review of eating disorder treatment and management plans | 90264, 90265 | ||
4 | Providing treatments under eating disorder treatment and management plans | 90271-90278 | ||
A40 | Telehealth attendance services | 1 | General practice video services |
|
2 | General practice phone services |
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3 | Focussed Psychological Strategies ‑ Video Services |
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10 | Focussed Psychological Strategies phone services |
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11 | Health Assessments for Aboriginal and Torres Strait Islander People ‑ Video Services |
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13 | GP management plans, team care arrangements and multidisciplinary care plans services – Video Services |
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15 | GP Pregnancy Support Counselling ‑ Video Services |
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16 | GP Pregnancy Support Counselling ‑ Phone Service |
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17 | GP, specialist and consultant physician complex neurodevelopmental disorder or disability service ‑ Video Services | 92142 | ||
19 | GP Mental Health Treatment Plan ‑ Video Services |
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20 | GP Mental Health Treatment Plan ‑ Phone Service |
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21 | GP Eating Disorder Treatment and Management Plan – Video Services |
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25 | Review of an Eating Disorder Plan ‑ Video Services | 92170, 92171 | ||
26 | Review of an Eating Disorder Plan – Phone Service | 92176, 92177 | ||
27 | Eating Disorder Psychological Treatment Services – Video Services |
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28 | Eating Disorder Psychological Treatment Strategies – Phone Service |
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29 | GP and Other Medical Practitioner ‑ Urgent After Hours Service in Unsociable Hours ‑ Video Services |
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39 | GP Blood Borne Viruses, Sexual or Reproductive Health Consultation – Video Services |
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40 | GP Blood Borne Viruses, Sexual or Reproductive Health Consultation – Phone Service |
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D1 | Miscellaneous diagnostic procedures and investigations | 3 | Otolaryngology | 11300-11318 |
4 | Respiratory | 11505, 11506 | ||
5 | Vascular | 11602-11615 | ||
6 | Cardiovascular | 11707, 11729, 11730 | ||
9 | Allergy testing | 12001-12004, 12012, 12017 | ||
10 | Other diagnostic procedures and investigations | 12200, 12306, 12312, 12315, 12320-12322, 12325, 12326 | ||
D2 | Nuclear medicine (non‑imaging) | 12500, 12524, 12527 | ||
M1 | Management of bulk‑billed services | 1 | Management of general bulk‑billed services |
|
2 | General support service |
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3 | Patients enrolled in MyMedicare |
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M3 | Allied health services |
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M6 | Psychological Therapy Services |
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M7 | Focussed Psychological Strategies (Allied Mental Health) |
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M8 | Pregnancy support counselling |
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M9 | Allied health group services |
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M10 | Complex neurodevelopmental disorder and disability services |
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M11 | Allied health services for Aboriginal and Torres Strait Islander people |
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M12 | Services provided by a practice nurse, an Aboriginal health worker or an Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner |
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M13 | Midwifery Services | 1 | MBS items for participating midwives | 82100-82115, 82130-82140 |
M14 | Nurse practitioners |
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M15 | Diagnostic audiology services |
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M16 | Eating disorders services |
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M18 | Allied Health telehealth services | 1 | Psychological therapies video services |
|
2 | Psychologist focussed psychological strategies video services |
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3 | Occupational Therapist focussed psychological strategies video services |
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4 | Social Worker focussed psychological strategies video services |
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5 | Nurse practitioner video services |
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6 | Psychological therapies phone services |
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7 | Psychologist focussed psychological strategies phone service |
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8 | Occupational therapist focussed psychological strategies phone services |
