Health Insurance (Section 3C General Medical Services – Botox Injection) Determination 2020

Administered by Department of Health, Disability and Ageing

Legislation au F2020L01302 In force Legislative Instrument

Legislation content

Health Insurance (Section 3C General Medical Services – Botox 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 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.

Selfrepealing 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If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.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 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 18361 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 18361 of this Determination was specified in subclause 5.8.2(1).

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 ($)

18361

Clostridium Botulinum Type A ToxinHaemagglutinin Complex (Dysport) or Botulinum Toxin Type A Purified Neurotoxin Complex (Botox) or IncobotulinumtoxinA (Xeomin), injection of, for the treatment of moderate to severe upper limb spasticity due to cerebral palsy if:

(a) the patient is at least 2 years of age; and

(b) 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

(Anaes.)

145.65

 

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

/subsubparagraph(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 = SubChapter(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 Injection) Determination 2020

13 Oct 2020 (F2020L01302)

1 Nov 2020 (s 2(1) item 1)

 

Health Insurance (Section 3C General Medical Services – Botox Injection) Amendment Determination 2020

23 Nov 2020 (F2020L01449)

1 Dec 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 353): 1 July 2021 (s 2(1) item 1)

Health Insurance Legislation Amendment (Indexation) Determination 2022

7 Apr 2022 (F2022L00553)

sch 1 (item 8): 1 July 2022 (s 2(1) item 1)

Health Insurance Legislation Amendment (Indexation) Determination 2023

24 Mar 2023 (F2023L00348)

sch 1 (item 6): 1 July 2023 (s 2(1) item 1)

Health Insurance Legislation Amendment (Indexation No. 2) Determination 2023

4 Sept 2023 (F2023L01183)

sch 1 (item 6): 1 Nov 2023 (s 2(1) item 1)

Health Insurance Legislation Amendment (Indexation) Determination 2024

21 May 2024 (F2024L00563)

sch 1 (item 5): 1 July 2024 (s 2(1) item 1)

Health Insurance Legislation Amendment (Indexation) Determination 2025

6 May 2025 (F2025L00554)

sch 1 (item 5): 1 July 2025 (s 2(1) item 1)

Health Insurance (Section 3C General Medical Services – Botox Injection) Amendment (Addition of Xeomin Injection) Determination 2025

3 Dec 2025 (F2025L01487)

1 Mar 2026 (s 2(1) item 1)

Health Insurance (Section 3C General Medical Services – Botox Injection) Amendment (Administrative) Determination 2026

27 Feb 2026 (F2026L00168)

1 Mar 2026 (s 2(1) item 1)

Health Insurance Legislation Amendment (Indexation) Determination 2026

8 May 2026 (F2026L00523)

sch 1 (item 9): 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 C4

 

am F2023L01183; F2024L00563; F2025L00554; F2026L00523

Schedule 1

 

Schedule 1................

am F2020L01449; F2021L00426; F2025L01487; F2026L00168

 

Overview

The Health Insurance (Section 3C General Medical Services – Botox Injection) Determination 2020 was enacted to address the need for specific coverage of Botox injections under the Medicare system for the treatment of moderate to severe upper limb spasticity due to cerebral palsy in children aged two years and older. This legislative instrument was made under the authority of subsection 3C(1) of the Health Insurance Act 1973, which allows for the specification of services to be covered under the Medicare Benefits Schedule (MBS). The determination aims to ensure that Botox injections for the specified medical condition are recognised as both professional and medical services, with corresponding fees indexed to account for inflation. The determination also amends the general medical services table to reflect these changes, ensuring that the appropriate fees are applied for Botox injections under the MBS.

Scope and Application

The Health Insurance (Section 3C General Medical Services – Botox Injection) Determination 2020 applies to the provision of health services related to Botox injections, specifically for the treatment of moderate to severe upper limb spasticity due to cerebral palsy. This determination operates under the Health Insurance Act 1973 and affects entities and individuals providing these services to patients meeting the specified criteria. The legislation's geographic reach is national, impacting all states and territories within Australia. The determination specifies particular conditions under which Botox injections will be covered under the Medicare Benefits Schedule, including the age of the patient and the number of injection sets permitted per day. Notably, it excludes other uses of Botox injections not listed in the Schedule. The application and scope of the provisions can be extended or modified through subordinate instruments, such as the Health Insurance Legislation Amendment (Indexation) Determination 2024 and other amending legislative instruments.

Key Provisions

The Health Insurance (Section 3C General Medical Services – Botox Injection) Determination 2020, made under subsection 3C(1) of the Health Insurance Act 1973, sets out the framework for the provision of Botox injections under the Medicare system. This determination specifies the conditions under which Botox injections are to be considered as both professional and medical services and outlines the fee structure for these services. The determination also incorporates an indexation mechanism to adjust the fees periodically to account for inflation. Botox injections are defined as a relevant service provided for the treatment of moderate to severe upper limb spasticity due to cerebral palsy in patients aged at least 2 years. The determination mandates that Botox injections be treated as both professional and medical services, aligning them with the provisions of the general medical services table. The determination imposes several obligations on parties involved. Firstly, healthcare providers must ensure that the Botox injections are administered in accordance with the specifications outlined in the determination, particularly for the treatment of the specified condition. Secondly, the fees for the Botox injections are fixed by the determination and must be adhered to when billing Medicare. The fees are subject to periodic indexation, which must be applied as per the schedule outlined in the determination. Additionally, the determination requires that Botox injections be provided under the conditions specified, including the limitation on the number of injection sets per day and per limb. Violations of the provisions of this determination may lead to administrative penalties or legal actions. For instance, healthcare providers who charge fees outside of those specified in the determination could face financial penalties or legal action for non-compliance. The specific penalties for such breaches are not explicitly detailed in the determination itself but would typically align with the provisions of the Health Insurance Act 1973 and any related regulations. These penalties could include fines or other civil consequences for overcharging or under-compliance with the specified conditions of treatment. Criminal consequences would typically not apply unless the breaches involved fraudulent intent or significant financial harm.

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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.