Health Insurance (Section 3C General Medical Services – Botox, Dysport or Xeomin Injection) Determination 2020
made under subsection 3C(1) of the
Health Insurance Act 1973
Compilation No. 9
Compilation date: 1 July 2026
Includes amendments: F2026L00523
About this compilation
This compilation
This is a compilation of the Health Insurance (Section 3C General Medical Services – Botox, Dysport or Xeomin Injection) Determination 2020 that shows the text of the law as amended and in force on 1 July 2026 (the compilation date).
The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.
Uncommenced amendments
The effect of uncommenced amendments is not shown in the text of the compiled law. The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. Any uncommenced amendments affecting the law are accessible on the Register (www.legislation.gov.au).
Application, saving and transitional provisions
If the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.
Editorial changes
For more information about any editorial changes made in this compilation, see the endnotes.
Presentational changes
The Legislation Act 2003 provides for First Parliamentary Counsel to make presentational changes to a compilation. Presentational changes are applied to give a more consistent look and feel to legislation published on the Register, and enable the user to more easily navigate those documents.
Modifications
If the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. Any modifications affecting the law are accessible on the Register.
Self‑repealing provisions
If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.
Contents
1. Name
3. Authority
4. Definitions
5. Treatment of relevant services
6. Application of provisions of the general medical services table
7. Indexation
Schedule 1 – relevant services
Endnotes
Endnote 1—About the endnotes
Endnote 2—Abbreviation key
Endnote 3—Legislation history
Endnote 4—Amendment history
1. Name
This instrument is the Health Insurance (Section 3C General Medical Services – Botox, Dysport or Xeomin Injection) Determination 2020.
3. Authority
This instrument is made under subsection 3C(1) of the Health Insurance Act 1973.
4. Definitions
(1) In this instrument:
Act means the Health Insurance Act 1973.
relevant provisions means 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.
relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in a Schedule.
Schedule means a Schedule to this instrument.
Note: The following terms are defined in subsection 3(1) of the Act:
clinically relevant service;
general medical services table;
item;
professional service.
(2) Unless the contrary intention appears, a reference in this instrument to a provision of the Act or the National Health Act 1953 or regulations made under the Act or under the National Health Act 1953 as applied, adopted or incorporated in relation to specifying a matter is a reference to those provisions as in force from time to time and any other reference to provisions of an Act or regulations is a reference to those provisions as in force from time to time.
5. Treatment of relevant services
For subsection 3C(1) of the Act, a relevant service, provided in accordance with this instrument and as a clinically relevant service, is to be treated, for the relevant provisions, as if:
(a) it were both a professional service and a medical service; and
(b) there were an item in the general medical services table that:
i. related to the service; and
ii. specified for the service a fee in relation to each State, being the fee specified in the Schedule in relation to the service.
6. Application of provisions of the general medical services table
(1) Clause 5.8.1 of the general medical services table shall have effect as if item 18365 of this Determination was specified in the clause.
(2) Clause 5.8.2 of the general medical services table shall have effect as if item 18365 of this Determination was specified in subclause 5.8.2(2) and 5.8.2(3).
7. Indexation
(1) At the start of 1 July 2026 (the indexation time), each amount covered by subsection (2) is replaced by the amount worked out using the following formula:
Note: The indexed fees could in 2026 be viewed on the Department of Health, Disability and Ageing’s MBS Online website (www.mbsonline.gov.au).
(2) The amounts covered by this subsection are the fee for each item in a Schedule of this Determination.
(3) An amount worked out under subsection (1) is to be rounded up or down to the nearest 5 cents (rounding down if the amount is an exact multiple of 2.5 cents).
Schedule 1 – relevant services
Group T11—Botulinum toxin | ||
Column 1 Item | Column 2 Description | Column 3 Fee ($) |
18365 | Botulinum Toxin Type A Purified Neurotoxin Complex (Botox) or Clostridium Botulinum Type A Toxin‑Haemagglutinin Complex (Dysport) or IncobotulinumtoxinA (Xeomin), injection of, for the treatment of moderate to severe spasticity of the upper limb following an acute event, if: (a) the patient is at least 18 years of age; and (b) treatment is provided as: (i) second line therapy when standard treatment for the condition has failed; or (ii) an adjunct to physical therapy; and (c) the patient does not have established severe contracture in the limb that is to be treated; and (d) the treatment is for all or any of the muscles subserving one functional activity and supplied by one motor nerve, with a maximum of 4 sets of injections for the patient on any one day (with a maximum of 2 sets of injections for each upper limb), including all injections per set; and (e) for a patient who has received treatment on 2 previous separate occasions—the patient has responded to the treatment | 129.90 |
Endnotes
Endnote 1—About the endnotes
The endnotes provide information about this compilation and the compiled law.
The following endnotes are included in every compilation:
Endnote 1—About the endnotes
Endnote 2—Abbreviation key
Endnote 3—Legislation history
Endnote 4—Amendment history
Abbreviation key—Endnote 2
The abbreviation key sets out abbreviations that may be used in the endnotes.
