Schedule 1 Table of general medical services
(regulation 5)
Part 1 Prescription of table
1 Prescription of table
For section 4 of the Act, these Regulations prescribe a table of general medical services that sets out:
(a) in Part 2 — rules for interpretation of the table; and
(b) in Part 3:
(i) items of general medical services; and
(ii) the amount of fees applicable for each item.
Part 2 Rules of interpretation
2 Application of table
An item in Part 3 does not apply to a service provided in contravention of a law of the Commonwealth or of a State or Territory.
3 General
(1) In this table, unless the contrary intention appears:
attendance of a minor nature or minor attendance, for an attendance on a patient by a consultant physician, means an attendance that:
(a) is a second or subsequent attendance on the patient, in the course of a single course of treatment by the consultant physician, during which it is not necessary for the consultant physician to carry out a physical examination of the patient; and
(b) does not result in a substantial alteration to the treatment of the patient.
closed reduction:
(a) means treatment of a dislocation or fracture by non‑operative reduction; and
(b) includes the use of percutaneous fixation, or external splintage by cast or splints.
comprehensive hyperbaric medicine facility means a separate hospital area that, on a 24-hour basis:
(a) is equipped and staffed so that it is capable of providing to a patient:
(i) hyperbaric oxygen therapy at a treatment pressure of at least 2.8 atmospheric pressure absolute (180 kilopascal gauge pressure); and
(ii) mechanical ventilation and invasive cardiovascular monitoring within a monoplace or multiplace chamber for the duration of the hyperbaric treatment; and
(b) is under the direction of at least 1 practitioner who is rostered, and immediately available, to the facility during normal working hours and who:
(i) is a specialist with training in diving and hyperbaric medicine; or
(ii) holds a Diploma of Diving and Hyperbaric Medicine of the South Pacific Underwater Medicine Society; and
(c) is staffed by:
(i) at least 1 medical practitioner with training in diving and hyperbaric medicine who is present in the facility and immediately available at all times when patients are being treated at the facility; and
(ii) at least 1 registered nurse with specific training in hyperbaric patient care to the published standards of the Hyperbaric Technicians and Nurses Association, who is present during hyperbaric oxygen therapy; and
(d) has admission and discharge policies in operation.
general intensive care unit means a separate hospital area that:
(a) is equipped and staffed so that it is capable of providing to a patient:
(i) mechanical ventilation for a period of several days; and
(ii) invasive cardiovascular monitoring; and
(b) is supported by:
(i) during normal working hours — at least 1 specialist, or consultant physician, in the specialty of intensive care, who is immediately available, and exclusively rostered, to that area; and
(ii) at all times — at least 1 registered medical practitioner who is present in the hospital and immediately available to that area; and
(iii) at least 18 hours each day — at least 1 registered nurse; and
(c) has admission and discharge policies in operation.
general practitioner means:
(a) a practitioner who is vocationally registered under section 3F of the Act; or
(b) a practitioner who:
(i) is a Fellow of the RACGP; and
(ii) participates in the quality assurance and continuing medical education program of the RACGP; and
(iii) meets the RACGP requirements for quality assurance and continuing education; or
(c) a practitioner who is undertaking a placement in general practice that is approved by the RACGP:
(i) as part of a training program for general practice leading to the award of Fellowship of the RACGP; or
(ii) as part of another training program recognised by the RACGP as being of an equivalent standard; or
(iii) as part of the Rural and Remote Area Placement Program administered by the Australian College of Rural and Remote Medicine; or
(d) an eligible non-vocationally recognised medical practitioner.
institution means a place (other than a hospital or residential aged care facility) at which residential accommodation or day care is, or both residential accommodation and day care are, made available to:
(a) disadvantaged children; or
(b) juvenile offenders; or
(c) aged persons; or
(d) chronically ill psychiatric patients; or
(e) homeless persons; or
(f) unemployed persons; or
(g) persons suffering from alcoholism; or
(h) persons addicted to drugs; or
(i) physically or intellectually disabled persons.
intensive care unit means a general intensive care unit or a neo-natal intensive care unit.
item means:
(a) an item mentioned, by number, in column 1 of:
(i) Part 3; or
(ii) Part 3 of the diagnostic imaging services table; or
(iii) Part 3 of the pathology services table; and
(b) in a reference immediately followed by a number — the item so numbered.
Example
A reference (if any) by number to item 55028 is a reference to the item so numbered in the diagnostic imaging services table.
neo-natal intensive care unit means a separate hospital area that:
(a) is equipped and staffed so that it is capable of providing to a patient who is a newly born child:
(i) mechanical ventilation for a period of several days; and
(ii) invasive cardiovascular monitoring; and
(b) is supported by:
(i) during normal working hours — at least 1 consultant physician in paediatric medicine who is immediately available, and exclusively rostered, to that area; and
(ii) at all times — at least 1 registered medical practitioner who is present in the hospital and immediately available to that area; and
(iii) at least 18 hours each day — at least 1 registered nurse; and
(c) has admission and discharge policies in operation.
open reduction means treatment of a dislocation or fracture by either:
(a) operative exposure, including the use of any internal or external fixation; or
(b) non-operative (closed) reduction using intra-medullary fixation or external fixation.
RACGP means the Royal Australian College of General Practitioners.
referring practitioner, for the referral of a patient, means:
(a) in the case of all referrals — a medical practitioner; and
(b) for a referral made to a specialist who is an ophthalmologist — an optometrist; and
(c) for a referral that arises out of a dental service provided by a dental practitioner and that is made to a specialist (but not a consultant physician) — a dental practitioner; and
(d) for a referral that arises out of a dental service provided by a dental practitioner who is approved by the Minister for the purposes of paragraph (b) of the definition of professional service in subsection 3 (1) of the Act and that is made to a consultant physician — a dental practitioner.
residential aged care facility means a facility where residential care (within the meaning given by section 41‑3 of the Aged Care Act 1997) is provided.
Rural, Remote and Metropolitan Areas Classification means the document so titled, as in force on 1 January 2001, setting out certain categories of areas in Australia that have been determined by the Department by reference to population size and remoteness of locality on the basis of 1991 census data published by the Australian Bureau of Statistics in 1994.
(2) A reference to a Group in the table includes every item in the Group, and a reference to a Subgroup in the table includes every item in the Subgroup.
(3) A reference in the table to an eligible non-vocationally recognised medical practitioner is a reference to:
(a) a medical practitioner (including an overseas trained practitioner or a temporary resident medical practitioner) who:
(i) is providing general medical services in a rural or remote area under the Rural, Remote and Metropolitan Areas Classification; and
(ii) is registered as a medical practitioner under the Rural Other Medical Practitioners’ Program; and
(iii) is not vocationally registered under section 3F of the Act, but is undertaking, or has indicated in writing an intention to undertake, additional training:
(A) that could enable vocational registration within 4 years or, on written application, 5 years, after commencing that training; and
(B) of which the Commission has written notice; or
(b) a medical practitioner who:
(i) is registered as a medical practitioner under the Outer Metropolitan (Other Medical Practitioners) Relocation Incentive Program; and
(ii) is providing general medical services in accordance with that Program; and
(iii) is not vocationally registered under section 3F of the Act, but is required under that Program to undertake additional training or other activities:
(A) that could enable vocational registration within 4 years or, on written application, 5 years, after commencing the training or other activities; and
(B) of which the Commission has written notice.
(4) For subrule (3):
(a) the Rural Other Medical Practitioners’ Program is a program administered by the Commission that, in relation to medical services provided to patients in rural and remote areas, provides a particular level of medicare benefits; and
(b) the Outer Metropolitan (Other Medical Practitioners) Relocation Incentive Program is a program administered by the Department that, in relation to medical services provided in accordance with the Program, provides a particular level of medicare benefits.
4 Meaning of symbols (S) and (G)
(1) An item including the symbol (S) applies only to a service performed by a specialist (and not to a service performed by a consultant physician) in the practice of his or her specialty, being:
(a) a service that:
(i) is provided to a patient who has been referred to the specialist; and
(ii) is the first service performed by the specialist in accordance with the referral; or
(b) a service that:
(i) is provided to a patient who has been referred to the specialist; and
(ii) is part of a single course of treatment given for the condition identified in the referral or, if no condition was identified in the referral, part of a single course of treatment for the condition identified by the specialist; and
(iii) is provided within the period of validity of the referral that is applicable under regulation 31 of the Health Insurance Regulations 1975; or
(c) a service that:
(i) is provided to a patient who has declared that a written referral completed by a named referring practitioner has been lost, stolen or destroyed before the service was provided; and
(ii) is the first service performed by the specialist in accordance with the referral; or
(d) a service that:
(i) is provided to a patient who has not been referred to the specialist; and
(ii) is a service that, in an emergency within the meaning of subregulation 30 (5) of the Health Insurance Regulations 1975, the specialist decides is necessary in the patient’s interests to be provided as soon as practicable without a referral.
(2) An item including the symbol (G) applies only to a service provided otherwise than by a specialist in accordance with subrule (1).
5 Meaning of single course of treatment in certain circumstances
(1) In subrules 3 (1), 4 (1) and 7 (1) and items 104, 105, 106, 107, 108, 110, 116, 119, 122, 128, 131, 385, 386, 387 and 388, single course of treatment, in relation to a patient, includes:
(a) the initial attendance on the patient by a specialist or consultant physician; and
(b) the continuing management or treatment up to and including the stage when the patient is referred back to the care of the referring practitioner; and
(c) any subsequent review of the patient’s condition by the specialist or consultant physician that may be necessary, whether the review is initiated by the referring practitioner or by the specialist or consultant physician.
(2) For subrule (1), single course of treatment does not include treatment of an unrelated illness that requires referral of the patient to the specialist’s or consultant physician’s care.
(3) For subrule (1), an attendance (the later attendance) on the patient by the specialist or consultant physician, after the end of the period of validity of the last referral to have application under regulation 31 of the Health Insurance Regulations 1975, initiates a new course of treatment if:
(a) the referring practitioner considers the later attendance necessary for the patient’s condition to be reviewed; and
(b) the patient was most recently attended by the specialist or consultant physician more than 9 months before the later attendance.
6 Meaning of professional attendance in certain items
(1) In items 1 to 338, 348 to 388, 410 to 417, 501 to 536, 601, 602, 697, 698, 2501 to 2727 and 10900 to 10929, professional attendance includes (but is not limited to) the provision, in relation to a patient, of any of the following services:
(a) the evaluation of the patient’s condition or conditions including, if applicable, evaluation using a health screening service mentioned in subsection 19 (5) of the Act;
(b) the formulation of a plan for the management and, if applicable, for the treatment of the patient’s condition or conditions;
(c) the provision of advice to the patient about the patient’s condition or conditions and, if applicable, about treatment;
(d) if authorised by the patient, the provision of advice to another person, or other persons, about the patient’s condition or conditions and, if applicable, about treatment;
(e) the recording of the clinical details of the service or services provided to the patient.
(2) If:
(a) in connection with a professional attendance mentioned in any of items 3 to 96, vaccine is supplied to a patient; and
(b) the cost of the vaccine is not subsidised by the Commonwealth or a State;
the professional attendance is taken not to include that supply.
7 Interpretation of items 104 to 131 and 300 to 388
(1) In items 104 to 131 and 300 to 388, a reference to an attendance on a patient by a specialist, or consultant physician, in the practice of his or her specialty following referral of the patient to him or her:
(a) includes such an attendance on a patient who:
(i) has declared that a written referral of the patient was completed by a medical practitioner; or
(ii) in an emergency (within the meaning of subregulation 30 (5) of the Health Insurance Regulations 1975) has not been referred to the specialist, or consultant physician, if the specialist or consultant physician decides that it is necessary in the patient’s interests to provide the service mentioned in the item as soon as practicable without a referral; but
(b) does not include such an attendance if:
(i) the attendance forms part of a single course of treatment in which the first service was provided more than 12 months (or such other period, if any, set by the referring practitioner in, or in connection with, the referral) before the attendance; and
(ii) a later referral has not been made.
(2) For this rule, referral means referral by a referring practitioner.
8 Meaning of amount under rule 8 in certain items
(1) In items 4, 13, 19 and 20, amount under rule 8 means an amount equal to the sum of:
(a) the fee for item 3; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance — $20.60 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.45.
(2) In items 24, 25, 33 and 35, amount under rule 8 means an amount equal to the sum of:
(a) the fee for item 23; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance — $20.60 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.45.
(3) In items 37, 38, 40 and 43, amount under rule 8 means an amount equal to the sum of:
(a) the fee for item 36; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance — $20.60 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.45.
(4) In items 47, 48, 50 and 51, amount under rule 8 means an amount equal to the sum of:
(a) the fee for item 44; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance — $20.60 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.45.
(5) In items 58, 81, 87 and 92, amount under rule 8 means an amount equal to the sum of:
(a) $8.50; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance — $15.50 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — 70 cents.
(6) In items 59, 83, 89, 93, 2610, 2631 and 2673, amount under rule 8 means an amount equal to the sum of:
(a) $16.00; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance — $17.50 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — 70 cents.
(7) In items 60, 84, 90, 95, 2613, 2633, 2675 and 2707, amount under rule 8 means an amount equal to the sum of:
(a) $35.50; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance — $15.50 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — 70 cents.
(8) In items 65, 86, 91, 96, 2616, 2635, 2677 and 2708, amount under rule 8 means an amount equal to the sum of:
(a) $57.50; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance — $15.50 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — 70 cents.
(9) In item 195, amount under rule 8 means an amount equal to the sum of:
(a) the fee for item 193; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance — $20.60 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.45.
(10) In item 414, amount under rule 8 means an amount equal to the sum of:
(a) the fee for item 410; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance — $20.60 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.45.
(11) In item 415, amount under rule 8 means an amount equal to the sum of:
(a) the fee for item 411; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance — $20.60 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.45.
(12) In item 416, amount under rule 8 means an amount equal to the sum of:
(a) the fee for item 412; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance — $20.60 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.45.
(13) In item 417, amount under rule 8 means an amount equal to the sum of:
(a) the fee for item 413; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance — $20.60 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.45.
9 Items 10809 and 10929 not to apply in certain circumstances
Items 10809 and 10929 do not apply if the patient’s requirement for contact lenses is only for any of the following reasons:
(a) because the patient does not want to wear spectacles for reasons of appearance;
(b) because the patient wants contact lenses for work or sporting purposes;
(c) because the patient has difficulty in using, or cannot use, spectacles for psychological reasons.
10 Personal attendance by medical practitioners generally
(1) The items mentioned in subrule (2) apply only to a service provided in the course of a personal attendance by a single medical practitioner on a single patient on a single occasion.
(2) The items are items 1 to 164, 173 to 338, 348 to 10816, 11012, 11015, 11018, 11021, 11212, 11304, 11500, 11600, 11627, 11701, 11712, 11724, 11921, 12000, 12003, 13030, 13100, 13103, 13106, 13109, 13110, 13112, 13209, 13290, 13292, 13300, 13303, 13306, 13309, 13312, 13318, 13319, 13400, 13500, 13503, 13506, 13700, 13815, 13818, 13830, 13839, 13842, 13845, 13848, 13851, 13854, 13857, 13870, 13873, 13876, 13879, 13882, 13885, 13888, 14100, 14103, 14106, 14109, 14112, 14115, 14118, 14120, 14122, 14124, 14126, 14128, 14130, 14132, 14200, 14203, 14206, 14209, 14212, 14215, 14224, 15600, 16003 to 16512 and 16515 to 51318.
(3) Items 170, 171, 172, 342, 344 and 346 apply only to a service provided in the course of a personal attendance by a single medical practitioner.
(4) For this rule, an attendance by a medical practitioner on a patient by way of a telepsychiatry consultation, to which any of items 353 to 358 applies, is taken to be a personal attendance by the medical practitioner on the patient.
11 Personal attendance by certain medical practitioners
(1) The items mentioned in subrule (3) apply only to a service provided in the course of a personal attendance by:
(a) a medical practitioner (other than a medical practitioner employed by the proprietor of a hospital that is not a private hospital); or
(b) a medical practitioner who:
(i) is employed by the proprietor of a hospital that is not a private hospital; and
(ii) provides the service otherwise than in the course of employment by that proprietor.
(2) Paragraph (1) (b) applies whether or not another person provides essential assistance to the medical practitioner in accordance with accepted medical practice.
(3) The items are items 1 to 10816, 11012, 11015, 11018, 11021, 11212, 11304, 11500, 11600, 11627, 11701, 11712, 11724, 11921, 12000, 12003, 13030, 13100, 13103, 13106, 13109, 13110, 13112, 13209, 13290, 13292, 13300, 13303, 13306, 13309, 13312, 13318, 13319, 13400, 13500, 13503, 13506, 13700, 13815, 13818, 13830, 13839, 13842, 13845, 13848, 13851, 13854, 13857, 13870, 13873, 13876, 13879, 13882, 13885, 13888, 14100, 14103, 14106, 14109, 14112, 14115, 14118, 14120, 14122, 14124, 14126, 14128, 14130, 14132, 14200, 14203, 14206, 14209, 14212, 14215, 14224, 15600, 16003 to 16512 and 16515 to 51318.
(4) For this rule, an attendance by a medical practitioner on a patient by way of a telepsychiatry consultation, to which any of items 353 to 358 applies, is taken to be a personal attendance by the medical practitioner on the patient.
12 Certain services may be provided by persons other than medical practitioners
(1) The items mentioned in subrule (2) apply whether the medical service is given by:
(a) a medical practitioner; or
(b) a person, other than a medical practitioner, who:
(i) is employed by a medical practitioner; or
(ii) in accordance with accepted medical practice, acts under the supervision of a medical practitioner.
(2) The items are items 11000, 11003, 11004, 11005, 11006, 11009, 11024, 11027, 11200, 11203, 11204, 11205, 11210, 11211, 11215, 11218, 11221, 11222, 11224, 11225, 11235, 11237, 11240, 11241, 11242, 11243, 11300, 11303, 11306, 11309, 11312, 11315, 11318, 11321, 11324, 11327, 11330, 11332, 11333, 11336, 11339, 11503, 11506, 11509, 11512, 11602, 11604, 11605, 11610, 11611, 11612, 11614, 11615, 11700, 11702, 11706, 11708, 11709, 11710, 11711, 11713, 11715, 11718, 11721, 11800, 11810, 11830, 11833, 11900, 11903, 11906, 11909, 11912, 11915, 11919, 12012, 12015, 12018, 12021, 12200, 12203, 12207, 12210, 12213, 12215, 12217, 12500 to 12533, 13020, 13025, 13200, 13203, 13206, 13212, 13215, 13218, 13221, 13703, 13706, 13709, 13750, 13755, 13757, 13760, 13915 to 13948, 14050, 14053, 14218, 14221, 15000 to 15336, 15339 to 15357, 15500 to 15539 and 16514.
13 Conditions under which certain services to be provided
Items 11309, 11312, 11315, 11318 and 11321 apply only to a service provided:
(a) in conditions that allow the establishment of determinate thresholds; and
(b) in a sound-attenuated environment with background noise conditions that comply with Australian Standard AS1269‑1983 of the Standards Association of Australia, as in force on 1 August 1987; and
(c) using calibrated equipment that complies with Australian Standard AS2586-1983 of the Standards Association of Australia, as in force on 1 August 1987.
14 Application of items 51700 to 53706
Items 51700 to 53706 apply only to a service provided in the course of dental practice by a dental practitioner approved by the Minister for the purposes of the definition of professional service in subsection 3 (1) of the Act.
15 Meaning of amount under rule 15 in certain items
(1) In item 15003, amount under rule 15 means an amount equal to the sum of:
(a) the fee for item 15000; and
(b) $13.85 for each field separately treated in excess of 1.
(2) In item 15009, amount under rule 15 means an amount equal to the sum of:
(a) the fee for item 15006; and
(b) $15.05 for each field separately treated in excess of 1.
(3) In item 15103, amount under rule 15 means an amount equal to the sum of:
(a) the fee for item 15100; and
(b) $15.25 for each field separately treated in excess of 1.
(4) In item 15109, amount under rule 15 means an amount equal to the sum of:
(a) the fee for item 15106; and
(b) $18.40 for each field separately treated in excess of 1.
(5) In item 15115, amount under rule 15 means an amount equal to the sum of:
(a) the fee for item 15112; and
(b) $38.35 for each field separately treated in excess of 1.
(6) In item 15214, amount under rule 15 means an amount equal to the sum of:
(a) the fee for item 15211; and
(b) $25.85 for each field separately treated in excess of 1.
(7) In items 15230, 15233, 15236, 15239, 15242, 15260, 15263, 15266, 15269 and 15272, amount under rule 15 means an amount equal to the sum of:
(a) $48.40; and
(b) $30.75 for each field separately treated in excess of 1.
16 Meaning of amount under rule 16 in certain items
In item 44376 (reamputation), amount under rule 16 means an amount equal to 75% of the fee specified for the item relating to an original amputation (any of items 44325 to 44373) of the body part for which the reamputation is performed.
16A Cleft lip and cleft palate services
An item in Group C1, C2 or C3 applies only to a service provided to a prescribed dental patient.
Note For the meaning of prescribed dental patient, see section 3 of the Act.
17 Meaning of (AD) in Group C2 — Oral and maxillofacial surgical services and Group C3 — General and prosthodontic services
An item in the range 75200 to 75206 and 75800 to 75854 that includes the symbol (AD) applies only to a service provided by a dental practitioner.
18 Orthodontic services
(1) An item in the range 75001 to 75006 or 75024 to 75051 that includes the symbol (AO) applies only to a service provided by an accredited orthodontist.
(2) An item in the range 75009 to 75023 that includes the symbol (AO) and the symbol (AOS) applies only to a service provided by:
(a) an accredited orthodontist; or
(b) a dental practitioner who is:
(i) registered or licensed as an oral and maxillofacial surgeon under a law of the State or Territory in which the service is rendered that provides for the registration or licensing of oral and maxillofacial surgeons; and
(ii) a dental practitioner approved by the Minister for the purposes of the definition of professional service in subsection 3 (1) of the Act.
(3) In this rule:
accredited orthodontist means:
(a) a dental practitioner who is:
(i) registered or licensed as an orthodontist under the relevant law; and
(ii) accredited by the Minister for the purposes of this rule; or
(b) a dental practitioner:
(i) who is not registered or licensed under the relevant law as an orthodontist or who practises in a State or Territory in which there is no provision for the registration or licensing of orthodontists; and
(ii) whose qualifications or experience demonstrate to the Committee his or her competence in the field of orthodontics that is applicable to the giving of the services specified in items 75001 to 75051; and
(iii) who is accredited by the Minister for the purposes of this rule.
Committee means the Medical Benefits (Dental Practitioners) Advisory Committee established under section 136 of the National Health Act 1953.
relevant law, in relation to a service provided to a patient, means a law of the State or Territory in which the service is provided that provides for the registration or licensing of orthodontists.
19 Oral surgery services
An item in the range 75150 to 75621 that includes the symbol (AOS) applies only to a service provided by a dental practitioner who is:
(a) registered as an oral and maxillofacial surgeon under a law of the State or Territory in which the service is rendered that provides for the registration or licensing of oral and maxillofacial surgeons; and
(b) a dental practitioner approved by the Minister for the purposes of the definition of professional service in subsection 3 (1) of the Act.
20 Meaning of report in Group D1 — Miscellaneous diagnostic procedures and investigations
In items 11000 to 12217, report means a report prepared by a medical practitioner.
21 Meaning of treatment cycle of a patient
In rule 22 and items 13200 to 13221, treatment cycle, of a patient, means a series of treatments of the patient that:
(a) begins:
(i) if treatment with superovulatory drugs is given — on the day on which that treatment begins; or
(ii) if treatment with superovulatory drugs is not given — on the first day of a menstrual cycle of the patient; and
(b) ends not more than 30 days after that day.
22 Items provided as part of treatment cycle relating to assisted reproductive services not to apply
(1) Subrule (2) applies to a service mentioned in:
(a) an item in Subgroup 3 of Group T1 (assisted reproductive services); and
(b) any other item (the associated item) associated with an item in Subgroup 3 of Group T1.
(2) A service provided as part of a treatment cycle to which an item in paragraph (1) (a) applies, is not a medical service for the purposes of the associated item.
23 Items relating to assisted reproductive services not to apply in certain pregnancy-related circumstances
Items 13200 to 13221 do not apply to a service provided in relation to a patient’s pregnancy, or intended pregnancy, that is, at the time of the service, the subject of an agreement, or arrangement, under which the patient makes provision for transfer to another person of the guardianship of, or custodial rights to, a child born as a result of the pregnancy.
24 Meaning of embryology laboratory services in items 13200 and 13206
In items 13200 and 13206, embryology laboratory services does not include semen preparation but includes:
(a) egg recovery from aspirated follicular fluid; and
(b) insemination; and
(c) monitoring of fertilisation and embryo development; and
(d) preparation of gametes or embryos for transfer or freezing.
25 Meaning of delivery in certain items
In items 16515, 16519 and 16522, delivery includes:
(a) induction of labour by surgical or intravenous infusion methods; and
(b) forceps or vacuum extraction; and
(c) breech delivery; and
(d) management of multiple deliveries; and
(e) episiotomy; and
(f) repair of tears; and
(g) evacuation of the products of conception by manual removal.
26 Meaning of maxilla in certain items
In items 45720 to 45752 and 52342 to 52375, maxilla includes the zygoma.
27 Items 46300 to 46534 apply only in certain circumstances
Items 46300 to 46534 apply only to a service provided in the course of an operation on a hand or hands.
28 Assistance at operations
(1) Items 51300 to 51318 apply only to assistance rendered by a medical practitioner other than:
(a) the practitioner performing the operation; or
(b) the anaesthetist administering the anaesthetic in connection with the operation, if any; or
(c) the assistant anaesthetist, if any.
(2) Items 51800 and 51803 apply only to assistance rendered by an approved dental practitioner other than:
(a) the practitioner performing the operation; or
(b) the anaesthetist administering the anaesthetic in connection with the operation, if any; or
(c) the assistant anaesthetist, if any.
29 Meaning of amount under rule 29 in items 51303 and 51803
In items 51303 and 51803, amount under rule 29, in relation to assistance at an operation or series of operations, means an amount equal to 20% of the sum of the fees payable under the Act for the services provided at that operation, or series of operations, by the practitioner to whom the assistance was given.
30 Meaning of amount under rule 30 in item 51309
(1) In item 51309, amount under rule 30, in relation to assistance at a series or combination of operations, means an amount equal to 20% of the sum of the fees payable under the Act for the services provided at those operations by the practitioner to whom the assistance was given.
(2) For subrule (1), the fee for the caesarean section component of the operations is the fee applicable to item 16520.
31 Meaning of amount under rule 31 in items 18219 and 18227
(1) In item 18219, amount under rule 31 means an amount equal to the sum of:
(a) the fee for item 18216; and
(b) $15.45 for each additional period of 15 minutes, and part of a period of 15 minutes, of continuous attendance beyond the first hour of attendance.
