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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

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

Administered by Department of Health, Disability and Ageing

Legislation au F2025N00481 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 – 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

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:

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 and Aged Care (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:
1. 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:
1. an eligible person (as defined in Section 3 of the Act); and
2. 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):
1. 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
2. is either:
  1. a professional non-referred service provided by a state remunerated prescribed medical practitioner, participating midwife, or participating nurse practitioner; or
  2. a professional referred service provided by a state remunerated allied health professional or dental practitioner.

DECLARE that this Direction commences on 1 July 2025 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 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: 16 June 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 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
A5	Prolonged attendances to which no other item applies
A6	Group therapy
A7	Acupuncture and non‑specialist practitioner items
A9	Contact lenses
A10	Optometric services provided by optometrist
A11	Urgent attendances after hours
A14	Health assessments
A15	GP chronic condition management plans, multidisciplinary care plans and case conferences	1	GP chronic condition management plans and multidisciplinary care plans
A15		2	Case Conferences	735, 739, 743, 747-758, 930-945
A17	Domiciliary and residential medication management reviews
A20	Mental health care
A22	General practitioner after‑hours attendances to which no other item applies
A23	Other non‑referred after‑hours attendances to which no other item applies
A27	Pregnancy support counselling
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
		3	Focussed Psychological Strategies ‑ Video Services
		10	Focussed Psychological Strategies phone services
		11	Health Assessments for Aboriginal and Torres Strait Islander People ‑ Video Services
		13	GP management plans, team care arrangements and multidisciplinary care plans services – Video Services
		15	GP Pregnancy Support Counselling ‑ Video Services
		16	GP Pregnancy Support Counselling ‑ Phone Service
		17	GP, specialist and consultant physician complex neurodevelopmental disorder or disability service ‑ Video Services	92142
		19	GP Mental Health Treatment Plan ‑ Video Services
		20	GP Mental Health Treatment Plan ‑ Phone Service
		21	GP Eating Disorder Treatment and Management Plan – Video Services
		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
		28	Eating Disorder Psychological Treatment Strategies – Phone Service
		29	GP and Other Medical Practitioner ‑ Urgent After Hours Service in Unsociable Hours ‑ Video Services
		39	GP Blood Borne Viruses, Sexual or Reproductive Health Consultation – Video Services
		40	GP Blood Borne Viruses, Sexual or Reproductive Health Consultation – Phone Service
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
		3	Patients enrolled in MyMedicare
M3	Allied health services
M6	Psychological Therapy Services
M7	Focussed Psychological Strategies (Allied Mental Health)
M8	Pregnancy support counselling
M9	Allied health group services
M10	Complex neurodevelopmental disorder and disability services
M11	Allied health services for Aboriginal and Torres Strait Islander people
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
M13	Midwifery Services	1	MBS items for participating midwives	82100-82115, 82130-82140
M14	Nurse practitioners
M15	Diagnostic audiology services
M16	Eating disorders services
M18	Allied Health telehealth services	1	Psychological therapies video services
		2	Psychologist focussed psychological strategies video services
		3	Occupational Therapist focussed psychological strategies video services
		4	Social Worker focussed psychological strategies video services
		5	Nurse practitioner video services
		6	Psychological therapies phone services
		7	Psychologist focussed psychological strategies phone service
		8	Occupational therapist focussed psychological strategies phone services
		9	Social worker focussed psychological strategies phone services
		10	Nurse practitioner phone services
		11	General allied health video services
		12	General allied health phone services
		13	Pregnancy support counselling video services
		14	Pregnancy support counselling phone services
		15	Complex neurodevelopmental disorder and disability video services
		16	Complex neurodevelopmental disorder and disability phone services
		17	Video attendance to person of Aboriginal and Torres Strait Islander descent
		18	Phone attendance to person of Aboriginal and Torres Strait Islander descent
		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
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, Ceduna SA 5690
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, Ceduna SA 5690
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, Ceduna SA 5690
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, Ceduna SA 5690
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, Ceduna SA 5690
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, Karoonda SA 5307
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, Ceduna SA 5690
Lameroo	Mallee Medical Practice, Lameroo	Riverland Mallee Coorong Local Health Network Inc	1 Vardon Terrace, Lameroo SA 5302	1 Vardon Terrace, Lameroo SA, 5302
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, Wallaroo SA 5556

