AUSTRALIAN GOVERNMENT
DEPARTMENT OF HEALTH, DISABILITY AND AGEING
HEALTH INSURANCE ACT 1973
Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Services Rendered at Commonwealth Urgent Care Clinic - Broome) Direction 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 – Services Rendered at Commonwealth Urgent Care Clinic - Broome) 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 the Commonwealth Urgent Care Clinic Program between the Department of Health and Aged Care (ABN: 83 605 426 759) and the practice listed in Schedule C of this Direction, in relation to medical services available to patients who attend a Commonwealth Urgent Care Clinic Location 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 section 4AA of the Act), or the pathology service table (means the table prescribed under section 4A of the Act) relates; or
- items specified in Schedule B 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 section 4AA of the Act), or the pathology service table (means the table prescribed under section 4A of the Act) relates; and
- are provided during the hours of operation; and
- at the time the service is being provided, there is not a practitioner who is described in paragraph (2)(c) of this Direction, in attendance at the practice listed in Schedule C to provide the service in person; 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, schedule K, one year extension to the National Health Reform Agreement for a service rendered to a public patient; or
- which attracts a payment through another government arrangement outside of the Commonwealth Urgent Care Clinic program for a service rendered to the patient; and
- The professional services referred to in paragraph (2)(a) must be provided:
- at a practice location in Schedule C of this Direction; and
- by a general practitioner, prescribed medical practitioner or participating nurse practitioner who is registered to provide services in Schedule A and B with Services Australia under the Commonwealth Urgent Care Clinic program mentioned in paragraph (2)(a).
- DECLARE that this Direction commences on 1 July 2025 and ceases to have effect at the end of 30 June 2026 unless earlier revoked.
Dated 20 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 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 | ||
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
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
MEDICARE BENEFITS SCHEDULE ITEMS WHERE A PRACTITIONER IS NOT ON SITE TO PROVIDE FACE-TO-FACE SERVICES 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 |
A40 | Telehealth and phone attendance services | 1 | General practice telehealth services | 91790, 91800, 91801, 91802, 91920 |
19 | GP Mental Health Treatment Plan ‑ Telehealth Service | 92115 | ||
T4 | Obstetrics | 1 | Obstetric telehealth services | 91853 |
M18 | Allied Health telehealth services | 5 | Nurse practitioner telehealth services | 91178, 91179, 91180 |
SCHEDULE C
APPROVED COMMONWEALTH URGENT CARE CLINIC LOCATIONS AS AGREED UNDER THE COMMONWEALTH URGENT CARE CLINIC PROGRAM
Approved primary care locations:
State | MMM 6 Location | Practice Name | Legal Name | Street Address |
WA | Broome | Kimberley Medical Group | The Trustee for Kimberley Medical Unit Trust | Unit 1 and 2, 19 Hamersley Street, Broome WA 6725 |