(2) In item 18227, amount under rule 31 means an amount equal to the sum of:
(a) the fee for item 18226; and
(b) $23.15 for each additional period of 15 minutes, and part of a period of 15 minutes, of continuous attendance beyond the first hour of attendance.
32 Histopathological proof of malignancy in certain cases for purposes of certain items relating to surgical procedures
For items 30196 to 30205, the requirement for histopathological proof of malignancy is satisfied in a case where multiple lesions are to be removed from a single anatomical region if a single lesion from that region is histologically tested and proven positive for malignancy.
33 Meaning of amount under rule 33 in items 16633 and 16636
(1) In item 16633, amount under rule 33 means, for a second or subsequent foetus, the amount that is equal to 50% of the amount of the fee specified in items 16606, 16609, 16612, 16615 and 16627 for services provided in relation to the multiple pregnancy.
(2) In item 16636, amount under rule 33 means, for a second or subsequent foetus, the amount that is equal to 50% of the amount of the fee specified in items 16600, 16603, 16618, 16621 and 16624 for services provided in relation to the multiple pregnancy.
34 Meaning of amount under rule 34 in item 51312
In item 51312, amount under rule 34, in relation to assistance at a procedure, means an amount equal to 20% of the sum of the fees payable under the Act for the services provided at that procedure by the practitioner to whom the assistance was given.
35 Meaning of amount under rule 35 in item 31340
In item 31340, amount under rule 35, in relation to the excision of muscle, bone or cartilage in association with the excision of a malignant tumour of skin under another item, means an amount equal to 75% of the fee payable under that other item.
36 Meaning of previous significant surgical complication in item 51318
In item 51318, previous significant surgical complication means:
(a) vitreous loss; or
(b) rupture of posterior capsule; or
(c) loss of nuclear material into the vitreous; or
(d) intraocular haemorrhage; or
(e) intraocular infection (endophthalmitis); or
(f) cystoid macular oedema; or
(g) corneal decompensation; or
(h) retinal detachment.
37 Meaning of amount under rule 37 in item 30001
In item 30001, amount under rule 37 means 50% of the specified fee that would normally apply for a surgical procedure if the surgical procedure had not been discontinued before completion.
38 Consultant occupational physicians
A fee specified for an attendance by a consultant occupational physician only applies if the attendance relates to 1 or more of the following matters:
(a) evaluation and assessment of a patient’s rehabilitation requirements where, in the consultant’s opinion, the patient has an accepted medical condition that:
(i) may be affected by the patient’s working environment; or
(ii) affects the patient’s capacity to be employed;
(b) management of an accepted medical condition that, in the consultant’s opinion, may affect a patient’s capacity for continued employment, or return to employment, following a non-compensable accident, injury or ill-health;
(c) evaluation and forming an opinion, including management as the case requires, of a patient’s medical condition where causation may be related to acute or chronic exposure to scientifically acknowledged environmental hazards or toxins.
39 Meaning of qualified sleep medicine practitioner
(1) For items 12203 to 12217, qualified sleep medicine practitioner means a qualified adult sleep medicine practitioner or a qualified paediatric sleep medicine practitioner.
(2) A person is a qualified adult sleep medicine practitioner or a qualified paediatric sleep medicine practitioner if:
(a) the person has been assessed by the Credentialling Subcommittee or the Appeal Committee as having had, before 1 March 1999, sufficient training and experience in the relevant field of sleep medicine to be competent in independent clinical assessment and management of patients with respiratory sleep disorders and in reporting sleep studies; or
(b) the person has been assessed by the Credentialling Subcommittee or the Appeal Committee as having had, before 1 March 1999, substantial training or experience in adult sleep medicine, but requiring further specified training or experience in the relevant field of sleep medicine to be competent in independent clinical assessment and management of patients with respiratory sleep disorders and in reporting sleep studies, and either:
(i) the period of 2 years immediately following that assessment has not expired; or
(ii) the person has been assessed by the Credentialling Subcommittee as having satisfactorily finished the further training or gained the further experience specified for that person; or
(c) the person has attained Level I or Level II of the relevant Advanced Training Program of the Thoracic Society of Australia and New Zealand and the Australasian Sleep Association, after having completed at least 12 months core training, including clinical practice in the relevant field of sleep medicine and in reporting sleep studies; or
(d) the Advisory Committee has recognised the person, in writing, as having training equivalent to the training mentioned in paragraph (c).
(3) In this rule:
Advisory Committee means the Specialist Advisory Committee in Thoracic and Sleep Medicine of the Royal Australasian College of Physicians.
Appeal Committee means the Appeal Committee of the Royal Australasian College of Physicians.
Credentialling Subcommittee means the Credentialling Subcommittee of the Advisory Committee.
relevant Advanced Training Program means:
(a) in relation to an assessment for qualification as a qualified adult sleep medicine practitioner — the Advanced Training Program in Adult Sleep Medicine; and
(b) in relation to an assessment for qualification as a qualified paediatric sleep medicine practitioner — the Advanced Training Program in Paediatric Sleep Medicine.
relevant field of sleep medicine means:
(a) in relation to an assessment for qualification as a qualified adult sleep medicine practitioner — adult sleep medicine; and
(b) in relation to an assessment for qualification as a qualified paediatric sleep medicine practitioner — paediatric sleep medicine.
40 Public health physicians
Items 410 to 417 apply to an attendance on a patient by a public health physician only if the attendance relates to 1 or more of the following matters:
(a) management of a patient’s vaccination requirements for immunisation programs;
(b) prevention or management of sexually transmitted disease;
(c) prevention or management of disease caused by scientifically accepted environmental hazards or toxins;
(d) prevention or management of infection arising from an outbreak of an infectious disease;
(e) prevention or management of an exotic disease.
Note An exotic disease is medically accepted as a disease that is of foreign origin.
41 Application of items in Group A14 to certain patients only
(1) Items 700, 702, 704 and 706 apply only to a service in relation to a patient who:
(a) is either:
(i) at least 75 years old; or
(ii) at least 55 years old and of Aboriginal or Torres Strait Islander descent; and
(b) is not an in-patient of a hospital or day-hospital facility, or a care recipient in a residential aged care facility.
(2) For subrule (1), a person is of Aboriginal or Torres Strait Islander descent if the person identifies himself or herself as being of that descent.
42 Application of items in Group A15 to certain patients only
(1) Items 720, 724, 726, 740, 742, 744, 759, 762 and 765 apply only to a service in relation to a patient who:
(a) suffers from at least 1 medical condition that:
(i) has been (or is likely to be) present for at least 6 months; or
(ii) is terminal; and
(b) is not an in-patient of a hospital or day-hospital facility, or a care recipient in a residential aged care facility.
(2) Items 722, 728, 746, 749, 757, 768, 771 and 773 apply only to a service in relation to a patient who:
(a) suffers from at least 1 medical condition that:
(i) has been (or is likely to be) present for at least 6 months; or
(ii) is terminal; and
(b) is an in-patient of a hospital or day-hospital facility; and
(c) is not a care recipient in a residential aged care facility.
(3) Items 730, 734, 736, 738, 775, 778 and 779 apply only to a service in relation to a patient who:
(a) suffers from at least 1 medical condition that:
(i) has been (or is likely to be) present for at least 6 months; or
(ii) is terminal; and
(b) is a care recipient in a residential aged care facility; and
(c) is not an in-patient of a hospital or day-hospital facility.
43 Meaning of health assessment
(1) For items 700, 702, 704 and 706, health assessment means the assessment of:
(a) a patient’s health and physical, psychological and social function; and
(b) whether preventative health care and education should be offered to the patient, to improve the patient’s health and physical, psychological and social function.
(2) A health assessment involves all of the following:
(a) a personal attendance by the medical practitioner;
(b) measurement of the patient’s blood pressure, pulse rate and rhythm;
(c) an assessment of the patient’s medication;
(d) an assessment of the patient’s continence;
(e) an assessment of the patient’s immunisation status for influenza, tetanus and pneumococcus;
(f) an assessment of the patient’s physical functions, including the patient’s activities of daily living and whether or not the patient has had a fall in the last 3 months;
(g) an assessment of the patient’s psychological function, including the patient’s cognition and mood;
(h) an assessment of the patient’s social function, including:
(i) the availability and adequacy of paid, and unpaid, help; and
(ii) whether the patient is responsible for caring for another person.
(3) A health assessment also includes:
(a) keeping a record of the health assessment; and
(b) offering the patient a written report about the health assessment, with recommendations about matters covered by the health assessment; and
(c) offering the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees) a copy of the report or extracts of the report relevant to the carer.
44 Meaning of multidisciplinary care plan
(1) For items 720, 722, 724, 726, 728 and 730 preparation of a multidisciplinary care plan means the preparation of a written plan describing all of the following matters:
(a) an assessment of the patient’s health care needs;
(b) an assessment of the kinds of treatment, health services and health care that the patient is likely to need;
(c) an assessment of any other kinds of services and care that the patient is likely to need;
(d) arrangements for giving the treatment, services and care referred to in paragraphs (b) and (c);
(e) management goals with which the patient agrees;
(f) arrangements to review the plan by a day specified in the plan.
Example
For paragraph (c), other kinds of services and care may include home and community care service providers.
(2) Preparation of a plan also includes:
(a) discussing the preparation of the plan with the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and
(b) telling the patient which persons will be included in the multidisciplinary care plan team; and
(c) recording the plan and the patient’s agreement to the preparation of the plan; and
(d) giving copies of relevant parts of the plan to persons who, under the plan, will give the patient the treatment, service and care mentioned in the plan; and
(e) offering a copy of the plan (and evidence of the contribution made to the plan by members of the team) to the patient and the patient’s carer (if any, and if the medical practitioner considers it appropriate and the patient agrees).
45 Meaning of multidisciplinary care plan team
(1) A multidisciplinary care plan team:
(a) includes a medical practitioner; and
(b) includes at least 2 other members, each of whom provides a different kind of care or service to the patient and is not a family carer of the patient, and 1 of whom may be another medical practitioner; and
(c) may additionally include a family carer of the patient.
Example
Examples of persons who, for paragraph (b), may be included in a team are:
(a) allied health professionals such as:
· Aboriginal health care workers
· asthma educators
· audiologists
· dental therapists
· dentists
· diabetes educators
· dieticians
· mental health workers
· occupational therapists
· optometrists
· orthoptists
· orthotists or prosthetists
· pharmacists
· physiotherapists
· podiatrists
· psychologists
· registered nurses
· social workers
· speech pathologists; and
(b) home and community service providers, or care organisers, such as:
· education providers
· ‘meals on wheels’ providers
· personal care workers
· probation officers.
(2) In subrule (1):
family carer includes a person who:
(a) is a relative or friend of the patient; and
(b) is providing care to the patient other than as a paid service.
46 Meaning of multidisciplinary discharge care plan
For items 722 and 728, a multidisciplinary discharge care plan is a multidisciplinary care plan that is prepared for a patient before the patient is discharged from a hospital.
47 Meaning of review of a multidisciplinary care plan
(1) For item 724, review of a multidisciplinary care plan means a process by which the medical practitioner:
(a) reviews the matters mentioned in subrule 44 (1); and
(b) considers whether the arrangements for treatment, service and care have been carried out; and
(c) considers, in consultation with other members of the multidisciplinary care plan team, whether different arrangements need to be made to achieve the management goals mentioned in the plan; and
(d) if different arrangements need to be made, prepares a revised multidisciplinary care plan stating those arrangements.
(2) The review of a plan also includes:
(a) discussing the review of the plan with the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and
(b) recording the patient’s agreement to reviewing the plan; and
(c) offering a copy of relevant parts of the revised multidisciplinary care plan (if any) to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees), and giving copies to persons who, under the revised plan, will give the patient the treatment, service and care mentioned in the plan.
48 Meaning of contribution to a plan
(1) For items 726, 728 and 730, a contribution to a multidisciplinary community care plan, a multidisciplinary discharge care plan or a multidisciplinary care plan in a residential aged care facility must be at the request of the person (or residential aged care facility) who prepares the plan, and may include:
(a) preparation of a part of the plan that relates to the treatment, service or care that the medical practitioner will give to the patient; and
(b) giving advice to the person who prepares the plan.
(2) Contribution to a plan does not necessarily include preparation of the plan or part of the plan.
49 Meaning of multidisciplinary case conference
For the items mentioned in Subgroup 2 of Group A15, a multidisciplinary case conference is a process by which a multidisciplinary case conference team (see rule 52) carries out all of the following activities:
(a) discussing a patient’s history;
(b) identifying the patient’s multidisciplinary care needs;
(c) identifying outcomes to be achieved by members of the case conference team giving care and service to the patient;
(d) identifying tasks that need to be undertaken to achieve these outcomes, and allocating those tasks to members of the case conference team;
(e) assessing whether previously identified outcomes (if any) have been achieved.
50 Meaning of multidisciplinary discharge case conference
For items 746, 749, 757, 768, 771 and 773, a multidisciplinary discharge case conference is a multidisciplinary case conference carried out in relation to a patient before the patient is discharged from a hospital or day-hospital facility.
51 Meaning of multidisciplinary case conference in a residential aged care facility
For items 734, 736, 738, 775, 778 and 779, a multidisciplinary case conference in a residential aged care facility is a multidisciplinary case conference carried out in relation to a care recipient in a residential aged care facility.
52 Meaning of multidisciplinary case conference team
(1) For this table, a multidisciplinary case conference team:
(a) includes a medical practitioner; and
(b) includes at least 2 other members, each of whom provides a different kind of care or service to the patient and is not a family carer of the patient, and 1 of whom may be another medical practitioner; and
(c) may additionally include a family carer of the patient.
Example
Examples of persons who, for paragraph (b), may be included in a team are:
(a) allied health professionals such as:
· Aboriginal health care workers
· asthma educators
· audiologists
· dental therapists
· dentists
· diabetes educators
· dieticians
· mental health workers
· occupational therapists
· optometrists
· orthoptists
· orthotists or prosthetists
· pharmacists
· physiotherapists
· podiatrists
· psychologists
· registered nurses
· social workers
· speech pathologists; and
(b) home and community service providers, or care organisers, such as:
· education providers
· ‘meals on wheels’ providers
· personal care workers
· probation officers.
(2) In subrule (1):
family carer includes a person who:
(a) is a relative or friend of the patient; and
(b) is providing care to the patient other than as a paid service.
53 Meaning of organise and co-ordinate in a multidisciplinary case conference and participation in a multidisciplinary case conference
(1) For items 734, 736, 738, 740, 742, 744, 746, 749 and 757, organise and co-ordinate a multidisciplinary case conference means undertaking all of the following activities in relation to a case conference:
(a) explaining to the patient the nature of a multidisciplinary case conference, and asking the patient whether the patient agrees to the conference taking place;
(b) recording the patient’s agreement to the conference;
(c) recording the day on which the conference was held, and the times at which the conference started and ended;
(d) recording the names of the participants;
(e) recording the matters mentioned in rule 49, and putting a copy of that record in the patient’s medical records;
(f) offering the patient and the patient’s carer (if any and if the practitioner considers appropriate and the patient agrees), and giving each other member of the team, a summary of the conference;
(g) discussing the outcomes of the conference with the patient and the patient’s carer (if any and if the practitioner considers appropriate and the patient agrees).
(2) For items 759, 762, 765, 768, 771, 773, 775, 778 and 779 participation in a multidisciplinary case conference must be at the request of the person who organises and co-ordinates the conference, and involves undertaking all of the following activities in relation to a case conference:
(a) explaining to the patient the nature of a multidisciplinary case conference, and asking the patient whether the patient agrees to the practitioner’s participation in the conference;
(b) recording the patient’s agreement to the practitioner’s participation;
(c) recording the day on which the conference was held, and the times at which the conference started and ended;
(d) recording the names of the participants;
(e) recording the matters mentioned in rule 49, and putting a copy of that record in the patient’s medical records.
(3) Participation in a multidisciplinary case conference does not include organising and co-ordinating a multidisciplinary case conference.
54 Meaning of living in a community setting in item 900
For item 900, a patient is living in a community setting if the patient:
(a) is not an in-patient of a hospital or day-hospital facility; and
(b) is not a care recipient in a residential aged care facility.
55 Meaning of amount under rule 55 in certain items
(1) In item 2503, amount under rule 55 means an amount equal to the sum of:
(a) the fee for item 2501; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance — $20.60 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.45.
(2) In item 2506, amount under rule 55 means an amount equal to the sum of:
(a) the fee for item 2504; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance — $20.60 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.45.
(3) In item 2509, amount under rule 55 means an amount equal to the sum of:
(a) the fee for item 2507; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance — $20.60 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.45.
(4) In item 2518, amount under rule 55 means an amount equal to the sum of:
(a) the fee for item 2517; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance — $20.60 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.45.
(5) In item 2522, amount under rule 55 means an amount equal to the sum of:
(a) the fee for item 2521; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance — $20.60 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.45.
(6) In item 2526, amount under rule 55 means an amount equal to the sum of:
(a) the fee for item 2525; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance — $20.60 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.45.
(7) In item 2547, amount under rule 55 means an amount equal to the sum of:
(a) the fee for item 2546; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance — $20.60 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.45.
(8) In item 2553, amount under rule 55 means an amount equal to the sum of:
(a) the fee for item 2552; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance — $20.60 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.45.
(9) In item 2559, amount under rule 55 means an amount equal to the sum of:
(a) the fee for item 2558; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance — $20.60 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.45.
(10) In item 2575, amount under rule 55 means an amount equal to the sum of:
(a) the fee for item 2574; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance — $20.60 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.45.
(11) In item 2578, amount under rule 55 means an amount equal to the sum of:
(a) the fee for item 2577; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance — $20.60 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.45.
(12) In item 2723, amount under rule 55 means an amount equal to the sum of:
(a) the fee for item 2721; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance — $20.60 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.45.
(13) In item 2727, amount under rule 55 means an amount equal to the sum of:
(a) the fee for item 2725; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance — $20.60 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.45.
56 Application of Subgroup 2 of Group A18 and Subgroup 2 of Group A19
(1) An item in Subgroup 2 of Group A18 or Subgroup 2 of Group A19 does not apply to a service that is provided to a patient who has already been provided, in the previous 12 months, with another service to which an item in either of those Subgroups applies.
(2) For an item in Subgroup 2 of Group A18 or Subgroup 2 of Group A19, a professional attendance completes the minimum requirements for an annual cycle of care of a patient with established diabetes mellitus if the attendance completes a series of attendances that involve, over 12 months (the current cycle), the following:
(a) at least 1 assessment of the patient’s diabetes control, by measuring the patient’s HbA1c;
(b) if the patient has not had a comprehensive eye examination in the 12 months immediately before the current cycle — at least 1 comprehensive eye examination;
(c) measurement of the patient’s weight and height, and calculation of the patient’s BMI;
(d) further measurement of the patient’s weight at least once every 6 months;
(e) measurement of the patient’s blood pressure at least once every 6 months;
(f) examination of the patient’s feet at least once every 6 months;
(g) at least 1 measurement of the patient’s total cholesterol, triglycerides and HDL cholesterol;
(h) at least 1 test of the patient’s microalbuminuria;
(i) provision to the patient of self-management education regarding diabetes;
(j) a review of the patient’s diet, and provision to the patient of information about appropriate dietary choices;
(k) a review of the patient’s level of physical activity, and provision to the patient of information about the appropriate level of physical activity;
(l) checking the patient’s tobacco smoking activity, and, if relevant, encouraging the patient to stop smoking;
(m) a review of the patient’s medication.
57 Application of Subgroup 3 of Group A18 and Subgroup 3 of Group A19
(1) An item in Subgroup 3 of Group A18 or Subgroup 3 of Group A19 does not apply to a service that:
(a) is provided to a patient who has already been provided, in the previous 12 months, with another service to which an item in either of those Subgroups applies; and
(b) is not clinically indicated.
(2) For an item in Subgroup 3 of Group A18 or Subgroup 3 of Group A19, a professional attendance completes the minimum requirements of the Asthma 3+ Visit Plan if the attendance completes a series of attendances that involve:
(a) documented diagnosis and documented assessment of severity; and
(b) at least 3 asthma‑related consultations (at least 2 of which are consultations that have been planned at any of the earlier asthma‑related consultations), over a period of not less than 4 weeks and not more than 4 months, that involve the following, for a patient with moderate to severe asthma:
(i) a review of the patient’s use of asthma‑related medication;
(ii) either:
(A) provision to the patient of a written asthma action plan; or
(B) if the patient is unable to use a written asthma action plan — discussion with the patient about an alternative method of providing an asthma action plan, and documentation of the discussion in the patient’s medical records;
(iii) provision to the patient of self-management education regarding asthma;
(iv) a review of the patient’s asthma action plan.
58 Meaning of approved site in items 15338 and 37220
For items 15338 and 37220, approved site, in relation to radiation oncology, means a site at which radiation oncology may be performed lawfully under the law of the State or Territory in which the site is located.
59 Group T10 applies only in connection with certain services
(1) Each of items 20100 to 21990 (other than item 21965), 22060, 23010 to 24136, 25200 and 25205 applies to a service only if the service is provided in connection with a service that:
(a) is a professional service within the meaning of subsection 3 (1) of the Act; and
(b) is specified in an item that includes, in its description, ‘(Anaes.)’.
(2) Each of items 22900 and 22905 applies to a service only if the service is provided in connection with a dental service (other than a dental service that is a prescribed medical service under paragraph (b) of the definition of professional service in subsection 3 (1) of the Act).
60 Services specified in Subgroups 21 to 25 of Group T10
In Subgroups 21 to 25 of Group T10:
(a) a reference to anaesthesia is a reference to administration of anaesthesia performed in association with a service to which any of items 20100 to 21997, 22900 and 22905 applies; and
(b) a reference to perfusion is a reference to perfusion to which item 22060 applies; and
(c) a reference to assistance is a reference to assistance:
(i) in the administration of anaesthesia; and
(ii) to which item 25200 or 25205 applies.
61 Meaning of service time in Subgroups 21, 24, 25 and 26 of Group T10
In Subgroups 21, 24, 25 and 26 of Group T10:
service time means:
(a) in relation to administration of anaesthesia on a patient by an anaesthetist — the period that:
(i) begins when the anaesthetist commences exclusive and continuous care of the patient for anaesthesia; and
(ii) ends when the anaesthetist places the patient safely under the supervision of other personnel; and
(b) in relation to perfusion performed on a patient under anaesthesia — the period that:
(i) begins when the anaesthetic commences; and
(ii) ends with the closure of the chest of the patient; and
(c) in relation to assistance given by an assistant anaesthetist in the administration of anaesthesia performed on a patient — the period when the assistant anaesthetist is actively attending on the patient.
62 Application of Subgroup 21 of Group T10
(1) An item in the range 23010 to 24136 applies to perfusion in addition to any other item that applies to the perfusion.
(2) An item in the range 23010 to 24136 applies to assistance only as a component of item 25200 or 25205 and for the purpose of calculating the amount of fee for that item.
63 Application of Subgroups 22 and 23 of Group T10
(1) An item in the range 25000 to 25020 applies to anaesthesia in addition to any other item that applies to the anaesthesia.
(2) An item in the range 25000 to 25020 applies to perfusion in addition to any other item that applies to the perfusion.
(3) An item in the range 25000 to 25020 applies to assistance only as a component of item 25200 or 25205 and for the purpose of calculating the amount of fee for that item.
64 Meaning of amount under rule 64 in items 25025, 25030 and 25050
(1) For item 25025 amount under rule 64 means the amount that is equal to 50% of the sum of:
(a) the fee specified in any of items 20100 to 21997 and 22900 for the initiation of management of anaesthesia in association with which the anaesthesia is performed; and
(b) the fee specified in the item in the range 23010 to 24136 that applies to the anaesthesia; and
(c) if any of items 25000 to 25015 applies to the anaesthesia — the fee specified in that item; and
(d) if a service specified in an item in the range 22001 to 22050 is performed in association with the anaesthesia — the fee specified in that item.
(2) For item 25030 amount under rule 64 means the amount that is equal to 50% of the sum of:
(a) $82.50; and
(b) the fee specified in the item in the range 23010 to 24136 that applies to the assistance; and
(c) if any of items 25000 to 25015 applies to the assistance — the fee specified in that item; and
(d) if a service specified in an item in the range 22001 to 22050 is performed in association with the assistance — the fee specified in that item.
(3) For item 25050 amount under rule 64 means the amount that is equal to 50% of the sum of:
(a) $330.00; and
(b) the fee specified in the item in the range 23010 to 24136 that applies to the perfusion; and
(c) if any of items 25000 to 25015 applies to the perfusion — the fee specified in that item; and
(d) if a service specified in an item in the range 22001 to 22050 is performed in association with the perfusion — the fee specified in that item.
65 Application of Subgroups 24 and 25 of Group T10
An item in the range 25025 to 25050 applies to the anaesthesia, assistance or perfusion in addition to any other item that applies to the service.
66 Meaning of complex paediatric case in item 25205
For item 25205, a complex paediatric case involves 1 or more of the following services:
(a) invasive monitoring, either intravascular or transoesophageal;
(b) organ transplantation;
(c) craniofacial surgery;
(d) major tumour resection;
(e) separation of conjoint twins.
67 Meaning of amount under rule 67 in items 25200 and 25205
For each of items 25200 and 25205, amount under rule 67, means the sum of:
(a) $82.50; and
(b) the fee specified in the item in the range 23010 to 24136 that applies to the assistance; and
(c) if any of items 25000 to 25020 applies to the assistance — the fee specified in that item.
68 Restriction of telepsychiatry consultations to rural and remote areas
Each of items 353 to 358 applies only to a consultation that is provided:
(a) by a consultant physician located in a Statistical Local Area that is a M1, M2 or R1 area within the meaning of the Rural, Remote and Metropolitan Areas Classification; and
(b) to a patient located in a different Statistical Local Area that is a R1, R2, R3, Rem1 or Rem2 area within the meaning of the Rural, Remote and Metropolitan Areas Classification.
69 Meaning of recognised emergency department and problem focussed history in Group A21
(1) In Group A21, recognised emergency department, of a private hospital, means a department of the hospital that is licensed, under a law of the State or Territory in which the hospital is located, to operate as an emergency department.
(2) In items 501, 503 and 507, problem focussed history means a history focussing on the medical condition of the patient that necessitates the patient presenting for emergency attention.
70 Prolonged attendances by emergency physicians
In items 519 to 536, an attendance for emergency evaluation of a critically ill patient with an immediately life threatening problem means an attendance that requires:
(a) immediate and rapid assessment; and
(b) initiation of resuscitation and electronic monitoring of vital signs; and
(c) taking a comprehensive history and evaluation while undertaking resuscitative measures; and
(d) ordering and evaluation of appropriate investigations; and
(e) transitional evaluation and monitoring; and
(f) formulation and documentation of a diagnosis and management plan in relation to 1 or more problems; and
(g) initiation of appropriate treatment interventions; and
(h) liaison with relevant health care professionals and discussion with, as appropriate, the patient or the patient’s relatives or agent.