Overview

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 was enacted to address the gap in primary healthcare services for people living in rural and remote areas of South Australia. The Act, enacted in 1973, provides the legislative framework for Medicare, the universal health insurance scheme in Australia. This Direction was made by Nigel Murray, acting under the authority of the Minister for Health and Ageing, pursuant to subsection 19(2) of the Health Insurance Act 1973. The policy objective of this Direction is to facilitate the provision of primary care services in underserved areas by enabling Medicare Benefits to be paid for specific professional services delivered in approved locations. This initiative is part of the broader Council of Australian Governments’ Improving Access to Primary Care in Rural and Remote Areas program. The Direction will be effective from 1 July 2025 until 30 June 2027 unless revoked earlier.

Scope and Application

This notifiable instrument is a Direction under the Health Insurance Act 1973, made by the Assistant Secretary of the MBS Policy and Specialist Programs Branch. The Direction specifies that Medicare Benefits will be payable for certain professional services provided under a Memorandum of Understanding between the Department of Health and Aged Care and South Australia. These services must be part of the Council of Australian Governments' Improving Access to Primary Care in Rural and Remote Areas initiative and relate to specified items in Schedule A of the Direction. The services must be provided to eligible persons by specified health professionals at approved practice locations in Modified Monash Model 5-7 areas in South Australia. The Direction applies to services provided from 1 July 2025 until 30 June 2027 unless earlier revoked. The Direction extends or restricts the application of the Act through subordinate instruments, such as the Health Insurance (General Medical Services Table) Regulations 2021 and the Health Insurance (Section 3C General Medical Services – Allied Health Services) Determination 2024. There are no stated exclusions or exemptions in this Direction. The Direction applies to health professionals and approved practice locations in South Australia and to eligible persons receiving the specified services. The geographic reach is limited to South Australia, specifically to Modified Monash Model 5-7 areas. The Direction does not specify any exclusions or exemptions, but it is subject to the terms of the Memorandum of Understanding between the Department of Health and Aged Care and South Australia, and the definitions provided in subordinate instruments. The Direction provides for the payment of Medicare Benefits for specified professional services provided under the COAG initiative, thereby extending the application of the Act in relation to these services.

Key Provisions

The key operative sections of this Direction (No. 2) under the Health Insurance Act 1973 (the Act) establish the criteria for which Medicare Benefits are payable for professional services provided in South Australia. Specifically, section 2 outlines the professional services eligible for Medicare benefits, which must align with the items specified in Schedule A and the relevant tables (general medical services, diagnostic imaging services, and pathology services tables). The services must be provided in approved Modified Monash Model 5-7 area practice locations as listed in Schedule B, to eligible persons, and to patients not part of an episode of hospital treatment. The services can either be professional non-referred services by state remunerated prescribed medical practitioners, participating midwives, or participating nurse practitioners, or professional referred services by state remunerated allied health professionals or dental practitioners. The Act imposes several obligations on the parties it governs. Eligible professionals must ensure that their services meet the criteria set out in the Direction, including the location and nature of the services provided. They must also ensure that they are registered and participating under the terms of the Memorandum of Understanding (MOU) between the Department of Health and Aged Care and South Australia. Patients must meet the eligibility criteria, which includes not being part of an episode of hospital treatment, and services must be provided at an approved practice location. Breach of the provisions outlined in this Direction may lead to civil or criminal penalties. While the specific penalties are not detailed in the Direction itself, under the Health Insurance Act 1973, breaches of the Act can result in substantial fines. For example, individuals or entities found guilty of providing false or misleading information to obtain Medicare benefits could face penalties of up to $222,250 for individuals and $1,111,250 for bodies corporate, along with potential imprisonment. Continuous or repeated breaches may attract even higher penalties, reflecting the seriousness with which the law regards non-compliance. Furthermore, revocation or suspension of Medicare benefits for non-compliance can have significant financial repercussions for healthcare providers.

Area of Law: Health Law
Instrument: Direction
Concepts: Definitions & Interpretation; Reporting & Disclosure Obligations; Enforcement Powers
Catchwords: Medicare Benefits; Professional Services; Approved Practice Locations

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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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