Contents

1............ Name of regulation.............................................................................. 1

2............ Commencement................................................................................... 1

3............ Authority............................................................................................. 1

4............ Schedule(s)......................................................................................... 1

5............ General medical services table............................................................. 1

6............ Dictionary........................................................................................... 1

Schedule 1--General medical services table                                       2

Part 1--Preliminary                                                                                                             2

Division 1.1--Interpretation                                                                                     2

1.1.1...... Meaning of eligible non-vocationally recognised medical practitioner 2

1.1.1A... Meaning of general practitioner......................................................... 3

1.1.2...... Meaning of multidisciplinary case conference.................................... 4

1.1.3...... Meaning of multidisciplinary case conference team........................... 5

1.1.4...... Meaning of single course of treatment................................................ 6

1.1.5...... Meaning of symbol (G)...................................................................... 7

1.1.6...... Meaning of symbol (H)...................................................................... 7

1.1.7...... Meaning of symbol (S)....................................................................... 7

Division 1.2--General application provisions                                                 9

1.2.1...... Application.......................................................................................... 9

1.2.2...... Attendance by specialist or consultant physician................................. 9

1.2.3...... Professional attendance services....................................................... 10

1.2.4...... Personal attendance by medical practitioners generally..................... 10

1.2.5...... Personal attendance by medical practitioners..................................... 11

1.2.6...... Consultant occupational physician.................................................... 12

1.2.7...... Application of items 3 to 10943........................................................ 12

1.2.8...... Services that may be provided by persons other than medical practitioners              13

1.2.9...... Meaning of participating in a video conferencing consultation........ 13

Part 2--Services and fees                                                                                                14

Division 2.1--Groups A1 to A10                                                                          14

2.1.1...... Meaning of amount under clause 2.1.1............................................ 14

Division 2.2--Group A1: General practitioner attendances to which no other item applies     17

Division 2.3--Group A2: Other non-referred attendances to which no other item applies       22

2.3.1...... Effect of determination under section 106TA of Act......................... 22

Division 2.4--Group A3: Specialist attendances to which no other item applies             26

2.4.1...... Limitation of item 99......................................................................... 26

Division 2.5--Group A4: Consultant physician (other than psychiatry) attendances to which no other item applies                                                                                            29

2.5.1...... Limitation of items 112 to 114.......................................................... 29

Division 2.5A--Group A29: Early intervention services for children with autism, pervasive developmental disorder or disability                                        33

2.5A.1... Meanings of eligible allied health provider and risk assessment...... 33

2.5A.2... Meaning of eligible disability............................................................ 33

Division 2.6--Group A28: Geriatric medicine                                             37

2.6.1...... Limitation of item 149....................................................................... 37

Division 2.7--Group A5: Prolonged attendances to which no other item applies           42

2.7.1...... Application of items 160 to 164........................................................ 42

Division 2.8--Group A6: Group therapy                                                        43

Division 2.9--Group A7: Acupuncture                                                             44

2.9.1...... Meaning of qualified medical acupuncturist..................................... 44

Division 2.10--Group A8: Consultant physician in practice of psychiatry for attendances to which no other item applies                                                                               47

2.10.1.... Application of items 291, 293 and 359............................................. 47

2.10.2.... Application of items 342, 344 and 346............................................. 47

2.10.3.... Restriction of telepsychiatry consultations to regional, rural and remote areas         47

2.10.4.... Limitation of item 288....................................................................... 47

2.10.5.... Meanings of eligible allied health provider and risk assessment...... 47

Division 2.11--Group A12: Consultant occupational physician attendances to which no other item applies                                                                                                       62

2.11.1.... Limitation of items 384 and 389........................................................ 62

Division 2.12--Group A13: Public health physician attendances to which no other item applies           65

2.12.1.... Public health physicians.................................................................... 65

Division 2.13--Miscellaneous services                                                              68

Division 2.14--Group A21: Emergency physician attendances to which no other item applies              69

2.14.1.... Meaning of recognised emergency department................................ 69

2.14.2.... Meaning of problem focussed history............................................... 69

2.14.3.... Attendance for emergency evaluation of critically ill patients............ 69

Division 2.15--Group A11: Urgent attendances after hours               73

2.15.1.... Meaning of patient's medical condition requires urgent treatment.. 73

2.15.2.... Meaning of responsible person........................................................ 73

2.15.3.... Application of Group A11................................................................ 74

2.15.4.... Effect of determination under section 106TA of Act......................... 74

Division 2.16--Group A14: Health assessments                                          76

2.16.1.... Application of Group A14................................................................ 76

2.16.2.... Types of health assessments............................................................. 76