71 Application of Subgroup 4 of Group A18 and Subgroup 4 of Group A19
(1) An item in Subgroup 4 of Group A18 or Subgroup 4 of Group A19 applies only to a service that is provided by a medical practitioner:
(a) whose name is entered in the register maintained by the Commission under regulation 3T of the Health Insurance Commission Regulations 1975; and
(b) who meets any training and skills requirements, as determined by the General Practice Mental Health Standards Collaboration, for providing services to which those Subgroups apply.
(2) An item in Subgroup 4 of Group A18 or Subgroup 4 of Group A19 does not apply to a service that:
(a) is provided to a patient who has already been provided, in the previous 12 months, with another service to which an item in either of those Subgroups applies; and
(b) is not clinically indicated.
(3) A reference in an item in Subgroup 4 of Group A18 or Subgroup 4 of Group A19 to the minimum requirements of the 3 Step Mental Health Process is a reference to the following procedures in relation to the patient concerned:
(a) at least 3 consultations related to a mental health disorder:
(i) at least 2 of which are consultations that have been planned at a previous consultation; and
(ii) each of which is of at least 20 minutes duration;
(b) assessment of the mental health disorder, including administration of an outcome measurement tool (except if considered clinically inappropriate);
(c) formulation or diagnosis or both formulation and diagnosis of the mental health disorder;
(d) supplying the patient or, if the patient agrees, the patient’s carer with:
(i) a written mental health plan; and
(ii) suitable education about the mental health disorder;
(e) at least 4 weeks, but no later than 6 months, after the consultation at which the written mental health plan was prepared:
(i) a review of the patient’s progress against the goals recorded in that plan; and
(ii) if necessary, adjustment of that plan; and
(iii) administration of the outcome measurement tool used in the assessment mentioned in paragraph (b) (except if considered clinically inappropriate).
(4) In this rule:
mental health disorder means a significant impairment of any or all of an individual’s cognitive, affective and relational abilities that:
(a) may require medical intervention; and
(b) may be a recognised, medically diagnosable illness or disorder; and
(c) is not dementia, delirium, tobacco use disorder or mental retardation.
Note In relation to this definition, practitioners should be aware of the Diagnostic and Management Guidelines for Mental Health Disorders in Primary Care (ICD-10, Chapter 5, Primary Care Version), developed by the World Health Organisation and published in 1996.
outcome measurement tool means a tool used to monitor changes in a patient’s health that occur in response to treatment received by the patient.
written mental health plan means a written plan that:
(a) is prepared in consultation with a patient or, if the patient agrees, a patient’s carer; and
(b) describes arrangements for:
(i) treatment of the mental health disorder or disorders; and
(ii) crisis intervention; and
(iii) relapse prevention.
72 Focussed psychological strategies
(1) An item in Group A20 applies only to a service that:
(a) is clinically indicated under the 3 Step Mental Health Process; and
(b) is provided by a medical practitioner:
(i) whose name is entered in the register maintained by the Commission under regulation 3T of the Health Insurance Commission Regulations 1975; and
(ii) who is identified in the register as a practitioner who can provide services to which Group A20 applies; and
(iii) who meets any training and skills requirements, as determined by the General Practice Mental Health Standards Collaboration, for providing services to which Group A20 applies; and
(c) is provided in a general practice that participates in the Practice Incentives Program or is an accredited general practice that is not participating in the Program.
(2) An item in Group A20 does not apply to:
(a) a service that:
(i) is provided to a patient who has already been provided, in the previous 12 months, with 6 other services to which any of the items in that Group applies; and
(ii) is provided before the medical practitioner managing the 3 Step Mental Health Process has conducted a review and has noted in the patient’s records a recommendation that the patient have more than 6 sessions of psychological strategies in 12 months; or
(b) a service that is provided to a patient who has already been provided, in the previous 12 months, with 12 other services to which any of items in that Group applies.
(3) In Group A20, a reference to focussed psychological strategies is a reference to any of the following mental health care management strategies, being a strategy that has been derived from evidence-based psychological therapies:
(a) psycho-education;
(b) cognitive-behavioural therapy that involves cognitive or behavioural interventions;
(c) relaxation strategies;
(d) skills training;
(e) interpersonal therapy.
(4) In this rule:
general practice means a business, consisting of 1 or more medical practitioners, that provides a general practice of medical services.
73 Meaning of qualified surgeon in items 31539 and 31545
For items 31539 and 31545, a medical practitioner is a qualified surgeon if:
(a) he or she is a specialist in the practice of his or her specialty of surgery; and
(b) the Commission has received a written notice from the Royal Australasian College of Surgeons stating that the person meets the skills requirements for providing services to which the items apply.
74 Meaning of qualified radiologist in item 31542
For item 31542, a medical practitioner is a qualified radiologist if:
(a) he or she is a specialist in the practice of his or her specialty of radiology; and
(b) the Commission has received a written notice from the Royal Australian and New Zealand College of Radiologists stating that the person meets the skills requirements for providing services to which the item applies.
75 Injection of botulinum toxin
Each of items 18350 to 18370 applies only to a service provided by a medical practitioner who is registered by the Commission to participate in the arrangements made, under paragraph 100 (1) (b) of the National Health Act 1953, for the purpose of providing an adequate pharmaceutical service for persons requiring treatment with botulinum toxin.
76 Meaning of qualified medical acupuncturist in items 193, 195, 197 and 199
For items 193, 195, 197 and 199, a person is a qualified medical acupuncturist if:
(a) the person is a general practitioner; and
(b) the Commission has received a written notice from the Royal Australian College of General Practitioners stating that the person meets the skills requirements for providing services to which the items apply.
Part 3 Services and fees
| Item | Service | Fee ($) | |
| Attendances Group A1 — General practitioner attendances to which no other item applies | |
| 1 | Professional attendance being an attendance at other than consulting rooms, by a general practitioner on not more than 1 patient on the 1 occasion — each attendance, other than an attendance between 11 pm and 7 am, on a public holiday, on a Sunday, before 8 am or after 1 pm on a Saturday or at any time other than between 8 am and 8 pm on a day not being a Saturday, Sunday or public holiday, where the attendance is initiated by or on behalf of the patient in the same unbroken after-hours period and where the patient’s medical condition requires immediate treatment | 96.05 | |
| 2 | Professional attendance being an attendance at consulting rooms, by a general practitioner on not more than 1 patient on the 1 occasion — each attendance, other than an attendance between 11 pm and 7 am, on a public holiday, on a Sunday, before 8 am or after 1 pm on a Saturday or at any time other than between 8 am and 8 pm on a day not being a Saturday, Sunday or public holiday, where the attendance is initiated by or on behalf of the patient in the same unbroken after-hours period and where the patient’s medical condition requires immediate treatment and where it is necessary for the doctor to return to, and specially open, consulting rooms for the attendance | 96.05 | |
| 3 | Professional attendance at consulting rooms (not being a service to which any other item applies) by a general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management — each attendance | 13.80 | |
| 4 | Professional attendance, other than a service to which any other item applies, and not being an attendance at consulting rooms, an institution, a hospital or a residential aged care facility by a general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management — an attendance on 1 or more patients on 1 occasion — each patient | Amount under rule 8 | |
| 13 | Professional attendance at an institution (not being a service to which any other item applies) by a general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management — an attendance on 1 or more patients at 1 institution on 1 occasion — each patient | Amount under rule 8 | |
| 19 | Professional attendance at a hospital (not being a service to which any other item applies) by a general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management — an attendance on 1 or more patients at 1 hospital on 1 occasion — each patient | Amount under rule 8 | |
| 20 | Professional attendance (not being a service to which any other item applies) at a residential aged care facility (other than a professional attendance at a self-contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in a residential aged care facility (not being accommodation in a self-contained unit) by a general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management — an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion — each patient | Amount under rule 8 | |
| 23 | Professional attendance at consulting rooms (not being a service to which any other item applies) by a general practitioner involving taking a selective history, examination of the patient with implementation of a management plan in relation to 1 or more problems, or a professional attendance of less than 20 minutes duration involving components of a service to which item 36 or 44 applies — each attendance | 30.20 | |
| 24 | Professional attendance, other than a service to which any other item applies, and not being an attendance at consulting rooms, an institution, a hospital or a residential aged care facility by a general practitioner involving taking a selective history, examination of the patient with implementation of a management plan in relation to 1 or more problems, or a professional attendance of less than 20 minutes duration involving components of a service to which item 37 or 47 applies — an attendance on 1 or more patients on 1 occasion — each patient | Amount under rule 8 | |
| 25 | Professional attendance at an institution (not being a service to which any other item applies) by a general practitioner involving taking a selective history, examination of the patient with implementation of a management plan in relation to 1 or more problems, or a professional attendance of less than 20 minutes duration involving components of a service to which item 38 or 48 applies — an attendance on 1 or more patients at 1 institution on 1 occasion — each patient | Amount under rule 8 | |
| 33 | Professional attendance at a hospital (not being a service to which any other item applies) by a general practitioner involving taking a selective history, examination of the patient with implementation of a management plan in relation to 1 or more problems, or a professional attendance of less than 20 minutes duration involving components of a service to which item 40 or 50 applies — an attendance on 1 or more patients at 1 hospital on 1 occasion — each patient | Amount under rule 8 | |
| 35 | Professional attendance (not being a service to which any other item applies) at a residential aged care facility (other than a professional attendance at a self-contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (not being accommodation in a self-contained unit) by a general practitioner involving taking a selective history, examination of the patient with implementation of a management plan in relation to 1 or more problems, or a professional attendance of less than 20 minutes duration involving components of a service to which item 43 or 51 applies — an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion — each patient | Amount under rule 8 | |
| 36 | Professional attendance at consulting rooms (not being a service to which any other item applies) by a general practitioner involving taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more problems, and lasting at least 20 minutes, or a professional attendance of less than 40 minutes duration involving components of a service to which item 44 applies — each attendance | 57.35 | |
| 37 | Professional attendance, other than a service to which any other item applies, and not being an attendance at consulting rooms, an institution, a hospital or a residential aged care facility by a general practitioner taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more problems, or a professional attendance of less than 40 minutes duration involving components of a service to which item 47 applies — an attendance on 1 or more patients on 1 occasion — each patient | Amount under rule 8 | |
| 38 | Professional attendance at an institution (not being a service to which any other item applies) by a general practitioner involving taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more problems, and lasting at least 20 minutes, or a professional attendance of less than 40 minutes duration involving components of a service to which item 48 applies — an attendance on 1 or more patients at 1 institution on 1 occasion — each patient | Amount under rule 8 | |
| 40 | Professional attendance at a hospital (not being a service to which any other item applies) by a general practitioner involving taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more problems, and lasting at least 20 minutes, or a professional attendance of less than 40 minutes duration involving components of a service to which item 50 applies — an attendance on 1 or more patients at 1 hospital on 1 occasion — each patient | Amount under rule 8 | |
| 43 | Professional attendance (not being a service to which any other item applies) at a residential aged care facility (other than a professional attendance at a self-contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (not being accommodation in a self-contained unit) by a general practitioner involving taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more problems, and lasting at least 20 minutes, or a professional attendance of less than 40 minutes duration involving components of a service to which item 51 applies — an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion — each patient | Amount under rule 8 | |
| 44 | Professional attendance at consulting rooms (not being a service to which any other item applies) by a general practitioner involving taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more complex problems, and lasting at least 40 minutes, or a professional attendance of at least 40 minutes duration for implementation of a management plan — each attendance | 84.45 | |
| 47 | Professional attendance, other than a service to which any other item applies, and not being an attendance at consulting rooms, an institution, a hospital or a residential aged care facility by a general practitioner taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more complex problems and lasting at least 40 minutes, or a professional attendance of at least 40 minutes duration for implementation of a management plan — an attendance on 1 or more patients on 1 occasion — each patient | Amount under rule 8 | |
| 48 | Professional attendance at an institution (not being a service to which any other item applies) by a general practitioner involving taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more complex problems, and lasting at least 40 minutes, or a professional attendance of at least 40 minutes duration for implementation of a management plan — an attendance on 1 or more patients at 1 institution on 1 occasion — each patient | Amount under rule 8 | |
| 50 | Professional attendance at a hospital (not being a service to which any other item applies) by a general practitioner involving taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more complex problems, and lasting at least 40 minutes, or a professional attendance of at least 40 minutes duration for implementation of a management plan — an attendance on 1 or more patients at 1 hospital on 1 occasion — each patient | Amount under rule 8 | |
| 51 | Professional attendance (not being a service to which any other item applies) at a residential aged care facility (other than a professional attendance at a self-contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (not being accommodation in a self-contained unit) by a general practitioner involving taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more complex problems, and lasting at least 40 minutes, or a professional attendance of at least 40 minutes duration for implementation of a management plan — an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion — each patient | Amount under rule 8 | |
| Group A2 — Other non-referred attendances to which no other item applies | |
| 52 | Professional attendance at consulting rooms of not more than 5 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — each attendance | 11.00 | |
| 53 | Professional attendance at consulting rooms of more than 5 minutes duration but not more than 25 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — each attendance | 21.00 | |
| 54 | Professional attendance at consulting rooms of more than 25 minutes duration but not more than 45 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — each attendance | 38.00 | |
| 57 | Professional attendance at consulting rooms of more than 45 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — each attendance | 61.00 | |
| 58 | Professional attendance (not being an attendance at consulting rooms, an institution, a hospital or a residential aged care facility) of not more than 5 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients on 1 occasion — each patient | Amount under rule 8 | |
| 59 | Professional attendance (not being an attendance at consulting rooms, an institution, a hospital or a residential aged care facility) of more than 5 minutes duration but not more than 25 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients on 1 occasion — each patient | Amount under rule 8 | |
| 60 | Professional attendance (not being an attendance at consulting rooms, an institution, a hospital or a residential aged care facility) of more than 25 minutes duration but not more than 45 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients on 1 occasion — each patient | Amount under rule 8 | |
| 65 | Professional attendance (not being an attendance at consulting rooms, an institution, a hospital or a residential aged care facility) of more than 45 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients on 1 occasion — each patient | Amount under rule 8 | |
| 81 | Professional attendance at an institution of not more than 5 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients at 1 institution on 1 occasion — each patient | Amount under rule 8 | |
| 83 | Professional attendance at an institution of more than 5 minutes duration but not more than 25 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients at 1 institution on 1 occasion — each patient | Amount under rule 8 | |
| 84 | Professional attendance at an institution of more than 25 minutes duration but not more than 45 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients at 1 institution on 1 occasion — each patient | Amount under rule 8 | |
| 86 | Professional attendance at an institution of more than 45 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients at 1 institution on 1 occasion — each patient | Amount under rule 8 | |
| 87 | Professional attendance at a hospital of not more than 5 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients at 1 hospital on 1 occasion — each patient | Amount under rule 8 | |
| 89 | Professional attendance at a hospital of more than 5 minutes duration but not more than 25 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients at 1 hospital on 1 occasion — each patient | Amount under rule 8 | |
| 90 | Professional attendance at a hospital of more than 25 minutes duration but not more than 45 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients at 1 hospital on 1 occasion — each patient | Amount under rule 8 | |
| 91 | Professional attendance at a hospital of more than 45 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients at 1 hospital on 1 occasion — each patient | Amount under rule 8 | |
| 92 | Professional attendance (not being a service to which any other item applies) at a residential aged care facility (other than a professional attendance at a self-contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (not being accommodation in a self-contained unit) of not more than 5 minutes duration by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion — each patient | Amount under rule 8 | |
| 93 | Professional attendance (not being a service to which any other item applies) at a residential aged care facility (other than a professional attendance at a self-contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (not being accommodation in a self-contained unit) of more than 5 minutes duration but not more than 25 minutes duration by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion — each patient | Amount under rule 8 | |
| 95 | Professional attendance (not being a service to which any other item applies) at a residential aged care facility (other than a professional attendance at a self-contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (not being accommodation in a self-contained unit) of more than 25 minutes duration but not more than 45 minutes by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion — each patient | Amount under rule 8 | |
| 96 | Professional attendance (not being a service to which any other item applies) at a residential aged care facility (other than a professional attendance at a self-contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (not being accommodation in a self-contained unit) of more than 45 minutes duration by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion — each patient | Amount under rule 8 | |
| 97 | Professional attendance being an attendance at other than consulting rooms, by a medical practitioner (not being a general practitioner) on not more than 1 patient on the 1 occasion — each attendance, other than an attendance between 11 pm and 7 am, on a public holiday, on a Sunday, before 8 am or after 1 pm on a Saturday or at any time other than between 8 am and 8 pm on a day not being a Saturday, Sunday or public holiday, where the attendance is initiated by or on behalf of the patient in the same unbroken after-hours period and where the patient’s medical condition requires immediate treatment | 80.30 | |
| 98 | Professional attendance being an attendance at consulting rooms, by a medical practitioner (not being a general practitioner) on not more than 1 patient on the 1 occasion — each attendance, other than an attendance between 11 pm and 7 am, on a public holiday, on a Sunday, before 8 am or after 1 pm on a Saturday or at any time other than between 8 am and 8 pm on a day not being a Saturday, Sunday or public holiday, where the attendance is initiated by or on behalf of the patient in the same unbroken after-hours period and where the patient’s medical condition requires immediate treatment and where it is necessary for the doctor to return to, and specially open, consulting rooms for the attendance | 80.30 | |
| Group A3 — Specialist attendances to which no other item applies | |
| 104 | Professional attendance by a specialist in the practice of his or her specialty following referral of the patient to him or her — an attendance (other than a second or subsequent attendance in a single course of treatment) where that attendance is at consulting rooms or hospital, not being a service to which item 106 applies | 71.10 | |
| 105 | Professional attendance by a specialist in the practice of his or her specialty following referral of the patient to him or her — an attendance (other than a second or subsequent attendance in a single course of treatment) where that attendance is at consulting rooms or hospital | 35.65 | |
| 106 | Professional attendance by a specialist in the practice of his or her specialty following referral of the patient to him or her — an attendance (other than a second or subsequent attendance in a single course of treatment) at which refraction is performed by a specialist ophthalmologist, and the attendance results in the issuing of a prescription for spectacles or contact lenses, including any consultation on the same occasion and any other attendance on the same day (not being a service to which any of items 10801 to 10816 applies) where that attendance is at consulting rooms or hospital | 59.00 | |
| 107 | Professional attendance by a specialist in the practice of his or her specialty following referral of the patient to him or her — an attendance (other than a second or subsequent attendance in a single course of treatment) where that attendance is at a place other than consulting rooms or hospital | 104.25 | |
| 108 | Professional attendance by a specialist in the practice of his or her specialty following referral of the patient to him or her — each attendance subsequent to the first in a single course of treatment where that attendance is at a place other than consulting rooms or hospital | 65.95 | |
| Group A4 — Consultant physician attendances to which no other item applies | |
| 110 | Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a medical practitioner — initial attendance in a single course of treatment | 125.40 | |
| 116 | Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a medical practitioner — each attendance (not being a service to which item 119 applies) subsequent to the first in a single course of treatment | 62.80 | |
| 119 | Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a medical practitioner — each minor attendance subsequent to the first in a single course of treatment | 35.65 | |
| 122 | Professional attendance at a place other than consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a medical practitioner — initial attendance in a single course of treatment | 152.20 | |
| 128 | Professional attendance at a place other than consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a medical practitioner — each attendance (other than a service to which item 131 applies) subsequent to the first in a single course of treatment | 92.00 | |
| 131 | Professional attendance at a place other than consulting rooms or hospital, by a consultant physician in the practice of his or her specialty (other than psychiatry) following referral of the patient to him or her by a medical practitioner — each minor attendance subsequent to the first in a single course of treatment | 66.25 | |
| Group A5 — Prolonged attendances to which no other item applies | |
| 160 | Professional attendance for a period of not less than 1 hour but less than 2 hours (not being a service to which any other item applies) on a patient in imminent danger of death requiring continuous attendance on the patient to the exclusion of all other patients | 180.45 | |
| 161 | Professional attendance for a period of not less than 2 hours but less than 3 hours (not being a service to which any other item applies) on a patient in imminent danger of death requiring continuous attendance on the patient to the exclusion of all other patients | 300.75 | |
| 162 | Professional attendance for a period of not less than 3 hours but less than 4 hours (not being a service to which any other item applies) on a patient in imminent danger of death requiring continuous attendance on the patient to the exclusion of all other patients | 420.95 | |
| 163 | Professional attendance for a period of not less than 4 hours but less than 5 hours (not being a service to which any other item applies) on a patient in imminent danger of death requiring continuous attendance on the patient to the exclusion of all other patients | 541.40 | |
| 164 | Professional attendance for a period of 5 hours or more (not being a service to which any other item applies) on a patient in imminent danger of death requiring continuous attendance on the patient to the exclusion of all other patients | 601.55 | |
| Group A6 — Group therapy | |
| 170 | Professional attendance for the purpose of group therapy of not less than 1 hour’s duration given under the direct continuous supervision of a medical practitioner, other than a consultant physician in the practice of his or her specialty of psychiatry, involving members of a family and persons with close personal relationships with that family — each group of 2 patients | 95.80 | |
| 171 | Professional attendance for the purpose of group therapy of not less than 1 hour’s duration given under the direct continuous supervision of a medical practitioner, other than a consultant physician in the practice of his or her specialty of psychiatry, involving members of a family and persons with close personal relationships with that family — each group of 3 patients | 100.95 | |
| 172 | Professional attendance for the purpose of group therapy of not less than 1 hour’s duration given under the direct continuous supervision of a medical practitioner, other than a consultant physician in the practice of his or her specialty of psychiatry, involving members of a family and persons with close personal relationships with that family — each group of 4 or more patients | 122.80 | |
| Group A7 — Acupuncture | |
| 173 | Professional attendance at which acupuncture is performed by a medical practitioner by application of stimuli on or through the surface of the skin by any means, including any consultation on the same occasion and any other attendance on the same day related to the condition for which the acupuncture was performed | 21.65 | |
| 193 | Professional attendance by a qualified medical acupuncturist at a place other than a hospital: (a) involving taking a selective history, examination of the patient with implementation of a management plan in relation to 1 or more problems; or (b) being attendance of less than 20 minutes duration involving components of a service to which item 197 or 199 applies; at which acupuncture is performed by the qualified medical acupuncturist by application of stimuli on or through the surface of the skin by any means, including any consultation on the same occasion and any other attendance on the same day related to the condition for which the acupuncture was performed | 30.20 | |
| 195 | Professional attendance by a qualified medical acupuncturist on 1 or more patients at a hospital on 1 occasion: (a) involving taking a selective history, examination of each patient with implementation of a management plan in relation to 1 or more problems; or (b) being attendance of less than 20 minutes duration involving components of a service to which item 197 or 199 applies; at which acupuncture is performed by the qualified medical acupuncturist by application of stimuli on or through the surface of the skin by any means, including any consultation on the same occasion and any other attendance on the same day related to the condition for which the acupuncture was performed | Amount under rule 8 | |
| 197 | Professional attendance by a qualified medical acupuncturist at a place other than a hospital: (a) involving taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more problems, and lasting at least 20 minutes; or (b) being attendance of at least 20 minutes, but less than 40 minutes, duration involving components of a service to which item 199 applies; at which acupuncture is performed by the qualified medical acupuncturist by application of stimuli on or through the surface of the skin by any means, including any consultation on the same occasion and any other attendance on the same day related to the condition for which the acupuncture was performed | 57.35 | |
| 199 | Professional attendance by a qualified medical acupuncturist at a place other than a hospital: (a) involving taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more complex problems, and lasting at least 40 minutes; or (b) being attendance of at least 40 minutes duration for implementation of a management plan; at which acupuncture is performed by the qualified medical acupuncturist by application of stimuli on or through the surface of the skin by any means, including any consultation on the same occasion and any other attendance on the same day related to the condition for which the acupuncture was performed | 84.45 | |
| Group A8 — Consultant psychiatrist attendances to which no other item applies | |
| 300 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — an attendance of not more than 15 minutes duration at consulting rooms (not being an attendance to which item 353 or 364 applies), if that attendance and any other attendance to which any of items 300 to 308 and 353 to 370 applies have not exceeded 50 attendances in a calendar year for the patient | 36.00 | |
| 302 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — an attendance of more than 15 minutes, but not more than 30 minutes, duration at consulting rooms (not being an attendance to which item 355 or 366 applies), if that attendance and any other attendance to which any of items 300 to 308 and 353 to 370 applies have not exceeded 50 attendances in a calendar year for the patient | 71.90 | |
