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HEALTH INSURANCE (GENERAL MEDICAL SERVICES TABLE) REGULATIONS 2018 (F2018L00766) - NOTES

By His Excellency's Command

Greg Hunt

Minister for Health

 

 

 

 

  

  

  


Contents

1............ Name............................................................................................................................. 1

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

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

4............ General medical services table....................................................................................... 1

5............ Dictionary...................................................................................................................... 1

6............ Schedule 2..................................................................................................................... 1

Schedule 1--General medical services table                                                                 2

Part 1--Preliminary                                                                                                                                        2

Division 1.1--Definitions                                                                                                                       2

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

1.1.2...... Meaning of general practitioner................................................................................... 3

1.1.3...... Meaning of multidisciplinary case conference.............................................................. 3

1.1.4...... Meaning of multidisciplinary case conference team...................................................... 4

1.1.5...... Meaning of single course of treatment.......................................................................... 5

1.1.6...... Meaning of symbol (H)................................................................................................. 5

Division 1.2--General application provisions                                                                           5

1.2.1...... Application.................................................................................................................... 5

1.2.2...... Attendance by specialist or consultant physician........................................................... 5

1.2.3...... Limitation of items--certain attendances by specialists and consultant physicians........ 6

1.2.4...... Professional attendance services.................................................................................... 6

1.2.5...... Personal attendance by medical practitioners generally.................................................. 7

1.2.6...... Personal attendance by medical practitioners................................................................. 7

1.2.7...... Application of items--services provided with non-medicare services........................... 8

1.2.8...... Application of items--services provided with autologous injections of blood or blood products            8

1.2.9...... Services that may be provided by persons other than medical practitioners................... 8

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 16

2.4.1...... Limitation of items 99 and 113.................................................................................... 16

Division 2.5--Group A4: Consultant physician (other than psychiatry) attendances to which no other item applies                                                                                                                       18

2.5.1...... Limitation of items 112 and 114.................................................................................. 18

Division 2.6--Group A29: Early intervention services for children with autism, pervasive developmental disorder or disability                                                                                                   21

2.6.1...... Meanings of eligible allied health provider and risk assessment................................ 21

2.6.2...... Meaning of eligible disability...................................................................................... 22

Division 2.7--Group A28: Geriatric medicine                                                                        24

2.7.1...... Limitation of item 149................................................................................................. 24

Division 2.8--Group A5: Prolonged attendances to which no other item applies 27

2.8.1...... Application of items 160 to 164.................................................................................. 27

Division 2.9--Group A6: Group therapy                                                                                  28

Division 2.10--Group A7: Acupuncture                                                                                    28

2.10.1.... Meaning of qualified medical acupuncturist............................................................... 28

Division 2.11--Group A8: Consultant physician in practice of psychiatry for attendances to which no other item applies                                                                                                          30

2.11.1.... Application of items 291, 293 and 359........................................................................ 30

2.11.2.... Application of items 342, 344 and 346........................................................................ 30

2.11.3.... Restriction of telepsychiatry consultations to regional, rural and remote areas............ 30

2.11.4.... Limitation of item 288................................................................................................. 30

2.11.5.... Meanings of eligible allied health provider and risk assessment................................ 30

Division 2.12--Group A12: Consultant occupational physician attendances to which no other item applies                                                                                                                                 40

2.12.1.... Consultant occupational physician............................................................................... 40

2.12.2.... Limitation of items 384 and 389.................................................................................. 41

Division 2.13--Group A13: Public health physician attendances to which no other item applies           42

2.13.1.... Public health physicians.............................................................................................. 42

Division 2.14--Miscellaneous services                                                                                        44

Division 2.15--Group A21: Emergency physician attendances to which no other item applies              44

2.15.1.... Meaning of recognised emergency department........................................................... 44

2.15.2.... Meaning of problem focussed history......................................................................... 44

2.15.3.... Attendance for emergency evaluation of critically ill patients...................................... 45

Division 2.16--Group A11: Urgent attendances after hours                                          47

2.16.1.... Meaning of patient's medical condition requires urgent assessment.......................... 47

2.16.2.... Meaning of responsible person................................................................................... 48

2.16.3.... Application of Group A11.......................................................................................... 48

2.16.4.... Meaning of after-hours rural area............................................................................. 48

2.16.5.... References to general practitioner in items do not include certain participants in After Hours Other Medical Practitioners Program....................................................................................................................... 48

Division 2.17--Group A14: Health assessments                                                                    50

2.17.1.... Application of Group A14.......................................................................................... 50

2.17.2.... Types of health assessments........................................................................................ 50

2.17.3.... Application of item 715 to certain patients only........................................................... 51

2.17.4.... Type 2 Diabetes Risk Evaluation................................................................................. 52

2.17.5.... 45 year old Health Assessment................................................................................... 52