2.16.3.... Application of item 715 to certain patients only................................ 78

2.16.4.... Healthy Kids Check.......................................................................... 78

2.16.5.... Type 2 Diabetes Risk Evaluation...................................................... 80

2.16.6.... 45 year old Health Assessment......................................................... 81

2.16.7.... Older Person's Health Assessment................................................... 82

2.16.8.... Comprehensive Medical Assessment for permanent resident of residential aged care facility  83

2.16.9.... Health assessment for a person with an intellectual disability........... 84

2.16.10.. Health assessment for a refugee or other humanitarian entrant.......... 86

2.16.11.. Aboriginal and Torres Strait Islander child health assessment.......... 87

2.16.12.. Aboriginal and Torres Strait Islander adult health assessment.......... 89

2.16.13.. Aboriginal and Torres Strait Islander Older Person's Health Assessment               91

2.16.14.. Restrictions on health assessments for Group A14........................... 92

Division 2.17--Group A15: GP management plans, team care arrangements and multidisciplinary care plans and case conferences                                                            95

Subdivision A--General                                                                                         95

2.17.1.... Service by medical practitioners........................................................ 95

Subdivision B--Subgroup 1 of Group A15                                                        95

2.17.2.... Meaning of associated medical practitioner..................................... 95

2.17.3.... Meaning of contribute to a multidisciplinary care plan.................... 95

2.17.4.... Meaning of coordinating the development of team care arrangements 96

2.17.5.... Meaning of coordinating a review of team care arrangements........ 97

2.17.6.... Meaning of multidisciplinary care plan............................................ 98

2.17.7.... Meaning of preparing a GP management plan................................ 99

2.17.8.... Meaning of reviewing a GP management plan................................. 99

2.17.9.... Application of items 721, 723, 729, 731 and 732........................... 100

2.17.10.. Application of items 701 to 723 and 732........................................ 101

2.17.11.. Limitation on items 721, 723, 729, 731 and 732............................. 102

Subdivision C--Subgroup 2 of Group A15                                                      105

2.17.12.. Meaning of multidisciplinary discharge case conference............... 105

2.17.13.. Meaning of multidisciplinary case conference in a residential aged care facility     105

2.17.14.. Meaning of organise and coordinate.............................................. 105

2.17.15.. Meaning of participate.................................................................... 106

2.17.16.. Meaning of coordinating................................................................ 107

2.17.17.. Meaning of case conference team................................................... 107

2.17.18.. Application of item 880................................................................... 108

Division 2.18--Group A17: Domiciliary and residential medication management reviews       115

2.18.1.... Meaning of living in a community setting....................................... 115

2.18.2.... Meaning of residential medication management review................. 115

2.18.3.... Application of items 900 and 903................................................... 116

Division 2.18A--Group A30: Medical practitioner video conferencing consultation   118

2.18A.1. Application of items........................................................................ 118

2.18A.2. Application of items 2125, 2138, 2179 and 2220........................... 118

2.18A.3. Meaning of amount under clause 2.18A.3...................................... 118

2.18A.4. Limitation of items.......................................................................... 119

Division 2.19--Groups A18 (General practitioner attendances associated with PIP payments) and A19 (Other non-referral attendances associated with PIP payments to which no other item applies)                                                                                                   125

2.19.1.... Application of Subgroup 2 of Groups A18 and A19...................... 125

2.19.2.... Application of Subgroup 3 of Groups A18 and A19...................... 126

Division 2.20--Group A20: Mental health care                                        139

2.20.1.... Definitions...................................................................................... 139

2.20.2.... Meaning of amount under clause 2.20.2........................................ 139

2.20.3.... Meaning of preparation of a GP mental health treatment plan...... 140

2.20.4.... Meaning of review of a GP mental health treatment plan............... 141

2.20.5.... Meaning of associated medical practitioner................................... 142

2.20.6.... Application of Subgroup 1 of Group A20...................................... 143

2.20.7.... Focussed psychological strategies................................................... 145

Division 2.21--Group A24: Palliative and pain medicine                     149

2.21.1.... Meaning of organise and coordinate.............................................. 149

2.21.2.... Meaning of participate.................................................................... 149

2.21.3.... Application of Group A24.............................................................. 150

2.21.4.... Limitation on items.......................................................................... 150

2.21.5.... Limitation of items.......................................................................... 150

Division 2.22--Group A27: Pregnancy support counselling               160

2.22.1.... Application of item 4001................................................................. 160

Division 2.23--Group A22: General practitioner after-hours attendances to which no other item applies                                                                                                                    162