| 304 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — an attendance of more than 30 minutes, but not more than 45 minutes, duration at consulting rooms (not being an attendance to which item 356 or 367 applies), if that attendance and any other attendance to which any of items 300 to 308 and 353 to 370 applies have not exceeded 50 attendances in a calendar year for the patient | 105.35 | |
| 306 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — an attendance of more than 45 minutes, but not more than 75 minutes, duration at consulting rooms (not being an attendance to which item 357 or 369 applies), if that attendance and any other attendance to which any of items 300 to 308 and 353 to 370 applies have not exceeded 50 attendances in a calendar year for the patient | 145.45 | |
| 308 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — an attendance of more than 75 minutes duration at consulting rooms (not being an attendance to which item 358 or 370 applies), if that attendance and any other attendance to which any of items 300 to 308 and 353 to 370 applies have not exceeded 50 attendances in a calendar year for the patient | 177.15 | |
| 310 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — an attendance of not more than 15 minutes duration at consulting rooms, if that attendance and any other attendance to which any of items 300 to 308 and 353 to 370 applies exceed 50 attendances in a calendar year for the patient | 18.00 | |
| 312 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — an attendance of more than 15 minutes, but not more than 30 minutes, duration at consulting rooms, if that attendance and any other attendance to which any of items 300 to 308 and 353 to 370 applies exceed 50 attendances in a calendar year for the patient | 36.00 | |
| 314 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — an attendance of more than 30 minutes, but not more than 45 minutes, duration at consulting rooms, if that attendance and any other attendance to which any of items 300 to 308 and 353 to 370 applies exceed 50 attendances in a calendar year for the patient | 52.70 | |
| 316 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — an attendance of more than 45 minutes, but not more than 75 minutes, duration at consulting rooms, if that attendance and any other attendance to which any of items 300 to 308 and 353 to 370 applies exceed 50 attendances in a calendar year for the patient | 72.80 | |
| 318 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — an attendance of more than 75 minutes duration at consulting rooms, if that attendance and any other attendance to which any of items 300 to 308 and 353 to 370 applies exceed 50 attendances in a calendar year for the patient | 88.65 | |
| 319 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — an attendance of more than 45 minutes duration at consulting rooms, if the patient has: (a) been diagnosed as suffering severe personality disorder, anorexia nervosa, bulimia nervosa, dysthymic disorder, substance-related disorder, somatoform disorder or a pervasive development disorder; and (b) for persons 18 years and over, been rated with a level of functional impairment within the range 1 to 50 according to the Global Assessment of Functioning Scale — if that attendance and any other attendance to which any of items 300 to 319 and 353 to 370 applies have not exceeded 160 attendances in a calendar year for the patient | 145.45 | |
| 320 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — an attendance of not more than 15 minutes duration at hospital | 36.00 | |
| 322 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — an attendance of more than 15 minutes, but not more than 30 minutes, duration at hospital | 71.90 | |
| 324 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — an attendance of more than 30 minutes, but not more than 45 minutes, duration at hospital | 105.35 | |
| 326 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — an attendance of more than 45 minutes, but not more than 75 minutes, duration at hospital | 145.45 | |
| 328 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — an attendance of more than 75 minutes duration at hospital | 177.15 | |
| 330 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — an attendance of not more than 15 minutes duration where that attendance is at a place other than consulting rooms or hospital | 66.05 | |
| 332 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — an attendance of more than 15 minutes, but not more than 30 minutes, duration where that attendance is at a place other than consulting rooms or hospital | 103.65 | |
| 334 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — an attendance of more than 30 minutes, but not more than 45 minutes, duration where that attendance is at a place other than consulting rooms or hospital | 143.75 | |
| 336 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — an attendance of more than 45 minutes, but not more than 75 minutes, duration where that attendance is at a place other than consulting rooms or hospital | 173.95 | |
| 338 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — an attendance of more than 75 minutes duration where that attendance is at a place other than consulting rooms or hospital | 207.35 | |
| 342 | Group psychotherapy (including any associated consultations with a patient taking place on the same occasion and relating to the condition for which group therapy is conducted) of not less than 1 hour’s duration given under the continuous direct supervision of a consultant physician in the practice of his or her specialty of psychiatry, involving a group of 2 to 9 unrelated patients or a family group of more than 3 patients, each of whom is referred to the consultant physician by a medical practitioner — each patient | 41.00 | |
| 344 | Group psychotherapy (including any associated consultations with a patient taking place on the same occasion and relating to the condition for which group therapy is conducted) of not less than 1 hour’s duration given under the continuous direct supervision of a consultant physician in the practice of his or her specialty of psychiatry, involving a family group of 3 patients, each of whom is referred to the consultant physician by a medical practitioner — each patient | 54.45 | |
| 346 | Group psychotherapy (including any associated consultations with a patient taking place on the same occasion and relating to the condition for which group therapy is conducted) of not less than 1 hour’s duration given under the continuous direct supervision of a consultant physician in the practice of his or her specialty of psychiatry, involving a family group of 2 patients, each of whom is referred to the consultant physician by a medical practitioner — each patient | 80.45 | |
| 348 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry, following referral of the patient to him or her by a medical practitioner, involving an interview of a person other than the patient of not less than 20 minutes, but less than 45 minutes, duration, in the course of initial diagnostic evaluation of a patient | 43.50 | |
| 350 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry, following referral of the patient to him or her by a medical practitioner, involving an interview of a person other than the patient of not less than 45 minutes duration, in the course of initial diagnostic evaluation of a patient | 97.80 | |
| 352 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry, following referral of the patient to him or her by a medical practitioner, involving an interview of a person other than the patient of not less than 20 minutes duration, in the course of continuing management of a patient — if that attendance and any other attendance to which this item applies have not exceeded 4 in a calendar year for the patient | 43.50 | |
| 353 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — a telepsychiatry consultation of not more than 15 minutes duration, if: (a) that attendance and any other attendance to which any of items 353 to 358 applies have not exceeded 4 since: (i) the patient first started telepsychiatry consultation; or (ii) if the patient has had a face-to-face consultation to which any of items 364 to 370 applies — the patient’s last face-to-face consultation; and (b) that attendance and any other attendance to which any of items 353 to 358 applies have not exceeded 12 attendances in a calendar year for the patient; and (c) that attendance and any other attendance to which any of items 300 to 308 and 353 to 370 applies have not exceeded 50 attendances in a calendar year for the patient | 41.40 | |
| 355 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — a telepsychiatry consultation of more than 15 minutes, but not more than 30 minutes, duration, if: (a) that attendance and any other attendance to which any of items 353 to 358 applies have not exceeded 4 since: (i) the patient first started telepsychiatry consultation; or | 82.65 | |
| | (ii) if the patient has had a face-to-face consultation to which any of items 364 to 370 applies — the patient’s last face-to-face consultation; and (b) that attendance and any other attendance to which any of items 353 to 358 applies have not exceeded 12 attendances in a calendar year for the patient; and (c) that attendance and any other attendance to which any of items 300 to 308 and 353 to 370 applies have not exceeded 50 attendances in a calendar year for the patient | | |
| 356 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — a telepsychiatry consultation of more than 30 minutes, but not more than 45 minutes, duration, if: (a) that attendance and any other attendance to which any of items 353 to 358 applies have not exceeded 4 since: (i) the patient first started telepsychiatry consultation; or (ii) if the patient has had a face-to-face consultation to which any of items 364 to 370 applies — the patient’s last face-to-face consultation; and (b) that attendance and any other attendance to which any of items 353 to 358 applies have not exceeded 12 attendances in a calendar year for the patient; and | 121.20 | |
| | (c) that attendance and any other attendance to which any of items 300 to 308 and 353 to 370 applies have not exceeded 50 attendances in a calendar year for the patient | | |
| 357 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — a telepsychiatry consultation of more than 45 minutes, but not more than 75 minutes, duration, if: (a) that attendance and any other attendance to which any of items 353 to 358 applies have not exceeded 4 since: (i) the patient first started telepsychiatry consultation; or (ii) if the patient has had a face-to-face consultation to which any of items 364 to 370 applies — the patient’s last face-to-face consultation; and (b) that attendance and any other attendance to which any of items 353 to 358 applies have not exceeded 12 attendances in a calendar year for the patient; and (c) that attendance and any other attendance to which any of items 300 to 308 and 353 to 370 applies have not exceeded 50 attendances in a calendar year for the patient | 167.30 | |
| 358 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — a telepsychiatry consultation of more than 75 minutes duration, if: (a) that attendance and any other attendance to which any of items 353 to 358 applies have not exceeded 4 since: (i) the patient first started telepsychiatry consultation; or (ii) if the patient has had a face-to-face consultation to which any of items 364 to 370 applies — the patient’s last face-to-face consultation; and | 203.75 | |
| | (b) that attendance and any other attendance to which any of items 353 to 358 applies have not exceeded 12 attendances in a calendar year for the patient; and (c) that attendance and any other attendance to which any of items 300 to 308 and 353 to 370 applies have not exceeded 50 attendances in a calendar year for the patient | | |
| 364 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — a face-to-face consultation of not more than 15 minutes duration, if: (a) the patient has had 4 telepsychiatry consultations to which any of items 353 to 358 applies: (i) before that attendance; or (ii) if the patient has previously had a face-to-face consultation to which any of items 364 to 370 applies — since the patient’s last face-to-face consultation; and (b) that attendance and any other attendance to which any of items 364 to 370 applies have not exceeded 3 attendances in a calendar year for the patient; and (c) that attendance and any other attendance to which any of items 300 to 308 and 353 to 370 applies have not exceeded 50 attendances in a calendar year for the patient | 36.00 | |
| 366 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — a face-to-face consultation of more than 15 minutes, but not more than 30 minutes, duration, if: (a) the patient has had 4 telepsychiatry consultations to which any of items 353 to 358 applies: (i) before that attendance; or (ii) if the patient has previously had a face-to-face consultation to which any of items 364 to 370 applies — since the patient’s last face-to-face consultation; and | 71.90 | |
| | (b) that attendance and any other attendance to which any of items 364 to 370 applies have not exceeded 3 attendances in a calendar year for the patient; and (c) that attendance and any other attendance to which any of items 300 to 308 and 353 to 370 applies have not exceeded 50 attendances in a calendar year for the patient | | |
| 367 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — a face-to-face consultation of more than 30 minutes, but not more than 45 minutes, duration, if: (a) the patient has had 4 telepsychiatry consultations to which any of items 353 to 358 applies: (i) before that attendance; or (ii) if the patient has previously had a face-to-face consultation to which any of items 364 to 370 applies — since the patient’s last face-to-face consultation; and (b) that attendance and any other attendance to which any of items 364 to 370 applies have not exceeded 3 attendances in a calendar year for the patient; and (c) that attendance and any other attendance to which any of items 300 to 308 and 353 to 370 applies have not exceeded 50 attendances in a calendar year for the patient | 105.35 | |
| 369 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — a face-to-face consultation of more than 45 minutes, but not more than 75 minutes, duration, if: (a) the patient has had 4 telepsychiatry consultations to which any of items 353 to 358 applies: (i) before that attendance; or (ii) if the patient has previously had a face-to-face consultation to which any of items 364 to 370 applies — since the patient’s last face-to-face consultation; and | 145.45 | |
| | (b) that attendance and any other attendance to which any of items 364 to 370 applies have not exceeded 3 attendances in a calendar year for the patient; and (c) that attendance and any other attendance to which any of items 300 to 308 and 353 to 370 applies have not exceeded 50 attendances in a calendar year for the patient | | |
| 370 | Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — a face-to-face consultation of more than 75 minutes duration, if: (a) the patient has had 4 telepsychiatry consultations to which any of items 353 to 358 applies: (i) before that attendance; or (ii) if the patient has previously had a face-to-face consultation to which any of items 364 to 370 applies — since the patient’s last face-to-face consultation; and (b) that attendance and any other attendance to which any of items 364 to 370 applies have not exceeded 3 attendances in a calendar year for the patient; and (c) that attendance and any other attendance to which any of items 300 to 308 and 353 to 370 applies have not exceeded 50 attendances in a calendar year for the patient | 177.15 | |
| Group A12 — Consultant occupational physician attendances to which no other item applies | |
| 385 | Professional attendance at consulting rooms or hospital by a consultant occupational physician in the practice of his or her specialty of occupational medicine following referral of the patient to him or her by a medical practitioner — initial attendance in a single course of treatment | 71.10 | |
| 386 | Professional attendance at consulting rooms or hospital by a consultant occupational physician in the practice of his or her specialty of occupational medicine following referral of the patient to him or her by a medical practitioner — each attendance subsequent to the first in a single course of treatment | 35.65 | |
| 387 | Professional attendance at a place other than consulting rooms or hospital by a consultant occupational physician in the practice of his or her specialty of occupational medicine following referral of the patient to him or her by a medical practitioner — initial attendance in a single course of treatment | 104.25 | |
| 388 | Professional attendance at a place other than consulting rooms or hospital by a consultant occupational physician in the practice of his or her specialty of occupational medicine following referral of the patient to him or her by a medical practitioner — each attendance subsequent to the first in a single course of treatment | 65.95 | |
| Group A13 — Public health physician attendances to which no other item applies | |
| 410 | Professional attendance at consulting rooms by a public health physician in the practice of his or her specialty of public health medicine — attendance for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management | 13.80 | |
| 411 | Professional attendance at consulting rooms by a public health physician in the practice of his or her specialty of public health medicine — attendance involving taking a selective patient history, examination of the patient with implementation of a management plan in relation to 1 or more problems, or an attendance of less than 20 minutes duration involving components of a service to which item 412 applies | 30.20 | |
| 412 | Professional attendance at consulting rooms by a public health physician in the practice of his or her specialty of public health medicine — attendance involving taking a detailed patient history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more problems, and lasting at least 20 minutes, or an attendance of less than 40 minutes duration involving components of a service to which item 413 applies | 57.35 | |
| 413 | Professional attendance at consulting rooms by a public health physician in the practice of his or her specialty of public health medicine — attendance involving taking an exhaustive patient history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more complex problems, and lasting at least 40 minutes, or an attendance of at least 40 minutes duration for implementation of a management plan | 84.45 | |
| 414 | Professional attendance at other than consulting rooms by a public health physician in the practice of his or her specialty of public health medicine — attendance for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management | Amount under rule 8 | |
| 415 | Professional attendance at other than consulting rooms by a public health physician in the practice of his or her specialty of public health medicine — attendance involving taking a selective patient history, examination of the patient with implementation of a management plan in relation to 1 or more problems, or an attendance of less than 20 minutes duration involving components of a service to which item 416 applies | Amount under rule 8 | |
| 416 | Professional attendance at other than consulting rooms by a public health physician in the practice of his or her specialty of public health medicine — attendance involving taking a detailed patient history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more problems, and lasting at least 20 minutes, or an attendance of less than 40 minutes duration involving components of a service to which item 417 applies | Amount under rule 8 | |
| 417 | Professional attendance at other than consulting rooms by a public health physician in the practice of his or her specialty of public health medicine — attendance involving taking an exhaustive patient history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more complex problems, and lasting at least 40 minutes, or an attendance of at least 40 minutes duration for implementation of a management plan | Amount under rule 8 | |
| Group A16 — Attendance by a medical practitioner who is a sports physician in the practice of sports medicine and to which no other item applies | |
| Subgroup 1 — Surgery consultations | |
| 444 | Professional attendance at consulting rooms for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management | 13.80 | |
| 445 | Professional attendance at consulting rooms involving taking a selective history, examination of the patient with implementation of a management plan in relation to 1 or more problems, or an attendance of less than 20 minutes duration involving components of a service to which item 446 applies | 30.20 | |
| 446 | Professional attendance at consulting rooms involving taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more problems, and lasting at least 20 minutes, or an attendance of less than 40 minutes duration involving components of a service to which item 447 applies | 57.35 | |
| 447 | Professional attendance at consulting rooms involving taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more complex problems, and lasting at least 40 minutes, or an attendance of at least 40 minutes duration for implementation of a management plan | 84.45 | |
| Subgroup 2 — Emergency attendances — after hours | |
| 448 | Professional attendance at consulting rooms where the attendance is initiated by or on behalf of the patient in the same unbroken after hours period and where the patient’s medical condition requires immediate treatment and where it is necessary for the practitioner to return to, and specially open, consulting rooms for the attendance — each attendance other than an attendance between 11 pm and 7 am, on a public holiday, on a Sunday, before 8 am or after 1 pm on a Saturday, or at any time other than between 8 am and 8 pm on a day not being a Saturday, Sunday or public holiday | 96.05 | |
| 449 | Professional attendance at consulting rooms where the attendance is initiated by or on behalf of the patient in the same unbroken after hours period and where the patient’s medical condition requires immediate treatment and where it is necessary for the practitioner to return to, and specially open, consulting rooms for the attendance — each attendance on any day of the week between 11 pm and 7 am | 114.85 | |
| Group A21 — Emergency physician attendances to which no other item applies | |
| 501 | Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine — attendance for the unscheduled evaluation and management of a patient, involving straightforward medical decision making that requires: (a) taking a problem focussed history; and (b) limited examination; and (c) diagnosis; and (d) initiation of appropriate treatment interventions | 13.80 | |
| 503 | Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine — attendance for the unscheduled evaluation and management of a patient, involving medical decision making of low complexity that requires: (a) taking an expanded problem focussed history; and (b) expanded examination of 1 or more systems; and (c) formulation and documentation of a diagnosis and management plan in relation to 1 or more problems; and (d) initiation of appropriate treatment interventions | 30.20 | |
| 507 | Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine — attendance for the unscheduled evaluation and management of a patient, involving medical decision making of moderate complexity that requires: (a) taking an expanded problem focussed history; and (b) expanded examination of 1 or more systems; and (c) ordering and evaluation of appropriate investigations; and (d) formulation and documentation of a diagnosis and management plan in relation to 1 or more problems; and (e) initiation of appropriate treatment interventions | 57.35 | |
| 511 | Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine — attendance for the unscheduled evaluation and management of a patient, involving medical decision making of moderate complexity that requires: (a) taking a detailed history; and (b) detailed examination of 1 or more systems; and (c) ordering and evaluation of appropriate investigations; and | 84.45 | |
| | (d) formulation and documentation of a diagnosis and management plan in relation to 1 or more problems; and (e) initiation of appropriate treatment interventions; and (f) liaison with relevant health care professionals and discussion with, as appropriate, the patient or the patient’s relatives or agent | | |
| 515 | Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine — attendance for the unscheduled evaluation and management of a patient, involving medical decision making of high complexity that requires: (a) taking a comprehensive history; and (b) comprehensive examination of 1 or more systems; and (c) ordering and evaluation of appropriate investigations; and (d) formulation and documentation of a diagnosis and management plan in relation to 1 or more problems; and (e) initiation of appropriate treatment interventions; and (f) liaison with relevant health care professionals and discussion with, as appropriate, the patient or the patient’s relatives or agent | 135.10 | |
| 519 | Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine — attendance for a total period (whether or not continuous) of at least 30 minutes but less than 1 hour (prior to patient’s admission to an in-patient hospital bed) for emergency evaluation of a critically ill patient with an immediately life threatening problem | 90.20 | |
| 520 | Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine — attendance for a total period (whether or not continuous) of at least 1 hour but less than 2 hours (prior to patient’s admission to an in-patient hospital bed) for emergency evaluation of a critically ill patient with an immediately life threatening problem | 180.45 | |
| 530 | Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine — attendance for a total period (whether or not continuous) of at least 2 hours but less than 3 hours (prior to patient’s admission to an in-patient hospital bed) for emergency evaluation of a critically ill patient with an immediately life threatening problem | 300.75 | |
| 532 | Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine — attendance for a total period (whether or not continuous) of at least 3 hours but less than 4 hours (prior to patient’s admission to an in-patient hospital bed) for emergency evaluation of a critically ill patient with an immediately life threatening problem | 420.95 | |
| 534 | Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine — attendance for a total period (whether or not continuous) of at least 4 hours but less than 5 hours (prior to patient’s admission to an in-patient hospital bed) for emergency evaluation of a critically ill patient with an immediately life threatening problem | 541.40 | |
| 536 | Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine — attendance for a total period (whether or not continuous) of at least 5 hours (prior to patient’s admission to an in-patient hospital bed) for emergency evaluation of a critically ill patient with an immediately life threatening problem | 601.55 | |
| Group A11 — Unsociable hours | |
| 601 | Professional attendance, being an attendance at other than consulting rooms, by a general practitioner on not more than 1 patient on the 1 occasion — each attendance on any day of the week between 11 pm and 7 am, where the attendance is initiated by or on behalf of the patient in the same unbroken after-hours period and where the patient’s medical condition requires immediate treatment | 114.85 | |
| 602 | Professional attendance, being an attendance at consulting rooms, by a general practitioner on not more than 1 patient on the 1 occasion — each attendance on any day of the week between 11 pm and 7 am, where the attendance is initiated by or on behalf of the patient in the same unbroken after-hours period and where the patient’s medical condition requires immediate treatment and where it is necessary for the doctor to return to, and specially open, consulting rooms for the attendance | 114.85 | |
| 697 | Professional attendance, being an attendance at other than consulting rooms, by a medical practitioner, (not being a general practitioner) on not more than 1 patient on the 1 occasion — each attendance on any day of the week between 11 pm and 7 am, where the attendance is initiated by or on behalf of the patient in the same unbroken after-hours period and where the patient’s medical condition requires immediate treatment | 99.40 | |
| 698 | Professional attendance, being an attendance at consulting rooms, by a medical practitioner (not being a general practitioner) on not more than 1 patient on the 1 occasion — each attendance on any day of the week between 11 pm and 7 am, where the attendance is initiated by or on behalf of the patient in the same unbroken after-hours period and where the patient’s medical condition requires immediate treatment and where it is necessary for the doctor to return to, and specially open, consulting rooms for the attendance | 99.40 | |
| Group A14 — Health assessments | |
| 700 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) at consulting rooms for a health assessment of a patient who is at least 75 years old — not being a health assessment of a patient in respect of whom, in the preceding 12 months, a payment has been made under this item or item 702, 704 or 706 | 157.50 | |
| 702 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) not being an attendance at consulting rooms, a hospital or a residential aged care facility, for a health assessment of a patient who is at least 75 years old — not being a health assessment of a patient in respect of whom, in the preceding 12 months, a payment has been made under this item or item 700, 704 or 706 | 222.75 | |
| 704 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) at consulting rooms for a health assessment of a patient who is at least 55 years old and of Aboriginal or Torres Strait Islander descent — not being a health assessment of a patient in respect of whom, in the preceding 12 months, a payment has been made under this item or item 700, 702 or 706 | 157.50 | |
| 706 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) not being an attendance at consulting rooms, a hospital or a residential aged care facility, for a health assessment of a patient who is at least 55 years old and of Aboriginal or Torres Strait Islander descent — not being a health assessment of a patient in respect of whom, in the preceding 12 months, a payment has been made under this item or item 700, 702 or 704 | 222.75 | |
| Group A15 — Multidisciplinary care plans and multidisciplinary case conferences | |
| Subgroup 1 — Multidisciplinary care plans | |
| 720 | Preparation by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), in consultation with a multidisciplinary care plan team, of a multidisciplinary community care plan for a patient (not being a service associated with a service to which items 734 to 779 apply) — payable not more than once in any 6 month period | 202.50 | |
| 722 | Preparation by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), in consultation with a multidisciplinary care plan team, of a multidisciplinary discharge care plan for a patient (not being a service associated with a service to which items 734 to 779 apply) — payable not more than once for each hospital admission | 202.50 | |
| 724 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), to review a multidisciplinary community care plan or a discharge care plan prepared by that medical practitioner for a patient and claimed for under item 720 or 722 (not being a payment for a service to which items 734 to 779 apply) — payable not more than once in any 3 month period, and not being an attendance in relation to a patient: (a) for whom, in the preceding 3 months, a payment has been made under item 720; or (b) for whom, in the preceding month, a payment has been made under item 722 | 101.25 | |
| 726 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a multidisciplinary care plan team, to contribute to a multidisciplinary community care plan or to a review of a multidisciplinary community care plan prepared by another provider (not being a payment for a service to which items 734 to 779 apply) — not being an attendance in relation to a patient for whom, in the preceding 6 months, a payment has been made under item 720 | 40.80 | |
| 728 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a multidisciplinary care plan team, to contribute to a multidisciplinary discharge care plan or to a review of a multidisciplinary discharge care plan prepared by another provider (not being a service associated with a service to which items 722 and 734 to 779 apply) | 40.80 | |
| 730 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a multidisciplinary care plan team, to make a contribution to a multidisciplinary care plan in a residential aged care facility or to a review of a multidisciplinary care plan in a residential aged care facility prepared by the residential aged care facility (not being a payment in respect of a service to which items 734 to 779 apply) | 40.80 | |
| Subgroup 2 — Case conferences | |