Legislation history and amendment history—Endnotes 3 and 4
Amending laws are annotated in the legislation history and amendment history.
The legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.
The amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.
Editorial changes
The Legislation Act 2003 authorises First Parliamentary Counsel to make editorial and presentational changes to a compiled law in preparing a compilation of the law for registration. The changes must not change the effect of the law. Editorial changes take effect from the compilation registration date.
If the compilation includes editorial changes, the endnotes include a brief outline of the changes in general terms. Full details of any changes can be obtained from the Office of Parliamentary Counsel.
Misdescribed amendments
A misdescribed amendment is an amendment that does not accurately describe how an amendment is to be made. If, despite the misdescription, the amendment can be given effect as intended, then the misdescribed amendment can be incorporated through an editorial change made under section 15V of the Legislation Act 2003.
If a misdescribed amendment cannot be given effect as intended, the amendment is not incorporated and “(md not incorp)” is added to the amendment history.
Endnote 2—Abbreviation key
ad = added or inserted | orig = original |
am = amended | p = page(s) |
amdt = amendment | para = paragraph(s)/subparagraph(s) |
C[x] = Compilation No. x | /sub‑subparagraph(s) |
ch = Chapter(s) | pres = present |
cl = clause(s) | prev = previous |
cont. = continued | (prev…) = previously |
def = definition(s) | pt = Part(s) |
Dict = Dictionary | r = regulation(s)/Court rule(s) |
disallowed = disallowed by Parliament | reloc = relocated |
div = Division(s) | renum = renumbered |
ed = editorial change | rep = repealed |
exp = expires/expired or ceases/ceased to have | rs = repealed and substituted |
effect | s = section(s)/subsection(s) |
gaz = gazette | /rule(s)/subrule(s)/order(s)/suborder(s) |
LA = Legislation Act 2003 | sch = Schedule(s) |
LIA = Legislative Instruments Act 2003 | SLI = Select Legislative Instrument |
(md) = misdescribed amendment can be given | SR = Statutory Rules |
effect | sub ch = Sub‑Chapter(s) |
(md not incorp) = misdescribed amendment | sub div = Subdivision(s) |
cannot be given effect | sub pt = Subpart(s) |
mod = modified/modification | underlining = whole or part not |
No. = Number(s) | commenced or to be commenced |
Ord = Ordinance |
|
Endnote 3—Legislation history
Name | Registration | Commencement | Application, saving and transitional provisions |
Health Insurance (Section 3C General Medical Services – Botox, Dysport or Xeomin Injection) Determination 2020 | 29 Apr 2020 (F2020L00511) | 1 May 2020 (s 2(1) item 1) |
|
Health Insurance Legislation Amendment (Section 3C General Medical and Diagnostic Imaging Services – Medicare Indexation) Determination 2020 | 18 June 2020 (F2020L00748) | sch 1 (item 79): 1 July 2020 (s 2(1) item 1) | — |
Health Insurance (Section 3C General Medical Services – Botox, Dysport or Xeomin Injection) Amendment Determination 2020 | 23 July 2020 (F2020L00941) | 1 Aug 2020 (s 2(1) item 1) | — |
Health Insurance Legislation Amendment (Section 3C General Medical and Diagnostic Imaging Services – Medicare Indexation) Determination 2021 | 8 Apr 2021 (F2021L00426) | sch 1 (item 354): 1 July 2021 (s 2(1) item 1) | — |
Health Insurance Legislation Amendment (Indexation) Determination 2022 | 7 Apr 2022 (F2022L00553) | sch 1 (item 7): 1 July 2022 (s 2(1) item 1) | — |
Health Insurance Legislation Amendment (Indexation) Determination 2023 | 24 Mar 2023 (F2023L00348) | sch 1 (item 2): 1 July 2023 (s 2(1) item 1) | — |
Health Insurance Legislation Amendment (Indexation No. 2) Determination 2023 | 4 Sept 2023 (F2023L01183) | sch 1 (item 2): 1 Nov 2023 (s 2(1) item 1) | — |
Health Insurance Legislation Amendment (Indexation) Determination 2024 | 21 May 2024 (F2024L00563) | sch 1 (item 2): 1 July 2024 (s 2(1) item 1) | — |
Health Insurance Legislation Amendment (Indexation) Determination 2025 | 6 May 2025 (F2025L00554) | sch 1 (item 2): 1 July 2025 (s 2(1) item 1) | — |
Health Insurance Legislation Amendment (Indexation) Determination 2026 | 8 May 2026 (F2026L00523) | sch 1 (item 10): 1 July 2026 (s 2(1) item 2) | — |
Endnote 4—Amendment history
Provision affected | How affected |
s 2..................... | rep LA s 48D |
s 7..................... | ad F2022L00553 |
| am F2023L00348 |
| ed C5 |
| am F2023L01183; F2024L00563; F2025L00554; F2026L00523 |
Schedule 1 |
|
Schedule 1................ | am F2020L00748; F2020L00941; F2021L00426 |