Sussan Ley
Minister for Health
Contents
1............ Name............................................................................................................................. 1
2............ Commencement............................................................................................................. 1
3............ Authority....................................................................................................................... 1
4............ Schedules...................................................................................................................... 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............................................................... 3
1.1.3...... Meaning of multidisciplinary case conference team....................................................... 4
1.1.4...... Meaning of single course of treatment........................................................................... 5
1.1.5...... Meaning of symbol (G)................................................................................................. 5
1.1.6...... Meaning of symbol (H)................................................................................................. 5
1.1.7...... Meaning of symbol (S)................................................................................................. 5
Division 1.2--General application provisions 6
1.2.1...... Application.................................................................................................................... 6
1.2.2...... Attendance by specialist or consultant physician........................................................... 6
1.2.3...... Professional attendance services.................................................................................... 7
1.2.4...... Personal attendance by medical practitioners generally.................................................. 7
1.2.5...... Personal attendance by medical practitioners................................................................. 8
1.2.6...... Consultant occupational physician................................................................................. 8
1.2.7...... Application of items--services provided with non-medicare services........................... 8
1.2.7A... Application of items--services provided with autologous injections of blood or blood products 9
1.2.8...... Services that may be provided by persons other than medical practitioners................... 9
1.2.9...... Meaning of participating in a video conferencing consultation...................................... 9
Part 2--Services and fees 9
Division 2.1--Groups A1 to A9 9
2.1.1...... Meaning of amount under clause 2.1.1.......................................................................... 9
Division 2.2--Group A1: General practitioner attendances to which no other item applies 11
Division 2.3--Group A2: Other non-referred attendances to which no other item applies 14
2.3.1...... Effect of determination under section 106TA of Act................................................... 14
Division 2.4--Group A3: Specialist attendances to which no other item applies 17
2.4.1...... Limitation of item 99................................................................................................... 17
Division 2.5--Group A4: Consultant physician (other than psychiatry) attendances to which no other item applies 19
2.5.1...... Limitation of items 112 to 114..................................................................................... 19
Division 2.5A--Group A29: Early intervention services for children with autism, pervasive developmental disorder or disability 22
2.5A.1... Meanings of eligible allied health provider and risk assessment.................................. 22
2.5A.2... Meaning of eligible disability...................................................................................... 22
Division 2.6--Group A28: Geriatric medicine 25
2.6.1...... Limitation of item 149................................................................................................. 25
Division 2.7--Group A5: Prolonged attendances to which no other item applies 28
2.7.1...... Application of items 160 to 164.................................................................................. 28
Division 2.8--Group A6: Group therapy 29
Division 2.9--Group A7: Acupuncture 29
2.9.1...... Meaning of qualified medical acupuncturist................................................................ 29
Division 2.10--Group A8: Consultant physician in practice of psychiatry for attendances to which no other item applies 31
2.10.1.... Application of items 291, 293 and 359........................................................................ 31
2.10.2.... Application of items 342, 344 and 346........................................................................ 31
2.10.3.... Restriction of telepsychiatry consultations to regional, rural and remote areas............ 31
2.10.4.... Limitation of item 288................................................................................................. 31
2.10.5.... Meanings of eligible allied health provider and risk assessment.................................. 31
Division 2.11--Group A12: Consultant occupational physician attendances to which no other item applies 42
2.11.1.... Limitation of items 384 and 389.................................................................................. 42
Division 2.12--Group A13: Public health physician attendances to which no other item applies 43
2.12.1.... Public health physicians.............................................................................................. 43
Division 2.13--Miscellaneous services 45
Division 2.14--Group A21: Emergency physician attendances to which no other item applies 46
2.14.1.... Meaning of recognised emergency department............................................................ 46
2.14.2.... Meaning of problem focussed history......................................................................... 46
2.14.3.... Attendance for emergency evaluation of critically ill patients...................................... 46
Division 2.15--Group A11: Urgent attendances after hours 49
2.15.1.... Meaning of patient's medical condition requires urgent treatment............................... 49
2.15.2.... Meaning of responsible person................................................................................... 49
2.15.3.... Application of Group A11.......................................................................................... 49
2.15.4.... Effect of determination under section 106TA of Act................................................... 49
Division 2.16--Group A14: Health assessments 51