| 734 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to organise and co-ordinate a multidisciplinary case conference in a residential aged care facility, where the conference time is at least 15 minutes, but less than 30 minutes (not being a service associated with a service to which item 730 applies) | 78.80 | |
| 736 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to organise and co-ordinate a multidisciplinary case conference in a residential aged care facility, where the conference time is at least 30 minutes, but less than 45 minutes (not being a service associated with a service to which item 730 applies) | 118.15 | |
| 738 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to organise and co-ordinate a multidisciplinary case conference in a residential aged care facility, where the conference time is at least 45 minutes (not being a service associated with a service to which item 730 applies) | 157.50 | |
| 740 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to organise and co-ordinate a community case conference, where the conference time is at least 15 minutes, but less than 30 minutes (not being a service associated with a service to which items 720 to 730 apply) | 78.80 | |
| 742 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to organise and co-ordinate a community case conference, where the conference time is at least 30 minutes, but less than 45 minutes (not being a service associated with a service to which items 720 to 730 apply) | 118.15 | |
| 744 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to organise and co-ordinate a community case conference, where the conference time is at least 45 minutes (not being a service associated with a service to which items 720 to 730 apply) | 157.50 | |
| 746 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to organise and co-ordinate a multidisciplinary discharge case conference, where the conference time is at least 15 minutes, but less than 30 minutes (not being a service associated with a service to which items 720 to 730 apply) — payable not more than once for each hospital admission | 78.80 | |
| 749 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to organise and co-ordinate a multidisciplinary discharge case conference, where the conference time is at least 30 minutes, but less than 45 minutes (not being a service associated with a service to which items 720 to 730 apply) — payable not more than once for each hospital admission | 118.15 | |
| 757 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to organise and co-ordinate a multidisciplinary discharge case conference, where the conference time is at least 45 minutes (not being a service associated with a service to which items 720 to 730 apply) — payable not more than once for each hospital admission | 157.50 | |
| 759 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to participate in a community case conference (other than to organise and co-ordinate the conference), where the conference time is at least 15 minutes, but less than 30 minutes (not being a service associated with a service to which items 720 to 730 apply) | 56.20 | |
| 762 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to participate in a community case conference (other than to organise and co-ordinate the conference), where the conference time is at least 30 minutes, but less than 45 minutes (not being a service associated with a service to which items 720 to 730 apply) | 90.00 | |
| 765 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to participate in a community case conference (other than to organise and co-ordinate the conference), where the conference time is at least 45 minutes (not being a service associated with a service to which items 720 to 730 apply) | 123.70 | |
| 768 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to participate in a multidisciplinary discharge case conference (other than to organise and co-ordinate the conference), where the conference time is at least 15 minutes, but less than 30 minutes (not being a service associated with a service to which items 720 to 730 apply) — payable not more than once for each hospital admission | 56.20 | |
| 771 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to participate in a multidisciplinary discharge case conference (other than to organise and co-ordinate the conference), where the conference time is at least 30 minutes, but less than 45 minutes (not being a service associated with a service to which items 720 to 730 apply) — payable not more than once for each hospital admission | 90.00 | |
| 773 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to participate in a multidisciplinary discharge case conference (other than to organise and co-ordinate the conference), where the conference time is at least 45 minutes, (not being a service associated with a service to which items 720 to 730 apply) — payable not more than once for each hospital admission | 123.70 | |
| 775 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to participate in a multidisciplinary case conference in a residential aged care facility, (other than to organise and co-ordinate the conference), where the conference time is at least 15 minutes, but less than 30 minutes (not being a service associated with a service to which item 730 applies) | 56.20 | |
| 778 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to participate in a multidisciplinary case conference in a residential aged care facility, (other than to organise and co-ordinate the conference), where the conference time is at least 30 minutes, but less than 45 minutes (not being a service associated with a service to which item 730 applies) | 90.00 | |
| 779 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to participate in a multidisciplinary case conference in a residential aged care facility, (other than to organise and co-ordinate the conference), where the conference time is at least 45 minutes, (not being a service associated with a service to which item 730 applies) | 123.70 | |
| 820 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to organise and co-ordinate a community case conference of at least 15 minutes but less than 30 minutes, with a multidisciplinary team of at least 3 other formal care providers of different disciplines | 115.55 | |
| 822 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to organise and co-ordinate a community case conference of at least 30 minutes but less than 45 minutes, with a multidisciplinary team of at least 3 other formal care providers of different disciplines | 173.40 | |
| 823 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to organise and co-ordinate a community case conference of at least 45 minutes, with a multidisciplinary team of at least 3 other formal care providers of different disciplines | 231.15 | |
| 825 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to participate in a community case conference (other than to organise and to co-ordinate the conference) of at least 15 minutes but less than 30 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines | 83.05 | |
| 826 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to participate in a community case conference (other than to organise and to co-ordinate the conference) of at least 30 minutes but less than 45 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines | 132.40 | |
| 828 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to participate in a community case conference (other than to organise and to co-ordinate the conference) of at least 45 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines | 181.80 | |
| 830 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to organise and co-ordinate a discharge case conference of at least 15 minutes but less than 30 minutes, with a multidisciplinary team of at least 3 other formal care providers of different disciplines | 115.55 | |
| 832 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to organise and co-ordinate a discharge case conference of at least 30 minutes but less than 45 minutes, with a multidisciplinary team of at least 3 other formal care providers of different disciplines | 173.40 | |
| 834 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to organise and co-ordinate a discharge case conference of at least 45 minutes, with a multidisciplinary team of at least 3 other formal care providers of different disciplines | 231.15 | |
| 835 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to participate in a discharge case conference (other than to organise and to co-ordinate the conference) of at least 15 minutes but less than 30 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines | 83.05 | |
| 837 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to participate in a discharge case conference (other than to organise and to co-ordinate the conference) of at least 30 minutes but less than 45 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines | 132.40 | |
| 838 | Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to participate in a discharge case conference (other than to organise and to co-ordinate the conference) of at least 45 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines | 181.80 | |
| 855 | Attendance by a consultant physician in the practice of his or her specialty of psychiatry, as a member of a case conference team, to organise and co-ordinate a community case conference of at least 15 minutes but less than 30 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines | 115.55 | |
| 857 | Attendance by a consultant physician in the practice of his or her specialty of psychiatry, as a member of a case conference team, to organise and co-ordinate a community case conference of at least 30 minutes but less than 45 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines | 173.40 | |
| 858 | Attendance by a consultant physician in the practice of his or her specialty of psychiatry, as a member of a case conference team, to organise and co-ordinate a community case conference of at least 45 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines | 231.15 | |
| 861 | Attendance by a consultant physician in the practice of his or her specialty of psychiatry, as a member of a case conference team, to organise and co-ordinate a discharge case conference of at least 15 minutes but less than 30 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines | 115.55 | |
| 864 | Attendance by a consultant physician in the practice of his or her specialty of psychiatry, as a member of a case conference team, to organise and co-ordinate a discharge case conference of at least 30 minutes but less than 45 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines | 173.40 | |
| 866 | Attendance by a consultant physician in the practice of his or her specialty of psychiatry, as a member of a case conference team, to organise and co-ordinate a discharge case conference of at least 45 minutes, with a multidisciplinary team of at least 2 other formal care providers of different disciplines | 231.15 | |
| Group A17 — Domiciliary medication management review | |
| 900 | Participation by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) in a Domiciliary Medication Management Review (DMMR) for patients living in a community setting, where the medical practitioner: (a) assesses a patient’s medication management needs and, following that assessment, refers the patient to a community pharmacy for a DMMR and, with the patient’s consent, provides relevant clinical information required for the review; and (b) discusses with the reviewing pharmacist the results of that review including suggested medication management strategies; and | 126.10 | |
| | (c) develops a written medication management plan following discussion with the patient. For any particular patient — applicable not more than once in each 12 month period, except where there has been a significant change in the patient’s condition or medication regimen requiring a new DMMR | | |
| Group A18 — General practitioner attendances associated with Practice Incentives Program (PIP) payments | |
| Subgroup 1 — Taking of a cervical smear from an unscreened or significantly underscreened woman | |
| 2501 | Professional attendance at consulting rooms by a general practitioner: (a) involving taking a selective history, examination of the patient with the implementation of a management plan in relation to 1 or more problems; or (b) being attendance of less than 20 minutes duration involving components of a service to which item 2504 or 2507 applies; at which a cervical smear is taken from a woman between the ages of 20 and 69 (inclusive), who has not had a cervical smear in the last 4 years | 30.20 | |
| 2503 | Professional attendance at a place other than consulting rooms by a general practitioner: (a) involving taking a selective history, examination of the patient with the implementation of a management plan in relation to 1 or more problems; or (b) being attendance of less than 20 minutes duration involving components of a service to which item 2506 or 2509 applies; at which a cervical smear is taken from a woman between the ages of 20 and 69 (inclusive), who has not had a cervical smear in the last 4 years | Amount under rule 55 | |
| 2504 | Professional attendance at consulting rooms by a general practitioner: (a) involving taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more problems, and lasting at least 20 minutes; or (b) being attendance of less than 40 minutes duration involving components of a service to which item 2507 applies; at which a cervical smear is taken from a woman between the ages of 20 and 69 (inclusive), who has not had a cervical smear in the last 4 years | 57.35 | |
| 2506 | Professional attendance at a place other than consulting rooms by a general practitioner: (a) involving taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more problems, and lasting at least 20 minutes; or (b) being attendance of less than 40 minutes duration involving components of a service to which item 2509 applies; at which a cervical smear is taken from a woman between the ages of 20 and 69 (inclusive), who has not had a cervical smear in the last 4 years | Amount under rule 55 | |
| 2507 | Professional attendance at consulting rooms by a general practitioner: (a) involving taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more complex problems, and lasting at least 40 minutes; or (b) being attendance of at least 40 minutes duration for implementation of a management plan; at which a cervical smear is taken from a woman between the ages of 20 and 69 (inclusive), who has not had a cervical smear in the last 4 years | 84.45 | |
| 2509 | Professional attendance at a place other than consulting rooms by a general practitioner involving: (a) taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more complex problems, and lasting at least 40 minutes; or (b) being attendance of at least 40 minutes duration for implementation of a management plan; at which a cervical smear is taken from a woman between the ages of 20 and 69 (inclusive), who has not had a cervical smear in the last 4 years | Amount under rule 55 | |
| Subgroup 2 — Completion of an annual cycle of care for patients with established diabetes mellitus | |
| 2517 | Professional attendance at consulting rooms by a general practitioner: (a) involving taking a selective history, examination of the patient with the implementation of a management plan in relation to 1 or more problems; or (b) being attendance of less than 20 minutes duration involving components of a service to which item 2521 or 2525 applies; that completes the minimum requirements for an annual cycle of care of a patient with established diabetes mellitus | 30.20 | |
| 2518 | Professional attendance at a place other than consulting rooms by a general practitioner: (a) involving taking a selective history, examination of the patient with the implementation of a management plan in relation to 1 or more problems; or (b) being attendance of less than 20 minutes duration involving components of a service to which item 2522 or 2526 applies; that completes the minimum requirements for an annual cycle of care of a patient with established diabetes mellitus | Amount under rule 55 | |
| 2521 | Professional attendance at consulting rooms by a general practitioner: (a) involving taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more problems, and lasting at least 20 minutes; or (b) being attendance of less than 40 minutes duration involving components of a service to which item 2525 applies; that completes the minimum requirements for an annual cycle of care of a patient with established diabetes mellitus | 57.35 | |
| 2522 | Professional attendance at a place other than consulting rooms by a general practitioner: (a) involving taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more problems, and lasting at least 20 minutes; or (b) being attendance of less than 40 minutes duration involving components of a service to which item 2526 applies; that completes the minimum requirements for an annual cycle of care of a patient with established diabetes mellitus | Amount under rule 55 | |
| 2525 | Professional attendance at consulting rooms by a general practitioner: (a) involving taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more complex problems, and lasting at least 40 minutes; or (b) being attendance of at least 40 minutes duration for implementation of a management plan; that completes the minimum requirements for an annual cycle of care of a patient with established diabetes mellitus | 84.45 | |
| 2526 | Professional attendance at a place other than consulting rooms by a general practitioner: (a) involving taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more complex problems, and lasting at least 40 minutes; or (b) being attendance of at least 40 minutes duration for implementation of a management plan; that completes the minimum requirements for an annual cycle of care of a patient with established diabetes mellitus | Amount under rule 55 | |
| Subgroup 3 — Completion of the Asthma 3+ Visit Plan | |
| 2546 | Professional attendance at consulting rooms by a general practitioner: (a) involving taking a selective history, examination of the patient with the implementation of a management plan in relation to 1 or more problems; or (b) being attendance of less than 20 minutes duration involving components of a service to which item 2552 or 2558 applies; that completes the minimum requirements of the Asthma 3+ Visit Plan | 30.20 | |
| 2547 | Professional attendance at a place other than consulting rooms by a general practitioner: (a) involving taking a selective history, examination of the patient with the implementation of a management plan in relation to 1 or more problems; or (b) being attendance of less than 20 minutes duration involving components of a service to which item 2553 or 2559 applies; that completes the minimum requirements of the Asthma 3+ Visit Plan | Amount under rule 55 | |
| 2552 | Professional attendance at consulting rooms by a general practitioner: (a) involving taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more problems, and lasting at least 20 minutes; or (b) being attendance of less than 40 minutes duration involving components of a service to which item 2558 applies; that completes the minimum requirements of the Asthma 3+ Visit Plan | 57.35 | |
| 2553 | Professional attendance at a place other than consulting rooms by a general practitioner: (a) involving taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more problems, and lasting at least 20 minutes; or (b) being attendance of less than 40 minutes duration involving components of a service to which item 2559 applies; that completes the minimum requirements of the Asthma 3+ Visit Plan | Amount under rule 55 | |
| 2558 | Professional attendance at consulting rooms by a general practitioner: (a) involving taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more complex problems, and lasting at least 40 minutes; or (b) being attendance of at least 40 minutes duration for implementation of a management plan; that completes the minimum requirements of the Asthma 3+ Visit Plan | 84.45 | |
| 2559 | Professional attendance at a place other than consulting rooms by a general practitioner: (a) involving taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more complex problems, and lasting at least 40 minutes; or (b) being attendance of at least 40 minutes duration for implementation of a management plan; that completes the minimum requirements of the Asthma 3+ Visit Plan | Amount under rule 55 | |
| Subgroup 4 — Completion of the 3 Step Mental Health Process | |
| 2574 | Professional attendance at consulting rooms by a general practitioner: (a) involving taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more problems, and lasting at least 20 minutes; or (b) involving components of a service to which item 2577 applies, being attendance of less than 40 minutes duration; that completes the minimum requirements of the 3 Step Mental Health Process | 57.35 | |
| 2575 | Professional attendance at a place other than consulting rooms by a general practitioner: (a) involving taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more problems, and lasting at least 20 minutes; or (b) involving components of a service to which item 2578 applies, being attendance of less than 40 minutes duration; that completes the minimum requirements of the 3 Step Mental Health Process | Amount under rule 55 | |
| 2577 | Professional attendance at consulting rooms by a general practitioner: (a) involving taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more complex problems, and lasting at least 40 minutes; or (b) for implementation of a management plan, being attendance of at least 40 minutes duration; that completes the minimum requirements of the 3 Step Mental Health Process | 84.45 | |
| 2578 | Professional attendance at a place other than consulting rooms by a general practitioner: (a) involving taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more complex problems, and lasting at least 40 minutes; or (b) for implementation of a management plan, being attendance of at least 40 minutes duration; that completes the minimum requirements of the 3 Step Mental Health Process | Amount under rule 55 | |
| Group A19 — Other non-referred attendances associated with Practice Incentives Program (PIP) payments to which no other item applies | |
| Subgroup 1 — Taking of a cervical smear from an unscreened or significantly underscreened woman | |
| 2600 | Professional attendance at consulting rooms of more than 5 minutes, but not more than 25 minutes, duration by a medical practitioner who practises in general practice (other than a general practitioner), at which a cervical smear is taken from a woman between the ages of 20 and 69 (inclusive) who has not had a cervical smear in the last 4 years | 21.00 | |
| 2603 | Professional attendance at consulting rooms of more than 25 minutes, but not more than 45 minutes, duration by a medical practitioner who practises in general practice (other than a general practitioner), at which a cervical smear is taken from a woman between the ages of 20 and 69 (inclusive) who has not had a cervical smear in the last 4 years | 38.00 | |
| 2606 | Professional attendance at consulting rooms of more than 45 minutes duration by a medical practitioner who practises in general practice (other than a general practitioner), at which a cervical smear is taken from a woman between the ages of 20 and 69 (inclusive) who has not had a cervical smear in the last 4 years | 61.00 | |
| 2610 | Professional attendance at a place other than consulting rooms of more than 5 minutes, but not more than 25 minutes, duration by a medical practitioner who practises in general practice (other than a general practitioner), at which a cervical smear is taken from a woman between the ages of 20 and 69 (inclusive) who has not had a cervical smear in the last 4 years | Amount under rule 8 | |
| 2613 | Professional attendance at a place other than consulting rooms of more than 25 minutes, but not more than 45 minutes, duration by a medical practitioner who practises in general practice (other than a general practitioner), at which a cervical smear is taken from a woman between the ages of 20 and 69 (inclusive) who has not had a cervical smear in the last 4 years | Amount under rule 8 | |
| 2616 | Professional attendance at a place other than consulting rooms of more than 45 minutes duration by a medical practitioner who practises in general practice (other than a general practitioner), at which a cervical smear is taken from a woman between the ages of 20 and 69 (inclusive) who has not had a cervical smear in the last 4 years | Amount under rule 8 | |
| Subgroup 2 — Completion of an annual cycle of care for patients with established diabetes mellitus | |
| 2620 | Professional attendance at consulting rooms of more than 5 minutes, but not more than 25 minutes, duration by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements for an annual cycle of care of a patient with established diabetes mellitus | 21.00 | |
| 2622 | Professional attendance at consulting rooms of more than 25 minutes, but not more than 45 minutes, duration by a medical practitioner who practises in general practice (other than a general practitioner), that completes the requirements for an annual cycle of care of a patient with established diabetes mellitus | 38.00 | |
| 2624 | Professional attendance at consulting rooms of more than 45 minutes duration by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements for an annual cycle of care of a patient with established diabetes mellitus | 61.00 | |
| 2631 | Professional attendance at a place other than consulting rooms of more than 5 minutes, but not more than 25 minutes, duration by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements for an annual cycle of care of a patient with established diabetes mellitus | Amount under rule 8 | |
| 2633 | Professional attendance at a place other than consulting rooms of more than 25 minutes, but not more than 45 minutes, duration by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements for an annual cycle of care of a patient with established diabetes mellitus | Amount under rule 8 | |
| 2635 | Professional attendance at a place other than consulting rooms of more than 45 minutes duration by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements for an annual cycle of care of a patient with established diabetes mellitus | Amount under rule 8 | |
| Subgroup 3 — Completion of the Asthma 3+ Visit Plan | |
| 2664 | Professional attendance at consulting rooms of more than 5 minutes, but not more than 25 minutes, duration by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements of the Asthma 3+ Visit Plan | 21.00 | |
| 2666 | Professional attendance at consulting rooms of more than 25 minutes, but not more than 45 minutes, duration by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements of the Asthma 3+ Visit Plan | 38.00 | |
| 2668 | Professional attendance at consulting rooms of more than 45 minutes duration by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements of the Asthma 3+ Visit Plan | 61.00 | |
| 2673 | Professional attendance at a place other than consulting rooms of more than 5 minutes, but not more than 25 minutes, duration by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements of the Asthma 3+ Visit Plan | Amount under rule 8 | |
| 2675 | Professional attendance at a place other than consulting rooms of more than 25 minutes, but not more than 45 minutes, duration by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements of the Asthma 3+ Visit Plan | Amount under rule 8 | |
| 2677 | Professional attendance at a place other than consulting rooms of more than 45 minutes duration by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements of the Asthma 3+ Visit Plan | Amount under rule 8 | |
| Subgroup 4 — Completion of the 3 Step Mental Health Process | |
| 2704 | Professional attendance at consulting rooms by a medical practitioner who practises in general practice (other than a general practitioner, a specialist or a consultant physician), that completes the minimum requirements of the 3 Step Mental Health Process, being attendance of more than 25 minutes, but not more than 45 minutes, duration | 38.00 | |
| 2705 | Professional attendance at consulting rooms by a medical practitioner who practises in general practice (other than a general practitioner, a specialist or a consultant physician), that completes the minimum requirements of the 3 Step Mental Health Process, being attendance of more than 45 minutes duration | 61.00 | |
| 2707 | Professional attendance at a place other than consulting rooms by a medical practitioner who practises in general practice (other than a general practitioner, a specialist or a consultant physician), that completes the minimum requirements of the 3 Step Mental Health Process, being attendance of more than 25 minutes, but not more than 45 minutes, duration | Amount under rule 8 | |
| 2708 | Professional attendance at a place other than consulting rooms by a medical practitioner who practises in general practice (other than a general practitioner, a specialist or a consultant physician), that completes the minimum requirements of the 3 Step Mental Health Process, being attendance of more than 45 minutes duration | Amount under rule 8 | |
| Group A20 — Focussed psychological strategies | |
| 2721 | Professional attendance at consulting rooms by a medical practitioner who practises in general practice (other than a specialist or a consultant physician), for providing focussed psychological strategies, being attendance of at least 30 minutes, but less than 40 minutes, duration | 72.25 | |
| 2723 | Professional attendance at a place other than consulting rooms by a medical practitioner who practises in general practice (other than a specialist or a consultant physician), for providing focussed psychological strategies, being attendance of at least 30 minutes, but less than 40 minutes, duration | Amount under rule 55 | |
| 2725 | Professional attendance at consulting rooms by a medical practitioner who practises in general practice (other than a specialist or a consultant physician), for providing focussed psychological strategies, being attendance of at least 40 minutes duration | 103.45 | |
| 2727 | Professional attendance at a place other than consulting rooms by a medical practitioner who practises in general practice (other than a specialist or a consultant physician), for providing focussed psychological strategies, being attendance of at least 40 minutes duration | Amount under rule 55 | |
| Group A9 — Contact lenses | |
| 10801 | Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription — 1 service in any period of 36 months — patients with myopia of 5.0 dioptres or greater (spherical equivalent) in 1 eye | 101.15 | |
| 10802 | Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription — 1 service in any period of 36 months — patients with manifest hyperopia of 5.0 dioptres or greater (spherical equivalent) in 1 eye | 101.15 | |
| 10803 | Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription — 1 service in any period of 36 months — patients with astigmatism of 3.0 dioptres or greater in 1 eye | 101.15 | |
| 10804 | Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription — 1 service in any period of 36 months — patients with irregular astigmatism in either eye, being a condition the existence of which has been confirmed by keratometric observation, if the maximum visual acuity obtainable with spectacle correction is worse than 0.3 logMAR (6/12) and if that corrected acuity would be improved by an additional 0.1 logMAR by the use of a contact lens | 101.15 | |
| 10805 | Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription — 1 service in any period of 36 months — patients with anisometropia of 3.0 dioptres or greater (difference between spherical equivalents) | 101.15 | |
| 10806 | Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription — 1 service in any period of 36 months — patients with corrected visual acuity of 0.7 logMAR (6/30) or worse in both eyes, being patients for whom a contact lens is prescribed as part of a telescopic system | 101.15 | |
| 10807 | Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription — 1 service in any period of 36 months — patients for whom a wholly or segmentally opaque contact lens is prescribed for the alleviation of dazzle, distortion or diplopia caused by pathological mydriasis, aniridia, coloboma of the iris, pupillary malformation or distortion, significant ocular deformity or corneal opacity — whether congenital, traumatic or surgical in origin | 101.15 | |
| 10808 | Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription — 1 service in any period of 36 months — patients who, by reason of physical deformity, are unable to wear spectacles | 101.15 | |
| 10809 | Attendance for the investigation and evaluation of a patient for the fitting of contact lenses, with keratometry and testing with trial lenses and the issue of a prescription — 1 service in any period of 36 months — patients who have a medical or optical condition (other than myopia, hyperopia, astigmatism, anisometropia or a condition to which item 10806, 10807 or 10808 applies) requiring the use of a contact lens for correction, where the condition is specified on the patient’s account | 101.15 | |
| 10816 | Attendance for the refitting of contact lenses with keratometry and testing with trial lenses and the issue of a prescription, where the patient requires a change in contact lens material or basic lens parameters, other than simple power change, because of a structural or functional change in the eye or an allergic response within 36 months of the fitting of a contact lens to which items 10801 to 10809 apply | 101.15 | |
| Group A10 — Optometric services | |
