Commonwealth Numbered Regulations Commonwealth Numbered RegulationsGreg Hunt
Minister for Health
Contents
1............................ Name............................................................................................................. 1
2............................ Commencement............................................................................................. 1
3............................ Authority....................................................................................................... 1
4............................ General medical services table....................................................................... 1
5............................ Schedule 2..................................................................................................... 1
Schedule 1--General medical services table 2
Part 1--Preliminary 2
Division 1.1--Interpretation 2
1.1.1...................... Dictionary..................................................................................................... 2
1.1.2...................... Meaning of eligible non-vocationally recognised medical practitioner......... 2
1.1.3...................... General practitioners..................................................................................... 3
1.1.4...................... Meaning of multidisciplinary case conference.............................................. 4
1.1.5...................... Meaning of multidisciplinary case conference team..................................... 4
1.1.6...................... Meaning of single course of treatment.......................................................... 5
1.1.7...................... Meaning of symbol (H)................................................................................ 5
1.1.8...................... References in this Schedule to items include items determined under section 3C of the Act 6
Division 1.2--General application provisions 6
1.2.1...................... Application.................................................................................................... 6
1.2.2...................... Restrictions on certain items--attendances by specialists and consultant physicians without referrals 6
1.2.3...................... Restrictions on certain items--attendances by specialist radiologists in conjunction with certain diagnostic imaging services............................................................................................ 6
1.2.4...................... Restrictions on certain items--attendances by specialists and consultant physicians on same day as they perform certain surgical operations............................................................... 7
1.2.5...................... Professional attendance services--matters included...................................... 7
1.2.6...................... Personal attendance by medical practitioners generally--application and matters included 7
1.2.7...................... Personal attendance by medical practitioners--application and matters included 8
1.2.8...................... Restriction on items--services provided with non-medicare services........... 9
1.2.9...................... Restrictions on items--services rendered in certain circumstances or for certain purposes 9
1.2.10.................... Restriction on items--services provided with harvesting, storage, in vitro processing or injection of non-haematopoietic stem cells....................................................................... 9
1.2.11.................... Services that may be provided by persons other than medical practitioners.. 9
1.2.12.................... Restriction on items--services involving video conferences between patients and medical practitioners separated by at least 15 km.......................................................................... 10
Part 2--Attendances 11
Division 2.1--Preliminary 11
2.1.1...................... Meaning of amount under clause 2.1.1...................................................... 11
Division 2.2--Group A1: General practitioner attendances to which no other item applies 12
2.2.1...................... Items in Group A1...................................................................................... 12
Division 2.3--Group A2: Other non-referred attendances to which no other item applies 14
2.3.1...................... Items in Group A2...................................................................................... 14
Division 2.4--Group A3: Specialist attendances to which no other item applies 16
2.4.1...................... Items in Group A3...................................................................................... 16
Division 2.5--Group A4: Consultant physician (other than psychiatry) attendances to which no other item applies 18
2.5.1...................... Items in Group A4...................................................................................... 18
Division 2.6--Group A29: Early intervention services for children with autism, pervasive developmental disorder or disability 22
2.6.1...................... Meaning of eligible disability...................................................................... 22
2.6.2...................... Meaning of risk assessment........................................................................ 22
2.6.3...................... Items in Group A29.................................................................................... 22
Division 2.7--Group A28: Geriatric medicine 24
2.7.1...................... Items in Group A28.................................................................................... 24
Division 2.8--Group A5: Prolonged attendances to which no other item applies 27
2.8.1...................... Restrictions on items in Group A5.............................................................. 27
2.8.2...................... Items in Group A5...................................................................................... 28
Division 2.9--Group A6: Group therapy 28
2.9.1...................... Items in Group A6...................................................................................... 28
Division 2.10--Group A7: Acupuncture and non-specialist practitioner items 29
2.10.1.................... Meaning of qualified medical acupuncturist............................................... 29
2.10.2.................... Items in Group A7...................................................................................... 29
Division 2.11--Group A8: Consultant psychiatrist attendances to which no other item applies 31
2.11.1.................... Restriction on timing of services in items 291, 293 and 359....................... 31
2.11.2.................... Restriction on items 342, 344 and 346........................................................ 31