2.16.1.... Application of Group A14.......................................................................................... 51
2.16.2.... Types of health assessments........................................................................................ 51
2.16.3.... Application of item 715 to certain patients only........................................................... 52
2.16.5.... Type 2 Diabetes Risk Evaluation................................................................................. 52
2.16.6.... 45 year old Health Assessment................................................................................... 53
2.16.7.... Older Person's Health Assessment............................................................................. 54
2.16.8.... Comprehensive Medical Assessment for permanent resident of residential aged care facility 55
2.16.9.... Health assessment for a person with an intellectual disability...................................... 55
2.16.10.. Health assessment for a refugee or other humanitarian entrant.................................... 57
2.16.10A.................................. Australian Defence Force Post-discharge GP Health Assessment 57
2.16.11.. Aboriginal and Torres Strait Islander child health assessment..................................... 59
2.16.12.. Aboriginal and Torres Strait Islander adult health assessment..................................... 60
2.16.13.. Aboriginal and Torres Strait Islander Older Person's Health Assessment.................. 61
2.16.14.. Restrictions on health assessments for Group A14..................................................... 62
Division 2.17--Group A15: GP management plans, team care arrangements and multidisciplinary care plans and case conferences 64
Subdivision A--General 64
2.17.1.... Service by medical practitioners.................................................................................. 64
Subdivision B--Subgroup 1 of Group A15 64
2.17.2.... Meaning of associated medical practitioner................................................................. 64
2.17.3.... Meaning of contribute to a multidisciplinary care plan................................................ 64
2.17.4.... Meaning of coordinating the development of team care arrangements......................... 64
2.17.5.... Meaning of coordinating a review of team care arrangements..................................... 65
2.17.6.... Meaning of multidisciplinary care plan........................................................................ 66
2.17.7.... Meaning of preparing a GP management plan............................................................. 66
2.17.8.... Meaning of reviewing a GP management plan............................................................ 67
2.17.9.... Application of items 721, 723, 729, 731 and 732........................................................ 67
2.17.10.. Application of items 701 to 723 and 732..................................................................... 68
2.17.10A.............................................. Application of items in relation to items 721, 723 and 732 68
2.17.11.. Limitation on items 721, 723, 729, 731 and 732......................................................... 69
Subdivision C--Subgroup 2 of Group A15 71
2.17.12.. Meaning of multidisciplinary discharge case conference............................................. 71
2.17.13.. Meaning of multidisciplinary case conference in a residential aged care facility.......... 71
2.17.14.. Meaning of organise and coordinate............................................................................ 71
2.17.15.. Meaning of participate................................................................................................. 72
2.17.16.. Meaning of coordinating............................................................................................. 72
2.17.17.. Meaning of case conference team................................................................................ 72
2.17.18.. Application of item 880............................................................................................... 73
Division 2.18--Group A17: Domiciliary and residential medication management reviews 78
2.18.1.... Meaning of living in a community setting................................................................... 78
2.18.2.... Meaning of residential medication management review............................................... 78
2.18.3.... Application of items 900 and 903................................................................................ 79
Division 2.18A--Group A30: Medical practitioner video conferencing consultation 79
2.18A.1. Application of items.................................................................................................... 79
2.18A.2. Application of items 2125, 2138, 2179 and 2220........................................................ 80
2.18A.3. Meaning of amount under clause 2.18A.3................................................................... 80
2.18A.4. Limitation of items....................................................................................................... 81
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) 85
2.19.1.... Application of Subgroup 2 of Groups A18 and A19.................................................. 85
2.19.2.... Application of Subgroup 3 of Groups A18 and A19.................................................. 86
Division 2.20--Group A20: Mental health care 94
2.20.1.... Definitions................................................................................................................... 94
2.20.2.... Meaning of amount under clause 2.20.2...................................................................... 95
2.20.3.... Meaning of preparation of a GP mental health treatment plan..................................... 95
2.20.4.... Meaning of review of a GP mental health treatment plan............................................ 96
2.20.5.... Meaning of associated medical practitioner................................................................. 97
2.20.6.... Application of Subgroup 1 of Group A20.................................................................. 97
2.20.7.... Focussed psychological strategies............................................................................... 98
Division 2.21--Group A24: Palliative and pain medicine 101
2.21.1.... Meaning of organise and coordinate.......................................................................... 101
2.21.2.... Meaning of participate............................................................................................... 101
2.21.3.... Application of Group A24........................................................................................ 102