2.23.1.... Application of Group A22.............................................................. 162

Division 2.24--Group A23: Other non-referred after-hours attendances to which no other item applies                                                                                                                    167

2.24.1.... Application of Group A23.............................................................. 167

Division 2.26--Group A26: Neurosurgery attendances to which no other item applies              170

2.26.1.... Limitation of items 6004 and 6016.................................................. 170

Division 2.27--Group A9: Contact lenses                                                     173

2.27.1.... Application of item 10809............................................................... 173

Division 2.28--Group A10: Optometric services provided by participating optometrist           176

2.28.1.... Application of items 10900, 10940 and 10941............................... 176

2.28.2.... Application of item 10929............................................................... 176

2.28.3.... Limitation on items.......................................................................... 176

2.28.4.... Application of items 10931, 10932 and 10933............................... 177

2.28.5.... Limitation of item 10943................................................................. 177

Division 2.29--Miscellaneous services                                                            184

Division 2.30--Group 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                                                                                                                    185

2.30.1.... Definitions for item 10997.............................................................. 185

2.30.2.... Application of item 10986............................................................... 185

2.30.3.... Restrictions on item 10986.............................................................. 186

2.30.4.... Application of item 10988............................................................... 186

2.30.5.... Application of item 10989............................................................... 187

2.30.6.... Limitation of item 10983................................................................. 187

Division 2.31--Group M1: Management of bulk-billed services      190

2.31.1.... Definitions for Division 2.31.......................................................... 190

2.31.2.... Application of items 10990, 10991 and 10992............................... 192

Division 2.33--Diagnostic procedures and investigations                    194

Division 2.34--Group D1: Miscellaneous diagnostic procedures and investigations     195

2.34.1.... Meaning of report........................................................................... 195

2.34.2.... Meaning of qualified sleep medicine practitioner........................... 195

2.34.3.... Application of Group D1................................................................ 197

Division 2.35--Group D2: Nuclear medicine (non-imaging)               220

2.35.1.... Application of Group D2................................................................ 220

Division 2.36--Therapeutic procedures                                                         221

2.36.1.... Definition........................................................................................ 221

2.36.2.... Medical services that may be provided by medical practitioner or specialist trainee 221

Division 2.37--Group T1: Miscellaneous therapeutic procedures  222

2.37.1.... Meaning of comprehensive hyperbaric medicine facility................ 222

2.37.2.... Meaning of embryology laboratory services.................................. 223

2.37.3.... Meaning of treatment cycle............................................................. 223

2.37.4.... Items provided as part of treatment cycle relating to assisted reproductive services not to apply              223

2.37.5.... Application of items 13020 to 14245.............................................. 224

2.37.6.... Limitation on item 13104................................................................ 224

2.37.7.... Items relating to assisted reproductive services not to apply in certain pregnancy-related circumstances 224

2.37.8.... Application of items 14227 to 14242.............................................. 224

2.37.9.... Application of item 14245............................................................... 224

2.37.10.. Limitation of item 13210................................................................. 225

Division 2.38--Group T2: Radiation oncology                                          240

2.38.1.... Meaning of amount under clause 2.38.1........................................ 240

2.38.2.... Meaning of approved site............................................................... 241

2.38.3.... Application of Group T2................................................................. 241

2.38.4.... Application of items 15556, 15559 and 15562............................... 241

Division 2.39--Group T3: Therapeutic nuclear medicine                    254

2.39.1.... Application of Group T3................................................................. 254

Division 2.40--Group T4: Obstetrics                                                              256

2.40.1.... Definitions for item 16400.............................................................. 256

2.40.2.... Meaning of amount under clause 2.40.2........................................ 256

2.40.3.... Meaning of delivery........................................................................ 257

2.40.4.... Application of Group T4................................................................. 257

2.40.5.... Application of item 16400............................................................... 257

2.40.5A. Limitation of item 16399................................................................. 258

2.40.6.... Limitation of items 16590 and 16591.............................................. 258

Division 2.41--Group T6: Examination by anaesthetist                       265

2.41.1.... Application of Group T6................................................................. 265

2.41.2.... Limitation of item 17609................................................................. 265

Division 2.42--Group T7: Regional or field nerve blocks                   269

2.42.1.... Meaning of amount under clause 2.42.1........................................ 269

2.42.2.... Application of Group T7................................................................. 269

Division 2.42A--Group T11: Botulinum toxin                                           273

2.42A.1. Injection of botulinum toxin............................................................ 273

2.42A.2. Limitation of items 18360 and 18364.............................................. 273

Division 2.43--Group T10: Anaesthesia performed in connection with certain services (Relative Value Guide)                                                                                                     277