2.17.6.... Older Person's Health Assessment............................................................................. 53

2.17.7.... Comprehensive Medical Assessment for permanent resident of residential aged care facility  54

2.17.8.... Health assessment for a person with an intellectual disability...................................... 54

2.17.9.... Health assessment for a refugee or other humanitarian entrant.................................... 56

2.17.10.. Australian Defence Force Post-discharge GP Health Assessment.............................. 56

2.17.11.. Aboriginal and Torres Strait Islander child health assessment..................................... 58

2.17.12.. Aboriginal and Torres Strait Islander adult health assessment..................................... 59

2.17.13.. Aboriginal and Torres Strait Islander Older Person's Health Assessment.................. 60

2.17.14.. Restrictions on health assessments for Group A14..................................................... 61

Division 2.18--Group A15: GP management plans, team care arrangements and multidisciplinary care plans and case conferences                                                                                      63

Subdivision A--General                                                                                                                   63

2.18.1.... Service by medical practitioners.................................................................................. 63

Subdivision B--Subgroup 1 of Group A15                                                                                  63

2.18.2.... Meaning of associated medical practitioner............................................................... 63

2.18.3.... Meaning of contribute to a multidisciplinary care plan.............................................. 63

2.18.4.... Meaning of coordinating the development of team care arrangements...................... 64

2.18.5.... Meaning of coordinating a review of team care arrangements.................................. 64

2.18.6.... Meaning of multidisciplinary care plan...................................................................... 65

2.18.7.... Meaning of preparing a GP management plan.......................................................... 66

2.18.8.... Meaning of reviewing a GP management plan........................................................... 66

2.18.9.... Application of items 721, 723, 729, 731 and 732........................................................ 67

2.18.10.. Application of items 721, 723 and 732........................................................................ 67

2.18.11.. Application of items in relation to items 721, 723 and 732.......................................... 68

2.18.12.. Limitation on items 721, 723, 729, 731 and 732......................................................... 68

Subdivision C--Subgroup 2 of Group A15                                                                                  70

2.18.13.. Meaning of multidisciplinary discharge case conference............................................ 70

2.18.14.. Meaning of multidisciplinary case conference in a residential aged care facility........ 70

2.18.15.. Meaning of organise and coordinate.......................................................................... 70

2.18.16.. Meaning of participate................................................................................................ 71

2.18.17.. Meaning of coordinating............................................................................................. 71

2.18.18.. Meaning of case conference team............................................................................... 72

2.18.19.. Application of item 880............................................................................................... 72

Division 2.19--Group A17: Domiciliary and residential medication management reviews       77

2.19.1.... Meaning of living in a community setting.................................................................... 77

2.19.2.... Meaning of residential medication management review............................................. 77

2.19.3.... Application of items 900 and 903................................................................................ 78

Division 2.20--Group A30: Medical practitioner video conferencing consultation       79

2.20.1.... Application of items.................................................................................................... 79

2.20.2.... Application of items 2125, 2138, 2179 and 2220........................................................ 79

2.20.3.... Meaning of amount under clause 2.20.3..................................................................... 79

2.20.4.... Limitation of items....................................................................................................... 80

Division 2.21--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)                                                                                                                                84

2.21.1.... Application of Subgroup 2 of Groups A18 and A19.................................................. 84

2.21.2.... Application of Subgroup 3 of Groups A18 and A19.................................................. 85

Division 2.22--Group A20: Mental health care                                                                     94

2.22.1.... Definitions................................................................................................................... 94

2.22.2.... Meaning of amount under clause 2.22.2..................................................................... 94

2.22.3.... Meaning of preparation of a GP mental health treatment plan.................................. 95

2.22.4.... Meaning of review of a GP mental health treatment plan........................................... 96

2.22.5.... Meaning of associated medical practitioner............................................................... 96

2.22.6.... Application of Subgroup 1 of Group A20.................................................................. 97

2.22.7.... Focussed psychological strategies............................................................................... 98

Division 2.23--Group A24: Palliative and pain medicine                                               100

2.23.1.... Meaning of organise and coordinate........................................................................ 100

2.23.2.... Meaning of participate.............................................................................................. 101

2.23.3.... Application of Group A24........................................................................................ 101

2.23.4.... Limitation on items.................................................................................................... 101

2.23.5.... Limitation of items..................................................................................................... 101

Division 2.24--Group A31: Addiction medicine                                                                  108

2.24.1.... Meaning of organise and coordinate........................................................................ 108

2.24.2.... Meaning of participate.............................................................................................. 108

2.24.3.... Limitation of items 6025 and 6026............................................................................ 108

2.24.4.... Application of item 6028........................................................................................... 109

Division 2.25--Group A32: Sexual health medicine                                                          112

2.25.1.... Meaning of organise and coordinate........................................................................ 112