2.11.3.................... Restriction on items 353 to 361--location of patient................................... 31
2.11.4.................... Meaning of risk assessment........................................................................ 31
2.11.5.................... Items in Group A8...................................................................................... 31
Division 2.12--Group A12: Consultant occupational physician attendances to which no other item applies 42
2.12.1.................... Restrictions on items in Group A12--attendances by consultant occupational physicians 42
2.12.2.................... Items in Group A12.................................................................................... 42
Division 2.13--Group A13: Public health physician attendances to which no other item applies 44
2.13.1.................... Restrictions on items in Group A13--attendances by public health physicians 44
2.13.2.................... Items in Group A13.................................................................................... 44
Division 2.14--Group A11: Urgent attendances after--hours 46
2.14.1.................... Meaning of patient's medical condition requires urgent assessment......... 46
2.14.2.................... Restrictions on items in Group A11............................................................ 46
2.14.3.................... Meaning of after-hours rural area............................................................. 47
2.14.4.................... Restrictions on items in Group A11--practitioners.................................... 47
2.14.5.................... Items in Group A11.................................................................................... 47
Division 2.15--Group A14: Health assessments 48
2.15.1.................... Restrictions on items in Group A14............................................................ 48
2.15.2.................... Types of health assessments....................................................................... 48
2.15.3.................... Application of item 715............................................................................... 50
2.15.4.................... Type 2 Diabetes Risk Evaluation................................................................ 50
2.15.5.................... 45 year old Health Assessment................................................................... 51
2.15.6.................... Older Person's Health Assessment............................................................. 51
2.15.7.................... Comprehensive Medical Assessment for care recipient in a residential aged care facility 52
2.15.8.................... Health assessment for a person with an intellectual disability..................... 53
2.15.9.................... Health assessment for a refugee or other humanitarian entrant.................... 54
2.15.10.................. Australian Defence Force Post-discharge GP Health Assessment.............. 55
2.15.11.................. Aboriginal and Torres Strait Islander child health assessment.................... 56
2.15.12.................. Aboriginal and Torres Strait Islander adult health assessment.................... 58
2.15.13.................. Aboriginal and Torres Strait Islander Older Person's Health Assessment.. 59
2.15.14.................. Restrictions on health assessments for Group A14..................................... 60
2.15.15.................. Items in Group A14.................................................................................... 60
Division 2.16--Group A15: GP management plans, team care arrangements and multidisciplinary care plans and case conferences 61
Subdivision A--General 61
2.16.1.................... Restrictions on items 729 to 866--services by certain medical practitioners 61
Subdivision B--Subgroup 1 of Group A15 62
2.16.2.................... Meaning of associated general practitioner............................................... 62
2.16.3.................... Meaning of contribute to a multidisciplinary care plan.............................. 62
2.16.4.................... Meaning of coordinating the development of team care arrangements...... 62
2.16.5.................... Meaning of coordinating a review of team care arrangements.................. 63
2.16.6.................... Meaning of multidisciplinary care plan...................................................... 64
2.16.7.................... Meaning of preparing a GP management plan.......................................... 64
2.16.8.................... Meaning of reviewing a GP management plan........................................... 65
2.16.9.................... Restrictions on items 721, 723, 729, 731 and 732--services for certain patients 65
2.16.10.................. Restrictions on items 721, 723 and 732...................................................... 66
2.16.11.................. Restrictions on other items--services provided on same day as services in items 721, 723 and 732 66
2.16.12.................. Conditions relating to timing of services in items 721, 723, 729, 731 and 732 if exceptional circumstances do not exist....................................................................................................... 67
2.16.13.................. Items in Subgroup 1 of Group A15............................................................ 68
Subdivision C--Subgroup 2 of Group A15 69
2.16.14.................. Meaning of multidisciplinary discharge case conference........................... 69
2.16.15.................. Meaning of organise and coordinate.......................................................... 69
2.16.16.................. Meaning of participate................................................................................ 70
2.16.17.................. Meaning of coordinating............................................................................ 70
2.16.18.................. Meaning of case conference team............................................................... 70
2.16.19.................. Restrictions on item 880--certain patients.................................................. 71
2.16.20.................. Items in Subgroup 2 of Group A15............................................................ 71
Division 2.17--Group A17: Domiciliary and residential medication management reviews 76
2.17.1.................... Meaning of living in a community setting................................................... 76
2.17.2.................... Meaning of residential medication management review............................. 76
2.17.3.................... Restrictions on items 900 and 903.............................................................. 77
2.17.4.................... Items in Group A17.................................................................................... 77
Division 2.18--Group A30: Medical practitioner video conferencing consultation 78
