Commonwealth Numbered Regulations Commonwealth Numbered RegulationsBy 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