2.25.2.... Meaning of participate.............................................................................................. 113

2.25.3.... Limitation of items 6059 and 6060............................................................................ 113

Division 2.26--Group A27: Pregnancy support counselling                                         117

2.26.1.... Application of item 4001........................................................................................... 117

Division 2.27--Group A22: General practitioner after-hours attendances to which no other item applies                                                                                                                                              118

2.27.1.... Application of Group A22........................................................................................ 118

Division 2.28--Group A23: Other non-referred after-hours attendances to which no other item applies                                                                                                                                              121

2.28.1.... Application of Group A23........................................................................................ 121

Division 2.29--Group A26: Neurosurgery attendances to which no other item applies              123

2.29.1.... Limitation of items 6004 and 6016............................................................................ 123

Division 2.30--Group A9: Contact lenses                                                                               125

2.30.1.... Application of item 10809......................................................................................... 125

Division 2.31--Miscellaneous services                                                                                      127

Division 2.32--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                                                                                                                                              127

2.32.1.... Definitions for item 10997........................................................................................ 127

2.32.2.... Application of item 10988......................................................................................... 127

2.32.3.... Application of item 10989......................................................................................... 127

2.32.4.... Limitation of item 10983........................................................................................... 128

Division 2.33--Group M1: Management of bulk-billed services                                 129

2.33.1.... Definitions for Division 2.33.................................................................................... 129

2.33.2.... Application of items 10990, 10991 and 10992.......................................................... 131

Division 2.34--Diagnostic procedures and investigations                                              132

Division 2.35--Group D1: Miscellaneous diagnostic procedures and investigations     132

2.35.1.... Meaning of report..................................................................................................... 132

2.35.2.... Meaning of qualified sleep medicine practitioner...................................................... 132

2.35.3.... Application of item 11801......................................................................................... 134

2.35.4.... Application of items 12306 to 12322........................................................................ 134

Division 2.36--Group D2: Nuclear medicine (non-imaging)                                         154

2.36.1.... Application of Group D2.......................................................................................... 154

Division 2.37--Group T1: Miscellaneous therapeutic procedures                             155

2.37.1.... Meaning of comprehensive hyperbaric medicine facility........................................... 155

2.37.2.... Meaning of embryology laboratory services............................................................. 156

2.37.3.... Meaning of treatment cycle....................................................................................... 156

2.37.4.... Items provided as part of treatment cycle relating to assisted reproductive services not to apply              156

2.37.5.... Application of items 13020 to 14245........................................................................ 157

2.37.6.... Limitation on item 13104........................................................................................... 157

2.37.7.... Items relating to assisted reproductive services not to apply in certain pregnancy-related circumstances 157

2.37.8.... Application of items 14227 to 14242........................................................................ 157

2.37.9.... Application of item 14245......................................................................................... 157

2.37.10.. Limitation of item 13210........................................................................................... 157

Division 2.38--Group T2: Radiation oncology                                                                    167

2.38.1.... Meaning of amount under clause 2.38.1................................................................... 167

2.38.2.... Meaning of approved site.......................................................................................... 168

2.38.3.... Meaning of IGRT...................................................................................................... 168

2.38.4.... Meaning of IMRT...................................................................................................... 168

2.38.5.... Application of Group T2........................................................................................... 168

2.38.6.... Application of items 15215 to 15272........................................................................ 168

2.38.7.... Application of items 15556, 15559 and 15562.......................................................... 168

Division 2.39--Group T3: Therapeutic nuclear medicine                                              179

2.39.1.... Application of Group T3........................................................................................... 179

Division 2.40--Group T4: Obstetrics                                                                                        180

2.40.1.... Definitions for item 16400........................................................................................ 180

2.40.2.... Meaning of midwife in items 16400 and 16408......................................................... 180

2.40.3.... Application of Group T4........................................................................................... 180

2.40.4.... Application of item 16400......................................................................................... 180

2.40.5.... Limitation of item 16399........................................................................................... 181

Division 2.41--Group T6: Examination by anaesthetist                                                 187

2.41.1.... Application of Group T6........................................................................................... 187

2.41.2.... Limitation of item 17609........................................................................................... 187

Division 2.42--Group T7: Regional or field nerve blocks                                              189

2.42.1.... Meaning of amount under clause 2.42.1................................................................... 189

2.42.2.... Application of Group T7........................................................................................... 190

Division 2.43--Group T11: Botulinum toxin                                                                         192

2.43.1.... Supply of botulinum toxin......................................................................................... 192

2.43.2.... Limitation of certain items......................................................................................... 192

Division 2.44--Group T10: Anaesthesia performed in connection with certain services (Relative Value Guide)                                                                                                                                196

2.44.1.... Meaning of amount under clause 2.44.1................................................................... 196

2.44.2.... Meaning of amount under clause 2.44.2................................................................... 197