2.18.1.................... Restrictions on items in Subgroups 1 and 2 of Group A30--services provided in association with certain other services.............................................................................................. 78
2.18.2.................... Location of attendance in items 2125, 2138, 2179 and 2220....................... 78
2.18.3.................... Meaning of amount under clause 2.18.3.................................................... 78
2.18.4.................... Restrictions on items in Subgroups 5 and 6 of Group A30 (video conferencing consultation attendances for patients in rural and remote areas)............................................................... 79
2.18.5.................... Items in Group A30.................................................................................... 79
Division 2.19--Groups A18 and A19 (Attendances associated with Practice Incentive Program payments) 84
2.19.1.................... Restrictions on items in Subgroup 2 of Groups A18 and A19--timing..... 84
2.19.2.................... Restrictions on items in Subgroup 3 of Groups A18 and A19--timing..... 85
2.19.3.................... Items in Group A18.................................................................................... 86
2.19.4.................... Items in Group A19.................................................................................... 92
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.................. 96
2.20.4.................... Meaning of review of a GP mental health treatment plan........................... 97
2.20.5.................... Meaning of associated general practitioner............................................... 97
2.20.6.................... Restrictions on items in Subgroup 1 of Group A20 (GP mental health treatment plans) 97
2.20.7.................... Restrictions on items in Subgroup 2 of Group A20 (focussed psychological strategies) 99
2.20.8.................... Items in Group A20.................................................................................... 99
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.................... Restrictions on items in Subgroups 2 and 4 of Group A24--timing........ 102
2.21.4.................... Items in Group A24.................................................................................. 102
Division 2.22--Group A27: Pregnancy support counselling 108
2.22.1.................... Restrictions on item 4001.......................................................................... 108
2.22.2.................... Items in Group A27.................................................................................. 109
Division 2.23--Group A21: Professional attendances at recognised emergency departments of private hospitals 109
2.23.1.................... Items in Group A21.................................................................................. 109
Division 2.24--Group A22: General practitioner after-hours attendances to which no other item applies 112
2.24.1.................... Restrictions on items in Group A22--timing............................................ 112
2.24.2.................... Items in Group A22.................................................................................. 113
Division 2.25--Group A23: Other non-referred after-hours attendances to which no other item applies 116
2.25.1.................... Restrictions on items in Group A23--timing............................................ 116
2.25.2.................... Items in Group A23.................................................................................. 116
Division 2.26--Group A26: Neurosurgery attendances to which no other item applies 118
2.26.1.................... Items in Group A26.................................................................................. 118
Division 2.27--Group A31: Addiction medicine 119
2.27.1.................... Meaning of organise and coordinate........................................................ 119
2.27.2.................... Meaning of participate.............................................................................. 120
2.27.3.................... Restrictions on item 6028.......................................................................... 120
2.27.4.................... Items in Group A31.................................................................................. 120
Division 2.28--Group A32: Sexual health medicine 124
2.28.1.................... Meaning of organise and coordinate........................................................ 124
2.28.2.................... Meaning of participate.............................................................................. 125
2.28.3.................... Items in Group A32.................................................................................. 125
Division 2.29--Group A9: Contact lenses 129
2.29.1.................... Restrictions on item 10809........................................................................ 129
2.29.2.................... Items in Group A9.................................................................................... 129
Division 2.30--Group A35: Non-referred attendance at a residential aged care facility 131
2.30.1.................... Fee in relation to the first patient during each attendance at a residential aged care facility 131
2.30.2.................... Items in Group A35.................................................................................. 131
Part 3--Miscellaneous services 134
Division 3.1--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 134
3.1.1...................... Definitions for item 10997........................................................................ 134
3.1.2...................... Restrictions on item 10988........................................................................ 134
3.1.3...................... Restrictions on item 10989........................................................................ 134
3.1.4...................... Items in Group M12................................................................................. 135
Division 3.2--Group M1: Management of bulk-billed services 136
3.2.1...................... Definitions................................................................................................ 136
3.2.2...................... Restrictions on items 10990, 10991 and 10992........................................ 138
3.2.3...................... Items in Group M1................................................................................... 138
Part 4--Diagnostic procedures and investigations 140
Division 4.1--Group D1: Miscellaneous diagnostic procedures and investigations 140
4.1.1...................... Meaning of report..................................................................................... 140