2.43.1.... Meaning of amount under clause 2.43.1........................................ 277

2.43.2.... Meaning of amount under clause 2.43.2........................................ 278

2.43.3.... Meaning of complex paediatric case............................................... 278

2.43.4.... Meaning of service time.................................................................. 278

2.43.5.... Application of Group T10............................................................... 279

2.43.6.... Application of Subgroup 21 of Group T10..................................... 280

2.43.7.... Services mentioned in Subgroups 21 to 25 of Group T10.............. 280

2.43.8.... Application of Subgroups 22 and 23 of Group T10....................... 280

2.43.9.... Application of Subgroups 24 and 25 of Group T10....................... 280

Division 2.44--Group T8: Surgical operations                                          321

Subdivision A--General                                                                                       321

2.44.1.... Meaning of approved site............................................................... 321

2.44.2.... Application of Group T8................................................................. 321

Subdivision B--Subgroup 1 of Group T8                                                        321

2.44.4.... Meaning of amount under clause 2.44.4........................................ 321

2.44.5.... Meaning of amount under clause 2.44.5........................................ 321

2.44.6.... Meaning of qualified surgeon......................................................... 322

2.44.7.... Meaning of qualified radiologist..................................................... 322

2.44.8.... Histopathological proof of malignancy in certain cases for purposes of certain items relating to surgical procedures........................................................................................................ 322

2.44.9.... Application of items 30299 and 30300........................................... 322

2.44.10.. Application of items 30440, 30451, 30492 and 30495................... 323

2.44.11.. Application of items 30688, 30690, 30692 and 30694................... 323

2.44.12.. Application of item 35412............................................................... 323

2.44.12A Application of items 31569, 31572, 31575, 31578, 31581, 31584, 31587 and 31590             323

Subdivision C--Subgroups 2 and 3 of Group T8                                           376

2.44.13.. Meaning of foreign body in items 35360 to 35363......................... 376

2.44.14.. Application of items 32500 to 32517 and 35321............................ 377

2.44.15.. Application of items 35404, 35406 and 35408............................... 377

2.44.15A........................................................................ Sacral nerve stimulation  377

2.44.15B...................................................................... Artificial bowel sphincter  378

Subdivision D--Subgroups 4, 5 and 6 of Group T8                                       405

2.44.16.. Application of items 38365, 38368 and 38654............................... 405

2.44.17.. Application of items 38470 to 38766.............................................. 405

Subdivision E--Subgroups 7 to 11 of Group T8                                            452

Subdivision F--Subgroups 12 and 13                                                               490

2.44.18.. Meaning of amount under clause 2.44.18...................................... 490

2.44.19.. Meaning of maxilla......................................................................... 491

Subdivision G--Subgroup 14                                                                              518

2.44.20.. Items 46300 to 46534 apply only in certain circumstances............. 518

Subdivision H--Subgroup 15                                                                              524

2.44.21.. Limitation of item 50303................................................................. 524

Division 2.45--Group T9: Assistance at operations                                572

2.45.1.... Meaning of amount under clause 2.45.1........................................ 572

2.45.2.... Meaning of amount under clause 2.45.2........................................ 572

2.45.3.... Meaning of amount under clause 2.45.3........................................ 572

2.45.4.... Meaning of previous significant surgical complication.................. 572

2.45.5.... Application of Group T9................................................................. 573

2.45.6.... Assistance at operations.................................................................. 573

Division 2.46--Oral and Maxillofacial services                                         575

2.46.1.... Application of Groups O1 to O11.................................................. 575

Division 2.47--Group O1: Consultations                                                      576

Division 2.48--Group O2: Assistance at operation                                 577

2.48.1.... Meaning of amount under clause 2.48.1........................................ 577

2.48.2.... Assistance at operations.................................................................. 577

Division 2.49--Group O3: General surgery                                                578

Division 2.50--Group O4: Plastic and reconstructive                           585

2.50.1.... Meaning of maxilla......................................................................... 585

Division 2.51--Group O5: Preprosthetic                                                      590

Division 2.52--Group O6: Neurosurgical                                                     591

Division 2.53--Group O7: Ear, nose and throat                                       592

Division 2.54--Group O8: Temporomandibular joint                           594

Division 2.55--Group O9: Treatment of fractures                                  596

Division 2.56--Group O10: Diagnostic procedures and investigations                598

Division 2.57--Group O11: Regional or field nerve blocks                599

Part 3--Dictionary                                                                                                            600

Schedule 2--Repeals                                                                                                        613

Health Insurance (General Medical Services Table) Regulation 2012        613

 

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