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Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Noarlunga and Smaller Medical Services in South Australia) Direction 2026

Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Noarlunga and Smaller Medical Services in South Australia) Direction 2026

Administered by Department of Health, Disability and Ageing

Legislation au F2026N00475 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 – Noarlunga and Smaller Medical Services in South Australia) Direction 2026

I, Nigel Murray, Assistant Secretary, MBS Policy and Specialist Programs Branch, Medical 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 – Noarlunga and Smaller Medical Services in South Australia) Direction 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:

(i) between the Commonwealth (represented by the Department of Health, Disability and Ageing, ABN: 83 605 426 759) and by, or on behalf of, or under an arrangement with South Australia Health (ABN: 97 643 356 590) 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), the diagnostic imaging services table (means the table prescribed under subsection 4AAof the Act) or the pathology services table (means the table prescribed under subsection 4Aof 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 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 Schedule L of the 2026-31 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.

DECLARE that this Direction shall have effect from the date of signature until
30 June 2028 inclusive unless earlier revoked.

Dated: 1 July 2026

Nigel Murray

Assistant Secretary

Medicare Benefits and Digital Health Division

Health Resourcing Group

Department of Health, Disability and Ageing

SCHEDULE A

MEDICARE BENEFITS SCHEDULE ITEMS AS AGREED BETWEEN THE DEPARTMENT OF HEALTH, DISABILITY AND AGEING AND south australia health

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.

Group	Group Name	Subgroup	Subgroup Name
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
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
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-hour attendances to which no other item applies
A27	Pregnancy support counselling
A29	Attendance services for complex neurodevelopmental disorder or disability
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
		3	Review of eating disorder treatment and management plans
		4	Providing treatments under eating disorder treatment and management plans
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
		19	GP Mental Health Treatment Plan - Video Services

		21	GP Eating Disorder Treatment and Management Plan – Video Services
		25	Review of an Eating Disorder Plan - Video services
		26	Review of an Eating Disorder Plan – Phone Service
		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
M1	Management of bulk billed services
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	1	Video conferencing consultation support service provided by a practice nurse, an Aboriginal health worker or an Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner
M12		3	Services provided by a practice nurse or an Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner
D1	Miscellaneous diagnostic procedures and investigations	2	Ophthalmology
		3	Otolaryngology
		4	Respiratory
		5	Vascular
		6	Cardiovascular
		8	Genito-urinary physiological investigations
		9	Allergy testing
		10	Other diagnostic procedures and investigations
D2	Nuclear Medicine (non-imaging)
T1	Miscellaneous therapeutic procedures	2	Dialysis
		4	Paediatric and neonatal
		5	Cardiovascular
		8	Haematology
		9	Procedures associated with intensive care and cardiopulmonary support
		11	Chemotherapeutic procedures
		13	Miscellaneous therapeutic procedures
T2	Radiation oncology	12	Kilovoltage
T3	Therapeutic nuclear medicine
T4	Obstetrics
T6	Examination by anaesthetist
T7	Regional or field nerve blocks
T8	Surgical Operations	1	General
		2	Colorectal
		3	Vascular
		4	Gynaecological
		5	Urological
		6	Cardio-thoracic
		7	Neurosurgical
		8	Ear, nose and throat
		9	Ophthalmology
		11	Paediatric
		15	Orthopaedic
T9	Assistance at operations
T10	Anaesthesia performed in connect with certain services (Relative Value Guide)

Diagnostic Imaging Services Table

Group	Group Name	Subgroup	Subgroup Name
I1	Ultrasound	6	Musculoskeletal ultrasound
I3	Diagnostic Radiology	1	Radiographic examination of extremities
		2	Radiographic examination of shoulder or pelvis
		3	Radiographic examination of head
		4	Radiographic examination of spine
		5	Bone age study and skeletal survey
		6	Radiographic examination of thoracic region
		7	Radiographic examination of urinary tract
		8	Radiographic examination of alimentary tract and biliary system
		12	Radiographic examination with opaque or contrast media
I6	Management of bulk-billed Services

Pathology Services Table

Group	Group Name
P1	Haematology
P2	Chemical
P9	Simple Basic Pathology Tests
P12	Management of bulk-billed services

SCHEDULE B

Approved Practice Locations

Approved locations:

LOCATION	PRACTICE NAME	STREET ADDRESS	MAILING ADDRESS
Sefton Park	Sefton Park Primary Health Care Services	Shop 5, 221 Main North Road, Sefton Park, South Australia 5083	Shop 5, 221 Main North Road, Sefton Park, South Australia 5083
Port Adelaide	Watto Purrunna Aboriginal Health Service	Wonggangga Turtpandi, 11 Church Street, Port Adelaide, South Australia 5015	Wonggangga Turtpandi, 11 Church Street, Port Adelaide, South Australia 5015
Elizabeth	Metropolitan Youth Health (North)	6 Gillingham Street, Elizabeth, South Australia 5112	6 Gillingham Street, Elizabeth, South Australia 5112
Angle Park	Metropolitan Youth Health (West)	40-44 Trafford Street, Angle Park, South Australia 5010	40-44 Trafford Street, Angle Park, South Australia 5010
Christies Beach	Metropolitan Youth Health (South)	50A Beach Road, Christies Beach, South Australia 5165	50A Beach Road, Christies Beach, South Australia 5165
Noarlunga Centre	Noarlunga Hospital	20 Alexander Kelly Drive, Noarlunga Centre, South Australia 5168	20 Alexander Kelly Drive, Noarlunga Centre, South Australia 5168

Overview

The Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Noarlunga and Smaller Medical Services in South Australia) Direction 2026, issued by Nigel Murray, Assistant Secretary of the Department of Health, Disability and Ageing, aims to repeal the previous Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Noarlunga and Smaller Medical Services in South Australia) Direction 2025. Enacted under the authority of the Health Insurance Act 1973, this legislative instrument seeks to facilitate the provision of Medicare benefits for specific professional services in South Australia, ensuring these services are accessible to eligible individuals who are not receiving hospital treatment or services funded under the National Health Reform Agreement. The Direction is effective from the date of signature until 30 June 2028 unless revoked earlier. It outlines the agreed Medicare benefits schedule items and specifies the approved practice locations where these services can be provided.

Scope and Application

The Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Noarlunga and Smaller Medical Services in South Australia) Direction 2026 applies to professional services provided by the Commonwealth, represented by the Department of Health, Disability and Ageing, in collaboration with South Australia Health. It specifies the Medicare benefits payable for professional services outlined in Schedule A of this Direction, which includes various medical services such as general practitioner attendances, mental health care, telehealth services, and diagnostic imaging procedures. These services must be provided to eligible persons who are not receiving them as part of a hospital treatment episode, nor as part of a service attracting payment under Schedule L of the 2026-31 Addendum to the National Health Reform Agreement for a public patient. The Direction mandates that these professional services must be delivered at specific practice locations detailed in Schedule B of the Direction. The Direction is in effect from the date of signature until 30 June 2028, unless revoked earlier. The Direction repeals the previous Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Noarlunga and Smaller Medical Services in South Australia) Direction 2025.

Key Provisions

The primary operative sections of the Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Noarlunga and Smaller Medical Services in South Australia) Direction 2026 (the Direction) establish the terms under which Medicare benefits will be payable for certain professional services in South Australia. Specifically, Section 2 of the Direction repeals the previous Direction 2025 and establishes new provisions for the payment of Medicare benefits for professional services agreed upon by the Commonwealth and South Australia Health. The Direction specifies that benefits will be payable for professional services listed in Schedule A, provided to eligible persons at locations specified in Schedule B, and where the services do not fall under certain other categories, such as hospital treatment or public patient services (Section 2(a)). The Direction is effective from 1 July 2026 until 30 June 2028, unless earlier revoked (Section 4). The Direction imposes several obligations on the parties involved. Both the Commonwealth and South Australia Health must ensure that the professional services are provided according to the agreed terms and that they comply with all relevant provisions of the Health Insurance Act 1973, the National Health Act 1953, and related regulations (Section 2(a)). Service providers must deliver the specified professional services at approved practice locations listed in Schedule B. Eligible persons must be provided with services that meet the criteria outlined in Section 2(a), ensuring the services are not part of hospital treatment or other excluded categories. Additionally, all parties must adhere to the requirements of the Health Insurance Act 1973 and the National Health Act 1953 as they pertain to medical services, professional services, and items. The Direction does not explicitly outline specific offences, penalties, or consequences for breach within its text. However, breaches of the Health Insurance Act 1973 or the National Health Act 1953, which the Direction references, could result in civil or criminal penalties. For example, under the Health Insurance Act 1973, fraudulent claims or misrepresentations could lead to fines or imprisonment, depending on the severity of the breach. The exact penalties would be determined in accordance with the relevant sections of these Acts, which may include substantial fines or terms of imprisonment for serious or repeated offences.

Area of Law: Health Law; Administrative Law
Instrument: Direction
Concepts: Definitions & Interpretation; Reporting & Disclosure Obligations; Regulatory Standards

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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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