4.1.2...................... Meaning of qualified adult sleep medicine practitioner, qualified paediatric sleep medicine practitioner and qualified sleep medicine practitioner.......................................................... 140
4.1.3...................... Restriction on item 11801--service provided in association with other services 141
4.1.4...................... Restrictions on items 12306 to 12322....................................................... 141
4.1.5...................... Items in Group D1.................................................................................... 142
Division 4.2--Group D2: Nuclear medicine (non-imaging) 173
4.2.1...................... Restriction on items in Group D2--services connected with services in item 12250 173
4.2.2...................... Items in Group D2.................................................................................... 173
Part 5--Therapeutic procedures 175
Division 5.1--Preliminary 175
5.1.1...................... Restriction on items in this Part--services connected with provision of pain pump for post-surgical pain management.............................................................................................. 175
Division 5.2--Group T1: Miscellaneous therapeutic procedures 175
5.2.1...................... Meaning of comprehensive hyperbaric medicine facility.......................... 175
5.2.2...................... Meaning of embryology laboratory services............................................ 175
5.2.3...................... Meaning of treatment cycle....................................................................... 176
5.2.4...................... Items provided as part of treatment cycle relating to assisted reproductive services not to apply 176
5.2.5...................... Restriction on item 13104--timing........................................................... 176
5.2.6...................... Restriction on items relating to assisted reproductive services--certain pregnancy-related circumstances.................................................................................................................. 176
5.2.7...................... Restrictions on items 14227 to 14242--patients....................................... 177
5.2.8...................... Restrictions on item 14245--practitioner and timing................................ 177
5.2.9...................... Restriction on item 13899--other services performed on the same day.... 177
5.2.10.................... Items in Group T1..................................................................................... 177
Division 5.3--Group T2: Radiation oncology 190
5.3.1...................... Meaning of amount under clause 5.3.1.................................................... 190
5.3.2...................... Restrictions on items 15215 to 15272--services provided to implement intensity-modulated radiation therapy dosimetry plans......................................................................................... 191
5.3.3...................... Restrictions on items 15556, 15559 and 15562........................................ 191
5.3.4...................... Items in Group T2..................................................................................... 191
Division 5.4--Group T3: Therapeutic nuclear medicine 202
5.4.1...................... Items in Group T3..................................................................................... 202
Division 5.5--Group T4: Obstetrics 203
5.5.1...................... Definitions for item 16400........................................................................ 203
5.5.2...................... Meaning of practice midwife in items 16400 and 16408........................... 203
5.5.3...................... Restrictions on item 16400--provider and timing..................................... 203
5.5.4...................... Items in Group T4..................................................................................... 203
Division 5.6--Group T6: Examination by anaesthetist 210
5.6.1...................... Items in Group T6..................................................................................... 210
Division 5.7--Group T7: Regional or field nerve blocks 212
5.7.1...................... Meaning of amount under clause 5.7.1.................................................... 212
5.7.2...................... Items in Group T7..................................................................................... 212
Division 5.8--Group T11: Botulinum toxin 214
5.8.1...................... Group T11 services do not include supply of botulinum toxin................. 214
5.8.2...................... Restrictions on items in Group T11.......................................................... 215
5.8.3...................... Items in Group T11................................................................................... 215
Division 5.9--Group T10: Anaesthesia performed in connection with certain services (Relative Value Guide) 218
5.9.1...................... Meaning of amount under clause 5.9.1.................................................... 218
5.9.2...................... Meaning of amount under clause 5.9.2.................................................... 219
5.9.3...................... Meaning of service time............................................................................ 219
5.9.4...................... Restrictions on items in Group T10.......................................................... 220
5.9.5...................... Application of Subgroup 21 of Group T10............................................... 220
5.9.6...................... Meaning of anaesthesia, assistance and perfusion in Subgroups 21 to 25 of Group T10 220
5.9.7...................... Application of Subgroups 22 and 23 of Group T10................................. 220
5.9.8...................... Application of Subgroups 24 and 25 of Group T10................................. 221
5.9.9...................... Items in Group T10................................................................................... 221
Division 5.10--Group T8: Surgical operations 248
Subdivision A--Subgroup 1 of Group T8 248
5.10.1.................... Meaning of amount under clause 5.10.1.................................................. 248
5.10.2.................... Meaning of amount under clause 5.10.2.................................................. 248
5.10.3.................... Histopathological proof of malignancy in certain cases for purposes of certain items relating to surgical procedures................................................................................................. 248
5.10.4.................... Restrictions on items 30299 and 30300--patients.................................... 248