2.21.4.... Limitation on items.................................................................................................... 102
2.21.5.... Limitation of items..................................................................................................... 102
Division 2.22--Group A27: Pregnancy support counselling 108
2.22.1.... Application of item 4001........................................................................................... 108
Division 2.23--Group A22: General practitioner after-hours attendances to which no other item applies 109
2.23.1.... Application of Group A22........................................................................................ 109
Division 2.24--Group A23: Other non-referred after-hours attendances to which no other item applies 113
2.24.1.... Application of Group A23........................................................................................ 113
Division 2.26--Group A26: Neurosurgery attendances to which no other item applies 115
2.26.1.... Limitation of items 6004 and 6016............................................................................ 115
Division 2.27--Group A9: Contact lenses 116
2.27.1.... Application of item 10809......................................................................................... 116
Division 2.29--Miscellaneous services 118
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 118
2.30.1.... Definitions for item 10997........................................................................................ 118
2.30.4.... Application of item 10988......................................................................................... 119
2.30.5.... Application of item 10989......................................................................................... 119
2.30.6.... Limitation of item 10983........................................................................................... 119
Division 2.31--Group M1: Management of bulk-billed services 121
2.31.1.... Definitions for Division 2.31.................................................................................... 121
2.31.2.... Application of items 10990, 10991 and 10992.......................................................... 122
Division 2.33--Diagnostic procedures and investigations 123
Division 2.34--Group D1: Miscellaneous diagnostic procedures and investigations 123
2.34.1.... Meaning of report...................................................................................................... 123
2.34.2.... Meaning of qualified sleep medicine practitioner....................................................... 124
2.34.3.... Application of item 11801......................................................................................... 125
Division 2.35--Group D2: Nuclear medicine (non-imaging) 143
2.35.1.... Application of Group D2.......................................................................................... 143
Division 2.37--Group T1: Miscellaneous therapeutic procedures 144
2.37.1.... Meaning of comprehensive hyperbaric medicine facility........................................... 144
2.37.2.... Meaning of embryology laboratory services............................................................. 144
2.37.3.... Meaning of treatment cycle........................................................................................ 144
2.37.4.... Items provided as part of treatment cycle relating to assisted reproductive services not to apply 145
2.37.5.... Application of items 13020 to 14245........................................................................ 145
2.37.6.... Limitation on item 13104........................................................................................... 145
2.37.7.... Items relating to assisted reproductive services not to apply in certain pregnancy-related circumstances 145
2.37.8.... Application of items 14227 to 14242........................................................................ 145
2.37.9.... Application of item 14245......................................................................................... 146
2.37.10.. Limitation of item 13210........................................................................................... 146
Division 2.38--Group T2: Radiation oncology 156
2.38.1.... Meaning of amount under clause 2.38.1.................................................................... 156
2.38.2.... Meaning of approved site.......................................................................................... 157
2.38.2A. Meaning of IGRT...................................................................................................... 157
2.38.2B. Meaning of IMRT..................................................................................................... 157
2.38.3.... Application of Group T2........................................................................................... 157
2.38.3A. Application of items 15215 to 15272........................................................................ 158
2.38.4.... Application of items 15556, 15559 and 15562.......................................................... 158
Division 2.39--Group T3: Therapeutic nuclear medicine 169
2.39.1.... Application of Group T3........................................................................................... 169
Division 2.40--Group T4: Obstetrics 170
2.40.1.... Definitions for item 16400........................................................................................ 170
2.40.2.... Meaning of amount under clause 2.40.2.................................................................... 170
2.40.3.... Meaning of delivery.................................................................................................. 171
2.40.4.... Application of Group T4........................................................................................... 171
2.40.5.... Application of item 16400......................................................................................... 171
2.40.5A. Limitation of item 16399........................................................................................... 171
2.40.6.... Limitation of items 16590 and 16591........................................................................ 171
Division 2.41--Group T6: Examination by anaesthetist 176
2.41.1.... Application of Group T6........................................................................................... 176
2.41.2.... Limitation of item 17609........................................................................................... 176
Division 2.42--Group T7: Regional or field nerve blocks 178
2.42.1.... Meaning of amount under clause 2.42.1.................................................................... 178