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9 | Social worker focussed psychological strategies phone services |
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10 | Nurse practitioner phone services |
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11 | General allied health video services |
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12 | General allied health phone services |
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13 | Pregnancy support counselling video services |
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14 | Pregnancy support counselling phone services |
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15 | Complex neurodevelopmental disorder and disability video services |
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16 | Complex neurodevelopmental disorder and disability phone services |
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17 | Video attendance to person of Aboriginal and Torres Strait Islander descent |
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18 | Phone attendance to person of Aboriginal and Torres Strait Islander descent |
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23 | Follow up service provided by a practice nurse or Aboriginal and Torres Strait Islander health practitioner – Telehealth Services |
| ||
25 | Allied health, group dietetics video services |
| ||
26 | Allied health, group dietetics phone services |
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T1 | Miscellaneous therapeutic procedures | 2 | Dialysis | 13105 |
6 | Gastroenterology |
| ||
13 | Miscellaneous therapeutic procedures | 14206 | ||
T4 | Obstetrics |
| 16400, 16406-16500, 16502-16514, 16530, 16590, 16591 | |
1 | Obstetric video services | 91850-91853 | ||
2 | Obstetric phone services | 91855-91858 | ||
T8 | Surgical operations | 1 | General | 30003, 30006, 30023, 30026-30055, 30061-30072, 30107, 30192-30207, 30216, 30219, 31356 |
2 | Colorectal | 32072, 32147 | ||
4 | Gynaecological | 35503 | ||
8 | Ear, nose and throat | 41500 | ||
15 | Orthopaedic | 47015, 47042, 47057, 47069, 47301, 47348, 47354, 47361, 47387, 47423, 47444, 47453, 47462, 47466, 47471, 47543, 47561, 47579, 47595, 47663, 47735, 47904, 47915, 47916, 47918 | ||
O1 | Consultations |
| 51700, 51703 | |
1 | dental practitioner video services | 54001, 54002 | ||
2 | dental practitioner phone services | 54004 | ||
Diagnostic Imaging Services Table
Group | Group Name |
I1 | Ultrasound |
I3 | Diagnostic radiology |
I6 | Management of bulk‑billed services |
Pathology Services Table
Group | Group Name |
P9 | Simple basic pathology tests |
P12 | Management of bulk‑billed services |
P13 | Bulk‑billing incentive |
SCHEDULE B
Approved Practice Locations AS AGREED under the Council of Australian Governments’ Improving Access to Primary Care in Rural and Remote Areas – COAG s19(2) Exemptions Initiative – South Australia
Approved locations:
Location | Practice Name | Legal Name | Street Address | Mailing Address |
Ceduna | Ceduna District Health Service and Ceduna Family Medical Practice | Eyre and Far North Local Health Network Inc | 3 Eyre Highway, Ceduna SA 5690 | PO Box 178, |
Cleve (Outreach service of Ceduna) | Mid Eyre Medical Practice – Cleve | Eyre and Far North Local Health Network Inc | 15 Main Street, Cleve SA 5640 | PO Box 178, |
Coober Pedy (Outreach service of Ceduna) | Coober Pedy Hospital and Coober Pedy Medical Practice | Eyre and Far North Local Health Network Inc | 89 McDougall Street, Coober Pedy SA 5723 | PO Box 178, |
Cowell (Outreach service of Ceduna) | Cowell Hospital and Mid Eyre Medical Practice – Cowell | Eyre and Far North Local Health Network Inc | 17 South Terrace, Cowell SA 5602 | PO Box 178, |
Elliston (Outreach service of Ceduna) | Elliston Hospital and Mid Eyre Medical Practice – Elliston | Eyre and Far North Local Health Network Inc | 1 Memorial Drive, Elliston SA 5670 | PO Box 178, |
Karoonda | Karoonda and District Soldiers’ Memorial Hospital & Mallee Medical Practice - Karoonda | Riverland Mallee Coorong Local Health Network Inc | 13 Stokes Road, Karoonda SA 5307 | PO Box 145, |
Kimba (Outreach service of Ceduna) | Mid Eyre Medical Practice – Kimba | Eyre and Far North Local Health Network Inc | 34 Park Terrace, Kimba SA 5641 | PO Box 178, |
Lameroo | Mallee Medical Practice, Lameroo | Riverland Mallee Coorong Local Health Network Inc | 1 Vardon Terrace, Lameroo SA 5302 | 1 Vardon Terrace, |
Peterborough | Peterborough Soldiers Memorial Hospital | Yorke and Northern Local Health Network Inc | 23 Hurlstone Street, Peterborough SA 5422 | PO Box 119, Peterborough SA 5422 |
Pinnaroo | Pinnaroo Soldiers’ Memorial Hospital | Riverland Mallee Coorong Local Health Network Inc | Bundey Terrace, Pinnaroo SA 5304 | PO Box 234, Pinnaroo SA 5304 |
Pinnaroo (Outreach service of Pinnaroo) | Mallee Medical Practice, Pinnaroo | Riverland Mallee Coorong Local Health Network Inc | 1 Gilbert Avenue, Pinnaroo SA 5304 | 1 Gilbert Avenue, Pinnaroo SA 5304 |
Wallaroo | Wallaroo Hospital and Health Service | Yorke and Northern Local Health Network Inc | 1 Ernest Terrace, Wallaroo SA 5556 | 1 Ernest Terrace, |