| 10900 | Professional attendance of more than 15 minutes duration, being the first in a course of attention — not payable within 24 months of an attendance to which item 10900, 10905, 10907, 10912, 10913, 10914 or 10915 applies | 59.00 | |
| 10905 | Professional attendance of more than 15 minutes duration, being the first in a course of attention, where the patient has been referred by another optometrist who is not associated with the optometrist to whom the patient is referred | 59.00 | |
| 10907 | Professional attendance of more than 15 minutes duration being the first in a course of attention where the patient has attended another optometrist within the previous 24 months for an attendance to which item 10900, 10905, 10907, 10912, 10913, 10914 or 10915 applies | 29.55 | |
| 10912 | Professional attendance of more than 15 minutes duration, being the first in a course of attention, where the patient has suffered a significant change of visual function requiring comprehensive reassessment within 24 months of an initial consultation to which item 10900, 10905, 10907, 10912, 10913, 10914 or 10915 at the same practice applies | 59.00 | |
| 10913 | Professional attendance of more than 15 minutes duration, being the first in a course of attention, where the patient has new signs or symptoms, unrelated to the earlier course of attention, requiring comprehensive reassessment within 24 months of an initial consultation to which item 10900, 10905, 10907, 10912, 10913, 10914 or 10915 at the same practice applies | 59.00 | |
| 10914 | Professional attendance of more than 15 minutes duration, being the first in a course of attention, where the patient has a progressive disorder (excluding presbyopia) requiring comprehensive reassessment within 24 months of an initial consultation to which item 10900, 10905, 10907, 10912, 10913, 10914 or 10915 applies | 59.00 | |
| 10915 | Professional attendance of more than 15 minutes duration, being the first in a course of attention involving the examination of the eyes, with the instillation of a mydriatic, of a patient with diabetes mellitus, requiring comprehensive reassessment | 59.00 | |
| 10916 | Professional attendance, being the first in a course of attention, of not more than 15 minutes duration (not being a service associated with a service to which item 10940 or 10941 applies) | 29.55 | |
| 10918 | Professional attendance being the second or subsequent in a course of attention not related to the prescription and fitting of contact lenses (not being a service associated with a service to which item 10940 or 10941 applies) | 29.55 | |
| 10921 | All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention in respect of which the first attendance is a service to which item 10900, 10905, 10907, 10912, 10913, 10914, 10915 or 10916 applies — payable only once in a period of 36 months — patients with myopia of 5.0 dioptres or greater (spherical equivalent) in 1 eye | 146.40 | |
| 10922 | All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention in respect of which the first attendance is a service to which item 10900, 10905, 10907, 10912, 10913, 10914, 10915 or 10916 applies — payable only once in a period of 36 months — patients with manifest hyperopia of 5.0 dioptres or greater (spherical equivalent) in 1 eye | 146.40 | |
| 10923 | All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention in respect of which the first attendance is a service to which item 10900, 10905, 10907, 10912, 10913, 10914, 10915 or 10916 applies — payable only once in a period of 36 months — patients with astigmatism of 3.0 dioptres or greater in 1 eye | 146.40 | |
| 10924 | All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention in respect of which the first attendance is a service to which item 10900, 10905, 10907, 10912, 10913, 10914, 10915 or 10916 applies — payable only once in a period of 36 months — patients with irregular astigmatism in either eye, being a condition the existence of which has been confirmed by keratometric observation, if the maximum visual acuity obtainable with spectacle correction is worse than 0.3 logMAR (6/12) and if that corrected acuity would be improved by an additional 0.1 logMAR by the use of a contact lens | 184.75 | |
| 10925 | All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention in respect of which the first attendance is a service to which item 10900, 10905, 10907, 10912, 10913, 10914, 10915 or 10916 applies — payable only once in a period of 36 months — patients with anisometropia of 3.0 dioptres or greater (difference between spherical equivalents) | 146.40 | |
| 10926 | All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention in respect of which the first attendance is a service to which item 10900, 10905, 10907, 10912, 10913, 10914, 10915 or 10916 applies — payable only once in a period of 36 months — patients with corrected visual acuity of 0.7 logMAR (6/30) or worse in both eyes, being patients for whom a contact lens is prescribed as part of a telescopic system | 146.40 | |
| 10927 | All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention in respect of which the first attendance is a service to which item 10900, 10905, 10907, 10912, 10913, 10914, 10915 or 10916 applies — payable only once in a period of 36 months — patients for whom a wholly or segmentally opaque contact lens is prescribed for the alleviation of dazzle, distortion or diplopia caused by pathological mydriasis, aniridia, coloboma of the iris, pupillary malformation or distortion, significant ocular deformity or corneal opacity — whether congenital, traumatic or surgical in origin | 184.75 | |
| 10928 | All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention in respect of which the first attendance is a service to which item 10900, 10905, 10907, 10912, 10913, 10914, 10915 or 10916 applies — payable only once in a period of 36 months — patients who, by reason of physical deformity, are unable to wear spectacles | 146.40 | |
| 10929 | All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention in respect of which the first attendance is a service to which item 10900, 10905, 10907, 10912, 10913, 10914, 10915 or 10916 applies — payable only once in a period of 36 months — patients who have a medical or optical condition (other than myopia, hyperopia, astigmatism, anisometropia or a condition to which item 10926, 10927 or 10928 applies) requiring the use of a contact lens for correction, where the condition is specified on the patient’s account | 184.75 | |
| 10930 | All professional attendances regarded as a single service in a single course of attention involving the prescription and fitting of contact lenses where the patient meets the requirements of an item in the series 10921 to 10929 and requires a change in contact lens material or basic lens parameters, other than a simple power change, because of a structural or functional change in the eye or an allergic response within 36 months of the fitting of a contact lens covered by items 10921 to 10929 | 146.40 | |
| 10940 | Full quantitative computerised perimetry (automated absolute static threshold), not being a service involving multifocal multichannel objective perimetry, performed by an optometrist, where indicated by the presence of relevant ocular disease or suspected pathology of the visual pathways or brain with assessment and report, bilateral — to a maximum of 2 examinations (including examinations to which item 10941 applies) in any 12 month period, not being a service associated with a service to which item 10916 or 10918 applies | 56.30 | |
| 10941 | Full quantitative computerised perimetry (automated absolute static threshold) not being a service involving multifocal multichannel objective perimetry, performed by an optometrist, where indicated by the presence of relevant ocular disease or suspected pathology of the visual pathways or brain with assessment and report, unilateral — to a maximum of 2 examinations (including examinations to which item 10940 applies) in any 12 month period, not being a service associated with a service to which item 10916 or 10918 applies | 33.95 | |
| Diagnostic procedures and investigations Group D1 — Miscellaneous diagnostic procedures and investigations Subgroup 1 — Neurology | |
| 11000 | Electroencephalography, not being a service: (a) associated with a service to which item 11003, 11006 or 11009 applies; or (b) involving quantitative topographic mapping using neurometrics or similar devices (Anaes.) | 102.30 | |
| 11003 | Electroencephalography, prolonged recording of at least 3 hours duration, not being a service: (a) associated with a service to which item 11000, 11004, 11005, 11006 or 11009 applies; or (b) involving quantitative topographic mapping using neurometrics or similar devices | 270.70 | |
| 11004 | Electroencephalography, ambulatory or video, prolonged recording of at least 3 hours duration up to 24 hours duration, recording on the first day, not being a service: (a) associated with a service to which item 11000, 11003, 11005, 11006 or 11009 applies; or (b) involving quantitative topographic mapping using neurometrics or similar devices | 270.70 | |
| 11005 | Electroencephalography, ambulatory or video, prolonged recording of at least 3 hours duration up to 24 hours duration, recording on each day subsequent to the first day, not being a service: (a) associated with a service to which item 11000, 11003, 11004, 11006 or 11009 applies; or (b) involving quantitative topographic mapping using neurometrics or similar devices | 270.70 | |
| 11006 | Electroencephalography, temporosphenoidal, not being a service involving quantitative topographic mapping using neurometrics or similar devices | 138.80 | |
| 11009 | Electrocorticography | 189.25 | |
| 11012 | Neuromuscular electrodiagnosis — conduction studies on 1 nerve or electromyography of 1 or more muscles using concentric needle electrodes or both these examinations (not being a service associated with a service to which item 11015 or 11018 applies) | 93.00 | |
| 11015 | Neuromuscular electrodiagnosis — conduction studies on 2 or 3 nerves with or without electromyography (not being a service associated with a service to which item 11012 or 11018 applies) | 124.60 | |
| 11018 | Neuromuscular electrodiagnosis — conduction studies on 4 or more nerves with or without electromyography or recordings from single fibres of nerves and muscles or both of these examinations (not being a service associated with a service to which item 11012 or 11015 applies) | 186.15 | |
| 11021 | Neuromuscular electrodiagnosis — repetitive stimulation for study of neuromuscular conduction or electromyography with quantitative computerised analysis or both of these examinations | 124.60 | |
| 11024 | Central nervous system evoked responses, investigation of, by computerised averaging techniques, not being a service involving quantitative topographic mapping of event-related potentials or involving multifocal multichannel objective perimetry — 1 or 2 studies | 94.65 | |
| 11027 | Central nervous system evoked responses, investigation of, by computerised averaging techniques, not being a service involving quantitative topographic mapping of event-related potentials or involving multifocal multichannel objective perimetry — 3 or more studies | 140.35 | |
| Subgroup 2 — Ophthalmology | |
| 11200 | Provocative test or tests for glaucoma, including water drinking | 33.90 | |
| 11203 | Tonography — in the investigation or management of glaucoma, of one or both eyes — using an electrical tonography machine producing a directly recorded tracing | 57.30 | |
| 11204 | Electroretinography of 1 or both eyes by computerised averaging techniques, including 3 or more studies performed according to current professional guidelines or standards | 89.95 | |
| 11205 | Electrooculography of 1 or both eyes performed according to current professional guidelines or standards | 89.95 | |
| 11210 | Pattern electroretinography of 1 or both eyes by computerised averaging techniques, including 3 or more studies performed according to current professional guidelines or standards | 89.95 | |
| 11211 | Dark adaptometry of 1 or both eyes with a quantitative estimation of threshold in log lumens at 45 minutes of dark adaptations | 89.95 | |
| 11212 | Optic fundi, examination of following intravenous dye injection | 58.30 | |
| 11215 | Retinal photography, multiple exposures, of 1 eye with intravenous dye injection | 102.20 | |
| 11218 | Retinal photography, multiple exposures of both eyes with intravenous dye injection | 126.25 | |
| 11221 | Full quantitative computerised perimetry (automated absolute static threshold), not being a service involving multifocal multichannel objective perimetry, performed by or on behalf of a specialist in the practice of his or her specialty, where indicated by the presence of relevant ocular disease or suspected pathology of the visual pathways or brain with assessment and report, bilateral — to a maximum of 2 examinations (including examinations to which item 11224 applies) in any 12 month period | 56.30 | |
| 11222 | Full quantitative computerised perimetry (automated absolute static threshold), not being a service involving multifocal multichannel objective perimetry, performed by or on behalf of a specialist in the practice of his or her specialty, with assessment and report, bilateral, where it can be demonstrated that a further examination is indicated in the same 12 month period to which item 11221 applies due to presence of 1 of the following conditions: (a) established glaucoma (where surgery may be required within a 6 month period) where there has been definite progression of damage over a 12 month period; | 56.30 | |
| | (b) established neurological disease which may be progressive and where a visual field is necessary for the management of the patient; (c) monitoring for ocular disease or disease of the visual pathways which may be caused by systemic drug toxicity, where there may also be other disease such as glaucoma or neurological disease; each additional examination | | |
| 11224 | Full quantitative computerised perimetry (automated absolute static threshold), not being a service involving multifocal multichannel objective perimetry, performed by or on behalf of a specialist in the practice of his or her specialty, where indicated by the presence of relevant ocular disease or suspected pathology of the visual pathways or brain with assessment and report, unilateral — to a maximum of 2 examinations (including examinations to which item 11221 applies) in any 12 month period | 33.95 | |
| 11225 | Full quantitative computerised perimetry (automated absolute static threshold), not being a service involving multifocal multichannel objective perimetry, performed by or on behalf of a specialist in the practice of his or her specialty, with assessment and report, unilateral, where it can be demonstrated that a further examination is indicated in the same 12 month period to which item 11224 applies due to presence of 1 of the following conditions: (a) established glaucoma (where surgery may be required within a 6 month period) where there has been definite progression of damage over a 12 month period; (b) established neurological disease which may be progressive and where a visual field is necessary for the management of the patient; (c) monitoring for ocular disease or disease of the visual pathways which may be caused by systemic drug toxicity, where there may also be other disease such as glaucoma or neurological disease; each additional examination | 33.95 | |
| 11235 | Examination of the eye by impression cytology of cornea for the investigation of ocular surface dysplasia, including the collection of cells, processing and all cytological examinations and preparation of report | 101.95 | |
| 11237 | Ocular contents, simultaneous ultrasonic echography by both unidimensional and bidimensional techniques, for the diagnosis, monitoring or measurement of choroidal and ciliary body melanomas, retinoblastoma or suspicious naevi or simulating lesions, 1 eye, not being a service associated with a service to which an item in Group I1 of the diagnostic imaging services table applies | 67.65 | |
| 11240 | Orbital contents, ultrasonic echography of, unidimensional, for the measurement of 1 eye prior to lens surgery on that eye, not being a service associated with a service to which an item in Group I1 of the diagnostic imaging services table applies | 67.65 | |
| 11241 | Orbital contents, ultrasonic echography of, unidimensional, for bilateral eye measurement prior to lens surgery on both eyes, not being a service associated with a service to which an item in Group I1 of the diagnostic imaging services table applies | 86.15 | |
| 11242 | Orbital contents, ultrasonic echography of, unidimensional, for the measurement of an eye previously measured and on which lens surgery has been performed, and where further lens surgery is contemplated in that eye, not being a service associated with a service to which an item in Group I1 of the diagnostic imaging services table applies | 66.65 | |
| 11243 | Orbital contents, ultrasonic echography of, unidimensional, for the measurement of a second eye if: (a) surgery for the first eye has resulted in more than 1 dioptre of error; or (b) more than 3 years have elapsed since the surgery for the first eye; not being a service associated with a service to which an item in Group I1 of the diagnostic imaging services table applies | 66.65 | |
| Subgroup 3 — Otolaryngology | |
| 11300 | Brain stem evoked response audiometry (Anaes.) | 159.95 | |
| 11303 | Electrocochleography, extratympanic method, 1 or both ears | 159.95 | |
| 11304 | Electrocochleography, transtympanic membrane insertion technique, 1 or both ears | 263.35 | |
| 11306 | Non-determinate audiometry | 18.25 | |
| 11309 | Audiogram, air conduction | 21.85 | |
| 11312 | Audiogram, air and bone conduction or air conduction and speech discrimination | 30.85 | |
| 11315 | Audiogram, air and bone conduction and speech | 40.90 | |
| 11318 | Audiogram, air and bone conduction and speech, with other cochlear tests | 50.45 | |
| 11321 | Glycerol induced cochlear function changes assessed by a minimum of 4 air conduction and speech discrimination tests (Klockoff’s test) | 95.90 | |
| 11324 | Impedance audiogram involving tympanometry and measurement of static compliance and acoustic reflex performed by, or on behalf of, a specialist in the practice of his or her specialty, where the patient is referred by a medical practitioner — not being a service associated with a service to which item 11309, 11312, 11315 or 11318 applies | 27.30 | |
| 11327 | Impedance audiogram involving tympanometry and measurement of static compliance and acoustic reflex performed by, or on behalf of, a specialist in the practice of his or her specialty, where the patient is referred by a medical practitioner — being a service associated with a service to which item 11309, 11312, 11315 or 11318 applies | 16.40 | |
| 11330 | Impedance audiogram where the patient is not referred by a medical practitioner — 1 examination in any 4 week period | 6.55 | |
| 11332 | Oto-acoustic emission audiometry for the detection of permanent congenital hearing impairment, performed by or on behalf of a specialist or consultant physician, on an infant or child who is at risk due to 1 or more of the following factors: (a) admission to a neonatal intensive care unit; (b) family history of hearing impairment; (c) intra-uterine or perinatal infection (either suspected or confirmed); (d) birthweight less than 1.5 kg; (e) craniofacial deformity; (f) birth asphyxia; (g) chromosomal abnormality, including Down’s Syndrome; | 48.65 | |
| | (h) exchange transfusion; where: (i) the patient is referred by another medical practitioner; and (j) middle ear pathology has been excluded by specialist opinion | | |
| 11333 | Caloric test of labyrinth or labyrinths | 37.05 | |
| 11336 | Simultaneous bithermal caloric test of labyrinths | 37.05 | |
| 11339 | Electronystagmography | 37.05 | |
| Subgroup 4 — Respiratory | |
| 11500 | Bronchospirometry, including gas analysis | 138.80 | |
| 11503 | Measurement of the mechanical or gas exchange function of the respiratory system, or of respiratory muscle function, or of ventilatory control mechanisms, using measurements of various parameters including pressures, volumes, flow, gas concentrations in inspired or expired air, alveolar gas or blood, electrical activity of muscles (the tests being performed under the supervision of a specialist or consultant physician or in the respiratory laboratory of a hospital) — each occasion at which 1 or more such tests are performed | 115.25 | |
| 11506 | Measurement of respiratory function involving a permanently recorded tracing performed before and after inhalation of bronchodilator — each occasion at which 1 or more such tests are performed | 17.05 | |
| 11509 | Measurement of respiratory function involving a permanently recorded tracing and written report, performed before and after inhalation of bronchodilator, with continuous technician attendance in a laboratory equipped to perform complex respiratory function tests (the tests being performed under the supervision of a specialist or consultant physician or in the respiratory laboratory of a hospital) — each occasion at which 1 or more such tests are performed | 29.65 | |
| 11512 | Continuous measurement of the relationship between flow and volume during expiration or inspiration involving a permanently recorded tracing and written report, performed before and after inhalation of bronchodilator, with continuous technician attendance in a laboratory equipped to perform complex lung function tests (the tests being performed under the supervision of a specialist or consultant physician or in the respiratory laboratory of a hospital) — each occasion at which 1 or more such tests are performed | 51.30 | |
| Subgroup 5 — Vascular | |
| 11600 | Blood pressure monitoring (central venous, pulmonary arterial, systemic arterial or cardiac intracavity), by indwelling catheter — each day of monitoring for each type of pressure up to a maximum of 4 pressures (not being a service to which item 13876 applies or a service associated with administration of anaesthesia) | 57.55 | |
| 11602 | Investigation of venous reflux or obstruction in 1 or more limbs at rest by CW Doppler or pulsed Doppler involving examination at multiple sites along the limb(s) using intermittent limb compression and/or Valsalva manoeuvres to detect prograde and retrograde flow, not being a service associated with a service to which item 32500 or 32501 applies — hard copy trace and report, maximum of two examinations in a 12 month period | 42.95 | |
| 11604 | Plethysmographic assessment of chronic venous disease, assessment of chronic venous disease in the lower and upper extremities, or in the lower or upper extremities (unilateral or bilateral) using venous occlusion plethysmography, strain gauge plethysmography or air plethysmography, not being a service associated with a service to which item 32500 or 32501 applies — examination, hard copy trace and report | 42.95 | |
| 11605 | Infrared photoplethysmographic assessment of complex chronic lower limb venous disease, assessment of chronic venous disease in the lower extremities (unilateral or bilateral) using infrared photoplethysmography, examination during and following exercise with and without superficial venous occlusion, to assess venous function (reflux and/or obstruction) to determine surgical intervention or the conservative management of deep venous thrombotic disease, not being a service associated with a service to which item 32500 or 32501 applies — hard copy trace, calculation of 90% recovery time and report | 42.95 | |
| 11610 | Measurement of ankle — brachial indices and arterial waveform analysis, measurement of posterior tibial and dorsalis pedis (or toe) and brachial arterial pressures bilaterally using Doppler or plethysmographic techniques, the calculation of ankle (or toe) brachial systolic pressure indices and assessment of arterial waveforms for the evaluation of lower extremity arterial disease — examination, hard copy trace and report | 42.95 | |
| 11611 | Measurement of wrist — brachial indices and arterial waveform analysis, measurement of radial and ulnar (or finger) and brachial arterial pressures bilaterally using Doppler or plethysmographic techniques, the calculation of the wrist (or finger) brachial systolic pressure indices and assessment of arterial waveforms for the evaluation of upper extremity arterial disease — examination, hard copy trace and report | 42.95 | |
| 11612 | Exercise study for the evaluation of lower extremity arterial disease, measurement of posterior tibial and dorsalis pedis (or toe) and brachial arterial pressures bilaterally using Doppler or plethysmographic techniques, the calculation of ankle (or toe) brachial systolic pressure indices for the evaluation of lower extremity arterial disease at rest and following exercise using a treadmill or bicycle ergometer or other such equipment where the exercise workload is quantifiably documented — examination and report | 79.05 | |
| 11614 | Transcranial doppler, examination of the intracranial arterial circulation using CW Doppler or pulsed Doppler with hard copy recording of waveforms, examination and report, not being a service associated with a service to which item 55280 of the diagnostic imaging services table applies | 42.95 | |
| 11615 | Measurement of digital temperature, 1 or more digits, (unilateral or bilateral) and report, with hard copy recording of temperature before and for 10 minutes or more after cold stress testing | 63.05 | |
| 11627 | Pulmonary artery pressure monitoring during open heart surgery, in a person under 12 years of age | 190.00 | |
| Subgroup 6 — Cardiovascular | |
| 11700 | Twelve-lead electrocardiography, tracing and report | 25.95 | |
| 11701 | Twelve-lead electrocardiography, report only where the tracing has been forwarded to another medical practitioner, not in association with a consultation on the same occasion | 12.95 | |
| 11702 | Twelve-lead electrocardiography, tracing only | 12.95 | |
| 11706 | Phonocardiography with electrocardiograph lead with indirect arterial or venous pulse tracing, with or without apex cardiogram — interpretation and report | 59.90 | |
| 11708 | Continuous ECG recording of ambulatory patient for 12 or more hours (including resting ECG and the recording of parameters), not in association with ambulatory blood pressure monitoring, involving microprocessor based analysis equipment, interpretation and report of recordings by a specialist physician or consultant physician, not being a service to which item 11709 applies | 106.30 | |
| 11709 | Continuous ECG recording (Holter) of ambulatory patient for 12 or more hours (including resting ECG and the recording of parameters), not in association with ambulatory blood pressure monitoring, utilising a system capable of superimposition and full disclosure printout of at least 12 hours of recorded ECG data, microprocessor based scanning analysis, with interpretation and report by a specialist physician or consultant physician | 139.20 | |
| 11710 | Ambulatory ECG monitoring, patient activated, single or multiple event recording, utilising a looping memory recording device which is connected continuously to the patient for 12 hours or more and is capable of recording for at least 20 seconds prior to each activation and for 15 seconds after each activation, including transmission, analysis, interpretation and report — payable once in any 4 week period | 43.10 | |
| 11711 | Ambulatory ECG monitoring for 12 hours or more, patient activated, single or multiple event recording, utilising a memory recording device which is capable of recording for at least 30 seconds after each activation, including transmission, analysis, interpretation and report — payable once in any 4 week period | 23.45 | |
| 11712 | Multi channel ECG monitoring and recording during exercise (motorised treadmill or cycle ergometer capable of quantifying external workload in watts) or pharmacological stress, involving the continuous attendance of a medical practitioner for not less than 20 minutes, with resting ECG, and with or without continuous blood pressure monitoring and the recording of other parameters, on premises equipped with mechanical respirator and defibrillator | 126.40 | |
| 11713 | Signal averaged ECG recording involving not more than 300 beats, using at least 3 leads with data acquisition at not less than 1000Hz of at least 100 QRS complexes, including analysis, interpretation and report of recording by a specialist physician or consultant physician | 57.95 | |
| 11715 | Blood dye — dilution indicator test | 100.40 | |
| 11718 | Implanted pacemaker testing involving electrocardiography, measurement of rate, width and amplitude of stimulus, including reprogramming when required, not being a service associated with a service to which item 11700 or 11721 applies | 28.85 | |
| 11721 | Implanted pacemaker testing of atrioventricular (AV) sequential, rate responsive, or antitachycardia pacemakers, including reprogramming when required, not being a service associated with a service to which item 11700 or 11718 applies | 57.95 | |
| 11724 | Up-right tilt table testing for the investigation of syncope of suspected cardiothoracic origin, including blood pressure monitoring, continuous ECG monitoring and the recording of the parameters, and involving an established intravenous line and the continuous attendance of a specialist or consultant physician — on premises equipped with a mechanical respirator and defibrillator | 140.35 | |
| Subgroup 7 — Gastroenterology and colorectal | |
| 11800 | Oesophageal motility test, manometric | 145.05 | |
| 11810 | Clinical assessment of gastro-oesophageal reflux disease involving 24-hour pH monitoring, including analysis, interpretation and report and including any associated consultation | 145.05 | |
| 11830 | Diagnosis of abnormalities of the pelvic floor involving anal manometry or measurement of anorectal sensation or measurement of the rectosphincteric reflex | 155.20 | |
| 11833 | Diagnosis of abnormalities of the pelvic floor and sphincter muscles involving electromyography or measurement of pudendal and spinal nerve motor latency | 207.55 | |
| Subgroup 8 — Genito-urinary physiological investigations | |
| 11900 | Urine flow study including peak urine flow measurement, not being a service associated with a service to which item 11919 applies | 22.90 | |
| 11903 | Cystometrography, not being a service associated with a service to which any of items 11012 to 11027, 11912, 11915, 11919, 11921 and 36800 or an item in Group I3 of the diagnostic imaging services table applies | 92.35 | |
| 11906 | Urethral pressure profilometry, not being a service associated with a service to which any of items 11012 to 11027, 11909, 11919, 11921 and 36800 or an item in Group I3 of the diagnostic imaging services table applies | 92.35 | |
| 11909 | Urethral pressure profilometry with simultaneous measurement of urethral sphincter electromyography, not being a service associated with a service to which item 11906, 11915, 11919, 36800 or an item in Group I3 of the diagnostic imaging services table applies | 137.15 | |
| 11912 | Cystometrography with simultaneous measurement of rectal pressure, not being a service associated with a service to which any of items 11012 to 11027, 11903, 11915, 11919, 11921 and 36800 or an item in Group I3 of the diagnostic imaging services table applies (Anaes.) | 137.15 | |
| 11915 | Cystometrography with simultaneous measurement of urethral sphincter electromyography, not being a service associated with a service to which any of items 11012 to 11027, 11903, 11909, 11912, 11919, 11921 and 36800 or an item in Group I3 of the diagnostic imaging services table applies (Anaes.) | 137.15 | |
| 11917 | Cystometrography in conjunction with ultrasound of 1 or more components of the urinary tract, with measurement of any 1 or more of urine flow rate, urethral pressure profile, rectal pressure, urethral sphincter electromyography; including all imaging associated with cystometrography, not being a service associated with a service to which any of items 11012 to 11027, 11900 to 11915, 11919, 11921 and 36800 applies (Anaes.) | 355.95 | |
| 11919 | Cystometrography in conjunction with contrast micturating cystourethrography, with measurement of any 1 or more of urine flow rate, urethral pressure profile, rectal pressure, urethral sphincter electromyography; including all imaging associated with cystometrography, not being a service associated with a service to which any of items 11012 to 11027, 11900 to 11917, 11921 and 36800 applies (Anaes.) | 355.95 | |
| 11921 | Bladder washout test for localisation of urinary infection — not including bacterial counts for organisms in specimens | 62.35 | |
| Subgroup 9 — Allergy testing | |
| 12000 | Skin sensitivity testing for allergens, using 1 to 20 allergens, not being a service associated with a service to which item 12012, 12015, 12018 or 12021 applies | 32.35 | |
| 12003 | Skin sensitivity testing for allergens, using more than 20 allergens, not being a service associated with a service to which item 12012, 12015, 12018 or 12021 applies | 48.90 | |
| 12012 | Epicutaneous patch testing in the investigation of allergic dermatitis using less than the number of allergens included in a standard patch test battery | 17.25 | |
| 12015 | Epicutaneous patch testing in the investigation of allergic dermatitis using all of the allergens in a standard patch test battery | 51.90 | |
| 12018 | Epicutaneous patch testing in the investigation of allergic dermatitis using all of the allergens in a standard patch test battery and additional allergens to a total of up to and including 50 allergens | 66.85 | |