2.42.2.... Application of Group T7........................................................................................... 179
Division 2.42A--Group T11: Botulinum toxin 181
2.42A.1. Supply of botulinum toxin......................................................................................... 181
2.42A.2. Limitation of certain items......................................................................................... 181
Division 2.43--Group T10: Anaesthesia performed in connection with certain services (Relative Value Guide) 185
2.43.1.... Meaning of amount under clause 2.43.1.................................................................... 185
2.43.2.... Meaning of amount under clause 2.43.2.................................................................... 186
2.43.3.... Meaning of complex paediatric case.......................................................................... 186
2.43.4.... Meaning of service time............................................................................................ 186
2.43.5.... Application of Group T10......................................................................................... 187
2.43.6.... Application of Subgroup 21 of Group T10............................................................... 187
2.43.7.... Services mentioned in Subgroups 21 to 25 of Group T10........................................ 187
2.43.8.... Application of Subgroups 22 and 23 of Group T10.................................................. 187
2.43.9.... Application of Subgroups 24 and 25 of Group T10.................................................. 188
Division 2.44--Group T8: Surgical operations 218
Subdivision A--General 218
2.44.1.... Meaning of approved site.......................................................................................... 218
2.44.2.... Application of Group T8........................................................................................... 218
Subdivision B--Subgroup 1 of Group T8 218
2.44.4.... Meaning of amount under clause 2.44.4.................................................................... 218
2.44.5.... Meaning of amount under clause 2.44.5.................................................................... 218
2.44.6.... Meaning of qualified surgeon.................................................................................... 218
2.44.7.... Meaning of qualified radiologist................................................................................ 218
2.44.8.... Histopathological proof of malignancy in certain cases for purposes of certain items relating to surgical procedures.................................................................................................................................. 219
2.44.9.... Application of items 30299 and 30300...................................................................... 219
2.44.10.. Application of items 30440, 30451, 30492 and 30495.............................................. 219
2.44.11.. Application of items 30688, 30690, 30692 and 30694.............................................. 219
2.44.12.. Application of item 35412......................................................................................... 219
2.44.12A.... Application of items 31569, 31572, 31575, 31578, 31581, 31584, 31587 and 31590 219
Subdivision C--Subgroups 2 and 3 of Group T8 263
2.44.13.. Meaning of foreign body in items 35360 to 35363................................................... 263
2.44.14.. Application of items 32500 to 32517 and 35321....................................................... 263
2.44.15.. Application of items 35404, 35406 and 35408.......................................................... 263
2.44.15A................................................................................................... Sacral nerve stimulation 263
2.44.15B................................................................................................. Artificial bowel sphincter 264
Subdivision D--Subgroups 4, 5 and 6 of Group T8 285
2.44.17.. Application of items 38470 to 38766........................................................................ 285
Subdivision E--Subgroups 7 to 11 of Group T8 324
Subdivision F--Subgroups 12 and 13 353
2.44.18.. Meaning of amount under clause 2.44.18.................................................................. 353
2.44.19.. Meaning of maxilla.................................................................................................... 353
Subdivision G--Subgroup 14 374
2.44.20.. Items 46300 to 46534 apply only in certain circumstances........................................ 374
Subdivision H--Subgroup 15 379
2.44.21.. Limitation of item 50303........................................................................................... 379
Division 2.45--Group T9: Assistance at operations 416
2.45.1.... Meaning of amount under clause 2.45.1.................................................................... 416
2.45.2.... Meaning of amount under clause 2.45.2.................................................................... 416
2.45.3.... Meaning of amount under clause 2.45.3.................................................................... 416
2.45.4.... Meaning of previous significant surgical complication.............................................. 416
2.45.5.... Application of Group T9........................................................................................... 416
2.45.6.... Assistance at operations............................................................................................ 417
Division 2.46--Oral and Maxillofacial services 418
2.46.1.... Application of Groups O1 to O11............................................................................. 418
Division 2.47--Group O1: Consultations 418
Division 2.48--Group O2: Assistance at operation 418
2.48.1.... Meaning of amount under clause 2.48.1.................................................................... 418
2.48.2.... Assistance at operations............................................................................................ 418
Division 2.49--Group O3: General surgery 419
Division 2.50--Group O4: Plastic and reconstructive 424
2.50.1.... Meaning of maxilla.................................................................................................... 424
Division 2.51--Group O5: Preprosthetic 427
Division 2.52--Group O6: Neurosurgical 428
Division 2.53--Group O7: Ear, nose and throat 429
Division 2.54--Group O8: Temporomandibular joint 430
Division 2.55--Group O9: Treatment of fractures 431
Division 2.56--Group O10: Diagnostic procedures and investigations 432
Division 2.57--Group O11: Regional or field nerve blocks 433
Part 3--Dictionary 433
Schedule 2--Repeals 442
Health Insurance (General Medical Services Table) Regulation 2015 442