5.10.5.................... Items 30440, 30451, 30492 and 30495 do not include imaging................ 248
5.10.6.................... Restrictions on items 30688, 30690, 30692 and 30694--patient notes..... 249
5.10.7.................... Application of item 35412......................................................................... 249
5.10.8.................... Restrictions on items 31569, 31572, 31575, 31578, 31581, 31587 and 31590--services provided on same occasion.................................................................................................... 249
5.10.9.................... Items in Subgroup 1 of Group T8............................................................. 249
Subdivision B--Subgroups 2 and 3 of Group T8 283
5.10.10.................. Meaning of foreign body in items 35360 to 35363................................... 283
5.10.11.................. Application of items 32084 and 32087..................................................... 283
5.10.12.................. Restrictions on items 32500 to 32517 and 35321--methods of providing services 283
5.10.13.................. Restrictions on items 35404, 35406 and 35408........................................ 284
5.10.14.................. When artificial bowel sphincter is contraindicated for items 32220 and 32221 284
5.10.15.................. Meaning of eligible stroke centre.............................................................. 284
5.10.16.................. Items in Subgroups 2 and 3 of Group T8................................................. 284
Subdivision C--Subgroups 4, 5 and 6 of Group T8 307
5.10.17.................. Restriction on items in Subgroup 6 of Group T8--surgical techniques.... 307
5.10.18.................. Items in Subgroups 4, 5 and 6 of Group T8............................................. 307
Subdivision D--Subgroups 7 to 11 of Group T8 345
5.10.19.................. Items in Subgroups 7 to 11 of Group T8.................................................. 345
Subdivision E--Subgroups 12 and 13 of Group T8 372
5.10.20.................. Meaning of amount under clause 5.10.20................................................ 372
5.10.21.................. Meaning of NOSE Scale........................................................................... 372
5.10.22.................. Meaning of maxilla................................................................................... 372
5.10.23.................. Items in Subgroups 12 and 13 of Group T8............................................. 372
Subdivision F--Subgroup 14 of Group T8 395
5.10.24.................. Restriction on items 46300 to 46534--hand operations............................ 395
5.10.25.................. Items in Subgroup 14 of Group T8........................................................... 395
Subdivision G--Subgroups 15, 16 and 17 of Group T8 400
5.10.26.................. Restriction on item 50303--timing........................................................... 400
5.10.27.................. Restrictions on items 51011 to 51112 and 51115 to 51171--services provided in conjunction with other services in Group T8................................................................................. 400
5.10.28.................. Restrictions on items 51061 to 51066--services provided in conjunction with certain other services 400
5.10.29.................. Meaning of motion segment...................................................................... 400
5.10.30.................. Items in Subgroups 15, 16 and 17 of Group T8....................................... 400
Division 5.11--Group T9: Assistance at operations 435
5.11.1.................... Meaning of amount under clause 5.11.1.................................................. 435
5.11.2.................... Meaning of amount under clause 5.11.2.................................................. 435
5.11.3.................... Meaning of amount under clause 5.11.3.................................................. 436
5.11.4.................... Restrictions on items in Group T9--medical practitioner providing assistance at operations 436
5.11.5.................... Items in Group T9..................................................................................... 436
Part 6--Oral and maxillofacial services 438
Division 6.1--Preliminary 438
6.1.1...................... Restriction on items Groups O1 to O11--providers of services............... 438
Division 6.2--Group O1: Consultations 438
6.2.1...................... Items in Group O1.................................................................................... 438
Division 6.3--Group O2: Assistance at operation 438
6.3.1...................... Meaning of amount under clause 6.3.1.................................................... 438
6.3.2...................... Restrictions on items in Group O2--approved dental practitioner providing assistance at operations 438
6.3.3...................... Items in Group O2.................................................................................... 439
Division 6.4--Group O3: General surgery 439
6.4.1...................... Items in Group O3.................................................................................... 439
Division 6.5--Group O4: Plastic and reconstructive 444
6.5.1...................... Meaning of maxilla................................................................................... 444
6.5.2...................... Items in Group O4.................................................................................... 444
Division 6.6--Group O5: Preprosthetic 447
6.6.1...................... Items in Group O5.................................................................................... 447
Division 6.7--Group O6: Neurosurgical 448
6.7.1...................... Items in Group O6.................................................................................... 448
Division 6.8--Group O7: Ear, nose and throat 449
6.8.1...................... Items in Group O7.................................................................................... 449
Division 6.9--Group O8: Temporomandibular joint 450
6.9.1...................... Items in Group O8.................................................................................... 450
Division 6.10--Group O9: Treatment of fractures 451
6.10.1.................... Items in Group O9.................................................................................... 451
Division 6.11--Group O11: Regional or field nerve blocks 453
6.11.1.................... Items in Group O11.................................................................................. 453
Part 7--Dictionary 454
7.1.1...................... Dictionary................................................................................................. 454
Schedule 2--Repeals 466
Health Insurance (General Medical Services Table) Regulations (No. 1) 2020 466