| 12021 | Epicutaneous patch testing in the investigation of allergic dermatitis, performed by or on behalf of a specialist in the practice of his or her specialty, using more than 50 allergens | 97.95 | |
| Subgroup 10 — Other diagnostic procedures and investigations | |
| 12200 | Collection of specimen of sweat by iontophoresis | 30.90 | |
| 12203 | Overnight investigation for sleep apnoea for a period of at least 8 hours duration, for a patient aged 18 years or more where: (a) continuous monitoring of oxygen saturation and breathing using a multi-channel polygraph, and recordings of EEG, EOG, submental EMG, anterior tibial EMG, respiratory movement, airflow, oxygen saturation and ECG are performed; and (b) a technician is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and (c) the patient is referred by a medical practitioner; and | 488.65 | |
| | (d) the necessity for the investigation is determined by a qualified adult sleep medicine practitioner prior to the investigation; and | | |
| | (e) polygraphic records are analysed (for assessment of sleep stage, arousals, respiratory events and assessment of clinically significant alterations in heart rate and limb movement) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute, and stored for interpretation and preparation of report; and (f) interpretation and report are provided by a qualified adult sleep medicine practitioner based on reviewing the direct original recording of polygraphic data from the patient. For any particular patient — applicable only in relation to each of the first 3 occasions the investigation is performed in any 12 month period | | |
| 12207 | Overnight investigation for sleep apnoea for a period of at least 8 hours duration, for a patient aged 18 years or more where: (a) continuous monitoring of oxygen saturation and breathing using a multi-channel polygraph, and recordings of EEG, EOG, submental EMG, anterior tibial EMG, respiratory movement, airflow, oxygen saturation and ECG are performed; and (b) a technician is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and (c) the patient is referred by a medical practitioner; and (d) the necessity for the investigation is determined by a qualified adult sleep medicine practitioner prior to the investigation; and | 488.65 | |
| | (e) polygraphic records are analysed (for assessment of sleep stage, arousals, respiratory events and assessment of clinically significant alterations in heart rate and limb movement) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute, and stored for interpretation and preparation of report; and (f) interpretation and report are provided by a qualified adult sleep medicine practitioner based on reviewing the direct original recording of polygraphic data from the patient; where it can be demonstrated that a further investigation is indicated in the same 12 month period to which item 12203 applies for the adjustment or testing, or both, of the effectiveness of a positive pressure ventilatory support device (other than nasal continuous positive airway pressure) in sleep, in a patient with severe cardio-respiratory failure, and where previous studies have demonstrated failure of continuous positive airway pressure or oxygen — each additional investigation | | |
| 12210 | Overnight paediatric investigation for a period of at least 8 hours duration for a patient aged 12 years or less, where: (a) continuous monitoring of oxygen saturation and breathing using a multi-channel polygraph, and recordings of EEG (with a minimum of 4 EEG leads or, in selected investigations, of 6 EEG leads), EOG, submental or diaphragm EMG (or both), respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen), airflow, measurement of carbon dioxide (either end-tidal or transcutaneous), oxygen saturation and ECG are performed; and | 583.25 | |
| | (b) a technician or registered nurse with sleep technology training is in continuous attendance under the supervision of a qualified paediatric sleep medicine practitioner; and (c) the patient is referred by a medical practitioner; and (d) the necessity for the investigation is determined by a qualified paediatric sleep medicine practitioner prior to the investigation; and | | |
| | (e) polygraphic records are analysed (for assessment of sleep stage, and maturation of sleep indices, arousals, respiratory events and assessment of clinically significant alterations in heart rate and body movement) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute, and stored for interpretation and preparation of report; and (f) interpretation and report are provided by a qualified paediatric sleep medicine practitioner based on reviewing the direct original recording of polygraphic data from the patient. For each particular patient — applicable only in relation to each of the first 3 occasions the investigation is performed in any 12 month period | | |
| 12213 | Overnight paediatric investigation for a period of at least 8 hours duration for a patient aged between 12 and 18 years, where: (a) recordings of EEG (with a minimum of 4 EEG leads or, in selected investigations, of 6 EEG leads), EOG, submental or diaphragm EMG (or both), respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen), airflow, measurement of carbon dioxide (either end-tidal or transcutaneous), oxygen saturation and ECG are performed; and (b) a technician or registered nurse with sleep technology training is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and (c) the patient is referred by a medical practitioner; and | 525.40 | |
| | (d) the necessity for the investigation is determined by a qualified sleep medicine practitioner prior to the investigation; and | | |
| | (e) polygraphic records are analysed (for assessment of sleep stage, and maturation of sleep indices, arousals, respiratory events and assessment of clinically significant alterations in heart rate and body movement) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute, and stored for interpretation and preparation of report; and (f) interpretation and report are provided by a qualified sleep medicine practitioner based on reviewing the direct original recording of polygraphic data from the patient. For each particular patient — applicable only in relation to each of the first 3 occasions the investigation is performed in any 12 month period | | |
| 12215 | Overnight paediatric investigation for a period of at least 8 hours duration for a patient aged 12 years or less, where: (a) continuous monitoring of oxygen saturation and breathing using a multi-channel polygraph, and recordings of EEG (with a minimum of 4 EEG leads or, in selected investigations, of 6 EEG leads), EOG, submental or diaphragm EMG (or both), respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen), airflow, measurement of carbon dioxide (either end-tidal or transcutaneous), oxygen saturation and ECG are performed; and (b) a technician or registered nurse with sleep technology training is in continuous attendance under the supervision of a qualified paediatric sleep medicine practitioner; and (c) the patient is referred by a medical practitioner; and (d) the necessity for the investigation is determined by a qualified paediatric sleep medicine practitioner prior to the investigation; and | 583.25 | |
| | (e) polygraphic records are analysed (for assessment of sleep stage, and maturation of sleep indices, arousals, respiratory events and assessment of clinically significant alterations in heart rate and body movement) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute, and stored for interpretation and preparation of report; and | | |
| | (f) interpretation and report are provided by a qualified paediatric sleep medicine practitioner based on reviewing the direct original recording of polygraphic data from the patient; where it can be demonstrated that a further investigation is indicated in the same 12 month period to which item 12210 applies, for the adjustment, or testing of the effectiveness, or both, of Continuous Positive Airway Pressure (CPAP) or of the bilevel pressure support or ventilation (or both), or if supplemental oxygen is required because of recurring hypoxia — each additional investigation | | |
| 12217 | Overnight paediatric investigation for a period of at least 8 hours duration for a patient aged between 12 and 18 years, where: (a) continuous monitoring of oxygen saturation and breathing using a multi-channel polygraph, and recordings of EEG (with a minimum of 4 EEG leads or, in selected investigations, of 6 EEG leads), EOG, submental or diaphragm EMG (or both), respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen), airflow, measurement of carbon dioxide (either end-tidal or transcutaneous), oxygen saturation and ECG are performed; and (b) a technician or registered nurse with sleep technology training is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and (c) the patient is referred by a medical practitioner; and | 525.40 | |
| | (d) the necessity for the investigation is determined by a qualified sleep medicine practitioner prior to the investigation; and (e) polygraphic records are analysed (for assessment of sleep stage, and maturation of sleep indices, arousals, respiratory events and assessment of clinically significant alterations in heart rate and body movement) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute, and stored for interpretation and preparation of report; and | | |
| | (f) interpretation and report to be provided by a qualified sleep medicine practitioner based on reviewing the direct original recording of polygraphic data from the patient; where it can be demonstrated that a further investigation is indicated in the same 12 month period to which item 12213 applies, for the adjustment, or testing of the effectiveness, or both, of Continuous Positive Airway Pressure (CPAP) or of the bilevel pressure support or ventilation (or both), or if there is recurring hypoxia and supplemental oxygen is required — each additional investigation | | |
| Group D2 — Nuclear medicine (non-imaging) | |
| 12500 | Blood volume estimation | 180.00 | |
| 12503 | Erythrocyte radioactive uptake survival time test or iron kinetic test | 353.05 | |
| 12506 | Gastrointestinal blood loss estimation involving examination of stool specimens | 252.05 | |
| 12509 | Gastrointestinal protein loss | 180.00 | |
| 12512 | Radioactive B12 absorption test — 1 isotope | 87.25 | |
| 12515 | Radioactive B12 absorption test — 2 isotopes | 191.05 | |
| 12518 | Thyroid uptake (using probe) | 87.25 | |
| 12521 | Perchlorate discharge study | 105.25 | |
| 12524 | Renal function test (without imaging procedure) | 131.55 | |
| 12527 | Renal function test (with imaging and at least 2 blood samples) | 70.55 | |
| 12530 | Whole body count — not being a service associated with a service to which another item applies | 105.25 | |
| 12533 | Carbon-labelled urea breath test using oral C-13 or C-14 urea, performed by a specialist or consultant physician, including the measurement of exhaled 13CO2 or 14CO2 , for either: (a) the confirmation of Helicobactor pylori colonisation, where: (i) suitable biopsy material for diagnosis cannot be obtained at endoscopy in patients with peptic ulcer disease, or where the diagnosis of peptic ulcer has been made on barium meal; or (ii) in patients with past history of duodenal ulcer, gastric ulcer or gastric neoplasia, where endoscopy is not indicated; or | 70.25 | |
| | (b) the monitoring of the success of eradication of Helicobactor pylori in patients with peptic ulcer disease; where any request for the test by another medical practitioner who collects the breath sample specifically identifies in writing 1 or more of the clinical indications for the test | | |
| Therapeutic procedures Group T1 — Miscellaneous therapeutic procedures Subgroup 1 — Hyperbaric oxygen therapy | |
| 13020 | Hyperbaric oxygen therapy, for treatment of decompression illness, gas gangrene, air or gas embolism, diabetic wounds (including diabetic gangrene and diabetic foot ulcers) or necrotising soft tissue infections (including necrotising fasciitis or Fournier’s gangrene), or for the prevention and treatment of osteoradionecrosis, performed in a comprehensive hyperbaric medicine facility, under the supervision of a medical practitioner qualified in hyperbaric medicine, for a period in the hyperbaric chamber of between 1 hour 30 minutes and 3 hours (both inclusive), including any associated attendance | 215.05 | |
| 13025 | Hyperbaric oxygen therapy, for treatment of decompression illness, air or gas embolism, performed in a comprehensive hyperbaric medicine facility, under the supervision of a medical practitioner qualified in hyperbaric medicine, for a period in the hyperbaric chamber greater than 3 hours, including any associated attendance — per hour (or part of an hour) | 96.20 | |
| 13030 | Hyperbaric oxygen therapy performed in a comprehensive hyperbaric medicine facility where the medical practitioner is pressurised in the hyperbaric chamber for the purpose of providing continuous life saving emergency treatment, including any associated attendance — per hour (or part of an hour) | 135.85 | |
| Subgroup 2 — Dialysis | |
| 13100 | Supervision in hospital by a medical specialist of — haemodialysis, haemofiltration, haemoperfusion or peritoneal dialysis, including all professional attendances, where the total attendance time on the patient by the supervising medical specialist exceeds 45 minutes in 1 day | 113.55 | |
| 13103 | Supervision in hospital by a medical specialist of — haemodialysis, haemofiltration, haemoperfusion or peritoneal dialysis, including all professional attendances, where the total attendance time on the patient by the supervising medical specialist does not exceed 45 minutes in 1 day | 59.15 | |
| 13106 | Declotting of an arteriovenous shunt | 100.90 | |
| 13109 | Indwelling peritoneal catheter (Tenckhoff or similar) for dialysis — insertion and fixation of (Anaes.) | 189.25 | |
| 13110 | Tenckhoff peritoneal dialysis catheter, removal of (including catheter cuffs) (Anaes.) | 189.85 | |
| 13112 | Peritoneal dialysis, establishment of, by abdominal puncture and insertion of temporary catheter (including associated consultation) (Anaes.) | 113.55 | |
| Subgroup 3 — Assisted reproductive services | |
| 13200 | Assisted reproductive services (such as in vitro fertilisation, gamete intra-fallopian transfer or similar procedures) involving the use of drugs to induce superovulation, and including quantitative estimation of hormones, ultrasound examinations, all treatment counselling and embryology laboratory services but excluding artificial insemination or transfer of frozen embryos or donated embryos or ova or a service to which item 13203, 13206 or 13218 applies — being services rendered during 1 treatment cycle, if the duration of the treatment cycle is at least 9 days | 1 661.45 | |
| 13203 | Ovulation monitoring services, for superovulated treatment cycles of less than 9 days duration and artificial insemination — including quantitative estimation of hormones and ultrasound examinations, being services rendered during 1 treatment cycle but excluding a service to which item 13200, 13206, 13212, 13215 or 13218 applies | 415.40 | |
| 13206 | Assisted reproductive services (such as in vitro fertilisation, gamete intra-fallopian transfer or similar procedures), using unstimulated ovulation or ovulation stimulated only by clomiphene citrate, and including quantitative estimation of hormones, ultrasound examinations, all treatment counselling and embryology laboratory services — but excluding artificial insemination, frozen embryo transfer or donated embryos or ova or treatment involving the use of drugs to induce superovulation — being services rendered during 1 treatment cycle but only if rendered in conjunction with a service to which item 13212 applies | 712.00 | |
| 13209 | Planning and management of a referred patient by a specialist for the purpose of treatment by assisted reproductive technologies including in vitro fertilisation, gamete intra-fallopian transfer and similar procedures, or for artificial insemination — payable once only during 1 treatment cycle | 71.10 | |
| 13212 | Oocyte retrieval by any means including laparoscopy or ultrasound-guided ova flushing, for the purposes of assisted reproductive technologies including in vitro fertilisation, gamete intra-fallopian transfer or similar procedures — only if rendered in conjunction with a service to which item 13200 or 13206 applies (Anaes.) | 302.65 | |
| 13215 | Transfer of embryos or both ova and sperm to the female reproductive system, by any means but excluding artificial insemination or the transfer of frozen or donated embryos — only if rendered in conjunction with a service to which item 13200 or 13206 applies, being services rendered in 1 treatment cycle (Anaes.) | 94.95 | |
| 13218 | Preparation and transfer of frozen or donated embryos or both ova and sperm, to the female reproductive system, by any means and including quantitative estimation of hormones and all treatment counselling but excluding artificial insemination services rendered in 1 treatment cycle and excluding a service to which item 13200, 13203, 13206, 13212 or 13215 applies (Anaes.) | 712.00 | |
| 13221 | Preparation of semen for the purposes of assisted reproductive technologies or for artificial insemination | 43.35 | |
| 13290 | Semen, collection of, from a patient with spinal injuries or medically induced impotence, for the purposes of analysis, storage or assisted reproduction, by a medical practitioner using a vibrator or electro-ejaculation device including catheterisation and drainage of bladder where required | 169.80 | |
| 13292 | Semen, collection of, from a patient with spinal injuries or medically induced impotence, for the purposes of analysis, storage or assisted reproduction, by a medical practitioner using a vibrator or electro-ejaculation device including catheterisation and drainage of bladder where required, under general anaesthetic, in a hospital or approved day-hospital facility (Anaes.) | 339.60 | |
| Subgroup 4 — Paediatric and neonatal | |
| 13300 | Umbilical or scalp vein catheterisation in a neonate with or without infusion or cannulation of a vein | 47.35 | |
| 13303 | Umbilical artery catheterisation with or without infusion | 70.15 | |
| 13306 | Blood transfusion with venesection and complete replacement of blood, including collection from donor | 277.60 | |
| 13309 | Blood transfusion with venesection and complete replacement of blood, using blood already collected | 236.70 | |
| 13312 | Blood for pathology test, collection of, by femoral or external jugular vein puncture in infants | 23.60 | |
| 13318 | Central vein catheterisation (via jugular or subclavian vein) — by open exposure, in a person under 12 years of age (Anaes.) | 189.05 | |
| 13319 | Central vein catheterisation in a neonate via peripheral vein (Anaes.) | 189.05 | |
| Subgroup 5 — Cardiovascular | |
| 13400 | Restoration of cardiac rhythm by electrical stimulation (cardioversion), other than in the course of cardiac surgery (Anaes.) | 80.45 | |
| Subgroup 6 — Gastroenterology | |
| 13500 | Gastric hypothermia by closed circuit circulation of refrigerant in the absence of gastrointestinal haemorrhage | 149.85 | |
| 13503 | Gastric hypothermia by closed circuit circulation of refrigerant for upper gastrointestinal haemorrhage | 299.75 | |
| 13506 | Gastro-oesophageal balloon intubation, Minnesota, Sengstaken-Blakemore or similar, for control of bleeding from gastric oesophageal varices | 153.30 | |
| Subgroup 8 — Haematology | |
| 13700 | Harvesting of homologous (including allogeneic) or autologous bone marrow for the purpose of transplantation (Anaes.) | 277.00 | |
| 13703 | Administration of blood including collection from donor | 99.25 | |
| 13706 | Administration of blood or bone marrow already collected | 69.35 | |
| 13709 | Collection of blood for autologous transfusion or when homologous blood is required for immediate transfusion in emergency situation | 40.25 | |
| 13750 | Therapeutic haemapheresis for the removal of plasma or cellular (or both) elements of blood, utilising continuous or intermittent flow techniques, including morphological tests for cell counts and viability studies, if performed; continuous monitoring of vital signs, fluid balance, blood volume and other parameters with continuous registered nurse attendance under the supervision of a consultant physician, not being a service associated with a service to which item 13755 applies — each day | 113.55 | |
| 13755 | Donor haemapheresis for the collection of blood products for transfusion, utilising continuous or intermittent flow techniques, including morphological tests for cell counts and viability studies; continuous monitoring of vital signs, fluid balance, blood volume and other parameters; with continuous registered nurse attendance under the supervision of a consultant physician — not being a service associated with a service to which item 13750 applies — each day | 113.55 | |
| 13757 | Therapeutic venesection for the management of haemochromatosis, polycythemia vera or porphyria cutanea tarda | 60.65 | |
| 13760 | In vitro processing (and cryopreservation) of bone marrow or peripheral blood for autologous stem cell transplantation as an adjunct to high dose chemotherapy for: (a) chemosensitive intermediate or high grade non-Hodgkin’s lymphoma at high risk of relapse following first line chemotherapy; or (b) Hodgkin’s disease which has relapsed following, or is refractory to, chemotherapy; or (c) acute myelogenous leukaemia in first remission, where suitable genotypically matched sibling donor is not available for allogenic bone marrow transplant; or (d) multiple myeloma in remission (complete or partial) following standard dose chemotherapy; or (e) small round cell sarcomas; or (f) primitive neuroectodermal tumour; or (g) germ cell tumours which have relapsed following, or are refractory to, chemotherapy; or (h) germ cell tumours which have had an incomplete response to first line therapy; performed under the supervision of a consultant physician — each day | 633.80 | |
| Subgroup 9 — Procedures associated with intensive care and cardiopulmonary support | |
| 13815 | Central vein catheterisation (via jugular, subclavian or femoral vein) by percutaneous or open exposure not being a service to which item 13318 applies (Anaes.) | 70.85 | |
| 13818 | Right heart balloon catheter, insertion of, including pulmonary wedge pressure and cardiac output measurement (Anaes.) | 94.50 | |
| 13830 | Intracranial pressure, monitoring of, by intraventricular or subdural catheter, subarachnoid bolt or similar, by a specialist or consultant physician — each day | 62.65 | |
| 13839 | Arterial puncture and collection of blood for diagnostic purposes | 19.10 | |
| 13842 | Intra-arterial cannulisation for the purpose of taking multiple arterial blood samples for blood gas analysis | 57.55 | |
| 13845 | Counterpulsation by intra-aortic balloon-management on the first day, including percutaneous insertion, initial and subsequent consultations and monitoring of parameters (Anaes.) | 449.55 | |
| 13848 | Counterpulsation by intra-aortic balloon-management on each day subsequent to the first, including associated consultations and monitoring of parameters | 108.90 | |
| 13851 | Circulatory support device, management of, on first day | 410.25 | |
| 13854 | Circulatory support device, management of, on each day subsequent to the first | 95.40 | |
| 13857 | Mechanical ventilation, initiation of (other than initiation of ventilation in the context of an anaesthetic for surgery), outside of an intensive care unit, where subsequent management of ventilatory support is undertaken in an intensive care unit | 121.65 | |
| Subgroup 10 — Management and procedures undertaken in an intensive care unit | |
| 13870 | Management of a patient in an intensive care unit by a specialist or consultant physician — including initial and subsequent attendances, electrocardiographic monitoring, arterial sampling, bladder catheterisation and blood sampling — management on the first day | 253.55 | |
| 13873 | Management of a patient in an intensive care unit by a specialist or consultant physician — including all attendances, electrocardiographic monitoring, arterial sampling, bladder catheterisation and blood sampling — management on each day subsequent to the first day | 188.80 | |
| 13876 | Central venous pressure, pulmonary arterial pressure, systemic arterial pressure or cardiac intracavity pressure, continuous monitoring by indwelling catheter by a specialist or consultant physician in an intensive care unit — each day of monitoring for each type of pressure up to a maximum of 4 pressures | 57.55 | |
| 13879 | Mechanical ventilation, initiation of, by a specialist or consultant physician, in an intensive care unit, including subsequent management of ventilatory support on the first day | 184.00 | |
| 13882 | Ventilatory support in an intensive care unit, management of, by a specialist or consultant physician — not being a service to which item 13879 applies — each day | 62.65 | |
| 13885 | Continuous arterio venous or veno venous haemofiltration, management by a specialist or consultant physician — on the first day in an intensive care unit | 113.25 | |
| 13888 | Continuous arterio venous or veno venous haemofiltration, management by a specialist or consultant physician — on each day subsequent to the first day in an intensive care unit | 59.00 | |
| Subgroup 11 — Chemotherapeutic procedures | |
| 13915 | Cytotoxic chemotherapy, administration of, either by intravenous push technique (directly into a vein, or a butterfly needle, or the side-arm of an infusion) or by intravenous infusion of not more than 1 hour’s duration, not being a service associated with photodynamic therapy with verteporfin — for any particular patient, once only on the same day | 54.05 | |
| 13918 | Cytotoxic chemotherapy, administration of, by intravenous infusion of more than 1 hour’s duration but not more than 6 hours duration — for any particular patient, once only on the same day | 81.35 | |
| 13921 | Cytotoxic chemotherapy, administration of, by intravenous infusion of more than 6 hours duration — for the first day of treatment | 92.05 | |
| 13924 | Cytotoxic chemotherapy, administration of, by intravenous infusion of more than 6 hours duration — on each day subsequent to the first in the same continuous treatment episode | 54.25 | |
| 13927 | Cytotoxic chemotherapy, administration of, either by intra-arterial push technique (directly into an artery, a butterfly needle or the side-arm of an infusion) or by intra-arterial infusion of not more than 1 hour’s duration — for any particular patient, once only on the same day | 70.15 | |
| 13930 | Cytotoxic chemotherapy, administration of, by intra-arterial infusion of more than 1 hour’s duration but not more than 6 hours duration — for any particular patient, once only on the same day | 97.90 | |
| 13933 | Cytotoxic chemotherapy, administration of, by intra-arterial infusion of more than 6 hours duration — for the first day of treatment | 108.60 | |
| 13936 | Cytotoxic chemotherapy, administration of, by intra-arterial infusion of more than 6 hours duration — on each day subsequent to the first in the same continuous treatment episode | 70.75 | |
| 13939 | Implanted pump or reservoir, loading of, with a cytotoxic agent or agents, not being a service associated with a service to which item 13915, 13918, 13921, 13924, 13927, 13930, 13933, 13936 or 13945 applies | 81.35 | |
| 13942 | Ambulatory drug delivery device, loading of, with a cytotoxic agent or agents for the infusion of the agent or agents via the intravenous, intra-arterial or spinal routes, not being a service associated with a service to which item 13915, 13918, 13921, 13924, 13927, 13930, 13933, 13936 or 13945 applies | 54.25 | |
| 13945 | Long-term implanted drug delivery device for cytotoxic chemotherapy, accessing of | 43.65 | |
| 13948 | Cytotoxic agent, instillation of, into a body cavity | 54.25 | |
| Subgroup 12 — Dermatology | |
| 14050 | PUVA therapy or UVB therapy administered in whole body cabinet (not being a service associated with a service to which item 14053 applies) including associated consultations other than an initial consultation | 43.85 | |
| 14053 | PUVA therapy or UVB therapy administered to localised body areas in a hand and foot cabinet (not being a service associated with a service to which item 14050 applies) including associated consultations other than an initial consultation | 43.85 | |
| 14100 | Laser photocoagulation using laser light within the wave length of 510-600nm in the treatment of severely disfiguring vascular lesions of the head or neck where abnormality is visible from 4 metres, including any associated consultation, up to a maximum of 6 sessions (including any sessions to which items 14100 to 14118 and 30213 apply) in any 12 month period — session of at least 30 minutes duration (Anaes.) | 126.75 | |
| 14103 | Laser photocoagulation using laser light within the wave length of 510-600nm in the treatment of severely disfiguring vascular lesions of the head or neck where abnormality is visible from 4 metres, including any associated consultation, up to a maximum of 6 sessions (including any sessions to which items 14100 to 14118 and 30213 apply) in any 12 month period — session of at least 60 minutes duration (Anaes.) | 155.65 | |
| 14106 | Laser photocoagulation using laser light within the wave length of 510-1064nm in the treatment of port wine stains, haemangiomas, café-au-lait macules and naevi of Ota, other than melanocytic naevi (common moles), including any associated consultation, up to a maximum of 6 sessions (including any sessions to which items 14100 to 14118 and 30213 apply) in any 12 month period — area of treatment up to 50 cm2 (Anaes.) | 126.75 | |
| 14109 | Laser photocoagulation using laser light within the wave length of 510-1064nm in the treatment of port wine stains, haemangiomas, café-au-lait macules and naevi of Ota, other than melanocytic naevi (common moles), including any associated consultation, up to a maximum of 6 sessions (including any sessions to which items 14100 to 14118 and 30213 apply) in any 12 month period — area of treatment more than 50 cm2 and up to 100 cm2 (Anaes.) | 155.65 | |
| 14112 | Laser photocoagulation using laser light within the wave length of 510-1064nm in the treatment of port wine stains, haemangiomas, café-au-lait macules and naevi of Ota, other than melanocytic naevi (common moles), including any associated consultation, up to a maximum of 6 sessions (including any sessions to which items 14100 to 14118 and 30213 apply) in any 12 month period — area of treatment more than 100 cm2 and up to 150 cm2 (Anaes.) | 184.35 | |
| 14115 | Laser photocoagulation using laser light within the wave length of 510-1064nm in the treatment of port wine stains, haemangiomas, café-au-lait macules and naevi of Ota, other than melanocytic naevi (common moles), including any associated consultation, up to a maximum of 6 sessions (including any sessions to which items 14100 to 14118 and 30213 apply) in any 12 month period — area of treatment more than 150 cm2 and up to 250 cm2 (Anaes.) | 213.10 | |
| 14118 | Laser photocoagulation using laser light within the wave length of 510-1064nm in the treatment of port wine stains, haemangiomas, café-au-lait macules and naevi of Ota, other than melanocytic naevi (common moles), including any associated consultation, up to a maximum of 6 sessions (including any sessions to which items 14100 to 14118 apply) in any 12 month period — area of treatment more than 250 cm2 (Anaes.) | 270.75 | |
| 14120 | Laser photocoagulation using laser light within the wave length of 510-600nm in the treatment of severely disfiguring vascular lesions of the head or neck where abnormality is visible from 4 metres, including any associated consultation-session of at least 30 minutes duration — where it can be demonstrated that a 7th or subsequent session (including any sessions to which items 14100 to 14118 and 30213 apply) is indicated in a 12 month period (Anaes.) | 126.75 | |
| 14122 | Laser photocoagulation using laser light within the wave length of 510-600nm in the treatment of severely disfiguring vascular lesions of the head or neck where abnormality is visible from 4 metres, including any associated consultation-session of at least 60 minutes duration — where it can be demonstrated that a 7th or subsequent session (including any sessions to which items 14100 to 14118 and 30213 apply) is indicated in a 12 month period (Anaes.) | 155.65 | |
| 14124 | Laser photocoagulation using laser light within the wave length of 510-1064nm in the treatment of port wine stains, haemangiomas, café-au-lait macules and naevi of Ota, other than melanocytic naevi (common moles), including any associated consultation-area of treatment up to 50 cm2 — where it can be demonstrated that a 7th or subsequent session (including any sessions to which items 14100 to 14118 and 30213 apply) is indicated in a 12 month period (Anaes.) | 126.75 | |
| 14126 | Laser photocoagulation using laser light within the wave length of 510-1064nm in the treatment of port wine stains, haemangiomas, café-au-lait macules and naevi of Ota, other than melanocytic naevi (common moles), including any associated consultation-area of treatment more than 50 cm2 and up to 100 cm2 — where it can be demonstrated that a 7th or subsequent session (including any sessions to which items 14100 to 14118 and 30213 apply) is indicated in a 12 month period (Anaes.) | 155.65 | |