2.44.3.... Meaning of complex paediatric case......................................................................... 197

2.44.4.... Meaning of service time............................................................................................ 197

2.44.5.... Application of Group T10......................................................................................... 198

2.44.6.... Application of Subgroup 21 of Group T10............................................................... 198

2.44.7.... Services mentioned in Subgroups 21 to 25 of Group T10........................................ 198

2.44.8.... Application of Subgroups 22 and 23 of Group T10.................................................. 198

2.44.9.... Application of Subgroups 24 and 25 of Group T10.................................................. 199

Division 2.45--Group T8: Surgical operations                                                                    225

Subdivision A--General                                                                                                                 225

2.45.1.... Meaning of approved site.......................................................................................... 225

2.45.2.... Application of Group T8........................................................................................... 225

Subdivision B--Subgroup 1 of Group T8                                                                                  225

2.45.3.... Meaning of amount under clause 2.45.3................................................................... 225

2.45.4.... Meaning of amount under clause 2.45.4................................................................... 225

2.45.5.... Meaning of qualified surgeon................................................................................... 226

2.45.6.... Meaning of qualified radiologist............................................................................... 226

2.45.7.... Histopathological proof of malignancy in certain cases for purposes of certain items relating to surgical procedures.................................................................................................................................. 226

2.45.8.... Application of items 30299 and 30300...................................................................... 226

2.45.9.... Application of items 30440, 30451, 30492 and 30495.............................................. 226

2.45.10.. Application of items 30688, 30690, 30692 and 30694.............................................. 227

2.45.11.. Application of item 35412......................................................................................... 227

2.45.12.. Application of items 31569, 31572, 31575, 31578, 31581, 31587 and 31590.......... 227

Subdivision C--Subgroups 2 and 3 of Group T8                                                                     259

2.45.13.. Meaning of foreign body in items 35360 to 35363.................................................... 259

2.45.14.. Application of items 32084, 32087, 32090 and 32093.............................................. 259

2.45.15.. Application of items 32500 to 32517 and 35321....................................................... 260

2.45.16.. Application of items 35404, 35406 and 35408.......................................................... 260

2.45.17.. Artificial bowel sphincter.......................................................................................... 260

2.45.18.. Meaning of eligible stroke centre.............................................................................. 260

Subdivision D--Subgroups 4, 5 and 6 of Group T8                                                                 282

2.45.19.. Application of items 38470 to 38766........................................................................ 282

Subdivision E--Subgroups 7 to 11 of Group T8                                                                      316

Subdivision F--Subgroups 12 and 13                                                                                          344

2.45.20.. Meaning of amount under clause 2.45.20................................................................. 344

2.45.21.. Meaning of maxilla................................................................................................... 344

Subdivision G--Subgroup 14                                                                                                        363

2.45.22.. Items 46300 to 46534 apply only in certain circumstances........................................ 363

Subdivision H--Subgroup 15                                                                                                        367

2.45.23.. Limitation of item 50303........................................................................................... 367

Division 2.46--Group T9: Assistance at operations                                                          400

2.46.1.... Meaning of amount under clause 2.46.1................................................................... 400

2.46.2.... Meaning of amount under clause 2.46.2................................................................... 400

2.46.3.... Meaning of amount under clause 2.46.3................................................................... 400

2.46.4.... Meaning of previous significant surgical complication............................................. 401

2.46.5.... Application of Group T9........................................................................................... 401

2.46.6.... Assistance at operations............................................................................................ 401

Division 2.47--Oral and Maxillofacial services                                                                   402

2.47.1.... Application of Groups O1 to O11............................................................................. 402

Division 2.48--Group O1: Consultations                                                                                402

Division 2.49--Group O2: Assistance at operation                                                           402

2.49.1.... Meaning of amount under clause 2.49.1................................................................... 402

2.49.2.... Assistance at operations............................................................................................ 403

Division 2.50--Group O3: General surgery                                                                          403

Division 2.51--Group O4: Plastic and reconstructive                                                      408

2.51.1.... Meaning of maxilla................................................................................................... 408

Division 2.52--Group O5: Preprosthetic                                                                                 411

Division 2.53--Group O6: Neurosurgical                                                                               412

Division 2.54--Group O7: Ear, nose and throat                                                                 412

Division 2.55--Group O8: Temporomandibular joint                                                      413

Division 2.56--Group O9: Treatment of fractures                                                            415

Division 2.57--Group O10: Diagnostic procedures and investigations                  416

Division 2.58--Group O11: Regional or field nerve blocks                                          416

Part 3--Dictionary                                                                                                                                       417

3.1......... Dictionary.................................................................................................................. 417

Schedule 2--Repeals                                                                                                                                   428

Health Insurance (General Medical Services Table) Regulations 2017                                 428

 




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