| 14128 | Laser photocoagulation using laser light within the wave length of 510-1064nm in the treatment of port wine stains, haemangiomas, café-au-lait macules and naevi of Ota, other than melanocytic naevi (common moles), including any associated consultation-area of treatment more than 100 cm2 and up to 150 cm2 — where it can be demonstrated that a 7th or subsequent session (including any sessions to which items 14100 to 14118 and 30213 apply) is indicated in a 12 month period (Anaes.) | 184.35 | |
| 14130 | Laser photocoagulation using laser light within the wave length of 510-1064nm in the treatment of port wine stains, haemangiomas, café-au-lait macules and naevi of Ota, other than melanocytic naevi (common moles), including any associated consultation-area of treatment more than 150 cm2 and up to 250 cm2 — where it can be demonstrated that a 7th or subsequent session (including any sessions to which items 14100 to 14118 and 30213 apply) is indicated in a 12 month period (Anaes.) | 213.10 | |
| 14132 | Laser photocoagulation using laser light within the wave length of 510-1064nm in the treatment of port wine stains, haemangiomas, café-au-lait macules and naevi of Ota, other than melanocytic naevi (common moles), including any associated consultation-area of treatment more than 250 cm2 — where it can be demonstrated that a 7th or subsequent session (including any sessions to which items 14100 to 14118 and 30213 apply) is indicated in a 12 month period (Anaes.) | 270.75 | |
| Subgroup 13 — Other therapeutic procedures | |
| 14200 | Gastric lavage in the treatment of ingested poison | 49.75 | |
| 14203 | Hormone or living tissue implantation, by direct implantation involving incision and suture (Anaes.) | 42.50 | |
| 14206 | Hormone or living tissue implantation — by cannula | 29.60 | |
| 14209 | Intra-arterial infusion or retrograde intravenous perfusion of a sympatholytic agent | 73.75 | |
| 14212 | Intussusception, management of fluid or gas reduction for (Anaes.) | 154.00 | |
| 14215 | Long-term implanted reservoir associated with the adjustable gastric band, accessing of to add or remove fluid | 81.35 | |
| 14218 | Implanted pump or reservoir, loading of, with a therapeutic agent or agents, for infusion to the subarachnoid or epidural space | 81.35 | |
| 14221 | Long-term implanted device for delivery of therapeutic agents, accessing of, not being a service associated with a service to which item 13945 applies | 43.65 | |
| 14224 | Electroconvulsive therapy, with or without the use of stimulus dosing techniques, including any electroencephalographic monitoring and associated consultation (Anaes.) | 58.45 | |
| Group T2 — Radiation oncology | |
| Subgroup 1 — Superficial | |
| 15000 | Radiotherapy, superficial (including treatment with x-rays, radium rays or other radioactive substances), not being a service to which another item in this group applies — each attendance at which fractionated treatment is given — 1 field | 35.40 | |
| 15003 | Radiotherapy, superficial (including treatment with x-rays, radium rays or other radioactive substances), not being a service to which another item in this group applies — each attendance at which fractionated treatment is given — 2 or more fields up to a maximum of 5 additional fields | Amount under rule 15 | |
| 15006 | Radiotherapy, superficial-attendance at which a single dose technique is applied — 1 field | 78.45 | |
| 15009 | Radiotherapy, superficial-attendance at which a single dose technique is applied — 2 or more fields up to a maximum of 5 additional fields | Amount under rule 15 | |
| 15012 | Radiotherapy, superficial — each attendance at which treatment is given to an eye | 44.40 | |
| Subgroup 2 — Orthovoltage | |
| 15100 | Radiotherapy, deep or orthovoltage — each attendance at which fractionated treatment is given at 3 or more treatments per week — 1 field | 39.65 | |
| 15103 | Radiotherapy, deep or orthovoltage — each attendance at which fractionated treatment is given at 3 or more treatments per week — 2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields) | Amount under rule 15 | |
| 15106 | Radiotherapy, deep or orthovoltage — each attendance at which fractionated treatment is given at 2 treatments per week or less frequently — 1 field | 46.80 | |
| 15109 | Radiotherapy, deep or orthovoltage — each attendance at which fractionated treatment is given at 2 treatments per week or less frequently — 2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields) | Amount under rule 15 | |
| 15112 | Radiotherapy, deep or orthovoltage — attendance at which a single dose technique is applied — 1 field | 99.90 | |
| 15115 | Radiotherapy, deep or orthovoltage — attendance at which a single dose technique is applied — 2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields) | Amount under rule 15 | |
| Subgroup 3 — Megavoltage | |
| 15211 | Radiation oncology treatment, using cobalt unit or caesium teletherapy unit — each attendance at which treatment is given — 1 field | 45.45 | |
| 15214 | Radiation oncology treatment, using cobalt unit or caesium teletherapy unit — each attendance at which treatment is given — 2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields) | Amount under rule 15 | |
| 15215 | Radiation oncology treatment, using a single photon energy linear accelerator, with or without electron facilities — each attendance at which treatment is given — 1 field — treatment delivered to primary site (lung) | 49.60 | |
| 15218 | Radiation oncology treatment, using a single photon energy linear accelerator, with or without electron facilities — each attendance at which treatment is given — 1 field — treatment delivered to primary site (prostate) | 49.60 | |
| 15221 | Radiation oncology treatment, using a single photon energy linear accelerator, with or without electron facilities — each attendance at which treatment is given — 1 field — treatment delivered to primary site (breast) | 49.60 | |
| 15224 | Radiation oncology treatment, using a single photon energy linear accelerator, with or without electron facilities — each attendance at which treatment is given — 1 field — treatment delivered to primary site for diseases or conditions not covered by item 15215, 15218 or 15221 | 49.60 | |
| 15227 | Radiation oncology treatment, using a single photon energy linear accelerator, with or without electron facilities — each attendance at which treatment is given — 1 field — treatment delivered to secondary site | 49.60 | |
| 15230 | Radiation oncology treatment, using a single photon energy linear accelerator, with or without electron facilities — each attendance at which treatment is given — 2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields) — treatment delivered to primary site (lung) | Amount under rule 15 | |
| 15233 | Radiation oncology treatment, using a single photon energy linear accelerator, with or without electron facilities — each attendance at which treatment is given — 2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields) — treatment delivered to primary site (prostate) | Amount under rule 15 | |
| 15236 | Radiation oncology treatment, using a single photon energy linear accelerator, with or without electron facilities — each attendance at which treatment is given — 2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields) — treatment delivered to primary site (breast) | Amount under rule 15 | |
| 15239 | Radiation oncology treatment, using a single photon energy linear accelerator, with or without electron facilities — each attendance at which treatment is given — 2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields) — treatment delivered to primary site for diseases or conditions not covered by item 15230, 15233 or 15236 | Amount under rule 15 | |
| 15242 | Radiation oncology treatment, using a single photon energy linear accelerator, with or without electron facilities — each attendance at which treatment is given — 2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields) — treatment delivered to secondary site | Amount under rule 15 | |
| 15245 | Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities — each attendance at which treatment is given — 1 field — treatment delivered to primary site (lung) | 49.60 | |
| 15248 | Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities — each attendance at which treatment is given — 1 field — treatment delivered to primary site (prostate) | 49.60 | |
| 15251 | Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities — each attendance at which treatment is given — 1 field — treatment delivered to primary site (breast) | 49.60 | |
| 15254 | Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities — each attendance at which treatment is given — 1 field — treatment delivered to primary site for diseases or conditions not covered by item 15245, 15248 or 15251 | 49.60 | |
| 15257 | Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities — each attendance at which treatment is given — 1 field — treatment delivered to secondary site | 49.60 | |
| 15260 | Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities — each attendance at which treatment is given — 2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields) — treatment delivered to primary site (lung) | Amount under rule 15 | |
| 15263 | Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities — each attendance at which treatment is given — 2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields) — treatment delivered to primary site (prostate) | Amount under rule 15 | |
| 15266 | Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities — each attendance at which treatment is given — 2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields) — treatment delivered to primary site (breast) | Amount under rule 15 | |
| 15269 | Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities — each attendance at which treatment is given — 2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields) — treatment delivered to primary site for diseases or conditions not covered by item 15260, 15263 or 15266 | Amount under rule 15 | |
| 15272 | Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities — each attendance at which treatment is given — 2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields) — treatment delivered to secondary site | Amount under rule 15 | |
| Subgroup 4 — Brachytherapy | |
| 15303 | Intrauterine treatment alone using radioactive sealed sources having a half-life greater than 115 days using manual afterloading techniques (Anaes.) | 296.70 | |
| 15304 | Intrauterine treatment alone using radioactive sealed sources having a half-life greater than 115 days using automatic afterloading techniques (Anaes.) | 296.70 | |
| 15307 | Intrauterine treatment alone using radioactive sealed sources having a half-life of less than 115 days including iodine, gold, iridium or tantalum using manual afterloading techniques (Anaes.) | 562.50 | |
| 15308 | Intrauterine treatment alone using radioactive sealed sources having a half-life of less than 115 days including iodine, gold, iridium or tantalum using automatic afterloading techniques (Anaes.) | 562.50 | |
| 15311 | Intravaginal treatment alone using radioactive sealed sources having a half-life greater than 115 days using manual afterloading techniques (Anaes.) | 276.95 | |
| 15312 | Intravaginal treatment alone using radioactive sealed sources having a half-life greater than 115 days using automatic afterloading techniques (Anaes.) | 274.95 | |
| 15315 | Intravaginal treatment alone using radioactive sealed sources having a half-life of less than 115 days including iodine, gold, iridium or tantalum using manual afterloading techniques (Anaes.) | 543.70 | |
| 15316 | Intravaginal treatment alone using radioactive sealed sources having a half-life of less than 115 days including iodine, gold, iridium or tantalum using automatic afterloading techniques (Anaes.) | 543.70 | |
| 15319 | Combined intrauterine and intravaginal treatment using radioactive sealed sources having a half-life greater than 115 days using manual afterloading techniques (Anaes.) | 337.40 | |
| 15320 | Combined intrauterine and intravaginal treatment using radioactive sealed sources having a half-life greater than 115 days using automatic afterloading techniques (Anaes.) | 337.40 | |
| 15323 | Combined intrauterine and intravaginal treatment using radioactive sealed sources having a half-life of less than 115 days including iodine, gold, iridium, or tantalum using manual afterloading techniques (Anaes.) | 600.00 | |
| 15324 | Combined intrauterine and intravaginal treatment using radioactive sealed sources having a half-life of less than 115 days including iodine, gold, iridium, or tantalum using automatic afterloading techniques (Anaes.) | 600.00 | |
| 15327 | Implantation of a sealed radioactive source (having a half-life of less than 115 days including iodine, gold, iridium or tantalum) to a region, under general anaesthesia, or epidural or spinal (intrathecal) nerve block, requiring surgical exposure and using manual afterloading techniques (Anaes.) | 652.75 | |
| 15328 | Implantation of a sealed radioactive source (having a half-life of less than 115 days including iodine, gold, iridium or tantalum) to a region, under general anaesthesia, or epidural or spinal (intrathecal) nerve block, requiring surgical exposure and using automatic afterloading techniques (Anaes.) | 652.75 | |
| 15331 | Implantation of a sealed radioactive source (having a half-life of less than 115 days including iodine, gold, iridium or tantalum) to a site (including the tongue, mouth, salivary gland, axilla, subcutaneous sites), where the volume treated involves multiple planes but does not require surgical exposure and using manual afterloading techniques (Anaes.) | 619.80 | |
| 15332 | Implantation of a sealed radioactive source (having a half-life of less than 115 days including iodine, gold, iridium or tantalum) to a site (including the tongue, mouth, salivary gland, axilla, subcutaneous sites), where the volume treated involves multiple planes but does not require surgical exposure and using automatic afterloading techniques (Anaes.) | 619.80 | |
| 15335 | Implantation of a sealed radioactive source (having a half-life of less than 115 days including iodine, gold, iridium or tantalum) to a site where the volume treated involves only a single plane but does not require surgical exposure and using manual afterloading techniques (Anaes.) | 562.50 | |
| 15336 | Implantation of a sealed radioactive source (having a half-life of less than 115 days including iodine, gold, iridium or tantalum) to a site where the volume treated involves only a single plane but does not require surgical exposure and using automatic afterloading techniques (Anaes.) | 562.50 | |
| 15338 | Prostate, radioactive seed implantation of, radiation oncology component, using transrectal ultrasound guidance, for localised prostatic malignancy at clinical stage T1, T2A or T2B, with a Gleason score of 6 or less and a prostate specific antigen (PSA) of 10ng/ml or less at the time of diagnosis, where the procedure is performed at an approved site in association with a urologist | 777.45 | |
| 15339 | Removal of a sealed radioactive source under general anaesthesia, or under epidural or spinal nerve block (Anaes.) | 63.30 | |
| 15342 | Construction and application of a radioactive mould using a sealed source having a half-life of greater than 115 days, to treat intracavity, intraoral or intranasal site | 158.15 | |
| 15345 | Construction and application of a radioactive mould using a sealed source having a half-life of less than 115 days including iodine, gold, iridium or tantalum to treat intracavity, intraoral or intranasal sites | 422.05 | |
| 15348 | Subsequent applications of radioactive mould referred to in item 15342 or 15345 — each attendance | 48.55 | |
| 15351 | Construction and first application of a radioactive mould not exceeding 5 cm in diameter to an external surface | 96.90 | |
| 15354 | Construction and first application of a radioactive mould more than 5 cm in diameter to an external surface | 117.65 | |
| 15357 | Attendance upon a patient to apply a radioactive mould constructed for application to an external surface of the patient other than an attendance which is the first attendance to apply the mould — each attendance | 33.20 | |
| 15360 | Catheter based intravascular brachytherapy for the treatment of in-stent restenoses of 1 coronary artery, administration of radioactive sealed sources having a half life of 115 days or less using automated intravascular brachytherapy systems approved by the Therapeutic Goods Administration. The procedure must be performed by a radiation oncologist in association with a cardiologist and be associated with a service to which item 35347, 35350, 35353 or 35356 applies | 300.00 | |
| 15363 | Catheter based intravascular brachytherapy for the treatment of in-stent restenoses of 1 coronary artery, administration of radioactive sealed sources having a half life of greater than 115 days using automated intravascular brachytherapy systems approved by the Therapeutic Goods Administration. The procedure must be performed by a radiation oncologist in association with a cardiologist and be associated with a service to which item 35347, 35350, 35353 or 35356 applies | 300.00 | |
| Subgroup 5 — Computerised planning | |
| 15500 | Radiation field setting using a simulator or isocentric x-ray or megavoltage machine or CT of a single area for treatment by a single field or parallel opposed fields (not being a service associated with a service to which item 15509 applies) | 201.70 | |
| 15503 | Radiation field setting using a simulator or isocentric x-ray or megavoltage machine or CT of a single area, where views in more than 1 plane are required for treatment by multiple fields, or of 2 areas (not being a service associated with a service to which item 15512 applies) | 258.95 | |
| 15506 | Radiation field setting using a simulator or isocentric x-ray or megavoltage machine or CT of 3 or more areas, or of total body or half body irradiation, or of mantle therapy or inverted Y fields, or of irregularly shaped fields using multiple blocks, or of off-axis fields or several joined fields (not being a service associated with a service to which item 15515 applies) | 386.70 | |
| 15509 | Radiation field setting using a diagnostic x-ray unit of a single area for treatment by a single field or parallel opposed fields (not being a service associated with a service to which item 15500 applies) | 174.85 | |
| 15512 | Radiation field setting using a diagnostic x-ray unit of a single area, where views in more than 1 plane are required for treatment by multiple fields, or of 2 areas (not being a service associated with a service to which item 15503 applies) | 225.30 | |
| 15513 | Radiation source localisation using a simulator or x-ray machine or CT of a single area, where views in more than 1 plane are required, for brachytherapy treatment planning for Iodine 125 seed implantation of localised prostate cancer, being a service associated with a service to which item 15338 applies | 254.85 | |
| 15515 | Radiation field setting using a diagnostic x-ray unit of 3 or more areas, or of total body or half body irradiation, or of mantle therapy or inverted Y fields, or of irregularly shaped fields using multiple blocks, or of off-axis fields or several joined fields (not being a service associated with a service to which item 15506 applies) | 326.15 | |
| 15518 | Radiation Dosimetry by a CT interfacing planning computer for megavoltage or teletherapy radiotherapy by a single field or parallel opposed fields to 1 area with up to 2 shielding blocks | 63.95 | |
| 15521 | Radiation Dosimetry by a CT interfacing planning computer for megavoltage or teletherapy radiotherapy to a single area by 3 or more fields, or by a single field or parallel opposed fields to 2 areas, or where wedges are used | 282.45 | |
| 15524 | Radiation Dosimetry by a CT interfacing planning computer for megavoltage or teletherapy radiotherapy to 3 or more areas, or by mantle fields or inverted Y fields or tangential fields or irregularly shaped fields using multiple blocks, or off-axis fields, or several joined fields | 529.65 | |
| 15527 | Radiation Dosimetry by a non-CT interfacing planning computer for megavoltage or teletherapy radiotherapy by a single field or parallel opposed fields to 1 area with up to 2 shielding blocks | 65.55 | |
| 15530 | Radiation Dosimetry by a non-CT interfacing planning computer for megavoltage or teletherapy radiotherapy to a single area by 3 or more fields, or by a single field or parallel opposed fields to 2 areas, or where wedges are used | 292.60 | |
| 15533 | Radiation Dosimetry by a non-CT interfacing planning computer for megavoltage or teletherapy radiotherapy to 3 or more areas, or by mantle fields or inverted Y fields, or tangential fields or irregularly shaped fields using multiple blocks, or off-axis fields, or several joined fields | 554.85 | |
| 15536 | Brachytherapy planning, computerised Radiation Dosimetry | 221.75 | |
| 15539 | Brachytherapy planning, computerised radiation dosimetry for Iodine 125 seed implantation of localised prostate cancer, being a service associated with a service to which item 15338 applies | 521.30 | |
| 15541 | Catheter based intravascular brachytherapy planning, computerised radiation dosimetry. The procedure must be performed by a radiation oncologist in association with a cardiologist and be associated with a service to which item 35347, 35350, 35353 or 35356 applies | 221.75 | |
| Subgroup 6 — Stereotactic radiosurgery | |
| 15600 | Stereotactic radiosurgery, including all radiation oncology consultations, planning, simulation, dosimetry and treatment | 1 414.70 | |
| Group T3 — Therapeutic nuclear medicine | |
| 16003 | Intra-cavitary administration of a therapeutic dose of Yttrium 90 (not including preliminary paracentesis and not being a service associated with selective internal radiation therapy) (Anaes.) | 540.65 | |
| 16006 | Administration of a therapeutic dose of Iodine 131 for thyroid cancer by single dose technique | 415.45 | |
| 16009 | Administration of a therapeutic dose of Iodine 131 for thyrotoxicosis by single dose technique | 283.50 | |
| 16012 | Intravenous administration of a therapeutic dose of Phosphorous 32 | 245.30 | |
| 16015 | Administration of Strontium 89 for painful bony metastases from carcinoma of the prostate where hormone therapy has failed and either: (a) the disease is poorly controlled by conventional radiotherapy; or | 3 395.40 | |
| | (b) conventional radiotherapy is inappropriate, due to the wide distribution of sites of bone pain | | |
| 16018 | Administration of 153 Sm-lexidronam for the relief of bone pain due to skeletal metastases (as indicated by a positive bone scan) from: (a) carcinoma of the prostate, where hormonal therapy has failed; or | 2 029.75 | |
| | (b) carcinoma of the breast, where both hormonal therapy and chemotherapy have failed and: (i) the disease is poorly controlled by conventional radiotherapy; or (ii) conventional radiotherapy is inappropriate, due to the wide distribution of sites of bone pain | | |
| Group T4 — Obstetrics | |
| 16500 | Antenatal attendance | 30.20 | |
| 16501 | External cephalic version for breech presentation, after 36 weeks where no contraindication exists, in a unit with facilities for caesarean section, including pre and post version CTG, with or without tocolysis, not being a service to which items 55718 to 55728 and 55768 to 55774 apply — chargeable whether or not the version is successful and limited to a maximum of 2 ECV’s per pregnancy | 116.80 | |
| 16502 | Polyhydramnios, unstable lie, multiple pregnancy, pregnancy complicated by diabetes or anaemia, threatened premature labour treated by bed rest only or oral medication, requiring admission to hospital — each attendance that is not a routine antenatal attendance, to a maximum of 1 visit per day | 30.20 | |
| 16504 | Treatment of habitual miscarriage by injection of hormones — each injection up to a maximum of 12 injections, where the injection is not administered during a routine antenatal attendance | 30.20 | |
| 16505 | Threatened abortion, threatened miscarriage or hyperemesis gravidarum, requiring admission to hospital, treatment of — each attendance that is not a routine antenatal attendance | 30.20 | |
| 16508 | Pregnancy complicated by acute intercurrent infection, intra-uterine growth retardation, threatened premature labour with ruptured membranes or threatened premature labour treated by intravenous therapy, requiring admission to hospital — each attendance that is not a routine antenatal attendance, to a maximum of 1 visit per day | 30.20 | |
| 16509 | Pre-eclampsia, eclampsia or antepartum haemorrhage, treatment of — each attendance that is not a routine antenatal attendance | 30.20 | |
| 16511 | Cervix, purse string ligation of (Anaes.) | 182.75 | |
| 16512 | Cervix, removal of purse string ligature of (Anaes.) | 52.75 | |
| 16514 | Antenatal cardiotocography in the management of high risk pregnancy (not during the course of the confinement) | 30.50 | |
| 16515 | Management of vaginal delivery as an independent procedure where the patient’s care has been transferred by another medical practitioner for management of the delivery and the attending medical practitioner has not provided antenatal care to the patient, including all attendances related to the delivery (Anaes.) | 288.05 | |
| 16518 | Management of labour, incomplete, where the patient’s care has been transferred to another medical practitioner for completion of the delivery (Anaes.) | 288.05 | |
| 16519 | Management of labour and delivery by any means (including Caesarean section) including post-partum care for 5 days (Anaes.) | 443.60 | |
| 16520 | Caesarean section and post-operative care for 7 days where the patient’s care has been transferred by another medical practitioner for management of the confinement and the attending medical practitioner has not provided any of the antenatal care (Anaes.) | 518.40 | |
| 16522 | Management of labour and delivery, or delivery alone, (including Caesarean section), where in the course of antenatal supervision or intrapartum management, 1 or more, of the following conditions is present, including postnatal care for 7 days: (a) multiple pregnancy; | 1 041.60 | |
| | (b) recurrent antepartum haemorrhage from 20 weeks gestation; (c) grade 2, 3 or 4 placenta praevia; (d) baby with a birth weight less than or equal to 2 500 gm; (e) pre-existing diabetes mellitus dependent on medication, or gestational diabetes requiring at least daily blood glucose monitoring; (f) trial of vaginal delivery in a patient with uterine scar, or trial of vaginal breech delivery; (g) pre-existing hypertension requiring antihypertensive medication, or pregnancy induced hypertension of at least 140/90mmHg associated with at least 1+ proteinuria on urinalysis; (h) prolonged labour greater than 12 hours with partogram evidence of abnormal cervimetric progress; (i) fetal distress defined by significant cardiotocograph or scalp pH abnormalities requiring immediate delivery; (j) conditions that pose a significant risk of maternal death (Anaes.) | | |
| 16525 | Management of second trimester labour, with or without induction, for intrauterine fetal death, gross fetal abnormality or life threatening maternal disease, not being a service to which item 35643 applies (Anaes.) | 245.75 | |
| 16564 | Evacuation of retained products of conception (placenta, membranes or mole) as a complication of confinement, with or without curettage of the uterus, as an independent procedure (Anaes.) | 181.15 | |
| 16567 | Management of postpartum haemorrhage by special measures such as packing of uterus, as an independent procedure (Anaes.) | 265.00 | |
| 16570 | Acute inversion of the uterus, vaginal correction of, as an independent procedure (Anaes.) | 345.75 | |
| 16571 | Cervix, repair of extensive laceration or lacerations (Anaes.) | 265.00 | |
| 16573 | Third degree tear, involving anal sphincter muscles and rectal mucosa, repair of, as an independent procedure (Anaes.) | 215.95 | |
| 16600 | Amniocentesis, diagnostic | 52.75 | |
| 16603 | Chorionic villus sampling, by any route | 101.30 | |
| 16606 | Fetal blood sampling, using interventional techniques from umbilical cord or fetus, including fetal neuromuscular blockade and amniocentesis (Anaes.) | 202.10 | |
| 16609 | Fetal intravascular blood transfusion, using blood already collected, including neuromuscular blockade, amniocentesis and fetal blood sampling (Anaes.) | 412.20 | |
| 16612 | Fetal intraperitoneal blood transfusion, using blood already collected, including neuromuscular blockade, amniocentesis and fetal blood sampling — not performed in conjunction with a service described in item 16609 (Anaes.) | 324.30 | |
| 16615 | Fetal intraperitoneal blood transfusion, using blood already collected, including neuromuscular blockade, amniocentesis and fetal blood sampling — performed in conjunction with a service described in item 16609 (Anaes.) | 172.65 | |
| 16618 | Amniocentesis, therapeutic, when indicated because of polyhydramnios with at least 500 ml being aspirated | 172.65 | |
| 16621 | Amnioinfusion, for diagnostic or therapeutic purposes in the presence of severe oligohydramnios | 172.65 | |
| 16624 | Fetal fluid filled cavity, drainage of | 248.55 | |
| 16627 | Feto-amniotic shunt, insertion of, into fetal fluid filled cavity, including neuromuscular blockade and amniocentesis | 506.05 | |
| 16633 | Procedure on multiple pregnancies relating to items 16606, 16609, 16612, 16615 and 16627 | Amount under rule 33 | |
| 16636 | Procedure on multiple pregnancies relating to items 16600, 16603, 16618, 16621 and 16624 | Amount under rule 33 | |
| Group T6 — Examination by an anaesthetist | |
| 17603 | Examination of a patient in preparation for the administration of an anaesthetic relating to a clinically relevant service, being an examination carried out at a place other than an operating theatre or an anaesthetic induction room | 35.65 | |
| Group T7 — Regional or field nerve blocks | |
| 18213 | Intravenous regional anaesthesia of limb by retrograde perfusion | 73.70 | |
| 18216 | Intrathecal or epidural infusion of a therapeutic substance, initial injection or commencement of, including up to 1 hour of continuous attendance by the medical practitioner (Anaes.) | 157.80 | |
| 18219 | Intrathecal or epidural infusion of a therapeutic substance, initial injection or commencement of, where continuous attendance by the medical practitioner extends beyond the first hour (Anaes.) | Amount under rule 31 | |
| 18222 | Infusion of a therapeutic substance to maintain regional anaesthesia or analgesia, subsequent injection or revision of, where the period of continuous medical practitioner attendance is 15 minutes or less | 31.25 | |
| 18225 | Infusion of a therapeutic substance to maintain regional anaesthesia or analgesia, subsequent injection or revision of, where the period of continuous medical practitioner attendance is more than 15 minutes | 41.65 | |
| 18226 | Intrathecal or epidural infusion of a therapeutic substance, initial injection or commencement of, including up to 1 hour of continuous attendance by the medical practitioner — for a patient in labour, where the service is provided between 8 pm to 8 am on any weekday, or on a Saturday, Sunday or public holiday | 236.65 | |
| 18227 | Intrathecal or epidural infusion of a therapeutic substance, initial injection or commencement of, where continuous attendance by a medical practitioner extends beyond the first hour — for a patient in labour, where the service is provided between 8 pm to 8 am on any weekday, or on a Saturday, Sunday or public holiday | Amount under rule 31 | |
| 18228 | Interpleural block, initial injection or commencement of infusion of a therapeutic substance | 51.95 | |
| 18230 | Intrathecal or epidural injection of neurolytic substance (Anaes.) | 198.15 | |
| 18232 | Intrathecal or epidural injection of substance other than anaesthetic, contrast or neurolytic solutions, not being a service to which another item in this group applies (Anaes.) | 157.80 | |
| 18233 | Epidural injection of blood for blood patch (Anaes.) | 157.80 | |
| 18234 | Trigeminal nerve, primary division of, injection of an anaesthetic agent (Anaes.) | 103.75 | |
| 18236 | Trigeminal nerve, peripheral branch of, injection of an anaesthetic agent (Anaes.) | 51.95 | |
| 18238 | Facial nerve, injection of an anaesthetic agent, not being a service associated with a service to which item 18240 applies | 31.25 | |
| 18240 | Retrobulbar or peribulbar injection of an anaesthetic agent | 77.75 | |
| 18242 | Greater occipital nerve, injection of an anaesthetic agent (Anaes.) | 31.25 | |
| 18244 | Vagus nerve, injection of an anaesthetic agent | 83.75 | |
| 18246 | Glossopharyngeal nerve, injection of an anaesthetic agent | 83.75 | |
| 18248 | Phrenic nerve, injection of an anaesthetic agent | 73.70 | |
| 18250 | Spinal accessory nerve, injection of an anaesthetic agent | 51.95 | |
| 18252 | Cervical plexus, injection of an anaesthetic agent | 83.75 | |
| 18254 | Brachial plexus, injection of an anaesthetic agent | 83.75 | |
| 18256 | Suprascapular nerve, injection of an anaesthetic agent | 51.95 | |
| 18258 | Intercostal nerve (single), injection of an anaesthetic agent | 51.95 | |
| 18260 | Intercostal nerves (multiple), injection of an anaesthetic agent | 73.70 | |
| 18262 | Ilio-inguinal, iliohypogastric or genitofemoral nerves, 1 or more of, injection of an anaesthetic agent (Anaes.) | 51.95 | |
| 18264 | Pudendal nerve, injection of an anaesthetic agent | 83.75 | |
| 18266 | Ulnar, radial or median nerve, main trunk of, 1 or more of, injection of an anaesthetic agent, not being associated with a brachial plexus block | 51.95 |